A longitudinal network analysis of suicide risk factors among service members and veterans sampled for suicidal ideation or attempt.

BACKGROUND: Suicidal thoughts and behaviors are elevated among active-duty service members (ADSM) and veterans compared to the general population. Hence, it is a priority to examine maintenance factors underlying suicidal ideation among ADSM and veterans to develop effective, targeted interventions. In particular, interpersonal risk factors, hopelessness, and overarousal have been robustly connected to suicidal ideation and intent. METHODS: To identify the suicidal ideation risk factors that are most relevant, we employed network analysis to examine between-subjects (cross-sectional), contemporaneous (within seconds), and temporal (across four hours) group-level networks of suicidal ideation and related risk factors in a sample of ADSM and veterans (participant n = 92, observations n = 10 650). Participants completed ecological momentary assessment (EMA) surveys four times a day for 30 days, where they answered questions related to suicidal ideation, interpersonal risk factors, hopelessness, and overarousal. RESULTS: The between-subjects and contemporaneous networks identified agitation, not feeling close to others, and ineffectiveness as the most central symptoms. The temporal network revealed that feeling ineffective was most likely to influence other symptoms in the network over time. CONCLUSION: Our findings suggest that ineffectiveness, low belongingness, and agitation are important drivers of moment-to-moment and longitudinal relations between risk factors for suicidal ideation in ADSM and veterans. Targeting these symptoms may disrupt suicidal ideation.

Fear of COVID-19, insomnia, and eating disorder symptoms among Iranian college students.

Objective: Eating disorders (EDs), fear of COVID-19, and insomnia have all increased during the COVID-19 pandemic in Western societies. Additionally, fear of COVID-19 and sleep disturbances relate to ED symptoms in Western societies. However, it is unknown whether fear of COVID-19 and insomnia relate to ED symptoms in non-Western countries, such as Iran. Thus, this study examined the relation between fear of COVID-19, insomnia, and ED symptoms among Iranian college students. Specifically, we hypothesized that insomnia and fear of COVID-19 would each uniquely relate to ED symptoms and the interaction between insomnia and fear of COVID-19 would also associate with increased ED symptoms. Method: College students (N =1,043) filled out measures assessing fear of COVID-19, insomnia, and ED symptoms. We ran moderation analyses using linear regression for global ED symptoms and negative binomial regressions for binge eating and purging. Results: Fear of COVID-19 and insomnia had unique effects on global ED symptoms and binge eating. Insomnia, but not fear of COVID-19, had a unique effect on purging. No significant interaction effect was found. Discussion: This study was the first to examine the association between fear of COVID-19 and insomnia on ED symptoms in Iran. Fear of COVID-19 and insomnia should be incorporated into novel assessments and treatments for EDs.

Unsound sleep, wound-up mind: a longitudinal examination of acute suicidal affective disturbance features among an eating disorder sample.

BACKGROUND: Suicide is one of the most commonly reported causes of death in individuals with eating disorders. However, the mechanisms underlying the suicide and disordered eating link are largely unknown, and current assessments are still unable to accurately predict future suicidal thoughts and behaviors. The purpose of this study is to test the utility of two promising proximal risk factors, sleep quality and agitation, in predicting suicidal ideation in a sample of individuals with elevated suicidal thoughts and behaviors, namely those with eating disorders. METHODS: Women (N = 97) receiving treatment at an eating disorder treatment center completed weekly questionnaires assessing suicidal ideation, agitation, and sleep. General linear mixed models examined whether agitation and/or sleep quality were concurrently or prospectively associated with suicidal ideation across 12 weeks of treatment. RESULTS: There was a significant interaction between within-person agitation and sleep quality on suicidal ideation [B(s.e.) = -0.02(0.01), p < 0.05], such that on weeks when an individual experienced both higher than their average agitation and lower than their average sleep quality, they also experienced their highest levels of suicidal ideation. However, neither agitation nor sleep quality prospectively predicted suicidal ideation. CONCLUSIONS: This study was the first to examine dynamic associations between interpersonal constructs and suicidal ideation in individuals with eating disorders. Results suggest that ongoing assessment for overarousal symptoms, such as agitation and poor sleep quality, in individuals with eating disorders may be warranted in order to manage suicidal ideation among this vulnerable population.

