Working out measurement overlap in the assessment of maladaptive exercise.

OBJECTIVE: Although exercise is generally considered healthy, many individuals engage in maladaptive exercise (e.g., compulsive in nature). Several definitions of maladaptive exercise exist, leading to multiple, varied assessment tools; assuming homogeneity across these assessments contributes to low consensus in etiological models. METHOD: We used a Jaccard Index to quantify content overlap among 15 commonly-used self-report instruments measuring maladaptive exercise, with 31 features identified across 224 items. RESULTS: The most common features were exercise to control weight/shape and to avoid negative affect (both included in 9/15 instruments), or compensate for calories consumed (8/15 instruments). Overlap among instruments was low (.206) and no features were common across all instruments. CONCLUSIONS: Findings generally support theoretical models of exercise in eating pathology. However, instruments most commonly used to assess maladaptive exercise measure heterogenous content. Careful consideration should be taken when comparing findings derived from differing instruments, when synthesizing literature on maladaptive exercise, and when selecting instruments to measure specific maladaptive exercise features. PUBLIC SIGNIFICANCE: Many, varied, tools exist for the assessment of maladaptive exercise (e.g., compulsive or compensatory) in the context of eating disorders. Assuming homogeneity across tools contributes to low consensus in the field. We used a Jaccard Index to quantify content overlap among 15 self-report instruments measuring maladaptive exercise. The most commonly used instruments measure heterogenous content. Careful consideration should be taken when synthesizing literature and selecting instruments to use in research.

Clinical characterization of Co-morbid autoimmune disease and eating disorders: a retrospective chart review.

Research suggests a link between autoimmune illnesses (AI) and eating disorders (ED). We retrospectively reviewed charts of adolescent patients presenting for eating disorder treatment. We compared the presentation and treatment course for those with an ED and comorbid AI [with (GI-AI, N = 59) or without (non-GI, N = 21) gastrointestinal inflammation] with matched ED-only cases. The sample was overwhelmingly female, with an average age of 15.40. Weight gain trajectories differed across groups, with similar rates of weight gain between controls and non GI-AI cases and with a lower rate of weight gain for individuals with comorbid GI-AI. Over half (56%) of patients reported an AI diagnosis prior to ED; 38% reported an AI diagnosis following ED, and 6% reported ED and AI simultaneous diagnosis. On presentation, ED-only controls had higher rates of comorbid anxiety than cases in either AI group, while those with non-GI AI were more likely to report depression. Mean total GI symptoms, % goal weight at presentation, vital sign instability, and markers of refeeding syndrome did not differ across groups. Health care professionals treating patients with either condition should have a low threshold for asking additional questions to identify the presence of the other condition.

The buffet challenge: a behavioral assessment of eating behavior in adolescents with an eating disorder.

OBJECTIVE: Eating disorders are characterized by disturbances in nutritional intake and abnormal mealtime behaviors. Laboratory eating paradigms offer a unique opportunity to accurately measure dietary intake and eating behaviors, however, these studies have predominantly occurred in adults. This paper describes the development and preliminary psychometric examination of the Buffet Challenge, a laboratory-based meal task for youths with an eating disorder. METHOD: We recruited and assessed 56 participants as part of a randomized controlled trial of Family-Based Treatment for adolescents with anorexia nervosa. Adolescents completed the Buffet Challenge at baseline, midway through treatment (~ week 16 of a 6 months course), and end of treatment. Participants and their parents also reported eating disorder symptomatology and treatment related variables of interest were recorded. RESULTS: All adolescents were willing to complete the Buffet Challenge at all time points, although one refused to give up their cellphone, and there were no significant adverse events recorded. Preliminary results are presented. CONCLUSIONS: Our initial pilot of this task in adolescents with anorexia nervosa demonstrates its acceptability, although investigation of our hypotheses was hindered by significant missing data due to COVID-related research shutdowns. Future studies should replicate procedures in a larger sample to ensure analyses are adequately powered.

Modifying an Open Science Online Grocery for parents of youth with anorexia nervosa: A proof-of-concept study.

