Self-Injury During COVID-19: Views From University Students With Lived Experience.

ABSTRACT: Concerns have been raised about the impact of the COVID-19 pandemic on individuals with lived experience of nonsuicidal self-injury (NSSI). Yet, few efforts have explored this. Accordingly, using a mixed-methods approach, we sought to examine whether emerging adults who have self-injured experienced changes in NSSI urges and behavior during the pandemic and what may have accounted for these changes. To do so, university students with lived experience of NSSI completed online questions asking about NSSI and self-reported changes in urges and behavior since the onset of COVID-19. They then answered open-ended questions asking what contributed to these changes and how they have coped during this timeframe. Approximately 80% of participants reported no change or a decrease in NSSI urges and behavior. Participants discussed removal from stressors (e.g., social stress) that previously evoked NSSI, as well as having time for self-care and to develop resilience as accounting for this. Nevertheless, some participants reported challenges amid the pandemic (i.e., exacerbated stress, isolation); approximately one fifth of participants reported increases in NSSI urges and behavior. Our findings add to recent evidence that many individuals with prior mental health difficulties, including NSSI, can demonstrate resilience in the face of collective adversity. Research and clinician implications are discussed.

#recovery: Understanding recovery from the lens of recovery-focused blogs posted by individuals with lived experience.

OBJECTIVE: Definitions of eating disorder (ED) recovery have primarily focused on symptom management (i.e., weight regain, reduced/absent ED behaviors, and normalized ED thoughts). Notwithstanding the importance of these approaches, there are arguably additional considerations in ED recovery. In order to get a more comprehensive understanding of recovery, it is necessary to turn to individuals with lived experience. Here, we examine how individuals with lived experience of an ED conceptualize and define recovery in narrative, recovery-focused blogs and consider how this understanding may contribute to definitions of recovery in the field. METHOD: Inductive thematic analysis was used to examine 168 blogs posted by at least 120 unique authors (95% women; 36% reporting anorexia nervosa diagnosis) to 10 moderated, ED websites. RESULTS: Results from the thematic analysis yielded seven themes: recovery as (1) existing in contrast to the ED, (2) existing in a broader context, (3) subjective, (4) a choice, (5) a complex, nonlinear process, (6) transformative, and (7) overcoming. DISCUSSION: The present findings are consistent with previous qualitative research, suggesting that recovery is multifaceted and encompasses more than just symptom management. Notably, bloggers highlighted that recovery may not be equally attainable for all individuals, citing numerous social justice issues in the conceptualization of recovery. This multifaceted and intersectional view of recovery is consistent with consumer models of recovery. We argue that a dimensional model of recovery may be a good starting framework for researchers and clinicians to develop a more comprehensive definition of recovery.

Dialectical behavior therapy self-help for binge-eating disorder: A randomized controlled study.

OBJECTIVE: The objective of this study was to compare the relative effectiveness of dialectical behavior therapy guided self-help (DBT-GSH) and DBT unguided self-help (DBT-USH) with an unguided self-help control condition in the treatment of binge-eating disorder (BED). METHOD: Seventy-one participants who met diagnostic criteria for BED based on Eating Disorder Examination (EDE) interview were randomly assigned to DBT-GSH, DBT-USH or active control USH for 12 weeks. Assessments took place at baseline, 12 weeks and 3-month follow-up. Outcome measures included the EDE to assess binge frequency, the EDE-Questionnaire (EDE-Q), the Brief Symptom Inventory, and the Short Form 6D. RESULTS: The overall completion rate was 65% at post-treatment and 63% at 3-month follow-up. Intention to treat analyses showed that participants in all three conditions reported significant reductions in binge frequency with large effect sizes. A similar pattern emerged for secondary outcome variables including eating disorder psychopathology, general psychological distress, and health-related quality of life. DISCUSSION: Self-help may be an effective way to disseminate DBT for BED. However, future research should evaluate DBT self-help using a larger sample size, possibly in a multisite design.

Dialectical behavior therapy guided self-help for binge-eating disorder.

