Weighty decisions: How symptom severity and weight impact perceptions of bulimia nervosa.

OBJECTIVE: The current study examined whether variations in patient weight and eating-disorder behavior frequency influenced the recognition of bulimia nervosa (BN) and the perception that it is a serious mental health concern. METHOD: Participants (N = 320) were randomly assigned to one of six conditions in which they read a vignette describing a young woman with BN. Each vignette was identical except for the variables of interest: weight status (underweight, healthy-weight, and overweight), and symptom frequency (daily or weekly binge-eating episodes and purging). RESULTS: Participants were more likely to have negative attitudes toward and blame the patient with overweight. Participants were less likely to believe that the patient with overweight was experiencing mental illness and that her problems were too serious to handle on her own. There were no significant differences by symptom frequency. DISCUSSION: Findings suggest the presence of weight stigma and that overweight might impede the recognition of eating disorders.

An Examination of Sexting, Sexual Violence, and Alcohol Use Among Men Arrested for Domestic Violence.

Technological advances provide greater opportunity for electronic communication to occur within romantic relationships. Sexting, defined as sending sexually explicit content via electronic mediums, is one such type of communication and its association with alcohol use and partner violence is supported by existing research. We extend this knowledge by examining the prevalence of past-year sexting within a clinical sample of men arrested for domestic violence (N = 312). The associations between sexting, alcohol use, and sexual violence perpetration in the past year were also examined. Findings indicated that sexting was a prevalent behavior among this population, with 60% of the sample having requested a sext from someone, 55% having been asked to send a sext, and 41% having sent a sext within the past year. Logistic regression analyses indicated that sexting was linked to past-year sexual violence perpetration, even after controlling for age and past-year alcohol use. This is the first study to provide evidence that sexting is prevalent among men arrested for domestic violence. Moreover, men who endorsed sexting within the past year were more likely to have perpetrated past-year sexual violence than men who did not engage in sexting. Understanding the relation between sexting and other problematic behaviors, such as alcohol use and sexual violence, will inform intervention efforts across various populations.

A Randomized Controlled Trial of a Mindfulness and Acceptance Group Therapy for Residential Substance Use Patients.

BACKGROUND: Substance use disorders are understood as a chronically relapsing condition that is difficult to treat. However, in recent years there have been promising developments in the treatment of substance use disorders, specifically with interventions based on mindfulness and acceptance and commitment therapy. Little research has examined whether these types of interventions may positively impact residential substance use treatment outcomes. OBJECTIVES: Thus, in the current study we developed and examined, in a randomized controlled trial, a 4-week, eight-session, adjunctive mindfulness and acceptance group therapy for patients in residential substance use treatment. Our primary outcomes were substance use cravings, psychological flexibility, and dispositional mindfulness at treatment discharge. METHODS: Patients (N = 117) from a private residential substance use facility were randomized to receive the adjunctive mindfulness and acceptance group or treatment-as-usual. Patients were assessed at treatment intake and at discharge from a 28-30-day residential program. RESULTS: Although treatment groups did not statistically differ at discharge on any primary outcome, small effect sizes favored the mindfulness and acceptance group on cravings and psychological flexibility. Conclusions/Importance: Continued research is needed to determine whether the addition of mindfulness and acceptance-based interventions improve outcomes long term following residential substance use treatment.

A preliminary investigation of the relationship between dispositional mindfulness and eating disorder symptoms among men in residential substance use treatment.

The comorbidity between eating disorders (EDs) and substance use disorders (SUDs) is of particular concern given the high rates of mortality, relapse and poor treatment outcomes associated with both disorders. As a result, there has been a growing impetus within the field to elucidate factors that might influence and aid treatment for this comorbidity. One such factor is dispositional mindfulness, as past literature has demonstrated a significant relationship between mindfulness and both EDs and SUDs. However, we are unaware of any research that has examined the relationship between dispositional mindfulness and ED symptoms in a sample of men in residential treatment for SUDs. Medical records from 152 men were included in the current study. Alcohol and drug use and problems, ED symptoms, and dispositional mindfulness were assessed with self-report measures. Hierarchical regression analysis indicated that dispositional mindfulness was inversely related to ED symptoms after controlling for alcohol use, drug use, and age. Although results are preliminary and continued research in this area is needed, our findings suggest that there may be potential usefulness in targeting and enhancing mindfulness among patients in residential treatment for SUDs with co-occurring psychiatric symptoms (e.g., EDs).