OBJECTIVE: For youth with anorexia nervosa (AN), remission requires high caloric goals to achieve weight restoration, consumption of a wide variety of calorically dense foods, and reintroduction of eliminated foods. Family-based treatment (FBT), the gold-standard treatment for youth with AN, empowers parents to renourish their child and restore them to health; yet, parents often report struggling with shifting meal planning and grocery shopping behaviors to focus on nutritional rehabilitation and weight restoration. METHODS: This proof-of-concept study aimed to modify a simulated grocery store (Open Science Online Grocery [OSOG]) for parents of youth with AN and explore the acceptability and feasibility of its use as part of standard care. Study staff collaborated with six parent research partners to modify the OSOG prior to piloting it with participants. Participants were 10 parents of youth undergoing a first-time hospitalization for medical stabilization of AN or atypical AN. Parents completed a battery of measures and a semistructured interview assessing the acceptability and feasibility of OSOG. RESULTS: Parents described the tool as credible and acceptable. Qualitative feedback highlighted common themes of caregiver burden, nutrition education, and acceptability of the tool. DISCUSSION: Results point to the need for more work in supporting parents in Phase I of FBT. PUBLIC SIGNIFICANCE: Families are instrumental in supporting youth to recover from anorexia nervosa. During treatment, parents are charged with selecting and serving their adolescent's meals, often requiring them to change grocery shopping and food preparation habits to meet their child's high caloric needs. Parents reported feeling overwhelmed by this task and noted struggling with learning different approaches to nourish their adolescent during an already stressful time. Collaboratively with parents, we modified a tool to support parents in shifting thier shopping habits, which they reported as being a helpful springboard in the early phase of treatment.

Medical and physiological complications of exercise for individuals with an eating disorder: A narrative review.

Individuals with eating disorders (ED) experience prolonged malnutrition, binge episodes, and compensatory behaviours that affect every organ system. Psychological and physiological symptoms are worsened with comorbid dysfunctional exercise, seen in up to 80% of those with an ED. Although return to exercise is an important component of treatment and recovery, little is known about the contraindications and risks of exercise engagement specific to those with an ED. This paper provides a comprehensive narrative review of the medical and physiological complications of engaging in exercise during ED treatment and outlines when exercise may be contraindicated or used in modified or cautionary ways. We conducted a literature search on MEDLINE, PubMed, and PsychArticles to identify relevant articles, which yielded six categories of medical and physiological complications of ED that may be exacerbated by exercise: energy availability, cardiovascular health, electrolyte abnormalities, biomedical function markers, sex hormones, and body composition. We summarize the evidence for these complications for readers and offer an initial set of recommendations for incorporating exercise during ED treatment based on our findings. This review may serve as a resource for members of ED treatment teams to help evaluate more readily and confidently whether exercise is safe for individual patients and when modifications and caution may be warranted.

Dysfunctional exercise (DEX) is a symptom of eating disorders (ED) that precedes, maintains and exacerbates ED pathology. Health professionals struggle to clinically address and manage DEX as little information is available about its assessment and safe management. The current review provides a comprehensive summary of the medical and physiological complications of ED that may be exacerbated by exercise and outlines when exercise may be contraindicated or used in a modified or cautionary way. The literature review yielded six categories of complications: energy availability, cardiovascular health, electrolyte abnormalities, biomedical function markers, sex hormones, and body composition. We summarize the evidence for these complications for readers and offer an initial set of recommendations for incorporating exercise during ED treatment based on our findings. This review may serve as a resource for members of ED treatment teams to help evaluate more readily and confidently whether exercise is safe for individual patients and when modifications and caution may be warranted.

Monitoring and treating hypoglycemia during meal-based rapid nutritional rehabilitation in patients with extreme anorexia nervosa.

