Eating Disorders,Normative Eating Self‐Efficacy and Body Image Self‐Efficacy: Women in Recovery Homes

Although eating disorders (EDs) and ED symptoms are common among individuals in recovery for substance abuse (SA), long‐term SA treatment programmes rarely address these problems. The present study examined the prevalence of EDs among women residing in Oxford Houses—low‐cost, self‐governed recovery homes for SA. Further, among women both with and without an ED diagnosis, the association between duration of Oxford House residency and eating‐related self‐efficacy scores was examined as an indicator of potential treatment effects on ED symptoms. During a telephone assessment, participants were administered the Structured Clinical Interview for DSM‐IV‐TR Axis I Disorders and the Eating Disorder Recovery Self‐Efficacy Questionnaire. Results indicated that 12 of the 31 women analysed met criteria for an ED (bulimia nervosa, 2; ED not otherwise specified, 10). Differential findings were evident for eating‐related self‐efficacy measures depending on ED diagnostic status and duration of residency. Potential interpretations, limitations and implications are discussed. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.     

Temporal Discounting and the Tendency to Delay Gratification across the Eating Disorder Spectrum

Bulimia nervosa (BN) and binge eating disorder (BED) have been associated with poorer reward‐related inhibitory control, reflected by a reduced tendency to delay gratification. The opposite has been reported in anorexia nervosa (AN), but differences have not been directly compared across eating disorders (EDs). This study investigated self‐reported (Delaying Gratification Inventory) and task‐based (temporal discounting) inhibitory control in 66 women with an ED and 28 healthy controls (HCs). Poorer task‐based inhibitory control was observed in the BN compared with the AN group and poorer self‐reported inhibitory control in the BN and in the BED groups compared with the AN and the HC groups, suggesting that reward‐related inhibitory control varies across EDs. Symptom severity correlated with poorer self‐reported (but not task‐based) inhibitory control across the EDs. These data provide some support for transdiagnostic mechanisms and highlight the importance of addressing perceived loss of control in the treatment of EDs. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

Self‐Discrepancy and Eating Disorder Symptoms Across Eating Disorder Diagnostic Groups

This study examined self‐discrepancy, a construct of theoretical relevance to eating disorder (ED) psychopathology, across different types of EDs. Individuals with anorexia nervosa (AN; n = 112), bulimia nervosa (BN; n = 72), and binge eating disorder (BED; n = 199) completed semi‐structured interviews assessing specific types of self‐discrepancies. Results revealed that actual:ideal (A:I) discrepancy was positively associated with AN, actual:ought (A:O) discrepancy was positively associated with BN and BED, and self‐discrepancies did not differentiate BN from BED. Across diagnoses, A:O discrepancy was positively associated with severity of purging, binge eating, and global ED psychopathology. Further, there were significant interactions between diagnosis and A:O discrepancy for global ED psychopathology and between diagnosis and A:I discrepancy for binge eating and driven exercise. These results support the importance of self‐discrepancy as a potential causal and maintenance variable in EDs that differentiates among different types of EDs and symptom severity. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.     

Sensitivity for Cues Predicting Reward and Punishment in Young Women with Eating Disorders

Increasing evidence shows that sensitivity to reward (SR) and punishment (SP) may be involved in eating disorders (EDs). Most studies used self‐reported positive/negative effect in rewarding/punishing situations, whereas the implied proneness to detect signals of reward/punishment is largely ignored. This pilot study used a spatial orientation task to examine transdiagnostic and interdiagnostic differences in SR/SP. Participants (14–29 years) were patients with anorexia nervosa of restricting type (AN‐R, n = 20), binge/purge ED group [AN of binge/purge type and bulimia nervosa (n = 16)] and non‐symptomatic individuals (n = 23). Results revealed stronger difficulties to redirect attention away from signals of rewards in AN‐R compared with binge/purge EDs, and binge/purge EDs showed stronger difficulties to direct attention away from signals of punishment compared with AN‐R. Findings demonstrate interdiagnostic differences and show that the spatial orientation task is sensitive for individual differences in SP/SR within the context of EDs, thereby sustaining its usefulness as behavioural measure of reinforcement sensitivity. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

