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The relative associations of shape and weight over-evaluation, preoccupation, dissatisfaction, and fear of weight gain with measures of psychopathology: An extension study in individuals with anorexia nervosa

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... Whereas some studies do not distinguish body image beyond the "umbrella" term of weight and shape concerns (e.g. La Mela et al., 2015;Stutts & Blomquist, 2018), emerging research (Askew et al., 2020;Calugi, El Ghoch, Conti, & Dalle Grave, 2018;Grilo, Ivezaj, Lydecker, & White, 2019;Grilo, Crosby, & Machado, 2019;Linardon et al., 2018;Mitchison et al., 2017;Sharpe et al., 2018) supports the preposition that specific body image facets have a distinct role in EDs. Specific body image facets are represented in the diagnostic criteria of EDs (American Psychiatric Association, 2013) in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5). ...
... Only three studies focused on individuals with BED and showed greater levels of feeling fat relative to a control group (Legenbauer et al., 2011;Mussell et al., 1996;Wilfley et al., 2000). Feeling fat has a unique role in explaining ED symptoms in AN and BN samples (Linardon et al., 2018) and was prospectively linked to greater fear of negative evaluation and depression in an ED clinical sample (Levinson, Williams, & Christian, 2020). Moreover, women with obesity reported higher levels of feeling fat if they also had a BED diagnosis (Mussell et al., 1996) and after episodes of binge eating (Powell & Thelen, 1996). ...
... During treatment of AN, patients' preoccupation predicted slower improvement in ED symptomatology (Calugi et al., 2018). Furthermore, preoccupation has been found to be strongly associated with dietary restraint, binge eating, and distress in adolescent girls and depression and anxiety symptoms in AN patients (Linardon et al., 2018). The paucity of studies with preoccupation may reflect the lack of validated assessment instrument (studies to date have relied on a single EDE/EDE-Q item). ...
Article
Body image disturbance is core to the psychopathology of eating disorders (EDs), and related disorders such as muscle dysmorphia (MD). Global measures of body image fail to quantify specific aspects of body image disturbance that characterizes EDs, and may be differentially associated to outcomes. The aim of this systematic review was to provide an overview of specific body image facets and synthesize findings from controlled studies that compared clinical ED/MD and control-comparison groups in body image disturbance. One-hundred sixty-seven studies met inclusion criteria, and reported on comparisons among 30,584 individuals in 28 body image facets, which were more broadly grouped into evaluative, perceptual, cognitive-affective and motivational categories for the purpose of the present review. Effect sizes were calculated as Cohen’s d for every comparison between ED and control groups. Body dissatisfaction (evaluative category) was the most prevalent facet assessed across studies (62 %), and differences between clinical and control groups were the largest in this category, especially for bulimia nervosa (d = 1.37). Scarcity of studies with male and MD clinical samples, and use of single-item and non-validated measures, should encourage development of instruments for body image facets pertinent to EDs and MD that can be validly applied across gender.
... The EDE is a semi-structured interview and widely used for diagnosing eating disorders [5][6][7]. Fear of WG has been examined in undergraduate women [8], women seeking treatment for anorexia nervosa (AN) [9], and women and men seeking treatment for bulimia nervosa (BN) [10]. In these populations, fear of WG is associated with a number of concerning disordered eating cognitions (body image dissatisfaction, overvaluation of shape), behaviors (unhealthy dietary restraint, emotional eating, overeating), and emotions (depression and anxiety symptoms) [8][9][10]. ...
... Fear of WG has been examined in undergraduate women [8], women seeking treatment for anorexia nervosa (AN) [9], and women and men seeking treatment for bulimia nervosa (BN) [10]. In these populations, fear of WG is associated with a number of concerning disordered eating cognitions (body image dissatisfaction, overvaluation of shape), behaviors (unhealthy dietary restraint, emotional eating, overeating), and emotions (depression and anxiety symptoms) [8][9][10]. Fear of WG and sensitivity to WG have also been examined within the context of broad weight/shape concerns, however sensitivity to WG has never been examined specifically outside of the context of broader body image concerns [11][12][13]. ...
... It is unknown, however, how fear of WG and sensitivity to WG present in individuals with BED or how this presentation may differ from their counterparts with excess weight who do not have BED. It is feasible that in individuals with overweight or obesity, who also are seeking to lose weight, greater fear of WG and sensitivity to WG might be related to unhealthy eating behaviors, poor body image, and depression, as with individuals in the underweight or healthy weight body mass index (BMI) ranges [9,18,19]. Alternatively, fear of WG and sensitivity to WG could be adaptive and contribute to active steps toward better health. ...
Article
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Purpose Weight concern, including fear of weight gain and sensitivity to weight gain, is indicative of disordered eating in individuals with underweight or healthy weight. It is unknown, however, whether or how these constructs present in individuals with excess weight, particularly among those with binge-eating disorder (BED). This study sought to characterize fear of weight gain and sensitivity to weight gain and examine their relationship with disordered eating and depression symptoms, in individuals seeking weight loss treatment, both with and without BED. Methods Adults seeking weight loss treatment in an urban primary care clinic (N = 131) completed the Eating Disorder Examination interview and Beck Depression Inventory. Height and weight were collected. Results Clinical levels of fear of weight gain and sensitivity to weight gain were present in this sample. Individuals with BED reported experiencing fear of weight gain (48.6%), significantly more than those without BED (20.9%); both groups reported similar and clinically elevated sensitivity to weight gain. Both constructs were related to greater levels of disordered eating and depression symptoms, at times based on BED status. Fear of weight gain was associated with overvaluation of weight and shape for those without BED only. Objective and subjective bulimic episodes were unrelated to fear of weight gain or sensitivity to weight gain, regardless of BED status. Conclusion Fear of weight gain and sensitivity to weight gain were common in this sample and may be maladaptive, as evidenced by associations with elevated eating psychopathology. Future studies should examine these variables within larger samples and should employ longitudinal designs. Level of evidence Level III: case–control analytic study.
... There is evidence that distinct attitudinal components of body image exist, and that these distinct components operate differently in terms of their relative clinical significance (Linardon et al., 2018a;Lydecker, White, & Grilo, 2017). For example, previous research in anorexia nervosa (AN) reported shape and weight over-evaluation and preoccupation to be the only independent attitudinal correlates of psychopathology (depressive/anxiety symptoms), while fear of weight gain emerged as the only independent attitudinal correlate of dietary restraint and compulsive exercise frequency (Linardon et al., 2018b). Additionally, shape and weight preoccupation has been shown to be the strongest attitudinal correlate (relative to over-evaluation and dissatisfaction) of objective binge eating and dietary restraint in high school female students (Mitchison et al., 2017). ...
... Preoccupation ("has thinking about your shape or weight made it very difficult or you to concentrate on things you are interested in?") was assessed with a single item. Good internal consistency (α's > 0.80) for these attitudinal components have been reported elsewhere (e.g., Linardon et al., 2018b), and previous research has provided evidence for these constructs convergent validity, by reporting significant and moderate correlations with other measures of body image concerns (e.g., Mitchison et al., 2017). ...
... This is consistent with recent research in which body image constructs, such as body dissatisfaction, fear of weight gain, preoccupation with weight and shape, and overvaluation of weight and shape, are recognized as being distinct from one another and also as having distinct relationships with core eating disorder symptoms in nonclinical samples of adolescents and clinical samples of patients with eating disorders. [32][33][34] Where direct comparisons across studies could be made, dietary restraint was related to preoccupation with weight and shape in adolescent girls and boys and patients with binge eating disorder, but not patients with AN, and to overvaluation of weight and shape in adolescent boys but not patients with either AN or binge eating disorder. Furthermore, binge eating was related to overvaluation in boys and to body dissatisfaction and preoccupation in girls in the adolescent sample, but was not related to any body image constructs in patients with binge eating disorder. ...
... Furthermore, binge eating was related to overvaluation in boys and to body dissatisfaction and preoccupation in girls in the adolescent sample, but was not related to any body image constructs in patients with binge eating disorder. [32][33][34] The greatest similarities across samples appeared for relationships with broader psychological outcomes, distress, or depression symptoms, whereby in all samples, overvaluation and preoccupation were uniquely related to higher symptomatology. Comparisons among samples are somewhat limited by lack of consistency in inclusion of body image constructs and eating disorder symptoms. ...
Article
Body dissatisfaction is a risk factor for development of eating disorders and represents a core psychopathologic feature of eating disorders. Prevention and treatment interventions address established risk and maintaining factors for body dissatisfaction: appearance pressures, internalization of appearance ideals, upward appearance comparison, avoidance and checking, and body disparagement. It is essential to address body dissatisfaction within eating disorders treatment to improve outcomes and reduce risk of relapse. Future directions in research and treatment aim to reach populations increasingly recognized as in need, including children, men, and individuals at higher weights, with the ultimate goal of reducing the significant distress associated with body dissatisfaction.
