Self-criticism, low self-esteem, depressive symptoms, and over-evaluation of shape and weight in binge eating disorder patients

Despite the fact that negative self-evaluations are widely considered to be prominent in eating disorders, the role of self-criticism has received little empirical attention. The vast majority of research on the construct of self-criticism has focused on its role as a specific personality vulnerability factor in depression-related phenomena. In this study of 236 patients with binge eating disorder, confirmatory factor analysis supported self-criticism, self-esteem, depressive symptoms, and over-evaluation of shape and weight as distinct, albeit related, constructs. Structural equation modeling demonstrated that the relation between self-criticism and over-evaluation of shape and weight was partly mediated or explained by low self-esteem and depressive symptoms. Continued efforts to understand the role of self-criticism in eating disorders appear warranted.     

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.     

Neurocognitive endophenotypes of impulsivity and compulsivity: towards dimensional psychiatry

A key criticism of the main diagnostic tool in psychiatry, the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-IV), is that it lacks a biological footing. In this article, we argue for a biological approach to psychiatry based on 'neurocognitive endophenotypes', whereby changes in behavioural or cognitive processes are associated with discrete deficits in defined neural systems. We focus on the constructs of impulsivity and compulsivity as key examples of the approach and discuss their possible cross-diagnostic significance, applying them to co-morbidities and commonalities across a range of disorders (attention-deficit/hyperactivity disorder, substance dependence, obsessive-compulsive disorder and eating disorders). We argue that this approach has important implications for the future classification of psychiatric disorders, genetics and therapeutics.     

Loneliness and eating disorders

This article examines the link between loneliness and eating disorders. This concept is evaluated through a systematic review of the literature that links loneliness and eating disorders and through a survey of themes connecting the 2 conditions. Eating disorders-including anorexia nervosa, bulimia nervosa, and eating disorders that are not otherwise specified, which include binge eating disorder-are challenging health issues. Each of these diagnoses specifically relates to loneliness. This negative emotion contributes to and fuels eating disorder symptoms. Negative interpersonal relationships, both real experiences and individuals' skewed perceptions, exacerbate eating disorders and feelings of loneliness. Characteristics that have been associated with loneliness clearly relate to eating disorders. Understanding this relationship is vital, so that we can appreciate our patients' struggles and work to target these intense emotions within the treatment setting. We need to be aware of the power of loneliness as it applies to individuals in general and specifically to those struggling with disordered eating.     

Objectification Theory as It Relates to Disordered Eating Among College Women

Objectification theory (B. L. Fredrickson & T. A. Roberts, 1997) demonstrates how sociocultural variables work together with psychological variables to predict disordered eating. Researchers have tested models that illustrate how certain constructsof objectification theory predict disordered eating, but a more comprehensive model that integrates a combination of constructs central to the theory (i.e., sexual objectification; self-objectification; body shame; poor interoceptive awareness of hunger, satiety, and emotions) has not yet been examined. In this study, we incorporated these variables within an inclusive model based on the assertions of B. L. Fredrickson and T. A. Roberts (1997) and examined it with 460 college women. Structural equation modeling analyses suggested that the model provided a good fit to the data and supported most propositions set forth by objectification theory and the eating disorders literature.     

The Semantics of Power Among People With Eating Disorders

The study aimed to empirically test the hypothesis, developed within the systemic-constructionist theory of family semantic polarities, that the semantics of power are particularly meaningful for people with eating disorders. The repertory grid technique was used to elicit constructs from 30 young patients (10 anorexic, 10 bulimic, and 10 obese) and from a matched control group; the two sets of constructs were compared in terms of their semantic content. Overall the results confirmed the hypothesis, although further investigation into the semantic peculiarities of individual eating disorders is required. Methodological limitations and possible clinical applications are discussed.     

Effects of positive mood on attention broadening for self-related information

Studies on cognitive effects of positive emotions have associated positive emotions to broadened attention. Given the widely investigated relationship between self-focused attention and mood, it is important to investigate the effect of positive mood on visuospatial attention for self-related information. We used a performance-based measure to assess fluctuations in attentional broadening from self-related contrasted to not-self-related information. In Experiment 1, we checked that the self-related versus not-self-related stimuli did not evoke differential attention effects in general. In Experiment 2, we manipulated mood and found that an increase in positive mood was associated with a relative broadening of attention for self-related information. These results suggest that the meaning of the target of attention provides an interesting dimension for further investigation into the relation between positive emotions and attentional broadening.     

