Pamela K Keel's research while affiliated with Florida State University and other places

Publications (263)

Article
Background Stress is associated with binge eating and emotional eating (EE) cross-sectionally. However, few studies have examined stress longitudinally, limiting understanding of how within-person fluctuations in stress influence EE over time and whether stress is a risk factor or consequence of EE. Additionally, little is known regarding how the b...
Article
This multi-method, two-study investigation tested the hypothesis that, controlling for guilt and negative affect, shame increases following binge eating. Support for this hypothesis constitutes the first step in testing the theory that shame mediates the link between binge eating and comorbid psychopathology. Study 1 employed a laboratory binge-eat...
Article
Longitudinal data are needed to examine effects of the COVID-19 pandemic on disordered eating. We capitalized on an ongoing, longitudinal study collecting daily data to examine changes in disordered eating symptoms in women across 49 days that spanned the time before and during the COVID-19 outbreak in the United States. Women from the Michigan Sta...
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Background: One type of overnutrition, binge eating (BE; eating an unusually large amount of food with loss of control), is prevalent among older adult women. Yet, little is known about the clinical significance of this eating disorder pathology in older adults, especially in relation to health outcomes used in geriatrics, while controlling for as...
Article
Background: While negative affect (NA) typically increases risk for binge eating, the ultimate impact of NA may depend on a person's ability to regulate their emotions. In this daily, longitudinal study, we examined whether emotion regulation (ER) modified the strength of NA-dysregulated eating associations. Methods: Women (N = 311) from the Mic...
Article
Objective: The study of emotional eating, or (over)eating in response to emotions, may inform transdiagnostic interventions for eating pathology. Prior work has focused on the role of negative affect in promoting emotional eating. The present study sought to extend this work through examining the role of cognitive biases. Method: Women who self-...
Article
Objective: The current study sought to examine the predictive validity of the purging disorder diagnosis at long-term follow-up by comparing naturalistic outcomes with bulimia nervosa. Method: Women with purging disorder (N = 84) or bulimia nervosa (N = 133) who had completed comprehensive baseline assessments as part of one of three studies bet...
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Objectives: Perimenopause is commonly viewed as a window of vulnerability for developing psychiatric and eating disorders, especially for women who experience severe symptoms. However, menopausal symptoms may have a lasting effect on older women's mental health and quality of life (QOL) into postmenopause. The current study examined older (60+) po...
Article
To identify biobehavioral mechanisms underlying excessive reward consumption, reward valuation-effort (RV-E) assessments should (a) parallel measures in basic science to permit translation from preclinical to clinical studies; (b) quantify constructs dimensionally from healthy to disease states; and (c) hold relevance across different diagnostic ca...
Chapter
Anorexia nervosa (AN) is a psychological disorder characterized by self-starvation and medically low body weight. AN is most common in adolescent girls and young women but affects other age groups and genders, with mixed evidence regarding differences in prevalence across racial/ethnic groups. The disorder's enigmatic nature has engendered much the...
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The COVID-19 pandemic has substantially impacted lives globally. Due to age-related risks, the older adult population has uniquely experienced negative changes caused by the pandemic. Research has also shown that the pandemic has disproportionately affected women. Therefore, it is important to understand how the mental health of older women has bee...
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To mitigate the spread of COVID-19, countries worldwide enacted quarantines, particularly for older adults, as mortality from COVID-19 is inequitably distributed among this group. Notably, social isolation in older adults is associated with a heightened risk of cardiovascular, autoimmune, and mental health problems (e.g., depression, anxiety). Furt...
Article
Exercise Satiation is a novel theoretical conceptualization for problematic exercise often observed in eating disorders. Problematic exercise is present across the spectrum of eating disorder presentations and is a cardinal symptom of eating disorders that has been difficult to treat historically. Conceptualizing exercise in the context of Reward S...
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Background Prior work supports delayed gastric emptying in anorexia nervosa and bulimia nervosa (BN) but not binge-eating disorder, suggesting that neither low body weight nor binge eating fully accounts for slowed gastric motility. Specifying a link between delayed gastric emptying and self-induced vomiting could offer new insights into the pathop...
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Background Suicide is a leading cause of death worldwide, and non-fatal suicide attempts, which occur far more frequently, are a major source of disability and social and economic burden. Both have substantial genetic etiology, which is partially shared and partially distinct from that of related psychiatric disorders. Methods We conducted a genom...
