A longitudinal examination of body-checking behaviors and eating disorder pathology in a community sample of adolescent males and females.

OBJECTIVE: Related to the cognitive-behavioral theory of eating disorders, body checking has gained increasing recognition as both a maintaining factor for eating disorders and an important target for treatment. However, it is unclear whether body-checking behaviors contribute to the development of disordered eating, or if these behaviors develop as a response to experiencing eating disorder thoughts and behaviors. This study aims to examine the relationships between body-checking behaviors and eating disordered thoughts and behaviors in adolescent females and males in the community over time. METHODS: Participants included 238 adolescents (n = 104 males, n = 134 females, Mage = 16.5 years) recruited from high schools in British Columbia, Canada, who completed the Eating Disorder Examination Questionnaire and Body Checking Questionnaire at baseline (T1) and again approximately 4 months later (T2). RESULTS: After controlling for baseline levels of eating pathology and body mass index (BMI), body checking at T1 predicted increases in eating pathology for both males and females. In contrast, after controlling for baseline levels of body checking and BMI, eating pathology at T1 did not predict changes in body checking for females, but it did for males. Findings suggest that, among adolescents, engaging in body-checking behaviors may increase risk for disordered eating. DISCUSSION: If supported by further research, targeting body-checking behaviors in prevention programs may be warranted.

Kindness begins with yourself: The role of self-compassion in adolescent body satisfaction and eating pathology.

OBJECTIVE: A wealth of evidence indicates that self-compassion is linked with positive psychological outcomes; however, little is known about the process through which self-compassion exerts its effect. The primary purpose of this research was to investigate the direct and indirect impact of self-compassion on body satisfaction and eating pathology in adolescents. METHOD: Two hundred and thirty-eight students were recruited from three local high schools (Mage = 16.49, 43.7% boys). All participants completed the Self-Compassion Scale (SCS), Hopkins Symptom Checklist (SCL-5), Body Areas Satisfaction Scale (BASS), and Eating Disorder Examination Questionnaire - Adolescent Version (EDE-Q) at baseline. The SCL-5, BASS, and EDE-Q were completed 4 months later. RESULTS: Self-compassion was positively associated with body satisfaction and negatively associated with psychological distress and eating pathology in boys and girls at both time points. Longitudinal conditional process analyses revealed that self-compassion predicted changes in body satisfaction and eating pathology through changes in psychological distress for girls only. Notably, self-compassion was higher in boys than in girls. DISCUSSION: Results underscore how self-compassion may be an important factor to target in fostering a positive body image and preventing disordered eating in adolescents.

A systematic review of the relation between self-compassion and depressive symptoms in adolescents.

Research on self-compassion and depressive symptoms is growing at an exponential pace. This systematic review provides an in-depth exploration of the relation between self-compassion and depressive symptoms in adolescents. In accordance with PRISMA guidelines, MEDLINE, CINAHL, and PsycINFO databases were systematically searched and 18 studies were identified. Results demonstrate the potentially pertinent role that self-compassion may play in the development, maintenance, and treatment of depression in adolescents, yet reflect on the paucity of research on this topic with respect to mechanisms of change. These studies further highlight how the impact of self-compassion may differ according to gender and age and underscore the need to account for other diversity-related variables, such as ethnic-racial group, socioeconomic status, and sexual orientation. Despite such limitations in the literature, the current findings extend research in adults by providing support for the relevance of self-compassion in adolescence, particularly with respect to the prevention of depressive symptoms.

Body Satisfaction During Pregnancy: The Role of Health-Related Habit Strength.

