The Social Appearance Anxiety Scale in Italian Adolescent Populations: Construct Validation and Group Discrimination in Community and Clinical Eating Disorders Samples.

Anxiety in situations where one's overall appearance (including body shape) may be negatively evaluated is hypothesized to play a central role in Eating Disorders (EDs) and in their co-occurrence with Social Anxiety Disorder (SAD). Three studies were conducted among community (N = 1995) and clinical (N = 703) ED samples of 11- to 18-year-old Italian girls and boys to (a) evaluate the psychometric qualities and measurement equivalence/invariance (ME/I) of the Social Appearance Anxiety (SAA) Scale (SAAS) and (b) determine to what extent SAA or other situational domains of social anxiety related to EDs distinguish adolescents with an ED only from those with SAD. Results upheld the one-factor structure and ME/I of the SAAS across samples, gender, age categories, and diagnostic status (i.e., ED participants with and without comorbid SAD). The SAAS demonstrated high internal consistency and 3-week test-retest reliability. The strength of the inter-relationships between SAAS and measures of body image, teasing about appearance, ED symptoms, depression, social anxiety, avoidance, and distress, as well as the ability of SAAS to discriminate community adolescents with high and low levels of ED symptoms and community participants from ED participants provided construct validity evidence. Only SAA strongly differentiated adolescents with any ED from those with comorbid SAD (23.2 %). Latent mean comparisons across all study groups were performed and discussed.

Body Dissatisfaction and Eating Disorder Symptomatology: A Latent Structural Equation Modeling Analysis of Moderating Variables in 18-to-28-Year-Old Males.

Although body dissatisfaction is recognized as the strongest risk factor for eating disturbances, a majority of young males are body dissatisfied, but do not concomitantly report severe levels of eating disorder symptomatology. The present investigation was designed to examine five theoretically relevant variables (i.e., body checking, emotional dysregulation, perfectionism, insecure-anxious attachment, and self-esteem) as potential moderators of the relationship between body dissatisfaction and two critical components of male eating disorder symptomatology: drive for muscularity and bulimic behaviors. Data collected from 551 Italian males between 18 and 28 years old were analyzed using latent structural equation modeling. The authors found that emotional dysregulation, body checking, insecure-anxious attachment and perfectionism intensified the relationship between body dissatisfaction and each criterion variable representing male eating disorder symptomatology; the interactions accounted respectively for an additional 2%, 7%, 4% and 5% of variance in drive for muscularity and for an additional 6%, 4%, 5%, and 2% of the variance in bulimic behaviors. By contrast self-esteem weakened this relationship and the interactions accounted for an additional 3% of the variance in both drive for muscularity and bulimic behaviors. Implications of these findings for prevention and treatment of male eating disturbances are discussed.

Testing the original and the extended dual-pathway model of lack of control over eating in adolescent girls. A two-year longitudinal study.

Stice's (1994, 2001) dual pathway model proposed a mediational sequence that links body dissatisfaction to lack of control over eating through dieting and negative affect. Van Strien et al. (2005) extended the negative affect pathway of the original dual pathway model by adding two additional intervening variables: interoceptive deficits and emotional eating. The purpose of this study was to test and compare the original and extended model using prospective data. Both types of loss of control over eating (i.e., subjective and objective binge eating) were evaluated. Data collected from 361 adolescent girls, who were interviewed and completed self-report measures annually over a 2-year period, were analysed using structural equation modeling. Although both models provided a good fit to the data, the extended model fit the adolescent girls' sample data better and accounted for a greater proportion of variance in binge eating than the original model. All proposed mediational pathways of both models were supported and all indirect effects examined through bootstrap procedure were significant. Although our results confirmed the validity of both models and extended previous findings to an early- to middle adolescent group, the bi-directional relationship between dietary restriction and negative affect suggests that the association between these key risk factors for binge eating are more complex than outlined in both the original and extended dual-pathway models.

Why do only a minority of men report severe levels of eating disorder symptomatology, when so many report substantial body dissatisfaction? Examination of exacerbating factors.

In recent years research employing female samples has indicated that although body dissatisfaction may be necessary for the onset of an eating disorder, it is not sufficient. This study examined body surveillance and difficulties in interpersonal domains (attachment anxiety and social anxiety) as potential moderators of the body dissatisfaction-eating disorder symptomatology relationship amongst Italian college men (N = 359). As expected, all examined variables were found to intensify this relationship such that body dissatisfaction was strongly related to men's eating disorder symptomatology when each moderator was at its highest level (i.e., 1 SD above the mean). Practical implications are discussed.

