The effects of parental presence on amygdala and mPFC activation during fear conditioning: An exploratory study

Learning safe versus dangerous cues is crucial for survival. During development, parents can influence fear learning by buffering their children's stress response and increasing exploration of potentially aversive stimuli. Rodent findings suggest that these behavioral effects are mediated through parental presence modulation of the amygdala and medial prefrontal cortex (mPFC). Here, we investigated whether similar parental modulation of amygdala and mPFC during fear learning occurs in humans. Using a within-subjects design, behavioral (final N = 48, 6-17 years, mean = 11.61, SD = 2.84, 60% females/40% males) and neuroimaging data (final N = 39, 6-17 years, mean = 12.03, SD = 2.98, 59% females/41% males) were acquired during a classical fear conditioning task, which included a CS+ followed by an aversive noise (US; 75% reinforcement rate) and a CS-. Conditioning occurred once in physical contact with the participant's parent and once alone (order counterbalanced). Region of interest analyses examined the unconditioned stress response by BOLD activation to the US (vs. implicit baseline) and learning by activation to the CS+ (vs. CS-). Results showed that during US presentation, parental presence reduced the centromedial amygdala activity, suggesting buffering of the unconditioned stress response. In response to learned stimuli, parental presence reduced mPFC activity to the CS+ (relative to the CS-), although this result did not survive multiple comparisons' correction. These preliminary findings indicate that parents modulate amygdala and mPFC activity during exposure to unconditioned and conditioned fear stimuli, potentially providing insight into the neural mechanisms by which parents act as a social buffer during fear learning. RESEARCH HIGHLIGHTS: (1)This study used a within-participant experimental design to investigate how parental presence (vs. absence) affects youth's neural responses in a classical fear conditioning task. (2)Parental presence reduced the youth's centromedial amygdala activation to the unconditioned stimulus (US), suggesting parental buffering of the neural unconditioned response (UR). (3)Parental presence reduced the youth's mPFC activation to a conditioned threat cue (CS+) compared to a safety cue (CS-), suggesting possible parental modulation of fear learning.

Telomere Erosion and Depressive Symptoms Across Development Following Institutional Care

OBJECTIVE

A large literature has identified exposure to early caregiving adversities as a potent risk for developing affective psychopathology, with depression, in particular, increasing across childhood into adolescence. Evidence suggests telomere erosion, a marker of biological aging, may underlie associations between adverse early-life experiences and later depressive behavior; yet, little is understood about this association during development.

METHOD

The current accelerated longitudinal study examined concurrent telomere length and depressive symptoms concurrently, 2 and 4 years later, from the preschool period through adolescence among children exposed (n =116) and not exposed (n = 242) to early previous institutional (PI) care.

RESULTS

PI care was associated with shorter telomeres on average and with quadratic age-related growth in depressive symptoms, indicating a steeper association between PI care and depressive symptoms in younger age groups that leveled off in adolescence. Contrary to studies in adult samples, telomere length was not associated with depressive symptoms, and it did not predict future symptoms.

CONCLUSION

These findings indicate that early caregiving disruptions increase the risk for both accelerated biological aging and depressive symptoms, although these variables did not correlate with each other during this age range.

Interpersonal early adversity demonstrates dissimilarity from early socioeconomic disadvantage in the course of human brain development: A meta-analysis

It has been established that early-life adversity impacts brain development, but the role of development itself has largely been ignored. We take a developmentally-sensitive approach to examine the neurodevelopmental sequelae of early adversity in a preregistered meta-analysis of 27,234 youth (birth to 18-years-old), providing the largest group of adversity-exposed youth to date. Findings demonstrate that early-life adversity does not have an ontogenetically uniform impact on brain volumes, but instead exhibits age-, experience-, and region-specific associations. Relative to non-exposed comparisons, interpersonal early adversity (e.g., family-based maltreatment) was associated with initially larger volumes in frontolimbic regions until ∼10-years-old, after which these exposures were linked to increasingly smaller volumes. By contrast, socioeconomic disadvantage (e.g., poverty) was associated with smaller volumes in temporal-limbic regions in childhood, which were attenuated at older ages. These findings advance ongoing debates regarding why, when, and how early-life adversity shapes later neural outcomes.

Characterizing the dimensional structure of early-life adversity in the Adolescent Brain Cognitive Development (ABCD) Study

Early-life adversity has profound consequences for youth neurodevelopment and adjustment; however, experiences of adversity are heterogeneous and interrelated in complex ways that can be difficult to operationalize and organize in developmental research. We sought to characterize the underlying dimensional structure of co-occurring adverse experiences among a subset of youth (ages 9-10) from the Adolescent Brain Cognitive Development (ABCD) Study (N = 7115), a community sample of youth in the United States. We identified 60 environmental and experiential variables that reflect adverse experiences. Exploratory factor analysis identified 10 robust dimensions of early-life adversity co-occurrence, corresponding to conceptual domains such as caregiver substance use and biological caregiver separation, caregiver psychopathology, caregiver lack of support, and socioeconomic disadvantage / neighborhood lack of safety. These dimensions demonstrated distinct associations with internalizing problems, externalizing problems, cognitive flexibility, and inhibitory control. Non-metric multidimensional scaling characterized qualitative similarity among the 10 identified dimensions. Results supported a nonlinear three-dimensional structure representing early-life adversity, including continuous gradients of "perspective", "environmental uncertainty", and "acts of omission/commission". Our findings suggest that there are distinct dimensions of early-life adversity co-occurrence in the ABCD sample at baseline, and the resulting dimensions may have unique implications for neurodevelopment and youth behavior.

The Added Value of Crosstalk Between Developmental Circuit Neuroscience and Clinical Practice to Inform the Treatment of Adolescent Anxiety

Significant advances have been made in recent years regarding the developmental trajectories of brain circuits and networks, revealing links between brain structure and function. Emerging evidence highlights the importance of developmental trajectories in determining early psychiatric outcomes. However, efforts to encourage crosstalk between basic developmental neuroscience and clinical practice are limited. Here, we focus on the potential advantage of considering features of neural circuit development when optimizing treatments for adolescent patient populations. Drawing on characteristics of adolescent neurodevelopment, we highlight two examples, safety cues and incentives, that leverage insights from neural circuit development and may have great promise for augmenting existing behavioral treatments for anxiety disorders during adolescence. This commentary seeks to serve as a framework to maximize the translational potential of basic research in developmental populations for strengthening psychiatric treatments. In turn, input from clinical practice including the identification of age-specific clinically relevant phenotypes will continue to guide future basic research in the same neural circuits to better reflect clinical practices. Encouraging reciprocal communication to bridge the gap between basic developmental neuroscience research and clinical implementation is an important step toward advancing both research and practice in this domain.