PURPOSE: Hypoglycemia, a complication of prolonged starvation, can be life-threatening and is presumed to contribute to the high mortality of anorexia nervosa. Furthermore, early refeeding in severe anorexia nervosa can precipitate paradoxical post-prandial hypoglycemia. Few studies have analyzed the course of hypoglycemia during nutritional rehabilitation in patients with extremely low-weight anorexia nervosa. No standard practice guidelines exist and recommended strategies for managing hypoglycemia (i.e., nasogastric feeds, high-fat diets) have limitations. METHODS: This cohort study assessed prevalence and correlates of hypoglycemia in 34 individuals with very low body mass index (BMI < 14.5 kg/m2) anorexia nervosa treated in an intensive eating disorders program with an exclusively meal-based rapid weight gain nutritional protocol. Hypoglycemia was monitored with frequent point of care (POC) glucose testing and treated with oral snacks and continuous slow intravenous 5% dextrose in 0.45% saline (IV D5 1/2 NS) infusion. RESULTS: POC hypoglycemia was detected in 50% of patients with highest prevalence noted on the day of admission. Hypoglycemia resolved during the first week of hospitalization in most cases and was generally asymptomatic. Seven patients (20.6%) experienced at least one episode of severe hypoglycemia with POC glucose < 50 mg/dl. Lower admission BMI was associated with higher likelihood of developing hypoglycemia and longer duration of hypoglycemia. CONCLUSION: Meal-based management of hypoglycemia supplemented by continuous IV D5 1/2 NS appears a viable alternative to alternate strategies such as enteral tube feeding. We discuss recommendations for hypoglycemia monitoring during nutritional rehabilitation and directions for future research. LEVEL OF EVIDENCE: Level III, retrospective cohort study.

Autistic characteristics in youth with anorexia nervosa before and after treatment.

OBJECTIVE: Cognitive characteristics common to autistic individuals are often seen in adults with anorexia nervosa (AN), raising the question of whether autistic people and people with AN may share an endophenotype. We need to examine autistic characteristics during the early stages of AN to accurately parse true symptom co-occurrence from behavioural alterations due to prolonged illness. METHODS: We conducted a post-hoc analysis examining autistic characteristics in 59 youth with AN. Adolescents and parents participating in a randomised-clinical trial for AN completed questionnaires probing autistic characteristics at baseline and treatment end. We categorised participants as above or below cut-offs of clinical indicators of autism using the Autism Probability Index (API) and the Autism Spectrum Quotient-10. RESULTS: Rates of high autistic characteristics ranged between 0% and 36% depending on the instrument used and how the data was obtained (i.e., by informant report or self-report). Paternal report of autistic characteristics differed across treatment completers versus non completers and maternal report indicated lower weight gain for those with elevated characteristics. CONCLUSIONS: Low rates of autism and fluctuations in autistic features during treatment underscore the importance of longitudinal examinations of autistic characteristics in adolescents with AN. Future studies need to replicate findings in a larger adolescent sample. TRIAL REGISTRATION: ClinicalTrails.gov Identifier NCT03928028.

Chinese translation of the Clinical Impairment Assessment (CIA 3.0): Psychometric properties and measurement invariance across sex and age in adolescents, young adults, and adult men.

The Clinical Impairment Assessment (CIA) is the most widely used instrument for assessing psychosocial impairment related to eating disorders (EDs). The CIA was translated into Chinese based on standard procedures. The psychometric properties of the Chinese CIA (C-CIA) were assessed among four adolescent and adult samples [i.e., 792 junior high school students (47.0% boys; Mage = 13.09 years), 1324 senior high school students (44.2% boys; Mage = 16.06 years), 812 undergraduate students (36.3% boys; Mage = 18.88 years), and 406 male adults from a general population (Mage = 28.53 years)]. The three-factor structure of the CIA was replicated. Excellent internal consistencies of the C-CIA were revealed, α = 0.93-0.98. The C-CIA showed moderate and good test-retest reliability in a six-month interval for junior high school students (ICC = 0.69) and senior high school students (ICC = 0.76), respectively. The C-CIA had good test-retest reliability in a two-week interval for undergraduate students (ICC = 0.78) and general adult men (ICC = 0.81). Our results supported good construct validity, known-group validity of the C-CIA, and measurement invariance across sex and age. These findings suggest that the C-CIA can be a useful tool assessing psychosocial impairment related to EDs for Chinese adolescents, young adults, and adult men.

The landscape of eating disorders research: A 40-year bibliometric analysis.

