An Investigation of the Factor Structure of the Beck Depression Inventory‐II in Anorexia Nervosa

Symptoms of depression frequently co‐occur with eating disorders and have been associated with negative outcomes. Self‐report measures such as the Beck Depression Inventory‐II (BDI‐II) are commonly used to assess for the presence of depressive symptoms in eating disorders, but the instrument's factor structure in this population has not been examined. The purposes of this study were to explore the factor structure of the BDI‐II in a sample of individuals (N = 437) with anorexia nervosa undergoing inpatient treatment and to examine changes in depressive symptoms on each of the identified factors following a course of treatment for anorexia nervosa in order to provide evidence supporting the construct validity of the measure. Exploratory factor analysis revealed that a three‐factor model reflected the best fit for the data. Confirmatory factor analysis was used to validate this model against competing models and the three‐factor model exhibited strong model fit characteristics. BDI‐II scores were significantly reduced on all three factors following inpatient treatment, which supported the construct validity of the scale. The BDI‐II appears to be reliable in this population, and the factor structure identified through this analysis may offer predictive utility for identifying individuals who may have more difficulty achieving weight restoration in the context of inpatient treatment. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.     

The rating of anorexia and bulimia (RAB) interview: development and preliminary validation

Most interviews of eating disorders have been developed on homogeneous, English‐speaking samples at particular academic institutions for research purposes, and tend to put scientific rigour before clinical utility. The present study deals with the development and preliminary validation of the Rating of Anorexia and Bulimia (RAB), a 56 item interview covering a wide range of eating disorder symptoms, related psychopathology and background variables, which can be used to generate operational DSM‐IV diagnoses. Eating disorder variables on the RAB can be compiled into four subscales: Body‐shape and Weight Preoccupation, Binge‐Eating, Anorexic Eating Behaviour and Compensatory Behaviour. The instrument was investigated among 409 patients participating in the Swedish multi‐centre study of eating disorders. Measures of internal consistency, diagnostic discrimination and correlations with the EDI‐2 suggest that the RAB is a promising measure that reliably measures important aspects of eating disorder psychopathology. Copyright © 1999 John Wiley & Sons, Ltd and Eating Disorders Association.     

Affect consciousness and eating disorders. Short term stability and subgroup characteristics

The aim of the study was to analyse differences in observer rated affect consciousness (AC) between subgroups of patients diagnosed with eating disorders (N = 44; 30 with anorexia nervosa and 14 with bulimia nervosa), and a non‐clinical group (N = 40). Another aim was to study the short‐term stability of AC over 10–11 weeks of treatment and its relation to self‐reported eating pathology and general psychopathology. A moderate short‐term stability of AC was found but the levels were not correlated with eating pathology or psychopathology. No differences between the two diagnostic categories were found, but the eating disorder group as whole had significantly lower AC compared with a non‐eating disorder reference group. AC seems to be a moderately stable ability that differentiates patients diagnosed with eating disorders from a non‐clinical population. However, AC is not related to symptoms of eating disorder or general psychiatric symptoms in this group of patients. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.     

Replication of a Modified Factor Structure for the Eating Disorder Examination‐Questionnaire: Extension to Clinical Eating Disorder and Non‐clinical Samples in Portugal

Psychometric investigations of the Eating Disorder Examination‐Questionnaire (EDE‐Q) have generally not supported the original scale structure. The present study tested an alternative brief factor structure in two large Portuguese samples: (1) a non‐clinical sample of N = 4117 female students and (2) a treatment‐seeking sample of N = 609 patients diagnosed with eating disorders. Confirmatory factor analysis revealed a poor fit for the original EDE‐Q structure in both the non‐clinical and the clinical samples but revealed a good fit for the alternative 7‐item 3‐factor structure (dietary restraint, shape/weight overvaluation and body dissatisfaction). Factor loadings were invariant across samples and across the different specific eating disorder diagnoses in the clinical sample. These confirmatory factor analysis findings, which replicate findings from studies with diverse predominately overweight/obese samples, supported a modified 7‐item, 3‐factor structure for the EDE‐Q. The reliable findings across different non‐clinical and clinical eating disorder groups provide confidence regarding the potential utility of this brief version. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

Does Enhanced Cognitive Behaviour Therapy for Eating Disorders Improve Quality of Life?

