Eating Disorders—The Regulation of Positive as well as Negative Emotion Experience

Disordered eating behaviors are often conceptualized as maladaptive emotion regulation strategies. The present study investigated links between emotional experience, schematic belief systems, and psychological themes associated with eating disorders. In contrast to the majority of studies, which focus on just one or two emotions and use nonclinical samples, this study compared the full range of emotional experience in women with eating disorders to a control group. Measures used include the Differential Emotional Scale-IV, Youngs Early Maladaptive Schema Questionnaire, and Eating Disorder Inventory-2. The study provides the first empirical evidence that women diagnosed with eating disorders report experiencing pleasant as well as unpleasant emotions more frequently than do controls. A surprising finding was that pleasant emotions (joy, interest, surprise) correlated with eating disorder themes (EDI-2 subscales) more consistently than unpleasant emotions in the eating disorder group, while the reverse was true of the control group. Also of note, eating-disordered women reported significantly less anger and similar levels of fear vs. controls. While eating-disordered women scored more highly than do controls on all maladaptive schema (suggesting high levels of distress in women with eating disorders), the pattern of correlations between schema and emotion experience was distinctly different for each group and counterintuitive for the eating disorder group. In particular, pleasant emotion was highly correlated with maladaptive schema in the eating-disordered group but not in the control group. These marked group differences in the pattern of relationships between emotion experience, eating disorder themes, and belief systems suggest that it is not valid to draw conclusions about eating disorders from research that employs only nonclinical samples. The authors discuss these findings, and suggest that women with eating disorders are proficient at using disordered eating behaviors to manipulate their experience of both positive and negative emotional states, and that this dynamic should be recognized as an important maintenance factor.     

Group therapy for eating disorders: A step-wise approach

Group therapy is emerging as a favored treatment for eating disorders. Open-ended psychodynamic group therapy is an effective treatment for the underlying conflicts in eating-disordered patients, yet these groups are difficult to form. The authors suggest a specific sequence using time-limited psychoeducational groups initially for symptom control, then offering an open-ended group for patients who are ready to address deeper issues in a group therapy setting.     

"I feel fat": an experimental induction of body displacement in disordered eating

Body displacement, the theory that predicts that individuals with eating disorders will displace negative feelings about themselves onto their body, was tested experimentally in this study. Unrestrained eaters (n = 61), restrained eaters (n = 33), and individuals with eating disorders (n = 26) were randomly assigned to a control condition or an ineffectiveness induction. In the ineffectiveness condition participants were asked to recall and reflect on a past experience when they felt useless or incapable (i.e., ineffective). Results showed that individuals with eating disorders who were made to feel ineffective reported more implicit appearance/body concern than those in the control condition. Unrestrained and restrained eaters did not show this effect. This is the first experimental study to support body displacement theory. These data can be used clinically to educate and encourage patients with eating disorders to address thoughts and feelings related to ineffectiveness directly, instead of displacing this distress onto their body and potentially perpetuating their eating disorder.     

A Meta-Analysis of the Dependency–Eating-Disorders Relationship: Strength, Specificity, and Temporal Stability

Meta-analysis of studies examining the dependency–eating-disorders relationship revealed that (1) there is a positive association between interpersonal dependency levels and eating disorder symptoms/diagnoses (r = .25); (2) this relationship is comparable in anorexic and bulimic participants; (3) although dependent personality disorder symptoms are elevated in eating-disordered participants, so are the symptoms of several other personality disorders; and (4) when eating disorder symptoms remit, dependency levels decrease. Conclusion: There is a statistically significant link between interpersonal dependency and eating disorders, but this relationship is modest in magnitude, nonspecific, and varies with eating disorder symptom levels. Clinical, empirical, and theoretical implications of these findings are discussed.     

Disordered eating in women of color

It has been assumed that the occurrence of eating disorders in American racial minority groups are rare. Indeed, whereas the cultural context may afford “protection” to the group, it does not necessarily protect specific individuals. Individuals within each racial/ethnic group are subject to the standards of the dominant culture, particularly when the culture-of-origin is devalued by the dominant culture. Social, familial, and individual factors which contribute to disorders eating symptomatology are discussed. Discussions of obstacles to detecting eating disorders and guidelines for developing more inclusive theory of and treatment of persons with eating disorders is included.     

