Factor structure and measurement invariance of the Body Appreciation Scale - 2 among Brazilian gender-expansive individuals and transgender men.

Among gender-expansive individuals and transgender men, body appreciation can play a protective role against minority stressors and is associated with gender euphoria. The Body Appreciation Scale (BAS-2; Tylka & Wood-Barcalow, 2015) is a leading measure of body appreciation that has been mainly validated in cisgender and mixed-gender samples; however, it has not been validated among Brazilian gender-expansive individuals and transgender men. Therefore, we evaluated the psychometric properties of the BAS-2 among adult Brazilian gender-expansive individuals and transgender men. Participants (158 gender-expansive individuals and 138 transgender men) were recruited through social media in Brazil. Confirmatory Factor Analysis (CFA) supported the original 10-item, unidimensional solution. Multigroup CFA showed configural, metric, and scalar invariance of the BAS-2 between gender-expansive individuals and transgender men. Moreover, the BAS-2 demonstrated significant negative associations, ranging from small to large, with self-objectification, drive for muscularity, and appearance-ideal internalization. We also found good internal consistency and test-retest reliability of the measure. Taken together, our results support the psychometric properties of the BAS-2 among Brazilian gender-expansive individuals and transgender men. The present work offers a valuable contribution towards better understanding facets of positive body image across gender-expansive and transgender populations.

Development and initial validation of Personality Disorder Syndrome scales for the MMPI-3.

The purpose of the present study was to revise and update the MMPI-2-RF personality disorder (PD) syndrome scales for the Minnesota Multiphasic Personality Inventory-3 (MMPI-3). Study 1 describes the development of the MMPI-3 PD syndrome scales in three separate samples of community participants (n = 1,591), university students (n = 1,660), and outpatient mental health patients (n = 1,537). The authors independently evaluated each of the 72 new MMPI-3 items and rated them for appropriateness for scale inclusion and used various statistical procedures for final item selection. Ultimately, all 10 scales were revised, with nine incorporating items that were new to the MMPI-3. In Study 2, we subsequently validated the new MMPI-3 PD Syndrome scales against measures of traditional PD measures, trait measures of the Alternative Diagnostic and Statistical Manual of Mental Disorders, fifth edition-5 model of personality disorders (AMPD) and the five-factor model (FFM) of personality, and specific criterion measures of externalizing, psychopathy, narcissism, emotional dysregulation, and self-harm, in two samples of university students (ns = 489 and 645). With some exceptions, the results were generally supportive of the convergent and discriminant validities of the MMPI-3 PD Syndrome scales. The Histrionic PD scale in particular was associated with questionable results and diverged most strongly from the theoretical construct it was originally meant to reflect. Further continuous validation of the scales is needed, especially in clinical samples, but the findings to date are promising. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Examining the validity and factor structure of the ICD-11 trait domains.

The International Classification of Diseases, 11th Edition (ICD-11) includes a new personality disorder (PD) severity diagnosis that may be further characterized using up to five trait domain specifiers. Most of the previous studies have investigated the ICD-11 trait domains using self-report measures. The present study aimed to validate ICD-11 PD trait domains using a multimethod design in a community mental health sample (n = 336). We conducted two confirmatory factor analyses to examine the factor structure of the ICD-11 PD trait model, utilizing clinician-rating, self-report, and informant-report measures. Finally, we examined associations between clinician-rated, self-reported, and informant-reported ICD-11 trait domains with external criteria, specifically traditional PD symptoms and the five-factor model of normal personality. All clinician-rated, self-reported, and informant-reported domain scores loaded meaningfully on their expected factors when controlling for nontrivial method factors. Generally, the trait domains exhibited meaningful associations with conceptually relevant external criteria, although the anankastia domain exhibited more variability in its pattern of correlations across methods. Overall, the ICD-11 trait domain model shows promising reliability and validity, indicating good progress within the field of PD assessment toward a more useful PD operationalization. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Perceptual Dysfunction in Eating Disorders.