OBJECTIVE: Employing bibliometric methods, the present study aimed to map out the general landscape of existing research on eating disorders (EDs) over the past decades. METHOD: Using the Web of Science database, we retrieved 41,917 research articles related to EDs published from 1981 to 2020. After removing those without an abstract, a total of 37,446 articles were retained. The study outlined the distribution of scholarship by time, languages, regions, and countries, and identified major research lines by applying latent topic modelling. RESULTS: Results revealed a general increasing trend in the number of publications on EDs research, and researchers from Western countries dominated the production of related scholarship. The distribution of published scholarship varied significantly by languages, regions, and countries. Seven main research topics emerged from past research (i.e., animal studies of food intake, risk factors and at-risk groups for eating disorders, body image in eating disorders, studies of cognition and brain in eating disorders, symptomatology and comorbidity of eating disorders, body weight and nutrition status in eating disorders, and treatment of eating disorders), with different topics showing unique research trends across the years. CONCLUSIONS: This bibliometric analysis presents the most complete up-to-date overview on published research on EDs. While there is an increasing trend for EDs research, the available research evidence is generally from Western countries; thus, it is suggested that cooperation on EDs research should be strengthened between Western countries and other countries in the future.

Eating disorders during the COVID-19 pandemic and quarantine: an overview of risks and recommendations for treatment and early intervention.

Individuals with eating disorders (EDs) are at significant risk for increases in symptomatology and diminished treatment access during the COVID-19 pandemic. Environmental precautions to limit coronavirus spread have affected food availability and access to healthy coping mechanisms, and have contributed to weight-stigmatizing social media messages that may be uniquely harmful to those experiencing EDs. Additionally, changes in socialization and routine, stress, and experiences of trauma that are being experienced globally may be particularly deleterious to ED risk and recovery. This paper presents a brief review of the pertinent literature related to the risk of EDs in the context of COVID-19 and offers suggestions for modifying intervention efforts to accommodate the unique challenges individuals with EDs and providers may be experiencing in light of the ongoing public health crisis.

Behavioral reinforcement of pathological exercise in anorexia nervosa.

Pathological exercise in anorexia nervosa (AN) is a harmful behavior associated with a chronic course and poor prognosis. To date, no comprehensive theoretical model exists to describe pathological exercise in the context of AN, and as such, few treatments are effective at promoting direct and sustained pathological exercise extinction. Using a framework put forth by Wise & Koob (2014), debating the relative importance of positive and negative reinforcement in substance use, we present three hypotheses of behavioral reinforcement of exercise, encompassing biological, psychological, and environmental influences. Specifically, we argue that exercise is positively reinforced through receipt of biological and behavioral rewards, negatively reinforced through avoidance of aversive emotions, and that these two systems work in tandem over time to engrain pathological exercise as a habit. We then present suggestions for testing each of these hypotheses as future directions for the field.

Cultural shifts in the symptoms of Anorexia Nervosa: The case of Orthorexia Nervosa.

Orthorexia Nervosa (ON) is a term describing a fixation on food purity, involving ritualized eating patterns and a rigid avoidance of "unhealthy foods." Those self-identified as having ON tend to focus on food composition and feel immense guilt after eating food deemed "unhealthy." Although not formally recognized as a psychiatric disorder by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), ON has received increasing attention since its identification in 1997. There is ongoing work to establish diagnostic and empirical tools for measuring ON; embedded in this is the question as to whether or not ON is a new eating disorder. In this paper, we argue ON is not a new psychiatric disorder but rather a new cultural manifestation of anorexia nervosa (AN). We begin by providing an overview of historical representations and classification of eating disorders, with a specific focus on AN. This is followed by discussion of the rise in diet culture and healthism since the 19th century. We conclude by examining the diagnostic validity and utility of ON through a discussion of empirical evidence. Classifying ON under the diagnostic umbrella of AN may improve our understanding of factors underlying restrictive eating behaviors.

Rumination & eating psychopathology among trans and nonbinary individuals: A path analysis integrating minority stress.

