Enfacement illusions: Filling a knowledge gap in eating disorder risk assessment, prevention, and intervention?

Body image disturbance (BID) is central to eating disorders (EDs), yet the role of self-face perception has received limited empirical attention despite rising sociocultural pressures emphasizing facial appearance through technologies such as social media. Emerging evidence suggests impairments in self-face recognition accuracy and distorted perceptions of facial appearance among individuals with EDs. Enfacement illusions, involving the experimental induction of perceived ownership over another's face, offer a novel paradigm to comprehensively investigate the perceptual multisensory integration processes underlying self-face perception disturbances in ED populations. Such an approach may hold promise for elucidating core pathological mechanisms contributing to BID and ED psychopathology. We discuss how rigorous investigation of self-face perception through the enfacement illusion paradigm represents an innovative direction of research and/or clinical application that may advance etiological models of EDs and possibly inform interventions targeting the potentially multidimensional nature of body and facial image disturbances characterizing EDs. PUBLIC SIGNIFICANCE STATEMENT: Body image disturbance is central to eating disorders (EDs), yet, the role of face-related disturbances remains critically under-investigated. After summarizing findings on face-related disturbances in EDs we propose how enfacement illusions (i.e., the experimental induction of ownership over another's face) may elucidate self-face perception disturbances in EDs, and their underlying mechanisms. Enfacement illusions may also offer an intervention to potentially address multifaceted face and body image disturbances characterizing EDs.

A new network analysis model in anorexia nervosa patients based on self-reported eating disorder symptoms, psychological distress, and cognitive flexibility.

OBJECTIVES: Cognitive flexibility and psychological distress, such as depression and anxiety, have been implicated in the aetiology of Anorexia Nervosa (AN). Despite the known associations between eating disorder (ED) symptoms, depression, anxiety, and cognitive flexibility, the specific pathways that connect these constructs are unclear. We therefore used network analysis to examine the relationship between these symptoms in an AN sample. METHODS: One hundred and ninety-three treatment-seeking individuals diagnosed with AN (95.6% female, M = 26.89 [SD = 9.45] years old) completed self-report measures assessing depression, anxiety, cognitive flexibility, and ED symptoms. To determine each symptom's influence in the network, we calculated the expected influence. RESULTS: The two relationships with the greatest edges were those between (1) weight/shape concerns and eating/dietary restraint and (2) weight/shape concerns and psychological distress (a measure that combined depression and anxiety). Cognitive flexibility was not connected to weight/shape concerns but had negative partial associations with eating concerns/dietary restraint and psychological distress. There was also a slight, non-zero connection between eating concerns/dietary restraint and psychological distress. CONCLUSIONS: The findings underscore the importance of weight/shape, eating/dietary concerns, and psychological distress in the AN network and suggest that addressing cognitive flexibility may be a useful target for eating concerns/dietary restraint and psychological distress. Future studies assessing the longitudinal course of psychopathology within the AN network structure may help in identifying whether specific symptoms function as risk factors or maintaining factors for this co-occurrence.

Effects of videoconferencing use on momentary changes in disordered eating urges, body dissatisfaction, and mood.

The coronavirus disease 2019 (COVID-19) pandemic led to a global surge in videoconferencing use for work/study-related reasons. Although these platforms heighten exposure to one's image, the implications of videoconferencing use on body image and eating concerns remain scantly examined. This study sought to investigate, in an Australian sample, whether videoconferencing for work/study-related reasons predicted increases in body dissatisfaction (BD), urge to engage in disordered eating (DE; restrictive eating, exercise, overeating/purging), and negative mood at the state level. Participants (N = 482, 78.8% women, Mage  = 20.5 years [SD = 5.3]) completed baseline demographic measures, accompanied by an ecological momentary assessment (EMA) of videoconferencing for work/study-related reasons, BD, DE urges, and negative mood six times a day for 7 days via a smartphone application. Most participants (n = 429; 89.0%) reported state-based videoconferencing use during the EMA phase. Consistent with expectations, state-based videoconferencing use was associated with an increase in state-level urges to engage in exercise. However, contrary to predictions, state-based videoconferencing use was linked to a decrease in state-level BD at the next assessment point and failed to predict negative mood and urges to engage in restrictive eating or overeating/purging at the state level. Given the simplified measure of videoconferencing use, the current research is considered preliminary and future replication and extension, using more nuanced measures, is warranted.

