Relationships between health behaviors,posttraumatic stress disorder,and comorbid general anxiety and depression

Poor health outcomes associated with posttraumatic stress disorder (PTSD) may reflect engagement in unhealthy behaviors that increase morbidity risk and disengagement in healthy behaviors that decrease morbidity risk. Although research supports this pattern, findings are not definitive, particularly for healthy behaviors. Many studies have not controlled for effects of concurrent generalized anxiety and depression, which might explain conflicting findings. To address this limitation, we used an online cross-sectional research design and multivariate multilevel modelling to evaluate associations between a multitude of health behaviors (i.e. sedentary behavior, sleep quality, physical activity, eating habits, alcohol use and substance use) and PTSD, while adjusting for comorbid generalized anxiety and depression, in a sample of trauma-exposed individuals (N = 246). Our results indicate that PTSD and comorbid generalized anxiety and depression symptoms were differentially associated with specific health constructs. Specifically, sedentary behavior and poor sleep quality were associated with PTSD, whereas low physical activity, poor sleep quality, and unhealthy eating habits were associated with depression. Both increased alcohol and substance use were associated with generalized anxiety. Results from our study highlight the need to conceptualize associations between health behaviors and specific psychological symptoms in a comprehensive manner as part of clinical presentations of PTSD.     

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.     

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.     

Self-Oriented Body Comparison and Self-Compassion: Interactive Models of Disordered Eating Behaviors Among Postpartum Women

Evidence suggests self-oriented body comparison (comparison of one’s postpartum body shape and weight to one’s prepregnant body shape and weight) is a critical factor associated with increased levels of disordered eating during the postpartum period. However, some postpartum women adopt a self-compassionate and acceptance-based perspective toward their body shape and weight changes. It is unclear whether self-compassion may buffer the associations between self-comparisons and disordered eating behaviors among postpartum women, which is the aim of the current study. A total of 306 postpartum women who gave birth in the past year completed an online survey asking about self-compassion, social comparison, broad eating pathology, dietary restraint, and binge eating. Results indicated that self-compassion appeared to buffer the associations between self-comparison and broad eating pathology and binge eating among postpartum women, such that for women with above-average levels of self-compassion, the associations between self-comparison and disordered eating was weaker than for women with average or below-average levels of self-compassion. Findings suggest self-compassion could be a potential target for intervention programs.     

Body checking and avoidance and the core features of eating disorders among obese men and women seeking bariatric surgery

This study examined two aspects of body checking and avoidance, and their relations to the core psychopathology of eating disorders (EDs), in severely obese men and women seeking bariatric surgery. A consecutive series of 260 (44 male and 216 female) gastric bypass candidates were administered measures to assess body checking and avoidance, binge eating, restraint, and overevaluation of weight and shape. The majority of patients reported regularly pinching areas of their body to check for fatness and avoided wearing clothing that made them particularly aware of their body. Significant associations were observed between checking and restraint, and between avoidance and binge eating. Both checking and avoidance behaviors were significantly associated with overevaluation of weight and shape. The positive associations between each of the two behaviors (body checking and avoidance) with overevaluation of weight/shape remained significant even after controlling for the effects of avoidance on body checking and vice versa. Stepwise multiple regression analyses revealed that binge eating, body checking, and avoidance behaviors made significant unique contributions and jointly accounted for 22-25% of the variance in overevaluation of weight and shape, respectively. This study documents the presence of eating disorder psychopathology among severely obese patients seeking bariatric surgery. The findings support the view that body checking and avoidance behaviors are manifestations of overevaluation of weight and shape and disordered eating.     

Associations between Stress,Psychosomatic Complaints,and Parental Criticism among Affluent Adolescent Girls

A growing body of research has shown that adolescent girls in the context of affluence face a series of unique pressures that may increase social-emotional problems. Little research, however, has examined associations between perceived stress and psychosomatic complaints among privileged youth. In the present study, we investigated the relationships between stress, psychosomatic complaints, and parental criticism in a sample of preadolescent and adolescent girls (n?=?218) from selective, private schools. Using OLS regression analyses, cross-sectional and longitudinal associations were evident between perceived stress and psychosomatic complaints, with increases in stress associated with increases in psychosomatic problems. Parental criticism was also examined as a predictor of girls’ psychosomatic complaints and stress levels. Results indicated that parental criticism was significantly and positively associated with psychosomatic problems in cross-sectional models and that perceived stress levels mediated this association. Additional analyses demonstrated that the relationship between psychosomatic complaints and stress may be bidirectional. Taken together, results from this exploratory study suggest that girls in the context of affluence may also experience psychosomatic complaints, in addition to social-emotional problems.     

Dietary restraint, body dissatisfaction, and psychological distress: a prospective analysis

This study uses prospective data from a survey of 1,177 adolescent girls to examine whether emotional eating, binge eating, abnormal attitudes to eating and weight, low self-esteem, stress, and depression are associated with dietary restraint or body dissatisfaction. In analyses that included both restraint and body dissatisfaction as independent predictors, restraint was associated only with more negative attitudes to eating, whereas body dissatisfaction was significantly associated with all the adverse outcomes. These results cast doubt on the proposition that restrained eating is a primary cause of bulimic symptoms, emotional eating, and psychological distress seen in individuals who are trying to control their weight, and rather suggest that body dissatisfaction is the key factor.     

