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.

Corrigendum: Severe and enduring' stage in anorexia nervosa: comparing eating attitudes, impairment and associated psychopathology.

[This corrects the article DOI: 10.3389/fnut.2022.867401.].

International consensus on patient-centred outcomes in eating disorders.

The effectiveness of mental health care can be improved through coordinated and wide-scale outcome measurement. The International Consortium for Health Outcomes Measurement has produced collaborative sets of outcome measures for various mental health conditions, but no universal guideline exists for eating disorders. This Position Paper presents a set of outcomes and measures for eating disorders as determined by 24 international experts from professional and lived experience backgrounds. An adapted Delphi technique was used, and results were assessed through an open review survey. Final recommendations suggest outcomes should be tracked across four domains: eating disorder behaviours and cognitions, physical health, co-occurring mental health conditions, and quality of life and social functioning. Outcomes are collected using three to five patient-reported measures. For children aged between 6 years and 12 years, the measures include the Children's Eating Attitude Test (or, for those with avoidant restrictive food intake disorder, the Eating Disorder in Youth Questionnaire), the KIDSCREEN-10, and the Revised Children's Anxiety and Depression Screener-25. For adolescents aged between 13 years and 17 years, the measures include the Eating Disorder Examination Questionnaire (EDE-Q; or, for avoidant restrictive food intake disorder, the Nine-Item Avoidant Restrictive Food Intake Disorder Screener [NIAS]), the two-item Patient Health Questionnaire (PHQ-2), the nine-item Patient Health Questionnaire (PHQ-9), the two-item Generalised Anxiety Disorder (GAD-2), the seven-item Generalised Anxiety Disorder (GAD-7), and the KIDSCREEN-10. For adults older than 18 years, measures include the EDE-Q (or, for avoidant restrictive food intake disorder, the NIAS), the PHQ-2, the PHQ-9, the GAD-2, the GAD-7, the Clinical Impairment Assessment, and the 12-item WHO Disability Assessment Schedule 2.0. These questionnaires should be supplemented by information on patient characteristics and circumstances (ie, demographic, historical, and clinical factors). International adoption of these guidelines will allow comparison of research and clinical interventions to determine which settings and interventions work best, and for whom.

Eating disorders during lockdown: the transcultural influence on eating and mood disturbances in Ibero-Brazilian population.

BACKGROUND: COVID-19 pandemic has implied exceptional restrictive measures to contain its widespread, with adverse consequences on mental health, especially for those people with a background of mental illness, such as eating disorders (EDs). In this population, the influence of socio-cultural aspects on mental health has been still underexplored. Then, the main aim of this study was to assess changes in eating and general psychopathology in people with EDs during lockdown regarding the ED subtype, age, and provenance, and considering socio-cultural aspects (e.g., socioeconomical factors such as work and financial losses, social support, restrictive measures, or health accessibility, among others). METHODS: The clinical sample was composed of 264 female participants with EDs (74 anorexia nervosa (AN), 44 bulimia nervosa (BN), 81 binge eating disorder (BED), and 65 other specified feeding and eating disorder (OSFED)), with a mean age of 33.49 years old (SD = 12.54), from specialized ED units in Brazil, Portugal, and Spain. The participants were evaluated using the COVID-19 Isolation Eating Scale (CIES). RESULTS: A global impairment in mood symptoms and emotion regulation was reported in all the ED subtypes, groups of age, and countries. Spanish and Portuguese individuals seemed more resilient than Brazilian ones (p < .05), who reported a more adverse socio-cultural context (i.e., physical health, socio-familial, occupational, and economic status) (p < .001). A global trend to eating symptoms worsening during lockdown was observed, regardless of the ED subtype, group of age, and country, but without reaching statistical significance. However, the AN and BED groups described the highest worsening of the eating habits during lockdown. Moreover, individuals with BED significantly increased their weight and body mass index, similarly to BN, and in contrast to the AN and OSFED groups. Finally, we failed to find significant differences between groups of age although the younger group described a significant worsening of the eating symptoms during lockdown. CONCLUSIONS: This study reports a psychopathological impairment in patients with EDs during lockdown, being socio-cultural aspects potential modulatory factors. Individualized approaches to detect special vulnerable groups and long-term follow-ups are still needed.