Article
Background Genetics and biology may influence the age at onset of anorexia nervosa (AN). The aims of this study were to determine whether common genetic variation contributes to AN age at onset and to investigate the genetic associations between age at onset of AN and age at menarche. Methods A secondary analysis of the Psychiatric Genomics Consor...
Article
Epidemiological data support higher prevalence of eating disorders in midlife than previously believed. Yet, few studies have examined risk factors unique to adult development. The present study examined how changes in life roles (educational, marital, and parental status) predicted disordered eating as participants transitioned from their 20s to t...
Preprint
Full-text available
Suicide is a leading cause of death worldwide and non-fatal suicide attempts, which occur far more frequently, are a major source of disability and social and economic burden. Both are known to have a substantial genetic etiology, which is partially shared and partially distinct from that of related psychiatric disorders. We conducted a genome-wide...
Article
Objective The Eating Disorder Inventory provides a theoretically informed multidimensional assessment of eating disorder symptoms and associated psychological factors widely used to examine the development and maintenance of eating disorders. Yet, mixed findings for some factors raise questions about whether their prognostic value varies as a funct...
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Conventional longitudinal behavioral genetic models estimate the relative contribution of genetic and environmental factors to stability and change of traits and behaviors. Longitudinal models rarely explain the processes that generate observed differences between genetically and socially related individuals. We propose that exchanges between indiv...
Article
Ovarian hormones significantly influence dysregulated eating in females. However, most women do not develop appreciable disordered eating, which suggests that ovarian hormones may not affect all women equally. We examined whether individual differences in trait negative affect (NA) moderate ovarian hormone–dysregulated eating associations in 446 wo...
Article
As the literature on the narrowly defined standards of beauty portrayed in social media has increased, a newer focus on body positivity messages has also emerged. Body positivity challenges the unrealistic standards of beauty present in the media by the promotion and acceptance of diverse body sizes and appearances. In an effort to further understa...
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Objective Amidst restrictions to reduce the spread of COVID‐19, jokes have surfaced regarding weight gain during the pandemic. The current study documents perceived changes since COVID‐19 and compares these to observed longitudinal changes in reported weight, BMI, and how college students described their weight from January to April 2020. Method U...
Article
Background Individuals with eating disorders (EDs) have increased rates of major depressive disorder (MDD) and anxiety disorders. Yet, few studies have investigated rates of EDs and their symptoms in individuals presenting with MDD/anxiety disorders. Identifying potential disordered eating in people with MDD/anxiety disorders is important because e...
Article
Research supports increasing cultural pressures for leanness among young men; however, few studies have examined whether weight dissatisfaction or efforts to alter weight have become more prevalent for men over time. The present study evaluated secular trends in weight dissatisfaction and related behaviors among college-age men across 4 decades; 1,...
Chapter
This chapter reviews information on the epidemiology of binge eating and disorders defined by the presence of recurrent binge-eating episodes, bulimia nervosa (BN), and binge-eating disorder (BED). Prevalence estimates indicate that binge eating affects 4.9% of females and 4% of males over their lifetimes. BN occurs in about 1.9% of females and 0.6...
Article
Eating disorders (EDs) are more common among younger women compared to older women and in women compared to men. As such, most ED research focuses on late adolescent and young adult females resulting in limited prospective research on gender differences in eating disorder psychopathology across the life span. The present study addresses this gap by...
Article
Objective Social media use has been implicated as a correlate and a cause of increased disordered eating (DE), but little is known about the impact of specific aspects of social media use, such as posting edited photos of the self. Utilizing a two‐stage design, the present study sought to determine how posting edited photos relates to DE, as well a...
Article
Objective: This preliminary study explored whether differences in meal-stimulated insulin or amylin release are linked to altered ingestive behaviors in individuals with bulimia nervosa (BN) or purging disorder (PD). Method: Women with BN (n = 15), PD (n = 16), or no eating disorder (n = 18) underwent structured clinical interviews and assessmen...
Article
There is extensive evidence for the clinical significance of Purging Disorder (PD), an eating disorder characterized by recurrent purging behavior (self-induced vomiting, laxative use, and diuretic use) in the absence of binge eating and low weight (Smith, Crowther, & Lavender, 2017). Research on the personality profile of PD is still developing bu...
