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Testing the measurement invariance of the Body Image Acceptance and Action Questionnaire between women with and without binge-eating disorder symptomatology: Further evidence for an abbreviated five-item version

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Abstract

The Body Image Acceptance and Action Questionnaire (BI-AAQ), a measure designed to assess body image flexibility, was originally developed for and psychometrically investigated with nonclinical populations, but it has been recently administered to people with binge-eating disorder (BED) symptomatology. Tests of measurement invariance are needed to understand whether the BI-AAQ operates in the same way for BED and non-BED populations, thereby ensuring meaningful comparison across these groups. We thus tested the measurement invariance of the BI-AAQ in participants with and without clinically significant BED symptomatology. Data were analyzed from 358 community-based participants. Participants were either classified as with (n = 179) or without (n = 179) "probable BED" based on self-reported symptom frequency. An unacceptable model fit was found across both groups, indicating that the unidimensional structure of the BI-AAQ was not replicated. We then sought to confirm the unidimensional structure of a recently proposed five-item version of the BI-AAQ. A unidimensional structure of this abbreviated version was replicated, and tests of measurement variance were upheld. Internal consistency, convergent validity, and incremental validity were documented for both the original and abbreviated BI-AAQ across individuals with and without BED symptomatology. Present findings provide further psychometric support for an abbreviated five-item BI-AAQ, although it is important for future research to replicate both the full and abbreviated BI-AAQ in more diverse samples. Overall, an abbreviated BI-AAQ may be an attractive alternative for researchers studying body image flexibility. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

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... For example, the BI-AAQ was found to be closely related to other measures assessing eating disorder symptomatology [e.g., r = 0.61 with the Binge Eating Scale (Gormally et al., 1982;Lucena-Santos et al., 2017); r = 0.75 with the Eating Disorder Examination Questionnaire (Fairburn & Beglin, 2008;Karekla et al., 2019)]. The measure was also shown to be able to detect differences between the clinical group with eating/weight disorders and the nonclinical group (e.g., Linardon et al., 2019;Lucena-Santos et al., 2017). Again, as reported in Lee et al. (2018), after controlling for BMI, depression, anxiety, and general psychological flexibility, body image flexibility was still able to significantly predict eating disorder risk, quality of life, and general mental health in a sample of patients under treatment for eating disorders. ...
... The original English version of BI-AAQ has been translated into several languages and validated in many countries, including Greece (Karekla et al., 2019), Portugal (Ferreira et al., 2011), Brazil (Lucena-Santos et al., 2017, Iran (Izaadi et al., 2013), and the English version in the U.S. (Basarkod et al., 2018;Kurz et al., 2016;Timko et al., 2014) and Australia (Linardon et al., 2019). Moreover, based on the benefits of equivalent short-form measures, such as reducing dropout rates and improving data quality (Cook et al., 2000;Roszkowski & Bean, 1990;Snyder et al., 2007), Basarkod et al. (2018) developed a short version of the BI-AAQ (i.e., BI-AAQ-5) based on the novel technique of genetic algorithms (GAs). ...
... The BI-AAQ-5 was found to be equivalent to the full 12-item version (r = .98 between the scores of BI-AAQ and BI-AAQ-5; Basarkod et al., 2018) and invariant between clinical and nonclinical populations (Linardon et al., 2019). ...
Article
The psychometric properties of the Chinese version of the Body Image Acceptance and Action Questionnaire (C-BI-AAQ) and its short form (C-BI-AAQ-5) were examined with a sample of Chinese undergraduates (n = 1068, 52.6% female). The factor structure, measurement reliability, measurement invariance across gender, and latent gender mean difference of the two scales were explored. Confirmatory factor analysis was used to examine the factor structure of the C-BI-AAQ and the C-BI-AAQ-5. The original one-factor structure was replicated for both the C-BI-AAQ and the C-BI-AAQ-5. Both the C-BI-AAQ and C-BI-AAQ-5 showed good internal consistency, test–retest reliability, and convergent and discriminant validity (e.g., relationship patterns in the expected directions with theoretically similar psychological flexibility, and with theoretically dissimilar body dissatisfaction, and psychological distress). The C-BI-AAQ-5 was shown to be equivalent to the C-BI-AAQ. Furthermore, strict measurement invariance across gender was confirmed for both the C-BI-AAQ and C-BI-AAQ-5, and latent mean difference tests showed that men had higher levels of body image flexibility than women. Thus, both the C-BI-AAQ and C-BI-AAQ-5 appear to be psychometrically sound instruments for use in the Chinese young adult population. In addition, body image flexibility measured by both the C-BI-AAQ and the C-BI-AAQ-5 fully mediated the relationship between body dissatisfaction and psychological distress.
... For example, the BI-AAQ was found to be closely related to other measures assessing eating disorder symptomatology [e.g., r = 0.61 with the Binge Eating Scale (Gormally et al., 1982;Lucena-Santos et al., 2017); r = 0.75 with the Eating Disorder Examination Questionnaire (Fairburn & Beglin, 2008;Karekla et al., 2019)]. The measure was also shown to be able to detect differences between the clinical group with eating/weight disorders and the nonclinical group (e.g., Linardon et al., 2019;Lucena-Santos et al., 2017). Again, as reported in Lee et al. (2018), after controlling for BMI, depression, anxiety, and general psychological flexibility, body image flexibility was still able to significantly predict eating disorder risk, quality of life, and general mental health in a sample of patients under treatment for eating disorders. ...