Ruminative thought patterns, defined as repetitive negative self-focused attention, are considered an avoidant coping strategy for managing stress. As trans and nonbinary (TNB) individuals commonly experience prejudice and discrimination in response to their gender identities (i.e. minority stressors), rumination over these stressors may contribute to heightened risk of psychopathology in these groups. Although rumination is a general risk factor for eating disorder (ED) psychopathology, no studies to date have examined whether eating- or gender-related ruminative patterns relate to maintenance of ED psychopathology for TNB individuals. This cross-sectional study investigated whether levels of rumination (both gender-related and ED-specific) mediated the relationship between minority stress and ED psychopathology. METHOD: Participants were 242 TNB adults (Mage = 24.92, SD = 6.5, Range = 18-70) recruited online, who completed measures of minority stress, gender-related rumination, ED-specific rumination, and ED psychopathology. We used Preacher-Hayes' approach to examine the parallel mediation model, with gender-related and ED-specific rumination as potential mediators. RESULTS: Gender-related rumination did not mediate the relation between gender minority stress and ED psychopathology, Indirect B = -0.00 [95% BCa CI: -0.01, 0.00]; however, ED-specific rumination was significant, indicating partial mediation, Indirect B = 0.01 [95% BCa CI: 0.00, 0.02]. CONCLUSION: As gender minority stress and ED-specific rumination relate to ED psychopathology, it is essential that clinicians adopt an intersectional minority stress framework in understanding ED psychopathology among TNB individuals.

Gastrointestinal symptomatology, diagnosis, and treatment history in patients with underweight avoidant/restrictive food intake disorder and anorexia nervosa: Impact on weight restoration in a meal-based behavioral treatment program.

OBJECTIVE: Gastrointestinal (GI) concerns are often presumed to complicate nutritional rehabilitation for restrictive eating disorders, yet their relationship to weight restoration outcomes is unclear. This retrospective chart review examined GI history and weight-related discharge outcomes in primarily adult, underweight inpatients with anorexia nervosa (AN, N = 107) or avoidant/restrictive food intake disorder (ARFID, N = 22) treated in a meal-based, behavioral eating disorder program. METHOD: Lifetime GI symptomatology, diagnoses, diagnostic tests, and procedures were abstracted from medical records. Generalized linear models examined associations of GI diagnoses, tests, and procedures with discharge BMI and rate of weight gain. RESULTS: Ninety-nine percent of patients reported GI symptomatology and 83% had one or more GI diagnoses; with constipation and GERD most common. GI diagnoses (p <.01) and testing (p <.001) were more common in ARFID than AN. Average inpatient weight gain (1.59 kg/week), and discharge BMI (18.5 kg/m2 ), did not differ by group. Slower weight gain in patients with (1.3 kg/week), versus without (1.7 kg/week), history of tube feeding (p = .02), accounted for a main effect of GI procedures on inpatient rate of gain (p = .01). DISCUSSION: Despite ubiquitous GI symptomatology, meal-based weight restoration achieved average weekly weight gain above recommended APA guidelines for hospitalized patients with an eating disorder. History of tube feeding was associated with slower mean weight gain, which remained, however, within recommended APA guidelines.

Change in normative eating self-efficacy is associated with six-month weight restoration following inpatient treatment for anorexia nervosa.

Anorexia nervosa (AN) is a disorder characterized by rigid and restrictive eating behaviors, resulting in significantly low body weight. While specialized behavioral intensive treatment programs can reliably support individuals with AN to normalize eating and weight control behaviors and achieve weight restoration, prognostic factors predicting relapse following treatment are unclear. We examined whether changes in (i) normative eating self-efficacy, (ii) body image self-efficacy, (iii) drive for thinness, and (iv) body dissatisfaction from inpatient admission to six-month follow-up were associated with weight restoration status at program discharge and at six-month follow-up. The sample comprised 146 participants with AN admitted to a meal-based inpatient-partial hospitalization program. Participants completed questionnaires at inpatient admission and six months following program discharge. Additionally, at follow-up, participants reported the frequency of engaging in normalized eating behaviors since discharge (e.g. eating with others and preparing a balanced meal). The majority (73.3%) of participants attained a BMI > 19 at discharge and 59.6% were weight restored at six-month follow-up. Change in normative eating self-efficacy was significantly associated with weight restoration at follow-up, whereas change in body image self-efficacy, drive for thinness, and body dissatisfaction were not. For each one unit increase in normative eating self-efficacy, patients were 4.65 times more likely to be weight restored at follow-up (p = .002). Additionally, individuals reporting a higher frequency of normalized eating behaviors at follow-up were more likely to be weight restored. Normative eating self-efficacy and normalized eating behaviors may represent vital treatment targets for relapse prevention interventions for this high-risk population.

