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.     

Multidimensional body image comparisons among patients with eating disorders,body dysmorphic disorder,and clinical controls: A multisite study

Body image disturbance is considered a core characteristic of eating disorders and body dysmorphic disorder (BDD), however its definition has been unclear within the literature. This study examined the multidimensional nature of body image functioning among individuals with either anorexia nervosa (AN; n = 35), bulimia nervosa (BN; n = 26), or BDD (n = 56), relative to female (n = 34) and male (n = 36) psychiatric controls. Participants were recruited from 10 treatment centers in the United States and England and completed psychometrically validated and standardized self-report measures of body image. Overall, the AN, BN, and BDD groups were characterized by significantly elevated disturbances in most body image dimensions relative to their gender-matched clinical controls. There was variability, however, in the comparisons among the three groups of interest, including foci of body dissatisfaction and body image coping patterns. On omnibus indices of body image disturbance and body image quality of life, patients with BDD reported more body image impairment than those with eating disorders. Although AN, BN, and BDD are characterized by body image disturbances, similar and partially distinctive cognitive, behavioral, and emotional elements of body image functioning exist among these groups. The study's empirical and clinical implications are considered.     

Exploring the integration of thin-ideal internalization and self-objectification in the prevention of eating disorders

Analyses of thin-ideal internalization and self-objectification were conducted within the context of a cognitive dissonance based eating disorder prevention program implemented in an undergraduate sorority. Participants completed self-report assessments at baseline (n = 177), post-intervention (n = 169), 5-month (n = 159), and 1-year follow-up (n = 105). Cross-sectional path analysis indicated that thin-ideal internalization and self-objectification predict each other and both predict body dissatisfaction, which in turn, predicts eating disorder symptoms. A longitudinal examination conducted using hierarchical linear modeling indicated that participants showed significant reductions in thin-ideal internalization, self-objectification, body dissatisfaction, and eating disorder symptoms after participating in the prevention program. Reductions of symptoms were maintained 1-year post-intervention, with the exception of self-objectification, which was significantly reduced up to 5-months post-intervention. Collectively, results suggest that targeting both thin-ideal internalization and self-objectification simultaneously within eating disorder prevention programs could increase the reduction of eating disorder symptoms.     

Randomized Controlled Trial of an Internet-Based Cognitive-Behavioral Treatment Program for Binge-Eating Disorder

Binge-eating disorder (BED) is a prevalent health condition associated with obesity. Few people with BED receive appropriate treatment. Personal barriers include shame, fear of stigma, geographic distance to mental health services, and long wait-lists. The aims of this study were to examine the efficacy of an Internet-based cognitive-behavioral intervention for adults with threshold BED (DSM-IV) and to examine the stability of treatment effects over 12 months. Participants were randomly assigned to a 16-week Internet-based cognitive-behavioral intervention (n = 69) or a wait-list condition (n = 70). Binge-eating frequency and eating disorder psychopathology were measured with the Eating Disorder Examination–Questionnaire and the Eating Disorder Examination administered over the telephone. Additionally, body weight and body mass index, depression, and anxiety were assessed before and immediately after treatment. Three-, 6-, and 12-month follow-up data were recorded in the treatment group. Immediately after the treatment the number of binge-eating episodes showed significant improvement (d = 1.02, between group) in the treatment group relative to the wait-list condition. The treatment group had also significantly reduced symptoms of all eating psychopathology outcomes relative to the wait-list condition (0.82 ≤ d ≤ 1.11). In the treatment group significant improvement was still observed for all measures 1 year after the intervention relative to pretreatment levels. The Internet-based intervention proved to be efficacious, significantly reducing the number of binge-eating episodes and eating disorder pathology long term. Low-threshold e-health interventions should be further evaluated to improve treatment access for patients suffering from BED.     

Body image in social anxiety disorder,obsessive–compulsive disorder,and panic disorder

Body dysmorphic disorder falls under the category of obsessive–compulsive and related disorders, yet research has suggested it may also be highly associated with social anxiety disorder. The current study examined body image variables among 68 outpatients with primary obsessive–compulsive disorder (OCD; n = 22), social anxiety disorder (SAD; n = 25), and panic disorder (PD; n = 21). Participants filled out self-report measures of body image disturbance, attitudes toward one's appearance, and anxiety. Body image disturbance and attitudes toward appearance did not significantly differ between the groups. However, SAD symptoms predicted body image disturbance, Appearance Evaluation and Body Areas Satisfaction, and OCD symptoms predicted Appearance Orientation. These findings suggest that SAD and OCD may be associated with different facets of body image. Implications for the treatment of anxiety disorders and for future research are discussed.     