... The original English version of BI-AAQ has been translated into several languages and validated in many countries, including Greece (Karekla et al., 2019), Portugal (Ferreira et al., 2011), Brazil (Lucena-Santos et al., 2017, Iran (Izaadi et al., 2013), and the English version in the U.S. (Basarkod et al., 2018;Kurz et al., 2016;Timko et al., 2014) and Australia (Linardon et al., 2019). Moreover, based on the benefits of equivalent short-form measures, such as reducing dropout rates and improving data quality (Cook et al., 2000;Roszkowski & Bean, 1990;Snyder et al., 2007), Basarkod et al. (2018) developed a short version of the BI-AAQ (i.e., BI-AAQ-5) based on the novel technique of genetic algorithms (GAs). ...
... The BI-AAQ-5 was found to be equivalent to the full 12-item version (r = .98 between the scores of BI-AAQ and BI-AAQ-5; Basarkod et al., 2018) and invariant between clinical and nonclinical populations (Linardon et al., 2019). ...
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Purpose As a 12-item Short Form of the Eating Disorder Examination Questionnaire (EDE-QS), the EDE-QS was developed based on Rasch modeling to address certain weaknesses of the EDE-Q, and it has been demonstrated to be a psychometrically sound measure. Thus, the current study aimed to obtain a Chinese version of the EDE-QS and validate its psychometric properties in the Chinese context. Methods According to standard procedures, the Chinese version of the EDE-QS (C-EDE-QS) was obtained. A total of 1068 Chinese college students finished the survey. The psychometric properties of the C-EDE-QS were examined under the frameworks of both classic test theory and Rasch modeling. Results The one-factor structure of the C-EDE-QS was confirmed in confirmatory factor analysis; the C-EDE-QS showed good reliability with a Cronbach’s α of 0.89; and the total scores of the C-EDE-QS were significantly correlated with eating disturbances and psychological distress in expected magnitudes and directions. Rasch analysis supported the unidimensional construct of the C-EDE-QS and the four-point rating scale structure. However, results revealed differential item functioning (DIF) across gender groups. Conclusions The findings suggest that the C-EDE-QS could be a useful tool to assess key attitudes and behavioral features of eating disorder psychopathologies in the Chinese context. Level of evidence V, descriptive (cross-sectional) study.
... Based on structural equation modeling, the BI-AAQ-5 performed comparably to the original 12-item version as evidenced by a positive association with self-compassion, and negative associations with body dissatisfaction, weight stigma, internalization of physical appearance norms in society, and poorer mental health. A recent study of the BI-AAQ-5 among women with and without binge eating symptoms supported the BI-AAQ-5′s unidimensional factor structure and psychometric properties (Linardon, Messer, Lee, & Fuller-Tyszkiewicz, 2019). Another study also found support for its unidimensional factor structure and invariance between predominantly White women and men (Linardon, Messer, Lisboa, Newton, & Fuller-Tyszkiewicz, 2020); interestingly, the researchers examined the factor structure of the full version of the BI-AAQ and did not find support for its unidimensional factor structure, further suggesting benefits in using the BI-AAQ-5. ...
Article
Positive body image is a multidimensional construct consisting of various facets including body appreciation, body image flexibility, and functionality appreciation measured via the Body Appreciation Scale-2 (BAS-2), Body Image-Acceptance and Action Questionnaire-5 (BI-AAQ-5), and Functionality Appreciation Scale (FAS), respectively. Research has supported the unidimensional factor structure of these measures; however, invariance testing based on sexual identity has yet to be conducted. The study’s primary aim was to assess the measurement invariance of the BAS-2, BI-AAQ-5, and FAS between sexual minority and heterosexual women. The secondary aim was to assess the psychometric properties of each positive body image measure among each sample. Participants were predominantly White, cisgender women who identified as a sexual minority (n = 310) or heterosexual (n = 360) and completed online questionnaires of positive body image, eating behaviors, and mental and physical health. Results supported invariance with no differences in BAS-2 or BI-AAQ-5 scores. A significant difference with a small effect size was found in FAS scores, with sexual minority women reporting lower FAS scores. Findings supported the BI-AAQ-5 and FAS’s incremental validity on perceived mental health. Overall, results suggest that the BAS-2, BI-AAQ-5, and FAS scores can be compared among women of varying sexual identities.
... The BI-AAQ contains a unidimensional structure, which has been replicated using confirmatory factor analyses (CFA) in Australian women from the general population (Pellizzer, Tiggemann, Waller, & Wade, 2018), Brazilian women with higher body mass indices (Lucena-Santos, Carvalho, da Silva Oliveira, & Pinto-Gouveia, 2017), and mixed-sex U.S. community samples (Ferreira, Pinto-Gouveia, & Duarte, 2011). The BI-AAQ also has good internal consistency, has demonstrated convergent validity, and contributes incremental variance to various wellbeing indices among U.S and Australian women (Bluett et al., 2016;Linardon, Messer, Lee, & Fuller-Tyszkiewicz, 2019). Although the validity and reliability of the BI-AAQ have been upheld in numerous studies, it remains unknown whether the BI-AAQ functions similarly for men and women. ...
