Intuitive Heuristics Linking Perfectionism, Control, and Beliefs Regarding Body Shape in Eating Disorders

A number of correlational studies have established a clear association between perfectionism, control and beliefs regarding body shape in eating disorders (EDs). The aim of this study is to test the effectiveness of the above- mentioned associations in exploring the presence of intuitive heuristics. Intuitive heuristics can be conceived as as mental shortcuts, cognitive processes that are highly susceptible to irrational biases. Forty one non clinical female controls and 27 in-patient females with an ED diagnosis participated in an experimental task that tested whether participants would show an intuitive rather than a logically based link between perfectionism in different domains (study, work, hygiene) and a thin body shape. In the healthy female participants the occurrence of proposed link was noted in the hygiene domain only, while ED participants showed this intuitive association in all the domains explored: study, work, and hygiene. The study confirms in clinical ED sample a wider employment of heuristics associating perfectionism and thinness that is based on purely intuitive irrational reasoning.     

The Role of Self-Objectification in the Experience of Women with Eating Disorders

Objectification theory has linked self-objectification to negative emotional experiences and disordered eating behavior in cultures that sexually objectify the female body. This link has not been empirically tested in a clinical sample of women with eating disorders. In the present effort, 209 women in residential treatment for eating disorders completed self-report measures of self-objectification, body shame, media influence, and drive for thinness on admission to treatment. Results demonstrated that the internalization of appearance ideals from the media predicted self-objectification, whereas using the media as an informational source about appearance and feeling pressured to conform to media ideals did not. Self-objectification partially mediated the relationship between internalized appearance ideals and drive for thinness; internalized appearance ideals continued to be an independent predictor of variance. In accordance with objectification theory, body shame partially mediated the relationship between self-objectification and drive for thinness in women with eating disorders; self-objectification continued to be an independent predictor of variance. These results illustrate the importance of understanding and targeting the experience of self-objectification in women with eating disorders or women at risk for eating disorders.     

Eating Disorders in Men: Current Considerations

Over the past two decades, there has been a change in the way men think about their bodies. The media portrays images of men with muscular bodies and a six pack abdomen. These images can create body dissatisfaction in males. With the change in the way that the media and society in the United States look at men, so has the drive for men to achieve this ideal body image. Eating disorders, body dysmorphia, and strict exercise and diet regimens seem to plague young men as do the images in advertisements. Although eating disorders in men are similar to what women experience, men seem to strive for more body mass whereas women try to obtain thinness. Gay men and heterosexual men seem to experience eating disorders in the same way although there are differences between how they perceive their bodies. This paper outlines how the media contributes to body dissatisfaction in men. In addition to understanding how the media affects men, it is important to review and possibly revise out understanding of eating disorders and body dysmorphia symptoms to gain a solid understanding of how these symptoms appear in men today.     

Mindfulness and Eating Disorders: A Network Analysis

Higher trait mindfulness may be protective against eating disorder (ED) pathology. However, little is understood about which specific mindfulness processes connect to specific ED symptoms. This study (N = 1,056 undergraduates) used network analysis at the symptom/process level to identify: (1) central nodes, or symptoms/processes with the greatest collective connection with all other symptoms/processes; and (2) bridge nodes, or symptoms/processes driving interconnection between mindfulness processes and ED symptoms. We conducted analyses both with and without food- and body-related mindfulness items. Central nodes included: describing how one feels in detail, expressing how one feels in words, and feeling guilty about eating due to shape/weight. Bridge nodes connecting higher mindfulness processes with lower ED symptoms included: the eating disorder symptom, being uncomfortable about others seeing one eat, and the mindfulness process, not criticizing oneself for having irrational/inappropriate emotions. Bridge nodes connecting higher mindfulness processes with higher ED symptoms included: noticing sensations of the body moving when walking and noticing how food/drinks affect thoughts, bodily sensations, and emotions. Findings suggest that future research should explore whether mindfulness-based interventions for EDs may be more effective by targeting mindfulness processes related to describing, expressing, and accepting emotions, accepting discomfort when eating with others, and reducing hyper-focus on and reactivity to food-and-body related sensations.     

Imagining Fear: Attachment,Threat, and Psychic Experience

Attachment theory is today considered an integral part of contemporary psychoanalytic theory and practice, and yet the theoretical and clinical implications of Bowlby’s emphasis on fear and the search for safety have been largely overlooked. From Bowlby’s perspective, the dynamic relationship between the experience of threat and attachment shapes the development and maintenance of essential relationships, the organization of psychic structure, and the nature of defenses and adaptation. This element of attachment theory—which alerts us to the ways in which the infant or child is compelled to seek safety when in a state of fearful arousal—is particularly relevant to the clinical situation. It helps us imagine moments of fearful arousal in our patients’ pasts, attend to their manifestations in the present, and understand current suffering in light of the long-term sequelae of adaptations that were crucial to survival. Finally, it helps us find language that brings alive or mentalizes these aspects of the patient’s early experience such that transformation is possible.     

Fairy Tales: Visions for Problem Resolution in Eating Disorders

This article introduces a framework that uses fairy tales, such as Cinderella, as a vision-to-action treatment alternative for psychological dysfunctions focusing on eating disorders. Clinical examples are provided that integrate guided imagery, cognitive reframing, and behavioral assignments.     

Eating Disorders in African American Girls: Implications for Counselors

Given the recent focus on eating disorders in children, it is imperative that counselors consider eating concerns that affect children of all racial and ethnic groups and hence are effective in working with this population. The author discusses risk factors that potentially contribute to eating disorders in African American girls given their unique socialization experiences as racial and ethnic minorities. Also, the author provides strategies for developing effective and culturally responsive counseling interventions to work with this population.     

