Group member attachment style interacts with actor and partner helping alliance to predict decreasing binge eating episodes.

OBJECTIVE: An individual's attachment style may impact how they interact with their therapy group. This study examined the moderating role of a group member's attachment on the dynamic relationships between that group member's (actor) and other group members' (partner) therapeutic alliances and symptom outcomes. Method: This is a secondary analysis of data from a trial testing the outcome of emotionally-focused group therapy for binge-eating disorder. The sample consisted of 2,360 sessions nested within 118 group members who attended a 20-session treatment. Patients recorded binge eating episodes (BEE), their body weight and an alliance measure session-by-session. RESULTS: Dynamic structural equation modelling showed decreases in BEE and weight over the therapy. When attachment style was not included in the model, higher-than-average partner's alliance scores in the previous session were related to decreases in BEE in the current session. Attachment style moderated these actor and partner effects. For patients with preoccupied attachments, higher-than-average actor alliance in the previous session was related to subsequent decreases in BEE. For patients with dismissing or disorganized attachments, higher partner alliance in the previous session was related to subsequent decreases in BEE. CONCLUSION: Group members' attachment characteristics can play a role in the development of alliance-outcome patterns in group therapy.

Patient and mentor language style matching as a predictor of working alliance, engagement with treatment as usual, and eating disorders symptoms over the course of an online guided self-help intervention for anorexia nervosa.

OBJECTIVE: The aim of this study was to examine the processes involved in a guided self-help (GSH) pre-treatment intervention (RecoveryMANTRA) for patients with anorexia nervosa (AN), by measuring the levels of patient/mentor Language Style Matching (LSM). RecoveryMANTRA was supported by student mentors or peer mentors (recovered individuals) over six weekly chat-based sessions. We examined whether LSM during RecoveryMANTRA predicted patients'working alliance with the clinic therapist, motivation, eating disorder (ED) and general psychopathology. A further aim was to examine differences in LSM between student mentors and peer mentors. METHOD: 87 AN adults received RecoveryMANTRA plus treatment as usual. The LSM algorithm was used to calculate verbal attunement between patient and mentor. Participants were assessed at baseline and at the end of the intervention. RESULTS: Both early (1st session) and late (6th session) LSM predicted higher working alliance with the clinic therapist. Moreover, late LSM predicted lower EDs symptoms at the end of the RecoveryMANTRA intervention. Patient/peer mentor dyads showed higher late verbal attunement than patient/student mentor dyads. CONCLUSIONS: These findings suggests that in the early phase of treatment relational aspects can impact on engagement with treatment. Verbal attunement in a GSH for AN is associated with working alliance and better clinical outcome.

Attachment anxiety, reflective functioning and well-being as predictors of burn-out and psychological distress among psychotherapists: A longitudinal study.

OBJECTIVE: This study aims to longitudinally investigate the effects of individual's factors on subsequent burn-out/psychological distress in a sample of mental health practitioners, testing if higher attachment anxiety and avoidance and lower reflective functioning (i.e., certainty and uncertainty of mental states) and well-being at baseline may lead to a greater psychological distress and burn-out 1 year later. METHODS: The sample consisted of 40 experienced psychotherapists (females: 72.5%; mean age: 47.40 ± 9.48 years) who completed a battery of questionnaires at baseline and 1 year later. Statistical analyses were conducted with Bayesian multiple linear regressions. RESULTS: Greater attachment anxiety and certainty about mental states and lower individual's well-being at baseline predicted greater burn-out 1 year later. Similarly, greater attachment anxiety and lower individual's well-being at baseline predicted psychological distress at 1 year follow-up. Of note, uncertainty of mental states and avoidant attachment were not associated with outcomes. CONCLUSION: These findings suggest that the levels of burn-out and psychological distress among psychotherapists may be alleviated with interventions targeting attachment insecurity, specific aspects of reflective functioning (i.e., certainty about mental states) and well-being.

The role of emotion regulation and intolerance to uncertainty on the relationship between fear of COVID-19 and distress.