... More recent work has found similar associations between FOWG and vigorous exercise in a transdiagnostic ED sample [9]. Additionally, another recent study found that FOWG mediated the relationship between over-emphasis on body shape and weight in self-evaluation and compulsive exercise frequency [10]. However, extant literature is cross-sectional in nature and has mainly used retrospective self-report measures of both FOWG and exercise over long periods (e.g., several months). ...
... Specifically, we observed that individuals were overall slightly more likely to engage in exercise following increased FOWG (although this did not reach statistical significance), but this relationship was most prominent for those engaging in adaptive exercise compared to maladaptive exercise. This finding is surprising given established cross-sectional associations between FOWG and compulsive exercise engagement [10]. It is possible that FOWG may need to be experienced over a longer time period before it might precipitate maladaptive exercise engagement. ...
Article
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Purpose Maladaptive exercise (i.e., exercise that is either driven or compensatory) is thought to momentarily down-regulate elevated fear of weight gain (FOWG). However, little research has examined associations between FOWG and exercise, and no research has measured FOWG at a momentary level or considered exercise type (i.e., maladaptive vs. adaptive). Thus, we examined both within- and between-subject associations between FOWG and exercise among individuals with trans-diagnostic binge eating. Methods We recruited treatment-seeking adults (N = 58, 82.9% female) to complete a 7–14-day ecological momentary assessment protocol which assessed levels of FOWG and exercise engagement and type. Mixed models and generalized estimating equations assessed within-subject associations, and linear regression assessed between-subject associations. Results There was no main effect of FOWG on exercise engagement at the next survey. However, unexpectedly, exercise type moderated this relationship such that the relationship between FOWG and exercise was strongest for episodes of adaptive exercise. Overall exercise frequency accounted for 10.4% of the variance in FOWG and exercise type explained an additional 1.7% of the variance in FOWG. Conclusion The findings of the current study indicate that momentary levels of FOWG are associated with subsequent adaptive exercise episodes, while higher overall levels of maladaptive exercise were associated with higher levels of FOWG. Future treatments should place a greater emphasis on reducing the frequency of maladaptive exercise by providing strategies for reducing FOWG. Level of evidence Level IV: Evidence obtained from multiple time series analysis such as case studies.
... Body dissatisfaction, overvaluation of shape/weight, and fear of weight gain are considered by many authorities to be aspects of body image disturbance with distinct correlates and diagnostic significance (Fairburn et al., 2003;McLean & Paxton, 2019). They also play unique roles in explaining ED psychopathology concurrently Linardon et al., 2018;Lydecker et al., 2017) and prospectively (Prnjak et al., 2021). Body dissatisfaction is a widely researched aspect of body image disturbance that is thought to promote dieting and hence increase risk for ED development (Stice et al., 2011). ...
... Participants had to estimate the number of days (for fear of weight gain) and severity (for dissatisfaction and overvaluation) on a 7-point Likert-type scale (0-No days/not at all; 6-Every day/markedly), with higher scores indicating greater body image disturbance. Previous studies showed these EDE-Q items are useful tools for assessment of shape/weight dissatisfaction, overvaluation, and fear of weight gain (Linardon et al., 2018;Mitchison et al., 2017). In the present study, Spearman-Brown coefficients for overvaluation and dissatisfaction scores were 0.934 and 0.928, respectively. ...
Article
Alongside thin ideals, internalizing muscular and/or lean body ideals is associated with eating disorder (ED) symptomatology, especially among males. However, assessment of drive for muscularity (DM) and drive for leanness (DL) also captures attitudes and behaviors that are normative in the general population. The aim of this study was to identify components of DM and DL that are independently linked to core body image disturbance in EDs-shape/weight dissatisfaction, overvaluation ,and fear of weight gain-in community adolescents using network analysis. A representative sample of 4,975 Australian adolescents (53% females, Mage = 14.92) from Wave 1 of the EveryBODY study was included in the analyses. We estimated regularized and unregularized networks, identified communities of items, estimated bridge centrality between communities, and explored sex differences in network structure and connectivity with a Network Comparison Test. Results showed that items "feeling better about oneself if having a lean body" and "wishing to be muscular" had the highest bridge centralities, and network structures of male and females did not significantly differ. Importantly, some components of DM were negatively associated with body image disturbance. These findings suggest that, when investigating the role of DL and DM in EDs, it would be useful to further assess these constructs as multifaceted since relationships between these phenomena are likely more nuanced than previously speculated. Development and subsequent use of instruments for certain behaviors and/or attitudes more specifically associated with body image disturbance might be more informative than somewhat artificially confined focus on either thinness, leanness, or muscularity. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
... Research has consistently supported the distinction between dissatisfaction and overvaluation (Grilo et al., 2009;Wade, Zhu, & Martin, 2011) and the prognostic importance of overvaluation (Grilo, White, Gueorguieva, Wilson, & Masheb, 2013). More recently, studies have yielded empirical evidence regarding potential variations in associations between the other EDE-based specific body-image constructs and measures of ED psychopathology (Blechart et al., 2011;Grilo, Ivezaj, Lydecker, & White, in press;Linardon et al., 2018; Fuller-Tyszkiewicz, de la Piedad Garcia, Messer, & Brennan, 2019; Lydecker et al., 2017;Mitchison et al., 2017) and outcomes (Calugi & Dalle Grave, 2019). A few recent studies have jointly considered several body-image constructs. ...
... Items are rated on a scale of 0 (none) to 6 (extreme). This approach follows the exact strategy used in the emerging literature on testing the distinctiveness of these specific body-image constructs Linardon et al., 2018;Lydecker et al., 2017;Mitchison et al., 2017). This strategy, which separates out the body-image variables instead of relying on the EDE-Q Weight Concern and Shape Concern scales, is supported by recent confirmatory factor analytic studies (Grilo, Reas, Hopwood, & Crosby, 2015;Machado et al., 2018). ...
Article
Objective: This study examined the distinctiveness of specific constructs of body-image disturbance in patients with anorexia nervosa (AN) and bulimia nervosa (BN). We compared weight/shape dissatisfaction, weight/shape overvaluation, weight/shape preoccupation, and fear of weight gain in patients with AN and BN and examined how each specific body-image construct relates to clinical measures within and between AN and BN. Method: A clinical sample of 490 treatment-seeking patients diagnosed with DSM-5 AN (N = 310) or BN (N = 180) by clinicians using structured interviews in Portugal completed the Eating Disorder Examination-Questionnaire to assess body image and eating-disorder (ED) psychopathology. Results: Both within and between AN and BN, the four body-image constructs varied in their strengths of association among themselves, with ED psychopathology, and body mass index (BMI). Analyses revealed considerable variability in variance accounted for in clinical measures by body-image constructs. Body-image constructs predicted significant, albeit small, variance in BMI within BN (dissatisfaction, preoccupation significant) but not within AN. Body-image constructs predicted significant, albeit small, variance in the frequencies of binge eating and purging in AN (with preoccupation significant for both and fear for purging) but not within BN. Body-image constructs predicted significant variance in ED psychopathology (large amounts of variance for Eating Concern and Restraint) within both AN and BN (with overvaluation, preoccupation, and fear significant). Conclusion: Clinical manifestations of body-image disturbances are complex and show important differences across AN and BN. Understanding distinctions and differential salience of different body-image constructs across different EDs can inform refinement of specific case conceptualization.
... The cognitive-affective component of the body image is typically measured by self-report questionnaires or interviews. It comprises different aspects that patients are usually consciously aware of and well able to describe, including, e.g., body dissatisfaction, overvaluation of shape or weight, preoccupation with shape or weight, and fear of weight gain (7). Despite diverse methods of measurement and ongoing debates on the relative importance of different aspects, there is a consensus that the cognitive-affective component of body image is strongly affected and negatively distorted in AN (7)(8)(9); thus, the cognitive-affective aspects of body image are an important treatment objective (10). ...
... It comprises different aspects that patients are usually consciously aware of and well able to describe, including, e.g., body dissatisfaction, overvaluation of shape or weight, preoccupation with shape or weight, and fear of weight gain (7). Despite diverse methods of measurement and ongoing debates on the relative importance of different aspects, there is a consensus that the cognitive-affective component of body image is strongly affected and negatively distorted in AN (7)(8)(9); thus, the cognitive-affective aspects of body image are an important treatment objective (10). Indeed, targeted treatment leads to clear improvements in body weight and overall eating disorder psychopathology (e.g., eating concern and weight concern). ...
