Cognitive Flexibility and Emotion Regulation in Eating Disorder Patients with Comorbid Generalized Anxiety and Posttraumatic Stress Symptoms.

Research has found that difficulties in emotion regulation negatively impact mental health, whereas cognitive flexibility may promote stress resilience and positive mental health. Little is known about cognitive flexibility and emotion regulation in people with comorbid eating disorder (ED) and anxiety and stress disorders. A transdiagnostic ED population (N=227) at an outpatient ED treatment facility completed several self-report instruments that measured cognitive flexibility, emotion regulation difficulties, posttraumatic stress disorder (PTSD) symptoms, and generalized anxiety disorder (GAD) symptoms upon admission. We investigated cognitive flexibility and emotion regulation differences for those with an ED without comorbidity and those with various combinations of comorbidity. In a one-way between-groups ANOVA, we investigated differences in cognitive flexibility for those with GAD, PTSD, neither, and both comorbidities. We found a statistically significant difference between these groups, with mean cognitive flexibility inventory scores being the lowest in the group with both comorbidities. However, when controlling for emotion regulation, a one-way between-groups ANCOVA indicated no significant differences in cognitive flexibility between comorbidity groups F(3,222)=1.20,p=.31 Partial η2=.02. Though self-reported cognitive flexibility levels differ among ED patients with and without comorbidities, it appears that these differences are better explained by emotion regulation. Therefore, addressing emotion regulation early in treatment for all individuals with EDs, regardless of comorbidity. Further research is needed to understand the impact of treating emotion regulation on ED treatment engagement, dropout, and effectiveness.

Does Terminology Matter When Measuring Stigmatizing Attitudes About Weight? Validation of a Modified Attitudes Toward Obese Persons Scale.

Commonly used medical terms like "obesity" and "overweight" have been identified as stigmatizing. Thus, this study sought to revise a commonly used measure of weight stigmatizing attitudes, the Attitudes Toward Obese Persons (ATOP) scale. We compared the original terminology in the ATOP (e.g., "obese")to a Modified version using neutral terms (e.g., "higher weight"). We randomized participants (N = 599) to either receive the original or Modified ATOP and compared their scores. There was no significant difference between the scores of participants who received the original ATOP and the Modified ATOP, t(597) = -2.46, p = .550. Through principal component analysis, we found the Modified ATOP is best used as a 13-item unidimensional measure. Findings suggest a Modified version of the ATOP with neutral language is suitable for assessing negative attitudes about higher-weight people without sacrificing psychometric properties. Further examination of the terminology used in weight stigma measures is needed to determine how to best assess weight stigma without reinforcing stigmatizing attitudes. The findings of the present study suggest that the use of neutral terms in measures of anti-fat bias is a promising solution that warrants further investigation.

Skepticism of and critical thinking about media messages: Conflicting relationships with body dissatisfaction.

Despite the theoretical connection between media literacy and body dissatisfaction, empirical findings about their relationship are decidedly mixed. There is not a clear explanation for these discrepancies. The present study aimed to 1) compare the attitudes young adult women with those of a reference group of adolescents to examine whether similar values were observed despite differences in age group and racial/ethnic identity, 2) to examine the relationships between media literacy and body dissatisfaction using recommended measures of media literacy. Racially diverse female undergraduate students (N = 152, Mage = 21.62) completed the Media Attitudes Questionnaire, the Critical Thinking about Media Measure, and the Body Shape Questionnaire online. Young adult women endorsed greater critical thinking about media messages and greater skepticism towards the similarity of media messages than adolescents. Additionally, greater skepticism towards the desirability and realism of media messages was associated with lower body dissatisfaction while greater critical thinking about media messages was found to be positively related to greater body dissatisfaction. It is possible that greater critical thinking within the context of media literacy cannot occur without increased attention towards or time spent thinking about media messages. Findings suggest that enhancing critical thinking about the media may not be the main mechanism of change for effective media literacy interventions. These findings underscore the complexities that exist within the relationships between media literacy and body dissatisfaction and highlight the continued need for research in this area.

Differences among feminist and non-feminist women on weight bias internalization, body image, and disordered eating.

