Associations between Race and Eating Disorder Symptom Trajectories in Black and White Girls

Epidemiological research suggests racial differences in the presentation of eating disorder symptoms. However, no studies have examined associations between race and eating disorder symptom trajectories across youth and adolescence, which is necessary to inform culturally sensitive prevention programs. The purpose of the current study was to examine the trajectories of eating disorder symptoms from childhood to young adulthood and to examine whether race was associated with trajectory group membership. Data were drawn from 2,305 Black and White girls who participated in a community-based longitudinal cohort study (Pittsburgh Girls Study) examining the development of psychopathology. The child and adult versions of the Eating Attitudes Test assessed self-reported eating disorder symptoms at six time points between ages 9 and 21 years. Growth mixture modeling was used to examine developmental trajectories of dieting, bulimia/food preoccupation, and total eating disorder symptom scores. Given potential confounds with race and disordered eating, financial strain (i.e., receiving public assistance) and weight were included as covariates. Four to six distinct developmental patterns were found across eating disorder symptoms, including none, increasing, decreasing, or increasing-decreasing trajectories. Black girls had a greater likelihood of being in the decreasing trajectories for dieting, bulimia/food preoccupation, and total eating disorder symptom scores. White girls were more likely to follow increasing trajectories of dieting and total eating disorder symptom scores compared to Black girls. These results highlight the importance of examining the influence of racial background on eating disorder symptoms and the potential need for differences in the timing and focus of prevention interventions in these groups.     

Eating Disorder Symptom and Fear Change Trajectories During Imaginal Exposure Therapy: A Slope Network Analysis

Eating disorders (EDs) are characterized by fears related to food, body image, and social evaluation. Exposure-based interventions hold promise for targeting a range of ED fears and reducing ED psychopathology. We investigated change mechanisms and optimal fear targets in imaginal exposure therapy for EDs using a novel approach to network analysis. Individuals with an ED (N = 143) completed up to four online imaginal exposure sessions. Participants reported ED symptoms and fears at pretreatment, posttreatment, and 6-month follow-up. We constructed networks of symptoms (Model 1), fears (Model 2), and combined symptoms and fears (Model 3). Change trajectory networks from the slopes of symptoms/fears across timepoints were estimated to identify how change in specific ED symptoms/fears related to change in other ED symptoms/fears. The most central changing symptoms and fears were feeling fat, fear of weight gain, guilt about one’s weight/shape, and feared concerns about consequences of eating. In Model 3, change in ED fears bridged to change in desire to lose weight, desiring a flat stomach, following food rules, concern about eating with others, and guilt. As slope networks present averages of symptom/fear change slopes over the course of imaginal exposure therapy, further studies are needed to examine causal relationships between symptom changes and heterogeneity of change trajectories. Fears of weight gain and consequences of eating may be optimal targets for ED exposure therapy, as changes in these fears were associated with maximal change in ED pathology. Slope networks may elucidate change mechanisms for EDs and other psychiatric illnesses.     

Weight Bias Internalization and Psychosocial,Physical, and Behavioral Health: A Meta-Analysis of Cross-Sectional and Prospective Associations

Coinciding with widespread efforts to address obesity, weight bias internalization (a process of self-devaluation wherein individuals apply weight-biased stereotypes to themselves) has gained increased attention as a robust correlate of poor health outcomes. The present meta-analysis aimed to provide the largest quantitative synthesis of associations between weight bias internalization and health-related correlates. Studies that provided zero-order correlations for cross-sectional or prospective associations between weight bias internalization and physical, psychosocial, and behavioral health correlates were included in the meta-analysis. Meta-regression determined whether these associations differed based on demographic (sex/gender, race, age), anthropometric (body mass index), and study-level (publication status, sample type, study quality) moderators. Data for 149 (sub)samples were identified that included between 14 and 18,766 participants (M sample size = 534.96, SD = 1,914.43; M age = 34.73, SD = 12.61, range = 9.95–65.70). Results indicated that greater weight bias internalization was concurrently associated with worse psychosocial (e.g., negative and positive mental health, social functioning), physical (e.g., BMI, weight maintenance, health-related quality of life [HRQoL]), and behavioral health (e.g., disordered eating behaviors, healthy eating, physical activity) across most constructs, with effects ranging from small to very large in magnitude. Preliminary evidence also suggested that greater weight bias internalization was subsequently associated with less weight loss and increased negative mental health. Notable variations in the nature and magnitude of these associations were identified based on the health-related correlate and moderator under consideration. These findings indicate that weight bias internalization is linked to multiple adverse health-related outcomes and provide insight into priorities for future research, theory building, and interventions in this area.     

