No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Self-disgust and disgust sensitivity are increased in anorexia nervosa inpatients, but only self-disgust mediates between comorbid and core psychopathology
Abstract
Objective: The possible role of abnormal disgust processing in the development and course of anorexia nervosa (AN) has been emphasized in theoretical models and research. However, disgust toward external stimuli and self-disgust have not yet been investigated together in a clinical sample of AN patients. Therefore, the purpose of the study was to measure these constructs
and examine their role in shaping eating pathology in AN patients and healthy controls (HCs), considering comorbid depressive and anxiety psychopathology. The study also aimed at testing the possible mediational roles of both disgust types in the associations between comorbid psychopathology and eating disorders (EDs) characteristics.
Method: Altogether, 63 inpatients with AN and 57 HCs partook in the study. Participants completed the Eating Disorder Inventory‐3, State‐Trait Anxiety Inventory, Beck Depression Inventory‐II, Disgust Scale–Revised and Self‐Disgust Scale.
Results: AN patients manifested higher self‐disgust and disgust sensitivity than HCs. In addition, self‐disgust predicted the severity of EDs characteristics and mediated the links of depressive symptoms and trait anxiety with EDs characteristics in both groups.
Discussion: Our findings imply the putative role of self‐disgust in the
development of EDs psychopathology in HCs and in its maintenance in AN patients.
... Nine studies utilized inventories developed specifically for disgust. These inventories include the Questionnaire for Assessment of Disgust Sensitivity [30], the Questionnaire for Assessment of Disgust Proneness [31], the Disgust Propensity and Sensitivity Scale [32] or its revised form [33], the Disgust Sensitivity Questionnaire [34,35], the Disgust Scale [36,37] or its revised form [38], or the Disgust Questionnaire [39,40]. Two studies [41,42] measured a cluster of emotions of which disgust was one emotion, but they did not measure disgust specifically. ...
... Two studies [41,42] measured a cluster of emotions of which disgust was one emotion, but they did not measure disgust specifically. The studies on selfdisgust (n = 4) used the Multi-dimensional Self-Disgust Scale [43], the Questionnaire for Assessment of Self-Disgust [44], and the Self-Disgust Scale [33,38]. See Table 1. ...
... A total of 10 case-control studies [27,30,[32][33][34][35][36][37][38]77] investigated overall disgust sensitivity in 1329 female participants, of which 767 had an ED with a mean age ranging from 21.9 to 29.7. Disgust sensitivity data are reported for the combined ED group, and two more meta-analyses were conducted on sub-samples (AN and BN groups). ...
Disgust and self-disgust are aversive emotions which are often encountered in people with eating disorders. We conducted a systematic review and meta-analysis of disgust and self-disgust in people with eating disorders using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The systematic review of the literature revealed 52 original research papers. There was substantial heterogeneity regarding the research question and outcomes. However, we found 5 articles on disgust elicited by food images, 10 studies on generic disgust sensitivity, and 4 studies on self-disgust, and we proceeded to a meta-analytic approach on these studies. We found that women with eating disorders have significantly higher momentary disgust feelings in response to food images (1.32; 95% CI 1.05, 1.59), higher generic disgust sensitivity (0.49; 95% CI 0.24, 0.71), and higher self-disgust (1.90; 95% CI 1.51, 2.29) compared with healthy controls. These findings indicate the potential clinical relevance of disgust and self-disgust in the treatment of eating disorders.
... For example, a series of studies found correlational evidence indicating that individuals with relatively high scores on eating disorder concerns are also relatively easily disgusted (i.e., show heightened disgust propensity) (e.g., Davey et al., 1998;Griffiths & Troop, 2006;Spreckelsen et al., 2018), and showed relatively high disgust to pictures of the own body (Masselman et al., 2023). These findings have been extended to clinical samples showing that also individuals with clinically diagnosed eating disorders reported both higher generic disgust propensity and self-directed disgust compared to individuals without eating disorders (e.g., Bektas et al., 2022;Kot et al., 2021). However, it remains to be specified and tested how exactly disgust may contribute to the persistence of weight and shape concerns. ...
Current models point to weight/shape concerns as core symptoms of eating disorders. A striking feature of these concerns is their persistence even in the absence of objective signs of overweight. To help delineate the mechanisms involved in persistent weight and shape concerns, we focused on feelings of disgust following food intake. In two studies, we tested if individuals with weight/shape concerns interpret feelings of disgust as a signal of threatening eating-disorder-related outcomes. Participants read scenarios involving high or low amounts of food intake that varied in the presence/absence of feelings of disgust. Following each scenario, participants rated perceived threat related to gaining weight. In Study 1, we compared women with high ( n = 26) versus low ( n = 32) weight/shape concerns. Specifically, the high group inferred heightened threat related to gaining weight when scenarios implied disgust. This disgust-based reasoning was especially pronounced following small amounts of food intake (i.e., low objective threat). These findings were replicated in Study 2 ( N = 346) using a correlational approach. This study showed a positive relationship between weight/shape concerns and disgust-based reasoning for scenarios implying low objective threat of food-induced weight gain. Together, the results provide converging evidence consistent with the view that disgust-based emotional reasoning might be involved in weight/shape concerns.
... The two conditions also share common psychopathological features, such as cognitive rigidity, atypical social cognition, and difficulties in emotion processing [6]. Moreover, the existence of alterations in sensory sensitivity, a typical feature observed both in patients with ASD and in patients with ED [7], has been linked with higher ED severity, difficulties in regulating emotions, and distorted perception of body image; notably, it often remains present despite treatment and weight restoration [8,9]. Though both full-blown ASD forms and subthreshold autistic traits have been identified in ED beyond Anorexia Nervosa (AN) [5], most research has concentrated on the latter. ...
Purpose
The relationship between autistic traits and eating disturbances has been given considerable attention over the last decades. The rise of a dimensional approach to psychopathology has expanded the way we think about autism, acknowledging that subthreshold autistic manifestations span across the general population and are more pronounced in psychiatric patients. Here we investigated the prevalence of eating disorders and its potential relationship with autistic traits and sensory sensitivity in a group of patients who were referred for the first time to a mental health outpatient clinic, without a formal diagnosis yet.
Methods
259 young adults (between 18 and 24 years old) completed: the Eating Attitude Test (EAT-26), the Swedish Eating Assessment for Autism Spectrum Disorders (SWEAA), the Autism Quotient (AQ), the Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R), and the Sensory Perception Quotient—Short Form 35 item (SPQ-SF35).
Results
23.55% of participants scored above the cut-off at the EAT-26, suggesting that they presented a risk for eating disorders and should be assessed by a specialized clinician; associations emerged between hypersensitivity in the touch and vision domain and both the EAT-26 and the SWEAA; the presence of autistic traits was largely associated with eating disturbances.
Conclusions
This study underlines the significance of the eating domain as a central psychopathological feature in the distress experienced by young adults with general psychiatric symptoms and psychological suffering; it adds evidence to the association between autistic traits and eating disorders and opens to new research questions about the role of subthreshold autistic traits in general psychopathology.
Level of evidence: Level I: Evidence obtained from experimental studies.
... Individual differences in the tendency to experience disgust (disgust propensity) and the tendency to experience it as aversive (disgust sensitivity) exist, both of which can interact and predispose an individual to psychopathology [9]. Disgust sensitivity and propensity have been associated with anorexia nervosa [10], post-traumatic symptoms [11], obsessivecompulsive symptoms [12], negative body image [13] and depression [14]. Disgust proneness has also been reported to be associated with distress and behavioral reactions in misophonia [5]. ...
Aim of the study
In the current study, the authors sought to examine whether the link between moral and sexual disgust and misophonia is mediated by mental contamination.
Subject or material and methods
An internationally diverse sample of 283 adults (193 females, 76 males, and 14 non-binary individuals) ranging in age from 18 to 60 years old was recruited from online social media platforms and survey recruitment sites. The sample completed an online battery of scales that consisted of the New York Misophonia Scale, State Metal Contamination Scale, and the Three-Domain Disgust Scale. The hypotheses were evaluated using a series of mediations. performed using the PROCESS add-on in SPSS.
Results
Correlations were found between emotional and aggressive-avoidant reactions in misophonia, mental contamination, pathogen disgust, and sexual disgust. Moral disgust and non-aggressive reactions in misophonia failed to correlate significantly with any of the other constructs. Sexual disgust had direct and indirect effects while pathogen disgust had only direct effects on aspects of misophonia.
Discussion
These findings partially support our hypothesis that mental contamination mediates the link between disgust propensity and misophonia while also confirming that pathogen-based disgust is not associated with mental contamination.
Conclusions
Findings imply that misophonia is distinct from obsessive-compulsive disorder. Further research into the conceptualization of moral disgust is warranted.