Perceived acceptability of anorexia and bulimia in women with and without eating disorder symptoms

Perceptions of the acceptability of eating‐disordered behaviour were examined in young adult women with (n = 44) and without (n = 268) eating disorder symptoms. All participants viewed vignettes of anorexia nervosa (AN) and bulimia nervosa (BN) and responded to the same series of questions—addressing different possible ways in which the conditions described might be seen to be acceptable—in relation to each vignette. Participants with eating disorder symptoms perceived eating‐disordered behaviour to be more acceptable than asymptomatic participants, and this was the case for both AN and BN vignettes and for a range of different items. Differences on items tapping the perception that it ‘might not be too bad’ to have an eating disorder and that an eating disorder is ‘nothing to be concerned about’ were particularly pronounced. The findings could not be accounted for by between‐group differences in body weight. The findings indicate the ambivalence towards eating‐disordered behaviour that exists among a subgroup of young women in the community and the clear association between such ambivalence and actual eating disorder symptoms. The perceived acceptability of eating‐disordered behaviour may need to be addressed in prevention and early‐intervention programs for eating disorders.     

青少年饮食失调：同伴的表现形式及作用机制

饮食失调在青少年群体中非常普遍, 同伴被认为是一种重要的影响因素。梳理其作用机制, 对青少年饮食失调的预防和干预有重要意义。研究表明, 同伴对青少年饮食失调具有消极影响, 主要表现为感知到的同伴行为、实际的同伴行为、身体不满意的中介作用、以及同伴质量的影响。研究者从直接、间接的角度就同伴对青少年饮食失调的作用机制及影响进行了阐释。未来的研究应深化研究内容, 如增加关于同伴影响的长期效应、同伴属性划分、影响路径作用大小以及同伴与饮食失调的其它社会影响因素间的交互作用等方面的研究。     

Personality disorder cognitions in the eating disorders

The eating disorders are frequently found to be comorbid with Axis II cluster B and C personality disorders. It is important to identify the personality-level cognitions that typify these disorders. This study of a clinical group examines the personality disorder cognitions in the eating disorders. The cognitions that were most relevant to the eating disorder pathology were those relating to avoidant and obsessive-compulsive personality disorder. Other personality disorder cognitions were associated with comorbid psychopathology in largely clinically meaningful ways. These findings extend our understanding of the comorbidity of eating disorders and personality pathology, suggesting that some cases need to be assessed and formulated with such cognitions in mind. Treatment strategies are required that address both the eating and the personality pathology, while considering the impact of these cognitions on the therapeutic relationship.     

Connecting Eating Pathology with Risk for Engaging in Suicidal Behavior: The Mediating Role of Experiential Avoidance

Individuals with eating pathology, particularly those with diagnosed eating disorders, are at high risk for suicide. It is less clear whether undiagnosed eating pathology and subsyndromal eating disorders carry the same risk and, if so, what mechanisms may explain why higher levels of eating pathology yield greater risk for engaging in suicidal behaviors. The indirect relationship between disordered eating and risk for suicidal behaviors via facets of experiential avoidance was tested using a multiple‐mediator model. The model was tested using bootstrapping estimates of indirect effects in a sample of 218 noncollege student adults (Mage = 32.33, 66.1% women) with a history of suicidal attempt and/or history of nonsuicidal self‐injury (NSSI). Results revealed that disordered eating indirectly predicted risk for suicidal behaviors, distress aversion (i.e., negative attitudes or dislike of distress), and procrastination (i.e., delaying engagement with distressing activities). Results suggest that targeting experiential avoidance and helping those who have a history of engaging in suicidal behaviors and/or NSSI develop regulation strategies to use during times of distress may be of utmost importance for treatment and prevention of eating pathology.     

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.     

