Putative Risk Factors for Non‐Suicidal Self‐Injury in Eating Disorders

Evidence suggests a common association between eating disorders (EDs) and non‐suicidal self‐injury (NSSI). The present study aimed to investigate the potential risk factors for NSSI among ED patients. We assessed 245 ED patients with the Oxford Risk Factor Interview for ED. The results showed that 33% of ED patients reported NSSI in their lifetime. NSSI appeared to occur more frequently among binge eating/purging type ED patients than among patients with other ED and to be related to a more severe eating pathology. A younger age at the onset of eating problems, more negative self‐evaluation, suicide attempts, substance abuse, parents' low weight, family tension at mealtime, parental alcohol problems, childhood abuse, peer aggression, and negative antecedent life events were more common among patients with co‐occurring EDs and NSSI than among patients without NSSI. The results may inform the risk assessment and treatment of NSSI in EDs in the early detection period. 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.     

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.     

Subjective and Objective Binge Eating in Relation to Eating Disorder Symptomatology,Depressive Symptoms,and Self‐Esteem among Treatment‐Seeking Adolescents with Bulimia Nervosa

This study investigated the importance of the distinction between objective (OBE) and subjective binge eating (SBE) among 80 treatment‐seeking adolescents with bulimia nervosa. We explored relationships among OBEs, SBEs, eating disorder (ED) symptomatology, depression, and self‐esteem using two approaches. Group comparisons showed that OBE and SBE groups did not differ on ED symptoms or self‐esteem; however, the SBE group had significantly greater depression. Examining continuous variables, OBEs (not SBEs) accounted for significant unique variance in global ED pathology, vomiting, and self‐esteem. SBEs (not OBEs) accounted for significant unique variance in restraint and depression. Both OBEs and SBEs accounted for significant unique variance in eating concern; neither accounted for unique variance in weight/shape concern, laxative use, diuretic use, or driven exercise. Loss of control, rather than amount of food, may be most important in defining binge eating. Additionally, OBEs may indicate broader ED pathology, while SBEs may indicate restrictive/depressive symptomatology. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.     

The Role of Non‐suicidal Self‐Injury and Binge‐Eating/Purging Behaviours in the Caregiving Experience Among Mothers and Fathers of Adolescents with Eating Disorders

This study investigated the caregiving experiences of mothers and fathers of restrictive and binge‐eating/purging eating disordered (ED) inpatients with and without non‐suicidal self‐injury (NSSI). Sixty‐five mothers and 65 fathers completed the Experience of Caregiving Inventory. All inpatients completed the Self‐Injury Questionnaire—Treatment Related to assess NSSI and the Eating Disorder Evaluation Scale to assess eating disorder symptoms. Mothers reported significant more negative and more positive caregiving experiences compared with fathers. Mothers (but not fathers) of restrictive ED patients reported more positive caregiving experiences compared with mothers of binge‐eating/purging patients. The presence of NSSI in ED patients was associated with more negative caregiving experiences of both parents. Mothers and fathers of ED inpatients differ in caregiving experiences, and both binge‐eating behaviours and NSSI negatively affect their caregiving experience. Therefore, supportive interventions for parents of ED patients are necessary, especially of those patients who engage in NSSI. Copyright © 2015 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.     

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.     

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.     

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.     

Emotion Regulation as a Transdiagnostic Feature Among Eating Disorders: Cross‐sectional and Longitudinal Approach

Emotion regulation (ER) difficulties are observed in eating disorders (EDs). However, few studies have explored ER before and after treatment. The aims are as follows: to explore ER difficulties across ED types and a healthy control (HC) group (Study 1) and to assess pretreatment and post‐treatment changes among ED types (Study 2). In Study 1, adult women with EDs (n = 438) and HC (n = 126) completed an assessment including Eating Disorders Inventory‐2, Difficulties in Emotion Regulation Scale and Symptom Checklist‐90‐Revised. Patients in Study 2 (n = 69) were also reassessed after treatment. All ED types reported worse ER compared with HC (p < .001); also, ER differences were found between ED types. Prospective analyses show ER improvements after treatment (p < .001; |d| = 0.51), especially in patients with bulimia nervosa (p < .001; |d| = 1.03; Reliable Change Index = 9.79) with greater improvement in those with a better treatment outcome (p = .034). In conclusion, emotion dysregulation is a part of all forms of EDs. Furthermore, emotional dysregulation can be modified. ED treatments for anorexia nervosa and binge eating disorder might be enhanced by targeting ER skills. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

‘I Know I Can Help You’: Parental Self‐efficacy Predicts Adolescent Outcomes in Family‐based Therapy for Eating Disorders

Family‐based therapy is regarded as best practice for the treatment of eating disorders in adolescents. In family‐based therapy, parents play a vital role in bringing their child or adolescent to health; however, little is known about the parent‐related mechanisms of change throughout treatment. The present study examines parent and adolescent outcomes of family‐based therapy as well as the role of parental self‐efficacy in relation to adolescent eating disorder, depressed mood and anxiety symptoms. Forty‐nine adolescents and their parents completed a series of measures at assessment, at 3‐month post‐assessment and at 6‐month follow‐up. Results indicate that, throughout treatment, parents experienced an increase in self‐efficacy and adolescents experienced a reduction in symptoms. Maternal and paternal self‐efficacy scores also predicted adolescent outcomes throughout treatment. These results are consistent with the philosophy of the family‐based therapy model and add to the literature on possible mechanisms of change in the context of family‐based therapy. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.     