A 20-year longitudinal study of body weight, dieting, and eating disorder symptoms

The article describes a 20-year longitudinal study of body weight, dieting, and disordered eating in women and men. Body weight increased significantly over time in both women and men. However, women's weight perception and dieting frequency decreased over time, whereas men's weight perception and dieting frequency increased, and disordered eating declined more in women than in men from late adolescence to midlife. In both women and men, changes in weight perception and dieting frequency were associated with changes in disordered eating. In addition, adult roles such as marriage and parenthood were associated with significant decreases in disordered eating from late adolescence to midlife in women, whereas few associations were observed in men. Despite different developmental trajectories, women demonstrated more weight dissatisfaction, dieting, and disordered eating compared with men across the period of observation.     

Characteristics of Dieting and Nondieting Adolescents in a Psychiatric Inpatient Setting

  The clinical and psychosocial characteristics of 239 dieting and nondieting adolescents (61% female; mean age=15.3) recruited from an inpatient psychiatric setting were examined. Dieting adolescents were compared to nondieting adolescents on exercise frequency, weight control behaviors, risky behaviors, psychiatric comorbidity and distress, eating disorder symptomatology, smoking, coping, and family factors. While dieters did not statistically differ from nondieters on scores of body mass index, dieting youth reported greater levels of self-reported distress, poorer coping, greater eating disorder symptomatology, and were more likely to engage in extreme weight control behaviors. In addition, dieting was associated with higher rates of major depression (58% vs 34%) and eating disorders (14% vs 1%). Among adolescent smokers, dieters endorsed smoking as a weight control behavior. Engaging in risky behaviors or familial factors did not differentiate dieters from nondieters. Given the number of negative correlates associated with dieting in adolescents, identifying dieting and weight control behaviors in clinical settings may prove to be an effective strategy in the development of prevention and intervention efforts for youth.     

The Buffering Role of Social Support Perceptions in Relation to Eating Disturbances among Women in Abusive Dating Relationships

Abuse is often associated with diminished social support networks, which typically serve to buffer individuals against stress-related outcomes, including eating disorders. The goal of the present study was to examine whether eating disturbances among women in abusive dating relationships varied as function of perceived social support. Although both physical and psychological aggression in women's (N=83) dating relationships was associated with symptomatic dieting and bulimic symptoms, only psychological aggression predicted unique variance. Although psychological aggression was directly related to eating symptoms, support from friends diminished the relation to bulimic symptoms, possibly because such support facilitated women's ability to distract themselves from their abusive situations. In contrast, perceived parental support buffered women in physically abusive relationships from disturbed eating patterns. Thus, depending on the nature of abuse women experienced, social support resources were differentially effective in buffering women from eating disturbances.     

Mental health problems and symptoms among male adolescents attending a teen health clinic

The purpose of this study was to examine the frequency and nature of mental health problems and symptoms among a group of 51 inner-city male adolescents attending a teen health clinic at a large county hospital in the southwestern part of the United States. They were administered a problem area checklist and a problem symptom checklist. The problem area checklist covered a range of mental health issues, including peer/friendship, relationship, and family problems; problems with money, time, and the law; substance use; and eating disorders. The problem symptom checklist queried participants about anger, nervousness, depression, fear, loneliness, suicide, aggression, and self-esteem. The results indicated that these young males experienced significant mental health problems and symptoms, such as relationship problems, problems with time and money, and symptoms of anger, depression, and aggression. Further, scared/afraid feelings correlated with five of the eight problem areas. The authors recommend investigating ways to target young males who present at such clinics in order to address their mental health problems and symptoms, as well as studying how their environment affects their overall health.     

Associations Between Multiple Types of Stress and Disordered Eating Among Girls and Boys in Middle School

Stress is common during adolescence, yet no known studies have linked particular types of stress (performance, relationship, education, financial, and family) with disordered eating among adolescents in middle school. The present study investigated sex differences in types of stress and how multiple types of stress were associated with girls’ and boys’ body dissatisfaction, dieting behaviors, and bulimic symptoms. We found that girls reported higher levels of stress than boys and that different associations between stress and disordered eating existed for girls and boys. We also examined a path model for both sexes such that stress first led to body dissatisfaction, which then led to dieting and finally bulimic symptoms. Our model was supported for girls with performance, relationship, and family stress driving the process. For boys, all five types of stress were associated with body dissatisfaction, which was linked with dieting; however, the relation between dieting and bulimic symptoms was not significant. Future research and therapy should focus on the unique experiences of each sex in order to gain a better understanding of the processes involved in coping with stress and promoting healthy development.     

