Debra L Franko's research while affiliated with Northeastern University and other places
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Publications (219)
Background:
The network approach has emerged as a useful framework for conceptualizing and investigating psychopathology, including eating disorders. Network connectivity, that is, the density of the connections among network nodes, has been somewhat neglected despite its theoretical relevance. As predicted by network theory, symptom connectivity...
Objective:
A sizeable minority of patients with binge-eating disorder (BED) do not fully respond to evidence-based treatments. Evidence to guide refinements of treatments is needed. Conceptualizing BED as arising from a network of symptom-to-symptom interactions allows for identification of the most strongly connected symptoms, which could inform...
To date, sociocultural models of body dissatisfaction and disordered eating have predominantly focused on the pursuit of thinness and have somewhat neglected sociocultural discourse and pressures that increase fear of fatness. Therefore, we tested a model to determine whether sociocultural pressures from media and interpersonal sources were associa...
Objective:
In adults, low-weight restrictive eating disorders, including anorexia nervosa (AN), are marked by chronicity and diagnostic crossover from restricting to binge-eating/purging. Less is known about the naturalistic course of these eating disorders in adolescents, particularly atypical AN (atyp-AN) and avoidant/restrictive food intake dis...
Promoting representation of historically marginalized racial and ethnic populations in the eating disorders (EDs) field among professionals and the populations studied and served has long been discussed, with limited progress. This may be due to a reinforcing feedback loop in which individuals from dominant cultures conduct research and deliver tre...
Background
Mothers and fathers have roles in shaping the eating behaviors of young children and the intergenerational transmission of eating attitudes. However, little is known regarding how parental intuitive eating practices are related to characteristics of home food and meal environments.
Objective
To investigate the relationship between paren...
Extant research on body image supports sociocultural theories emphasizing the internalization of societal pressures to attain the thin-ideal, as well as other White or Eurocentric ideals that are predominant in mainstream media. While earlier research suggests that Black women are less likely to report body dissatisfaction and thin-ideal internaliz...
Objective:
Anhedonia, or loss of pleasure, is related to deficits in reward processing across a variety of psychiatric disorders. In light of research suggesting abnormal reward processing in eating disorders (EDs), the study of anhedonia in EDs may yield important insights into the role of reward in eating pathology. This meta-analysis and review...
Longitudinal associations between eating disorders (EDs) and comorbid psychiatric disorders are poorly understood but important to examine as comorbidities are common and can impede ED recovery. We examined two common comorbidities, major depressive disorder (MDD)and substance use disorder (SUD), in adult women with intake diagnoses of anorexia ner...
Objective
Cognitive-behavioral therapy (CBT)—therapist-led (CBTth) and guided-self-help (CBTgsh)—has efficacy for binge-eating disorder (BED) but many patients do not benefit sufficiently. We examined predictors and moderators for these two CBT methods.
Method
Data were aggregated from randomized controlled trials (RCTs) testing psychosocial treat...
The stigmatization of larger bodies is omnipresent in Western society and may be associated with fear of fat, one of the core elements of body image and eating concerns. To date, while much work has focused on sociocultural influences towards thinness, parallel work exploring sociocultural influence on fear of fat is lacking. This study therefore a...
Objective: Sociocultural theories hold that family and peer weight‐related teasing increases the risk for unhealthy weight control behaviors (UWCBs) by negatively impacting body image. Although much cross‐sectional support exists for these pathways, longitudinal data are lacking. This study tested the longitudinal relationships among peer and famil...
The COVID-19 pandemic has profoundly disrupted household food purchasing and preparation, including elements identified as important drivers of household food waste. The two main aims of this study were (1) to examine changes in food waste behaviors since the start of the COVID-19 pandemic in the U.S. and Italy; and (2) to investigate potential pre...
Objective
Although muscle dysmorphia (MD) is a new addition to DSM‐5 as a specifier of body dysmorphic disorder (BDD), previous studies have treated MD as a stand‐alone diagnosis. We aimed to assess the validity of MD as a stand‐alone diagnosis via systematic and meta‐analytic review of MD literature using both Robins and Guze criteria and addition...
Objective
More adopted individuals report experiencing general psychopathology, poor parental attachment, and early childhood eating difficulties than nonadopted individuals, yet little is known about disordered eating in this population. This study sought to describe the relationship between adoption status and behavioral eating‐disorder (ED) symp...
