A MEDIATIONAL MODEL RELATING SOCIOTROPY, AMBIVALENCE OVER EMOTIONAL EXPRESSION, AND DISORDERED EATING

Two factors that have been found to predict eating disorders are sociotropy or dependent personality style and ambivalence over emotional expression, but there has been little consideration of the relationship between them and how this relationship may contribute to an understanding of eating disorders. A mediational model is proposed in which high sociotropy leads to greater ambivalence over expressing emotions, which in turn increases vulnerability to eating disorders. Consistent with predictions, among 115 college women, a high level of sociotropy was associated with a high level of ambivalence over emotional expression, which in turn was associated with increased disordered eating. Furthermore, ambivalence over emotional expression significantly mediated the effect of sociotropy on disordered eating, even when controlling for depression level. Findings are considered within a developmental framework, and treatment implications are discussed.     

Perceived acceptability of anorexia and bulimia in women with and without eating disorder symptoms

Perceptions of the acceptability of eating‐disordered behaviour were examined in young adult women with (n = 44) and without (n = 268) eating disorder symptoms. All participants viewed vignettes of anorexia nervosa (AN) and bulimia nervosa (BN) and responded to the same series of questions—addressing different possible ways in which the conditions described might be seen to be acceptable—in relation to each vignette. Participants with eating disorder symptoms perceived eating‐disordered behaviour to be more acceptable than asymptomatic participants, and this was the case for both AN and BN vignettes and for a range of different items. Differences on items tapping the perception that it ‘might not be too bad’ to have an eating disorder and that an eating disorder is ‘nothing to be concerned about’ were particularly pronounced. The findings could not be accounted for by between‐group differences in body weight. The findings indicate the ambivalence towards eating‐disordered behaviour that exists among a subgroup of young women in the community and the clear association between such ambivalence and actual eating disorder symptoms. The perceived acceptability of eating‐disordered behaviour may need to be addressed in prevention and early‐intervention programs for eating disorders.     

Ambivalence About Interpersonal Problems and Traits Predicts Cross‐Situational Variability of Social Behavior

Multiple theoretical perspectives suggest that maladjusted personality is characterized by not only distress, but also opposing or “ambivalent” self‐perceptions and behavioral lability across social interactions. However, the degree to which ambivalence about oneself predicts cross‐situational variability in social behavior has not been examined empirically. Using the interpersonal circumplex (IPC) as a nomological framework, the present study investigated the extent to which endorsing opposing or “ambivalent” tendencies on IPC measures predicted variability in social behavior across a range of hypothetical interpersonal scenarios (Part 1; N = 288) and naturalistic social interactions (Part 2; N = 192). Ambivalent responding for interpersonal problems and traits was associated with measures of distress, maladaptive interpersonal tendencies, and greater variability of social behavior across both hypothetical and daily social interactions, though more consistently for interpersonal problems. More conservative tests suggested that ambivalence predicted some indexes of behavioral variability even when accounting for mean levels and squared means of social behaviors, vector length, gender, and depressive symptoms. Results suggest that processes theorized as typifying personality disorder may apply more broadly to personality maladjustment occurring outside of clinical samples.     

Evidence for Discontinuity Patterns Across the Stages of Change: A Role for Attitudinal Ambivalence

Cross-sectional analyses of the transtheoretical ("stages of change") model (TTM) can provide valuable information concerning the variables that are likely to shift individuals from one stage to the next. The present study was designed to investigate the roles of theory of planned behaviour (TPB) variables and attitudinal ambivalence across the stages of change. Two samples derived from the general population completed measures of stage, TPB and attitudinal ambivalence with respect to consuming a low-fat diet (n = 148) and eating five portions of fruit and vegetables per day (n = 151). Consistent with previous research, the present study found linear increases in TPB variables across the stages of change. However, as predicted, attitudinal ambivalence showed discontinuity patterns, displaying a quadratic relationship with the stages of change, such that least ambivalence was experienced in the precontemplation and maintenance stages. Discussion of the findings focuses on implications for the development of theory-driven interventions.     

