Quantification of carpal tunnel morphology using centroid-to-boundary distance shape signatures.

Morphology analysis is valuable to understanding risk factors and the etiology of carpal tunnel (CT) syndrome. The objective of this study was to investigate morphology changes along the length of the CT using shape signatures (SS). Analysis was performed on ten cadaveric specimens in neutral wrist posture. Centroid-to-boundary distance SS were generated for proximal, middle, and distal CT cross-sections. Phase shift and Euclidean distance were quantified relative to a template SS for each specimen. Medial, lateral, palmar, and dorsal peaks were identified on each SS to generate metrics of tunnel width, tunnel depth, peak amplitude, peak angle. Width and depth measures were also performed using previously reported methods to serve as a basis of comparison. The phase shift revealed twisting of 21° between the ends of the tunnel. Distance from the template and width varied significantly over the length of the tunnel, while depth did not. Measures of width and depth using the SS method were consistent with previously reported methods. The SS method afforded the advantage of peak analysis with overall trends of peak amplitude indicating flattening of the tunnel at the proximal and distal ends relative to a rounder shape in the middle.

The impact of social media use on body image and disordered eating behaviors: Content matters more than duration of exposure.

Social media use is rapidly expanding in terms of frequency, duration, and the diversity of platforms available. Given evidence for associations between social media use, body image disturbances, and disordered eating it is important to identify potentially harmful aspects of social media use that could serve as intervention targets. This study surveyed two demographically diverse undergraduate student cohorts in 2015 and 2022 to compare patterns in social media use, body image, and disordered eating behaviors between samples, including as a function of the COVID-19 pandemic, and to test the hypothesized moderating role of specific content consumed in the association between social media use and maladaptive outcomes. Participants in 2022 reported greater body image disturbances, more frequent vomiting and laxative use, and more time spent on a greater number of social media accounts, with significantly greater use of image-based platforms such as Snapchat, TikTok, and YouTube. Moderated regression analyses suggest that type of content consumed, but not the amount of time spent on social media or diversity of platforms utilized, is associated with body image disturbances and disordered eating behaviors after controlling for gender and body mass index. Specifically, exposure to weight loss content was associated with lower body appreciation, greater fears of negative appearance evaluation, and more frequent binge eating. Contrary to initial hypotheses, exposure to body positivity/neutrality content did not have protective effects. Findings suggest that interventions targeting negative consequences of social media use should focus on addressing content consumed, rather than time spent on social media platforms.

Carpal tunnel volume distribution and morphology changes with flexion-extension and radial-ulnar deviation wrist postures.

Non-neutral wrist postures have been reported to cause decreased carpal tunnel volume (CTV) contributing to impingement of the median nerve and development of carpal tunnel syndrome. Recent analysis found CTV did not change with ±20° flexion-extension (FE), however, CTV decreased with ulnar deviation over the range of -5° to 15° radial-ulnar deviation (RUD). These findings suggest CTV may be too coarse of a measure to reflect the effects of slight non-neutral postures, or that volume is conserved and redistributed due to changes in tunnel morphology with posture. The objective of this study was to assess volume distribution along the length of the carpal tunnel and to quantify regional morphology changes with deviated wrist postures in both FE and RUD. Analysis was performed on a dataset of computed tomography scans collected on ten cadaveric specimens (5 male, 5 female, mean age = 80.7 ± 10.9 years) over a range of FE and RUD postures. The carpal tunnel of each scan was divided into four quartiles of equal length along the tunnel to quantify volume distribution. Volume within the carpal tunnel was seen to redistribute with both FE and RUD. Decreased volume in the distal aspect of the tunnel with flexion and proximal aspect of the tunnel with ulnar deviation may contribute to localized compression of the medial nerve. Measures of mean cross-sectional area, width and depth by quartile provided an indication of the morphology changes associated volume redistribution. Morphology analysis also revealed twisting between the proximal and distal aspects of the tunnel which increased with flexion and ulnar deviation and may further contribute to strain on the median nerve.

Exploring the contributions of affective constructs and interoceptive awareness to feeling fat.

