Eating disturbances in girls with diabetes: the contribution of adolescent self-concept,maternal weight and shape concerns and mother-daughter relationships

BACKGROUND: This study examined the relative contribution of adolescent self-concept, maternal weight and shape concerns (WSC), and mother-daughter relationships to eating disturbances among girls with type 1 diabetes mellitus (DM). METHOD: Eighty-eight adolescent girls (mean = 15.0 years, S.D. = 2.2) and their mothers completed self-report measures of disordered eating and weight control behaviours, with teens also reporting on disturbed eating and body attitudes. Based on reported symptoms, adolescents were classified as highly (N = 18), mildly (N = 30) and non-eating disturbed (N = 40). Self-concept was assessed by adolescent self-report. Mother-daughter relationships were assessed by adolescent self-report and by observed mother-daughter interactions that were rated using a macroanalytic coding system that assesses intimacy and autonomy in these relationships. RESULTS: Hierarchical regressions illustrated that adolescent self-concept deficits, maternal WSC, and impaired mother-daughter relationships significantly predicted eating disturbances in girls with DM, accounting for 57% of the variance. Mothers who engaged in dieting and binge-eating were more impaired in their ability to support their daughters' emerging autonomy. The quality of mother-daughter relationships partly mediated the influence of maternal WSC on adolescent eating disturbances. Moreover, the impact of maternal WSC and mother-daughter relationships on eating disturbances was mediated by adolescent self-concept. CONCLUSIONS: Findings illustrate two pathways through which mother-daughter relationships may impact upon risk of eating disturbances in girls with DM and highlight the need to evaluate family-based interventions specifically tailored for this high-risk population.     

Understanding affective and cognitive self‐evaluations about the body for adolescent girls

Objective. The aim of this study was to understand relations between cognitive and affective self‐evaluations about the body for adolescent girls in the context of their diverse experiences of the body. Method. The project involved adolescent girls (N =141), including underweight to overweight schoolgirls, and hospitalized girls with anorexia nervosa (AN). Materials were brief, reliable inventories of self‐concepts about body, movement and appearance, and feelings about the body. Results. Measurement models confirmed the related yet discrete self‐concepts about the body, movement and appearance, and feeling OK, guilt, worry, disgust, and anger about the body. Self‐concepts and feelings were not correlated with body weight, and were sensitive and specific for girls with AN versus low‐weight schoolgirls. Relations among self‐concepts and feelings about the body vary with the context. In particular, self‐concepts and feelings about the body were incongruent for AN girls with acute experiences of making self‐evaluations of their bodies. Discussion. It is clear that self‐evaluations by adolescent girls do not necessarily reflect actual body weight. Findings suggest that associations between thoughts and feelings about the body vary with diverse experiences of the body. Results support brief, reliable, and valid indicators of self‐concepts and feelings about the body that are vital in the design of prevention, intervention, and monitoring, and the evaluation of programmes for girls in clinical and educational settings.     

Body‐related cognitive distortions (thought–shape fusion body) associated with thin‐ideal exposure in female students—An ecological momentary assessment study

Etiological models of eating disorders (EDs) describe body dissatisfaction (BD)as one of the major influences fostering dysfunctional body‐related behaviour and disordered eating behaviour. BD is influenced by repeated exposure to thin ideals that evoke high self‐ideal discrepancy and result in body‐related cognitive distortions such as thought–shape fusion body (TSF‐B). The aim of this study was to investigate the covariation of daily media exposure and the experience of TSF‐B in a naturalistic setting. It was further analysed whether TSF‐B is associated with self‐ideal discrepancy, dysfunctional body‐related behaviour, and disordered eating behaviour. Moreover, person‐related predictors of TSF‐B were explored. Altogether, 51healthy female students (mean age 21.06years, SD = 1.76) participated in an ecological momentary assessment study with four daily surveys during 10consecutive days. Exposure with thin ideals in contrast to exposure to unspecific media contents went along with the experience of TSF‐B. TSF‐B was associated with higher self‐ideal discrepancy and dysfunctional body‐related behaviour as well as more pronounced disordered eating behaviour, suggesting that TSF‐B is a common phenomenon in young healthy females' everyday life. A main effect of trait measures (e.g., pre‐existing BD) on TSF‐B was observable but has no moderating effect. Thus, a specific vulnerability has not been detected.     