Objectives Body satisfaction during pregnancy is an important determinant of maternal and fetal health outcomes. It is therefore critical to investigate factors related to changes in body satisfaction and to elucidate how body satisfaction changes over time in pregnant women. The purpose of this study was to examine the relation between two novel factors (i.e., healthy eating habit strength and physical activity habit strength) and body satisfaction during pregnancy. Methods Participants (n = 67 pregnant North American women) completed online questionnaires at the beginning of their second trimester (Time 1) and at the end of pregnancy. Maternal characteristics, relationship satisfaction, self-esteem, and psychological distress were assessed at Time 1 and habit strength, body satisfaction, and weight were assessed at both time points. Results Strength of healthy eating and physical activity habits remained stable over time and body satisfaction decreased over time. Healthy eating habit strength at Time 1 predicted increases in body satisfaction from the second trimester to the end of pregnancy, even when controlling for gestational weight gain. Conclusions This study suggests that health-related habit strength in women of reproductive age may offer protection against low levels of body satisfaction during pregnancy.

A meta-analysis of the relation between therapeutic alliance and treatment outcome in eating disorders.

The therapeutic alliance has demonstrated an association with favorable psychotherapeutic outcomes in the treatment of eating disorders (EDs). However, questions remain about the inter-relationships between early alliance, early symptom improvement, and treatment outcome. We conducted a meta-analysis on the relations among these constructs, and possible moderators of these relations, in psychosocial treatments for EDs. Twenty studies met inclusion criteria and supplied sufficient supplementary data. Results revealed small-to-moderate effect sizes, ßs = 0.13 to 0.22 (p < .05), indicating that early symptom improvement was related to subsequent alliance quality and that alliance ratings also were related to subsequent symptom reduction. The relationship between early alliance and treatment outcome was partially accounted for by early symptom improvement. With regard to moderators, early alliance showed weaker associations with outcome in therapies with a strong behavioral component relative to nonbehavioral therapies. However, alliance showed stronger relations to outcome for younger (vs. older) patients, over and above the variance shared with early symptom improvement. In sum, early symptom reduction enhances therapeutic alliance and treatment outcome in EDs, but early alliance may require specific attention for younger patients and for those receiving nonbehaviorally oriented treatments.

The role of the therapeutic alliance in eating disorder treatment outcomes: a systematic review.

The therapeutic alliance has proven to be an important construct in psychotherapy outcomes research for numerous psychiatric disorders. Given that dropout rates from treatment are especially high for individuals with eating disorders, it is critical to clarify the role that the therapeutic alliance plays in predicting treatment outcomes for this specific population. MEDLINE, CINAHL, and PsycINFO databases were systematically reviewed for studies that formally measured the therapeutic alliance construct and at least one other treatment variable in the context of eating disorder treatment. We identified 19 studies that indicate the therapeutic alliance may be an important factor in eating disorder treatment, yet reflect on the paucity of research on this topic in the context of treatment outcomes for both adult and adolescent populations. Current trends and limitations in the literature are highlighted to guide future research and ultimately improve clinical outcomes for patients with eating disorders.

Factors related to advanced stages of change in a clinical sample of adolescents.

BACKGROUND: The purpose of the present study was to examine the factors predicting a greater motivation to change in a clinical sample of adolescents. METHOD: A total of 107 adolescents participated in this research prior to beginning outpatient treatment. Participants completed a modified version of the Motivational Stages of Change for Adolescents Recovering from an ED, the Difficulties in Emotional Regulation Scale and the Behavioral Assessment System for Children-Self-Report. RESULTS: More advanced stages of change were associated with better parent-adolescent relationships and better emotional regulation. CONCLUSION: Incorporating parents in treatment to enhance parent-adolescent relationships and instructing parents in emotional regulation techniques to assist the adolescent may enhance their motivation to recover.

Appearance comparison on Instagram: The impact of fitspiration and transformation imagery on young women's body satisfaction.