Interpersonal early adversity demonstrates dissimilarity from early socioeconomic disadvantage in the course of human brain development: A meta-analysis

It has been established that early-life adversity impacts brain development, but the role of development itself has largely been ignored. We take a developmentally-sensitive approach to examine the neurodevelopmental sequelae of early adversity in a preregistered meta-analysis of 27,234 youth (birth to 18-years-old), providing the largest group of adversity-exposed youth to date. Findings demonstrate that early-life adversity does not have an ontogenetically uniform impact on brain volumes, but instead exhibits age-, experience-, and region-specific associations. Relative to non-exposed comparisons, interpersonal early adversity (e.g., family-based maltreatment) was associated with initially larger volumes in frontolimbic regions until ~10-years-old, after which these exposures were linked to increasingly smaller volumes. By contrast, socioeconomic disadvantage (e.g., poverty) was associated with smaller volumes in temporal-limbic regions in childhood, which were attenuated at older ages. These findings advance ongoing debates regarding why, when, and how early-life adversity shapes later neural outcomes.

Parent problem drinking trajectory classes predict anxiety in adolescence and emerging adulthood

BACKGROUND

This study identified latent trajectory classes for maternal problem drinking and paternal problem drinking and examined the associations between these trajectory classes and offspring anxiety symptoms during adolescence and emerging adulthood.

METHODS

Participants (n = 870; 54% female; 59% non-Hispanic White; Mage = 16.10, SD = 0.71) were administered surveys during the spring of 2007, 2008, and 2009, and 2014.

RESULTS

Fit indices from parallel process growth mixture models suggested three dual trajectory classes: (1) Low initial levels of maternal problem drinking and paternal problem drinking that increased over time (Low-Both); (2) Low initial levels of maternal problem drinking that increased over time and high initial levels of paternal problem drinking that increased slightly over time (Low-Mom/High-Dad); (3) High initial levels of maternal problem drinking that increased slightly over time and low initial levels of paternal problem drinking that remained relatively stable over time (High-Mom/Low-Dad). Girls were more likely than boys to be classified in the Low-Mom/High-Dad and High-Mom/Low-Dad classes, relative to the Low-Both trajectory class. In addition, adolescents in the High-Mom/Low-Dad trajectory class reported the most anxiety symptoms during adolescence and emerging adulthood.

LIMITATIONS

Limitations include the reliance on one informant (the adolescent/emerging adult) and the geographically limited sample (northeastern United States).

CONCLUSIONS

Prevention and intervention programs aimed at reducing anxiety should consider changes in alcohol use in both the father and the mother over time. Moreover, special attention should be paid to maternal problem drinking given that it appears to be a salient risk factor for anxiety during adolescence and emerging adulthood.

Modeling heterogeneity in the simultaneous emotional costs and social benefits of co-rumination

Co-rumination is the act of perseverating on problems or negative emotions with another person. Past research has shown that co-rumination has tradeoffs, as it is related to more anxiety and depressive symptoms, yet also heightened feelings of closeness and better relationship quality. However, there has been little repeated measures work, leaving unknown the influence of within-person changes in co-rumination on individuals' functioning. Using data from 1,504 adolescents collected as part of a seven-wave study over 4 years, we hypothesized that at times when adolescents coruminated above their own average level of co-rumination, they would report more anxiety and depressive symptoms, as well as increased closeness with friends at concurrent timepoints. Moreover, we investigated heterogeneity in these effects, exploring whether there was variability in whether adolescents experienced simultaneous costs and benefits of increased co-rumination. The results reveal that the average adolescent reported associated increases in anxiety symptoms, depressive symptoms, and closeness with friends at times when they reported coruminating at higher-than-typical levels. Yet, there was significant heterogeneity in these effects, as some adolescents solely experienced costs of co-rumination and others experienced just benefits. Moreover, adolescents who experienced stronger-than-average effects of co-rumination on anxiety and depressive symptoms reported less of an increase in closeness with friends. These findings offer important insight into how co-rumination is associated with social-emotional functioning and have implications for recommending best practices for seeking support and discussing problems with close others. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Appearance-related teasing and substance use during early adolescence

Appearance-related teasing is a pervasive form of bullying during adolescence. Yet, the impact of appearance-related teasing on risk for alcohol and marijuana use is unknown. This study, therefore, examined the relationship between appearance-related teasing and the use of alcohol and marijuana in a sample of 1,344 students (52% female; 51% non-Hispanic White; ages 11-14 years, M = 13.20, SD = 0.65) from 5 public middle schools. Participants completed a survey that assessed demographic characteristics, weight status, depressive symptoms, general peer victimization, experiences of appearance-related teasing perpetrated by family and peers, and substance use in the fall of 2016 (Time 1 [T1]) and spring of 2017 (T2). Findings at baseline (T1) indicated that more frequent appearance-related teasing was associated with higher concurrent levels of total alcohol consumption, binge drinking, and marijuana use (ps < .001). Longitudinally, more frequent appearance-related teasing at T1 predicted greater increases in total alcohol consumption (p < .01) and binge drinking frequency (p < .05) by T2 but was unrelated to changes in marijuana use (p > .05), adjusting for age, gender, race and ethnicity, perceived socioeconomic status, body mass index z scores, depressive symptoms, general peer victimization frequency, and substance use at T1. Moderation analyses generally suggested that the positive associations between appearance-related teasing and alcohol use measures were stronger among adolescents who were girls (vs. boys) and who were overweight or obese (vs. nonoverweight). These findings suggest that appearance-related teasing may play a role in the origins of alcohol use during early adolescence and emphasize the need to mitigate the effects of appearance-related teasing and prevent early substance use. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Social media use and risky behaviors in adolescents: A meta-analysis

INTRODUCTION

This systematic review and meta-analysis examined the associations between social media use and risky behaviors during adolescence, and evaluated study characteristics (e.g., sample age, type of social media platform assessed) that may moderate these relationships.

METHODS

A comprehensive search strategy identified relevant studies from PsycInfo, PubMed, Google Scholar, and Proquest Dissertations and Theses Global.

RESULTS

The final sample included 27 independent cross-sectional studies with a total of 67,407 adolescents (M_age = 15.5, range: 12.6-18.0 years; 51.7% girls; 57.2% White). Results from random effects models indicated that there were positive, small-to-medium correlations between social media use and engagement in risky behaviors generally (r = 0.21, 95% CI = 0.16-0.25), substance use (r = 0.19, 95% CI = 0.12-0.26), and risky sexual behaviors (r = 0.21, 95% CI = 0.15-0.28). There were an insufficient number of independent samples available to conduct a random effect models for violence-related behaviors (k = 3). Moderator analyses suggested that studies assessing solely early social media platforms (e.g., Facebook/MySpace only) in relation to substance use had smaller effect sizes than substance use studies assessing a broader range of contemporary social media platforms. In addition, younger samples had larger effect sizes for studies focused on social media use and risky sexual behaviors.

CONCLUSIONS

The positive links identified between social media and risky behaviors during adolescence in this meta-analysis suggest that developmental theories of risk taking would benefit from incorporating the social media context. Longitudinal studies are needed to clarify directionality and make more specific practice and policy recommendations so that social media is a safe place in which adolescents can thrive.