Eating disorders (EDs) are characterized by abnormal responses to food and weight-related stimuli and are associated with significant distress, impairment, and poor outcomes. Because many of the cardinal symptoms of EDs involve disturbances in perception of one's body or abnormal affective or cognitive reactions to food intake and how that affects one's size, there has been longstanding interest in characterizing alterations in sensory perception among differing ED diagnostic groups. Within the current review, we aimed to critically assess the existing research on exteroceptive and interoceptive perception and how sensory perception may influence ED behavior. Overall, existing research is most consistent regarding alterations in taste, visual, tactile, and gastric-specific interoceptive processing in EDs, with emerging work indicating elevated respiratory and cardiovascular sensitivity. However, this work is far from conclusive, with most studies unable to speak to the precise etiology of observed perceptual differences in these domains and disentangle these effects from affective and cognitive processes observed within EDs. Further, existing knowledge regarding perceptual disturbances in EDs is limited by heterogeneity in methodology, lack of multimodal assessment protocols, and inconsistent attention to different ED diagnoses. We propose several new avenues for improving neurobiology-informed research on sensory processing to generate actionable knowledge that can inform the development of innovative interventions for these serious disorders.

Examining eating disorder pathology and self-stigma of help-seeking behaviors in a community sample of sexual minority adults: an intersectional investigation of race and gender.

BACKGROUND: Self-stigma of seeking psychological help is a critical factor prohibiting individuals from seeking eating disorder (ED) treatment, but has been widely unexplored in racial/ethnic and sexual minority (SM) samples. The current study examined differences in ED pathology and self-stigma of help-seeking at the intersection of race and gender within a cisgender SM sample. METHODS: Cisgender SM participants (n = 354) identifying as Black, Indigenous, or People of Color (BIPOC; 52%), Asian American and Pacific Islander (AAPI; 24%), or White (24%) were recruited through Prolific Academic. One-way analyses of variance were used to examine differences in the Self-Stigma of Seeking Help Scale (SSOSH) and Eating Pathology Symptom Inventory (EPSI) subscales among men and women in each group. Pearson's correlations explored associations between SSOSH and EPSI subscales within each subgroup. RESULTS: Findings indicated significant between-group differences on the SSOSH and the EPSI subscales of Body Dissatisfaction, Purging, and Excessive Exercise. SSOSH was significantly positively correlated with Body Dissatisfaction in the White SM cis-women group and Binge Eating in the BIPOC SM cis-men group. CONCLUSIONS: Results demonstrate unique, intersectional between-group differences in ED pathology and self-stigma among SM individuals. Further research on the impact of intersectionality on these constructs within larger samples is warranted.

Urinary Incontinence in Primary Care-The Gap Between Recommendations and Real World.

IMPORTANCE: Routine screening for urinary incontinence (UI) by primary care providers (PCPs) is recommended. OBJECTIVES: We aimed to describe the rate of incident UI diagnosed at annual PCP visits, the prevalence of UI in a large primary care population, and estimate the rate of screening for UI during primary care preventive and annual wellness visits. Secondary aims were to describe PCP knowledge and behavior as they relate to UI screening and diagnosis. STUDY DESIGN: The electronic health record was used to abstract the number of adult female patients seen by PCPs within a regional health system with a diagnosis of UI before our study period and with a new diagnosis over a 2-year period. Additional new diagnoses and screening practices were found on chart review of an additional 824 representative charts. Primary care providers within the health system were surveyed about their screening practices and knowledge about UI. RESULTS: There were 192,053 women primary care patients seen over 2 years. A total of 5.7% had a UI diagnosis preceding the study period and 3.4% had a UI diagnosis during the study period. A total of 42% of PCPs reported that they screen for UI at least half the time and none were completely satisfied with their ability to screen for UI. Sixteen percent of annual wellness visits had any documentation of screening for UI. CONCLUSION: In a large primary care population, screening for and detection of UI in women was low.

Weight gained during treatment predicts 6-month body mass index in a large sample of patients with anorexia nervosa using ensemble machine learning.