Despite the negative emotional experiences that often accompany the pursuit of an idealized appearance, we know little about emotion regulation in the context of female drive for muscularity. To address this knowledge gap, we examined whether distress tolerance and difficulties in emotion regulation were significantly associated with the drive for...
The current COVID‐19 pandemic has created a global context likely to increase eating disorder (ED) risk and symptoms, decrease factors that protect against EDs, and exacerbate barriers to care. Three pathways exist by which this pandemic may exacerbate ED risk. One, the disruptions to daily routines and constraints to outdoor activities may increas...
Objective:
Outcome states, such as remission and recovery, include specific duration criteria for which individuals must be asymptomatic. Ideally, duration criteria provide predictive validity to outcome states by reducing symptom-return risk. However, available research is insufficient for deriving specific recommendations for remission or recove...
Objective:
This study examined the relationship between eating-disorder behaviors-including restrictive eating, binge eating, and purging-and suicidal ideation. We hypothesized that restrictive eating would significantly predict suicidal ideation, beyond the effects of binge eating/purging.
Methods:
Participants were 82 adolescents and young adu...
Objective:
We aimed to characterize the current and lifetime prevalence of comorbid psychiatric diagnoses and suicidality in treatment- and nontreatment-seeking individuals with full and subthreshold avoidant/restrictive food intake disorder (ARFID). We also sought to examine unique associations between the three DSM-5 ARFID profiles (i.e., sensor...
Objective:
There is increasing public and scientific focus on women's pursuit of a muscular and toned appearance. However, the psychological correlates of women's drive for muscularity are currently unclear. Therefore, we examined the associations of drive for muscularity with four important negative psychological indices among women: eating disor...
Background:
Psychiatric comorbidity is common in eating disorders (EDs) and associated with poor outcomes, including increased risk for relapse and premature death. Yet little is known about comorbidity following ED recovery.
Methods:
We examined two common comorbidities, major depressive disorder (MDD) and substance use disorder (SUD), in adult...
Recruiting diverse samples for prevention trials is challenging, but essential. This paper provides baseline data for four racial/ethnic groups from a randomized controlled trial of a mobile-based prevention intervention and systematically reviews recruitment trends in diversity across technology-based prevention studies. Female emerging adults com...
Public health approaches constitute a potentially powerful avenue for universal prevention and efforts to promote positive embodiment and body image. A small number of public health interventions have aimed, directly or indirectly, to increase these positive ways of inhabiting the body. The present chapter reviews public health interventions at the...
Objective
Avoidant/restrictive food intake disorder (ARFID) and anorexia nervosa (AN) are restrictive eating disorders. There is a proposal before the American Psychiatric Association to broaden the current DSM‐5 criteria for ARFID, which currently require dietary intake that is inadequate to support energy or nutritional needs. We compared the cli...
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 o...
Purpose of Review
Eating disorders are recognized to occur across ethnic and racial groups. The aim of the present review was to examine recent advances in the understanding of the development, presentation, and intervention approaches specific to eating disorders among ethnic and racial minority groups.
Recent Findings
An increasing number of mea...
Mobile interventions promoting positive body image are lacking. This study presents a randomized controlled evaluation of BodiMojo, a mobile application (app) intervention grounded in self-compassion to promote positive body image. A sample of 274 adolescents, mean (SD) age = 18.36 (1.34) years, 74% female, were allocated to a control group or used...
Fear and disgust are distinct emotions that have been independently linked with EDs and may motivate avoidance behaviors that may be relevant targets for ED interventions (e.g., food rejection). Despite similar motivational function, it is possible that one emotion is more strongly associated with ED symptoms, relative to the other. Given that emer...
Objective:
To investigate the prevalence and risk factors for disordered weight control behaviors (DWCB) in South Korean adolescents at multiple levels, including individual, family, school, and geographic area.
Method:
We drew participants from the 11th Korea Youth Risk Behavior Web-based Survey, conducted in 2015, with 65,529 adolescents (31,6...
Socially promoted physical appearance ideals for women place increasing importance on muscularity, resulting in growing muscularity concerns among traditional college-age women. To date, however, instruments for assessing the type of muscularity concerns reported by women are lacking. The aim of the present study was therefore to develop such a sca...
Objective
The objective of this study was to investigate predictors of long-term recovery from eating disorders 22 years after entry into a longitudinal study.
Method
One hundred and seventy-six of the 228 surviving participants (77.2%) were re-interviewed 20-25 years after study entry using the Longitudinal Interval Follow-up Evaluation to assess...