Food for thought: Examining the relationship between low calorie density foods in Instagram feeds and disordered eating symptoms among undergraduate women.

BACKGROUND: Ample studies have tested how viewing bodies on social media impacts eating disorder symptoms; however, the relationship between viewing food images on social media and disordered eating remains understudied. This study investigated whether viewing images of healthy, palatable food on Instagram impacted disordered eating attitudes across two samples of undergraduate women. METHODS: This pre-registered online study was conducted at two sites. Participants identifying as female (study 1 n = 222; study 2 n = 214) were randomly assigned to view one of two Instagram feeds - either a feed featuring low calorie, aesthetically pleasing foods or a control condition featuring travel images. Participants completed state measures of disordered eating intentions, self-esteem, and body image before and after viewing the feeds. RESULTS: A main effect of condition on disordered eating intentions was found at the Midwestern site, but not the Southeastern site. CONCLUSIONS: Viewing healthy palatable food images on Instagram could increase risk for disordered eating behaviors among college females. If findings are replicated, individuals vulnerable to disordered eating may benefit from removing these types of feeds from their social media. Further research is needed to determine whether other forms of visual content on Instagram may be associated with disordered eating.

Longitudinal relationships between muscle dysmorphia symptoms and suicidal ideation.

INTRODUCTION: Muscle Dysmorphia (MD) is a severe subtype of body dysmorphic disorder (BDD) that shares symptomatic overlap with eating disorders. Although associations between eating disorders/BDD and suicidality are well documented, research has rarely examined associations between MD symptoms and suicidality, which is concerning given MD is associated with additional suicide risk factors compared with these disorders. Further, existing associations between MD symptoms and suicidality have yet to establish temporal ordering for these relationships. Therefore, the current study investigated longitudinal relationships between MD symptoms and suicidal ideation to establish the direction of the MD-suicidality relationship. METHODS: Participants were 272 US men displaying sub-clinical MD symptoms who completed self-report measurement at three time points over 6 weeks. Longitudinal relationships between MD symptoms and suicidal ideation were examined using a three-wave autoregressive cross-lagged model. RESULTS: Certain MD symptoms were longitudinally predicted by suicidal ideation. Specifically, suicidal ideation longitudinally predicted increased drive for size and appearance intolerance. CONCLUSIONS: Results may suggest that individuals engage in MD symptoms potentially to cope with distressing thoughts of suicide. Clinicians should provide clients with comorbid MD and suicidality with appropriate coping tools to manage distress from suicidal thoughts outside of engaging in compulsive exercise characteristic of MD symptoms.

Conformity to masculine norms, masculine discrepancy stress, and changes in muscle dysmorphia symptoms.

Muscle dysmorphia (MD) is a severe psychiatric illness; however, little is known regarding risk factors for MD development. Conformity to masculine norms may represent a risk factor for MD, but research has yet to establish temporal ordering for these relationships. Masculine discrepancy stress (distress at not amounting to masculine stereotypes) could represent a mechanism underlying these relationships. Therefore, the current study examined longitudinal relationships between conformity to masculine norms, masculine discrepancy stress, and MD symptoms. Participants were 272 men displaying elevated MD symptoms who completed self-report questionnaires at three timepoints. An autoregressive cross-lagged mediation model was specified to examine relationships between conformity to masculine norms and MD symptoms and test if masculine discrepancy stress mediated these relationships. Masculine discrepancy stress did not mediate relationships between masculine norms and MD symptoms. However, MD symptoms predicted increased masculine discrepancy stress, and conformity to masculine norms was related to MD symptoms. MD symptoms were both a predictor and outcome of masculine norms, and signs for relationships differed on the masculine norm endorsed. Conformity to masculine norms may represent a risk factor and outcome for MD symptoms. If clinicians provide clients with tools to reduce rigid adherence to masculine identities, this may prevent MD symptom development.

