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The relationship between dietary restraint and binge eating: Examining eating-related self-efficacy as a moderator
Abstract
Although dietary restraint has been shown to be a robust predictor of binge eating among women, many women report elevated levels of dietary restraint but do not concurrently exhibit symptoms of binge eating. Moderating variables could therefore interact with dietary restraint to affect its relation to binge eating. One potential factor that may attenuate this relationship is eating-related self-efficacy, defined as the tendency to feel confident in the ability to control eating behaviour under a diverse set of circumstances (e.g., under negative affect, social conflicts). This cross-sectional study examined whether eating-related self-efficacy moderated the relationship between flexible (i.e., a graded approach to dieting, defined by behaviour such as taking smaller servings to regulate body weight, yet still enjoying a variety of foods) and rigid restraint (i.e., an all-or-none approach to eating, characterised by inflexible diet rules) and binge eating. Data were analysed from 237 women. Greater levels of rigid restraint, flexible restraint, and a poorer self-efficacy were shown to predict unique variance in binge eating severity. A significant interaction effect was observed between flexible (but not rigid) restraint and self-efficacy scores on binge eating. Contrary to expectations, however, the flexible restraint-binge eating relationship was largest for those with moderate to strong self-efficacy, and was non-significant for those with poor self-efficacy. Overall, findings suggest that different mechanisms may be operating to maintain binge eating in those with varying levels of eating-related self-efficacy.
... Los atracones, específicamente, se relacionan con los intentos por restringir la dieta, la que generalmente tiene normas rígidas, que al romperse generan descontrol y un abandono total de las estrictas pautas de alimentación 9 . Esta asociación entre restricción-atracón parece estar moderada por la capacidad de autoeficacia relacionada con la alimentación 10 . ...
... Los problemas interpersonales en TA se relacionan con un gran afecto negativo, a la vez este se vincula a una alta frecuencia de atracones y de psicopatología, por lo que el impacto de los problemas interpersonales en la sintomatología de TA parece estar mediada, en parte, por el afecto negativo 10 . ...
... De esta forma es que varios autores han remarcado la importancia de clarificar un modelo explicativo que pueda cubrir la interacción entre factores que influyen en el TA, para de este modo además entregar un diagnóstico acorde y un tratamiento efectivo que pueda abarcar a largo plazo la dismi-nución de los factores de riesgo internos, entre ellos los pensamientos y emociones negativos, la impulsividad y la desregulación emocional vinculada a la alimentación 10,41 . ...
Introducción: el Trastorno por Atracón (TA) es habitual en obesidad y en quienes buscan tratamiento para bajar de peso, aunque también puede presentarse en personas con peso normal. En el desarrollo y mantenimiento de este cuadro psicopatológico interfieren distintos factores psicológicos y sociales que es relevante tener en cuenta para su abordaje. Objetivo: este artículo tiene por objetivo proponer una perspectiva integral de esta problemática, que considera estos distintos elementos psicosociales implicados, considerando también las consecuencias que acarrea este problema. Metodología: se realiza una revisión narrativa de antecedentes teóricos y empíricos a fin de generar un modelo comprehensivo de TA. Resultados: para contextualizar, se comienza describiendo el TA y ofreciendo cifras de prevalencia, para posteriormente presentar factores de riesgo, la relación de la enfermedad con la salud mental y algunas de sus consecuencias. A partir de todo esto se presenta el modelo que sintetiza toda esta información. Discusión: en el desarrollo de TA influyen factores internos y externos que es necesario tener presentes al momento de realizar diagnóstico e intervención para este trastorno. Conclusión: es relevante que los distintos profesionales de la salud implicados en el abordaje de la obesidad y la nutrición en general, como médicos, nutricionistas y psicólogos, mantengan una mirada atenta al posible diagnóstico de TA, adoptando una comprensión compleja del fenómeno, a fin de favorecer la efectividad de su intervención.
... Additionally, data on marital status, educational level, occupation and monthly income were obtained, as some studies demonstrated an association between these variables and BED, e.g., high-income individuals and individuals with occupational stress have an increased risk of BED, as the former have easier access to food, and the latter were found to use binge eating as a coping mechanism for stress [31]. Smoking and eating habits were part of the sociodemographic information; smoking has been shown to be associated with BED [32], and individuals on restricted diets have a higher risk of developing BED [33]. Participants were asked to self-report their height, weight and medical history-certain diseases are linked to a higher risk of BED [34]. ...
... Another potential theory proposes that the constant attempts to sustain cognitive control over food consumption seem to fail when disinhibitors (e.g., mood fluctuations) disrupt this cognitive control. In summary, dietary restriction is a possible central risk factor and/or maintaining factor for BED [33]. Table 5 Pearson's correlation coefficient for BMI, the total anxiety score and the total depression score The results of our study showed that high BEDS-7 scores were associated with high scores of depression and anxiety. ...
Background
Binge eating disorder (BED) is defined as recurrent ingestion of an unusually large amount of food in a discrete period of time. BED has the highest prevalence of all eating disorders. Studies have shown a strong relationship between BED and both physical and psychological factors such as obesity, depression and anxiety. This research aimed to report the prevalence and associated factors of BED among Bahrainis (aged 15–30 years).
Methods
A total of 959 participants (aged 15–30 years) completed self-administered online questionnaires. BED was measured using the binge eating disorder Screener-7. The Patient Health Questionnaire-9 and General Anxiety Disorder-7 were used to measure depression and anxiety, respectively.
Results
Out of all participants, 21.2% had binge eating symptoms. A higher BMI, a restricted diet, depression and anxiety were associated with more frequent binge eating symptoms. Out of all associated factors, depression had the strongest association with binge eating, (rp = 0.371, p < 0.0001). However, sociodemographic variables including age and other medical conditions were not significantly associated with BED symptoms.
Conclusion
In conclusion, the prevalence of BED symptoms was significantly high among the study participants. The results point out the crucial role of awareness of the interaction between obesity, depression and anxiety as potential risk factors for binge eating tendencies. Further research should examine their relationship with BED.
... Instead of excluding certain foods completely, they are consumed in limited quantities without guilt (Westenhoefer, 1991;Westenhoefer et al., 1999;Duarte et al., 2017;Hagerman et al., 2021). A mismatch between internal (e.g., hunger) and external stimuli (e.g., food odor) as can be found in former dimension is associated with pathological dietary behaviors (Mann and Ward, 2001;Brown et al., 2012;Linardon, 2018) and lower intuitive eating (Tylka and Kroon Van Diest, 2013;Strodl et al., 2020). Currently, the Eating Disorder Examination-Questionnaire (EDE-Q; Fairburn and Beglin, 1994) addresses a broad range of ED symptoms, such as Diatary Restraint, and is thus widely used to screen for and assess ED. ...
... In fact, we found latent correlation coefficients sufficiently large to assume associations with both OCD and ED. This is in line with previous studies assessing the psychometric qualities of the IEQ (Duarte et al., 2016;Linardon, 2018;Tie et al., 2022). These correlation patterns may again indicate the potentially significant role of Inflexible Eating in the development of ED (e.g., AN) mentioned above. ...
Objective
The present article introduces the German translation of the Inflexible Eating Questionnaire (IEQ-G), performs a psychometric evaluation, and explores the relationship of Inflexible Eating to the subscales of the Eating Disorder Examination-Questionnaire (EDE-Q) and Obsessive-Compulsive (OC) symptoms.
Methods
The cross-sectional study was carried out in the German-speaking area. A paper and pencil survey was completed by 612 females and 442 males of the general population.
Results
SEM analyses showed that the IEQ-G allows for calculating a total score and invariance tests were mostly promising. As a side result, the original 4-factorial structure of the EDE-Q could not be replicated, but a 3 dimensional solution proved convincing. From a psychometric point of view, the IEQ-G outperformed the EDE-Q. On a latent level, Inflexible Eating was remarkably strong related to OC-symptoms and the EDE-Q subscales.
Discussion
The detail analyses revealed that Eating Disorder assessment in general lacks subgroup-specific aspects, for instance, regarding gender or dietary preferences, important for early diagnosis and screening of ED. The IEQ-G proved applicable in a German speaking adult population and recommends itself for cross-cultural studies.
... Eating style is a psychology-related concept known as 'one's cues to eat', including emotional eating, restraint eating, and external eating, which could determine the functioning of both adults and children [12]. In simple terms, emotional eating is associated with the tendency to eat due to negative emotions; similarly, external eating implies eating stimulated by environmental factors, such as the aroma and appearance of delicious food; restraint eating represents the act of reducing caloric intake for weight control [13][14][15]. According to reports, these eating styles could negatively affect human health, connecting with depression, overeating, and obesity [16][17][18]. ...
... Thirdly, patients with restraint eating often set strict rules to reduce food intake at first. As time passes, the body may not be able to distinguish food shortage from self-imposed food restriction and acts as if in starvation mode, resulting in more hunger and greater appetite than before [15]. On the other hand, such strict rules will become increasingly difficult to maintain, and the inevitable breaking may induce overeating [41]. ...
(1) Background: Few studies have investigated the association between eating styles and IBS. This study aimed to explore the association between abnormal eating styles and irritable bowel syndrome (IBS). (2) Methods: This cross-sectional study investigated students in China Medical University and Shenyang Medical College. Eating styles were evaluated by the Dutch Eating Behavior Questionnaire (DEBQ), and IBS was diagnosed according to Rome III criteria. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). (3) Results: A total of 335 students were diagnosed with IBS. Students with the total scores in tertile 2 and 3 had 1.29 times and 2.75 times higher risk of IBS than students with the total scores in tertile 1, respectively. Simultaneously, the risk of IBS in the tertile 3 of external eating, emotional eating, and restraint eating trends was 3.87 times, 2.71 times, and 3.82 times higher than that of tertile 1, respectively. (4) Conclusions: this study showed that a high score in both total eating styles and each eating style was associated with the odds of having IBS and suggested that the psychological factors behind eating styles may play a critical role in controlling the IBS.
