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Introduction
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January 2008 - June 2016
Publications
Publications (75)
Anorexia Nervosa (AN) is a serious psychiatric disorder defined by energy restriction, fear of weight gain, behavior that inhibits weight gain, and body image disturbance. AN commonly is associated with co-morbid psychiatric illness, such as mood and anxiety disorders, and has a high mortality rate. Malnutrition ensuing from AN can cause poor physi...
Bulimia nervosa (BN) is characterized by recurrent binge eating, compensatory behaviors, and weight/shape overvaluation in the absence of underweight status. BN occurs across the lifespan and in all gender and racial/ethnic groups. Development of BN involves a complex interplay of genetic, personality, and developmental factors. BN can result in ne...
Background:
Anorexia Nervosa is highly comorbid with depressive, anxiety, and obsessive-compulsive spectrum disorders. However, it has not previously been reported as comorbid with antisocial personality traits, except when substance use disorder is also identified. We present an unusual case of a patient with resistant anorexia nervosa and comorb...
Objective
To characterize helpful parent feeding strategies using reflections on childhood eating experiences of adults with symptoms of Avoidant/Restrictive Food Intake Disorder (ARFID).
Method
We explored a unique text-based dataset gathered from a population of N = 19,239 self-identified adult “picky eaters.” The sample included adults with sym...
The Clinical Impairment Assessment (CIA) is a widely used self-report measure of the psychosocial impairment associated with eating-disorder symptoms. Past studies recommended a global CIA score of 16 to identify clinically significant impairment associated with a probable eating disorder (ED). However, to date, research on the properties of the CI...
Interventions that address binge eating and food insecurity are needed. Engaging people with lived experience to understand their needs and preferences could yield important design considerations for such interventions. In this study, people with food insecurity, recurrent binge eating, and obesity completed an interview-based needs assessment to l...
Gastrointestinal (GI) problems are common in individuals with eating disorders (EDs) and associated with distress, impairment, and increased healthcare utilization. GI symptoms may be exacerbated by meals and other interventions central to ED recovery thereby contributing to negative clinical outcomes. Informed by models emphasizing the role of the...
Objective:
This study tested the association between food insecurity and eating disorder (ED) pathology, including probable ED diagnosis, among two cohorts of university students before and during the beginning of the COVID-19 pandemic.
Method:
Students (n = 579) from a large Midwestern American university completed self-report questionnaires as...
Purpose of Review
Binge eating disorder (BED) is characterized by recurrent binge eating episodes (i.e., eating an objectively large amount of food accompanied by a sense of loss of control while eating) in the absence of regular compensatory behavior. BED follows a chronic course marked by significant dysfunction and impairment. This review focuse...
BACKGROUND
Accounting for how end-users engage with technologies is imperative for designing an efficacious mobile behavioral intervention.
OBJECTIVE
This mixed-methods analysis examined the translational potential of user-centered design and basic behavioral science to inform the design of a mobile intervention for obesity and binge eating.
METH...
Background
Accounting for how end users engage with technologies is imperative for designing an efficacious mobile behavioral intervention.
Objective
This mixed methods analysis examined the translational potential of user-centered design and basic behavioral science to inform the design of a new mobile intervention for obesity and binge eating....
Proper assessment and diagnosis of eating disorders (EDs) are critical to determine to whom prevention and treatment efforts should be targeted, the extent to which treatment is working, and when an individual has recovered. Although existing ED diagnostic interviews have numerous strengths, they also have certain limitations, including poor intern...
Severe and enduring anorexia nervosa (SE‐AN) is well known to clinicians who treat eating disorders, especially in adults, yet an empirically validated definition of SE‐AN is lacking. Current approaches to delineating SE‐AN rely on expert opinion, and there is little consensus regarding the criteria that distinguish SE‐AN from other clinical presen...
Despite growing recognition of the importance of workforce diversity in health care, limited research has explored diversity among eating disorder (ED) professionals globally. This multi-methods study examined diversity across demographic and professional variables. Participants were recruited from ED and discipline-specific professional organizati...
Objective:
User-centered design can improve engagement with and the potential efficacy of behavioral interventions, but is underutilized in health care. This work demonstrates how design methodologies can inform the design of a mobile behavioral intervention for binge eating and obesity.
Method:
A needs assessment was conducted with end-users (N...
Objective:
Technology-enabled services frequently have limited reach and suboptimal engagement when implemented in real-world settings. One reason for these implementation failures is that technology-enabled services are not designed for the users and contexts in which they will be implemented. User-centered design is an approach to designing tech...
BACKGROUND: Efforts to examine alternative classifications (e.g., personality) of anorexia nervosa (AN) using empirical techniques are crucial to elucidate diverse symptom presentations, personality traits, and psychiatric comorbidities. AIM: The purpose of this study was to use an empirical approach (mixture modeling) to test an alternative classi...