The preliminary reliability and validity of the Survey for Eating Disorders (SEDs): a self‐report questionnaire for diagnosing eating disorders

The present study examined the reliability and validity of the Survey for Eating Disorders (SEDs), a self‐report questionnaire intended to assess eating disorders (ED) according to the classification in the DSM‐IV. This appraisal was conducted with a clinical sample of subjects with ED (N = 45), and a student sample (N = 124). In the clinical sample, the SEDs was validated against the Eating Disorder Examination (EDE) which is considered to be the ‘gold standard’ for the assessment of ED. In this sample, there were only two false positive cases of 45 on the SEDs, when patients were reassessed by the EDE interview. Thus, the positive predictive value was as high as 0.96. In the student sample, the SEDs was validated against the Eating Disorders Inventory (EDI) where the results showed strong evidence of concurrent and discriminant validity, and very high test–retest reliability (2 weeks). The SEDs is relatively brief and easy to administer, and these preliminary findings support its reliability and validity. Copyright © 2002 John Wiley & Sons, Ltd and Eating Disorders Association.     

Male eating disorder patients with and without non-suicidal self-injury: a comparison of psychopathological and personality features

In the present study, we investigated the prevalence and comorbidity of non‐suicidal self‐injury (NSSI) in male eating disorder (ED) patients. In total, 130 male ED patients completed a list of 10 impulse‐control problems (including NSSI), the Eating Disorder Inventory‐2, the Symptom Checklist‐90‐Revised and the Temperament and Character Inventory. Overall, 21% of the male ED patients (n = 27) engaged in at least one type of NSSI, and we did not find significant differences between the ED subtypes. Self‐injurious male ED patients showed significantly more severe ED symptoms and more affective, interpersonal and impulse‐control problems than ED patients without NSSI. As previously described in female ED, our data confirm the affect regulation and impulse regulation functions of NSSI in male ED patients. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.     

The Spanish Validation of the Accommodation and Enabling Scale for Eating Disorders Among Carers: A Pilot Study

Literature suggests that families may accommodate patients' symptoms in attempts to alleviate family conflict and stress. These accommodating and enabling behaviours may have a negative impact on carers and those they care for. There are no self‐report questionnaires validated in Spanish to measure accommodation among relatives of patients with an eating disorder. The aim of this study was to examine the psychometric properties of the Spanish version of the Accommodation and Enabling Scale for Eating Disorders (AESED‐S) among relatives of eating disorder patients. A cross‐sectional study of 90 relatives was carried out to explore the factor structure, reliability and validity of the AESED‐S. The internal consistency of the Spanish version of the AESED subscales was good, ranging from .89 to .81. The correlation of the five subscales with conceptually related measures (negative caregiving experience and distress) supports the convergent validity of this instrument in this sample. Results indicated that the Spanish version of the AESED provides a reliable and valid tool for assessing family accommodation in the context of having a relative with an eating disorder. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.     

Construction,scoring and validation of the Short Evaluation of Eating Disorders (SEED)

The paper introduces the construction and scoring principles of the Short Evaluation of Eating Disorders (SEED), which was developed for the assessment of the key eating disorders symptoms. The questionnaire uses six items and allows the calculation of two severity indices for anorexia and bulimia nervosa symptoms. Data from two patient and one non‐patient sample as well as therapist ratings are used to investigate different validity aspects of the SEED. Overall, the analyses underline the validity of the instrument. Recommendations for future research activities on the SEED are outlined. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association.     