Time Course of Attention in Socially Anxious Individuals: Investigating the Effects of Adult Attachment Style

Theoretical models of social anxiety propose that attention biases maintain symptoms of social anxiety. Research findings regarding the time course of attention and social anxiety disorder have been mixed. Adult attachment style may influence attention bias and social anxiety, thus contributing to the mixed findings. This study investigated the time course of attention toward both negative and positive stimuli for individuals diagnosed with social anxiety disorder (SAD) and assessed whether attachment style moderates this relationship.One hundred and thirty participants (age: M = 29.03) were assessed using a semistructured clinical interview. Those meeting eligibility criteria for the clinical sample met DSM-IV criteria for SAD (n = 90, age: M = 32.18), while those in the control sample did not meet criteria for any mental disorder (n = 23, age: M = 26.04, 11 females). All participants completed self-report measures examining depression, social anxiety, adult attachment style, and completed an eye-tracking task used to measure the time course of attention. Eye-tracking data were analysed using growth curve analysis.The results indicate that participants in the control group overall displayed greater vigilance towards emotional stimuli, were faster at initially fixating on the emotional stimulus, and had a greater percentage of fixations towards the emotional stimulus as the stimulus presentation time progressed compared to those in the clinical group. Thus, the clinical participants were more likely to avoid fixating on emotional stimuli in general (both negative and positive) compared to those in the control group.These results support the Clark and Wells (1995) proposal that socially anxious individuals avoid attending to emotional information. Attachment style did not moderate this association, however anxious attachment was related to greater vigilance toward emotional compared to neutral stimuli.     

Prevention programme for eating disturbances in adolescents. Is their effect on body image maintained at 30 months later?

We assessed changes in the body image of Spanish adolescents who participated in a programme aimed at preventing disordered eating, with a 30-month follow-up. 254 girls and 189 boys aged 12–14 were assigned to a control group (n = 201) or one of two possible experimental conditions: media literacy programme (ML, n = 143) and media literacy plus nutrition awareness programme (ML + NUT, n = 99). Body image was assessed with the Body Image Questionnaire (Qüestionari d’Imatge Corporal; QÜIC). Pre-test, post-test, 7- and 30-month follow-up measurements were taken. Linear model analyses were carried out with a 2 × 3 × 3 ANOVA (sex × group × phase), adjusted by the baseline level. At 30-month follow-up, ML and ML + NUT participants showed fewer body problems and more body satisfaction than the control group. There is a need for prevention programmes addressing eating and body image disturbances that involve both boys and girls.     

The role of BIS/BAS in the vulnerability for depression in adolescent girls

Reinforcement Sensitivity Theory (RST), the original (i.e. Gray, 1982) or revised (Gray & McNaughton, 2000), has yet to be used as a framework for investigating vulnerability to Major Depressive Disorder (MDD) in adolescents. The present study employed a high-risk design to examine whether aberrant BIS-FFFS/BAS activity was similarly present in both depressed girls and girls at high risk for depression.MethodsN = 85 age-matched biological daughters of mothers with differential MDD status: (a) MDD (n = 17), (b) high-risk (n = 34), and (c) healthy controls (n = 34) completed measures of the BIS/BAS, depression, and anxiety.ResultsMDD girls scored significantly higher on BIS than healthy controls but not high-risk girls, and the high-risk and control groups did not differ. No group differences were found on BAS or FFFS-Fear.ConclusionsElevated BIS was not identified as a vulnerability factor for MDD; however, it does distinguish depressed adolescents from healthy controls.     