... ResEat was also predisposed to adequate intake of fruit and vegetables. Nevertheless, promoting restrained eating to improve one's dietary habits in the long-term is controversial due to the results showing correlation between ResEat intensity, poorer psychological parameters, higher risk of binge eating episodes, or even higher BMI [9,10,15,35,54]. Those aspects were not included in the study, except for BMI. ...
... Links between restrained, emotional, and external eating [8,15] were confirmed by positive correlations in our study, yet their strength was mostly weak. Only EmoEat and ExtEat were found to moderately correlate (r = 0.49). ...
Knowledge of associations between emotional, external, and restrained eating with food choices is still limited due to the inconsistent results of the previous research. The aim of the study was to adopt the Dutch Eating Behavior Questionnaire (DEBQ) and then to examine the relationship between emotional, external, and restrained eating styles and dietary patterns distinguished on the basis of intake of fruit and vegetables (fresh and processed separately), fruit and/or vegetable unsweetened juices, sweets and salty snacks, and the adequacy of fruit and vegetable intake. The cross-sectional study was conducted in 2020, in a sample of 1000 Polish adults. The questionnaire consisted of the Dutch Eating Behavior Questionnaire, questions on selected food groups intake, and metrics. DEBQ structure was tested using both exploratory and confirmatory factor analysis (EFA, CFA) and structural equation modelling (SEM), while multi-group analysis was used to test measurement invariance. Logistic regression was applied to investigate the association between eating styles and dietary patterns, identified with the use of K-means cluster analysis. EFA, CFA and SEM revealed a three-factor, 29-item tool with satisfactory psychometric parameters. Restrained eating (ResEat) and external eating (ExtEat) were found to decrease chances of low intake of both favorable (fruit, vegetables, and unsweetened juices) and unfavorable (sweets and salty snacks) foods and increased the chances of their moderate intake. ResEat increased the probability of the high intake of favorable and moderate or high intake of unfavorable foods. ResEat and ExtEat were predisposed to adequate intake of fruit and vegetables while emotional eating had the opposite effect. Gender, education, and BMI were also found to determine food intake. Our results provide evidence that both eating styles and sociodemographic characteristics should be taken into account while explaining food intake as they may favor healthy and unhealthy eating in different ways.
... There has been considerable debate regarding the utility of an FA "diagnosis" without considering the contribution of dietary restraint in increasing FA symptoms [13][14][15][16][17]. While FA is not recognized by the DSM, the term diagnosis is used loosely throughout this manuscript. ...
... Newly proposed models suggest that clinicians go beyond a "no dieting" approach for all ED presentations and should incorporate addiction neuroscience [46,47]. Some authors recommend that researchers and clinicians distinguish between flexible and rigid restraint [14]. In some cases, restraint is related to a lower body weight, better weight regulation, and a better diet quality while in others, restraint predicts poor diet, overeating, and obesity [48]. ...
Converging evidence from both animal and human studies have implicated hedonic eating as a driver of both binge eating and obesity. The construct of food addiction has been used to capture pathological eating across clinical and non-clinical populations. There is an ongoing debate regarding the value of a food addiction "diagnosis" among those with eating disorders such as anorexia nervosa binge/purge-type, bulimia nervosa, and binge eating disorder. Much of the food addiction research in eating disorder populations has failed to account for dietary restraint, which can increase addiction-like eating behaviors and may even lead to false positives. Some have argued that the concept of food addiction does more harm than good by encouraging restrictive approaches to eating. Others have shown that a better understanding of the food addiction model can reduce stigma associated with obesity. What is lacking in the literature is a description of a more comprehensive approach to the assessment of food addiction. This should include consideration of dietary restraint, and the presence of symptoms of other psychiatric disorders (substance use, posttraumatic stress, depressive, anxiety, attention deficit hyperactivity) to guide treatments including nutrition interventions. The purpose of this review is to help clinicians identify the symptoms of food addiction (true positives, or "the signal") from the more classic eating pathology (true negatives, or "restraint") that can potentially elevate food addiction scores (false positives, or "the noise"). Three clinical vignettes are presented, designed to aid with the assessment process, case conceptualization, and treatment strategies. The review summarizes logical steps that clinicians can take to contextualize elevated food addiction scores, even when the use of validated research instruments is not practical.
... Some studies demonstrated the relation between eating self-efficacy and eating disorders [26,27] or disordered eating habits in non-clinical samples (e.g. [28,29]), evidencing its potential role not only in obesity but also in eating disorders research, prevention and treatment. ...
... In particular, the two latent ESEBS scales were negatively correlated with two measures of disordered eating and emotional eating. The association between eating self-efficacy and behavioural and psychological characteristics related to eating disorders [1,[26][27][28][29] is well documented in previous studies. Moreover, it has been reported an association between the use of dysfunctional strategies for regulating emotions and food intake increase [5,6]. ...
PurposeEating self-efficacy (ESE) is the belief in one’s ability to self-regulate eating. Social and emotional situations may be differently challenging depending on the individual eating habits, body mass index and affects. Several ESE scales have been developed but most of them focus on weight management, dieting or healthy eating. The aim of the study was to validate a new brief scale assessing ESE in situations in which people face social or emotional pressures for excessive food intake.Methods
Study 1: A sample of 412 volunteer females (age M = 25.44 ± 5.03) completed a first 25-item version of the scale. Exploratory factor analysis (EFA) was conducted for selecting a subgroup of items composing the ESE brief scale (ESEBS). Study 2 assessed its psychometric properties through a Confirmatory Factor Analysis (CFA), analyzing the responses of 410 volunteer adults (273 females, 137 males).ResultsEFA of Study 1 evidenced a bifactorial structure. Four items for each factor were selected, explaining 63% of the variance. Study 2 confirmed the good fit of the bifactorial model (CFI = 0.9589; χ2 (19) = 62.852, p < 0.001; RMSEA = 0.075; SRMR = 0.040) and provided support for the measurement invariance of the scale across gender. The internal consistency was as follows: Social (α = 0.786), Emotional (α = 0.820). The concurrent validity of the subscales was demonstrated by significant latent negative correlations with measures of eating disorders and emotional eating.Conclusions
The 8-items ESEBS appears as a valid and reliable instrument to assess eating self-efficacy related to social and emotional situations. Future studies should evaluate its potential use in non-clinical and clinical research and interventions.Level of evidenceLevel V, descriptive cross-sectional study.
... Individuals who practice this form of restraint tend to think dichotomously about food and dieting, set themselves multiple demanding diet "rules," and engage in various regimented dieting behaviors (e.g., calorie counting, fasting, skipping meals; Westenhoefer et al., 1999). This form of restraint has been consistently shown in experimental (Knight & Boland, 1989), prospective (Agras & Telch, 1998), and cross-sectional (Linardon, 2018;Tylka, Calogero, & Daníelsdóttir, 2015) studies to be strongly associated with more severe and frequent binge eating. Flexible restraint, however, reflects a more graded approach to dieting, defined by behaviors such as allowing oneself to eat a wide variety of food types while still paying attention to weight/shape, and opting for "healthier" foods if "unhealthier" foods were consumed earlier. ...
... The flexible control subscale has demonstrated good internal consistency (α > .80) construct validity (e.g., via its association with lower self-reported energy intake and weight loss), and incremental validity in community samples (Linardon, 2018), in individuals who are obese (Westenhoefer et al., 1999), and in individuals with BED (Blomquist & Grilo, 2011). ...
Objective:
Previous research has shown that certain eating patterns (rigid restraint, flexible restraint, intuitive eating) are differentially related to binge eating. However, despite the distinctiveness of these eating patterns, evidence suggests that they are not mutually exclusive. Using a machine learning-based decision tree classification analysis, we examined the interactions between different eating patterns in distinguishing recurrent (defined as ≥4 episodes the past month) from nonrecurrent binge eating.
Method:
Data were analyzed from 1,341 participants. Participants were classified as either with (n = 512) or without (n = 829) recurrent binge eating.
Results:
Approximately 70% of participants could be accurately classified as with or without recurrent binge eating. Intuitive eating emerged as the most important classifier of recurrent binge eating, with 75% of those with above-average intuitive eating scores being classified without recurrent binge eating. Those with concurrently low intuitive eating and high dichotomous thinking scores were the group most likely to be classified with recurrent binge eating (84% incidence). Low intuitive eating scores were associated with low binge eating classification rates only if both dichotomous thinking and rigid restraint scores were low (33% incidence). Low flexible restraint scores amplified the relationship between high rigid restraint and recurrent binge eating (81% incidence), and both a higher and lower BMI further interacted with these variables to increase recurrent binge eating rates.
Conclusion:
Findings suggest that the presence versus absence of recurrent binge eating may be distinguished by the interaction among multiple eating patterns. Confirmatory studies are needed to test the interactive hypotheses generated by these exploratory analyses.