The Relationship Between Generalized Anxiety Symptoms and Treatment Dropout Among Women in Residential Treatment for Substance Use Disorders.

BACKGROUND: Generalized anxiety disorder (GAD) co-occurs with substance use disorders (SUDs) at an alarmingly high rate, and the presence of anxiety is associated with an increased risk for relapse to substance use following treatment. Furthermore, comorbid SUDs and other forms of psychopathology are associated with an increased risk for leaving treatment against medical advice (AMA). OBJECTIVE AND METHOD: Research has yet to examine whether the presence of GAD symptoms is associated with leaving treatment AMA in SUDs populations. Thus, the current study sought to address this important gap in the literature by examining this relationship among a sample of 122 women in residential treatment for SUDs. RESULTS: Results demonstrated that GAD symptoms were significantly associated with the decision to leave treatment AMA after controlling for age, education, problematic alcohol and drug use, and depression symptoms. CONCLUSIONS/IMPORTANCE: Our finding indicates the potential importance of assessing and targeting GAD in treatment for SUDs, which may increase treatment compliance.

Are Borderline Personality Symptoms Associated With Compulsive Sexual Behaviors Among Women in Treatment for Substance Use Disorders? An Exploratory Study.

OBJECTIVE: Extant literature has documented a significant relationship between borderline symptoms and substance use disorders. As supported in past work, there is a significant theoretical relationship between borderline symptoms and compulsive sexual behaviors because both disorders share common underlying behaviors and traits. There is no known research that has examined the empirical relationship between borderline symptoms and compulsive sexual behaviors in a population with substance use disorders. To fill this important gap in the literature, this relationship was examined in the current study. METHOD: Medical records from 120 women admitted to a private, residential treatment program for substance use disorders were reviewed for the current study. RESULTS: Hierarchical multiple regression analysis demonstrated that borderline symptoms were significantly associated with compulsive sexual behaviors after controlling for alcohol use and problems, drug use and problems, age, and positive impression management. CONCLUSION: Results from this study provide potentially important research and clinical implications, which could ultimately aid treatment and reduce relapse. However, continued research is needed to further examine the relationship between symptoms and compulsive sexual behaviors.

The Temporal Association Between Traditional and Cyber Dating Abuse Among Adolescents.

While research has explored adolescents' use of technology to perpetrate dating violence, little is known about how traditional in-person and cyber abuse are linked, and no studies have examined their relationship over time. Using our sample of 780 diverse adolescents (58 % female), we found that traditional and cyber abuse were positively associated, and cyber abuse perpetration and victimization were correlated at each time point. Cyber abuse perpetration in the previous year (spring 2013) predicted cyber abuse perpetration 1 year later (spring 2014), while controlling for traditional abuse and demographic variables. In addition, physical violence victimization and cyber abuse perpetration and victimization predicted cyber abuse victimization the following year. These findings highlight the reciprocal nature of cyber abuse and suggest that victims may experience abuse in multiple contexts.

A preliminary investigation of the relationship between early maladaptive schemas and compulsive sexual behaviors in a substance-dependent population.

Past research has consistently demonstrated high co-occurrence between substance use disorders (SUDs) and compulsive sexual behaviors (CSBs). Numerous studies have also indicated that maladaptive core beliefs and early maladaptive schemas (EMS) are prevalent among individuals with SUDs and CSBs. However, research has yet to examine the relationship between EMS and CSBs among substance-dependent populations. Thus, the purpose of the current study was to examine this relationship in a sample of 198 men and 62 women in residential treatment for SUDs. Findings demonstrated that the five EMS domains were positively associated with CSBs. Results further demonstrated that patients meeting the cutoff score for CSBs scored significantly higher than patients not meeting the cutoff score for CSBs on the EMS domains of disconnection/rejection, impaired autonomy, and impaired limit. These findings suggest that there is an important and significant relationship between EMS and CSBs among adults in substance use treatment. Results from the current study indicate that EMS may provide a potentially important focus for treatment, particularly among individuals with co-morbid CSBs and SUDs. Given the preliminary nature of this study, continued research is needed to replicate and extend the findings from the current study.

Dispositional Mindfulness and Aggression Among Women in Residential Substance Use Treatment.