Quality of life (QOL) is the degree of enjoyment and satisfaction experienced in life, and embraces emotional well‐being, physical health, economic and living circumstances, and work satisfaction. QOL recovery with eating disorder treatment has received sparse attention, and until now, no study has investigated QOL recovery with enhanced cognitive behaviour therapy (CBT‐E). Patients (n = 196) admitted to a specialist eating disorders outpatient programme and receiving CBT‐E completed measures of QOL, eating disorder psychopathology, depression, anxiety and self‐esteem, before and after treatment. QOL at intake was compared with community norms, and QOL below the norm was predicted from sociodemographic and clinical correlates with logistic regression. Baseline QOL below the norm was associated with depression and anxiety Axis I comorbidity, and severity of depressive symptoms. Predictors of post‐treatment QOL were baseline QOL and level of depressive symptoms and self‐esteem at post‐treatment. CBT‐E was associated with gains in QOL over the course of treatment, in addition to eating disorder symptom relief. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.     

Emotional Reactivity and Appraisal of Food in Relation to Eating Disorder Cognitions and Behaviours: Evidence to Support the Motivational Conflict Hypothesis

Eating disorders are associated with both negative and positive emotional reactions towards food. Individual eating disorder symptoms may relate to distinct emotional responses to food, which could necessitate tailored treatments based on symptom presentation. We examined associations between eating disorder symptoms and psychophysiological responses to food versus neutral images in 87 college students [mean (SD) age = 19.70 (2.09); mean (SD) body mass index = 23.25(2.77)]. Reflexive and facial electromyography measures tapping negative emotional reactivity (startle blink reflex) and appraisal (corrugator muscle response) as well as positive emotional reactivity (postauricular reflex) and appraisal (zygomaticus muscle response) were collected. Eating disorder cognitions correlated with more corrugator activity to food versus neutral images, indicating negative appraisals of food. Binge eating was associated with increased postauricular reflex reactivity to food versus neutral images, suggesting enhanced appetitive motivation to food. The combination of cognitive eating disorder symptoms and binge eating may result in motivational conflict towards food. Copyright © 2017 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.     

Psychometric Evaluation of the Eating Disorder Examination Adapted for Children

The Eating Disorder Examination adapted for children (ChEDE) is the child version of the semi‐structured gold standard eating disorder interview for adults. This study was a comprehensive test statistic evaluation of the German ChEDE in a large sample of children and adolescents with anorexia nervosa, binge eating disorder, loss of control eating, overweight and obesity, as well as non‐eating‐disordered and chronically ill control probands (n = 352). Excellent inter‐rater reliability, adequate internal consistency and satisfactory stability of ChEDE indicators were demonstrated. ChEDE indicators discriminated between diverse forms of eating and weight disturbances and normative eating and were significantly correlated with conceptually related measures. Factorial validity was not convincing; a brief eight‐item scale showed the best fit. Item statistics were mostly acceptable. Overall, the ChEDE's German translation reliably and validly assesses psychopathology across the eating and weight disorder spectrum and facilitates international comparison of eating disorder research. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.     

Biopsychosocial Correlates of Binge Eating Disorder in Caucasian and African American Women with Obesity in Primary Care Settings

This study examined racial differences in eating‐disorder psychopathology, eating/weight‐related histories, and biopsychosocial correlates in women (n = 53 Caucasian and n = 56 African American) with comorbid binge eating disorder (BED) and obesity seeking treatment in primary care settings. Caucasians reported significantly earlier onset of binge eating, dieting, and overweight, and greater number of times dieting than African American. The rate of metabolic syndrome did not differ by race. Caucasians had significantly elevated triglycerides whereas African Americans showed poorer glycaemic control (higher glycated haemoglobin A1c [HbA1c]), and significantly higher diastolic blood pressure. There were no significant racial differences in features of eating disorders, depressive symptoms, or mental and physical health functioning. The clinical presentation of eating‐disorder psychopathology and associated psychosocial functioning differed little by race among obese women with BED seeking treatment in primary care settings. Clinicians should assess for and institute appropriate interventions for comorbid BED and obesity in both African American and Caucasian patients. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.     