The mediating role of self-criticism, experiential avoidance and negative urgency on the relationship between ED-related symptoms and difficulties in emotion regulation.

OBJECTIVE: Difficulties in emotion regulation are thought to play a transdiagnostic role across eating disorders (ED). In the current study, we explored with a path analysis the mediating role of self-criticism, experiential avoidance and negative urgency on the relationship between ED-related symptoms and dimensions of difficulties in emotion regulation. METHOD: Participants were 103 female outpatients recruited at a Portuguese ED hospital unit, diagnosed with an ED, aged 14-60 years old (M = 28.0, SD = 10.5), body mass index (BMI) ranging from 11.72 to 39.44 (M = 20.1, SD = 5.4). RESULTS: The path analysis resulted in a model with an adequate fit to the data (SRMR = 0.05; RMSEA = 0.07 [0.00, 0.12], PCLOSE = 0.269; TLI = 0.97; IFI = 0.99; GFI = 0.95). A final model in which the relationship between ED-related symptoms and dimensions of difficulties in emotion regulation was mediated by self-criticism, experiential avoidance and negative urgency, accounted for a variance of 71% for strategies, 57% for non-acceptance, 62% for impulses, 56% for goals and 20% for clarity. CONCLUSION: Results suggest that self-criticism, experiential avoidance and negative urgency, combined, are relevant in the relationship between ED-related symptoms and difficulties in emotion regulation. ED treatment and emotion regulation skills may be enhanced through the inclusion of specific components that target self-criticism, experiential avoidance and negative urgency, as they become prominent during the therapeutic process.

Severe and Enduring' Stage in Anorexia Nervosa: Comparing Eating Attitudes, Impairment and Associated Psychopathology.

This study aimed to assess differences in eating attitudes, impairment, and related psychopathology at treatment presentation for patients with "Non-severe and enduring Anorexia Nervosa" (illness duration of <7 years) and patients with "severe and enduring Anorexia Nervosa" (illness duration of 7 years or more). One hundred and thirty-nine patients diagnosed with Anorexia Nervosa participated in this study. Participants were interviewed with the Eating Disorder Examination (EDE) and asked to complete several questionnaires at the end of the first treatment appointment. We also explored differences at treatment presentation by considering alternative criteria to define groups, namely a composite of illness duration and clinical impairment (≥16 CIA total score). No differences were found when comparing participants based on illness duration. However, when participants were classified into a different classification scheme: "Non-severe and enduring Anorexia Nervosa" (illness duration <7 years and a CIA total score <16) vs. "severe and enduring Anorexia Nervosa" (illness duration ≥7 years and CIA total score ≥16), significant differences were found in terms of eating pathology, depressive symptomatology, psychological distress, and emotion dysregulation. Further research is needed to better understand the role of illness duration and clinical impairment in informing the course of AN.

The impact of COVID-19 lockdown on disordered eating behaviors: the mediation role of psychological distress.

PURPOSE: This study aimed to explore the early associations between the experienced psychosocial impact of the COVID-19 pandemic crisis during lockdown, depressive symptomatology, anxiety/stress levels, and disordered eating behaviors in adults during a first COVID-19 lockdown period. METHODS: This was a community-based cross-sectional study assessing 254 Portuguese adults (82.7% women; 35.82 ± 11.82 years) 1 week after the end of the first mandatory COVID-19 lockdown in Portugal. An online survey was conducted to evaluate psychological distress, disordered eating, and psychosocial impact of the COVID-19 pandemic. Pearson correlations and Structural Equation Modeling were performed. RESULTS: Participants reported the presence of meal skipping (52.8%), grazing eating behavior (80.9%), overeating (81.0%), loss of control over eating (47.2%), and binge eating episodes (39.2%) during lockdown. Structural equation modeling analyses, controlling for age and sex, indicated that there was a significant indirect effect of the experienced psychosocial impact of COVID-19 pandemic on disordered eating behaviors mediated through psychological distress. CONCLUSION: The psychosocial impact of the COVID-19 pandemic crisis may lead to disordered eating, and this relation may occur through the elevation of psychological distress. These findings can be used to inform interventions, to enhance mental health and manage disordered eating during similar future situations. Level of evidence V: cross-sectional descriptive study.