... OCD, especially contamination-related OCD, is characterized by a heightened experience of disgust [7,8]. Further, disgust was presented as a transdiagnostic feature across EDs [9] from Anorexia Nervosa [10] to Binge eating disorder [11]. Disgust, especially body odor disgust sensitivity [12], is a primary emotion that is supposed to be evolved as a pathogen avoidance mechanism [13], and the obsession with healthy eating might be related to the overactivation of a pathogen avoidance mechanism. ...
Background
It remains unclear among clinicians and researchers whether orthorexia nervosa (ON) is a part of the obsessive–compulsive disorder spectrum or eating disorders. Disgust seems to be a shared psychopathological factor in these clinical presentations, indicating a potentially crucial role in ON. On the other hand, numerous psychometric tools have been developed to evaluate ON. The Dusseldorf Orthorexia Scale (DOS) was recently validated in an Italian sample. However, the study's primary limitation was that the scale was only administered to undergraduate university students. This study aimed to investigate the psychometric properties (including factorial structure, reliability, and measurement invariance conditional on sex) of the Italian version of the DOS (I-DOS) on a sample from the general population. Additionally, the study sought to determine the nomological validity of the I-DOS by examining its relationship with disgust sensitivity.
Methods
A sample of 521 participants took part in this study and completed a battery that assessed ON and disgust sensitivity. To assess the I-DOS structure, reliability, and measurement invariance we respectively conducted confirmatory factor analysis (CFA), computed McDonalds’s omega, and performed hierarchical series of multigroup CFAs. Then, we tested the relationship between ON and disgust sensitivity.
Results
CFA confirmed the unifactorial model of I-DOS and it respected the configural, metric, and strict invariance while a partial scalar invariance was achieved. It also showed good reliability with an omega of 0.87. In addition, we found a positive relationship between ON and disgust sensitivity, thus confirming the nomological validity of I-DOS.
Conclusions
Our findings suggest that the Italian version of the Dusseldorf orthorexia scale (I-DOS) exhibits strong psychometric properties and can be an effective instrument for assessing ON in a general population sample. Notably, the most significant and innovative outcome was the positive correlation between ON and disgust sensitivity. As disgust has been linked to other clinical presentations, this preliminary result could serve as a foundation for future research exploring this phenomenon in greater detail.
... Further, disgust was presented as a transdiagnostic feature across eating disorders [9] from Anorexia Nervosa [10] to Binge eating disorder [11]. Disgust, especially body odor disgust sensitivity [12], is a primary emotion that is supposed to be evolved as a pathogen avoidance mechanism [13], and the obsession with healthy eating might be related to the overactivation of a pathogen avoidance mechanism. ...
Background
It remains unclear among clinicians and researchers whether Orthorexia Nervosa (ON) is a part of the obsessive-compulsive disorder (OCD) spectrum or eating disorders (EDs). Disgust seems to be a shared psychopathological factor in these clinical presentations, indicating a potentially crucial role in ON. On the other hand, numerous psychometric tools have been developed to evaluate ON. The Dusseldorf Orthorexia Scale (DOS) was recently validated in an Italian sample. However, the study's primary limitation was that the scale was only administered to undergraduate university students. This study aimed to investigate the psychometric properties (including factorial structure, reliability, and measurement invariance conditional on sex) of the Italian version of the DOS (I-DOS) on a sample from the general population. Additionally, the study sought to determine the nomological validity of the I-DOS by examining its relationship with disgust sensitivity.
Methods
A sample of 521 participants took part in this study and completed a battery that assessed ON and disgust sensitivity. To assess the I-DOS structure, reliability, and measurement invariance we respectively conducted confirmatory factor analysis (CFA), computed McDonalds’s omega, and performed hierarchical series of multigroup CFAs. Then, we tested the relationship between ON and disgust sensitivity.
Results
CFA confirmed the unifactorial model of I-DOS and it respected the configural, metric, and strict invariance while a partial scalar invariance was achieved. It also showed good reliability with an omega of 0.87. In addition, we found a positive relationship between ON and disgust sensitivity, thus confirming the nomological validity of I-DOS.
Conclusions
Our findings suggest that the Italian version of the Dusseldorf Orthorexia Scale (I-DOS) exhibits strong psychometric properties and can be an effective instrument for assessing ON in a general population sample. Notably, the most significant and innovative outcome was the positive correlation between ON and disgust sensitivity. As disgust has been linked to other clinical presentations, this preliminary result could serve as a foundation for future research exploring this phenomenon in greater detail.
... These behaviours align with eating disorder pathology, which might be one of the reasons for the growing number of studies on self-disgust in eating disorders, on which most samples include only women (Bektas et al. 2022). In both healthy women and women diagnosed with anorexia nervosa, self-disgust was positively associated with drive for thinness, body dissatisfaction, ineffectiveness, interpersonal distrust, and interoceptive awareness (Kot et al. 2021). ...
Self-disgust is a complex emotion related to feeling aversion or revulsion about internal and personal physical attributes, personality, functioning and behaviours. The aim of the present study was to adapt, validate and examine the psychometric properties of the Multidimensional Self-Disgust Scale, in a sample of Portuguese adolescents (MSDS-A). Participants were 540 adolescents (n = 308 females, 57%), with ages between 13 and 18 years. Data were analysed through SPSS and MPLUS was used to perform a Confirmatory Factor Analysis (CFA). Self-report questionnaires were used to assess several indicators of psychopathology and self-compassion. Results from the CFA showed that a 4-factor model with a second order factor presented good fit indices. The full scale and its factors showed good internal consistency, adequate temporal stability, and good convergent, divergent and incremental validity. The MSDS-A seems a valid measure to assess self-disgust in adolescents, with important implications to clinical context and research.
... All participants presented a pathological score in the disgust scale, confirming the findings of previous studies [36,37]. However, we did not find any significant difference in disgust among different DGBIs. ...
Background:
Gastrointestinal (GI) symptoms are very common in subjects with eating disorders (EDs). This study aimed to (a) investigate the prevalence of gut-brain interaction disorders (DGBIs) in anorexia nervosa (AN) patients, according to ROME IV criteria; and (b) explore AN psychopathological assets and disgust that might impact GI symptoms.
Methods:
Thirty-eight female patients consecutively diagnosed with untreated AN (age 19.32 ± 5.59) in an outpatient clinic devoted to EDs underwent Eating Disorder Inventory-3 (EDI-3), Hospital Anxiety and Depression Scale (HADS), Social Phobia Anxiety Scale (SPAS), Body Uneasiness Test (BUT), and Disgust Scale (DS) questionnaires. The presence of DGBIs was evaluated and GI symptoms were assessed using a standardized intensity-frequency questionnaire.
Results:
A total of 94.7% of our sample met the diagnostic criteria for functional dyspepsia (FD), of which 88.8% presented the postprandial distress syndrome (PDS) subtype and 41.6% presented the epigastric pain syndrome (EPS) subtype. In addition, 52.6% of the sample met the diagnostic criteria for irritable bowel syndrome (IBS), while for functional constipation (FC), prevalence reached 7.9%. All participants presented a pathological score on the disgust scale. Significant correlations were found between several GI symptoms and psychopathological asset and disgust.
Conclusions:
AN is a multifactorial disorder. It is necessary to implement studies with an integrated approach, taking into account DGBIs, as well as to monitor the emotional-cognitive structure that acts as a factor in maintaining the disorder.
... OCD, especially contamination-related OCD, is characterized by a heightened experience of disgust [12,13]. Further, disgust was presented as a transdiagnostic feature across eating disorders [14] from Anorexia Nervosa [15] to Binge eating disorder [16]. ...
Background
It remains unclear among clinicians and researchers whether Orthorexia Nervosa (ON) is a part of the obsessive-compulsive disorder (OCD) spectrum or eating disorders (EDs). Disgust seems to be a shared psychopathological factor in these clinical presentations, indicating a potentially crucial role in ON. On the other hand, numerous psychometric tools have been developed to evaluate ON. The Dusseldorf Orthorexia Scale (DOS) was recently validated in an Italian sample. However, the study's primary limitation was that the scale was only administered to undergraduate university students. This study aimed to investigate the psychometric properties (including factorial structure, reliability, and measurement invariance conditional on sex) of the Italian version of the DOS (I-DOS) on a sample from the general population. Additionally, the study sought to determine the nomological validity of the I-DOS by examining its relationship with disgust sensitivity.
Methods
A sample of 521 participants took part in this study and completed a battery that assessed ON and disgust sensitivity. To assess the I-DOS structure, reliability, and measurement invariance we respectively conducted confirmatory factor analysis (CFA), computed McDonalds’s omega, and performed hierarchical series of multigroup CFAs. Then, we tested the relationship between ON and disgust sensitivity.
Results
CFA confirmed the unifactorial model of I-DOS and it respected the configural, metric, and strict invariance while a partial scalar invariance was achieved. It also showed good reliability with an omega of 0.87. In addition, we found a positive relationship between ON and disgust sensitivity, thus confirming the nomological validity of I-DOS.
