Isabel Krug

King's College London | KCL · Department of Psychological Medicine

Plain English Summary A large proportion of individuals with eating disorders (ED) or ED symptomatology within the community do not seek treatment or professional help. Low rates of detection and early intervention, low treatment uptake, stigma, shame and lack of motivation to seek help can lead to significant physical and psychological impairment....

Plain English summary Our understanding of the prevalence and impact of eating disorders has improved significantly over the past 20-years. Research highlights that rates of eating disorders are increasing. To inform the development of the Eating Disorder Research and Translation Strategy 2021–2031 this review aimed to better understand the global...

Objective: This study evaluated the severity ratings for anorexia nervosa (AN) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and an alternative severity rating based on overvaluation of weight/shape, on a range of psychological and biological variables. Method: A sample of 312 treatment-seeking patient...

Emotional regulation is a complex multidimensional construct implied in the ability to regulate competencies such as impulsivity, frustration tolerance (necessary to avoid and manage negative emotional states such as anger, stress, anxiety, or depression), and planning and coping skills in situations of potential conflict. It has been hypothesized...

Background: Risk factors represent a range of complex variables associated with the onset, development, and course of eating disorders. Understanding these risk factors is vital for the refinement of aetiological models, which may inform the development of targeted, evidence-based prevention, early intervention, and treatment programs. This Rapid...

Videoconferencing for work/study purposes has increased rapidly due to the COVID-19 global pandemic. Given this practice often involves viewing one's own video image, higher appearance concerns whilst videoconferencing may be linked to poorer performance whereby individuals may not feel they are able to engage or have control during a work/study me...

Background: Social media content on Western platforms promoting thinness, or thinspiration, has been found to negatively affect body image perception of users. Less is known about non-Western social media use and its effects on body image concerns. Chinese TikTok, known as Douyin, is a popular short video platform with 600 million daily active user...

The centrality of physical appearance in dating app environments may constitute an appearance-related pressure that increases the likelihood of body dissatisfaction (BD) and disordered eating (DE), thus exacerbating the relationship between DE-predictive traits and DE itself. Although dating app use has been linked to BD and DE, prior research has...

Objective: The use of videoconferencing has increased during the pandemic, creating prolonged exposure to self-image. This research aimed to investigate whether eating disorder (ED) risk was associated with videoconferencing performance for work or study and to explore whether the use of safety behaviors and self-focused attention mediated the rel...

The dual pathway model (DPM) for bulimia nervosa (BN) symptoms proposes that increased body mass index (BMI) leads to pressures to be thin, and body dissatisfaction. Pressures to be thin are also thought to lead to thin-ideal internalization and body dissatisfaction. According to the model, the effects of body dissatisfaction on BN symptoms are med...

Background: Eating disorders (EDs) are potentially severe, complex, and life-threatening illnesses. The mortality rate of EDs is significantly elevated compared to other psychiatric conditions, primarily due to medical complications and suicide. The current rapid review aimed to summarise the literature and identify gaps in knowledge relating to a...

We examined whether rumination, brooding, and reflection differed between patients with depression, anxiety, and eating disorders and healthy controls. We also examined correlations between psychopathology and rumination, brooding, and reflection. Systematic searches of four electronic databases from July 2008 to December 2021 identified 585 abstra...

This work proposes that trait body dissatisfaction rests on two dissociable components: 1) frequency of body dissatisfaction episodes, and 2) duration of such episodes, with higher trait body dissatisfaction resulting from more frequent and/or prolonged episodes. The current research aimed to develop a measure of these two dimensions (i.e., the Bod...

With the recent proliferation of food delivery applications (‘apps’; FDAs), accessing a meal is more convenient and immediate than ever. These apps may potentially foster dysregulated eating behaviours, including maladaptive eating to cope with negative emotional states. Using ecological momentary assessment (EMA), the current study assessed whethe...

The Body Dissatisfaction Frequency Duration Questionnaire (BDFDQ) is freely available for use. Copyright Dondzilo, Rodgers, Fuller-Tyszkiewicz, Vartanian, Krug, Preece, MacLeod, and MacLeod (2022).

