Size of drawings influences body size estimates by women with and without eating concerns

Research has inconsistently shown that women, particularly those with eating concerns, inaccurately estimate their body size. In the present study, drawings of female bodies, ranging from emaciated to obese, were presented to women with and without eating concerns. Drawings approximated the women's actual height or were reduced (15.7 cm). Women selected the drawing that represented how they thought they looked (cognitive rating), felt they looked (affective rating), and would like to look (desired rating). Women tended to select larger drawings when reduced-size drawings were used. Participants with eating concerns overestimated their body size and were more dissatisfied with their body size than participants without eating concerns. Size of drawings and the presence of eating concerns did not affect ratings of the size of a neutral object. Women did not demonstrate a generalized problem in estimating size. Overestimation of body size may be exaggerated in research that used reduced-size drawings.     

The measurement of impairment due to eating disorder psychopathology

Eating disorders have a profound and highly specific impact on psychosocial functioning. The aim of this research was to develop a measure of such secondary impairment. A 16-item, self-report instrument was developed, the Clinical Impairment Assessment (CIA), which was designed to measure such impairment overall and in three specific domains (personal, cognitive, social). The psychometric properties of the instrument were evaluated using data collected in the context of a transdiagnostic treatment trial. The findings consistently supported the utility of the instrument with the CIA being shown to have high levels of internal consistency, construct and discriminant validity, test-retest reliability, and sensitivity to change. The CIA should be of value to clinicians when assessing patients with eating disorders and their response to treatment. It should also help inform epidemiological research.     

The severity and status of eating disorder NOS: implications for DSM-V

"Eating disorder NOS" is the most common eating disorder encountered in outpatient settings yet it has been neglected. The aim of this study was to describe the characteristics of eating disorder NOS, establish its severity, and determine whether its high relative prevalence might be due to the inclusion of cases closely resembling anorexia nervosa or bulimia nervosa. One hundred and seventy consecutive patients with an eating disorder were assessed using standardised instruments. Operational DSM-IV diagnoses were made and eating disorder NOS cases were compared with bulimia nervosa cases. Diagnostic criteria were then adjusted to determine the impact on the prevalence of eating disorder NOS. Cases of eating disorder NOS comprised 60.0% of the sample. These cases closely resembled the cases of bulimia nervosa in the nature, duration and severity of their psychopathology. Few could be reclassified as cases of anorexia nervosa or bulimia nervosa. The findings indicate that eating disorder NOS is common, severe and persistent. Most cases are "mixed" in character and not subthreshold forms of anorexia nervosa or bulimia nervosa. It is proposed that in DSM-V the clinical state (or states) currently embraced by the diagnosis eating disorder NOS be reclassified as one or more specific forms of eating disorder.     

Habitual starvation and provocative behaviors: Two potential routes to extreme suicidal behavior in anorexia nervosa

Anorexia nervosa (AN) is perhaps the most lethal mental disorder, in part due to starvation-related health problems, but especially because of high suicide rates. One potential reason for high suicide rates in AN may be that those affected face pain and provocation on many fronts, which may in turn reduce their fear of pain and thereby increase risk for death by suicide. The purpose of the following studies was to explore whether repetitive exposure to painful and destructive behaviors such as vomiting, laxative use, and non-suicidal self-injury (NSSI) was a mechanism that linked AN-binge-purging (ANBP) subtype, as opposed to AN-restricting subtype (ANR), to extreme suicidal behavior. Study 1 utilized a sample of 787 individuals diagnosed with one or the other subtype of AN, and structural equation modeling results supported provocative behaviors as a mechanism linking ANBP to suicidal behavior. A second, unexpected mechanism emerged linking ANR to suicidal behavior via restricting. Study 2, which used a sample of 249 AN patients, replicated these findings, including the second mechanism linking ANR to suicide attempts. Two potential routes to suicidal behavior in AN appear to have been identified: one route through repetitive experience with provocative behaviors for ANBP, and a second for exposure to pain through the starvation of restricting in ANR.     

Body Poly-texts: Discourses of the Anorexic Body

It is now increasingly acknowledged that anorexia nervosa is a ‘culture-bound syndrome’ which must be understood within the context of an increasing idealization of female thinness and a high prevalence of dieting and body dissatisfaction, particularly amongst women and girls. Whilst this socioculturally-oriented perspective is important, it is also simplistic to conceptualize anorexia simply as a ‘slimmer's disease’. The ways in which contemporary Western culture is imbricated in anorexia are both complex and multiple. This paper uses a discourse-analytic approach, informed by feminist Foucauldian theory, to examine some of the multiple and often conflicting meanings and discursive constructions of the (female) anorexic body. The paper is based on a series of interviews conducted with 23 women (21 diagnosed as anorexic and 2 self-diagnosed). The analysis focuses on the explication of two discourses: a romantic discourse and a discourse of Cartesian dualism evidenced in the interviews. By contrasting the very different ways in which these two discourses constitute the anorexic body, this paper aims to provide thereby a socioculturally contextualized and gender-oriented account of the multiple discursive constructions of ‘anorexia nervosa’ and ‘anorexic’ bodies. Implications for psychotherapeutic interventions are discussed.     