Electrocortical Evidence of Enhanced Performance Monitoring in Social Anxiety

Self-focused attention is thought to be a key feature of social anxiety disorder. Yet few studies have used event-related potentials (ERPs) to examine whether socially anxious individuals display greater monitoring of their performance and attention to their errors. Similarly, only a few studies have used ERPs to examine how social anxiety is related to processing of performance feedback. Individuals with high (n = 26) and low (n = 28) levels of social anxiety completed a trial-and-error learning task. Self-focus was manipulated using false heart-rate feedback during a random subset of trials. Performance feedback was given using emotional and neutral faces in a positive context (correct = happy face; incorrect = neutral face) and negative context (correct = neutral face; incorrect = disgust face) in order to investigate biased interpretation and attention to feedback. Socially anxious subjects displayed enhanced amplitude of the ERN and CRN, suggesting greater response monitoring, and enhanced Pe amplitude, suggesting greater processing of errors relative to the low social anxiety group. No group differences were observed with respect to feedback processing. Before learning stimulus–response mappings in the negative context, the FRN was larger for self-focus compared to standard trials and marginally larger for socially anxious subjects compared to controls. These findings support cognitive models and suggest avenues for future research.     

Axis I anxiety and mental health disorders among stuttering adolescents

PurposeThe purpose of this study was to evaluate anxiety and psychological functioning among adolescents seeking speech therapy for stuttering using a structured, diagnostic interview and psychological questionnaires. This study also sought to determine whether any differences in psychological status were evident between younger and older adolescents.MethodParticipants were 37 stuttering adolescents seeking stuttering treatment. We administered the Computerized Voice Version of the Diagnostic Interview Schedule for Children, and five psychometric tests. Participants were classified into younger (12–14 years; n = 20) and older adolescents (15–17 years; n = 17).ResultsThirty-eight percent of participants attained at least one diagnosis of a mental disorder, according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; APA, 2000), with the majority of these diagnoses involving anxiety. This figure is double current estimates for general adolescent populations, and is consistent with our finding of moderate and moderate–severe quality of life impairment. Although many of the scores on psychological measures fell within the normal range, older adolescents (15–17 years) reported significantly higher anxiety, depression, reactions to stuttering, and emotional/behavioral problems, than younger adolescents (12–14 years). There was scant evidence that self-reported stuttering severity is correlated with mental health issues. There are good reasons to believe these results are conservative because many participants gave socially desirable responses about their mental health status.DiscussionThese results reveal a need for large-scale, statistically powerful assessments of anxiety and other mental disorders among stuttering adolescents with reference to control populations.Educational Objectives: The reader will be able to: (a) explain the clinical importance of assessing for mental health with stuttering adolescents, (b) state the superior method for adolescent mental health assessment and (c) state a major issue with determining the genuineness of stuttering adolescent responses to psychological assessment.     

Body checking and avoidance in ethnically diverse female college students

Although body checking and avoidance behaviors are common in women with eating disorders, minimal research has examined the nature or correlates of these behaviors in ethnically diverse female college students without eating disorders. Self-identified European American (n = 268), Asian American (n = 163), Latina (n = 146), and African American (n = 73) women completed self-report measures of body checking and avoidance, thin-ideal internalization, eating pathology, and clinical impairment. Results indicated that European and Asian American women reported significantly more body checking and avoidance than African American and Latina women. Generally, correlates of body checking and avoidance were consistent across ethnic groups: Regression analyses indicated that type of ethnicity predicted body checking and avoidance; and ethnicity, body checking, and body avoidance predicted eating pathology and clinical impairment. These associations suggest that body checking and avoidance are not benign behaviors in diverse nonclinical women.     

Testing the Tripartite Influence Model of body image and eating disturbance among Hungarian adolescents

We tested the Tripartite Influence Model of body image and eating disturbance on two separate samples of Hungarian boys (n = 145) and girls (n = 225), aged 10–16 years. Our results supported the model among Hungarian adolescents; however we found notable gender differences. The associations were stronger in girls compared to boys; moreover, internalization and body dissatisfaction mediated the relationship between appearance-related sociocultural influences and self-esteem only in girls. BMI and weight perception were also involved in the model, and we could present evidence that the sociocultural influence and the weight perception predict independently body dissatisfaction. Our data are in line with previous results; however, further exploration of gender, age, and culture-related differences in the pattern of associations may contribute to the refinement of intervention programs.     