Fitspiration, or imagery of thin muscular individuals that displays their physiques while posing or exercising, is a popular type of content on Instagram which ostensibly exists to encourage individuals to engage in a healthy lifestyle. A subtype of fitspiration imagery, "transformation" imagery, depicts physical changes following a "lifestyle change" involving diet and exercise. Despite its intentions, fitspiration imagery largely promotes one idealized body type (the fit ideal) and can be accompanied by messages encouraging restrained eating. Viewing fitspiration imagery has been associated with body dissatisfaction and appearance comparison in women, but the impact of transformation imagery specifically on women's body image has not yet been studied, nor has the impact of the broader fitspiration category and the transformation subtype on women's body image been compared. The current study aimed to clarify the relations between fitspiration and transformation imagery, appearance comparison, and body satisfaction using an experimental design. Female participants (N = 161) completed a measure of body satisfaction and then were randomly assigned to view one of three types of images: fit ideal only, body transformation, or travel (control). Participants then completed measures of appearance comparison and body satisfaction. Viewing fit ideal only and body transformation imagery was associated with lower body satisfaction and higher appearance comparison. The relation between image type and changes in body satisfaction was mediated by appearance comparison. Findings suggest that individuals may benefit from limiting exposure to fit ideal and body transformation imagery, particularly if they are vulnerable to engaging in appearance comparison.

'Fake' Instagram use is associated with real differences in users' self-photo activities: An exploratory investigation considering body satisfaction.

BACKGROUND: Creating private spaces on social media (SM) for authentic self-presentation has rapidly gained popularity amongst young people. This pattern of use is particularly prevalent on Instagram in women under 25 as these users often report creating a second, low stakes account for authentic self-presentation, commonly referred to as a Finsta (a portmanteau of 'Fake' and 'Instagram'). Previous research has associated Instagram use with body dissatisfaction in young women, but it remains unclear whether this association is applicable when considering different patterns of use. METHOD: The present study investigates the association between self-photo activities (i.e., photo selection, investment, and manipulation) and body satisfaction in a sample of undergraduate female Instagram users (N = 224) with (n = 112) and without (n = 112) a Finsta. RESULTS: A series of analyses of covariance (ANCOVA) controlling for minutes on Instagram and age revealed that, when comparing their Finsta to their own main account and to the main account of users without a Finsta, Finsta users reported taking fewer photos of themselves, engaging in less photo editing, and feeling less invested in their posts. Furthermore, body satisfaction was differentially associated with self-photo activities in Finsta users and non-users. Specifically, body satisfaction was negatively associated with photo selection, investment, and editing in users without a Finsta only. CONCLUSION: Finsta users do not show the same associations between body satisfaction and self-photo activities as Instagram users without a Finsta. The implications of these results, limitations of the present study, and suggestions for future research are discussed.

Eating disorder psychopathology as a marker of psychosocial distress and suicide risk in female and male adolescent psychiatric inpatients.

OBJECTIVE: The aim of this study was to examine psychosocial correlates of specific aspects of eating disorder (ED) psychopathology (ie, dietary restriction, body dissatisfaction, binge eating, and self-induced vomiting) in psychiatrically hospitalized adolescent girls and boys. METHOD: A total of 492 psychiatric inpatients (286 adolescent girls and 206 adolescent boys), aged 12 to 19 years, completed self-report measures of psychosocial and behavioral functioning, including measures of suicide risk and ED psychopathology. Associations between ED psychopathology and psychosocial functioning were examined separately by sex and after controlling for depressive/negative affect using Beck Depression Inventory scores. RESULTS: Among the adolescent boys and girls, after controlling for depressive/negative affect, ED psychopathology was significantly associated with anxiety, low self-esteem, and current distress regarding childhood abuse. Among adolescent girls, after controlling for depressive/negative affect, ED psychopathology was significantly related to hopelessness and suicidality. Among adolescent boys, after controlling for depressive/negative affect, ED psychopathology was positively related to self-reported history of sexual abuse and various externalizing problems (drug abuse, violence, and impulsivity). CONCLUSION: In psychiatrically hospitalized adolescents, ED psychopathology may be an important marker of broad psychosocial distress and behavioral problems among girls and boys, although the nature of the specific associations differs by sex.

