Exploring the relationship between emotion regulation, inhibitory control, and eating psychopathology in a non-clinical sample.

OBJECTIVE: The present study aimed to explore the relationship between difficulties in emotion regulation and deficits in inhibitory control, and the role of these processes in eating psychopathology in a non-clinical sample. We also explored the specificity in which deficits in inhibitory control may underlie eating psychopathology, namely whether they can be conceptualised as context specific or more extensive in nature. METHOD: Participants were 107 healthy individuals recruited at a major Portuguese university, aged between 18 and 43 years-old (M = 21.23, SD = 4.79). Two computerised neuropsychological tasks (i.e., emotional go/no-go and food go/no-go tasks) were used to assess response inhibition in the presence of general versus context-specific stimuli. A set of self-report measures was used to assess variables of interest such as emotion regulation and eating psychopathology. RESULTS: Results indicated higher response inhibition deficits among participants with higher difficulties in emotion regulation comparing to those with lower difficulties in emotion regulation, particularly in the context of food-related stimuli. In addition, the relationship between difficulties in emotion regulation and eating psychopathology was moderated by inhibitory control deficits in both the context of food and pleasant stimuli. CONCLUSIONS: The present findings highlight inhibitory control as an important process underlying the relationship between difficulties in emotion regulation and eating psychopathology in non-clinical samples. Findings have important implications for clinical practice and the prevention of eating psychopathology in healthy individuals and individuals with eating disorders.

The Mediating Role of Emotion Dysregulation in the Association Between Perfectionism and Eating Psychopathology Symptoms.

INTRODUCTION: This study explored the possible mediating role of emotion dysregulation in the association between perfectionism and eating psychopathology symptoms. METHOD: One hundred forty-two outpatients with eating disorders (EDs) were enrolled. Perfectionism, emotion dysregulation, ED psychopathology, anxious and depressive symptoms were assessed. Correlation, mediation and 95% bias corrected and accelerated (BCa CI) bootstrapped analyses were run. RESULTS: Emotion dysregulation was found to mediate the association between concern over mistakes perfectionism and restraint (indirect effect: 0.093, BCa CI: 0.001-0.02, adjusted R2 = 0.3324, p < 0.001), shape concern (indirect effect: 0.0130, BCa CI: 0.004-0.03, adjusted R2 = p < 0.001) and weight concern (indirect effect: 0.0142, BCa CI: 0.004-0.03, adjusted R2 = 0.2986, p < 0.001). CONCLUSION: Among ED outpatients, emotion dysregulation may be involved in the association between concern over mistakes perfectionism and persistence of eating psychopathology symptoms. Emotion dysregulation could be considered as possible therapeutic target to reduce the persistence, and severity, of eating psychopathology symptoms among ED patients with concern over mistakes perfectionism.

Effects of mealtime assistance in the nutritional rehabilitation of eating disorders.

PURPOSE: The aim of the study was to examine the effects of meal supervision, provided by health professionals, volunteers or family members, on anthropometric, nutritional, psychological, and behavioural outcomes in patients with eating disorders (EDs). METHODS: The present systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The last search was conducted in three databases (PubMed, Scopus, and the Cochrane library). Inclusion criteria considered paediatric and adult patients suffering from EDs, regardless of ethnicity, and treated in different therapeutic settings. The quality of the studies was evaluated using the Newcastle Ottawa Scale (NOS) adapted for cross-sectional studies and Version 2 of the Cochrane risk-of-bias assessment tool for randomised trials. RESULTS: 3282 articles were retrieved, out of which only 6 met the eligibility criteria. A marked heterogeneity in definitions and approaches to supervised mealtime was observed. This variability emerged in the methodologies used in the supervised meal, and in the reference values for the outcome measures that were used, such as the analysis of different parameters. Based on these observations, mealtime assistance provided to patients with EDs shows an overall positive effect on eating behaviour and dysfunctional attitudes. Future research should be prompted to provide a thorough definition of a structured procedure for meal assistance to be potentially and systematically included in the nutritional rehabilitation protocols for patients with EDs. LEVEL OF EVIDENCE: Level IV systematic reviews of uncontrolled trials.

Pregorexia: a systematic review and meta-analysis on the constructs of body image dissatisfaction and eating disturbances by gestational age in the peripartum.