Registered report: Initial development and validation of the eating disorders safety behavior scale.

Anxiety and eating disorders (EDs) often co-occur, prompting calls to explore anxiety-related maintenance processes in ED samples. Safety behaviors, which function to prevent a feared outcome from occurring or to reduce anxiety associated with a feared stimulus, are observed across anxiety disorders and, along with overt avoidance behaviors, are an important target in treatment. Data suggest that individuals with EDs also engage in safety behaviors. However, no existing assessments provide a comprehensive measure of eating-disorder-specific overt avoidance and safety behaviors. The goal of this Stage 1 Registered Report is to develop a comprehensive self-report measure of ED-specific safety behaviors. In Study 1, we will recruit 50 women with EDs to complete the scale and provide feedback on the response scale. Feedback from these participants will be used to refine the measure. In Study 2, we will evaluate the psychometric properties of the measure in a large sample of women with EDs (n dependent on the size of measurement) and a community sample without current or a history of ED symptoms. We will explore the measure factor structure, known-groups validity by comparing scores from women with EDs to healthy controls, internal consistency, and convergent and divergent validity with other psychological instruments.

The relationship between body weight and dietary restraint is explained by body dissatisfaction and body image inflexibility among young adults in China.

OBJECTIVE: Eating disorders and obesity are commonly recognized as key public health concerns worldwide. Although rates of obesity and disordered eating have traditionally been lower in China than Western countries, these rates are on the rise. As such, interest is growing in identifying mechanisms that may address these conditions. While associations between body weight and dissatisfaction are well established, burgeoning research aims to examine how these factors are related to dietary restraint and body image inflexibility. This study aimed to explore the possible mediation effect of body dissatisfaction and body image inflexibility between body weight (body mass index) and dietary restraint. Furthermore, we explored how these relationships differed across men and women. METHODS: A sample of 1068 young adults (563 females and 505 males) in China participated in the study. Participants completed the Eating Disorder Inventory and Three-Factor Eating Questionnaire as well as the Body Image-Acceptance and Action Questionnaire. RESULTS: Results showed that: (1) body dissatisfaction and body image inflexibility fully mediated the relationship between body mass index and dietary restraint; (2) this model fit both genders, although differences were found in the regression coefficients between the mediation model for men and women. CONCLUSION: These findings support body image dissatisfaction and inflexibility as mediators of the relationship between body weight and dietary restraint, highlighting these as potential mechanisms for treatment. LEVEL OF EVIDENCE: Level III, case-control analytic study.

Acceptability and tolerability of a meal-based, rapid refeeding, behavioral weight restoration protocol for anorexia nervosa.

OBJECTIVE: Safe, tolerable, effective approaches to weight restoration are needed for adults with anorexia nervosa (AN). We examined weight outcomes and patient satisfaction with an integrated, inpatient-partial hospitalization, meal-based behavioral program that rapidly weight restores a majority of patients. METHOD: Consecutively discharged inpatients (N = 149) treated on weight gain protocol completed an anonymous questionnaire assessing treatment satisfaction at inpatient discharge. Responders (107/149) rated their satisfaction with program components, feeling included in treatment, and likelihood of returning, or recommending the program to others. Clinical and demographic data were abstracted by chart review on all cases. RESULTS: Over 70% of adult patients met BMI≥19 kg/m2 by program discharge. Mean inpatient rate of gain was 1.85 kg/week (SD = 0.89). A majority (83.2%) would recommend the program to others and 71.4% endorsed a willingness to return if needed. The behavioral treatment focus was rated highly by 82.9% of respondents and was the strongest predictor of likelihood of referring others. DISCUSSION: Results indicate a behaviorally focused, integrated, meal-based specialty program for eating disorders that includes rapid weight gain is acceptable to most participants. Data have implications for quality care, outcome reporting, and cost-effectiveness of inpatient behavioral weight restoration programs for individuals with AN.