PURPOSE: Feeling fat, a subjective feeling of being overweight that does not always correspond to actual body weight, is commonly reported in patients with an eating disorder. Research suggests that feeling fat relates to deficits in interoceptive awareness, the perception and integration of signals related to body states. Relatedly, recent work has linked feeling fat to affective constructs, such as depressive symptoms and guilt. The current study explores the unique relationships between feeling fat, self-reported, and objective IA, guilt, alexithymia, and depressive symptoms. METHOD: Female undergraduates (N = 128) completed the 11th item of the Eating Disorder Examination Questionnaire, the Toronto Alexithymia Scale, the Guilt subscale of the Positive and Negative Affect Schedule, and the Beck Depression Inventory-II. Participants also completed two IA measures: a heartbeat perception task and the Multidimensional Assessment of Interoceptive Awareness. RESULTS: All collected measures explained 56% of the variability in feeling fat. Depressive symptoms, self-reported IA, and BMI accounted for significant variability in feeling fat. Relative weights analyses revealed that depressive symptoms accounted for the most variability in feeling fat (19%). This finding remained significant after controlling for BMI, which also accounted for significant variability in feeling fat (25%). CONCLUSIONS: Our results replicate previous findings that depressive symptoms relate significantly to feeling fat and extend this work by incorporating the role of interoceptive awareness, guilt, and alexithymia. Endorsement of feeling fat during an intake assessment may alert clinicians to assess for depressive symptoms, and focusing on depressive symptoms in treatment may improve feeling fat. LEVEL OF EVIDENCE: Level I Evidence obtained from an experimental study.

Effects of slight flexion-extension and radial-ulnar deviation postures on carpal tunnel volume.

BACKGROUND: Non-neutral wrist postures are a commonly reported risk factor for carpal tunnel syndrome. It is unclear how slight flexion-extension and radial-ulnar deviation postures affect the carpal tunnel. The objective was to determine the effects of slight non-neutral postures by quantifying carpal tunnel volume. METHODS: Computed tomography images were collected on ten cadaveric specimens in target postures of -20°, -10°, -5°, 0°, 5°, 10°, and 20° of flexion and - 10°, -5°, 0°, 5°, and 10° of radial-ulnar deviation. Surface meshes of the carpal tunnel, carpal bones, radius, and third metacarpal were generated with manual segmentation. Carpal tunnel volume was calculated as the volume between proximal and distal boundaries defined with anatomical landmarks and the orientation of the tunnel. The precise wrist posture of each scan was determined with inertial-based coordinate systems of the radius and third metacarpal. FINDINGS: Through multiple linear regression it was determined that, over the observed range of postures, flexion-extension angle does not have a significant effect (p = 0.99) while radial-ulnar deviation angle has a significant effect of -5.9 mm3/degree (p = 0.003). The findings were consistent with previous studies of postural effects on carpal tunnel pressure. INTERPRETATION: For the treatment and prevention of carpal tunnel syndrome, results suggest that attention should be given to slight radial-ulnar deviation postures (<10°), while slight flexion-extension postures (<20°) are of lesser consequence to carpal tunnel volume.

The role of rumination and positive beliefs about rumination in eating pathology.

PURPOSE: General and eating disorder (ED)-specific ruminations have been identified as key factors that may contribute to eating pathology. Positive beliefs about rumination (e.g., "Ruminating helps me to prevent future mistakes") may impact this association. However, the effect of positive beliefs about rumination on the links between rumination and ED symptom severity has not been investigated. This study sought to clarify relations between rumination and ED symptom severity and to evaluate the potential moderating effect of positive beliefs about rumination on these associations. METHODS: During a laboratory visit, undergraduate participants (N = 473, MAge = 18.90 ± 2.27, MBMI = 23.45 kg/m2 ± 4.31, 54.8% female) completed an online battery of questionnaires assessing general and ED-specific ruminative processes (e.g., brooding, reflection), positive beliefs about rumination, and global ED symptoms. Hierarchical multiple regression analyses assessed the unique contributions of specific ruminative processes, and the moderating effect of positive beliefs on associations between ruminative processes and ED symptom severity. RESULTS: Hierarchical multiple regression results suggest that, after controlling for gender and BMI, ED-specific brooding, b = 1.32, SE = 0.13, ß = 0.46, p < 0.0001, and reflection, b = 1.44, SE = 0.33, ß = 0.19, p < 0.0001, accounted for unique variance in ED symptom severity. Moderation model results indicate that, at low levels of general reflection, b = - 0.06, SE = 0.02, ß = - 0.51, p = 0.003, and ED-specific reflection, b = - 0.15, SE = 0.03, ß = - 0.59, p < 0.0001, increased positive beliefs about rumination were associated with greater ED symptom severity. CONCLUSION: Findings suggest ED-specific rumination accounts for ED symptom severity above and beyond general rumination, and that rumination-related expectancies influence the association between reflection and ED symptom severity. LEVEL OF EVIDENCE: Level III, evidence obtained from a well-designed cohort study.

