Clinical Eating Disorders Research Articles

The influence of non-clinical eating-related psychopathology on the recognition of emotion from static faces and realistic social interactions

Emotion recognition deficits have consistently been reported in clinical and sub-clinical disordered eating. However, most studies have used static faces, despite the dynamic nature of everyday social interactions. The current aims were to confirm previous findings of emotion recognition deficits in non-clinical disordered eating and to determine if these deficits would be more evident in response to static as compared to dynamic emotional stimuli. We also aimed to establish if these emotion recognition deficits could be explained by comorbid psychopathology (depression, anxiety or alexithymia). Eighty-nine females were assigned to groups based on scores on the Eating Disorders Inventory (EDI); high (n = 45) and low (n = 44). Participants were presented with emotional faces and video clips portraying fear, anger, disgust, sadness, happiness, surprise and neutral affect. As predicted, the high EDI group correctly recognised fewer emotional displays than did the low EDI group. However, this deficit was not more evident for negative as opposed to positive emotions. Furthermore, the deficit was not larger for static stimuli in comparison to dynamic. Overall emotion recognition accuracy was negatively associated with Drive for Thinness, but not Bulimia or Body Dissatisfaction. Importantly, the emotion recognition deficits observed in the high EDI group and that were associated with eating disorder symptoms were independent of depression, anxiety and alexithymia. Findings confirm that even minor elevations in disordered eating are associated with poorer emotion recognition. This is important, as problems in recognition of the emotional displays of others are thought to be a risk factor for clinical eating disorders.

Disordered eating behaviors among adolescent patients with type I diabetes mellitus

Background Clinical and subclinical eating disorders (EDs) are common in adolescents with type I diabetes. Diabetes is associated with a high prevalence of risk factors for EDs such as high BMI, depression, low self-esteem, and anxiety. Aim This work aimed to study the prevalence of abnormal eating behaviors in adolescent patients with type I diabetes mellitus, and its association with depressive and anxiety symptoms. Patients and methods Seventy-five patients were recruited from the Endocrinology and Diabetes Clinic at Kasr Al Ainy Hospital. Eating Disorders Examination Questionnaire and Diabetes Eating Problem Survey were used to screen for abnormal eating behaviors. The diagnosis was checked using the criteria for EDs according to the fifth ed. of the Diagnostic and Statistical Manual of Mental Disorders. Subsequent assessments for depression and anxiety were performed using the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale, respectively. Results Disordered eating behaviors (DEB) were found in 34.7% of the study group; all were diagnosed with EDs not otherwise specified. Fifty percent of the participants had depressive symptoms and 54% had anxiety symptoms. Conclusion DEBs were found in adolescent patients with type I diabetes. Depression and anxiety were found in nearly half of the patients with DEBs.

Biases in attention and memory for body shape images in eating disorders.

To investigate attentional and memorial biases towards body shape pictures among female patients with clinical eating disorders and healthy female controls. A visual dot-probe task was used to assess attention towards pictures reflecting either a thin, normal, or obese female body shape. Pictures were presented in pairs; each pair depicted two different body shapes and were presented twice. Participant responses were compared across time and population. Overall, the eating disorder patients responded more slowly than controls, F(1,63) = 20.32, p < .001. Both groups showed an attentional bias towards the larger of two body shapes, F(1,63) = 4.30, p = .04, and responded more quickly the second time they viewed the picture pairs, F(1,63) = 33.80, p < .001. Upon second viewing of picture pairs, the eating disorder patients had a larger decrease in reaction time (86ms) than the control sample (33ms) only when both pictures included extreme body shapes (thin and obese); the decrease in reaction time when one of the pictures included a normal body shape was the same across groups upon second viewing (eating disorder: 37ms; control: 32ms), F(1,63) = 9.32, p = .003. These findings suggest that individuals with eating disorders may be biased towards recall of dichotomous and/or extreme body shape images. While it remains unclear whether attentional and/or memorial bias is a risk, maintenance, or causal factor in eating disorders, future studies should employ longitudinal, prospective research designs to address these questions. Level II, comparative study.

