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.

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.

Accuracy of a Low-Cost 3D-Printed Wearable Goniometer for Measuring Wrist Motion.

Wrist motion provides an important metric for disease monitoring and occupational risk assessment. The collection of wrist kinematics in occupational or other real-world environments could augment traditional observational or video-analysis based assessment. We have developed a low-cost 3D printed wearable device, capable of being produced on consumer grade desktop 3D printers. Here we present a preliminary validation of the device against a gold standard optical motion capture system. Data were collected from 10 participants performing a static angle matching task while seated at a desk. The wearable device output was significantly correlated with the optical motion capture system yielding a coefficient of determination (R2) of 0.991 and 0.972 for flexion/extension (FE) and radial/ulnar deviation (RUD) respectively (p < 0.0001). Error was similarly low with a root mean squared error of 4.9° (FE) and 3.9° (RUD). Agreement between the two systems was quantified using Bland-Altman analysis, with bias and 95% limits of agreement of 3.1° ± 7.4° and -0.16° ± 7.7° for FE and RUD, respectively. These results compare favourably with current methods for occupational assessment, suggesting strong potential for field implementation.

Total Transfer Time for Ground vs. Air Transport for Interhospital and Scene Transfers of Acute Stroke Patients.

OBJECTIVES: Stroke patients are frequently transported to a comprehensive stroke center for treatment, either from a regional hospital via interhospital transfer or from the field via direct-from-scene transfer, by air or ground transportation. We sought to determine whether air or ground transport was faster in both transfer circumstances. MATERIALS AND METHODS: A retrospective study of patients transferred to a single comprehensive stroke center for stroke treatment was conducted. EMS and medical records were used to evaluate the time and distance of transfer and functional outcome. RESULTS: Of the 205 transfers, 47 were interhospital transfers by air (22.9%), 68 were interhospital transfers by ground (33.2%), 40 were scene transfers by air (19.5%), and 50 were scene transfers by ground (24.4%). Ground transfers had shorter alarm to EMS departure times (30 min. vs 40 min.; p<0.0001). Air transfers had shorter EMS departure to arrival times when normalized by transfer distance indicating a faster travel velocity. Interhospital transfers by air were predicted to be faster than ground over 40 miles, and scene transfers by air were predicted to be faster than ground over 28 miles. Transfer mode had no significant effect on functional outcome when controlling for tPA, thrombectomy, and NIH Stroke Scale in this small study. CONCLUSIONS: Transfer efficiency for stroke patients depends on logistics prior to EMS arrival as well as the speed of travel. While air transport clearly results in faster travel velocity, total interhospital transfer times are faster for air transportation only when traveling more than 40 miles.

Sexual Orientation-Based Differential Item Functioning in Measures of Body Image Concerns and Ideals among Men.

Body image concerns and body ideals are linked with eating disorders and psychological health. Body image and ideals among men differ by sexual orientation, which may influence the utility of common measures of such constructs. The present study used differential item functioning (DIF) analyses to examine whether item endorsement differs as a function of sexual orientation in three commonly used measures of body image concerns and ideals. Participants were sexual minority (n=209) and heterosexual (n=494) men in the United States. Scores on the Drive for Muscularity Scale (DMS), Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4), and Objectified Body Consciousness Scale (OBCS) were examined. DIF was tested in a three-step regression wherein item scores were predicted by: (1) subscale score, (2) subscale and sexual orientation, and (3) subscale, sexual orientation and their product term. Model fit and variance explain comparisons identified DIF. Δ pseudo R2 value ≥ .035 from step 1 to 3 signified clinical significant DIF. There was no evidence of clinically significant DIF for the DMS, SATAQ-4, or OBSC. Findings suggest that DMS, SATAQ-4, and OBSC perform similarly for sexual minority and heterosexual men.

Differential item functioning analysis for the Eating Disorder Examination Questionnaire among heterosexual and sexual minority men.

PURPOSE: Sexual minority (SM) men are at a higher risk for eating disorders and related issues, relative to heterosexual men. However, it is currently unknown whether commonly used measures of eating pathology are appropriate to use among diverse groups of men. Determining the unique functioning of existing assessments may help better and more accurately understand eating disorder pathology within this population. The present study examined differences in item endorsement between sexual orientation in the Eating Disorder Examination Questionnaire (EDE-Q) through differential item functioning (DIF). METHODS: Heterosexual and SM men (N = 703) completed the EDE-Q and a demographic questionnaire. EDE-Q scores were examined for clinically significant DIF based on participants' self-reported sexual orientation (e.g., heterosexual men vs SM men). RESULTS: SM men reported higher EDE-Q symptom composite scores than heterosexual men. DIF was observed for all EDE-Q items relative to the global score; however, only one item met clinical significance (EDE-Q #19; ∆R2 ≥ 0.13). CONCLUSION: Results suggest that SM men experience greater levels of ED pathology than heterosexual men. While the EDE-Q is a commonly used measure of eating pathology, findings suggest that sexual orientation bias may impact many items on the EDE-Q. However, results from this study indicated that only one item introduces bias that has clinical implications. Additional research is needed to further explore and replicate this finding among more diverse samples of SM and heterosexual men. LEVEL OF EVIDENCE: Level III, case-control analytic study.

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.

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.

Patterns and predictors of postsecondary re-enrollment in the acquisition of stackable credentials.