Article
Background The DSM-5 introduced purging disorder (PD) as an other specified feeding or eating disorder characterized by recurrent purging in the absence of binge eating. The current study sought to describe the long-term outcome of PD and to examine predictors of outcome. Methods Women ( N = 84) who met research criteria for PD completed a compreh...
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Punishment sensitivity can contribute to eating pathology, but the mechanisms of this relationship are understudied. In a longitudinal study of undergraduate females (N = 95), results supported an indirect association between sensitivity to punishment and eating pathology via shame. Findings suggest that sensitivity to punishment was associated wit...
Article
Background: Low emotion differentiation (the tendency to experience vague affective states rather than discrete emotions) is associated with psychopathology marked by emotion regulation deficits and impulsive/maladaptive behavior. However, research examining associations between emotion differentiation and dysregulated eating is nascent and has ye...
Article
Objective: The cognitive-behavioral therapy (CBT) model of eating disorders suggests that compensatory purging behaviors (e.g., self-induced vomiting, inappropriate laxative use) are primarily driven by binge eating. However, many individuals endorse purging in the absence of binge eating (i.e., noncompensatory purging [NCP]). Research is needed t...
Article
Purpose Schachter’s externality theory posits a connection between the inability to eat according to internal cues and higher body mass index (BMI); however, related work has not investigated associations between body trust and the wide range of BMIs found in general samples. This study examined the association between body trust and BMI across lev...
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Objective: Body dissatisfaction is intricately linked to the development of disordered eating. However, as male body dissatisfaction appears more oriented toward muscularity, versus thinness per se, existing measures of eating disorder psychopathology may lack sensitivity in capturing disordered eating that is muscularity-focused. The aim of the p...
Article
Purpose of review: The present review aims to help specialists remain up-to-date on research from the past 2 years on epidemiology, risk factors, biological correlates, treatment, and outcomes for purging disorder, a DSM-5 other specified feeding and eating disorder. Recent findings: Purging disorder affects 2.5-4.8% of adolescent females in pop...
Article
Recent research indicates that weight suppression (WS: defined as the difference between highest lifetime and current weight) prospectively predicts illness trajectory across eating disorders characterized by binge eating, including AN binge-purge subtype (ANbp), bulimia nervosa (BN), and binge eating disorder (BED), collectively referred to as bul...
Article
Objective Research suggests that weight suppression (WS) is linked to non‐suicidal self‐injury (NSSI) and that drive for thinness and depression may explain this association. We conducted a proof‐of‐concept study using a randomized control trial design to determine if improving body esteem and reducing depressive symptoms reduced NSSI in individual...
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Objective Elevated ovarian hormone levels are associated with increased risk for binge eating (BE) and emotional eating (EE) during the midluteal phase of the menstrual cycle. However, past studies have not examined whether pronounced hormonal changes that precede the midluteal phase (i.e., the dramatic decrease in estradiol and increase in progest...
Article
Objective This study examined a hypothesized pathway by which interoceptive dysfunction accounted for associations between personality features (harm avoidance, self‐directedness, and perfectionism) and anorexia nervosa (AN) severity (indicated by drive for thinness, eating disorder‐related preoccupations and rituals, and body mass index). Method...
Article
During adolescence, peer approval becomes increasingly important and may be perceived as contingent upon appearance in girls. Concurrently, girls experience hormonal changes, including an increase in progesterone. Progesterone has been implicated in affiliative behavior but inconsistently associated with body image concerns. The current study sough...
Article
Objective Previous research suggests that men with eating disorders are less likely to seek treatment than are women. Given stereotypes linked to eating disorders, men may be less likely to recognize when they have an eating disorder, which could act as a barrier to treatment‐seeking. Method The current study examined differences in self‐recogniti...
Article
Objective Research evidence supports the clinical significance of subjective feelings of loss of control over eating; however, limited attention has been given to how this construct is assessed. Two measures have been developed in recent years (i.e., Eating Loss of Control Scale [ELOC] and Loss of Control over Eating Scale [LOCES]), but further val...
Article
Objectives: Public health initiatives to increase parental awareness about children's obesity have become more prominent in the past decade. These initiatives may contribute to increased concern in parents for their children's weight, even if their children are at a healthy weight. The aim of the present study was to document trends in parental (N...