Replication of a Modified Factor Structure for the Eating Disorder Examination-Questionnaire: Extension to Clinical Eating Disorder and Non-clinical Samples in Portugal.

Psychometric investigations of the Eating Disorder Examination-Questionnaire (EDE-Q) have generally not supported the original scale structure. The present study tested an alternative brief factor structure in two large Portuguese samples: (1) a non-clinical sample of N = 4117 female students and (2) a treatment-seeking sample of N = 609 patients diagnosed with eating disorders. Confirmatory factor analysis revealed a poor fit for the original EDE-Q structure in both the non-clinical and the clinical samples but revealed a good fit for the alternative 7-item 3-factor structure (dietary restraint, shape/weight overvaluation and body dissatisfaction). Factor loadings were invariant across samples and across the different specific eating disorder diagnoses in the clinical sample. These confirmatory factor analysis findings, which replicate findings from studies with diverse predominately overweight/obese samples, supported a modified 7-item, 3-factor structure for the EDE-Q. The reliable findings across different non-clinical and clinical eating disorder groups provide confidence regarding the potential utility of this brief version. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Children Exposed to Marital Conflict Exhibit More Disordered Eating Behaviors: Child Emotional Insecurity and Anxiety as Mechanisms of Risk

Disordered eating in children is a major public health concern, as it is precursor to clinical eating disorders and obesity. However, little is known about the potential causes of child disordered eating. The current study examined marital conflict as a predictor of disordered eating in a sample of children aged 5–12 years, from the perspective of emotional security theory. Ninety five children and their parents in the Southeast United States participated in the study. We found that marital conflict was associated with higher levels of restrained eating, emotional eating and external eating behaviors controlling for demographics and parental feeding practices. Further, we examined the possible pathways between marital conflict and child disordered eating and found that marital conflict was related to greater child emotional insecurity about the family, which was associated with greater child anxiety, which were then related to disordered eating. In addition to serving as a secondary pathway linking emotional insecurity to child disordered eating, anxiety also significantly directly mediated the association between marital conflict and all three types of disordered eating: restrained eating, emotional eating and external eating in children. Next we examined if parental feeding practices (food monitoring, food restriction and parental pressure to eat) moderate the relation between marital conflict and child disordered eating. Parental pressure to eat was negatively associated with child disordered eating under higher marital conflict. The current study highlights the importance of marital conflict and child emotional security as precursors of child disordered eating.

Weight-related peer-teasing moderates genetic and environmental risk and disordered eating: twin study.

BackgroundWeight-related peer-teasing is considered a potent prospective risk factor for development of disordered eating and clinical eating disorders. Currently, the interplay between genetic and environmental influences has yet to be elucidated.AimsTo determine whether peer-teasing moderates latent genetic and/or environmental risk for disordered eating among female adolescent twins.MethodFull quantitative gene-environment interplay modelling of longitudinal trajectory of disordered eating in 685 female twins from the Australian Twin Registry.ResultsA model permitting moderation of disordered eating by peer-teasing involving genetic and non-shared environment effects fit these data best. As levels of peer-teasing increased, both genetic and environmental influences on disordered eating strengthened; however, genetic sources increased proportionally more than environmental sources.ConclusionsWeight-related peer-teasing represents a particularly powerful trigger for disordered eating. Nevertheless, it is amenable to intervention/prevention activities spanning individual to universal levels of endeavour.

Dissonance-based eating disorder program reduces cardiac risk: A preliminary trial.