Striving to support the supporters: A mixed methods evaluation of the strive support groups for caregivers of individuals with an eating disorder.

This mixed-methods study evaluated a peer-led support group for ED caregivers; the Eating Disorders Families Australia strive support groups. Quantitatively, 110 past or current strive attendees completed an online survey assessing their own and their care recipients' demographic profiles, strive's impact on caregiving experiences, and caregivers' psychological distress, burden, caregiving skills and self-efficacy. Qualitative assessment comprised open-ended survey questions about caregivers' strive experiences, reinforced by in-depth focus group assessment of nine participants. Quantitative analyses revealed that participants felt more confident and supported, and less isolated in their caregiving since attending strive. Caregivers displayed mid-range psychological distress and caregiver burden, and moderate caregiver skills and self-efficacy. Qualitatively, the most helpful aspects of strive were the shared experience among participants, education, and support. The most difficult elements were emotional distress and overly dominant members. Reflections discussed the necessity of caregiver support and factors impacting strive attendance. Participants recommended resuming face-to-face contact and differentiating groups based on participant characteristics (e.g. care recipients' age/stage of illness). The current findings provide support for the importance and overall positive contribution of support groups led by caregivers, such as strive.

Validating and developing a shortened version of the detail and flexibility (DFlex) questionnaire for eating disorders, anxiety and depression.

OBJECTIVE: To validate the original and a shortened version of the Detail and Flexibility (DFlex) Questionnaire. METHOD: Confirmatory factor analyses, internal consistency, and discriminant validity estimates were conducted within individuals with a diagnosis of an eating disorder (ED) (n = 124), an anxiety disorder and/or depression (n = 219), and a community sample (n = 852) (Part 1). Convergent validity of the DFlex through comparisons with the Autism Spectrum Quotient, Wisconsin Card Sorting Task, and Group Embedded Figures Task was undertaken within a combined ED and community sample (N = 68). Test-retest reliability of the DFlex was also examined across 2 years in a community sample (N = 85) (Part 2). RESULTS: The original factor structure of the DFlex was not supported. Hence, a shortened version, the DFlex-Revised, was developed. Good discriminant validity was obtained for the DFlex and DFlex-Revised, however, support for convergent validity was mixed. Finally, the 2-year test-retest reliability for the two DFlex versions was found to be low, suggesting potential malleability in construct over this timeframe. CONCLUSIONS: Further research is needed to validate the DFlex in clinical and non-clinical populations using different neurocognitive tests. Test-retest, using varied time intervals, should also be assessed.

Psychiatric comorbidity and severity in anorexia nervosa: a comparative study of the DSM-5, the ICD-11, and overvaluation of Weight/Shape severity ratings.

This study assessed the rate of a.) the total and b.) specific psychiatric comorbidities among the three severity ratings for Anorexia Nervosa (AN): DSM-5, ICD-11 and overvaluation of weight and shape (OWS). The sample comprised 312 treatment-seeking patients with AN (mean age = 26.9). Weight and height were taken at intake to calculate BMI, the foundation for the DSM-5 and ICD-11 severity indices. The EDE-Q was used to assess OWS, and the Mini International Neuropsychiatric Interview was conducted to assess psychiatric comorbidities. For the DSM-5, the mild severity group showed a higher total number of psychiatric comorbidities, especially for panic, social anxiety, generalised anxiety, and post-traumatic stress disorders compared to the severe and extremely severe groups. ICD-11 and OWS severity groups did not significantly differ in total comorbidities, except for major depressive disorder and obsessive-compulsive disorders being more prevalent in the "significantly low BMI" ICD-11 group. The high OWS group displayed a notably higher rate of major depressive disorder than the low OWS group. The study underscores inconsistent patterns across the three severity systems, emphasising the need to recognise the current limitations of the assessed severity classification systems in AN assessment and guiding treatment.