Article
Background: Given the negative consequences of excess weight, a large portion of the US population is seeking to obtain and maintain weight loss. Weight Suppression (WS) represents the difference between previous highest adult weight and current weight and may have negative psychological consequences. The current study examined the link between WS...
Article
Purging disorder (PD) has been included as a named condition within the DSM-5 category of Other Specified Feeding or Eating Disorder and differs from bulimia nervosa (BN) in the absence of binge-eating episodes. The current study evaluated satiation through behavioral and self-report measures to understand how this construct may explain distinct sy...
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Avoidant-restrictive food intake disorder (ARFID) is a current diagnosis in the “Feeding and Eating Disorders” section of the Diagnostic and Statistical Manual of Mental Disorders (fifth edition) and captures a heterogeneous presentation of eating disturbances. In recent years, ARFID has been studied primarily within the context of eating disorders...
Article
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...
Article
Objective: Little is known about biological factors that contribute to purging after normal amounts of food-the central feature of purging disorder (PD). This study comes from a series of nested studies examining ingestive behaviors in bulimic syndromes and specifically evaluated the satiety peptide YY (PYY) and the hunger peptide ghrelin in women...
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This study investigated associations between sensitivity to punishment and reward, shame, and eating pathology by testing alternative mediation models in which shame mediated associations between temperament and eating pathology or eating pathology mediated associations between temperament and shame. Participants were 96 female undergraduate studen...
Article
Objective: Longitudinal studies support a prospective relationship between weight suppression (WS) and bulimic syndrome (BN-S) maintenance. Although biobehavioral mechanisms have been proposed to explain this link, such mechanisms have yet to be identified. Given that weight loss would reduce leptin levels which may influence eating, this study ex...
Article
Theoretical models of binge eating and eating disorders include both transdiagnostic and eating disorder-specific risk factors. Negative urgency (i.e., the tendency to act impulsively when distressed) is a critical transdiagnostic risk factor for binge eating, but limited research has examined interactions between negative urgency and disorder-spec...
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This introduction presents the context in which the Journal of Abnormal Psychology created a special section to highlight outstanding contributions by young investigators in the field of eating disorders. The first motivating factor relates to our field’s approach to mentoring and supporting its next generation of researchers. The second motivating...
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This is a time of striking progress in the field of eating disorders, and outstanding young psychological scientists are playing an important role in this progress. This special section provides a sample of this work, which is characterized by a diversity of research questions and methods. The importance of transdiagnostic processes that increase r...
Article
Objective: Pressures for men to conform to a lean, muscular ideal have, in part, contributed to eating disorder and muscle dysmorphia symptoms, yet few programs have been developed and empirically evaluated to help men. This study investigated the acceptability and efficacy of a cognitive dissonance-based (DB) intervention in reducing eating disor...
Article
Objective: Atypical anorexia nervosa (AAN) is defined by the symptoms of anorexia nervosa in the presence of "significant weight loss" in individuals who are not underweight. Description of current weight in AAN has been limited, significant weight loss has not been defined, and the distinction between having AAN versus having weight suppression h...
Article
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...
Article
Weight suppression predicts the onset and maintenance of bulimic syndromes. Despite this finding, no study has examined psychological mechanisms contributing to these associations using a longitudinal design. Given societal pressures to be thin and an actual history of higher weight, it is possible that greater weight suppression contributes to inc...
Article
Objective: Prior twin studies provide support for a single "common factor" that contributes genetic and environmental risk to a range of disordered eating symptoms. However, the common factor may be indexed less well by binge eating (BE) than other symptoms of eating disorders [i.e., body dissatisfaction (BD) and weight preoccupation (WP)]. We sou...
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Objective: Popular beliefs suggest that parents influence children's eating disorder risk through modeling pathological behaviors and attitudes, and this history may contribute to disordered eating in adulthood. However, the empirical basis for this popular thinking is limited by a reliance on cross-sectional designs that do not distinguish betwee...
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Recent data show shifts in genetic and environmental influences on emotional eating across the menstrual cycle, with significant shared environmental influences during pre-ovulation and primarily genetic effects during post-ovulation. Factors driving differential effects are unknown, although increased estradiol during pre-ovulation and increased p...
Article
The current studies examined the hypothesis that maturity fears are increasing among undergraduate men and women from the United States over time. Study 1 used a time-lag method to assess generational effects of maturity fears among a large sample (n = 3291) of undergraduate men and women assessed in 1982, 1992, 2002, and 2012. Results revealed tha...