5‐HT2AR and BDNF gene variants in eating disorders susceptibility

Evidence from family and twin studies points to a genetic contribution to the etiology of eating disorders (EDs), confirmed by the association of several single nucleotide polymorphisms (SNPs) with this group of disorders. Previous reports have suggested that the serotonin receptor (5‐HT2AR) and brain‐derived neurotrophic factor (BDNF) genes could be both involved in EDs susceptibility. In order to provide further evidence about such association, we focused our attention on two SNPs located in these genes carrying out a genetic association study on a large Italian cohort composed of 556 ED patients and 355 controls (CTRs). Obtained results confirm the presence of an association between 5‐HT2AR and BDNF genes and the susceptibility to EDs.     

Strategies of emotion regulation in adolescents and young adults with substance dependence or eating disorders

Some authors argue that both substance dependence and eating disorders should be considered as dependent behaviours. Similarities and differences between these disorders, however, remain unclear. This study compares processes of emotion regulation in adolescents and young adults (15 to 25 years old) with substance dependence (SD) or eating disorders (ED). One hundred and thirteen SD, 50 ED and 86 non‐clinical subjects (NC), recruited in four French and Swiss locations, completed a self‐report questionnaire of emotion regulation strategies. This questionnaire addresses the subjects' relationships, concerning past and present family, and refers to Main's (1990) concept of primary strategy (balanced activation and deactivation of attachment behaviours), and of secondary strategies (hyperactivation or excessive deactivation of the attachment system). Participants were also questioned in structured interviews, about life events and DSM‐IV classification criteria. SD reported more adverse events than ED and NC. SD and ED reported using fewer primary strategies than NC, and SD had secondary strategies that were different from those of ED. Patients with eating disorders reported more hyperactivation, and SD reported more deactivation of the attachment system. It is hypothesized that while subjects with SD and ED have in common poorly regulated strategies, they differ in the way they process emotion or relationship‐related information. Copyright © 2002 John Wiley & Sons, Ltd.     

Factors of risk and maintenance for eating disorders: psychometric exploration of the cross-cultural questionnaire (CCQ) across five European countries

Objective: To explore the psychometric properties of the Cross‐Cultural Questionnaire (CCQ), a new self‐report tool for assessing factors of risk and maintenance for eating disorders (ED). Method: Data was collected during a multi‐centre case‐control study. The sample included 854 ED patients and 784 healthy participants from the UK, Spain, Austria, Slovenia and Italy. Exploratory factor analyses examined the factor structure of each section of the CCQ, and Cronbach's alpha coefficients valued the internal consistency of each derived scale score. Logistic regression and receiver operating characteristic (ROC) curve procedure assessed the screening accuracy and predictive validity of the empirical factors. Results: Based on a total of 127 items, nine dimensions emerged, with satisfactory internal consistency and high congruence between countries. CCQ scores demonstrated satisfactory accuracy for discriminating between ED cases and controls (area under the ROC curve = 0.88). Most of the items achieved discriminative accuracy. Conclusions: This study offers preliminary evidence that the CCQ, available in five languages, is a useful and valid tool to assess factors of risk and maintenance for EDs. Copyright © 2010 John Wiley & Sons, Ltd. Key Practitioner Message: ? The CCQ is a new self‐report questionnaire for assessing factors of risk and maintenance for eating disorders. ? The CCQ is available in five languages (Spanish, English, German, Italian and Slovenian) and is free of charge for research purposes. ? CCQ scores demonstrated satisfactory accuracy for discriminating between ED cases and controls.     

Eating disorder behaviors and depression: a minimal relationship beyond social comparison,self‐esteem,and body dissatisfaction

Existing literature fails to comprehensively identify factors contributing to the comorbid relationship between eating disorder (ED) behaviors and unipolar depression. Maladaptive social comparison, body dissatisfaction, and low self‐esteem are disruptive psychological patterns common to both constructs. It is unclear whether a unique relationship exists between depression and eating disorder behaviors beyond the effects exerted by this negative cognitive triad. The purpose of the present study is to examine whether a unique relationship exists between depression and ED behaviors after controlling for maladaptive social comparison, body dissatisfaction, and low self‐esteem. We predict minimal unique variance in ED behaviors will be explained by depression after controlling for this negative cognitive triad. © 2009 Wiley Periodicals, Inc. J Clin Psychol 65:1–11, 2009.     

