Eating Disorder Thoughts Research Articles

Community Violence Exposure and Eating Disorder Symptoms among Belgian, Russian and US Adolescents: Cross-Country and Gender Perspectives.

Community violence exposure (CVE) is one of the most common adverse childhood experiences worldwide. Despite this, its potential effect on disordered eating in adolescents from different cultures is underexplored. In the present cross-sectional study, self-reported data were collected from 9751 students (Mean age = 14.27) from Belgium, Russia and the US on CVE (witnessing violence and violence victimization), eating disorder (ED) symptoms (ED thoughts with associated compensatory behaviors), and comorbid symptoms of posttraumatic stress, depression and anxiety. Increased CVE (from no exposure to witnessing to victimization) was associated with more ED symptoms, and the associations remained significant after adjusting for comorbid conditions. The associations were similar for adolescents across the three countries. No gender differences were observed in the association between CVE and ED symptoms, even though girls in general reported more ED symptoms than boys. We conclude that CVE appears to be associated with ED symptoms in three culturally different samples of adolescents.

COVID-19 related familial economic disruptions and eating disorder patients’ mental health concerns and motivation to recover

BackgroundFamily support has been shown to be important for adolescents and young adults (AYA) in eating disorder (ED) treatment. Many families were impacted by the pandemic, potentially altering their ability to support individuals in ED treatment. This study examined the association of COVID-19 related familial economic change with self-reported mental health (MH) and ED concerns in AYA seeking treatment for ED.MethodsAYA patients with EDs aged 10–27 years enrolled in the Registry of Eating Disorders and their Co-morbidities OVER time in Youth (RECOVERY) completed an additional COVID-19-specific survey (n = 89) that assessed their perception of the effects of the pandemic on their lives and their ED. Participants self-reported on familial economic disruptions, measured through a composite score of four markers: (1) family member’s work hours cut, (2) family member was required to stop working, (3) family member lost job permanently, and (4) family lost health insurance/benefits. In bivariate analyses, we examined the association between self-reporting any familial economic disruption and self-reported changes in intrusive ED thoughts, feelings of anxiety, feelings of depression, feelings of isolation, and motivation to recover from their ED. Logistic regression models were used to examine the association between familial economic disruptions on self-reported changes in ED/MH affect and motivation to recover adjusting for age and ED diagnosis.ResultsForty-six percent of participants self-reported that the pandemic had resulted in at least one economic familial disruption. Of patients reporting any familial economic disruption, 29% reported decreased motivation for ED recovery, and over 75% reported worsening feelings of depression, anxiety, isolation, and/or intrusive eating disorder thoughts. Reporting any COVID-19 familial economic disruption was marginally associated with feelings of isolation (p = 0.05). Though the findings were only marginally significant, the odds of reporting worsening feelings of depression, anxiety, intrusive ED thoughts or motivation to recover were nearly twice in those who reported a COVID-19-related familial economic disruption compared to those who did not report such a disruption.ConclusionsFamily-related economic disruptions are associated with ED/MH-related concerns and motivation to recover from an ED during the COVID-19 pandemic in AYA patients.

Menstrual disorders in adolescents and young adults with eating disorders

Although amenorrhea is no longer a specific criterion required to make the diagnosis of anorexia nervosa (AN), the relationship between restrictive eating and menstrual status remains important in the diagnosis, treatment, and consequences for patients with eating disorders. Clinicians should understand the relationship between menstrual irregularities and malnutrition due to eating disorders, as it may be possible to intervene sooner if the diagnosis is made earlier. Treatment of AN (in those who are underweight) and atypical AN (in those who are not underweight) is aimed at cessation of restrictive thoughts and behaviors, restoration of appropriate nutrition and weight, and normal functioning of the body. While eating disorder thoughts and behaviors are helped by both therapy and nutrition, regular functioning of the body, including regular menstruation, is linked to both appropriate nutrition and weight. Patients who are not underweight based on their body mass index (BMI) may still have oligo/amenorrhea due to their caloric restriction; thus any patient who has irregular menses should have a detailed dietary evaluation as part of their workup. Timely diagnosis and treatment of patients with eating disorders and amenorrhea is important due to the impact on bone mass accrual for adolescents who have prolonged amenorrhea. Menstrual abnormalities may also be seen in patients with bulimia nervosa (BN).

