The association of alcohol use and positive and negative urgency to same day objective binge eating in emerging adults.

Introduction: Objective binge eating and problematic alcohol use often co-occur and are common behaviors in emerging adults. Both behaviors are thought to be driven by affect regulation processes. Objective binge eating often occurs in the context of increasing or acute negative affect, and often occurs in solitude. Alcohol use in emerging adults can also be associated with negative affect regulation. However, in contrast to objective binge eating, a large body of research indicates that there are positively valenced pathways to alcohol use in this age group. Emerging adults often drink socially, to enhance enjoyment, and in the context of positive mood. We propose that one pathway to objective binge eating in this developmental period is through alcohol use itself, such that emerging adults who consume alcohol and who are more likely to act impulsively in the context of positive emotion (i.e., have high levels of positive urgency) may be more likely to binge eat following drinking. Methods: We collected data using ecological momentary assessment in 106 undergraduates on positive and negative affect, motives for drinking and eating, and alcohol use and objective binge eating, in addition to baseline questionnaires of impulsivity. Results: There were no significant changes in affect prior to drinking in this sample. Alcohol use at one time point significantly increased odds of objective binge eating at a later time point in the same day. Individual differences in positive urgency, the tendency to act rashly while experiencing positive affect, were also associated with increased odds of objective binge eating that occurred after alcohol use. Individual differences in negative urgency, the tendency to act rashly after experiencing negative affect, did not have a main effect on objective binge episodes, but did interact with alcohol use to increase the odds of objective binge eating following drinking. The vast majority of drinking episodes prior to objective binge eating were social drinking episodes, and participants most commonly endorsed "to have fun" as a reason for drinking. Discussion: Results suggest that alcohol consumption may increase risk for objective binge eating in emerging adults.

Predictors of current suicidal ideation in a multi-diagnostic sample of individuals with eating disorders.

BACKGROUND: Individuals with eating disorders (EDs) have high rates of suicidal ideation (SI) and attempts (SA). Fasting, body dissatisfaction, binge eating and purging have been associated with SI in non-clinical samples, individuals with anorexia nervosa or low-weight EDs, and a multi-diagnostic sample. However, few studies have examined how ED symptoms contribute to risk for SI in conjunction with other well-established risk factors, such as nonsuicidal self-injury (NSSI) and past SA. The aim of this study was to examine which ED symptoms contribute unique risk for current SI in a multi-diagnostic, clinical sample when statistically adjusting for gender, NSSI, past SA, and past SI. METHODS: We conducted a chart review of 166 individuals who presented for ED treatment at an outpatient facility and signed informed consent. Initial intake interviews were coded for the presence versus absence of fasting, fear of weight gain, binge eating, purging, excessive exercise, restriction, body checking, self-weighing, and body dissatisfaction, as well as NSSI, past SA, past SI, and current SI. RESULTS: A total of 26.5% of the sample endorsed current SI. In a logistic regression analysis, identifying as male (n = 17) or having a non-binary gender identity (n = 1), the presence of fasting, and past SI were all significantly associated with increased odds of current SI, whereas excessive exercise significantly decreased odds of current SI. Fasting was equally common across all diagnostic groups. CONCLUSIONS: Future research should establish the temporal relationship between fasting and SI to better inform intervention.

Caregiver and adolescent intuitive eating behavior: associations with weight change during family-based treatment for anorexia nervosa.

PURPOSE: Intuitive eating (IE) is an adaptive eating construct for which little research exists in eating disorder (ED) samples. IE is negatively correlated with disordered eating behaviors in healthy adolescents and adults, and similar associations have been found in adults with EDs. This study aims to examine IE in a treatment seeking sample of adolescents and their caregivers to understand the role of IE in weight gain during FBT. METHODS: Descriptive statistics and bivariate correlations were calculated in a sample of 47 pairs of adolescent patients and their caregivers who initiated outpatient FBT at a large academic medical center. Analyses examined associations between caregiver and adolescent IE on the Intuitive Eating Scale (IES), change in percent expected body weight (%EBW) by session 4 and end of treatment (EOT), clinical impairment, and ED pathology. RESULTS: Significant correlations were found between aspects of adolescent IE, ED symptoms, and clinical impairment. Caregiver IES scores (Reliance on Hunger and Satiety Cues, Body-Food Choice Congruence, IES Total) were negatively related to adolescent ED symptoms (EDE-Q Weight Concerns, EDE-Q Shape Concerns, EDE-Q Global) at baseline. Caregiver IE (Eating for Physical Rather than Emotional Reasons) was positively associated with adolescent weight gain at FBT session 4 and EOT, even when statistically adjusting for gender and initial level of care. CONCLUSION: Study results were consistent with past research indicating adolescent IE is negatively associated with ED behaviors, cognitions, and impairment. This study is the first to provide evidence that caregiver IE is positively associated with adolescent weight gain in FBT and is the first to provide evidence that caregiver IE is negatively related to adolescent ED symptoms. Future research should examine adolescent and caregiver IE throughout FBT to understand the role of IE in treatment response. LEVEL OF EVIDENCE: Level III: Evidence obtained from cohort or case-control analytic studies.

