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.

The Metacognitions about Binge Eating Questionnaire: Investigation of the association between specific metacognitions and Binge Eating Disorder.

Literature suggested that metacognitions are involved in eating problems and may be relevant to the understanding of Binge Eating Disorder (BED). The goal of the current studies was to develop the first self-report instrument on metacognitions about binge eating. In Study 1, a community sample completed the Metacognitions about Binge Eating Questionnaire (MBEQ); an Exploratory Factor Analysis (EFA) was performed. In study 2, a community sample completed the MBEQ and measures assessing severity of binge eating, irrational food beliefs, anxiety, depression, impulsiveness. A Confirmatory Factor Analysis (CFA) was performed. Concurrent and incremental validity were assessed. In study 3, a clinical sample of participants with a diagnosis of BED completed the MBEQ and other measures. Bivariate correlational analysis and hierarchical linear regression were performed. Participants from the general population and participants with a diagnosis of BED were compared. EFA and CFA supported a two-factor solution consisting of positive and negative metacognitions about binge eating. Concurrent and incremental validity were acceptable. The metacognitions factors correlated positively with anxiety, depression, irrational food beliefs, impulsiveness in the community sample, and anxiety, irrational food beliefs, impulsiveness in clinical sample. The metacognitions factors contributed to the prediction of BEDs symptoms, in community and clinical samples, over and above age, gender, impulsiveness, anxiety, depression, irrational food beliefs. The MBEQ possesses good psychometric properties and appears a reliable and valid measure of positive and negative metacognitions about binge eating. Metacognitions about binge eating could be a therapeutic target to reduce the severity of binge eating episodes.

The relationship between alexithymia and maladaptive perfectionism in eating disorders: a mediation moderation analysis methodology.

OBJECTIVE: This work aimed to explore the relationship between alexithymia and maladaptive perfectionism in the psychological process leading to eating disorders (ED). METHOD: Forty-nine individuals with ED and 49 controls completed the Concern over Mistakes subscale of the Frost Multidimensional Perfectionism Scale, the Perfectionism subscale of the Eating Disorders Inventory, the total score of the Toronto Alexithymia Scale, and the Drive for Thinness, Bulimia, and Body Dissatisfaction subscales of the Eating Disorders Inventory. We tested a model in which alexythimia is the independent variable and perfectionism is the possible mediator or moderator. RESULTS: Analyses confirmed the assumed model. In addition, it emerged that perfectionism played a mediating or moderating role when measured by different instruments. This result suggested that different instruments measured subtly different aspects of the same construct. DISCUSSION: Results could suggest that alexithymia is a predisposing factor for perfectionism, which in turn may lead to the development of eating disorders.

Perfectionism as a mediator between perceived criticism and eating disorders.

OBJECTIVE: In this work we aimed to test the hypothesis that perfectionism plays a third variable role in the psychological process leading from perceived criticism to eating disorders (ED). METHOD: Forty-nine individuals with ED and 49 controls completed the Concern over Mistakes subscale of the Multidimensional Perfectionism Scale, the Perceived Criticism Inventory, and the Drive for Thinness, Bulimia, and Body Dissatisfaction subscales of the Eating Disorders Inventory. Mediational and moderational models were tested. RESULTS: Analyses revealed that perfectionism mediates between perceived criticism and drive for thinness. Results for bulimia and body dissatisfaction were controversial. Moderational models were rejected. DISCUSSION: Results suggest that restrictive dieting is related to a process in which perceived criticism is the initial factor and perfectionism is an intervening mediator.

Neural correlates of worry in generalized anxiety disorder and in normal controls: a functional MRI study.

BACKGROUND: Worry is considered a key feature of generalized anxiety disorder (GAD), whose neural correlates are poorly understood. It is not known whether the brain regions involved in pathological worry are similar to those involved in worry-like mental activity in normal subjects or whether brain areas associated with worry are the same for different triggers such as verbal stimuli or faces. This study was designed to clarify these issues. METHOD: Eight subjects with GAD and 12 normal controls underwent functional magnetic resonance imaging (fMRI) mood induction paradigms based on spoken sentences or faces. Sentences were either neutral or designed to induce worry. Faces conveyed a sad or a neutral mood and subjects were instructed to empathize with those moods. RESULTS: We found that the anterior cingulate and dorsal medial prefrontal cortex [Brodmann area (BA) 32/23 and BA 10/11] were associated with worry triggered by sentences in both subjects with GAD and normal controls. However, GAD subjects showed a persistent activation of these areas even during resting state scans that followed the worrying phase, activation that correlated with scores on the Penn State Worry Questionnaire (PSWQ). This region was activated during the empathy experiment for sad faces. CONCLUSIONS: The results show that worry in normal subjects and in subjects with GAD is based on activation of the medial prefrontal and anterior cingulate regions, known to be involved in mentalization and introspective thinking. A dysregulation of the activity of this region and its circuitry may underpin the inability of GAD patients to stop worrying.