Article
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One key symptom of anorexia nervosa (AN) is body image distortion (BID). For example, AN patients who are asked to perform body size estimation tasks tend to overestimate their body size; this is thought to indicate a distortion of the perceptive component of body image. Although BID is an important treatment objective, only few treatment approaches explicitly target body image, and even fewer target the perceptive component. Moreover, very little is known about how patients’ perceptive body image changes after treatment and related weight gain. Consequently, we investigated changes of the perceptive BID in adolescent AN patients at the beginning (T1) and the end (T2) of inpatient treatment using a body size estimation task. A total of 38 AN patients performed the test for Body Image Distortion in Children and Adolescents (BID-CA) within the first 2 weeks of inpatient treatment and at the end of treatment. The results were compared to 48 healthy control (HC) participants performing the same task once. At T1, AN patients overestimated their body size more than HC, i.e., a total overestimation of 33% in AN patients vs. 11% in HC. At T2, AN patients overestimated their arm size to the same degree that they did at TI, but overestimations for the thigh and waist were reduced, and their overestimations for the waist no longer differed from the HC group. Thus, after treatment, AN patients were partly able to more realistically estimate their body size. Several factors may have influenced the observed changes in body size estimation, including task repetition, deliberate adjustment, growing into their preexisting perceptive body image through weight gain, as well as targeted and non-specific psychotherapeutic treatments. In conclusion, the perceptive BID in adolescent AN patients is persistent but also modifiable. Although diverse factors presumably play a role in changing BID, these findings suggest that AN patients may benefit from targeted treatment of BID.
... In addition, they usually feel an intense fear of gaining weight (FGW) and disturbances in the way they experience their body weight and shape, also referred to as body image disturbances [7]. Greater FGW has also been related to more severe ED symptoms [8,9], and it is considered as one of the strongest predictors of ED symptomatology (e.g., dietary restraint and compulsive exercise) in AN patients [10]. In fact, it has been suggested that AN patients are more susceptible to learning fear associations than healthy individuals [11] (Strober, 2004); for instance, they are more likely to develop an intense FGW after starting a low-fat diet. ...
... Similar tendencies were observed not only among patients with AN but, also, among women with high BD. These results support the increasing evidence in favor of the critical role that the FGW might display not only in AN [6,[8][9][10] but, also, in healthy women with body concerns. Indeed, several studies have reported high prevalence of FGW among adult women [2,57] and young women between 16 to 25 years old [58]. ...
Article
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Fear of gaining weight (FGW), body image disturbances, associated anxiety and body-related attentional bias are the core symptoms of anorexia nervosa (AN) and play critical roles in its development and maintenance. The aim of the current study is to evaluate the usefulness of virtual reality-based body exposure software for the assessment of important body-related cognitive and emotional responses in AN. Thirty female patients with AN, one of them subclinical, and 43 healthy college women, 25 with low body dissatisfaction (BD) and 18 with high BD, owned a virtual body that had their silhouette and body mass index. Full-body illusion (FBI) over the virtual body was induced using both visuo-motor and visuo-tactile stimulation. Once the FBI was induced, the FBI itself, FGW, body anxiety and body-related attentional bias toward weight-related and non-weight-related body areas were assessed. One-way analyses of covariance (ANCOVA), controlling for age, showed that AN patients reported higher FGW, body anxiety and body-related attentional bias than healthy controls. Unexpectedly, patients with AN reported significantly lower FBI levels than healthy participants. Finally, Pearson correlations showed significant relationships between visual analog scales and body-related attentional bias measures, compared to other eating disorder measures. These results provide evidence about the usefulness of virtual reality-based body exposure to elicit FGW and other body-related disturbances in AN patients. Thus, it may be a suitable intervention for reducing these emotional responses and for easing weight recovery.
... For example, early meta-analytic research of prospective studies has shown body dissatisfaction to be a strong predictor of eating pathology in non-clinical samples (Stice, 2002), and a recent meta-analysis of cross-sectional stud-ies of clinical samples (binge-eating disorder and bulimia nervosa) reported robust links between shape and weight over-evaluation and disordered eating and psychological distress (Linardon, 2016). Recent research also suggests that preoccupation with shape and weight is a strong and independent predictor of problematic eating patterns even after controlling for other facets of body image (i.e., dissatisfaction and over-evaluation; Linardon et al., 2018;Lydecker et al., 2017;Mitchison et al., 2017). Findings on the significance of these distinct body image components have prompted calls for clinicians to screen, assess, and target these different facets during prevention and intervention programs (Lydecker et al., 2017) Another purportedly distinct attitudinal component of body image is "feeling fat." ...
... Higher scores reflect greater symptom severity. Overvaluation of weight and shape was also calculated by averaging scores on items 22 and 23 (i.e., importance of shape/weight on self-worth) to create a composite overvaluation score, consistent with earlier work (Grilo et al., 2010;Linardon et al., 2018aLinardon et al., , 2018bLinardon et al., , 2018c. Internal consistency was α = 0.90 for the global score and α = 0.87 for the overvaluation of weight and shape composite score in this study. ...
Article
The Yale Food Addiction Scale 2.0 (YFAS) assesses addiction-like eating of palatable foods based on the 11 diagnostic criteria for substance use disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This study was the first to investigate the factor structure, psychometric properties, and clinical significance of the YFAS 2.0 in individuals with binge-eating disorder (BED) symptomatology. Data were analysed from 220 community-based participants who met criteria for “probable BED” based on self-report symptom frequency. Classification of food addiction (FA) was met by 42.3% of the sample. The YFAS 2.0 exhibited a unidimensional structure, adequate internal consistency, and convergent and incremental validity. YFAS 2.0 scores contributed the largest percentage of unique variance in psychological distress and impairment over other BED features (overvaluation of weight and shape, binge eating, BMI), highlighting the clinical significance of the FA construct in BED. Support for the validity and reliability of the YFAS 2.0 in individuals with BED-like symptoms was found. Findings also suggest that the presence of FA may represent a more disturbed group of BED characterised by greater general and eating disorder-specific psychopathology. Our findings overall highlight the potential need to screen and assess addictive-like eating behaviours during interventions for BED.
... Research has traditionally focused on describing, explaining, and predicting negative body image in the absence of considering positive body image (e.g., Cash, 2012;Kearney-Cooke & Tieger, 2015). For example, several theoretical models have garnered support in understanding precipitating and perpetuating factors of negative body image, and more recent research demonstrates that distinct negative components of body image differentially predict various ill-health outcomes (Linardon, Fuller-Tyszkiewicz, de la Piedad Garcia, Messer, & Brennan, 2019;Linardon et al., 2018aLinardon et al., , 2018bLydecker, White, & Grilo, 2017). Such work has helped inform effective prevention and intervention strategies for negative body image (Alleva, Sheeran, Webb, Martijn, & Miles, 2015). ...
Article
The Body Image Acceptance and Action Questionnaire (BI-AAQ), a measure designed to assess body image flexibility, was originally developed for and psychometrically investigated with nonclinical populations, but it has been recently administered to people with binge-eating disorder (BED) symptomatology. Tests of measurement invariance are needed to understand whether the BI-AAQ operates in the same way for BED and non-BED populations, thereby ensuring meaningful comparison across these groups. We thus tested the measurement invariance of the BI-AAQ in participants with and without clinically significant BED symptomatology. Data were analyzed from 358 community-based participants. Participants were either classified as with (n = 179) or without (n = 179) "probable BED" based on self-reported symptom frequency. An unacceptable model fit was found across both groups, indicating that the unidimensional structure of the BI-AAQ was not replicated. We then sought to confirm the unidimensional structure of a recently proposed five-item version of the BI-AAQ. A unidimensional structure of this abbreviated version was replicated, and tests of measurement variance were upheld. Internal consistency, convergent validity, and incremental validity were documented for both the original and abbreviated BI-AAQ across individuals with and without BED symptomatology. Present findings provide further psychometric support for an abbreviated five-item BI-AAQ, although it is important for future research to replicate both the full and abbreviated BI-AAQ in more diverse samples. Overall, an abbreviated BI-AAQ may be an attractive alternative for researchers studying body image flexibility. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
... Eating problems are noted to be highest among those with negative body image problems owing to failed dieting and depression [68]. Body shape and weight over-evaluation with impairments in psychological functioning exhibited a robust relationship on binge eating disorders [69,70]. On the contrary, another study reported that BID is not associated with eating attitudes and is present among adolescents irrespective of whether they exhibit behaviors that make them vulnerable to eating disorders [71]. ...
Article
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Background: Adults with body image dissatisfaction (BID) are more likely to be depressed, anxious, and suicidal when compared to those without intense dissatisfaction over their appearance. The current study aimed to estimate the prevalence and factors associated with BID among out-patients with mental illness in Singapore. Methods: Data was collected from 310 psychiatric out-patients using a self-administered questionnaire. Measurements used were socio-demographic characteristics, Body Mass Index scores, Body Shape Questionnaire, Binge Eating Scale, Eating Attitudes Test, Beck’s Depression Inventory, Beck’s Anxiety Inventory and Alcohol Use Disorders Identification Test. Results: A prevalence of 30.9% of BID was established among psychiatric out-patients in Singapore. Being female, having higher BMI scores, binge eating behavior, eating disorders, and those diagnosed with depression were positively associated with BID. Conclusion: BID is prevalent among those with psychiatric illnesses which could lead to a higher degree of psychological distress and the emergence of eating disorders.