Pre‐adolescent gender differences in associations between temperament,coping, and mood

Relationships between temperament, coping, depressive and aggressive mood in 8–12‐year‐old boys (n = 185) and girls (n = 219) were investigated, with a focus on gender differences. Children completed two self‐report questionnaires: the Early Adolescent Temperament Questionnaire‐Revised and Children's Coping Strategies Checklist‐Revised1. Comparing boys and girls on three temperament dimensions, positive affectivity, negative affectivity and effortful control, girls scored higher than boys on the first two dimensions. Girls also scored higher than boys on avoidant coping and depressive mood. For both boys and girls, aggressive and depressive mood were predicted by negative affectivity. Coping did not add towards this prediction. Gender specific models of temperament, coping and depressive mood were tested. For girls, both effortful control and active problem solving, accounted for the variability in depressive mood. For boys, only effortful control accounted for variance in depressive mood. Results showed that gender specific vulnerability to depression in girls is apparent before adolescence and can be linked to temperament and coping. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message:

• Pre‐adolescent girls are more vulnerable to depression than boys. Interventions focussing on self‐control, emotion regulation and active coping are tailored towards vulnerabilities in temperament and coping in girls.

     

Self‐image and treatment drop‐out in eating disorders

Introduction . Drop‐out from treatment is a serious problem in eating disorders which remains poorly understood. The present study investigated whether self‐image and interpersonal theory could help to explain why eating disorder patients drop out of treatment. Method . Intake data on eating disorder patients who terminated treatment prematurely (N=54) were compared with patients who had completed treatment (N=54) and those who were still in treatment after 12 months (N=54). Self‐image was assessed using the structural analysis of social behaviour (SASB), and comparisons were made on demographic and clinical variables. Results . Patients who dropped out had initially presented with less negative self‐image and fewer psychological problems compared with remainers. Low levels of SASB self‐blame discriminated drop‐outs from completers and remainers and significantly predicted treatment drop‐out. Discussion . Drop‐out in eating disorders appears to be a complex phenomenon, not necessarily as pathological as often assumed. There may be important differences in the treatment goals of drop‐outs and therapists; patients who drop out may be choosing to disengage at a time when symptom improvement creates space for closer examination of interpersonal issues.     

Longitudinal gains in self‐regulation from regular physical exercise

Objectives. The purpose of the present study was to test whether the repeated practice of self‐regulation could improve regulatory strength over time. Method. Regulatory performance was assessed at baseline, then at monthly intervals for a period of 4 months using a visual tracking task. Perceived stress, emotional distress, self‐efficacy and general regulatory behaviour were assessed by questionnaire. Following a 2‐month control phase, participants entered a 2‐month self‐regulation programme designed to increase regulatory strength: a programme of regular physical exercise. Results. Relative to the control phase, participants who exercised showed significant improvement in self‐regulatory capacity as measured by an enhanced performance on the visual tracking task following a thought‐suppression task. During the regulatory exercise phase, participants also reported significant decreases in perceived stress, emotional distress, smoking, alcohol and caffeine consumption, and an increase in healthy eating, emotional control, maintenance of household chores, attendance to commitments, monitoring of spending and an improvement in study habits. The control phase showed no systematic changes in performance on the visual tracking task across sessions. Reports of perceived stress, emotional distress and regulatory behaviours were also stable across sessions. Conclusions. The uptake and maintenance of an exercise programme over a 2‐month period produced significant improvements in a wide range of regulatory behaviours. Nearly every major personal and social problem has some degree of regulatory failure. The idea that the capacity for self‐regulation can be improved is therefore of vast practical importance.     

Disordered eating in girls with Type 1 diabetes: Examining directions for prevention

Girls with Type 1 diabetes (insulin‐dependent diabetes mellitus [IDDM]) have been identified to be at an increased risk for developing bulimia nervosa (BN) and subthreshold eating disorders. The co‐occurrence of these conditions can severely compromise the physical health of these individuals and can even accelerate mortality. The use of a unique and dangerous purging behaviour called insulin manipulation is of particular concern among young women with IDDM because this has been shown to be associated with metabolic dysfunction and devastating complications such as retinopathy. Therefore, development of prevention programs designed to protect girls with IDDM against developing disordered eating is a critical priority. To date, however, no such prevention programs have been evaluated in the literature. Therefore a general overview of research in the areas of IDDM and disordered eating is provided, as well as a review of the design and content of effective eating disorder intervention programs, with suggestions about how such programs should be adapted, in order that they can be used and evaluated with an IDDM population.     