Consequences of Repeated Critical Versus Neutral Body Checking in Women With High Shape or Weight Concern.

Body checking is a repeated behavior conducted in an attempt to gain information about one's shape, weight, size, or body composition. Body checking is associated with negative behavioral, emotional, and cognitive outcomes and may maintain body dissatisfaction and eating disorders. The precise function and consequences of body checking remain less well understood. Specifically, immediate and delayed impacts of repeated critical body checking (CBC) have not been determined. The current study randomly assigned 142 young women with high shape/weight concern to daily 10-min CBC, neutral body checking (NBC), or a non-body critical checking (NBCC) comparison condition, examining their immediate and delayed (one-week follow-up) effects on body satisfaction, self-esteem, and negative affect. Multilevel modeling and follow-up planned comparisons found that compared to NBCC, CBC participants' body satisfaction and self-esteem immediately decreased, but negative affect improved from baseline to follow-up. Compared to CBC, NBC participants' self-esteem and negative affect improved immediately, and their self-esteem improved over time compared to NBCC. Over time, all participants' state body satisfaction improved, regardless of condition. Our findings suggest a 10-min CBC session may function differently than typical (harmful) in vivo body checking. However, reasons for this difference are unclear. Additional research is needed to distinguish (harmful) in vivo body checking from CBC procedures such as this and other mirror exposure interventions. Research is needed to examine the effects of varying CBC duration and instructions during body exposure to further clarify mechanisms of change during body exposures.

Does the tripartite influence model of body image and eating pathology function similarly across racial/ethnic groups of White, Black, Latina, and Asian women?

The tripartite influence model suggests that appearance pressures from family, peers, and the media contribute to thin-ideal internalization, which leads to increased body dissatisfaction and subsequent eating disorder pathology. The tripartite influence model was initially developed and tested among primarily White samples, and emerging research suggests racial/ethnic differences in mean levels of particular model constructs. Consequently, the model's appropriateness for understanding eating disorder risk in racial/ethnic minorities warrants investigation to determine its usefulness in explicating eating disorder risk in diverse populations. Participants in the current study were White (n = 1167), Black (n = 212), Latina (n = 203), and Asian (n = 176) women from five geographically disparate college campuses in the United States. Participants completed the Sociocultural Attitudes Towards Appearance Questionnaire-4, the Multidimensional Body-Self Relations Questionnaire - Appearance Evaluation Subscale, and the Eating Disorder Examination-Questionnaire. Analysis of variance was used to compare mean levels of each construct across racial/ethnic groups. Multigroup structural equation modeling was used to assess the appropriateness of the tripartite influence model for each racial/ethnic group, and to examine differences in the strength of the model pathways across groups. There were significant mean level differences across groups for most model constructs. However, results indicated similar model fit across racial/ethnic groups, with few differences in the strength of model pathways. Findings suggest that although some groups report lower levels of proposed risk factors, the sociocultural risk processes for eating pathology identified through the tripartite influence model are similar across racial/ethnic groups of young adult women. Such information can be used to inform culturally-sensitive interventions.

Rapid response is predictive of treatment outcomes in a transdiagnostic intensive outpatient eating disorder sample: a replication of prior research in a real-world setting.

