A longitudinal examination of body-checking behaviors and eating disorder pathology in a community sample of adolescent males and females.

OBJECTIVE: Related to the cognitive-behavioral theory of eating disorders, body checking has gained increasing recognition as both a maintaining factor for eating disorders and an important target for treatment. However, it is unclear whether body-checking behaviors contribute to the development of disordered eating, or if these behaviors develop as a response to experiencing eating disorder thoughts and behaviors. This study aims to examine the relationships between body-checking behaviors and eating disordered thoughts and behaviors in adolescent females and males in the community over time. METHODS: Participants included 238 adolescents (n = 104 males, n = 134 females, Mage = 16.5 years) recruited from high schools in British Columbia, Canada, who completed the Eating Disorder Examination Questionnaire and Body Checking Questionnaire at baseline (T1) and again approximately 4 months later (T2). RESULTS: After controlling for baseline levels of eating pathology and body mass index (BMI), body checking at T1 predicted increases in eating pathology for both males and females. In contrast, after controlling for baseline levels of body checking and BMI, eating pathology at T1 did not predict changes in body checking for females, but it did for males. Findings suggest that, among adolescents, engaging in body-checking behaviors may increase risk for disordered eating. DISCUSSION: If supported by further research, targeting body-checking behaviors in prevention programs may be warranted.

Kindness begins with yourself: The role of self-compassion in adolescent body satisfaction and eating pathology.

OBJECTIVE: A wealth of evidence indicates that self-compassion is linked with positive psychological outcomes; however, little is known about the process through which self-compassion exerts its effect. The primary purpose of this research was to investigate the direct and indirect impact of self-compassion on body satisfaction and eating pathology in adolescents. METHOD: Two hundred and thirty-eight students were recruited from three local high schools (Mage = 16.49, 43.7% boys). All participants completed the Self-Compassion Scale (SCS), Hopkins Symptom Checklist (SCL-5), Body Areas Satisfaction Scale (BASS), and Eating Disorder Examination Questionnaire - Adolescent Version (EDE-Q) at baseline. The SCL-5, BASS, and EDE-Q were completed 4 months later. RESULTS: Self-compassion was positively associated with body satisfaction and negatively associated with psychological distress and eating pathology in boys and girls at both time points. Longitudinal conditional process analyses revealed that self-compassion predicted changes in body satisfaction and eating pathology through changes in psychological distress for girls only. Notably, self-compassion was higher in boys than in girls. DISCUSSION: Results underscore how self-compassion may be an important factor to target in fostering a positive body image and preventing disordered eating in adolescents.

A meta-analysis of the relation between therapeutic alliance and treatment outcome in eating disorders.

The therapeutic alliance has demonstrated an association with favorable psychotherapeutic outcomes in the treatment of eating disorders (EDs). However, questions remain about the inter-relationships between early alliance, early symptom improvement, and treatment outcome. We conducted a meta-analysis on the relations among these constructs, and possible moderators of these relations, in psychosocial treatments for EDs. Twenty studies met inclusion criteria and supplied sufficient supplementary data. Results revealed small-to-moderate effect sizes, ßs = 0.13 to 0.22 (p < .05), indicating that early symptom improvement was related to subsequent alliance quality and that alliance ratings also were related to subsequent symptom reduction. The relationship between early alliance and treatment outcome was partially accounted for by early symptom improvement. With regard to moderators, early alliance showed weaker associations with outcome in therapies with a strong behavioral component relative to nonbehavioral therapies. However, alliance showed stronger relations to outcome for younger (vs. older) patients, over and above the variance shared with early symptom improvement. In sum, early symptom reduction enhances therapeutic alliance and treatment outcome in EDs, but early alliance may require specific attention for younger patients and for those receiving nonbehaviorally oriented treatments.

Factors related to advanced stages of change in a clinical sample of adolescents.

BACKGROUND: The purpose of the present study was to examine the factors predicting a greater motivation to change in a clinical sample of adolescents. METHOD: A total of 107 adolescents participated in this research prior to beginning outpatient treatment. Participants completed a modified version of the Motivational Stages of Change for Adolescents Recovering from an ED, the Difficulties in Emotional Regulation Scale and the Behavioral Assessment System for Children-Self-Report. RESULTS: More advanced stages of change were associated with better parent-adolescent relationships and better emotional regulation. CONCLUSION: Incorporating parents in treatment to enhance parent-adolescent relationships and instructing parents in emotional regulation techniques to assist the adolescent may enhance their motivation to recover.

Appearance comparison on Instagram: The impact of fitspiration and transformation imagery on young women's body satisfaction.