... Several studies have suggested a direct relationship between the FGW and greater ED symptomatology [12,13], indicating that the FGW is a core mechanism underlying AN symptomatology. Indeed, recent studies have found that the FGW is directly associated with overvaluing the body and feeling guilty after overeating [14], with the FGW being the strongest predictor of ED symptomatology (e.g., dietary restraint) in AN patients [15]. ...
Article
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In vivo body exposure therapy is considered an effective and suitable intervention to help patients with anorexia nervosa (AN) reduce their body image disturbances (BIDs). However, these interventions have notable limitations and cannot effectively reproduce certain fears usually found in AN, such as the fear of gaining weight (FGW). The latest developments in virtual reality (VR) technology and embodiment-based procedures could overcome these limitations and allow AN patients to confront their FGW and BIDs. This study aimed to provide further evidence of the efficacy of an enhanced (by means of embodiment) VR-based body exposure therapy for the treatment of AN. Thirty-five AN patients (16 in the experimental group, 19 in the control group) participated in the study. FGW, BIDs, and other body-related and ED measures were assessed before and after the intervention and three months later. The experimental group received treatment as usual (TAU) and five additional sessions of VR-based body exposure therapy, while the control group received only TAU. After the intervention, ED symptoms were clearly reduced in both groups, with most of the changes being more noticeable in the experimental group. Specifically, after the intervention and at follow-up, significant group differences were found in the FGW and BIDs, with the experimental group showing significantly lower values than the control group. The current study provides new insights and encouraging findings in the field of exposure-based therapies in AN. VR technology might improve research and clinical practice in AN by providing new tools to help patients confront their core fears (i.e., food- or weight-related cues) and improve their emotional, cognitive, and behavioral responses to their body image.
... These body image aspects were defined as continuous variables based upon responses on a 7-point Likert-type scale (0 = no days/not at all, 6 = every day/markedly) where participants had to estimate the number of days or the severity with which they experienced body image disturbance, with higher scores indicating greater severity. In the absence of scale measures of these constructs, the use of these singular items for assessment of these body image aspects has been applied in previous research (e.g., Linardon et al., 2018;Mitchison et al., 2017). ...
Article
Recent research suggests specific body image aspects, namely weight/shape dissatisfaction, overvaluation of weight/shape, weight/shape preoccupation, and fear of weight gain, have distinct roles in eating disorder (ED) onset and maintenance. The aim of this study was to investigate unique associations between these body image aspects and ED onset, distress, and quality of life in a community sample of adolescents prospectively after 1 year. Adolescents (n = 1,327; 51% female; age range 11-19 years) who completed Waves 1 and 2 of the EveryBODY Study and did not meet criteria for an ED at Wave 1 completed measures of ED symptoms, distress, and quality of life impairment. Results showed that 18.2% of participants (70% female) met criteria for an ED at Wave 2. Only weight/shape dissatisfaction was prospectively associated with onset of any ED. No other body image aspect was uniquely associated with greater distress nor lower quality of life in longitudinal analyses. However, all body image aspects were independent correlates of ED diagnosis within Wave 2. These findings suggest that dissatisfaction might operate as a risk factor for ED development in adolescence, whereas overvaluation, preoccupation, and fear of weight gain could be more proximal markers of ED psychopathology. Therefore, these body image phenomena should be assessed as separate constructs as they may play unique roles in ED onset and classification. ED prevention efforts in adolescence may need to target dissatisfaction first, whereas a focus on other aspects of body image may be more important for early intervention programs. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
... weight and shape over-evaluation, preoccupation, dissatisfaction, and fear of weight gain (Linardon et al., 2018). ...
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Objective Anorexia nervosa (AN) is a complex disease in which obsessive thoughts about body image, shape, or weight are expressed. The intensity of these concerns varies among individuals, and only a few studies have focused on their impact on patients’ clinical course when patients are treated on an outpatient basis. Our study aimed to determine whether marked body concerns at inclusion were predictive of the one-year follow-up. Method Participants (N = 72) were women seeking treatment for AN in a specialized unit for eating disorder management. All participants were assessed at inclusion and at the 1-year follow-up. Clinical outcome was assessed using the Morgan & Russel Outcome Average Score (MROAS), and body concerns were assessed using the Body Shape Questionnaires (BSQ). Results Marked body concerns (BSQ score >140) at inclusion were associated with a poorer outcome at the 12-month follow-up (lower MROAS “total score”). Other characteristics at inclusion that were predictive of a poorer outcome at 12 months were as follows: higher severity of ED at inclusion, longer hospitalization during follow-up, and experiencing a lower impact of the illness on school/work life. Discussion The results confirmed the importance of a multifocal treatment that should address body concerns and motivation to change. Our results also highlighted the necessity of promoting the maintenance of school/work during the treatment course.
... The biopsychosocial pathogenesis of ED is widely acknowledged [1]. In ED, there is a persistent overevaluation of body shape and weight [6]. As a result, individuals have extreme weight-control behaviors, including dietary restraint, purging, abuse of laxative and diuretic substances and over-exercising, and the ability to control their weight underlies the core psychopathology of ED [7]. ...
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Eating disorders (EDs) are complicated mental illnesses with significant treatment resistance and dropout rates. For successful treatment, it is important for clinicians to better understand the patients’ narrative and their lived experiences. A thorough psychodynamic understanding of patients’ childhood attachment and primary relationships, personality traits and mental processes is, therefore, crucial for managing patients with ED. Interestingly, several studies have observed an association between functional urinary symptoms and individuals with ED. EDs such as anorexia nervosa are associated with an increased risk of all urinary symptoms, and functional incontinence was also more common in extreme female athletes with low energy availability and with disordered eating. There is, however, a dearth of literature describing this relationship, and the underlying mechanisms remain remote. In this paper, we present a psychoanalytic approach to the presence of urinary symptoms in females with EDs. We hypothesize that these symptoms are tied to specific traits or characteristics of ED patients, namely the overarching need for control, a pathological strive for perfection and the self-denial of basic bodily urges. This is discussed in relation to psychopathological processes, development and personality factors commonly seen in patients with ED.
... Puberty coincides with rapid changes in body size and shape, which then must be integrated within one's body image [58]. These rapid changes can result in increases in weight and shape concerns [11,26,47,49] which, in turn, are important risk factors and maintaining factors for AN [26,37,69]. Weight and shape concerns entail the subjective negative appraisal of one's body and the overvalued ideals about the personal implications of weight and shape [29]. ...
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Background Inherent to anorexia nervosa are repetitive thoughts about weight and shape. Growing research suggests the relevance of intolerance of uncertainty and worry in maintaining these types of repetitive thoughts. The relation between these cognitive processes and weight and shape concerns in adolescent girls with anorexia nervosa is understudied. This study investigated associations between prospective (desire for predictability) and inhibitory (uncertainty paralysis) intolerance of uncertainty, and weight and shape concerns and the mediating role of worry in these associations. Methods In a cross-sectional study, 93 adolescent girls with anorexia nervosa completed questionnaires measuring the variables of interest. A mediation model with worry as a mediator between inhibitory and prospective intolerance of uncertainty and weight and shape concerns was tested. Results A total and direct effect of inhibitory intolerance of uncertainty on weight and shape concerns was found. Worry did not mediate this relation. Conclusions These results confirm the importance of inhibitory intolerance of uncertainty in adolescent girls with anorexia nervosa, more specifically to weight and shape concerns. This group may benefit from intervention strategies targeting intolerance of uncertainty. General worry seems less relevant to weight and shape concerns in adolescent girls with anorexia nervosa. Plain English summary Adolescent girls with anorexia nervosa often experience repetitive thoughts about weight and shape. Growing research suggests the relevance of intolerance of uncertainty and worry in maintaining these types of repetitive thoughts. Intolerance of uncertainty is defined as the incapacity to tolerate uncertainty and is often divided into two components; prospective intolerance of uncertainty (desire for predictability) and inhibitory intolerance of uncertainty (uncertainty paralysis). The relation between intolerance of uncertainty, worry and weight and shape concerns in adolescent girls with anorexia nervosa is understudied. This study aims to investigate study relations between prospective and inhibitory intolerance of uncertainty, worry, and weight and shape concerns. A total of 93 adolescent girls with anorexia nervosa completed three questionnaires, measuring prospective and inhibitory intolerance of uncertainty worry, and weight and shape concerns, respectively. The results of this study confirmed the importance of inhibitory intolerance of uncertainty in adolescent girls with anorexia nervosa, more specifically to weight and shape concerns. This group may benefit from intervention strategies targeting intolerance of uncertainty. General worry seems less relevant to weight and shape concerns in adolescent girls.
