A pilot randomized controlled trial of a cognitive-behavioral therapy guided self-help mobile app for the post-acute treatment of anorexia nervosa: A registered report.

INTRODUCTION: Relapse following acute treatment for anorexia nervosa (AN) is common. Evidence suggests cognitive-behavioral therapy (CBT) may be useful in the post-acute period, but few patients have access to trained providers. mHealth technologies have potential to increase access to high-quality care for AN, including in the post-acute period. The aim of this study is to estimate the preliminary feasibility and effectiveness of a CBT-based mobile intervention plus treatment as usual (TAU), offered with and without an accompanying social networking feature. METHOD: In the current pilot randomized controlled trial, women with AN who have been discharged from acute treatment in the past 2 months (N = 90) will be randomly assigned to a CBT-based mobile intervention plus treatment as usual (TAU), a CBT-based mobile intervention including social networking plus TAU, or TAU alone. We will examine feasibility, acceptability, and preliminary effectiveness of the three conditions in terms of reducing eating disorder psychopathology, reducing frequency of eating disorder behaviors, achieving weight maintenance, reducing depression and suicidal ideation, and reducing clinical impairment. We will examine rehospitalization and full recovery rates in an exploratory fashion. We will also examine whether the mobile intervention and social networking feature change the proposed targets and whether changes in targets are associated with benefit, as well as conduct exploratory analyses to identify within-mobile intervention predictors and moderators of outcome. DISCUSSION: Ultimately, this research may lead to increased access to evidence-based treatment for individuals with AN and prevention of the extreme negative consequences that can result from this serious disorder. PUBLIC SIGNIFICANCE: Relapse after acute treatment for anorexia nervosa is common, and few patients have access to trained providers to support them following acute care. This study will pilot a coached mobile app, including a social networking component, for this population. If ultimately successful, our approach could greatly increase access to evidence-based treatment for individuals with anorexia nervosa and ultimately prevent the extreme negative consequences that can result from this serious disorder.

Subjective and objective binge episodes in relation to eating disorder and depressive symptoms among middle-aged women.

PURPOSE: Evidence suggests loss of control over eating may be the driving component of binge eating, a transdiagnostic symptom of eating disorders and highly comorbid with depressive symptoms. Prior studies have evaluated eating disorder and depressive symptoms across types of binge episodes among adolescent and young adult samples, yet no studies have focused on middle-aged women who may be particularly vulnerable to both binge eating and depressive symptoms. The goal of this study was to compare eating disorder symptoms and depressive symptoms across different types of binge eating episodes among middle-aged women. METHODS: Women (N = 347), ages 40-63, completed an online survey about both objective (OBE) and subjective binge episodes (SBE), eating disorder symptoms, and depressive symptoms. Participants were categorized as OBEs only, SBEs only, both OBEs and SBEs, and no binge eating. RESULTS: Controlling for group differences, results showed middle-aged women who experienced SBEs only reported greater levels of anorexia nervosa attitudes and behaviors compared to all other groups, and greater dietary restraint compared to those who experienced only OBEs and those with no binge eating. Middle-aged women who experienced any type of binge eating reported greater levels of body image concerns and depressive symptoms compared to those who reported no binge eating. CONCLUSIONS: Findings suggest that loss of control is more clinically relevant in terms of associations with eating disorder and depressive symptoms in middle-aged women. LEVEL OF EVIDENCE: Level V based on descriptive studies.

Lived experiences of subjective binge eating: An inductive thematic analysis.

