Irrational Beliefs and Their Role in Specific and Non-Specific Eating Disorder Symptomatology and Cognitive Reappraisal in Eating Disorders

Experience with multiple devaluation is associated with elevated emotional eating, perceived weight, and body mass index: An exploration of mediating factors and the role of irrational beliefs in general population and university samples

Weight stigma, the social devaluation of people based on a perception of high body weight, is associated with a number of adverse health consequences including avoidance of medical care, suicide risk, disordered eating, decreased exercise, and weight gain. Experiences of stigma in a variety of domains in addition to weight may intersect to exacerbate these outcomes. Participants in two samples (one of 327 women and men from the general population and one of 128 female university students) reported experiences of devaluation on three body size and eight non-body size-related characteristics (referred to as multiple devaluation experience or MDE) and completed assessments of emotional eating (EE), feeling fat, weight self-stigma, impulsivity, and irrational beliefs. Participants were also asked to rate their body weight. MDE was correlated with elevated weight self-devaluation and anticipation of weight stigma, negative EE (NEE), feeling fat, and impulsivity in both men and women. None of these measures moderated the relationship between MDE and EE. The positive relationship between MDE and NEE was mediated by anticipated weight stigma only in women in the general population sample at higher levels of irrational beliefs. The positive relationship between MDE and body mass index (BMI) was mediated by NEE in women in the general population. The positive relationship between MDE and perceived body weight was mediated by feeling fat in women in both samples. These results suggest that women's experiences of stigma may increase anticipation of ongoing stigma, prompting NEE and resulting in elevated BMI. The results also suggest that feelings of fatness could lead to an elevation of women's perceived body weight, which in prospective studies is linked to later elevation of actual weight.

Personalized assessment of eating disorder cognitions during treatment: A new measure of cognitive pathology change

OBJECTIVE

Modifying cognitive distortions, or thinking errors, is crucial in eating disorders (ED) treatment. To address the lack of a personalized measure for ED cognitions, the Thought Inventory was developed. The study aimed to establish its feasibility and validity, identify thinking error contents and types, examine changes in belief of irrational thoughts, and investigate associations with change in ED symptoms. Hypotheses, procedure, and planned analyses were pre-registered to ensure transparency.

METHODS

Participants (N = 55) completed the Thought Inventory, the Eating Disorder Examination Questionnaire, the Eating Pathology Symptom Inventory, the Frost Multidimensional Perfectionism Scale, the Beck Depression Inventory, and the Penn State Worry Questionnaire at pre-and post-ten weeks of treatment. Using the Thought Inventory, participants collaborated with study therapists to identify ED-related thinking errors and rate the degree of belief in these thoughts on a scale of 0 to 100 %.

RESULTS

Cognitions primarily contained self-judgments, food rules, and concern over shape, while catastrophizing/fortune telling, emotional reasoning, and should/must statements were the most common types of thinking errors. Belief in cognitions significantly decreased over treatment and change in thought belief was positively associated with change in ED symptoms.

CONCLUSION

The Thought Inventory shows promise as a personalized measure. Future research should explore whether ED cognitions, assessed in this manner, are a mechanism of change in ED treatment.

Taking a Deeper Dive Into OSFED Subtypes: A Meta-Analysis and Systematic Review

OBJECTIVE

To compare all other specified feeding or eating disorders (OSFED) groups (atypical anorexia nervosa [AN], purging disorder [PD], night eating syndrome [NES], subthreshold bulimia nervosa [sub-BN], and subthreshold binge-eating disorder [sub-BED]) to threshold eating disorders (EDs [AN, BN, and BED]) and control groups (CGs) on measures of eating and general psychopathology.

METHOD

We conducted a comprehensive search in PsycINFO, Medline, Embase, and CINAHL on all published studies from January 2013 to February 2024 using DSM-5 diagnostic criteria via clinical interviews or well-established diagnostic tools. We also undertook a quality appraisal using an adapted version of the Downs and Black criteria and registered the review with PROSPERO (ID: CRD42022314495).

RESULTS

Overall, our meta-analyses (n = 33 eligible studies) indicated that the combined OSFED and several specific OSFED subtypes displayed comparable levels of eating psychopathology to full-threshold EDs. Our systematic review (n = 33 eligible studies) found individuals with OSFED to have comparable levels of eating and general psychopathology to full-threshold EDs, but higher levels of eating and general psychopathology than CGs. These findings were specifically attributed to atypical AN and NES. There was a lack of evidence available for sub-BN and sub-BED. Studies mainly met the quality appraisal criteria. The main limitations identified in the included studies were insufficient reporting of their statistical power (78%) and no adjusting for potential confounding factors (67%).

