Hopelessness Theory Research Articles

Prospective Relations Between Inferential Styles and Depressive Symptoms Among Children of Mothers with Major Depression

ABSTRACT Objective Current models of depression risk in children include both family history and cognitive models of risk; however, these models are rarely integrated. This study aimed to address this gap by examining how cognitive vulnerabilities featured in the hopelessness theory of depression – negative inferential styles for the causes, consequences, and self-characteristic implications of negative events – may increase risk for the intergenerational transmission of depression. Specifically, we examined whether children of mothers with a history of major depressive disorder (MDD), compared to children of never-depressed mothers, exhibit more negative inferential styles and whether maternal history of MDD moderates prospective relations between children’s inferential styles and depressive symptoms. Method Participants were 251 children (ages 8–14 at baseline; 51% girls; 81% Non-Hispanic White) of mothers with (n = 129) or without (n = 122) a history of MDD. Children’s inferential styles and depressive symptoms were assessed at baseline and then every 6 months for 2 years. Results Using random intercept cross-lagged panel models (RI-CLPMs), we found that children of mothers with a history of MDD, compared to children of never-depressed mothers, had more negative inferential styles for the causes and consequences of negative events, but not for self-characteristics, and higher depressive symptom levels, across the follow-up. In addition, there were reciprocal, transactional relations between children’s inferential styles for causes and their depressive symptoms across the follow-up, with no evidence for moderation by maternal MDD. Conclusions Children’s inferential styles for the causes of negative events may be a useful marker of risk for the intergenerational transmission of depression, which could be targeted to reduce risk for depression.

First- and Second-Generation Psychological Theories of Suicidal Behaviour.

Suicidal behaviour is defined as taking actions with the intention of killing oneself and thinking of performing these actions. Suicide is a serious public health problem with complex biological, social and psychological risk factors and a multidimensional clinical appearance, occurring all over the world and ranking among the leading causes of death. In this study, psychological approaches explaining suicide were evaluated under the headings of first-generation and second-generation suicide theories, the different aspects of these theories were put forward, and previously published studies and recent evidence were reviewed. A literature review on the theoretical foundations of suicide is presented. First-generation suicide theories were developed before the 2000s and second-generation suicide theories were developed after the 2000s. While Psychodynamic Theory, Social Learning Theory, Hopelessness Theory, Shneidman's Suicide Theory and Escape Theory are included under the title of first-generation suicide theories, Interpersonal Psychological Suicide Theory, Three Stage Suicide Theory, Complementary Motivational-Demotivational Theory and Variable Predisposition Theory are examined as second-generation suicide theories. The approaches of the theories provide important evidence in understanding suicidal behaviour and recognising various risk factors in the transition from suicidal ideation to suicidal action. Controlling the risk factors may contribute both in terms of preventive community mental health and in the development of health policies.

Similarities and Differences in the Architecture of Cognitive Vulnerability to Depressive Symptoms in Black and White American Adolescents: A Network Analysis Study.

The hopelessness theory, Beck's cognitive theory, and the response styles theory dominate our understanding and the treatment of depression in adolescents. However, research supporting them is largely based on White individuals. Further, the associations between stressors, cognitive vulnerabilities, and depressive symptoms in Black adolescents are not as one would expect based on the predictions from those theories. Both raise the question of if and to what degree these theories and previous findings can be generalized to Black adolescents. Additionally, without a theoretical basis, clinicians regularly use interventions developed based on one theory to influence vulnerabilities described in another theory. Thus, the purpose of our study was to examine the structure of an integrated cognitive stress-vulnerability model as well as the strengths of associations between stressors, cognitive vulnerabilities, and depressive symptoms in Black and White adolescents. In our study, 295 Black (37% female) and 213 White (49% female) ninth-grade students from a public high school participated. Network analyses demonstrated that the three original cognitive theories of depression can and should be integrated and that each variable we examined is comparably relevant for Black and White adolescents. At the same time, the structure of the two integrated networks differed significantly among Black and White adolescents, exhibiting specific distinctions at four edge levels. Furthermore, the predictability of the network is notably lower for Black adolescents than for White adolescents. Important theoretical and clinical implications can be derived.

Taking a heavier toll? Racial differences in the effects of workplace mistreatment on depression.