The factorial structure and psychometric properties of the Committed Action Questionnaire (CAQ-8) in a Portuguese clinical sample with eating disorders.

The Committed Action Questionnaire (CAQ-8) is an instrument developed to measure committed action, an adaptive psychological process. The main goal in the current study was to confirm the factorial structure of the Portuguese version of the CAQ-8 in a transdiagnostic clinical sample of participants diagnosed with an eating disorder (ED). Participants were 102 female outpatients (Mage = 28.1, SD = 10.6; MBMI = 20.0, SD = 5.5) recruited from a clinical setting specialized in the treatment of ED. Confirmatory factor analysis (CFA) was used to confirm the CAQ-8's factorial structure. Both first- and second-order models revealed adequate goodness-of-fit indices (e.g. χ2 /df = 1.545, p = .06; SRMR = 0.049; RMSEA = 0.073; CFI/TLI > 0.95). A moderation model revealed that the conditional effect of weight, shape and eating concerns on experiential avoidance was significantly moderated by increased levels of committed action, F(3, 97) = 23.79, p < .001, accounting for 42% of the final variance. The present study supports the usefulness of the CAQ-8 as a measure of levels of committed action with patients diagnosed with an ED.

A systematic review of instruments for the assessment of eating disorders among adults.

PURPOSE OF REVIEW: The availability of psychometrically sound assessment instruments for assessing eating disorder symptomatology is crucial for both clinical practice and research. The purpose of the current review is to provide the reader with a list of psychometrically validated assessments for adults that are available within the field of eating disorders. Eating disorder interviews and self-report questionnaires were identified using online literature searches, reviewing previous review articles, and via research and/or clinical experience of the authors. The focus of the review was on (1) standard assessments that were frequently used in eating disorder research (such as the Eating Disorder Examination and Eating Attitudes Test), and (2) newer assessments that were developed over the past 5 years. Information compiled on each instrument included the purpose of the assessment, scores that can be derived, psychometric information, translations in other languages, and availability for use in research and clinical settings. RECENT FINDINGS: Several recent trends in assessment instruments were identified including updates based upon Diagnostic and Statistical Manual criteria, briefer assessments, assessments for specific populations, and assessment of specific clinical features observed in people with eating disorders. SUMMARY: The current review provides eating disorder clinicians and researchers a guide for making informed decisions about the selection of eating disorder assessments.

A preliminary study on the psychosocial impact of COVID-19 lockdown in post-bariatric surgery women: the importance of eating behavior, health care access, and social support.

This study aims to characterize the psychosocial impact of COVID-19 lockdown for post-bariatric surgery (≥ 36 months) women and its association with disordered eating and psychological distress. The medium to long-time follow up is a period of increased susceptibility for poorer weight outcomes which might be triggered by the lockdown. Twenty-four participants responded to an online questionnaire and a telephone interview. About half (n = 14; 58.3%) reported perceived weight gain during the lockdown, 13 (54.1%) limited access to social support, and 12 (50%) limited access to medical care. Co-habiting with a higher number of persons during lockdown was associated with fewer difficulties in dealing with emotionally activating situations, less fear of gaining weight, less fear of losing control over eating, and less disordered eating. The global perceived psychosocial impact of lockdown was significantly correlated with difficulties in dealing with emotionally activating situations and stress symptoms. Results highlight the need to monitor post-bariatric patients, facilitate health care access, and promote social support during the lockdown period. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12144-021-01529-6.