The relationship between negative communication and body image dissatisfaction in adolescent females with Type 1 Diabetes Mellitus

Maladaptive eating attitudes and behaviors are common in adolescent females with Type 1 Diabetes Mellitus (T1DM). This research assessed potential pathways through which individual and familial factors relate to treatment adherence and glycemic control. Seventy-five females with T1DM (aged 11-17 years) and their mothers completed questionnaires regarding communication, diabetes management, and eating attitudes and behaviors. Hierarchical regression analyses found that body image dissatisfaction moderates the relationship between negative communication and maladaptive eating attitudes and behaviors. Treatment adherence mediates the relationship between maladaptive eating attitudes and behaviors and glycemic control. None of the participants endorsed omitting insulin for the purposes of weight management. This study highlights the need to address familial and individual factors along with treatment adherence within this population.     

A dimensional examination of eating disorder symptoms in relation to cognitive processing: An event‐related potentials study

Identifying neurocognitive mechanisms involved in individuals experiencing eating disorder (ED) symptoms may be important for preventing EDs and improving rates of recovery. The present pilot study assessed how cognitive functioning may be associated with ED symptoms in college students (N = 41). Cognitive functioning was examined using electroencephalography during an auditory response inhibition task to measure the P3 component of event‐related potentials. Multiple regression analysis revealed that longer P3 latencies in the frontal region of the cortex were significantly and linearly associated with greater ED symptoms F(3, 37) = 13.62, p < .001, R² = 0.525, Adj. R² = 0.486. These pilot findings build upon prior work in clinical samples in that they indicate that functional brain differences are observable across a wide span of ED symptoms, not just in those with diagnosed ED. The present findings provide support for further exploration of changes in P3 latencies among individuals with ED symptoms to enhance our understanding of neural mechanisms that may pertain to the dimensional aspects of disordered eating attitudes and behaviors.     

The impact of a self‐esteem group for people with eating disorders: an uncontrolled study

Low self‐esteem is widely recognized as a predisposing, precipitating and maintaining factor in the aetiology of eating disorders. This paper examines the effectiveness of a self‐esteem group for women with eating disorders, delivered repeatedly over a 20‐month period. Forty‐one patients began and 33 completed the programme and both pre‐ and post‐measures. Eight were excluded from the final analysis as they were in concurrent psychological treatment. Outcome was assessed using standardized measures and records of symptom levels and drop‐out rates. Significant improvements in self‐esteem, depression, and eating attitudes were observed. It is concluded that a treatment focusing solely on self‐esteem can be beneficial in reducing eating disordered attitudes. Copyright © 2003 John Wiley & Sons, Ltd.     

Interoceptive accuracy is related to long‐term stress via self‐regulation

Interoception describes the ability to perceive internal bodily signals. Previous research found a relationship between interoceptive accuracy (IAcc) and cardiovascular outcomes during or after acute stress. So far, the association between IAcc and long‐term stress has not been investigated, although this would be important to identify a starting point to prevent long‐term stress. To address this idea in the current study, we examined the relationship between IAcc and long‐term stress, which was assessed with different questionnaires and biological markers, including cortisol and dehydroepiandrosterone (DHEA). Furthermore, we investigated self‐regulation as a mechanism linking IAcc to long‐term stress. The sample consisted of 98 participants. To measure IAcc, participants completed the heartbeat perception task. Perceived long‐term stress and self‐regulation were assessed via an online questionnaire. Moreover, hair samples were taken from 65 participants to determine long‐term stress with cortisol and DHEA as well as the ratio of both. Results showed that IAcc was positively related to DHEA and weakly negatively related to the other indicators of long‐term stress, except for the nonsignificant relationships to the indicators cortisol and stress experiences due to negative events. Furthermore, these relationships were mediated by participants' enhanced self‐regulation. Thus, our results suggest that enhanced self‐regulation could be a mechanism explaining why IAcc is associated with long‐term stress.     

A collaborative care skills workshop for carers: Can it be delivered in 1 day?