BACKGROUND: Research yields mixed results on whether feminist beliefs or self-identification are protective against body image disturbance and eating pathology in non-clinical populations. Further, no studies have examined feminism among those with diagnosed eating disorders. Additionally, previous studies have not examined the relationship between feminist identity and weight stigma. This study investigated these relationships and if there are differences in body image, eating pathology, and weight stigma among feminist identity types in women with eating disorders and college women using ANCOVAs. METHODS: Participants completed self-report measures and were women with eating disorders (N = 100) and college women (N = 240). RESULTS: Sixty-four percent of the women with eating disorders and 75.8% of the college women identified as a feminist. An independent samples t-test found a significantly higher weight bias internalization in the clinical eating disorder sample than in the college women sample. No significant interactions were found between sample type and feminist identity for body image or weight bias internalization. Results were consistent when using a dichotomous feminist identity item and a seven-item continuous feminist identity item. CONCLUSIONS: Despite the clear impacts of the intersection of weight status and gender, results from this study suggest that identifying as a feminist is not sufficient to combate weight stigma. Findings highlight the need for further research investigating weight bias internalization within eating disorder prevention efforts and interventions.

Internalized Stigma as a Transdiagnostic Factor for Women with Eating Disorders.

This study aimed to examine how internalized weight bias (IWB), body surveillance, and body shame relate to eating pathology in women with diagnosed eating disorders (EDs) across the weight spectrum. Previous research has examined these variables in primarily non-clinical populations, binge eating disorder, and higher weight populations. In a sample of 98 women with diagnosed EDs, the association of IWB, body surveillance, and body shame on the severity of ED symptoms was examined with hierarchical multiple regression analyses. Results indicate that IWB, body surveillance, and body shame significantly predicted global eating pathology, F (4, 93) = 40.74, p < .001. IWB, body surveillance, and body shame related to global eating pathology, even after controlling for previous weight bias experiences. Analyses with specific symptom clusters found that only body surveillance predicted dietary restraint, only IWB and body shame predicted overvaluation of shape/weight, and only IWB predicted body dissatisfaction. The findings in this study provide initial support for internalized stigma variables (IWB, body surveillance, and body shame) related to ED pathology in a transdiagnostic clinical eating disorder sample across the weight spectrum. Results suggest that further examination of internalized stigma is needed within ED treatment.

Adaptive depends on context: An examination of the Intuitive Eating Scale-2 in an eating disorder sample.

Though there is a robust literature base linking intuitive eating (IE) to better psychological health and reduced eating pathology, little is known about the psychometric properties of IES-2 measurement or how IE relates to eating psychopathology within eating disorder clinical samples. Importantly, some seemingly adaptive eating behaviors in non-clinical populations could conceivably result from disordered eating within clinical eating disorder populations (e.g., not eating when not hungry because of distorted hunger-fullness cues, furthering restriction). This study examined the factor structure, psychometric properties, and correlates of the Intuitive Eating Scale-2 (IES-2) in a transdiagnostic eating disorder sample (N = 224). Participants at an eating disorder specialty treatment center completed the IES-2 upon assessment, along with other symptomology measures. A confirmatory factor analysis was performed, finding a poor model fit in this transdiagnostic sample, CFI = 0.889, TLI = 0.869, RMSEA = 0.095, TLI = 0.869, and SRMR = 0.099. Through exploratory factor analysis, we identified a factor solution for the measure that can be used transdiagnostically in this population, with revised scoring and modifications. As expected, the IES-2 demonstrated construct validity, with higher IE being associated with lower eating pathology (r = -0.36, p < .01), lower clinical impairment (r = -0.26, p < .01), lower body image dissatisfaction (r = -0.39, p < .05), and lower depressive symptoms (r = -0.20, p < .01), supporting construct validity. As anticipated, IES-2 was not related to emotion regulation, supporting discriminant validity. This study suggests that the IES-2 does not perform as expected in a transdiagnostic clinical eating disorder population, and instead, a revised scored 21-item IES-2 is suggested, with interpretation of only the total score and two subscales.

Inconsistent Reporting of Adverse Life Events Is Predicted by Current Internalizing Distress Among Military Service Members.