Conclusions
Our findings suggest that the Italian version of the Dusseldorf Orthorexia Scale (I-DOS) exhibits strong psychometric properties and can be an effective instrument for assessing ON in a general population sample. Notably, the most significant and innovative outcome was the positive correlation between ON and disgust sensitivity. As disgust has been linked to other clinical presentations, this preliminary result could serve as a foundation for future research exploring this phenomenon in greater detail.
Disgust is a powerful emotion, that evolved to protect us from contamination and diseases; it also cores to very human feelings, such as shame. In anorexia nervosa, most of the knowledge on disgust regards food. However, disgust can be elicited by varied drivers, including body-related self-disgust, which may be more central to this condition. Here, we investigate in depth how disgust triggers related to the body influence altered representations in anorexia nervosa.
Women with anorexia nervosa and healthy women performed the Hand Laterality Task, in which they were asked to judge the laterality of hands without and with a disgust charging feature (i.e. with a body product or with a body violation). We computed accuracy and reaction time for the effect of biomechanical constraints, an index of motor imagery. We also measured the general disgust sensitivity through a self-report questionnaire.
Participants with anorexia nervosa were overall less accurate and slower compared to controls, suggesting a non-canonical (i.e. not based on motor imagery) approach to solving the task. However, they showed the same pattern of responses as controls for disgust-charged stimuli, despite reporting higher levels of disgust sensitivity.
Our results suggested the absence of specific effects of disgust drivers on the (altered) body in action representation in anorexia nervosa. We discuss this evidence focusing on the role of the psychopathological symptoms characterizing anorexia nervosa. We also reflect on the efficacy of experimental methodologies used to detect alterations in body representation in this clinical condition.
Bozulmuş yeme tutumları, uyumsuz yeme davranışlarını tetikleyebilmekte ve yeme bozuklukları için bir yatkınlık oluşturabilmektedir. Beliren yetişkinlik döneminde yaygın olarak gözlenen yeme ile ilgili sorunlarda, çocukluk dönemindeki örseleyici yaşantıların rolü ortaya koyulmuş olmakta birlikte, bu ilişkide açıklayıcı duygusal mekanizmalara dair bilgi ihtiyacı devam etmektedir. Bu çalışmada, çocukluk travmaları ile bozuk yeme tutumu arasındaki ilişkide öz tiksinme ve beden utancının aracılık rolünün incelenmesi amaçlanmıştır. Araştırma, yaşları 18 ile 25 (Ort. = 21.89, SS = 2.11) arasında değişen 397 gönüllü kadın katılımcı ile yürütülmüştür. Çalışmanın verisi Çocukluk Çağı Ruhsal Travma Ölçeği, Öz Tiksinme-Revize Formu, Nesneleştirilmiş Beden Bilinci Ölçeği ve Yeme Tutum Testi kullanılarak çevrimiçi toplanmıştır. Korelasyon analizi sonuçları çocukluk travmaları, benliğe yönelik tiksinme, beden utancı ve yeme tutumunda bozulmanın birbirleri ile pozitif yönde ilişkili olduğunu göstermiştir. Seri aracılık modeli de öz tiksinme ve beden utancının hem bağımsız olarak hem de bir arada çocukluk travması ile yeme tutumu arasında tam aracı rolünün olduğunu ortaya koymuştur. Bu bulgular, yeme ile ilgili sorunların kavramsallaştırılmasına katkı sunmakta; önleyici ve sağaltıma yönelik uygulamaların etkililiği için çocukluk dönemindeki travmatik deneyimlerin ve sürdürücü duygusal mekanizmaların değerlendirilmesinin önemine işaret etmektedir.
Purpose
Self-disgust appears to be a prominent feature in anorexia nervosa (AN), which might help explain why AN is often such a persistent disorder. Little is known about how this emotion can impact on recovering from this disorder. This study aims to develop our understanding of how people experience the emotion of self-disgust after physical recovery from AN.
Design/methodology/approach
Twelve female participants who reported previously having had a clinical diagnosis of AN but had physically recovered according to their EDE-Q scores took part in a semi-structured interview to explore their experiences of recovery and the role self-disgust played within this. Interpretative phenomenological analysis was used to explore the data.
Findings
Three themes were identified within the data to explain the experiences of self-disgust in those with AN: continued self-disgust following physical “Recovery”, multiple manifestations of self-disgust in recovery and increasing self-disgust in recovery as a driver for relapse.
Practical implications
Self-disgust was something each participant appeared to experience often, despite being physically recovered from AN. Disgust-based reactions to the self are enduring and highly resistant to change even whilst other aspects of the disorder become less potent. Self-disgust is multi-faceted and may trigger relapse as the signs of improvement and behaviours inherent in recovering were generally viewed as disgusting to the individuals.
Originality/value
Self-disgust is an emotion that continues to affect people with AN despite physical recovery. The recovery process itself is not linear and self-disgust is enduring and may cause those affected to relapse. Considering this emotion within therapeutic intervention may encourage those with AN to accept their recovered self.
Background
Understanding the emotional context of feeding behavior may help identify causal mechanisms of food avoidance among individuals with anorexia nervosa. Although predominant food avoidance models assume fear of fat drives feeding behavior, disgust may be more theoretically and proximally relevant to moment‐to‐moment experiences of feeding. This study, therefore, aimed to examine affect and food avoidance using automated affect analysis from facial response by measuring time‐specific transitions in disgust during a laboratory eating paradigm. We hypothesized that phase transitions in disgust would distinguish temporally self‐initiated eating from food avoidance.
Methods
Sixty‐three adolescents with anorexia nervosa or another low‐weight eating disorder (LWED) and 27 age‐ and sex‐matched controls were recruited as part of a larger study; 45 patients and 22 controls provided data on autonomous eating and facial affect during a laboratory meal. Dynamic structural equation models quantified moment‐to‐moment relationships between disgust and feeding behavior.
Results
Self‐initiated eating was associated with greater increases in disgust, but not fear, intensity among those with LWED relative to control participants and greater disgust intensity predicted lower likelihood of self‐initiated eating.
Discussion
Phasic transitions in disgust provide moment‐to‐moment evidence of affective influence on self‐initiated eating and lend credibility to the hypothesis that disgust contributes to food avoidance and initiation in individuals with LWED.
We present a model of disgust-induced avoidant processing of autobiographical memories contributing to the persistence of psychopathology. Following the model, autobiographical memory retrieval is biased toward disgust-related experiences. Critically, disgust promotes the avoidance of specific autobiographical memories by reactively aborting the processing of those memories or by strategically preventing access to them, making disgust appraisals immune to corrective information. In the context of eating disorders/body image, studies provided consistent evidence for a bias toward disgust-related memories of their own body in women with a more negative body image. Although the current research casts doubt on disgust-induced strategic avoidant retrieval of body-related memories, it provided initial evidence for reactive avoidance of such memories. Insight into the role of disgust-induced avoidant memory processing as a transdiagnostic mechanism may help in understanding the refractoriness of disgust-relevant psychopathologies (including depressive and trauma-related disorders) and point to the necessity of therapeutic strategies to address disgust-induced avoidance.
Previous research has shown that patients with anorexia nervosa (AN) show an attentional bias to food. However, due to different conceptualizations of attentional bias and the use of various paradigms, results are inconclusive and more precise insights into the exact nature of this attentional bias are needed. Therefore, an eye-tracking paradigm with food (low and high caloric) and non-food (objects) pictures was used to investigate biases in AN patients (n = 25) compared to healthy controls (n = 22). Several indices of visual attention were examined, both during free (initial orientation, fixation frequency, fixation time) and explicitly instructed (engagement, disengagement) viewing. Our results during the free viewing phase indicated that AN patients (as compared to healthy matched controls) looked less frequently and spent less time fixating on food stimuli, compared to the comparison group. No differences between both groups (n = 47) in initial orientation could be observed. Interestingly, during the instructed viewing phase, no differences between the patient and the comparison group were observed in engagement or disengagement to food stimuli. These results suggest an (initial) attentional avoidance of food in AN patients when closely investigating spontaneous attentional processes, while this could not be observed during gaze behaviour when receiving clear instructions. Hence, future research should look into how attentional bias during spontaneous gaze patterns could serve as a potential marker of AN, and how targeting this bias could be applied in treatment interventions.
Disgust is a basic emotion of rejection providing an ancestral defensive mechanism against illness. Based on research documenting altered experience of disgust across several psychopathological conditions, we provided a narrative review to address the hypothesis that altered disgust may serve as transdiagnostic criterion of mental illness. Our narrative synthesis of the last decades literature shows that, compared to healthy population, patients with mental disorders exhibit abnormal sensitivity or propensity to disgust in all analyzed dimensions. We also outlined common alterations in brain areas relevant to disgust processing such as the insula and the cortico-basal ganglia network. Our review provides preliminary support to the proposal that altered disgust provides a transdiagnostic index across all the examined mental and personality disorders.