OBJECTIVE: Growing evidence suggests that subjective binge eating (SBE; loss of control eating involving subjectively, but not objectively, large quantities of food) is clinically concerning even though it is not currently considered a diagnostic criterion for eating disorders. However, the lived experience of SBEs has not been examined in a systematic, and data-driven way. METHOD: The current study used a qualitative, inductive interview approach to further define SBEs as described by individuals who experience them. Participants (N = 14; 11 cisgender women, Mage  = 35.29, 12 White/non-Latinx) reported SBEs that occurred at least twice per week over the prior 3 months. We completed semi-structured qualitative phone interviews with participants regarding their most recent SBE and objective binge-eating episode (OBE) if applicable, as well as broader experiences and attitudes regarding non-binge eating. RESULTS: Inductive, reflexive, thematic coding yielded descriptive and interpretive codes regarding SBEs. Main themes regarding SBE experience included: (a) SBEs Occur Across Contexts and Food Types, (b) SBEs Are Contrasts to General Over-Control, (c) SBEs Are Distress- and Disconnection-Inducing, Not Relieving, (d) SBEs Are Responses to Hunger and Restriction, and (e) SBEs Can Be "Echoes" of OBEs. DISCUSSION: The current study explored the lived experiences of those who report SBEs and provides an important foundation for hypothesis generation for future research on and clinical interventions for SBEs.

Comparing eating disorder characteristics and treatment in self-identified competitive athletes and non-athletes from the National Eating Disorders Association online screening tool.

OBJECTIVE: We compared eating disorder (ED) characteristics and treatment seeking behaviors between self-identified competitive athletes and non-athletes in a large, community-based sample. METHOD: During the 2018 National Eating Disorders Awareness Week, 23,920 respondents, 14.7% of whom identified as competitive athletes, completed the National Eating Disorders Association online screen. Data were collected on demographics, disordered eating behaviors, probable ED diagnosis/risk, treatment history, and intent to seek treatment. RESULTS: The sample was predominantly White (81.8%), female (90.3%), and between 13 and 24 years (82.6%). Over 86% met criteria for an ED/subthreshold ED, and of those, only 2.5% were in treatment. Suicidal ideation was reported in over half of the sample. Athletes reported a significantly greater likelihood of engaging in and more frequent excessive exercise episodes than non-athletes. Athletes also reported a significantly lower likelihood of engaging in and less frequent binge-eating episodes compared with non-athletes. Athletes were more likely to screen positive for an ED/subthreshold ED than non-athletes, but percentages across all probable ED diagnoses were similar. No significant differences between athletes and non-athletes emerged on treatment history or intention to seek treatment post-screen (less than 30%). DISCUSSION: Although the distribution of probable ED diagnoses was similar in athletes and non-athletes, symptom profiles related to disordered eating behavior engagement and frequency may differ. Athletes may be less likely to seek treatment due to stigma, accessibility, and sport-specific barriers. Future work should directly connect survey respondents to tailored treatment tools and increase motivation to seek treatment.

2019-nCOV distress and depressive, anxiety and OCD-type, and eating disorder symptoms among postpartum and control women.

This study compared postpartum and control women on depressive, anxiety, and OCD-type symptoms, and eating disorder symptoms during the 2019-nCOV pandemic and evaluated if associations between 2019-nCOV distress and these mental health symptoms differed for postpartum compared to control women. A community sample of women, ages 18-39, who had either given birth in the past 12 months (n = 232) or had no pregnancy history (n = 137; controls), was recruited to complete an online survey about their depressive, anxiety, OCD, and eating disorder symptoms. Postpartum women reported greater OCD-type symptoms related to concerns about both contamination and responsibility for harm (ps < .05) compared to controls. After controlling for general stress and mental health history, the association between 2019-nCOV distress and OCD-type symptoms related to concerns about contamination was stronger among postpartum compared to control women (ps < .002). For all women, 2019-nCOV distress was positively related to general anxiety symptoms, total OCD-type symptoms, and OCD-type symptoms related to concerns about responsibility for harm after controlling for general stress and mental health history (ps < .03). Data are first to suggest postpartum women may be at elevated risk for OCD-type symptoms during 2019-nCOV pandemic, and pandemic distress is associated with anxiety and OCD-type symptoms among postpartum women more so than control women.

Subjective binge eating: a marker of disordered eating and broader psychological distress.

