An Exploratory Evaluation of the Family Meal Intervention for Adolescent Anorexia Nervosa

Although weight restoration is a crucial factor in the recovery of anorexia nervosa (AN), there is scarce evidence regarding which components of treatment promote it. In this paper, the author reports on an effort to utilize research methods in her own practice, with the goal of evaluating if the family meal intervention (FMI) had a positive effect on increasing weight gain or on improving other general outcome measures. Twenty‐three AN adolescents aged 12–20 years were randomly assigned to two forms of outpatient family therapy (with [FTFM] and without [FT]) using the FMI, and treated for a 6‐month duration. Their outcome was compared at the end of treatment (EOT) and at a 6‐month posttreatment follow‐up (FU). The main outcome measure was weight recovery; secondary outcome measures were the Morgan Russell Global Assessment Schedule (MRHAS), amenorrhea, general psychological symptoms, and eating disorder symptoms. The majority of the patients in both groups improved significantly at EOT, and these changes were sustained through FU. Given its primarily clinical nature, findings of this investigation project preclude any conclusion. Although the FMI did not appear to convey specific benefits in causing weight gain, clinical observation suggests the value of a flexible stance in implementation of the FMI for the severely undernourished patient with greater psychopathology.     

Body size and body esteem in women: The mediating role of possible self expectancy

We predicted that an expectancy of acquiring a feared fat self and an expectancy of acquiring a hoped-for thin self both mediate the impact of body size on women's body esteem. We also predicted that the mediating pathway through the feared fat self would be stronger than that through the hoped-for thin self. A community sample of 251 women reported their age, height, weight, and completed measures of body esteem and expectancy perceptions of acquiring the feared fat and hoped-for thin selves. Bayesian Structural Equation Modeling (SEM) demonstrated that expectancies about the feared fat self and about the hoped-for thin self mediated the relationship between body size and body esteem. Bayesian SEM also revealed that the pathway through the feared fat self was stronger than that through the hoped-for thin self. Implications for future research and the development of eating pathology are discussed.     

Size of drawings influences body size estimates by women with and without eating concerns

Research has inconsistently shown that women, particularly those with eating concerns, inaccurately estimate their body size. In the present study, drawings of female bodies, ranging from emaciated to obese, were presented to women with and without eating concerns. Drawings approximated the women's actual height or were reduced (15.7 cm). Women selected the drawing that represented how they thought they looked (cognitive rating), felt they looked (affective rating), and would like to look (desired rating). Women tended to select larger drawings when reduced-size drawings were used. Participants with eating concerns overestimated their body size and were more dissatisfied with their body size than participants without eating concerns. Size of drawings and the presence of eating concerns did not affect ratings of the size of a neutral object. Women did not demonstrate a generalized problem in estimating size. Overestimation of body size may be exaggerated in research that used reduced-size drawings.     

The interactive effects of age,education, and BMI on cognitive functioning

We examined the moderating effects of age and cognitive reserve on the relationship between body mass index (BMI) and processing speed, executive function, and working memory based on the literature suggesting that obese individuals perform more poorly on measures of these abilities. Fifty-six healthy, dementia-free community-dwelling older (mean age 65.72 ± 7.40) and younger (mean age 21.10 ± 2.33) adults completed a neuropsychological battery and reported height and weight. Mixed effects models were used to evaluate the interactive effects of age, education (a proxy for cognitive reserve), and BMI on cognitive scores. Higher education was protective for executive deficits in younger, but not older adults. Age differences in executive functions were reduced at higher education levels but increased in individuals with higher BMI. Results suggest the inter-relationships between cognitive reserve – as measured by education – and BMI differ across age, and that obesity may accelerate the cognitive aging process.     

Occupational Therapy in the Rehabilitation of the Patient with Anorexia Nervosa

The first part of this paper develops an ecological and rehabilitative stance for the occupational therapist in relation to the anorexic patient. Maximizing the individual's level of psychosocial functioning is regarded as the primary aim of treatment. A model for approaching the anorexic patient is described which examines environmental factors, and the importance of assessment and follow up. The cognitive behavioral approach is discussed and suggestions are made for adapting it to the occupational therapist's orientation towards practical activity. In the second part of the paper concrete suggestions for therapy are made.     