Pregnancy and childbirth result in dramatic changes in a woman's body shape, which can be associated with body image concerns. To date, however, little is known about how sociocultural factors may influence body dissatisfaction in postpartum women. This study aimed to test a sociocultural model of body image and eating concerns among a sample of po...
Objective:
Anorexia nervosa is associated with social-emotional functioning deficits and low levels of the social neurohormone oxytocin, even after weight gain. The relationship between low oxytocin levels and social-emotional functioning impairment has not been studied.
Method:
We performed a cross-sectional study of 79 women (19 who were less...
Objective:
Anxiety is a risk factor for disordered eating, but the mechanisms by which anxiety promotes disordered eating are poorly understood. One possibility is local versus global cognitive processing style, defined as a relative tendency to attend to details at the expense of the "big picture." Anxiety may narrow attention, in turn, enhancing...
Self-compassion is thought to protect from body image concerns. However, the mechanisms of this effect remain unclear. This study examined three positive dimensions of self-compassion as moderators of the mediated relationship between perceived overweight status, appearance comparison, and appearance esteem. A sample of 232 youth aged 13–18 years,...
Network analysis has recently been introduced as a clinically relevant methodology for understanding the structure of mental disorders and for evaluating cognitive behavioral models of psychopathology. The current study uses network analysis to validate the transdiagnostic model of eating disorders by examining the association between overvaluation...
Objective:
For some, fat phobia or fear of uncontrollable weight gain is diagnostic of eating disorders, often inhibiting treatment engagement and predicting symptom relapse. Prior research has reported weight changes at infrequent or long intervals, but rate, shape, and magnitude of long-term changes remain unknown. Our study examined 22-year lon...
Objective:
The course of eating disorders is often protracted, with fewer than half of adults achieving recovery from anorexia nervosa or bulimia nervosa. Some argue for palliative management when duration exceeds a decade, yet outcomes beyond 20 years are rarely described. This study investigates early and long-term recovery in the Massachusetts...
The aim of the study was to test the feasibility of a mindfulness and self-compassion based program for adolescents, to be delivered though mobile phones. Twenty racially and ethnically diverse US adolescents enrolled in a study to use the app for 30 days, after which they provided satisfaction data and participated in focus groups to describe thei...
This study evaluated the impact on young women’s body satisfaction of an advertising campaign: Aerie Real, which included images of models who were not digitally modified. In total, 200 female students were randomly allocated to view either Aerie Real images or digitally modified images from previous campaigns. In the total sample, no condition dif...
In this paper, I report the development of a mentoring program in a College of Health Sciences comprised of schools of nursing, pharmacy, and health professions (which include physical therapy, speech pathology and audiology, applied psychology, and physician assistant programs) at a large private university. Although university-wide mentoring prog...
Purpose
– Mentoring of junior faculty members (i.e. professors) in higher education has been documented to be critical to their academic success which most often takes the form of receiving tenure and/or promotion to higher academic ranks at universities in the USA. A “junior faculty member” would be defined as someone who has not yet been tenured...
Background:
Suicidal ideation is relatively common among people with eating disorders (EDs). The Interpersonal-Psychological Theory of Suicide holds that suicidal ideation has two proximal causes: thwarted belongingness and perceived burdensomeness. It is unknown which ED symptoms are positively associated with suicidal ideation, and whether thwar...
Objective:
To evaluate the capacity of a mobile technology-based intervention to support healthy eating among ethnic minority female students.
Participants:
Forty-three African-American and Hispanic female students participated in a three-week intervention between January and May 2013.
Methods:
Participants photographed their meals using their...
Introduction. - Indoor tanning is associated with increased risk of melanoma and is particularly prevalent among female college students in the U.S. Objectives. - The present study aimed to explore why female students decide to engage, and keep engaging in indoor tanning. Methods. - We included eighteen female undergraduates who participated in gro...
Objective:
The purpose of this meta-analytic review was, first, to evaluate the efficacy of Internet-based programs in decreasing eating disorder (ED) symptoms, and, second, to identify moderator variables these effects.
Method:
Twenty studies were identified and between-group effect sizes were calculated for ED symptoms and risk factors.
Resul...
Previous research has indicated that exposure to pro-eating disorder websites might increase eating pathology; however, the magnitude of this effect is unknown. This study aimed to conduct a systematic review and meta-analysis to examine the effect of exposure to pro-eating disorder websites on body image and eating pathology. Studies examining the...