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Third-wave behavioural interventions are increasingly popular for treating and preventing mental health conditions. Recently, researchers have begun testing whether these interventions can effectively targeting eating disorder risk factors (disordered eating, body image concerns). This meta-analysis examined whether third-wave behavioural interventions (acceptance and commitment therapy; dialectical behaviour therapy; mindfulness-based interventions; compassion-focused therapy) show potential for being effective eating disorder prevention programs, by testing their effects on eating disorder risk factors in samples without an eating disorder. Twenty-four studies (13 randomized trials) were included. Most studies delivered selective prevention programs (i.e. participants who reported elevated risk factor). Third-wave interventions led to significant pre–post (g = 0.59; 95% CI = 0.43, 0.75) and follow-up (g = 0.83; 95% CI = 0.38, 1.28) improvements in disordered eating, and significant pre–post improvements in body image (g = 0.35; 95% CI = 0.13, 0.56). DBT-based interventions were associated with the largest effects. Third-wave interventions were also significantly more efficacious than wait-lists (g = 0.39; 95% CI = 0.09, 0.69) in reducing disordered eating, but did not differ to other interventions (g = 0.25; 95% CI = –0.06, 0.57). Preliminary evidence suggests that third-wave interventions may have a beneficial effect in ameliorating eating disorder risk.
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Despite frequently co-occurring, the temporal relationship between depression and eating disorder symptoms remains poorly understood. This exploratory study sought to investigate the reciprocal relationship between depressive symptoms and (1) shape and weight dissatisfaction, (2) shape and weight overvaluation, (3) preoccupation with shape or weight, (4) preoccupation with food, (5) dietary restraint and (6) binge eating in early adolescence. Adolescents (N = 1393) aged between 11.4 and 13.9 years (M = 12.50, SD = 0.38) completed the Centre for Epidemiological Depression Scale-Revised and Eating Disorder Examination Questionnaire-Adolescent version at the beginning of secondary school (T1) and 12-months later (T2). Cross-lagged models were created to assess the reciprocal relationship between depressive symptoms and ED symptoms. Depressive symptoms at T1 predicted shape and weight dissatisfaction, shape and weight overvaluation, preoccupation with shape or weight, preoccupation with food, dietary restraint and binge eating at T2. Shape and weight dissatisfaction and binge eating were the only ED symptoms at T1 to predict depressive symptoms at T2. Findings suggest young adolescents who experience depressive symptoms in their first year of secondary school are at-risk of developing ED symptoms over the subsequent 12-month period.
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Muscularity-oriented disordered eating (MODE) refers to a broad cluster of pathological eating patterns driven by the pursuit of muscularity and leanness. Although increasing attention has been devoted towards understanding these symptoms in men, little work has been conducted to understand MODE in women. It is also unclear whether MODE contributes unique variance to functional impairment and emotional distress beyond thinness-oriented disordered eating symptoms. We addressed these gaps in a sample of 1,321 community-based adult women (n = 1136) and men (n = 185). Hierarchical multiple regressions revealed that MODE explained a significant proportion of unique variance in functional impairment in both men and women, even after controlling for traditional thinness-oriented disordered eating symptoms. MODE also contributed unique variance in symptoms of depression and anxiety in women, but not for men. Findings highlight the possible significance of these unique symptoms patterns geared towards the pursuit of muscularity and leanness. MODE symptoms may be a viable target in eating disorder intervention or prevention programs, although further longitudinal research is needed.
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Background Inherent to anorexia nervosa (AN) are repetitive thoughts about weight and shape. Growing research suggests the relevance of intolerance of uncertainty (IU) and worry in maintaining these types of repetitive thoughts. The relation between these cognitive processes and weight and shape concerns in adolescents with AN is understudied. This study aims to investigate associations between prospective and inhibitory IU, worry, and weight and shape concerns. Methods In a cross-sectional study, 93 adolescent girls with AN completed three questionnaires, measuring prospective and inhibitory IU, worry, and weight and shape concerns, respectively. A mediation model with worry as a mediator between inhibitory IU and prospective IU and weight and shape concerns was tested. Results A direct and total effect of inhibitory IU on weight and shape concerns was found. Worry did not mediate the relation between inhibitory or prospective IU and weight and shape concerns. Conclusions These results confirm the importance of inhibitory IU in adolescents with AN, more specifically to weight and shape concerns. This group may benefit from intervention strategies targeting IU. Worry seems less relevant to weight and shape concerns in adolescents.
Article
Using a prospective design, we investigated possible bi-directional relationships between intuitive eating and four empirically distinct components of negative body image: overvaluation (judgements of self-worth contingent upon weight/shape), dissatisfaction (general discontent with weight/shape), preoccupation (ruminative thinking about weight/shape), and fear of weight gain. We assessed adult women at baseline (T1) and four-month follow-up (T2), as prior work has demonstrated that this time lag is sufficient to detect change in intuitive eating scores. After adjusting for T1 intuitive eating scores and demographic confounds, higher T1 dissatisfaction was the only body image component to significantly predict lower T2 intuitive eating scores in both univariate and multivariate models. Higher T1 intuitive eating scores also significantly predicted lower scores on each of the four negative body image components at T2. Findings suggest that general body discontent may be one of the more important body image variables that lead to decreases in intuitive eating principles. Present findings also add to a growing body of evidence demonstrating the potentially adaptive role of intuitive eating on psychological health indices.
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ARCTT is a peer-reviewed all-purpose journal covering a wide variety of topics of interest to the mental health, neuroscience, and rehabilitation communities. The mission of ARCTT is to provide systematic, periodic examinations of scholarly advances in the field of CyberTherapy and Telemedicine through original investigations in the telemedicine and cybertherapy areas, novel experimental clinical studies, and critical authoritative reviews. It is directed to healthcare providers and researchers who are interested in the applications of advanced media for improving the delivery and efficacy of mental healthcare and rehabilitative services. www.arctt.info
Article
Objective There has been interest in the antecedents and mental health impacts of eating and body image disturbances in adolescence. Less is known about longer-term mental health impacts into young adulthood, as longitudinal studies with data spanning this developmental period are rare. We capitalize on mental health data collected across adolescence and young adulthood from a population-based cohort study that has been following >2000 Australian children and their families from infancy to young adulthood. Method This sample comprised 1,568 participants who completed the Eating Disorder Inventory drive for thinness and bulimic behavior (the severity of binge-purge patterns) subscales, and a modified version of the body dissatisfaction subscale in mid-adolescence (15–16 years), or the Depression Anxiety Stress Scales in young adulthood (19–20, 23–24, and 27–28 years). Results After adjusting for baseline demographic and prior mental health factors (<13 years of age), all three indices of eating and body image disturbances in adolescence predicted each mental health outcome in young adulthood. Mental health risks associated with adolescent body dissatisfaction and bulimic behavior scores remained stable across young adulthood, with men having more pronounced problems associated with bulimic behavior scores than women. In contrast, mental health risks associated with adolescent drive for thinness scores diminished across this period similarly for men and women. Discussion Findings suggest that adolescent eating and body image disturbances may have long-term mental health impacts that extend into young adulthood. This underscores the need for early preventative intervention, and longer-term monitoring and support for body image and eating disturbances.
Chapter
Exposure-based interventions have been proposed as an appropriate method for the treatment of fear of gaining weight (FGW) and body image disturbance (BID) in the treatment of anorexia nervosa (AN). However, exposure-based therapies have notable limitations (e.g., negative initial reaction in patients or higher risk of dropout). The use of virtual reality (VR)-based exposure techniques may overcome these limitations. This study provides initial evidence of the usefulness of a VR-based exposure therapy in the treatment of a 14-year-old female adolescent with AN. Over five exposure sessions, the patient was embodied in a virtual representation of her own silhouette whose weight was progressively increased. FGW, body anxiety, drive for thinness, BID, and Body Mass Index (BMI) were assessed before and after the intervention, and at 3-month follow-up. FGW, body anxiety and full body illusion (FBI) were also assessed at the beginning of each session. The patient was exposed to the immersive virtual scenario using a VR head mounted display (HMD-HTC-VIVE). After the intervention there was a clear reduction in FGW, drive for thinness, body-related anxiety, and BID. BMI rose slightly over the course of the intervention. FBI levels also rose progressively in each exposure session. However, these changes were not fully maintained at follow-up, when the improvement was lower than that achieved immediately post-treatment. This innovative VR-based exposure procedure achieved promising results for targeting FGW and AN symptoms in a short time. To pursue this study further, and to assess the effectiveness of this new VR software, a larger controlled clinical trial will be conducted.