OBJECTIVE: This study used machine learning methods to analyze data on treatment outcomes from individuals with anorexia nervosa admitted to a specialized eating disorders treatment program. METHODS: Of 368 individuals with anorexia nervosa (209 adolescents and 159 adults), 160 individuals had data available for a 6-month follow-up analysis. Participants were treated in a 6-day-per-week partial-hospital program. Participants were assessed for eating disorder-specific and non-specific psychopathology. The analyses used established machine learning procedures combined in an ensemble model from support vector machine learning, random forest prediction, and the elastic net regularized regression with an exploration (training; 75%) and confirmation (test; 25%) split of the data. RESULTS: The models predicting body mass index (BMI) at 6-month follow-up explained a 28.6% variance in the training set (n = 120). The model had good performance in predicting 6-month BMI in the test dataset (n = 40), with predicted BMI significantly correlating with actual BMI (r = .51, p = 0.01). The change in BMI from admission to discharge was the most important predictor, strongly correlating with reported BMI at 6-month follow-up (r = .55). Behavioral variables were much less predictive of BMI outcome. Results were similar for z-transformed BMI in the adolescent-only group. Length of stay was most predictive of weight gain in treatment (r = .56) but did not predict longer-term BMI. CONCLUSIONS: This study, using an agnostic ensemble machine learning approach in the largest to-date sample of individuals with anorexia nervosa, suggests that achieving weight gain goals in treatment predicts longer-term weight-related outcomes. Other potential predictors, personality, mood, or eating disorder-specific symptoms were relatively much less predictive. PUBLIC SIGNIFICANCE: The results from this study indicate that the amount of weight gained during treatment predicts BMI 6 months after discharge from a high level of care. This suggests that patients require sufficient time in a higher level of care treatment to meet their specific weight goals and be able to maintain normal weight.

Comparing changes in eating disorder psychopathology and comorbid symptoms over treatment in anorexia nervosa and atypical anorexia nervosa in a partial hospitalization program.

OBJECTIVE: The objective of this study is to compare treatment trajectories in anorexia nervosa (AN) and atypical AN. METHOD: Adolescents and adults with AN (n = 319) or atypical AN (n = 67) in a partial hospitalization program (PHP) completed diagnostic interviews and self-report questionnaires measuring eating disorder (ED), depression, and anxiety symptoms throughout treatment. RESULTS: Premorbid weight loss did not differ between diagnoses. Individuals with atypical AN had more comorbid diagnoses, but groups did not differ on specific diagnoses. ED psychopathology and comorbid symptoms of depression/anxiety did not differ at admission between groups nor did rate of change in ED psychopathology and comorbid symptoms of depression/anxiety from admission to 1-month. From admission to discharge, individuals with atypical AN had a faster reduction in ED psychopathology and comorbid symptoms of depression and anxiety (ps < 0.05; rs = 0.01-0.32); however, there were no group differences in ED psychopathology or depression symptoms at discharge (ps>.50; ds = .01-.30). Individuals with atypical AN had lower anxiety at discharge compared to individuals with AN (p = 0.05; d = .4). Length of stay did not differ between groups (p = 0.11; d = .21). DISCUSSION: Groups had similar ED treatment trajectories, suggesting more similarities than differences. PHP may also be effective for AAN. PUBLIC SIGNIFICANCE: This study supports previous research that individuals with AN and atypical AN have more similarities than differences. Results from this study indicate that individuals with AN and atypical AN have similar treatment outcomes for both ED psychopathology and depressive symptoms; however, individuals with atypical AN have lower anxiety symptoms at discharge compared to individuals with AN. AN and atypical AN also have more symptom similarity at admission and throughout treatment, which challenges their current designation as distinct disorders.

Early change in gastric-specific anxiety sensitivity as a predictor of eating disorder treatment outcome.