Eyes are bigger than the stomach: correlation between body mass index, satiety, and prediction of satiety.

We investigated if among adult subjects there is any correlation between body mass index (BMI), evaluation of current satiety after a standard meal and predicted satiety hypothesizing to have a second helping of the same food. One hundred and twenty-eight adult subjects randomly recruited during a village festival were included into the study; 20 were underweight, 74 normal weight and 34 overweight. Just after eating a highly caloric bean-soup, they were requested to evaluate current satiety and to predict their satiety before having a second helping of the same food they had just eaten to find out if there was any correlation between BMI and the evaluations. There was a significant negative correlation between participants' BMI and predicted satiety, no correlation was found between BMI and current satiety. The outcomes of the study give suggestions for prevention and treatment of overweight patients.

The influence of stress on the relationship between cognitive variables and measures of eating disorders (in healthy female university students): a quasi-experimental study.

OBJECTIVE: Perfectionism, poor self-esteem and stress have all been described as important risk factors for eating disorders. The purpose of this study was to assess whether a stressful situation is significantly correlated to and associated with significantly higher levels of perfectionism, stress, quantifiable measures of eating disorders, and with significantly lower levels of self-esteem in a non-clinical sample. METHOD: Thirty-five female university students completed the Multidimensional Perfectionism Scale, the Rosenberg Self-Esteem Scale, the Perceived Stress Scale, and the Eating Disorder Inventory two times; once on an average university day and once on the day of an exam. Descriptive statistics and t-tests were calculated to verify whether a stressful situation was associated with a significant difference in levels of perfectionism, self-esteem, stress, and measures of eating disorders. Bivariate correlations were calculated for both the stress and non-stress situation, to observe how the dimensions of perfectionism, self-esteem, and stress were associated with measures of eating disorders. RESULTS: During the stress situation, the study participants had, on average, significantly higher levels of concern over mistakes, body dissatisfaction, drive for thinness, and perceived stress. Bivariate correlations revealed that during the stress situation perceived stress, cognitive variables and measures of eating disorders showed significant correlations with each other that were absent in the non stress situation. DISCUSSION: The results of the present study suggest that the dimensions of pathological perfectionism, low self-esteem, and perceived stress are related to an increase in dieting thoughts and dissatisfaction with body aspect in non-clinical women during a performance that could potentially challenge the perception of their self-esteem. The stressful situation can be interpreted as an experience of invalidation, which could explain the connection between cognitive constructs and behaviours related to eating disorders.

Psychopathology and treatment of night eating syndrome: a review.

The article reviews the international literature about psychopathological aspects and treatments of Night Eating Syndrome (NES). Studies were found using Medline; data from recent international books and conferences about ED are included, but single case descriptions are not included in the study. NES seems to be consistently related to mood disorders and anxiety. There is a low overlap between other eating disorders, including binge eating disorder (BED), and NES. The relationship between the syndrome and substance abuse is unclear and needs further study. Sleep architecture seems not to be severely altered among those with NES. A limited number of treatment studies for NES have been published or presented. Most of the literature focuses on pharmacological treatment, with fewer psychotherapeutic approaches reported at this time. Larger, multi-site treatment studies would serve to confirm the findings of this first wave of clinical trials.

Worry and eating disorders: a psychopathological association.

UNLABELLED: Worry is a mental process associated with anxiety disorders. The key feature of worry is the predominance of a negative-type and preoccupied thought about possible threatening future events. OBJECTIVE: Some studies have shown that worry may be a feature of eating disorders. This study aims to measure whether worry is significantly higher in eating disordered individuals than in a normal control group and whether worry is associated with the Eating Disorders Inventory. METHODS: Sixty-three individuals affected by an eating disorder (34 anorexics and 29 bulimics) completed the Penn State Worry Questionnaire, the Structured Clinical Interview for DSM, and the Eating Disorder Inventory. Thirty normal controls completed the Penn State Worry Questionnaire. RESULTS: Penn State Worry Questionnaire scores were significantly higher in eating disordered individuals than in controls. It was associated with all the symptoms of eating disorders and was correlated with all the EDI subscales, except for the subscale 'bulimia'. These findings suggest that worry is important for understanding the psychopathology of eating disorders.