The Dialogical Subject and its Multiple and Opposing Positions

The aim of our study is to describe how the voices of others constitute the dialogical subject: an individual who is not closed off from others, but is, rather, characterized by intersubjectivity and a plurality of positions in connection with those of others. Analysis of ten semi-structured interviews carried out on members of an association supporting the right of fathers to joint custody of children shows that interviewees employed a wide variety of voices – voices in support of shared custody, but also voices which opposed it. While they most often identified with and assumed voices in favor of joint custody, they also did so with voices expressing opposing positions. Our results belie the common expectation that individuals who are committed to a cause will not be open to the opinions of others, and are incapable of seeing the world from others’ points of view.     

MODERN WOMEN AND THE DYNAMICS OF SOCIAL PSYCHOLOGICAL AMBIVALENCE

Because gender roles are rapidly changing, a more dynamic conceptualization of role is especially needed. Working toward this end, we build on the contributions of scholars such as Merton and Barber (1963), Rossi (1972), Bardwick and Douvan (1971), Koma-rovsky (1973a, 1973b), and Room (1976); develop two pivotal concepts, social psychological ambivalence and developmental alienation; and interpret current findings on the changing roles of women. Conflicts contemporary women may face because they are attracted to opposing values also are explored. One challenge for future researchers will be to clarify the situational factors that link ambivalence on the individual (i.e., psychological) level to structural or sociological ambivalence and to collective social action.     

Cognitive behaviour therapy for eating disorders: a "transdiagnostic" theory and treatment

This paper is concerned with the psychopathological processes that account for the persistence of severe eating disorders. Two separate but interrelated lines of argument are developed. One is that the leading evidence-based theory of the maintenance of eating disorders, the cognitive behavioural theory of bulimia nervosa, should be extended in its focus to embrace four additional maintaining mechanisms. Specifically, we propose that in certain patients one or more of four additional maintaining processes interact with the core eating disorder maintaining mechanisms and that when this occurs it is an obstacle to change. The additional maintaining processes concern the influence of clinical perfectionism, core low self-esteem, mood intolerance and interpersonal difficulties. The second line of argument is that in the case of eating disorders shared, but distinctive, clinical features tend to be maintained by similar psychopathological processes. Accordingly, we suggest that common mechanisms are involved in the persistence of bulimia nervosa, anorexia nervosa and the atypical eating disorders. Together, these two lines of argument lead us to propose a new transdiagnostic theory of the maintenance of the full range of eating disorders, a theory which embraces a broader range of maintaining mechanisms than the current theory concerning bulimia nervosa. In the final sections of the paper we describe a transdiagnostic treatment derived from the new theory, and we consider in principle the broader relevance of transdiagnostic theories of maintenance.     

Disentangling the Impact of Resistance and Ambivalence on Therapy Outcomes in Cognitive Behavioural Therapy for Generalized Anxiety Disorder

Resistance and ambivalence about change are increasingly recognized as important determinants of treatment outcomes. Moreover, resistance and ambivalence are thought to be theoretically related in that clients who are more ambivalent about change are more likely to demonstrate resistance to the process and tasks of treatment. In the context of cognitive behavioural therapy (CBT) for generalized anxiety disorder, the present study simultaneously examined early resistance and ambivalence using two observer-based coding systems in order to determine their inter-relationship and, importantly, to investigate their relative contributions to outcome. Resistance was also coded during mid-treatment in order to investigate possible mediation pathways. Early ambivalence (clients’ arguments against change or counter-change talk) was found to be no longer related to outcomes when early resistance was taken into account, suggesting that disharmony in the therapeutic relationship is more important to outcomes than ambivalence per se. Moreover, mid-treatment resistance partially mediated the relationship between early resistance and post-treatment worry severity. That is, higher early opposition to therapist direction is related to poorer outcomes, in part because it is associated with greater resistance during the working phase of CBT. The findings underscore the critical need for therapists to be sensitive to identifying resistance early and throughout treatment.     