... We acknowledge that an interviewer-based assessment using a longer time-frame (three months for DSM-V and six months for DSM-IV) is the preferred method to assess recurrent binge eating or to establish the presence of a BED diagnosis (e.g., DeBar et al., 2011;Striegel-Moore et al., 2010). However, prior work has shown that (a) the two methods of recurrent binge eating classification (i.e., the 28-day self-report versus six-month interview criteria) are associated with comparable levels of eating pathology and functional impairment (Harrison et al., 2015), and (b) those who meet the 28-day self-report criteria report greater eating and general psychopathology than those who binge eat below this threshold (Harrison et al., 2015;Linardon, Messer, Lee, & Fuller-Tyszkiewicz, 2019). Thus, the validity and clinical significance of the selfreport recurrent binge eating criteria have been established. ...
Article
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.
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The 10-item Body Appreciation Scale-2 (BAS-2; Tylka & Wood-Barcalow, 2015) is a widely used contemporary measure of positive body image that assesses one’s love for, acceptance and appreciation of, and respect for their body. Given the need for abbreviated measures to reduce participant burden and study cost, we aimed to generate a short form of the BAS-2 (BAS-2SF). Two versions of the BAS-2SF emerged: a 3-item version derived deductively from theory (items selected based on their unique contribution to the body appreciation construct), and a 2-item version generated empirically (items selected based on a genetic algorithm approach). Psychometric evidence was garnered across five studies, totaling 3114 participants. Both BAS-2SF versions correlated highly (rs = .93–.97) with the original 10-item BAS-2 and demonstrated internally consistent and stable scores. Factor analyses revealed high item-factor loadings, unidimensionality, and gender invariance of the 3-item BAS-2SF. Correlations with construct validity measures, as well as model pathways, were similar between both BAS-2SF versions and the 10-item BAS-2. BAS-2SF versions also evidenced incremental validity. Both BAS-2SF versions retain the psychometric integrity of the BAS-2 and are recommended for use; however, the 3-item BAS-2SF is an ideal option for researchers who wish to estimate a body appreciation latent factor.
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Objective Establishing factors that protect against the onset of eating disorder symptoms is needed to identify critical intervention targets to inform the design of more potent prevention programs. Knowledge of robust protective factors is lacking, which might account for the limited effectiveness of existing prevention programs. As positive body image, intuitive eating, and self-compassion show protective potential, the present study tested whether these factors protect against the onset of a range of different eating disorder symptoms. Method Data were analyzed from 1,270 women who completed study measures at baseline and 8 months. Logistic regressions tested whether, among initially asymptomatic women, baseline and changes in positive body image components (body appreciation, body image flexibility, and functionality appreciation), intuitive eating, and self-compassion predicted the continued absence versus onset of seven core eating disorder symptoms at follow-up. Results Each of the five factors at baseline was associated with a lower odds of symptom onset for each outcome in univariate analyses. Baseline body appreciation and intuitive eating scores remained consistent, unique predictors of a lower odds of experiencing symptom onset in multivariate models. Greater increases in intuitive eating and body appreciation over time were the two factors consistently associated with a lower odds of symptom onset across several outcomes. Discussion This study provides strong evidence for the protective influence of positive body image components, intuitive eating, and self-compassion against several eating disorder symptoms. Building these factors within established prevention programs may, in the longer term, help reduce the incidence of eating disorder syndromes and symptoms.
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Body image flexibility refers to the ability to openly experience thoughts or feelings about the body without acting on them or trying to change them. Accumulating evidence has demonstrated that body image flexibility is connected to numerous adaptive processes, and that it is sensitive to change during psychological interventions. However, a quantitative synthesis of empirical research on body image flexibility is lacking. We conducted the first meta-analysis on body image flexibility and its correlates. Sixty-two studies were included. Random effects meta-analyses were conducted on 19 psychological correlates, divided into three clusters: eating and body image disturbances, positive body-related and general psychological constructs, and general psychopathology. Meta-analyses showed inverse correlations between body image flexibility and each construct within the eating and body image disturbances cluster (rs= −.45 to −.67), and the general psychopathology cluster (rs= −.37 to −.58). Body image flexibility was positively associated with each positive psychology construct (rs = .23 – .58). Men reported higher levels of body image flexibility than women (d = 0.32). Psychological interventions were more effective than control groups at enhancing body image flexibility in randomized controlled trials (d = 0.42). Findings confirm that body image flexibility is consistently connected to indices of mental health, and that it can be enhanced during psychological interventions.
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Although Loss of Control (LOC) is a transdiagnostic factor in eating pathology, there are few standalone assessments of LOC. The objective of this study was to evaluate the uni-dimensionality and measurement equivalence of the Eating Loss of Control Scale (ELOCS). Confirmatory factor analyses were used to achieve a well-fitting uni-dimensional model in clinical (N = 226) and non-clinical (N = 476) samples. Measurement equivalence was tested in a factor analytic framework, and effect sizes were computed to evaluate the impact of non-equivalence. A well-fitting model was achieved in both samples after the removal of 4 items. The instrument showed configural equivalence but not metric equivalence. Results suggest that the ELOCS is a reliable and valid measure of LOC in clinical and non-clinical samples. However, while the nature of the LOC construct is similar across binge eating and non-clinical participants, comparisons of ELOCS across these groups are affected by measurement non-equivalence. This research also revealed novel insights into the relative sensitivity of model fitting and effect size approaches to investigating measurement equivalence.
