An Examination of Psychosocial Correlates of Disordered Eating among Undergraduate Women

Multivariate analyses were used to compare key eating behavior, cognitive, affective, and body variables to determine the similarities and differences between eating-disordered, symptomatic, and asymptomatic female undergraduates. On the eating behavior (i.e., bulimic symptoms, concern for dieting, weight fluctuation), and some of the cognitive (i.e., impression management, approval by others, dichotomous thinking, self-control, rigid weight regulation, weight and approval) and body (i.e., concern with body shape, satisfaction with face) variables, the eating-disorder group reported the most severe symptoms, followed linearly by the symptomatic and asymptomatic groups. On the affective (i.e., sad, anxious, guilty, shameful, stressed, happy, confident, overall self-esteem) and the remaining cognitive (i.e., vulnerability, catastrophizing) and body (i.e., importance of being physically fit and being attractive, satisfaction with body) variables, the symptomatic and eating-disorder groups did not differ from one another but had higher levels of distress than did the asymptomatic women. These findings suggest that (1) counselors need to be aware that a large percentage of female undergraduates are nondiagnosable yet experience eating-disorder symptoms, and (2) these symptomatic women are experiencing high levels of distress, particularly in the areas of affect and body image.A version of this article was presented at the 110th Annual Convention of the American Psychological Association, Chicago, IL, August, 2002     

Developing a model of the treatment for eating disorder: Using neuroscience research to examine the how rather than the what of change

Treatments for eating disorders, in particular for people with anorexia nervosa, have often been adaptations of therapies designed for other conditions. Indeed, there is a move advocating the use of a transdiagnostic treatment approach in which general module based treatments are mixed together as needed rather than using a specific anorexia nervosa targeted strategy. The outcome of treatment is relatively poor, especially for those who for some reason do not have the benefit of an expert form of early intervention for anorexia nervosa. Technological advances in the neurosciences and genetics have radically altered how eating disorders and in particular anorexia nervosa have been conceptualised. In this paper we describe evidence that suggests that key aspects of the social information processing network both the cognitive and affective elements may be anomalous in people with anorexia nervosa. This has implications for models of treatment which can be tailored more directly to these causal and or maintaining factors. We describe the Maudsley method of working with adults with anorexia nervosa which has integrated these elements. This treatment approach includes working with the individual to develop a more flexible and holistic cognitive style with greater emotional intelligence. This is supplemented with work with the families to interrupt interactions that either accommodate to or aggravate the symptoms. Thus we are now in the position to understand and work to change how people with anorexia nervosa think and behave rather than focusing on what people think and say they do. Our prediction is that treatments that focus more directly on aetiology such as the intrapersonal and interpersonal maintaining factors will improve outcome.     

Characteristics of Dieting and Nondieting Adolescents in a Psychiatric Inpatient Setting

  The clinical and psychosocial characteristics of 239 dieting and nondieting adolescents (61% female; mean age=15.3) recruited from an inpatient psychiatric setting were examined. Dieting adolescents were compared to nondieting adolescents on exercise frequency, weight control behaviors, risky behaviors, psychiatric comorbidity and distress, eating disorder symptomatology, smoking, coping, and family factors. While dieters did not statistically differ from nondieters on scores of body mass index, dieting youth reported greater levels of self-reported distress, poorer coping, greater eating disorder symptomatology, and were more likely to engage in extreme weight control behaviors. In addition, dieting was associated with higher rates of major depression (58% vs 34%) and eating disorders (14% vs 1%). Among adolescent smokers, dieters endorsed smoking as a weight control behavior. Engaging in risky behaviors or familial factors did not differentiate dieters from nondieters. Given the number of negative correlates associated with dieting in adolescents, identifying dieting and weight control behaviors in clinical settings may prove to be an effective strategy in the development of prevention and intervention efforts for youth.     

Caregiver burden and family functioning in different neurological diseases

Aim of this study is to examine caregiver burden and family functioning in different neurological conditions. Forty-two primary caregivers of patients with Amyotrophic Lateral Sclerosis (ALS), Alzheimer’s Disease and other dementia (AD), Parkinson’s Disease (PD), Acquired Brain Injuries (ABI) and Multiple Sclerosis (MS) were administered scales for the evaluation of caregiver burden (CBI) and family functioning (FACES IV). Caregiver burden was overall high, with caregivers of patients with ALS and ABI having exceeded the CBI cut-off score for possible burn-out. The average scores of caregivers of patients with AD or other dementia and PD were close to the cut-off score, whereas those of caregivers of patients with MS were significantly lower than the others. Family cohesion, family satisfaction and the quality of family communication were associated with reduced levels of caregiver burden, whereas disengagement was associated with a higher burden. The data from the present study confirm that caregiver burden is a relevant issue in the context of neurological diseases, especially for those causing higher degrees of impairment. Significant correlations with family functioning emerged as well, highlighting the importance of studying and treating caregiver burden within the context of family relations.     