Positive Core Beliefs and Their Relationship to Eating Disorder Symptoms in Women

Positive core beliefs, compared with negative self or negative core beliefs, are relatively neglected in the eating disorder (ED) research literature, despite their significance in treatment. Using a sample of younger women and relevant to those who typically experience EDs, this study outlines a new measure of positive core beliefs and examines its psychometric properties. On the basis of factor analysis, two subscales were developed: positive social self beliefs and positive individual self beliefs. The measure had good internal consistency and good construct validity. Positive individual self beliefs predicted low levels of ED symptoms when confounds were controlled. Positive social self beliefs predicted low levels of depressive symptoms, when confounds were controlled. Positive core beliefs would benefit from further study in subclinical and clinical ED groups of younger women. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.     

Non‐Suicidal Self‐Injury in Patients with Eating Disorder: Associations with Identity Formation Above and Beyond Anxiety and Depression

In the present study, we investigated the association between non‐suicidal self‐injury (NSSI) and problems in identity formation among patients with eating disorder (ED). NSSI is highly prevalent in ED, and problems with identity formation are characteristic of both NSSI and ED. Few studies, however, have investigated identity formation in patients with ED with and without NSSI while taking into account comorbid psychopathology (e.g. anxiety and depression). Therefore, we investigated the relationships between NSSI characteristics, identity confusion/synthesis, and anxiety/depression in 99 female patients with ED by means of self‐report questionnaires. The results showed that 58.6% of the patients with ED engaged in at least one type of NSSI (most frequently cutting), with no significant differences in rates of NSSI or identity problems among ED subtypes. Presence, versatility and automatic negative reinforcement functions of NSSI were each significantly and positively related to identity confusion and negatively related to identity synthesis. Even after controlling for age, anxiety, and depression, lack of identity synthesis remained a significant predictor of NSSI in patients with ED. Given that NSSI may constitute an effort to deal with identity confusion/synthesis in patients with ED, therapists should take this developmental task into account while treating patients with ED with NSSI. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.     

Early Maladaptive Schemas in Eating Disordered Patients With or Without Non‐Suicidal Self‐Injury

This study investigates early maladaptive schemas (EMSs) in function of eating disorder (ED) subtypes (restrictive/bulimic) and the presence/absence of non‐suicidal self‐injury (NSSI). Female inpatients (N = 491) completed the Young Schema Questionnaire and the Self‐Injury Questionnaire. The influence of ED subtype and the presence/absence of NSSI and their interaction on the EMS were investigated by means of a MANCOVA. The results showed main effects of ED subtype and the presence of NSSI on EMS. Patients with bulimia scored significantly higher on insufficient self‐control and emotional deprivation, which are more related to cluster B compared with restrictive patients, whereas restrictive patients scored significantly higher on social undesirability, failure to achieve, subjugation and unrelenting standards compared with patients with bulimia that are more related to cluster C. Patients with ED with NSSI reported significantly higher EMS levels compared with patients without NSSI, suggesting that they could be of particular interest to benefit from schema therapy. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.     

Food Addiction in a Spanish Sample of Eating Disorders: DSM‐5 Diagnostic Subtype Differentiation and Validation Data

Although the concept of ‘food addiction’ (FA) has raised growing interest because of evidence for similarities between substance dependence and excessive food intake, there is a lack of studies that explore this construct among the wide spectrum of eating disorders (EDs). Besides providing validation scores of a Spanish version of the Yale FA Scale (YFAS‐S), this study examined the prevalence of ‘FA’ among ED subtypes compared with healthy‐eating controls (HCs) and the association between ‘FA’ scores, eating symptomatology and general psychopathology. A sample of 125 adult women with ED, diagnosed according to Diagnostic and Statistical Manual of Mental Disorders 5 criteria, and 82 healthy‐eating women participated in the study. All participants were assessed with the YFAS‐S, the ED Inventory‐2 and the Symptom Checklist‐Revised. Results showed that the internal structure of the one‐dimensional solution for the YFAS‐S was very good (α = 0.95). The YFAS‐S has a good discriminative capacity to differentiate between ED and controls (specificity = 97.6% and sensitivity (Se) = 72.8%; area under receiver operating characteristic curve = 0.90) and a good Se to screen for specific ED subtypes. YFAS‐S scores were associated with higher levels of negative affect and depression, higher general psychopathology, more severe eating pathology and greater body mass index. When comparing the prevalence of ‘FA’ between ED subtypes, the lowest prevalence of ‘FA’, measured with the YFAS‐S, was for the anorexia nervosa (AN) restrictive subtype with 50%, and the highest was for the AN binge–purging subtype (85.7%), followed by bulimia nervosa (81.5%) and binge eating disorder (76.9%). In conclusion, higher YFAS‐S scores are associated with bingeing ED‐subtype patients and with more eating severity and psychopathology. Although the ‘FA’ construct is able to differentiate between ED and HC, it needs to be further explored. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.     