There is a large literature on substance misuse and interpersonal aggression, including aggression perpetrated by women in treatment for substance misuse. There is also a growing body of literature on mindfulness and substance use, as well as mindfulness and aggression. However, to date, there has been little research on whether dispositional mindfulness is associated with increased aggression among women in treatment for substance misuse. The current study, therefore, examined whether dispositional mindfulness was associated with aggression, above and beyond substance use and demographic characteristics, in women in residential substance misuse treatment (N = 137). Results showed that lower dispositional mindfulness was associated with increased aggression (physical, verbal, and aggressive attitude). Moreover, this relationship between dispositional mindfulness and aggression remained even after controlling for alcohol problems, drug problems, and age, all known predictors of aggression. Our results provide the first empirical evidence that dispositional mindfulness is negatively associated with aggression in women in treatment for substance misuse. Pending replication, this could have important implications for treatment. Specifically, mindfulness-based interventions may prove helpful for the concurrent treatment of substance misuse and aggression.

Eating Disorder Symptoms and Length of Stay in Residential Treatment for Substance Use: A Brief Report.

OBJECTIVE: Treatment dropout is common both among people in treatment for eating disorders and for substance use disorders. Because of the high rates of co-occurrence and mortality associated with these disorders, the purpose of the current study was to examine the relationship among eating disorder symptoms, length of stay, and decisions to leave against medical advice among individuals in substance use treatment. METHODS: We analyzed de-identified medical record data for 122 adult women enrolled in residential treatment for substance use disorders over a 12-month period. Routine treatment intake included standardized assessments of eating disorders, depression, and substance use. RESULTS: Participants averaged 43.1 years of age (SD = 10.7) and were primarily non-Hispanic Caucasian (n = 118, 96.7%). Approximately 8 (6.6%) patients met criteria for a probable eating disorder and 79 (64.8%) for a probable alcohol use disorder. Mean length of stay was 28.1 days (SD = 6.6) and 21 (17%) patients left against medical advice. Logistic regression analysis showed that eating disorder symptoms were significantly associated with decisions to leave treatment against medical advice after controlling for age, years of education, depression symptoms, alcohol problems, and drug problems: χ(2) = 14.88, df = 6, p =.02. This model accounted for 19.1% (Nagelkerke R(2)) of the variance in discharge type. Eating disorder symptoms were not associated with length of treatment. CONCLUSIONS: Our findings suggest the importance of assessing and monitoring eating disorder symptoms among individuals in treatment for substance use disorders.

Early Maladaptive Schemas and Aggression in Men Seeking Residential Substance Use Treatment.

Social-cognitive theories of aggression postulate that individuals who perpetrate aggression are likely to have high levels of maladaptive cognitive schemas that increase risk for aggression. Indeed, recent research has begun to examine whether early maladaptive schemas may increase the risk for aggression. However, no known research has examined this among individuals in substance use treatment, despite aggression and early maladaptive schemas being more prevalent among individuals with a substance use disorder than the general population. Toward this end, we examined the relationship between early maladaptive schemas and aggression in men in a residential substance use treatment facility (N = 106). Utilizing pre-existing patient records, results demonstrated unique associations between early maladaptive schema domains and aggression depending on the type of aggression and schema domain examined, even after controlling for substance use, antisocial personality, age, and education. The Impaired Limits domain was positively associated with verbal aggression, aggressive attitude, and overall aggression, whereas the Disconnection and Rejection domain was positively associated with physical aggression. These findings are consistent with social-cognitive models of aggression and advance our understanding of how early maladaptive schemas may influence aggression. The implications of these findings for future research are discussed.

The Relationship Between Early Maladaptive Schemas, Depression, and Generalized Anxiety among Adults Seeking Residential Treatment for Substance Use Disorders.

Previous research has shown that early maladaptive schemas (EMS) play an important role in substance use, depression, and anxiety. However, few studies have examined the role of EMS within the context of all three concurrently. The goal of this study was to determine the role of EMS in predicting symptoms of Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) among adults in residential treatment for substance dependence. We used pre-existing patient records of adults diagnosed with a substance use disorder from a residential substance use treatment facility (N=122). The EMS domains of disconnection and rejection and impaired limits were associated with symptoms of MDD and the domain of impaired autonomy and performance was associated with symptoms of GAD, even after controlling for age, gender, years of education, alcohol use, drug use, and symptoms of MDD (when predicting GAD) and GAD (when predicting MDD). Findings suggest that EMS may play an important role in comorbid mental health problems among men and women in residential substance use treatment. Continued treatment outcome research is needed to examine whether modification of EMS results in improved mental health and substance use outcomes.