Cognitive and behavioral correlates of depressive symptoms in a community sample of adolescents.

Research in adults demonstrates a positive association among obsessive-compulsive symptoms, eating pathology, cognitive distortions, and comorbid depressive symptoms. Given that adolescence is characterized by unique and rapid changes in biopsychosocial processes, it is imperative to elucidate the relationship between these variables in youth. In this cross-sectional study, we explored whether obsessive-compulsive symptoms, thought-action fusion, thought-shape fusion, and eating pathology would be positively associated with and predict depressive symptoms in a school-based community sample of adolescents (n = 86; Mage = 15.60). All study variables were positively correlated with depressive symptoms. Results indicated that obsessive-compulsive symptoms, thought-shape fusion, and eating pathology explained a significant proportion of variance in depressive symptoms, whereas thought-action fusion did not. In accordance with the cognitive behavioral model of psychopathology, these findings highlight the relationships between key interrelated correlates of depressive symptoms that may be pertinent targets for prevention and treatment efforts in adolescents.

Factors related to motivation for change in adolescents with eating disorders.

OBJECTIVE: To examine the association between motivation for change and eating disorder symptom severity, the quality of the parent-adolescent relationship and depressive symptom severity in adolescents with eating disorders. METHOD: Fifty-four female adolescents with eating disorders (mean age = 15.8 years, SD = 1.6) participated in this research prior to beginning outpatient treatment. Participants completed the Motivational Stages of Change for Adolescents Recovering from an Eating Disorder, the Eating Disorders Inventory-2, the Relations with Parents scale from the Behavioral Assessment System for Children and Adolescents Self-report and the Child Depression Inventory. RESULTS: Greater motivation for change was associated with less body dissatisfaction, more adaptive parent-adolescent relationships and fewer depressive symptoms. The association between motivation for change and adolescents' perception of their relationship with their parents remained significant even after controlling for age, body dissatisfaction and depressive symptoms. CONCLUSION: Involvement of families in treatment for adolescents with eating disorders may serve to enhance their motivation to recover.

Changing from the inside out? Examining relationships between overweight identification, dieting behaviours, and body measurements over time.

OBJECTIVE: To investigate whether changes in overweight identification were associated with dieting behaviours and body measurements over time. DESIGN: Longitudinal study with assessments at three time points: before and twice during (i.e., baseline, 6 months, 12 months) a 1-year self-directed weight loss attempt. METHOD: Eighty individuals with overweight or obesity (classified by BMI ≥ 25) reported their personal (i.e., I see myself as overweight), social (i.e., I identify/feel strong ties with other overweight people), and affective (i.e., I am pleased to be overweight) overweight identification; dieting behaviours (e.g., eat less, exercise, eat more fruit and vegetables); and had their body measurements taken (i.e., weight, height, body fat, waist circumference). RESULTS: Linear mixed modelling was used to examine between-person differences and within-person changes in overweight identification on dieting behaviours and body measurements over time. Between-person differences mattered for measurements: Higher personal overweight identification was associated with higher BMI, body fat, and waist circumference over time. Higher social overweight identification was associated with higher BMI over time. Within-person changes mattered for behaviours over time: At 12 months, decreases in social overweight identification were associated with increases in a subset of 'Eat Less, Move More' dieting behaviours, but not a subset of 'Healthy' dieting behaviours. At 12 months, decreases in affective overweight identification were also associated with increases in 'Eat Less, Move More' dieting behaviours. CONCLUSION: Addressing different aspects of overweight identification and how they change over time, may harness an important psychological pathway to support behavioural change and health irrespective of weight loss. Statement of contribution What is already known on this subject? Psychological factors, such as self-concept clarity and weight stigma, are associated with dieting behaviours and body measurements. Qualitative data suggest that identity change may be tied to dieting behaviours and weight loss. What does this study add? New insights into the nature of another psychological factor, overweight identification, among individuals with overweight and obesity attempting to lose weight. The first quantitative evidence that different aspects of overweight identification, and changes in these aspects of overweight identification over time, influence body measurements and dieting behaviours.