Food Addiction and Bulimia Nervosa

In individuals with obesity and binge eating disorder (BED), eating patterns can show addictive qualities, with similarities to substance use disorders on behavioural and neurobiological levels. Bulimia nervosa (BN) has received less attention in this regard, despite their regular binge eating symptoms. The Yale Food Addiction Scale (YFAS) was developed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnostic criteria for substance use disorders, and food addiction can be diagnosed when at least three addiction symptoms are endorsed and a clinically significant impairment or distress is present. Although the prevalence of food addiction diagnoses is increased in individuals with obesity and BED, recent studies which used the YFAS showed that there are also individuals with normal weight who can be classified as being ‘food addicted’. Based on self‐reported eating disorder symptoms, women with current (n = 26) or remitted (n = 20) BN, and a control group of women matched for age and body mass index (n = 63) completed the YFAS and other measures. Results revealed that all patients with current BN received a food addiction diagnosis according to the YFAS while only six (30%) women with remitted BN did. None of the women in the control group received a food addiction diagnosis. Results provide support for the notion that BN can be described as addiction‐like eating behaviour and suggest that food addiction most likely improves when BN symptoms remit. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.     

A prospective study of obsessive‐compulsive and borderline personality traits,race and disordered eating

Most previous investigations of the relationship between personality and disordered eating have been cross‐sectional and have utilised relatively homogeneous samples. The current study sought to prospectively explore two specific putative personality risk factors for disordered eating in an ethnically diverse sample of women (n = 58). During the initial and 2‐year follow‐up assessments, semi‐structured diagnostic interviews were administered. Analyses revealed that borderline personality disorder symptoms, as well as an interaction between obsessive‐compulsive personality disorder symptoms and race, significantly predicted disordered eating over a 2‐year period. Obsessive‐compulsive personality pathology was most strongly predictive of disordered eating for the African American women, specifically. These data supported both borderline and obsessive‐compulsive personality pathology as predictors of the development of eating disorder symptoms among women over a 2‐year period in college. In addition, race may be an important consideration in understanding the role of personality in the aetiology of disordered eating. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association.     

Demographic,psychiatric, and personality correlates of adults seeking treatment for disordered gambling with a comorbid binge/purge type eating disorder

Preliminary evidence suggests that binge/purge type eating disorders and gambling disorder may commonly co‐occur. However, this dual‐diagnosis population remains understudied. The present research examined the prevalence rates and correlates of binge/purge type eating disorders (i.e., bulimia nervosa, binge‐eating disorder, and anorexia nervosa binge/purge type) among adults seeking treatment for their gambling (N = 349). In total, 11.5% of the sample (n = 40) met criteria for a binge/purge type eating disorder, most commonly bulimia nervosa (n = 33). There was a higher preponderance of binge/purge type eating disorders in women. People with a comorbid binge/purge type eating disorder reported more days gambling, gambling‐related cognitive distortions, impulsivity, suicidality, and other current psychiatric comorbidities including addictive behaviours. These findings suggest that binge/purge type eating disorders in people seeking treatment for gambling may be more common than previously believed. Furthermore, the increased psychopathology among people with binge/purge type eating disorder and gambling disorder identify vulnerabilities of this dual‐diagnosed population that may require clinical attention.     

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 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.     

Psychometric Properties of the Chinese Version of the Eating Attitudes Test in Young Female Patients with Eating Disorders in Mainland China

The study aimed to investigate the reliability and validity of the Chinese version of the eating attitudes test (EAT‐26) among female adolescents and young adults in Mainland China. This scale was administered to 396 female eating disorder patients and 406 noneating disorder healthy controls, in addition 35 healthy controls completed a retest after a 4‐week intervals. Tests for reliability, convergent validity and receiver operating characteristic analysis were performed to detect the psychometric properties. The EAT‐26 demonstrated good internal consistency (Cronbach's alpha = 0.822–0.922), test–retest reliability (interclass correlation coefficient = 0.817) and convergent validity(r = 0.450–0.750). The receiver operating characteristic analysis showed that the cut‐off 14 for anorexia nervosa and 15 for bulimia nervosa represented good compromises with approximate sensitivity (0.66–0.68) and specificity (0.85–0.86). Our findings provided evidence that the Chinese version of the EAT‐26 was a psychometrically reliable and valid self‐rating instrument for identifying people suffering from an eating disorder in Mainland China. A clinical cut‐off range between 14 and 15 could be used, but caution should be exercised because of the low sensitivity of the tool. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

Naturalistic outcomes for a day‐hospital programme in a mixed diagnostic sample of adolescents with eating disorders