... Rigid or inflexible DR encompasses two dimensions, namely behavioural (i.e., obeying restrictive rules that include calorie counting, avoiding high-calorie food, skipping meals, and even fasting to lose weight) [3], and psychological (i.e., the belief that one must constantly adhere to inflexible, arbitrary rules that provide a feeling of empowerment and foster a sense of self-control) [6]. Inflexible DR has been associated with detrimental health effects, including affective and emotional disturbances [7,8], and body image concerns [4,5,[9][10][11]. Moreover, there is evidence that inflexible eating is a significant predictor of disordered eating [7], and represents a critical aspect of understanding eating patterns and psychopathology [7,[12][13][14]. ...
Background: The Inflexible Eating Questionnaire (IEQ) is an 11-item instrument designed to evaluate the behavioural and psychological components of inflexible eating. However, the psychometric properties of the instrument have been infrequently examined, and no previous work has examined its utility in the context of the Middle East.
Methods: A total of 826 Lebanese citizens and residents completed a novel Arabic translation of the IEQ, as well as previously validated measures of body appreciation, functionality appreciation, and disordered eating.
Results: The unidimensional factor structure of the IEQ was upheld through both exploratory and confirmatory factor analyses, with all 11 items retained. We obtained evidence of scalar invariance across gender and found that there were no significant differences in observed IEQ scores between men and women. IEQ scores were also found to have adequate composite reliability and adequate patterns of concurrent validity.
Conclusion: The present findings provide support for the psychometric properties of the Arabic version of the IEQ in examining inflexible eating in Arabic-speaking adults in Lebanon.
... Early intervention, particularly increasing self-efficacy, can prevent these eating disorders [12]. Selfefficacy is related to an individual's belief in their abilities to change risky practices associated with eating behavior [13]. To reduce the risk of developing complications in diabetes management, it is necessary to support positive health-related behaviors, give up negative behaviors, and strengthen self-efficacy [14]. ...
Objective: This study aimed to determine the frequency of eating disorders and symptoms, anxiety and self-care management status, and factors that have an impact on eating disorders in diabetics during the COVID-19 pandemic. Method: This cross-sectional web-based study used a survey comprising a socio-demographic information form, the Bulimic Investigation Test of Edinburgh (BITE), Perceived Diabetes Self-Management Scale (PDSMS), and Generalized Anxiety Disorder Scale (GAD-7). Independent samples t Test, Mann Whitney U Test, Chi Square Test, Pearson correlation analysis, and Simple Regression Analysis were applied to the variables. Results: Totally, 110 (52 Type 1, 58 Type 2) diabetics aged 18-65 participated in the study. BITE total score was determined as 20.92±7.99 (Min:8; Max:32). Eating disorder frequency was 29.1% while anxiety disorders frequency was 30.9%. Perceived Diabetes Self-Management Scale point is 24.80±3.85 (Min:8; Max:40). Married individuals and diabetics with anxiety disorder mostly had eating disorders (p<.005). There was no significant relationship between anxiety disorder, eating disorder and PDSMS scores of the participants and socio-demographics (p>.05). Anxiety was a significant predictor of eating disorders in diabetics (R=.45; R2 =.20; F (1.108)=28.61, p<.001). Conclusion: Eating disorder symptoms and severity of diabetics, and their coping styles with anxiety should be determined during the pandemic by diabetes care and specialist. Family eating habits and the presence of anxiety disorders should be taken into account to reduce eating disorders. People with diabetes can be emotionally and self-management empowered through online training and counseling.
... Public Health 2022, 19, 15523 2 of 8 control, are more likely to engage in binge eating [15]. Some empirical tests of the restraint model have shown positive associations between dietary restraint and binge eating [16]. However, Spoor and colleagues [17] did not find a prospective association between dietary restraint and later binge eating, and other research found that in a multivariable model with restraint and body dissatisfaction, only body dissatisfaction was significantly associated with bulimic symptoms [18]. ...
Body dissatisfaction is a key predictor of binge eating, yet less is known about factors that may potentiate the association between body dissatisfaction and binge eating. This study examined self-reported dietary restraint and sweet taste reward sensitivity as candidate moderators of the association between body dissatisfaction and binge eating in adults. A convenience sample of 221 tobacco product users completed measures of eating disorder pathology and sweet taste reward sensitivity. Results revealed that elevated sweet taste reward sensitivity strengthened the positive association between higher body dissatisfaction and binge eating. However, there was no main effect, or moderation effect, of dietary restraint on binge eating. The findings of this study demonstrate the key role of sweet taste reward sensitivity in potentiating the association between body dissatisfaction and binge eating. Sweet taste reward sensitivity may serve as a key dispositional factor for uncontrolled eating.
... Dietary restraint refers to the cognitions (e.g., cognitive restraint) related to the intention of restraining caloric intake to manipulate one's body weight [8][9][10]. These cognitions, when combined with other risk factors, can increase one's risk for the development of eating disorders and adverse psychological effects, such as obsessive worry about weight and body shape, in high-risk individuals [10][11][12][13][14]. ...
Dietary restraint and low body appreciation are common among female-identifying undergraduates and are related to the development of disordered eating, which female-identifying undergraduates engage in throughout college. Training students in intuitive eating, an approach that promotes eating by internal cues, may be a way to ameliorate dietary restraint and low body appreciation, ultimately decreasing disordered eating. The purpose of this study was to examine the impact of a five-week intuitive eating intervention on dietary restraint, body appreciation, and intuitive eating in female-identifying undergraduates. A five-week intuitive eating intervention (NCT0394700) was facilitated by two Registered Dietitians. One treatment group (TG) (n = 7) and one waitlist control group (WLCG) (n = 7) participated in the trial. From baseline to post-intervention, there was a significant decrease in dietary restraint, t(12) = -2.88, p = 0.01, and a significant increase in intuitive eating, t(12) = 4.03, p = 0.002, in the TG compared to the WLCG. The intervention had replicable effects on all outcome variables. Measurements at the five-week follow-up suggested the impact was sustained. This study provides preliminary data suggesting an intuitive eating intervention may help improve disordered eating risk factors by decreasing dietary restraint and increasing intuitive eating in female-identifying undergraduates.
... Among females, a profile of depressed and restrained personality traits along with a tendency to be younger in age and concerned with weight and shape was associated with restrained eating, consistent with past findings (American Psychiatric Association, 2013;Devrim et al., 2018;DuBois et al., 2017;Fairburn, 2008;Puccio et al., 2017;Santos et al., 2007). In interpreting the current results, it is important to note the frequent co-occurrence of restrictive and binge eating behaviours (De Young et al., 2014;Linardon, 2018). More specifically, impulsive, hasty or rash personality traits have been previously associated with binge or emotional eating patterns (Elfhag & Morey, 2008;Helle et al., 2018), and this may explain the significance of low cautiousness in the current model, in addition to the indirect effect of high impulsivity on restrictive eating. ...
There is a wealth of research that has highlighted the relationship between personality and eating disorders. It has been suggested that understanding how subclinical disordered eating behaviours are uniquely associated with personality can help to improve the conceptualization of individuals with eating disorders. This study aimed to explore how the facets of the Five‐Factor Model (FFM) predicted restrictive eating, binge eating, purging, chewing and spitting, excessive exercising and muscle building among males and females. An online survey assessing disordered eating behaviours, FFM and general psychopathology was completed by 394 females and 167 males aged between 16 and 30 years. Simultaneous equations path models were systematically generated for each disordered eating behaviour to identify how the FFM facets, body dissatisfaction and age predicted behaviour. The results indicated that each of the six disordered behaviours were predicted by a unique pattern of thinking, feeling and behaving. Considerable differences between males and females were found for each path model, suggesting differences between males and females in the personality traits that drive disordered eating behaviours. It was concluded that it is important to take personality into account when treating males and females who engage in disordered eating behaviours.
... This may suggest that some forms of dietary restraint, including avoidance of eating and desire for an empty stomach, are indicative of overall ED severity, including shape and weight dissatisfaction.This study does not provide any information regarding whether different profiles of dietary restraint are differentially associated with treatment response, but we anticipate that the present findings could have important clinical implications. Existing research indicates that cognitive behavior therapy for B-EDs (CBT-E) is effective for reducing dietary restraint among individuals with high levels of baseline dietary restraint, which is associated with improvements in binge eating for these patients(Accurso et al., 2016;Linardon, 2018b;Presseller et al., 2022). This may be due to theemphasis in CBT-E on reducing dietary restraint. ...
Objective:
The relationship of dietary restraint in increasing risk for binge eating among individuals with binge-spectrum eating disorders (B-EDs) is well established. However, previous research has not yet identified whether these individuals exhibit heterogeneous profiles of dietary restraint and whether these profiles are associated with differences in eating pathology.
Methods:
Individuals with B-EDs (N = 290) completed the Eating Disorder Examination. Latent profile analysis was conducted on dietary restraint frequency data, including restriction of overall amount of food consumed, avoidance of eating, desire for an empty stomach, food avoidance, and dietary rules. Identified latent profiles were compared on binge eating frequency, compensatory behaviors frequency, and ED pathology using the three-step procedure.
Results:
A four-class model of dietary restraint best fit the data. Classes significantly differed in frequency of compensatory behaviors (F[3, 286] = 31.01, p < .001), EDE Eating Concern (F[3, 286] = 14.36, p < .001), EDE Shape Concern (F[3, 286] = 7.06, p < .001), EDE Weight Concern (F[3, 286] = 6.83, p < .001), and ED Pathology (F[3, 286] = 12.86, p < .001), but did not differ in frequency of objective (F[3, 286] = 2.45, p = .06) or subjective binge episodes (F[3, 286] = 1.87, p = .14).