PURPOSE: Pregorexia is a phenomenon posited to occur in the peripartum, characterized by an attempt to counter pregnancy's physiological changes in body shape through reduced calorie intake or increased physical activity. METHODS: In this pre-registered systematic review and meta-analysis, body image dissatisfaction and eating psychopathology in the peripartum according to gestational age were formally assessed. PubMed was searched up to May 2023. Selection criteria were represented by studies on body image concerns or eating psychopathology in the peripartum (up to 1 year after delivery). The population needed to include women from the general population or among patients with a history of (or current) eating disorder. For the meta-analysis, 17 studies were included: 10 for body image dissatisfaction (2625 individuals overall), 7 for eating behaviors (2551 individuals overall). The interplay between body image and the following themes was examined in depth: the adoption of breastfeeding, peripartum depression, sociocultural influences on body image, sexual disturbances, experiencing or reporting an altered food intake. RESULTS: Progressive dissatisfaction with body image during pregnancy by gestational age was observed, stably elevated for at least 12 months postpartum. Eating psychopathology was observed as elevated only at 12 months in the postpartum, but not during pregnancy. DISCUSSION: The current work offers normative values of body image satisfaction and eating psychopathology in the peripartum by gestational age. The relevance of current results was discussed, in order to inform both current clinical practice and future public policies. LEVEL OF EVIDENCE: Level I-Evidence obtained from: systematic reviews and meta-analyses.

Mediation models of anxiety and depression between temperament and drive for thinness and body dissatisfaction in anorexia nervosa.

PURPOSE: Anorexia nervosa (AN) is a life-threatening condition in which temperament, anxiety, depression, and core AN body-related psychopathology (drive for thinness, DT, and body dissatisfaction, BD) are intertwined. This relationship has not been to date disentangled; therefore, we performed a multiple mediation analysis aiming to quantify the effect of each component. METHODS: An innovative multiple mediation statistical method has been applied to data from 184 inpatients with AN completing: Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire, Eating Disorders Inventory-2, State-Trait Anxiety Inventory, and Beck Depression Inventory. RESULTS: All affective temperaments but the hyperthymic one were involved in the relationship with DT and BD. Only the anxious temperament had a significant unmediated direct effect on DT after the strictest correction for multiple comparisons, while the depressive temperament had a significant direct effect on DT at a less strict significance level. State anxiety was the strongest mediator of the link between affective temperament and core AN body-related psychopathology. Depression showed intermediate results while trait anxiety was not a significant mediator at all. CONCLUSION: Affective temperaments had a relevant impact on body-related core components of AN; however, a clear direct effect could be identified only for the anxious and depressive temperaments. Also, state anxiety was the strongest mediator thus entailing interesting implications in clinical practice. LEVEL OF EVIDENCE: V, cross-sectional study.

The powerful effect of body image inflexibility on the explanation of eating psychopathology severity.

PURPOSE: Feelings of shame and social comparison focused on physical appearance have been identified as important risk factors for the engagement in disordered eating behaviours. Further, recent studies have emphasized the role of body-image psychological (in)flexibility in the association between several risk factors and eating psychopathology. The current study intended to explore, in two different path models, the effects of external shame, physical appearance-related social comparison, and body image inflexibility on the explanation of eating psychopathology severity. METHODS: This study follows a cross-sectional design and was conducted in a sample of 776 emerging-adult women, aged between 18 and 28, who completed an online battery of self-report measures. Path analyses were conducted using a structural equation modeling. RESULTS: Model 1's results showed that external shame and unfavourable social comparison based on physical appearance directly accounts for 26% of the variance in disordered eating. In turn, when body image inflexibility is introduced as a mediator in the relationship presented in Model 1, variance in disordered eating increases to 60% (Model 2). These results suggest that both external shame and unfavourable physical appearance-related social comparison have an impact on disordered eating behaviours. However, when body image inflexibility is introduced, the mentioned relationships change and reveal that psychological inflexibility is a significant mediator of these associations. CONCLUSION: These findings seem to demonstrate that body image inflexibility is a key process for the engagement in disordered eating, so the promotion of psychological flexibility focused on one's body is crucial for the prevention and treatment of disordered eating behaviours and attitudes. LEVEL OF EVIDENCE: Level IV: Cross-sectional study.

Disturbed families or families disturbed: a reconsideration.