Health-Related Quality of Life in Women with Eating Disorders: Association with Subjective and Objective Binge Eating

This study examined health-related quality of life (QOL) and its association with different forms of binge eating in 53 women with eating disorders. Participants had enrolled in treatment for anorexia nervosa, bulimia nervosa, binge eating disorder, or other eating disorders not otherwise specified and completed measures of QOL, eating-related psychopathology, and mood disturbance. Eating- and mood-related psychopathology, and to a lesser extent, mental-component QOL scores, were severely impaired in this sample relative to population norms. QOL was significantly and independently predicted by subjective bulimic episodes and compensatory behaviors, including food avoidance, laxative abuse, and self-induced vomiting, accounting for 32% of the variance. Subjective bulimic episodes and food avoidance also independently predicted the physical-component QOL, accounting for 27% of the variance. These findings suggest that subjective bulimic episodes may be independently associated with impairment in QOL and may require specific attention as targets of treatment.     

Early Onset Binge Eating and Purging Eating Disorders: Course and Outcome in a Population-Based Study of Adolescents

This study aimed to describe the course of early onset eating disorders in a population-based sample followed from 14 to 20 years; identify variables that could account for the persistence of eating disorders from 14 to 20 years; and describe outcome of early onset eating disorders with reference to general and psychological functioning at age 20. Participants (N?=?1,383; 49 % male) were drawn from the Western Australian Pregnancy Cohort (Raine) Study, which has followed children from pre-birth to young adulthood. Eating disorder symptoms were assessed using an adapted version of the Eating Disorder Examination-Questionnaire, at ages 14, 17 and 20. At age 14, 70 participants met DSM-IV criteria for a binge eating or purging eating disorder. Nearly half (44 %) of these adolescents ceased to meet criteria for an eating disorders at ages 17 and 20, whilst one-quarter still met criteria for an eating disorder at age 20 and one-fifth met criteria for an eating disorder at all three time points. Purging at age 17 and externalising behaviour problems at age 14 were the strongest predictors of eating disorder persistence to age 20. Participants who experienced a persistent eating disorder were less likely to complete high school than other participants, and reported pronounced depressive and anxiety symptoms at age 20. This study provides new data the course and outcome of early onset eating disorders at a population level. Behavioural difficulties in early adolescence and purging in middle adolescence may predict persistent eating pathology to young adulthood.     

Virtual Reality Based Treatments in Eating Disorders and Obesity: A Review

Since the late 1990s the use of virtual reality (VR) has expanded in the field of mental disorders. During this time, several VR-based applications have been developed for the treatment of eating disorders (ED) and obesity. Both these pathologies involve disturbances related to eating behavior, weight, and body image. Although effective and well-established protocols are now available for the treatment of ED and obesity, relapses are frequent and a proportion of patients do not improve after intervention. In this context, VR has been shown to be a useful technology for enhancing traditional cognitive-oriented therapies. The main objective of this review was therefore to examine the evidence regarding the efficacy of VR-based treatments as a component of therapeutic interventions for ED and obesity. To this end, three databases (PsycInfo, Medline, and PsycArticles) were searched for the period 1986–2012. Only research articles and case studies were selected. Although several methodological deficiencies were detected in the reviewed studies, there is fair evidence for the effectiveness of VR-based treatments in ED and obesity. VR-based interventions usually combine exposure to VR environments with cognitive therapies. The VR component seems to be especially suitable for reducing body image disturbances, such as body image dissatisfaction, and for increasing self-esteem and self-efficacy. The rationale for the use of VR in these areas is also presented and discussed.     

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.     

Eating Disorders: A Bond between Medicine,Culture and Psychoanalysis

Action in connection with the therapeutic process is often equated with acting out. The subtle behaviour that belongs to ?the complicated system of transmitting and receiving unconscious signals? (Sandler), with which the patient attempts to make the analyst behave as the object of transference or to fulfill an unconscious desire, is also described as acting out or micro-acting out (Treurniet). This fine-grained action, however, means nothing; it is not symbolic or communicative action. Its intention is, rather, to trigger effects and induce interactions. It occurs not only on the side of the analysand but also on that of the analyst, and is part of the unconscious communication in the therapeutic process. Presented here are some of the various interactive ways and means with which the analyst is prompted into unconscious action and certain, unnoticed, ways in that he turn ?treats? the patient. The analyst's action responses can bear the character of interpretations with which he may unintentionally reveal how he regards the behaviour of the patient.     

Inside Out and Counseling: Creative Interventions to Facilitate Emotional Intelligence

Emotional intelligence is an essential component of mental health and functioning. When traditional talk therapy is intimidating for young clients, creative approaches can supplement practice to foster a nonthreatening and supportive environment. The present article introduces innovative interventions inspired by the popular film Inside Out as helpful mechanisms to facilitate emotional intelligence in clients.     

Acceptance and Commitment Therapy for Eating Disorders: Rationale and Literature Review

Empirical studies using Acceptance and commitment therapy (ACT) and its components to treat eating disorders (EDs) were reviewed. Evidence suggests that emotional avoidance is a major component in the onset and maintenance of EDs. Acceptance and commitment therapy targets emotional avoidance and control strategies with six core processes. These core processes have been applied to EDs and demonstrated improvement in subjects’ functioning and reduction in disordered eating. There are several advantages of using ACT for treating EDs: ACT fundamentally equalizes the therapeutic relationship; experiential techniques in ACT may facilitate lasting treatment gains; ACT navigates the ego-syntonic nature of EDs; the ACT conceptualization based on experiential avoidance and cognitive rigidity in EDs is consistent with current literature. The six core processes of ACT can be further modified to fit the challenges of treating EDs. Specifically, concerns about client motivation for treatment can be addressed by emphasizing creative hopelessness and a values construction process earlier in treatment.