Although the fear of fat is considered central to the transdiagnostic conceptualization and treatment of eating disorders, the origin of this fear is unclear. Self-disgust, the profound revulsion at one's own character or actions, has been linked with various eating disorders symptoms, including drive for thinness, and may be a mechanism that partially explains the fear of fat observed among those with eating disorders. The present study examines the extent to which self-disgust explains the association between an eating disorder diagnosis and fear of fat. The sample consisted of community adult females diagnosed with an eating disorder (n = 30) and healthy comparisons (n = 30). Participants completed validated measures of fear of fat, self-disgust, and depression. Compared to healthy participants, individuals with an eating disorder reported significantly more fear of fat (t(58) = 9.51, p < .001, d = -2.45), self-disgust (t(46.58) = 8.87, p < .001, d = -2.29, and depression (t(41.17) = 8.30, p < .001, d = -2.14). Mediation analyses revealed self-disgust significantly mediated the relationship between an eating disorder diagnosis and fear of fat after controlling for depression (Effect = 6.10, SE = 1.41). Findings suggest that individuals with an eating disorder may employ various maladaptive strategies to prevent gaining weight (i.e., purging) that partially originate from a profound revulsion of the self. The implications for a transdiagnostic conceptualization and treatment of self-disgust in eating disorders as well as limitations and suggestions for future research directions are discussed.
Self-disgust is a negative self-conscious emotion that reflects disgust or revulsion directed toward oneself. A growing body of research has demonstrated a link between self-disgust, depression, and anxiety. However, the strength of these associations varied considerably across studies, suggesting the need to conduct a meta-analysis to produce a synthesized truer estimate. This review aimed to summarize the primary literature and improve our insight into these associations. The present study used three-level meta-analytic models to synthesize effect sizes and investigate potential moderators of the associations of self-disgust with depression and anxiety. The results revealed a significant association between self-disgust and depression (pooled r = 0.520, 95 % CI [0.485; 0.669], p < .001). The results also showed a significant and moderate association between self-disgust and anxiety (pooled r = 0.452, 95 % CI [0.419; 0.556], p < .001). These associations were held according to sex and age. In conclusion, this meta-analysis supports a moderate-to-large association between self-disgust, depression, and anxiety, suggesting that it is worthy of consideration in research and clinical practice.
Objective:
Traumatic events in childhood have been implicated in the development of psychosis, but given that trauma is not in itself sufficient to cause psychosis, researchers have started to investigate other psychological constructs potentially involved in explaining this relationship. Given that self-disgust as a transdiagnostic construct plays a role in the development/maintenance of a range of mental health difficulties, the objective of this study was to investigate whether self-disgust mediates the relationship between childhood trauma and psychosis.
Method:
A cross-sectional quantitative study design was used. Seventy-eight participants (Mage = 37.64 years, SDage = 11.57 years; 77% women; 88% White Caucasian) who reported experiencing clinical levels of psychosis were recruited using social media. The participants completed online survey measures of childhood trauma, self-disgust, experiences of psychosis, self-esteem, and external shame. The data were analysed using correlation and mediation analyses.
Results:
Significant indirect effects of childhood trauma on both positive (β = .17, BC 95% CI [0.06, 0.30]) and negative symptoms (β = .26, BC 95% CI [0.14, 0.40]) of psychosis via self-disgust were observed. These effects remained despite the inclusion of self-esteem and external shame as control variables in the mediation models.
Conclusion:
This study is the first to show a mediating role for self-disgust in the relationship between childhood trauma and later psychosis. Although the findings should be considered preliminary until strengthened by further research, they nevertheless provide corroboration of the potential utility of self-disgust as a transdiagnostic construct not only from a theoretical perspective, but also from its potential to inform formulation and interventions.
Practitioner points:
When assessing individuals with psychosis, especially those with a trauma history explore experiences and feelings related to the construct of self-disgust. Such experiences are likely to centre on feelings of repulsion towards the self/need for distance and might also manifest in the content of their psychotic experiences. Individuals with significant levels or experiences of self-disgust are likely to need specific interventions to address these; while interventions seeking to improve positive aspects of their identity might well be useful, they are unlikely to address the specific maladaptive elements of self-disgust. While self-disgust-focused interventions have not been widely researched, limited current evidence suggests cognitive restructuring and affirmation techniques might be useful.
Purpose of Review
Ambulatory assessment methods, including ecological momentary assessment (EMA), have often been used in eating disorders (EDs) to assess the type, frequency, and temporal sequencing of ED symptoms occurring in naturalistic environments. Relatedly, growing research in EDs has explored the utility of ecological momentary interventions (EMIs) to target ED symptoms. The aims of the present review were to (1) synthesize recent literature pertaining to ambulatory assessment/EMA and EMI in EDs, and (2) identify relevant limitations and future directions in these domains.
Recent Findings
With respect to ambulatory assessment and EMA, there has been substantial growth in the expansion of constructs assessed with EMA, the exploration of state- vs. trait-level processes, integration of objective and passive assessment approaches, and consideration of methodological issues. The EMI literature in EDs also continues to grow, though most of the recent research focuses on mobile health (mHealth) technologies with relatively minimal EMI components that adapt to momentary contextual information.
Summary
Despite these encouraging advances, there remain several promising areas of ambulatory assessment research and clinical applications in EDs going forward. These include integration of passive data collection, use of EMA in treatment evaluation and design, evaluation of dynamic system processes, inclusion of diverse samples, and development and evaluation of adaptive, tailored EMIs such as just-in-time adaptive interventions. While much remains to be learned in each of these domains, the continual growth in mobile technology has potential to facilitate and refine our understanding of the nature of ED psychopathology and ultimately improve intervention approaches.
Objective
Anxiety is thought to influence the development and maintenance of eating disorders (EDs). However, little is known about how, specifically, anxiety influences ED symptoms and vice versa. Network analysis identifies how symptoms within and across disorders are interconnected. In a network, central nodes (i.e., symptoms) have the strongest relations to other nodes and are thought to maintain psychopathology. Bridge nodes are symptoms in one diagnostic cluster that are strongly connected to symptoms in another diagnostic cluster and are thought to explain comorbidity. We identified central and bridge nodes in a network of ED symptoms and trait anxiety features.
Method
We estimated a regularized partial correlation network in patients with mixed EDs (N = 296). ED symptoms were assessed with the Eating Disorder Examination–Questionnaire. Trait anxiety was assessed with the Trait subscale of the State–Trait Anxiety Inventory. Items to include in the network were selected with a statistical algorithm to ensure that all nodes represented unique constructs. Central and bridge nodes were identified with empirical calculations.
Results
Central ED nodes were dietary restraint, as well as overvaluation of and dissatisfaction with shape and weight. The central trait anxiety node was low feelings of satisfaction. The strongest ED bridge node was avoidance of social eating. The strongest trait anxiety bridge node was low self‐confidence.
Discussion
Avoidance of social eating and low self‐esteem may be routes through which EDs and trait anxiety are linked.
This systematic literature review examined the clinical utility of the construct of self‐disgust in understanding mental distress. Specifically, the review assessed whether there is a shared conceptual definition of self‐disgust, the face and construct validity of the quantitative assessment measures of self‐disgust, and the predictive validity of self‐disgust in formulating the development of a range of psychological difficulties. A systematic database search supplemented by manual searches of references and citations identified thirty‐one relevant papers (27 quantitative, 3 qualitative, 1 mixed). Analysis of qualitative papers indicated a
number of shared features in the definition of self‐disgust, including a visceral sense of self‐elicited nausea accompanied by social withdrawal and attempts at cleansing or suppressing aspects of the self. Quantitative assessment measures appeared to capture these dimensionand evidenced good psychometric properties, although some measures may have only partially captured the full self‐disgust construct. Strong relationships were observed between self‐disgust and a range of mental health presentations, in particular depression, body‐image difficulties, and trauma‐related difficulties. However, these relationships are smaller when the effects of other negative self‐referential emotions were controlled, and stronger conclusions about the predictive validity of self‐disgust are limited by the cross‐sectional nature of many of the studies.
Consistent with the view that disgust might be involved in persistent body dissatisfaction, there is preliminary evidence showing a positive correlation between measures of negative body image and indices of both trait disgust and self-directed disgust. In two correlational studies among undergraduates (N = 577 and N = 346, respectively) we aimed at replicating and extending these findings by testing a series of critical relationships, which follow from our hypotheses that 1) trait disgust propensity would increase the risk of developing a negative body image by increasing the likelihood of feeling self-disgust, and 2) trait disgust sensitivity would heighten the impact of self-disgust on the development of persistent negative body appraisals. Replicating previous research, both studies showed that negative body image was positively related to self-disgust, disgust propensity and disgust sensitivity. Mediation analyses showed that, in line with our model, self-disgust partly accounted for the association between disgust propensity and negative body image. Although disgust sensitivity showed an independent relationship with body image, disgust sensitivity did not moderate the association between self-disgust and negative body image. All in all, findings are consistent with the view that self-disgust-induced avoidance may contribute to persistent negative body appraisals.