We examined whether internalization of sociocultural body ideals mediated the relationship between conformity to masculine norms and drive for muscularity, leanness, and thinness in a sample of males from Sweden, US, UK, and Australia. Over six hundred young men [n=142 (Sweden); n=192 (US); n=141 (UK); n=160 (Australia)] completed an online survey...
Previous research has suggested that men's conformity to masculine norms (CMN) is an important correlate of men's drive for muscularity. The present study aimed to further delineate the relationship between masculinity and men's body image by examining various dimensions of CMN in relation to various dimensions of men's body image (muscularity, lea...
Overvaluation of body shape/weight is thought to be the core psychopathology underlying eating disorders, which propels engagement in non-compensatory weight-control behaviors. In turn, these behaviors lead to binge eating and/or maintenance of low weight thereby reinforcing overvaluation. The present study investigated the reciprocal relationship...
Previous studies have separately examined conformity to masculine norms and internalization of body ideals in the media in relation to the drive for muscularity (DM). This study was designed to examine these factors together in relation to DM, and further examine how they may differ in relation to drive for thinness (DT) and drive for leanness (DL)...
Introduction
Universities are believed to present rich opportunities for eating disorder prevention research. However, the widespread recruitment from psychology subject pools and the attractive compensation offered widens the gap between efficacy trials and effectiveness studies, and raises concerns about the possibility of wide-scale disseminatio...
Objective:
The aim of the study was to examine gender differences in baseline and outcome variables in clinical trials for binge eating disorder (BED).
Method:
Data from 11 randomized controlled psychosocial treatment studies were aggregated (N = 1,325: 208 male, 1,117 female). Baseline and outcome symptoms were assessed via the interview and qu...
Interventions aiming to help ethnically diverse emerging adults engage in healthy eating have had limited success. The aim of this study was to assess the feasibility of and adherence to an intervention capitalizing on mobile technology to improve healthy eating. Participants created an online photo food journal and received motivational text messa...
Objectives:
To date, tanning prevention programs have led to limited success. The aim of the present study was to investigate potential unexpected prevention effects of completing an online survey focused on tanning attitudes, behaviors, and knowledge among female college tanners.
Methods:
A sample of 92 female undergraduate students from the US...
This prospective study examined the predictive role of three types of coping responses (i.e., voluntary disengagement, involuntary engagement, and involuntary disengagement) in response to social stress on bulimic symptoms among undergraduate women and men. A total of 883 (308 men; 35%) participants completed the Response to Stress Questionnaire, t...
Background
Adolescents and young adults use text messaging as their primary mode of communication, thus providing an opportunity to use this mode of communication for mobile health (mHealth) interventions. Youth with diabetes are an important group for these mHealth initiatives, as diabetes management requires an enormous amount of daily effort and...
Fat Talk Free Week (FTFW), a social marketing campaign designed to decrease self-disparaging talk about body and weight, has not yet been evaluated. We conducted a theory-informed pilot evaluation of FTFW with two college samples using a pre- and posttest design. Aligned with the central tenets of the Elaboration Likelihood Model (ELM), we investig...
BodiMojo, an Internet program designed to promote positive body image in adolescents, was tested with 178 high school students (mean age 15.2 years, 67.6% ethnic minority) in 3 public high schools in the U.S. The BodiMojo group used the program for 4 class periods, while controls participated in their usual health curriculum. Body image measures we...
Research indicates a relationship between masculinity and body image and highlights the importance of muscularity in young men's sense of masculinity. However, cross-cultural differences in these relationships have not been explored. We examined how conformity to masculine norms relates to attitudes toward muscularity, leanness, and thinness in men...
Media images promote the female thin ideal and have been associated with risk for body dissatisfaction and disordered eating. Little is known about the images of women presented in magazines targeting Latina women, a group vulnerable to body shape and eating concerns. Our aims were to examine time trends in (a) figure type and figure size of magazi...
Objective
Adolescents who self-injure often engage in bingeing/purging (BP). Ecological momentary assessment (EMA) has potential to offer insight into the relationship between self-injury and BP. The aims of this study were to examine the frequency and context of BP using EMA in a sample of nonsuicidal self-injurious (NSSI) adolescents. Method
Thir...