Discussion:
Individuals with B-EDs exhibit distinct profiles of dietary restraint, which are associated with frequency of compensatory behaviors and severity of ED pathology.
Public significance statement:
Individuals with binge-spectrum eating disorders have different patterns of restrictive eating symptoms. These profiles of restrictive eating behaviors are associated with differences in severity of compensatory behaviors and cognitive eating disorder symptoms, like shape and weight dissatisfaction. Understanding the relationships between profiles of restrictive eating behaviors and other eating disorder symptoms may allow for personalization of treatment and improvements in treatment efficacy.
... From this result, it can be concluded that cognitive restraint may not cause problems and may even be beneficial for health in the context of HeOr. This type of eating can be referred to as "flexible" restraint [44]. Uncontrolled eating and emotional eating behaviors were positively associated with OrNe and negatively associated with HeOr. ...
Purpose
The obsession with healthy eating associated with restrictive behaviors is called Orthorexia Nervosa (OrNe). Nevertheless, some studies suggest that orthorexia can also be a non-pathological interest in healthy eating which is called Healthy Orthorexia (HeOr). First, one of the main objectives of this study is to compare HeOr, OrNe and eating behaviors in different dietary patterns (vegan, vegetarian and omnivore). Second is to reveal the relationship between HeOr, OrNe and eating behaviors (cognitive restraint, uncontrolled eating, and emotional eating). Lastly, to determine the potential predictors of HeOr and OrNe.
Methods
Participants (N = 426 with an omnivorous diet; N = 415 with a vegan diet, N = 324 with a vegetarian diet) completed a web-based descriptive survey, the Teruel Orthorexia Scale and the Three-Factor Eating Questionnaire-R 21.
Results
HeOr and OrNe were more common in individuals following both vegan and vegetarian diets. Individuals following a vegan or a vegetarian diet had lower body mass index and higher body image satisfaction than individuals following an omnivorous diet. Cognitive restraint and following a vegan or a vegetarian diet were the two main predictors of both HeOr and OrNe. Cognitive restraint was positively associated with both HeOr and OrNe (more strongly correlated with OrNe), whereas uncontrolled eating and emotional eating behaviors were positively related to OrNe and negatively related to HeOr.
Conclusion
The present study contributes to a better understanding of the some similarities and differences between HeOr and OrNe. It also points to higher rates of orthorexia in individuals following a vegan or vegetarian diet and represents a further step towards developing prevention and intervention programs by identifying risk factors for OrNe.
Level V Cross-sectional descriptive study.
... Of the small number of low intensity or brief family interventions to have been developed in EDs, none involve adult patients (see [39][40][41]), something that may be particularly important given the need to support selfefficacy in this population [42,43]. ...
Background:
Eating disorders are associated with significant personal and family costs. Clinical guidelines recommend family members be involved and supported during care, but little has been reported regarding the preferences of adults around carer involvement in treatment. The necessary intensity of family work with adults is also unknown. A trial of a standardised brief family involvement method was conducted in an adult eating disorder service offering treatment-as-usual. Uptake and feasibility of implementing the approach as part of standard outpatient care and the preliminary impact on issues identified by adult patients and carers were evaluated.
Methods:
Eligible referrals at an adult eating disorders outpatient clinic were offered as needed family consultation to address presenting interpersonal problems identified by patients and their family members, and outcomes were evaluated 4 weeks later. Pre and post intervention surveys identified participant self-reported change in (i) problem frequency, (ii) distress and disruption caused, and (iii) confidence regarding presenting problems. Open text responses provided an overview of patient and carer goals for family involvement and revealed how the novel method impacted these areas as well as overall experience of, and feedback regarding, the brief family intervention.
Results:
Twenty-four female participants aged 18-53, and 22 carers participated in 31 consultations. Common concerns raised were eating disorder related interpersonal and communication issues. The focused sessions, offered on a one-at-a-time basis, showed preliminary effectiveness for reducing both patients and carer concerns. For example, adult patients reported that life interference from interpersonal problems was lower and confidence to deal with them was higher following family consultation. Carers also reported that frequency, level of worry, and life interference around presenting problems were lower after the structured family intervention.
Conclusions:
Brief family consultation, with a single focus on issues identified by family members and adult patients, was a safe and feasible procedure with adults affected by eating disorders. Effective at meeting the needs of participants, the framework investigated in the current study may also be a useful direction for adult services to consider when looking to support families and meet recommendations for their routine involvement in the outpatient care.
Trial registration:
Australian Clinical Trials Register number: ACTRN12621000047897 (www.anzctr.org.au).
... Dieting, disordered eating, or eating disorders appearing in the past can also alter the sensation of hunger and satiety [7,57]. For example, higher intake of unfavorable foods as a result of unconditional permission to eat what is desired (UPE) might be only a temporary effect observed among individuals previously engaging in rigid dietary control and restrictions, known as a risk factor for excessive consumption or eating for reasons unrelated to physical hunger [58,59]. Our results may be due to the influence of previous individuals' experiences, yet such factors were not included in our study. ...
Intuitive (IE) and mindful (ME) eating share internally focused eating, yet previous studies have shown that these concepts are not strongly correlated, which suggests that they might be differently related to food intake. The study aimed to adapt the original Intuitive (IES-2) and Mindful (MES) Eating Scales to the Polish language, to test their psychometric parameters and, further, to examine associations of IE and ME with an intake of selected food groups, i.e., healthy foods (fresh and processed vegetables, fresh fruit) and unhealthy foods (sweets, salty snacks). A cross-sectional study was conducted in 2020 in a group of 1000 Polish adults (500 women and 500 men) aged 18–65 (mean age = 41.3 ± 13.6 years). The factor structure was assessed with exploratory (EFA) and confirmatory (CFA) factor analysis as well as structural equation modeling (SEM). Measurement invariance across gender was assessed with multiple-group analysis. Internal consistency and discriminant validity of the two scales was tested. Spearman’s correlation coefficient was used to examine the correlation between IES-2 and MES subscales with food intake. A 4-factor, 16-item structure was confirmed for IES-2, while EFA and CFA revealed a 3-factor, 17-item structure of MES. Both scales demonstrated adequate internal consistency and discriminant validity. Full metric and partial scalar invariance were found for IES-2, while MES proved partial invariances. “Awareness” (MES) and “Body–Food Choice Congruence” (IES-2) positively correlated with intake of healthy foods and negatively with the intake of unhealthy ones. “Eating For Physical Rather Than Emotional Reasons” (IES-2) and “Act with awareness” (MES) favored lower intake of unhealthy foods, whereas “Unconditional Permission to Eat” and “Reliance on Hunger and Satiety Cues” (IES-2) showed an inverse relationship. A greater score in “Acceptance” (MES) was conducive to lower intake of all foods except sweets. The results confirmed that adapted versions of the IES-2 and MES are valid and reliable measures to assess IE and ME among Polish adults. Different IE and ME domains may similarly explain intake of healthy and unhealthy foods, yet within a single eating style, individual domains might have the opposite effect. Future studies should confirm our findings with the inclusion of mediating factors, such as other eating styles, childhood experiences, dieting, etc.
... Ironically, however, rigid restriction can lead to more disinhibited eating (Westenhoefer et al., 1999). This is in part due to the physiological and emotional pressures of hunger (Greenway, 2015;MacLean et al., 2015; for a discussion, see; Linardon, 2018), as well as a common all-or-nothing mindset of dieting whereby any violation of restriction becomes a binge (e.g., the abstinence violation effect; Carels et al., 2004;Herman & Mack, 1975;Mooney et al., 1992;(Polivy, Herman, & Rajbir, 2010); for reviews, see Polivy & Herman, 2020;Keel & Heatherton, 2010). Although feelings of eating self-efficacy can lead to improvements in the quality of one's nutrition (e.g. ...
Body weight is often viewed as personally controllable. This belief, however, ignores the complex etiology of body weight. While such attributions of personal willpower may help some individuals regulate their eating patterns, they have also been associated with increased internalized weight stigma which, itself, is associated with more disinhibited eating. The current investigation aimed to examine how internalized weight stigma, along with BMI, may explain the effect of weight controllability beliefs on disparate dietary behaviors. A community sample of 2702 U.S. adults completed an online survey about their weight controllability beliefs, eating behaviors, and internalized weight stigma, as well as demographic items and self-reported BMI. Results showed that greater weight controllability beliefs were positively related to both more restricted eating, β = 0.135, p < .001, and more disinhibited eating, β = 0.123, p < .001. This ironic effect was partially explained by increased internalized weight stigma. Moreover, BMI moderated the relationship, such that individuals with lower weights demonstrated stronger effects for two of the three eating outcomes than those with higher weights. These findings advance our understanding of the relationship between attributions of personal control for body weight and subsequent health behaviors, and further underscore the need to target internalized weight stigma in dietary interventions.
... Eating behavior has a crucial role in energy balance and weight control. Changes eating behavior may have an effect on losing and gaining weight (16) . ...
Objective
It is known that social isolation process has an impact on individuals’ eating behaviors. Continuing nutritional behavior resulting from emotional eating, uncontrolled eating and cognitive restriction may turn into eating disorders in the future. The purpose of this study is to evaluate the possible effects of Corona Virus Disease-2019 (COVID-19) pandemic and social isolation process on individuals’ nutritional behaviors and body weight changes.
Design
Retrospective cohort study.
Setting
Nutritional behaviors of the participants before the COVID-19 pandemic and in the social isolation process were evaluated with the Three Factor Nutrition Questionnaire (TFEQ-R18). The changes in individuals’ body weight during this period was also evaluated.