Cognitive processing of body and appearance words as a function of thin-ideal internalization and schematic activation

To better understand how women at risk of body image disturbance respond when their body concerns are activated, we examined attentional and memory biases in undergraduate women with high thin-ideal internalization, an identified risk factor for eating disorders, following priming of body and appearance concerns. Female undergraduates (N = 186) viewed photos of either sports cars or attractive swimsuit models, then completed the Lexical Decision Test, a word recall test, and questionnaires assessing thin-ideal internalization and eating disorder symptomatology. High thin-ideal internalizers did not exhibit cognitive biases predicted by cognitive models of eating disorders, even when their body and appearance concerns were primed by exposure to attractive models. Converging evidence suggests that high-risk non-clinical samples rarely exhibit cognitive biases characteristic of individuals with eating disorders, and, in fact, may actually incorporate ideal appearance into their schemas and preferentially attend to attractive stimuli.     

Supervision for Counselors Working With Eating Disorders Groups: Countertransference Issues Related to Body Image,Food, and Weight

Because of similarities in age, education, and background, group counselors and members of eating disorders groups may easily identify and connect with each other. Although it can be positive, such overidentification may also create countertransference issues and demand attention in supervision. A model of supervision based on parallel process is presented to address these issues. The article describes (a) societal values related to eating disorders and countertransference; (b) specific themes in eating disorder groups and their impact on group process; (c) examples of countertransference related to body image, food, and weight; and (d) guidelines for supervision of female counselors working with eating disorders groups.     

Nutritional Intervention in Young Women with Eating Disorders: A Brief Report

Eating disorders in young women are often associated with a number of comorbid conditions, including mood disorders and cognitive problems. Although group therapy is often used as part of overall treatment for eating disorders in many types of settings, specific nutritional interventions used in such settings have rarely been evaluated. In this study, I evaluated the effects of a nutritional intervention used by 78 girls, aged 12–18 years, at a private school. My results showed that nutritional knowledge increased following intervention, but attitudes toward eating healthy did not change.     

Phyloanalysis: Theoretical and Practical Considerations on Burrow's Group Analytic and Socio-Therapeutic Method by W. Riese and H. Syz

Abstract

Women in an eating disorders partial hospital program and a psychiatric partial hospital program were compared on a self-report measure of group climate following a psychodynamic-interpersonal therapy group. Those with eating disorders experienced their groups as more engaged and as more avoiding than those in the psychiatric partial hospital group. Therapists may be able to use initial heightened engagement in eating disorder groups to counteract the tendency to avoid content.     

The use of group therapy to help women with eating disorders differentiate and articulate affect

In this discussion of eating disorders, symptoms are viewed as responses to unprocessed and unprocessable affect—what Stolorow and Atwood, Krystal, and Sifneos have called alexithymia. The article explores ways in which a group experience can help to provide an arena for the articulation and exploration of this affect. The group can provide its members with the responsive milieu necessary for the development of an internal structure that eliminates the need for the eating behavior. The metaphor of a child learning to swim is used to suggest that the group process can be seen as a kind of group swimming lesson. Group members work together with the therapist to develop the necessary skills and muscles to negotiate the waves of their own feelings, making the eating behavior unnecessary.     

On Targeting Emotion Regulation Deficits in Eating Disorders through Defense Analysis

ABSTRACT

Psychodynamic approaches to the treatment of individuals with eating disorders are underrepresented in research and in academia. This will increasingly deprive patients of a viable therapeutic alternate to the dominant behavioral family-based models. As psychodynamic approaches may have unique benefits, there is value in resolving this loss. Recent models of dynamic therapies for eating disorders within modern, empirically derived theory show promise for future psychodynamic viability. An attachment-focused approach targeting disordered attachment patterns that are common in individuals with eating disorders has recently been introduced. To complement this model, this article proposes an approach for individuals with eating disorders that is hypothesized to target emotion regulation deficits that are also commonly found in individuals with eating disorders. Observed parallels between the implicit branch of the emotion regulation system and that of contemporary constructs of defense mechanisms guide this proposal. Developmental considerations reveal important connections between this biologically based model and a two-person model based in attachment theory. In this way, this proposal offers a flexible psychodynamic approach that integrates with the existing literature. Further development of this approach could one day help patients to have a greater range of therapeutic options for recovery from eating disorders.     

