The self and eating disorders

In our review, we focus on self-related constructs in the context of eating disorders with four aims. First, we examine a variety of self-related constructs that have been theoretically and empirically linked to the development and course of eating disorders. In addition to the more well-researched constructs of self-esteem and self-efficacy, we also report on findings related to selflessness, contingent self-worth, self-objectification, ego-syntonicity, self-concept clarity, self-compassion, social comparison, self-oriented perfectionism/self-criticism, and narcissism. Second, we discuss self-related constructs that may be especially relevant to comorbidities common among those with eating disorders. Third, we review intervention and prevention programs where self-related constructs play a prominent role. Lastly, we share future research directions regarding self-related constructs and eating disorders that we believe will advance a deeper understanding of the role of the self in the eating disorders.     

The interpretation of symptoms of severe dietary restraint

A recent cognitive-behavioural theory of eating disorders proposes that people with eating disorders interpret symptoms of dietary restraint in terms of control. The primary aim of the present study was to test this hypothesis. A second aim was to test the hypothesis derived from clinical observation that people with eating disorders view these symptoms positively. Forty-four participants meeting DSM-IV criteria for a clinical eating disorder and 80 control participants with no history of an eating disorder completed an ambiguous scenario paradigm and self-report measures of eating disorder features and depression. Patients with eating disorders were significantly more likely to interpret symptoms of dietary control in terms of control, providing support for the cognitive-behavioural theory. There was only partial support for the second hypothesis. The implications for the new cognitive-behavioural theory and therapy are discussed.     

The Semantics of Freedom in Agoraphobic Patients: An Empirical Study

This study aimed to empirically test the clinical theory, common to constructivist and constructionist psychotherapeutic approaches, that the semantics of freedom (i.e., bipolar constructs regarding the dimension of meaning “free/constrained”) are psychologically linked to agoraphobia. Repertory grid technique was used to elicit constructs from 30 agoraphobic patients and from a matched control group of patients suffering from other psychological disorders, and the two sets of constructs were compared in terms of their semantic content. Results confirm the hypothesis, suggesting that freedom semantics seem to be prevalent in agoraphobia in terms of both frequency and importance. These results and their limitations are discussed in relation to their clinical applications and in light of the methodological issues arising from the study.     

From one extreme to the other: Negative evaluation anxiety and disordered eating as candidates for the extreme female brain

Simon Baron-Cohen pioneered the idea that different brain types evolved to process information in gender specific ways. Here we expand this approach to looking at eating disorders as a byproduct of the extreme female brain. The incidence of eating disorders is higher among females, and recent findings show that hormones may play a role in eating disorders. We present new evidence from four studies that both an empathizing bias and hyper-mentalizing (as measures of the extreme female brain; EFB) are related to disordered eating and negative evaluation anxiety in women. We also advance the novel hypothesis that concerns about animal welfare (a unique expression of the EFB) may account for the relationship between vegetarianism and eating disorders.     

On Targeting Emotion Regulation Deficits in Eating Disorders through Defense Analysis

ABSTRACT

Psychodynamic approaches to the treatment of individuals with eating disorders are underrepresented in research and in academia. This will increasingly deprive patients of a viable therapeutic alternate to the dominant behavioral family-based models. As psychodynamic approaches may have unique benefits, there is value in resolving this loss. Recent models of dynamic therapies for eating disorders within modern, empirically derived theory show promise for future psychodynamic viability. An attachment-focused approach targeting disordered attachment patterns that are common in individuals with eating disorders has recently been introduced. To complement this model, this article proposes an approach for individuals with eating disorders that is hypothesized to target emotion regulation deficits that are also commonly found in individuals with eating disorders. Observed parallels between the implicit branch of the emotion regulation system and that of contemporary constructs of defense mechanisms guide this proposal. Developmental considerations reveal important connections between this biologically based model and a two-person model based in attachment theory. In this way, this proposal offers a flexible psychodynamic approach that integrates with the existing literature. Further development of this approach could one day help patients to have a greater range of therapeutic options for recovery from eating disorders.     

Thinness and eating expectancies predict subsequent binge-eating and purging behavior among adolescent girls

One's expectancies for reinforcement from eating or from thinness are thought to represent summaries of one's eating-related learning history and to thus influence the development of binge-eating and purging behavior. In a 3-year longitudinal study, the authors tested this hypothesis and the hypothesis that binge eating also influences subsequent expectancy development. The authors used trajectory analysis to identify groups of middle school girls who followed different trajectories of binge eating, purging, eating expectancies, and thinness expectancies. Initial eating and thinness reinforcement expectancies identified girls whose binge eating and purging increased during middle school, and expectancies differentiated girls who began these problem behaviors from girls who did not. Initial binge-eating scores differentiated among eating expectancy developmental trajectories. The onset of most behaviors can be understood in terms of learned expectancies for reinforcement from these behaviors. The same model can be applied to the risk for eating disorders.     