Participants
A total of 1036 volunteer individuals (827 women, 209 men) aged 18 and over participated in the study.
Results
During the COVID-19 pandemic and social isolation process, there was an increase in emotional eating and uncontrolled eating behaviors of individuals, but no significant change in cognitive restriction behavior occurred (p = <0.00; p = <0.00 and p = 0.53, respectively). It was reported that the body weight of 35% of the individuals who participated in the study increased during this period.
Conclusion
Social isolation process practiced as a result of COVID-19 pandemic may lead to changes in some nutritional behaviors. Some precautions should be taken to prevent this situation that occurs in nutritional behaviors from causing negative health problems in the future.
... Overeating might be associated with one of the following eating styles: Restrained, emotional, or external. In restrained eating, when someone is following a strict dietary regimen, eating something forbidden may induce "all-or-nothing" reaction leading to overconsumption [17]. Negative, positive, or neutral emotional states (e.g., sadness, anxiety, joy, boredom) might also increase food intake (emotional eating). ...
Rapidly increasing prevalence of overweight and obesity indicates a need to search for their main causes. Addictive-like eating and associated eating patterns might result in overconsumption, leading to weight gain. The aim of the study was to identify main determinants of food intake variety (FIV) within eating addiction (EA), other lifestyle components, and sociodemographic characteristics. The data for the study were collected from a sample of 898 Polish adults through a cross-sectional survey in 2019. The questionnaire used in a study included Food Intake Variety Questionnaire (FIVeQ), Eating Preoccupation Scale (EPS) and questions regarding lifestyle and socio-demographic factors. High eating addiction was found in more than half of people with obesity (54.2%). In the study sample physical activity at leisure time explained FIV in the greatest manner, then subsequently EPS factor: Eating to provide pleasure and mood improvement. In the group of people with obesity, the score of this EPS factor was the best predictor of FIV, in a way that its higher score was conducive to a greater variety of food intake. Socio-demographic characteristics differentiated FIV only within group with normal body weight (age) and with overweight (education). As conclusion, food intake variety (FIV) was associated with physical activity at leisure time, and then with EPS factor “Eating to provide pleasure and mood improvement”, whereas socio-demographic characteristics were predictors of FIV only within groups identified by Body Mass Index (BMI). Nevertheless, our observations regarding Eating to provide pleasure and mood improvement factor and its associations with food intake variety indicate a need for further research in this area. Future studies should also use other tools to explicitly explain this correlation.
... Rigid behaviors like fasting prospectively predict (Agras and Telch, 1998), and in cross-sectional research are linked, with binge eating among women with bulimia and binge eating disorder (Masheb et al., 2011). In weight loss cohorts, there are links between rigid restraint and binge eating, shape/weight overvaluation, body dissatisfaction, disinhibited eating, dichotomous thinking, depressive and anxiety symptoms, and poorer wellbeing (Linardon, 2018;Linardon and Mitchell, 2017;Smith et al., 1999;Timko and Perone, 2005;Tylka et al., 2015;Westenhoefer et al., 1999). In contrast, flexible restraint is linked with lowered disordered eating, body image concerns, body weight, and psychological distress (Shearin et al., 1994;Smith et al., 1999;Westenhoefer et al., 1999Westenhoefer et al., , 2013 and increases in flexible control are associated with binge eating abstinence, greater weight loss in the course of therapy (Blomquist and Grilo 2011), and in one study, predicted long-term weight maintenance among women with obesity (Teixeira et al., 2010). ...
The popularity of physique sports is increasing, yet there are currently few comprehensive nutritional guidelines for these athletes. Physique sport now encompasses more than just a short phase before competition and offseason guidelines have recently been published. Therefore, the goal of this review is to provide an extensive guide for male and female physique athletes in the contest preparation and recovery period. As optimal protein intake is largely related to one’s skeletal muscle mass, current evidence supports a range of 1.8-2.7 g/kg. Furthermore, as a benefit from having adequate carbohydrate to fuel performance and activity, low-end fat intake during contest preparation of 10-25% of calories allows for what calories remain in the “energy budget” to come from carbohydrate to mitigate the negative impact of energy restriction and weight loss on training performance. For nutrient timing, we recommend consuming four or five protein boluses per day with one consumed near training and one prior to sleep. During competition periods, slower rates of weight loss (≤0.5% of body mass per week) are preferable for attenuating the loss of fat-free mass with the use of intermittent energy restriction strategies, such as diet breaks and refeeds, being possibly beneficial. Additionally, physiological and psychological factors are covered, and potential best-practice guidelines are provided for disordered eating and body image concerns since physique athletes present with higher incidences of these issues, which may be potentially exacerbated by certain traditional physique practices. We also review common peaking practices, and the critical transition to the post-competition period.
... Los estudios que han descrito incrementos en el peso corporal han utilizado ratas Sprague-Dawley y se ha reportado que es relativamente fácil observar cambios en el peso corporal en dichas ratas pero es muy difícil observar cambios en el peso corporal de las ratas Wistar (Hildebrandt, Klump, Racine, & Sisk, 2014; Tordoff, Alarcon, & Lawler, 2008). Así, aunque los modelos de acceso restringido (con animales y humanos) han sido de utilidad para el estudio de la conducta de atracón su utilidad para el estudio de la obesidad ha sido limitada (Linardon, 2018). ...
Binge eating behavior has been defined as an increased intake of palatable food during a short time period. The experimental models with rodents that had studied this eating behavior had implicitly or explicitly assumed that the induction protocol produced a permanent change in palatable eating, although there is no description of the persistence of the behavioral pattern despite this pice of information may be needed to evaluate any therapeutic strategy. Therefore, present objectives were: a) determine whether binge eating behavior persist after its induction with a 2h access to sucrose solution concurrent to free access to rat chow food for 24 h and, b) determine whether the deprivation level of chow food modulates maintenance of binge eating behavior. To this aim, rats had a 2h daily access to 10% sucrose with concurrent access to ad lib food and water. It was observed that after 25 days subjects develop binge eating behavior. It was also observed that along 8 weeks at least, binge eating behavior was stable and neither ad lib access or food deprivation modulated binge eating behavior, that remained similar to the last induction day. Stability of binge eating behavior reproduced observations with human patients and may aloud the study of long term neural changes induced after binge induction.
... Moreover, cross-sectional research examining the impact of a specific rigid control behavior, namely meal-skipping, has linked this behavior with an increased frequency of binge eating in women with BED [91] and with depressive symptoms, anxiety symptoms, and quality of life impairment in women with AN and BN [92]. Finally, numerous other cross-sectional studies using the Rigid Control subscale of the Cognitive Restraint Scale-which assesses the broad range of inflexible dietary behaviors [83]-have reported consistent and robust links between rigid control and numerous adverse health outcomes in both male and female participants, including disordered eating behaviors and attitudes (e.g., binge eating, disinhibited eating, dichotomous thinking), body image concerns (e.g., shape/weight overvaluation, body dissatisfaction), psychological distress (e.g., depressive and anxiety symptoms), and poorer wellbeing [11,83,[93][94][95][96]. Taken together, the available evidence suggests that a rigid approach to dieting may be potentially detrimental. ...
Physique athletes strive for low body fat with high lean mass and have higher body image and eating disorder rates than the general population, and even other weightlifting populations. Whether athletes with a background or tendency to develop these issues are drawn to the sport, or whether it drives these higher incidences, is unknown. However, the biological drive of cyclical energy restriction may contribute to binge-eating behavior. Additionally, requisite monitoring, manipulation, comparison, and judgement of one’s physique may contribute to body image concerns. Contest preparation necessitates manipulating body composition through energy restriction and increased expenditure, requiring dietary restraint and nutrition, exercise, and physique assessment. Thus, competitors are at mental health risk due to (1) pre-existing or predispositions to develop body image or eating disorders; (2) biological effects of energy restriction on eating psychology; and (3) dietary restraint attitudes and resultant physique, exercise, and nutrition monitoring behavior. In our narrative review we cover each factor, concluding with tentative best-practice recommendations, including dietary flexibility, slower weight loss, structured monitoring, gradual returns to offseason energy intakes, internal eating cues, appropriate offseason body compositions, and support from nutrition and mental health professionals. A mental health focus is a needed paradigm shift in bodybuilding nutrition practice and research.
Many people can see a very deep meaning in their work, connected with helping others. A sense of fulfi llment, satisfaction that what they do makes the lives of others happy, gives them a chance to live a normal life, becomes the driving force behind many activities. However, in many cases, professional work is the cause of serious burdens and creates a lot of stress and problems. The nature of the work performed is one of the most important factors determining the degree of risk of occupational burnout, affecting individual and public safety. Working in constant, contact with people, as in the
uniformed services, is often characterized by a high degree of emotional involvement. If we add to this the impact of stress and the need to deal with unrealistic expectations of the environment, we can confi dently assume that the uniformed services group, is a
high-risk group whose condition affects the level of national security. Personal observations and experiences led the authors to develop an article, the main purpose of which
is to analyze, present and study the process of professional burnout among employees of the uniformed services and to fi nd possible instruments to counteract this process.
Game habit and game addiction are distinguished in terms of psychological motivation, meaning, and a player's experience of gaming. The majority of contemporary studies address either the challenges or difficulties of particular habit formation often in the context of disciplined force or negative consequences of game addiction. Game habit does not necessarily imply game addiction. The objective of this study is to investigate the key antecedents of game habit formation using a quantitative study with 341 respondents collected in West Malaysia and analysed via structural equation modeling. The results demonstrate that game habit formation is formed more naturally with automatic control mechanisms, influenced by play intensity, flow experience, and self-efficacy, and the effect of play intensity towards game habit is interacted by network externality.