The impact of attitudinal ambivalence on weight loss decisions: Consequences and mitigating factors

This research takes a new look at individuals' attitudes and intentions towards losing weight. Study 1 examines the relationship among those interested in losing weight and individual self‐evaluative ambivalence on attitude towards trying to achieve a weight loss goal and the intentions to achieve the weight loss goal. For Study 2, a between‐subjects experimental design, where attitudinal ambivalence and prior outcome feedback were manipulated and self‐efficacy was measured, is conducted to examine attitude towards eating healthier and intention to change eating behaviours. Findings across the two studies show that attitudinal ambivalence about the self and the individual's abilities and motivation to change the health behaviour produces a negative relationship between health‐related attitudes and intentions. We provide implications of how self‐efficacy and the provision of outcome feedback can alleviate the negative effect and improve the individuals' intentions to try to achieve a weight loss goal. Copyright © 2014 John Wiley & Sons, Ltd.     

Assessing readiness for change in adolescents with eating disorders

The Readiness and Motivation Interview (RMI) is a semistructured interview measure of readiness and motivation to change that can be used for all eating disorder diagnoses. The RMI has demonstrated excellent psychometric properties and has both clinical and predictive utility in adult samples. This study examined the psychometric properties of the RMI in a younger population, namely, 12- to 18-year-old girls with eating disorders. Study participants (N = 65) completed the RMI and measures of convergent, discriminant, and criterion validity. Adolescents with eating disorders were able to conceptualize and articulate their readiness for change and to report the extent to which change efforts were for themselves versus for others. RMI readiness profiles across eating disorder symptom domains in adolescents were comparable to those in adults, with higher reported readiness to change binge eating than to change dietary restriction or compensatory strategies. Differences in internal consistency between adult and adolescent samples are discussed. Interviewing adolescents early in treatment about readiness may assist clinicians in forming an alliance with this difficult-to-engage population, while also providing valuable information for treatment planning.     

Ambivalence and Alliance Ruptures in Cognitive Behavioral Therapy for Generalized Anxiety

Client ambivalence about change (or motivation) is regarded as central to outcomes in cognitive behavioral therapy (CBT). However, little research has been conducted to examine the impact of client ambivalence about change on therapy process variables such as the therapeutic alliance. Given the demonstrated limitations of self-report measures of key constructs such as ambivalence and motivation, the present study instead employed a newly adapted observational measure of client ambivalence. Client statements regarding change (change talk (CT) and counter-change talk (CCT)) were coded in early (session 1 or 2) therapy sessions of CBT for generalized anxiety disorder. The frequency of CT and CCT was then compared between clients who later experienced an alliance rupture with their therapist, and clients who did not. The results showed that clients in dyads who later experienced an alliance rupture expressed significantly more CCT at the outset of therapy than clients who did not later experience an alliance rupture. However, CT utterances did not significantly differ between alliance rupture and no-rupture groups. CCT may strain the alliance because clients expressing higher levels of CCT early in therapy may be less receptive to therapist direction in CBT. Consequently, it is recommended that clients and therapists work together to carefully address these key moments in therapy so as to prevent alliance rupture and preserve client engagement in therapy.     

HARASSED BODIES

The present study examined the relationships among sexual harassment and body image and eating disturbances using a sample of 195 undergraduate women. Sexual harassment was associated with a variety of eating disorder symptoms, even when controlling for experiences of sexual abuse/assault and physical abuse. Whereas sexual abuse/assault and physical abuse appear to be nonspecific risk factors for such symptoms, sexual harassment was more closely associated with eating disorder symptomatology than other types of psychological distress. The results of structural equation modeling better supported a model in which body image and eating disturbances were outcomes rather than antecedents of sexual harassment. Finally, several analyses indicated that disordered eating may function as a way to cope with the negative emotions associated with sexual harassment.     