BACKGROUND: The relationship between anorexia nervosa (AN) and family disturbance has been a subject of debate since its first description. What began as a clear view of the pathologically disturbed family causing AN has become ever more complex over the decades. OBJECTIVE: The aim of this review is to explore the literature to examine the changes and evolution of clinical opinion around family dysfunction and AN over the last 20 years. METHODS: A narrative review of heterogeneous studies in peer-reviewed publications sourced from the major databases, including PubMed and ScienceDirect, to illuminate the topic of family distress and AN by highlighting the conflicting and complementary ways it has been studied. RESULTS: This review has highlighted the complexity of the relationship between anorectic sufferers and their families. It has explored the literature about parental burden, emotions and cognitive mechanisms together with parental attitudes about weight and shape. It is clear that there is no consistent psycho-social pathology in families which has been shown to be causative. However, over the last twenty years, research has highlighted the distress and family dysfunction caused by having to look after an anoretic child with poor mentalisation skills, insecure attachment and emotion dysregulation. CONCLUSION: The area has become clearer over the last 20 years; research suggests a bi-directional relationship between AN and family dysfunction, with difficult dynamics becoming entrenched within the family. This is best addressed, the consensus suggests, by specialist family therapy and carer skills interventions. Longitudinal research is needed to definitively answer the question with rigorous scientific certainty. EMB RATING: Level V. LEVEL OF EVIDENCE: Level I: Evidence obtained from: at least one properly designed randomized controlled trials; systematic reviews and meta-analyses; experimental studies. Level II: Evidence obtained from well-designed controlled trials without randomization. Level III: Evidence obtained from well-designed cohort or case-control analytic studies. Level IV: Evidence obtained from with multiple time series analysis such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence. Level V: Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

The relationship between working alliance with peer mentors and eating psychopathology in a digital 6-week guided self-help intervention for anorexia nervosa.

OBJECTIVE: The quality of working alliance (WA) is associated with treatment outcomes across several types of psychiatric disorders and psychological interventions. This study examined the role of WA with peer mentors (people with lived experience of illness) and student mentors (graduated psychology students) in a 6-week, digital, guided self-help (GSH) intervention for anorexia nervosa. METHOD: Ninety-nine patients rated weekly, for 6 weeks: (a) eating psychopathology using the short version of the Eating Disorder Examination Questionnaire (EDE-QS) and (b) WA with a student mentor (n = 14) or a peer mentor (n = 10). WA was assessed by asking patients the extent to which they felt comfortable working with their mentor and the extent to which they agreed with them on the goals for support. WA with mentors and the association with eating psychopathology change were measured on a session-by-session basis. The analysis involved a random intercepts cross-lagged panel model. RESULTS: WA with peer mentors was slightly higher than WA with students (ES = 0.3). Peer mentors' WA in the previous session was significantly associated with eating psychopathology ratings in the next session. No significant relationship was found between the previous session's EDE-QS scores and peer mentor alliance in the following session. In the student mentor group, there were no session-by-session associations between WA and eating psychopathology. However, greater WA with the student mentor across sessions was associated with less eating psychopathology. DISCUSSION: These findings suggest that clinical outcomes are in part associated with the characteristics of the mentor delivering guidance in an online GSH for eating disorders.

How psychological inflexibility mediates the association between general feelings of shame with body image-related shame and eating psychopathology severity?

Adolescence is considered a transitional stage characterized by several physical, psychological and social changes. During this period, there is an increased propensity for the emergence of emotional difficulties, especially those related to body image and eating attitudes and behaviours. In particular, shame has been pointed out as a key risk factor for body image and eating-related difficulties. However, research seems to be scarce regarding this association in adolescent samples. Therefore, the current study aimed to explore whether psychological inflexibility impacts the association between general feelings of shame with body image-related shame and eating psychopathology severity. The study was conducted with 226 adolescent girls from the community, aged between 12 and 18, who completed self-report measures. Path analysis indicated that higher levels of external shame were associated with more externalized and internalized body image shame and also with greater engagement in disordered eating behaviours. Furthermore, the model demonstrated that these relationships were mediated by increased levels of psychological inflexibility. The tested model accounted for a total of 30% and 22% of externalized and internalized body image variances, respectively, and 51% of the variance of disordered eating behaviours. These findings appear to suggest that in adolescent girls, body shame and disordered eating may emerge as defensive and maladaptive strategies to cope with general feelings of inferiority, particularly in the presence of psychological inflexibility. Also, this study highlights the importance of assessing and working underlying maladaptive processes in this association, mainly in adolescents with high levels of shame.

Early intervention in child and adolescent eating disorders: The role of a parenting group.