A single blind comparison of amisulpride, fluoxetine and clomipramine in the treatment of restricting anorectics.

1. The study evaluated the efficacy of amisulpride, fluoxetine and clomipramine at the beginning of the re-feeding phase of the treatment of restricting anorexia nervosa according to DSM-IV criteria. 2. 13 patients, mean weight 37.61 kg +/- 9.80 SD, were treated with clomipramine at a mean dosage of 57.69 mg +/- 25.79 SD; 10 patients, mean weight 40.90 kg +/- 6.98 SD, were treated with fluoxetine at a mean dosage of 28.00 mg +/- 10.32 SD; 12 patients, mean weight 38.41 kg +/- 8.33 SD, were treated with amisulpride at a mean dosage of 50.00 mg +/- 0.00 SD. 3. Clinical evaluation was carried out under single-blind condition at basal time and after three months by a structured clinical interview, the Eating Disorder Interview based on Long Interval Follow-up Evaluation (LIFE II BEI). 4. Patients treated with amisulpride showed a more significant increase (p=0.016) of mean weight. Concerning weight phobia, body image disturbance and amenorrhoea, no significant difference resulted.

Stress plays a role in the association between cognitive constructs and measures of eating disorders in male subjects.

OBJECTIVE: Several theorists have hypothesized that stressful situations may trigger abnormal eating and even eating disorders in predisposed people. The purpose of this study was to assess whether a stressful situation would reveal an association between perfectionism and low self-esteem, and measures of eating disorder symptoms in male high school students. METHOD: A sample of 61 male high school students completed the Eating Disorder Inventory, the Multidimensional Perfectionism Scale, and the Self Liking and Competence Scale three times: on an average school day, on the day of an exam and on the day the subjects received the results of that exam. Linear regression analysis was carried out to verify whether the dimensions of perfectionism were associated with the measures of eating disorders. RESULTS: Interoceptive awareness was associated with 'Bulimia' only during the stressful situation and with 'Drive for thinness' both in stress and non stress situations. Other results were contradictory and difficult to interpret. DISCUSSION: The results suggest that in nonclinical male individuals stress might bring out a previously absent association between some psychological predisposing factors for eating disorders and an actual desire or plan for ED related thoughts and behaviours. Such a finding suggests that stress may stimulate behaviours related to eating disorders in a predisposed personality. A central role may be played by interoceptive awareness in male subjects.

Eating Attitudes Test and culture: a study in northern and southern Italy.

The EAT (Eating Attitudes Test) has been widely used to compare eating morbidity in cultural groups and variations in it have been taken as indicative of cultural differences. This study assumed the existence of cultural differences between the north and the south of Italy. The EAT scores of female students from a northern and a southern Italian high school were compared. They were both higher than in other European studies, though there were no significant differences between the two groups. The result could be due to sampling limitations, but could also indicate that the EAT is not a reliable yardstick of cultural differences.

Body dissatisfaction and its interrelations with other risk factors for bulimia nervosa in 12 countries.

BACKGROUND: It is widely accepted that risk factors for bulimia nervosa, mainly body dissatisfaction, are dependent on cultural factors. However, to date few studies have compared data from different cultures with an appropriate methodology. Therefore we aimed to gather reliable information on body dissatisfaction and other risk factors for bulimia from different nations and to reveal their functional interrelations. METHODS: A series of 10 silhouettes, designed to be as far as possible free from cultural and other detailed aspects, was shown to 1,751 medical and nursing students in 12 nations. A functional model was applied to each sample and tested by structural equation methodology. RESULTS: The most extreme body dissatisfaction was found in northern Mediterranean countries, followed by northern European countries. Countries currently undergoing a process of westernization show an intermediate amount of body dissatisfaction, and non-western countries demonstrate rather low values. Body dissatisfaction is the most important influence on dieting behaviour in most countries. CONCLUSIONS: Despite ongoing adoption of western values worldwide, we observe remarkable differences in body dissatisfaction between different cultures. That body dissatisfaction seems disturbingly partly detached from the actual BMI, i.e. possible overweight, as well as from feelings of low self-esteem in some western countries, raises new questions about the possible origin of the pressure to be thin.