The COVID-19 pandemic is increasing negative consequences on mental health around the globe. To date, research on what psychological factors could influence individuals' distress is still scarce. The current study aims to test a multiple mediation model to examine the role of Intolerance of Uncertainty (IU) and emotional regulation (i.e., expressive suppression and cognitive reappraisal) as joint factors, which can increase understanding of psychological distress due to the COVID-19 outbreak. An online survey measuring fear of COVID-19, IU, emotional regulation, and psychological distress was administered to 3863 Italian adults (females 73.3%; M age = 36.44; SD = 14.74) during lockdown. Results showed that IU partially mediated the effect of fear of COVID-19 on depression, anxiety and stress. Moreover, individuals with difficulties in managing the uncertainties due to their fear of COVID-19 may be at risk for heightened use of expressive suppression and depression. However, individuals with both higher IU and expressive suppression showed lower level of stress. High cognitive reappraisal has a mediational effect on the relationship between fear of COVID-19, IU, and lower psychological distress. Findings suggest that IU and emotional regulation should be targeted for informing the development of tailored treatments to reduce the negative consequences of the outbreak. Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-022-03071-5.

The relationship between working alliance with peer mentors and eating psychopathology in a digital 6-week guided self-help intervention for anorexia nervosa.

OBJECTIVE: The quality of working alliance (WA) is associated with treatment outcomes across several types of psychiatric disorders and psychological interventions. This study examined the role of WA with peer mentors (people with lived experience of illness) and student mentors (graduated psychology students) in a 6-week, digital, guided self-help (GSH) intervention for anorexia nervosa. METHOD: Ninety-nine patients rated weekly, for 6 weeks: (a) eating psychopathology using the short version of the Eating Disorder Examination Questionnaire (EDE-QS) and (b) WA with a student mentor (n = 14) or a peer mentor (n = 10). WA was assessed by asking patients the extent to which they felt comfortable working with their mentor and the extent to which they agreed with them on the goals for support. WA with mentors and the association with eating psychopathology change were measured on a session-by-session basis. The analysis involved a random intercepts cross-lagged panel model. RESULTS: WA with peer mentors was slightly higher than WA with students (ES = 0.3). Peer mentors' WA in the previous session was significantly associated with eating psychopathology ratings in the next session. No significant relationship was found between the previous session's EDE-QS scores and peer mentor alliance in the following session. In the student mentor group, there were no session-by-session associations between WA and eating psychopathology. However, greater WA with the student mentor across sessions was associated with less eating psychopathology. DISCUSSION: These findings suggest that clinical outcomes are in part associated with the characteristics of the mentor delivering guidance in an online GSH for eating disorders.

The impact of Facebook use on self-reported eating disorders during the COVID-19 lockdown.

BACKGROUND: The social isolation due to the COVID-19-related lockdown has had an impact on social media consumption around the world. This study examines the relationship between fear of COVID-19, Facebook use and disordered eating. METHODS: Structural Equation Modeling was used to analyse two-wave survey data (T0: Italian first lockdown; T1: after two months) during the pandemic. Young adults with self-reported dysfunctional eating behaviors (N = 115; 91.3% females; mean age = 28.60 ± 7.31) were recruited to complete an online survey at T0; 66 participants (92.4% females; mean age = 28.85 ± 7.85) completed the survey at T1. They were assessed on Facebook use, dysfunctional eating cognitions, and fear of COVID-19. RESULTS: Participants' disordered eating cognitions increased during the pandemic. At T0, higher fear of COVID-19 was positively associated to time spent on Facebook, which in turn predicted disordered eating cognitions at T1. Moreover, maladaptive Facebook use mediated the relationship between daily time on Facebook and Shape concerns. CONCLUSIONS: The findings of this study suggest an influence of dysfunctional Facebook use in increasing disordered eating cognitions during the pandemic.

Group as a social microcosm: The reciprocal relationship between intersession intimate behaviors and in-session intimate behaviors.

The social microcosm is defined as group members replicating their everyday (intersession) interpersonal behaviors in group sessions and new behaviors, learned in the group (in-session), replicating in the members' everyday life. We examined intersession and in-session intimate behaviors, at the within-member (differences in intimate behaviors between weeks/sessions), between-member (average differences in intimate behaviors between group members) and between-groups (group-level differences in intimate behaviors). Participants were 178 graduate students (86% identifying as women and 14% as men) participating in 10 5-session growth groups led by experienced group therapists. Before group sessions, group members completed the Interpersonal Relations Scale Checklist (IRScl; Shadish, 1984) indicating their number of intersession intimate behaviors for the previous week and, at the end of group sessions, they filled in the IRScl to indicate their in-session intimate behaviors. A 3-level HLM analysis (sessions, members, groups) predicting in-session intimate behaviors from previous week intersession intimate behaviors showed significant within-member, between-member, and between-groups effects. A second 3-level HLM analysis (sessions, members, groups), predicting following week intersession intimate behaviors from in-session intimate behaviors, showed significant between-member and between-groups effects. Between-member and within-member in-session intimate behaviors interacted to predict intersession intimate behaviors. Group members who generally had a low number of in-session intimate behaviors engaged in more intersession intimate behaviors in weeks following sessions with higher than average in-session intimate behaviors. These results provide support for the social microcosm proposition that members' trait-like everyday behaviors are replayed in the group. However state-like and other-member everyday behaviors also contribute to members' social microcosm. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The role of online social comparison as a protective factor for psychological wellbeing: A longitudinal study during the COVID-19 quarantine.