PURPOSE: There is building, but limited evidence to suggest that subjective binge eating (SBE) is clinically concerning. The current study examined associated features of SBEs including disordered eating, body shame, negative affect, and interpersonal problems, as well as how SBE occurrence relates to other daily eating experiences. METHODS: Participants were 400 individuals recruited via internet snowball or Amazon Mechanical Turk, including 132 with at least one SBE [with or without objective binge eating episodes (OBEs)] in the prior 3 months, 135 with at least one OBE (and no SBEs) in the prior 3 months, and 133 with no loss of control eating in the prior 3 months nor a likely lifetime history of anorexia nervosa. Participants responded to questionnaires assessing eating disorder behaviors (i.e., frequency of compensatory behaviors, dietary restriction), body shame, negative affect (depressive/anxiety symptoms), interpersonal difficulties, and perception of daily eating experiences. RESULTS: Individuals with SBEs had higher numbers of vomiting, laxative misuse and hard exercise episodes, dietary restriction, body shame, depressive and anxiety symptoms, and negative perceptions of daily eating experiences as compared to those with only OBEs and no loss of control eating. CONCLUSION: These results suggest that SBEs (whether on their own or combined with OBEs) are more related to disordered eating symptoms, body image concerns, depressive/anxiety symptoms, and general eating distress than OBEs on their own, suggesting that clinicians may view SBEs as markers of concern across domains. LEVEL OF EVIDENCE: III, well-designed group-comparison regression analysis.

Examining the roles of emotion dysregulation and impulsivity in the relationship between psychological trauma and substance abuse among women with bulimic-spectrum pathology.

Individuals with bulimia nervosa report elevated rates of childhood maltreatment, which appears to increase risk for co-occurring substance use problems and negatively impact clinical course. The current study sought to examine the mechanistic pathways by which specific forms of childhood maltreatment may give rise to substance use problems among individuals with bulimic-spectrum pathology. Women with bulimic-spectrum disorders (N = 204) completed measures of childhood trauma, emotion dysregulation, impulsivity, and substance use. Path analysis was used to examine emotion dysregulation and impulsivity as mediators of the relationship between distinct forms of childhood trauma (physical abuse, physical neglect, emotional abuse, emotional neglect, and sexual abuse) and the presence of problematic alcohol/drug use. In the full path model, significant pathways from childhood emotional abuse to emotion dysregulation, childhood emotional neglect to impulsivity, and emotion dysregulation to problematic substance use emerged. Further, emotion dysregulation significantly mediated the relationship between emotional abuse and substance use. Results indicate that emotion dysregulation may be an important mechanism linking a history of childhood emotional maltreatment to later eating and substance use problems, and therefore may be an important treatment target among individuals with co-occurring eating and substance use concerns.Childhood emotional abuse was related to greater emotion dysregulation.Childhood emotional neglect was related to greater impulsivity.Emotion dysregulation was related to greater problematic substance use.Emotional abuse may impact substance use through emotion dysregulation.Creating emotion dysregulation may improve substance and eating disorder symptoms.

Predicting a comprehensive operationalization of eating disorder recovery: Examining self-concept, personality, and negative affect.

OBJECTIVE: Our goal was to examine potential predictors of a comprehensive operationalization of eating disorder recovery, characterized by physical, behavioral, and cognitive recovery, focusing on constructs related to self-concept, personality, and negative affect. METHOD: Participants were women with a history of an eating disorder who provided data via survey and interview at two time points separated by about 7-8 years and who met criteria for an eating disorder diagnosis at baseline (N = 36). RESULTS: Logistic regression models revealed that self-esteem was a significant predictor of recovery status (OR = 1.12, p = .039) such that individuals with higher self-esteem at baseline demonstrated significantly greater odds of being in full recovery at follow-up. However, when self-esteem was considered in a set along with baseline imposter phenomenon and anxiety, no single construct emerged as a significant unique predictor of recovery in logistic regression analyses. DISCUSSION: These results highlight the potential importance of self-esteem in relation to recovery, with clinical implications related to bolstering self-esteem as part of eating disorder treatment. Future research should continue to explore predictors using a comprehensive operationalization of eating disorder recovery in larger, more diverse samples to optimally identify factors associated with achieving recovery.

Body appreciation and intuitive eating in eating disorder recovery.