Objective
Thinness/restriction expectancies (i.e., perceived rewards from thinness/dietary restriction) and negative affect reduction expectancies (i.e., beliefs that eating will reduce negative emotions) are associated with disordered eating, but have largely been studied in isolation despite evidence that individuals can endorse these expectancies simultaneously. Guided by the goal conflict model, we hypothesized that for individuals reporting high levels of one type of expectancy, stronger endorsement of the second expectancy category would be associated with more dietary restriction, binge eating, and compensatory behaviors. A secondary aim included testing an adapted goal conflict model.
Design
Interaction effects were tested using multiple linear and negative binomial regressions. Exploratory indirect effect models tested the adapted goal conflict model. Given gender differences, hypotheses were tested separately by gender.
Measures.
Participants (N = 406, 54.2 % female, non-Hispanic White = 68.8 %, Mage = 20.99, MBMI = 25.05) completed measures of thinness/restriction expectancies, negative affect expectancies, dietary restriction, binge eating, and compensatory behaviors (e.g., purging, laxative/diuretic use, compensatory exercise).
Results
No statistically significant interaction of thinness/restriction and negative affect expectancies on disordered eating was observed for either the male or female sample. Main effects models revealed consistent findings across subsamples. Greater thinness/restriction expectancies were associated with more dietary restriction, binge eating, and compensatory behaviors. Greater negative affect reduction expectancies were associated with more binge eating. Exploratory indirect effect models yielded significant effects of each expectancy category on disordered eating.
Conclusion
Expectancies may be independent risk factors for disordered eating. Disordered eating prevention and intervention efforts may benefit from explicitly targeting thinness/restriction and negative affect expectancies.
Background
Binge-eating disorder (BED) is defined as recurrent abnormal ingestion of large amount of food in a discrete period of time. BED has the highest prevalence of all eating disorders (EDs). Studies have shown strong relationship between BED and both physical and psychological factors such as obesity, depression and anxiety. This research aimed to highlight the significance and predisposing factors of BED among Bahrainis (aged 15-30).
Methods
959 participants (aged 15–30 years) completed self-administered online questionnaires. BED was measured using the binge eating disorder screener-7 (BEDS-7). The questionnaire also included the Patient health questionnaire -9 (PHQ-9) And general anxiety disorder -7 (GAD -7) to measure depression and anxiety, respectively.
Results
Out of all participants, 21.2% had binge eating symptoms. Higher BMI, restrictive diet, depression and anxiety were associated with higher binge eating. Out of all risk factors, depression had the strongest association with a value of (p<0.0001, r=0.371) . However, sociodemographic variables including age and other medical conditions showed no statistical significance.
Conclusion
In conclusion, the prevalence of binge-eating disorder symptoms was significantly high among the study participants. The results point out the crucial role of awareness of the interaction between obesity, depression and anxiety as potential risk factors for binge eating tendencies. Further research should seek to examine their relationship with BED.
The objective of this paper is to examine definitions of the terms “drug,” “drug use, “drug abuse,” and “addiction” to determine if the most commonly consumed foods in America are similar or consistent with drug use, abuse, and addiction. The methodology consists of reviewing published studies in the “food addiction” literature to determine if any consensus on the issue is achieved. Further, the author analyzes research on harms (including illness, death, medical costs and productivity losses) of illicit drugs, licit drugs, and foods. The author finds evidence that some food consumption is consistent with drug use and drug abuse, and that food addiction is real. Further, the harms caused by the unhealthy foods we eat dwarf those caused by crime and illegal drugs combined. Based on the data, the author suggests we reprioritize what we believe to be dangerous and “criminal” as well as rethink the “war on drugs.”
Binge eating is increasingly prevalent among adolescents and young adults and can have a lasting harmful impact on mental and physical health. Mechanistic insights suggest that aberrant reward-learning and biased cognitive processing may be involved in the aetiology of binge eating. We therefore investigated whether recently developed approaches to catalyse brief interventions by putatively updating maladaptive memory could also boost the effects of cognitive bias modification training on binge eating behaviour. A non-treatment-seeking sample of 90 binge eating young adults were evenly randomised to undergo either selective food response inhibition training, or sham training following binge memory reactivation. A third group received training without binge memory reactivation. Laboratory measures of reactivity and biased responses to food cues were assessed pre-post intervention and bingeing behaviour and disordered eating assessed up to 9 months post-intervention. The protocol was pre-registered at https://osf.io/82c4r/. We found limited evidence of premorbid biased processing in lab-assessed measures of cognitive biases to self-selected images of typical binge foods. Accordingly, there was little evidence of CBM reducing these biases and this was not boosted by prior ‘reactivation’ of binge food reward memories. No group differences were observed on long-term bingeing behaviour, caloric consumption or disordered eating symptomatology. These findings align with recent studies showing limited impact of selective inhibition training on binge eating and do not permit conclusions regarding the utility of retrieval-dependent memory ‘update’ mechanisms as a treatment catalyst for response inhibition training.
Background: Eating disorders (EDs) are prevalent in adolescents and young adults, leading to various psychiatric and physical complications that affect the quality of life and even mortality. Objectives: The present study aimed to investigate the mediating role of self-efficacy and self-esteem in the relationship of perfectionism and negative reactivity with EDs. Methods: This descriptive study was performed on 302 students selected from the University of Tehran during 2018 - 2019. The data collection tools were the ED Examination-Questionnaire Short form, Self-esteem Scale, Weight Efficacy Lifestyle Questionnaire‑Short Form, ED Inventory-Perfectionism Scale, and Perth Emotional Reactivity Scale. Pearson’s correlation coefficient and structural equation modeling were used to analyze the data. Results: The results showed that EDs had significant positive correlations with perfectionism (r = 0.4, P = 0.01) and general negative reactivity (r = 0.53, P = 0.01). On the other hand, these disorders had a significant negative correlation with self-esteem (r = -0.48, P = 0.01) and self-efficacy (r = 0.53, P=0.01). Self-esteem had a negative significant relationship with perfectionism (r = -0.12, P = 0.05) and negative reactivity (r = -0.68, P = 0.01). Moreover, self-efficacy had a negative significant relationship with perfectionism (r = -0.28, P = 0.01) and negative reactivity (r = -0.5, P = 0.01). The findings of path analysis showed that self-esteem and self-efficacy played mediating roles in the relationship of negative reactivity and perfectionism with EDs. Negative reactivity directly affected eating pathology (t = 1.27, ß = 0.13) but is not significant. Conclusions: Our findings showed that self-esteem and self-efficacy are protective factors against the negative effects of perfectionism and negative reactivity. Therefore, self-esteem and self-efficacy can be considered as parts of prevention and treatment programs for EDs.
Introduction
Independently, food insecurity (FI) and binge-spectrum eating disorders (B-ED) are widespread problems; moreover, FI is associated with elevated binge-eating symptoms. However, extant research has not explored how FI may contribute to the development of B-ED symptoms, nor potential impacts of FI on eating disorder treatment.
Method
This study aimed to qualitatively examine (1) mechanisms by which FI impacts B-ED development and maintenance, (2) effects of past and/or present FI on ED treatment, and (3) participant recommendations for addressing FI in future B-ED treatment. Fourteen individuals who completed B-ED treatment and endorsed FI completed a 30-min interview about their experiences.
Results
Participants reported that FI contributed to binge eating by maintaining dietary restraint-binge-eating cycle and by leading them to use food as a coping mechanism or for emotional comfort, both in past and present situations. Present FI interfered with treatment, particularly with adhering to treatment recommendations and food purchasing choices, however, participants did not report any impact of past FI on B-ED treatment. Participants reported that rarely was FI addressed as part of treatment; most participants suggested that future treatments work to (1) assess and problem solve present FI to minimize interference and (2) assess and understand the influence of past FI on current symptoms to validate the function of behavior.
Discussion
These findings provide qualitative support that FI may reinforce B-ED symptoms and present FI may interfere with treatment. This study emphasizes the need for assessment and consideration of FI as a factor when treating individuals with B-EDs.
In this chapter we discuss nutritional interventions for food addiction (FA). As of yet, there is no clear established diet or food plan for FA treatment. Many approaches will likely prove useful, with further study. One potential approach is an abstinence-based one, essentially promoting strict restriction from certain types of foods that are highly addictive (especially those including high sugar, fat, and salt or highly refined ingredients). An alternate approach would be to not abstain from any food in particular, but rather to pay more attention to the quantity of foods consumed. Still others have recommended taking a more individualized approach, paying attention to particular trigger foods for each person. Increasing consumption of more nutritional and filling foods can also be emphasized. Other considerations to keep in mind include underlying comorbidities including eating disorders (EDs) and other psychiatric illnesses including addiction to other substances. In this chapter we explore the evidence to support the various approaches, including effects on cravings and maintenance of recovery.
Purpose
This study aims to investigate relationships among body mass index (BMI), socioeconomic variables, dietary self-efficacy and consumer dietary stress in healthy food buying and explore whether different levels of personal values influence these relationships.
Design/methodology/approach
The study is based on an online representative cross-sectional study with 380 food consumers. Structural equation modeling served to estimate direct, mediating and moderating effects between the studied constructs and variables.