163. Evaluation of Eating Disorder Thoughts and Behaviors During Admission at a Day Treatment Program for Adolescent Patients

The aim of this study is to examine outcomes associated with attendance at an eating disorder day treatment program using preexisting chart data from November 2017 through March 2019. Demographic and clinical factors were analyzed in association with patient outcomes and two validated self-report measures: the Revised Children’s Anxiety and Depression Scale (RCADS), which looks at the frequency of various symptoms of anxiety and low mood, and Difficulties in Emotion Regulation Scale (DERS), which examines subjective emotional dysregulation.

Access to care and worsening eating disorder symptomatology in youth during the COVID-19 pandemic

BackgroundShelter-in-place orders and social distancing guidelines, in response to the COVID-19 pandemic, have limited traditional face-to-face interactions and led to many clinical providers transitioning to the use of videoconferencing platforms. The present study aims to assess how the COVID-19 pandemic has impacted adolescents’/young adults’ (AYA) eating disorder (ED)-related care, and how access to, changes in, perceived disruptions to, and quality of care are associated with ED thoughts and behaviors.MethodsAYA enrolled in the RECOVERY study, a pre-existing web-based longitudinal study, and completed a COVID-19-specific survey (n = 89). We examined bivariate associations of four markers of care: i) access to care, ii) changes in care, iii) perceived disruption to care, and iv) quality of care. Using multiple logistic regression, we examined the associations of pandemic-related markers of care with changes in ED thoughts and behaviors. We excluded those not engaged in treatment pre-pandemic (n = 16).ResultsIn the remaining 73 participants, reported access to care was high, with 92% of respondents continuing care with at least one ED provider during the pandemic; however, 47% stopped some treatment during the pandemic. Nearly one-third (32%) perceived a disruption in treatment. Quality of care remained high with 67% reporting care to be better than or as good as pre-pandemic. Respondents acknowledged heightened symptomatology: 81% reported increased ED thoughts and 81% reported increased ED behaviors due to COVID-19-related factors. However, none of the markers of care described were significantly associated with ED thoughts or behaviors in regression analyses adjusting for demographic variables and baseline characteristics, except our quality of care measure which was approaching significance (p = 0.07).ConclusionsOur findings show the majority of AYA who had care prior to the pandemic continued receiving some element of their multi-disciplinary ED treatment and perceived their care as high quality. None of the markers of care described were statistically associated with increased ED thoughts and behaviors.

A longitudinal examination of body-checking behaviors and eating disorder pathology in a community sample of adolescent males and females.

Related to the cognitive-behavioral theory of eating disorders, body checking has gained increasing recognition as both a maintaining factor for eating disorders and an important target for treatment. However, it is unclear whether body-checking behaviors contribute to the development of disordered eating, or if these behaviors develop as a response to experiencing eating disorder thoughts and behaviors. This study aims to examine the relationships between body-checking behaviors and eating disordered thoughts and behaviors in adolescent females and males in the community over time. Participants included 238 adolescents (n = 104 males, n = 134 females, Mage = 16.5 years) recruited from high schools in British Columbia, Canada, who completed the Eating Disorder Examination Questionnaire and Body Checking Questionnaire at baseline (T1) and again approximately 4 months later (T2). After controlling for baseline levels of eating pathology and body mass index (BMI), body checking at T1 predicted increases in eating pathology for both males and females. In contrast, after controlling for baseline levels of body checking and BMI, eating pathology at T1 did not predict changes in body checking for females, but it did for males. Findings suggest that, among adolescents, engaging in body-checking behaviors may increase risk for disordered eating. If supported by further research, targeting body-checking behaviors in prevention programs may be warranted.