Dialectical Behavior Therapy Modified for Adolescent Binge Eating Disorder: A Case Report

Given the lack of empirically supported treatments available for adolescents with eating disorders, it is important to investigate the clinical utility of extending treatments for adults with eating disorders to younger populations. Dialectical behavior therapy for binge eating disorder, based on the affect-regulation model, conceptualizes binge eating as a behavioral attempt to influence, change, or control painful emotional states. With promising research findings in adult women, it is of clinical interest whether the dialectical behavior therapy for binge eating disorder treatment manual could be usefully adapted for an adolescent population. This report describes adolescent-specific modifications (including the use of family sessions) to standard dialectical behavior therapy for binge eating disorder, with an illustrative case study. While more rigorous case studies are needed prior to establishing justification for a randomized trial, this pilot case provides preliminary support for a modified version of dialectical behavior therapy for binge eating disorder as a therapeutic option for adolescents with binge eating disorder.     

Eating disorder pathology among overweight treatment-seeking youth: clinical correlates and cross-sectional risk modeling

Preliminary research suggests that pediatric overweight is associated with increased eating disorder pathology, however, little is known about which overweight youth are most vulnerable to eating disorder pathology. We therefore investigated 122 overweight treatment-seeking youth to describe eating disorder pathology and mental health correlates, and to identify psychopathological constructs that may place overweight youth at increased risk for eating disorder pathology. Youth participated in a comprehensive assessment of eating disorders, mood and anxiety disorders, general psychopathology, and risk variables involving semi-structured clinical interviews and self- and parent-report questionnaires prior to the initiation of weight-loss treatment. Ten youth met criteria for an eating disorder, and over one-third endorsed recent binge eating. Eating disorder pathology was associated with depressive and anxious symptoms (p's<0.001). Structural equation modeling indicated increased negative affect, teasing experience, and thin-ideal internalization, and decreased perfectionism were associated with increased eating disorder pathology. Findings corroborate earlier work indicating that eating disorder pathology is elevated and clinically significant in overweight treatment-seeking youth, bolstering the need for mental health assessment of such individuals. Cross-sectional modeling proposed key variables that relate to eating disorder pathology in overweight treatment-seeking youth, which following prospective replication, may inform the development of effective interventions for overweight and eating disorders.     

Mindfulness and Eating Disorders: A Network Analysis

Higher trait mindfulness may be protective against eating disorder (ED) pathology. However, little is understood about which specific mindfulness processes connect to specific ED symptoms. This study (N = 1,056 undergraduates) used network analysis at the symptom/process level to identify: (1) central nodes, or symptoms/processes with the greatest collective connection with all other symptoms/processes; and (2) bridge nodes, or symptoms/processes driving interconnection between mindfulness processes and ED symptoms. We conducted analyses both with and without food- and body-related mindfulness items. Central nodes included: describing how one feels in detail, expressing how one feels in words, and feeling guilty about eating due to shape/weight. Bridge nodes connecting higher mindfulness processes with lower ED symptoms included: the eating disorder symptom, being uncomfortable about others seeing one eat, and the mindfulness process, not criticizing oneself for having irrational/inappropriate emotions. Bridge nodes connecting higher mindfulness processes with higher ED symptoms included: noticing sensations of the body moving when walking and noticing how food/drinks affect thoughts, bodily sensations, and emotions. Findings suggest that future research should explore whether mindfulness-based interventions for EDs may be more effective by targeting mindfulness processes related to describing, expressing, and accepting emotions, accepting discomfort when eating with others, and reducing hyper-focus on and reactivity to food-and-body related sensations.     

Moderator effects of attitudinal ambivalence on attitude–behaviour relationships

Attitudinal ambivalence is generally construed as existing when the same attitude object is evaluated simultaneously as both positive and negative. The present research examined the moderating role of attitudinal ambivalence (as assessed by split‐semantic differential measure) on the relationship between bipolar semantic differential measures of attitude and subsequent behaviour using moderated regression analysis. In Study 1, higher levels of attitudinal ambivalence were shown to result in weaker attitude–behaviour relationships for eating a low‐fat diet (N = 140) and eating 5 portions of fruit and vegetables per day (N = 142). Study 2 (N = 361) replicated this effect when also including a measure of past behaviour for eating a low‐fat diet. Implications for understanding the relationship between attitudes and behaviour are discussed. Copyright © 2002 John Wiley & Sons, Ltd.     