Previous studies have found that workplace mistreatment positively relates to depression, a critical mental health disorder. However, it is unknown whether mistreatment affects all individuals' depressive symptoms equally. Drawing from the hopelessness theory of depression and the stigma literature, we suggest that Blacks suffer from greater depression than Whites when they experience similar levels of workplace mistreatment because Blacks, as members of a racial minority group, are more likely to attribute workplace mistreatment to their race. This, in turn, causes them to make a pessimistic attribution (i.e., attributions that are internal, stable, and global) about themselves that, ultimately, leads to depression. We tested these predictions across two studies. In Study 1, we used a multiyear time-lagged design and multiple indicators of depression (i.e., self-reported clinical depression scale, device-traced sleep quantity, and self-reported sleep quality) and found that the positive relationship between workplace mistreatment and depression was stronger for Blacks than Whites, and that these patterns were consistent across the various indicators (although only results with the clinical depression scale and sleep quantity were statistically significant). In Study 2, we found that the influence of workplace mistreatment on depression is partly due to racial differences in how workplace mistreatment is attributed. We conclude by discussing the theoretical and practical implications of these findings and directions for future research. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Discrimination, cognitive styles, and their associations with adolescents' mental and physical health.

This study is based on the hopelessness theory of depression and previous research on perceived everyday discrimination (PED) and both depressive symptoms and Interleukin-6 (an inflammatory cytokine; IL-6) in adolescents. The purpose of this study is to examine the negative attribution, self, and consequence cognitive styles (CSs) proposed in the hopelessness theory as a possible mechanism underlying the association between PED and inflammation in adolescents and expand our understanding of the comorbidities between depressive symptoms and systemic inflammation (IL-6). This cross-sectional study featured a sample of 102 adolescents aged 13-16 (M = 14.10, SD = 0.52) who identified as White (47.5%), Black (41.4%), Mixed Race (7.1%), Latino (2%), and other (2%). Data analysis was conducted using PROCESS to compute regressions and effects between PED, negative CSs, depressive symptoms, and Interleukin-6. Results showed that negative attribution CSis the only negative CSassociated with PED, depressive symptoms, and IL-6. Negative attribution CS is also the only negative CS of the three negative CSs that mediates both the association between PED and depressive symptoms and PED and IL-6 in our adolescent sample. Overall, these results indicate that individual negative CSs proposed in the hopelessness theory impact adolescents' physical and mental outcomes differently, which can inform targeted treatments. Nurses should provide cognitive-based interventions and promote societal-level change to reduce the experience and impact of PED on the mental and physical health of their adolescent patients.

Determinants of depressive symptoms in patients with heart failure based on the hopelessness theory of depression.

Depressive symptoms are common in patients with heart failure (HF) and are associated with adverse outcomes in this group. This study examined depressive symptoms and associated determinants in patients with HF based on the hopelessness theory of depression. In this cross-sectional study, a total of 282 patients with HF were recruited from 3 cardiovascular units of a university hospital. Symptom burden, optimism, maladaptive cognitive emotion regulation strategies (MCERSs), hopelessness, and depressive symptoms were assessed using self-reported questionnaires. A path analysis model was established to evaluate the direct and indirect effects. The prevalence of depressive symptoms was 13.8% in the patients. Symptom burden had the greatest direct effect on depressive symptoms (β = 0.406; P < 0.001), optimism affected depressive symptoms both directly and indirectly with hopelessness as the mediator (direct: β = -0.360; P = 0.001; indirect: β = -0.169; P < 0.001), and MCERSs only had an indirect effect on depressive symptoms with hopelessness as the mediator (β = 0.035; P < 0.001). In patients with HF, symptom burden, decreased optimism, and hopelessness contribute to depressive symptoms directly. What is more, decreased optimism and MCERS lead to depressive symptoms indirectly via hopelessness. Accordingly, interventions aimed at decreasing symptom burden, enhancing optimism, and reducing the use of MCERSs, while declining hopelessness, may be conducive to relieving depressive symptoms in patients with HF.

