Overconcern with weight and shape is not the same as body dissatisfaction: evidence from a prospective study of pre-adolescent boys and girls

Overconcern with weight and shape and body dissatisfaction have both emerged as significant predictors of disordered eating. However, it is unclear how these constructs relate to each other, and if each has different antecedents and consequences. This study aimed to identify prospective predictors of each construct and to determine their relative importance in predicting dietary restraint and binge eating. Eight- to 13-year-old boys and girls (N = 259) were assessed at baseline and one-year follow-up, using a range of measures that included the Child Eating Disorder Examination. Psychosocial variables predicted overconcern with weight and shape whilst objective weight predicted body dissatisfaction. Body dissatisfaction and weight and shape concern predicted restraint, and weight and shape concern and restraint predicted binge eating. Findings provide support for the theoretical differences between body dissatisfaction and overconcern with weight and shape, and highlight the importance of focusing on specific body image variables.     

Exploring gender differences in body image,eating pathology,and sexual harassment

This study examines the relationship between body image (weight/shape concerns), eating pathology, and sexual harassment among men and women (N = 2446). Hierarchical regressions controlling for depression revealed main effects of gender such that women reported greater weight/shape concerns, eating pathology, dietary restraint, eating concerns, and binge eating compared to men. Main effects for sexual harassment indicated that as harassment increased, participants reported increased weight/shape concerns, eating pathology, dietary restraint, eating concerns, binge eating, and compensatory behaviors. There were small but significant interactions between gender and harassment for eating pathology total score (which included each of the domains listed above), weight/shape concerns, dietary restraint, and eating concerns such that the relationship between increased harassment and increased pathology was stronger for women compared to men. The largest interaction was found for compensatory behaviors, such that while women and men's scores both increased as harassment increased, the relationship was stronger for men.     

Meta-analysis of the effects of cognitive-behavioral therapy on the core eating disorder maintaining mechanisms: implications for mechanisms of therapeutic change

The original and enhanced cognitive model of eating disorders proposes that cognitive-behavioral therapy (CBT) "works" through modifying dietary restraint and dysfunctional attitudes towards shape and weight. However, evidence supporting the validity of this model is limited. This meta-analysis examined whether CBT can effectively modify these proposed maintaining mechanisms. Randomized controlled trials that compared CBT to control conditions or non-CBT interventions, and reported dietary restraint and shape and weight concern outcomes were searched. Twenty-nine trials were included. CBT was superior to control conditions in reducing shape (g=0.53) and weight (g=0.63) concerns, and dietary restraint (g=0.36). These effects occurred across all diagnoses and treatment formats. Improvements in shape and weight concerns and restraint were also greater in CBT than non-CBT interventions (g's=0.25, 0.24, 0.31, respectively) at post-treatment and follow-up. The magnitude of improvement in binge/purge symptoms was related to the magnitude of improvement in these maintaining mechanisms. Findings demonstrate that CBT has a specific effect in targeting the eating disorder maintaining mechanisms, and offers support to the underlying cognitive model. If changes in these variables during treatment are shown to be causal mechanisms, then these findings show that CBT, relative to non-CBT interventions, is better able to modify these mechanisms.     

Body‐Weight Self‐Schema: Determinant of Mood and Behavior in Women With an Eating Disorder1

The schema approach to self‐concept was used to investigate the association between body‐weight self‐conception and self‐esteem, negative affect states, and disordered eating behavior in women with anorexia nervosa (n= 26) or bulimia nervosa (N= 53) using experience sampling methodology. We predicted that self‐esteem would be lower and unpleasant affect and disordered eating behaviors would be higher when the body‐weight self‐schema was activated in working memory compared to when non‐weight‐related self‐schemas were activated. Participants recorded the currently activated self‐schema, self‐esteem, affect, and behavior in response to an alarm‐watch signal 5 times daily for 5 days. Activation of the body‐weight self‐schema was associated with lower self‐esteem and higher negative affect, but not higher levels of disordered eating behavior. Low self‐esteem and negative affect, however, were associated with disordered eating behavior. Findings have important implications for treatment of eating disorders.     