OBJECTIVE: Parental involvement is emphasised in treatment guidelines for Eating Disorders (ED). The primary aim of this phase II study was to estimate the impact of a parent group intervention delivered immediately post-diagnosis on weight gain and ED psychopathology in a cohort of young people referred to a community ED service. A secondary aim was to identify predictor variables for early treatment response in children whose parents attended the programme. METHOD: Parents of 64 new cases of Anorexia Nervosa (AN; n = 50) and Atypical Anorexia (AAN, n = 14) attended a 6 week parent group intervention in addition to treatment as usual in which patients were weighed and reviewed, but had no other contemporaneous psychological intervention. Age and gender adjusted BMI (%median [m] BMI) and ED psychopathology at baseline, 6-week and 6-month follow-up were analysed to assess weight gain and identify predictors of outcome. RESULTS: The intervention was associated with weight gain and improved ED psychopathology by the end of the programme; these gains were sustained at 6 months %mBMI at 6 weeks was the only predictor of outcome (%mBMI) at 6 months. CONCLUSIONS: This preliminary work highlights the positive benefit of an ED focused parent group early intervention that could be further evaluated.

Feeling imperfect and imperfectly feeling: A network analysis on perfectionism, interoceptive sensibility, and eating symptomatology in anorexia nervosa.

OBJECTIVE: In recent years, the network analysis (NA) methodology has been applied to identify the central features of the psychopathology of anorexia nervosa (AN) and specific connections to previously recognized vulnerabilities. However, an NA investigating both multidimensional perfectionism and interoceptive sensibility in connection to eating symptomatology is currently missing. METHOD: A total of 260 individuals (139 patients with AN, 121 healthy control individuals) completed the Frost Multidimensional Perfectionism Scale, the Multidimensional Assessment of Interoceptive Awareness and the Eating Disorders Inventory-2. Using state-of-the-art techniques, we estimated a main network with data from all participants and then compared the two separated networks. We checked the variables for empirical overlap through goldbricker, combined as suggested and implemented the empirical measure of the bridge nodes. RESULTS: Ineffectiveness and need for control over self and body (resulting from combining Asceticism and Drive for Thinness) were the most central nodes, whereas perfectionistic evaluative concerns (resulting from combining Doubts about Actions and Concern over Mistakes) and mistrust in body sensations were the bridge nodes. No significant differences between the patient and control networks emerged. CONCLUSIONS: Perfectionistic evaluative concerns and mistrust in body sensations could be key components in the relationships among perfectionism, interoceptive sensibility and eating symptomatology.

The brief (seven-item) eating disorder examination-questionnaire: Evaluation of a non-nested version in men and women.

OBJECTIVE: Several recent studies have examined the psychometric properties of brief measures of eating disorder attitudes based on the Eating Disorder Examination Questionnaire (EDE-Q). A seven-item version (the EDE-Q7) has been proposed but, as yet, has only been investigated by looking at the items when presented as part of the longer EDE-Q (i.e., as a nested version). The current study presented the EDE-Q7 as a standalone instrument and examined factor structure fit and measurement invariance across male and female genders. METHODS: University students (244 women; 155 men; 1 did not identify with either gender) completed questionnaires as part of two independent studies. All individuals completed the EDE-Q7 and measures of eating disorder behaviors. In a mixed-gender subsample (n = 286), measures of depression and eating disorder-specific quality of life were also included. Confirmatory factor analysis of the EDE-Q7 was conducted on males and females independently, in addition to estimates of internal consistency reliability and validity. Measurement invariance was assessed through multigroup confirmatory factor analysis. RESULTS: The EDE-Q7 demonstrated good internal consistency and findings supported measurement invariance by gender. In a mixed-gender subsample, the measure showed positive associations with depression and both eating disorder behaviors and eating disorder-specific quality of life. DISCUSSION: The present study adds to the literature supporting the psychometric properties of the EDE-Q7, extending this to use of the questionnaire as a standalone instrument. Measurement invariance suggests that the measure may be appropriate for college-age men and women, although future studies should establish psychometric properties more fully.

Insecure striving as an exacerbator of the toxic effect of shame feelings on disordered eating.