Impact of COVID-19 Lockdown in Eating Disorders: A Multicentre Collaborative International Study.

BACKGROUND: The COVID-19 lockdown has had a significant impact on mental health. Patients with eating disorders (ED) have been particularly vulnerable. AIMS: (1) To explore changes in eating-related symptoms and general psychopathology during lockdown in patients with an ED from various European and Asian countries; and (2) to assess differences related to diagnostic ED subtypes, age, and geography. METHODS: The sample comprised 829 participants, diagnosed with an ED according to DSM-5 criteria from specialized ED units in Europe and Asia. Participants were assessed using the COVID-19 Isolation Scale (CIES). RESULTS: Patients with binge eating disorder (BED) experienced the highest impact on weight and ED symptoms in comparison with other ED subtypes during lockdown, whereas individuals with other specified feeding and eating disorders (OFSED) had greater deterioration in general psychological functioning than subjects with other ED subtypes. Finally, Asian and younger individuals appeared to be more resilient. CONCLUSIONS: The psychopathological changes in ED patients during the COVID-19 lockdown varied by cultural context and individual variation in age and ED diagnosis. Clinical services may need to target preventive measures and adapt therapeutic approaches for the most vulnerable patients.

Impact of COVID-19 lockdown measures on a cohort of eating disorders patients.

BACKGROUND: Lockdown implemented to prevent the COVID-19 spread resulted in marked changes in the lifestyle. The objective of the current study was to assess the impact of lockdown measures on a cohort of eating disorder (ED) patients being followed as part of an ongoing naturalistic treatment study. METHODS: Ninety-nine patients aged 18 or older, currently or previously, in treatment at a Portuguese specialized hospital unit were contacted by phone and invited to participate in the current survey. Fifty-nine agreed to be interviewed by phone, and 43 agreed to respond to a set of self-report measures of ED symptoms, emotion regulation difficulties, clinical impairment, negative urgency, and COVID-19 impact, during the week after the end of the lockdown period. RESULTS: Data showed that of the 26 patients currently in treatment: 8 remained unchanged (31%), 7 deteriorated (27%), and 11 reliably improved (42%). Of the 17 participants not currently in treatment: 3 deteriorated (18%), 9 remained unchanged (53%), and 5 (29%) improved after the lockdown period. The Coronavirus Impact Scale showed that most patients considered their routines moderately or extremely impacted, experienced stress related to coronavirus, and showed difficulty in maintaining physical exercise and feeding routines. Results suggest that higher impact of COVID-19 lockdown was significantly correlated with eating disorder symptoms and associated psychopathology, impulsivity, difficulties in emotion regulation and clinical impairment measured at post-lockdown. In addition, the impact of COVID-19 and lockdown measures on clinical impairment was mediated by difficulties in emotion regulation. CONCLUSIONS: Findings suggest that some ED patients may experience worsening of their condition, especially if associated with difficulties in emotion regulation, and these difficulties might be exacerbated in the context of a stressful crisis and lockdown measures, highlighting the need for intervention strategies to mitigate its negative impact.

The Portuguese version of the body investment scale: psychometric properties and relationships with disordered eating and emotion dysregulation.

BACKGROUND: This study aimed to examine the psychometric properties of the Portuguese version of the Body Investment Scale (BIS) in a nonclinical sample of students and a clinical sample of outpatients with eating disorders, to analyse the differences in the BIS factors between the samples and to explore the relationships among body investment, eating disorder symptoms and difficulties in emotion regulation. METHODS: The clinical (n = 93) and nonclinical (n = 448) samples completed self-report measures. RESULTS: In contrast to the nonclinical sample, confirmatory factor analysis showed an acceptable fit for the original four-factor solution of the BIS in the clinical sample. This scale also demonstrated adequate internal consistency in both samples. Significant differences in BIS factors were found between the samples; outpatients with eating disorders presented more negative feelings about the body, less comfort with touch and lower levels of body protection than those of the students. In the clinical sample, significant relationships were found between these factors and a higher severity of disordered eating, as well as between these factors and higher difficulties in emotion regulation. CONCLUSIONS: The Portuguese version of the BIS is a psychometrically sound measure for the assessment of body investment, and it is especially appropriate in a clinical setting of outpatients with eating disorders.