Adolescent Psychological Functioning and Membership in Latent Adolescent-Parent Communication Dual Trajectory Classes

The primary goal of this study was to examine the relationship between adolescents' psychological functioning (as indicated by depressive symptoms) and substance use (alcohol and drug use) and membership in adolescent-parent communication trajectory subgroups in a large, diverse community sample of adolescents from the United States (n = 1,057; 53% female; 51% Caucasian; Age: M = 16.15, SD = .75). Adolescents completed questionnaires at three annual assessments. Fit indices from parallel process growth mixture models suggested three dual trajectory classes: (1) Average communication with both parents (Average-Both); (2) Good adolescent-mother and poor adolescent-father communication (Good-Mom/Poor-Dad); and (3) Poor adolescent-mother and good adolescent-father communication (Poor-Mom/Good-Dad). The trajectory classes differed by gender. In addition, psychological functioning and substance use were differentially related to the trajectory classes.

Self-Competence and Depressive Symptoms in Middle-Late Adolescence: Disentangling the Direction of Effect

This study examined the temporal relation between self-competence (academic, social, athletic, physical appearance, and close friend) and depressive symptoms in a large, diverse community sample of 636 adolescents. Surveys were administered to all 10th- and 11th-grade students at participating high schools at baseline (mean age = 16.10, SD = .71) and 1 year later. Girls reported higher levels of self-competence in close friendships and more depressive symptoms, whereas boys reported higher levels of self-competence in athletics and physical appearance. However, there were no gender differences in the associations between self-competence and depressive symptoms. Results from autoregressive, cross-lagged path analyses indicated that depressive symptoms predicted self-competence more consistently than self-competence predicted depressive symptoms during middle-late adolescence. Implications for prevention are discussed.

Body Image Dissatisfaction and Anxiety Trajectories During Adolescence

The primary goal of this study was to examine the associations between baseline body image dissatisfaction (BID) and subsequent anxiety trajectories in a diverse, community sample of adolescent girls and boys. Participants were 581 adolescents (baseline age: M = 16.1, SD = 0.7; 58% female; 65% non-Hispanic White) from U.S. public high schools. Self-report questionnaires were administered during school at 3 annual assessment waves. Latent growth curve modeling examined the association between baseline BID and growth factors of anxiety disorder symptom trajectories. Covariates included baseline gender, age, race/ethnicity, parental education attainment, body mass index standard scores, and depressive symptoms. Higher BID at baseline was significantly associated with higher initial symptoms of generalized anxiety disorder (GAD), panic disorder (PD), social anxiety disorder (SAD), and significant school avoidance (SSA; ps = .001-.04) but was unrelated to initial separation anxiety disorder (SEP) symptoms (p = .27). Higher baseline BID also was associated with attenuated decreases in SAD symptoms across time (p = .001). Among adolescents with low baseline anxiety symptoms only, higher BID was associated with more attenuated decreases in SAD symptoms (p = .01) and greater increases in PD symptoms (p = .02). BID was unrelated to changes in GAD, SEP, and SSA symptoms (ps = .11-.94). Findings suggest that BID is associated with concurrent symptoms of multiple anxiety disorders and may have a prospective link to SAD and PD symptoms during adolescence. As such, assessing body image issues may be important to assess when identifying adolescents at risk for exacerbated SAD and PD symptoms.

Psychometric properties of the brief loss of control over eating scale (LOCES-B) in early adolescents

OBJECTIVE

The purpose of this study was to evaluate the psychometric properties of the brief loss of control over eating scale (LOCES-B) in a community sample of adolescents.

METHOD

Participants were 1,116 adolescents (11-15 years; 53% girls; 53% non-Hispanic White) recruited from middle schools in the Northeast United States. Participants were administered self-report surveys during school in the fall of 2016.

RESULTS

Confirmatory factor analyses indicated that the LOCES-B total score was unidimensional, which was invariant across gender and weight status. The LOCES-B had excellent internal consistency (α = .92). The LOCES-B total score had large, positive relationships with the frequency of LOC eating episodes, objective bulimic episodes, and subjective bulimic episodes, and a small, positive relationship with objective overeating episode frequency. After adjusting for demographics, anthropometrics, and LOC eating frequency, adolescents reporting higher scores on the LOCES-B total score had greater body image dissatisfaction, more internalizing symptoms, and lower trait effortful control.

DISCUSSION

Findings suggested that the LOCES-B is a reliable and valid measure of LOC eating in early adolescents. The availability of the LOCES-B has the potential to elucidate the developmental trajectories, predictors, and outcomes of LOC eating across the full severity spectrum in large cohort studies of youth.

Associations between friend conflict and affective states in the daily lives of adolescents

This study examined the associations between friend conflict, defined as arguments with friends, and affective states using a daily diary design in a community sample of adolescents. Participants were 100 U.S. adolescents (13-17 years; 40% girls; 79% white). Adolescents completed an online survey on 14 consecutive evenings. Adolescents reported significantly higher anger/hostility, confusion, and tension/anxiety and less friendliness on days during which they experienced friend conflict relative to no-conflict days. However, no same-day associations for depressed affect, fatigue, or vigor were found. Adolescents experiencing friend conflict reported increased next-day anger/hostility, depressed affect, and tension/anxiety, but not other affective states. Higher levels of anger/hostility and depressed affect predicted an increased likelihood of next-day friend conflict. Conversely, higher levels of friendliness and vigor predicted a decreased likelihood of next-day friend conflict. These findings suggest that directional relationships between adolescents' friend conflicts and their affective states vary by affective domain.

Family functioning and adolescent internalizing symptoms: A latent profile analysis

This study aimed to characterize adolescent family functioning typologies using latent profile analysis (LPA). A secondary aim was to examine profile associations with adolescent internalizing symptoms at one-year follow-up. Students (N = 1029; 53% female; mean age = 16.14, SD = .75 years) completed measures of family functioning, anxiety, and depressive symptoms at two time points. LPA was conducted to characterize family functioning typologies at Time 1, revealing five profiles: 1) Low Family Functioning, 2) Only Close to Father, 3) Average Family Functioning, 4) Only Close to Mother, and 5) High Family Functioning. Results indicated that the Low and Only Close to Mother profiles had greater depressive symptoms at Time 2, compared with the Average profile. The High profile had fewer depressive symptoms at Time 2. The Low and Only Close to Mother profiles also had significantly more anxiety symptoms at Time 2. Findings highlight the utility of examining family functioning profiles.

Using Time-Varying Effect Modeling to Examine Age-Varying Gender Differences in Coping Throughout Adolescence and Emerging Adulthood

PURPOSE

Little is known about how and when coping trajectories differ between males and females. The current study aimed to examine gender differences in the use of specific coping strategies across developmental ages using time-varying effect modeling (TVEM) in a large, diverse community sample.

