Bulimic symptomatology and coping in a nonclinical sample

A daily diary study of self-compassion and adaptive coping behaviours in women with symptoms of bulimia nervosa

BACKGROUND

Mental health is more than the absence of illness and includes the ability to cope adaptively with stress. To shed light on the factors that promote mental health in people with eating disorders, this daily diary study examined whether daily and trait levels of self-compassion predict adaptive coping behaviours in women with symptoms of bulimia nervosa (BN).

METHODS

Women (N = 124) who met the DSM-5 criteria for BN completed 2 weeks of nightly measures assessing their daily level of self-compassion and their daily adaptive coping behaviours, namely, their use of problem-solving strategies, seeking and receiving of instrumental social support, and seeking and receiving of emotional social support.

RESULTS

Multilevel modelling revealed that on days when self-compassion levels were higher than their personal mean level or than the preceding day's level, participants reported greater use of problem-solving strategies, greater seeking and receiving of instrumental social support, and greater receiving of emotional social support. Daily levels of self-compassion, but not increased self-compassion from the preceding day, were associated with emotional support sought. Further, higher trait self-compassion, as measured by participants' mean level of self-compassion over the 2 weeks, was associated with increased seeking and receiving of instrumental and emotional social support but not with problem-solving strategies. All models controlled for participants' daily and mean eating pathology over the 2 weeks, highlighting the unique contribution of self-compassion to adaptive coping behaviours.

CONCLUSIONS

Results suggest that self-compassion may help individuals with symptoms of BN cope with challenges in their daily life more adaptively, an integral component of positive mental health. The present study is among the first to suggest that the benefits of self-compassion for individuals with eating disorder symptoms may lie not only in facilitating reduced eating pathology, as evidenced by prior research, but also in promoting positive mental health. More broadly, findings underscore the potential value of interventions designed to build self-compassion in individuals with eating disorder symptoms.

An Exploration of Social Functioning in Young People with Eating Disorders: A Qualitative Study

Previous research indicates adults with eating disorders (EDs) report smaller social networks, and difficulties with social functioning, alongside demonstrating difficulties recognising and regulating emotions in social contexts. Concurrently, those recovered from the illness have discussed the vital role offered by social support and interaction in their recovery. To date, little is known about the social skills and social networks of adolescents with EDs and this study aimed to conduct focus groups to explore the social functioning of 17 inpatients aged 12-17. Data were analysed using thematic analysis and six core themes were identified: group belonging, self-monitoring, social sensitivity, impact of hospitalisation, limited coping strategies and strategies for service provision. Key areas for service provision were: management of anxiety, development and/or maintenance of a social network and development of inter and intrapersonal skills. The most salient finding was that adolescents with EDs reported social difficulties which appeared to persist over and above those typically experienced at this point in the lifespan and therefore a key area for future focus is the development of appropriate coping strategies and solutions to deal with these reported difficulties.

Coping and social support as potential moderators of the relation between anxiety and eating disorder symptomatology

Trait anxiety and eating disorder (ED) symptomatology are often thought to be inextricably linked. Because anxiety often precedes an ED, predicts poor outcome, and persists even after recovery from an ED, it is important to examine whether certain factors have the ability to potentially attenuate anxiety's effect on eating pathology. In the current study, we examined two possible moderating factors: coping skills and social support. Participants were 96 females seen at one point for an ED at a Midwestern clinic, including 53 with a current ED diagnosis and 43 who no longer met criteria for an ED and who were at varying levels of recovery. Results revealed that emotion-oriented coping moderated the relation between anxiety and ED symptoms. Individuals who were high in trait anxiety and who reported low levels of emotion-oriented coping reported much lower levels of ED symptomatology than those with high trait anxiety and high emotion-oriented coping. Contrary to our hypotheses, task-oriented coping, avoidance-oriented coping, and perceived social support (total, family, friend, and special person) did not emerge as moderators of the relation between trait anxiety and eating pathology. Results provide growing support that factors that interact with anxiety can lessen anxiety's effect on eating pathology. Implications for treatment and future directions are discussed.

Do coping strategies discriminate eating disordered individuals better than eating disorder features? An explorative study on female inpatients with anorexia and bulimia nervosa

The purpose of this explorative research was to examine how the COPE (Coping Orientation to Problem Experienced Inventory), an established instrument for measuring coping styles, and EDI-2 (Eating Disorder Inventory-2), a widely used questionnaire for assessing psychological and behavioural features of eating disorders (ED), discriminate among healthy individuals, inpatients with anorexia nervosa (AN) and inpatients with bulimia nervosa (BN). A discriminant analysis approach was used. Results showed that coping styles such as positive attitude, planning and social support are even more discriminative variables than eating disorder features. Implications for further studies are discussed.

The effects of stress on body weight: biological and psychological predictors of change in BMI

OBJECTIVE

To investigate individual differences in the effects of stress on BMI.

RESEARCH METHODS AND PROCEDURES

Participants were 71 healthy women volunteers enrolled in a university-based nurse practitioner program. Predictors of change in BMI were hypothesized to be cortisol secretion, dietary restraint, binging, mastery, mood, and eating attitudes. Measures were made at the beginning of the academic semester and 12 weeks later during the participants' examination period.