Eating Disorder Examination - Questionnaire short forms: A comparison.

OBJECTIVE: The Eating Disorder Examination - Questionnaire (EDE-Q) is a widely used self-report measure of eating-disordered behaviors and attitudes. Recent studies utilizing confirmatory factor analyses (CFA) have proposed alternative and shorter forms. The aim of this study was to compare the full-length version of the EDE-Q and several proposed short forms (7-item, 8-item, and 18-item) in terms of their psychometric properties, including concurrent, convergent and discriminant validity, factor structure, and sensitivity to change. METHODS: Participants from two eating-disorder clinical samples (N = 175 and 38) and from a nonclinical sample (N = 3,413) completed a battery of measures, including the Portuguese version of the EDE-Q. Analyses compared psychometric properties of the available short forms of the EDE-Q among each other. RESULTS: All forms of the EDE-Q showed good internal consistency values, correlated highly among each other (r > .90) and with different measures of eating psychopathology (r > .80). All EDE-Q forms were able to distinguish between cases and controls with moderate-to-high accuracy and were sensitive to change. CFA failed to support the proposed factor structure for all the EDE-Q forms, except for the 7-item form. DISCUSSION: The present study provides empirical background for choosing between different forms of the EDE-Q. Findings indicate that for nonclinical and for clinical research, including studies of treatment change and outcome, the short forms of the EDE-Q can be used. A shorter version is a viable alternative when less time-consuming alternatives are needed, such to quickly screen for eating-disorder psychopathology or to perform session-by-session treatment monitoring.

Validation of the Portuguese version of the Clinical Impairment Assessment (CIA) in eating disorders' patients.

PURPOSE: The purpose of the study was to assess the psychometric properties of the Portuguese version of the Clinical Impairment Assessment (CIA) in eating disorders (ED) patients. METHOD: The CIA is a 16-item brief self-reported instrument developed to assess psychosocial impairment secondary to EDs. The CIA was administered to a clinical sample of 237 women with EDs and a college sample of 196 women. The clinical sample completed the Eating Disorders Examination Questionnaire, the Beck Depression Inventory and the Outcome-45 Questionnaire. Reliability, confirmatory factor analysis, validity, and clinically significant change were calculated. RESULTS: Confirmatory factor analysis validated the original 3-factor structure showing an adequate model fit. CIA showed good psychometric properties with high internal consistency, good convergent validity with the EDE-Q, the OQ-45, and the BDI. For divergent validity, participants CIA scores in the clinical sample were significantly higher than in the non-clinical sample. ROC curve analysis provided a cutoff of 15. For known-groups validity participants' scoring above CIA cutoff reported significantly higher CIA scores. In addition, non-underweight participants and participants reporting the presence of dysfunctional ED behaviors had significantly higher CIA scores. Finally, for clinically significant change, a reliable change index of 5 points was obtained to consider a reliable change in the CIA global score. CONCLUSIONS: Our findings support the validity and clinical utility of the CIA as a good self-report measure to be used in both clinical and research settings. LEVEL OF EVIDENCE: Level V. Cross-sectional descriptive study.

Psychometric properties of the Portuguese version of the Invalidating Childhood Environment Scale.