Fitspiration, or imagery of thin muscular individuals that displays their physiques while posing or exercising, is a popular type of content on Instagram which ostensibly exists to encourage individuals to engage in a healthy lifestyle. A subtype of fitspiration imagery, "transformation" imagery, depicts physical changes following a "lifestyle change" involving diet and exercise. Despite its intentions, fitspiration imagery largely promotes one idealized body type (the fit ideal) and can be accompanied by messages encouraging restrained eating. Viewing fitspiration imagery has been associated with body dissatisfaction and appearance comparison in women, but the impact of transformation imagery specifically on women's body image has not yet been studied, nor has the impact of the broader fitspiration category and the transformation subtype on women's body image been compared. The current study aimed to clarify the relations between fitspiration and transformation imagery, appearance comparison, and body satisfaction using an experimental design. Female participants (N = 161) completed a measure of body satisfaction and then were randomly assigned to view one of three types of images: fit ideal only, body transformation, or travel (control). Participants then completed measures of appearance comparison and body satisfaction. Viewing fit ideal only and body transformation imagery was associated with lower body satisfaction and higher appearance comparison. The relation between image type and changes in body satisfaction was mediated by appearance comparison. Findings suggest that individuals may benefit from limiting exposure to fit ideal and body transformation imagery, particularly if they are vulnerable to engaging in appearance comparison.

Eating disorder psychopathology as a marker of psychosocial distress and suicide risk in female and male adolescent psychiatric inpatients.

OBJECTIVE: The aim of this study was to examine psychosocial correlates of specific aspects of eating disorder (ED) psychopathology (ie, dietary restriction, body dissatisfaction, binge eating, and self-induced vomiting) in psychiatrically hospitalized adolescent girls and boys. METHOD: A total of 492 psychiatric inpatients (286 adolescent girls and 206 adolescent boys), aged 12 to 19 years, completed self-report measures of psychosocial and behavioral functioning, including measures of suicide risk and ED psychopathology. Associations between ED psychopathology and psychosocial functioning were examined separately by sex and after controlling for depressive/negative affect using Beck Depression Inventory scores. RESULTS: Among the adolescent boys and girls, after controlling for depressive/negative affect, ED psychopathology was significantly associated with anxiety, low self-esteem, and current distress regarding childhood abuse. Among adolescent girls, after controlling for depressive/negative affect, ED psychopathology was significantly related to hopelessness and suicidality. Among adolescent boys, after controlling for depressive/negative affect, ED psychopathology was positively related to self-reported history of sexual abuse and various externalizing problems (drug abuse, violence, and impulsivity). CONCLUSION: In psychiatrically hospitalized adolescents, ED psychopathology may be an important marker of broad psychosocial distress and behavioral problems among girls and boys, although the nature of the specific associations differs by sex.

Cognitive and behavioral correlates of depressive symptoms in a community sample of adolescents.

Research in adults demonstrates a positive association among obsessive-compulsive symptoms, eating pathology, cognitive distortions, and comorbid depressive symptoms. Given that adolescence is characterized by unique and rapid changes in biopsychosocial processes, it is imperative to elucidate the relationship between these variables in youth. In this cross-sectional study, we explored whether obsessive-compulsive symptoms, thought-action fusion, thought-shape fusion, and eating pathology would be positively associated with and predict depressive symptoms in a school-based community sample of adolescents (n = 86; Mage = 15.60). All study variables were positively correlated with depressive symptoms. Results indicated that obsessive-compulsive symptoms, thought-shape fusion, and eating pathology explained a significant proportion of variance in depressive symptoms, whereas thought-action fusion did not. In accordance with the cognitive behavioral model of psychopathology, these findings highlight the relationships between key interrelated correlates of depressive symptoms that may be pertinent targets for prevention and treatment efforts in adolescents.

Factors related to motivation for change in adolescents with eating disorders.

OBJECTIVE: To examine the association between motivation for change and eating disorder symptom severity, the quality of the parent-adolescent relationship and depressive symptom severity in adolescents with eating disorders. METHOD: Fifty-four female adolescents with eating disorders (mean age = 15.8 years, SD = 1.6) participated in this research prior to beginning outpatient treatment. Participants completed the Motivational Stages of Change for Adolescents Recovering from an Eating Disorder, the Eating Disorders Inventory-2, the Relations with Parents scale from the Behavioral Assessment System for Children and Adolescents Self-report and the Child Depression Inventory. RESULTS: Greater motivation for change was associated with less body dissatisfaction, more adaptive parent-adolescent relationships and fewer depressive symptoms. The association between motivation for change and adolescents' perception of their relationship with their parents remained significant even after controlling for age, body dissatisfaction and depressive symptoms. CONCLUSION: Involvement of families in treatment for adolescents with eating disorders may serve to enhance their motivation to recover.