Overvaluation of shape and weight in binge eating disorder, bulimia nervosa, and sub-threshold bulimia nervosa

Increasing empirical evidence supports the validity of binge eating disorder (BED), a research diagnosis in the appendix of DSM-IV, and its inclusion as a distinct and formal diagnosis in the DSM-V. A pressing question regarding the specific criteria for BED diagnosis is whether, like bulimia nervosa (BN), it should be characterized by overvaluation of shape and weight. This study compared features of eating disorders in 436 treatment-seeking women comprising four groups: 195 BED participants who overvalue their shape/weight, 129 BED participants with subclinical levels of overvaluation, 61 BN participants, and 51 participants with sub-threshold BN. The BED clinical overvaluation group had significantly higher levels of specific eating disorder psychopathology than the three other groups which did not differ significantly from each other. Findings suggest that overvaluation of shape and weight should not be considered as a required criterion for BED because this would exclude a substantial proportion of BED patients with clinically significant problems. Rather, overvaluation of shape and weight warrants consideration either as a diagnostic specifier or as a dimensional severity rating as it provides important information about severity within BED.     

Anorexia nervosa and brain tumor in a 14-year-old girl

A 14-year-old girl with anorexia nervosa (AN) was found to have an intracranial neoplasm. Atypical psychological symptoms prompted further evaluation, including electroencephalogram and neuroimaging, which revealed a sellar and suprasellar mass. This patient had an eating disorder and a brain tumor, which appear to be two unrelated conditions. However, it remains unclear how each affected the other. The diagnosis of AN, like all other psychiatric disorders, requires that possible medical etiologies and coexisting medical problems be excluded. AN and other eating disorders are particularly difficult to diagnose in children and adolescents because they often do not present in the manner typical of adults. Perceptual and cognitive disturbances associated with AN are difficult to evaluate because children and adolescents normally change over time as they progress through different stages of development. Therefore, it is particularly important to evaluate for the presence of medical conditions when a diagnosis of an eating disorder is made in a child or adolescent.     

Ambivalence, Uncertainty, and Processes of Candidate Evaluation

The on-line and memory-based processing models of candidate evaluation can be better understood by incorporating the concepts of ambivalence and uncertainty, both as subjective feeling states and as objective properties of information. An experiment was designed to address three questions: What are the relationships between ambivalence and uncertainty? What are the informational foundations of subjective ambivalence and uncertainty, and to what extent are they rooted in on-line (time of exposure) and memory-based (time of judgment) processes? What are the consequences of ambivalence and uncertainty for candidate evaluation? The results suggest that (1) subjective uncertainty is more strongly rooted in information about the candidate than is subjective ambivalence; (2) subjective uncertainty and (to a lesser extent) ambivalence are associated with an increased propensity to engage in memory-based processing; and (3) subjective ambivalence and uncertainty result in more negative evaluations, particularly among less sophisticated people. These results suggest ways in which the on-line and memory-based models might productively be combined.     

Contextual Sources of Ambivalence

When will people become ambivalent about politics? One possibility is that the roots of ambivalence lie within the individual, with differences in political knowledge and attitude strength predicting whether a person internalizes the conflicts of politics. Alternately, attitudinal ambivalence could result from structural differences in the way political choices are presented in the wider political environment. We explore the degree to which different environments promote or limit ambivalence using a matching approach in conjunction with a set of multilevel models. We find that campaign environments can induce candidate ambivalence. In presidential elections, campaign efforts promote ambivalence most when competition between partisan campaign efforts is high. In House elections, campaign spending has a direct effect on levels of candidate ambivalence, where a candidate's spending decreases ambivalence about that candidate and increases ambivalence about opponents.