Objective:
This study evaluated the benefits of olanzapine compared with placebo for adult outpatients with anorexia nervosa.
Methods:
This randomized double-blind placebo-controlled trial of adult outpatients with anorexia nervosa (N=152, 96% of whom were women; the sample's mean body mass index [BMI] was 16.7) was conducted at five sites in No...
Increased prevalence of eating disorders has been found in populations that have experienced childhood trauma. Conversely, a history of childhood trauma has been found to be associated with increased eating disorder severity, as well as increased psychiatric comorbidity in patients with eating disorders. Available data suggest that individuals with...
Objective
Research evidence supports the clinical significance of subjective feelings of loss of control over eating; however, limited attention has been given to how this construct is assessed. Two measures have been developed in recent years (i.e., Eating Loss of Control Scale [ELOC] and Loss of Control over Eating Scale [LOCES]), but further val...
Anorexia nervosa (AN) is an eating disorder characterized by severe food restriction resulting in low body weight and an intense fear of gaining weight. This disorder has one of the highest suicide rates of any psychiatric illness; however, few studies have investigated prospective predictors of suicide ideation (SI) in this population. Quality‐of‐...
Background
Desired weight is an indicator of illness severity in youth with anorexia nervosa (AN), but its impact on eating disorder symptoms over time and in adults is unknown. This study examined longitudinal associations between two desired weight constructs (desired weight percentage, weight difference percentage) and eating disorder severity a...
Purpose:
Neuroimaging studies suggest that altered brain responses to food-related cues in reward-sensitive regions characterize individuals who experience binge-eating episodes. However, the absence of longitudinal data limits the understanding of whether reward-system alterations increase vulnerability to binge eating, as theorized in models of...
Epidemiological research suggests racial differences in the presentation of eating disorder symptoms. However, no studies have examined associations between race and eating disorder symptom trajectories across youth and adolescence, which is necessary to inform culturally sensitive prevention programs. The purpose of the current study was to examin...
Objective:
Individuals with eating disorders (ED), particularly anorexia nervosa (AN), and bulimia nervosa (BN), often wish to reduce their body weight in pursuit of a thin ideal, but no study has examined the relation between desired weight and ED pathology in a clinical population of youth. Given the potential impact of desired weight on normali...
Objective:
Clinical studies suggest comorbidity between eating disorders and aggressive behaviors. This study examined the pattern of comorbidity between intermittent explosive disorder (IED) and eating disorders (ED).
Methods:
Data were analyzed from both the adult and adolescent samples of the National Comorbidity Survey-Replication (n = 19,43...
Objective:
The purpose of this study was to test the concurrent and predictive validity of dietary-negative affect subtypes among patients with anorexia nervosa (AN; N = 194).
Method:
Latent profile analysis was used to identify subtypes of AN based on dimensions of dietary restraint and negative affect. Chi-square and multivariate analysis of v...
Comparing individuals of varying weight statuses on their identification and regulation of emotions may increase our understanding of mechanisms that drive excess weight gain and highlight more precise weight regulation targets. In Study I (N = 1333), adults with obesity had reduced self-reported attention to and repair of emotions compared to adul...
Targeted approaches for the treatment of severe and enduring anorexia nervosa (SE-AN) have been recommended, but there is no consensus definition of SE-AN to inform research and clinical practice. This study aimed to take initial steps toward developing an empirically based definition of SE-AN by characterizing associations among putative indicator...
Objective:
Several theoretical models describe the structure of eating disorders (EDs), and a burgeoning empirical literature has sought to identify whether eating pathology is conceptualized best as categorical (presence or absence of disorder), dimensional (continuous), or a hybrid of categories and dimensions.
Methods:
This study used structu...
Major depression and eating disorders (EDs) are highly co-morbid and may share liability. Impaired emotion regulation may represent a common etiological or maintaining mechanism. Research has demonstrated that depressed individuals and individuals with EDs exhibit impaired emotion regulation, with these impairments being associated with changes in...
Objective:
Research in individuals with bulimia nervosa has highlighted the clinical significance of weight suppression (WS), defined as the difference between one's highest and current weight. More recently, studies have suggested that WS also may play a role in symptom maintenance and weight gain during treatment in anorexia nervosa (AN) and tha...
Emotion regulation difficulties are implicated in the development and maintenance of anorexia nervosa (AN). However, research has been limited by an almost exclusive reliance on self-report. This study is the first to use the emotion-modulated startle paradigm (EMSP) to investigate emotional reactivity and voluntary emotion regulation in individual...