Eating disorders (EDs) are often accompanied by gastrointestinal (GI) distress. Anxiety sensitivity is the tendency to interpret sensations of anxiety as threatening or dangerous, and includes both broad physical symptoms (e.g., elevated heartrate) and GI-specific symptoms. Physical and GI-specific anxiety sensitivity may be important risk and maintaining factors in EDs. This study tested the hypothesis that greater reductions in both types of anxiety sensitivity during the first month of treatment would predict lower ED symptoms and trait anxiety at discharge and 6-month follow-up. Patients (n = 424) in ED treatment reported physical and GI-specific anxiety sensitivity, ED symptoms, and trait anxiety at treatment admission, 1-month into treatment, discharge, and 6-month follow-up. Analyses were conducted with hierarchical linear regression with imputation, controlling for relevant covariates. Results indicated that early reduction in GI-specific but not general physical anxiety sensitivity predicted both lower ED symptoms and lower trait anxiety at discharge and 6-month follow-up. These findings demonstrate the importance of GI-specific anxiety sensitivity as a potential maintaining factor in EDs. Developing and refining treatments to target GI-specific anxiety sensitivity may have promise in improving the treatment not only of EDs, but also of commonly co-morbid anxiety disorders.

Development and Psychometric Validation of the Body Trust Scale.

Interoception (e.g., abilities to recognize/attend to internal sensations) is robustly associated with psychopathology. One form of interoception, body trust, is relevant for the development of disordered eating and suicidal thoughts/behaviors. However, measures of body trust are narrow, despite research suggesting body trust is multifaceted. The aim of this study was to develop a comprehensive measure of body trust: The Body Trust Scale (BTS). 479 U.S. adults completed self-report surveys containing the BTS and psychopathology measures. Exploratory and confirmatory factor analyses revealed a three-factor structure: Comfort with One's Body, Physical Attractiveness, and Comfort with Internal Sensations. Factors showed strong construct, convergent, and divergent validity, as well as moderate predictive validity for suicidal thoughts/non-suicidal self-injury. Furthermore, factors showed strong internal consistency, test-retest reliability, and were invariant across the gender binary. The BTS can be used in research and clinical settings to understand how specific facets of body trust relate to psychopathology.

Differential effects of community involvement on eating disorder prevention outcomes in sexual minority men.

Prior research has been conflicted on whether gay community involvement serves as a risk or protective factor for body image and eating disorders (EDs) in sexual minority men (SMM), perhaps given that prior research has examined community involvement unidimensionally. The present study examined whether non-appearance-based ("social activism") and appearance-based ("going out/nightlife") community involvement differentially predicted ED prevention outcomes in SMM. SMM (N = 73) enrolled in a randomized controlled trial of an ED prevention program completed measures of community involvement, drive for muscularity, body dissatisfaction, and bulimic symptoms at pre-intervention, post-intervention, and 1-month follow-up. "Social activism" community involvement moderated intervention effects for drive for muscularity and body dissatisfaction scores, but not bulimic symptoms, such that those who placed higher importance on social activism demonstrated expected improvements, while those who placed lower importance on social activism did not exhibit expected improvements. "Going out/nightlife" community involvement did not moderate intervention outcomes; however, greater importance of going out/nightlife was associated with increased body dissatisfaction. Findings support that the impact of community involvement on body image and ED risk for SMM may be nuanced. Encouraging community involvement through activism could help enhance ED prevention efforts for SMM.

Reducing Care Overuse in Older Patients Using Professional Norms and Accountability : A Cluster Randomized Controlled Trial.