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.     

Self-criticism, low self-esteem, depressive symptoms, and over-evaluation of shape and weight in binge eating disorder patients

Despite the fact that negative self-evaluations are widely considered to be prominent in eating disorders, the role of self-criticism has received little empirical attention. The vast majority of research on the construct of self-criticism has focused on its role as a specific personality vulnerability factor in depression-related phenomena. In this study of 236 patients with binge eating disorder, confirmatory factor analysis supported self-criticism, self-esteem, depressive symptoms, and over-evaluation of shape and weight as distinct, albeit related, constructs. Structural equation modeling demonstrated that the relation between self-criticism and over-evaluation of shape and weight was partly mediated or explained by low self-esteem and depressive symptoms. Continued efforts to understand the role of self-criticism in eating disorders appear warranted.     

LOVING THEM TO DEATH: THE ANOREXIC AND HER OBJECTS

The author suggests that eating disorders function to reinforce phantasies of control of the internal parents, a feature of Klein's view of the manic defence. Using this hypothesis, she attempts to differentiate between anorexia and bulimia. It is argued that in anorexia objects are felt to be permanently in thrall, suspended or frozen, whereas in bulimia they are attacked in a frenzied and intermittent way. Using case material from three seriously ill patients, the author draws attention to some important differences between them. Two of the patients were treated in psychoanalysis, while the third was seen for an extended consultation and once-weekly treatment thereafter. It is suggested that the nature and degree of the murderous attack on the internal couple may determine the severity of the illness as well as the patient's capacity to benefit from treatment. The conclusions drawn are discussed in relation to some contemporary views on eating disorders as well as writings on the difficulties of working through the Oedipus complex more generally. The author suggests that eating disorders may represent a special case of oedipal illusions.     

Reciprocal Associations Between Depressive Symptoms and Disordered Eating Among Adolescent Girls and Boys: A Multiwave,Prospective Study

Symptoms of depression and eating disorders increase during adolescence, particularly among girls, and they tend to co-occur. Despite this evidence, there is meager research on whether depression increases the risk of future eating pathology, or vice versa, and we do not know whether these processes are different for adolescent girls and boys. Accordingly, this study explored the prospective reciprocal associations between depressive symptoms and disordered eating at different time points from preadolescence to mid-adolescence and tested the moderator effect of gender on these associations. A community-based sample of Spanish youth (N?=?942, 49 % female) was assessed at ages of approximately 10-11 (T1), 12-13 (T2), 14-15 (T3), and 16-17 (T4) years. The bidirectional relationships between depressive symptoms and disordered eating were estimated in an autoregressive cross-lagged model with latent variables. A unidirectional, age-specific association between depressive symptoms at T1 and disordered eating at T2 was found. No other significant cross-lagged effect emerged, but the stability of the constructs was considerable. Gender did not moderate any of the links examined. Regardless of gender, the transition from childhood to adolescence appears to be a key period when depressive symptoms foster the development of disordered eating. These findings suggest that early prevention and treatment of depression targeting both girls and boys may result in lower levels of depressive symptoms and disordered eating in adolescence.     

Spirituality and Ten False Beliefs and Pursuits of Women With Eating Disorders: Implications for Counselors

Women with eating disorders often struggle with deep spiritual conflicts that can be a major impediment to their recovery. On the basis of clinical experience with more than 350 women in an inpatient eating disorder treatment facility, the authors describe 10 false beliefs that women with eating disorders may hold; the authors explain how the pursuit of these beliefs can prevent the women from connecting with God and with others in genuine ways. The authors also suggest some therapeutic strategies that may help women with eating disorders find a healing and helpful spiritual perspective.     

Confirmatory factor analysis of eating disorder symptoms in college women

Recent studies have found that the eating disorders can best be conceptualized as multidimensional. Four factors have consistently emerged from factor analytic studies of eating disorder symptoms: dietary restraint, bulimic behaviors, neurotic personality characteristics, and body image/body dysphoria. Confirmatory factor analysis was utilized to determine if this four-factor structure of eating disorder symptoms would be found in a sample of college women. Principal components analysis extracted four factors which were supported with a confirmatory factor analysis procedure. These four factors were negative affect and body dysphoria, bulimic behaviors, restrictive eating, and body image. The negative affect and body dysphoria factor was positively correlated with the other factors (i.e., bulimic behaviors, restrictive eating, and body image). This factor structure was similar to the factor structure found in samples of patients with bulimia and anorexia nervosa, except that the factors were more highly intercorrelated in the nonclinical sample. Results suggest that the measures of eating disorder symptoms used in this investigation are measuring the same multidimensional constructs in clinical and nonclinical subjects.This paper is partially based upon the master's thesis of the first author.     