COVID‐19 and implications for eating disorders

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#recovery: Understanding recovery from the lens of recovery‐focused blogs posted by individuals with lived experience

Definitions of eating disorder (ED) recovery have primarily focused on symptom management (i.e., weight regain, reduced/absent ED behaviors, and normalized ED thoughts). Notwithstanding the importance of these approaches, there are arguably additional considerations in ED recovery. In order to get a more comprehensive understanding of recovery, it is necessary to turn to individuals with lived experience. Here, we examine how individuals with lived experience of an ED conceptualize and define recovery in narrative, recovery-focused blogs and consider how this understanding may contribute to definitions of recovery in the field. Inductive thematic analysis was used to examine 168 blogs posted by at least 120 unique authors (95% women; 36% reporting anorexia nervosa diagnosis) to 10 moderated, ED websites. Results from the thematic analysis yielded seven themes: recovery as (1) existing in contrast to the ED, (2) existing in a broader context, (3) subjective, (4) a choice, (5) a complex, nonlinear process, (6) transformative, and (7) overcoming. The present findings are consistent with previous qualitative research, suggesting that recovery is multifaceted and encompasses more than just symptom management. Notably, bloggers highlighted that recovery may not be equally attainable for all individuals, citing numerous social justice issues in the conceptualization of recovery. This multifaceted and intersectional view of recovery is consistent with consumer models of recovery. We argue that a dimensional model of recovery may be a good starting framework for researchers and clinicians to develop a more comprehensive definition of recovery.

Compulsive exercise and weight suppression: Associations with eating pathology in distance runners

Some athletes, particularly those who participate in activities that emphasize leanness such as competitive running, are at greater risk for eating disorder (ED) pathology. Compulsive exercise (CE) is linked with ED pathology among female athletes, with evidence that CE for weight control is most strongly correlated with ED thoughts and behaviors. Weight suppression (WS), the discrepancy between highest adult weight and current weight, is also linked with ED symptoms. Taken together, runners with greater WS may be more likely to engage in CE to influence their weight or shape and may subsequently report other associated ED symptoms. As such, the current study investigated associations between CE and ED pathology in a mixed-gender sample of adult distance runners (N = 277, 51% female), and tested the impact of WS on this association. Results indicated that females reported greater CE and ED pathology, whereas males reported greater WS. A significant interaction effect for CE x WS, (p < .05) indicated that the relation between CE and ED scores was stronger among male runners who reported higher WS. In contrast, WS did not impact the association between CE and ED pathology for female runners. Results from the current study have important implications for the assessment and treatment of ED in athletes, specifically runners, and suggest that WS is an important factor to consider when working with male athletes.

Desired weight and treatment outcome among adolescents in a novel family-based partial hospitalization program

The purpose of the current study was to investigate desired weight percentage and weight difference percentage and their association with treatment outcome in a novel family-based partial hospitalization program. Twenty-six adolescents with anorexia nervosa or subthreshold anorexia nervosa between the ages of 12 and 19 completed the Eating Disorder Examination (EDE) at intake and upon completion from a partial hospitalization program in which parents played a large role in the recovery process, consistent with family-based treatment principles. Lower desired weight percentage at baseline was associated with higher scores on the restraint subscale of the EDE at end of treatment. Higher weight difference percentage (greater desire to lose weight) at baseline was associated with higher scores on all EDE subscales and global score at end of treatment. Neither desired weight percentage nor weight difference percentage at baseline were associated with treatment dropout or percent expected body weight at end of treatment. In a family-based program, participants’ desired weight may be related to eating disorder thoughts (for example, shape or weight concerns) but not to behavioral outcomes such as weight gain or treatment dropout, which may be more directly under the influence of the parents.

