Dysfunctional Eating in an Australian Community Sample: The Role of Emotion Regulation,Impulsivity, and Reward and Punishment Sensitivity

This study aimed to examine the role of emotion regulation and reinforcement sensitivity in dysfunctional eating behaviours. Two hundred twenty‐eight adults from the Australian community completed self‐report inventories assessing the variables. Dysfunctional restrained eaters differed from those who did not engage in restrained eating in terms of their emotion regulation, impulsivity, and sensitivity to reward. Difficulties in emotion regulation, low impulsivity, and sensitivity to reward predicted engagement in restrained eating. Emotional eaters significantly differed from those who did not engage in dysfunctional levels of emotional eating in terms of their emotion regulation, impulsivity, and sensitivity towards reward, and difficulties in emotion regulation predicted emotional eating. Finally, dysfunctional external eaters differed from non‐dysfunctional external eaters in terms of their emotion regulation, impulsivity, sensitivity towards reward, as well as sensitivity towards punishment, and difficulties with emotion regulation and sensitivity towards reward predicted external eating. These findings highlight the importance of the inclusion of emotional functioning in models of development and maintenance of eating disorders, and support the potential implementation of treatment interventions that address emotion regulation and include strategies to cope with impulsivity and reinforcement sensitivities.     

IMPACT OF PARENTAL BINGE EATING DISORDER: EXPLORING CHILDREN'S EMOTIONAL/BEHAVIORAL PROBLEMS AND THE QUALITY OF PARENT–CHILD FEEDING INTERACTIONS

This study examines psychopathological problems in children of parents with binge eating disorder (BED), particularly the effect of parental diagnosis on their offspring's psychopathology and the mediating power of the quality of parent–infant feeding interactions. Two hundred parents and their offspring were administered a questionnaire for the assessment of their children's psychopathology at 18 (T1) and 36 (T2) months of age. An observational measure to evaluate feeding interactions was administered at T1. Children with both parents with BED showed the highest affective, anxiety, oppositional/defiant, and autism spectrum problems, but no influence of paternal diagnosis was found on the offspring's psychopathology. Maternal BED had an influence on children's affective and autism spectrum problems, and diagnosis of BED in both parents had an effect on infants’ affective problems. Paternal BED had an effect on oppositional/defiant problems through the quality of father–infant interactions, and maternal BED had an effect on the offspring's affective and anxiety problems through the mediation of mother–infant interactions. These results suggest the importance of intervention programs focusing both on parental psychopathology and on mother–child and father–child feeding interactions in families with parents with BED.     

Guided Recovery: An Interpretative Phenomenological Analysis of Service Users’ Experiences of Guided Self-Help for Bulimic and Binge Eating Disorders

The efficacy of Cognitive Behavioral Therapy–based Guided Self-Help for mild to moderate bulimia and binge eating disorders has been well supported. However, limited research has explored in-depth individual experiences of this treatment approach. In-depth semi-structured interviews were conducted with 4 individuals who had completed Cognitive Behavioral Therapy–based Guided Self-Help (CBT-GSH) for bulimic or binge eating disorders. The interviews were transcribed verbatim and subsequently analyzed using Interpretative Phenomenological Analysis (IPA). Three superordinate themes emerged: Autonomy and volition; A dynamic relationship: the guided and the guide; and The unwanted friend. The reciprocal nature of the guide/guided relationship was identified as integral to the success of the therapeutic approach. However, participants expressed initial uncertainty towards the therapeutic process, and experienced an uncomfortable dissonance between a lack of volition in therapy seeking and the need to continually self-prescribe CBT-GSH. The findings affirm the central role of the guide in promoting motivation to engage with therapy and highlight the potential benefits of in-session weighing. However, it may be necessary to provide additional support on commencing CBT-GSH to address concerns about the therapeutic approach in this group.     

Do shame and perfectionistic self-presentation explain the link between early affiliative memories and eating psychopathology?

This study tested a model examining the impact that early affiliative memories (both with family and peers) on eating psychopathology, and whether these links are carried by the mechanisms of external shame and body image-related perfectionistic self-presentation, in a sample of 480 female college students. Path analyses’ results revealed that this model accounted for 48% of disordered eating’s variance and suggests that the lack of early positive emotional memories is associated with higher levels of shame (feelings of inferiority and unattractiveness), and with higher tendency to adopt body image-related perfectionistic strategies, that seem to explain excessive eating concern and rigid control of one’s eating behaviors. This study offers important insights for future research and for the development of intervention programs, by revealing the importance of assessing and targeting shame and perfectionistic strategies and suggesting the importance of promoting adaptive emotion regulation strategies.     