How to assess eating disorder severity in males?The DSM-5 severity index versus severity based on drive for thinness.

Using a male eating disorder (ED) sample, this study assessed the clinical utility of the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) severity indices for males with anorexia nervosa (AN) and bulimia nervosa (BN) and compared it to an alternative transdiagnostic severity categorisation based on drive for thinness (DT). The participants included 143 males with an ED (60 [42.0%] AN and 83 [58.0%] BN) diagnosis, who were classified using these two severity classifications. The different severity categories were then compared based on ED symptoms, general psychopathology, and personality traits. Our results revealed that the DSM-5 "mild" and DT "low" severity categories were most prevalent in the AN and BN male patients. Clinically significant findings were strongest for the DT categorisation for both AN and BN. The current findings provide initial support for an alternative transdiagnostic DT severity classification for males that may be more clinically meaningful than the DSM-5 severity indices.

"Can you see me?" Videoconferencing and eating disorder risk during COVID-19: Anxiety, impairment, and mediators.

OBJECTIVE: The use of videoconferencing has increased during the pandemic, creating prolonged exposure to self-image. This research aimed to investigate whether eating disorder (ED) risk was associated with videoconferencing performance for work or study and to explore whether the use of safety behaviors and self-focused attention mediated the relationship between ED risk and perceived control over performance anxiety, impaired engagement, or avoidance of videoconferencing for work or study. METHOD: In 2020, an online survey was distributed within Australia to those aged over 18 years via academic and social networks, measuring: use of videoconferencing for work/study, demographics, ED risk, safety behaviors for appearance concerns, self-focused attention, perceived control over performance anxiety, perceived engagement impairment, and avoidance of videoconferencing. A total of 640 participants (77.3% female, Mage  = 26.2 years) returned complete data and were included in analyses. RESULTS: 245 participants (38.7%) were considered at-risk for EDs (SCOFF > 2). Those at-risk reported significantly more safety behaviors, self-focused attention, impaired engagement, and avoidance, plus lower perceived control over performance anxiety than those not at-risk. Multiple mediation models found the effects of ED risk on control over performance anxiety, impaired engagement, and avoidance were partially mediated by safety behaviors and self-focused attention. DISCUSSION: Our cross-sectional findings suggest videoconferencing for work/study-related purposes is associated with performance anxiety, impaired engagement, and avoidance among individuals at-risk for EDs. Poorer videoconferencing outcomes appear more strongly related to social anxiety variables than ED status. Clinicians and educators may need to provide extra support for those using videoconferencing. PUBLIC SIGNIFICANCE: Because videoconferencing often involves seeing your own image (via self-view) we wondered whether the appearance concerns experienced by those with eating disorders (EDs) might interfere with the ability to focus on or to contribute to work/study videoconferencing meetings. We found that although those with EDs experience more impairments in their videoconferencing engagement/contribution, these were linked just as strongly to social anxiety as they were to appearance concerns.

Posttraumatic Stress and Alexithymia: Symptom Associations.

ABSTRACT: There is a demonstrated association between alexithymia and posttraumatic stress disorder (PTSD). However, work has largely focused on male-dominant, high-risk occupation populations. We aimed to explore the relationship between posttraumatic stress (PTS) and alexithymia among 100 trauma-exposed female university students. Participants completed a Life Events Checklist, the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (PCL-5), and the Toronto Alexithymia Scale (TAS-20). Multiple regressions were run to examine whether alexithymia was associated with each of the PCL-5 subscales. The TAS-20 total scores were associated with total PTS scores, ß = 0.47, t(99) = 5.22, p < 0.001. On a subscale level, Difficulty in Identifying Feelings (DIF) was positively associated (ß = 0.50 to 0.41) with all PCL-5 subscales except for Avoidance. Our results align with research showing that for women, the DIF subscale is most strongly associated with PTS, in contrast with the literature on male samples, showing strongest associations with the Difficulties in Describing Feelings subscale, suggesting sex differences in associations between PTS and alexithymia. Our study supports the universality of the associations between alexithymia and PTS.