During the COVID-19 pandemic crisis, the experience of quarantine has been an undesirable condition for people and it can have a negative impact on mental health and psychological wellbeing. Social isolation has led to an increase in time spent on social network sites, with people interacting more frequently with each other, and comparing online the way in which they are experiencing the same state of home confinement. Our study aimed to investigate the role of online social comparison on individuals' psychological distress and life satisfaction during the COVID-19-related quarantine. Specifically, a cross-lagged panel study at three-waves was conducted in Italy in order to examine the change in psychosocial distress levels (e.g. depression, anxiety, stress, loneliness, low life-satisfaction) from before the quarantine for a period of one month, as well as the predictive role of online social comparison to ameliorate individual distress. An online survey was distributed through a social media platform three times after the initial lockdown and at the epidemic's peak two and five weeks later. A total of 113 participants participated in an online survey between the 7th of March and 14th of April 2020. The results showed an increase in the levels of loneliness, depression, stress, anxiety and a decrease in the level of life satisfaction in the pre/post quarantine comparison. Our cross-lagged results also showed that online social comparison at T1 and T2 predicted the individual's improvement in levels of anxiety, stress, loneliness and life satisfaction over time. Overall, the results of the current study underline the positive effects of online social comparison on the reduction of psychological distress during the COVID-19 quarantine.

Self-esteem and binge eating: Do patients with binge eating disorder endorse more negatively worded items of the Rosenberg Self-Esteem Scale?

OBJECTIVE: Self-esteem is a core aspect of eating disorder symptomatology. This study aims to examine whether method effects associated with negatively worded items of the Rosenberg Self-Esteem Scale (RSES) may interact the negative self-evaluations experienced by patients with obesity and binge eating disorder (BED). We also examined whether negatively worded items were associated with psychological distress and eating symptoms. METHOD: Five hundred thirty three female outpatients (mean age: 42.59) with BED (n = 160) or obesity without BED (n = 373) completed the RSES and measures of interpersonal problems, psychological distress, and eating symptoms. RESULTS: Patients with BED responded more strongly to the negatively worded items of the RSES than those with obesity. The RSES negatively worded item factor was negatively associated with higher interpersonal problems, psychological distress, and binge eating. CONCLUSIONS: Patients with BED may be more responsive to negatively phrased items on the RSES consistent with their negative self-evaluations and self-perceptions.

Effects of COVID-19 lockdown on eating disorders and obesity: A systematic review and meta-analysis.

OBJECTIVE: This systematic review and meta-analysis aimed to examine: the pooled prevalence of symptomatic behaviours and mental health deterioration amongst individuals with eating disorders (EDs) and obesity during the COVID-19 confinement. Moreover, we examined changes in EDs and distress before and during the confinement, and the association between psychosocial factors and EDs symptoms. METHOD: A systematic search was carried out in biomedical databases from January 2020 to January 2021. Both cross-sectional and longitudinal studies that used quantitative measures of ED symptoms and psychological distress during and after the COVID-19 confinement were included. RESULTS: A total of 26 studies met inclusion criteria (n = 3399, 85.7% female). The pooled prevalence of symptomatic deterioration in EDs was 65% (95% CI[48,81], k = 10). The pooled prevalence of increased weight in obesity was 52% (95% CI[25,78], k = 4). More than half of the participants experienced depression and anxiety. Moreover, at least 75% of the individuals with EDs reported shape and eating concerns, and increased thinking about exercising. However, the pooled analyses of longitudinal studies showed no significant differences from pre-pandemic levels to the first lockdown phase in Body Mass Index and ED symptoms, whereas only few studies suggested increased distress, particularly among individuals with anorexia nervosa. CONCLUSIONS: The majority of individuals with EDs and obesity reported symptomatic worsening during the lockdown. However, further longitudinal studies are needed to identify vulnerable groups, as well as the long-term consequences of COVID-19.