Article
Objective: Eating-related fear and anxiety are hallmark symptoms of eating disorders (EDs). However, it is still unclear which fears are most important (e.g., food, weight gain), which has practical implications, given treatments for eating-related fear necessitate modifications based on the specific fear driving ED pathology. For example, exposure treatments should be optimized based on specific fears that maintain pathology. The current study (N = 1,622 combined clinical ED and undergraduate sample) begins to answer questions on the precise nature of ED fears and how they operate with other ED symptoms. Method: We used network analysis to create two models of ED fears and symptoms. The first model consisted of ED fears only (e.g., fears of food, fears of weight gain) to identify which fear is most central. The second model consisted of ED fears and ED symptoms to detect how ED fears operate with ED symptoms. Results: We found fear of disliking how one's body feels due to weight gain, disliking eating in social situations, feeling tense around food, fear of judgment due to weight gain, and food anxiety were the most central ED fears. We also identified several bridge symptoms between ED fears and symptoms. Finally, we found that the most central ED fears predicted excessive exercise at two-month follow-up. Discussion: These data support the idea that consequences (i.e., judgment) associated with fears of weight gain and interoceptive fears are the most central ED fears. These data have implications for the future development of precision interventions targeted to address ED-related fear.
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Emerging theoretical and empirical evidence indicates that negative body image might be implicated in the onset or maintenance of ON symptoms. However, existing research investigating associations between negative body image and ON is limited to cross-sectional designs and has failed to consider the independent role of distinct components of body image. To overcome these limitations, the present study examined the prospective associations between five components of body image (i.e., overvaluation, dissatisfaction, preoccupation, body checking, and body image avoidance) and ON symptoms in community-based adult women. Participants were assessed at baseline and at a three-month follow-up, with 558 women included in the final analyses. After adjusting for baseline ON symptoms, higher scores on each of the five body image components at baseline significantly predicted greater increases in ON symptoms in univariate analyses. However, in multivariate analyses, overvaluation with weight and shape was the only component of body image to uniquely predict ON symptoms. Findings suggest that certain components of negative body image may increase the risk for ON symptoms. Findings also lend support to recent proposals that ON may be better viewed as a variant of an existing eating disorder, given that both appear to share similar underlying risk factors.
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A core feature of anorexia nervosa is an over-estimation of body size. However, quantifying this over-estimation has been problematic as existing methodologies introduce a series of artefacts and inaccuracies in the stimuli used for judgements of body size. To overcome these problems, we have: (i) taken 3D scans of 15 women who have symptoms of anorexia (referred to henceforth as anorexia spectrum disorders, ANSD) and 15 healthy control women, (ii) used a 3D modelling package to build avatars from the scans, (iii) manipulated the body shapes of these avatars to refect biometrically accurate, continuous changes in body mass index (BMI), (iv) used these personalized avatars as stimuli to allow the women to estimate their body size. The results show that women who are currently receiving treatment for ANSD show an over-estimation of body size which rapidly increases as their own BMI increases. By contrast, the women acting as healthy controls can accurately estimate their body size irrespective of their own BMI. This study demonstrates the viability of combining 3D scanning and CGI techniques to create personalised realistic avatars of individual patients to directly assess their body image perception.
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Overvaluation of shape and weight in binge-eating disorder (BED) is associated with greater eating-disorder psychopathology and greater weight-bias internalization, which are-in turn-associated with poorer mental and physical health. Little is known, however, about the significance of other cognitive processes, such as rumination, in BED. This study examined rumination and overvaluation of shape/weight with eating-disorder psychopathology and weight-bias internalization among 237 treatment-seeking patients with BED and comorbid obesity. Hierarchical multiple regressions indicated that rumination was associated with eating-disorder psychopathology and weight-bias internalization above and beyond the influence of overvaluation of shape/weight. Findings suggest that, among patients with BED/obesity, rumination is an important cognitive process associated with severity of eating-disorder psychopathology even after accounting for overvaluation of shape/weight. Patients with greater rumination might be more likely to dwell on weight-based discrimination experiences and internalize these negative attitudes. Additional controlled examination could determine whether rumination represents another potential target for BED/obesity treatment. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Objective: The distinctiveness and relative clinical significance of overvaluation, dissatisfaction, and preoccupation with body weight/shape remains inconclusive. This study sought to add to the evidence by testing associations between these three body image constructs and indicators of clinical significance. Method: Male and female secondary students (N = 1,666) aged 12-18 years completed a survey that included measures of dissatisfaction with, overvaluation of, and preoccupation with weight/shape, psychological distress, eating disorder behaviors, and basic demographic information. Conditional process analysis was employed to test the independent and mediating effects of overvaluation, dissatisfaction, and preoccupation on distress, dietary restraint, and objective binge eating. Results: Overvaluation, dissatisfaction, and preoccupation were highly correlated (r = 0.47-0.84). In girls, preoccupation demonstrated the strongest independent and mediating effects on distress, dietary restraint, and binge eating; whereas neither the direct or indirect effects of dissatisfaction on distress and overvaluation on binge eating were significant. Among boys however, the direct and indirect effects of overvaluation, dissatisfaction, and preoccupation on distress and eating disorder behaviors were relatively equal. Discussion: Preoccupation with weight/shape may be particularly clinically significant in girls, whereas all constructs of body image disturbance may be equally clinically significant in boys. The findings are consistent with the view that these constructs, while closely related, are distinct. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016).
Article
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Alexithymia and intolerance of uncertainty (IU) are relevant factors in social and emotional processing abilities in anorexia nervosa (AN) eventually rendering emotional coping difficult. However, the link potentially existing in AN between IU and alexithymia has been so far understudied. Sixty-one patients affected by AN and 59 healthy controls (HC) were enrolled and assessed for study purposes. All participants completed the following self-report questionnaires: Intolerance of Uncertainty Scale, State Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI) and Toronto Alexithymia Scale. IU and alexithymia were greater in patients with AN when compared to HC. Moreover, in both AN and HC groups, IU and alexithymia significantly correlated with each other as well as with anxiety (STAI score) and depression (BDI score). No correlations were found between alexithymia and age. Patients' duration of illness was negatively correlated with two alexithymia subscales. After adjusting for anxiety, depression, body mass index and duration of illness (for AN), the correlation between IU and alexithymia remained significant. In addition to confirming previous findings on marked levels of IU and alexithymia in AN, this study showed for the first time a correlation between IU and alexithymia in both AN and HC. Moreover, this result remained significant after controlling for a number of clinical variables. Taken together, these findings may have useful clinical implications for the treatment of AN sufferers. © 2015 S. Karger AG, Basel.
Article
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In order to elucidate the individual and community health burden of body dissatisfaction (BD), we examined impairment in quality of life associated with BD in a large, general population sample of women. Self-report measures of BD, health-related quality of life (SF-12 Physical and Mental Component Summary scales) and subjective quality of life (WHOQOL-BREF Psychological Functioning and Social Relationships subscales) were completed by 5,255 Australian women aged 18 to 42 years. Most participants (86.9%) reported some level of dissatisfaction with their weight or shape and more than one third (39.4%) reported moderate to marked dissatisfaction. Higher levels of BD were associated with poorer quality of life for all items of both quality of life measures, the degree of impairment being proportional to the degree of BD. Associations were strongest for items tapping mental health and psychosocial functioning, although greater BD was associated with substantially increased risk of impairment in certain aspects of physical health even when controlling for body weight. Post-hoc analysis indicated that the observed associations between BD and quality of life impairment were not accounted for by an association between BD and eating disorder symptoms. In women, BD is associated with marked impairment in aspects of quality of life relating to mental health and psycho-social functioning and at least some aspects of physical health, independent of its association with body weight and eating disorder symptoms. Greater attention may need to be given to BD as a public health problem. The fact that BD is "normative" should not be taken to infer that it is benign.
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Eating disorder not otherwise specified (EDNOS) is the most prevalent eating disorder (ED) diagnosis. In this meta-analysis, the authors aimed to inform Diagnostic and Statistical Manual of Mental Disorders revisions by comparing the psychopathology of EDNOS with that of the officially recognized EDs: anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). A comprehensive literature search identified 125 eligible studies (published and unpublished) appearing in the literature from 1987 to 2007. Random effects analyses indicated that whereas EDNOS did not differ significantly from AN and BED on eating pathology or general psychopathology, BN exhibited greater eating and general psychopathology than EDNOS. Moderator analyses indicated that EDNOS groups who met all diagnostic criteria for AN except for amenorrhea did not differ significantly from full syndrome cases. Similarly, EDNOS groups who met all criteria for BN or BED except for binge frequency did not differ significantly from full syndrome cases. Results suggest that EDNOS represents a set of disorders associated with substantial psychological and physiological morbidity. Although certain EDNOS subtypes could be incorporated into existing Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) categories, others-such as purging disorder and non-fat-phobic AN-may be best conceptualized as distinct syndromes. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
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In order to elucidate the nature of excessive exercise among individuals with eating disorders, exercise behaviours were compared between eating disorder patients receiving specialist treatment and healthy women, and between subgroups of patients. Self-report measures of obligatory exercise, motivation for exercise and frequency of hard exercise for weight or shape reasons were completed by eating disorder patients (n=102) and healthy women (n=184). The experience of intense guilt when exercise is missed and exercising solely or primarily for reasons of weight, shape or physical attractiveness, were the exercise behaviours that most clearly differentiated between women with eating disorders and healthy women. Patients with the purging form of anorexia nervosa (n=13) and those with bulimia nervosa (n=41) tended to have higher scores on measures of these behaviours than those with the restricting form of anorexia nervosa (n=15). Research addressing the prevalence and correlates of excessive exercise in eating disorder patients would benefit from a broader assessment of exercise behaviour than has typically been used in previous studies. In addition, the findings may indicate specific targets for the clinical management of excessive exercise as well as for community-based health promotion initiatives.