The Research Domain Criteria (RDoC) project was initiated by the National Institute of Mental Health as a heuristic for addressing the limitations of categorical, symptom-based psychiatric diagnoses. RDoC is conceptualized as a matrix, with the rows representing dimensional constructs or domains implicated in the expression of psychiatric symptoms...
Objective
Theoretical models of emotion regulation difficulties in anorexia nervosa (AN) specify a role for factors that predispose to or precipitate emotion dysregulation. The current study considered whether childhood abuse (i.e., emotional, sexual, physical) might be related to emotion regulation difficulties and eating disorder symptom severity...
This study aimed to evaluate the preliminary effectiveness of Emotion Acceptance Behavior Therapy (EABT), an outpatient psychotherapeutic intervention for anorexia nervosa (AN) based on a disorder-specific model of symptom maintenance that emphasizes emotion avoidance. EABT combines standard behavioral interventions that are central to the clinical...
Purpose of review:
This article provides an overview of current thinking about the association between disordered eating and obesity, emphasizing binge eating, binge eating disorder and food addiction as useful conceptual models.
Recent findings:
Binge eating, recurrent and persistent episodes of overeating coupled with a lack of control over ea...
Objective:
Emotion regulation difficulties have been implicated in theoretical models of anorexia nervosa (AN) development/maintenance, and several treatments for AN have been designed to target emotion dysregulation. However, no research has used longitudinal methodology to examine whether emotion regulation difficulties predict the maintenance o...
Prefrontal dopamine (DA) transmission participates in the reinforcement of reward-driven behaviors like eating. Because catechol-O-methyltransferase (COMT) degrades DA and is expressed in the prefrontal cortex, variation in the COMT gene may modulate eating behavior. Previous studies have shown that the met allele of the COMT val158met single nucle...
© 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2014;).
Eating pathology in Seasonal Affective Disorder (SAD) may be more severe than hyperphagia during winter. Although research has documented elevated rates of subclinical binge eating in women with SAD, the prevalence and correlates of binge eating disorder (BED) in SAD remain largely uncharacterized. We examined the prevalence and correlates of binge...
The Eating Pathology Symptoms Inventory [EPSI; Forbush KT, Wildes JE, Pollack LO, Dunbar D, Luo J, Patterson K, et al. Development and validation of the EPSI. Psychological Assessment, in press] is an empirically derived self-report measure of eating disorder (ED) symptoms. The EPSI is able to capture the majority of variance associated with establ...
Using Wakefield's conceptualization of mental disorder as "harmful mental dysfunction" (Wakefield, Am Psychol, 47, 373-388, 1992), we examined the evidence for including obesity as a mental disorder in DSM-V.
We searched computer databases and examined reference lists from review articles published in the last 10 years to identify empirical papers...
Objective
Extant research suggests that individuals with anorexia nervosa (AN) have deficits in emotion regulation across a variety of domains. The current study investigated associations between specific difficulties with emotion regulation and the core symptoms of AN. Method
Participants were 192 patients with AN presenting to an intensive eating...
Anorexia nervosa (AN) is characterized by within-group heterogeneity in symptom presentation, which poses problems for research on etiology and treatment. This study sought to identify homogeneous subtypes of AN, and examine their short-term stability, using empirical methods. A treatment-seeking sample with AN (n = 194) was assessed at baseline an...
Given renewed interest in dimensional approaches in psychiatric nosology, we review evidence for the utility of including dimensions of eating disorder (ED) psychopathology, comorbid psychopathology, and neurobiology in the classification of EDs.
We searched on-line databases and reference lists of published papers for articles on dimensional metho...
Many current measures of eating disorder (ED) symptoms have 1 or more serious limitations, such as inconsistent factor structures or poor discriminant validity. The goal of this study was to overcome these limitations through the development of a comprehensive multidimensional measure of eating pathology. An initial pool of 160 items was developed...
There is increasing recognition of the limitations of current approaches to psychiatric classification. Nowhere is this more apparent than in the eating disorders (EDs). Several alternative methods of classifying EDs have been proposed, which can be divided into two major groups: 1) those that have classified individuals on the basis of disordered...
The nature of disturbance in body experience in anorexia nervosa (AN) remains poorly operationalized despite its prognostic significance. We examined the relationship of subjective reports of sensitivity to and behavioral avoidance of sensory experience (e.g., to touch, motion) to body image disturbance and temperament in adult women currently diag...
To evaluate the effect of negative emotion on self-reported eating disorder symptoms and objectively-measured eating behavior in patients with anorexia nervosa (AN).
Twenty-eight females with AN were randomized to a negative or neutral mood induction followed by a test meal. Participants completed assessments one week before the experimental sessio...
Objective: Using Wakefield's conceptu-alization of mental disorder as ''harmful mental dysfunction'' (Wakefield, Am Psy-chol, 47, 373–388, 1992), we examined the evidence for including obesity as a mental disorder in DSM-V. Method: We searched computer databases and examined reference lists from review articles published in the last 10 years to ide...