Findings
Examples of moderating and moderated mediating effects include a negative impact of BMI on dietary stress for consumers with low levels of enjoyment value but no significant effect for consumers with high levels of enjoyment. BMI also had a greater negative impact on dietary self-efficacy when the level of respect/achievement was high (vs low), and respect/achievement positively moderated the mediating effect of BMI on dietary stress through dietary self-efficacy.
Research limitations/implications
This study focuses on analyzing healthy food buying in a particular cultural setting and may suffer from a lack of generalizability to other cultures. The results suggest that research should take into account personal values when investigating stress.
Practical implications
Food managers and health authorities can improve their ability to reduce dietary stress when addressing consumers by understanding the role of personal values in healthy food choice and the impact on mental well-being.
Originality/value
This study offers a novel, more fine-grained conceptual model of how consumers develop dietary stress when buying healthy food.
The current study evaluated components of existing theoretical models for loss of control (LOC) eating in young men. The link between body image concerns, including concerns with fat and muscularity, and LOC eating frequency was evaluated in 1109 ethnically/racially diverse men (18–30y). Dietary restraint, compulsive exercise, and emotion dysregulation were evaluated as putative mediators. Body mass index (BMI) and race/ethnicity were examined as moderators. Participants completed online surveys. Path analyses in Mplus tested indirect paths using the bias-corrected bootstrap method. Higher body fat concerns were directly linked to LOC eating frequency and indirectly linked through greater dietary restraint, compulsive exercise, and emotional dysregulation (ps<.01). The link among fat concerns, restraint, and LOC eating frequency was moderated by body mass, such that this association was particularly strong for men with a low-to-average BMI relative to those with a high BMI (p < .001). Higher muscularity concerns were not directly linked to LOC eating frequency but were indirectly linked through greater emotion dysregulation (p < .001). Body image concerns are associated with LOC eating in young men. The pathways to LOC eating may differ depending on the nature of men’s body image concerns (muscularity vs. thinness). Prospective data are needed to verify these findings.
Background: This study has been carried out in order to investigate the mediating effect of depression on the relationship of self discouragement and binge eating behaviour of university female students with diet experience. Methods: The data of diet experience existence, depression, binge eating behavior and self discouragement were obtained. Lastly, the total data of 296 undergraduate female students were analyzed. Results: The results of this study were as follows. First, 76% of college women reported a Diet experience. This figure was more than three times the female students reported that this diet experience. Second, In college students with diet experience, the variables of depression, binge eating behavior and self-disappointment were all significantly correlated. Third, binge eating behavior partially mediated the relation between depression and self discouragement. Conclusions: Binge eating behavior mediated the relation between depression and self discouragement of University female students with diet experience.
The Inflexible Eating Questionnaire (IEQ) is a recently developed measure that assesses an individual's inflexible adherence to rigid eating rules, along with the tendency to respectively feel empowered or distressed when such rules are or are not followed. At present, evidence supporting the unidimensional structure and psychometric properties of the IEQ is limited to one specific sample of Portuguese adults. Establishing whether the IEQ is a valid and reliable measure in a different sample and by an independent research team is needed. We sought to examine the factor structure and psychometric properties of the IEQ in large sample (n = 1000) of Australian female adults. A unidimensional structure was replicated and evidence of internal consistency (α = .89) was found. IEQ scores were significantly and moderately correlated with various eating restraint measures and intuitive eating, providing evidence of convergent validity. IEQ scores also predicted incremental variance in global eating disorder symptomatology and psychosocial impairment after controlling for intuitive eating, flexible control, and rigid dietary control. Present findings offer further support for the validity and reliability of the IEQ in a non-clinical sample of women. A brief measure that assesses the inflexible adherence to eating rules may be valuable for validating current models of eating disorder psychopathology. Furthermore, incorporating the IEQ into the assessment of future randomized trials of eating disorder prevention or treatment programs may be beneficial for elucidating these interventions mechanisms of change.
Binge eating disorder (BED) is characterized by recurrent overeating episodes, accompanied by loss of control (LOC), in the absence of compensatory behaviors. The literature supports that men overeat as often or more often than do women, but they are less likely to endorse LOC and other BED symptoms. Thus, rates of BED are lower among men. However, differences in prevalence rates may reflect gender bias in current conceptualizations of eating disorders and BED diagnostic criteria, not necessarily truly lower rates of disordered eating among men. The purpose of this study was to gather detailed information about how men experience overeating and related body image concerns, to identify common themes. The grounded theory approach was utilized to examine narratives from 11 overweight/obese male college students about their experiences with overeating, with results suggesting that overeating is consistent with male gender role, but LOC is not. Other overeating themes included mindless eating, emotional antecedents, negative consequences, unintentional dietary restriction, and social encouragement to overeat. Participants also reported dissatisfaction with their bodies, a desire for their bodies to be both muscular and thin, concerns related to their physical functioning and health, and a distinction between body image and self-worth. Collectively, these themes suggest further study to more fully explore the features and consequences of how disordered eating and body image concerns may manifest among men.
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.
Objective:
Several health behavior theories converge on the hypothesis that attitudes, norms, and self-efficacy are important determinants of intentions and behavior. However, inferences regarding the relation between these cognitions and intention or behavior rest largely on correlational data that preclude causal inferences. To determine whether changing attitudes, norms, or self-efficacy leads to changes in intentions and behavior, investigators need to randomly assign participants to a treatment that significantly increases the respective cognition relative to a control condition, and test for differences in subsequent intentions or behavior. The present review analyzed findings from 204 experimental tests that met these criteria.
Method:
Studies were located using computerized searches and informal sources and meta-analyzed using STATA Version 11.
Results:
Experimentally induced changes in attitudes, norms, and self-efficacy all led to medium-sized changes in intention (d+ = .48, .49, and .51, respectively), and engendered small to medium-sized changes in behavior (attitudes-d+ = .38, norms-d+ = .36, self-efficacy-d+ = .47). These effect sizes generally were not qualified by the moderator variables examined (e.g., study quality, theoretical basis of the intervention, methodological characteristics, and features of the targeted behavior), although effects were larger for interventions designed to increase (vs. decrease) behavioral performance.
Conclusion:
The present review lends novel, experimental support for key predictions from health behavior theories, and demonstrates that interventions that modify attitudes, norms, and self-efficacy are effective in promoting health behavior change. (PsycINFO Database Record
Researchers have found that rigid dietary control is connected to higher psychological distress, including disordered and disinhibited eating. Two approaches have been touted by certain scholars and/or health organizations as healthier alternatives: intuitive eating and flexible control-yet these approaches have not been compared in terms of their shared variance with one another and psychological well-being (adjustment and distress). The present study explored these connections among 382 community women and men. Findings revealed that intuitive eating and flexible control are inversely related constructs. Intuitive eating was related to lower rigid control, lower psychological distress, higher psychological adjustment, and lower BMI. In contrast, flexible control was strongly related in a positive direction to rigid control, and was unrelated to distress, adjustment, and BMI. Further, intuitive eating incrementally contributed unique variance to the well-being measures after controlling for both flexible and rigid control. Flexible control was positively associated with psychological adjustment and inversely associated with distress and BMI only when its shared variance with rigid control was extracted. Collectively, these results suggest that intuitive eating is not the same phenomenon as flexible control, and that flexible control demonstrated substantial overlap and entanglement with rigid control, precluding the clarity, validity, and utility of flexible control as a construct. Discussion addresses the implications of this distinction between intuitive eating and flexible control for the promotion of healthy eating attitudes and behaviors.
Copyright © 2015. Published by Elsevier Ltd.
Although sociocultural pressures are thought to contribute to bulimia nervosa, little research has examined the mechanisms by which these factors might actually produce eating pathology. The present study tested an integrative model of bulimia that centers around dietary restraint and affect regulation pathways. It also incorporates perceived sociocultural pressure, body-mass, ideal-body internalization, and body dissatisfaction. Using data from 257 female undergraduates, structural equation modeling revealed that the model accounted for 71% of the variance in bulimic symptomatology. The relation between perceived sociocultural pressure and bulimic symptoms was mediated by ideal-body internalization, body dissatisfaction, dietary restraint, and negative affect. The results support the dual pathway model of bulimia and suggest variables that might be targeted in prevention efforts.
Examine the association between components of restrained eating, cognitive performance and weight loss maintenance.
106 women, all members of a commercial slimming organisation for at least 6months (mean±SD: 15.7±12.4months), were studied who, having lost 10.1±9.7kg of their initial weight, were hoping to sustain their weight loss during the 6month study. Dietary restraint subcomponents flexible and rigid restraint, as well as preoccupying cognitions with food, body-shape and diet were assessed using questionnaires. Attentional bias to food and shape-related stimuli was measured using a modified Stroop test. Working memory performance was assessed using the N-back test. These factors, and participant weight, were measured twice at 6month intervals.
Rigid restraint was associated with attentional bias to food and shape-related stimuli (r=0.43, p<0.001 resp. r=0.49, p<0.001) whereas flexible restraint correlated with impaired working memory (r=-0.25, p<0.05). In a multiple regression analyses, flexible restraint was associated with more weight lost and better weight loss maintenance, while rigid restraint was associated with less weight loss.
Rigid restraint correlates with a range of preoccupying cognitions and attentional bias to food and shape-related stimuli. Flexible restraint, despite the impaired working memory performance, predicts better long-term weight loss. Explicitly encouraging flexible restraint may be important in preventing and treating obesity.