This study aimed to assess the relationship between self-disgust and sensory processing within eating psychopathology. Five hundred and ninety-one women with a self-reported diagnosis of anorexia nervosa, bulimia nervosa or who had no previous history of an eating disorder completed a battery of online questionnaires measuring disgust, emotion and sensory variables. Those with an eating disorder reported significantly higher rates of self-disgust than those with no history of disordered eating. In groups of women with self-reported bulimia, self-disgust was associated with sensation avoidance and sensation seeking. Within the group with anorexia nervosa, self-disgust was associated with low registration and sensation seeking. This report is the first to examine the expression of the emotion self-disgust within eating psychopathology and examine associations of this factor with sensory processing. The emotion self-disgust needs to be further examined to understand its possible role in the onset and maintenance of disordered eating. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
Depression and anxiety are commonly associated with anorexia nervosa (AN) and contribute to difficulties in social integration, a negative factor for outcome in AN. The link between those disorders and AN has been poorly studied. Thus, our objective was to investigate (1) the link between outcome nine years after hospitalisation for AN and the occurrence of lifetime anxious or depressive comorbidities; (2) the prognostic value of these comorbidities on patient outcome; 181 female patients were hospitalised for AN (between 13 and 22 years old), and were re-evaluated for their psychological, dietary, physical and social outcomes, from 6 to 12 years after their hospitalisation. The link between anxious and depressive disorders (premorbid to AN and lifetime) and the outcome assessment criteria were tested through multivariate analyses; 63% of the participants had good or intermediate outcome, 83% had presented at least one anxiety or depression disorder in the course of their lives, half of them before the onset of AN. Premorbid obsessive compulsive disorders (OCD), BMI at admission, and premenarchal AN all contribute to poor prognosis. Social phobia and agoraphobia affect the subjects’ quality of life and increase eating disorder symptoms. These results encourage a systematic assessment of, and care for, anxiety and depression comorbidities among female adolescent patients with a particular focus on premorbid OCD.
Evidence documents a direct relationship between disgust processing and Body Mass Index (BMI). People with high BMI tend to have a lower disgust sensitivity (DS) threshold, while this trait is more accentuated in people with low BMI. Here we provide new insights to this issue by exploring the relationship between BMI and the experience of moral disgust. Results document a significant negative correlation between BMI and moral disapproval rating (MDR) for ethical violations, in that the higher the BMI the lower the MDR. In concordance with previous investigations, we also found that BMI correlates with DS, as measured with a standard test, in that the higher the BMI the lower the DS. Overall, the main result of this paper, which might may have direct implication for research in social justice, highlights the relevance of BMI, as an individual variable, in predicting ethical behavior.
Our current understanding of the etiology and maintenance of eating disorders and obesity continues to be far from complete. Similarly, our understanding of determinants of both successful and unsuccessful weight loss surgery is also quite limited. While a number of research methodologies have been applied to these areas, one methodology that has recently seen a rise in popularity is the use of ecological momentary assessment (EMA). EMA allows one to study a variety of variables of interest in the natural environment. The study of eating disorders, obesity, and bariatric surgery has all been conducted using EMA recently. The current study is a review of these areas and summarizes the recent literature (past 3 years) in eating disorders, obesity, and bariatric surgery using EMA methodology.
Paper presents results of psychometric analyses of the Polish translation of the
Beck’s Depression Inventory BDI-II. The sample included 456 subjects – 337 controls,
43 patients with depressive episodes and disorders (19 – current episode mild and moderate,
24 – current episode severe), 26 patients with anxiety disorders including mixed
anxiety and depressive disorder, as well as 23 male prisoners and 27 females, experiencing
domestic violence. The analyses comprise factorial structure of BDI-II items
and their criterion-related validity (correlation with medical diagnosis of depression and
severity of depression obtained by Clinical Global Impression – Severity Scale), as well
as reliability and validity of the total BDI-II scale, done in control and clinical groups. The
validity studies of the BDI-II scale were focused on construct-oriented validity (correlations
with scales of TALEIA-400A inventory, assessing clinical disorders) and criterionoriented
validity (analyses of differences of BDI-II scores among control, demographic
and clinical samples). Finally, the culture specific norms in the form of cut-off scores,
differing controls and depressed subjects, were derived for diagnosing the mild and
severe depression, as well as several indices of validity of diagnosis (like ‘total misclassification
rate’, ‘sensitivity’, etc.). The results indicate the very high reliability and
validity of the BDI-II translation, fully equivalent to the original version, what enables to
recommend this inventory for use in scientific research and clinical practice regarding
Polish-speaking subjects.
The development and validation of a new measure, the Eating Disorder Inventory (EDI) is described. The EDI is a 64 item, self-report, multiscale measure designed for the assessment of psychological and behavioral traits common in anorexia nervosa (AN) and bulimia. The EDI consists of eight sub-scales measuring: 1) Drive for Thinness, 2) Bulimia, 3) Body Dissatisfaction, 4) Ineffectiveness, 5) Perfectionism, 6) Interpersonal Distrust, 7) Interoceptive Awareness and 8) Maturity Fears. Reliability (internal consistency) is established for all subscales and several indices of validity are presented. First, AN patients (N = 113) are differentiated from female comparison (FC) subjects (N = 577) using a cross-validation procedure. Secondly, patient self-report subscale scores agree with clinician ratings of subscale traits. Thirdly, clinically recovered AN patients score similarly to FCs on all subscales. Finally, convergent and discriminate validity are established for subscales. The EDI was also administered to groups of normal weight bulimic women, obese, and normal weight but formerly obese women, as well as a male comparison group. Group differences are reported and the potential utility of the EDI is discussed.
makes every effort to ensure the accuracy of all the information (the "Content") contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
To the Editor: In the June issue, the Journal published aninteresting study on recovered anorexia nervosa and bulimianervosa (1). The authors of this research used sweet tastes,with (sucrose) and without (sucralose) caloric content, to in-terrogate gustatory neurocircuitry involving the anterior insulaand related regions that modulate sensory-interoceptive-rewardsignals in response to palatable foods. In particular, the rightanterior insula response to sucrose was diminished in anorexianervosa and exaggerated in bulimia nervosa relative to com-parison subjects.This abnormal insula response associated with the ex-posure to sweet compounds led the authors to concludethat there may be a failure to accurately recognize hungersignals. This conclusion is consistent with the suggestionthat an altered interoceptive awareness may be a pre-cipitating and reinforcing factor in both populations, al-though this altered awareness leads to antithetical feedingbehaviors.The neural pattern observed by the authors suggestsanother, not mutually exclusive, interpretation of the result,whichreferstothehypothesisofanaltereddisgustsensitivity.AssuggestedbyChapmanandAnderson(2),disgustmaybeparticularly strongly associated with visceral changes, consis-tent with its apparent origins in defending against the ingestionof contaminated foods. Given the key role of the anteriorinsula in interoception (3) and disgust processing (4), onecould argue that the reported abnormal activity of this neuralregion in response to sweet tastes may reflect an altereddisgust processing at the visceral level.Thissuggestionissupportedbyresearchexamining disgustsensitivity in these clinical populations before recovery. Forexample, Aharoni and Hertz (5) reported that anorexia nervosapatients scored consistently higher on all domains of disgustsensitivity,with a particularregard to the fooddomain. Moreover,Troop et al. (6) reported higher levels of disgust sensitivity tofood in bulimia nervosa. On the other hand, Houben andHavermans (7) reported lower disgust sensitivity in over-weight individuals.Given the evidence of this relationship between disgustsensitivity and feeding behavior, an assessment of disgustsensitivity could provide important clues for interpreting thepattern of neural activity reported by Oberndorfer et al. (1) intheanterior insulaof recovered anorexianervosa and bulimianervosa patients.References
The EDI-2 manual is currently out of print but the attached file provides the table of contents for the EDI-3 which includes all of the EDI-2 items as well as the updated scale structure and scoring system for the EDI-3
Background:
Several theoretical models suggest that deficits in emotional regulation are central in the maintenance of anorexia nervosa (AN). Few studies have examined how patients view the relationship between negative affect and anorectic behaviour. We explored how patients with AN manage the aversive emotions sadness, anger, fear and disgust, and how they link these experiences to their eating disorder behaviours.
Methods:
Qualitative data were collected through semi-structured interviews with 14 women aged 19-39 years diagnosed with AN (DSM-IV). Interviews were analyzed using Grounded Theory methods.
Results:
The participants tended to inhibit expression of sadness and anger in interpersonal situations and reported high levels of anger towards themselves, self-disgust and fear of becoming fat. Different emotions were managed by means of specific eating disorder behaviours. Sadness was particularly linked to body dissatisfaction and was managed through restrictive eating and purging. Anger was avoided by means of restrictive eating and purging and released through anorectic self-control, self-harm and exercising. Fear was linked to fear of fatness and was managed through restrictive eating, purging and body checking. Participants avoided the feeling of disgust by avoiding food and body focused situations.