The relationship between early maladaptive schemas and eating-disorder symptomatology among individuals seeking treatment for substance dependence.

Numerous studies have examined early maladaptive schemas (EMS) and their relationship to psychological disorders, including eating disorders (EDs) and substance use disorders (SUDs). However, to date, there are no empirical investigations that have examined the relationship between EMS and EDs among individuals seeking treatment for substance use. In an attempt to further elucidate this relationship, the purpose of the current, exploratory study was to examine the relationship between EMS, ED symptomatology (i.e., bulimia and binge-eating but not anorexia), and substance use and to directly compare EMS among individuals with and without a probable ED diagnosis. Participants were 387 men and 132 women seeking residential treatment for substance use. Results demonstrated that 11 of the 18 EMS were significantly associated with ED. Moreover, patients with a probable ED scored significantly higher than patients without a probable ED on 8 of the 18 EMS. Results suggest that EMS are prevalent among individuals with ED pathology seeking treatment for substance use. Thus treatment programs could potentially benefit from the assessment and treatment of EMS among dually-diagnosed patients. Given the exploratory and preliminary nature of the study, continued research is needed to further examine the relationship between EMS, EDs, and substance use.

Male batterers' alcohol use and gambling behavior.

Little work has examined the interrelations among intimate partner violence (IPV), alcohol use, and gambling behavior, and no studies have examined these relationships among males court-ordered to batterer intervention programs (BIPs). The aim of the current investigation was to explore the associations between IPV, alcohol use, and gambling behavior among 341 males court-mandated to attend BIPs utilizing self-report measures. Voluntary, anonymous questionnaires were administered and completed during regularly scheduled BIP sessions. Compared to the general population, a higher percentage of the sample met criteria for pathological gambling (9%), and problem gambling (17%). Further, males exhibiting pathological gambling were more likely to be hazardous drinkers, and hazardous drinkers were more likely to exhibit pathological gambling. Additionally, pathological gamblers were at an increased risk for the perpetration of both physical and sexual aggression. Finally, gambling behavior uniquely predicted the perpetration of sexual aggression above and beyond alcohol use, impulsivity, and relationship satisfaction. The implications of these results for future research and intervention are discussed.

Relationships Among Dispositional Mindfulness, Distress Tolerance, and Women's Dating Violence Perpetration: A Path Analysis.

Scant research examined mechanisms underlying the relationship between dispositional mindfulness and dating violence (DV) perpetration. Using a cross-sectional design with 203 college women, we examined whether distress tolerance mediated the relationship between dispositional mindfulness and DV perpetration (i.e., psychological aggression and physical assault). Path analyses results revealed indirect effects of mindfulness facets nonjudging of inner experiences and nonreactivity to inner experiences on both psychological aggression and physical assault through distress tolerance. Mindfulness facets observing, describing, and acting with awareness were not linked to DV perpetration through distress tolerance. Results suggest that women who allow internal experiences to come and go without assigning criticism or avoidance are better able to tolerate transient distress and less likely to abuse a dating partner. Future research may examine distress tolerance and dispositional mindfulness facets as potential intervention targets for women who abuse dating partners.

Cyber Abuse among Men Arrested for Domestic Violence: Cyber Monitoring Moderates the Relationship between Alcohol Problems and Intimate Partner Violence.

OBJECTIVE: We provide the first investigation of the prevalence and frequency of cyber abuse among men arrested for domestic violence (DV). We also offer the first conceptualization of cyber monitoring, a facet of cyber abuse, within the I3 theory of IPV. That is, the risk of IPV perpetration may be higher for men with alcohol problems who also frequently access emotionally-salient instigatory cues, namely, information gleaned from cyber monitoring. Thus, we hypothesized that alcohol problems would positively relate to IPV perpetration among men who engaged in high, but not low, levels of cyber monitoring. METHODS: Using a cross-sectional sample of 216 men arrested for DV and court-referred to batterer intervention programs (BIPs), we explored the prevalence and frequency of cyber abuse perpetration and victimization. Hierarchical multiple regression analyses tested the interaction between cyber monitoring and alcohol problems predicting IPV perpetration (psychological aggression and physical assault). RESULTS: Eighty-one percent of men endorsed perpetrating at least one act of cyber abuse in the year prior to entering BIPs. Alcohol problems and both psychological and physical IPV perpetration positively related at high, but not low, levels of cyber monitoring. CONCLUSION: Clinicians should assess for cyber abuse and alcohol use among DV offenders. Amendments to legal statutes for DV offenders should consider incorporating common uses of technology into legal definitions of stalking and harassment. Social media campaigns and BIPs should increase individuals' awareness of the criminal charges that may result from some forms of cyber abuse and monitoring.