What Diverse Samples Can Teach Us About Cognitive Vulnerability to Depression

Tests of generalizability can diversify psychological science and improve theories and measurement. To this end, we conducted five studies testing the cognitive vulnerability to depression hypothesis featured in the hopelessness theory of depression: Study 1 was conducted with Honduran young adults (n = 50); Study 2 was conducted with Nepali adults (n = 34); Study 3 was conducted with Western hemisphere adults (n = 104); Study 4 was conducted with Black U.S. adults (n = 119); and Study 5 was conducted with U.S. undergraduates (n = 110). Results showed that cognitive vulnerability could be measured reliably in diverse populations and the distribution of vulnerability scores was similar for all samples. However, the tendency to generate negative inferences about stress had different implications for depression depending on sample; the association between cognitive vulnerability and depressive symptoms did not generalize to Honduran and Nepali participants. It is now necessary to understand why a negative cognitive style confers risk for depression in some contexts but not others (e.g., is it issues related to measurement, theory, or both). The results also suggest that understanding and reducing the global burden of depression will require more than simply “translating” existing cognitive measures and theories to other countries.

Childhood emotional but not physical or sexual maltreatment predicts prosocial behavior in late adolescence: A daily diary study

BackgroundChildhood maltreatment (CM), including physical, emotional, and sexual maltreatment, is detrimental to adolescents' psychological and behavioral outcomes. However, most studies on the relationship between CM and prosocial behavior focused on the overall experience of CM. Since different forms of CM exert various influences on adolescents, it is essential to find out which form of CM has the strongest link with prosocial behavior and the underlying mechanism behind it to fully understand this relationship and design a specific intervention for promoting prosocial behavior. ObjectiveGuided by internal working model theory and hopelessness theory, this study aimed to investigate the connections of multiple forms of CM with prosocial behavior, and explore the mediating mechanism of gratitude from the perspective of the broaden-and-build theory through a 14-day daily diary study. ParticipantsA total of 240 Chinese late adolescents (217 females; Mage = 19.02, SDage = 1.83) from a college volunteered for this study and completed questionnaires regarding CM, gratitude, and prosocial behavior. MethodsA multilevel regression analysis was conducted to investigate which form of CM was correlated to prosocial behavior, and a multilevel mediation analysis was applied to examine the underlying mechanism (i.e., gratitude) behind this relationship. ResultsThe results of the multilevel regression analysis showed that it was childhood emotional maltreatment, but not physical or sexual maltreatment that negatively predicted prosocial behavior. The results of the multilevel mediation analysis indicated that gratitude mediated the relationship between childhood emotional maltreatment and prosocial behavior. ConclusionsFindings from the present study highlight the predictive effect of childhood emotional maltreatment on late adolescents' prosocial behavior and the mediating role of gratitude in this link.

Experiences of new diagnoses among HIV-positive persons: implications for public health

BackgroundReady acceptance of experiences of new diagnoses among HIV-positive persons is a known personal and public health safety-net. Its beneficial effects include prompt commencement and sustenance of HIV-positive treatment and care, better management of transmission risk, and disclosure of the HIV-positive status to significant others. Yet, no known study has explored this topic in Ghana; despite Ghana’s generalised HIV/AIDS infection rate. Existing studies have illuminated the effects of such reactions on affected significant others; not the infected.MethodsThis paper studied qualitatively the experiences of new diagnoses among 26 persons living with HIV/AIDS. Sample selection was random, from two hospitals in a district in Ghana heavily affected by HIV/AIDS. The paper applied the Hopelessness Theory of Depression.ResultsAs expected, the vast majority of respondents experienced the new diagnoses of their HIV-positive infection with a myriad of negative psychosocial reactions, including thoughts of committing suicide. Yet, few of them received the news with resignation. For the vast majority of respondents, having comorbidities from AIDS prior to the diagnosis primarily shaped their initial reactions to their diagnosis. The respondents’ transitioning to self-acceptance of their HIV-positive status was mostly facilitated by receiving counselling from healthcare workers.ConclusionsAlthough the new HIV-positive diagnosis was immobilising to most respondents, the trauma faded, paving the way for beneficial public health actions. The results imply the critical need for continuous education on HIV/AIDS by public health advocates, using mass media, particularly, TV. Healthcare workers in VCTs should empathise with persons who experience new diagnoses of their HIV-positive status.