The social psychology of disordered eating: The Situated Identity Enactment model

Eating disorders and subclinical behaviours such as dangerous dieting are a significant public health burden in the modern world. We argue that a social-psychological model of disordered eating is needed to explain how sociocultural factors are psychologically represented and subsequently reflected in an individual’s cognitions and behaviour. We present evidence that three central elements shape disordered eating – social norms, social identity and social context – and integrate these within a Situated Identity Enactment (SIE) model. Specifically, the SIE model states that social context determines the salience of both social norms and social identities. Social norms then influence disordered eating behaviour, but only to the extent that they are consistent represented in the content of a person’s social identities. We conclude by outlining the implications of the SIE model for researchers and practitioners in the domain of disordered eating, focusing in particular on the need for, and potential value of, theory-derived social interventions.     

Understanding the Role of Gender and Ethnic Oppression when Treating Mexican American Women for Eating Disorders

Gender, ethnicity, and weight issues are often the basis for internalized oppression. Mexican American women with eating disorders are subject to such internalization, complicated by cultural and family factors. Mexican American women (n = 136) were assessed. The resulting culturally discrepant gender identity theory describes the complicated set of relationships between weight, cultural weightism, gender identity, assimilation to U.S. culture, family factors, and eating disorder symptoms. Therapists treating eating disorders should consider ethnic and gender identity in addressing the conflicts between family, culture, and gender expectations; and demonstrate sensitivity to the complex inter-generational relationships in Mexican American families.     

Effectiveness of Dialectical Behavior Therapy for Treating Eating Disorders

This study evaluated the effectiveness of dialectical behavior therapy (DBT) for treating eating disorder episodes and co‐occurring depression symptoms among individuals diagnosed with eating disorders. Separate meta‐analytic procedures for between‐groups and single‐group studies were conducted and yielded large effect sizes, indicating that DBT may be efficacious for decreasing disordered episodes among women diagnosed with eating disorders; medium to large effect sizes were noted for treating depression symptoms. Implications for evidence‐supported practice and study limitations are discussed.     

Les troubles des comportements alimentaires chez des étudiants de première année : une étude prospective multigroupes

There is increasing use of the phrase “campus eating symptoms” to describe regular binge eating (together with frequent exercise, and occasional reliance on vomiting or laxatives), concerns about body image, depressive symptoms, stress, and university adjustment problems among students. Incidence of eating disorders in the early grades of university is increasing, and the period from age 17–19 years (peak of bulimia) which corresponds to the beginning of study at university is critical. Given the stressful environment that is the 1st academic year, it is useful to consider eating disorders risk factors.

Method

Our study is longitudinal. At the beginning, the participants consisted of 1110 freshmen. Data regarding adjustment to university, gender, body image, BMI, transactional variables (perceived stress and coping) and eating disorders (EAT-26) were collected. At T2 (end of academic year), 556 students were recruited to reassess their eating behaviours. The aim of the study was to test gender invariance of a theoretical eating disorders model including all these variables and eating disorders measured a year apart from a mixed population integrating the university for the first times. This model assumes that these variables exert direct effects on eating disorders as measured in time one who in turn will affect the stability of these troubles a year later. Although very little research include boys in the study of eating disorders, the results of our multi-group analysis support the idea of the existence of sex differences in eating disorder predictors: the only common predictor of eating disorders among girls and boys was the use emotion-focused coping. Among boys, the best predictors of eating disorders were problem-focused coping, and seeking social support. Among girls, our results revealed that body mass index, body image, and academic adjustment and stress were the predictors of eating disorders. Finally, we found a temporal stability of eating disorders. This study showed that personal and contextual aspects have a direct impact on students’ eating behaviour. However, among boys, neither body image nor perceived stress affect the eating behaviour but how they cope with stress. The gender gap in the explanation of eating disorders suggest to not exclude the male population in this type of study and to treat the data separately.