PURPOSE: The current study aimed to examine the psychometric properties of the Portuguese version of the invalidating childhood environment scale (ICES) in a non-clinical and clinical sample of eating disorder (ED) patients. This study also investigated the between-sample differences regarding invalidating parental behaviors and family styles and explored the associations between invalidating childhood environments and eating pathology. METHODS: A sample of 410 high school and college students and 101 patients with a diagnosis of ED completed self-report measures. Principal component analyses and confirmatory factor analyses were conducted to examine the factor structure of the ICES. The internal consistency and the between-sample differences and associations between invalidating childhood environments and eating pathology were also tested. RESULTS: Principal component analyses and confirmatory factor analyses indicated a two-factor solution for each parent. The ICES demonstrated high internal consistency and was able to differentiate between non-clinical and clinical samples. The perception of parental invalidation was higher in ED patients, and the clinical sample presented higher scores in the chaotic and perfect family styles and lower scores in the validating family style, in comparison with the non-clinical sample. Both maternal invalidation and invalidating styles were significantly associated with a higher ED symptomatology. CONCLUSIONS: The Portuguese version of the ICES revealed adequate psychometric properties. Considering the relationship between invalidation in family and eating pathology, the ICES may be useful in clinical practice, especially among ED patients. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Examining the distinctiveness of body image concerns in patients with anorexia nervosa and bulimia nervosa.

OBJECTIVE: This study examined the distinctiveness of specific constructs of body-image disturbance in patients with anorexia nervosa (AN) and bulimia nervosa (BN). We compared weight/shape dissatisfaction, weight/shape overvaluation, weight/shape preoccupation, and fear of weight gain in patients with AN and BN and examined how each specific body-image construct relates to clinical measures within and between AN and BN. METHOD: A clinical sample of 490 treatment-seeking patients diagnosed with DSM-5 AN (N = 310) or BN (N = 180) by clinicians using structured interviews in Portugal completed the Eating Disorder Examination-Questionnaire to assess body image and eating-disorder (ED) psychopathology. RESULTS: Both within and between AN and BN, the four body-image constructs varied in their strengths of association among themselves, with ED psychopathology, and body mass index (BMI). Analyses revealed considerable variability in variance accounted for in clinical measures by body-image constructs. Body-image constructs predicted significant, albeit small, variance in BMI within BN (dissatisfaction, preoccupation significant) but not within AN. Body-image constructs predicted significant, albeit small, variance in the frequencies of binge eating and purging in AN (with preoccupation significant for both and fear for purging) but not within BN. Body-image constructs predicted significant variance in ED psychopathology (large amounts of variance for Eating Concern and Restraint) within both AN and BN (with overvaluation, preoccupation, and fear significant). CONCLUSION: Clinical manifestations of body-image disturbances are complex and show important differences across AN and BN. Understanding distinctions and differential salience of different body-image constructs across different EDs can inform refinement of specific case conceptualization.

Treatment delivery strategies for eating disorders.

PURPOSE OF REVIEW: The traditional model of treatment delivery, based on a psychotherapeutic intervention delivered by a trained professional, in a one-to-one relationship, occurring in a treatment setting context (e.g., clinic, private office, and hospital), highly restricts access to the best standards of care to all of those in need.In this article, we will be focusing on treatment delivering methods for eating disorders that depart from the traditional mode of delivery. We will focus on the use of self-help strategies, both in a pure self-help format, and with external minimal support, guided self-help. We will additionally review the evidence on the use of internet and mobile technology (m-Health) for delivering treatment. RECENT FINDINGS: Internet-based self-help interventions based on cognitive behavioral approaches have shown to be superior to no treatment for patients diagnosed with bulimia nervosa, binge eating disorder, and other specified feeding or eating disorders with binge/purge characteristics. Although face-to-face, traditional, interventions seem to be more effective than internet-based ones, the latter might have cost benefits and constitute a viable first line of treatment in a stepped care model, or as an alternative to a waitlist while treatment is not available. Other forms of mobile health (e.g., mobile apps) have experienced a surge but remain under researched. SUMMARY: Mobile health and the internet are promising media for delivering eating disorder treatment. However, more research is needed to determine the utility of internet-based treatments by comparing them to traditional face-to-face treatments for eating disorders, and explore the moderators and mediators impacting adherence and outcome.