We conducted a randomized, controlled preliminary trial to examine the effect of a dissonance-based eating disorder program on eating disorder symptoms and cardiac risk indices in a community sample of women with subclinical and clinical symptoms (N = 47), examining the efficacy of the program in both the indicated prevention and treatment realms. Eating disorder symptoms, body mass index, and biomarkers of cardiac risk were examined in dissonance and assessment-only control conditions at baseline, postintervention, and 2-month follow-up. Specifically, we assessed mean R wave amplitude, QT interval length, vagal tone (high frequency spectral power of heart rate variability), and sympathetic tone (low/high frequency spectral power ratio) via electocardiography (ECG) at each assessment period. We predicted a statistically significant 2 (condition: control, dissonance) × 3 (time: baseline, postintervention, 2-month follow-up) interaction in the mixed factorial MANOVA results. Results confirmed this hypothesis. Eating disorder symptoms and cardiac risk indices decreased significantly among participants in the dissonance condition at postintervention and 2-month follow-up compared with baseline. Results provide support for the efficacy of a dissonance-based program in the reduction of eating disorder symptoms and cardiac risk indices among women with subclinical and clinical eating disorder symptoms. Findings establish the efficaciousness of this dissonance-based approach in the indicated prevention and treatment realms and establish its efficacy in reducing cardiac risk indicators. (PsycINFO Database Record

Eating disorders and weight control behaviors change over a collegiate sport season.

Determine whether the prevalence of eating disorder classifications (i.e., clinical eating disorder, subclinical eating disorder, and asymptomatic) and pathogenic weight control behaviors (e.g., bingeing, vomiting) change over a five-month sport season. Longitudinal study. Female collegiate gymnasts and swimmers (N=325) completed the Questionnaire for Eating Disorder Diagnoses as well as six items from the Bulimia Test-Revised at Time 1 (two weeks into the beginning of their athletic season) and Time 2 (final two weeks of the athletic season); data collections were separated by five months. Over the course of the season, 90% of the athletes (18 out of 20) retained a clinical eating disorder diagnosis or moved to the subclinical classification. Of the 83 subclinical athletes at Time 1, 37.3% persisted with that classification and 10.8% developed a clinical eating disorder; the remainder became asymptomatic/healthy eaters by Time 2. The majority of Time 1 asymptomatic athletes (92.3%) remained so at Time 2. Exercise and dieting/fasting were the most frequent forms of weight control behaviors, though each was used less frequently at Time 2 (exercise=35.4%; dieting=9.2%) than at Time 1 (exercise=42.5%; dieting=12.3%). Eating disorder classifications, particularly clinical and subclinical, remain stable across a competitive season, supporting the need for early detection and purposeful intervention. Athletes engage in weight control behaviors that may be reinforced in the sport environment (e.g., supplemental exercise), making identification more challenging for sports medicine professionals.

Female athlete experiences of seeking and receiving treatment for an eating disorder

Clinical eating disorders are common among athletes; however research has yet to explore the process of seeking and receiving treatment for an eating disorder in this population. Semi-structured interviews were conducted with 13 female athletes currently receiving treatment for an eating disorder. A total of three themes emerged: challenges to treatment seeking, feeling out of place, and coping with exercise transitions. Athletes reported low levels of eating disorder literacy and lacked motivation to engage with therapy due to a lack of perceived relevance. Athletes found it challenging to relinquish exercise behaviours in treatment and expressed concerns around managing a return to sport. It may be necessary to provide additional support to athletes when embarking on and leaving treatment programs, particularly with regards to managing expectations about exercise.

A qualitative analysis of factors related to eating disorder onset in female collegiate athletes and non-athletes

ABSTRACTFemale athletes are at risk for clinical eating disorders, yet their onset experiences have rarely been studied with qualitative methods. This study, which included interviews with 12 collegiate female athletes and 17 non-athletes, identified factors that contributed to eating disorder onset for both subgroups. Inductive content analysis revealed that low self-worth, peer issues, and comorbid psychological disorders were common in both groups. However, athletes reported sport-specific factors including performance pressure, team weigh-ins, and injuries, whereas family dysfunction, bullying, and puberty were more commonly reported triggers for non-athletes. Findings support prevention and treatment programs customized for unique vulnerabilities for each subgroup.

An empirical test of the interpersonal theory of suicide in a heterogeneous eating disorder sample.