Self-reported reflective functioning mediates the association between attachment insecurity and well-being among psychotherapists.

Objective: Subjective well-being is a crucial variable for mental health practitioners. This study examines the influence of therapists' attachment dimensions and self-reported reflective functioning on their perceived well-being. Further, it examines if reflective functioning mediates the association between attachment insecurity and well-being. Method: A total of 416 experienced psychotherapists were enrolled in this cross-sectional study, and completed self-report measures of attachment insecurity, reflective functioning, and well-being. We tested the hypothesized mediation model with path analysis that examined indirect effects. Results: Both attachment anxiety and avoidance dimensions had a significant negative association with perceived well-being with small to medium effects. "Certainty" in reflective functioning had a small positive effect on therapist well-being. Reflective functioning mediated the association between insecure attachment dimensions and well-being, suggesting that therapist's lower ability to mentalize may partially account for the effects of higher attachment insecurity on lower well-being. Conclusion: The well-being of psychotherapists with greater insecure attachment may deserve special attention, and therapists' mentalizing capacities may be targeted by researchers and trainers as a core ability to be cultivated in order to preserve therapists' professional and personal resources.

Maintaining everyday life praxis in the time of COVID-19 pandemic measures (ELP-COVID-19 survey).

BACKGROUND: The extreme social circumstances caused by declared COVID-19 pandemic deeply intervene people's everyday life and should not be neglected but seen through the view of social reality pinpointing the 'ordinary' people. In this article, authors explored basic segments of everyday and their subjective perception to what extent sleeping habits, physical inactivity, physical activity, nutritional habits and smoking have changed. METHODS: The online survey was conducted in nine European countries (Bosnia and Herzegovina, Croatia, Greece, Kosovo*, Italy, Serbia, Slovakia, Slovenia and Spain) in 4108 participants, aged 15-82 years. The survey took place 30-40 days after World Health Organization declared COVID-19 pandemic state, from 15 April to 3 May 2020. RESULTS: The results have shown 30 min longer sleeping time, 50% longer physical inactivity time, 65% longer screen time, 43% shorter walking time, 24% shorter sport time and 37% longer physical work time. Additionally, body mass gains (0.3 kg) could be explained in 20.6% with meals sizes, unhealthy food consumption, screen time and sport time. Further, respondents reported more regular meals (44%) and healthier meals with less alcohol consumption and less smoking, which have been positive outcomes of home confinement. CONCLUSION: The findings draw attention to negative changes in everyday praxis (inactivity, body mass gain) after such a short period. Because of possible risk to population's health (especially of countries such as Italy and Spain with serious threat and more stringent measures), findings enable development of recommendations for maintaining healthy lifestyle habits with minimal negative health consequences in similar pandemic circumstances.

Task-sharing interventions for patients with anorexia nervosa or their carers: a systematic evaluation of the literature and meta-analysis of outcomes.

The eating disorder clinical and scientific community advocates for the use of a shared approach to healthcare that actively involves patients and carers. A systematic review of the literature on guided self-help or self-help in anorexia nervosa (targeting either the individual affected by the illness or their carers) and meta-analyses of studies using randomised controlled designs for the evaluation of the outcomes: (1) drop-out from end-of-treatment assessment, (2) body mass index (BMI), (3) anxiety, (4) depression and (5) quality of life, were undertaken. Guided self-help was directed to patients in 15 studies and to carers in seven studies. The interventions were based on a variety of theoretical models, used different formats (books and digital materials), and were delivered by individuals with a range of experiences and expertise (e.g. individuals with lived experience of the illness, graduate students, or clinically trained professionals). Guided self-help was associated with significantly lower drop-out from the completion of end-of-treatment assessments compared to a control condition. There was an improvement in carers' wellbeing from skill-sharing interventions. Guided self-help may facilitate patients' treatment engagement and also improve carers' wellbeing.

The codevelopment of group relationships: The role of individual group member's and other group members' mutual influence and shared group environment.