OBJECTIVE: There is a growing call to identify specific outcome predictors in real-world eating disorder (ED) treatment settings. Studies have implicated several ED treatment outcome predictors [rapid response (RR), weight suppression, illness duration, ED diagnosis, and psychiatric comorbidity] in inpatient settings or randomized controlled trials of individual outpatient therapy. However, research has not yet examined outcome predictors in intensive outpatient programs (IOP). The current study aimed to replicate findings from randomized controlled research trials and inpatient samples, identifying treatment outcome predictors in a transdiagnostic ED IOP sample. METHOD: The current sample comprised 210 consecutive unique IOP patient admissions who received evidence-based ED treatment, M(SD)Duration = 15.82 (13.38) weeks. Weekly patient measures of ED symptoms and global functioning were obtained from patients' medical charts. RESULTS: In relative weight analysis, RR was the only significant predictor of ED symptoms post treatment, uniquely accounting for 45.6% of the predicted variance in ED symptoms. In contrast, baseline ED pathology was the strongest unique predictor of end-of-treatment global functioning, accounting for 15.89% of predicted variance. Baseline factors did not differentiate patients who made RR from those who did not. CONCLUSIONS: Consistent with findings in more controlled treatment settings, RR remains a robust predictor of outcome for patients receiving IOP-level treatment for EDs. Future work should evaluate factors that mediate and moderate RR, incorporating these findings into ED treatment design and implementation. LEVEL OF EVIDENCE: Level IV, uncontrolled intervention.

Vegetarians and omnivores with diagnosed eating disorders exhibit no difference in symptomology: a retrospective clinical chart review.

PURPOSE: Past work suggests that vegetarianism is common in patients diagnosed with eating disorders (EDs), but the exact nature of this association is unclear, with reports conflicting as to whether vegetarianism is a risk factor for EDs, complicates ED treatment, or is wholly innocuous. Since vegetarianism has been on the rise, the need for current data on possible links with EDs is substantial. METHODS: We collected data on demographics, vegetarian status, ED diagnosis, current body mass index (BMI), highest and lowest BMI, Eating Attitudes Test, and Multifactorial Assessment of Eating Disorders Symptoms scores at intake in 124 patients (84.7% women, 90.3% white, Mage = 23.92 ± 9.16 years) admitted to an intensive outpatient ED program. RESULTS: We first compared omnivores (n = 72, 58.1%), meat-reducers (n = 27, 21.8%), vegetarians (n = 20, 16.1%), and vegans (n = 5, 4.0%) and found no significant differences in any demographic or outcome variable, with the exception that vegetarians reported significantly lower highest-ever BMI compared to meat-reducers (p = 0.03). To mirror past chart reviews, we then compared the combined groups of meat avoiders (n = 52, 41.9%) to the omnivores (n = 72, 58.1%) and found no significant differences in demographics or ED symptoms (all ps > 0.05). CONCLUSION: Overall, data support that meat restriction does not imply greater ED severity. LEVEL OF EVIDENCE: Level V, descriptive study, retrospective chart review.

Female Athlete Body Project Intervention with Professional Dancers: A Pilot Trial.

As aesthetic athletes, professional dancers have increased vulnerability for eating disorders (EDs), with three times higher risk than non-dancers. Among ballet dancers, generalized risk for EDs associated with internalization of western cultural female beauty ideals is compounded by idealization of a ballet-specific body ideal, a combination that confers unique vulnerability for eating pathology. Empirical support has been established for an athlete-specific intervention promoting body acceptance and reduced eating pathology among general populations of young-adult women and female collegiate athletes; the current study adapted this intervention for pilot implementation among professional ballet dancers. Participants from two elite ballet companies (N = 19) were randomized to a control and intervention condition. All participants self-reported eating pathology and related variables pre- and post-intervention, and at six-week follow-up. Post-intervention, participants receiving the intervention demonstrated reductions in body dissatisfaction, p = .005, r = -.63, dietary restraint, p = .008, r = -.59, and eating pathology, p = .007, r = -.60, as compared to control group counterparts; significant differences were retained at follow-up. Results provide preliminary evidence that this intervention has the potential to provide a feasible and acceptable means of ED prevention in female professional ballet dancers. Barriers to feasibility are identified and discussed.