Binge-eating disorder (BED) is a prevalent and serious public health issue. BED is characterized by recurrent out-of-control binge eating episodes in the absence of extreme weight control behavior and is associated with significant psychosocial and physiological impairment. Dialectical Behavior Therapy (DBT), based on the affect regulation model of binge eating, is an evidence-based treatment (EBT) approach for BED. Unfortunately, access to EBTs is often limited due to geographical barriers (i.e., lack of local providers with specialized training in EBTs), lack of financial resources, and/or time constraints. Self-help approaches (via guided and unguided versions) to delivering DBT for BED offer a potentially effective means of more widely disseminating this treatment. Compared to traditional, higher intensity approaches, self-help DBT for BED is less time-consuming, less financially costly, and requires less need for specialized therapist-training. This paper will present how DBT for BED has been adapted for self-help delivery, review the limited but promising research on DBT self-help available to date, and provide directions for future research.

Understanding self-injury recovery: Views from individuals with lived experience.

OBJECTIVE: Nonsuicidal self-injury (NSSI) recovery has typically been conceptualized through the lens of formal frameworks or as the cessation of NSSI. These understandings, however, have been developed largely devoid of views from those with lived NSSI experience, who may offer novel and critical insights. To advance the conception of NSSI recovery, the current study elicited such views. METHODS: Two hundred and thirty-three emerging adults with a history of NSSI (77% female, mean age = 18.9 years), responded to open-ended questions regarding recovery. Results were thematically analyzed using an inductive approach. RESULTS: Responses yielded seven themes: (a) recovery is complete NSSI cessation; (b) recovery is more than cessation; (c) recovery involves lingering NSSI features; (d) recovery involves developing resilience; (e) recovery is a process; (f) evolution in understanding recovery; and (g) recovery is a subjective experience. CONCLUSION: Recovery seems to be multifarious, nonlinear, and subjective. Conceptual and clinical implications are discussed.

I weigh therefore I am: Implications of using different criteria to define overvaluation of weight and shape in binge-eating disorder.

OBJECTIVE: Research suggests that overvaluation of weight and shape is a clinical feature in binge-eating disorder (BED). However, this construct has been differentially defined in the literature even when using the same measure. Here we compare two cut-offs that have previously been used to differentiate clinical and subthreshold overvaluation using the EDE-Q. METHOD: Individuals with BED (n = 72, 93% female) and no history of an eating disorder (NED; n = 21, 91% female) completed measures of eating disorder (ED) and general psychopathology online. Individuals with BED were categorized as having clinical or subthreshold overvaluation using two different cut-offs used in previous studies. The clinical, subthreshold, and NED groups were compared on ED and general psychopathology. The association between overvaluation and psychopathology was also assessed in the BED and NED groups. RESULTS: The two cut-offs yielded identical results, with individuals in the clinical overvaluation group reporting greater ED psychopathology than those in the subthreshold and NED groups. When considered as a continuous variable, overvaluation was a significant predictor of both ED-related and general psychopathology. DISCUSSION: The two cut-offs yielded identical results, likely due to the high internal consistency between overvaluation items. Under such circumstances, the use of either cut-off seems appropriate. However, given the associations reported in the regression analyses, we propose that considering overvaluation as a dimensional variable, rather than a categorical one, may have greater utility.

An examination of the relationship between binge eating disorder and insomnia symptoms.

OBJECTIVE: Although studies on sleep difficulties in binge eating disorder (BED) have produced inconsistent findings, research has linked poor sleep to the presence of related concerns (e.g., obesity, anxiety, and depression). To clarify the relationship between BED and sleep problems, this study aimed to compare insomnia symptoms in individuals with BED and those with no history of an eating disorder (NED). METHOD: An adult community sample of individuals with BED (N = 68) and NED (N = 78) completed measures of insomnia, depression and anxiety, and eating disorder symptoms. RESULTS: Individuals with BED reported significantly greater insomnia symptoms than the NED group. The relationship between BED and insomnia symptoms was partially mediated by anxiety. Depression fully mediated the positive association between insomnia symptom severity and binge frequency in the BED group. DISCUSSION: These findings suggest that depression, anxiety, and sleep are important constructs to consider in BED development and presentation.

Testing predictions of the emotion regulation model of binge-eating disorder.