Although recent research has provided empirical support for the codevelopment of group interaction (defined as development in a common direction of perceptions of group relationships), no studies have yet investigated the "causes" of codevelopment among group members in the long term. The aim of the current study is to examine how the perceptions of an individual group member, and other group members, regarding group relationships influence each other over the course of treatment. We analyzed group data from 168 adult obese patients who participated in (1 of 20) 12-session therapy groups for weight management. Group relationships were measured by the Group Questionnaire (Krogel et al., 2013), which was administered to group members in early, middle and late group sessions. The longitudinal version of the group actor-partner interdependence model was used to analyze the influence among members. Results showed that there is no mutual influence in the codevelopment of both positive bonding and negative relationship. However, positive bonding of other group members in the middle of the group influenced positive bonding of the individual group member in the late group session. Moreover, individual group member negative relationships in early and middle sessions influenced other group member negative relationships in middle and late sessions. Finally, there was evidence of mutual influence in the codevelopment of positive working early in the group. The findings show that the process of influence among members is complex with regard to the specific dimension of the group relationship assessed and the time spent in group treatment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

From telescope to binoculars. Dyadic outcome resulting from psychological counselling for infertile couples undergoing ART.

OBJECTIVE: This longitudinal study aims to evaluate the effect of psychological counselling on quality of life, marital satisfaction and need for parenthood in couples undergoing fertility treatments (ART). BACKGROUND: Recent guidelines on the ART suggest that psychological counselling should target both members of the infertile couple in order to improve their conjoint management of the infertility-related stress. However, studies on the dyadic outcome of couples are scarce. METHODS: 262 patients were originally considered in the study and completed questionnaires on quality of life, need for parenthood and marital satisfaction, before treatment (T1) and at the day of intrauterine insemination/embryo transfer (T2). For the purposes of this study, 34 counselled couples were then matched to 34 non-counselled couples by propensity scores. The Common Fate Model (CFM) was used to examine dyadic changes. RESULTS: Couples receiving counselling had higher dyadic quality of life and lower dyadic stress due to the need for parenthood at T2 compared to non-counselled couples. No differences were found on marital satisfaction. CONCLUSION: The findings provide support for the effectiveness of counselling on interpersonal outcome. The CFM allows researchers to examine how the dyad as a whole responds to counselling, highlighting the change in the couple's relational dynamics.

Patients with Binge Eating Disorder and Obesity have qualitatively different interpersonal characteristics: Results from an Interpersonal Circumplex study.

BACKGROUND: Patients with Binge Eating Disorder (BED) and obesity experience distressing relationships, which could trigger negative affect and over-eating. To date no studies compared the interpersonal profiles and prototypicality of both groups using the Interpersonal Circumplex. METHOD: A sample of 177 patients with BED (mean age: 41.0 ±â€¯12.5 years; 11.3% males), 321 obese non-BED adults (mean age: 44.5 ±â€¯13.4 years; 28% males), and 108 normal weight adults (mean age: 37.3 ±â€¯9.6 years; 52.77% males) completed the Inventory of Interpersonal Problems (IIP-32), and scales of binge eating and psychological distress at one time-point. RESULTS: Compared to normal weight and obese participants, those with BED reported higher levels of interpersonal problems on all circumplex dimensions, except for Vindictive, with small to medium effects. All groups had highly prototypical profiles. Both obese and normal weight adults had very similar interpersonal profiles characterized by predominant friendly-dominant themes. On the contrary, those with BED had predominant friendly-submissive themes. Patients with BED reported significantly higher levels of psychological distress and binge eating severity, compared to the other two groups. Greater Domineering, Cold, Socially Inhibited and Non-Assertive scale scores, and lower Vindictive scale scores significantly predicted higher binge eating and psychological distress, regardless of group membership. DISCUSSION: Findings lend support to an interpersonal model of binge eating and to the presence of qualitative differences between patients with obesity and BED. Finally, results suggest some strategies for the clinical management of BED focused on non-assertion and problems with experiences and expression of anger.

The Role of Couples' Attachment Styles in Patients' Adjustment to Cancer.