Using 15 years of student enrollment histories from administrative data spanning the 2004-05 through 2018-19 school years at all public colleges, universities, and technical/trade schools in the state of Ohio, we examine rates of re-enrollment in postsecondary education for individuals pursuing additional credentials following the receipt of a sub-baccalaureate certificate. We find that the majority of certificate recipients re-enroll to continue their progression toward stacking credentials. The likelihood of re-enrollment diminishes for certificate earners as they get further out from the term when their initial certificate was completed. Certificate earners re-enroll at an accelerated rate if they acquired their initial certificate at a community college, if they currently have low wages at their jobs, and following increases in local unemployment rates. Our findings lend support to sociological ideas about the role of institutional contexts, opportunity costs, and labor market opportunities in shaping non-traditional postsecondary pathways across the life course.

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.

Identifying duration criteria for eating-disorder remission and recovery through intensive modeling of longitudinal data.

OBJECTIVE: Outcome states, such as remission and recovery, include specific duration criteria for which individuals must be asymptomatic. Ideally, duration criteria provide predictive validity to outcome states by reducing symptom-return risk. However, available research is insufficient for deriving specific recommendations for remission or recovery duration criteria for eating disorders. METHOD: We intensively modeled the relation between duration criteria length and rates of remission, recovery, and subsequent symptom return in longitudinal data from a treatment-seeking sample of women with anorexia nervosa (AN) and bulimia nervosa (BN). We hypothesized that the length of the duration criterion would be inversely associated with both rates of remission and recovery and with subsequent rates of symptom return. RESULTS: Generalized estimating equations supported our hypotheses for all investigated eating-disorder features except for symptom return when using the Psychiatric Status Rating for AN. DISCUSSION: We recommend that 6 months be used for remission definitions applied to binge eating, purging, and BN symptom composite measures, whereas no duration criteria be used for low weight and AN symptom composites. We further recommend that 6 months be used for recovery definitions applied to BN symptom composites and AN symptom composites, whereas 18 months be used for individual symptoms of binge eating, purging, and low weight. The adoption of these duration criteria into comprehensive definitions of remission and recovery will increase their predictive validity, which in turn, maximizes their utility.

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.

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.

An investigation of the affective experience of females at high risk for eating disorders in general and pathology-specific contexts.

OBJECTIVE: Difficulties with emotional experiences have long been implicated in the development or maintenance of eating disorders (EDs). However, the vast majority of this work is theoretical or self-report, with few studies examining the somatic-affective experience of individuals with EDs under experimental conditions. The aim of the current study was to: i) examine physiological reactivity and subjective report of emotional experiences in response to ED pathology-specific and general affective film clips, and ii) examine the impact of film on body size estimation in females at risk for EDs. METHOD: Females aged 14-24 years old of either high (N = 42) or low (N = 43) risk for EDs viewed pathology-specific and general affective film clips and provided their affective ratings and body-size estimations post film clips. Heart Rate and Skin Conductance Levels were recorded during each clip. RESULTS: High risk participants evidenced greater physiological arousal across conditions and in both general and pathology-specific affective contexts. Negative affect induced via the ED-pathology specific film clip had a greater impact on the high risk group's body-size estimations. CONCLUSIONS: Individuals at risk for EDs seem to experience greater physiological arousal and this may influence the experience of their bodies, or direct attention to their body as a way to attenuate unwanted emotion or due to somatic feedback.

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.

Evaluating Associations Between Perfectionism, Emotion Regulation, and Eating Disorder Symptoms in a Mixed-Gender Sample.

Prior research supports maladaptive perfectionism as a risk factor for eating disorders; however, not all individuals with elevated levels of perfectionism endorse eating pathology, suggesting additional variables may interact with perfectionism to account for this association. The current study examined the influence of difficulties in emotion regulation on the relation between perfectionism and eating disorders. Undergraduate students (N = 309, 50.7% male) from a large university completed measures of perfectionism, emotion dysregulation, and eating pathology. The results indicated that high levels of perfectionism only accounted for significant variance in eating disorder symptoms among individuals with limited access to adaptive strategies to regulate emotions, but not among those with greater access to adaptive strategies. Findings demonstrate that clinicians and researchers should consider the role of emotion regulation among individuals with elevated levels of perfectionism and eating pathology. Future research should prospectively evaluate these associations and examine mechanisms that may further elucidate these relations.

Associations among fear, disgust, and eating pathology in undergraduate men and women.

Fear and disgust are distinct emotions that have been independently linked with EDs and may motivate avoidance behaviors that may be relevant targets for ED interventions (e.g., food rejection). Despite similar motivational function, it is possible that one emotion is more strongly associated with ED symptoms, relative to the other. Given that emerging evidence suggests that disgust-based behavior may be more difficult to change than fear-based behaviors, research is needed to evaluate whether each emotion differentially relates to ED symptoms. Therefore, the current study tested the relative importance of fear and disgust in accounting for variance in ED symptoms. Participants included undergraduate men (n = 127) and women (n = 263) from a university in the northeast US. Participants completed self-report measures assessing demographics, disordered eating attitudes and behaviors, and visual analog scales assessing fear and disgust responses to high-calorie food images, low-calorie food images, and non-food fear and disgust images. Bivariate correlations revealed significant positive associations among fear, disgust, and EDE-Q global symptom scores. Relative weights analysis results yielded relative importance weights that suggested disgust responding to high calorie food images accounts for the greatest total variance in EDE-Q global symptom scores in men, and fear responding to high calorie food images accounts for the greatest total variance in EDE-Q scores in women. Findings provide initial evidence that investigative and clinical efforts should consider fear and disgust as unique facets of negative affect with different patterns of relative importance to ED symptoms in undergraduate men and women.