Journal of Eating Disorders - Latest Articles

Attitudinal and perceptual factors in body image distortion: an exploratory study in patients with anorexia nervosa

Amanda Waldman — 2013-05-03T00:00:00Z

Background: Body image disturbance is a core feature of anorexia nervosa (AN). Attitudinal and cognitive biases as well as fundamental perceptual differences have been hypothesized to play a role in this disturbance.MethodThis study investigated body image dissatisfaction and distortion, haptic perception and perfectionism in 30 patients with AN and 31 age-matched healthy controls. Participants completed perceptual tasks and self-report measures. Results: As predicted, participants with AN scored significantly higher on body dissatisfaction, perfectionism measures and had greater body distortion (as assessed by a body size estimation task). Cognitive–affective factors and perfectionism were highly correlated with body image distortion in AN. No significant differences were found between groups on the generic perception task. Conclusions: Findings did not confirm the hypothesis of fundamental perceptual inefficiencies in body image disturbance in individuals with AN. Despite renewed interest in fundamental perceptual factors implicated in body image disturbance, these findings suggest that it continues to be important to focus treatment on cognitive affective biases versus fundamental perceptual inefficiencies.

The relationship between obsessive-compulsive personality disorder traits, obsessive-compulsive disorder and excessive exercise in patients with anorexia nervosa: a systematic review

Sarah Young — 2013-05-02T00:00:00Z

ObjectiveObsessive-compulsive personality disorder (OCPD) traits and obsessive-compulsive disorder (OCD) are commonly associated with patients with Anorexia Nervosa (AN). The aim of this review was to systematically search the literature to examine whether OCPD and OCD are positively associated with excessive exercise in patients with AN.MethodA systematic electronic search of the literature (using PsycInfo, Medline and Web of Knowledge) was undertaken to identify relevant publications until May 2012. Results: A total of ten studies met criteria for inclusion in the review. The design of the studies varied from cross-sectional to retrospective and quasi-experimental. Seven out of the ten studies reviewed demonstrated a positive relationship between OCPD and/or OCD in AN patients who exercise excessively, whilst three studies found a lack of relationship, or a negative relationship, between these constructs. Conclusion: There is evidence from the literature to suggest that there is a positive relationship between OCPD and excessive exercise in patients with AN. However, the relationship between OCD and excessive exercise is less clear and further research is required to qualify the strength of such relationships. Future research should utilise the most comprehensive and reliable clinical assessment tools, and address prognostic factors, treatment factors and specific interventions for patients with OCPD and/or OCD and excessive exercise.

Disordered eating and the muscular ideal

Scott Griffiths — 2013-04-25T00:00:00Z

Letter to the editor, so I thought that no abstract would be required. Please clarify if this is not the case. Also, the field on our website which asks you to choose the subject area to which your manuscript is primarily relevant does not contain psychology-related areas (it seems to contain mostly biology-related areas), so I chose Neuroscience.

Score reliability and factor similarity of the Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3) among four ethnic groups

Cortney Warren — 2013-04-22T00:00:00Z

Background: This study evaluated the score reliability and equivalence of factor structure of the Sociocultural Attitudes towards Appearance Questionnaire-3 (SATAQ-3) 1 in a sample of female college students from the four largest ethnic groups in the USA. Methods: Participants were 1245 women who self-identified as European American/White (n = 543), African American/Black (n = 137), Asian American (n = 317), or Latina/Hispanic (n = 248). All completed the SATAQ-3 and a demographic questionnaire. To test the factor similarity and score reliability across groups, we used exploratory factor analysis and calculated Cronbach’s alphas (respectively). Results: Score reliability was high for all groups. Tests of factor equivalence suggested that the four pre-established factors of the SATAQ-3 (i.e., knowledge, perceived pressure, thin-ideal internalization, athletic-ideal internalization) were similar for women of all ethnic groups. Only two items (20 and 27) did not consistently load on the previously identified scale across all four groups. When scored, African Americans reported significantly less perceived pressure and internalization than all other groups. Conclusions: Results support the use of the SATAQ-3 in female college students of these four ethnicities.