OBJECTIVE: Eating disorder recovery research has emphasized the absence of symptoms over the presence of adaptive aspects like positive body image and healthy eating attitudes. The current study examined how body appreciation and intuitive eating related to eating disorder recovery using a comprehensive recovery definition (physical, behavioral, and cognitive recovery). METHOD: Data were collected from 66 women with an eating disorder history and 31 controls with no history of eating pathology. Participants completed an online survey followed by a phone interview. RESULTS: The fully recovered group did not differ from controls on body appreciation, with both groups endorsing significantly higher levels of body appreciation than the partially recovered and current eating disorder groups. Similarly, the fully recovered group did not differ from controls on overall intuitive eating, with both groups endorsing significantly higher levels of overall intuitive eating than the partially recovered and current eating disorder groups. DISCUSSION: Positive psychological constructs such as body appreciation and intuitive eating relate to eating disorder recovery status. Understanding recovery within a strengths-based framework may inform intervention and relapse prevention.

The self and eating disorders.

In our review, we focus on self-related constructs in the context of eating disorders with four aims. First, we examine a variety of self-related constructs that have been theoretically and empirically linked to the development and course of eating disorders. In addition to the more well-researched constructs of self-esteem and self-efficacy, we also report on findings related to selflessness, contingent self-worth, self-objectification, ego-syntonicity, self-concept clarity, self-compassion, social comparison, self-oriented perfectionism/self-criticism, and narcissism. Second, we discuss self-related constructs that may be especially relevant to comorbidities common among those with eating disorders. Third, we review intervention and prevention programs where self-related constructs play a prominent role. Lastly, we share future research directions regarding self-related constructs and eating disorders that we believe will advance a deeper understanding of the role of the self in the eating disorders.

Menopausal status and disordered eating and body image concerns among middle-aged women.

OBJECTIVE: Eating disorders are present among middle-aged women, yet most eating disorder knowledge comes from adolescents and young adults. There is arguably a need for research specific to middle-aged women and eating pathology. One biological factor that may contribute to eating disorder symptoms and is unique to middle-aged women is menopause, given the changes in body shape and weight that direct women's bodies away from the young, thin beauty standard. METHOD: This study explored group differences in disordered eating and body image by menopausal status. Participants were 310 middle-aged women between the ages of 40 and 68. They completed an online survey about their menopausal status, disordered eating, and body image concerns. We compared disordered eating behaviors and attitudes across three groups: premenopausal women, perimenopausal women, and postmenopausal women. RESULTS: Results indicated no group differences on either disordered eating or body image concerns by menopausal status. DISCUSSION: These findings suggest the perimenopausal period may not be a window of vulnerability for women in general. Given these mixed findings, future research should examine moderators to determine when there are menopausal status group differences on eating pathology.

Longitudinal follow-up of a comprehensive operationalization of eating disorder recovery: Concurrent and predictive validity.

OBJECTIVE: We aimed to replicate the concurrent validity of a comprehensive definition of eating disorder recovery (physical, behavioral, and cognitive indices) in a sample followed up 7-8 years from baseline, and to examine, for the first time with this comprehensive definition, predictive validity. METHOD: Participants were 66 women with a history of an eating disorder and 31 age-matched controls who completed an online survey and phone interview. RESULTS: In general, women who were fully recovered were statistically indistinguishable from controls and had significantly less eating disorder attitudes and behaviors than the partially recovered and eating disorder groups. Being fully recovered at baseline was a robust predictor of stability: of those fully recovered at baseline, 80% remained fully recovered at follow-up. One-third of those with an eating disorder and one-half of those in partial recovery at baseline attained full recovery at follow-up. DISCUSSION: These findings support the current operationalization of eating disorder recovery, encompassing physical, behavioral, and cognitive indices, as valid and highlight that full recovery is not only possible but predicts full recovery years later. Future research should examine this operationalization in diverse samples and study trajectories of recovery to identify predictors.

Eating disorder recovery in men: A pilot study.