The impact of anxiety on sexual arousal in women

This study examined the impact of state anxiety, trait anxiety, and anxiety sensitivity on physiological and self-report measures of sexual arousal and sexual function in a non-clinical sample of women. Physiological sexual responses to an erotic stimulus were assessed using vaginal photoplethysmography, and subjective reactions were measured using questionnaires. Results suggested a curvilinear relationship between state anxiety and physiological sexual arousal (vaginal pulse amplitude; VPA). Trait anxiety and anxiety sensitivity were correlated with self-reported sexual arousal outside the laboratory. The findings may be interpreted in light of sympathetic nervous system (SNS) influences on sexual arousal and potential cognitive interference mechanisms associated with anxiety.     

Body ideals in women after viewing images of typical and healthy weight models

Viewing thin models, pervasive in popular culture, is correlated with body dissatisfaction and anxiety in women. Whether or not the same is true when viewing healthy weight models is unknown. In this study we tested whether viewing healthy weight models increases the ideal female body size. Body image, anxiety, happiness and depression were measured in 44 female participants following viewing of images of thin or healthy weight models (within-subject separated by two weeks). We found that after viewing images of healthy weight models, women's body ideals (as measured by a participant-adjusted virtual model) were significantly larger than when the same women viewed images of very thin models. This effect was greatest in those women with the highest levels of baseline anxiety (as measured by the Hospital Anxiety and Depression Scale). These results suggest that viewing healthy weight models results in more healthy body ideals than those typically promoted through media.     

Cultural representations of thinness in women, redux: Playboy magazine's depiction of beauty from 1979 to 1999

Playboy's portrayal of the male ideal of feminine beauty, in terms of overall body size, percent normative weight, and waist-to-hip ratios (WHRs), was analyzed for the years 1979–1999. Trends were examined through body measurements obtained from Playboy centerfolds. Results reveal a continuation of the low body mass index (BMI) found in the Playmates by earlier studies; however, for the 21 years examined, the trend towards increasing thinness seems to have stabilized and may have begun to actually reverse. There was also an increase in the centerfolds’ WHRs over the 21-year time period. Overall, the results support the continued valuing in American society of a thin ideal for women; while the images of beauty have become somewhat heavier over the 21-year period reviewed, the Playmates remain markedly below weights normative for their age group.     

Body Image: A Study in a Tri-Ethnic Sample of Low Income Women

This study was designed to examine the evaluative, affective, and behavioral components of body image among 1,217 low-income European American, African American, and Latina women. Participants completed a multidimensional body image questionnaire while awaiting an outpatient clinic appointment. Body mass index (BMI) was determined by medical chart review. Nearly all normal weight and a number of overweight and obese African Americans characterized their weight as normal. In contrast, nearly all overweight and obese European Americans and Latinas regarded themselves as overweight as did over 30% of those of normal weight. European Americans and Latinas with higher BMIs reported more appearance shame than their lower BMI peers did; this pattern was not observed among African Americans. Among Latinas, body image was influenced by length of residency in the U.S. Dr. Berenson is supported by Grant Number K24HD043659, a Midcareer Investigator Award in Patient-Oriented Research, from the National Institute of Child Health and Human Development. Heather Littleton is now at Sam Houston State University.     

A test of the interactive effects of anxiety sensitivity and mindfulness in the prediction of anxious arousal, agoraphobic cognitions, and body vigilance

The present investigation sought to examine the interactive effects of anxiety sensitivity [AS; Reiss, S., & McNally, R. J. (1985). Expectancy model of fear. In S. Reiss, & R. R. Bootzin (Eds.), Theoretical issues in behavior therapy (pp. 107-121). San Diego: Academic Press] and mindfulness [Brown, K. W., & Ryan, R. M. (2003). The benefit of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84, 822-848] in predicting panic-relevant processes. A community sample of 248 individuals participated in the study by completing a battery of self-report instruments. Consistent with prediction, the interaction between AS and mindfulness significantly predicted anxious arousal symptoms and agoraphobic cognitions, above and beyond the individual main effects, and did not significantly predict anhedonic depression symptoms. Contrary to prediction, the AS by mindfulness interaction did not significantly predict body vigilance. Theoretical implications are discussed and future directions are delineated.     

Parenting behaviors in parents with anxiety disorders

Anxiety disorders are familial, and although considerable evidence supports the role of genetic/biological parameters in their development, these alone do not entirely explain their etiology. In this study, the role of parenting behavior as a possible factor in the transmission of anxiety from parent to child was examined. Using interview, self-report, and direct behavioral observation, behaviors of parents with an anxiety disorder were compared to those of parents without an anxiety disorder on a number of dimensions, but particularly with respect to whether anxious parents actively inhibited their children from engaging in normal age appropriate activities. These behaviors were assessed during routine activities and in a structured non-conflictual play task. Although anxious parents did not overtly restrict their child's behavior in either type of activity, they reported higher levels of distress when their children were engaged in these activities. Similarly, the "emotional climate" in families with an anxious parent differed significantly from families without an anxious parent. The results are discussed in terms of how parenting behaviors might influence the development of maladaptive anxiety via social learning and information transfer, and their heuristic implications.     