BACKGROUND: Effective strategies are needed to curtail overuse that may lead to harm. OBJECTIVE: To evaluate the effects of clinician decision support redirecting attention to harms and engaging social and reputational concerns on overuse in older primary care patients. DESIGN: 18-month, single-blind, pragmatic, cluster randomized trial, constrained randomization. (ClinicalTrials.gov: NCT04289753). SETTING: 60 primary care internal medicine, family medicine and geriatrics practices within a health system from 1 September 2020 to 28 February 2022. PARTICIPANTS: 371 primary care clinicians and their older adult patients from participating practices. INTERVENTION: Behavioral science-informed, point-of-care, clinical decision support tools plus brief case-based education addressing the 3 primary clinical outcomes (187 clinicians from 30 clinics) were compared with brief case-based education alone (187 clinicians from 30 clinics). Decision support was designed to increase salience of potential harms, convey social norms, and promote accountability. MEASUREMENTS: Prostate-specific antigen (PSA) testing in men aged 76 years and older without previous prostate cancer, urine testing for nonspecific reasons in women aged 65 years and older, and overtreatment of diabetes with hypoglycemic agents in patients aged 75 years and older and hemoglobin A1c (HbA1c) less than 7%. RESULTS: At randomization, mean clinic annual PSA testing, unspecified urine testing, and diabetes overtreatment rates were 24.9, 23.9, and 16.8 per 100 patients, respectively. After 18 months of intervention, the intervention group had lower adjusted difference-in-differences in annual rates of PSA testing (-8.7 [95% CI, -10.2 to -7.1]), unspecified urine testing (-5.5 [CI, -7.0 to -3.6]), and diabetes overtreatment (-1.4 [CI, -2.9 to -0.03]) compared with education only. Safety measures did not show increased emergency care related to urinary tract infections or hyperglycemia. An HbA1c greater than 9.0% was more common with the intervention among previously overtreated diabetes patients (adjusted difference-in-differences, 0.47 per 100 patients [95% CI, 0.04 to 1.20]). LIMITATION: A single health system limits generalizability; electronic health data limit ability to differentiate between overtesting and underdocumentation. CONCLUSION: Decision support designed to increase clinicians' attention to possible harms, social norms, and reputational concerns reduced unspecified testing compared with offering traditional case-based education alone. Small decreases in diabetes overtreatment may also result in higher rates of uncontrolled diabetes. PRIMARY FUNDING SOURCE: National Institute on Aging.

Executive function differences as a function of parent-reported binge eating and weight: Results from the adolescent brain cognitive development study.

Background: Binge eating is a relatively common disordered eating behavior among children, and is associated with poor health outcomes. Executive function (EF)-higher order cognitive abilities related to planning and impulse control-may be implicated in both binge eating and pediatric obesity. Although EF deficits are evident among individuals with obesity and/or binge eating, findings are mixed across the lifespan. Methods: The present study examined differences in EF among children with varying weight statuses and parent-reported binge eating. The sample included 10,017 children from the Adolescent Brain Cognitive Development study, aged 9-10 years. Results: Children with parent-reported binge eating-either with overweight/obesity or normal weight-had significantly lower EF than those with no binge eating and a normal weight status but did not differ from those with no binge eating and overweight/obesity. Children with no binge eating and overweight/obesity also had statistically significantly lower EF than those with normal weight status. Although all significant differences between groups were negligible to very small, results may indicate similar neurocognitive profiles among children with binge eating and those with overweight/obesity. Conclusions: Alterations in EF among children with binge eating may not be solely related to weight-specific factors, as significant differences also emerged among children with normal weight status, with versus without parent-reported binge eating. Future research is needed to understand temporal associations between obesity, disordered eating, and neurocognition in children using multi-informant methods for assessing binge eating.

Examining the placement of atypical anorexia nervosa in the eating disorder diagnostic hierarchy relative to bulimia nervosa and binge-eating disorder.