The Interpersonal Theory of Suicide (IPTS) model has not been fully tested in a clinical eating disorder (ED) population. Participants (N = 114) completed questionnaires assessing suicidal ideation (SI), suicide attempts (SA), and constructs of the IPTS. Logistic regressions determined whether thwarted belongingness and perceived burdensomeness were associated with lifetime SI. Among those who endorsed lifetime SI, logistic regressions were used to determine whether elements of the acquired capability for suicide (fearlessness about death and painful and provocative events) were associated with lifetime SA. Sixty-five participants (57.0%) had lifetime SI and 24 (21.1%) had lifetime SA. Thwarted belongingness (P<0.001) and perceived burdensomeness (P < 0.01) were associated with lifetime SI. Painful and provocative events were associated with lifetime SA (P < 0.03). The IPTS was partially supported. Targeting interpersonal variables may be important in treating and preventing suicidality. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:162-165).

The Compulsive Exercise Test: confirmatory factor analysis and links with eating psychopathology among women with clinical eating disorders.

BackgroundThis study aimed to determine the psychometric properties of the Compulsive Exercise Test (CET) among an adult sample of patients with eating disorders.MethodThree hundred and fifty six patients and 360 non-clinical control women completed the CET and the Eating Disorders Examination questionnaire (EDE-Q).ResultsA confirmatory factor analysis revealed that the clinical data showed a moderate fit to the previously published five factor model derived from a community sample (Taranis L, Touyz S, Meyer C, Eur Eat Disord Rev 19:256-268, 2011). The clinical group scored significantly higher than the non-clinical group on four of the five CET subscales, and logistic regression analysis revealed that the CET could successfully discriminate between the two groups. A Receiver Operating Curve analysis revealed that a cut-off score of 15 on the CET resulted in acceptable values of both sensitivity and specificity.ConclusionsThe CET appears to have a factor structure that is acceptable for use with an adult sample of patients with eating disorders. It can identify compulsive exercise among patients with eating disorders and a cut-off score of 15 is acceptable as indicating an appropriate cut-off point.

"Strong beats skinny every time": Disordered eating and compulsive exercise in women who post fitspiration on Instagram.

Fitspiration is a recent Internet trend designed to motivate people to eat healthily and to exercise. The aim of the study was to investigate disordered eating and exercise in women who post fitspiration on Instagram. Participants were 101 women who post fitspiration images on Instagram and a comparison group of 102 women who post travel images. Both groups completed measures of disordered eating and compulsive exercise. Women who post fitspiration images scored significantly higher on drive for thinness, bulimia, drive for muscularity, and compulsive exercise. Almost a fifth (17.5%) of these women were at risk for diagnosis of a clinical eating disorder, compared to 4.3% of the travel group. Compulsive exercise was related to disordered eating in both groups, but the relationship was significantly stronger for women who post fitspiration images. For some women, posting fitspiration images on Instagram may signify maladaptive eating and exercise behaviors. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2017; 50:76-79).

Eating disorders in sport: Review of prevalence, risk factors, and studies of eating disorders in highly competing athletes

Ismailova Dilyara, Gazdowska Zuzanna. Eating disorders in sport: Review of prevalence, risk factors, and studies of eating disorders in highly competing athletes. Journal of Education, Health and Sport. 2016;6(6):351-358. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.55703 http://ojs.ukw.edu.pl/index.php/johs/article/view/3588 The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 755 (23.12.2015). 755 Journal of Education, Health and Sport eISSN 2391-8306 7 © The Author (s) 2016; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 05.05.2016. Revised 25.05.2016. Accepted: 10.06.2016. Eating disorders in sport: Review of prevalence, risk factors, and studies of eating disorders in highly competing athletes Dilyara Ismailova University of Social Sciences and Humanities, Warsaw, Poland Zuzanna Gazdowska University of Social Sciences and Humanities, Warsaw, Poland Dilyara Ismailova University of Social Sciences and Humanities, Warsaw, Poland mgr Zuzanna Gazdowska University of Social Sciences and Humanities, Warsaw, Poland; zgazdowska@swps.edu.pl Abstract In today’s society, where thinness is idealized and correlates with good personal characteristics, people resort to different actions in order to comply with social norms. Athletes do not differ; they face the same issue of body image and weight concerns as the rest of the society. In addition to general factors of eating disorders, they have an extra pressure from their sport environment to maintain certain body weight and body measurements. This type of pressure puts them in the high-risk zone for developing clinical eating disorders (Brownell, 1991; Byrne & McLean, 2002; Rodin & Larson, 1992; Smolak, Murnen, & Ruble, 2000). Numerous studies investigated this problem related to variety of risk factors (Krentz & Warschburger, 2011; Picard, 1999; Sundgot-Borgen, 1994). This paper is focused on reviewing the available and newest literature on prevalence, risk factors, and consequences of eating disorders in sport, specifically among elite athletes. Key words: eating disorders, eating disorders in sport, sport psychology.

