Jason M. Lavender

Uniformed Services University of the Health Sciences | USUHS · Department of Medicine

Existing measures of emotion dysregulation typically assess dispositional tendencies and are therefore not well suited for study designs that require repeated assessments over brief intervals. The aim of this study was to develop and validate a state-based multidimensional measure of emotion dysregulation. Psychometric properties of the State Diffi...

Despite increasing empirical interest in muscle dysmorphia (MD), a dearth of research has assessed this construct in sexual minority populations. In particular, the psychometric properties of one of the most widely used measures of MD symptoms—the Muscle Dysmorphic Disorder Inventory (MDDI)—have not been evaluated in sexual minority populations des...

Purpose Evidence suggests that difficulties identifying and describing one’s feelings, core components of alexithymia, are associated with attitudinal and behavioral symptoms of disordered eating; depressive symptoms also may underlie these associations. Specifically, research indicates that alexithymia is positively related to depressive symptoms,...

Background Although the Eating Disorder Examination-Questionnaire (EDE-Q) is one of the most widely used self-report assessments of eating disorder symptoms, evidence indicates potential limitations with its original factor structure and associated psychometric properties in a variety of populations, including sexual minority populations. The aims...

Loss of control (LOC)-eating, excess weight, and anxiety are robustly linked, and are independently associated with markers of poorer cardiometabolic health, including hypertension. However, no study has examined whether frequency of LOC-eating episodes among youth with anxiety symptoms and elevated weight status may confer increased risk for hyper...

Objective: The Eating Disorder Examination-Questionnaire (EDE-Q) is one of the most widely used self-report assessments of eating disorder symptoms. However, evidence indicates potential problems with its original factor structure and associated psychometric properties in a variety of populations, including gender minority populations. The aim of...

Background: Significant clinical similarities have been observed between the recently described ‘Long-Haul’ COVID-19 (LHC) syndrome, Postural Orthostatic Tachycardia Syndrome (POTS) and Inappropriate Sinus Tachycardia (IST). Shared symptoms include light-headedness, palpitations, tremulousness, generalized weakness, blurred vision, chest pain, dysp...

Approximately 35 years after its initial publication, the Eating Disorder Examination (EDE) remains one of the most widely used semi-structured interviews for assessing eating disorder diagnoses and symptomatology. Although the interview provides certain advantages over other common measurement approaches (ie, questionnaires), there are particular...

(1) Background: Standard-of-care lifestyle interventions show insufficient effectiveness for the prevention and treatment of excess weight and its associated cardiometabolic health concerns in adolescents, necessitating more targeted preventative approaches. Anxiety symptoms are common among adolescents, especially girls at risk for excess weight g...

Direct and indirect body-focused self-damaging behaviors are highly prevalent and associated with negative outcomes. Despite progress in understanding the expected consequences (i.e., expectancies) that motivate individuals to engage in these behaviors, less is known about the co-occurrence of, and specific expectancies for, body-focused self-damag...

Muscle dysmorphia (MD) is characterized by a pervasive belief or fear of insufficient muscularity and an elevated drive for muscularity, representing the pathological and extreme pursuit of muscularity. Psychometric properties of one of the most widely used measures of MD symptoms—the Muscle Dysmorphic Disorder Inventory (MDDI)—have yet to be evalu...

Today, many women are driven to subscribe to a more athletically oriented appearance ideal hallmarked by muscle tone (referred to as athletic- or fit-looking). However, the constellation of unhealthy eating and exercise behaviors that may accompany the pursuit of toned muscularity among women is not yet well characterized. To address this knowledge...

Objective: There are limited data to guide the interpretation of scores on measures of eating-disorder psychopathology among underrepresented individuals. We aimed to provide norms for the Eating Disorder Examination-Questionnaire (EDE-Q) and Clinical Impairment Assessment (CIA) across racial/ethnic, gender, and sexual identities, and sexual orien...

Purpose Muscle dysmorphia is generally classified as a specific form of body dysmorphic disorder characterized by a pathological drive for muscularity and the preoccupation that one is too small or not sufficiently muscular. The majority of research on the condition has been conducted in cisgender men with a paucity of literature on gender minority...