Conclusion:
Treatment models of eating disorders highlight the significance of working with emotional acceptance and coping in this patient group. Knowledge about how patients understand the relationships between their negative emotions and their anorectic behaviour may be an important addition to treatment programmes for AN.
Body image distortion is a key symptom of anorexia nervosa (AN). The majority of the neuroimaging studies on body image distortion in AN conceptualized it as an unidimensional symptom. However, behavioural research considers such symptom as a multidimensional construct. Our paper systematically reviews the functional magnetic resonance (fMRI) studies on body image distortion in AN and classifies them according to a speculative model of body image distortion, that consists of the three most widely accepted components in the behavioural research: perceptive, affective and cognitive. We found that: (1) the perceptive component is mainly related to alterations of the precuneus and the inferior parietal lobe; (2) the affective component is mainly related to alterations of the prefrontal cortex, the insula and the amygdala; (3) the cognitive component has been weakly explored. These evidences seem to confirm that specific neural alterations are related to the components of the body image distortion in AN. Further neuroimaging studies are needed to better understand the complexity of the body image distortion in AN.
Studies concentrating on interindividual differences in experiencing disgust have indicated that disgust propensity is associated with certain disorders, such as fear of blood and fear of spiders (de Jong & Merckelbach, 1998). However, current indices of disgust propensity suffer from conceptual overlap with other measures of psychopathology.Moreover, in addition to high levels of disgust propensity, a relatively negative appreciation of experiencing the emotion of disgust (disgust sensitivity) may also be critically involved in psychopathology. To address these issues, the Disgust Propensity and Sensitivity Scale (DPSS) was devised (Cavanagh & Davey, 2000). This study examined its psychometric qualities. Students (N = 967) completed the DPSS, the Disgust Questionnaire (DQ), the Disgust Scale (DS), the Blood-Injury Phobia Questionnaire (BIQ), and the Fear of Spiders Questionnaire (FSQ). The DPSS meaningfully differentiated between disgust propensity and sensitivity. These factors were differentially related to blood and spider fear. The present findings sustain the importance of differentiating between individual differences in disgust propensity and sensitivity as factors that may be independently involved in psychopathology. The DPSS appears a valuable addition to the arsenal of indices presently available in disgust research.
This review analyses the accumulating evidence from psychological, psychophysiological, neurobiological and cognitive studies suggesting that the disease-avoidance emotion of disgust is a predominant emotion experienced in a number of psychopathologies. Current evidence suggests that disgust is significantly related to small animal phobias (particularly spider phobia), blood-injection-injury phobia and obsessive-compulsive disorder contamination fears, and these are all disorders that have primary disgust elicitors as a significant component of their psychopathology. Disgust propensity and sensitivity are also significantly associated with measures of a number of other psychopathologies, including eating disorders, sexual dysfunctions, hypochondriasis, height phobia, claustrophobia, separation anxiety, agoraphobia and symptoms of schizophrenia--even though many of these psychopathologies do not share the disease-avoidance functionality that characterizes disgust. There is accumulating evidence that disgust does represent an important vulnerability factor for many of these psychopathologies, but when disgust-relevant psychopathologies do meet the criteria required for clinical diagnosis, they are characterized by significant levels of both disgust and fear/anxiety. Finally, it has been argued that disgust may also facilitate anxiety and distress across a broad range of psychopathologies through its involvement in more complex human emotions such as shame and guilt, and through its effect as a negative affect emotion generating threat-interpretation biases.
Anorexia nervosa is a serious illness with major physical and psychological morbidity. It has largely been understood in terms of cultural and environmental explanations. However these are insufficient to explain the diverse clinical features of the illness, nor its rarity given the universality of sociocultural factors. Over the last 20 years, there has been a steady accumulation of neurobiological evidence requiring a re-formulation of current causal models. We now offer a new empirically-derived hypothesis implicating underlying rate-limiting dysfunction of insula cortex as a crucial risk factor for the development of anorexia nervosa. Supporting evidence for this hypothesis is drawn from anatomical and clinical research of insula cortex damage in humans and neuroscientific studies of relevant clinical features including taste, pain perception and reward processing. This hypothesis, if sustainable, would be the first fully to explain the disorder and predicts promising novel treatment possibilities including Cognitive Remediation and Motivation Enhancement Therapies. The knowledge that the challenging behaviours, so characteristic of AN, are the result of underlying cerebral dysfunction, rather than being purely volitional, could help to reduce the stigma patients experience and improve the therapeutic alliance in this poorly understood and difficult to treat disorder.
Purpose of review:
Ecological momentary assessment (EMA) is an important tool for clarifying common precipitants and consequences of eating disorder symptoms that might be meaningfully targeted in treatments for these pernicious disorders. This article reviews recent advances in EMA work conducted within clinical eating disorder samples.
Recent findings:
Published studies from the past 2.5 years can broadly be categorized as involving functional analysis of eating disorder behaviors, examining hypothesized predictors of eating disorder symptoms, or applying novel approaches to EMA data. Examples of the latter category include the use of latent profile analysis with EMA data, integration of neurocognitive (e.g., ambulatory inhibitory control task) or biological indicators (e.g., fMRI, plasma leptin), and examining changes in associations between momentary variables over time through multiwave EMA data collection.
Summary:
EMA studies in eating disorders have advanced significantly in recent years, with findings demonstrating strong support for the emotion regulation function of eating disorder behaviors and momentary predictors of distinct eating disorder symptoms. The use of novel statistical and data collection approaches represent exciting areas of growth, with likely implications for intervention approaches, including those that utilize ambulatory technology to deliver treatment.
Anorexia nervosa (AN) is a severe psychiatric disorder leading to life-threatening emaciation. Weight restoration is crucial in treatment but few data are available on how to achieve it. Nutritional supplements are needed in treatment but patients' preferences about natural versus medical foods and their gustatory/hedonic perception are unclear. We aimed to measure disgust and reward-based eating in AN and to assess psychological, interoceptive awareness-related, behavioral, and hedonic aspects comparing natural versus medical food. Thirty-three inpatients with AN and 39 healthy controls (HCs) were recruited and received 50 ml of either apricot juice or nutritional liquid supplement with apricot flavor on two consecutive days. Disgust, reward-based eating, and eating psychopathology were evaluated. Visual Analogue Scales measuring anxiety, hunger, confusion about internal states, need for over-exercise, restraint, and satiety were completed before and after the experiment. Disgust and hedonic responses were measured after the experiment. Patients with AN reported preserved disgust sensitivity and higher reward-based eating drive. When compared to HCs, inpatients with AN reported higher scores on anxiety, hunger, confusion about internal states, urge to over-exercise, urge to eating restraint, and satiety before and after the tasting experiment. The supplement slightly increased patients' anxiety with HCs reporting the same trend. Still, patients reported more food-related disgust after the supplement but their overall hedonic evaluation was similar for both conditions. Also, anxiety, confusion about internal states, and urge to over-exercise and restraint did not significantly increase after consuming either food. Therefore, if we take into account patients’ level of heightened satiety and suppressed hunger, supplements could be helpful for patients with severe AN since greater energy intakes could be provided with only small volumes of food and little changes of eating concerns.
Objective:
We aimed to provide a comprehensive overview of the role of self-esteem in the treatment of patients with anorexia nervosa (AN). Specifically, our objectives were to investigate the differences in self-esteem between individuals with AN and healthy controls, or individuals with other eating disorders, and to examine self-esteem as an outcome, predictor, moderator, and mediator in AN treatment.
Method:
The databases PsycINFO, PSYNDEXplus, Ovid MEDLINE®, and ProQuest were searched for studies published from 1990 to 2018. To estimate aggregated effect sizes, we performed random-effects meta-analyses.
Results:
A screening of 1,596 abstracts and 203 full-texts identified 68 relevant publications. Results suggest a significantly lower global self-esteem in individuals with AN than in healthy controls (d = -1.90, p < .001). In contrast, global self-esteem of AN and bulimia nervosa (BN) patients was found to be comparable (d = 0.05, p = .529). It might be specific to AN patients that negative self-evaluations may not affect scholastic and professional abilities. Significantly moderate self-esteem increases were observed in treated AN patients at the end of treatment (d = 0.56, p < .001), short-term (d = 0.50, p < .001), and long-term (d = 0.75, p < .001) follow-up. Self-esteem did not predict end of treatment remission-or weight-related outcome and treatment dropout. However, small to moderate predictive effects were detected on short-term (r = .15, p = .007) and long-term remission or weight (r = .33, p = .017). Finally, first indications point to self-esteem as a mediator in adult AN inpatient treatment.