Eating Disorder-15 (ED-15): Factor structure, psychometric properties, and clinical validation.

OBJECTIVE: The purpose of the current study was to explore the factor structure and psychometric properties of the Portuguese version of the Eating Disorder-15 (ED-15), as well as to establish cutoff scores and normative data for the Portuguese version. METHODS: Participants from a nonclinical sample (N = 860) and an eating disorders clinical sample (N = 260) were invited to complete a set of questionnaires, including the Portuguese version of the ED-15. RESULTS: The first-order two-factor structure originally proposed by the ED-15 authors was endorsed through a confirmatory factor analysis (χ2 /df = 2.610; standardized root-mean-square residual = 0.0325; root-mean-square error of approximation = 0.079; Tucker-Lewis index/goodness-of-fit index/incremental fit index > 0.95). Items revealed adequate construct validity (λ = .54-.90; R2  = .29-.81). The ED-15 revealed excellent internal consistency (α = .91) and temporal stability (intraclass correlation coefficient = .92; 95% CI [.84-.95]). Normative data for the ED-15 were provided. The ED-15 demonstrated acceptable concurrent and convergent validity. Receiver operating characteristic analysis revealed that the ED-15 total score accurately discriminates between participants with and without an eating disorder (area under de curve = .80; SE = .017; p ≤ .001; 95% CI [.766-.834]). A cutoff score for clinical significance and a reliable change index were computed. CONCLUSIONS: The Portuguese version of the ED-15 is a reliable and valid measure of eating psychopathology and symptoms, whenever a brief measure is needed, as in session-by-session assessment of therapy progress and outcome.

Weight loss trajectories and psychobehavioral predictors of outcome of primary and reoperative bariatric surgery: a 2-year longitudinal study.

BACKGROUND: Long-term behavioral and psychological aspects associated with weight outcomes after reoperative bariatric surgery have rarely been investigated. OBJECTIVES: This study sought (1) to identify differences in weight loss trajectories during the first 24 months in reoperative bariatric surgery (R group) and primary bariatric surgery (P group) and (2) to investigate pre- and postsurgery psychobehavioral predictors of weight loss and weight regain for both groups. SETTING: Hospital center and university, Portugal. METHODS: This longitudinal study compared an R group (n = 157) and a P group (n = 216). Patients were assessed at presurgery and at 6, 12, 18, and 24 months postsurgery. Assessment included the Eating Disorder Examination-Questionnaire and Repetitive Eating Questionnaire diagnostic interviews and a set of self-report measures assessing eating disorder symptomatology, grazing, depression, anxiety, and impulsive behavior. RESULTS: The P and R groups presented a similar trajectory for the percentage of total weight loss (%TWL) (ß = 1.46, standard error = 1.96; Wald χ2 = .55, P = .457) and weight regain (ß = 1.66, standard error = 2.72; Wald χ2 = .24, P = .622). No significant presurgery predictors of weight loss and weight regain were found for the P and R groups. Regarding postsurgery predictors, higher Eating Disorder Examination-Questionnaire scores (Wald χ2(1) = 6.88, P = .009) and grazing behavior (Wald χ2(1) = 8.30, P = .004) were associated with less %TWL for both groups. Belonging to the P group emerged as a significant predictor of more weight loss (Wald χ2(1) = 7.25, P = .007). Postsurgery anxiety predicted less %TWL in R group (Wald χ2(1) = 3.89, P = .043). Considering weight regain, higher postoperative disordered eating (global Eating Disorder Examination-Questionnaire; Wald χ2(1) = 4.66, P = .031) was associated with increased weight regain for the P and R groups. CONCLUSIONS: Problematic eating behaviors and psychological distress are significant predictors of poor weight outcomes for both groups.