Article
The maintenance of normal body weight is disrupted in patients with anorexia nervosa (AN) for prolonged periods of time. Prior to the onset of AN, premorbid body mass index (BMI) spans the entire range from underweight to obese. After recovery, patients have reduced rates of overweight and obesity. As such, loci involved in body weight regulation m...
Article
Reliability has a long history as one of the key psychometric properties of a test. However, a given test might not measure people equally reliably. Test scores from some individuals might have considerably greater error than others. This study proposed two approaches using intraindividual variation to estimate test reliability for each person. A s...
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Objective: Of the two primary features of binge eating, loss of control (LOC) eating is well validated while the role of eating episode size is less clear. Given the ICD-11 proposal to eliminate episode size from the binge-eating definition, the present study examined the incremental validity of the size criterion, controlling for LOC. Method: I...
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Objective: Purging behaviors, including self-induced vomiting, laxative abuse, and diuretic abuse, are present across many of the eating disorders. Here we review the major medical complications of these behaviors. Method: Although we identified over 100 scholarly articles describing medical complications associated with purging, most papers inv...
Article
Objective: Little empirical attention has been paid to the DSM-5 definition of binge eating disorder (BED), particularly to the associated features of binge episodes. The present study sought to determine how the associated features and undue influence of weight/shape on self-evaluation contribute to evidence of a clinically significant eating dis...
Article
Bulimia nervosa (BN) is a serious eating disorder that can persist for years and contribute to medical complications and increased mortality, underscoring the need to better understand factors maintaining this disorder. Higher levels of weight suppression (WS) have been found to predict both the onset and maintenance of BN; however, no studies have...
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Previous studies have shown significant within-person changes in binge eating and emotional eating across the menstrual cycle, with substantial increases in both phenotypes during post-ovulation. Increases in both estradiol and progesterone levels appear to account for these changes in phenotypic risk, possibly via increases in genetic effects. How...
Article
Cross-sectional studies support that bisexual and gay (BG) men are at increased risk for eating pathology, and romantic relationships may buffer against risk; however, no studies have examined this association longitudinally. The current study examined how romantic relationships impact the trajectory of eating pathology in BG versus heterosexual me...
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Full-text available
Objective Negative urgency (NU; tendency to act impulsively when experiencing negative emotions) is a risk factor for binge eating, although few studies have examined interviewer-assessed objective binge episodes (OBEs). Moreover, research has not investigated how NU relates to the core components of OBEs: loss of control (LOC) eating and objective...
Article
Purging disorder (PD) was recently included as an otherwise specified feeding or eating disorder (OSFED) in the DSM-5; however, limited information is available on its prevalence, and its etiology is unknown. Data from 1,790 monozygotic and 1,440 dizygotic European American female twins (age range = 18-29 years) from the Missouri Adolescent Female...
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This study examined pre- and postprandial glucagon-like peptide 1 (GLP-1) levels in women with bulimia nervosa (BN), purging disorder (PD), and non-eating disorder control women to better understand whether alterations in satiation-related hormones in BN may be linked to binge-eating episodes or other altered ingestive behaviors. Participants inclu...
Article
Fat-talk is a common experience in college-aged women, yet little is known about fat-talk in men and across the lifespan. Exposure to fat-talk was compared in a large sample of men (n = 819) and women (n = 1,696) across four age cohorts. Greater exposure to fat-talk was associated with increased disordered eating for men and women. Men experienced...
Article
Research suggests that affect may play an important role in the propensity to purge among women with purging disorder (PD). However, prior work has been constrained to cross-sectional or laboratory designs, which impact temporal interpretations and ecological validity. This study examined negative affect (NA) and positive affect (PA) in triggering...
Article
Prenatal testosterone exposure may be protective against disordered eating. However, prior studies have produced mixed results. Developmental differences in prenatal testosterone's protective effects on disordered eating may explain these discrepancies. Indeed, studies have differed in the age of participants assessed, with data supporting prenatal...
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Eating disorders are serious psychiatric illnesses associated with health problems. Such problems may compromise military performance, highlighting the need to establish the level of eating pathology that exists in military samples. This article qualitatively reviews prevalence estimates of eating disorder symptoms and diagnoses in military samples...