OBJECTIVE: The emotion regulation (ER) model of binge eating posits that individuals with binge-eating disorder (BED) experience more intense emotions and greater difficulties in ER than individuals without BED, leading them to binge eat as a means of regulating emotions. According to this model, individuals with BED should report greater difficulties in ER than their non-BED counterparts, the severity of these difficulties should be positively associated with BED symptoms, and this association should be stronger when individuals experience persistent negative emotions (i.e., depression). Studies examining these hypotheses, however, have been limited. METHOD: Data were collected from adults meeting the DSM 5 criteria for BED (n = 71; 93% female) and no history of an eating disorder (NED; n =  79; 83.5% female). Participants completed self-report measures of difficulties in ER, eating disorder (ED) psychopathology, and depression. RESULTS: Individuals with BED reported greater difficulties in ER compared to those with NED. Moreover, difficulties in ER predicted unique variance in binge frequency and ED psychopathology in BED. Depression moderated the association between ER difficulties and binge frequency such that emotion dysregulation and binge frequency were positively associated in those reporting high, but not low, depression levels. DISCUSSION: The association between difficulties in ER and ED pathology in BED suggests that treatments focusing on improving ER skills may be effective in treating this ED; however, the moderating effect of depression underscores the need for research on individual differences and treatment moderators. These findings suggest the importance of ER in understanding and treating BED.

More than an outcome: a person-centered, ecological framework for eating disorder recovery.

BACKGROUND: Eating disorder recovery is a complex phenomenon. While historical understandings focused on weight and behaviours, the importance of psychological factors is now widely recognized. It is also generally accepted that recovery is a non-linear process and is impacted by external factors. Recent research suggests a significant impact of systems of oppression, though these have not yet been named in models of recovery. BODY: In this paper, we propose a research-informed, person-centered, and ecological framework of recovery. We suggest that there are two foundational tenets of recovery which apply broadly across experiences: recovery is non-linear and ongoing and there is no one way to do recovery. In the context of these tenets, our framework considers individual changes in recovery as determined by and dependent on external/personal factors and broader systems of privilege. Recovery cannot be determined by looking solely at an individual's level of functioning; one must also consider the broader context of their life in which changes are being made. To conclude, we describe the applicability of the proposed framework and offer practical considerations for incorporating this framework in research, clinical, and advocacy settings.

Eating disorder recovery research suggests that this is a complicated phenomenon that is characterized by psychological changes and impacted by external factors. Here, we present a novel framework for thinking about recovery which considers outcomes as a non-linear process and which occur in the broader context of someone's life. Consistent with current views of recovery, we suggest that there is no one way to do recovery and that it is an ongoing journey. The framework also names that achieving certain recovery outcomes is dependent on (and should be considered in the context of) broader life experiences. This includes personal factors such as daily life experiences and other mental health challenges, as well as systems of oppression (e.g., White supremacy) which make recovery more attainable for some individuals. Importantly, we suggest that outcomes which have historically been included in recovery definitions (e.g., weight) may not be important to all individuals. Because of this, our framework is person-centered: individuals are able to determine what outcomes are important in their own recovery journey. We give some examples of how this framework may be useful in research, clinical, and advocacy settings.

Lived experience perspectives on a definition of eating disorder recovery in a sample of predominantly white women: a mixed method study.

BACKGROUND: There has recently been a push for recovery-focused research in the eating disorder (ED) field, starting with a consensus definition of recovery. One definition, in particular, proposed by Bardone-Cone et al. [21] has received considerable attention given its transdiagnostic nature and validation studies. However, no studies to date have elicited lived experience views of this definition. The goal of the current study was to examine perspectives on this definition of recovery from individuals with a past or present ED and to determine whether participant agreement with the model differed based on diagnostic history or current symptom severity. METHODS: Sixty-two individuals (95.2% women; 91.9% White/European) participated in a 1-2 h interview aimed at capturing their perspectives on ED recovery. Transcripts were analyzed using qualitative content analysis and codebook thematic analysis to examine agreement with and thoughts on Bardone-Cone's definition of recovery, respectively. Chi-squared tests of independence and binary logistic regression were computed to determine whether agreement with the definition differed across diagnostic history and self-reported symptoms. RESULTS: Although some participants indicated acceptance of the definition, the majority expressed concerns related to its categorical nature, proposed criteria, feasibility, language, and applications. There were no differences in acceptance based on diagnostic history or current symptom severity. CONCLUSION: A single definition of recovery does not seem to fit individuals' lived ED experience. Future research may benefit from distinguishing between recovery as an individually-defined phenomenon and related constructs such as remission (i.e., loss of diagnosis or absence of clinical symptoms). A more comprehensive multi-faceted, and person-centered model of recovery may have merit in clinical settings.