An effectiveness trial of a new enhanced dissonance eating disorder prevention program among female college students

Objective

Efficacy trials indicate that a dissonance-based prevention program in which female high school and college students with body image concerns critique the thin-ideal reduced risk factors, eating disorder symptoms, and future eating disorder onset, but weaker effects emerged from an effectiveness trial wherein high school clinicians recruited students and delivered the program under real-world conditions. The present effectiveness trial tested whether a new enhanced dissonance version of this program produced larger effects when college clinicians recruited students and delivered the intervention using improved procedures to select, train, and supervise clinicians.

Method

Young women recruited from seven universities across the US (N = 408, M age = 21.6, SD = 5.64) were randomized to the dissonance intervention or an educational brochure control condition.

Results

Dissonance participants showed significantly greater decreases in risk factors (thin-ideal internalization, body dissatisfaction, dieting, negative affect) and eating disorder symptoms versus controls at posttest and 1-year follow-up, resulting in medium average effect size (d = .60). Dissonance participants also reported significant improvements in psychosocial functioning, but not reduced health care utilization or unhealthy weight gain.

Conclusions

This novel multisite effectiveness trial with college clinicians found that the enhanced dissonance version of this program and the improved facilitator selection/training procedures produced average effects that were 83% larger than effects observed in the high school effectiveness trial.     

An experimental test of the effects of dieting on bulimic symptoms: the impact of eating episode frequency

Prospective studies suggest dieting increases bulimic symptoms, but experiments suggest that dieting decreases bulimic symptoms. One possible explanation for the conflicting findings is that real world dieting involves less healthy dieting techniques, such as meal skipping, than prescribed diets. We tested whether the manipulation of eating episode frequency during dieting impacted bulimic symptoms. We expected that people on a diet involving fewer eating episodes would exhibit greater increases in bulimic symptoms than people on a diet involving more frequent eating episodes or waitlist controls. Participants on both 6-week diets lost more weight than controls, confirming dieting was manipulated, and showed greater reductions in bulimic symptoms than controls; however, the dieting conditions did not differ on either outcome. Results provide further experimental evidence that dieting does not increase bulimic symptoms, but suggests that eating episode frequency has little impact on this outcome.     

Exploring the Effectiveness of a Mixed-Diagnosis Group Cognitive Behavioral Therapy Intervention Across Diverse Populations

Depression and anxiety are the most common mental health disorders seen in clinical practice and they are highly comorbid. Cognitive behavioral therapy (CBT) has been demonstrated as an effective treatment for both depression and anxiety but is often not available to all individuals who could benefit from it. This paper investigates the effectiveness of a mixed-diagnosis group CBT intervention that incorporates mindfulness meditation for individuals presenting with depression and/or anxiety: CBT Basics II. This intervention was evaluated across two distinct mental health programs to determine both if it can demonstrate positive results and if it is feasible to implement in these types of programs. Sample 1 (n = 42 completers) consisted of higher-functioning individuals in a general mental health program. Sample 2 (n = 53 completers) consisted of individuals with more chronic and severe mental health diagnoses. Overall, intent-to-treat analyses revealed improvements in psychiatric symptoms, and increases in CBT knowledge and mindfulness skill across both programs. This indicates that CBT Basics II is effective across diverse mental health populations and shows promise for improving access to CBT.     

Modeling the symptoms of psychopathology: A pluralistic approach

Our understanding of mental disorders has traditionally focused on syndromes and symptom clusters rather than on the nature of the symptom and signs themselves. Using a core symptom of depression, anhedonia, as an extended example, this paper illustrates how the development of multiple models of symptoms, at various scales of analysis, may advance the explanation and classification of mental disorders. We begin by outlining the Phenomena Detection Method (PDM), which links different phases of the inquiry process to provide a methodology for conceptualizing the symptoms of psychopathology and for constructing multi-level models of the pathological processes that comprise them. Next, we apply the PDM to anhedonia, building a compositional explanation of this core symptom by way of multiple models across four scales (levels): molecular, neural, cognitive, and phenomenological. Finally, we evaluate our approach in comparison to existing strategies for understanding mental disorders.     

Sex differences in ADHD trajectories across childhood and adolescence

Previous studies have hinted at sex differences in developmental trajectories in ADHD symptoms; however, little is known about the nature or cause of these differences and their implications for clinical practice. We used growth mixture modelling in a community‐ascertained cohort of n = 1,571 participants to study sex differences in ADHD symptom developmental trajectories across the elementary and secondary school years. Participants were measured at ages 7, 8, 9, 10, 11, 12, 13, and 15. We found that females were more likely to show large symptom increases in early adolescence while males were more likely to show elevated symptoms from childhood. For both males and females, early adolescence represented a period of vulnerability characterized by relatively sudden symptom increases. Females affected by hyperactivity/impulsivity may be more likely to be excluded from diagnosis due to current age of onset criteria. More attention should be paid to early adolescence as a period of risk for hyperactivity/impulsivity symptom onset or worsening.     