Do eating disorder voice characteristics predict treatment outcomes in anorexia nervosa? A pilot study

Individuals with anorexia nervosa often describe experiencing an internal “voice” of their disorder, which previous research has associated with multiple dimensions of eating pathology. This pilot study examined whether eating disorder measures use invoice characteristics at the outset of outpatient therapy predicted changes in disordered eating over the course of treatment. Participants were 14 individuals meeting ICD-10 criteria for anorexia nervosa. Participants completed measures relating to the severity of disordered eating and voice-related characteristics (perceived voice power and metacognitive appraisals about its nature) at the start and end of therapy. Results indicated that the perceived power of the eating disorder was reduced over the course of outpatient therapy, although its other characteristics remained stable. Greater levels of voice power, omnipotence and benevolence at the outset of therapy were related to greater improvements in eating attitudes. No voice-related characteristics were associated with changes in weight. These findings suggest that voice-related appraisals do not obstruct the effectiveness of outpatient therapies for anorexia nervosa. Further studies are needed to ratify these preliminary findings.     

Meta-analysis of the effects of third-wave behavioural interventions on disordered eating and body image concerns: implications for eating disorder prevention

Third-wave behavioural interventions are increasingly popular for treating and preventing mental health conditions. Recently, researchers have begun testing whether these interventions can effectively targeting eating disorder risk factors (disordered eating, body image concerns). This meta-analysis examined whether third-wave behavioural interventions (acceptance and commitment therapy; dialectical behaviour therapy; mindfulness-based interventions; compassion-focused therapy) show potential for being effective eating disorder prevention programs, by testing their effects on eating disorder risk factors in samples without an eating disorder. Twenty-four studies (13 randomized trials) were included. Most studies delivered selective prevention programs (i.e. participants who reported elevated risk factor). Third-wave interventions led to significant pre–post (g = 0.59; 95% CI = 0.43, 0.75) and follow-up (g = 0.83; 95% CI = 0.38, 1.28) improvements in disordered eating, and significant pre–post improvements in body image (g = 0.35; 95% CI = 0.13, 0.56). DBT-based interventions were associated with the largest effects. Third-wave interventions were also significantly more efficacious than wait-lists (g = 0.39; 95% CI = 0.09, 0.69) in reducing disordered eating, but did not differ to other interventions (g = 0.25; 95% CI = –0.06, 0.57). Preliminary evidence suggests that third-wave interventions may have a beneficial effect in ameliorating eating disorder risk.     

Women’s regulation styles for eating behaviors and outcomes: The mediating role of approach and avoidance food planning

The purpose of this article was to examine the role played by different orientations in planning for eating behaviors as mediators of the relationship between regulation styles and eating behaviors. In Study 1, a new scale was developed to assess approach food planning and avoidance food planning. Results from confirmatory analyses (N = 241) supported the two-factor structure of the scale. In Study 2 (N = 202), in agreement with past research on the effects of autonomous and controlled motivation for the regulation of eating behaviors, we found that approach food planning partially mediated the effects of autonomous regulation for eating behaviors on healthy eating behaviors, while avoidance food planning partially mediated the effects of controlled regulation for eating behaviors on dysfunctional eating behaviors. Implications of these results for self-determination theory and for promoting healthy eating behaviors are discussed.

限制性饮食者对食物线索的注意偏向：基于目标矛盾理论模型

采用点探测变式探讨了120名成功和失败女性限制性饮食者对两类食物线索的注意偏向机制。结果发现, 当只启动享乐目标时, 成功的限制者存在对美味食物线索的注意回避, 失败的限制者存在对美味食物线索的注意脱离困难; 当相继启动享乐目标和节食目标时, 成功和失败两类限制者均存在对美味食物线索的注意回避, 但失败者仍然存在注意脱离困难。从目标矛盾模型理论对实验结果进行了讨论。     

西方家庭影响进食障碍的研究述评

家庭是进食障碍发展过程中一个重要的影响因素。已有众多西方学者采用各种方法对进食障碍和家庭之间的关系进行了研究。从时间发展脉络来看, Minuchin等学者首先对此进行了经典临床研究; 随后有众多量化研究出现, 对此可以依据不同的测量水平、研究变量和被试视角进行梳理; 近些年, 有学者采用质化研究方法重新对此进行探讨。进食障碍家庭研究的发展趋势表现出：重视本土化研究、对家庭做多水平的探讨、兼顾家庭结构和家庭变化过程。     

Subtyping children and adolescents with loss of control eating by negative affect and dietary restraint

OBJECTIVE: Research suggests that subtyping adults with binge eating disorders by dietary restraint and negative affect predicts comorbid psychopathology, binge eating severity, and treatment outcome. Little research has explored the validity and clinical utility of subtyping youth along these dimensions. METHOD: Children (aged 8-18 years) reporting loss of control eating (n=159) were characterized based upon measures of dietary restraint and negative affect using cluster analysis, and then compared regarding disordered eating attitudes and behaviors, and parent-reported behavior problems. RESULTS: Robust subtypes characterized by dietary restraint (n=114; 71.7%) and dietary restraint/high negative affect (n=45; 28.3%) emerged. Compared to the former group, the dietary restraint/high negative affect subtype evidenced increased shape and weight concerns, more frequent binge eating episodes, and higher rates of parent-reported problems (all ps<0.05). CONCLUSION: Similar to findings from the adult literature, the presence of negative affect may mark a more severe variant of loss of control eating in youth. Future research should explore the impact of dietary restraint/negative affect subtypes on psychiatric functioning, body weight, and treatment outcome.