Introduction: Suicide models propose that the capability for suicide, such as fearlessness about death (FAD), is necessary for the transition from suicidal desire to a suicide attempt. Most studies have relied on self-report methods to assess FAD. However, this research has produced equivocal results. As individuals may have limited awareness of l...

Adolescent military-dependents are an understudied population who face unique stressors due to their parents’ careers. Research suggests tat adolescent military-dependents report more anxiety and disordered-eating than their civilian counterparts. While anxiety symptoms predict the onset and worsening of disordered-eating attitudes, the mechanisms...

This study examined relationship status (e.g., single versus not single) and number of sexual partners in relation to muscularity- and disordered eating-related attitudes and behaviors among 1090 cisgender gay men enrolled in The PRIDE Study in 2018. Participants completed measures assessing muscle dysmorphia (MD) symptoms, disordered eating attitu...

Weight gain attempts are common among adolescents, yet a paucity of research has explored these behaviors among adults, particularly in relation to substance use behaviors. To address this gap in the literature, pooled data from the 2018 and 2019 International Food Policy Study (N = 42,108) were analyzed. The association of weight gain attempts in...

Background Recent research has emphasized a growing trend of weight gain attempts, particularly among adolescents and boys and young men. Little research has investigated these efforts among adults, as well as the specific diet modifications individuals who are trying to gain weight engage in. Therefore, the aims of this study were to characterize...

Purpose To determine the association between compulsive exercise and vaping among college students aged 18–26 years, and to characterize the type of vaping used among participants who report compulsive exercise. Methods Cross-sectional, pooled data from two survey years (2018–2020; N = 2125) of the national (U.S.) Healthy Minds Study were analyzed...

Objectives: Adolescent military-dependents experience distinct risk and protective factors, which may necessitate additional clinical considerations. In civilian youth, overweight/obesity is associated with eating, internalizing, and externalizing difficulties, with some studies reporting more difficulties among non-Hispanic White (vs. non-Hispani...

Objective: Appearance and performance-enhancing drugs and supplements (APEDS) can be used to enhance muscle growth, athletic performance, and physical appearance. The aim of this study was to examine the lifetime use of APEDS and associations with eating disorder and muscle dysmorphia symptoms among gender minority people. Method: Participants w...

Purpose Appearance and performance-enhancing drugs and supplements (APEDS) are used to enhance muscle growth, athletic performance, and physical appearance. The aim of this study was to examine the lifetime use of APEDS and associations with eating disorder and muscle dysmorphia symptoms among cisgender sexual minority people. Methods Participants...

The utility of traditional eating disorder measures in the assessment of muscularity-oriented disordered eating has been questioned. To address this limitation, the Muscularity-Oriented Eating Test (MOET) was recently developed and validated in a sample of U.S. college men. We aimed to develop a multicultural Spanish-language version of the MOET fo...

Objective Toned muscularity continues to emerge as a salient aspect of women's body image. However, there is a dearth of research investigating the potentially maladaptive eating practices and related cognitions that accompany the drive for muscularity in women. This may be attributable to the limited empirical and clinical attention previously giv...

Objective To determine the prevalence and correlates of weight gain attempts in a pooled sample of adults aged 18 and older from Canada, Australia, the United Kingdom, the United States, and Mexico. Method Data collected during 2 years (2018 and 2019) of the International Food Policy Study (N = 42,108) were analyzed. Unadjusted 12-month prevalence...

Purpose Representing the pathological extreme pursuit of muscularity, muscle dysmorphia (MD) is characterized by a pervasive belief or fear around insufficient muscularity and an elevated drive for muscularity. Despite evidence of heightened body image-related concerns among gender minority populations, little is known about the degree of MD sympto...

Background Representing the pathological extreme pursuit of muscularity, muscle dysmorphia (MD) is characterized by a pervasive belief or fear around insufficient muscularity and an elevated drive for muscularity. Despite evidence of elevated body image-related concerns among sexual minority populations, little is known about the degree of muscle d...

Reward response patterns may contribute to risk and maintenance of eating disorders (EDs), and there may be clinically meaningful heterogeneity in behavioral responses to different actual and anticipated rewards across ED diagnoses. We used an empirical approach to classify individuals with EDs based on self-reported tendencies for responding to re...

The use of assessment questionnaires that demonstrate reliability and validity when used with particular groups of respondents is crucial for both research and clinical activities. Many traditional eating disorder questionnaires were developed based on theories and observations regarding the nature of symptoms as they typically present in girls/wom...