Purpose of review: The cessation of in-person teaching to reduce the spread of COVID-19 dramatically increased the use of videoconferencing for home learning among adolescents. Recent findings: A consistent finding across studies assessing the relationship between videoconferencing and appearance concerns was that time spent focused on self-view...

Background: 'Classic' embodiment illusions (e.g., the feeling of owning another person's hand) involves a three-way interaction between visual, proprioceptive, and tactile stimuli. These illusions have been studied in eating disorder (ED) populations given the potential implications for better understanding and improving body image concerns. Recen...

Background Limited screening practices, minimal eating disorder training in the healthcare professions, and barriers related to help-seeking contribute to persistent low rates of eating disorder detection, significant unmet treatment need, and appreciable associated disease burden. The current review sought to broadly summarise the literature and i...

Background Eating disorders (EDs) are highly complex mental illnesses associated with significant medical complications. There are currently knowledge gaps in research relating to the epidemiology, aetiology, treatment, burden, and outcomes of eating disorders. To clearly identify and begin addressing the major deficits in the scientific, medical,...

Purpose The centrality of physical appearance in dating app environments may constitute an appearance related pressure that increases the likelihood of body dissatisfaction (BD) and disordered eating (DE). Although dating app use has been linked to BD and DE, prior research has neglected the role of individuals’ dating app use motivations and relev...

Dating apps may potentially serve as an environment that subjects young women to the harmful effects of appearance-related pressure. The current study assessed for the first time whether women's dating app use predicted body dissatisfaction (BD), urges to engage in disordered eating (DE), and negative mood in daily life. We also examined the unique...

Objectives: Obsessive-compulsive personality disorder (OCDP) traits are commonly associated with eating disorders (EDs), with evidence demonstrating that these traits predispose and exacerbate the ED illness course. However, limited research has examined the symptomatic interplay between ED and OCDP traits. We used network analysis to (1) identify...

The current study used ecological momentary assessment (EMA) to investigate whether appearance-based comments, social and performance-based evaluations affected levels of body dissatisfaction (BD) and urges to engage in disordered eating behaviours (DE) throughout daily life. A total of 620 participants completed a baseline questionnaire assessing...

Night eating syndrome (NES) is currently classified as an Other Specified Feeding or Eating Disorder (OSFED) under the Diagnostic Statistical Manual−5 (DSM-5). This systematic review aims to consolidate the studies that describe the sociodemographic, clinical and psychological features of NES in a population of patients with eating disorders (ED),...

Background Despite a wide range of proposed risk factors and theoretical models, prediction of eating disorder (ED) onset remains poor. This study undertook the first comparison of two machine learning (ML) approaches [penalised logistic regression (LASSO), and prediction rule ensembles (PREs)] to conventional logistic regression (LR) models to enh...

Objectives To assess the clinical significance and distinctiveness of purging disorder (PD) from other eating disorder (ED) diagnoses. Method Participants included 3127 women consecutively admitted to an ED treatment centre (246 PD, 465 anorexia nervosa restrictive [AN-R], 327 AN-binge purging [AN-BP], 1436 bulimia nervosa [BN], 360 binge eating d...

Objective The high co-occurrence of non-suicidal self-injury (NSSI) behaviours and eating disorder (ED) symptoms suggests these conditions share common aetiological processes. We assessed a new integrative model of shared factors for NSSI and ED symptoms, where affect dysregulation, impulsivity, self-esteem, and body dissatisfaction mediated the re...

Purpose Autism spectrum disorder traits have been implicated in the psychopathology of eating disorders and may also be relevant for the development of orthorexia symptoms. Further, intolerance of uncertainty (IUS) may indirectly contribute to the development of disordered eating, as the displacement of anxiety onto food may help achieve a sense of...

Objective: The high co-occurrence of non-suicidal self-injury (NSSI) behaviours and eating disorder (ED) symptoms suggests these conditions share common aetiological processes. We assessed whether insecure attachment and maladaptive schemas were related to NSSI and ED symptoms through affect dysregulation, impulsivity, self-esteem, and body dissati...

We introduce the term “seasonal body image” to refer to within-person variation in body image that occurs across the Gregorian seasons of Spring, Summer, Autumn, and Winter. Herein, we (i) quantified and visualised seasonal body image and its mechanisms, and (ii) identified individual predictors of seasonal body image. Sexual minority men (N = 823)...