This study investigated the construct validity of two dietary restraint subscales, flexible control (FC) and rigid control (RC), identified by Westenhoefer (1991; Appetite, 16, 45–55) as a subset of the restraint scale items from the Three-Factor Eating Questionnaire (TFEQ, Stunkard & Messick. [1985]. Journal of Psychosomatic Research, 29, 71–83). The subjects were 31 women on long-term personality disorder units. Based on the Structured Clinical Interview for DSM-III-R (SCID), 68% has past anorexia and/or bulimia diagnoses and 94% were borderline. The subjects completed the TFEQ and supplied weight and height data for body mass index (BMI) calculations. The results supported the validity of the two restraint constructs by showing that FC was inversely related to BMI and predicted an anorexia diagnosis. In contrast, RC directly predicted BMI when tested concurrently with FC. RC was also more associated with a history of bulimia and problems with weight fluctuations than FC was. Thus, the FC-RC distinction was valid and useful in this population of women. © 1994 by John Wiley & Sons, Inc.
Following from Bandura's (1977a) self-efficacy theory, an Eating Self-Efficacy Scale (ESES) was developed and its psychometric properties established. Factor analysis of the 25-item scale yielded two reliable factors—one concerned with eating when experiencing negative affect (NA) and the other with eating during socially acceptable circumstances (SAC). The ESES demonstrated good internal consistency, test-retest reliability, and convergent validity. A clinical study using this measure found that increases in ESES scores were significantly related to weight losses among weight loss program participants. A laboratory study using a mood induction procedure found that NA subscale scores predicted food consumption irrespective of whether negative affect was induced. This finding may indicate that people have difficulty accurately discriminating the specific circumstances under which their eating difficulties occur and/or that eating difficulties tend to be global in nature. The significant correlation of the two ESES subscales (r =.39, p .001) supports these possibilities. The clinical and research utility of the ESES and the implications of the findings are discussed.
The purpose of this study was to examine the potential improvements in eating self-efficacy, eating behavior and other psychological factors in obese subjects participating in a weight management program. The participants in this study consisted of 96 persons (76 women and 20 men) who were attending the first session of a commercially run 20-week treatment program for weight reduction. Self-efficacy in relation to eating was assessed by the Weight Efficacy Lifestyle Questionnaire. The participants also completed the Three Factor Eating Questionnaire (TFEQ), Rosenberg Self-esteem Scale, Social Physique Anxiety Scale, State Trait Anxiety Inventory and Body Parts Satisfaction Scale prior to weight management program and again 20 weeks after the program. High self-efficacy score was significantly associated with high weight loss among all participants. Also, high negative emotions and physical discomfort scores were significantly associated with high weight loss among all participants. Results indicated that there was a significant decrease in the TFEQ hunger and disinhibition scores during the study. As a conclusion, our findings suggest that the role of self-efficacy has an important role in obesity treatment regarding to weight control behavior.
Nisbett's (1972) model of obesity implies that individual differences in relative deprivation (relative to set-point weight) within obese and normal weight groups should produce corresponding within-group differences in eating behavior. Normal weight subjects were separated into hypothetically deprived (high restraint) and non-deprived (low restraint) groups. The expectation that high restraint subjects' intake would vary directly with preload size while low restraint subjects would eat in inverse proportion to preload size, was confirmed. It was concluded that relative deprivation rather than obesity per se may be the cirtical determinant of individual differences in eating behavior. Consideration was given to the concept of "restraint" as an important behavioral mechanism affecting the expression of physiologically-based hungar.
The purpose of this study was to conduct an assessment of binge eating severity among obese persons. Two questionnaires were developed. A 16-item Binge Eating Scale was constructed describing both behavioral manifestations (e.g., eating large amounts of food) and feeling/cognitions surrounding a binge episode (e.g., guilt, fear of being unable to stop eating). An 11-item Cognitive Factors Scale was developed measure two cognitive phenomena thought to be related to binge eating: the tendency to set unrealistic standards for a diet (e.g., eliminating "favorite foods") and low efficacy expectations for sustaining a diet. The results showed that the Binge Eating Scale successfully discriminated among persons judged by trained interviewers to have either no, moderate or severe binge eating problems. Significant correlation between the scales were obtained such that severe bingers tended to set up diets which were unrealistically strict while reporting low efficacy expectations to sustain a diet. The discussion highlighted the differences among obese persons on binge eating severity and emphasized the role of cognitions in the relapse of self control of eating.
This study was designed to test the hypothesis that different types of dieting strategies are associated with different behavioral outcomes by investigating the relationship of dieting behaviors with overeating, body mass and mood. A sample of 223 adult male and female participants from a large community were studied. Only a small proportion of the sample (18%) was seeking weight loss treatment, though almost half (49.3%) of the subjects were significantly overweight (body mass index, BMI>30). Subjects were administered questionnaires measuring dietary restraint, overeating, depression and anxiety. Measurements of height and weight were also obtained in order to calculate BMI. Canonical correlation was performed to evaluate the relationship of dietary restraint variables with overeating variables, body mass, depression and anxiety. The strongest canonical correlation (r=0.65) was the relationship between flexible dieting and the absence of overeating, lower body mass and lower levels of depression and anxiety. The second strongest canonical correlation (r=0.59) associated calorie counting and conscious dieting with overeating while alone and increased body mass. The third canonical correlation (r=0.57) found a relationship between low dietary restraint and binge eating. The results support the hypothesis that overeating and other adverse behaviors and moods are associated with the presence or absence of certain types of dieting behavior.
Two subscales for the Eating Inventory (Three-Factor Eating Questionnaire) are developed and validated: Rigid and Flexible control of eating behavior.
Study I is an analysis of questionnaire data and a 7-day food diary of 54,517 participants in a computer-assisted weight reduction program. Study II is a study of 85 subjects used to develop a final item pool. Study III is a questionnaire survey of a random sample (N = 1,838) from the West German population aged 14 years and above used to validate the developed subscales.
Rigid control is associated with higher scores of Disinhibition, with higher body mass index (BMI), and more frequent and more severe binge eating episodes. Flexible control is associated with lower Disinhibition, lower BMI, less frequent and less severe binge eating episodes, lower self-reported energy intake, and a higher probability of successful weight reduction during the 1-year weight reduction program.
Rigid and flexible control represent distinct aspects of restraint having different relations to disturbed eating patterns and successful weight control.
In treatment of binge eating, measures of self-concept, eating self-efficacy, and social support were examined at 0, 6, and 18 months to determine if improvements in these variables were associated with reductions in binge eating severity.
Obese adult females (N = 125) were treated for 6 months, with 12 months of maintenance meetings. The Binge Eating Scale (BES), Tennessee Self-Concept Scale (TSC), Dieter's Inventory of Eating Temptations (DIET), and a social support measure (SocSup) were used.
Over the first 6 months, improvements in BES were associated with improvements in the TSC and DIET. Over 18 months, improvements in BES were associated with improvements in the TSC, DIET, and SocSup.
Therapy for binge eating should result in improvement in self-concept and eating self-efficacy, as well as reductions in binge eating. This study showed that self-concept and eating self-efficacy were associated with improvement in binge eating severity. The association with social support did not appear until long-term follow-up. Improvement in self-concept and eating self-efficacy may be processes leading to clinical improvement in this eating disorder, or they may result from changes in binge eating.
This study represented the first attempt to directly evaluate Fairburn et al's (1986) cognitive-behavioral model of bulimia nervosa--the model on which the most widely used treatment for bulimia nervosa is based.
The major predictions of the model were tested using structural equation modeling. Data were collected from the responses of 526 subjects to a number of self-report measures.
The factors of self-esteem, overconcern with weight and shape, and dietary restraint accounted for a large proportion of the variance in binge eating and purging. The key pathway in the model was the link between overconcern with weight and shape and the adoption of purgative behaviors, which then fed into a vicious cycle of binge eating and purging. Contrary to Fairburn's hypothesis, high levels of dietary restraint did not predict increased binge eating.
The results suggest that the components of Fairburn's model may operate to maintain the bulimic cycle in a slightly different way to that originally proposed.
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.
Most research on eating self-efficacy has focused on its relationship with eating behaviors and weight-loss in clinical populations. The purpose of this study was to investigate the relationship between eating self-efficacy and the behavioral and psychological characteristics associated with eating disorders in a non-clinical sample of adults. A total of 219 men and women aged 18 and older completed questionnaires measuring eating disorder symptoms and eating self-efficacy. The results indicated that low confidence in the ability to control eating while experiencing negative emotions was associated with greater weight preoccupation and bulimic thought and behaviors. In addition, low confidence in ability to control eating when an abundance of food is available was inversely related to feelings of ineffectiveness or general negative self-evaluation. Ultimately, the findings suggest that low eating self-efficacy may also be associated with eating problems within populations not seeking treatment for either eating disorders or weight-loss. The implications of the findings are discussed.
In this trial, adolescent girls with body dissatisfaction (N = 481, M age = 17 years) were randomized to an eating disorder prevention program involving dissonance-inducing activities that reduce thin-ideal internalization, a prevention program promoting healthy weight management, an expressive writing control condition, or an assessment-only control condition. Dissonance participants showed significantly greater reductions in eating disorder risk factors and bulimic symptoms than healthy weight, expressive writing, and assessment-only participants, and healthy weight participants showed significantly greater reductions in risk factors and symptoms than expressive writing and assessment-only participants from pretest to posttest. Although these effects faded over 6-month and 12-month follow-ups, dissonance and healthy weight participants showed significantly lower binge eating and obesity onset and reduced service utilization through 12-month follow-up, suggesting that both interventions have public health potential.
Self-efficacy: toward a unifying theory of behavioral change
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