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Objective The purpose of this study was to examine the psychometric properties of the Body Image-Acceptance and Action Questionnaire in a severe eating disorder population, as previous validation has occurred only with nonclinical samples. Method Data on body image psychological flexibility, general psychological flexibility, eating disorder severity, and other related constructs were gathered from 72 adolescent and 60 adult female, residential patients diagnosed with an eating disorder. Psychometrics were examined through the use of exploratory and confirmatory factor analyses, Cronbach's alpha, correlations, and hierarchical multiple regressions to assess model fit, reliability, and validity. Results The BI-AAQ demonstrated excellent convergent, discriminant, and incremental validity as well as excellent internal reliability, however, factor analyses resulted in overall poor model fit. Removal of item 6 from the BI-AAQ resulted in improved psychometric properties in all regards, yet still demonstrated overall poor model fit. Discussion This study suggests that the BI-AAQ is psychometrically sound in many areas and provides some clinical utility; however, it may be somewhat problematic when used in severe eating disorder populations. When using the measure in clinical settings, removal of item 6 is recommend. Recommendations for future measurement and utilization of body image flexibility are discussed.
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Objective: This study aimed to investigate the relative contributions of binge eating, body image disturbance, and body mass index (BMI) to distress and disability in binge-eating disorder (BED). Method: A community sample of 174 women with BED-type symptomatology provided demographic, weight, and height information, and completed measures of overvaluation of weight/shape and binge eating, general psychological distress and impairment in role functioning. Correlation and regression analyses examined the associations between predictors (binge eating, overvaluation, BMI), and outcomes (distress, functional impairment). Results: Binge eating and overvaluation were moderately to strongly correlated with distress and functional impairment, whereas BMI was not correlated with distress and only weakly correlated with functional impairment. Regression analysis indicated that both overvaluation and binge eating were strong and unique predictors of both distress and impairment, the contribution of overvaluation to variance in functional impairment being particularly strong, whereas BMI did not uniquely predict functional impairment or distress. Discussion: The findings support the inclusion of overvaluation as a diagnostic criterion or specifier in BED and the need to focus on body image disturbance in treatment and public health efforts in order to reduce the individual and community health burden of this condition.
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Objective: Body-image disturbance is a core aspect of eating disorders, yet the clinical manifestations of individuals' weight and shape concerns are complex, vary considerably, and are poorly understood by clinicians and researchers. This study aimed to distinguish different aspects of body-image disturbance-including weight/shape dissatisfaction, weight/shape overvaluation, weight/shape preoccupation, and fear of weight gain-in patients with binge-eating disorder (BED). Examining how each specific body image construct relates to biopsychosocial features of BED could contribute to the refinement of conceptualization and treatment planning. Method: The current study assessed body-image disturbance and eating-disorder psychopathology in 748 treatment-seeking patients with BED using established investigator-based interviews reliably administered by doctoral clinicians. Results: The 4 body image constructs, although related to one another, showed some important similarities in associations with biopsychosocial clinical features, as well as some important distinctions. The relation between overvaluation and self-esteem was, as conceptualized, more strongly negative than for other body image variables, and preoccupation was more associated than other body image variables with eating concerns. Biopsychosocial features of BED were associated with different forms of body-image disturbance, but associations of body image variables with body mass index (BMI) were not significant and associations with binge-eating frequency did not differ across body image variables. Conclusion: Manifestations of body-image disturbance in BED are complex and understanding the distinctions between different body image constructs can contribute to treatment formulation. (PsycINFO Database Record
Article
Although third-wave behaviour therapies are being increasingly used for the treatment of eating disorders, their efficacy is largely unknown. This systematic review and meta-analysis aimed to examine the empirical status of these therapies. Twenty-seven studies met full inclusion criteria. Only 13 randomized controlled trials (RCT) were identified, most on binge eating disorder (BED). Pooled within- (pre-post change) and between-groups effect sizes were calculated for the meta-analysis. Large pre-post symptom improvements were observed for all third-wave treatments, including dialectical behaviour therapy (DBT), schema therapy (ST), acceptance and commitment therapy (ACT), mindfulness-based interventions (MBI), and compassion-focused therapy (CFT). Third-wave therapies were not superior to active comparisons generally, or to cognitive-behaviour therapy (CBT) in RCTs. Based on our qualitative synthesis, none of the third-wave therapies meet established criteria for an empirically supported treatment for particular eating disorder subgroups. Until further RCTs demonstrate the efficacy of third-wave therapies for particular eating disorder subgroups, the available data suggest that CBT should retain its status as the recommended treatment approach for bulimia nervosa (BN) and BED, and the front running treatment for anorexia nervosa (AN) in adults, with interpersonal psychotherapy (IPT) considered a strong empirically-supported alternative.