Fear of gaining weight: its validity as a visual analogue scale in anorexia nervosa

Despite fear of gaining weight (FGW) being a criterion for diagnosing anorexia nervosa (AN) there are no validated scales that assess it directly. The convergent validity of a visual analogue scale to assess FGW was tested. On admission to an inpatient unit, 114 females with AN were administered the FGW then, some days later, the Goldfarb Fear of Fat Scale (GFFS) and Eating Disorders Inventory (EDI). Concurrent validity for the FGW and GFFS was strong (r = 0.836), as was construct validity, their relationships to the EDI subscales paralleling each other. The strongest relationship for FGW was with drive for thinness (EDI‐DT) (r = 0.859). In 54 patients at discharge, predictive validity with EDI‐DT was strong (r = 0.771). Reliability was moderate (r = 0.636). With statistical validity established, the FGW could prove useful in integrating theory, clinical work and research in AN. Its direct assessment in this study has already highlighted its strong relationships to some maintaining and risk factors in AN. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association.     

Self‐Disgust within Eating Disordered Groups: Associations with Anxiety,Disgust Sensitivity and Sensory Processing

This study aimed to assess the relationship between self‐disgust and sensory processing within eating psychopathology. Five hundred and ninety‐one women with a self‐reported diagnosis of anorexia nervosa, bulimia nervosa or who had no previous history of an eating disorder completed a battery of online questionnaires measuring disgust, emotion and sensory variables. Those with an eating disorder reported significantly higher rates of self‐disgust than those with no history of disordered eating. In groups of women with self‐reported bulimia, self‐disgust was associated with sensation avoidance and sensation seeking. Within the group with anorexia nervosa, self‐disgust was associated with low registration and sensation seeking. This report is the first to examine the expression of the emotion self‐disgust within eating psychopathology and examine associations of this factor with sensory processing. The emotion self‐disgust needs to be further examined to understand its possible role in the onset and maintenance of disordered eating. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

Clinical and socio‐demographic characteristics of university students referred to an eating disorders service

This study describes the socio‐demographic characteristics and eating disorders symptomatology of university students assessed by a specialised NHS eating disorders service in the UK over a 4‐year period. Information was gathered on past treatment history, source of referral, details of university and course of study, whether the patient was still open to the service or discharged, and if the patient had dropped out of contact from services. The study also describes the diagnosis of the assessed patients as well as the results of the Eating Disorders Inventory (EDI), Rosenberg Self‐Esteem Scale (RSES) and Revised Symptom Check List 90 (SCL‐90‐R) questionnaires. The study shows that the university students attending an eating disorder service often suffer from severe conditions, which are generally well‐established before they start their university studies. The study discuses the implication of those results in service delivery and future service development. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association.     

Self‐liking and self‐competence: relationship to symptoms of anorexia nervosa

Self‐esteem has been hypothesised to play a pivotal role in the development and treatment, and outcome of anorexia nervosa (AN). Though this relationship is typically investigated by considering self‐esteem as a unitary construct, research suggests that this comprises of two related but distinct components of self‐liking and self‐competence. This study investigates the association between self‐liking, self‐competence, and symptomatology of AN through the course of a defined treatment episode in 77 women. Self‐liking was significantly associated with laxative abuse. Self‐competence was significantly associated with elevated ineffectiveness, perfectionism and interpersonal distrust. Although self‐competence and eating disturbance severity significantly improved over the treatment episode, one in three participants reported a reduced self‐like or self‐competence. Changes in both self‐competence and self‐liking at the end of treatment was associated with changes in drive for thinness. Such findings have implications for treatment models concerned with improving self‐esteem. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association.     