Body dissatisfaction and disordered eating attitudes in 7- to 11-year-old girls: Testing a sociocultural model

We examined the sociocultural model of body dissatisfaction and disordered eating attitude development in young girls for the first time. According to the model, internalizing an unrealistically thin ideal body increases the risk of disordered eating via body dissatisfaction, dietary restraint, and depression. Girls aged 7–11 years (N = 127) completed measures of thin-ideal internalization, body dissatisfaction, dieting, depression, and disordered eating attitudes. Participants’ height and weight were measured and their body mass index calculated. Thin-ideal internalization predicted disordered eating attitudes indirectly via body dissatisfaction, dietary restraint, and depression; it also predicted disordered eating attitudes directly. Path analyses showed that a revised sociocultural model fit well with the data. These data show that a sociocultural framework for understanding disordered eating and body dissatisfaction in adults is useful, with minor modifications, in understanding the development of related attitudes in young girls.     

Dietary restraint moderates genetic risk for binge eating

Dietary restraint is a prospective risk factor for the development of binge eating and bulimia nervosa. Although many women engage in dietary restraint, relatively few develop binge eating. Dietary restraint may increase susceptibility for binge eating only in individuals who are at genetic risk. Specifically, dietary restraint may be a behavioral exposure factor that activates genetic predispositions for binge eating. We investigated this possibility in 1,678 young adolescent and adult same-sex female twins from the Minnesota Twin Family Study and the Michigan State University Twin Registry. Twin moderation models were used to examine whether levels of dietary restraint moderate genetic and environmental influences on binge eating. Results indicated that genetic and nonshared environmental factors for binge eating increased at higher levels of dietary restraint. These effects were present after controlling for age, body mass index, and genetic and environmental overlap among dietary restraint and binge eating. Results suggest that dietary restraint may be most important for individuals at genetic risk for binge eating and that the combination of these factors could enhance individual differences in risk for binge eating.     

Stability and Change in Domain‐specific Self‐esteem and Global Self‐esteem

A notable uptick of interest in the stability of self‐esteem has been observed over the past few years. Most researchers, however, have focused on unidimensional rather than multidimensional conceptualizations of self‐esteem. The paucity of empirical research is surprising given conflicting theoretical perspectives on the stability of self‐esteem. The goal of the present study was to thoroughly disentangle different conceptualizations of self‐esteem and test opposing classical theories on (i) the stability and (ii) the direction of mutual influence of these different forms of self‐esteem. We analysed two‐year longitudinal data from participants (N = 644 at T1, N = 241 at T2) with an average age of 47.0 years (SD = 12.4). Analyses using a latent variable approach revealed that the domains of self‐esteem were relatively stable in terms of rank order and mean levels. In fact, the size of the stability coefficients was comparable to that of other trait measures that have been reported in the literature and paralleled the stability observed for global self‐esteem. Results did not provide support for either top‐down or bottom‐up effects between domain‐specific and global self‐esteem. These findings have important theoretical and practical implications regarding the stability and development of self‐esteem in adulthood and advance the understanding of self‐esteem in personality theory. © 2018 European Association of Personality Psychology     

Reformulating and testing the perfectionism model of binge eating among undergraduate women: a short-term, three-wave longitudinal study

The perfectionism model of binge eating (PMOBE) is an integrative model explaining why perfectionism is related to binge eating. This study reformulates and tests the PMOBE, with a focus on addressing limitations observed in the perfectionism and binge-eating literature. In the reformulated PMOBE, concern over mistakes is seen as a destructive aspect of perfectionism contributing to a cycle of binge eating via 4 binge-eating maintenance variables: interpersonal discrepancies, low interpersonal esteem, depressive affect, and dietary restraint. This test of the reformulated PMOBE involved 200 undergraduate women studied using a 3-wave longitudinal design. As hypothesized, concern over mistakes appears to represent a vulnerability factor for binge eating. Bootstrapped tests of mediation suggested concern over mistakes contributes to binge eating through binge-eating maintenance variables, and results supported the incremental validity of the reformulated PMOBE beyond perfectionistic strivings and neuroticism. The reformulated PMOBE also predicted binge eating, but not binge drinking, supporting the specificity of this model. The reformulated PMOBE offers a framework for understanding how key contributors to binge eating work together to generate and to maintain binge eating.     

The effects of fat talk on body dissatisfaction and eating behavior: The moderating role of dietary restraint

Although research suggests that fat talk, the normalized conversations that involve degrading one's body shape/weight and size, can increase body dissatisfaction and disordered eating behavior, the extent to which dietary restraint may moderate these relationships remains uncertain. A pilot study (N = 30) comparing online videos with researcher-developed vignettes as prospective manipulations for fat talk exposure suggested use of the vignettes as potent yet subtle stimuli. In the main study, women undergraduates (N = 116) were randomized to read a fat talk or neutral vignette and then completed standardized measures of body dissatisfaction and dietary restraint while being concurrently presented with food stimuli. Results suggest significant moderation effects for dietary restraint: whereas fat talk exposure was associated with increased body dissatisfaction among low dietary restrainers, it appeared to reduce food consumption among high dietary restrainers. Findings highlight the importance of individual differences in shaping responses to fat talk.     