To gather information about picky eating and its correlates in adults and to determine whether picky eating is distinct from other eating disorder symptoms.
Nearly 6,895 adults completed a web-based survey of picky eating behaviors, eating disorder symptoms, and putative associated features. Latent class analysis was used to identify groups based o...
Previous studies have documented that weight suppression (a person's highest adult weight minus current weight) predicts weight gain and disordered eating symptoms during treatment of bulimia spectrum disorders, but no research has examined weight suppression in individuals with anorexia nervosa (AN). Thus, this study sought to characterize weight...
Elucidation of clinically relevant subtypes has been proposed as a means of advancing treatment research, but classifying anorexia nervosa (AN) patients into restricting and binge-eating/purging types has demonstrated limited predictive validity. This study aimed to evaluate whether an approach to classifying eating disorder patients on the basis o...
This case series describes the development of a novel psychotherapeutic intervention for older adolescents and adults with anorexia nervosa (AN). Emotion acceptance behavior therapy (EABT) is based on a model that emphasizes the role of anorexic symptoms in facilitating avoidance of emotions. EABT combines standard behavioral interventions that are...
Objective:
This study aimed to evaluate emotion avoidance in patients with anorexia nervosa (AN) and to examine whether emotion avoidance helps to explain (i.e., mediates) the relation between depressive and anxiety symptoms and eating disorder (ED) psychopathology in this group.
Method:
Seventy-five patients with AN completed questionnaires to...
This study sought to document self-reported binge eating in a large sample of severely obese children and to examine the impact of binge eating on changes in percent overweight among children randomized to family-based behavioral treatment (intervention) versus control (usual care).
As part of a larger randomized controlled trial, 192 children aged...
This study was designed to document eating disorder symptoms in a well-defined sample of patients with bipolar disorder and to evaluate the relationship of current loss of control over eating (LOC) to demographic and clinical features hypothesized to characterize bipolar patients at risk for disordered eating. Eighty-one patients enrolled in the Bi...
This study used standardized assessments to evaluate the association between childhood maltreatment (i.e., emotional, physical, and sexual abuse and emotional and physical neglect) and Axis I and II psychiatric disorders in patients presenting for bariatric surgery.
Participants (N = 230) provided demographic information and completed the Childhood...
The objectives of the study were to evaluate the clinical significance of lifetime eating disorder comorbidity in a well-defined sample of patients with bipolar spectrum disorders and to describe cognitive correlates of disordered eating in this group.
Twenty-six bipolar patients with a lifetime history of a Diagnostic and Statistical Manual of Men...
We used a dimensional measure of mood psychopathology to document lifetime depressive and manic-hypomanic spectrum symptoms in 50 patients with anorexia nervosa (AN).
Participants provided demographic information and completed the Self-Report Questionnaire for Mood Spectrum, a 161-item instrument that documents lifetime symptoms, traits, and behavi...
We provide a model to explicate how factors representing different levels of analysis (i.e., biology, psychology, sociodemographics, and behavior) interact to influence the onset and maintenance of obesity in bipolar disorder.
We conducted MEDLINE (1966-2005) and PsycInfo (1872-2005) searches of all English-language articles using the keywords obes...
Objective
The goals of this study were to assess eating disorder symptoms in depressed women with no history of eating disturbance and to evaluate the clinical significance of these symptoms relative to those reported by women with bulimia spectrum disorder.Method
Participants were 63 women with major depressive disorder (MDD) (n = 19), bulimia spe...
Childhood adversity places individuals with major depression at risk for anxiety and dysthymia co-morbidity. The goal of the present paper is to broaden this area of research by examining specificity between the type of adversity (e.g. abuse versus neglect/indifference) and the resulting co-morbid disorder (e.g. anxiety versus dysthymia co-morbidit...
Research suggests that negative life events and social support are associated with the course of major depressive episodes. However, the manner in which these variables may be specifically interrelated remains unclear. The present study compared two models of the relation among life events, number of social relationships, and the naturalistic cours...
This meta-analysis involved 35 studies examining eating disturbance and body dissatisfaction in white and non-white populations and the role of acculturation in the development of eating-related psychopathology. While the role of acculturation in predisposing non-whites to eating disorders remains to be determined, mean effect sizes indicate that w...
Projects
Project (1)
Food insecurity affects more than 10% of people in the United States. The goal of this research program is to 1) understand how food insecurity affects eating behavior, 2) identify the psychological and physiological mechanisms that maintain this relationship, and 3) modify existing, and develop new, interventions for weight management, nutrition, and disordered eating to better meet the needs of people affected by current and/or past food insecurity.