METHODS

A longitudinal study following adolescents across 4 years of high school and 5 years post graduation (N = 1,251) was combined with a nationally representative cross-sectional study of 18- to 22-year-olds (N = 595) to examine changes in gender differences in the use of coping strategies between ages 13 and 25. The same coping questionnaire was administered to both samples. TVEM was used to examine the age-varying prevalence rates of coping in males and females.

RESULTS

Gender differences were greatest during middle-to-late adolescence (15-19 years) for active coping, social support seeking, planning, and venting emotions. Females reported greater use of these strategies than males, but males' use increased over time and became equivalent to females after the age of ~19-20. Gender differences in the use of humor did not emerge until the age of 22, at which point the use of humor increased continuously among males but remained stable among females. The use of denial was fairly stable across time, with no gender differences at any age.

CONCLUSIONS

Findings highlight the utility of TVEM for advancing our knowledge on gender and coping across developmental time, as males and females used coping strategies at differing rates throughout adolescence and emerging adulthood. Implications for tailoring gender- and age-specific intervention efforts to improve coping and related health behaviors are discussed.

A systematic review of attentional biases in disorders involving binge eating

OBJECTIVE

Attentional bias (AB) may be one mechanism contributing to the development and/or maintenance of disordered eating. AB has traditionally been measured using reaction time in response to a stimulus. Novel methods for AB measurement include eye tracking to measure visual fixation on a stimulus, and electroencephalography to measure brain activation in response to a stimulus. This systematic review summarizes, critiques, and integrates data on AB gathered using the above-mentioned methods in those with binge eating behaviors, including binge eating, loss of control eating, and bulimia nervosa.

METHOD

Literature searches on PubMed and PsycInfo were conducted using combinations of terms related to binge eating and biobehavioral AB paradigms. Studies using AB paradigms with three categories of stimuli were included: food, weight/shape, and threat. For studies reporting means and standard deviations of group bias scores, Hedges' g effect sizes for group differences in AB were calculated.

RESULTS

Fifty articles met inclusion criteria and were reviewed. Individuals who binge eat in the absence of compensatory behaviors show an increased AB to food cues, but few studies have examined such individuals' AB toward weight/shape and threatening stimuli. Individuals with bulimia nervosa consistently show an increased AB to shape/weight cues and socially threatening stimuli, but findings for AB to food cues are mixed.

DISCUSSION

While there are important research gaps, preliminary evidence suggests that the combination of AB to disorder-specific cues (i.e., food and weight/shape) and AB toward threat may be a potent contributor to binge eating. This conclusion underscores previous findings on the interaction between negative affect and AB to disorder-specific cues. Recommendations for future research are provided.

Body Mass Index z-Scores and Weight Status Predict Conduct Disorder Symptoms in Adolescents

PURPOSE

The goal of the study was to examine whether baseline body mass index (BMI) z-scores and weight status predicted conduct disorder (CD) symptoms in 368 adolescents (15-17 years).

METHODS

Participants in the 10th and 11th grades completed self-report questionnaires at baseline and at a 2-year follow-up. Baseline BMI z-scores and weight status were derived from self-reports of height and weight. CD symptoms were assessed using a symptom checklist. Covariates included baseline demographics, depressive symptoms, alcohol consumption, drug use, and a retrospective report of CD symptoms before age 15 years.

RESULTS

A cubic association was observed between baseline BMI z-scores and follow-up CD symptoms (p = .047), such that a positive association emerged only among adolescents with BMI z-scores of greater than ∼1.5. Adolescents who were obese at baseline reported more follow-up CD symptoms than nonoverweight adolescents (p = .008). Higher baseline BMI z-scores were associated with increased odds of endorsing probable CD at follow-up (p's < .03). Obese adolescents were more likely to report the presence of probable CD at follow-up than overweight and nonoverweight adolescents (p's ≤ .01).

CONCLUSIONS

Findings suggest that nutritional status, particularly high BMI z-scores and obese weight status, may contribute to elevated CD symptoms during adolescence, which should be dually addressed in screening and intervention efforts.

Examination of the interpersonal model of loss of control eating in the laboratory

BACKGROUND

The interpersonal model of loss of control (LOC) eating proposes that interpersonal problems lead to negative affect, which in turn contributes to the onset and/or persistence of LOC eating. Despite preliminary support, there are no data examining the construct validity of the interpersonal model of LOC eating using temporally sensitive reports of social stress, distinct negative affective states, and laboratory energy intake.

METHOD

117 healthy adolescent girls (BMI: 75th-97th %ile) were recruited for a prevention trial targeting excess weight gain in adolescent girls who reported LOC eating. Prior to the intervention, participants completed questionnaires of recent social stress and consumed lunch from a multi-item laboratory test meal. Immediately before the test meal, participants completed a questionnaire of five negative affective states (anger, confusion, depression, fatigue, anxiety). Bootstrapping mediation models were conducted to evaluate pre-meal negative affect states as explanatory mediators of the association between recent social stress and palatable (desserts and snack-type) food intake. All analyses adjusted for age, race, pubertal stage, height, fat mass percentage, and lean mass.

RESULTS

Pre-meal state anxiety was a significant mediator for recent social stress and palatable food intake (ps<.05). By contrast, pre-meal state anger, confusion, depression, and fatigue did not mediate the relationship between social stress and palatable food intake (ps>.05).

DISCUSSION

Pre-meal anxiety appears to be the salient mood state for the interpersonal model among adolescent girls with LOC eating. Interventions that focus on improving both social functioning and anxiety may prove most effective at preventing and/or ameliorating disordered eating and obesity in these adolescents.

Gender Differences in Anxiety Trajectories from Middle to Late Adolescence

Although developmental trajectories of anxiety symptomatology have begun to be explored, most research has focused on total anxiety symptom scores during childhood and early adolescence, using racially/ethnically homogenous samples. Understanding the heterogeneous courses of anxiety disorder symptoms during middle to late adolescence has the potential to clarify developmental risk models of anxiety and to inform prevention programs. Therefore, this study specifically examined gender differences in developmental trajectories of anxiety disorder symptoms (generalized anxiety disorder, panic disorder, and social anxiety disorder) from middle to late adolescence in a diverse community sample (N = 1000; 57 % female; 65 % White), assessed annually over 2 years. Latent growth curve modeling revealed that girls exhibited a slight linear decrease in generalized anxiety disorder, panic disorder, and social anxiety disorder symptoms, whereas boys exhibited a stable course. These models suggested that one trajectory was appropriate for panic disorder symptoms in both girls and boys. Growth mixture models indicated the presence of four latent generalized anxiety disorder symptom trajectory classes: low increasing, moderate decreasing slightly, high decreasing, and very high decreasing rapidly. Growth mixture models also suggested the presence of five latent social anxiety disorder symptom trajectory classes: a low stable trajectory class and four classes that were qualitatively similar to the latent generalized anxiety disorder trajectories. For both generalized anxiety disorder and social anxiety disorder symptoms, girls were significantly more likely than boys to be in trajectory classes characterized by moderate or high initial symptoms that subsequently decreased over time. These findings provide novel information regarding the developmental course of anxiety disorder symptoms in adolescents.