Despite initial data suggesting positive treatment outcomes for adolescent eating disorder day‐hospital programmes (DHPs), existing studies have included limited follow‐up, small samples, and a focus on restricting‐type eating disorders. To address these gaps, we explored naturalistic outcomes for an adolescent eating disorders DHP. Adolescent participants (N = 265) completed measurements at treatment admission, discharge (n = 170), and various lengths of follow‐up (n = 126; M_{follow up} = 278.87 days). Results from multilevel models indicated significant increases in body weight for the anorexia nervosa group throughout treatment and maintenance of increased body weight from discharge to follow‐up. In bulimic spectrum disorders, binge eating and purging significantly decreased from intake to discharge and did not change from discharge to follow‐up. Across the entire sample, eating disorder symptoms decreased from intake to discharge and did not change from discharge to follow‐up. Further, anxiety and depression decreased over the course of treatment and continued to decrease over the follow‐up period. The current investigation represents the first study to explore longitudinal DHP outcomes within adolescent bulimic spectrum eating disorders. Our findings also highlight many challenges inherent in conducting naturalistic research; it is critical that the field continue to develop solutions to the barriers inherent in conducting longitudinal research on eating disorder treatment.     

The Moderating Role of Purging Behaviour in the Relationship Between Sexual/Physical Abuse and Nonsuicidal Self‐Injury in Eating Disorder Patients

This study sought to examine predictors of nonsuicidal self‐injury (NSSI) in eating disorder patients and to evaluate the moderating role of purging behaviours in the relationship between a theorised predictor (i.e. sexual/physical abuse) and NSSI. Participants in this study were 177 female patients with eating disorders (age range = 14–38 years) who completed semistructured interviews assessing eating disorder symptoms and eating disorder‐related risk factors (e.g. history of sexual and physical abuse, history of NSSI and feelings of fatness). Results revealed that 65 participants (36.7%) reported lifetime engagement in NSSI, and 48 participants (27.1%) reported a history of sexual/physical abuse. Early onset of eating problems, lower BMI, feeling fat, a history of sexual/physical abuse and the presence of purging behaviours were all positively associated with the lifetime occurrence of NSSI. The relationship between sexual/physical abuse before eating disorder onset and lifetime NSSI was moderated by the presence of purging behaviours, such that the relationship was stronger in the absence of purging. These findings are consistent with the notion that purging and NSSI may serve similar functions in eating disorder patients (e.g. emotion regulation), such that the presence of purging may attenuate the strength of the association between sexual/physical abuse history (which is also associated with elevated NSSI risk) and engagement in NSSI behaviours. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.     

Clusters of Personality Disorder Cognitions in the Eating Disorders

This study examined whether comorbid personality disorder pathology in the eating disorders clusters into broader patterns, and whether those clusters have clinical validity in terms of levels of eating pathology and axis 1 comorbidity. The sample consisted of 214 eating‐disordered women who completed measures of personality disorder cognitions, eating pathology and axis 1 pathology at assessment. Three clusters of eating disorder patients emerged—low levels of personality pathology overall, high levels of cognitions underpinning anxiety‐based personality pathology, and high levels of all of the dimensions of personality pathology. These groups were validated by differences in levels of eating cognitions and axis 1 pathology. Personality disorder cognitions are clinically relevant to the eating disorders, but they might best be understood as broader sets of cognitions (‘anxiety‐centred’ and ‘general’), rather than in terms of individual personality disorder comorbidity or existing DSM personality disorder clusters. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.     

Exploring Types of Family Environments in Youth with Eating Disorders

While many studies have explored the relationship between different eating disorder diagnoses and the familial social environment, current evidence does not support associations between distinct family interaction patterns (e.g. high enmeshment) and particular diagnoses (e.g. anorexia nervosa). The current study seeks to move beyond the current literature to explore whether empirically derived subtypes of family environment are associated with clinical features within a transdiagnostic sample of youth seeking treatment for eating disorders (n = 123). Latent class modelling of the Family Environment Scale identified three classes (i.e. different Family Environment Scale profiles): (1) Control‐Oriented; (2) System Maintenance‐Oriented; and (3) Conflict‐Oriented. Data are presented to characterize the classes (e.g. age, gender, rates of different eating disorders, severity of eating disorder pathology and rates of comorbid disorders). These preliminary results suggest that family interaction types may help personalize treatment for eating disorders and encourage future research to guide such efforts. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.