Article
Body image concerns are typically linked with negative outcomes such as disordered eating and diminished wellbeing, but some people can exhibit psychological flexibility and remain committed to their valued goals despite being dissatisfied about their bodies. Such flexibility is most frequently measured by the Body Image-Acceptance and Action Questionnaire (BI-AAQ). This study used a recently validated, fully-automated method based on genetic algorithms (GAs) on data from an American community sample (N1=538, 71.5% female, Age: M = 40.87, SD = 13.5) to abbreviate the 12-item BI-AAQ to a 5-item short form, BI-AAQ-5. Validation tests were conducted on data from an independent community sample (N2= 762, 44.6% female, Age: M = 40.65, SD = 13.06). The short form performed comparably to the long form in terms of its factor structure and correlations with theoretically relevant constructs, including body image dissatisfaction, stigma, internalisation of societal norms of appearance, self-compassion, and poor mental health. Further, preliminary analyses using structural equation modelling showed that body image flexibility, as measured by either the long or short form, was associated with almost all the criterion variables, even while controlling for a highly related construct of body image dissatisfaction. These results demonstrate the potential discriminant validity of both the long and short form of the BI-AAQ, and show that the BI-AAQ-5 is a suitable alternative to its long form. We discuss how psychological flexibility with respect to body image dissatisfaction can be conducive to positive functioning.
Article
A low-intensity 4-week intervention that included components of compassion, mindfulness, and acceptance was delivered to women diagnosed with binge eating disorder. Participants were randomly assigned to 1 of 2 conditions: intervention (n = 11) or waiting list control (n = 9). Participants in the intervention condition were invited to practise mindfulness, soothing rhythm breathing, and compassionate imagery practices with a focus on awareness and acceptance of emotional states and triggers to binge eating and engagement in helpful actions. Results revealed that, in the intervention group, there were significant reductions in eating psychopathology symptoms, binge eating symptoms, self-criticism, and indicators of psychological distress; there were significant increases in compassionate actions and body image-related psychological flexibility. Data suggest that developing compassion and acceptance competencies may improve eating behaviour and psychological well-being in individuals with binge eating disorder. Key practitioner message A low-intensity 4-week intervention for BED was tested. The intervention included components of compassion, mindfulness, and acceptance. Results showed efficacy in reduced binge eating and eating psychopathology. Participants showed reductions in self-criticism and psychological distress. Participants increased in self-compassion and body image psychological flexibility.
Article
The current study aimed to examine the factor structure, reliability, and validity of 3 measures of body image disturbance (body image flexibility, body avoidance, and body checking) considered to be relevant to eating disorder psychopathology, with the aim of determining the optimal structure of each for use in treatment planning and outcome monitoring. Additionally, the study aimed to identify which factors had the strongest association with disordered eating. Participants were 328 female undergraduate university students aged 17-25 years. Confirmatory factor analyses were conducted followed by correlational, regression, and t test analyses. The original proposed models were retained for the body image flexibility and body checking measures, while an alternative model was supported for the body image avoidance measure. All 3 solutions were found to have acceptable validity and reliability. Scores on each measure differed significantly between normal and disordered eaters. The body image flexibility measure and selected subscales of the body image avoidance and checking measures had unique associations with eating disorder psychopathology and psychosocial impairment. Results of this study indicate how the assessment of body image can be achieved in treatment of eating disorders in such a way as to reduce participant burden while adequately assessing the body image disturbance that is characteristic of eating disorders. (PsycINFO Database Record
Article
This meta-analysis assessed the strength of the association between correlates of shape and weight over-evaluation across binge eating disorder and mixed eating disorder samples. Across 32 studies, over-evaluation correlates were divided into demographic, eating pathology, or psychosocial. Shape and weight over-evaluation was associated with higher eating pathology and psychosocial impairment. The method of assessment (interview versus self-report questionnaire) moderated some of the relationships. Over-evaluation was unrelated to demographics and treatment outcome. These findings highlight the importance of addressing shape and weight over-evaluation during treatment, and supports the idea of using shape and weight over-evaluation as a severity specifier for binge eating disorder.
Article
This systematic review synthesised the literature on predictors, moderators, and mediators of outcome following Fairburn's CBT for eating disorders. Sixty-five articles were included. The relationship between individual variables and outcome was synthesised separately across diagnoses and treatment format. Early change was found to be a consistent mediator of better outcomes across all eating disorders. Moderators were mostly tested in binge eating disorder, and most moderators did not affect cognitive-behavioural treatment outcome relative to other treatments. No consistent predictors emerged. Findings suggest that it is unclear how and for whom this treatment works. More research testing mediators and moderators is needed, and variables selected for analyses need to be empirically and theoretically driven. Future recommendations include the need for authors to (i) interpret the clinical and statistical significance of findings; (ii) use a consistent definition of outcome so that studies can be directly compared; and (iii) report null and statistically significant findings.