Eating disorder pathology and compulsive exercise during the COVID-19 public health emergency: Examining risk associated with COVID-19 anxiety and intolerance of uncertainty.

OBJECTIVE: COVID-19 has led to disruptions in daily living and increased uncertainty about physical, financial, social, and psychological consequences, which may contribute to anxiety, eating disorder (ED) pathology, and compulsive exercise. Individual factors, such as intolerance of uncertainty, may impact risk for ED pathology and CE in response to COVID-19 anxiety. The current study examined associations between COVID-19 anxiety, trait intolerance of uncertainty, and COVID-19 intolerance of uncertainty and ED pathology and compulsive exercise. METHOD: Undergraduate participants (N = 295) completed a series of online questionnaires between March and April of 2020. RESULTS: COVID-19 anxiety and intolerance of uncertainty were associated with ED pathology, but not compulsive exercise. Additionally, both trait and COVID-19 intolerance of uncertainty moderated associations between COVID-19 anxiety and compulsive exercise and ED pathology. COVID-19 anxiety was more strongly related to compulsive exercise and ED pathology for individuals with lower intolerance of uncertainty. DISCUSSION: COVID-19 anxiety may increase risk for ED pathology and may be specifically important in determining risk for ED pathology and compulsive exercise among individuals with lower intolerance of uncertainty. These results contribute to a growing body of research aimed at understanding the mental health consequences of the COVID-19 and suggest that individual factors (e.g., anxiety and intolerance of uncertainty) are important in determining risk for ED pathology and compulsive exercise in the context of the pandemic.

Factor structure of the Eating Disorder Examination - Questionnaire among heterosexual and sexual minority males.

Eating disorder (ED) pathology is increasingly recognized among males; however, presentations within males differ from traditional descriptions of ED pathology in females. Additionally, experiences of ED pathology differ between sexual minority (SM) and heterosexual males. These differences suggest that existing ED assessments, which are primarily based on female samples, do not adequately capture ED pathology in SM and heterosexual males. The Eating Disorder Examination-Questionnaire (EDE-Q) is a commonly used assessment of ED pathology; however, at present the factor structure of this instrument in SM and heterosexual males is unclear. This study aimed to determine the most appropriate factor structure of the EDE-Q by evaluating proposed factor structures in a large, non-clinical sample consisting of heterosexual and SM men. Additionally, this study examined differences in the factor structures and severities of ED pathology between SM and heterosexual males. Confirmatory Factor Analyses examining existing factor structures of the EDE-Q indicated that the brief three-factor model was the best fitting model for both heterosexual and SM males. Subsequent comparisons of factor scores between groups indicated that SM males in our sample experienced higher levels of dietary restraint, overvaluation of shape and weight, and body dissatisfaction than heterosexual males. Results provide preliminary support for the use of the brief three-factor model of the EDE-Q when assessing ED pathology among SM and heterosexual males in non-clinical research settings.

Expectancies about the Effects of Cannabis Use on Eating Disorder Symptoms.

Background: Substance use, specifically cannabis use, is common among individuals with eating disorder (ED) symptoms; however, few studies have specifically explored the relation between EDs and cannabis use. Purpose: The present study examined expectancies about the impact of cannabis on cognitive, affective and behavioral ED symptoms. Additionally, this study explored associations between cannabis-related expectancies, cannabis use and cannabis-related problems. Methods: Cannabis users with ED symptoms (N = 137) reported on frequency of cannabis use, cannabis-related problems and expectancies about the impact of cannabis on ED symptoms, Results: Participants expected cannabis to decrease restrictive eating, compensatory behaviors, and preoccupation with body shape and weight and fear of eating and weight gain. In contrast, cannabis was expected to increase binge-eating behaviors. Expectancies about the impact of cannabis use on ED symptoms were not associated with more frequent cannabis use nor were they associated with cannabis-related problems. Conclusions: These findings suggest that individuals believe cannabis will improve some ED symptoms; however, these expected improvements are not associated with increased cannabis use and problems. Future research should examine cannabis expectancies in clinical populations and should further explore the association between cannabis expectancies, use, and ED symptoms longitudinally.