In this book, we summarize the most up-to-date information on eating disorders among boys and men regarding presentation, assessment, medical and nutritional considerations, prevention, treatment, and sociocultural considerations. These chapters also identify key gaps and areas of future research to further drive the field. More sensitive methods t...

Although much of the literature on eating disorders and body dissatisfaction among men involves samples in early adulthood, these concerns can affect boys and men across the lifespan. Evidence suggests that socioculturally prescribed body size preferences and body dissatisfaction can emerge even in early childhood, as can eating disturbances of var...

Purpose of Review Evidence suggests that youth from marginalized racial/ethnic groups (i.e., Latino, Black, Asian American, Native American youth) engage in disinhibited eating at greater rates than their non-Latino White peers. This review aims to discuss the prevalence of disinhibited eating among youth of color, identify culturally-specific corr...

Objective Poorer executive function (EF) has been linked to disinhibited eating in youth, suggesting poor EF predisposes toward obesity, yet the specific nature and extent of interconnections between facets of these domains is unclear. Network analysis provides a promising framework for elucidating the relationship between poor EF and disinhibited...

Background: Among adults, weight stigma is associated with markers of poor cardiometabolic health. Although weight-based teasing (WBT) is common among youth with high body weight, few studies have examined its associations with cardiometabolic markers. Owing to unique stressors (e.g., parental deployment and frequent moves), military-dependent yout...

Although the construct of impulsivity has generally been found to be associated with obesity and health behaviors in adults, research among adolescents is more limited and studies have yet to elucidate which facets of impulsivity may be most salient with regard to different eating and physical activity behaviors. Therefore, the present cross-sectio...

The clinical presentation of binge eating disorder (BED) and data emerging from task-based functional neuroimaging research suggests that this disorder may be associated with alterations in reward processing. However, there is a dearth of research investigating the functional organization of brain networks that mediate reward in BED. To address thi...

Objective Military-dependent youth appear to be at greater risk for disordered-eating than their civilian counterparts. Permanent change of station moves (PCS-moves), typically occurring every 2–3 years, are commonly experienced by adolescent military-dependents. However, the links between PCS-moves and disordered-eating in this population have not...

Boys and men with eating disorders remain a population that is under-recognized and underserved within both research and clinical contexts. It has been well documented that boys and men with eating disorders often exhibit distinct clinical presentations with regard to core cognitive (e.g., body image) and behavioral (e.g., pathological exercise) sy...

Hedonic hunger (i.e., extreme responsiveness to food) has been associated with obesity and poor diet, but findings in the existing literature have primarily been cross-sectional. The current study examined hedonic hunger as a prospective predictor of the longitudinal trajectory of unhealthy food and drink intake across adolescence. Ninth grade stud...

Background Legal performance-enhancing substances (PES), such as creatine, are commonly used by adolescents and young adults. As PES are mostly unregulated by the US Food and Drug Administration, there has been limited empirical attention devoted to examining their long-term safety and health outcomes. Preliminary studies have demonstrated associat...

A wide range of assessments are available to measure body image concerns. Measures have been developed to assess various facets of body image generally, as well as body image in specific populations. This entry provides an overview of body image assessment generally as well as assessments in the field of clinical health psychology.

Body image is a multidimensional construct that refers to a person's subjective appraisal of his or her own physical characteristics and qualities. Body image concerns are prevalent in a number of medical conditions and clinical populations (e.g., individuals with obesity, patients with cancer). In addition, several psychiatric disorders are associ...

Prevailing conceptualizations of muscle dysmorphia (MD) have highlighted the role of adherence to stereotypical ideals of masculinity. In addition, the endorsement of masculine norms has been associated with dysfunctional emotional regulation, itself a correlate of body image psychopathology. Building on this, the present study sought to investigat...

Muscularity dissatisfaction is documented to be a pervasive phenomenon among men. While previous studies have examined theoretically relevant predictors of muscularity dissatisfaction, such as adherence to traditional masculine norms, to the best of our knowledge we are not aware of empirical research that has assessed how perceived discrepancies i...

