Abnormalities in visual processing amongst students with body image concerns

Individuals with body dysmorphic disorder (BDD) appear to possess abnormalities in the way they observe and discriminate visual information. A pre-occupation with perceived defects in appearance has been attributed to a local visual processing bias. We studied the nature of visual bias in individuals who may be at risk of developing BDD – those with high body image concerns (BICs) – by using inverted stimulus discrimination. Inversion disrupts global, configural information in favor of local, feature-based processing. 40 individuals with high BIC and 40 low BIC controls performed a discrimination task with upright and inverted faces, bodies, and scenes. Individuals with high BIC discriminated inverted faces and bodies faster than controls, and were also more accurate when discriminating inverted bodies and scenes. This reduction in inversion effect for high BIC individuals may be due to a stimulus-general local, detail-focused processing bias, which may be associated with maladaptive fixation on small features in their appearance.     

Gender differences on the Five to Fifteen questionnaire in a non‐referred sample with inattention and hyperactivity‐impulsivity and a clinic‐referred sample with hyperkinetic disorder

Lambek, R., Trillingsgaard, A., Kadesjö, B., Damm, D. & Thomsen, P. H. (2010). Gender differences on the Five to Fifteen questionnaire in a non‐referred sample with inattention and hyperactivity‐impulsivity and a clinic‐referred sample with hyperkinetic disorder. Scandinavian Journal of Psychology 51, 540–447. The aim of the present study was to examine gender differences in children with inattention, hyperactivity, and impulsivity on the Five to Fifteen (FTF) parent questionnaire. First, non‐referred girls (n = 43) and boys (n = 51) with problems of attention and hyperactivity‐impulsivity and then clinic‐referred girls (n = 35) and boys (n = 66) with hyperkinetic disorder (HKD) were compared on the FTF. Results suggested that non‐referred boys were more hyperactive‐impulsive than non‐referred girls, whereas clinic‐referred boys and girl with HKD were more similar than dissimilar on the FTF questionnaire. Secondly, it was examined whether the application of gender mixed norms versus gender specific norms would result in varying proportions of clinic‐referred children with HKD being identified as impaired on the subdomains of the FTF questionnaire. Based on results it was concluded that the use of a gender mixed normative sample may lead to overestimation of impairment in boys with HKD, but the type of sample applied to define impairment on the FTF should depend on the purpose for applying the questionnaire.     

Victimization,social anxiety,and body dysmorphic concerns: Appearance-based rejection sensitivity as a mediator

Body dysmorphic disorder (BDD) is characterized by extreme preoccupation with perceived deficits in physical appearance, and sufferers experience severe impairment in functioning. Previous research has indicated that individuals with BDD are high in social anxiety, and often report being the victims of appearance-based teasing. However, there is little research into the possible mechanisms that might explain these relationships. The current study examined appearance-based rejection sensitivity as a mediator between perceived appearance-based victimization, social anxiety, and body dysmorphic symptoms in a sample of 237 Australian undergraduate psychology students. Appearance-based rejection sensitivity fully mediated the relationship between appearance-based victimization and body dysmorphic symptoms, and partially mediated the relationship between social anxiety and body dysmorphic symptoms. Findings suggest that individuals high in social anxiety or those who have a history of more appearance-based victimization may have a bias towards interpreting further appearance-based rejection, which may contribute to extreme appearance concerns such as BDD.     

Childhood maltreatment and adult personality disorder symptoms in a non‐clinical sample

It can be argued that the well‐substantiated relationship between childhood maltreatment and adult personality disorder (PD) symptoms may be confounded by comorbid symptoms of depression, anxiety or dysfunctional childhood family environments. Therefore, the current study was designed to test the hypothesis that retrospective reports of childhood maltreatment would still be significantly related to reports of more PD symptoms when statistically controlling for these factors. One hundred and seventy‐eight non‐clinical participants were divided into groups reporting childhood maltreatment (n = 54) or not (n = 124) according to scores on the Childhood Trauma Questionnaire. Participants also completed questionnaires measuring current depression, anxiety, and PD symptoms as well as retrospective reports of their childhood environment. Results showed that individuals reporting childhood maltreatment reported more symptoms of PD than those not reporting childhood maltreatment, even when statistically controlling for depression, anxiety and retrospective reports of dysfunctional family environment. These findings underscore the relevance and independent contribution of childhood maltreatment to the development of PDs, with important implications for further research and clinical practice.     