How do adolescents with bulimia nervosa rate the acceptability and therapeutic relationship in family-based treatment?

OBJECTIVE: To describe therapeutic alliance and treatment acceptability ratings of adolescents with bulimia nervosa (BN) participating in family-based treatment (FBT-BN) and to explore how participant characteristics relate to these constructs. METHOD: Adolescents with BN (n = 80) in a randomized controlled trial comparing FBT-BN and individual supportive psychotherapy (SPT), completed the Eating Disorder Examination, Rosenberg Self-esteem Scale, and Beck Depression Inventory prior to treatment. The Helping Relationship Questionnaire, patient expectancy for treatment, treatment suitability, and self-reported estimates of improvement ratings were obtained at multiple points throughout treatment. RESULTS: Therapeutic alliance and treatment acceptability ratings were positive in both treatments and generally did not differ. Within FBT-BN, more severe eating disorder symptomatology pretreatment was related to lower alliance ratings mid-treatment (p < .05). However, reductions in binge and purge behaviors over the course of treatment were not related to alliance or acceptability for participants in FBT-BN (all p's > .10). CONCLUSION: Contrary to expectations of FBT-BN, adolescents receiving both treatments develop a strong alliance with the therapist.

Assessing readiness for change in adolescents with eating disorders.

The Readiness and Motivation Interview (RMI) is a semistructured interview measure of readiness and motivation to change that can be used for all eating disorder diagnoses. The RMI has demonstrated excellent psychometric properties and has both clinical and predictive utility in adult samples. This study examined the psychometric properties of the RMI in a younger population, namely, 12- to 18-year-old girls with eating disorders. Study participants (N = 65) completed the RMI and measures of convergent, discriminant, and criterion validity. Adolescents with eating disorders were able to conceptualize and articulate their readiness for change and to report the extent to which change efforts were for themselves versus for others. RMI readiness profiles across eating disorder symptom domains in adolescents were comparable to those in adults, with higher reported readiness to change binge eating than to change dietary restriction or compensatory strategies. Differences in internal consistency between adult and adolescent samples are discussed. Interviewing adolescents early in treatment about readiness may assist clinicians in forming an alliance with this difficult-to-engage population, while also providing valuable information for treatment planning.

Body-related social comparison and disordered eating among adolescent females with an eating disorder, depressive disorder, and healthy controls.

The purpose of this study was to investigate the association between body-related social comparison (BRSC) and eating disorders (EDs) by: (a) comparing the degree of BRSC in adolescents with an ED, depressive disorder (DD), and no psychiatric history; and (b) investigating whether BRSC is associated with ED symptoms after controlling for symptoms of depression and self-esteem. Participants were 75 girls, aged 12-18 (25 per diagnostic group). To assess BRSC, participants reported on a 5-point Likert scale how often they compare their body to others'. Participants also completed a diagnostic interview, Eating Disorders Inventory-2 (EDI-2), Beck Depression Inventory-II (BDI-II), and Rosenberg Self-Esteem Scale (RSE). Compared to adolescents with a DD and healthy adolescents, adolescents with an ED engaged in significantly more BRSC (p ≤ 0.001). Collapsing across groups, BRSC was significantly positively correlated with ED symptoms (p ≤ 0.01), and these associations remained even after controlling for two robust predictors of both ED symptoms and social comparison, namely BDI-II and RSE. In conclusion, BRSC seems to be strongly related to EDs. Treatment for adolescents with an ED may focus on reducing BRSC.

Beyond shape and weight: exploring the relationship between nonbody determinants of self-esteem and eating disorder symptoms in adolescent females.

OBJECTIVE: Recent research using the Shape and Weight-Based Self-Esteem (SAWBS) Inventory has shown that basing self-esteem on shape and weight is related to eating disorder and psychiatric symptoms. This study examined the relationship between other determinants of self-esteem assessed in the SAWBS Inventory (e.g., friendships, intimate relationships, school/work competence) and eating disorder and psychological health variables. METHOD: Female high school adolescents (N = 235) participated in this study. The relative contribution of the self-esteem dimensions to eating disorder and self-esteem was examined. RESULTS: In addition to shape and weight, basing self-esteem on intimate relationships was also related to higher eating disorder symptoms and lower body and global self-esteem. The only protective factors to emerge in this study were basing self-esteem on competence at school and other activities. DISCUSSION: Basing self-esteem on intimate relationships was associated with similar physical and health problems to basing self-esteem on shape and weight. The implications of these findings with regard to healthy adolescent development are addressed.