Conceptualizing eating disorder recovery research: Current perspectives and future research directions.

BACKGROUND: How we research eating disorder (ED) recovery impacts what we know (perceive as fact) about it. Traditionally, research has focused more on the "what" of recovery (e.g., establishing criteria for recovery, reaching consensus definitions) than the "how" of recovery research (e.g., type of methodologies, triangulation of perspectives). In this paper we aim to provide an overview of the ED field's current perspectives on recovery, discuss how our methodologies shape what is known about recovery, and suggest a broadening of our methodological "toolkits" in order to form a more complete picture of recovery. BODY: This paper examines commonly used methodologies in research, and explores how incorporating different perspectives can add to our understanding of the recovery process. To do this, we (1) provide an overview of commonly used methodologies (quantitative, qualitative), (2) consider their benefits and limitations, (3) explore newer approaches, including mixed-methods, creative methods (e.g., Photovoice, digital storytelling), and multi-methods (e.g., quantitative, qualitative, creative methods, psycho/physiological, behavioral, laboratory, online observations), and (4) suggest that broadening our methodological "toolkits" could spur more nuanced and specific insights about ED recoveries. We propose a potential future research model that would ideally have a multi-methods design, incorporate different perspectives (e.g., expanding recruitment of diverse participants, including supportive others, in study co-creation), and a longitudinal course (e.g., capturing cognitive and emotional recovery, which often comes after physical). In this way, we hope to move the field towards different, more comprehensive, perspectives on ED recovery. CONCLUSION: Our current perspectives on studying ED recovery leave critical gaps in our knowledge about the process. The traditional research methodologies impact our conceptualization of recovery definitions, and in turn limit our understanding of the phenomenon. We suggest that we expand our range of methodologies, perspectives, and timeframes in research, in order to form a more complete picture of what is possible in recovery; the multiple aspects of an individual's life that can improve, the greater number of people who can recover than previously believed, and the reaffirmation of hope that, even after decades, individuals can begin, and successfully continue, their ED recovery process.

How we research eating disorder (ED) recovery impacts what we know (perceive as fact) about it. In this paper we aim to provide an overview of the ED field's current perspectives on recovery, discuss how our methodologies shape what is known about recovery, and suggest a broadening of our methodological "toolkits" in order to form a more complete picture of recovery. To do this, we (1) provide an overview of commonly used methodologies (quantitative, qualitative), (2) consider their benefits and limitations, (3) explore newer approaches, including mixed-methods, creative methods (e.g., Photovoice, digital storytelling), and multi-methods (e.g., quantitative, qualitative, creative methods, psycho/physiological, behavioral, laboratory, online observations), and (4) propose a potential future research model with a multi-methods design, incorporating different perspectives (e.g., increasing recruitment of diverse participants, including supportive others in study co-creation), and a longitudinal course (e.g., capturing cognitive recovery, which often comes after physical). In this way, we seek to expand our picture of what is possible in recovery; the multiple aspects of an individual's life that can improve, the greater number of people who can recover than previously believed, and the reaffirmation of hope that, even after decades, individuals can begin and continue their ED recovery process.

Reconceptualizing Recovery: Integrating Lived Experience Perspectives Into Traditional Eating Disorder Recovery Frameworks.

Eating disorder recovery has long been conceptualized as comprising the domains of weight, behaviors, and thoughts. Criteria for these domains are generally absolute (e.g., no specified behaviors in a set time frame) and determined by researchers and/or clinicians. This Open Forum draws on the knowledge of experts with lived experience to situate their perspectives against existing models of eating disorder recovery. Definitions of eating disorder recovery could be improved by deemphasizing a single weight target in recovery and acknowledging the nonlinear nature of thoughts and behaviors. The authors provide examples of ways that clinicians and researchers can integrate these improvements into their practice.

Examining Adherence to Suicide Reporting Guidelines in Initial Reports on High-Profile Celebrity Suicides.