Introduction Objectification theory argues that self-objectification confers risk for disordered eating (DE) both directly, and indirectly through a cascade of negative psychological consequences (e.g. low mood and self-conscious body monitoring). Robust cross-sectional evidence supports these relationships. However, these cross-sectional studies d...

Introduction Studies have suggested that stress predicts both body dissatisfaction (BD) and disordered eating (DE) patterns. However, the mechanisms of this process are not entirely clear and could be elucidated through further exploration in daily life. Objectives The purpose of this study was to 1) explore the concurrent and lagged relationship...

Introduction The Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) introduced severity indices for Eating Disorders (ED). Objectives This study assessed in a male ED sample the DSM-5 severity indices for Anorexia Nervosa (AN), Bulimia Nervosa (BN) and Binge Eating Disorder (BED) and compared them to an alternative transdiagnostic dri...

Through an experimental Ecological Momentary Assessment (EMA) design, we assessed the effects of fitspiration images (relative to neutral) on body image, mood and disordered eating and whether trait body dissatisfaction, thin-ideal internalization and pressures from the media, family and peers moderated these effects. After completing trait-based m...

Objective: To assess an alternative trans-diagnostic indicator for severity based on drive for thinness (DT) for anorexia nervosa (AN), bulimia nervosa (BN), binge-eating disorder (BED), and other specified feeding or eating disorder (OSFED), and to compare this new approach to the fifth edition of the Diagnostic and Statistical Manual of Mental D...

To date, little is known about the impact of fitspiration and thinspiration exposure on men, as previous studies on these social media trends were primarily conducted on women. Male participants (n = 223) completed baseline measures of trait body image, then used a smartphone application to complete up to six state-based assessments daily for seven...

Objectives: To assess the natural grouping of Purging Disorder (PD) patients based on purging symptomatology and to evaluate the derived classes (a) against each other and (b) to a control group on a range of clinical and psychological measures. Method: Participants included 223 PD women consecutively admitted to a tertiary ED treatment centre a...

Recent work using naturalistic, repeated, ambulatory assessment approaches have uncovered a range of within-person mood- and body image-related dynamics (such as fluctuation of mood and body dissatisfaction) that can prospectively predict eating disorder behaviors (e.g., a binge episode following an increase in negative mood). The prognostic signif...

Objectives To assess whether maladaptive perfectionism (parental and intrapersonal), mediated by self-esteem and internalized shame, lead to depressive symptoms, and to identify whether this model was invariant (i.e., structurally unchanged) across groups of Australian domestic and Asian international students.MethodsA total of 624 (308 Australian...

Objective: Using a daily monitoring framework, we examined the psychological consequences of Fitbit self-tracking on state body satisfaction, disordered eating (DE; i.e., binge eating and dietary restraint), levels of exercise engagement, and motivations (appearance vs. fitness/health) in adult women. A further aim within the Fitbit group was to a...

Accumulating lab-based studies have identified attentional biases in processing of negative appearance-related information among individuals with elevated trait body shape and weight dissatisfaction (BD). How these biases translate into experiences of BD in daily life remains unclear and, hence, was the focus of the present study. Thirty-eight wome...

Objective: The cognitive-interpersonal model proposes that high levels of attention to detail and cognitive rigidity confer risk for the development of eating disorders (EDs) and that socioemotional deficits, such as alexithymia, contribute to their maintenance. However, no studies have examined the direct and indirect relationships of these const...

Objective: The current study used network analysis to explore associations between specific groupings of borderline personality disorder (BPD) and eating disorder (ED) symptoms, and other transdiagnostic variables including insecure attachment, rejection sensitivity, emotion dysregulation, a theory of mind, and emotion recognition. Method: Netwo...

Objectives Recent evidence suggests that parents’ negative experiences of combining work and family roles can have harmful effects on children, but little is known about the mechanisms that explain the crossover from the work–family interface to children’s mental health over time. This study tested whether inter-parental conflict mediated the relat...

The present study evaluated whether individuals with varying levels of trait body image flexibility differ in the severity, variability, and correlates of state body dissatisfaction experienced in their daily lives. One hundred and forty-seven women completed a baseline measure of trait body image flexibility, followed by a 7-day ecological momenta...