Article
Objective: The purpose of this study was to test whether pre-treatment levels of psychological flexibility would longitudinally predict quality of life and eating disorder risk in patients at a residential treatment facility for eating disorders. Method: Data on body image psychological flexibility, quality of life, and eating disorder risk were collected from 63 adolescent and 50 adult, female, residential patients (N=113) diagnosed with an eating disorder. These same measures were again collected at post-treatment. Sequential multiple regression analyses were performed to test whether pre-treatment levels of psychological flexibility longitudinally predicted quality of life and eating disorder risk after controlling for age and baseline effects. Results: Pre-treatment psychological flexibility significantly predicted post-treatment quality of life with approximately 19% of the variation being attributable to age and pre-treatment psychological flexibility. Pre-treatment psychological flexibility also significantly predicted post-treatment eating disorder risk with nearly 30% of the variation attributed to age and pre-treatment psychological flexibility. Discussion: This study suggests that levels of psychological flexibility upon entering treatment for an eating disorder longitudinally predict eating disorder outcome and quality of life.
Article
The objective of this study was to examine the relationship between overvaluation of weight/shape (‘overvaluation’) and emotion regulation (ER) difficulties among women with binge eating disorder (BED) symptoms. Four groups of women were recruited from a community-based sample and compared on ER difficulties: individuals with probable BED with (n = 102) and without (n = 72) overvaluation, and non-binge eating obese (n = 40) healthy-weight (n = 40) control participants. Data for patients with a formal diagnosis of BED receiving treatment from a previous study were included for numerical comparative purposes. Women with probable BED and overvaluation reported significantly greater ER difficulties than all other groups and had similar levels of ER difficulties to BED patients. Women with probable BED in the absence of overvaluation were comparable to the obese control group on total ER difficulties and the majority of the ER difficulties subscales. The findings provide further evidence for the clinical significance of overvaluation among individuals with BED symptomatology. BED in the absence of overvaluation does not appear to align with current models of the disorder in which ER difficulties are viewed as a core etiological mechanism. Further research is needed to elucidate the status of this presentation.
Article
We sought to elucidate the nature and extent of impairment in quality of life among individuals with binge eating disorder (BED) with and without the overvaluation of weight or shape ("overvaluation"). Subgroups of women - probable BED with overvaluation (n = 102), probable BED without overvaluation (n = 72), obese individuals reporting no binge eating ("obese control", n = 40), and "normal weight" individuals reporting no binge eating ("healthy control," n = 40) - were recruited from a community-based sample in which individuals with eating disorder symptoms were over-represented. They were compared on measures of eating disorder psychopathology and generic and disease-specific measures of quality of life. Scores on these measures among individuals with BED receiving specialist treatment were also considered. Participants with BED and overvaluation had high levels of eating disorder psychopathology and impairment in both generic and disease-specific quality of life, comparable to those of BED patients receiving specialist treatment, and significantly higher than all other subgroups, whereas participants with BED in the absence of overvaluation did not differ from obese controls on any of these measures. The findings provide further evidence for the need to consider reference to overvaluation among the diagnostic criteria for BED. The relative merits of the inclusion of overvaluation as a diagnostic criterion or as a diagnostic specifier for BED warrant greater consideration. Copyright © 2015. Published by Elsevier Ltd.
Article
Acceptance and mindfulness components are increasingly incorporated into treatment for eating disorders with promising results. The development of measures of proposed change processes would facilitate ongoing scientific progress. The current series of studies evaluated one such instrument, the Body Image-Acceptance and Action Questionnaire (BI-AAQ), which was designed to measure body image flexibility. Study one focused on the generation and reduction of items for the BI-AAQ and a demonstration of construct validity. Body image flexibility was associated with increased psychological flexibility, decreased body image dissatisfaction, and less disordered eating. Study two demonstrated adequate internal consistency and test–retest reliability of BI-AAQ. Study three extended findings related to structural and construct validity, and demonstrated an indirect effect of body image dissatisfaction on disordered eating via body image flexibility. Research and clinical utility of the BI-AAQ are discussed. The BI-AAQ is proposed as a measure of body image flexibility, a potential change process in acceptance-oriented treatments of eating disorders.
Article
This study included a replicated derivation of a behavioral screener for executive functions among children, longitudinal invariance analyses to evaluate measurement reliability across time, and latent growth modeling of 4 executive functions: problem solving, attentional control, behavioral control, and emotional control. The sample included 1,237 (52% female) participants age 6 to 11 years. Participants were tracked longitudinally for 3 years with 5 assessment waves, and new participants were recruited at each wave to compensate for attrition. As predicted, the 4-factor model was successfully replicated, with longitudinal invariance newly confirmed. These findings support this screener as a reliable childhood measure for executive functions, and latent growth modeling identified predictive qualities of gender and age on levels and changes in these constructs. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
Article
Measurement invariance is usually tested using Multigroup Confirmatory Factor Analysis, which examines the change in the goodness-of-fit index (GFI) when cross-group constraints are imposed on a measurement model. Although many studies have examined the properties of GFI as indicators of overall model fit for single-group data, there have been none to date that examine how GFIs change when between-group constraints are added to a measurement model. The lack of a consensus about what constitutes significant GFI differences places limits on measurement invariance testing. We examine 20 GFIs based on the minimum fit function. A simulation under the two-group situation was used to examine changes in the GFIs (ΔGFIs) when invariance constraints were added. Based on the results, we recommend using Δcomparative fit index, ΔGamma hat, and ΔMcDonald's Noncentrality Index to evaluate measurement invariance. These three ΔGFIs are independent of both model complexity and sample size, and are not correlated with the overall fit measures. We propose critical values of these ΔGFIs that indicate measurement invariance.