DISCUSSION

Findings support the conceptualization of atypical AN, and NES as clinically significant EDs with similar severity to full-threshold EDs.

The role of irrational beliefs in the relationship between attention deficit hyperactivity disorder (ADHD) symptoms and disordered eating in two general student samples

Attention deficit hyperactivity disorder (ADHD) symptoms are associated with disordered eating and negative mood. The purpose of this study was to examine whether irrational beliefs mediate this relationship along with previously reported mediators such as depression and impulsivity. Irrational beliefs trigger negative automatic thoughts which are believed, in cognitive behavior therapies, to be a source of psychopathology. Challenges brought about by symptoms of ADHD may lead to habitual emotion-eliciting thought patterns which, in turn, could lead to negative mood and disordered eating. Undergraduate students (N = 127) completed online questionnaires assessing ADHD symptoms and disordered eating and several potential mediators including irrational beliefs, depression, impulsivity, interoceptive accuracy, and reward responsiveness. The results, which were replicated in a second study (N = 254), indicated that irrational beliefs and depression mediated the relationship between ADHD symptoms and disordered eating. In the second study, impulsivity due to negative urgency was also a mediator. These findings support the theory that the symptoms of ADHD lead to enhancement of irrational beliefs, depression, and negative urgency which are linked to disordered eating.

Exploring the Role of Irrational Beliefs, Lifestyle Behaviors, and Educational Status in 10-Year Cardiovascular Disease Risk: the ATTICA Epidemiological Study

BACKGROUND

Irrational beliefs, maladaptive emotions, and unhealthy lifestyle behaviors can adversely affect health status. However, limited research has examined the association between irrational beliefs and cardiovascular disease (CVD). The aim of this study was to evaluate the association between irrational beliefs and the 10-year CVD incidence among apparently healthy adults, considering the potential moderating or mediating role of particular social and lifestyle factors.

METHODS

The ATTICA study is a population-based, prospective cohort (2002-2012), in which 853 participants without a history of CVD [453 men (aged 45 ± 13 years) and 400 women (aged 44 ± 18 years)] underwent psychological evaluations. Among other tools, participants completed the irrational beliefs inventory (IBI, range 0-88), a self-reported measure consistent with the Ellis model of psychological disturbance. Demographic characteristics, detailed medical history, dietary, and other lifestyle habits were also evaluated. Incidence of CVD (i.e., coronary heart disease, acute coronary syndromes, stroke, or other CVD) was defined according to the International Coding Diseases (ICD)-10 criteria.

RESULTS

Mean IBI score was 53 ± 2 in men and 53 ± 3 in women (p = 0.88). IBI score was positively associated with 10-year CVD risk (hazard ratio 1.07, 95%CI 1.04, 1.13), in both men and women, and more prominently among those with less healthy dietary habits and lower education status; specifically, higher educational status leads to lower IBI score, and in conjunction they lead to lower 10-year CVD risk (HR for interaction 0.98, 95%CI 0.97, 0.99).

CONCLUSIONS

The findings of this study underline the need to build new, holistic approaches in order to better understand the inter-relationships between irrational beliefs, lifestyle behaviors, social determinants, and CVD risk in individuals.

Randomized Clinical Trial Evaluating AcceptME-A Digital Gamified Acceptance and Commitment Early Intervention Program for Individuals at High Risk for Eating Disorders

Eating disorders (ED) constitute a serious public health issue affecting predominantly women and appearing typically in adolescence or early adulthood. EDs are extremely difficult to treat, as these disorders are ego-syntonic, and many patients do not seek treatment. It is vital to focus on the development of successful early-intervention programs for individuals presenting at risk and are on a trajectory towards developing EDs. This study is a randomized controlled trial evaluating an innovative digital gamified Acceptance and Commitment early-intervention program (AcceptME) for young females showing signs and symptoms of an ED and at high risk for an ED. Participants (n = 92; Mage = 15.30 years, SD = 2.15) received either AcceptME (n = 62) or a waitlist control (n = 30). Analyses indicated that the AcceptME program effectively reduced weight and shape concerns with large effects when compared to waitlist controls. Most participants scored below the at-risk cut-off (WCS score < 52) in the AcceptME at end-of-intervention (57.1%) compared to controls (7.1%), with odds of falling into the at-risk group being 14.5 times higher for participants in the control group. At follow-up, 72% of completers reported scores below the at-risk cut-off in the AcceptME group. The intervention also resulted in a decrease in ED symptomatology and increased body image flexibility. Overall, results suggest that the AcceptME program holds promise for early-intervention of young women at risk for developing an ED.