Age and sex differences in health habits and beliefs of schoolchildren

All children in Grades 3 through 12 of one school system completed a survey about health habits and beliefs including smoking and eating habits, perceptions of exercise, weight, and parental involvement in health. The surveys were factor-analyzed within grade and sex, and the overall factors that emerged were Smoking Habits, Family Discussion of Health, Family Thinking About Health, Nutritional Habits, and Health Locus of Control. Analysis of variance of each factor revealed that girls generally reported healthier food habits than did boys. However, girls reported more smoking and less exercise. There are also changes in habits and belief with age; junior high school is a particularly important time for the development of several habits. The findings are discussed in relation to theories of child development and the implications for the content and timing of future health education intervention programs with children.     

Incremental Validity of Teacher and Parent Symptom and Impairment Ratings when Screening for Mental Health Difficulties

Although universal screening for mental health difficulties is increasingly recognized as a way to identify children who are at risk and provide early intervention, little research exists to inform decisions about screening, such as the choice of informants and the type of information collected. The present study examined the incremental validity of teacher- and parent-rated (primarily mothers) symptoms and impairment in a non-referred sample of early elementary school children (n = 320, 49 % boys, ages 6 to 9) in terms of predicting impairment as rated by a different teacher 1 year later. Teacher-rated symptoms and impairment and parent-rated impairment were each unique predictors of later impairment; however, parent-rated symptoms did not contribute to the prediction of later impairment above and beyond these other indicators. The results indicate that, when screening for mental health difficulties in the school system, impairment ratings collected across settings add useful information, but it may not be necessary to use parent symptom ratings when teacher symptom ratings are available.     

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.     

异地复学震区中小学生PTSD及心理健康状况的调查

创伤后应激障碍（Posttraumatic Stress Disorder, PTSD）是指突发性、威胁性或灾难性生活事件导致个体延迟出现和长期持续存在的精神障碍,其临床表现以再度体验创伤为特征,并伴有情绪的易激惹和回避行为,影响患者的心理健康。采用创伤后应激障碍自评量表和症状自评量表对异地复学的震区中小学生进行测量,了解他们的PTSD及心理健康状况。结果表明：震区中小学生PTSD和SCL-90的检出率都较高;不同性别、不同年级学生受地震的负性影响不同,其心理健康状况也有差别     

Bulimic Eating Disorders in Primary Care: Hidden Morbidity Still?

The current study examined the features of women with bulimic-type eating disorders (n = 24) attending primary care in two smaller urban regions of the USA. The assessment included measures of eating disorder psychopathology, medical comorbidity, impairment in role functioning, potential barriers to treatment and actual use of health services. Eating disorders, primarily variants of bulimia nervosa and binge eating disorder not meeting formal diagnostic criteria, were associated with marked impairment in psychosocial functioning. Although two-thirds of participants recognized a problem with their eating, less than 40% had ever sought treatment from a health professional for an eating or weight problem and only one in ten had sought such treatment from a mental health specialist. Only one-third had ever been asked about problems with eating by a primary care practitioner or other health professional. However, more than 80% had sought treatment from a health professional for symptoms of anxiety or depression. Most reported some degree of discomfort in discussing eating problems with others, and half reported that they would not be truthful about such problems if asked. Having an eating disorder was associated with several chronic medical conditions, including joint pain, gastrointestinal problems and fatigue. Although the small sample size limits any firm conclusions, the findings suggest that the health burden of bulimic-type eating disorders is substantial but remains largely hidden. Efforts may be needed to improve the eating disorders “mental health literacy” of both patients and primary care practitioners in order to facilitate early, appropriate intervention.     

Child and adolescent development: common mental disorders according to age and gender

Despite the increase in the incidence and prevalence rates of children and adolescents' mental disorders, there are few works performed with large and representative samples of children and adolescents with psychopathological symptoms. The present work analyses 588 participants referred by first care pediatricians to a specialized unit for children and adolescents' mental health. As a result of the study, a statistically significant relation was found between age and diagnosis: a larger incidence of behavioral disorders, communication disorders, elimination disorders, pervasive developmental disorders, impulse-control disorders from 0 to 5 years; behavioral disorders and attention deficit hyperactivity disorder (ADHD) were more common from 6 to 11 years, behavioral and anxiety disorders were more likely at 12 to 15 years; and, lastly, behavioral disorders were more prevalent from 16 to 18 years. With respect to gender, there was a significant relationship with diagnosis: boys had more behavioral disorders, whereas girl had more anxiety disorders. To conclude, a relationship between mental disorders and developmental achievements could be indicated in the younger group. Additionally, externalizing disorders in boys and internalizing ones n girls were more prevalent across all ages.