OBJECTIVE: This study aimed to understand how psychological variables and attachment styles can contribute to improve effective and functional adjustment to the disease and promote better psychological well-being. METHODS: A total of 176 participants (88 couples) took part in this research. One member of each couple attended surgery centers at the Oncology Department of the University Hospital of Palermo. Each participant had filled in 5 questionnaires assessing the variables couple relationships, quality of life, anxiety, depression, and psychosocial adjustment to illness. RESULTS: Significant correlations were found among the observed variables. Levels of anxiety and the attachment styles of couples influence adjustment to tumor disease and negatively affect the quality of conjugal relationships. Moreover, the results highlighted the correlation between levels of anxiety and depression in patients and in their respective partners. Finally, we found a correlation between the level of psychological distress of the patient and the level of marital satisfaction perceived by the partner: the latter is lower in couples where the oncological patient has high levels of distress. CONCLUSIONS: The results suggest that psychological variables and attachment styles of cancer patients and their partners may be important factors affecting adjustment in multiple domains.

A longitudinal examination of dyadic distress patterns following a skills intervention for carers of adolescents with anorexia nervosa.

Family interventions in anorexia nervosa (AN) have been developed to ameliorate maladaptive patterns of patient-carer interaction that can play a role in illness maintenance. The primary aim of this study is to examine the inter-relationship between baseline and post-treatment distress in dyads of carers and patients with AN to examine the interdependence between carers and patients. The secondary aim is to examine whether a carer skills intervention [Experienced Carer Helping Others (ECHO)] impacts on this inter-relationship. Dyads consisting of treatment-seeking adolescents with AN and their primary carer (n = 149; mostly mothers) were randomised to receive a carer skills intervention (ECHO) in addition to treatment as usual (TAU), or TAU alone, as part of a larger clinical trial. Carers and patients completed a standardised measure of psychological distress (The Depression, Anxiety, and Stress Scale) at baseline and 12 months post-treatment. The Actor Partner Interdependence Model was used to examine longitudinal changes in interdependence by treatment group. As expected, post-treatment levels of distress were related to baseline levels in both groups (actor effects). Moreover, carer distress at 12 months was related to patient distress at baseline for the TAU (partner effects), but not for the ECHO group. Finally, carers' distress change was not a significant predictor of patients' body mass index (BMI) change in the two treatment conditions. These findings are limited to predominantly mother-offspring dyads and may not generalise to other relationships. The ECHO intervention which is designed to teach carers skills in illness management and emotion regulation may be an effective addition to TAU for ameliorating interdependence of distress in patients and their primary carers over time.

Group relationships in early and late sessions and improvement in interpersonal problems.

Groups are more effective when positive bonds are established and interpersonal conflicts resolved in early sessions and work is accomplished in later sessions. Previous research has provided mixed support for this group development model. We performed a test of this theoretical perspective using group members' (actors) and aggregated group members' (partners) perceptions of positive bonding, positive working, and negative group relationships measured early and late in interpersonal growth groups. Participants were 325 Italian graduate students randomly (within semester) assigned to 1 of 16 interpersonal growth groups. Groups met for 9 weeks with experienced psychologists using Yalom and Leszcz's (2005) interpersonal process model. Outcome was assessed pre- and posttreatment using the Inventory of Interpersonal Problems, and group relationships were measured at Sessions 3 and 6 using the Group Questionnaire. As hypothesized, early measures of positive bonding and late measures of positive working, for both actors and partners, were positively related to improved interpersonal problems. Also as hypothesized, late measures of positive bonding and early measures of positive working, for both actors and partners, were negatively related to improved interpersonal problems. We also found that early actor and partner positive bonding and negative relationships interacted to predict changes in interpersonal problems. The findings are consistent with group development theory and suggest that group therapists focus on group-as-a-whole positive bonding relationships in early group sessions and on group-as-a-whole positive working relationships in later group sessions. (PsycINFO Database Record

Does the Interpersonal Model Generalize to Obesity Without Binge Eating?

The interpersonal model has been validated for binge eating disorder (BED), but it is not yet known if the model applies to individuals who are obese but who do not binge eat. The goal of this study was to compare the validity of the interpersonal model in those with BED versus those with obesity, and normal weight samples. Data from a sample of 93 treatment-seeking women diagnosed with BED, 186 women who were obese without BED, and 100 controls who were normal weight were examined for indirect effects of interpersonal problems on binge eating psychopathology mediated through negative affect. Findings demonstrated the mediating role of negative affect for those with BED and those who were obese without BED. Testing a reverse model suggested that the interpersonal model is specific for BED but that this model may not be specific for those without BED. This is the first study to find support for the interpersonal model in a sample of women with obesity but who do not binge. However, negative affect likely plays a more complex role in determining overeating in those with obesity but who do not binge. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.