Food for Thought: Ego‐dystonicity and Fear of Self in Eating Disorders

Degree of ego‐dystonicity in obsessions is clinically relevant to the conceptualization and treatment of eating disorders (EDs). Obsessive–compulsive disorder research has suggested that the transformation of intrusive thoughts into obsessions is linked to the degree to which intrusive thoughts threaten core perceptions of the self. This study aims to explore the relationship between the ego‐dystonic nature of obsessions in ED patients and a fear of self, the link between ED symptom severity and ego‐dystonicity in obsessions, and differences between non‐clinical and individuals with EDs in the presence of ego‐dystonic thoughts and a fear of self. Ego‐dystonicity (Ego‐dystonicity Questionnaire (EDQ)) and feared self (Fear of Self Questionnaire (FSQ)) degrees were measured in a clinical sample (n = 57 with EDs) and a non‐clinical sample (n = 45). EDQ and FSQ scores were highly correlated in both samples. EDQ scores were not significantly correlated to ED symptom severity with the exception of the EDQ Irrationality subscale, which was strongly related to compulsion severity. Participants with an ED had significantly higher EDQ and FSQ scores compared with controls. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.     

Anorexia nervosa: Towards an integrative neuroscience model

We reviewed the evidence for emotion‐related disturbances in anorexia nervosa (AN) from behavioural, cognitive, biological and genetic domains of study. These domains were brought together within the framework of an integrative neuroscience model that emphasizes the role of emotion and feeling and their regulation, in brain organization. PsychInfo and Medline searches were performed to identify published peer‐reviewed papers on AN within each domain. This review revealed evidence for ‘Emotion’, ‘Thinking and Feeling’ and ‘Self‐regulation’ disturbances in AN that span non‐conscious to conscious processes. An integrative neuroscience framework was then applied to develop a model of AN, from which hypotheses for empirical investigation are generated. We propose that AN reflects a core disturbance in emotion at the earliest time stage of information processing with subsequent effects on the later stages of thinking, feeling and self‐regulation. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.     

Perfectionism and Eating Psychopathology Among Dancers: The Role of High Standards and Self‐criticism

This study examined the associations between conscientious perfectionism (high standards), self‐evaluative perfectionism (self‐criticism) and eating psychopathology among dancers. A sample of 244 female dancers, with a mean age of 20.11 years (standard deviation = 1.97) completed the Perfectionism Inventory and Eating Disorder Examination Questionnaire. Self‐evaluative perfectionism predicted eating psychopathology (eating restraint, eating concern, weight concern and shape concern). This relationship was not moderated by conscientious perfectionism. The mediation analyses showed that although conscientious perfectionism predicted eating psychopathology, this relationship was fully mediated by self‐evaluative perfectionism. These findings demonstrate the greater influence of self‐evaluative perfectionism, rather than conscientious perfectionism, on eating psychopathology in dancers. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.     

Psychometric Evaluation and Norms for the Multidimensional Assessment of Interoceptive Awareness (MAIA) in a Clinical Eating Disorders Sample

Altered interoceptive awareness (IA) has been implicated in the pathophysiology of eating disorders; however, few comprehensive self‐report measures of IA exist in eating disorders. The present study sought to validate the Multidimensional Assessment of Interoceptive Awareness (MAIA), originally developed to assess IA in individuals practicing mind–body therapies, in an eating disorder sample. Adult and adolescent patients (n = 376) completed assessments upon admission to a partial hospital programme. Analyses examined the factor structure of the MAIA, scale means, scale–scale correlations, internal consistency and construct validity. Analyses also examined associations between MAIA subscales and eating disorder symptoms. Results supported the original eight‐factor structure of the MAIA. Internal consistency was acceptable, and the scales converged with associated measures. Importantly, Not Distracting, Self‐regulation, Body Listening and Trusting were most strongly associated with eating disorder symptoms. Results support use of the MAIA among eating disorders and provide further support for the relevance of IA in eating disorders. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

Delay Discounting of Reward and Impulsivity in Eating Disorders: From Anorexia Nervosa to Binge Eating Disorder