Inviting eating disorder patients to discuss the academic literature: a model program for psychoeducation

BackgroundPsychoeducation initiatives in which patients read primary scientific literature have not yet been studied as a treatment intervention for eating disorders. In this paper, we discuss and evaluate the acceptability of a novel psychoeducational journal club for individuals with anorexia and bulimia nervosa in inpatient and partial hospitalization program settings. Primary literature about eating disorders is presented and discussed with patients. By presenting scientifically-supported information, our “Psychoeducational Research Group” is designed to help patients restructure disordered thoughts and encourage adherence to evidence-based treatment.MethodsUsing a Likert scale questionnaire (0 = not at all; 5 = very much), participants provided ratings for how much they liked the group and felt that it helped them across several domains.ResultsAverage scores from 33 participants (26 inpatient, 7 partial hospital patients) indicated they would recommend this group to others receiving eating disorder treatment (4.8 ± 0.6). Scores also suggested patients’ likeability (4.6 ± 0.8), benefit regarding challenging eating disorder thoughts (4.1 ± 1.1), improved motivation for eating behavior change (4.0 ± 1.0) and completion of prescribed nutritional plan (3.6 ± 1.0), and usefulness in working towards treatment goals (4.2 ± 0.9) associated with group participation.ConclusionsPreliminary findings support the acceptability of this psychoeducational group and that it may serve as a useful adjunct to larger evidence-based programming across eating disorder treatment settings.

Ward outings: providing patients with meal support in the real world

Ward outings provide patients the opportunity to practice what they have learnt during their inpatient admission in a real-life context, to learn to feel comfortable eating out in public. The ward outing is for patients that are progressing well and have demonstrated that they can manage their meal plans on the unit and on leave. The outing provides patients with an opportunity to challenge their eating disorder thoughts and beliefs around certain foods, by providing patients flexible options, whether the challenge is eating a sandwich in public, tackling a fear food or, having a meal that has not been eaten since the onset of a patient's illness. During the outing the social worker provides patients with a positive social experience over a meal and activity of the patient's choosing. They conduct themselves as a positive role model; demonstrating to patients how to manage eating their meal in public, providing patients with a high level of support, encouraging the patients to order an appropriate meal, or, to consider challenging their eating disorder cognitions around certain foods. This is with the aim that patients will become more flexible with meal choices and be more willing to challenge their eating disorders.

Parental Bonding and Body Mass Index in a Female Community Sample: The Mediating Role of Eating Disorder Thoughts and Core Beliefs.

It is likely that disrupted early parent-child relationships, eating disorder related cognitions and negative self-beliefs are relevant to some women who are overweight/obese. This study tested the hypotheses that disrupted parent-child relationships would be linked to higher body mass index (BMI) and that this relationship would then be mediated by cognition. A group of women were recruited from the community and completed measures of eating disorder (ED) thoughts, negative self-beliefs, and parental bonding. Individual body mass indices (BMIs) were calculated. One hundred and eighteen women completed the study. There was a relationship between parental bonding and higher BMI. As hypothesized, the relationship between parental bonding (as measured by maternal care, and paternal overprotection) and BMI appeared to be mediated by a range of ED thoughts, and some negative self-beliefs. The cognitions measured here, both ED related cognitions and negative self-beliefs, may be a useful target when considering psychological treatment for women who are overweight or obese.

