Eating disorder diagnoses: empirical approaches to classification

Decisions about the classification of eating disorders have significant scientific and clinical implications. The eating disorder diagnoses in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) reflect the collective wisdom of experts in the field but are frequently not supported in empirical studies and do not capture the disorders of eating experienced by most people with an eating disorder. Statistical approaches to classification such as latent class analysis and taxometrics can help to create a classification system with greater scientific validity and clinical utility. The field would benefit from direct empirical comparisons of different classification schemes with various clinical and scientific validators. Such studies would enable the creators of the next DSM eating disorder classification to increase understanding of the advantages and disadvantages associated with choosing various diagnostic criteria sets for the eating disorders.     

Social anxiety disorder in childhood and adolescence: descriptive psychopathology

Although the presentation of social anxiety disorder (SAD) in adults is well documented, less is known about its clinical manifestation in children and adolescents. To date, most studies have included combined samples of children and adolescents despite the fact that this age range represents an extensive period of growth and development. This study compares and contrasts the clinical presentation of SAD among children (ages 7-12) and adolescents (ages 13-17). One hundred and fifty children (n=74) and adolescents (n=76) with a primary diagnosis of SAD participated in the study. The assessment battery included clinical ratings and behavioral observation as well as parental and self-report. The results indicate that, although the symptom presentation of children and adolescents with primary SAD shares many features, children tend to present with a broader pattern of general psychopathology, while adolescents have a more pervasive pattern of social dysfunction and may be more functionally impaired as a result of their disorder. These findings suggest that interventions for SAD need to carefully consider clinical presentation of the disorder as it manifests in childhood and adolescence.     

Adolescent Girls and Their Mothers Talk About Experiences of Binge and Loss of Control Eating

Evidence suggests that adolescents’ experience of binge eating (BE) might differ in important ways from that of adults. Moreover, although BE appears more common in African American women than other disordered eating behaviors, little is known about the influence of cultural factors on this behavior in adolescents. The current investigation used qualitative methodology to examine the perceptions of White and African American adolescent girls and their mothers regarding experiences of binge and loss of control eating. Five focus groups were completed with 19 adolescent girls (aged 13–17, 58 % African American, 41 % White) who endorsed loss of control eating behaviors. Their mothers (N = 19) also completed separate, concurrent focus groups addressing food and eating behaviors. Responses to focus group questions were analyzed using thematic qualitative analysis. Adolescents’ awareness of their eating behaviors varied greatly. Girls reported some awareness of how emotions influence their eating behaviors, and described using food to achieve autonomy. Mothers evidenced awareness of their daughters’ problematic eating behaviors, the effects of emotions on eating for both their daughters and themselves, and sociocultural factors influencing diet. Data from these focus groups can inform the development of innovative interventions for adolescent girls engaging in loss of control eating.     

Gender Differences among Self-Reported Genital Piercing Stories

Through the investigation of a rich, qualitative dataset of 484 self-reported genital piercing stories, we significantly expand an understanding of the characteristics, motivations, experiences, and outcomes of persons with genital piercings. While many of our findings confirm and elaborate prior research, some of our findings also challenge this research. In particular, we find that contrary to the expectations of prior research, there is: (1) little evidence to support the frequently made claim that genital piercings are pathological and (2) little evidence to support the alternatively framed claim that genital piercings somehow offer resistance to traditional gender and sexual norms. Instead, we argue that, by and large, genital piercings are just another mainstream and fairly conventional type of body decoration and adornment.     

Precipitating Circumstances of Suicide among Active Duty U.S. Army Personnel Versus U.S. Civilians, 2005–2010

To help understand suicide among soldiers, we compared suicide events between active duty U.S. Army versus civilian decedents to identify differences and inform military prevention efforts. We linked 141 Army suicide records from 2005 to 2010 to National Violent Death Reporting System (NVDRS) data. We described the decedents’ military background and compared their precipitators of death captured in NVDRS to those of demographically matched civilian suicide decedents. Both groups commonly had mental health and intimate partner precipitating circumstances, but soldier decedents less commonly disclosed suicide intent.     

Integrating Web-Based Applications into Aged Care: Two Case Studies and Discussion

In anticipation of the growing need for adequate mental health care for older adults in residential aged care facilities, psychologists are challenged to overcome several barriers that impede the uptake and delivery of their services in such settings. Information and communication technologies (ICT) have strong potential to overcome some of these barriers by supporting the delivery of evidence-based psychosocial treatments for common psychogeriatric issues. This paper presents two case studies that illustrate when and how psychologists can use various ICT applications (e.g., tablet devices, web-based applications) integrated with cognitive behavioural and reminiscence-based therapies. Both case studies demonstrate that ICT can effectively support the therapeutic alliance, enhance therapeutic engagement, and individualize treatment delivery to accommodate the needs of elderly patients. It is hoped that these case studies will encourage clinicians to consider using ICT to augment therapy with their elderly patients.     