Testing the Tripartite Influence Model among heterosexual, bisexual, and lesbian women.

This cross-sectional study explored similarities and differences between heterosexual, bisexual, and lesbian women in levels of, and relationships between, the following constructs using a Tripartite Influence Model framework: family, peer, and media appearance pressures, thin- and muscular-ideal internalization, and eating disorder (ED) pathology. Self-identified heterosexual (n = 1,528), bisexual (n = 89), and lesbian (n = 278) undergraduate women completed the Sociocultural Attitudes Towards Appearance Questionnaire-4 and the Eating Disorder Examination-Questionnaire. Sexual orientation differences in appearance pressures, appearance-ideal internalization, and ED pathology were examined via analysis of variance tests. Relationships between these variables were examined with multi-group path analyses, controlling for age, race/ethnicity, and body mass index. Compared with lesbian women, heterosexual and bisexual women reported higher levels of peer appearance pressures. Paths from peer appearance pressures and thin-ideal internalization to shape/weight overvaluation and body dissatisfaction were strongest for bisexual women. Overall, results indicate notable similarities between heterosexual, bisexual, and lesbian women. However, preliminary evidence for potential differences highlights the importance of examining variation in ED risk between sexual minority subgroups.

Gender-based differential item functioning in measures of eating pathology.

OBJECTIVE: Eating disorder (ED) symptoms are common and impairing in males, despite their perception as "female" disorders. As existing self-report symptom measures were developed and primarily validated in women, there is a need to establish the utility of these measures in men. The present study used differential item functioning (DIF) analyses to explore whether item endorsement differed by gender for three commonly used ED symptom measures. METHOD: Participants were undergraduate men (n = 1,083) and women (n = 2,424) from three universities in the United States. Global scores on the Eating Attitudes Test-26 (EAT-26), Eating Disorder Examination Questionnaire (EDEQ), and Eating Disorder Diagnostic Scale for DSM-IV (EDDS) were examined. Tests of DIF were conducted by regressing each item against its composite scale score, and then comparing fit and variance explained (R2 ) to a model with the interaction of item*gender. The clinical significance threshold for DIF is ΔR2 ≥ 0.13. RESULTS: There was no evidence of clinically significant DIF within the EAT-26, EDEQ, or EDDS. DISCUSSION: Findings suggest that the examined measures perform similarly for undergraduate men and women, supporting their use in nonclinical male samples. However, development and testing of items reflecting ED symptoms that more commonly occur in males (e.g., muscularity-oriented behaviors) is encouraged.

A preliminary naturalistic clinical case series study of the feasibility and impact of interoceptive exposure for eating disorders.

Recent literature suggests that individuals with eating disorders demonstrate altered interoceptive processing, which may relate to the maintenance of symptoms and thus represent a salient treatment target. Adopting treatment techniques effective for other conditions characterized by disturbed interoceptive processes (e.g., anxiety disorders) could aid in improving the outcomes of psychological interventions for eating disorders. The current investigation was a naturalistic case series (N = 4) that examined adjunctive interoceptive exposure (IE) for eating disorders, with an emphasis on evaluating the feasibility, acceptability, and impact of this intervention on anxiety sensitivity, interoceptive deficits, and eating disorder symptoms. Results suggested that all individuals who received 4 consecutive sessions of traditional and eating-disorder-specific IE exercises demonstrated decreases in interoceptive deficits and subjective distress. Results for anxiety sensitivity and eating disorder symptoms were encouraging yet more mixed. Findings also generally suggested that the intervention was feasible and acceptable, yet between-session practice compliance varied considerably among participants. Overall, we describe how IE may be used to target interoceptive deficits in eating disorders and provide preliminary evidence of how this may be accomplished within naturalistic intensive outpatient settings.

Gender differences in relations between alcohol-related compensatory behavior and eating pathology.