The association between automatic thoughts about eating, the actual–ideal weight discrepancies, and eating disorders symptoms: a longitudinal study in late adolescence

ObjectiveThis study tested the reciprocal relationships between automatic thoughts about eating and the actual–ideal weight discrepancies, and their role in the formation and maintenance of eating disorders (ED) symptoms in a non-clinical sample of adolescents. In particular, we investigated whether thoughts about eating mediated the effects of weight discrepancies on ED formation and whether weight discrepancies mediated the effects of thoughts about eating on ED formation were investigated.MethodData were collected three times, with a 2-month interval between Time 1 (T1) and Time 2 (T2), and a 9-month interval between T2 and Time 3 (T3). Adolescents (N = 55) aged 15–18 filled out the SCOFF Questionnaire, assessing eating disorders symptoms, and the Eating Disorder Thoughts Questionnaire, evaluating automatic thoughts. To assess weight discrepancies questions about actual (subjectively reported) and ideal body weight were asked followed by objective measurement of height and weight.ResultsNegative thoughts about eating (T2) mediated the relation between weight discrepancies (T1) and symptoms of anorexia and bulimia (T3). In addition, the association between negative thoughts (T1) and eating disorders symptoms (T3) was mediated by weight discrepancies (T2).ConclusionThe negative thoughts and the actual (both subjectively reported and objectively measured)–ideal weight discrepancies constitute a vicious cycle, related to higher ED symptoms. Prevention of eating disorders should be directed to adolescents who manifest large weight discrepancies or high levels of negative thoughts about eating, as they are at risk for developing eating disorder symptoms.

Applying a cognitive model to binge eating in a female community sample

ObjectiveLittle is known about a potential cognitive model for binge eating, although cognitive behavioural techniques have been proposed as appropriate models of intervention. This study initiated the development of a cognitive model by applying an established cognitive model for bulimia nervosa. MethodA community sample of women was recruited via the internet and participants completed measures of eating disorder thoughts, negative self-beliefs, attachment, mood and binge eating severity. ResultsEating disorder thoughts and negative self-beliefs were applicable to women in the community who binge eat. Attachment relationships characterised by decreased emotional warmth and increased overprotection, were correlated with binge eating in women and this relationship was mediated by eating disorder thoughts and negative self-beliefs. DiscussionThe cognitive model of bulimia was applicable to some extent to women in the community who binge eat. Attachment may also be related to binge eating and this relationship may be mediated by cognition.

The measurement of “eating-disorder-thoughts” and “eating-disorder-behaviors”: Implications for assessment and detection of eating disorders in epidemiological studies

To test a theoretically driven second-order factor model of eating disorders, with eating-disordered thoughts and eating-disordered behaviors representing the higher order factors, we conducted a confirmatory factor analysis using a female university student sample ( N = 1816). The ‘Thought’ latent construct was comprised of indicators representing fear of fat and dissatisfaction with body shape/weight and the latent construct ‘Behavior’ was comprised of indicators representing binging, purging and restricting. From the thought and behavior latent factors, composite groups were created by varying the level of thoughts and behaviors (high, moderate, and few/or none). We examined the independent contributions of thoughts and behaviors on a measure of psychopathology (depression). A second-order model of “eating disorder thoughts” and “eating disorder behaviors” was supported by the data, based on model fit, factor loadings, and model parsimony. Mean scores on depression were clinically significant for groups engaged in any level of eating disorder behavior whereas thoughts contributed to risk for depression only at the extreme end. Because of the disproportionate representation of eating disorder thoughts (high) and eating disorder behaviors (low) in non-clinical populations, the measurement and detection of eating disorders may be enhanced by measuring thoughts separate from behaviors.

Assessing Eating Disorder Thoughts and Behaviors: The Development and Preliminary Evaluation of Two Questionnaires

This paper describes the development of two measures. The first is designed to assess eating disorder-related automatic thoughts; the second is designed to assess a wide range of eating disorder-related behaviors. Principal components analysis identified three dimensions of thoughts: positive thoughts about eating, negative thoughts about eating, and permissive thoughts. Principal components analysis also identified six dimensions of behavior related to: shape and weight, bingeing, dieting, food, eating, and overeating. Both measures possess promising psychometric properties, including good construct and criterion-related validity. Both successfully discriminated eating disorder patients from dieting and non-dieting groups. The two measures may be useful additions to those currently available to researchers (and clinicians) interested in eating disorders.