An Evaluation of the Body Dysmorphic Disorder Symptom Scale as a Measure of Treatment Response and Remission in Psychotherapy and Medication Trials

The Body Dysmorphic Disorder Symptom Scale (BDD-SS) is a self-report tool that captures an array of representative behavioral and cognitive symptoms commonly displayed by individuals with BDD. The BDD-SS is regularly used among experts in the field, though its utility as a measure of treatment response has not yet been formally evaluated. Results from two clinical trials of BDD treatment were pooled from an archived database to create a sample of 220 BDD participants who received either psychosocial or medication-based interventions for BDD. We used baseline BDD-SS scores to describe psychometric properties, baseline correlations with other scales to examine the content validity of the BDD-SS, and longitudinal symptom data to evaluate capacity to detect clinically relevant change. Results indicated that the BDD-SS has good psychometric properties and is able to detect symptom change over time, although it showed lower rates of reliable change with treatment relative to the gold standard rater-administered Yale-Brown Obsessive-Compulsive Scale Modified for BDD (BDD-YBOCS). The BDD-SS offers meaningful information about treatment response in a self-report format and may be particularly useful to employ in clinical practice settings as a means of gathering symptom and treatment response data via self-report when rater-administered interviews are not feasible, although it may underestimate the extent of improvement with treatment.     

Affective development and etiological implication in body image disorders and anorexia: reflections on bdd manifestations and refusal of food in a psychodynamic view

The literature demonstrates that relational experiences during childhood have a strong impact on the trajectories of psychological growth. This article focuses on the major developmental phases for identity formation, psychological growth, mentalization skills, and ability to share affective states. It presents a careful analysis of some key factors that influence the representation of body image and the relationship with food, from a perspective that integrates relational psychodynamic models. In particular, it looks at the ways in which individuals and caregivers actively co-create the symptomatic process of intrapsychic reality in which body disease and refusal of food are performed.     

The role of body image and self‐perception in anorexia nervosa: the neuroimaging perspective

Anorexia nervosa is a severe psychiatric illness characterized by intense fear of gaining weight, relentless pursuit of thinness, deep concerns about food and a pervasive disturbance of body image. Functional magnetic resonance imaging tries to shed light on the neurobiological underpinnings of anorexia nervosa. This review aims to evaluate the empirical neuroimaging literature about self‐perception in anorexia nervosa. This narrative review summarizes a number of task‐based and resting‐state functional magnetic resonance imaging studies in anorexia nervosa about body image and self‐perception. The articles listed in references were searched using electronic databases (PubMed and Google Scholar) from 1990 to February 2016 using specific key words. All studies were reviewed with regard to their quality and eligibility for the review. Differences in brain activity were observed using body image perception and body size estimation tasks showing significant modifications in activity of specific brain areas (extrastriate body area, fusiform body area, inferior parietal lobule). Recent studies highlighted the role of emotions and self‐perception in anorexia nervosa and their neural substrate involving resting‐state networks and particularly frontal and posterior midline cortical structures within default mode network and insula. These findings open new horizons to understand the neural substrate of anorexia nervosa.     

Anorexia Nervosa in Adolescence and Maudsley Family‐Based Treatment

Anorexia nervosa is a serious psychiatric disorder that usually occurs in adolescence. The course of the illness can be protracted. Current empirical evidence suggests that the Maudsley Family‐Based Treatment (MFBT) is efficacious for adolescents. MFBT empowers parents as a crucial treatment resource to assist in their child's recovery. The authors review the diagnostic criteria and course of anorexia in adolescence, present empirical evidence and key theoretical concepts of MFBT, and provide a case study.     