Socio-cultural context of eating disorders in Poland.

BackgroundThe goal of this study was to assess the relationship between sociocultural factors and clinical eating disorders during the intensive process of Westernisation in Poland that occurred after 1989. The study population included girls diagnosed with an eating disorder according to DSM-IV criteria (n = 47 anorexia nervosa restrictive type [ANR], n = 16 anorexia binge/purge type [ANBP], n = 34 bulimia nervosa [BN], n = 19 eating disorder not otherwise specified [EDNOS]) who received consultation for the first time between 2002 and 2004 in the Department of Clinical Child and Adolescent Psychiatry, University Hospital, Kraków, Poland. The study included an age-matched normal control group [NOR] of 85 schoolgirls from Kraków.MethodsRelationships between two given qualitative features were investigated using the chi-square test or Fisher’s exact test. Correspondence analysis was applied to graphically explore the relationship. The Kruskal-Wallis test with the Bonferroni was performed to compare quantitative results across groups.ResultsObjective sociodemographic variables and responses to the 62-item Questionnaire of Socio-cultural Context were measured. The mothers of ANBP and BN patients were less professionally active than mothers of ANR patients and NOR subjects. Subjective socio-cultural factors were more relevant for the BN group than the ANR group. Questionnaire responses in the ANBP group were more similar to those in the BN group than to those in the ANR group. The most unambiguous and specific characteristic of the ANR group was a sense of belonging to the middle class. Variables that differentiated the BN group from the NOR group included the importance attached to thinness treated as an expression of power and control over one’s self, as well as a multifaceted negative evaluation of one’s own family, including a negative assessment of the position of women and parental lack of concern for appearance and principles of nutrition. All patients, regardless of diagnosis, identified with other people with similar problems and considered anorexia and bulimia to be a major issue of their generation and social environment.ConclusionsThe results of this first in Poland exploratory study of socio-cultural context of eating disorders indicate the importance of both objective and subjective socio-cultural factors in eating disorders in the group studied.

Eating disorder symptoms pre- and postpartum.

The study aimed to investigate symptoms of disordered eating pre- and postpartum using a standardised and widely used measure of eating disorder (ED) psychopathology. A consecutive series of women attending either prenatal (N = 426) or postnatal (N = 345) clinics in metropolitan Stockholm were assessed using the Eating Disorder Examination Questionnaire (EDE-Q). Assessments were conducted at either the first visit to prenatal clinics (10-12weeks of pregnancy) or 6 to 8months postpartum. An optimised shortened version of the EDE-Q was best suited for studying eating disorders pre- and postpartum. Using the optimised version of the instrument with 14 items and a cut-off score of ≥2.8, it was estimated that 5.3% of prepartum and 12.8% of postpartum mothers were suffering from clinical eating disorders. Seriously disordered eating behaviour during, and especially after, pregnancy may be more common than previously thought. It is imperative that health services focus increased attention on these problems by raising awareness, developing and extending specialist services, as well as through implementing educational programmes and training directed toward frontline healthcare services.