Cyberbullying and Depression: An empirical study of Indian executives

The purpose of this paper is to investigate the linkage between cyberbullying and depression. Using the multi-mediation routes this study also explores the cyberbullying-depression relationship via helplessness and self-esteem. This study is a multi-mediation model with a sample size of 340 respondents. The study draws cross-sectional data from respondents from diverse industry backgrounds ranging from information technology, education, banking, and retail. Partial least square (PLS-SEM) was used for the analysis. Using the cognitive theory of depression, results showed that cyberbullying is positively related to depression. Also, the study found that helplessness and self-esteem mediate the linkage between cyberbullying and depression. The study is unique as perhaps for the first time the multi mediation mechanism has been studied in the relationship of cyberbullying and depression. Drawing from helplessness/ hopelessness theory, the study has conceptualized and tested cyberbullying as a stressor that triggers various adverse cognitions which have been tested in multi-mediational route. The study highlights several issues emerging with the increased use of the internet and the severe abusive behaviour in form of cyberbullying. There is a need for organizations and managers to have specific actions to reduce the tendency of helplessness and low self-esteem due to cyberbullying to control adverse cognition of depression among employees.

Breaking Point: Second Generation Suicide Theories

Suicide is the second leading cause of death among young people in the world. In this respect, it is emphasized that theories explaining suicidal behavior should be examined to understand the factors behind suicidal behavior. Many theorists have proposed different ideas in explaining suicidal behavior and its occurrence until the beginning of the twenty-first century. These theories are discussed as psychological, sociological, and biological theories. Psychoanalytic Theory, Spiritual Theory, Hopelessness Theory, and Escape Theory were among the psychological theories. It would not be wrong to call these theories first-generation suicide theories. On the other hand, after the 2000s, contemporary psychological theories dealing with suicidal behavior with risk factors have attracted attention. These theories have been called second-generation suicide theories because they have been put forward more recently. Considering the need to examine these theories under a single roof, in this article, the Interpersonal Theory of Suicide, Three-Step Theory of Suicide, Integrative Motivational-Volitional Model, and Fluid Vulnerability Theories are presented. Moreover, an overview of the psychological mechanisms underlying suicidal behavior development has been submitted, and a critical discussion has been made. These theories show that the factors and processes that support the development of suicidal thoughts are different from those associated with suicidal behavior. Hopelessness and suicidality are the common points of theories. In addition, these theories focused on dynamic risk factors and risk assessment that appear in life, change over time, and immediately bring them closer to suicide. Keywords: Suicide, suicide theories, risk factors, suicidal behavior

Day-to-day changes in negative attributions of stress: A daily diary study of cognitive vulnerability and negative affect in adults with elevated risk of suicidal thoughts and behaviors

BackgroundThe hopelessness theory is one of the most studied cognitive vulnerability theories of depression. It proposes that risk for depression is conferred by attributing the causes of negative events to global, internal, stable causes and inferring future negative consequences and negative characteristics about oneself from these events. Nearly all research has operationalized cognitive style using individuals’ responses to hypothetical events at single timepoints. Far less research has explored attributions of specific events as they occur, none of which has involved clinical samples. MethodsThis study aimed to examine if measuring event-specific attributions clarifies the relationship between negative cognitive style and clinical symptoms. Adults (n = 51), who had attempted suicide at least once in the year prior, were recruited from the community via online forums related to suicide risk. Participants provided nightly ratings of hopelessness and attributions of the most stressful event that day for four weeks. ResultsThe daily diary composite measure of cognitive style was more strongly associated with hopelessness and depressive symptoms than the trait measure. Daily attributions fully mediated the relationship between trait cognitive style and hopelessness. LimitationsThe measurement period could not capture the occurrence of a next depressive episode for all participants. Relatedly, we could not account for the precise nature of individual stressors. ConclusionsAt a population level, trait measures alone may be a useful risk factor. But, with the goal to move towards more personalized prediction and intervention, more dynamic, ecologically valid, and real time measures may help gain more traction.

Relations of cognitive styles, depressive symptoms, and blood pressure in community college students

Objective We proposed cognitive styles described in the Hopelessness Theory would be associated with depressive symptoms and Systolic Blood Pressure (SBP) and that depressive symptoms mediate these associations. Participants This cross-sectional study had 324 community college student participants (ages: 18 to 62 years, M = 24.08, SD = 9.10; 57.3% female; 57.3% White, 29.8% Black, 8.8% Latinx, 8.8% Other). Methods Besides self-reports of cognitive styles and depressive symptoms, resting blood pressure was measured three times at 1-min intervals and the mean was used in the analysis. Results Path analyses demonstrated differing associations between each cognitive style and SBP and no mediation, suggesting cognitive styles and depressive symptoms are independently associated with SBP. Conclusions When conceptualizing and measuring the associations of cognitive styles with depressive symptoms and SBP, the styles should be evaluated individually. Interventions targeting cognitive styles might be especially beneficial as changing them might improve mental and physical health.