Mindfulness as a way to cope with COVID‐19‐related stress and anxiety

COVID‐19 brought significant challenges to college students in Spring 2020. Mindfulness‐based interventions might help students cope with COVID‐19‐related stressors in at least three ways: by cultivating attention that is self‐directed rather than reactive to a rapidly changing situation; by teaching the acceptance and regulation of negative thoughts and feelings; and by encouraging individuals to view adverse events non‐judgementally and as opportunities for growth. The purpose of our study was to determine whether Koru Mindfulness (KM), a four‐week, mindfulness‐based group therapy designed for emerging adults, could help students cope with COVID‐19‐related stress and anxiety. Students were assigned to either KM or waitlist at the beginning of the 2020 Spring semester. Assessment of students’ functioning occurred at baseline before the onset of COVID‐19, mid‐semester at the height of the COVID‐19 crisis on campus, and the end of the semester after students had returned home and transitioned to remote learning. After treatment, KM participants reported greater mindfulness and self‐compassion and less stress, anxiety and sleep problems than controls. KM participants also showed superior functioning on performance‐based measures of attention. Most gains were maintained over time. Increased mindfulness mediated the relationship between KM and reductions in stress and anxiety. KM can help students cope with academic and COVID‐19‐related stressors by improving mindfulness.     

Trauma‐related rumination mediates the effect of naturally occurring depressive symptoms but not momentary low mood on trauma intrusions

Comorbid depression is known to contribute to the maintenance of posttraumatic stress disorder (PTSD) including distressing intrusive trauma memories. It is theorised that depression is a risk factor for persistent PTSD through preventing optimal habituation of distress provoked by trauma memories and reminders, but the underlying cognitive mechanisms responsible are uncertain. The present study investigated trauma‐related rumination as a possible mediator for the effect of depression on trauma intrusions. Participants received a low mood induction or control procedure. Following viewing an analogue trauma film, frequency of film‐related intrusions and associated distress levels were measured and at 1‐week follow‐up. Between the two occasions, participants rated their levels of rumination about the film. Existing depression symptoms but not induced momentary sad mood predicted frequency of film intrusions and associated distress at 1‐week follow‐up. Some evidence was found that ruminative trauma processing mediated the relationship between baseline depressive symptoms and later intrusion frequency and associated distress. Future research is warranted to better understand the role of rumination in the depression–intrusion relationship, which may shed light on the clinical applicability of rumination‐targeted intervention for PTSD and comorbid depression.     

Emotional health,support, and self‐efficacy in young adults with a history of language impairment

Children and adolescents with language impairment (LI) are at risk of emotional health difficulties. However, less is known about whether these difficulties continue into adulthood for this group, or about the potential role of environmental resources (e.g., social support) or internal resources (e.g., self‐efficacy). This study investigates emotional health in 81 adults with a history of developmental LI (aged 24) compared with 87 age‐matched peers (AMPs) using Beck Inventories. Social support and self‐efficacy measures were examined as predictors. The results were fourfold: (1) adults with LI had higher levels of emotional health problems; (2) whilst the availability of social support was similar across groups, people with LI received more help from others compared to peers; (3) social support was not significantly related to emotional health in those with LI – in contrast, for AMPs, uptake of support indicated poorer emotional health; (4) self‐efficacy was the strongest predictor of emotional health in both groups and fully mediated the relationship between language and emotional health (no moderation by group). This cross‐sectional study has implications for concurrent factors that might affect emotional health outcomes for children and young people with and without LI.     

The impact of advertisements featuring ultra‐thin or average‐size models on women with a history of eating disorders

Previous research demonstrates that exposure to ultra‐thin media models leads to increased body image concerns amongst women (Groesz, Levine, & Murnen, 2002 ). There is emerging evidence that attractive, average‐size models do not have this negative effect and can be effective in advertising (e.g. Halliwell & Dittmar, 2004 ). The present study investigates these factors amongst women with a history of eating disorders. Participants either viewed advertisements featuring ultra‐thin, average‐size or control images. Immediately after exposure, they reported their body‐focused anxiety and rated the effectiveness of the advertisements. Whereas exposure to ultra‐thin models did not lead to increased body‐focused anxiety, exposure to average‐size models produced a relief effect, whereby women reported lower levels of body‐focused anxiety. Advertisements featuring ultra‐thin and average‐size models were equally effective. The results suggest that average‐size, attractive models could be used effectively in advertising, which may help to relieve body image concerns amongst these women. Copyright © 2005 John Wiley & Sons, Ltd.     