Article
The purpose of this study was to systematically review the reliability of scores on the Eating Disorder Examination (EDE) and the Eating Disorder Examination-Questionnaire (EDE-Q) and to examine the validity of their use as measures of eating disorder symptoms. Articles describing the psychometric properties of the EDE and EDE-Q were identified in a systematic search of major computer databases and a review of reference lists. Articles were selected based on a priori inclusion and exclusion criteria. Fifteen studies were identified that examined the psychometrics of the EDE, whereas 10 studies were found that examined the psychometrics of the EDE-Q. Both instruments demonstrated reliability of scores. There is evidence that scores on the EDE and EDE-Q correlate with scores on measures of similar constructs and support for using the instruments to distinguish between cases and non-cases. Additional research is needed to broaden the generalizability of the findings.
Article
To compare the goodness-of-fit of five models of Eating Disorder Examination-Questionnaire (EDE-Q) data, in clinical and community samples. The EDE-Q was administered to 228 eating disorder patients and 211 non-eating disordered university students. Confirmatory factor analysis was used to compare the validity of the original four EDE-Q subscales with that of brief one-factor, extended one-factor, two-factor, and three-factor models. Measurement invariance across the two samples was considered. The only model to provide an acceptable fit to the data was the brief one-factor model consisting of eight Weight and Shape Concern items. Scores on this scale correlated highly with the original EDE-Q subscales. The reliability of the EDE-Q may be increased if a modified scoring system is used. This complements findings from recent research with the Eating Disorder Examination (EDE).
Article
This study aimed to investigate the initial psychometric properties and to establish norms for the Clinical Impairment Assessment (CIA v. 3.0) among a nonclinical sample of young adult women. The CIA is a brief, 16-item self-report measure designed to assess psychosocial impairment due to eating disorder features over the past 28 days. We administered the CIA and the Eating Disorder Examination-Questionnaire (EDE-Q v. 6.0) to 438 university women (mean age = 25 years). Participants' mean global CIA score was 6.4 (SD = 7.5; range 0-40). Acceptable levels of internal consistency (Cronbach's alpha = 0.94) and 1-week test-retest reliability were observed. Significant correlations were found between the CIA and the EDE-Q total and subscale scores (Spearman rhos = 0.58-0.79), indicating that greater levels of impairment were associated with higher levels of eating disorder psychopathology. Results demonstrated satisfactory psychometric properties of the CIA among a sample of young adult women, suggesting the utility of the CIA to measure impairment due to eating disorder features in nonclinical samples.
Article
This article proposes that binge eating is motivated by a desire to escape from self-awareness. Binge eaters suffer from high standards and expectations, especially an acute sensitivity to the difficult (perceived) demands of others. When they fall short of these standards, they develop an aversive pattern of high self-awareness, characterized by unflattering views of self and concern over how they are perceived by others. These aversive self-perceptions are accompanied by emotional distress, which often includes anxiety and depression. To escape from this unpleasant state, binge eaters attempt the cognitive response of narrowing attention to the immediate stimulus environment and avoiding broadly meaningful thought. This narrowing of attention disengages normal inhibitions against eating and fosters an uncritical acceptance of irrational beliefs and thoughts. The escape model is capable of integrating much of the available evidence about binge eating.
Article
A detailed comparison was made of two methods for assessing the features of eating disorders. An investigator-based interview was compared with a self-report questionnaire based directly on that interview. A number of important discrepancies emerged. Although the two measures performed similarly with respect to the assessment of unambiguous behavioral features such as self-induced vomiting and dieting, the self-report questionnaire generated higher scores than the interview when assessing more complex features such as binge eating and concerns about shape. Both methods underestimated body weight.
Article
The psychometric properties of the Depression Anxiety Stress Scales (DASS) were evaluated in two studies using large clinical samples (N = 437 and N = 241). In Study 1, the three scales comprising the DASS were shown to have excellent internal consistency and temporal stability. An exploratory factor analysis (principal components extraction with varimax rotation) yielded a solution that was highly consistent with the factor structure previously found in nonclinical samples. Between-groups comparisons indicated that the DASS distinguished various anxiety and mood disorder groups in the predicted direction. In Study 2, the conceptual and empirical latent structure of the DASS was upheld by findings from confirmatory factor analysis. Correlations between the DASS and other questionnaire and clinical rating measures of anxiety, depression, and negative affect demonstrated the convergent and discriminant validity of the scales. In addition to supporting the psychometric properties of the DASS in clinical anxiety and mood disorders samples, the results are discussed in the context of current conceptualizations of the distinctive and overlapping features of anxiety and depression.
Article
To test the construct validity of the short-form version of the Depression anxiety and stress scale (DASS-21), and in particular, to assess whether stress as indexed by this measure is synonymous with negative affectivity (NA) or whether it represents a related, but distinct, construct. To provide normative data for the general adult population. Cross-sectional, correlational and confirmatory factor analysis (CFA). The DASS-21 was administered to a non-clinical sample, broadly representative of the general adult UK population (N = 1,794). Competing models of the latent structure of the DASS-21 were evaluated using CFA. The model with optimal fit (RCFI = 0.94) had a quadripartite structure, and consisted of a general factor of psychological distress plus orthogonal specific factors of depression, anxiety, and stress. This model was a significantly better fit than a competing model that tested the possibility that the Stress scale simply measures NA. The DASS-21 subscales can validly be used to measure the dimensions of depression, anxiety, and stress. However, each of these subscales also taps a more general dimension of psychological distress or NA. The utility of the measure is enhanced by the provision of normative data based on a large sample.