Background: Research has found varying adherence by media professionals to recommendations for reporting on suicide. Aims: We compared adherence to recommendations for what to do and what not to do when reporting on suicide in initial reports of high-profile celebrity suicides in major media outlets. Method: A total of 100 articles published in news outlets during 2004-2018 and reporting on celebrity suicides were examined for adherence to reporting guidelines using content analysis. Results: Articles frequently adhered to guidelines for what not to do when reporting on suicide (83%), but rarely adhered to guidelines for what to do (26%). Limitations: This study was a single cross-sectional analysis and may not generalize to different outlets, guidelines, or countries. Conclusion: While news articles frequently do not include harmful information, they also do not include potentially protective content.

Depression Partially Mediates the Association Between Binge Eating Disorder and Health-Related Quality of Life.

Research has found that individuals with binge eating disorder (BED) report significantly worse health-related quality of life (HRQL) than those without eating disorders. Studies indicate that the association between BED and HRQL is largely accounted for by psychopathology (e.g., depression), rather than physiology [e.g., increased body mass index (BMI)]. However, to our knowledge, no study has yet investigated whether mental health symptoms could potentially mediate the relationship between BED and HRQL. To this aim, the present study compared a sample of adults who met DSM-5 criteria for BED (n = 72) recruited from the community for a treatment trial and a community sample of individuals with no history of an eating disorder (NED; n = 79). Participants completed self-report measures of HRQL (Short-Form 6D), eating disorder psychopathology (Eating Disorder Examination Questionnaire), and anxiety and depressive symptoms (Brief Symptom Inventory). Consistent with previous findings, the BED group reported significantly worse HRQL than the NED group after controlling for age, BMI, anxiety, depression, and eating disorder psychopathology. Moreover, depression partially mediated the relationship between BED diagnosis and HRQL. These results suggest that lessened HRQL may be partly explained by comorbid symptoms of depression in BED. Clinicians may find it helpful to specifically assess and treat depression in BED as a means of enhancing patients' well-being. Future research should replicate these findings using longitudinal data that will allow for causal inferences.

An examination of emotion-related facets of impulsivity in binge eating disorder.

OBJECTIVE: While research suggests a positive association between negative urgency (NU) and binge eating, the association between positive urgency (PU) and binge eating has been less well studied. Moreover, few studies have examined NU and PU in binge eating disorder (BED). The present study examined Whiteside and Lynam's (2001) five facets of impulsivity (including NU and PU) in individuals with BED and a control group with no history of an eating disorder (NED). METHOD: Community samples of adults with BED (n = 72) and NED (n = 79) completed self-report measures of impulsivity, eating disorder (ED) psychopathology, and symptoms of depression and anxiety. RESULTS: The only facet of impulsivity that differed between the groups was NU, with the BED group reporting significantly higher scores on NU than the NED group. Although differences in PU initially emerged, these were no longer significant after controlling for NU. None of the impulsivity subscales predicted binge frequency, but four of the five subscales (NU, perseverance, premeditation, and PU) were significantly related to ED psychopathology. DISCUSSION: The present findings suggest that those with BED exhibit greater NU than those without BED and that this may play role in BED symptomatology. Furthermore, the association between various impulsivity factors and ED psychopathology suggests that additional research is needed to understand these relationships in BED.

Single injection of rapamycin blocks post-food restriction hyperphagia and body-weight regain in rats.

Given the increasing prevalence of and severity of complications associated with obesity, there is great need for treatments resulting in prolonged weight loss. Long-term maintenance of weight loss requires sustained changes in food-intake and energy-expenditure strategies, which are unfortunately often taxing, resulting in a return to predieting weight. Therefore, drug therapies may facilitate greater adherence to a restricted diet and prolong weight loss. One such drug is rapamycin (RAP), a mechanistic target of rapamycin (mTOR) inhibitor. Here, we show that a single injection of RAP dampens the hyperphagic response in calorically restricted rats when they are returned to free feed immediately or 10 days after injection. Moreover, we demonstrate that a single injection of RAP given to calorically restricted rats prevents body-weight regain when animals are returned to free feed either immediately or 10 days after injection. Furthermore, we extend our previous findings that RAP does not produce malaise or illness and show that RAP does not produce any behavioral deficits that may inhibit an animal from eating. Thus, we suggest that mTOR may be a useful target in obesity research, given that its inhibition may decrease the hyperphagic response following caloric restriction. (PsycINFO Database Record (c) 2019 APA, all rights reserved).