Tonight, I'm disordered eating: The effects of food delivery app use, loneliness, and mood on daily body dissatisfaction and disordered eating urges.

With the recent proliferation of food delivery applications ('apps'; FDAs), accessing a meal is more convenient and immediate than ever. However, these apps may foster dysregulated eating behaviours, including maladaptive eating to cope with negative emotional states. Using ecological momentary assessment (EMA), the current study assessed whether FDA use at baseline predicted levels of EMA-assessed disordered eating urges and body dissatisfaction, whether negative mood and loneliness impacted disordered eating urges and body dissatisfaction at the state level, and whether the latter relationships were moderated by FDA usage frequency. Participants (N = 483; 78.7% women; 20.1% men; 1.2% other) completed a baseline questionnaire and were characterised as current FDA users (49.3%) or non-users (50.7%). Participants then completed a smartphone-facilitated investigation into their experiences of loneliness, negative mood, body dissatisfaction, and disordered eating urges, six times per day for 7-days. Across the entire sample, current FDA users at baseline reported greater EMA-assessed urges to overeat. At the state level, loneliness and negative mood predicted greater body dissatisfaction, with the latter also predicting greater urges for restrictive eating and overeating. Among current FDA users at baseline, at the state level, loneliness predicted greater body dissatisfaction, and negative mood predicted greater body dissatisfaction and urges for overeating. No moderating effects were observed for baseline FDA usage frequency. These results elucidate FDA use and daily experiences of loneliness and negative mood as factors elevating eating disorder (ED)-related risk. Further extensions of this research with nuanced measures of state FDA use are required.

Assessing severity in anorexia nervosa: Do the DSM-5 and an alternative severity rating based on overvaluation of weight and shape severity differ in psychological and biological correlates?

OBJECTIVE: This study evaluated the severity ratings for anorexia nervosa (AN) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and an alternative severity rating based on overvaluation of weight/shape, on a range of psychological and biological variables. METHOD: A sample of 312 treatment-seeking patients with AN (mean age = 25.3, SD = 7.6; mean BMI = 16.8 kg/m2 , SD = 2.4) were categorised using both DSM-5 severity levels (mild/moderate/severe/extreme) and weight/shape (low/high) overvaluation. The severity categories were compared on a range of psychological (e.g., eating psychopathology) and biological (e.g., sodium) variables. RESULTS: Results showed that the overvaluation of weight/shape appeared better at indexing the level of severity in psychological variables among patients with AN compared to the DSM-5 severity rating with moderate to large effect sizes. Moreover, the DSM-5 mild and moderate severity groups experienced significantly higher eating and general psychopathology than the severe and extreme groups. Finally, neither the DSM-5 nor the weight/shape severity groups differed on any of the biological variables. CONCLUSIONS: This study provided no support for the DSM-5 severity rating for AN, while initial support was found for the weight/shape overvaluation approach in indexing psychological but not biological correlates.

Zoomers: videoconferencing, appearance concerns, and potential effects on adolescents.

PURPOSE OF REVIEW: The cessation of in-person teaching to reduce the spread of COVID-19 dramatically increased the use of videoconferencing for home learning among adolescents. RECENT FINDINGS: A consistent finding across studies assessing the relationship between videoconferencing and appearance concerns was that time spent focused on self-view was related to greater appearance concerns. Videoconferencing was associated with an increase in desire for cosmetic surgery and other nonsurgical treatments. Among those at risk of eating disorders, videoconferencing was associated with more appearance-management behaviours and less engagement in the video call. Research to date has been correlational and predominantly involved White, adult women in the USA and in Australia, leaving important gaps in our knowledge, especially around impacts on adolescents. SUMMARY: Given their vulnerability to appearance concerns, we encourage practitioners to speak to adolescents about their use of videoconferencing and how they can migitate the potential negative impacts on body image.