OBJECTIVE Although anorexia nervosa has a high mortality rate, our understanding of the timing and predictors of mortality in eating disorders is limited. The authors investigated mortality in a long-term study of patients with eating disorders. METHOD Beginning in 1987, 246 treatment-seeking female patients with anorexia nervosa or bulimia nervosa...
This study tested the efficacy of an Internet-based health promotion program, BodiMojo, designed to promote positive body image in adolescents. Participants were 178 students (mean age 15.2 years, 67.6% ethnic minority) in three public high schools. Intervention groups used BodiMojo for four weekly health class periods, while controls participated...
Objective:
Binge eating disorder (BED) is prevalent among individuals from minority racial/ethnic groups and among individuals with lower levels of education, yet the efficacy of psychosocial treatments for these groups has not been examined in adequately powered analyses. This study investigated the relative variance in treatment retention and po...
Food insecurity affects a significant percentage of US children. Food insecurity affects households through limited intake and by reducing dietary quality. The objective of this study was to examine the associations between consumption of ready-to-eat (RTE) cereal and nutrient intake, the Healthy Eating Index, and adiposity by food secure status in...
To prospectively explore the relationship between exposure to potentially distressing news content and disordered eating.
Within 2 weeks of the March 3, 2011 Japan earthquake, an online survey was conducted among non-Japanese adults in distant countries (N = 698) assessing time spent on TV and the internet watching the news as well as peritraumatic...
Objective:
Inadequate fruit and vegetable (FV) consumption signals a need for identifying predictors and correlates of intake, particularly in diverse adolescents.
Design:
Participants completed an on-line assessment in early 2010.
Setting:
Computer classrooms in 4 high schools.
Participants:
One hundred twenty-two Caucasian and 125 minority...
The efficacy of 2 computer-based programs was tested with Latina college women (N= 64). Compared with participants in the control group, intervention participants improved their motivation to eat fruits and vegetables (F & V; p= .042) and to participate in physical activity (p= .023) and significantly increased their F&V intake (pre- to posttest, p...
Latina women are vulnerable to poor body image, eating disorders, and obesity, particularly during the college years. This study sought to identify common cultural antecedents of these concerns in order to inform the development of prevention programs for this population. Six groups of university students who identified as Latina (N=27) discussed c...
Latina college women are at risk for eating disorders (EDs), but assessment is problematic, because the psychometric properties of risk factor measures have not been evaluated with this group.
Reliability and validity estimates of the Eating Disorder Examination Questionnaire, Body Esteem Scale, Sociocultural Attitudes Toward Appearance Questionnai...
To determine how often patients diagnosed with bulimia nervosa (BN) surpass their highest pre-morbid weight during the course of their disorder.
The weight histories of individuals with BN were determined using retrospective weight data (Study 1) and combined retrospective/prospective data (Study 2).
Retrospective analyses indicated that 59.0% (n =...
The pursuit of muscularity is an important body image concern among boys which has been described within sociocultural models of risk for eating disorders. This study explored a sociocultural model of disordered eating in which drive for thinness and pursuit of muscularity were both pathways to disordered eating among French adolescent boys. A samp...
Although adult sexual assault has been suggested to be a risk factor for disordered eating, little is known about the pathways leading to this disorder. This study aimed to examine the mediating effect of depressive symptoms and symptoms of posttraumatic stress disorder (PTSD), in the relationship between sexual assault and disordered eating among...
The delivery of psychiatric services may be affected by clinicians' negative reactions to treatment-resistant or stigmatized patient groups. Some research has found that clinicians across professional disciplines react negatively to patients with eating disorders, but empirical data related to this topic have not been systematically reviewed. The a...
Recent studies suggest that binge eating disorder (BED) is as prevalent among African American and Hispanic Americans as among Caucasian Americans; however, data regarding the characteristics of treatment-seeking individuals from racial and ethnic minority groups are scarce. The purpose of this study was to investigate racial/ethnic differences in...
To investigate whether, at study entry, (a) weight suppression (WS), the difference between highest past adult weight and current weight, prospectively predicts time to first full remission from bulimia nervosa (BN) over a follow-up period of 8 years, and (b) weight change over time mediates the relationship between WS and time to first full remiss...
The aims of this study were firstly to evaluate the psychometric properties of the French version of the Orientation towards Chocolate Questionnaire (OCQ), secondly to examine differences in chocolate craving as a function of weight status, and thirdly to examine the OCQ craving dimensions as predictors of body dissatisfaction and disordered eating...