PURPOSE: Concerns about caloric intake associated with alcohol use (e.g., fear of weight gain) are positively associated with compensatory eating behaviors (e.g., caloric restriction, self-induced vomiting), a phenomenon that has been identified across gender. Specific motivations for compensatory behaviors differ; some relate to eating disorder (ED) pathology (e.g., shape and weight concerns), and others to alcohol (e.g., enhancing effects). Research examining motivations for alcohol-related compensatory behaviors in men is limited to date. The current study sought to assess how specific types of alcohol-related compensatory behaviors and their association with ED pathology present differently by gender. METHODS: Undergraduates (N = 530, 48% female) completed the Compensatory Eating Behaviors in Response to Alcohol Consumption Scale (CEBRACS), Eating Disorders Diagnostic Scale (EDDS), and reported height, weight, and frequency and quantity of alcohol consumption. Data were examined using linear regression, and relations between CEBRACS behaviors and eating pathology were compared across gender. RESULTS: Factors that were positively associated with EDDS scores for both men and women included alcohol-related dietary restraint, and exercise. For women, but not men, alcohol-related bulimic behavior also contributed to elevations in EDDS scores. CONCLUSIONS: Findings indicate that specific types of alcohol-related compensatory eating behaviors (i.e., dietary restraint and exercise) are positively related to ED pathology for both male and female participants. In contrast, bulimic behaviors' association with ED pathology is gender specific. Understanding gender differences in alcohol-related compensatory behaviors and ED risk may inform gender-specific intervention targets. LEVEL OF EVIDENCE: Cross-sectional descriptive study, Level V.

Comparing internalization of appearance ideals and appearance-related pressures among women from the United States, Italy, England, and Australia.

Researchers have observed variation in levels of body image disturbance and eating pathology among women from different Western countries. Examination of cross-cultural differences in the established risk factors (i.e., thin-ideal internalization, muscular-ideal internalization, and appearance pressures from family, peers, and media) for negative outcomes may help to elucidate the prominence of specific risk factors within a given Western society and guide associated interventions. Women from the United States (US), Italy, England, and Australia completed the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4). Analysis of covariance controlling for age and BMI indicated significant cross-country differences for all SATAQ-4 subscales. Results typically indicated higher levels of appearance-ideal internalization and appearance pressures in the US and lower levels in Italy; however, associated effect sizes were generally small. A medium effect of country was observed for peer-appearance pressures, which were highest in the US compared with all other countries. Repeated-measures analysis of variance and paired samples t tests conducted within each country identified thin-ideal internalization and media appearance pressures as the predominant risk factors for all four countries. Overall, findings suggest more cross-country similarities than differences, and highlight the importance of delivering interventions to address thin-ideal internalization and media appearance pressures among women from Western backgrounds.Level of evidence Descriptive study, Level V.

Identifying a male clinical cutoff on the Eating Disorder Examination-Questionnaire (EDE-Q).

OBJECTIVE: Evidence suggests that eating disorders (EDs) may be under-detected in males. Commonly used measures of EDs such as the Eating Disorder Examination-Questionnaire (EDE-Q) were initially developed within female samples, raising concern regarding the extent to which these instruments may be appropriate for detecting EDs in males. The current study used receiver operating characteristic curve analysis to (a) examine the accuracy of the EDE-Q global score in correctly classifying males with and without clinically significant ED pathology, and (b) establish the optimal EDE-Q global clinical cutoff for males. METHOD: Participants were a clinical sample of 245 male ED patients and a control sample of 205 male undergraduates. RESULTS: Eating Disorder Examination-Questionnaire global scores demonstrated moderate-high accuracy in predicting ED status (area under the curve = 0.85, 95% CI: 0.82-0.89). The optimal cutoff of 1.68 yielded a sensitivity of 0.77 and specificity of 0.77. DISCUSSION: Overall, results provide preliminary support for the discriminant validity of EDE-Q scores among males. However, concerns remain regarding the measure's ability to comprehensively assess domains of disordered eating most relevant to males. Therefore, careful attention to the possibility for measurement bias and continued evaluation of the scale in males is encouraged.