Where does purging disorder lie on the symptomatologic and personality continuum when compared to other eating disorder subtypes? Implications for the DSM.

OBJECTIVES: To assess the clinical significance and distinctiveness of purging disorder (PD) from other eating disorder (ED) diagnoses. METHOD: Participants included 3127 women consecutively admitted to an ED treatment centre (246 PD, 465 anorexia nervosa restrictive [AN-R], 327 AN-binge purging [AN-BP], 1436 bulimia nervosa [BN], 360 binge eating disorder [BED], 177 atypical AN and 116 unspecified feeding or eating disorder [UFED]) who were diagnosed according to DSM-5 criteria. Additionally, 822 control participants were recruited from the community. All participants completed measures assessing ED symptoms (EDI-2), general psychopathology (SCL-90-R) and personality (TCI-R). RESULTS: Patients with PD, when compared to controls, scored significantly higher on the EDI-2 and SCL-90-R, and most TCI-R dimensions. Most of the significant differences between PD and the other ED diagnoses emerged between PD and AN-R, followed by Atypical-AN, UFED, AN-BP and BED, with patients with PD typically reporting higher scores on the EDI-2 and SCL-90-R subscales. Significant differences between PD and BN were also present, but to a lesser extent. The findings for personality varied amongst the different ED diagnoses. CONCLUSIONS: PD is a clinically significant disorder, which seems to be more similar to BN than it is to AN and the other ED subtypes.

Bridging of childhood obsessive-compulsive personality disorder traits and adult eating disorder symptoms: A network analysis approach.

OBJECTIVES: Obsessive-compulsive personality disorder (OCDP) traits are commonly associated with eating disorders (EDs), with evidence demonstrating that these traits predispose and exacerbate the ED illness course. However, limited research has examined the symptomatic interplay between ED and OCDP traits. We used network analysis to (1) identify the most central symptoms in a network comprised of OCPD traits retrospectively assessed in childhood and ED symptoms and (2) to identify symptoms which bridged OCPD traits and ED symptoms. METHODS: Participants were 320 females with an ED (anorexia nervosa n = 227, bulimia nervosa n = 93), who completed the semi-structured EATATE interview and the Eating Disorder Inventory-2. Expected influence (EI) was computed to determine each symptom's influence in the network. Bridge symptoms were identified by computing bridge EI. RESULTS: A regularised partial correlation network showed that ascetism, social insecurity, ineffectiveness, and impulsivity had the highest EI in the OCPD and ED network. With respect to bridging symptoms, interpersonal distrust emerged as a possible bridging node between the OCPD and ED trait/symptom clusters. DISCUSSION: These findings highlight the centrality of non-specific ED symptoms in the ED symptom network and suggest that interpersonal distrust may play a functional role through which childhood OCPD traits and ED symptoms are connected.

Ramadan intermittent fasting induced poorer training practices during the COVID-19 lockdown: A global cross-sectional study with 5529 athletes from 110 countries.