Social media use and anxiety in emerging adults

INTRODUCTION

Social media use is central to the lives of emerging adults, but the implications of social media use on psychological adjustment are not well understood. The current study aimed to examine the impact of time spent using social media on anxiety symptoms and severity in emerging adults.

METHODS

Using a web-based recruitment technique, we collected survey information on social media use and anxiety symptoms and related impairment in a nationally representative sample of 563 emerging adults from the U.S. (18-22 years-old; 50.2% female; 63.3% Non-Hispanic White). Participants self-reported the amount of time they spent using various social media sites on an average day, and responded to anxiety questionnaires RESULTS: Hierarchical regression revealed that more time spent using social media was significantly associated with greater symptoms of dispositional anxiety (B=0.74, 95% CI=0.59-0.90, p<0.001), but was unrelated to recent anxiety-related impairment (B=0.06, 95% CI=0.00-0.12, p=0.051), controlling for age, gender, race/ethnicity, and education level. Logistic regression also revealed that more daily social media use was significantly associated with a greater likelihood of participants scoring above the anxiety severity clinical cut-off indicating a probable anxiety disorder (AOR=1.032, 95% CI=1.004-1.062, p=0.028).

LIMITATIONS

Study limitations include the cross-sectional design and reliance on self-report questionnaires.

CONCLUSIONS

Given the ubiquity of social media among emerging adults, who are also at high risk for anxiety disorders, the positive association between social media use and anxiety has important implications for clinicians. Gaining a more nuanced understanding of this relationship will help to inform novel approaches to anxiety treatment.

Emotion dysregulation and loss-of-control eating in children and adolescents

OBJECTIVE

To examine the associations among self-reported loss-of-control (LOC) eating, emotion dysregulation, body mass, and objective energy intake among youth. Emotion dysregulation may be 1 individual factor that promotes excess energy intake and increases in body mass among youth with LOC eating.

METHOD

Children and adolescents (N = 230; 8 to 17 years) enrolled in a nonintervention study completed a structured interview to determine the presence or absence of self-reported LOC eating. Children's emotion dysregulation was assessed via parent-report with the Child Behavior Checklist. Youth also completed 2 test meals to capture "binge" and "normal" eating. Body composition was examined using air displacement plethysmography.

RESULTS

After controlling for relevant covariates, youth with self-reported LOC eating had higher parent-reported emotion dysregulation than those without LOC. Parent-reported emotion dysregulation was also associated with greater observed energy intake (after accounting for body mass), as well as higher fat mass. Emotion dysregulation also moderated associations between LOC status/gender and body mass variables; among youth with self-reported LOC eating and girls, those with high parent-described emotion dysregulation (vs. low) had significantly higher fat mass and BMIz.

CONCLUSIONS

Data from the current study suggest that emotion dysregulation may play a role in energy intake and obesity, particularly among youth with self-reported LOC eating and girls. Additional studies are needed to identify the prospective mechanisms linking poor emotion regulation and LOC eating. These mechanisms, in turn, may inform future interventions targeting excess energy intake and obesity in pediatric samples. (PsycINFO Database Record

Effect of adapted interpersonal psychotherapy versus health education on mood and eating in the laboratory among adolescent girls with loss of control eating

OBJECTIVE

Interpersonal psychotherapy (IPT) is aimed at improving negative affect that is purported to contribute to the development and maintenance of loss-of-control (LOC) eating. Although youth who report LOC over eating tend to consume more snack-foods than those without LOC, it is unknown if IPT impacts objective energy intake.

METHODS

To test if IPT improves mood and eating in the laboratory, we examined a sample of 88 girls with LOC eating who were randomized to either IPT (n = 46) or a standard-of-care health education (HE) group program. At baseline, and 6-month (follow-up 1) and 1-year (follow-up 2) following the initiation of the groups, girls consumed lunch from a multi-item meal with an instruction designed to model a LOC episode. Girls also reported mood state immediately before each meal.

RESULTS

Girls in IPT experienced no significant changes in pre-meal state depressive affect, while girls in HE experienced a non-significant improvement by follow-up 1 and then returned to baseline by follow-up 2 (p < .04). We found no significant group difference for changes in total intake relative to girls' daily energy needs (p's ≥ .25). However, IPT reduced, while HE increased, the percentage of daily energy needs consumed from snack-foods by follow-up 2 (p = .04). Within-groups, HE increased their snack food intake from follow-up 1 to follow-up 2 (p = .01).

CONCLUSIONS

In adolescent girls with LOC, IPT did not change total intake at the test meal and was associated with reduced snack-food intake. Data are required to determine if IPT effectively prevents excess weight gain in the longer-term. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:490-498).

Behavioral and neurodevelopmental precursors to binge-type eating disorders: support for the role of negative valence systems

BACKGROUND

Pediatric loss-of-control (LOC) eating is a robust behavioral precursor to binge-type eating disorders. Elucidating precursors to LOC eating and binge-type eating disorders may refine developmental risk models of eating disorders and inform interventions.

METHOD

We review evidence within constructs of the Negative Valence Systems (NVS) domain, as specified by the Research Domain Criteria framework. Based on published studies, we propose an integrated NVS model of binge-type eating-disorder risk.

RESULTS

Data implicate altered corticolimbic functioning, neuroendocrine dysregulation, and self-reported negative affect as possible risk factors. However, neuroimaging and physiological data in children and adolescents are sparse, and most prospective studies are limited to self-report measures.

CONCLUSIONS

We discuss a broad NVS framework for conceptualizing early risk for binge-type eating disorders. Future neural and behavioral research on the developmental trajectory of LOC and binge-type eating disorders is required.

Mindfulness and eating behavior in adolescent girls at risk for type 2 diabetes

OBJECTIVE

The purpose of this investigation was to examine the relationship of dispositional mindfulness to binge eating and associated eating attitudes and behaviors among adolescent girls at risk for type 2 diabetes (T2D).

METHODS

Participants were 114 overweight or obese adolescents enrolled in a study of girls with a family history of T2D and mild depressive symptoms. Adolescent self-reports of mindfulness, eating in the absence of hunger, and depressive symptoms were collected. An interview was administered to determine presence of binge eating episodes and a behavioral task was used to assess the reinforcing value of food relative to other nonsnack food rewards. Body composition was assessed using dual-energy X-ray absorptiometry.

RESULTS

In analyses accounting for race, percent body fat, lean mass, height, age, and depressive symptoms, dispositional mindfulness was associated with a lower odds of binge eating (p = .002). Controlling for the same potential confounds, mindfulness was also inversely associated with eating concern, eating in the absence of hunger in response to fatigue/boredom, and higher food reinforcement relative to physical activity (all p < .05).

DISCUSSION

In girls with a family history of T2D, independent of body composition and depressive symptoms, intraindividual differences in mindfulness are related to binge eating and associated attitudes and behaviors that may confer risk for obesity and metabolic problems. Further research is needed to determine the extent to which mindfulness plays a role in the etiology and/or maintenance of disinhibited eating in adolescents at risk for T2D.