The cognitive-interpersonal maintenance model of anorexia nervosa revisited: a summary of the evidence for cognitive, socio-emotional and interpersonal predisposing and perpetuating factors

Janet Treasure — 2013-04-15T00:00:00Z

AimTo describe the evidence base relating to the Cognitive-Interpersonal Maintenance Model for anorexia nervosa (AN). Background: A Cognitive-Interpersonal Maintenance Model maintenance model for anorexia nervosa was described in 2006. This model proposed that cognitive, socio-emotional and interpersonal elements acted together to both cause and maintain eating disorders.MethodA review of the empirical literature relating to the key constructs of the model (cognitive, socio-emotional, interpersonal) risk and maintaining factors for anorexia nervosa was conducted. Results: Set shifting and weak central coherence (associated with obsessive compulsive traits) have been widely studied. There is some evidence to suggest that a strong eye for detail and weak set shifting are inherited vulnerabilities to AN. Set shifting and global integration are impaired in the ill state and contribute to weak central coherence. In addition, there are wide-ranging impairments in socio-emotional processing including: an automatic bias in attention towards critical and domineering faces and away from compassionate faces; impaired signalling of, interpretation and regulation of emotions. Difficulties in social cognition may in part be a consequence of starvation but inherited vulnerabilities may also contribute to these traits. The shared familial traits may accentuate family members’ tendency to react to the frustrating and frightening symptoms of AN with high expressed emotion (criticism, hostility, overprotection), and inadvertently perpetuate the problem. Conclusion: The cognitive interpersonal model is supported by accumulating evidence. The model is complex in that cognitive and socio-emotional factors both predispose to the illness and are exaggerated in the ill state. Furthermore, some of the traits are inherited vulnerabilities and are present in family members. The clinical formulations from the model are described as are new possibilities for targeted treatment.

Resumption of menses in anorexia nervosa during a course of family-based treatment

Julianne Faust — 2013-04-08T00:00:00Z

Background: The resumption of menses (ROM) is considered an important clinical marker in weight restoration for patients with anorexia nervosa (AN). The purpose of this study was to examine ROM in relation to expected body weight (EBW) and psychosocial markers in adolescents with AN. Methods: We conducted a retrospective chart review at The University of Chicago Eating Disorders Program from September 2001 to September 2011 (N = 225 females with AN). Eighty-four adolescents (Mean age = 15.1, SD = 2.2) with a DSM-IV diagnosis of AN, presenting with secondary amenorrhea were identified. All participants had received a course of outpatient family-based treatment (FBT), i.e., ~20 sessions over 12 months. Weight and menstrual status were tracked at each therapy session throughout treatment. The primary outcome measures were weight (percent of expected for sex, age and height), and ROM. Results: Mean percent EBW at baseline was 82.0 (SD = 6.5). ROM was reported by 67.9% of participants (57/84), on average at 94.9 (SD = 9.3) percent EBW, and after having completed an average of 13.5 (SD = 10.7) FBT sessions (~70% of standard FBT). Compared to participants without ROM by treatment completion, those with ROM had significantly higher baseline Eating Disorder Examination Global scores (p = .004) as well as Shape Concern (p < .008) and Restraint (p < .002) subscale scores. No other differences were found. Conclusions: Results suggest that ROM occur at weights close to the reference norms for percent EBW, and that high pre-treatment eating disorder psychopathology is associated with ROM. Future research will be important to better understand these differences and their implications for the treatment of adolescents with AN.

Masculinity and femininity in the divergence of male body image concerns

Stuart Murray — 2013-03-28T00:00:00Z

Background: Given recent assertions suggesting that gender role endorsement may be relevant in the divergence of male body image concerns, this study examined the self-reported gender role endorsement in opposing dimensional extremes of male body image disorders, namely, muscle dysmorphia and anorexia nervosa. This study further examined the relationship between gender role endorsement and eating disordered and muscle dysmorphia disorder pathology.MethodologyParticipants were 21 male muscle dysmorphia patients, 24 male anorexia nervosa patients, and 30 male gym-using controls from Australia, the United Kingdom, and the United States. All participants completed multidimensional measures of masculinity and femininity, and measures of eating disorder and muscle dysmorphia symptomatology. Results: Patients with muscle dysmorphia reported significantly elevated adherence to masculine (but not feminine) norms relative to control gym-using men and men with anorexia nervosa, whereas patients with anorexia nervosa exhibited elevated feminine (but not masculine) gender role endorsement relative to control gym-using men and men with muscle dysmorphia. Conclusions: Masculine and feminine gender role endorsement appear to be associated with the divergence of body image concerns towards muscularity and thinness-oriented ideals respectively.