Reciprocal Associations Between Depressive Symptoms and Disordered Eating Among Adolescent Girls and Boys: A Multiwave,Prospective Study

Symptoms of depression and eating disorders increase during adolescence, particularly among girls, and they tend to co-occur. Despite this evidence, there is meager research on whether depression increases the risk of future eating pathology, or vice versa, and we do not know whether these processes are different for adolescent girls and boys. Accordingly, this study explored the prospective reciprocal associations between depressive symptoms and disordered eating at different time points from preadolescence to mid-adolescence and tested the moderator effect of gender on these associations. A community-based sample of Spanish youth (N?=?942, 49 % female) was assessed at ages of approximately 10-11 (T1), 12-13 (T2), 14-15 (T3), and 16-17 (T4) years. The bidirectional relationships between depressive symptoms and disordered eating were estimated in an autoregressive cross-lagged model with latent variables. A unidirectional, age-specific association between depressive symptoms at T1 and disordered eating at T2 was found. No other significant cross-lagged effect emerged, but the stability of the constructs was considerable. Gender did not moderate any of the links examined. Regardless of gender, the transition from childhood to adolescence appears to be a key period when depressive symptoms foster the development of disordered eating. These findings suggest that early prevention and treatment of depression targeting both girls and boys may result in lower levels of depressive symptoms and disordered eating in adolescence.     

Ethnic differences in BMI, weight concerns, and eating behaviors: comparison of Native American, White, and Hispanic adolescents

Evidence suggests that substantial proportions of adolescents, regardless of ethnicity or gender, are engaged in excessive weight control behaviors. Crago and Shisslak (2003), however, have noted that small samples and poorly validated instruments have limited the value of previous ethnic difference studies. Using the McKnight Risk Factor Survey, we compared Native American, White, and Hispanic adolescents. Native students were divided into groups with one (NA-mixed) or two (NA) Native American biological parents. Surveys were completed by 5th through 10th grade students. BMI z-scores were significantly higher for boys and girls in the NA group, and boys in this group were significantly more engaged in weight control behaviors, including purging. A higher percentage of Native and Hispanic girls preferred a larger body size. BMI was positively correlated with weight and shape concerns and with weight control behaviors, regardless of ethnicity or gender. Overweight among Native adolescents may put them at greater risk for eating problems than their White peers.     

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.     

Teasing, acculturation, and cultural conflict: psychosocial correlates of body image and eating attitudes among South Asian women

The current study examined sociocultural correlates of body dissatisfaction and maladaptive eating attitudes among 74 South Asian American women. Participants completed measures assessing three forms of teasing--general appearance, weight/shape, and ethnic--as well as thin-ideal internalization, acculturation, cultural conflict, body dissatisfaction, and maladaptive eating attitudes. Results indicated that all three types of teasing and cultural conflict were significantly related to body dissatisfaction and maladaptive eating attitudes. Cultural conflict was found to mediate the relationship between ethnic teasing and body dissatisfaction. Neither thin-ideal internalization nor acculturation was significantly associated with either body dissatisfaction or maladaptive eating attitudes. However, body dissatisfaction was found to mediate the relationship between weight/shape teasing and maladaptive eating attitudes. Implications of these findings and possible future directions for research on South Asian American women are discussed.     

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.     

Eating behaviour, body image, and self-esteem of adolescent girls in Malaysia

This cross-sectional study was undertaken with 489 secondary school girls, ages 15-17 years, to examine disordered eating behaviours of adolescent girls in Malaysia and to estimate associations with body weight, body-size discrepancy, and self-esteem. Dietary restraint, binge eating, body image, and self-esteem were assessed using the Restrained Eating scale of the Dutch Eating Behaviour Questionnaire, the Binge Scale Questionnaire, the Contour Drawing Rating Scale, and the Rosenberg Self-Esteem Scale, respectively. Pearson correlations estimated associations between variables. There were 3.1% underweight, 9.8% at risk of being overweight, and 8.6% overweight girls. A total of 87.3% were dissatisfied with their own body size. Dietary restraint and binge eating were reported by 36.0% and 35.4%, respectively. Body Mass Index (r = .34, p < .01) and body-size dissatisfaction (r = .24, p < .01) were significantly associated with dietary restraint and binge eating, but self-esteem (r = -.20, p < .001) was significantly associated only with binge eating.     

The relationships among trauma, stress, ethnicity, and binge eating

The present study investigated whether trauma, stress, and discriminatory experiences influenced binge eating among 93 African American and 85 Caucasian women. Trauma and stress were significantly related to binge eating for both groups, although the stress- binge eating relationship was stronger for Caucasian women. Ethnicity did not moderate the relationship between trauma and binge eating, but did moderate the stress-binge eating relationship. Finally, the hypothesis that trauma and stress would influence binge eating through their effects on function of eating was partially supported; the relationship between stress and binge eating was partially mediated by function of eating among Caucasian women. The implications of these findings for our understanding of binge eating are discussed.     