Description of an Intensive Dialectical Behavior Therapy Program for Multidiagnostic Clients With Eating Disorders

The authors describe an intensive outpatient dialectical behavior therapy (DBT) program for multidiagnostic clients with eating disorders who had not responded adequately to standard, empirically supported treatments for eating disorders. The program integrates DBT with empirically supported cognitive behavior therapy approaches that are well established for the treatment of eating disorders. Attention is given to inclusion and exclusion criteria, how the program differs from standard treatments for eating disorders, and the application of specific DBT treatment components for multidiagnostic clients with eating disorders.     

Eating disorders as psychosomatic illness the implications for treatment

Abstract

This paper describes a body of theory which points to the possibility that eating disorders can be seen as psychosomatic illness, which is to say a symbolization of affect via the body rather than with words. The author concludes from this that eating disorders may respond better to non-verbal experiential therapies than they do to verbal therapy. She then describes four years of work with groups of eating-disordered women using non-verbal experiential therapies and suggests that the improvement in their symptoms may be the result of these methodologies and that her hypothesis merits further testing and exploration.     

Personal Constructs of Students with Eating Disorders: Implications for Counselling

Members of two self-help groupsfor university andpolytechnic students with eating disorders were asked to generale personal constructs. The analysis of the subsequent grids showed that the students were concerned with similar emotional issues. Il also produceda significant difference between ratings of'self and 'ideal self, butfailed to produce evidence of' tight' construing. Discussion ofthe grids made a positive contribution to the self-help process.     

An object-oriented simulation of anorexia based on brain structure interaction

A computer simulation using an object-oriented strategy was developed to model brain mechanisms that underlie eating disorders. The simulation was based on neuroanatomical and neurochemical evidence from published literature. Testing of the simulation required that the activity levels of the raphe nuclei of the brain stem be altered and the resulting activity levels of associated brain structures be compared with results from human and animal data. The results supported the serotonin hypothesis of anorexia that increasing the activity level of the raphe nuclei would result in dramatic changes in the activity level of the paraventricular nucleus. The findings are discussed with respect to the feasibility of computer simulations to test theories of brain-based disorders.     

The relationship of body dysmorphic disorder and eating disorders to obsessive-compulsive disorder

Body dysmorphic disorder (BDD) and eating disorders are body image disorders that have long been hypothesized to be related to obsessive-compulsive disorder (OCD). Available data suggest that BDD and eating disorders are often comorbid with OCD. Data from a variety of domains suggest that both BDD and eating disorders have many similarities with OCD and seem related to OCD. However, these disorders also differ from OCD in some ways. Additional research is needed on the relationship of BDD and eating disorders to OCD, including studies that directly compare them to OCD in a variety of domains, including phenomenology, family history, neurobiology, and etiology.     

Preliminary Data on Risk Factors and Disordered Eating in Male College Students

The present study investigated four (anger, depression, anxiety, impulsivity) potential risk factors for the development of eating disorders in 79 male college students. All participants completed the Setting Conditions for Anorexia Nervosa Scale (SCANS), to determine if they were at-risk for the development of an eating disorder. The hypothesis, that males who are at-risk for the development of an eating disorder would show a higher occurrence of the potential risk factors, was partially supported. Those who scored high on the Dissatisfaction subscale of the SCANS had high positive correlations with all four risk factors. The SCANS Perfectionism subscale showed no such relationships with any of the risk factoes.     

Neurocognitive endophenotypes of impulsivity and compulsivity: towards dimensional psychiatry

A key criticism of the main diagnostic tool in psychiatry, the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-IV), is that it lacks a biological footing. In this article, we argue for a biological approach to psychiatry based on 'neurocognitive endophenotypes', whereby changes in behavioural or cognitive processes are associated with discrete deficits in defined neural systems. We focus on the constructs of impulsivity and compulsivity as key examples of the approach and discuss their possible cross-diagnostic significance, applying them to co-morbidities and commonalities across a range of disorders (attention-deficit/hyperactivity disorder, substance dependence, obsessive-compulsive disorder and eating disorders). We argue that this approach has important implications for the future classification of psychiatric disorders, genetics and therapeutics.     

The influence of trait anger,trait anxiety and negative urgency on disordered eating

Negative affectivity and impulsivity are potential risk factors for eating pathology. Both are heterogeneous constructs, yielding varied effect sizes in the prediction of pathology. The use of a specific construct, negative urgency, the tendency to act impulsively while distressed, improves the predictive utility of ‘impulsivity’ in eating pathology. The use of specifically defined affectivity constructs may similarly improve theories of risk. Anger and anxiety both represent high arousal, negatively valenced emotions, but promote different interactions with the environment; approach vs. avoidance. Undergraduate women completed measures of negative urgency, trait anger, trait anxiety, and eating pathology 3 months apart. Negative urgency and trait anxiety prospectively accounted for unique variance in increases in global eating pathology, while negative urgency prospectively accounted for unique variance in binge eating. Anger was not a significant predictor. Results suggest that the use of both specifically defined impulsivity and affectivity constructs improves predictive utility of traits in eating pathology.