Comprehensive examination of the trans-diagnostic cognitive behavioral model of eating disorders in males.

The Trans-diagnostic Model (TM) of eating pathology describes how one or more of four hypothesized mechanisms (i.e., mood intolerance, core low self-esteem, clinical perfectionism and interpersonal difficulties) may interrelate with each other and with the core psychopathology of eating disorders (i.e., over-evaluation of weight and shape) to maintain the disordered behaviors. Although a cognitive behavioral treatment based on the TM has shown to be effective in treating eating disorders, the model itself has undergone only limited testing. This is the first study to both elaborate and test the validity of the TM in a large sample (N=605) of undergraduate men. Body mass index was controlled within structural equation modeling analyses. Although not all expected associations for the maintenance variables were significant, overall the validity of the model was supported. Concern about shape and weight directly led to exercise behaviors. There was a direct path from binge eating to exercise and other forms of compensatory behaviors (i.e., purging); but no significant path from restriction to binge eating. Of the maintaining factors, mood intolerance was the only maintaining variable directly linked to men's eating disorder symptoms. The other three maintaining factors of the TM indirectly impacted restriction through concerns about shape and weight, whereas only interpersonal difficulties predicted low self-esteem and binge eating. Potential implications for understanding and targeting eating disturbances in men are discussed.

Attachment insecurities, maladaptive perfectionism, and eating disorder symptoms: a latent mediated and moderated structural equation modeling analysis across diagnostic groups.

Although 96-100% of individuals with eating disorders (EDs) report insecure attachment, the specific mechanisms by which adult insecure attachment dimensions affect ED symptomatology remain to date largely unknown. This study examined maladaptive perfectionism as both a mediator and a moderator of the relationship between insecure attachment (anxiety and avoidance) and ED symptomatology in a clinical, treatment seeking, sample. Insecure anxious and avoidant attachment, maladaptive perfectionism, and ED symptomatology were assessed in 403 participants from three medium size specialized care centres for EDs in Italy. Structural equation modeling indicated that maladaptive perfectionism served as mediator between both insecure attachment patterns and ED symptomatology. It also interacted with insecure attachment to predict higher levels of ED symptoms - highlighting the importance of both insecure attachment patterns and maladaptive aspects of perfectionism as treatment targets. Multiple-group comparison analysis did not reveal differences across diagnostic groups (AN, BN, EDNOS) in mediating, main and interaction effects of perfectionism. These findings are consistent with recent discussions on the classification and treatment of EDs that have highlighted similarities between ED diagnostic groups and could be viewed through the lens of the Trans-theoretical Model of EDs. Implications for future research and intervention are discussed.

Italian version of the Dutch Eating Behavior Questionnaire. Psychometric proprieties and measurement invariance across sex, BMI-status and age.

The purpose of this study was to examine the basic psychometric proprieties of the Dutch Eating Behavior Questionnaire (DEBQ) and its measurement invariance across sex, BMI-status (normal weight/overweight), and age in a community sample of 990 Italian adults. The analysis of the dimensionality of the DEBQ using exploratory factor analysis revealed the existence of three major factors - emotional, restrained and external eating. Single and multi-group confirmatory factor analyses replicated the three-factor structure, and this dimensional structure proved to be invariant across sex, BMI-status, and age. Findings upheld the criterion-related validity (e.g., via its associations with Eating Attitudes Test-26). The DEBQ's subscales displayed high internal consistency and test-retest reliability over a 4-week period. Statistically significant differences were found when sex, BMI and age groups are compared in the latent means of emotional, external and restrained eating and they are discussed with reference to theory, past and recent empirical findings. Overall, results support the measurement invariance of the DEBQ and suggest that the Italian version is a psychometrically reliable, valid and useful measurement instrument for assessing adult eating behaviors.

Disordered eating behaviors among Italian men: objectifying media and sexual orientation differences.

Objectification theory was tested as a suitable framework for explaining sexual orientation differences in disordered eating behaviors in college-aged Italian men. The theory's applicability to 125 homosexual and 130 heterosexual men was investigated using self-report questionnaires. Gay men scored significantly higher on exposure to sexually objectifying media, body surveillance, body shame, disordered eating behaviors, and depression than heterosexual men. Although path analyses support the theory's applicability to both groups, for gay men the path model demonstrated a better fit to the objectification theory for disordered eating and depression. Practical implications are discussed.