Subtypes of Adaptive and Maladaptive Perfectionism in Anorexia Nervosa: Associations with Eating Disorder and Affective Symptoms

Perfectionism is hypothesized to contribute to the etiology of anorexia nervosa (AN). However, there is little research regarding whether individuals with AN can be classified according to maladaptive (e.g., evaluative concerns) and adaptive (e.g., high personal standards) facets of perfectionism that predict distinct outcomes and might warrant different intervention approaches. In this study, a latent profile analysis was conducted using data from adults with AN (n?=?118). Frost Multidimensional Perfectionism Scale (Frost et al. Cognitive Therapy and Research, 14(5), 449–46, 1990) subscales were used to identify subgroups differing according to endorsed perfectionism features (e.g., adaptive and maladaptive perfectionism). Generalized linear models were used to compare subgroups on eating disorder and affective symptoms measured through questionnaire and ecological momentary assessment. Four subgroups were identified: (a) Low Perfectionism; (b) High Adaptive and Maladaptive Perfectionism; (c) Moderate Maladaptive Perfectionism; and (d) High Maladaptive Perfectionism. Subgroups differed on overall eating disorder symptoms (p?<?.001), purging (p?=?.005), restrictive eating (p?<?.001), and body checking (p?<?.001) frequency, depressive (p?<?.001) and anxiety (p?<?.001) symptoms, and negative (p?=?.001) and positive (p?<?.001) affect. The Low Perfectionism group displayed the most adaptive scores and the Moderate and High Maladaptive Perfectionism groups demonstrated the most elevated clinical symptoms. The High Adaptive and Maladaptive Perfectionism group demonstrated low affective disturbances, but elevated eating disorder symptoms. Results support the clinical significance of subtyping according to perfectionism dimensions in AN. Research is needed to determine if perfectionism subtyping can enhance individualized treatment targeting in AN.     

Changes in body image during cognitive-behavioral treatment in women with bulimia nervosa

The purposes of this study were: (1) to examine multidimensional aspects of body image of individuals with bulimia nervosa (BN) at pre-treatment, post-treatment, and at follow-up, compared to a group of participants without BN; and (2) to investigate whether measures of body image predicted outcome at post-treatment and follow-up. The clinical sample consisted of 109 females with BN who were enrolled in a 12-week cognitive-behavioral group treatment program. Participants were assessed at baseline, at the completion of treatment, and at 1- and 6-month follow-up visits. The 82 females who comprised the non-bulimic sample were assessed at comparable time intervals. At baseline, the participants with BN reported greater body dissatisfaction and overestimated body size to a significantly greater degree than the comparison group, and reported a significantly smaller ideal size relative to perceived size. Results at the end of treatment indicated significant improvement in self-reported attitudinal disturbance and size overestimation, with continued reductions at follow-up. Logistic regression analyses did not demonstrate a predictive relationship between body image measures at baseline and outcome at post-treatment or follow-up, or between post-treatment and follow-up. Implications for treatment include specifying the source of body image-related distress and enhancing treatment efforts for perceptual and attitudinal aspects of body image.     

Investigating the mechanisms of visually-evoked tactile sensations

When attempting to detect a near-threshold signal, participants often incorrectly report the presence of a signal, particularly when a stimulus in a different modality is presented. Here we investigated the effect of prior experience of bimodal visuotactile stimuli on the rate of falsely reported touches in the presence of a light. In Experiment 1, participants made more false alarms in light-present than light-absent trials, despite having no experience of the experimental visuotactile pairing. This suggests that light-evoked false alarms are a consequence of an existing association, rather than one learned during the experiment. In Experiment 2, we sought to manipulate the strength of the association through prior training, using supra-threshold tactile stimuli that were given a high or low association with the light. Both groups still exhibited an increased number of false alarms during light-present trials, however, the low association group made significantly fewer false alarms across conditions, and there was no corresponding group difference in the number of tactile stimuli correctly identified. Thus, while training did not affect the boosting of the tactile signal by the visual stimulus, the low association training affected perceptual decision-making more generally, leading to a lower number of illusory touch reports, independent of the light.