The effect of training to target cognitive biases towards social rejection in eating disorders.

OBJECTIVE: This study examined the effect of cognitive bias modification for interpretation (CBM-I) training in Korean women with eating disorders (EDs). METHOD: Sixty-three women with EDs participated in the study. Participants were randomly assigned to the intervention group where they received six sessions of CBM-I training (n = 31) in addition to treatment-as-usual or were put on a waiting list (n = 32). Participants' interpretation and attention biases, emotion regulation, affect, and ED psychopathology were assessed at baseline, end-of-intervention (4 weeks), and follow-up (8 weeks). RESULTS: Participants who completed the CBM-I training displayed greater reductions in negative interpretation bias (Δη2 = 0.107) and emotion dysregulation (Δη2  = 0.085) with medium to large effect sizes compared to the control group, which were maintained from baseline to follow-up. Disengagement from negative faces and a focus on positive faces was found in the intervention group with a moderate effect size at the end-of-intervention (Δη2  = 0.090). Both intervention and control groups showed improvements in ED psychopathology. Baseline neuroticism was positively correlated with CBM-I effect. DISCUSSION: The results suggest that modifying interpretation bias towards ambiguous social stimuli might be an effective adjuvant treatment to reduce negative expectations of social situations and improve emotion regulation in women with bulimia nervosa and anorexia nervosa.

Effect of modifying negative interpretation bias toward ambiguous social stimuli across eating and personality disorders.

OBJECTIVE: Heightened sensitivity toward social rejection has been implicated in eating disorders (ED) and personality disorder (PD). This study examined the effect of a cognitive bias modification training (CBM-I) targeting the interpretation of ambiguous social situations in individuals with comorbid ED and PD. METHOD: A total of 128 participants [33 with ED and PD, 22 with ED-only, 22 with PD-only, and 51 healthy controls (HC)] were recruited from a hospital and university settings, and included in the final analyses. The participants were randomly assigned to a CBM-I task with benign resolutions or a control task with neutral resolutions in a counterbalanced order in two sessions using a within-subject design. Interpretation bias toward social stimuli was measured using the ambiguous sentence completion task before and after completing the assigned task. RESULTS: The CBM-I task increased benign and decreased negative interpretations with large effect sizes in the diagnostic groups, and with a moderate effect size in the HC group. Participants' anxiety levels were also reduced after the task. The size of the change in negative interpretation was positively associated with baseline negative affect, and negatively associated with baseline positive affect. DISCUSSION: The results suggest that modifying interpretation bias has the potential as a transdiagnostic target of treatment for ED and PD, and a fully powered clinical trial with consecutive sessions would be warranted. PUBLIC SIGNIFICANCE: Participants with eating disorders and/or personality disorder, and healthy controls completed a single session of a cognitive training intervention targeting rejection sensitivity. The training produced a large decrease in negative interpretation in the diagnostic groups, and a moderate effect in healthy controls. The findings indicate that training for positive processing of social information may be of value to augment treatment in conditions such as eating disorders and personality disorder, in which there are high levels of rejection sensitivity.

Biochemical, hematologic, and skeletal features associated with underweight, overweight, and eating disorders in young Korean women: A population-based study.

Background: Extreme weight conditions in young women are associated with adverse health outcomes. Closely linked with extreme weight status, eating disorders (EDs) are associated with several medical complications and high mortality rates. Objective: The study aimed to investigate the biochemical, hematologic, and skeletal features of young Korean women with underweight (UW) and overweight/obesity (OW) conditions, and patients with anorexia nervosa (AN) and bulimia nervosa (BN) compared to women with normal-weight (NW). Method: A total of 808 women (mean age 22.3 ± 3.4 years) were recruited for the study, including 144 with UW status [body mass index (BMI) < 18.5 kg/m2], 364 with NW, 137 with OW or obesity (27 with obesity; BMI ≥ 25 kg/m2), 63 patients with anorexia nervosa (AN), and 100 with bulimia nervosa (BN). We measured blood pressure and performed biochemical, hematologic and bone mineral density (BMD) evaluations at the lumbar and femoral neck. Results: Blood pressure and triiodothyronine levels were found to be lower in both ED groups and higher in the OW group, but no difference in the UW group, compared to the NW group. The aminotransferases and total cholesterol levels were higher in the ED and OW groups, compared to the NW group. Blood cell counts were decreased in the AN group, while increased in the OW group, compared to the NW group. Blood urea nitrogen was elevated in both ED groups. The UW and AN groups had lower BMD, whereas the OW group had higher BMD, compared to the NW group. Conclusion: Our findings suggested that both ED groups were associated with decreases in the resting energy expenditure. OW status was associated with a risk of metabolic syndrome, and UW status with lower BMD in young women. Overall, the medical parameters in Korean patients with ED were similar to the patterns reported in Western samples in previous studies, with few exceptions such as potassium level in BN.

Negative emotion-related eating behaviours in young women with underweight status, overweight status, anorexia nervosa, and bulimia nervosa in Korea.

OBJECTIVE: This study aimed at investigating the negative emotion-related eating behaviours of young women with extreme weights or eating disorders (EDs). METHOD: A total of 808 young women participated including 144 with underweight (UW), 364 with normal-weight (NW) and 137 with overweight (OW; including 27 with obesity) from universities, and 63 patients with anorexia nervosa (AN), and 100 patients with bulimia nervosa (BN) from a hospital. Participants were interviewed and completed questionnaires on eating behaviours related to negative emotions. RESULTS: While both OW and BN groups ate more in response to negative emotions, UW and AN groups ate less compared to NW group. Negative feelings after overeating were prominent in OW group and patients with ED. In negative emotions, patients with EDs preferred sweet tastes, but BN group preferred spicy tastes less. Patients with EDs had increased external eating, and BN group also showed increased restrained eating. Neuroticism had indirect impacts on OW status via emotional eating unlike BN. CONCLUSIONS: The results suggest that UW and OW status were on the spectrum of emotional eating, and AN and BN were on the extremes of external eating, which may be integrated into the development of interventions targeting each status.