Testing intrusive thoughts as illness pathways between eating disorders and obsessive-compulsive disorder symptoms: a network analysis.

Obsessive-compulsive disorder (OCD) and eating disorders (EDs) frequently co-occur. Intrusive thoughts are a mechanism that may maintain this comorbidity. This study used network analysis to identify central ED-related intrusive thoughts and tested which intrusive thoughts connected ED and OCD symptoms. Two cross-sectional graphical LASSO networks were computed using a sample of 353 non-clinical participants (mean age = 35.38, SD = 9.9, 40% female, 81.6% Caucasian) with elevated disordered eating symptoms. Model 1 included just ED-related intrusive thoughts, and Model 2 included ED-related intrusive thoughts, ED, and OCD symptoms. In Model 1, we found that thoughts about one's bodily appearance (i.e., looking horrible, getting fat, gaining weight) were most central. In Model 2, we found that desire to lose weight, eating in secret, and shape dissatisfaction were most central. We identified one illness pathway (i.e., difficulty concentrating due to thoughts of food/calories) connecting intrusive thoughts, ED symptoms, and OCD symptoms. However, intrusive thoughts did not bridge ED and OCD symptoms. Hence, we found some evidence that ED-related intrusive thoughts may contribute to ED and OCD symptoms based on thought content and frequency. However, other aspects of intrusive thoughts should be considered to ascertain whether they do in fact significantly contribute to ED and OCD comorbidity. Prevention efforts targeting ED-related intrusive thoughts may attenuate ED and OCD symptoms among subclinical individuals.

Examining weekly relationships between obsessive-compulsive and eating disorder symptoms.

BACKGROUND: Despite the severity and high rate of co-occurrence between eating disorders (ED) and obsessive-compulsive disorder (OCD), less is known regarding the longitudinal sequencing of their comorbidity and whether and how their symptoms may influence one another over time. The current study sought to answer these questions by testing if a bidirectional, longitudinal relationship exists between ED symptoms and OCD obsessions and compulsions. METHODS: We examined the relationship between ED symptoms, obsessions and compulsions across five time points, each one week apart using auto-regressive cross-lagged panel modeling. The final sample consisted of 358 individuals from the community with moderate levels of ED and OCD symptoms, the majority of whom identified as White and male. RESULTS: Bivariate correlations revealed that ED symptoms, obsessions and compulsions were associated with one another across the five weeks. Two cross-lagged panel models indicated that ED symptoms predicted OCD symptoms at numerous time points and vice versa. However, we found this significant longitudinal associations across only certain weeks. Notably, the models found that only ED symptoms and OCD obsessions predicted one another across different time points across the five weeks; ED symptoms and OCD compulsions did not predict one another. LIMITATIONS: Due to the non-clinical nature of the sample, there is limited generalizability to clinical populations. CONCLUSIONS: Our results provide preliminary evidence that there is a bidirectional, longitudinal relationship between ED symptoms and OCD symptoms among a community sample, particularly with respect to cognitive as opposed to behavioral symptoms.

Using shape and weight overvaluation to empirically differentiate severity of other specified feeding or eating disorder.