Neuropeptides in eating disorders

The past decade has witnessed a dramatic acceleration in research on the role of the neuropeptides in the regulation of eating behavior and body weight homeostasis. This expanding research focus has been driven in part by increasing public health concerns related to obesity and the eating disorders anorexia nervosa (AN) and bulimia nervosa (BN). Preclinical advances have been facilitated by the development of new molecular and behavioral research methodologies. With a focus on clinical investigations in AN and BN, this article reviews research on selected hypothalamic and gut-related peptide systems with prominent effects on eating behavior. Studies of the orexigenic peptides neuropeptide Y and the opioid peptides have shown state-related abnormalities in patients with eating disorders. With respect to gut-related peptides, there appears to be substantial evidence for blunting in the meal-related release of the satiety promoting peptide cholecystokinin in BN. Fasting plasma levels of the orexigenic peptide ghrelin have been found to be elevated in patients with AN. As discussed in this review, additional studies will be needed to assess the role of nutritional and body weight changes in neuropeptide alterations observed in symptomatic eating disorder patients, and to identify stable trait-related abnormalities in neuropeptide regulation that persist in individuals who have recovered from an eating disorder.     

Eating disorder pathology among overweight treatment-seeking youth: clinical correlates and cross-sectional risk modeling

Preliminary research suggests that pediatric overweight is associated with increased eating disorder pathology, however, little is known about which overweight youth are most vulnerable to eating disorder pathology. We therefore investigated 122 overweight treatment-seeking youth to describe eating disorder pathology and mental health correlates, and to identify psychopathological constructs that may place overweight youth at increased risk for eating disorder pathology. Youth participated in a comprehensive assessment of eating disorders, mood and anxiety disorders, general psychopathology, and risk variables involving semi-structured clinical interviews and self- and parent-report questionnaires prior to the initiation of weight-loss treatment. Ten youth met criteria for an eating disorder, and over one-third endorsed recent binge eating. Eating disorder pathology was associated with depressive and anxious symptoms (p's<0.001). Structural equation modeling indicated increased negative affect, teasing experience, and thin-ideal internalization, and decreased perfectionism were associated with increased eating disorder pathology. Findings corroborate earlier work indicating that eating disorder pathology is elevated and clinically significant in overweight treatment-seeking youth, bolstering the need for mental health assessment of such individuals. Cross-sectional modeling proposed key variables that relate to eating disorder pathology in overweight treatment-seeking youth, which following prospective replication, may inform the development of effective interventions for overweight and eating disorders.     

From one extreme to the other: Negative evaluation anxiety and disordered eating as candidates for the extreme female brain

Simon Baron-Cohen pioneered the idea that different brain types evolved to process information in gender specific ways. Here we expand this approach to looking at eating disorders as a byproduct of the extreme female brain. The incidence of eating disorders is higher among females, and recent findings show that hormones may play a role in eating disorders. We present new evidence from four studies that both an empathizing bias and hyper-mentalizing (as measures of the extreme female brain; EFB) are related to disordered eating and negative evaluation anxiety in women. We also advance the novel hypothesis that concerns about animal welfare (a unique expression of the EFB) may account for the relationship between vegetarianism and eating disorders.     

Gender role typing,the superwoman ideal,and the potential for eating disorders

The interactive effects of gender role typing and adherence to a superwoman ideal (desiring to excel in many diverse roles) on the potential for disordered eating were examined among a nonclinical sample of women. Results indicated that both masculine and feminine gender-typed women who strongly adhered to a superwoman ideal were at greater risk for eating disorders than androgynous superwomen. In contrast, androgynous superwomen had relatively low potential for disordered eating and appeared comparable to women who, regardless of gender typing, rejected the superwoman ideal. Women undifferentiated with regard to gender type, whether superwomen or not, also had reduced potential for disordered eating. Findings are discussed with regard to gender role socialization and expectations, and the implications for mediating the potential for eating disorders are considered.     