Trait attributions and threat appraisals explain why an entity theory of personality predicts greater internalizing symptoms during adolescence.

Adolescents who hold an entity theory of personality - the belief that people cannot change - are more likely to report internalizing symptoms during the socially stressful transition to high school. It has been puzzling, however, why a cognitive belief about the potential for change predicts symptoms of an affective disorder. The present research integrated three models - implicit theories, hopelessness theories of depression, and the biopsychosocial model of challenge and threat - to shed light on this issue. Study 1 replicated the link between an entity theory and internalizing symptoms by synthesizing multiple datasets (N = 6,910). Study 2 examined potential mechanisms underlying this link using 8-month longitudinal data and 10-day diary reports during the stressful first year of high school (N = 533, 3,199 daily reports). The results showed that an entity theory of personality predicted increases in internalizing symptoms through tendencies to make fixed trait causal attributions about the self and maladaptive (i.e., "threat") stress appraisals. The findings support an integrative model whereby situation-general beliefs accumulate negative consequences for psychopathology via situation-specific attributions and appraisals.

Hopelessness, Interpersonal, and Emotion Dysregulation Perspectives on Suicidal Ideation: Tests in a Clinical Sample

Objective The present study directly compared three perspectives of suicidality: Interpersonal Theory of Suicide (IPTS), Hopelessness Theory, and a perspective emphasizing emotion dysregulation. Method 219 adults seeking outpatient psychological services completed questionnaires during intake between November 2015 and February 2019. Patients were included if they completed surveys related to thwarted belongingness (TB), perceived burdensomeness (PB), hopelessness, depressive symptoms, negative affect, and Borderline Personality Disorder (BPD) symptoms. Analyses tested the ability of TB, PB, depressive symptoms, hopelessness, and emotion dysregulation to relate to total scores on Beck Scale for Suicide Ideation. We employed Pearson’s correlations and linear regressions to investigate these relations. Results Constructs related to emotion dysregulation—negative affect (r = 0.161, p < .05) and Borderline Personality Disorder symptoms (r = 0.284, p < .01)—were significantly correlated with suicidal ideation, as were those relevant to Hopelessness Theory—depressive symptoms (r = 0.46, p < .01) and hopelessness (r = 0.45, p < .01)— and IPTS—TB (r = 0.36, p < .01) and PB (r = 0.43, p < .01). Notably the combinations of constructs as proposed by theories were significantly associated with suicidal ideation, but did not improve upon single constructs. This indicated that theoretically relevant constructs alone were strongly associated with suicidal ideation, but were not bested by interactions. Conclusions This project compared constructs relevant to three theories of suicidality among a sample of treatment seeking outpatients. Findings indicated that suicidal ideation assessment was similarly informed by Hopelessness Theory and IPTS, and to a lesser degree emotion dysregulation. The cross sectional nature of the data and the reliance upon self-report measures limit the inferences that can be made.

The Architecture of Cognitive Vulnerability to Depressive Symptoms in Adolescence: A Longitudinal Network Analysis Study

Rates of subclinical symptoms and full-blown depression significantly increase during adolescence. Hence, understanding how multiple cognitive risk factors are related to depression in adolescence is of major importance. For this purpose, we simultaneously considered multiple cognitive vulnerabilities, as proposed by three major cognitive theories for depression, namely Beck’s cognitive theory, hopelessness theory, and response style theory. In this four-wave study, we investigated the architecture, interplay, and stability of cognitive vulnerability mechanisms, depressive symptoms, and stressors in a large group of adolescents over a period of one year (n = 469; mean age = 15 years; 64% female). Network analysis was used to shed light on the structure of cognitive vulnerabilities in a data-driven fashion. Analyses revealed that different cognitive vulnerabilities were intertwined and automatic thoughts played the role of hub node in the network. Moreover, the interplay among cognitive vulnerabilities and depressive symptoms was already markedly stable in adolescence and did not change over a 12-month period. Finally, no evidence was found that cognitive vulnerabilities interacted with stressors, as proposed by diathesis-stress models. These findings advance our understanding of multiple cognitive risk factors for depression in adolescence.