The role of discrimination and adverse childhood experiences in disordered eating.

BACKGROUND: In clinical research, there has been a call to move beyond individual psychosocial factors towards identifying cultural and social factors that inform mental health. Similar calls have been made in the eating disorders (ED) field underscoring the need to understand larger sociocultural influences on EDs. Discrimination is a social stressor that may influence mental health in similar ways to traumatic or adverse childhood experiences (ACEs). Given the high rates of EDs and discrimination among marginalized groups, it is vital to understand the role of discrimination and ACEs as predictors of ED symptoms in these populations. The aim of this study is to examine how perceived discrimination predicts ED pathology when statistically adjusting for gender, race, and ACEs. METHODS: The diverse study sample consisted of 331 undergraduate students from a longitudinal cohort study (ages 18-24; 66% female; 35% White/non-Hispanic). Participants completed measures of everyday discrimination, ACEs, and ED pathology. RESULTS: Following adjustment for multiple statistical comparisons, the frequency of daily discrimination predicted all ED symptoms above and beyond history of ACEs. In follow-up analyses, number of reasons for discrimination predicted cognitive restraint and purging. Differences in ED symptomatology were found based on the reason for discrimination, gender, and race. Specifically, those who experienced weight discrimination endorsed higher scores on all ED symptoms, and those experiencing gender discrimination endorsed higher body dissatisfaction, cognitive restraint, and restriction. People of color endorsed higher restriction, while female participants endorsed higher scores on all ED symptom with the exception of cognitive restraint. CONCLUSION: Discrimination is a salient risk factor for ED symptoms even when accounting for individuals' history of ACEs. Future research should utilize an intersectional approach to examine how perceived discrimination affects ED pathology over time. (Word count: 234).

Adverse childhood experiences (ACEs) increase risk for eating disorders (EDs). Discrimination based on race, gender, and gender and sexual identity is also linked to ED behaviors. This paper examined whether discrimination impacted ED behaviors when ACEs were considered to understand how they both might play a role in risk for EDs. Findings suggest that experiences of discrimination may have a greater impact on eating disorder symptoms in college students than a history of ACEs. More research is needed to understand the negative impacts of discrimination on eating disorders, in addition to history of trauma. Clinicians should attend to the ways discrimination may impact their clients' eating disorder behaviors, and whether individuals experience bias or discrimination when seeking eating disorder treatment.

Eating Disorders and Posttraumatic Stress Disorder: A Network Analysis of the Comorbidity.

Eating disorders (EDs) and posttraumatic stress disorder (PTSD) commonly co-occur, but the mechanisms driving this co-occurrence are not well understood. The current study explored the relationships between symptoms of ED and PTSD in a sample of male and female undergraduate students in order to identify pathways that may maintain the comorbidity. Network analysis was conducted in a sample of 344 first-year undergraduates to visualize partial correlations between each symptom in the comorbidity. Core symptoms, bridge symptoms, and direct pathways between ED and PTSD symptoms were identified. The PTSD symptoms negative emotions (strength = 1.13) and negative beliefs (strength = 1.11) were the strongest symptoms in the network. The strongest bridge nodes were the ED symptoms restriction (bridge strength = 3.32) and binge eating (bridge strength = 2.63). The strongest edges between ED and PTSD nodes were between binge eating and concentration (part r = .16), restriction and sleep (part r = .14), and binge eating and positive emotions (part r = .11). Findings suggest that PTSD symptoms related to negative alterations in cognitions and mood may be highly influential in the ED-PTSD network due to their relatedness to all other symptoms. The pathway between binge eating and inability to experience positive emotions suggest that the comorbidity may be partially maintained through an affect regulation function of binge eating.

Recent Sexual Assault Predicting Changes in Coping Motives for Alcohol Use in First-Year College Women.

Sexual assault and heavy alcohol consumption are common among college students. There is strong evidence that the two are associated, but more remains to be understood about the nature of the relationship. Drinking motives have been found to mediate the relationship between sexual assault and drinking problems and between depression and alcohol risk (Kenney, Anderson, & Stein, 2018; Lindgren, Neighbors, Blayney, Mullins, & Kasen, 2012), however drinking motives have not been studied as an outcome. The current study investigated the impact of a recent sexual assault on the endorsement of coping motives for drinking in first year college women using hierarchical regression analysis with Time 2 coping motives as the outcome variable. Lifetime experience of sexual assault and Time 1 coping motives were entered in the first step of the model and a dichotomous variable indicating a recent sexual assault was entered in the second step of the model. Sexual assault during the first semester of college was found to be a significant predictor of coping motives at the end of the semester after controlling for lifetime history of sexual assault and endorsement of coping motives at Time 1. These findings suggest that coping motives for drinking may change following a sexual assault and are of concern due to the negative outcomes associated with drinking to cope. Drinking motives may be an important target of interventions provided to survivors of sexual assault to reduce risk of future drinking-related problems.