Depressed affect and dietary restraint in adolescent boys' and girls' eating in the absence of hunger

Data suggest that depressed affect and dietary restraint are related to disinhibited eating patterns in children and adults. Yet, experimental research has not determined to what extent depressed affect acutely affects eating in the absence of physiological hunger (EAH) in adolescents. In the current between-subjects experimental study, we measured EAH in 182 adolescent (13-17 y) girls (65%) and boys as ad libitum palatable snack food intake after youth ate to satiety from a buffet meal. Just prior to EAH, participants were randomly assigned to view either a sad or neutral film clip. Dietary restraint was measured with the Eating Disorder Examination. Adolescents who viewed the sad film clip reported small but significant increases in state depressed affect relative to adolescents who viewed the neutral film clip (p < .001). Yet, there was no main effect of film condition on EAH (p = .26). Instead, dietary restraint predicted greater EAH among girls, but not boys (p < .001). These findings provide evidence that adolescent girls' propensity to report restrained eating is associated with their greater disinhibited eating in the laboratory. Additional experimental research, perhaps utilizing a more potent laboratory stressor and manipulating both affective state and dietary restraint, is required to elucidate how state affect may interact with dietary restraint to influence EAH during adolescence.

Attentional bias to food cues in youth with loss of control eating

Emerging data indicate that adults with binge eating may exhibit an attentional bias toward highly palatable foods, which may promote obesogenic eating patterns and excess weight gain. However, it is unknown to what extent youth with loss of control (LOC) eating display a similar bias. We therefore studied 76 youth (14.5 ± 2.3 years; 86.8% female; BMI-z 1.7 ± .73) with (n = 47) and without (n = 29) reported LOC eating. Following a breakfast to reduce hunger, youth participated in a computerized visual probe task of sustained attention that assessed reaction time to pairs of pictures consisting of high palatable foods, low palatable foods, and neutral household objects. Although sustained attentional bias did not differ by LOC eating presence and was unrelated to body weight, a two-way interaction between BMI-z and LOC eating was observed (p = .01), such that only among youth with LOC eating, attentional bias toward high palatable foods versus neutral objects was positively associated with BMI-z. These findings suggest that LOC eating and body weight interact in their association with attentional bias to highly palatable foods cues, and may partially explain the mixed literature linking attentional bias to food cues with excess body weight.

Neural activation during anticipated peer evaluation and laboratory meal intake in overweight girls with and without loss of control eating

The interpersonal model of loss of control (LOC) eating proposes that socially distressing situations lead to anxious states that trigger excessive food consumption. Self-reports support these links, but the neurobiological underpinnings of these relationships remain unclear. We therefore examined brain regions associated with anxiety in relation to LOC eating and energy intake in the laboratory. Twenty-two overweight and obese (BMIz: 1.9±0.4) adolescent (15.8±1.6y) girls with LOC eating (LOC+, n=10) and without LOC eating (LOC-, n=12) underwent functional magnetic resonance imaging (fMRI) during a simulated peer interaction chatroom paradigm. Immediately after the fMRI scan, girls consumed lunch ad libitum from a 10,934-kcal laboratory buffet meal with the instruction to "let yourself go and eat as much as you want." Pre-specified hypotheses regarding activation of five regions of interest were tested. Analysis of fMRI data revealed a significant group by peer feedback interaction in the ventromedial prefrontal cortex (vmPFC), such that LOC+ had less activity following peer rejection (vs. acceptance), while LOC- had increased activity (p<.005). Moreover, functional coupling between vmPFC and striatum for peer rejection (vs. acceptance) interacted with LOC status: coupling was positive for LOC+, but negative in LOC- (p<.005). Activity of fusiform face area (FFA) during negative peer feedback from high-value peers also interacted with LOC status (p<.005). A positive association between FFA activation and intake during the meal was observed among only those with LOC eating. In conclusion, overweight and obese girls with LOC eating may be distinguished by a failure to engage regions of prefrontal cortex implicated in emotion regulation in response to social distress. The relationship between FFA activation and food intake supports the notion that heightened sensitivity to incoming interpersonal cues and perturbations in socio-emotional neural circuits may lead to overeating in order to cope with negative affect elicited by social discomfort in susceptible youth.

Atrial fibrillation in patients undergoing liver transplantation-a single-center experience

BACKGROUND

As the prevalence of atrial fibrillation rises with age and older patients increasingly receive transplants, the perioperative management of this common arrhythmia and its impact on outcomes in liver transplantation is of relevance.

METHODS

Retrospective review of 757 recipients of liver transplantation from January 2002 through December 2011.

RESULTS

Nineteen recipients (2.5%) had documented pre-transplantation atrial fibrillation. Sixteen patients underwent liver and 3 a combined liver-kidney transplantation. Three patients died within 30 days (84.2% 1-month survival) and another 3 within 1 year of transplantation (68.4% 1-year survival). Compared with patients without atrial fibrillation, the relative risk of death in the atrial fibrillation group was 5.29 at 1 month (P = .0034; 95% confidence interval [CI], 1.73-16.18) and 3.28 at 1 year (P = .0008; 95% CI, 1.63-6.59). Time to extubation and intensive care unit (ICU) and hospital readmissions were not different from the control cohort. Rapid ventricular response requiring treatment occurred in 4 patients during surgery and 7 after surgery, resulting in 3 ICU and 3 hospital readmissions.

CONCLUSIONS

The results suggest that patients with atrial fibrillation may be at increased risk of mortality after liver transplantation. Optimization of medical therapy may decrease ICU and hospital readmission due to rapid ventricular response.

Psychiatric co-morbidity in women presenting across the continuum of disordered eating

OBJECTIVE

To compare the prevalence and correlates of psychiatric co-morbidity across a large sample of college women without an eating disorder, those at high risk for an eating disorder and women diagnosed using DSM-5 criteria for an eating disorder.

PARTICIPANTS

549 college women aged 18-25.

METHODS

Data from the Eating Disorder Examination, the Structured Clinical Interview for DSM-IV Axis I disorders and self-report questionnaires were analyzed using logistic regression for categorical data and ANCOVA for continuous measures.

RESULTS

Eating disordered symptomatology was strongly associated with anxiety disorders, mood disorders and insomnia. These co-morbidities (type and severity) tend to increase with eating disorder symptom severity.

CONCLUSIONS

Prevention and treatment programs for eating disorders need to address the high levels of mood, anxiety and sleep problems in this population. The findings on insomnia are novel and suggest that sleep disturbance may play an integral role in eating-related difficulties.

Puberty and the manifestations of loss of control eating in children and adolescents

OBJECTIVE

We investigated the manifestations of pediatric loss of control (LOC) eating at different stages of pubertal development.

METHOD

Participants were a nonclinical sample of 468 youth (8-17 years). Physical examination determined pubertal stage. LOC eating and disordered eating attitudes were assessed with the Eating Disorder Examination. In a randomized crossover design, a subset (n = 244) ate ad libitum from two test meals designed to capture normal and LOC eating.