Factors Associated with Underweight, Overweight, and Eating Disorders in Young Korean Women: A Population-Based Study.

Both underweight (UW) and overweight (OW) conditions are problematic in young women. The aim of this study was to examine the factors associated with extreme weight status and eating disorders (EDs) in young Korean women. A total of 808 women (mean age 22.3 ± 3.4 years) participated, including 144 with UW [Body Mass Index (BMI) < 18.5kg/m2], 364 with NW, and 137 with OW or obesity (BMI ≥ 25kg/m2), and 63 patients with anorexia nervosa (AN) and 100 with bulimia nervosa (BN). Participants completed questionnaires regarding nutrients consumed, eating behaviors, health behaviors, body image, and obsessive-compulsive symptoms with face to face interviews. The associations between the status of participants and the data were analyzed with NW group as a reference. OW status was associated with overeating and with frequent eating. UW status was associated with less frequent overeating and with longer sleep duration. AN status was associated with less frequent consumption of alcohol. BN status was associated with a larger discrepancy between the ideal and current body shape. Both OW status and BN were associated with more obsessive-compulsive symptoms. The results suggested that certain dietary, health, and psychological factors are associated with extreme weight conditions and EDs.

Determinants of binge eating disorder among normal weight and overweight female college students in Korea.

PURPOSE: The aim of the present study was to describe the clinical features of binge eating disorder (BED) in normal weight and overweight undergraduate Korean women. METHODS: 117 overweight (BMI ≥ 25 kg/m2) and 346 normal weight (18 kg/m2 ≤ BMI < 25 kg/m2) undergraduate Korean women completed questionnaires to assess for BED. Their emotional eating behaviors, binge eating-related behaviors, a spectrum of compulsive behaviors such as substance abuse and obsessive-compulsive disorder, and psychological profiles were evaluated through personal interviews and questionnaires. The features of those with BED were compared to those without BED in the overweight and normal weight groups. RESULTS: Both normal weight and overweight BED women had higher levels of functional impairment, eating disorder psychopathology including emotional and external eating behaviors, and neuroticism than their non-BED counterparts. In the normal weight group, BED women had more frequent alcohol consumption and obsessive-compulsive symptoms than non-BED women. In the overweight group, BED women had higher levels of depression and lower extraversion than non-BED women. CONCLUSIONS: BED is associated with global functional impairment and mental health problems. Thus, the association with high functional impairments and psychiatric comorbidities suggest that people with BED may benefit from treatment. LEVEL III: Evidence obtained from well-designed case-control analytic studies, from more than one center.

The utility of the bifactor model in understanding unique components of anxiety sensitivity in a South Korean sample.

The present study was the first to examine the applicability of the bifactor structure underlying the Anxiety Sensitivity Index-3 (ASI-3) in an East Asian (South Korean) sample and to determine which factors in the bifactor model were significantly associated with anxiety, depression, and negative affect. Using a sample of 289 South Korean university students, we compared (a) the original 3-factor AS model, (b) a 3-group bifactor AS model, and (c) a 2-group bifactor AS model (with only the physical and social concern group factors present). Results revealed that the 2-group bifactor AS model fit the ASI-3 data the best. Relatedly, although all ASI-3 items loaded on the general AS factor, the Cognitive Concern group factor was not defined in the bifactor model and may therefore need to be omitted in order to accurately model AS when conducting factor analysis and structural equation modeling (SEM) in cross cultural contexts. SEM results also revealed that the general AS factor was the only factor from the 2-group bifactor model that significantly predicted anxiety, depression, and negative affect. Implications and importance of this new bifactor structure of Anxiety Sensitivity in East Asian samples are discussed.

Perceptions of overweight in US and global cultures.

We explored the hypothesis that perceptions of overweight vary in accord with the prevalence of overweight in specific populations. The present study investigated this relationship in samples from diverse groups in the US and four other countries. The perceptual threshold for overweight is the scalar point at which individuals determine the transition from normal to overweight. Perceptual thresholds for overweight were obtained from 812 adults in Korea, Mexico, Ukraine, Tanzania, and the US (Black, Hispanic, White and college student samples). A linear relationship was observed between the perceptual threshold for overweight and the population prevalence (r=0.52, adjusted R(2)=0.22, F (1/15)=5.24, p<.05), and this relationship was considerably stronger in the non-US samples. This finding links with the results of other studies documenting the influence of the social environment on both weight perception and weight transmission. Together, they suggest that the socio-cultural milieu and weight norms are components of the obesogenic environment and argue for the inclusion of weight norm interventions in weight management programs and public health initiatives.

The effect of the definition of menstrually-related headache on the response to biofeedback treatment.

Twelve women with either pure migraine headache (HA) or a combination of migraine and tension-type HA monitored HA activity over two menstrual cycles while noting onset of menstruation and onset of ovulation. They then received 12 sessions of thermal biofeedback (TBF) with adjunctive autogenic training. Six women with only tension-type HA participated in similar monitoring before receiving 9 sessions of progressive relaxation training. Results for those with vascular HA showed a significant reduction in HA activity and a reduction in medication taken for HAs. Those with tension-type HA did not respond significantly to the relaxation training. Depending upon how one defined menstrually-related HAs among those with vascular HA, there either was, or was not, a differential effect of TBF on menstrual-cycle-related HA.