Eating Disorders,Substance Use Disorders,and Impulsiveness among Disordered Gamblers in a Community Sample

Disordered gambling and many eating disorders (EDs) involve recurrent loss of impulse control. We examined rates of specific EDs, ED psychopathology, substance use disorders, and their interrelationships with impulsiveness among community members with disordered gambling. Community‐recruited adults with pathological (n = 95) or problem (n = 9) gambling (N = 104; 51% female) completed structured interviews and questionnaires. We observed high rates of substance dependence, lifetime EDs, and current ED psychopathology; 20.8% of women (vs 1.9% of men) had a DSM‐IV ED, and 37.8% (vs 3.9%) had an ED according to proposed DSM‐5 criteria. Although disordered gambling severity was not associated with ED diagnosis or severity of ED psychopathology, greater disordered gambling severity and an ED diagnosis were both associated with increased impulsiveness. These findings suggest that impulsiveness might constitute a common personality characteristic that underlies disordered gambling and EDs. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.     

Survey of Eating Disorder Symptoms among Women in Treatment for Substance Abuse

A strong association between substance use disorders (SUDs) and eating disorders (EDs) in women has been established. Yet, little is known about the rates and impact of ED symptoms in women presenting to addiction treatment. The current investigation assessed the prevalence of ED symptoms and their effect on treatment outcomes in a sample of substance abusing women with co‐occurring posttraumatic stress disorder (PTSD) enrolled in outpatient substance use programs. Participants were 122 women who participated in a multisite clinical trial comparing two behavioral treatments for co‐occurring SUD and PTSD. The Eating Disorder Examination‐self report, and measures of PTSD and SUD symptoms were administered at baseline, during treatment and at four follow‐up points. Two subgroups emerged; those reporting binge eating in the 28 days prior to baseline (Binge group; n = 35) and those who reported no binge eating episodes (No Binge group; n = 87). Women in the Binge group endorsed significantly higher ED, PTSD, and depression symptoms at baseline than those in the No Binge group. Although all participants showed significant reductions in PTSD symptoms and improvements in abstinence rates during the study period, the improvements for the Binge group were significantly lower. These findings suggest that a subgroup of women with co‐occurring PTSD and SUDs, who endorsed binge ED symptoms, responded differently to SUD/PTSD group treatment. Identification of ED symptoms among treatment‐seeking women with SUDs may be an important element in tailoring interventions and enhancing treatment outcomes. (Am J Addict 2010;19:245–251)     

The Impact of Self‐Reported Pubertal Status and Pubertal Timing on Disordered Eating in Irish Adolescents

This paper considers the impact of pubertal status and pubertal timing on disordered eating in Irish adolescents. 1190 boys and 1841 girls completed the Eating Attitudes Test‐26, the Eating Disorder Inventory‐III and self‐report measures of pubertal status and pubertal timing. Regarding pubertal status, greater maturity in girls was associated with increased overall eating concerns, higher drive for thinness and higher levels of body dissatisfaction. In boys, greater maturity was associated with lower drive for thinness and lower body dissatisfaction. Regarding pubertal timing, early‐maturing girls showed the most eating concerns, the highest drive for thinness, scored highest on bulimic symptoms and were the most dissatisfied with their bodies. In contrast, late‐maturing boys had more bulimic symptoms and more dissatisfaction with their bodies than on‐time peers. The findings suggest that puberty itself is a risk factor for disordered eating for girls rather than boys; however, pubertal timing is a risk factor for both. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.     

Content of Children's Loss of Control Eating Episodes Assessed by Self‐Report and Laboratory Test Meal

Pediatric loss of control (LOC) eating heightens risk for excessive weight gain and further disordered eating. Assessment of LOC typically involves self‐report interview or laboratory test meal, although no study has concurrently examined data from both methods. We gathered eating episode data via interview (Child Eating Disorder Examination; ChEDE) and a laboratory test meal, among 22 overweight girls (aged 7–12 years) reporting LOC eating. Children consumed more energy during ChEDE episodes, although ChEDE and test meal episodes did not differ in macronutrient content. Episodes' correlation for amount consumed (grams) did not reach significance, p = .076. In exploratory analyses among the seven children reporting LOC during the test meal, episodes were significantly correlated for grams consumed. Findings provide preliminary data to suggest that semi‐structured interviews accurately capture children's LOC episode quantity. Episodes did not qualitatively differ, although children reported consuming more energy during self‐reported episodes. Replication is warranted in larger studies. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.