Experiential Avoidance and Bulimic Symptoms among Men in Residential Treatment for Substance Use Disorders: A Preliminary Examination.

There has been a growing focus on identifying factors that underlie and maintain bulimic symptoms and substance use disorders (SUDs), as both are associated with high mortality and poor clinical outcomes. Experiential avoidance has been an area of interest within both the eating disorder and SUD fields, as it is a robust risk factor for both disorders. No known research has examined the relationship between experiential avoidance and bulimic symptoms in a SUD treatment-seeking sample. Moreover, the extant literature has focused exclusively on female samples. The purpose of this exploratory study was to examine the relationship between bulimic symptoms and experiential avoidance within an understudied population: men in treatment for a SUD. Three separate hierarchical regression analyses were conducted to examine the following relationships: (1) experiential avoidance and bulimic symptoms; (2) experiential avoidance and alcohol use and problems; and (3) experiential avoidance and drug use and problems. Results demonstrated that, controlling for alcohol and drug use and problems, experiential avoidance was significantly associated with bulimic symptoms. Experiential avoidance was also significantly associated with alcohol use and problems and drug use and problems. These findings are preliminary and future research is needed to further examine this relationship.

Dispositional Mindfulness as a Moderator of the Relationship Between Perceived Partner Infidelity and Women's Dating Violence Perpetration.

Mindfulness gained increased attention as it relates to aggressive behavior, including dating violence. However, no known studies examined how the combined influences of dispositional mindfulness and perceived partner infidelity, a well-documented correlate of dating violence, relate to women's dating violence perpetration. Using a sample of college women ( N = 203), we examined the relationship between perceived partner infidelity and physical dating violence perpetration at varying levels of dispositional mindfulness, controlling for the influence of alcohol use. Results indicated perceived partner infidelity and dating violence perpetration were positively related for women with low and mean dispositional mindfulness, but not for women with high dispositional mindfulness. These results further support the applicability of mindfulness theory in the context of dating violence. Implications of the present findings provide preliminary support for mindfulness intervention in relationships characterized by infidelity concerns.

Suicidal Ideation among Women Court-Referred to Batterer Intervention Programs.

Identifying the prevalence and correlates of suicidal ideation in women mandated to batterer intervention programs is necessary to prevent suicide in this greatly understudied population. This study used cross-sectional, self-report survey methodology to identify the prevalence and correlates of suicidal ideation among 79 women attending batterer intervention programs. Thirty-three percent of the sample reported experiencing suicidal ideation during the two weeks prior to entering the program. Multiple linear regression analysis indicated that, while controlling for number of batterer intervention sessions attended, symptoms of depression and borderline personality disorder, but not symptoms of antisocial personality disorder, were associated with suicidal ideation.

Antisocial Traits, Distress Tolerance, and Alcohol Problems as Predictors of Intimate Partner Violence in Men Arrested for Domestic Violence.

OBJECTIVE: Men with antisocial personality disorder (ASPD) traits are at an increased risk for consuming alcohol and perpetrating intimate partner violence (IPV). However, previous research has neglected malleable mechanisms potentially responsible for the link between ASPD traits, alcohol problems, and IPV perpetration. Efforts to improve the efficacy of batterer intervention programs (BIPs) would benefit from exploration of such malleable mechanisms. The present study is the first to examine distress tolerance as one such mechanism linking men's ASPD traits to their alcohol problems and IPV perpetration. METHODS: Using a cross-sectional sample of 331 men arrested for domestic violence and court-referred to BIPs, the present study used structural equation modeling to examine pathways from men's ASPD traits to IPV perpetration directly and indirectly through distress tolerance and alcohol problems. RESULTS: Results supported a two-chain partial mediational model. ASPD traits were related to psychological aggression perpetration directly and indirectly via distress tolerance and alcohol problems. A second pathway emerged by which ASPD traits related to higher levels of alcohol problems, which related to psychological aggression perpetration. Controlling for psychological aggression perpetration, neither distress tolerance nor alcohol problems explained the relation between ASPD traits and physical assault perpetration. CONCLUSION: These results support and extend existing conceptual models of IPV perpetration. Findings suggest intervention efforts for IPV should target both distress tolerance and alcohol problems.