Ramadan intermittent fasting during the COVID-19 lockdown (RIFL) may present unique demands. We investigated training practices (i.e., training load and training times) of athletes, using pre-defined survey criteria/questions, during the 'first' COVID-19 lockdown, comparing RIFL to lockdown-alone (LD) in Muslim athletes. Specifically, a within-subject, survey-based study saw athletes (n = 5,529; from 110 countries/territories) training practices (comparing RIFL to LD) explored by comparative variables of: sex; age; continent; athlete classification (e.g., world-class); sport classification (e.g., endurance); athlete status (e.g., professional); and level of training knowledge and beliefs/attitudes (ranked as: good/moderate/poor). During RIFL (compared to LD), athlete perceptions (ranges presented given variety of comparative variables) of their training load decreased (46-62%), were maintained (31-48%) or increased (2-13%). Decreases (≥ 5%, p < 0.05) affected more athletes aged 30-39 years than those 18-29 years (60 vs 55%); more national than international athletes (59 vs 51%); more team sports than precision sports (59 vs 46%); more North American than European athletes (62 vs 53%); more semi-professional than professional athletes (60 vs 54%); more athletes who rated their beliefs/attitudes 'good' compared to 'poor' and 'moderate' (61 vs 54 and 53%, respectively); and more athletes with 'moderate' than 'poor' knowledge (58 vs 53%). During RIFL, athletes had different strategies for training times, with 13-29% training twice a day (i.e., afternoon and night), 12-26% at night only, and 18-36% in the afternoon only, with ranges depending on the comparative variables. Training loads and activities were altered negatively during RIFL compared to LD. It would be prudent for decision-makers responsible for RIFL athletes to develop programs to support athletes during such challenges.

Drive for thinness provides an alternative, more meaningful, severity indicator than the DSM-5 severity indices for eating disorders.

OBJECTIVE: To assess an alternative trans-diagnostic indicator for severity based on drive for thinness (DT) for anorexia nervosa (AN), bulimia nervosa (BN), binge-eating disorder (BED), and other specified feeding or eating disorder (OSFED), and to compare this new approach to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) severity categories for EDs. METHOD: A total of 2,811 ED [428 AN-restrictive (AN-R), 313 AN-binge purging (AN-BP), 1,340 BN, 329 BED, 154 OSFED/atypical AN (AT), and 223 OSFED/purging disorder (PD)] patients were classified using: (a) The DSM-5 severity categories and (b) a DT categorisation. These severity classifications were then compared based on ED symptoms, general psychopathology, personality, and impulsive behaviours. RESULTS: For the DSM-5 categories, most ED patients fell into the 'mild' to 'moderate' categories. Using the DT categories, AN patients were mainly represented in the 'low' DT category, and BN, OSFED/AT, and PD in the 'high' DT category. The clinically significant findings were stronger for the DT than the DSM-5 severity approach (medium-to-large effect sizes). AN-BP and AN-R provided the most pronounced effects. CONCLUSION: Our findings question the clinical value of the DSM-5 severity categorisation, and provide initial support for an alternative DT severity approach for AN. HIGHLIGHTS : This study assessed an alternative trans-diagnostic drive for thinness (DT) severity. Category for all eating disorder (ED) sub-types, and then compared this to the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) severity indices for EDs. ED symptoms, general psychopathology, personality, and impulsive behaviours were assessed using both classifications in a total of 2,811 female patients diagnosed with EDs. Clinically significant findings were stronger for the DT than the DSM-5 severity category (medium-to-large effect sizes); there was differentiation of the anorexia nervosa (AN) patients into mainly 'low' DT, and bulimia nervosa (BN) spectrum patients into mainly 'high' DT, vs. most patients were clustered in the 'mild-to-moderate' DSM-5 categories. Our findings provide initial support for an alternative trans-diagnostic DT severity category that may be more clinically meaningful than the DSM-5 severity indices for EDs.

Do orthorexia and intolerance of uncertainty mediate the relationship between autism spectrum traits and disordered eating symptoms?

PURPOSE: Autism spectrum disorder traits have been implicated in the psychopathology of eating disorders and may also be relevant for the development of orthorexia symptoms. Further, intolerance of uncertainty (IUS) may indirectly contribute to the development of disordered eating, as the displacement of anxiety onto food may help achieve a sense of control and maximise certainty. We examined a new cognitive model of eating pathology which assessed the role of IU and orthorexia symptoms as potential mediators of the relationship between autistic traits and disordered eating in a community sample. METHODS: Three-hundred-and-ninety-six female participants (M = 20.07, SD = 4.52 years old) completed an online self-report questionnaire which assessed the variables of interest. RESULTS: Despite finding significant bivariate correlations, our model results showed that autistic traits did not directly predict disordered eating or orthorexia symptoms. Significant indirect relationships were found between autistic traits and eating disorder symptoms through both IU and orthorexia symptoms. CONCLUSION: The findings provide partial support for our proposed model suggesting that autistic traits may increase the vulnerability for disordered eating, not directly, but through their associations with mechanisms such as IU and the development of problematic eating behaviours typical of orthorexia. Future research should focus on whether targeting IU may assist in preventing the development of disordered eating. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

A network analysis of borderline personality disorder symptoms and disordered eating.