Fast screening of eating disorders among patients with bipolar disorder: Validation of the French version of BEDS questionnaire

IntroductionThe prevalence and morbidity of eating disorders (ED) is high in patients with bipolar disorder (BD). Simple tools are necessary to easily and rapidly screen for ED in bipolar patients.ObjectiveThe aim of this study was to validate the French version of Bipolar Eating Disorder Scale (BEDS-F).MethodED and BD diagnoses were established with a structured-interview in 80 patients according to the DSM-IV criteria. The BEDS was translated into French using appropriate methods. Patients were administered the following scales: BEDS-F, SCOFF, Bulimic Investigatory Test Edinburgh (BITE) and Eating Disorder Inventory-two (EDI-2).ResultsBEDS-F score were significantly higher in bipolar patients with ED. The BEDS-F showed high feasibility (no omission response), excellent discriminating abilities (ROC AUC = 0.97) with a sensibility of 98% and specificity of 85% for BEDS ≥ 11, high internal consistency (Cronbach's alpha coefficient = 0.86) and test-retest reliability (ICC = 0.99). No floor/ceiling effect was observed. The BEDS-F sensitivity was equivalent to that of the BITE and EDI-2 subscale B. The BEDS-F specificity was slightly lower than that of the EDI-2 subscale B, but equivalent to that of BITE.ConclusionThe BEDS-F is a valid scale for fast ED screening in patients with bipolar disorder, and easier to administer than other currently used scales.     

Validation and predictive utility of the Sociocultural Attitudes Toward Appearance Questionnaire for Eating Disorders (SATAQ-ED): internalization of sociocultural ideals predicts weight gain

A widely used measure of societal influences on body image and eating disturbances—the Sociocultural Attitudes Toward Appearance Questionnaire (SATAQ) was validated in women with eating disorders. The original SATAQ and measures of convergence and divergence were administered to 165 eating disordered inpatients. Factor analyses were conducted to determine the underlying structure of the SATAQ. Convergent validity, diagnostic category norms and the predictive utility of the revised SATAQ were examined. Factor analyses indicated three factors: Internalization, Awareness, and Success. Internalization significantly predicted treatment success after controlling for admission BMI and drive for thinness. The revised SATAQ-ED measures multiple aspects of societal influence, predicts short-term outcome, and can be a useful tool for evaluating potential outcome and treatment efficacy.     

Body representations and cognitive ontology: Drawing the boundaries of the body image

The distinction between body image and body schema has been incredibly influential in cognitive neuroscience. Recently, researchers have begun to speculate about the relationship between these representations (Gadsby, 2017, 2018; Pitron & de Vignemont, 2017; Pitron et al., 2018). Within this emerging literature, Pitron et al. (2018) proposed that the long-term body image and long-term body schema co-construct one another, through a process of reciprocal interaction. In proposing this model, they make two assumptions: that the long-term body image incorporates the spatial characteristics of tools, and that it is distorted in the case of Alice in wonderland syndrome. Here, I challenge these assumptions, with a closer examination of what the term “long-term body image” refers to. In doing so, I draw out some important taxonomic principles for research into body representation.     

Experiences of Patients in Cognitive Behavioural Group Therapy: A Qualitative Study of Eating Disorders

The aim of this study was to investigate whether there was a difference in skin conductance response between 2 groups of military personnel when exposed to emotionally neutral and charged stimuli. The 2 groups were a combat experience group (n?=?10) with prior experience of emotionally charged war situations and a comparison group (n?=?10) with no such experience. Results showed that the comparison group reacted more strongly to exposure to both charged and neutral pictures than did the combat experience group, regardless of exposure time. The results are discussed in terms of emotional numbing and differences in anxiety state between the 2 groups.     

Eating disorder examination questionnaire and clinical impairment assessment questionnaire: general population and clinical norms for young adult women in Sweden

Optimal use of assessment instruments for the detection and diagnosis of eating disorders (ED) depends on the availability of normative data. The aim of this work was to, for the first time, collect norms for both the Eating Disorder Examination Questionnaire (EDE-Q) and the newly developed Clinical Impairment Assessment (CIA) Scale from a general population of young women in Sweden, as well as from a clinical population of ED patients in Sweden. Participants were composed of both a randomized sample from the general population of women aged 18–30 years (N = 760) as well as from a clinical population aged 18–66 years (N = 2383). Data for the clinical population was extracted from the Stepwise database. Mean scores, standard deviations and percentile ranks for the global for the EDE-Q (as well as its subscales) and the CIA are presented. Prevalence figures of key eating disorder behaviors are also reported. Comparisons are made between the results in the present study with other existing normative studies on the EDE-Q and the CIA. The present study contributes to improving the accuracy of the interpretation of scores of the widely used self-report measure of ED, the EDE-Q, and the CIA, both of which play important roles in for diagnosis, prevention and intervention of ED.