How do adolescents with bulimia nervosa rate the acceptability and therapeutic relationship in family-based treatment?

OBJECTIVE: To describe therapeutic alliance and treatment acceptability ratings of adolescents with bulimia nervosa (BN) participating in family-based treatment (FBT-BN) and to explore how participant characteristics relate to these constructs. METHOD: Adolescents with BN (n = 80) in a randomized controlled trial comparing FBT-BN and individual supportive psychotherapy (SPT), completed the Eating Disorder Examination, Rosenberg Self-esteem Scale, and Beck Depression Inventory prior to treatment. The Helping Relationship Questionnaire, patient expectancy for treatment, treatment suitability, and self-reported estimates of improvement ratings were obtained at multiple points throughout treatment. RESULTS: Therapeutic alliance and treatment acceptability ratings were positive in both treatments and generally did not differ. Within FBT-BN, more severe eating disorder symptomatology pretreatment was related to lower alliance ratings mid-treatment (p < .05). However, reductions in binge and purge behaviors over the course of treatment were not related to alliance or acceptability for participants in FBT-BN (all p's > .10). CONCLUSION: Contrary to expectations of FBT-BN, adolescents receiving both treatments develop a strong alliance with the therapist.

Assessing readiness for change in adolescents with eating disorders.

The Readiness and Motivation Interview (RMI) is a semistructured interview measure of readiness and motivation to change that can be used for all eating disorder diagnoses. The RMI has demonstrated excellent psychometric properties and has both clinical and predictive utility in adult samples. This study examined the psychometric properties of the RMI in a younger population, namely, 12- to 18-year-old girls with eating disorders. Study participants (N = 65) completed the RMI and measures of convergent, discriminant, and criterion validity. Adolescents with eating disorders were able to conceptualize and articulate their readiness for change and to report the extent to which change efforts were for themselves versus for others. RMI readiness profiles across eating disorder symptom domains in adolescents were comparable to those in adults, with higher reported readiness to change binge eating than to change dietary restriction or compensatory strategies. Differences in internal consistency between adult and adolescent samples are discussed. Interviewing adolescents early in treatment about readiness may assist clinicians in forming an alliance with this difficult-to-engage population, while also providing valuable information for treatment planning.

A qualitative analysis of aspects of treatment that adolescents with anorexia identify as helpful.

This study aimed to identify aspects of treatment that adolescents with anorexia nervosa (AN) believe are helpful or unhelpful. Adolescent females receiving treatment for AN or subthreshold AN (n=21) were prompted during semi-structured interviews to generate responses to open-ended questions on what they felt would be most helpful or unhelpful in treating adolescents with eating disorders. Eight codes were developed and the two most frequently endorsed categories were (1) Alliance, where the therapist demonstrates clinical expertise and also expresses interest in the patient (n=21, 100.0%), and (2) Client Involvement in treatment (n=16, 76.2%). These top two categories were shared by participants with AN versus subthreshold AN and participants with high versus low readiness to change their dietary restriction behaviours. Development of the coding scheme and sample participant responses will be discussed. The integration of identified factors into empirically supported treatments for adolescent AN, such as Family-based Treatment, will be considered. This study provides initial information regarding aspects of treatment that adolescents identify as most helpful or unhelpful in their treatment.

Therapeutic engagement: Perspectives from adolescents with eating disorders.