Research supports increasing cultural pressures for leanness among young men; however, few studies have examined whether weight dissatisfaction or efforts to alter weight have become more prevalent for men over time. The present study evaluated secular trends in weight dissatisfaction and related behaviors among college-age men across 4 decades; 1,...

Numerous conceptualizations addressing the onset or persistence of binge-eating behaviors have been proposed within the literature. This chapter provides an overview of a wide range of theories addressing the development or maintenance of binge eating. The models vary across a number of features, and this chapter is generally organized based on the...

Models of anorexia nervosa (AN) posit that symptoms are maintained through deficient reward and enhanced punishment processing. However, theoretical and empirical inconsistencies highlight the need for a more nuanced conceptualization of this literature. Our goal was to comprehensively review the research on reward and punishment responding in AN f...

Background Metabolic syndrome in adolescence has been associated with adverse cardiometabolic outcomes in adulthood. Preliminary data suggest that boys may have worsened metabolic syndrome components compared to girls. Yet, little is known about the physical health of military dependents, a potentially at‐risk population. Objective Examine sex dif...

Interoceptive awareness (IA), or the awareness of internal body states, is known to be impaired in individuals with eating disorders (EDs); however, little is understood about how IA and ED symptoms are connected. Network analysis is a statistical approach useful for examining how symptoms interrelate and how comorbidities may be maintained. The pr...

Weight-based teasing (WBT) by family members is commonly reported among youth and is associated with eating and mood-related psychopathology. Military dependents may be particularly vulnerable to family WBT and its sequelae due to factors associated with their parents’ careers, such as weight and fitness standards and an emphasis on maintaining one...

Objective: Models of anorexia nervosa (AN) posit that set-shifting deficits may contribute to behavioral inflexibility and extreme dietary restriction. Findings from neurocognitive studies of set-shifting in AN have been somewhat mixed, perhaps due to the use of tasks that cannot distinguish shifting from other processes (i.e., learning). To more...

Objective: It is our sincere pleasure to introduce a special issue of the International Journal of Eating Disorders focused on eating disorders and related symptoms in male populations. Method: Contributions focused on three main themes among male populations: (a) the nature of eating disorder symptoms and recovery; (b) long-term outcomes follow...

This study examined dispositional emotion-, personality/temperament-, and reward-related variables in relation to post-surgery eating pathology and weight-change among 107 adults who underwent Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric banding (LAGB). As part of a prospective cohort study, annual post-surgical assessments we...

Dialectical behavior therapy (DBT) has demonstrated initial efficacy for the treatment of eating disorders (EDs). However, no study has examined potential processes that may contribute to observed improvements in DBT for EDs. The present study sought to investigate changes in DBT skills use throughout treatment as a predictor of symptom change in a...

Objective: Body dissatisfaction is intricately linked to the development of disordered eating. However, as male body dissatisfaction appears more oriented toward muscularity, versus thinness per se, existing measures of eating disorder psychopathology may lack sensitivity in capturing disordered eating that is muscularity-focused. The aim of the p...

Objective: The network theory of psychopathology has been described as an "innovative framework" that may "transform" clinical psychological science. Several network studies have identified central eating disorder (ED) symptoms, yet studies have been comprised primarily of women. Using two large samples, we constructed ED symptom networks among me...

While previous literature suggests that emotion dysregulation is a salient factor contributing to the onset and maintenance of eating disorders (EDs), less is known about how maladaptive, cognitively oriented regulation strategies such as rumination and thought suppression may be uniquely related to ED symptoms in men and women. The present study s...

Perfectionism is hypothesized to contribute to the etiology of anorexia nervosa (AN). However, there is little research regarding whether individuals with AN can be classified according to maladaptive (e.g., evaluative concerns) and adaptive (e.g., high personal standards) facets of perfectionism that predict distinct outcomes and might warrant dif...

Introduction Anorexia nervosa (AN) is a serious psychiatric disorder that is difficult to treat and often follows a protracted course. A number of theoretical models have been proposed for the etiology and maintenance of AN. Two domains that have received substantial attention in the literature on AN are affect and reward/punishment processes. Howe...

Impulsivity, and specific subdomains of inhibitory control and reward sensitivity, are trait-level factors that have been implicated in the onset and maintenance of pediatric obesity and disordered eating, but their associations with real-world eating behavior are unknown. We investigated associations of these trait-level constructs with naturalist...