Sweets,Sex, or Self‐Esteem? Comparing the Value of Self‐Esteem Boosts With Other Pleasant Rewards

Abstract Many people ascribe great value to self‐esteem, but how much value? Do people value self‐esteem more than other pleasant activities, such as eating sweets and having sex? Two studies of college students ( Study 1 : N=130; Study 2 : N=152) showed that people valued boosts to their self‐esteem more than they valued eating a favorite food and engaging in a favorite sexual activity. Study 2 also showed that people valued self‐esteem more than they valued drinking alcohol, receiving a paycheck, and seeing a best friend. Both studies found that people who highly valued self‐esteem engaged in laboratory tasks to boost their self‐esteem. Finally, personality variables interacted with these value ratings. Entitled people thought they were more deserving of all pleasant rewards, even though they did not like them all that much (both studies), and people who highly value self‐esteem pursued potentially maladaptive self‐image goals, presumably to elevate their self‐esteem ( Study 2 ).     

An exploration of spiritual superiority: The paradox of self‐enhancement

Spiritual training is assumed to reduce self‐enhancement, but may have the paradoxical effect of boosting superiority feelings. It can thus operate like other self‐enhancement tools and contribute to a contingent self‐worth that depends on one's spiritual accomplishments. In three studies (N = 533, N = 2,223, N = 965), a brief measure of spiritual superiority showed good internal consistency and discriminant validity. As predicted, it was distinctly related to spiritual contingency of self‐worth, illustrating that the self‐enhancement function of spirituality is similar to other contingency domains. It was correlated with self‐esteem and, more strongly, with communal narcissism, corroborating the notion of spiritual narcissism. Spiritual Superiority scores were consistently higher among energetically trained participants than mindfulness trainees and were associated with supernatural overconfidence and self‐ascribed spiritual guidance. Our results illustrate that the self‐enhancement motive is powerful and deeply ingrained so that it can hijack methods intended to transcend the ego and, instead, adopt them to its own service.     

Differential relations of grandiose narcissism and vulnerable narcissism to emotion dysregulation: Self‐esteem matters

The present study aims to explore the effects of grandiose and vulnerable narcissism on emotion dysregulation and examine the mediating role of self‐esteem on these associations. Undergraduates (N = 426) completed self‐report measurements on grandiose narcissism, vulnerable narcissism, self‐esteem and emotion dysregulation. Correlation analyses indicated that grandiose narcissism was negatively correlated with emotion dysregulation, while vulnerable narcissism was positively correlated with emotion dysregulation. Moreover, mediational analyses revealed that self‐esteem fully mediated the association between grandiose narcissism and emotion dysregulation, and partially mediated the association between vulnerable narcissism and emotion dysregulation. The present study highlights the importance of self‐esteem and deepens the understanding of the associations between the two forms of narcissism and emotion dysregulation.     

On Self‐Love and Outgroup Hate: Opposite Effects of Narcissism on Prejudice via Social Dominance Orientation and Right‐Wing Authoritarianism

Previous research has obtained mixed findings as to whether feelings of self‐worth are positively or negatively related to right‐wing ideological beliefs and prejudice. We propose to clarify the link between self‐worth and ideology by distinguishing between narcissistic and non‐narcissistic self‐evaluations as well as between different dimensions of ideological attitudes. Four studies, conducted in three different socio‐political contexts: the UK (Study 1, N = 422), the US (Studies 2 and 3, Ns = 471 and 289, respectively), and Poland (Study 4, N = 775), investigated the associations between narcissistic and non‐narcissistic self‐evaluations, social dominance orientation (SDO), right‐wing authoritarianism (RWA), and ethnic prejudice. Confirming our hypotheses, the results consistently showed that after controlling for self‐esteem, narcissistic self‐evaluation was positively associated with SDO (accounting for RWA), yet negatively associated with RWA (accounting for SDO). These associations were similar after controlling for psychopathy and Machiavellianism (Study 3) as well as collective narcissism and Big Five personality characteristics (Study 4). Studies 2–4 additionally demonstrated that narcissistic self‐evaluation was indirectly positively associated with prejudice through higher SDO (free of RWA) but indirectly negatively associated with prejudice through lower RWA (free of SDO). Implications for understanding the role of self‐evaluation in right‐wing ideological attitudes and prejudice are discussed. Copyright © 2017 The Authors. European Journal of Personality published by John Wiley & Sons Ltd on behalf of European Association of Personality Psychology     

