Investigating the role of attachment in social comparison theories of eating disorders within a non‐clinical female population

Objective : The present study aimed to integrate attachment theory and sociocultural theory as predictors of disordered eating, thereby combining two previously distinct literatures in order to provide a more comprehensive model of eating disorder development. It was specifically proposed that women's attachment style may influence their tendency to socially compare themselves to idealised others. Method : Participants (N = 213) were non‐clinical female undergraduates. Sociocultural attitudes to appearance, social comparison, attachment and eating disorder symptomatology were assessed using self‐report questionnaires. Results : Consistent with the hypothesis, social comparison was found to mediate the relationship between attachment anxiety and disordered eating. In addition, attachment avoidance, was not significantly associated with either internalisation of cultural ideals or social comparison but was significantly related to eating psychopathology. C onclusion : The findings suggest that attachment anxiety and avoidance influence disordered eating via different pathways, with attachment anxiety specifically being implicated in sociocultural models of disordered eating. Copyright © 2009 John Wiley & Sons, Ltd and Eating Disorders Association.     

Self‐esteem,depression and eating disordered attitudes: A cross‐cultural comparison between Cypriot and British young women

The evidence suggests that eating disorders in countries that fall outside the Western template are not immune to eating disturbance as previously thought. This cross‐cultural study investigated self‐esteem, depression in relation to eating disordered attitudes across similarly constituted samples from two different cultures, Cyprus and Great Britain. Results revealed higher rates of eating disordered attitudes and depressive tendencies in Cypriot women. For both samples, a positive relationship was found between depression and eating disordered attitudes and this relationship was found to be significant. This study explores the native influences and possible vulnerability factors which may contribute in the development of eating disturbances in a non‐Western country, Cyprus. Implications for future research are discussed. Copyright © 2009 John Wiley & Sons, Ltd and Eating Disorders Association.     

Illness pathways between eating disorder and post‐traumatic stress disorder symptoms: Understanding comorbidity with network analysis

Eating disorders (EDs) and post‐traumatic stress disorder (PTSD) are highly comorbid. However, specific mechanisms by which PTSD‐ED comorbidity is maintained are unknown. The current study constructed two PTSD‐ED comorbidity networks (25 EDs and 17 PTSD symptoms) in two samples: a clinical (N = 158 individuals with an ED diagnosis) and a nonclinical sample (N = 300 college students). Glasso networks were constructed to identify (1) pathways between disorders (bridge symptoms) and (2) core symptoms. Three illness pathways emerged: between binge eating and irritability, between desire for a flat stomach and disturbing dreams, and between concentration problems and weight and shape‐related concentration problems. Our findings suggest that pathways between binge eating and irritability, body dissatisfaction and trauma reminders, and concentration difficulties may be the mechanisms by which comorbidity is maintained. Interventions disrupting these pathways and targeting core and bridge symptoms may be more efficient than traditional treatment approaches.     

A computer assisted eating disorder specific quality management system: EQUAL‐TREAT

In 1997 the COST B6 European Collaboration, which includes researchers from 19 European countries, began to develop a system of quality management to be used in the treatment of eating disorders. The system which arose out of this collaboration is presented in the current article. It is an extension of the ‘Heidelberg–Stuttgart Model’ of quality management which was designed for the treatment of patients with psychiatric illnesses. This model is well established in Germany where it has been used in a number of psychiatric hospitals for over 6 years. The model relies on the concept of ‘active internal quality management’ with external support. It incorporates solutions of the three key tasks of quality management: (1) the construction of an inventory for monitoring of relevant quality criteria in clinical practice, (2) operationalization of assessment tools which allow comparison with norms (Ist–Soll–Vergleich) on various levels of service provision and (3) provision of feedback tools. The central function of the system is the alarm function, which signals a possible deficit in treatment. This is based on treatment outcomes for individual patients according to the system. This information is then aggregated to facilitate continuous internal monitoring of quality, and is finally arranged for external comparisons. In this article we explain the principles of the system, introduce the model and illustrate its use with two clinical examples. Copyright © 1999 John Wiley & Sons, Ltd and Eating Disorders Association.     

French adaptation of the eating disorder recovery self‐efficacy questionnaire (EDRSQ): Psychometric properties and conceptual overview

High prevalence of Eating Disorders (EDs) and poor treatment outcome rates have urged research in the assessment of EDs. Self‐efficacy is a key motivational factor in the recovery from EDs. A self‐report measure, the Eating Disorder Recovery Self‐Efficacy Questionnaire (EDRSQ), was recently developed to assess confidence in adopting healthy eating behaviours and in maintaining a realistic body image. The objectives of this study were to (a) translate the EDRSQ to French (EDRSQ‐F), (b) assess the psychometric properties of this French version, and (c) establish normative data for a non‐clinical sample. Participants were 203 undergraduate women. They completed the EDRSQ‐F and measures of ED symptoms, depression and self‐esteem. A confirmatory factor analysis (CFA) revealed a bi‐factorial structure. Both scales demonstrated evidence of reliability and theoretically consistent evidence of construct validity. Findings support the validity of the EDRSQ‐F and suggest it is a useful instrument for the assessment of EDs. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.     

Let eating disorder patients decide: Providing choice may reduce early drop‐out from inpatient treatment

Premature drop‐out from treatment is a highly prevalent phenomenon among eating disorder (ED) patients. In a specialized inpatient treatment unit a major change was made in the admission strategy in 2001, giving a maximum of personal choice to the patients. A quasi‐experimental research was carried out comparing 87 patients treated till 2000 (‘old’ strategy) with 87 patients treated from 2001 on (‘new’ strategy). The results indicate that the provision of choice at the beginning of treatment significantly reduced drop‐out during the first weeks of inpatient treatment. No differences between both strategies on later drop‐out and weight change (in anorexia nervosa patients) during inpatient treatment were found. The results are discussed in the light of the importance placed on dynamics of personal choice, autonomy and volition within the framework of the self‐determination theory (SDT). Copyright © 2009 John Wiley & Sons, Ltd and Eating Disorders Association.     

A longitudinal study on the association between facets of mindfulness and eating disorder symptoms in individuals diagnosed with eating disorders

Mindfulness‐based treatments for eating disorders could be improved by understanding how facets of mindfulness predict eating disorder symptoms over time. We examined whether facets of mindfulness predict eating disorder symptoms over time and vice versa. Individuals with an eating disorder diagnosis (N = 124; 87.9% diagnosed with anorexia nervosa) and an undergraduate sample (N = 290) completed measures of mindfulness at baseline. The clinical sample also completed these measures 1 month later. Individuals in the clinical sample had lower acting with awareness and higher observing than individuals in the undergraduate sample (ps < 0.002). In the clinical sample, higher body dissatisfaction prospectively predicted lower acting with awareness (p = 0.02). Lower acting with awareness prospectively predicted higher drive for thinness (p < 0.01) and bulimic symptoms (p < 0.01). Acting with awareness shows potential as a process that can be altered to effect positive outcomes on drive for thinness and bulimic symptoms.     

Drop‐out from treatment for the eating disorders: A problem for clinicians and researchers

All professionals who work in the field of eating disorders will have encountered patients who do not make it into or through a course of treatment. This paper considers some of the difficulties that drop‐out poses to clinicians and researchers. It also suggests strategies for addressing these challenges in future research and clinical practice. Copyright © 2009 John Wiley & Sons, Ltd and Eating Disorders Association.