Linking Pavlovian Disgust Conditioning and Eating Disorder Symptoms: An Analogue Study

Although the experience of disgust is commonly endorsed among women with eating disorders, it remains unclear how to best model this emotion in relation to disordered eating. The present study sought to identify potential disgust conditioning abnormalities that may underlie the development of eating disorder symptoms. Individuals high and low in eating disorder symptoms (HED, n = 19; LED, n = 18) completed a Pavlovian conditioning procedure in which one neutral food item (conditioned stimulus; CS +) was followed by disgusting videos of individuals vomiting (unconditioned stimulus; US) and another neutral food item (CS–) was not reinforced with the disgusting video. Following this acquisition procedure, there was an extinction procedure in which both CSs were presented unreinforced. The results showed that ratings of disgust, fear, and willingness to eat the CS + and CS- did not significantly vary as a function of the conditioning phase for the LED group. However, the HED group rated the CS + as significantly more disgusting and fear inducing than the CS- after the acquisition phase and this pattern persisted after extinction. These conditioning effects were also observed to be significantly larger for disgust compared to fear. The HED group also reported being significantly less willing to eat the CS + compared to the CS- after the acquisition phase and this pattern also persisted after extinction. In the full sample, only discriminant disgust responding after acquisition was associated with the amount of calorie consumption over the 24-hour period after conditioning. These findings suggest that eating disorder symptoms may result from a heightened proneness to associate disgusting outcomes with otherwise neutral food items. This pattern of disgust learning may reinforce food avoidance in eating disorders and appears to be difficult to fully unlearn.     

Integrative Response Therapy for Binge Eating Disorder

Binge eating disorder (BED), a chronic condition characterized by eating disorder psychopathology and physical and social disability, represents a significant public health problem. Guided self-help (GSH) treatments for BED appear promising and may be more readily disseminable to mental health care providers, accessible to patients, and cost-effective than existing, efficacious BED specialty treatments, which are limited in public health utility and impact given their time and expense demands. No existing BED GSH treatment has incorporated affect regulation models of binge eating, which appears warranted given research linking negative affect and binge eating. This article describes Integrative Response Therapy (IRT), a new group-based guided self-help treatment based on the affect regulation model of binge eating, which has shown initial promise in a pilot sample of adults meeting DSM-IV criteria for BED. Fifty-four percent and 67% of participants were abstinent at posttreatment and 3-month follow-up, respectively. There was a significant reduction in the number of binge days over the previous 28 days from baseline to posttreatment [14.44 (± 7.16) to 3.15 (± 5.70); t = 7.71, p < .001; d = 2.2] and from baseline to follow-up [14.44 (± 7.16) to 1.50 (± 2.88); t = 5.64, p < .001; d = 1.7]. All subscales from both the Eating Disorder Examination–Questionnaire and Emotional Eating Scale were significantly lower at posttreatment compared to baseline. One hundred percent of IRT participants would recommend the program to a friend or family member in need. IRT's longer-term efficacy and acceptability are presently being tested in a NIMH-funded randomized controlled trial.     

French validation of the 7-item Game Addiction Scale for adolescents

IntroductionThe Game Addiction Scale (GAS: Lemmens, Valkenburg, & Peter, 2008, 2009) is a short instrument (7-item) for evaluating video game playing by adolescents.ObjectiveThe aim of the current research was to investigate the psychometric properties of a French version of the 7-item Game Addiction Scale for adolescents.MethodTwo studies were conducted with two samples of French adolescents between the ages of 10 and 18 (study 1: n = 159; study 2: n = 306). First, we examined the factor structure and internal consistency. Second, we added a concurrent validity analysis with estimation of the daily time spent playing video games and an assessment of depression and anxiety.ResultsIn both studies, the factor analysis revealed a one-factor structure that had good psychometric properties and fit the data well. The analysis also confirmed good internal consistency of the scale. Correlation analysis in the second study showed that the GAS score had significant positive relationships with the time spent playing video games, depression, anxiety, and the fact of being a boy, thereby supporting the concurrent validity of the scale.ConclusionThis French version of the GAS seems to be a reliable tool for identifying and assessing problematic use of video games.     