Subtyping children and adolescents with loss of control eating by negative affect and dietary restraint

OBJECTIVE: Research suggests that subtyping adults with binge eating disorders by dietary restraint and negative affect predicts comorbid psychopathology, binge eating severity, and treatment outcome. Little research has explored the validity and clinical utility of subtyping youth along these dimensions. METHOD: Children (aged 8-18 years) reporting loss of control eating (n=159) were characterized based upon measures of dietary restraint and negative affect using cluster analysis, and then compared regarding disordered eating attitudes and behaviors, and parent-reported behavior problems. RESULTS: Robust subtypes characterized by dietary restraint (n=114; 71.7%) and dietary restraint/high negative affect (n=45; 28.3%) emerged. Compared to the former group, the dietary restraint/high negative affect subtype evidenced increased shape and weight concerns, more frequent binge eating episodes, and higher rates of parent-reported problems (all ps<0.05). CONCLUSION: Similar to findings from the adult literature, the presence of negative affect may mark a more severe variant of loss of control eating in youth. Future research should explore the impact of dietary restraint/negative affect subtypes on psychiatric functioning, body weight, and treatment outcome.     

A structural equation model of intuitive eating with adolescents

IntroductionThe tendency to eat by paying attention and respecting the body's hunger and satiety cues is called intuitive eating. This eating behavior has been linked to positive health and well-being outcomes.ObjectiveThe purpose of this study was to test a global model linking intuitive eating with self-esteem, body esteem, media influence and including fear of negative appearance evaluation in adolescents’ boys and girls.MethodIn total, 740 adolescent high school students (51.5% girls; M age = 14, SD = 1.5) completed self-report questionnaires with measures of intuitive eating, body esteem, self-esteem, media influence and fear of negative appearance evaluation.ResultsStructural equation modeling revealed an overall excellent fit for the final four-variable model excluding the fear of negative appearance evaluation variable. Mediation analyses showed an indirect relationship between intuitive eating and body esteem via media influence, for girls but not for boys. Body esteem mediated the relationship between intuitive eating and self-esteem, for girls and boys.ConclusionA new model is proposed where intuitive eating is associated with self-esteem through body esteem and media influence. These findings suggest that regulating attitudes and behaviors toward food may be related to higher psychological well-being.     

Predictors of Symptom Trajectories After Cognitive-Behavioral Therapy in Adolescents With an Age-Adapted Diagnosis of Binge-Eating Disorder

Although evidence demonstrated efficacy of cognitive-behavioral therapy (CBT) in adolescents with binge-eating disorder (BED), treatment response is heterogeneous. This study uniquely examined baseline predictors of symptom trajectories in N = 73 adolescents (12–20 years) with an age-adapted diagnosis of BED (i.e., based on objective and subjective binge-eating episodes). Based on evidence from adult BED, dietary restraint, overvaluation of weight/shape, and depressive symptoms were used to predict changes in abstinence from binge eating and eating disorder psychopathology after 4 months of individual, face-to-face CBT using growth models. Longitudinal trajectories of abstinence from objective and subjective binge eating and global eating disorder psychopathology assessed via the Eating Disorder Examination were modeled for five time points (pre- and posttreatment, 6-, 12-, and 24-month follow-up). Beyond significant, positive effects for time, no significant predictors for abstinence from binge eating emerged. In addition to significant decreases in eating disorder psychopathology over time, higher pretreatment dietary restraint and overvaluation of weight/shape significantly predicted greater decreases in eating disorder psychopathology over time. Consistent with research in adult BED, adolescents with higher than lower eating disorder-specific psychopathology especially benefit from CBT indicating that restrained eating and overvaluation of weight/shape may be BED-specific prognostic characteristic across developmental stages. Future predictor studies with an additional focus on potential age-specific predictors, such as family factors, and within-treatment processes may be critical in further evaluating treatment-related symptom trajectories in adolescent BED.     

Self-help for binge eating disorder in primary care: A randomized controlled trial with ethnically and racially diverse obese patients

Objective

The objective was to examine the effectiveness of a self-help treatment as a first line primary care intervention for binge eating disorder (BED) in obese patients. This study compared the effectiveness of a usual care plus self-help version of cognitive behavioral therapy (shCBT) to usual care (UC) only in ethnically/racially diverse obese patients with BED in primary care settings in an urban center.