Reducing self-objectification: are dissonance-based methods a possible approach?

Carolyn Becker — 2013-03-19T00:00:00Z

Background: Previous research has documented that self-objectification is associated with numerous negative outcomes including body shame, eating disorder (ED) pathology, and negative affect. This exploratory open study investigated whether or not an evidence-based body image improvement program that targets thin-ideal internalization in university women also reduces self-objectification. A second aim of the study was to determine if previous findings showing that body shame mediated the relationship between self-objectification and eating disorder pathology at a single time point (consistent with self-objectification theory) but did not mediate longitudinally (inconsistent with self-objectification theory) would be replicated in a new sample under novel conditions. Methods: Ninety-six university women completed a peer-led dissonance-based intervention, along with assessment measures at pre-, post-intervention, 8-week and 8-month follow-up. To address the open trial nature of this study, a planned manipulation check was included to make sure that peer-led dissonance decreased thin-ideal internalization, body dissatisfaction, eating disorder pathology, and negative affect with effect sizes being similar to past randomized controlled trials. We hypothesized that all three subscales of the Objectified Body Consciousness Scale (i.e., self-surveillance, body shame, and appearance control beliefs) would be reduced. In addition, we hypothesized that body shame would mediate the relationship between self-objectification (i.e., self-surveillance) and eating disorder pathology at a both at a single time point and longitudinally. Results: The planned manipulation check supported the interpretation that peer-led dissonance in this study largely yielded comparable changes to past controlled trials. In terms of changes in dependent variables, results supported all hypotheses with the exception of body shame, which remained unchanged. With regards to the mediation analyses, our first (cross-sectional) hypothesis but not our second (longitudinal) was supported. Conclusions: Findings provide preliminary support for the use of dissonance interventions in reducing self-surveillance and body control beliefs. Results for body shame and the mediation analyses suggest that greater scrutiny of the body shame construct is warranted.

Enhancing quality of life in people with disordered eating using an online self-help programme

Sau Leung — 2013-03-11T00:00:00Z

Background: Eating disorders are serious mental illnesses that have a significant effect on afflicted individuals’ quality of life. Evidence has shown that they can be improved with treatment. Internet-based interventions are useful in engaging individuals with eating disorders in self-management and treatment. This study aimed primarily to identify the change in quality of life of individuals with disordered eating after participating in an open trial of an Internet-based self-help programme, and compared their quality of life at assessment with that of healthy controls. Factors affecting their quality of life were examined. Secondary outcomes related to symptom improvement were also reported. Methods: This study included 194 individuals with disordered eating and 50 healthy controls. The former group was recruited from eating disorder outpatient clinics and treatment units, as well as via information disseminated through various Internet websites, while the healthy controls were recruited from university student newspapers and university campuses. The Medical Outcomes Study Short Form Survey (SF-36v2) was used to assess participants’ quality of life. Other measures were used to assess their symptoms and motivational stages of change to recover from an eating disorder. The Wilcoxon signed ranks test and one-way repeated measures ANOVA were used to identify the change in quality of life of individuals with disordered eating from baseline to 1-, 3- and 6-month follow-ups. The Mann–Whitney U test was employed to compare the difference in quality of life between participants with disordered eating and the healthy controls. Spearman rank order correlations were performed to examine the factors associated with quality of life. Results: The participants with disordered eating had significantly poorer quality of life than the healthy controls in both physical and psychological domains. The factors associated with their poor quality of life included dieting behaviour, use of laxatives, severe eating disorder psychopathology, depression and anxiety. Over a six-month follow-up period, a significant number of participants engaged in self-help behaviours using the Internet-based programme. They experienced improvements in their quality of life, eating disorder psychopathology, depression severity, anxiety level and motivational stages of change. Conclusions: Internet-based self-help programmes have the potential to enhance quality of life in individuals with disordered eating and could be useful adjuncts to professional treatment.

DSM-5: problems and suggestions

Andreas Birgegård — 2013-02-25T00:00:00Z

The upcoming DSM5 will impact clinical work and research substantially, and we here point to a few problems that may have been overlooked. These concern inconsistencies and lack of clarity, and the future “not elsewhere classified” atypical anorexia nervosa category. We propose solutions in the form of working definitions and operationalizations to facilitate clinical implementation as well as streamline research.