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Clinical manifestations of body image disturbance in anorexia nervosa are described including size misperceptions and faulty beliefs about shape. The empirical investigations of body image aberrations in anorexia nervosa are critically reviewed. Methodological issues such as reliability, validity subject selection and sources of experimental bias are discussed with recommendations for further research. Theoretical explanations for the mechanisms determining self-overestimation are presented with data indicating a relationship between self-overestimation, body satisfaction and self-esteem. Finally, a therapeutic approach is suggested that is aimed specifically at modifying the patient's faculty beliefs about her body while coping with her refractory self-misperceptions.
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The purpose of this study was to examine the role of perfectionism as a phenotypic trait in anorexia nervosa and its relevance across clinical subtypes of this illness. The Multidimensional Perfectionism Scale and the perfectionism subscale of the Eating Disorder Inventory were administered to 322 women with a history of anorexia nervosa who were participating in an international, multicenter genetic study of anorexia nervosa. All participants were additionally interviewed with the Yale-Brown Obsessive Compulsive Scale and the Yale-Brown-Cornell Eating Disorder Scale. Mean differences on dependent measures among women with anorexia nervosa and comparison subjects were examined by using generalized estimating equations. Persons who had had anorexia nervosa had significantly higher total scores on the Multidimensional Perfectionism Scale than did the healthy comparison subjects. In addition, scores of the anorexia subjects on the Eating Disorder Inventory-2 perfectionism subscale exceeded Eating Disorder Inventory-2 normative data. For the anorexia nervosa participants, the total score on the Multidimensional Perfectionism Scale and the Eating Disorder Inventory-2 perfectionism subscale score were highly correlated. Total score on the Multidimensional Perfectionism Scale was also significantly related to the total score and the motivation-for-change subscale score of the Yale-Brown-Cornell Eating Disorder Scale. These data show that perfectionism is a robust, discriminating characteristic of anorexia nervosa. Perfectionism is likely to be one of a cluster of phenotypic trait variables associated with a genetic diathesis for anorexia nervosa.
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The present review addresses the outcome of anorexia nervosa and whether it changed over the second half of the 20th century. A total of 119 study series covering 5,590 patients suffering from anorexia nervosa that were published in the English and German literature were analyzed with regard to mortality, global outcome, and other psychiatric disorders at follow-up. There were large variations in the outcome parameters across studies. Mortality estimated on the basis of both crude and standardized rates was significantly high. Among the surviving patients, less than one-half recovered on average, whereas one-third improved, and 20% remained chronically ill. The normalization of the core symptoms, involving weight, menstruation, and eating behaviors, was slightly better when each symptom was analyzed in isolation. The presence of other psychiatric disorders at follow-up was very common. Longer duration of follow-up and, less strongly, younger age at onset of illness were associated with better outcome. There was no convincing evidence that the outcome of anorexia nervosa improved over the second half of the last century. Several prognostic features were isolated, but there is conflicting evidence. Most clearly, vomiting, bulimia, and purgative abuse, chronicity of illness, and obsessive-compulsive personality symptoms are unfavorable prognostic features. Anorexia nervosa did not lose its relatively poor prognosis in the 20th century. Advances in etiology and treatment may improve the course of patients with anorexia nervosa in the future.
Article
This study aimed to replicate and extend from Tylka, Calogero, and Daníelsdóttir (2015) findings by examining the relationship between rigid control, flexible control, and intuitive eating on various indices of disordered eating (i.e., binge eating, disinhibition) and body image concerns (i.e., shape and weight over-evaluation, body checking, and weight-related exercise motivations). This study also examined whether the relationship between intuitive eating and outcomes was mediated by dichotomous thinking and body appreciation. Analysing data from a sample of 372 men and women recruited through the community, this study found that, in contrast to rigid dietary control, intuitive eating uniquely and consistently predicted lower levels of disordered eating and body image concerns. This intuitive eating-disordered eating relationship was mediated by low levels of dichotomous thinking and the intuitive eating-body image relationship was mediated by high levels of body appreciation. Flexible control predicted higher levels of body image concerns and lower levels of disordered eating only when rigid control was accounted for. Findings suggest that until the adaptive properties of flexible control are further elucidated, it may be beneficial to promote intuitive eating within public health approaches to eating disorder prevention. In addition to this, particular emphasis should also be made toward promoting body acceptance and eradicating a dichotomous thinking style around food and eating.
Article
This meta-analysis assessed the strength of the association between correlates of shape and weight over-evaluation across binge eating disorder and mixed eating disorder samples. Across 32 studies, over-evaluation correlates were divided into demographic, eating pathology, or psychosocial. Shape and weight over-evaluation was associated with higher eating pathology and psychosocial impairment. The method of assessment (interview versus self-report questionnaire) moderated some of the relationships. Over-evaluation was unrelated to demographics and treatment outcome. These findings highlight the importance of addressing shape and weight over-evaluation during treatment, and supports the idea of using shape and weight over-evaluation as a severity specifier for binge eating disorder.
Article
This systematic review synthesised the literature on predictors, moderators, and mediators of outcome following Fairburn's CBT for eating disorders. Sixty-five articles were included. The relationship between individual variables and outcome was synthesised separately across diagnoses and treatment format. Early change was found to be a consistent mediator of better outcomes across all eating disorders. Moderators were mostly tested in binge eating disorder, and most moderators did not affect cognitive-behavioural treatment outcome relative to other treatments. No consistent predictors emerged. Findings suggest that it is unclear how and for whom this treatment works. More research testing mediators and moderators is needed, and variables selected for analyses need to be empirically and theoretically driven. Future recommendations include the need for authors to (i) interpret the clinical and statistical significance of findings; (ii) use a consistent definition of outcome so that studies can be directly compared; and (iii) report null and statistically significant findings.
Article
Objective: Anorexia nervosa (AN) is a psychiatric condition characterised by a distortion of body image. However, whether individuals with AN can accurately perceive the size of other individuals' bodies is unclear. Method: In the current study, 24 women with AN and 24 healthy control participants undertook two biological motion tasks while eyetracking was performed: to identify the gender and to indicate the walkers' body size. Results: Anorexia nervosa participants tended to 'hyperscan' stimuli but did not demonstrate differences in how visual attention was directed to different body areas, relative to controls. Groups also did not differ in their estimation of body size. Discussion: The hyperscanning behaviours suggest increased anxiety to disorder-relevant stimuli in AN. The lack of group difference in the estimation of body size suggests that the AN group was able to judge the body size of others accurately. The findings are discussed in terms of body image distortion specific to oneself in AN. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.
Article
Anorexia nervosa is an important cause of physical and psychosocial morbidity. Recent years have brought advances in understanding of the underlying psychobiology that contributes to illness onset and maintenance. Genetic factors influence risk, psychosocial and interpersonal factors can trigger onset, and changes in neural networks can sustain the illness. Substantial advances in treatment, particularly for adolescent patients with anorexia nervosa, point to the benefits of specialised family-based interventions. Adults with anorexia nervosa too have a realistic chance of achieving recovery or at least substantial improvement, but no specific approach has shown clear superiority, suggesting a combination of re-nourishment and anorexia nervosa-specific psychotherapy is most effective. To successfully fight this enigmatic illness, we have to enhance understanding of the underlying biological and psychosocial mechanisms, improve strategies for prevention and early intervention, and better target our treatments through improved understanding of specific disease mechanisms.
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This book describes the application of cognitive behavioural principles to patients with a wide range of eating disorders - it covers those with straightforward problems and those with more complex conditions or co-morbid states. The book takes a highly pragmatic view. It is based on the published evidence, but stresses the importance of individualized, principle-based clinical work. It describes the techniques within the widest clinical context, for use across the age range and from referral to discharge. Throughout the text, the links between theory and practice are highlighted in order to stress the importance of the flexible application of skills to each new situation. Case studies and sample dialogs are employed to demonstrate the principles in action and the book concludes with a set of useful handouts for patients and other tools. This book will be essential reading for all those working with eating-disordered patients including psychologists, psychiatrists, nurses, counsellors, dieticians, and occupational therapists. © G. Waller, H. Cordery, E. Corstorphine, H. Hinrichsen, R. Lawson, V. Mountford & K. Russell 2007.