Method

48 obese patients with BED were randomly assigned to either shCBT (N = 24) or UC (N = 24) for four months. Independent assessments were performed monthly throughout treatment and at post-treatment.

Results

Binge-eating remission rates did not differ significantly between shCBT (25%) and UC (8.3%) at post-treatment. Mixed models of binge eating frequency determined using the Eating Disorder Examination (EDE) revealed significant decreases for both conditions but that shCBT and UC did not differ. Mixed models of binge eating frequency from repeated monthly EDE-questionnaire assessments revealed a significant treatment-by-time interaction indicating that shCBT had significant reductions whereas UC did not during the four-month treatments. Mixed models revealed no differences between groups on associated eating disorder psychopathology or depression. No weight loss was observed in either condition.

Conclusions

Our findings suggest that pure self-help CBT did not show effectiveness relative to usual care for treating BED in obese patients in primary care. Thus, self-help CBT may not have utility as a front-line intervention for BED for obese patients in primary care and future studies should test guided-self-help methods for delivering CBT in primary care generalist settings.     

Differential association between food craving,food addiction and eating-related characteristics in persons at risk for eating disorders

IntroductionFood craving is a key feature of eating disorders, but its association with medical and psychological outcome might depend on the type of eating disorder.ObjectivesThis study investigated the factors associated with food craving in individuals at risk for DSM-5 eating disorder.MethodSeventy-six women were recruited from a non-clinical population (n = 372) based on their positive screening (EDDS, QEWP-R) for binge eating disorder (BED; n = 29), anorexia nervosa (AN; n = 28) or bulimia nervosa (BN; n = 19). They completed self-administered questionnaires assessing food craving (FCQ- T-r), Body Mass Index (BMI), eating behaviour (DEBQ), food addiction (YFAS 2.0), and anxiety and depressive symptoms (HADS).ResultsIndividuals at risk for BED or BN had higher food craving than those at risk for AN. Food craving was associated with BMI only in the BED group. Food craving was positively correlated with external eating in all groups, and with emotional eating in the AN and BED groups and correlated with anxiety only in BN. Food addiction prevalence was higher in the BN group than in the AN or BED groups (respectively 94.7%, 46.4% and 65.5%; p < 0.01). In this non-clinical population, we demonstrated that food craving was differentially associated with BMI and eating-related characteristics according to the type of eating disorder.ConclusionThis suggests that food craving is a transdiagnostic dimension that should be differentially targeted depending on the type of eating disorder; future studies should test this hypothesis in clinical populations.     

An examination of the interpersonal model of loss of control eating in children and adolescents

The interpersonal model of binge eating disorder proposes that social problems lead to negative affect which, in turn, precipitates binge eating episodes. However, no study to date has examined this model among youth who report loss of control (LOC) eating. Participants were 219 non-treatment-seeking children and adolescent volunteers, age 8-17 years (13.1 ± 2.8y; 50% female). Children's social problems were assessed by parent report. Youth completed self-report questionnaires of negative affect that assessed depressive symptoms and anxiety. Participants were interviewed to determine the presence or absence of LOC eating in the month prior to assessment. Structural equation modeling analyses found that social problems were positively related to LOC eating presence (p = .02). Negative affect mediated the relationship between social problems and LOC eating (95% CI Product = .00247, .01336). These preliminary results suggest that the interpersonal model of binge eating may describe one possible pathway for the development of LOC eating among non-treatment-seeking youth.     

Eating behaviour, body image, and self-esteem of adolescent girls in Malaysia

This cross-sectional study was undertaken with 489 secondary school girls, ages 15-17 years, to examine disordered eating behaviours of adolescent girls in Malaysia and to estimate associations with body weight, body-size discrepancy, and self-esteem. Dietary restraint, binge eating, body image, and self-esteem were assessed using the Restrained Eating scale of the Dutch Eating Behaviour Questionnaire, the Binge Scale Questionnaire, the Contour Drawing Rating Scale, and the Rosenberg Self-Esteem Scale, respectively. Pearson correlations estimated associations between variables. There were 3.1% underweight, 9.8% at risk of being overweight, and 8.6% overweight girls. A total of 87.3% were dissatisfied with their own body size. Dietary restraint and binge eating were reported by 36.0% and 35.4%, respectively. Body Mass Index (r = .34, p < .01) and body-size dissatisfaction (r = .24, p < .01) were significantly associated with dietary restraint and binge eating, but self-esteem (r = -.20, p < .001) was significantly associated only with binge eating.