Muscle dysmorphia: A systematic and meta-analytic review of the literature to assess diagnostic validity.

OBJECTIVE: Although muscle dysmorphia (MD) is a new addition to DSM-5 as a specifier of body dysmorphic disorder (BDD), previous studies have treated MD as a stand-alone diagnosis. We aimed to assess the validity of MD as a stand-alone diagnosis via systematic and meta-analytic review of MD literature using both Robins and Guze criteria and additional criteria from Kendler. METHOD: We performed a systematic search of ProQuest, PsycInfo, and PubMed databases for the period of January 1993 to October 2019 resulting in 40 papers to examine Robins and Guze's criteria (clinical picture) as well as those added by Kendler (antecedent validators; concurrent validators; predictive validators). RESULTS: We identified two distinct symptomatic presentations of MD using cluster analysis, a behavioral type and cognitive/behavioral type. For examining the concurrent validators, quantitative meta-analyses differentiated MD populations from controls; however, results were inconclusive in delineating MD from existing disorders. For assessing antecedent and predictive validators, the symptomatic profiles, treatment response, and familial links for MD were similar to those for BDD and for eating disorders. DISCUSSION: We found preliminary support for MD as a clinically valid presentation, but insufficient evidence to determine whether it is best categorized as a specifier of BDD or unique psychiatric condition.

OBJECTIVO: Aunque la dismorfia muscular (MD, por sus siglas en inglés) es una nueva adición al DSM-5 como un especificador del trastorno dismórfico corporal (BDD, por sus siglas en inglés), los estudios previos han tratado la MD como un diagnóstico independiente. El objetivo fue evaluar la validez de la MD como un diagnóstico independiente a través de revisiones sistemáticas y metaanalíticas de la literatura de MD utilizando los criterios de Robin y Guze (1970) y los criterios adicionales de Kendler (1980). MÉTODO: Realizamos una búsqueda sistemática de las bases de datos ProQuest, PsycInfo y PubMed para el período de enero de 1993 a octubre de 2019, lo que resultó en 40 documentos para examinar los criterios de Robins y Guze (cuadro clínico), así como los agregados por Kendler (validadores antecedentes; validadores concurrentes; validadores predictivos). RESULTADOS: identificamos dos presentaciones sintomáticas distintas de MD mediante análisis de conglomerados, una de tipo conductual y una de tipo cognitivo / conductual. Para examinar los validadores concurrentes, los metaanálisis cuantitativos diferenciaron las poblaciones de MD de los controles; sin embargo, los resultados no fueron concluyentes para delinear la MD de los trastornos existentes. Para evaluar los validadores antecedente y predictivo, los perfiles sintomáticos, la respuesta al tratamiento y los vínculos familiares para la MD fueron similares a los de la BDD y los trastornos de la conducta alimentaria. DISCUSIÓN: Encontramos apoyo preliminar para la MD como una presentación clínicamente válida, pero evidencia insuficiente para determinar si se clasifica mejor como un especificador de BDD o una condición psiquiátrica única.

Getting shredded: Development and validation of a measure of muscularity-oriented disordered eating.

This study describes the development and initial psychometric evaluation of the Eating for Muscularity Scale (EMS), a measure of muscularity-oriented disordered eating (MDE) attitudes and behaviors. We conducted a literature review to define the construct of MDE and relevant subdomains. This review informed a large pool of items addressing these subdomains, which were then reduced based on feedback from subject-matter experts. Confirmatory factor analyses (CFA) were conducted to refine the measure and identify latent factors in 2 samples of participants recruited online. Preliminary psychometric evaluation of EMS items was conducted in a subset of the original sample (n = 266). CFA supported a 27-item short form of the measure. The EMS demonstrated high internal consistency (Cronbach's α = .95), moderate to strong concurrent validity with related measures (r = .43-.78), good construct validity using known-group assessment, and strong test-retest reliability (r = .90). These findings provide preliminary support for the EMS as a reliable and valid measure of MDE. The instrument has the potential to support future research to improve clinical understanding and assessment of MDE and its etiology, prevalence, and treatment outcomes. Further studies are required to evaluate the clinical and research utility of the scale. (PsycInfo Database Record (c) 2020 APA, all rights reserved).