The current study explores the effect of body dissatisfaction (both stable, trait-level and specific, state-based instances in daily life) on sexting behaviors, and the impact of sending and receiving sexts on body dissatisfaction levels in daily life. One hundred and forty-seven women aged 18 to 42 years completed baseline measures of body dissati...

We investigated potential crossover from mothers' and fathers' work-family conflict to their own and their partner's perception of inter-parental conflict and parenting irritability, and subsequent influences on children's and adolescents' mental health. Using a representative sample of Australian children (N = 3061), an autoregressive model tested...

Isabel Krug,1 Sarah Giles,1 Chiara Paganini2,31Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia; 2Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia; 3Faculty of Health, Federation University, Ballarat, VIC, AustraliaAbstract: Emerging evidence suggests that disordered eating, pa...

Although appearance comparisons, self-monitoring, and appearance-related comments have been linked to body dissatisfaction in prior studies, the combined and unique influences of these variables on state body dissatisfaction in daily life has yet to be explored. The present study addressed this gap, and also evaluated whether these state-based effe...

Despite theoretical arguments that brief app-based interventions could be a useful adjunct to longer traditional treatment programs, there has been limited evaluation of the acceptability, feasibility, and efficacy of these micro-interventions. In the present study, 247 women from the general population were randomly assigned to the intervention or...

The current study tested a new interpersonal model of disordered eating behaviours, whereby maladaptive schemas and theory of mind decoding (ToM-decoding) were related with disordered eating attitudes (body dissatisfaction) and behaviours (binging/purging and food restriction) through the mediating variable appearance-based rejection-sensitivity. A...

Objective This study extends the dual pathway model (DPM) of bulimic symptoms by considering the bidirectional effects amongst symptoms of depression, dietary restraint, and bulimia. We also assessed the influence of negative urgency, a personality construct associated with bulimic symptoms, on the DPM. Method Participants were 244 females (Mage =...

Objective Although exercise is typically found to improve body satisfaction, this effect may be reduced or even reversed for trait body‐dissatisfied individuals. The reasons for this remain unclear. This study tested the possibility that these effects are due to appearance‐related motives and/or increased appearance awareness post‐exercise. Method...

Rationale: Work-family conflict and enrichment refer to parents' challenges and benefits of combining work and family roles. Emerging evidence suggests detrimental effects of work-family conflict and facilitating effects of work-family enrichment on couple, family, and child functioning. This effect may be more pronounced in mothers, who must jugg...

Dietary restriction contributes to disordered eating (DE) behaviors and associated cognitions. However, it is unclear how these outcomes are impacted by dietary restriction for religious purposes, such as fasting observed by Muslims during Ramadan. Using ecological momentary assessment, this study assessed the impact of Ramadan fasting on DE behavi...

This review sought to systematically review and quantify the evidence related to body checking and body avoidance in eating disorders (EDs) to gauge the size of effects, as well as examine potential differences between clinical and nonclinical populations, and between different ED subtypes. PsycINFO, PsycARTICLES, PsycEXTRA, Cochrane Library, and M...

The present study evaluated the relation of key features of state body dissatisfaction experiences - inertia, instability from moment-to-moment, and average level across time-points - to trait body dissatisfaction and/or eating disorder risk. Participants included 161 women who completed measures of trait body dissatisfaction and disordered eating...

Social media has been associated with body dissatisfaction and eating disorder symptoms among young women and adolescent girls. However, despite notable evidence of susceptibility to body image pressures, it remains unknown whether these associations generalize to sexual minority men. A nationwide sample of 2,733 sexual minority men completed an on...

Studies indicate that Polycystic Ovarian Syndrome (PCOS) features (e.g. insulin instability, food cravings, overproduction of androgens and menstrual irregularities) associate with increased appetite, impaired impulse control and feelings of body dissatisfaction. Counter intuitively, binge eating behaviors have been shown to reinforce PCOS symptoma...

Using experience sampling methodology, we examined the effects of frequency and occurrence of appearance-based comparisons on disordered eating behaviors (binge eating, restrictive behaviors, and weight-related exercise). A total of 161 Australian women (aged 18–48) completed a baseline measure of eating pathology. An iPhone application prompted pa...