Gender differences in coping and daily stress in conduct-disordered and non-conduct-disordered adolescents

Research shows that conduct disorder (CD) manifests differently in boys and girls, yet little is known about specific characteristics of girls with CD. This study examined gender differences in stress and coping in both CD (n = 69) and non-conduct-disordered (NCD) adolescents (n = 64). Results indicated similar patterns of gender differences in stress and coping, although CD adolescents reported a higher frequency of stress and maladaptive coping strategies than NCDs. Girls reported more daily stress and greater use of coping associated with both social relationships and emotional venting. A significant interaction effect distinguished girls with CD from other groups by their higher level of daily stress, more frequent use of self-injurious behavior and emotion-focused coping, and deficits in active coping.     

Empirically Defining Treatment Response and Remission in Body Dysmorphic Disorder Using a Short Self-Report Instrument

Determining response or remission status in body dysmorphic disorder (BDD) usually requires a lengthy interview with a trained clinician. This study sought to establish empirically derived cutoffs to define treatment response and remission in BDD using a brief self-report instrument, the Appearance Anxiety Inventory (AAI). Results from three clinical trials of BDD were pooled to create a sample of 123 individuals who had received cognitive-behavioral therapy for BDD, delivered via the Internet. The AAI was compared to gold-standard criteria for response and remission in BDD, based on the clinician-administered Yale–Brown Obsessive Compulsive Scale, modified for BDD (BDD-YBOCS), and evaluated using signal detection analysis. The results showed that a ≥ 40% reduction on the AAI best corresponded to treatment response, with a sensitivity of 0.71 and a specificity of 0.84. A score ≤ 13 at posttreatment was the optimal cutoff in determining full or partial remission from BDD, with a sensitivity of 0.75 and a specificity of 0.88. These findings provide benchmarks for using the AAI in BDD treatment evaluation when resource-intensive measures administered by clinicians are not feasible.     

Gender differences in adolescent coping behaviors and suicidal ideation: findings from a sample of 73,238 adolescents

Suicide among adolescents is an emerging global public health problem as well as a socioeconomic problem. Stress-coping strategies have been shown to be associated with suicidal ideation. We examined coping behaviors related to suicidal ideation and gender differences in adolescents using the data from the 2010 Korea Youth Risk Behavior Survey (ages 12–19 years; N = 73,238). Logistic regression analysis was used to evaluate associations between suicidal ideation and specific coping behaviors while controlling for potentially confounding variables. In both male and female groups, the coping behavior “drinking alcoholic beverages” and “smoking cigarettes” were positively associated with suicidal ideation. “Watching TV,” “playing online/mobile games,” and “sleeping” were negatively associated with suicidal ideation in both groups. In males, “engaging in sports” was negatively related to suicidal ideation. In females, “venting by talking to others” and “eating” were negatively related to suicidal ideation. The results indicate that there are gender differences in the effects of coping behaviors on adolescent suicidal ideation, and that developing adaptive coping strategies may function to reduce suicidality. Future studies are needed to examine whether improving coping skills can reduce suicidal ideation in a gender-specific manner.     

An investigation into the possibility of an innovative treatment for weight‐related hyperphagia: Towards a more effective combination of physiological and psychological treatment for clinically obese patients who binge‐eat,category DSM IV EDNOS (Eating Disorders Not Otherwise Specified)

This paper describes Phase One of a five‐phase doctoral research inquiry into hyperphagia (eating beyond requirement) as experienced in Binge Eating Disorder (BED). It is a response to the need for a treatment plan which combines the opportunity to explore psychological reasons for overeating, as well as to understand physiological reasons for uncontrollable cravings. Three participants, recruited through local gyms, received twelve sessions of integrative counselling combining cognitive behavioural therapy and physiological information with a person‐centred approach and psychodynamic theory to help participants discover for themselves the emotional causes of their overeating. The results informed Phase Two in which a small group addressed the same issues. The outcome of both phases will be used to design a treatment programme (Phase Three) for a larger group as a pilot study (Phase Four), all phases being part of an action research project which will be evaluated in Phase Five. The study is aimed at promoting a better understanding on the part of health professionals and counsellors of the need for sufferers of BED to address emotional causes of overeating and providing such treatment in primary care. Participants in Phase One self‐reported a steady decrease in Body Mass Index (BMI) during an interval of one year and achieved an awareness of the way in which their complex relationship with food was underpinned by emotionally painful and avoidant relationships with others.