Evidence points to eating disorder patients displaying altered rates of delay discounting (one's degree of preference for immediate rewards over larger delayed rewards). Anorexia nervosa (AN) patients are believed to have an increased capacity to delay reward, which reflects their ability to override the drive to eat. Contrarily, binge eating disorder (BED) patients are associated with a reduced predisposition to delay gratification. Here, we investigated monetary delay discounting and impulsivity in 80 adult women with EDs (56 AN and 24 BED), diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria, and 80 healthy controls. AN‐restrictive (AN‐R) subtype patients showed less steep discounting rates than BED and AN‐bingeing/purging subtype patients. Compared with healthy controls and AN‐R patients, BED and AN‐bingeing/purging patients presented higher delay discounting and positive and negative urgency levels. Our findings suggest that restriction in AN‐R patients is associated with disproportionate self‐control, whereas bingeing behaviours could be more driven by emotional states and impulsivity traits. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

Psychosocial Characteristics in Relation to Disordered Eating Attitudes in Greek Adolescents

The study explores possible links between eating attitudes in Greek adolescents and certain psychosocial characteristics such as self‐esteem, empathy and anxiety. A total of 202 students (109 boys and 93 girls), 15–18 years old, have been recruited. The following questionnaires were used: the Eating Attitudes Test (EAT‐26), the State‐Trait Anxiety Inventory, the Self‐Perception Profile for Adolescents, the Multidimensional Body‐Self‐Questionnaire‐Overweight Preoccupation and the Index of Empathy of Children and Adolescents. The EAT‐26 revealed that 18.3% of the total sample of students (12.8% of boys and 24.7% of girls) reported having disordered eating attitudes. Adolescents with disordered eating attitudes had significantly higher levels of anxiety and scored less in self‐reported physical appearance and romantic appeal. Empathy and global self‐esteem did not differ significantly between the two groups. Adolescents with disordered eating attitudes have certain psychosocial characteristics which differentiate them from the students with healthier eating attitudes. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.     

Short‐Term Intensive Family Therapy for Adolescent Eating Disorders: 30‐Month Outcome

Family therapy approaches have generated impressive empirical evidence in the treatment of adolescent eating disorders (EDs). However, the paucity of specialist treatment providers limits treatment uptake; therefore, our group developed the intensive family therapy (IFT)—a 5‐day treatment based on the principles of family‐based therapy for EDs. We retrospectively examined the long‐term efficacy of IFT in both single‐family (S‐IFT) and multi‐family (M‐IFT) settings evaluating 74 eating disordered adolescents who underwent IFT at the University of California, San Diego, between 2006 and 2013. Full remission was defined as normal weight (≥95% of expected for sex, age, and height), Eating Disorder Examination Questionnaire (EDE‐Q) global score within 1 SD of norms, and absence of binge–purging behaviours. Partial remission was defined as weight ≥85% of expected or ≥95% but with elevated EDE‐Q global score and presence of binge–purging symptoms (<1/week). Over a mean follow‐up period of 30 months, 87.8% of participants achieved either full (60.8%) or partial remission (27%), while 12.2% reported a poor outcome, with both S‐IFT and M‐IFT showing comparable outcomes. Short‐term, intensive treatments may be cost‐effective and clinically useful where access to regular specialist treatment is limited. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.     

A pilot evaluation of a novel First Episode and Rapid Early Intervention service for Eating Disorders (FREED)

This pilot study assesses the impact of FREED (First Episode Rapid Early Intervention for Eating Disorders [ED]), a novel transdiagnostic service for emerging adults with recent ED onset, on clinical outcomes. Data were collected from 56 patients and 19 carers for 12 months following enrolment. FREED patients showed significant improvements in ED and other symptoms across time. Carers also showed psychological improvements. For FREED anorexia nervosa (AN) patients, body mass index (BMI) at initial clinical assessment was similar to that of comparable patients (audit cohort) seen in our service before (16.4 vs 16.1 kg/m²). By start of treatment, because of their shorter wait, FREED‐AN had gained weight whereas audit patients had lost (16.7 vs 15.8 kg/m²). This difference continued throughout treatment, and at 12 months, nearly 60% FREED‐AN patients returned to a BMI of 18.5 or greater. FREED shows promise as a service model for emerging adults with EDs.