Holding fat stereotypes is associated with lower body dissatisfaction in normal weight Caucasian women who engage in body surveillance

This study examined the moderating effect of body surveillance on the relationship between fat stereotype endorsement and body dissatisfaction in normal weight women. Participants (N = 225) completed online measures of fat stereotyping, body surveillance, body dissatisfaction, and internalized thin ideals. After accounting for thin ideals, body surveillance moderated the relationship between fat stereotypes and body dissatisfaction. Contrary to hypotheses, higher fat stereotype endorsement predicted lower body dissatisfaction in women with higher body surveillance. Conversely, higher fat stereotype endorsement predicted greater body dissatisfaction in women with lower body surveillance. Thus, endorsing fat stereotypes appears protective against body dissatisfaction in normal weight women who extensively engage in body surveillance. For women who hold fat stereotypes and report high body surveillance, we propose that downward appearance comparison may create a contrast between themselves and the people with overweight whom they denigrate, thus improving body dissatisfaction.     

Time-course of attention for threatening pictures in high and low trait anxiety

Cognitive studies about anxiety suggest that the interplay between automatic and strategic biases in attention to threat is related to the persistence of fear. In the present study, the time-course of attention to pictures with varying threat levels was investigated in high trait anxious (HTA, n=21) and low trait anxious (LTA, n=22) students. In a visual probe detection task, high and mild threat pictures were presented at three durations: 100, 500, and 1250 ms. Results indicated that all individuals attended to the high threat pictures for the 100 ms condition. Differential responding between HTA and LTA individuals was found for the 500 ms condition: only HTA individuals showed an attentional bias for mild threatening stimuli. For the 1250 ms condition, the HTA individuals attended away from high and mild threat pictures. The observed pattern of differential attention to threatening pictures may explain the persistence of fear in HTA individuals.     

The importance of body satisfaction to physical self‐concept and body mass index in Spanish adolescents

This research examines the association between measured body mass index (BMI) and the perception of BMI by young students. Moreover, this research tests the importance of BMI and self‐concept, in order to predict body dissatisfaction in high school students. The sample consisted of 2087 individuals from different high schools in Extremadura, Spain, both males (n = 1046) and females (n = 1041), ranging in age from 15 to 17 years old (M = 15.42; SD = 0.86). Initially, participants' BMIs were assessed through anthropometry. Later, all individuals were asked about their weight and height, and their self‐reported BMI was calculated. Participants also answered a questionnaire about their perception of self‐concept, as well as completed a test about body image perception using Stunkard images. Outcomes revealed that factors concerning self‐concept and perceived BMI explained body dissatisfaction. Finally, results are discussed with the aim of improving knowledge in body dissatisfaction context.     

A cross-sectional study of changes in Norwegian adolescents' body image from 1992 to 2002

The present study examines changes in adolescents’ body image over a 10-year period. Both satisfaction with appearance in general, and satisfaction with different aspects of appearance (e.g., face, muscle tone, and weight) are considered. We analyzed data from two general population studies of 13–19-year-old Norwegians, “Young in Norway 1992” (N = 10,460, response rate = 97.0%) and “Young in Norway 2002” (N = 11,371, response rate = 92.3%). These studies used identical sampling procedures, data collection procedures, and measures of body image. The analyses showed a polarization in adolescents’ body image — concurrent with an increase in the proportion of adolescents with a very negative body image, there was an increase in the proportion of adolescents with a very positive body image. The greater proportion of adolescents with a very negative body image could partly be explained statistically by the increased body mass index (BMI) in the same period. Girls had a more problematic body image than boys, both in 1992 and in 2002. Whether the strength of this gender difference changed or not depended on the aspect of appearance considered.     

The relative contributions of subjective and objective measures of body shape and size to body image and disordered eating in women

This research explored the relative contributions of subjective perceptions of body weight and body shape/proportion, as well as objective measures of body mass index (BMI) and waist-to-hip ratio (WHR) to disordered eating, exercise involvement, and body image. One hundred and fifty-eight female university students completed questionnaires and provided body measurements for this study. Although an interaction between BMI and WHR was found for some measures (i.e., Eating Disorder Examination Questionnaire total and subscale scores), results indicated that BMI was consistently the better objective predictor of disordered eating and body image. Subjective perceptions of body weight and, to a lesser extent, body shape, were found to account for the greatest proportion of variance in the dependent measures (disordered eating, body esteem, and body dissatisfaction). Overall, these results offer more support for sociocultural theories emphasizing the importance of thinness for women, than evolutionary theories emphasizing the role of WHR.     