BACKGROUND: Empirical evidence has previously shown the impact of shame and insecure striving on the emergence of eating psychopathology. However, interactions between these variables and the development of pathological eating remain unclear. OBJECTIVE: The present study aimed at exploring the moderator effect of insecure striving on the relationship between shame and disordered eating, while controlling for BMI effects. METHODS: Participants of this study were 458 women from the general population, with a mean age of 30.74 (SD = 12.15) and a mean BMI of 23.14 kg/m2 (SD = 3.99), who completed an online investigation protocol. Out of these participants, 7.0% were underweight, 67.9% had a normal weight, 18.8% were overweight and 6.3% were obese. RESULTS: Results showed that the study variables were positive and significantly intercorrelated. A multiple regression analysis revealed that insecure striving and shame explained 20.5% of disordered eating. The exacerbating role of insecure striving on the relationship between shame and disordered eating was further confirmed through path analysis. The model explained 38% of disordered eating and the plotted graph revealed that, for any level of shame, women who manifested a greater need to strive to avoid inferiority, expressed higher levels of disordered eating, in comparison to those who felt a lower pressure to prove others that they are attractive through the achievement of excellence goals. CONCLUSIONS: These results support the notion that eating psychopathology may be regarded as a striving to avoid inferiority strategy, establishing an important avenue for disordered eating-related investigation and clinical practice. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Self-to-others and self-to-self relationships: paths to understanding the valence of body image and eating attitudes in emerging adult women.

PURPOSE: Interpersonal and intrapersonal factors contributing to body appreciation in emerging adult women remain poorly explored. Thus, the present study aimed to test the impact of early memories of warmth and safeness with peers, self-compassion, and social safeness, in body appreciation and in disordered eating attitudes and behaviours. METHODS: A total of 387 women aged between 18 and 25 completed a set of self-report questionnaires. Data were analysed through descriptive and correlation statistics, and the suitability of a theoretical model was explored via path analysis. Self-report instruments assessed participants' weight and height, early memories of warmth and safeness with peers, self-compassion, social safeness, body appreciation, as well as disordered eating. RESULTS: Early memories of warmth and safeness with peers associated with higher self-compassion and feelings of social safeness, which were both positively linked to body appreciation. Body appreciation associated with a lower display of disordered eating. CONCLUSION: It seems that childhood and adolescent experiences may have an important influence on the development of self-to-self and self-to-others secure relationships, with consequences on the way women behave and relate with their unique body characteristics. The pertinence of developing self-compassion and affiliative skills to promote positive body image among females is suggested, as well as of applying compassion-based strategies when clinically approaching symptoms of eating disorders. LEVEL OF EVIDENCE: Cross-sectional descriptive study, Level V.

Body compassion safeguards against the impact of major life events on binge eating.

Body compassion is a fresh construct that incorporates two multidimensional concepts: body image and self-compassion. Although self-compassion has revealed a protective role against body image and eating-related problems (e.g., binge eating), the study of this specific compassionate competence focused on body image is still largely unexplored. The present study aimed to test two moderation models which hypothesized that body compassion moderates the impacts of (i) the cumulative number and (ii) negative appraisal of major life events on binge eating behaviours, in a sample of 458 women from the Portuguese general population. Results showed that body compassion was negatively associated with major life events and binge eating. Moderation analysis results demonstrated the moderator effect of body compassion on the relationship between major life events (both cumulative number and negative appraisal) and binge eating, accounting for 34% and 33% of the variance of binge eating, respectively. The moderator effect of body compassion was confirmed to low to medium levels of body compassion and, overall, results seem to suggest that, for the same levels of major life events (in number or negative appraisal), women who present higher body compassion present less binge eating symptoms. Although these data are preliminary and need support from a longitudinal design research, current findings appear to be promising by suggesting the relevance of promoting body compassion in prevention and treatment programs for disordered eating attitudes and behaviours.

Negative affect and eating psychopathology: the moderator effect of gender.

PURPOSE: This study examined the moderator role of gender in the relationship between negative affect and eating psychopathology as well as gender differences in these variables. METHODS: A community sample of 285 students (61.8% females), aged 13-25, was recruited in middle and high schools and universities. They filled instruments that assess negative affect and eating disordered symptoms (restraint, eating concern, shape concern, weight concern, and global scale). RESULTS: Females scored higher both in all subscales and the global scale of eating psychopathology. The restraint subscale was the only subscale showing non-significant differences between females and males. Controlling for BMI, moderation analyses revealed that gender moderated the relationship between negative affect and eating psychopathology, except for restraint behavior. CONCLUSIONS: To deal with negative affect, females engage in more cognitive symptoms associated with disordered eating than males, but both endorse equally in eating restraint. These findings suggest that interventions focused on emotion regulation could help to reduce eating disordered symptoms among females and males. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Steps toward understanding the impact of early emotional experiences on disordered eating: The role of self-criticism, shame, and body image shame.