INTRODUCTION: Accurate measurement of adverse life events is critical for understanding the effects of stressors on health outcomes. However, much of this research uses cross-sectional designs and self-report years after the events take place. The reliability of this retrospective reporting and the individual difference factors associated with inconsistent recall over time are not frequently addressed, especially among military service members. MATERIALS AND METHODS: A longitudinal cohort of National Guard service members (n = 801) completed the Deployment Risk and Resilience Inventory-2 Prior Stressors scale and several measures of general well-being, including anxious depressive symptomatology, personal functioning, perceived social support, and overall health at two time points (before and after completion of basic combat training; median 11-month interval). RESULTS: Consistency in reporting the life event items ranged from 69.5% to 99.7%, with an overall Cohen's kappa coefficient of 0.215 for the scale, indicating minimal agreement. Lower well-being scores at Time 1 independently predicted yes-to-no changes in responding, whereas lower well-being scores at Time 2 independently predicted no-to-yes changes in responding. Follow-up mediations were conducted using study measures available only at Time 2. For all study measures, Time 2 well-being independently predicted changes from no-to-yes responding by way of indirect effects through self-reported non-specific internalizing distress and arousal. CONCLUSIONS: These findings highlight the confounding effects of fluctuations in current emotional distress on past stressor recall. There is a need for additional caution regarding the use of retrospective self-report of adverse life events in research and clinical practice and greater consideration of current psychological distress at the time of measurement completion.

Psychological and eating disorder symptoms as predictors of starting eating disorder treatment.

OBJECTIVE: Little is known about the treatment uptake rate for adults diagnosed with an eating disorder through formal assessment. This study aimed to identify psychological and eating disorder symptoms that predict whether individuals with diagnosed eating disorders start treatment after receiving a diagnostic assessment and recommendation to begin treatment. Identifying barriers to starting treatment can inform interventions to improve the uptake of treatment. METHOD: After a diagnostic assessment at an eating disorder specialty clinic, 223 adults were recommended to begin treatment and completed self-report measures of psychological functioning, clinical impairment, and eating psychopathology. Patient attendance was assessed to determine rates and predictors of starting treatment within 3 months of the assessment. RESULTS: Of the 223 patients recommended to begin treatment, approximately two-third started treatment within 3 months of the assessment. Logistic regression identified greater avoidance of eating, greater laxative use frequency, more social eating concerns, and lower weight dissatisfaction as predicting lower likelihood of beginning treatment after assessment. A chi-square test for independence found no significant differences between diagnostic groups on starting treatment. DISCUSSION: Findings identify eating disorder symptoms that predict treatment enrollment after diagnostic assessment and recommendation to begin treatment. Assessing for these symptoms at the diagnostic assessment stage is recommended to address potential treatment barriers. Future research should identify strategies that increase treatment uptake at this stage of the process.

Predictors of Weight Restoration in a Day-Treatment Program that Supports Family-Based Treatment for Adolescents with Anorexia Nervosa.

Family-Based Treatment (FBT) is considered a first-line treatment for adolescents with eating disorders. The traditional outpatient model of FBT may not, however, be appropriate for adolescents requiring more intensive treatment due to severe medical complications or insufficient progress in traditional outpatient FBT. In response, efforts have been made to incorporate FBT into higher levels of care, such as day-treatment programs (DTPs), for families who need additional support. Little is known about the factors that predict weight restoration for DTPs intended to support FBT. The current study examined the ability of specific adolescent and caregiver variables to predict weight restoration at discharge for adolescents with anorexia nervosa (AN) enrolled in a skills-based DTP that supports FBT. Participants were 87 adolescents diagnosed with AN and their caregivers (N = 74). Body Mass Index (BMI) at baseline, percentage of Expected Body Weight (%EBW) gain within the first 4 weeks, and caregiver empowerment level at baseline were found to significantly predict weight restoration. Higher BMI at baseline and higher %EBW gained in the first 4 weeks of treatment were predictive of weight restoration, whereas lower caregiver empowerment at baseline was predictive of weight restoration. Additionally, the rate of weight gain is reported for this DTP grounded in FBT philosophy.

Factor structure of the Personal Growth Initiative Scale-II: Evidence of a bifactor model.

Personal growth initiative has been shown to be an important predictor of psychological health. It is currently measured by the Personal Growth Initiative Scale-II (PGIS-II), which consists of 4 interrelated factors. Past research across various samples has consistently selected the 4-factor model as the best fit for the data compared to single-factor and second-order models. However, its fit has typically been adequate (not strong), and, to date, no research has examined alternate factor structures, such as a bifactor solution. The current study examined 4 theoretically informed potential models-single-factor, 4-factor, second-order 4 factor, and bifactor-across 3 samples drawn from different populations: 223 college students, 307 Mechanical Turk participants, and 281 clinical therapy clients. Across all 3 samples, the bifactor model was the best fit for the data, and tests of multigroup invariance indicated this model was invariant through the scalar level. Finally, analyses of the explained common variance and percentage of uncontaminated correlations indicated that the PGIS-II can be appropriately modeled unidimensionally. (PsycINFO Database Record