This study aimed to identify factors that adolescents with eating disorders (ED) consider important for therapeutic engagement, and to examine similarities and differences in the number of identified factors considered important for therapeutic engagement based on diagnostic status and readiness and motivation to change dietary restriction behaviors. Treatment seeking adolescent females (n=34, Mage=16.33, SD=1.34) with an ED were prompted to generate responses to 4 constructs related to therapeutic engagement: (1) Trust, (2) Agreement on therapeutic goals, (3) Confidence in Ability to Change and (4) Feelings of Inclusion in therapeutic decisions. A coding scheme for each construct was developed using a random sample of responses, and each category within a construct was rated as present or absent for each participant. Frequencies and percentages of participants who reported each category within each construct are reported. Additionally, findings indicate that the top two out of three categories reported within each construct were the same between participants with AN versus EDNOS, and between participants high and low in readiness and motivation to change dietary restriction behaviors. This study is a first step in identifying aspects of therapeutic engagement that are important to adolescents with ED, which may differ from adults.

Temporal associations between disordered eating and nonsuicidal self-injury: examining symptom overlap over 1 year.

Disordered eating (DE) and nonsuicidal self-injury (NSSI) commonly co-occur. This study compared several models of the longitudinal relationship between DE and NSSI, including concurrent and prospective models, and examined the possible moderating roles of self-objectification, impulsivity, and emotion dysregulation in these relationships. Individuals with NSSI (N=197) recruited from online forums completed measures of NSSI and DE every 3 months for 1 year. We tested the associations between NSSI and DE using hierarchical linear models. Results supported a concurrent relationship, wherein frequency of NSSI positively covaried with concurrent DE severity. Body surveillance moderated the concurrent relationship between NSSI and DE. Individuals who engaged in more body surveillance endorsed high levels of DE pathology, whereas those lower in body surveillance engaged in more frequent NSSI only at higher levels of DE. In addition, whereas DE did not prospectively predict NSSI, frequency of NSSI predicted more severe DE 3 months later. The prospective relationship between DE and later NSSI was moderated by emotion dysregulation, such that highly dysregulated individuals had a stronger relationship between DE and later NSSI, whereas this relationship was not significant among individuals low in emotion dysregulation. These findings add valuable information regarding the co-occurrence of self-damaging behaviors.

Body-related social comparison and disordered eating among adolescent females with an eating disorder, depressive disorder, and healthy controls.

The purpose of this study was to investigate the association between body-related social comparison (BRSC) and eating disorders (EDs) by: (a) comparing the degree of BRSC in adolescents with an ED, depressive disorder (DD), and no psychiatric history; and (b) investigating whether BRSC is associated with ED symptoms after controlling for symptoms of depression and self-esteem. Participants were 75 girls, aged 12-18 (25 per diagnostic group). To assess BRSC, participants reported on a 5-point Likert scale how often they compare their body to others'. Participants also completed a diagnostic interview, Eating Disorders Inventory-2 (EDI-2), Beck Depression Inventory-II (BDI-II), and Rosenberg Self-Esteem Scale (RSE). Compared to adolescents with a DD and healthy adolescents, adolescents with an ED engaged in significantly more BRSC (p ≤ 0.001). Collapsing across groups, BRSC was significantly positively correlated with ED symptoms (p ≤ 0.01), and these associations remained even after controlling for two robust predictors of both ED symptoms and social comparison, namely BDI-II and RSE. In conclusion, BRSC seems to be strongly related to EDs. Treatment for adolescents with an ED may focus on reducing BRSC.

A Case Series of Family-Based Therapy for Weight Restoration in Young Adults with Anorexia Nervosa.

This case series aims to examine the preliminary efficacy, acceptability and feasibility of Family-Based Treatment to promote weight restoration in young adults with anorexia nervosa. Four young adults with sub/threshold anorexia nervosa were provided 11-20 sessions of Family-Based Treatment for young adults with pre-, post- and follow-up assessments. At post- and follow-up, 3/4 participants were in the normal weight range, 3/4 were in the non-clinical range on the Eating Disorders Examination and reported being not/mildly depressed. At post-treatment, 2/4 were in the good psychosocial functioning range and by follow-up, 3/4 were in this range. These results suggest that Family-Based Treatment for young adults with anorexia nervosa is a promising treatment.