Types of self-reported anxiety in outpatients with DSM-III-R anxiety disorders1

To ascertain whether psychiatric outpatients can be classified into distinct types according to their self-reported symptoms of anxiety, the Beck Anxiety Inventory (BAI) was administered to 655 outpatients diagnosed with DSM-III-R anxiety disorders. Cluster analysis identified three internally consistent subscales representing subjective, somatic, and panic symptoms. Further analysis revealed six types of outpatients reflecting below average, panic-subjective, low subjective, low somatic-panic, above average, and subjective-somatic anxiety. The types were differentiated with respect to age, primary diagnosis, clinically rated anxiety, and both self-reported and clinically rated depression.     

Female physical attractiveness in Britain and Malaysia: a cross-cultural study

Two purported cues to perceived female physical attractiveness are body mass index (BMI) and body shape as measured by the waist-to-hip ratio (WHR). This study examined the relative contribution of both cues in several culturally socio-economically distinct populations. Six hundred and eighty-two participants from Britain and Malaysia were asked to rate a set of images of real women with known BMI and WHR. The results showed that BMI is the primary determinant of female physical attractiveness, whereas WHR failed to emerge as a significant predictor. The results also showed that there were significant differences in preferences for physical attractiveness along a gradient of socio-economic development, with urban participants preferring images of women with significantly lower BMIs than their rural counterparts. The findings are discussed in terms of evolutionary psychological explanations of mate selection, and sociocultural theory, which emphasises the learning of preferences for body sizes in social and cultural contexts.     

Acute exercise effects on worry,state anxiety,and feelings of energy and fatigue among young women with probable Generalized Anxiety Disorder: A pilot study

BackgroundLittle is known about the acute effects of exercise among individuals with clinical or subclinical Generalized Anxiety Disorder (GAD).PurposeThus, this study examined worry, state anxiety, and feelings of energy and fatigue responses to acute aerobic exercise and quiet rest, and explored potential moderators of response among young adult women with worry scores indicative of GAD.MethodsSeventeen young women with Penn State Worry Questionnaire scores ≥45 (60 ± 8) completed 30-min treadmill running at 65%–85% heart rate reserve (%HRR) and 30-min seated quiet rest in counterbalanced order. Outcomes included worry, state anxiety, and feelings of energy and fatigue. Two condition X two time repeated measures ANOVA examined differences across condition and time. Hedges’ d effect sizes (95%CI) were calculated to quantify and compare the magnitude of change. Independent-samples t-tests explored potential moderators of outcome response.ResultsTotal exercise time was 35.8 ± 3.4min with a mean 30.3 ± 0.16 in-zone minutes (65%-85%HRR); participants exercised at ∼72.9 ± 0.03 %HRR (range 66%–79%). Compared with quiet rest, acute exercise significantly improved worry engagement, state anxiety, and feelings of energy and fatigue (all p ≤ 0.031). Moderate-to-large (d = 0.44 to 1.69) reductions in state anxiety and feelings of fatigue and improvements in feelings of energy were found. Exercise-induced reductions in worry engagement were significantly larger among non-high trait anxious participants. Compared to normal sleepers, quiet rest significantly increased feelings of fatigue among poor sleepers.ConclusionFindings provide support for the positive effects of acute aerobic exercise on worry, state anxiety, and feelings of energy and fatigue among young women with worry indicative of GAD.     

The swimsuit issue: Correlates of body image in a sample of 52,677 heterosexual adults

Past research on adults’ body image has typically used small convenience samples, limiting the ability to examine associations of personal characteristics to body satisfaction. This study of 52,677 heterosexual adults ages 18–65 examined associations of body satisfaction to age, height, gender, and body mass index (BMI). Age and height were mostly unrelated to body satisfaction. Consistent with an Objectification Theory perspective, fewer men than women reported being too heavy (41% versus 61%), rated their body as unattractive (11% versus 21%), or avoided wearing a swimsuit in public (16% versus 31%). Men felt better about their bodies than women across most of the weight span, although among underweight individuals, women felt better than men. Slender women (BMIs 14.5–22.49) were more satisfied than most other women (BMIs 22.5–40.5). Among men, underweight and obese men were least satisfied. These findings highlight gender differences in the association of weight to body satisfaction.