Article
In order to establish norms for the Eating Disorder Examination Questionnaire (EDE-Q) among young adult women, the questionnaire was administered to a large general population sample of women aged 18-42 yr in the Australian Capital Territory (ACT) region of Australia. Normative data were derived for EDE-Q subscales and for the occurrence of specific eating disorder behaviours, for each of five age bands (18-22, 23-27, 28-32, 33-37, 38-42 yr). Mean scores (SDs) for the Restraint, Eating Concern, Weight Concern and Shape Concern subscales for the total sample (n = 5,255) were, respectively, 1.30 (1.40), 0.76 (1.06), 1.79 (1.51) and 2.23 (1.65). The mean global score was 1.52 (1.25). The regular occurrence of objective and subjective overeating episodes was reported by 10.6% and 12.7% of participants, respectively. The regular use of self-induced vomiting, laxative misuse, and use of diuretics, was reported by 1.4%, 1.0%, and 0.3%, of participants, respectively, while 2.2% of participants reported regularly using diet pills. "Extreme dietary restraint" and "excessive exercise" were reported by 3.4% and 4.9% of participants, respectively. Both attitudinal and behavioural features of eating disorder psychopathology tended to decrease with increasing age. These data will inform researchers intending to use the EDE-Q in epidemiological studies.
Article
To discuss issues in the design of a measurement strategy related to the use of patient-reported outcomes (PROs) in support of a labelling claim. In association with the release by the US Food and Drug Administration of its draft guidance on the use of PROs to support labeling claims, the Mayo/FDA Patient-Reported Outcomes Consensus Writing Group was formed. This paper, part of a series of manuscripts produced by the Writing Group, focuses on designing a PRO measurement strategy. Developing a PRO measurement strategy begins with a clear statement about the proposed label claim that will derive from the PRO data. Investigators should identify the relevant domains to measure, develop a conceptual framework, identify alternative approaches for measuring the domains, and synthesize the information to design the measurement strategy. Often, there is not an already existing single instrument that has been developed and validated for the purposes of a given study. In such cases, investigators may consider supplementing an already existing questionnaire with additional scales or questions, modifying already existing instruments for a new application or patient population, or developing a new instrument altogether. The level of revalidation required for modifications and adaptations depends on the extent of the changes made. Revalidation requirements may range from cognitive testing/debriefing to confirm that subjects respond to the new instrument as expected to full-scale reliability and validity evaluations. A position of "reasonable pragmatism" is recommended such that the best available measurement strategy be considered as evidence for labeling.
Article
Confidence intervals are widely accepted as a preferred way to present study results. They encompass significance tests and provide an estimate of the magnitude of the effect. However, comparisons of correlations still rely heavily on significance testing. The persistence of this practice is caused primarily by the lack of simple yet accurate procedures that can maintain coverage at the nominal level in a nonlopsided manner. The purpose of this article is to present a general approach to constructing approximate confidence intervals for differences between (a) 2 independent correlations, (b) 2 overlapping correlations, (c) 2 nonoverlapping correlations, and (d) 2 independent R2s. The distinctive feature of this approach is its acknowledgment of the asymmetry of sampling distributions for single correlations. This approach requires only the availability of confidence limits for the separate correlations and, for correlated correlations, a method for taking into account the dependency between correlations. These closed-form procedures are shown by simulation studies to provide very satisfactory results in small to moderate sample sizes. The proposed approach is illustrated with worked examples.
Acceptance and commitment therapy for women diagnosed with This document is copyrighted by the American Psychological Association or one of its allied publishers
  • M L Hill
  • A Masuda
  • H Melcher
  • J R Morgan
  • M P Twohig
Hill, M. L., Masuda, A., Melcher, H., Morgan, J. R., & Twohig, M. P. (2015). Acceptance and commitment therapy for women diagnosed with This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
binge eating disorder: A case-series study
  • Messer Linardon
  • Lee Fuller-Tyszkiewicz
LINARDON, MESSER, LEE, AND FULLER-TYSZKIEWICZ binge eating disorder: A case-series study. Cognitive and Behavioral Practice, 22, 367-378. http://dx.doi.org/10.1016/j.cbpra.2014.02.005
Body image disturbance and the development of eating disorders
  • A Kearney-Cooke
  • D Tieger
Kearney-Cooke, A., & Tieger, D. (2015). Body image disturbance and the development of eating disorders. In L. Smolak & M. D. Levine (Eds.), The Wiley handbook of eating disorders (pp. 283-296). West Sussex, UK: Wiley. http://dx.doi.org/10.1002/9781118574089.ch22
Mplus user's guide: Statistical analysis and latent variables
  • L K Muthén
  • B O Muthén
Muthén, L. K., & Muthén, B. O. (2010). Mplus user's guide: Statistical analysis and latent variables. Los Angeles, CA: Author.