Psychometric properties of a short version of the Eating Attitudes Test (EAT-8) in a German representative sample

PurposeDisordered eating is common for all ages and sexes in the general population. However, only some individuals are known to develop clinically relevant eating disorders. There is a critical need of efficient, reliable and valid screening instruments to measure disordered eating for the general population. The Eating Attitudes Test was shortened into an 8-item-version to screen individuals at high risk of developing clinical eating disorders in a general population sample. MethodsPsychometric properties (Cronbach's α, construct and concurrent validity and factor structure), cutoff scores (with sensitivity, specificity, positive and negative predictive value) and norms were determined in a representative sample of the German population (N=2527). Factorial validity was investigated using item response modeling. ResultsResults confirmed reliability and validity of the questionnaire. Internal consistency and convergent validity were good. Analysis revealed different cutoff points for male and female participants. Values for sensitivity and specificity were satisfying and the positive predictive value was higher compared to other short screening instruments for disordered eating. Factorial analysis revealed a one-factor solution with an excellent model fit. The elimination of one item was discussed. Gender- and age-specific norms are reported. ConclusionsOverall results indicated that the EAT-8 is an efficient instrument suitable for screening purposes in large general population samples.

Attention-deficit/hyperactivity disorder–specific stimulant misuse, mood, anxiety, and stress in college-age women at high risk for or with eating disorders

ABSTRACTObjective: To examine the misuse of attention-deficit/hyperactivity disorder (ADHD)-specific stimulants in a college population at high risk for or with clinical or subclinical eating disorders. Participants: Four hundred forty-eight college-age women aged 18–25 at high risk for or with a clinical or subclinical eating disorder. Methods: Participants completed assessments of stimulant misuse and psychopathology from September 2009 to June 2010. Results: Greater eating disorder pathology, objective binge eating, purging, eating disorder–related clinical impairment, depressive symptoms, perceived stress, and trait anxiety were associated with an increased likelihood of stimulant misuse. Subjective binge eating, excessive exercise, and dietary restraint were not associated with stimulant misuse. Conclusions: ADHD-specific stimulant misuse is associated with eating disorder and comorbid pathology among individuals at high risk for or with clinical or subclinical eating disorders. Screening for stimulant misuse and eating disorder pathology may improve identification of college-age women who may be engaging in maladaptive behaviors and inform prevention efforts.

Eating disorder examination: Factor structure and norms in a clinical female pediatric eating disorder sample.

The factor structure of the eating disorder examination (EDE) has never been tested in a clinical pediatric sample, and no normative data exist. The factor structure of an adapted EDE was examined in a clinical sample of 665 females aged 9-17 years with anorexia nervosa spectrum (70%), bulimia nervosa spectrum (12%), purging disorder (3%), and unspecified feeding and eating disorders (15%). The original four-factor model was a good fit in a confirmatory factor analysis as well a higher order model with three dimensions of restraint, eating concern, and combined weight concern/shape concern. Normative data are reported for clinicians to identify the percentiles in which their patients' score. The findings support dimensions of restraint, eating concern, weight concern, and shape concern in a clinical pediatric sample. This supports the factorial validity of the EDE, and the norms may assist clinicians to evaluate symptoms in females under 18 years.

Experiences of using pro-eating disorder websites: a qualitative study with service users in NHS eating disorder services.

Previous research into the impact of pro-eating disorder (pro-ED) websites has predominantly been undertaken using experimental and survey designs. Studies have used both clinical and non-clinical (college student) samples. The present study aimed to explore the underlying functions and processes related to the access and continued use of pro-ED websites within a clinical eating disorder population using a qualitative research design. Participants were recruited through NHS community mental health teams and specialist eating disorder services within South Wales, UK. Face-to-face semi-structured interviews were conducted with seven adult women in treatment for an eating disorder who had disclosed current or historic use of pro-ED websites. Interviewees ranged in age from 20 to 40years (M=31.2; SD=7.8). Constructivist Grounded Theory was used to analyse interview transcripts. Five key themes were identified within the data, namely fear; ambivalence; social comparisons; shame; and pro-ED websites maintaining eating disordered behaviour. The pro-ED websites appeared to offer a sense of support, validation and reassurance to those in the midst of an eating disorder, whilst simultaneously reinforcing and maintaining eating disordered behaviour. Themes are discussed in relation to implications and recommendations for clinical practice. Limitations of the present study and suggestions for future research are also outlined.