Patient drawings of their melanoma: A novel approach to understanding symptom perception and appraisal prior to health care

Although previous research showed that the thin ideal provided by the media affects body image and eating behaviour in young children, less is known about specific media contents that are related to body image and eating behaviour. This study tested the associations between watching soaps and music television and body dissatisfaction and restrained eating directly, and indirectly through thin ideal internalisation. We conducted a survey in class, in which 245 girls (aged 7–9) completed scales on their television watching behaviour, thin ideal internalisation, body dissatisfaction and restrained eating. Additionally, height and weight were measured. Watching soaps and music television often was associated with higher thin ideal internalisation, which in turn was associated with higher body dissatisfaction and restrained eating. Furthermore, a direct association between watching soaps and music television and restrained eating was found. If watching other types of children's programmes or maternal encouragement to be thin were included in the models, watching soaps and music television remained an important factor, especially with regard to restrained eating. Therefore, our results suggest that if young girls watch soaps and music television often, this is related to higher restrained eating and body dissatisfaction, directly or indirectly, through higher thin ideal internalisation.     

Ethnic identity,thin-ideal internalization,and eating pathology in ethnically diverse college women

Although much research suggests that ethnic identity is positively correlated with psychological health for ethnic minority women, research examining ethnic identity's relationships to thin-ideal internalization, weight concerns, and eating concerns is sparse. Consequently, this study examined these relationships in European American, African American, Latina, and Asian American college women (N = 816). As expected, univariate analyses of variance indicated that European American women scored lowest on ethnic identity and highest on eating and weight concerns, whereas African American women scored lowest on thin-ideal internalization. Hierarchical regression analyses indicated that ethnic identity was negatively associated with eating and weight concerns, while body mass index and thin-ideal internalization were positively associated. Ethnic identity moderated the relationship between thin-ideal internalization and eating concerns such that the relationship was stronger for participants with lower ethnic identity. These results suggest ethnic identity may be a direct or interactive protective factor against eating concerns in ethnically diverse college women.     

Intake of high-intensity sweeteners alters the ability of sweet taste to signal caloric consequences: implications for the learned control of energy and body weight regulation

Recent results from both human epidemiological and experimental studies with animals suggest that intake of noncaloric sweeteners may promote, rather than protect against, weight gain and other disturbances of energy regulation. However, without a viable mechanism to explain how consumption of noncaloric sweeteners can increase energy intake and body weight, the persuasiveness of such results has been limited. Using a rat model, the present research showed that intake of noncaloric sweeteners reduces the effectiveness of learned associations between sweet tastes and postingestive caloric outcomes (Experiment 1) and that interfering with this association may impair the ability of rats to regulate their intake of sweet, but not nonsweet, high-fat and high-calorie food (Experiment 2). The results support the hypothesis that consuming noncaloric sweeteners may promote excessive intake and body weight gain by weakening a predictive relationship between sweet taste and the caloric consequences of eating.     

Relationships between psychological stress, coping and disordered eating: A review

Abstract Objective: Psychological stress and inadequate coping skills have been hypothesized to play important roles in the etiology of disordered eating. This paper reviews the empirical evidence which has emerged regarding the proposed relationships among stress. coping skills and various forms of disordered eating. Method: A search of psychological and medical databases was conducted to identify studies examining life events, and other types of psychological stress and coping strategies, in relation to the onset of disordered eating. Results: Despite methodological limitations such as the use of non-representative samples and retrospective methodologies, evidence of relationships between stress. coping and disordered eating was obtained in the majority of studies reviewed. Discussion: The implications of these findings am discussed and suggestions for future research, including the utilization of longitudinal. prospective studies, am presented.     

Relationships between psychological stress,coping and disordered eating: A review

Abstract

Objective: Psychological stress and inadequate coping skills have been hypothesized to play important roles in the etiology of disordered eating. This paper reviews the empirical evidence which has emerged regarding the proposed relationships among stress. coping skills and various forms of disordered eating. Method: A search of psychological and medical databases was conducted to identify studies examining life events, and other types of psychological stress and coping strategies, in relation to the onset of disordered eating. Results: Despite methodological limitations such as the use of non-representative samples and retrospective methodologies, evidence of relationships between stress. coping and disordered eating was obtained in the majority of studies reviewed. Discussion: The implications of these findings am discussed and suggestions for future research, including the utilization of longitudinal. prospective studies, am presented.     

Psychological Separation,Self-Control,and Weight Preoccupation Among Elite Women Athletes

Given the paucity of research on the prevalence of eating disorders in college athletes, the authors raised two questions: (a) Is weight preoccupation more prevalent among elite women athletes than among their nonathletic counterparts? (b) Does the empirical link between psychological distress and weight preoccupation pertain to elite athletes as well? Results showed that 10.9% of a sample of elite swimmers could be characterized as “weight preoccupied,” a percentage comparable to the general population of college women. In addition, the athletes reported using significantly more benign than punitive self-control strategies, suggesting for them, weight preoccupation is a means to an end rather than an indication of an eating disorder. Implications for counseling are discussed.