OBJECTIVE: The current study used network analysis to explore associations between specific groupings of borderline personality disorder (BPD) and eating disorder (ED) symptoms, and other transdiagnostic variables including insecure attachment, rejection sensitivity, emotion dysregulation, a theory of mind, and emotion recognition. METHOD: Network analysis was undertaken on self-report data from 753 adults (81.5% women), of whom 109 reported a lifetime ED diagnosis. RESULTS: Comorbidity between BPD and ED symptoms was only partially conceptualized through the transdiagnostic variables. The centrality indices from the network analysis indicated that emotion dysregulation and abandonment were the most central elements in the network. Conversely, the theory of mind and emotion recognition had very few connections with the other transdiagnostic variables in the network. DISCUSSION: The findings provide empirical insight into the nature of the observed co-occurrence between BPD and ED symptoms and serve to improve clinical decision-making regarding psychological interventions for both problem sets.

The cognitive-interpersonal model of disordered eating: A test of the mediating role of alexithymia.

OBJECTIVE: The cognitive-interpersonal model proposes that high levels of attention to detail and cognitive rigidity confer risk for the development of eating disorders (EDs) and that socioemotional deficits, such as alexithymia, contribute to their maintenance. However, no studies have examined the direct and indirect relationships of these constructs. We investigated the mediating role of specific alexithymia traits (difficulties describing feelings, difficulties identifying feelings, and externally oriented thinking) on the relationship between attention to detail, cognitive rigidity, and ED symptoms while controlling for anxiety and depression symptoms. METHOD: Four hundred and one nonclinical female participants (M = 20.57, SD = 4.99 years old) completed self-report measures assessing the variables of interest. RESULTS: Path analyses revealed that difficulties identifying feelings was the only significant mediator between attention to detail and cognitive rigidity to ED symptoms. However, these mediation effects became nonsignificant after controlling for anxiety and depression. CONCLUSIONS: Difficulties identifying feelings may in part underlie the relationship between attention to detail and cognitive rigidity and ED symptoms, providing support for the cognitive-interpersonal model. However, these relationships are heavily influenced by anxiety and depression symptoms. Enhancing individual's ability to identify emotional states may help to decrease ED symptoms for individuals who report high levels of attention to detail and cognitive rigidity.

A cluster analysis of purging disorder: Validation analyses with eating disorder symptoms, general psychopathology and personality.

OBJECTIVES: To assess the natural grouping of Purging Disorder (PD) patients based on purging symptomatology and to evaluate the derived classes (a) against each other and (b) to a control group on a range of clinical and psychological measures. METHOD: Participants included 223 PD women consecutively admitted to a tertiary ED treatment centre and 822 controls. Purging behaviours (self-induced vomiting, laxative and diuretic use) were used as indicators, while the EDI-2 (ED symptoms), the SCL-90-R (general psychopathology), and the TCI-R (personality traits) were used as validators. RESULTS: Three distinct PD clusters emerged: Cluster 1 (only self-induced vomiting), Cluster 2 (self-induced vomiting and laxative use) and Cluster 3 (all purging methods). Significant differences between Cluster 1 and Cluster 3 were found for the EDI-2 drive for thinness and perfectionism subscales, and the TCI-persistence scale. All clusters differed significantly from the controls on all the EDI-2 and the SCL-90-R scales, but findings for the TCI-R scales were less consistent. CONCLUSIONS: This study adds to a growing literature on the validity and distinctiveness of PD and provides evidence of dimensional symptom differences amongst PD clusters.