Suicide and the Elderly During the COVID-19 Pandemic: An Overview of Different Suicide Theories.

To expand knowledge during the coronavirus disease 2019 (COVID-19) pandemic with regard to suicide prevention among the elderly population by providing recommendations for interview strategies using 3 suicide theories. Two hypothetical geriatric suicide cases (1 low lethality and 1 high lethality) are presented and categorized according to 3 suicide theories: interpersonal theory of suicide, three-step theory of suicide, and hopelessness theory of depression. In crisis intervention, the clinician's interview must match the intrinsic belief of the suicide attempter to enable engagement and rapport. Use of different aspects of the 3 suicide theories can be useful but are dependent on the emergent nature of the attempt. The need for identification and treatment of those with mental health issues, especially among the elderly population, and collaborative multidiscipline management teams is increasing during the current global pandemic. Specific interview strategies are needed when engaging with elderly suicidal patients. Suicide prevention in elderly patients is worthy of strong public attention.

Attributional Styles and Social Functioning in Schizophrenia. Is the Learned Helplessness Model Suitable?

We tried to verify whether the reformulated Learned Helplessness Model and its more fully articulated form, the Hopelessness Theory of Depression, were adequate to predict symptoms and social functioning (SF) in persons with schizophrenia-spectrum disorders by comparing a clinical group (n = 25) with a non-clinical one (n = 30). Bivariate correlations and multiple linear regressions were conducted to assess relationships between the Attribution Styles Questionnaire (ASQ), clinical variables, and SF within the clinical group. Differences between groups were found for most of attributional dimensions. A “pessimistic style” predicted depression within the clinical group. An unstable attribution bias predicted positive symptoms. General psychopathology and a global attribution style predicted 50% of the variance in general SF. The Learned Helplessness Model was suitable to predict depression regardless of psychotic symptoms and may be useful to predict clinical symptoms and SF in persons with schizophrenia spectrum disorders. Clinical and theoretical implications were discussed.

Negative Cognitive Style and Cortisol Reactivity to a Laboratory Stressor: a Preliminary Study

According to the hopelessness theory of depression, some individuals have a cognitive vulnerability (i.e., negative cognitive style) that interacts with stressful life events to produce depression. A negative cognitive style is associated with a maladaptive cognitive response to stress (i.e., increased negative attributions); however, no study has assessed whether this cognitive vulnerability is also associated with a maladaptive endocrine (e.g., cortisol) response to stress. If shown to be related, individual differences in cognitive style may potentially explain why the literature on the association between cortisol stress reactivity and depression is mixed, as cortisol responses to stress may vary as a function of attributional style. The aim of the present study was to provide a preliminary test of whether cognitive vulnerability was related to cortisol reactivity to an acute laboratory stressor among a sample of young adults (n = 20; Mage = 23.1 years; 10 females). Negative cognitive style and depressive symptoms were assessed via the Cognitive Style Questionnaire and the Patient Health Questionnaire, respectively. All participants also completed the Trier Social Stress Test (TSST). Salivary cortisol was collected before, during, and after the TSST. Results showed a significant association between negative cognitive style and cortisol stress reactivity, such that a greater negative cognitive style was related to a larger cortisol response to the TSST. Post hoc analyses revealed that this association was moderated by gender (i.e., effect observed in males only). Cortisol responses to the TSST, in general, were lower among females, but this relationship was not moderated by cognitive style. These findings may be related to underlying gender differences in stress vulnerability, which may have clinical implications for understanding the interactive effect of cognitive and neuroendocrine processes on vulnerability and resiliency to depression.

Perceived Everyday Discrimination and Depressive Symptoms: Does Cognitive Style Mediate?

In the hopelessness theory of depression, a causal chain from stressors (e.g., perceived everyday discrimination [PED]) to 5 negative cognitive styles (NCSs) and depressive symptoms is delineated. In a sample of 243 diverse community college students, PED was positively associated with 4 NCSs. Furthermore, 2 specific NCSs were associated with depressive symptoms and mediated the effect between PED and depressive symptoms. Implications for research and practice with individuals who experience PED are discussed.