This study investigated whether engaging in mindfulness following food consumption produced changes in affect and body satisfaction, as compared to a control distraction task. The moderating effects of eating pathology and neuroticism were also examined. A total of 110 female university students consumed food and water before engaging in either a m...

Objective: This study aimed to investigate Australian healthcare practitioners’ knowledge and attitudes toward binge eating disorder (BED). Method: Participants were 175 healthcare professionals, who were randomized to one of two conditions that assessed diagnostic and treatment knowledge of either comorbid BED and obesity or only obesity via case...

Objectives: To examine the relationship between psychological and social factors (depression, emotional control, sexual abuse, and parental physical punishment) and adolescent drive for Thinness and Bulimic behaviors in a large community sample, and to investigate possible genetic moderation. Method: Data were drawn from the Australian Temperament...

Aim: The current study assessed a new interpersonal model for eating disorders (EDs), in which interpersonal rejection sensitivity (RS), appearance-based RS and social rank were hypothesised to mediate the relationship between insecure attachment and disordered eating. Method: The sample comprised a clinical ED group (N = 122) and a control grou...

This study examined whether self-reported and observationally measured parental behaviours were associated with disordered eating, and investigated possible moderation by a serotonin-transporter polymorphism (5-HTTLPR). Study 1 included 650 adolescents from the Australian Temperament Project who completed the Eating Disorder Inventory-2 Drive for T...

Objective: The present study aims to explore the potentially longitudinal bi-directional effects of disordered eating (DE) symptoms with depression and anxiety. Method: Participants were 189 (49.5% male) adolescents from Melbourne, Australia. DE, depressive and anxiety symptoms were assessed at approximately 15, 16.5 and 18.5 years of age. Resu...

Aim: The current study aimed to assess insecure attachment and the disconnection and rejection domain of maladaptive schema in the context of disordered eating. Rejection sensitivity (RS) was proposed as a mediator between maladaptive schema and disordered eating. Method: The sample consisted of 108 female participants with a lifetime eating dis...

Altered reward reactivity is a potential risk endophenotype for eating disorders (EDs). The aim of this study was to examine reward reactivity in female twins with EDs and compare it with a twin control group. A sample of 112 twins [n = 51 met lifetime DSM-IV ED criteria (anorexia nervosa n = 26; bulimic disorders n = 24), n = 19 unaffected cotwins...

Objective To replicate the Dual Pathway Model (DPM) of bulimia nervosa (BN) symptoms prospectively, and to assess whether a revised version of the DPM that included the variables social comparisons made on Facebook and sociotropy influenced the DPM. Method Participants were 245 females who completed baseline measures (T1) that assessed the DPM, a...

Objective: To assess differences in trait objectifying measures and eating pathology between Australian Caucasians and Asian women living in Australia and in Hong Kong with high and low levels of western cultural identification (WCI) and to see if exposure to objectifying images had an effect on state-objectification. A further aim was to assess us...

Although the influence of stable, trait-like factors (such as trait body dissatisfaction and appearance internalization) on instances of appearance comparison has been well documented, the additive and interactive influence of contextual factors (such as one’s current body satisfaction) on comparison behaviors is unknown. Therefore, the present stu...

Objective: To investigate the interactions between low parental warmth and monitoring at age 13-14 years and disordered eating attitudes and behaviours at age 15-16 years. Method: Data on 1300 (667 females) adolescents and their parents were drawn from The Australian Temperament Project (ATP), a 30 year (15 wave) population based longitudinal st...

Objective To examine the impact of appearance comparison behaviours, trait body dissatisfaction and eating pathology on women's state body dissatisfaction and engagement in disordered eating behaviours in daily life. Method Using ecological sampling method (ESM), 116 women residing in Australia, completed a baseline questionnaire containing the tr...

Background Despite the considerable number of studies that have assessed evidence for a longitudinal relationship between eating pathology and depression, there is no clear consensus regarding whether they are uni- or bi-directionally related. Objective To undertake a meta-analysis to provide a quantitative synthesis of longitudinal studies that a...

Background Gene × environment (G × E) interactions in eating pathology have been increasingly investigated, however studies have been limited by sample size due to the difficulty of obtaining genetic data. Objective To synthesize existing G × E research in the eating disorders (ED) field and provide a clear picture of the current state of knowledg...