BACKGROUND: Although no severity specifiers are noted in the Diagnostic and Statistical Manual of Mental Disorders - 5 for other specified feeding or eating disorder (OSFED), shape/weight overvaluation is a proposed eating disorder (ED) severity specifier. We used structural equation modeling (SEM) Trees to empirically determine values of shape/weight overvaluation that differentiate OSFED severity. We additionally tested whether the SEM Tree-defined thresholds or a clinical cutoff for shape/weight overvaluation differentiated severity more meaningfully. METHODS: Participants were 690 females with OSFED presenting to residential ED treatment. SEM Tree analyses specified an outcome model of OSFED severity and then recursively partitioning the outcome model into severity groups. The SEM Tree-defined and clinical cutoff severity groups were compared on clinical characteristics. RESULTS: SEM Trees identified one split that occurred at value 5.12 on our shape/weight overvaluation items from the Eating Disorder Examination Questionnaire. The subgroup with higher overvaluation had significantly greater intensity of ED and depressive symptoms and longer lengths of stay. The subgroups created from the shape/weight overvaluation clinical-cut off value of 4 differed on the same clinical characteristics as the SEM Tree-derived groups, with the exception of laxative use frequency. Effect sizes were larger for the clinical cutoff as compared to the SEM Tree severity specification scheme. LIMITATIONS: These cross-sectional data were used from a predominately white and female residential treatment sample; this likely skewed the subgroups and may limit generalizability. CONCLUSIONS: Shape/weight overvaluation can meaningfully differentiate OSFED severity. The clinical cutoff slightly outperformed the empirically determined thresholds for shape/weight overvaluation.

Relations between implicit attitudes towards eating disorder stimuli and disordered eating symptoms among at-risk college women.

This study examined implicit attitudes towards different eating disorder (ED) relevant stimuli- emaciation, hard-exercise, the self, and eating related stimuli-and their relationship with explicit ED symptoms in two symptomatic samples of college-aged women. Study 1 found that positive implicit attitudes towards eating and self-relevant images were associated with greater state body image satisfaction and self-esteem and with less ED-related intentions. Study 2 found that positive implicit attitudes towards eating and self-relevant images were associated with less trait global ED psychopathology and distress and greater self-esteem. Overall, positive implicit evaluations of eating and self-related stimuli were negatively associated with ED symptoms and related psychopathology and positively related to self-esteem. However, implicit attitudes towards emaciation and hard exercise were not associated with explicit ED symptoms in either sample. These findings suggest that implicit attitudes towards eating and self-related stimuli, in particular, may be viable targets for reconditioning in novel treatment paradigms such as therapeutic evaluative conditioning interventions.

Perfectionism and Difficulty Controlling Thoughts Bridge Eating Disorder and Obsessive-Compulsive Disorder Symptoms: A Network Analysis.

BACKGROUND: Eating disorders (ED) and obsessive-compulsive disorder (OCD) are highly comorbid, but little is known about how this comorbidity is maintained. Prior research suggests that obsessive thoughts and perfectionism may be shared maintenance factors for EDs and OCD. METHODS: The current study used network analysis to (1) identify bridge pathways in an ED-OCD comorbidity network and (2) test if perfectionism symptoms bridge between ED-OCD symptoms in a combined network model including ED, OCD, and Perfectionism symptoms. Participants (N = 1,619) were a mixed sample of undergraduate students and individuals diagnosed with EDs. RESULTS: Difficulty controlling thoughts was the symptom with the highest bridge centrality in both models, connecting with ED-related worry and doubts. In the ED-OCD-Perfectionism comorbidity network, doubts about simple everyday things and repeating things over and over bridged between ED and OCD symptoms. Additionally, specific and distinct pathways were identified between OCD and two types of ED pathology: restricting (checking compulsions and rigidity around food) and binge eating (hoarding and binge eating symptoms). LIMITATIONS: Due to the cross-sectional nature of the data, no directional inferences can be made. Due to a higher OCD symptom prevalence rate than reported in previous studies, our undergraduate sample may not be representative of other college populations. CONCLUSIONS: The presence of intrusive cognitions and maladaptive perfectionism may contribute to the maintenance of co-occurring ED and OCD symptoms. These findings begin to delineate specific pathways among OCD and ED symptoms, which can be used in the development of interventions to disrupt connections among these disorders.