RESULTS

The women were of normal weight (BMI 25.2 +/- 4.3) for their age [43; standard deviation (SD), 7]. By the examination period, 40 had gained weight (mean, 5.5 pounds; SD, 2.2), 19 lost weight (mean, 2.5 pounds; SD, 1.5), and 12 had stable weight. BMI, salivary cortisol secretion, binging behavior, depression, and anxiety increased significantly, whereas scores on dietary restraint, weight, shape, and eating concerns, and mastery decreased significantly. Regression analysis showed that change in daily cortisol secretion significantly predicted change in BMI and that mastery significantly moderated this relationship. However, a reduction in dietary restraint was a perfect mediator of this relationship. Change in cortisol secretion also significantly predicted change in dietary restraint, and this was moderated by dietary restraint at the beginning of the academic semester. Reduction in dietary restraint was also predicted by a reduction in mastery and weight concern.

DISCUSSION

We identified individual differences that confer vulnerability to weight gain during stressful life events (dietary restraint and mastery). Given that women are exposed to daily stressors and use cognitive strategies to restrain their dietary intake, increasing awareness of the role of stress on eating behavior and weight is an important goal.

Mediating and moderating effects of stress perception and situation type on coping responses in women with disordered eating

Effects of stress perception and situation type on coping behavior were assessed in undergraduate females. Women with high (n=28) and low (n=28) Eating Attitudes Test (EAT) scores listened to audiotaped scenes representing two different situation types and two levels of stress. As predicted, the High EAT group rated scenes as more stressful and endorsed more of the maladaptive emotion-oriented coping, compared to the low EAT condition. Importantly, analyses revealed that stress perception mediated the relationship between group membership and emotion-oriented coping. Scene type appeared to moderate the effect of group on emotion-oriented coping. However, stress perception was shown to mediate, or account for, the moderating effect of situation type; a relationship termed mediated moderation. So although the two groups appeared to differ in the effect of situation type on coping, this apparent interaction effect can be attributed to differences in their perception of stress. Finally, women with High EAT scores did not exhibit a deficit in the more productive task-oriented coping behaviors, nor did they exhibit an avoidant coping style. In sum, the maladaptive coping used by women with disordered eating may represent characteristic emotional responses to exaggerated perceptions of stress and a preoccupation with issues specific to body image and food, rather than deficits in productive coping skills or an avoidant coping style.

Bulimic symptomatology, body-image, and personality characteristics of university men

This study examined the relationships, using regression analysis, among bulimic symptomatology, body-image characteristics, and personality factors in a nonclinical sample of 46 undergraduate university men. They completed the Bulimia Test-Revised (a measure of bulimic symptomatology), the Eysenck Personality Questionnaire-Revised (a measure of personality characteristics), and the Multidimensional Body-Self Relations Questionnaire (a multidimensional measure of body-image parameters). Statistically significant relationships were identified among Appearance Evaluation, Neuroticism, and Psychoticism, and the BULIT-R scores.

Coping style and disturbed eating attitudes in adolescent girls

OBJECTIVE

The main goal of this work was to explore the relationship between coping styles and predisposition to eating disorders in a sample of adolescent girls.

METHOD

The sample comprised 186 females (mean age 15.91 years) and the questionnaires used were the Eating Disorders Inventory-2 (EDI-2) and the Adolescent Coping Scale (ACS).

RESULTS

The regression analyses indicated that the coping strategy most closely linked to the predisposition to develop an eating disorder was intropunitive avoidance, which explained the following percentage of variance: 29% of the total EDI-2 score, 23% of the personal factor, 28% of the social factor, and 4% of the bodily factor. On the other hand, the scale of intropunitive avoidance dimension with the most explanatory power was the tension reduction, which reflects emotional reactions to problems such as crying, shouting, or taking drugs.

DISCUSSION

A cultural hypothesis is presented in an attempt to account for the low percentage of variance of bodily factor explained by intropunitive avoidance and emphasis is placed on the need for prevention programs for adolescents, particularly those at risk.

Interrater agreement on the Coping Inventory for Stressful Situations (CISS)

The Coping Inventory for Stressful Situations (CISS) is a 48-item self-report inventory designed to measure three basic coping styles: Task Oriented, Emotion Oriented, and Avoidance Oriented coping. The psychometric properties of this inventory are promising, but CISS scores have not yet been shown to reflect behavioral variation in response to stress. This study was designed as a first step toward this end by examining the relationship between self- and peer-report on the CISS. One hundred and sixty-three pairs of friends completed the CISS, a peer form of the CISS, and a friendship questionnaire. Positive but modest correlations were found for each construct. Higher correlations were obtained when comparing scores across forms completed by the same informant, indicating that examinees believe their friends cope as they do themselves. Actual friend similarity was apparent only on Avoidance Oriented coping. Neither depth of relationship nor item observability moderated peer-self agreement.

Personality and bulimic symptomatology

This study examined the relationship between bulimic symptomatology as measured by scores on the BULIT-R and personality characteristics based on the EPQ-R in a nonclinical sample of 166 female college students. A relationship was obtained between Neuroticism, Addictiveness, and scores on the BULIT-R.