Discussion:
The review provides insights relevant for theory, research, and practice. Implications concern the overall support for transdiagnostic approaches and the recommendation to consider low initial self-esteem for decisions on after-care.
Background:
Loneliness and self-disgust have been considered as independent predictors of depressive symptoms. In the present study, we hypothesized that self-disgust can explain the association between loneliness and depression, and that emotion regulation strategies interact with self-disgust in predicting depressive symptoms.
Methods:
Three hundred and seventeen participants (M = 29.29 years, SD = 14.11; 76.9% females) completed structured anonymous self-reported measures of loneliness, self-disgust, emotion regulation strategies, and depressive symptoms.
Results:
One-way MANOVA showed that participants in the high-loneliness group reported significantly higher behavioural and physical self-disgust, compared to those in the middle and low-loneliness groups. Bootstrapped hierarchical linear regression analysis showed that self-disgust significantly improved predicted variance in depressive symptoms, after controlling for the effects of loneliness. Regression-based mediation modelling showed that both physical and behavioural self-disgust significantly mediated the association between loneliness and depression. Finally, moderated regression analysis showed that expressive suppression interacted with self-disgust in predicting depressive symptoms.
Limitations:
A cross-sectional design was used, and our study focused on expressive suppression and cognitive reappraisal but not on other aspects of emotion regulation or the modulation of emotional arousal and responses.
Conclusions:
We demonstrated, for the first time, that self-disgust plays an important role in the association between loneliness and depressive symptoms. Furthermore, variations in emotion regulation strategies can explain the association between self-disgust and depressive symptoms.
Objective
This study examined whether patterns of eating‐disorder (ED) psychopathology differed by gender across DSM‐5 severity specifiers in anorexia nervosa (AN) and bulimia nervosa (BN).
Method
We tested whether ED psychopathology differed across DSM‐5 severity specifiers among 532 adults (76% female) in a residential treatment center with AN or BN. We hypothesized that severity of ED psychopathology would increase in tandem with increasing severity classifications for both males and females with AN and BN.
Results
Among females with BN, DSM‐5 severity categories were significantly associated with increasing ED psychopathology, including Eating Disorder Examination‐Questionnaire dietary restraint, eating concern, shape concern, and weight concern; and Eating Disorder Inventory drive for thinness and bulimia. ED psychopathology did not differ across DSM‐5 severity levels for males with BN. For both males and females with AN, there were no differences in ED psychopathology across severity levels.
Discussion
Results demonstrate that DSM‐5 severity specifiers may function differently for males versus females with BN. Taken together, data suggest DSM‐5 severity specifiers may not adequately capture severity, as intended, for males with BN and all with AN. Future research should evaluate additional clinical validators of DSM‐5 severity categories (e.g., chronicity, treatment non‐response), and consider alternate classification schemes.
Background
Network analysis is increasingly applied to psychiatric populations to understand relationships among symptoms.
Methods
Network analysis was applied on 955 patients with anorexia nervosa (AN; 631 restricting‐type [ANR] and 324 binge eating‐/purging‐type [ANBP]), assessed with Symptom Check‐List 90 (SCL‐90), Eating Disorder Inventory (EDI), and Tridimensional Personality Questionnaire.
Results
Depression, anxiety, interpersonal sensitivity (SCL‐90), and ineffectiveness (EDI) had the highest centrality (strength from 1.19 to 1.35 in ANBP, and from 1.15 to 1.51 in ANR). Body mass index (BMI) had low centrality (0.14 ANBP and 0.41 ANR). Drive for thinness showed the strongest correlation with central nodes in ANBP (correlation around 0.44) and ANR (correlation range 0.38–0.47), and drive for thinness had higher centrality in ANR (1.15) than in ANBP (0.81), whereas body dissatisfaction in ANBP (0.73) than in ANR (0.61).
Discussion
In addition to ED‐core symptoms, psychiatric comorbid symptoms should be the focus of specific treatments in patients with AN, independently from BMI.
Functional magnetic resonance imaging (fMRI) studies have displayed a dysregulation in the way in which the brain processes pleasant taste stimuli in patients with anorexia nervosa (AN) and bulimia nervosa (BN). However, exactly how the brain processes disgusting basic taste stimuli has never been investigated, even though disgust plays a role in food intake modulation and AN and BN patients exhibit high disgust sensitivity. Therefore, we investigated the activation of brain areas following the administration of pleasant and aversive basic taste stimuli in symptomatic AN and BN patients compared to healthy subjects. Twenty underweight AN women, 20 symptomatic BN women and 20 healthy women underwent fMRI while tasting 0.292 M sucrose solution (sweet taste), 0.5 mM quinine hydrochloride solution (bitter taste) and water as a reference taste. In symptomatic AN and BN patients the pleasant sweet stimulus induced a higher activation in several brain areas than that induced by the aversive bitter taste. The opposite occurred in healthy controls. Moreover, compared to healthy controls, AN patients showed a decreased response to the bitter stimulus in the right amygdala and left anterior cingulate cortex, while BN patients showed a decreased response to the bitter stimulus in the right amygdala and left insula. These results show an altered processing of rewarding and aversive taste stimuli in ED patients, which may be relevant for understanding the pathophysiology of AN and BN.
Suicide risk is highly prevalent among individuals with posttraumatic stress disorder (PTSD). Self-disgust, defined as disgust directed internally and comprised of disgust with oneself (disgusting self) and with one’s behaviors (disgusting ways), may impact this increased risk. The present study examined self-disgust as a putative mechanism linking PTSD symptoms with suicide risk. A sample of 347 trauma-exposed undergraduates completed measures of PTSD symptoms, suicide risk, self-disgust, and depressive symptoms. Controlling for depressive symptoms, a process model indicated PTSD symptoms were positively linked to suicide risk via increased disgusting self but not disgusting ways. Process models examining individual PTSD symptom clusters revealed positive, indirect links between all PTSD symptom clusters except alterations in arousal and reactivity and suicide risk via disgusting self. These findings expand on growing literature documenting the importance of self-disgust in trauma-related pathology by identifying connections with suicide risk. Future directions and clinical considerations are discussed.
The development and validation of a new measure, the Eating Disorder Inventory (EDI) is described. The EDI is a 64 item, self-report, multiscale measure designed for the assessment of psychological and behavioral traits common in anorexia nervosa (AN) and bulimia. The EDI consists of eight subscales measuring: Drive for Thinness, Bilimia, Body Dissatisfaction, Ineffectiveness, Perfectionism, Interpersonal Distrust, Interoceptive Awareness and Maturity Fears. Reliability (internal consistency) is established for all subscales and several indices of validity are presented. First, AN patients (N=113) are differentiated from femal comparison (FC) subjects (N=577) using a cross-validation procedure. Secondly, patient self-report subscale scores agree with clinician ratings of subscale traits. Thirdly, clinically recovered AN patients score similarly to FCs on all subscales. Finally, convergent and discriminant validity are established for subscales. The EDI was also administered to groups of normal weight bulimic women, obese, and normal weight but formerly obese women, as well as a male comparison group. Group differences are reported and the potential utility of the EDI is discussed.
Anorexia nervosa is characterized by chronic food avoidance that is resistant to change. Disgust conditioning offers one potential unexplored mechanism for explaining this behavioral disturbance because of its specific role in facilitating food avoidance in adaptive situations. A food based reversal learning paradigm was used to study response flexibility in 14 adolescent females with restricting subtype anorexia nervosa (AN-R) and 15 healthy control (HC) participants. Expectancy ratings were coded as a behavioral measure of flexibility and electromyography recordings from the levator labii (disgust), zygomaticus major (pleasure), and corrugator (general negative affect) provided psychophysiological measures of emotion. Response inflexibility was higher for participants with AN-R, as evidenced by lower extinction and updated expectancy ratings during reversal. EMG responses to food stimuli were predictive of both extinction and new learning. Among AN-R patients, disgust specific responses to food were associated with impaired extinction, as were elevated pleasure responses to the cued absence of food. Disgust conditioning appears to influence food learning in acutely ill patients with AN-R and may be maintained by counter-regulatory acquisition of a pleasure response to food avoidance and an aversive response to food presence. Developing strategies to target disgust may improve existing interventions for patients with AN.
Copyright © 2015 Elsevier Ltd. All rights reserved.
Disgust has been implicated as a factor that maintains and exacerbates eating disorder (ED) symptoms. Emerging research suggests that disgust may be a risk factor for suicidality. Given the high rates of suicidality among individuals with EDs, we propose that disgust may contribute to the link between EDs and suicidality. To test this hypothesis, self-report data were collected from 341 young adults (66% women). Cross-sectional associations between disgust with the self, others and the world and disgust sensitivity and propensity, ED symptoms and suicidal ideation were examined using multivariate regression analyses. ED symptoms and body dissatisfaction were associated with increased suicidal ideation at high levels of disgust with the self and the world; at low levels of disgust, ED symptoms and body dissatisfaction did not significantly relate to suicidal ideation. Disgust may indicate risk for suicidal ideation among individuals with eating psychopathology. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.
Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.
Objective:
The clinical presentation of anorexia nervosa (AN) is characterized by preoccupation with body experience, intrusive concerns regarding shape, and pathological fears of weight gain. These symptoms are suggestive of unrelenting self-focused attention. No research to date has characterized self-focused attention (SFA) in AN nor examined neurocognitive features that may facilitate an excessive, rigid, or sustained focus on one's appearance.
Method:
This study examined SFA, body image disturbance, and executive functioning in women with current anorexia nervosa (AN-C; n = 24), a history of AN who were weight-restored at the time of the study (WR; n = 19), and healthy controls (n = 24).
Results:
Private and public SFA were highest among WR and lowest among AN-C. Shape concerns were negatively correlated with SFA, especially among AN-C, after controlling for depression and social anxiety symptoms.
Discussion:
Lower levels of SFA among AN-C were unexpected and suggest the acute state of AN may lessen pathological self-focus, negatively reinforcing symptoms. In addition, body image concerns may distract from general SFA. Deficits in executive attention may explain these findings, as each one unit increase in perseverative errors among AN-C participants was associated with an almost one-half unit decrease in public SFA.
Aim
To study in a prospective manner the long-term prognostic value of the initially recorded Eating Disorder Inventory (EDI) scores in anorexia nervosa (AN) patients.
Methods
The 5–10-year outcome of 26 consecutive malnourished AN patients was prospectively recorded according to the initial EDI score. We selected only patients with full 6-month assessments for more than 5 years (mean 8.5 years). Eating behavior, quality of life, autonomy and insight capacity were prospectively assessed by the Morgan-Russell scale and a semi-structured interview. At the end of follow-up, 13 patients recovered and the 13 others had a poor outcome.
Results
In monovariate analyses, high initial EDI total score (P < .0007) and high initial scores for perfectionism (P < .001), ineffectiveness (P < .002), interpersonal distrust (P < .004), interoceptive awareness (P < .03) and drive for thinness (P < .05) were significantly associated with a poor prognosis 5–10 years afterward. In a multivariate analysis, only high initial scores for perfectionism (F = 8.43; P = 0.008) and interpersonal distrust (F = 7.46; P = 0.012) were significantly associated with illness severity.
Discussion
High EDI total score and subscales for perfectionism and interpersonal distrust could predict a long-term severe outcome in AN.
Abstract Gilbert (2005) proposed that the capacity for self-compassion is integral to overcoming shame and psychopathology. We tested this model among 74 individuals with an eating disorder admitted to specialized treatment. Participants completed measures assessing self-compassion, fear of self-compassion, shame, and eating disorder symptoms at admission and every 3 weeks during treatment. At baseline, lower self-compassion and higher fear of self-compassion were associated with more shame and eating disorder pathology. Multilevel modeling also revealed that patients with combinations of low self-compassion and high fear of self-compassion at baseline had significantly poorer treatment responses, showing no significant change in shame or eating disorder symptoms over 12 weeks. Results highlight a new subset of treatment-resistant eating disorder patients.
Two studies are described which investigated the relationship between disgust sensitivity and eating disorders. In a normal sample, Study 1 found a significant correlation between measures of eating disorder and measures of disgust sensitivity, but only in female subjects. This relationship was not mediated by existing levels of anxiety or depression. Study 2 found that subjects who had clinically-diagnosed eating disorders exhibited significantly higher levels of disgust than matched normal control subjects. Both studies indicated that elevated disgust in relation to eating disorders appeared to be confined primarily to disgust of food, the body and body products, and did not extend to disgusting stimuli which are not associated with food or the body. © 1998 John Wiley & Sons, Ltd and Eating Disorders Association.
This study explored the outcome of introducing Compassion Focused Therapy (CFT) into a standard treatment programme for people with eating disorders. In particular, the aim was to evaluate the principle that CFT can be used with people with eating disorders and improve eating disorder symptomatology.
Routinely collected questionnaire data were used to assess cognitive and behavioural aspects of eating disorders and social functioning/well being (n = 99).
There were significant improvements on all questionnaire measures during the programme. An analysis by diagnosis found that people with bulimia nervosa improved significantly more than people with anorexia nervosa on most of the subscales. Also, in terms of clinical significance, 73% of those with bulimia nervosa were considered to have made clinically reliable and significant improvements at the end of treatment (compared with 21% of people with anorexia nervosa and 30% of people with atypical eating disorders).
This study demonstrates the potential benefits of using CFT with people with eating disorders and highlights the need for further research on this new approach. Copyright
Disgust is an emotion that is intimately linked to food and eating and it has been proposed that disgust may therefore be an important emotion in eating disorders. However, empirical evidence has been mixed.
Two hundred and eight participants with a history of eating disorders completed measures of current and past eating disorder symptoms and a disgust questionnaire measuring disgust sensitivity in five domains (foodstuffs of animal origin, human body and body products, invertebrate animals, gastroenteric products, sexual practices).
Despite some differences with previous results, both current and remitted eating disorder volunteers reported higher levels of disgust towards foodstuffs of animal origin and to the human body and its products. In addition, those in remission from an eating disorder had lower levels of disgust towards the human body and its products than did those who were still ill but these groups did not differ in their disgust towards foodstuffs of animal origin.
It is concluded that eating disorders are not associated with an increased global disgust sensitivity but that this is specific to areas that concern food and the body. Copyright © 2001 John Wiley & Sons, Ltd and Eating Disorders Association.
The current study was designed to assess the emotion states that occur across the clinical disorders of depression, anxiety and mixed anxiety depression. The emotion states were assessed using the Basic Emotions Scale, which includes a set of simple and complex emotions rationally derived from the basic emotions of sadness, anger, fear, disgust and happiness. The profiles of emotion states across the clinical disorders and across a matched healthy control group supported an analysis in which emotions related to sadness and disgust were elevated in the depressed and mixed disorders, whereas increased levels of anger and fear, and decreased levels of happiness did not distinguish between clinical groups but were found in all disorders in comparison to healthy controls. Further factor analyses gave support for the proposed basic emotions model and did not support alternative models such as the Positive Affect-Negative Affect model. The findings demonstrate how a theoretically based emotion analysis can provide a useful foundation from which to explore the emotional disorders. Copyright © 2007 John Wiley & Sons, Ltd.
Previous research indicates that self-disgust partially mediates the relationship between dysfunctional cognitions and depression.
However, as self-disgust is only a partial mediator, other variables are also likely to mediate this relationship. One potential
variable is self-esteem, which has consistently been linked to depression in the literature. Hence, the current study aimed
to examine whether self-disgust and self-esteem both mediate the relationship between dysfunctional cognitions and depression.
Measures of self-disgust, self-esteem, dysfunctional cognitions and depression were completed by a non clinical sample of
120 participants. Self-disgust and self-esteem were found to be conceptually distinct constructs and both constructs were
found to be partial mediators of the relationship between dysfunctional cognitions and depression: a finding which generalised
across two measures of depression. The important mediational role of emotions in the development of depression needs to be
taken into account in therapeutic practice.
KeywordsDysfunctional cognitions-Mediator analysis-Depression-Self-disgust-Self-esteem
We describe the development of a reliable measure of individual differences in disgust sensitivity. The 32-item Disgust Scale includes 2 true-false and 2 disgust-rating items for each of 7 domains of disgust elicitors (food, animals, body products, sex, body envelope violations, death, and hygiene) and for a domain of magical thinking (via similarity and contagion) that cuts across the 7 domains of elicitors. Correlations with other scales provide initial evidence of convergent and discriminant validity: the Disgust Scale correlates moderately with Sensation Seeking (r= - 0.46) and with Fear of Death (r= 0.39), correlates weakly with Neuroticism (r = 0.23) and Psychoticism (r= - 0.25), and correlates negligibly with Self-Monitoring and the Eysenck Personality Questionnaire Extraversion and Lie scales. Females score higher than males on the Disgust Scale. We suggest that the 7 domains of disgust elicitors all have in common that they remind us of our animality and, especially, of our mortality. Thus we see disgust as a defensive emotion that maintains and emphasizes the line between human and animal.
Previous studies found inconsistent differences in disgust sensitivity between patients with a variety of eating disorders and normal controls.
The objective of this study was to compare disgust sensitivity between a larger and more specific sample of anorexia nervosa (AN) patients and control subjects.
We compared the scores on the 'disgust sensitivity scale' of AN patients (N = 62) and control subjects (N = 62) using a multivariate analysis of variance. All subjects were women.
AN patients scored consistently higher on all domains of disgust sensitivity. This difference was significant for six of eight disgust domains. The largest significant difference between the groups was on the domains food and magical thinking.
Our findings elaborate on previous findings and are in line with recent neurological findings suggesting that disgust and insular impairments are associated with AN. Clinical implications of our findings are discussed.