OBJECTIVE: This pilot study examined the validity of a comprehensive definition of recovery (physical, behavioral, and cognitive recovery indices) for the first time in men. METHOD: Men with an eating disorder history were recruited from former patients at eating disorder centers, university campuses, and fitness centers/gyms. At baseline and a 12-month follow-up, data were collected via online surveys, diagnostic interviews, and measured weight and height from men with an eating disorder history (n = 36) and men with no eating disorder history (n = 27). RESULTS: Of the men with an eating disorder history, 15 met criteria for an eating disorder, 7 met criteria for partial recovery, and 5 for full recovery. Men who met criteria for full recovery did not differ significantly from men with no eating disorder history and had significantly lower levels of broad eating pathology, thinness and restricting expectancies, body shame, difficulties in stopping thoughts about body, food, or exercise, and male body attitudes related to muscularity and body fat than men with an eating disorder. Men meeting criteria for full recovery had higher levels of body acceptance and intuitive eating than men who met criteria for partial recovery or an eating disorder. In terms of predictive validity, of those fully recovered at baseline, 60% also met full recovery criteria at follow-up. DISCUSSION: Preliminary findings suggest that a comprehensive definition of recovery applies to men. Although research with larger samples is needed, this research provides some optimism for the potential of recovery in men.

Treatment experiences of Latinas with current or past binge eating disorder and/or bulimia nervosa.

This study utilized a female sample of 43 Latinas with a history of binge eating disorder and/or bulimia nervosa to investigate disparities in health care that may act as barriers to or correlates of treatment for these women. Results indicated that 65% of our sample sought treatment for their eating disorder. The most commonly utilized treatment providers were psychologist/therapist for individual therapy and nutritionist/dietician, while therapist-led group therapy was rated as the most helpful treatment and treatment by a physician was rated as least helpful. Participants endorsed eating disorder stigma, eating disorder shame, mental health shame, and cost of treatment as the most influential barriers to seeking or receiving treatment. Acculturation to White dominant society was associated with greater perceived treatment helpfulness. Findings from this study can be used to inform treatments for Latinas in order to potentially increase effectiveness, treatment-seeking, and recovery rates.

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.

An Overview of Conceptualizations of Eating Disorder Recovery, Recent Findings, and Future Directions.

PURPOSE OF REVIEW: This review delineates issues in the conceptualization and operationalization of eating disorder recovery, highlights recent findings about recovery (since 2016), and proposes future directions. RECENT FINDINGS: A longstanding problem in the field is that there are almost as many different definitions of recovery in eating disorders as there are studies on the topic. Yet, there has been a general shift to accepting that psychological/cognitive symptoms are important to recovery in addition to physical and behavioral indices. Further, several operationalizations of recovery have been proposed over the past two decades, and some efforts to validate operationalizations exist. However, this work has had limited impact and uptake, such that the field is suffering from "broken record syndrome," where calls are made for universal definitions time and time again. It is critical that proposed operationalizations be compared empirically to help arrive at a consensus definition and that institutional/organizational support help facilitate this. Themes in recent recovery research include identifying predictors, examining biological/neuropsychological factors, and considering severe and enduring anorexia nervosa. From qualitative research, those who have experienced eating disorders highlight recovery as a journey, as well as factors such as hope, self-acceptance, and benefiting from support from others as integral to the process of recovery. The field urgently needs to implement a universal definition of recovery that is backed by evidence, that can parsimoniously be implemented in clinical practice, and that will lead to greater harmonization of scientific findings.

Influence of product placement in children's movies on children's snack choices.

BACKGROUND: Media exposure affects health, including obesity risk. Children's movies often contain food placements-frequently unhealthy foods. However, it is not known if these cues influence children's food choices or consumption after viewing. We explored whether children's snack choices or consumption differs based on: 1) recent exposure to movies with high versus low product placement of unhealthy foods; and 2) children's weight status. METHODS: Children ages 9-11 were assigned to watch a high ("Alvin and the Chipmunks," n = 54) or low ("Stuart Little," n = 60) product-placement movie. After viewing, participants selected a snack choice from each of five categories, several of which were specifically featured in "Alvin." Uneaten snacks from each participant were weighed upon completion. Snack choice and amount consumed by movie were compared by t-tests, and differences in snack choices by movie were tested with logistic regression. RESULTS: Participants consumed an average of 800.8 kcal; mean kcal eaten did not vary by movie watched. Participants who watched the high product-placement movie had 3.1 times the odds (95% CI 1.3-7.2) of choosing cheese balls (most featured snack) compared to participants who watched the low product-placement movie. Children who were overweight or obese consumed a mean of 857 kcal (95% CI: 789-925) compared to 783 kcal (95% CI: 742-823, p = 0.09) for children who were underweight or healthy weight. Children's weight status did not significantly affect their choice of snack. CONCLUSIONS: Branding and obesogenic messaging in children's movies influenced some choices that children made about snack foods immediately following viewing, especially food with greatest exposure time in the film, but did not affect total calories consumed. Future studies should examine how the accumulation of these messages affects children's long-term food choices.