Article
A meta-analysis of single-item measures of overall job satisfaction (28 correlations from 17 studies with 7,682 people) found an average uncorrected correlation of .63 (SD = .09) with scale measures of overall job satisfaction. The overall mean correlation (corrected only for reliability) is .67 (SD = .08), and it is moderated by the type of measurement scale used. The mean corrected correlation for the best group of scale measures (8 correlations, 1,735 people) is .72 (SD = .05). The correction for attenuation formula was used to estimate the minimum level of reliability for a single-item measure. These estimates range from .45 to .69, depending on the assumptions made.
Article
Objective: Recent advances in neuroimaging techniques have enabled a better understanding of the neurobiological underpinnings of anorexia nervosa (AN). The aim of this paper was to summarise our current understanding of the neurobiology of AN. Methods: The literature was searched using the electronic databases PubMed and Google Scholar, and by additional hand searches through reference lists and specialist eating disorders journals. Relevant studies were included if they were written in English, only used human participants, had a specific AN group, used clinical populations of AN, group comparisons were reported for AN compared to healthy controls and not merely AN compared to other eating disorders or other psychiatric groups, and were not case studies. Results: The systematic review summarises a number of structural and functional brain differences which are reported in individuals with AN, including differences in neurotransmitter function, regional cerebral blood flow, glucose metabolism, volumetrics and the blood oxygen level dependent response. Conclusion: Several structural and functional differences have been reported in AN, some of which reverse and others which persist following weight restoration. These findings have important implications for our understanding of the neurobiological underpinnings of AN, and further research in this field may provide new direction for the development of more effective treatments.
Article
Objective: In 2010, the authors identified in a separate publication, Mind the evidence gap, the sparse evidence-base for the treatment of adult anorexia nervosa and barriers to accessing care. We report on the ensuing development, implementation and first 18-month results of a novel eating disorder service bridging the primary and specialist continuum of care in Victoria, Australia. Method: Using literature review, stakeholder, and consumer and carer consultation, a model for a community eating disorder service was developed and then implemented. All patients entering the service were then assessed at intake and, if they gave consent, at 12 month follow-up. Results: From December 2010 to July 2012, 208 patients accessed The Body Image Eating Disorders Treatment and Recovery Service (BETRS). Fifty-three per cent had a diagnosis of anorexia nervosa and the mean number of co-morbid psychiatric diagnoses was two. Twenty-three per cent attended a day patient programme and showed a significant improvement in their body mass index. Measures of depression, anxiety and eating disorder symptomatology showed a concomitant, significant decrease. Conclusions: The development of BETRS has led to markedly improved access and effectiveness of specialist services in the region.
Article
The study aimed to explore the Eating Disorder Examination (EDE) for adolescent males with eating disorders (EDs) compared with adolescent females with EDs. Data were collected from 48 males and matched on percent median body weight (MBW) and age to 48 females at two sites. Adolescent males with anorexia nervosa-type presentation scored significantly lower than matched females on Shape Concern, Weight Concern, and Global score. They also scored lower on a number of individual items. The EDE has clinical utility with adolescent males with anorexic-type presentation although males' scoring ranges are consistently lower than those from adolescent females with similar clinical presentations. Males scored significantly lower on a number of items representing core symptoms such as desire to lose weight. More research is needed to gain a better understanding of the experience of adolescent males with EDs, particularly in relation to the nature of shape concern.
Article
The purpose of this study was to systematically review the reliability of scores on the Eating Disorder Examination (EDE) and the Eating Disorder Examination-Questionnaire (EDE-Q) and to examine the validity of their use as measures of eating disorder symptoms. Articles describing the psychometric properties of the EDE and EDE-Q were identified in a systematic search of major computer databases and a review of reference lists. Articles were selected based on a priori inclusion and exclusion criteria. Fifteen studies were identified that examined the psychometrics of the EDE, whereas 10 studies were found that examined the psychometrics of the EDE-Q. Both instruments demonstrated reliability of scores. There is evidence that scores on the EDE and EDE-Q correlate with scores on measures of similar constructs and support for using the instruments to distinguish between cases and non-cases. Additional research is needed to broaden the generalizability of the findings.
Article
The psychometric properties of the Depression Anxiety Stress Scales (DASS) were evaluated in a normal sample of N = 717 who were also administered the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). The DASS was shown to possess satisfactory psychometric properties, and the factor structure was substantiated both by exploratory and confirmatory factor analysis. In comparison to the BDI and BAI, the DASS scales showed greater separation in factor loadings. The DASS Anxiety scale correlated 0.81 with the BAI, and the DASS Depression scale correlated 0.74 with the BDI. Factor analyses suggested that the BDI differs from the DASS Depression scale primarily in that the BDI includes items such as weight loss, insomnia, somatic preoccupation and irritability, which fail to discriminate between depression and other affective states. The factor structure of the combined BDI and BAI items was virtually identical to that reported by Beck for a sample of diagnosed depressed and anxious patients, supporting the view that these clinical states are more severe expressions of the same states that may be discerned in normals. Implications of the results for the conceptualisation of depression, anxiety and tension/stress are considered, and the utility of the DASS scales in discriminating between these constructs is discussed.
Article
There has been particular confusion concerning two aspects of the psychopathology of bulimia nervosa: dissatisfaction with body shape and overvalued ideas about shape and weight. Whilst these features are closely related, they are nevertheless distinct. Body shape dissatisfaction is commonly found in these patients but is not necessarily present; whilst the over-valued ideas about shape and weight are a necessary diagnostic feature. Analysis of the relationship between these two features and depressed mood and self-esteem showed that, in the course of treatment, change in body shape dissatisfaction was closely associated with change in mood; and change in the overvalued ideas was closely associated with change in self-esteem. This finding supports the distinction between these two facets of the core psychopathology of bulimia nervosa.
Article
The psychometric properties of the Depression Anxiety Stress Scales (DASS) were evaluated in two studies using large clinical samples (N = 437 and N = 241). In Study 1, the three scales comprising the DASS were shown to have excellent internal consistency and temporal stability. An exploratory factor analysis (principal components extraction with varimax rotation) yielded a solution that was highly consistent with the factor structure previously found in nonclinical samples. Between-groups comparisons indicated that the DASS distinguished various anxiety and mood disorder groups in the predicted direction. In Study 2, the conceptual and empirical latent structure of the DASS was upheld by findings from confirmatory factor analysis. Correlations between the DASS and other questionnaire and clinical rating measures of anxiety, depression, and negative affect demonstrated the convergent and discriminant validity of the scales. In addition to supporting the psychometric properties of the DASS in clinical anxiety and mood disorders samples, the results are discussed in the context of current conceptualizations of the distinctive and overlapping features of anxiety and depression.
Article
This paper is concerned with the psychopathological processes that account for the persistence of severe eating disorders. Two separate but interrelated lines of argument are developed. One is that the leading evidence-based theory of the maintenance of eating disorders, the cognitive behavioural theory of bulimia nervosa, should be extended in its focus to embrace four additional maintaining mechanisms. Specifically, we propose that in certain patients one or more of four additional maintaining processes interact with the core eating disorder maintaining mechanisms and that when this occurs it is an obstacle to change. The additional maintaining processes concern the influence of clinical perfectionism, core low self-esteem, mood intolerance and interpersonal difficulties. The second line of argument is that in the case of eating disorders shared, but distinctive, clinical features tend to be maintained by similar psychopathological processes. Accordingly, we suggest that common mechanisms are involved in the persistence of bulimia nervosa, anorexia nervosa and the atypical eating disorders. Together, these two lines of argument lead us to propose a new transdiagnostic theory of the maintenance of the full range of eating disorders, a theory which embraces a broader range of maintaining mechanisms than the current theory concerning bulimia nervosa. In the final sections of the paper we describe a transdiagnostic treatment derived from the new theory, and we consider in principle the broader relevance of transdiagnostic theories of maintenance.
Article
Modern western culture emphasizes thinness, denigrates excess weight, and stigmatizes obese individuals, making it likely that obese people internalize these messages and feel badly about the physical presence that brands them. There is clear evidence that obesity is linked with poor body image, but not all obese persons suffer from this problem or are equally vulnerable. Risk factors identified thus far are degree of overweight, being female, and binge eating, with some evidence of risk increasing with early age of onset of obesity, race, and several additional factors. Treatments do exist for improving body image in overweight individuals. Key questions are how to identify those in need of body image intervention, how such programs can be integrated with weight loss treatments, and ultimately, how body image distress can be prevented.
Assessment of eating disorders: Interview or selfreport questionnaire?
  • C G Fairburn
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Fairburn, C. G., & Beglin, S. (1994). Assessment of eating disorders: Interview or selfreport questionnaire? International Journal of Eating Disorders, 16, 363-370.
Depictive and metric body size estimation in anorexia nervosa and bulimia nervosa: A systematic review and meta-analysis
E, K. (2017). Depictive and metric body size estimation in anorexia nervosa and bulimia nervosa: A systematic review and meta-analysis. Clinical Psychology Review, 57, 21-31.