Carers of individuals with eating disorders (EDs) report high levels of burden and distress and describe a number of unmet needs. As a result, a number of interventions have been designed to support carers, including the “Maudsley eating disorder collaborative care skills workshops,” which comprise six 2‐hr workshops delivered over 3 months for parents and carers of people with EDs. The current study aimed to test a proof‐of‐concept that this workshop could be effectively delivered in 1 day. An additional aim was to assess whether the workshop had direct effects on carer skills. A nonexperimental repeated measures research design was employed, giving measures before and after a 1‐day workshop. Results suggested significant increases in carer self‐efficacy and carer skills, with moderate to large effect sizes. Qualitative analyses supported these results whilst also generating ideas to improve the 1‐day workshop.     

Patterns of place‐based self‐regulation and associated mental health of urban adolescents

Efforts to simultaneously address adolescent self‐regulation, activity space (routine locations), and mental health represent a promising social ecological approach aimed at understanding the lives and development of urban youth. This type of examination of contextual influences on self‐regulation is considered an important area of developmental research, yet one that is understudied (McCabe, Cunnington, & Brooks‐Gunn, 2004 ). Little is known about the self‐regulatory experiences that might link specific types of locations with mental health problems, particularly with urban youth who live in areas characterized by chronic and severe stressors such as personal violence, criminal activity, and poverty. Recent research has demonstrated the “power of context” (Tolan, Gorman‐Smith, Henry, Chung, & Hunt, 2002 ) to influence coping styles and has demonstrated that without detailed and specified knowledge of the social ecology of urban youth, measurement of critical variables and interpretation of results are likely to be misinformed (Tolan & Grant, 2009 ). Given the importance of understanding youth through an interactive and contextual framework (Bronfenbrenner, 1979 ; Szapocznik & Coatsworth, 1999 ), the present study examined self‐regulatory experiences, specified favorite locations, and mental health with urban adolescents residing in low‐resource and high‐risk environments. © 2010 Wiley Periodicals, Inc.     

Phenotypic heterogeneity and mutational spectrum in a cohort of 45 Italian males subjects with X‐linked ectodermal dysplasia

Ectodermal dysplasias (EDs) are a group of genetic disorders characterized by the abnormal development of the ectodermal‐derived structures. X‐linked hypohidrotic ectodermal dysplasia, resulting from mutations in ED1 gene, is the most common form. The main purpose of this study was to characterize the phenotype spectrum in 45 males harboring ED1 mutations. The study showed that in addition to the involvement of the major ectodermal tissues, the majority of patients also have alterations of several minor ectodermal‐derived structures. Characterizing the clinical spectrum resulting from ED1 gene mutations improves diagnosis and can direct clinical care.     

Interpersonal profiles in eating disorders: Ratings of SASB self‐image

Introduction: Although evidence suggests that interpersonal psychotherapy may be an efficacious treatment for eating disorders, there is surprisingly little systematic knowledge about the interpersonal world of these patients. Method: SASB self‐image ratings were used to explore interpersonal profiles in a large heterogeneous sample of eating disorders (N = 830), matched normal controls (N = 105) and a small group of controls with subclinical depression (N = 26). Results: Eating disorder patients clearly presented with significantly more negative interpersonal profiles compared to controls. Within the eating disorder group, anorexics were characterized by high self‐control, self‐blame and self‐attack. Patients with binge eating disorder expressed the least negative self‐image, and were significantly more self‐affirming than bulimics and less self‐controlling than patients with atypical eating disorders. Conclusions: Eating disorder patients may have distinct interpersonal profiles that increase the risk of negative therapeutic reaction. Better knowledge of interpersonal processes in eating disorders may help to improve both diagnostic assessment and treatment.     

Eating disorders and eating problems among adolescents with type 1 diabetes: exploring relationships with temperament and character

OBJECTIVE: To determine temperament and character among adolescents with type 1 diabetes with and without disordered eating. METHOD: A clinical sample of 199 adolescents from multiple centers with a mean age of 14.1 (SD, 2.5) years were screened and diagnosed for eating disorders. Assessed were temperament and character as conceptualized by Cloninger, glycemic control, and depression. RESULTS: Adolescent patients with clinical eating disorders or subthreshold eating problems had significantly higher mean scores in harm avoidance and lower mean scores in self-directedness. Harm avoidance remained significant even after controlling for depressive pathology. DISCUSSION: This study is the first to show evidence that among youths (in particular, girls) with type 1 diabetes, there is an association between low self-directedness, high harm avoidance, and the presence of eating, weight, and shape pathology. For these particular youths, important implications for clinical practice are outlined.