Meta-analysis of the effects of cognitive-behavioral therapy on the core eating disorder maintaining mechanisms: implications for mechanisms of therapeutic change

The original and enhanced cognitive model of eating disorders proposes that cognitive-behavioral therapy (CBT) "works" through modifying dietary restraint and dysfunctional attitudes towards shape and weight. However, evidence supporting the validity of this model is limited. This meta-analysis examined whether CBT can effectively modify these proposed maintaining mechanisms. Randomized controlled trials that compared CBT to control conditions or non-CBT interventions, and reported dietary restraint and shape and weight concern outcomes were searched. Twenty-nine trials were included. CBT was superior to control conditions in reducing shape (g=0.53) and weight (g=0.63) concerns, and dietary restraint (g=0.36). These effects occurred across all diagnoses and treatment formats. Improvements in shape and weight concerns and restraint were also greater in CBT than non-CBT interventions (g's=0.25, 0.24, 0.31, respectively) at post-treatment and follow-up. The magnitude of improvement in binge/purge symptoms was related to the magnitude of improvement in these maintaining mechanisms. Findings demonstrate that CBT has a specific effect in targeting the eating disorder maintaining mechanisms, and offers support to the underlying cognitive model. If changes in these variables during treatment are shown to be causal mechanisms, then these findings show that CBT, relative to non-CBT interventions, is better able to modify these mechanisms.     

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.     

Selective processing of food,weight, and body-shape words in nonpatient women with bulimia nervosa: Interference on the Stroop task

The study investigated whether the Stroop interference effect could be found in nonpatients with a self-report consistent with a diagnosis of bulimia nervosa. The nonpatient bulimic group showed significantly more interference to disorder-specific words (food, weight, and body shape) than to control words. The two nonpatient comparison groups, a depressed-nonbulimic group and a nonbulimic-nondepressed group, showed no interference. These results indicate that nonpatients with bulimia nervosa can be used to test various models of the cognitive and emotional processes involved in bulimia nervosa with the modified Stroop task. Methodological issues in the use of the computerized Stroop task with clinical populations are also noted.     

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     

Eating Disorders—The Regulation of Positive as well as Negative Emotion Experience

Disordered eating behaviors are often conceptualized as maladaptive emotion regulation strategies. The present study investigated links between emotional experience, schematic belief systems, and psychological themes associated with eating disorders. In contrast to the majority of studies, which focus on just one or two emotions and use nonclinical samples, this study compared the full range of emotional experience in women with eating disorders to a control group. Measures used include the Differential Emotional Scale-IV, Youngs Early Maladaptive Schema Questionnaire, and Eating Disorder Inventory-2. The study provides the first empirical evidence that women diagnosed with eating disorders report experiencing pleasant as well as unpleasant emotions more frequently than do controls. A surprising finding was that pleasant emotions (joy, interest, surprise) correlated with eating disorder themes (EDI-2 subscales) more consistently than unpleasant emotions in the eating disorder group, while the reverse was true of the control group. Also of note, eating-disordered women reported significantly less anger and similar levels of fear vs. controls. While eating-disordered women scored more highly than do controls on all maladaptive schema (suggesting high levels of distress in women with eating disorders), the pattern of correlations between schema and emotion experience was distinctly different for each group and counterintuitive for the eating disorder group. In particular, pleasant emotion was highly correlated with maladaptive schema in the eating-disordered group but not in the control group. These marked group differences in the pattern of relationships between emotion experience, eating disorder themes, and belief systems suggest that it is not valid to draw conclusions about eating disorders from research that employs only nonclinical samples. The authors discuss these findings, and suggest that women with eating disorders are proficient at using disordered eating behaviors to manipulate their experience of both positive and negative emotional states, and that this dynamic should be recognized as an important maintenance factor.     

The Sporting Body: Body Image and Eating Disorder Symptomatology Among Female Athletes from Leanness Focused and Nonleanness Focused Sports

Female athletes experience pressure to conform to social and sporting norms concerning body weight. This study compared general and sporting body dissatisfaction and disordered eating symptomatology among 320 elite, recreational, and noncompetitive female athletes aged 17 to 30 years competing in leanness focused sports and nonleanness focused sports. Participants completed an online questionnaire including demographic questions, the Eating Attitudes Test, and the Figure Rating Scale. Athletes from leanness focused sports reported higher levels of body dissatisfaction and greater disordered eating symptomatology regardless of participation level. Elite athletes reported higher levels of body dissatisfaction and greater disordered eating symptomatology regardless of sport type, and differences between recreational and noncompetitive athletes were not found. More than 60% of elite athletes from leanness focused and nonleanness focused sports reported pressure from coaches concerning body shape. The findings have important implications for identifying risk factors for eating disorders among female athletes, where athletes who compete at elite level and those who compete in leanness focused sports at any level may be at higher risk for developing eating disorders.