OBJECTIVE: Some individuals meet the criteria for atypical anorexia nervosa and another eating disorder simultaneously. The current study evaluated whether allowing a diagnosis of atypical anorexia nervosa to supersede a diagnosis of bulimia nervosa (BN) or binge-eating disorder (BED) provided additional information on psychological functioning. METHODS: Archival data from 650 university students (87.7% female, 69.4% white) who met Eating Disorder Diagnostic Survey for DSM-5 eating disorder criteria and completed questionnaires assessing quality of life, eating disorder-related impairment, and/or eating pathology at a single time point. Separate regression models used diagnostic category to predict quality of life and impairment. Two diagnostic schemes were used: the DSM-5 diagnostic scheme and an alternative scheme where atypical anorexia nervosa superseded all diagnoses except anorexia nervosa. Model fit was compared using the Davidson-Mackinnon J test. Analyses were pre-registered (https://osf.io/2ejcd). RESULTS: Allowing an atypical anorexia nervosa diagnosis to supersede a BN or BED diagnosis provided better fit to the data for eating disorder-related impairment (p = .02; n = 271), but not physical, psychological, or social quality of life (p's ≥ .33; n = 306). Allowing an atypical anorexia nervosa diagnosis to supersede a BN or BED diagnosis provided a better fit in cross-sectional models predicting purging (p = .02; n = 638), but not body dissatisfaction, binge eating, restricting, or excessive exercise (p's ≥ .08; n's = 633-647). DISCUSSION: The current data support retaining the DSM-5 diagnostic scheme. More longitudinal work is needed to understand the predictive validity of the atypical anorexia nervosa diagnosis. PUBLIC SIGNIFICANCE: The current study examined how changes to the diagnostic categories for eating disorders may change how diagnoses are associated with quality of life and impairment. Overall, findings suggest that the diagnostic hierarchy should be maintained.

Promoting Resilience to Improve Disordered Eating (PRIDE): A case series of an eating disorder treatment for sexual minority individuals.

OBJECTIVE: Despite the increased risk for eating disorders (EDs) among sexual minority (SM) individuals, no ED treatments exist specifically for this population. SM stress and appearance-based pressures may initiate and/or maintain ED symptoms in SM individuals; thus, incorporating strategies to reduce SM stressors into existing treatments may help address SM individuals' increased ED risk. This mixed-methods study evaluated the feasibility, acceptability, and preliminary efficacy of Promoting Resilience to Improve Disordered Eating (PRIDE)-a novel ED treatment for SM individuals. METHODS: N = 14 SM individuals with an ED diagnosis received 14 weekly sessions integrating Enhanced Cognitive Behavioral Therapy for EDs (CBT-E) with techniques and principles of SM-affirmative CBT developed to address SM stressors. Participants completed qualitative interviews and assessments of ED symptoms and SM stress reactions at baseline (pretreatment), posttreatment, and 1-month follow-up. RESULTS: Supporting feasibility, 12 of the 14 (85.7%) enrolled participants completed treatment, and qualitative and quantitative data supported PRIDE's acceptability (quantitative rating = 3.73/4). By 1-month follow-up, 75% of the sample was fully remitted from an ED diagnosis. Preliminary efficacy results suggested large and significant improvements in ED symptoms, clinical impairment, and body dissatisfaction, significant medium-large improvements in internalized stigma and nonsignificant small-medium effects of sexual orientation concealment. DISCUSSION: Initial results support the feasibility, acceptability, and initial efficacy of PRIDE, an ED treatment developed to address SM stressors. Future research should evaluate PRIDE in a larger sample, compare it to an active control condition, and explore whether reductions in SM stress reactions explain reductions in ED symptoms. PUBLIC SIGNIFICANCE: This study evaluated a treatment for SM individuals with EDs that integrated empirically supported ED treatment with SM-affirmative treatment in a case series. Results support that this treatment was well-accepted by participants and was associated with improvements in ED symptoms and minority stress outcomes.

Validation of a measure of hypervigilance and anxiety about gastrointestinal symptoms for individuals with elevated eating pathology.