Connections Between Marital Conflict and Adolescent Girls’ Disordered Eating: Parent–Adolescent Relationship Quality as a Mediator

The family system has frequently been suggested to play an important role in adolescents’ health. Particularly, conflict within the marital dyad has been associated with maladjustment among adolescents, although studies have rarely focused on disordered eating as a possible negative outcome. In this study, we examined the direct association between marital conflict and disordered eating among 123 adolescent girls in middle school and high school. We also tested the mediating role of adolescents’ positive relationship quality with their mothers and fathers (e.g., high warmth and low control) in this relation. For our hypothesized direct effects and mediation models, we formed latent constructs with cross-sectional data collected from girls’ self-report questionnaires and applied bootstrapping procedures. We found that marital conflict was both directly and indirectly, via poor mother– and father–adolescent relationship quality, associated with girls’ disordered eating. This suggests that the mother–father, mother–adolescent, and father–adolescent family subsystems can play a part in influencing girls’ eating patterns. Clearly, family subsystems have significant roles in promoting the health of young, female adolescents. Future research and treatment efforts for girls exhibiting disordered eating should aim to include family members and address the roles of different family subsystems.     

Differences in Emotion Regulation Difficulties Across Types of Eating Disorders During Adolescence

Emotion regulation appears to play a key role in eating disorders. However, prior attempts to associate specific emotion regulation abilities with specific types of eating disorders resulted in inconsistent findings. Moreover, far less is known about emotion regulation in eating disorders during adolescence, a critical period of emotional development. The current study addresses this gap, comparing emotion regulation characteristics between adolescents with restrictive types of eating disorders and those with binge eating or purging types of eating disorders. Ninety-eight adolescents with eating disorders (49 with restrictive and 49 with binge eating/purging eating disorders) completed a set of questionnaires including the Difficulties in Emotion Regulation Scale (DERS). The results revealed that binge eating/purging types of eating disorders were associated with greater difficulties in a variety of emotion regulation dimensions including impulse control, goal-directed behavior and access to effective emotion regulation strategies. Awareness and clarity of emotions were also worse in the binge eating/purging types of eating disorders, but this difference did not remain when comorbid psychopathology measures were controlled for. Moreover, the emotion regulation profile of adolescents with anorexia nervosa-binging/purging type was more similar to that of adolescents with bulimia nervosa than to that of adolescents with anorexia nervosa-restrictive type. While both restrictive and binge eating/purging eating disorders have been associated with emotion regulation difficulties, the current study shows that the presence of binge eating or purging episodes is linked with greater severity of emotion regulation deficits among adolescents with eating disorders.     

The Weight Influenced Self-Esteem Questionnaire (WISE-Q): Factor structure and psychometric properties

Weight-based self-esteem (WBSE) is hypothesized to be the core cognitive feature of eating disorders. The Weight Influenced Self-Esteem Questionnaire (WISE-Q) was designed to measure the influence of a negatively perceived body image on multiple dimensions of self-esteem, which we believe to be one aspect of WBSE. Study 1 sought to determine the factor structure of the WISE-Q as well as to examine the reliability and concurrent validity of WISE-Q scores among eating disorder and undergraduate student participants. In Study 2, validity was further investigated by examining changes in WISE-Q scores with treatment. The WISE-Q has two factors representing generalized and expected WBSE. Evidence of internal and test–retest reliability was found. Also, the pattern of correlations between WISE-Q scores and other constructs was in line with predictions. As expected, WISE-Q scores improved with treatment yet remained high.     

Genetics in eating disorders: state of the science

Eating disorders have been viewed as psychiatric illnesses that are strongly influenced by societal pressures towards thinness and attractiveness. Although the environmental context of these disorders must not be neglected, recent research in the area of genetic epidemiology suggests a substantial influence of genetic factors on liability to eating disorders. This review presents a synthesis of current knowledge about genetic factors implicated in the etiology of eating disorders.     