In research, it has been suggested that early threatening emotional experiences, characterized by abuse, rejection, neglect or absence of affiliative signals may activate maladaptive defensive responses. Further, several studies have emphasised the association between the recall of early emotional experiences and eating psychopathology. However, this relationship does not seem to be direct. Thus, the current study explored the mediator roles of self-criticism and shame (general and body image-focused shame) in the link between early emotional experiences and the engagement in disordered eating, while controlling for the effect of body mass index. The sample of this study included 552 female participants, aged between 18 and 40 years old. The path analysis indicated that the absence of early positive emotional experiences was associated with disordered eating behaviours, through an increased perception of being negatively perceived as inferior or unattractive by others, self-critical attitudes, and body image-focused shame. The tested model accounted for 63% of body image shame and for 67% of disordered eating's variance, and showed an excellent model fit. These findings suggest that shame and self-criticism are defensive mechanisms associated with early threatening emotional experiences, which may trigger disordered eating behaviours. These data appear to offer important research and clinical implications supporting the development of intervention community programs for body and eating difficulties, that specifically target shame (general and body image-focused shame) and self-criticism, through the development of more adaptive emotional regulation strategies.

Do shame and perfectionistic self-presentation explain the link between early affiliative memories and eating psychopathology?

This study tested a model examining the impact that early affiliative memories (both with family and peers) on eating psychopathology, and whether these links are carried by the mechanisms of external shame and body image-related perfectionistic self-presentation, in a sample of 480 female college students. Path analyses' results revealed that this model accounted for 48% of disordered eating's variance and suggests that the lack of early positive emotional memories is associated with higher levels of shame (feelings of inferiority and unattractiveness), and with higher tendency to adopt body image-related perfectionistic strategies, that seem to explain excessive eating concern and rigid control of one's eating behaviors. This study offers important insights for future research and for the development of intervention programs, by revealing the importance of assessing and targeting shame and perfectionistic strategies and suggesting the importance of promoting adaptive emotion regulation strategies.

How do warmth, safeness and connectedness-related memories and experiences explain disordered eating?

Literature suggested that the recall of early positive experiences have a major impact on the promotion of feelings of connectedness and social safeness, and seems to protect individuals against psychopathology. Recent research has also demonstrated that the absence of these positive rearing memories play a key role on disordered eating-related behaviours. The impact of early affiliative memories on disordered eating do not seem to be direct, and the mechanisms underlying this relationship are scarcely investigated. The present study aimed to clarify how memories of warmth and safeness explain the adoption of disordered eating attitudes, and tested the mediator role of social safeness, external shame and appearance-focused social comparison on aforementioned relationship, in a sample of 277 young women. The tested model explained 36% of eating psychopathology's variance and presented an excellent fit. Path analysis results indicated that the impact of rearing memories on eating psychopathology was fully mediated through the mechanisms of social safeness, external shame and appearance-focused social comparison. Specifically, these findings suggested that the extent to which positive rearing memories are associated with lower levels of disordered eating attitudes is influenced by the current feelings of social safeness and connectedness, which in turn are totally carried by decreased feelings of external shame and by lower endorsement on unfavourable comparison based on physical appearance with proximal targets (peers). These results seem to offer important insights for research and clinical work on body image and eating-related difficulties, suggesting the relevance of promoting warm and safe interactions with others. LEVEL OF EVIDENCE: Level V, descriptive study.

What makes dietary restraint problematic? Development and validation of the Inflexible Eating Questionnaire.

This study presents the Inflexible Eating Questionnaire (IEQ), which measures the inflexible adherence to subjective eating rules. The scale's structure and psychometric properties were examined in distinct samples from the general population comprising both men and women. IEQ presented an 11-item one-dimensional structure, revealed high internal consistency, construct and temporal stability, and discriminated eating psychopathology cases from non-cases. The IEQ presented significant associations with dietary restraint, eating psychopathology, body image inflexibility, general psychopathology symptoms, and decreased intuitive eating. IEQ was a significant moderator on the association between dietary restraint and eating psychopathology symptoms. Findings suggested that the IEQ is a valid and useful instrument with potential implications for research on psychological inflexibility in disordered eating.