Gastrointestinal symptoms are common within eating disorders and gastrointestinal-specific anxiety is a posited maintenance factor. The present study sought to validate a modified version of an existing measure of gastrointestinal-specific anxiety and hypervigilance in a sample with elevated eating pathology. Esophageal-specific terms in the Esophageal Hypervigilance and Anxiety Scale were modified to measure any gastrointestinal symptoms as a general measure of gastrointestinal-specific anxiety and hypervigilance. Three hundred eighty-two undergraduate students (83.5% female, 87.4% White) with elevated eating pathology completed a questionnaire battery that also measured gastrointestinal symptoms, general anxiety sensitivity, and lower gastrointestinal-specific anxiety on two occasions. Analyses were preregistered at Open Science Framework. Confirmatory factor analysis indicated a two-factor solution (anxiety and hypervigilance) fit the data best. Internal consistency and 2-week test-retest reliability were good for subscale scores. Subscale scores exhibited large associations with a measure of lower gastrointestinal-specific anxiety but did not exhibit the hypothesized relationships with general anxiety sensitivity. Subscale scores were at least moderately correlated with measures of gastrointestinal symptoms and somatic symptom severity, with some exceptions (hypervigilance with nausea/vomiting, postprandial fullness/early satiety, bloating). Subscale scores exhibited negligible associations with discriminant validity measures. Results suggest that gastrointestinal-specific anxiety and hypervigilance are separable in samples with elevated eating pathology. The Anxiety and Hypervigilance subscale scores showed good reliability in a sample with elevated eating pathology. Correlations with measures of gastrointestinal symptoms and gastrointestinal-specific anxiety generally demonstrated good convergent and discriminant validity. We recommend researchers use subscale scores, rather than total score, in future research on gastrointestinal symptoms associated with eating pathology. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Development and psychometric evaluation of the Personality Disorder Severity ICD-11 (PDS-ICD-11) Clinician-Rating Form.

No clinician-rating tool has formally been developed to assess the ICD-11 model of personality disorder (PD) severity. We therefore developed and evaluated the 14-item personality disorder Severity ICD-11 (PDS-ICD-11) Clinician-Rating Form. A combined sample of 195 patients was rated by mental health professionals or clinical research assistants in New Zealand using the PDS-ICD-11 Clinician-Rating Form. Responses were subjected to item-response theory analysis and confirmatory factor analysis. In a subsample, we examined interrater reliability and convergence with self- and informant-reported measures of personality impairment, dysfunction in various psychopathology domains, and traditional PD symptoms. Item-response theory and confirmatory factor analyses supported the item functioning and unidimensionality, respectively, of the PDS-ICD-11 Clinician-Rating Form. The interrater reliability was very promising (intraclass correlation coefficient = 0.94, p < 0.001). PDS-ICD-11 Clinician-Rating Form scores were associated with established measures of personality dysfunction at large effect sizes. This initial development study suggests that the PDS-ICD-11 Clinician-Rating Form constitutes a psychometrically sound instrument that provides a clinically based impression of the severity of personality dysfunction according to the official ICD-11 description. More research is needed to corroborate its validity and utility, and a structured interview is warranted for diagnostic purposes. The final PDS-ICD-11 Clinician-Rating Form is included as online supporting information.

Elevated interoceptive deficits in individuals with eating disorders and self-injurious thoughts and behaviors: A replication and extension.

INTRODUCTION: People with eating disorders (EDs) frequently report self-injurious thoughts and behaviors (SITBs). We aimed to replicate and extend findings demonstrating greater interoceptive deficits according to SITB severity. We predicted that interoceptive deficits would be greater among people with versus without lifetime SITBs and among those with multiple suicide attempts compared with single attempts or nonsuicidal self-injury. We also predicted that interoception would be increasingly impaired with greater current suicidality severity. METHOD: Adults (N = 118) seeking ED treatment reported current and lifetime SITBs upon admission to treatment. We used planned contrasts to compare interoceptive deficits (self-reported using the Eating Disorders Inventory) by SITB and current suicidality groups (assessed by self-report and clinical interview). RESULTS: Interoceptive deficits were greater among people with any SITB history compared to those without. People with multiple suicide attempts did not differ in interoceptive deficits from those with single attempts or only nonsuicidal self-injury. Interoceptive deficits were elevated among those with any current suicidality compared to those with no suicidal symptoms; interoceptive deficits did not differ according to severity of suicidality. CONCLUSION: Among those with EDs, interoceptive deficits are elevated among those with concurrent SITBs. Interventions aimed at improving interoception may reduce the risk for SITBs.