No evidence of attentional bias in obsessive compulsive checking on the dot probe paradigm

Attentional biases have been proposed as maintaining and causal factors in anxiety, and it has been suggested that training attentional bias can impact on emotional responding. Given the severity of obsessive compulsive disorder (OCD) and the considerable number of clients who do not respond to traditional therapies, understanding the factors that maintain anxiety in OCD is critical for the development of effective treatments. This study investigated attentional biases in a homogenous group of OCD patients whose primary concern was checking (OCD-Check; n = 18) compared to a Control group individually matched for age, gender and level of education (Control; n = 18) using a dot probe task. No evidence of attentional bias, or of differences in orienting to or disengaging from checking-relevant stimuli, was found in the OCD group compared to the matched Control group. From this data, it would appear that attentional bias may not be a feature of obsessive compulsive checking. The limitations of the present study and future research directions are discussed.     

Sociocultural pressures and adolescent eating in the absence of hunger

Parental feeding practices and sociocultural pressures theoretically influence eating behavior. Yet, whether these factors relate to eating in the absence of hunger (EAH) is unknown. We assessed if sociocultural pressures were associated with EAH among 90 adolescents (M_age = 15.27, SD = 1.39; 48% female). Parents completed the Child Feeding Questionnaire. Adolescents completed the Perceived Sociocultural Pressures Scale, Sociocultural Attitudes Towards Appearance Questionnaire-3, and Multidimensional Body Self-Relations Questionnaire-Appearance Scales. On two occasions, EAH was assessed as snack food intake after adolescents ate to satiety. Controlling for body composition and demographics, parental restriction and family pressure to be thin were associated with greater EAH. Media pressure was related to more EAH in girls. Appearance orientation and preoccupation with becoming overweight mediated links between sociocultural pressures and EAH. Findings support the notion that sociocultural pressures and their links to body image may contribute to the course of disinhibited eating behaviors during adolescence.     

German version of the Multidimensional Body-Self Relations Questionnaire – Appearance Scales (MBSRQ-AS): Confirmatory factor analysis and validation

The Multidimensional Body-Self Relations Questionnaire (MBSRQ) is a widely used questionnaire that measures body image as a multidimensional construct. The Appearance Scales (AS) of the MBSRQ (Appearance Evaluation, Appearance Orientation, Body Areas Satisfaction, Overweight Preoccupation and Self-Classified Weight) are subscales which facilitate a parsimonious assessment of appearance-related aspects of body image. The current study tested the psychometric properties and factor structure of a German translation of the MBSRQ-AS. Participants were n = 230 female patients with the SCID diagnosis of an eating disorder and n = 293 female healthy controls. In a confirmatory factor analysis, convincing goodness-of-fit indices emerged. The subscales of the questionnaire yielded good reliability and convergent and discriminant validity coefficients, with most items showing excellent characteristics. Like the English version, the German adaptation of the questionnaire can be recommended for a multidimensional assessment of appearance-related aspects of body image in both research and clinical practice.     

Effects of exercise self-regulation on subsequent eating self-regulation: Implications for depletion vs. improvement based on behavioral treatment foci

IntroductionAn improved understanding of individuals’ ability to self-regulate through barriers in the management of their weight-loss behaviors is important. Although self-regulation related to exercise might carry-over to increased eating-related self-regulation through the development of such skills, it also might be depleted because self-regulation is thought to be a limited resource. Additionally, mood might affect self-regulation change.ObjectiveThis field study aimed to determine if exercise-related self-regulation was associated with subsequent eating-related self-regulation, how treatment foci affected that relationship, and if mood change concurrently influenced self-regulation.MethodAn educational weight-loss treatment (n = 52) and a behaviorally based self-regulatory-focused treatment (n = 57) was administered to women with obesity via a community health-promotion setting. Baseline – Month 3 changes in their exercise self-regulation and overall negative mood, and Months 3–6 change in eating self-regulation, were assessed.ResultsImprovements were significantly greater in the self-regulation treatment group on exercise self-regulation, eating self-regulation, and mood. For the self-regulation group, there was a significant positive relationship between changes in exercise self-regulation and eating self-regulation, β = 0.27, p = 0.044. Conversely, the association of those variables was significant and inverse in the educational group, β = −0.29, p = 0.039. Reduction in negative mood was significantly related to increased exercise self-regulation, across groups, β = −0.32, p = 0.001.ConclusionWhen self-regulation was focused upon and rehearsed within an exercise context, its changes positively affected subsequent changes in eating self-regulation. However, when self-regulation was not targeted, self-regulation used for maintaining exercise depleted eating-focused self-regulation. Findings contributed to self-regulatory theory and had implications for the improvement of behavioral weight-loss treatments.