Identifying processes that may interfere with corrective learning during treatments for anorexia nervosa (AN) may help to improve the effectiveness of existing interventions. We propose that certain cognitive processes characteristic of the AN temperament may help explain previous findings in AN suggesting difficulty updating previously learned ass...

The pathophysiology of anorexia nervosa (AN) and bulimia nervosa (BN) are still poorly understood, but psychobiological models have proposed a key role for disturbances in the neuroendocrines that signal hunger and satiety and maintain energy homeostasis. Mounting evidence suggests that many neuroendocrines involved in the regulation of homeostasis...

Purpose: Appearance-related stress may result from appearance-focused events such as seeing one's reflection, seeing media images, and shopping for clothes. The purpose of this study was to examine the prospective association between momentary appearance-related stress and eating disorder (ED) behaviors (i.e., binge eating and vomiting) among wome...

Neurobiological disturbances associated with reward and/or habit learning are theorized to maintain symptoms of anorexia nervosa (AN). Although research has investigated responses in brain regions associated with reward and habit to disorder‐specific cues (e.g., food) and presumed rewards (e.g., money), little is known about the functional organiza...

Stigma is a factor commonly experienced by marginalized groups that may serve as a maintenance factor for dysregulated eating. In the current paper, we propose a momentary maintenance model, grounded in previous theoretical and empirical research, termed the stigma control model of dysregulated eating. Our model proposes that momentary experiences...

Objective: In recent years there has been increasing clinical and empirical interest in neurocognitive functioning in eating disorders (EDs), which has resulted in numerous quantitative and qualitative reviews. However, there has yet to be a comprehensive synthesis or critical review of this literature to identify future directions to advance the...

Eating disorders (ED), including Anorexia Nervosa (AN), Bulimia Nervosa (BN), and Binge Eating Disorder (BED), are medically dangerous psychiatric disorders of unknown etiology. Accumulating evidence supports a biopsychosocial model that includes genetic heritability, neurobiological vulnerability, and psychosocial factors, such as stress, in the d...

Rumination is a cognitive process involving repetitive thoughts about negative experiences and emotions and is associated with psychopathology. Rumination has been implicated in mood and anxiety disorders, and there is a growing body of research on rumination in relation to eating disorder (ED) psychopathology. The current meta-analytic review focu...

It has been theorized that state the levels of self-control depletion (as caused by negative affect and restraint) may lead to binge eating (BE) when individuals also endorse momentary expectancies that eating will make them feel better (EE). Given commonalities in precipitants of BE across populations, the current study tested this theory in a sam...

Objective: Cognitive-behavioral and interpersonal models of loss of control (LOC) eating have been underexplored in adolescents. Methods: By using data from community-based adolescent girls assessed annually over 4 years, the cognitive-behavioral (n = 416) and interpersonal (n = 418) models were examined by using a regression-based bootstrapping...

There is growing recognition that impulsivity may serve as an underlying risk factor for binge eating. In addition, the association of impulsivity with binge eating may be moderated by other affective and cognitive risk factors. This study examined independent and interactive associations of negative affect, dietary restraint, and facets of impulsi...

Objective: Research investigating the link between eating disorder (ED) diagnosis and executive dysfunction has had conflicting results, yet no meta-analyses have examined the overall association of ED pathology with executive functioning (EF). Method: Effect sizes were extracted from 32 studies comparing ED groups (27 of anorexia nervosa, 9 of...

Objective: Ecological momentary assessment (EMA) research has produced contradictory findings regarding the trajectory of negative affect after binge-eating episodes. Given the clinical implications, the objective of the current study was to reconcile these inconsistencies by comparing the two most commonly employed statistical approaches used to...

Borderline personality disorder (BPD) traits are common among those with bulimia nervosa (BN). However, how these traits impact the state experience of precipitants of BN behavior, such as stressful events and emotional reactivity, has not been determined. Thus, the purpose of this naturalistic study was to examine this trait–state association in B...

Although a growing body of research has examined Purging Disorder (PD), there remains a lack of conclusive evidence regarding the diagnostic validity of PD. This meta-analysis compared PD to DSM–5 eating disorders (i.e., Anorexia Nervosa [AN], Bulimia Nervosa [BN], and Binge Eating Disorder [BED]) and controls. A comprehensive literature search ide...