Objective and subjective bulimic episodes in the classification of bulimic-type eating disorders: Another nail in the coffin of a problematic distinction

We sought to further explore the validity of the distinction between objective bulimic episodes (OBEs) and subjective bulimic episodes (SBEs) in the study of bulimic-type eating disorders. Drawing on data obtained at the second, interview phase of a large-scale epidemiological study, we identified mutually exclusive subgroups of women with bulimic-type eating disorders who engaged in regular OBEs but not SBEs (n = 37) or regular SBEs but not OBEs (n = 52). These subgroups were compared on a wide range of outcomes, including socio-demographic characteristics, current levels of eating disorder psychopathology, general psychological distress and impairment in role functioning, current and lifetime impairment in quality of life specifically associated with an eating problem, (self)-recognition of an eating problem, health service utilization and use of psychotropic medication. The only difference between groups was that participants who reported regular OBEs were heavier than those who reported regular SBEs. The findings converge with those of previous research in suggesting that bulimic-type eating disorders characterized by regular SBEs, but not OBEs, do not differ in any clinically meaningful way from those characterized by regular OBEs, but not SBEs. Inclusion of bulimic-type eating disorders characterized by regular SBEs as a provisional category requiring further research in DSM-V appears warranted.     

A Review of Eating Disorders in Athletes

SUMMARY

The current review aims to evaluate the literature on eating disorders and athletes with the purpose of making recommendations for sport psychologists and other relevant personnel on how to proceed in identifying, managing, and preventing eating disorders in school settings. Whereas the intention of this review is to make recommendations for secondary educational settings, research on other populations such as collegiate and young adult athletes was also reviewed where helpful or where information on adolescent athletes was not available. Recommendations for prevention and intervention include ongoing education of athletes and coaches regarding nutrition, body composition, and performance, using appropriate screening to detect eating disorders, and use of a sport management team to aid in athlete recovery.     

ACCULTURATION AND EATING DISORDERS IN A MEXICAN AMERICAN COMMUNITY SAMPLE

Our purpose was to investigate acculturation and eating disorders by examining the role of ethnic identity and by utilizing a bidimensional perspective toward two cultures. We predicted that orientation toward European American culture and lower ethnic identity would be positively associated with eating disorders. Participants were 188 Mexican American women recruited from the community (79 with eating disorders and 109 control women). The Structured Clinical Interview for DSM-IV-TR and Eating Disorder Examination were used to establish diagnoses. The Acculturation Rating Scale for Mexican Americans–II and the Multigroup Ethnic Identity Measure assessed Anglo orientation, Mexican orientation, and ethnic identity. Orientation toward Anglo American culture was significantly associated with eating disorders, whereas orientation toward Mexican culture and strength of ethnic identity were not associated with eating disorder status. Findings point to the role of Anglo cultural orientation in the development of eating disorders and underscore the need for future research to utilize bidimensional models.     

Thought-action fusion: a comprehensive analysis using structural equation modeling

Thought-action fusion (TAF), the phenomenon whereby one has difficulty separating cognitions from corresponding behaviors, has implications in a wide variety of disturbances, including eating disorders, obsessive-compulsive disorder, generalized anxiety disorder, and panic disorder. Numerous constructs believed to contribute to the etiology or maintenance of TAF have been identified in the literature, but to date, no study has empirically integrated these findings into a comprehensive model. In this study, we examined simultaneously an array of variables thought to be related to TAF, and subsequently developed a model that elucidates the role of those variables that seem most involved in this phenomenon using a structural equation modeling approach. Results indicated that religiosity, as predicted by ethnic identity, was a significant predictor of TAF. Additionally, the relation between ethnic identity and TAF was partially mediated by an inflated sense of responsibility. Both TAF and obsessive-compulsive symptoms were found to be significant predictors of engagement in neutralization activities. Clinical and theoretical implications are discussed.     

Young Women at Risk for Eating Disorders: Perceived Family Dysfunction and Parental Psychological Problems

These results of this study are consistent with theories of eating disorders that highlight the role of family factors in the etiology and maintenance of eating disorders. When 27 young women at risk for eating disorders who scored above the clinical cut-off score on the EDI-II were compared with age and SES matched controls, they were found to obtain more dysfunctional scores on the Family Assessment Device and on ratings of perceived maternal and paternal symptomatology on the SCL-90-R.