RESULTS

There were no differences in the prevalence rates or frequency of reported LOC eating episodes across pubertal stages (ps ≥ 0.50). There were, however, puberty by LOC eating interactions in disordered eating attitudes and palatable food consumption (ps ≤ .05), even after adjusting for age and body composition. LOC eating was associated with elevated global disordered eating attitudes, weight concern, and shape concern in post-pubertal youth (ps ≤ .001), but not pre-pubertal youth (ps ≥ .49). In late-puberty, youth with LOC eating consumed less energy from protein (p < .001) and more from carbohydrate (p = .003) and snack-type foods (p = .02) than those without LOC eating, whereas endorsement of LOC eating in pre- or early-to-mid-puberty was not associated with differences in eating behavior (ps ≥ 0.20).

CONCLUSIONS

Findings suggest that puberty may be a critical risk period, when LOC eating behaviors in boys and girls may become accompanied by greater weight and shape concerns and more obesogenic food consumption patterns. Interventions for LOC eating during pre-puberty should be evaluated to determine if they are particularly beneficial for the prevention of exacerbated eating disorder psychopathology and adverse weight outcomes.

Using ecological momentary assessment to examine interpersonal and affective predictors of loss of control eating in adolescent girls

OBJECTIVE

Pediatric loss of control (LOC) eating is predictive of partial- and full-syndrome binge eating disorder. The interpersonal model proposes that LOC eating is used to cope with negative mood states resulting from interpersonal distress, possibly on a momentary level. We therefore examined temporal associations between interpersonal problems, negative affect, and LOC eating among overweight adolescent girls using ecological momentary assessment (EMA).

METHOD

Thirty overweight and obese (≥85th body mass index (BMI) percentile; BMI: M = 36.13, SD = 7.49 kg/m(2)) adolescent females (Age: M = 14.92, SD = 1.54 y; 60.0% African American) who reported at least two LOC episodes in the past month completed self-report momentary ratings of interpersonal problems, state affect, and LOC eating for 2 weeks. A series of 2-level multilevel models with centering within subjects was conducted.

RESULTS

Between- and within-subjects interpersonal problems (p's < .05), but not between- (p = .12) or within- (p = .32) subjects negative affect predicted momentary LOC eating. At the between-subjects level, interpersonal problems significantly predicted increases in negative affect (p < 001).

DISCUSSION

Naturalistic data lend support to the predictive value of interpersonal problems for LOC eating among adolescents. Interventions targeting interpersonal factors on a momentary basis may be useful during this developmental stage.

Targeted prevention of excess weight gain and eating disorders in high-risk adolescent girls: a randomized controlled trial

BACKGROUND

The high prevalence and incidence of obesity and eating disorders in US adolescent girls are serious health problems. Because of the shared risk factors for obesity and eating disorders, a targeted prevention of both conditions is a priority.

OBJECTIVE

We determined whether an adapted interpersonal psychotherapy prevention program is more efficacious for reducing excess weight gain and worsening disordered eating than health education in adolescent girls at high risk of obesity and eating disorders.

DESIGN

A parallel-group, randomized controlled trial was conducted between September 2008 and January 2013 in a university-based laboratory and a federal research hospital. The study included 113 adolescent (12-17-y-old) girls deemed at high risk of adult obesity and eating disorders because of a body mass index (BMI) between the 75th and 97th percentiles and reports of episodes of a loss of control over their eating. Girls were randomly assigned to participate in an adapted interpersonal psychotherapy or a health-education group program for 12 weekly 90-min group sessions. Follow-up assessments occurred immediately after group programs and at 6 and 12 mo.

RESULTS

Participation in both conditions was associated with decreases in expected BMI gain, age-adjusted BMI metrics, the percentage of fat by using dual-energy X-ray absorptiometry, symptoms of depression and anxiety, and the frequency of loss-of-control eating over 12 mo of follow-up (Ps < 0.001) with no group difference. In follow-up analyses, interpersonal psychotherapy was more efficacious than health education at reducing objective binge eating at the 12-mo follow-up (P < 0.05).

CONCLUSIONS

The intervention with adolescent girls with loss-of-control eating is associated with lower age-adjusted BMI and percentage of adiposity as well as improved mood symptoms over 1 y. Interpersonal psychotherapy further reduced objective binge eating. Additional research is needed to elucidate the mechanisms by which physical and psychological improvements were observed. This trial was registered at clinicaltrials.gov as NCT00680979.

History of weight control attempts among adolescent girls with loss of control eating

OBJECTIVE

Loss of control (LOC) eating and a weight control attempt (WCA) history during adolescence are important behavioral risk factors for eating disorders and obesity. The current study investigated the significance of the presence of a WCA history among adolescent girls with LOC eating.

METHOD

Participants were 114 obesity-prevention-seeking 12-17-year-old (M = 14.5, SD = 1.7 years) girls who were between the 75th and 97th body mass index (BMI) percentile (BMI-z: M = 1.5, SD = 0.3) and reported LOC eating episodes during the previous month (M = 4.0, SD = 4.9 episodes; Median = 2.0). Measures included the Eating Disorder Examination to assess LOC eating, eating pathology, and WCA history, and self-report questionnaires for symptoms of general psychopathology. Eating behavior was observed during a laboratory meal designed to capture a LOC eating episode.

RESULTS

67.5% reported a WCA history. As compared to girls without a WCA history (no-WCA), those with a WCA history (WCA) had greater disordered eating attitudes and depressive symptoms (ps < .04). There were no significant group differences in BMI-z or LOC eating frequency (ps > .10). During the laboratory meal, WCA consumed less energy from snack-type foods than no-WCA (M = 245.0, SD = 156.1 vs. M = 341.6, SD = 192.3 kcal; p = .01).

CONCLUSIONS

Reported WCAs are highly prevalent and are associated with greater psychopathology symptoms among adolescent girls with LOC eating. Prospective data are needed to determine whether these overlapping risk behaviors confer differential vulnerability for developing eating disorders and obesity.

Adapting interpersonal psychotherapy for the prevention of excessive weight gain in rural African American girls

OBJECTIVE

To obtain focus group data regarding the perspectives of rural African American (AA) girls, parents/guardians, and community leaders on obesity, loss of control (LOC) eating, relationships, and interpersonal psychotherapy for the prevention of excessive weight gain (IPT-WG).

METHODS

7 focus groups (N = 50 participants) were moderated and the transcripts analyzed by Westat researchers using widely accepted methods of qualitative and thematic analysis. A session was held with experts in health disparities to elucidate themes.

RESULTS

Participants understood LOC eating; however, they had culturally specific perceptions including usage of alternative terms. Relationships were highly valued, specifically those between mothers and daughters. IPT-WG program components generally resonated with participants, although modifications were recommended to respect parental roles. Experts interpreted focus group themes and discussed potential barriers and solutions to recruitment and participation.