Tests of escape theory of binge eating among Latinas.

OBJECTIVES: Despite comparable prevalence of some eating disorders (e.g., binge eating disorder) among Latinas compared with Caucasians, eating disorders are still thought of as primarily afflicting Caucasian women. This has led to a lag in research on eating disorders among Latinas. Our objective was to test 3 escape theory models involving the culturally specific independent variables of acculturative stress, family disconnection, and discriminatory stress; the mediator of negative affect; and the dependent variable of binge eating frequency. METHOD: We recruited a female sample of 119 Latinas (78 who have suffered from an eating disorder, 41 who have never had an eating disorder). RESULTS: Results indicated that all of the relationships between culturally specific factors and binge eating were mediated by negative affect, and that there was a significant direct pathway from discriminatory stress to binge eating. CONCLUSIONS: Findings from this study can be used to tailor interventions to Latinas who engage in binge eating, targeting culturally specific factors and their relationships with negative affect and binge eating. (PsycINFO Database Record

Factors associated with self-identification of an eating disorder history among Latinas meeting criteria for past or current eating disorders.

OBJECTIVE: This paper compared Latinas who self-identified as having had an eating disorder (ED) with those who did not (despite both groups meeting criteria for an ED history) on ED pathology and mental health stigma. METHOD: Seventy-seven Latinas completed an online survey. RESULTS: All 77 participants met criteria for lifetime EDs, and 92% met current criteria for an ED; however, 47% did not report having an ED history vs. 53% did report an ED history. There was no difference on binge eating frequency. Those who endorsed an ED history engaged in more compensatory behaviors, had higher EAT-26 scores, and were less fearful of stigmatization due to seeking mental health treatment. Those reporting an ED history were more likely to have met criteria for anorexia nervosa or bulimia nervosa, generally more recognizable EDs than binge eating disorder and other specified feeding or eating disorders, than those who did not report an ED history. DISCUSSION: Latinas with certain patterns of eating pathology and those with less fear of being stigmatized due to seeking mental health treatment were more likely to endorse an ED history, which has implications for treatment seeking. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:1032-1035).

Dimensions of impulsivity in relation to eating disorder recovery.

OBJECTIVE: Impulsivity is associated with eating pathology, but different dimensions of impulsivity have not been extensively studied in the eating disorders. The current study examined the relationship between four facets of impulsivity and eating disorder recovery status. METHOD: Females formerly seen for an eating disorder were categorized as having an eating disorder (n = 53), partially recovered (n = 15), or fully recovered (n = 20) based on a diagnostic interview and physical, behavioral, and psychological indices. These groups and non-eating disorder controls were compared on impulsivity facets from the UPPS Impulsive Behavior Scale (UPPS): Urgency (negative urgency), Premeditation (lack of), Perseverance (lack of), and Sensation Seeking. RESULTS: Negative urgency (the tendency to engage in impulsive behavior to alleviate negative affect) was related to recovery. The fully recovered group and controls experienced significantly less negative urgency than those with a current eating disorder; the partially recovered group did not differ from the eating disorder group. DISCUSSION: Findings suggest that negative urgency may be a particularly important facet of impulsivity to target in therapeutic intervention for eating disorders, especially among those with a history of binge eating and/or purging. Future longitudinal work is needed to test a potential causal relationship between negative urgency and eating disorder recovery. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:1027-1031).