CONCLUSION

Findings suggest that adapting IPT-WG may be acceptable to rural AA families. This research is the first step in developing a sustainable excessive weight gain and binge eating disorder prevention program for rural AA adolescents.

What constitutes clinically significant binge eating? Association between binge features and clinical validators in college-age women

OBJECTIVE

To investigate the association between binge features and clinical validators.

METHOD

The Eating Disorder Examination assessed binge features in a sample of 549 college-age women: loss of control (LOC) presence, binge frequency, binge size, indicators of impaired control, and LOC severity. Clinical validators were self-reported clinical impairment and current psychiatric comorbidity, as determined via a semistructured interview.

RESULTS

Compared with women without LOC, those with LOC had significantly greater odds of reporting clinical impairment and comorbidity (ps < 0.001). Among women with LOC (n = 252), the indicators of impaired control and LOC severity, but not binge size or frequency, were associated with greater odds of reporting clinical impairment and/or comorbidity (ps < 0.05). DICUSSION: Findings confirm that the presence of LOC may be the hallmark feature of binge eating. Further, dimensional ratings about the LOC experience--and possibly the indicators of impaired control--may improve reliable identification of clinically significant binge eating.

Latent profile analysis to determine the typology of disinhibited eating behaviors in children and adolescents

OBJECTIVE

We used latent profile analysis (LPA) to classify children and adolescents into subtypes based on the overlap of disinhibited eating behaviors-eating in the absence of hunger, emotional eating, and subjective and objective binge eating.

METHOD

Participants were 411 youths (8-18 years) from the community who reported on their disinhibited eating patterns. A subset (n = 223) ate ad libitum from two test meals.

RESULTS

LPA produced five subtypes that were most prominently distinguished by objective binge eating (OBE; n = 53), subjective binge eating (SBE; n = 59), emotional eating (EE; n = 62), a mix of emotional eating and eating in the absence of hunger (EE-EAH; n = 172), and no disinhibited eating (No-DE; n = 64). Accounting for age, sex, race, and body mass index z score (BMI-z), the four disinhibited eating groups had more problem behaviors than the no disinhibited eating group (p = .001). OBE and SBE subtypes had greater BMI-z, percent fat mass, disordered eating attitudes, and trait anxiety than EE, EE-EAH, and No-DE subtypes (ps < .01). However, the OBE subtype reported the highest eating concern (p < .001), and the OBE, SBE, and EE subtypes reported higher depressive symptoms than the EE-EAH and No-DE subtypes. Across both test meals, OBE and SBE subtypes consumed a lesser percentage of protein and a higher percentage of carbohydrate than the other subtypes (ps < .02), adjusting for age, sex, race, height, lean mass, percent fat mass, and total intake. EE subtypes also consumed a greater percentage of carbohydrate and a lower percentage of fat than the EE-EAH and No-DE subtypes (ps < .03). The SBE subtype consumed the least total calories (p = .01).

DISCUSSION

We conclude that behavioral subtypes of disinhibited eating may be distinguished by psychological characteristics and objective eating behavior. Prospective data are required to determine whether subtypes predict the onset of eating disorders and obesity.

Behavioral Interventions and Cardiovascular Risk in Obese Youth: Current Findings and Future Directions

The identification and early intervention of pediatric obesity is critical to reducing cardiovascular disease (CVD). Family-based behavioral interventions have consistently demonstrated efficacy in reducing adiposity and CVD risk factors (i.e., blood pressure, cholesterol, fasting glucose levels, insulin resistance, metabolic syndrome). Even modest weight loss in severely obese youth can lead to sustained improvement in CVD risk factors. However, weight regain following treatment cessation remains a challenge in the contemporary obesogenic environment. Intensive family-based interventions spanning socioenvironmental contexts (i.e., home, peer, community) show promise in sustaining weight loss in the long-term. Despite having effective treatments for pediatric obesity and CVD risk factors, families rarely have access to these programs and so increasing the role of healthcare providers in screening and referral efforts is imperative. Moving forward, it is also essential to establish communication and cooperative networks across sectors build sustainable prevention and intervention programs and to provide cohesive health messages.

Eating patterns in youth with and without loss of control eating

OBJECTIVE

To compare the characteristic meal patterns of adolescents with and without loss of control (LOC) eating episodes.

METHOD

The Eating Disorder Examination was administered to assess self-reported LOC and frequency of meals consumed in an aggregated sample of 574 youths (12-17 years; 66.6% female; 51.2% Caucasian; BMI-z: 1.38 ± 1.11), among whom 227 (39.6%) reported LOC eating.

RESULTS

Compared to those without LOC, youth with LOC were less likely to consume lunch and evening meals (p's < .05), but more likely to consume morning, afternoon, and nocturnal snacks (p's ≤ .05), accounting for age, sex, race, socio-economic status, BMI-z, and treatment-seeking status.

DISCUSSION

Adolescents with reported LOC eating appear to engage in different meal patterns compared to youth without LOC, and adults with binge eating. Further research is needed to determine whether the meal patterns that characterize adolescents with LOC play a role in worsening disordered eating and/or excessive weight gain.

Atrial laceration caused by removal of a transjugular intrahepatic portosystemic shunt necessitates emergent cardiopulmonary bypass during liver transplant: a case report

In situ transjugular intrahepatic portosystemic shunting (TIPS) can complicate liver transplantation. We present a case where an intraoperative attempt to remove a malpositioned TIPS resulted in atrial laceration. Massive transfusion and emergent institution of cardiopulmonary bypass allowed patient resuscitation and completion of surgery. We describe our surgical and anesthesiologic management, and discuss the absence of criteria to predict when TIPS may become adherent to the inferior vena cava or the right atrium and difficult to remove.

Construct validity of the emotional eating scale adapted for children and adolescents

BACKGROUND

Emotional eating, defined as eating in response to a range of negative emotions, is common in youths. Yet, there are few easily administered and well-validated methods to assess emotional eating in pediatric populations.

OBJECTIVE

The current study tested the construct validity of the Emotional Eating Scale (EES) Adapted for Children and Adolescents (EES-C) by examining its relationship to observed emotional eating at laboratory test meals.

METHOD

A total of 151 youths (8-18 years) participated in two multi-item lunch buffet meals on separate days. They ate ad libitum after being instructed to 'eat as much as you would at a normal meal' or to 'let yourself go and eat as much as you want'. State negative affect was assessed immediately before each meal. The EES-C was completed 3 months, on average, before the first test meal.

RESULTS

Among youths with high EES-C total scores, but not low EES-C scores, higher pre-meal state negative affect was related to greater total energy intake at both meals, with and without the inclusion of age, race, sex and body mass index (BMI) standard deviation as covariates (ps<0.03).

DISCUSSION

The EES-C demonstrates good construct validity for children and adolescents' observed energy intake across laboratory test meals designed to capture both normal and disinhibited eating. Future research is required to evaluate the construct validity of the EES-C in the natural environment and the predictive validity of the EES-C longitudinally.