A quantitative assessment of the predictive utility of grit in sport.

In high-performance sport, an athlete's ability to overcome setbacks and sustain their pursuit of long-term goals is essential for success. Grit (i.e., passion and perseverance over long-terms) has been linked to success in a variety of domains but is often critiqued for its limited predictive utility when compared to other psychological variables including self-control, conscientiousness, and mental toughness. The purpose of this study was to examine whether grit predicted important athlete outcomes (i.e., various measures of sport performance and athlete well-being) beyond other determinants of success. Data from 214 collegiate student-athletes (111 women, 103 men; Mage = 21.02, SD = 2.26) from Western Canadian universities were analysed. When predicting performance, the addition of the grit subscales (i.e., consistency of interests, perseverance of effort, adaptability to situations) explained an additional 11% of variance (R2 = 0.37, F[7, 203] = 7.16, p < .001) beyond self-control, conscientiousness, and mental toughness in subjective sport performance perceptions; however, grit did not add unique variance when entered into models predicting athlete goal achievement perceptions or highest level of competition. When predicting well-being, addition of the grit subscales added 18% of unique variance (R2 = 0.43, F[7, 203] = 21.43, p < .001) beyond other determinants of success in eudaimonic well-being, and 5% (R2 = 0.17, F[7, 203] = 6.95, p < .001) in satisfaction with sport, but did not add any unique variance to the model predicting mood. The partial support of the predictive utility of grit illustrates the complexity of forecasting success in sport and offers evidence that grit should continue to be studied as a motivational disposition in the domain of sport.

Exploring the Relationship Between Mental Toughness and Self-Compassion in the Context of Sport Injury.

Helping athletes cope effectively with injury is likely of great interest to many sport stakeholders. Mental toughness is one psychological factor positively associated with resilience and sport performance, though stubborn persistence through injury might not always be conducive to adaptive athlete outcomes. Self-compassion-a balanced, nonjudgmental approach in relating to oneself when experiencing suffering-might help circumvent these pitfalls and complement injury recovery. The purpose of this study was to explore the relationship between mental toughness and self-compassion in a sport injury context. This study consisted of 2 phases-phase I quantitatively assessed the relationships between mental toughness, self-compassion, and other psychological constructs, while phase II used qualitative interviews to corroborate and inform these findings. In phase I, competitive athletes who were injured at the time of data collection (n = 81) completed mental toughness, self-compassion, coping resources, self-esteem, and self-criticism questionnaires. Self-compassion was positively correlated with mental toughness (r = .48, P < .01), coping resources (r = .54, P < .05), and self-esteem (r = .60, P < .01). Self-compassion and self-criticism were negatively correlated with each other (r = -.52, P < .01). Results from hierarchical multiple regression analyses revealed that self-compassion was a significant predictor of mental toughness (ΔR2 = .07, P < .01), coping resources (ΔR2 = .10, P < .01), and self-criticism (ΔR2 = .06, P < .01), beyond the effects of self-esteem. Four injured athletes who scored above the median on mental toughness and self-compassion measures were interviewed in phase II. Thematic analysis generated 2 themes: (1) self-compassion grants access to wise mental toughness and (2) mental toughness helps activate self-compassionate actions during injury. These findings are consistent with recent research and suggest that both mental toughness and self-compassion can work together to help athletes cope with sport injury.

A pilot and feasibility study of a randomized clinical trial testing a self-compassion intervention aimed to increase physical activity behaviour among people with prediabetes.

BACKGROUND: Seventy-five per cent of individuals with prediabetes will eventually be diagnosed with type 2 diabetes. Physical activity is a cornerstone in reducing type 2 diabetes risk but can be a challenging behaviour to adopt for those living with prediabetes. Individuals with prediabetes experience difficult emotions associated with being at risk for a chronic disease, which can undermine self-regulation. Self-compassion enhances self-regulation because it mitigates difficult emotions and promotes adaptive coping. We performed a pilot randomized controlled trial to determine the feasibility and acceptability of a self-compassion informed intervention to increase physical activity for persons with prediabetes. METHODS: This explanatory mixed methods study tested the feasibility and acceptability of a two-arm, randomized, single-blind, actively controlled, 6-week online intervention. Using a 1:1 allocation ratio, participants (identified as people with prediabetes, low physical activity, and low self-compassion) were randomized to a self-compassion (Mage = 60.22 years) or control condition (Mage = 56.13 years). All participants received behaviour change education (e.g. SMART goals, action-coping planning) and either other health knowledge (control condition: e.g. sleep, benefits of water) or self-compassion training (intervention condition: practising mindfulness, writing a letter to themselves offering the same support that they would offer to a friend). The primary outcome was to determine the feasibility and acceptability of the trial. To be considered feasible, our outcomes needed to meet or surpass our pre-determined criteria (e.g. time for group formation: 14-20 participants per month). Feasibility was assessed by examining the recruitment rates, retention, adherence, fidelity, and capacity. Semi-structured interviews were conducted with participants to determine trial acceptability. As a secondary purpose, we examined the means on key study variables (secondary and exploratory variables; see Table 1) at all planned time points (baseline, intervention-end, 6- and 12-week follow-up) to identify if they are suitable to include in the efficacy trial (see Additional Table 3). RESULTS: Eighteen participants were screened and randomized to one of two conditions. Retention, instructor fidelity, safety, capacity, adherence to most of the study aspects, and acceptability by participants and facilitators all met the criteria for feasibility. Recruitment rate, process time, and adherence to home practice were below our criteria, and we offer ways to address these shortcomings for the efficacy trial. CONCLUSION: The results from this study suggest that it should be feasible to deliver our intervention while highlighting the alterations to components that may be altered when delivering the efficacy trial. We outline our changes which should improve and enhance the feasibility and acceptability of our planned intervention. Funding for this study was from the Canadian Institutes of Health Research (CIHR). TRIAL REGISTRATION: ClinicalTrials.gov, NCT04402710 . Registered on 09 April 2020.

The Associations Among Self-Compassion, Self-Esteem, Self-Criticism, and Concern Over Mistakes in Response to Biomechanical Feedback in Athletes.

Athletes regularly face the possibility of failing to meet expectations in training and competition, and it is essential that they are equipped with strategies to facilitate coping after receiving performance feedback. Self-compassion is a potential resource to help athletes manage the various setbacks that arise in sport over and above other psychological resources. The primary purpose of this research was to explore how athletes respond to objective biomechanical feedback given after a performance. Specifically, we investigated if levels of self-compassion, self-esteem, self-criticism, and concern over mistakes were related to one another before and after a series of sprint tests interspersed with biomechanical feedback, and whether self-compassionate athletes achieved a better sprint performance after receiving and implementing biomechanical feedback. Forty-eight athletes (20 female: M age = 19.8 years, SD = 3.1; 28 male: M age = 23.6 years, SD = 7.8) completed online measures of self-compassion, self-esteem, self-criticism and concern over mistakes before performing four sets of 40-m sprints. Participants received personalized biomechanical feedback after each sprint that compared their performance to gold standard results. Following all sprints, they then completed measures of self-criticism, and reported emotions, thoughts, and reactions. Self-compassion was positively correlated with self-esteem (r = 0.57, p < 0.01) and negatively related to both self-criticism (r = -0.52, p < 0.01) and concern over mistakes (r = -0.69, p < 0.01). We also found that athletes with higher levels of self-compassion prior to sprint performance experienced less self-critical thoughts following biomechanical feedback and subsequent sprint trials (r = -0.38, p < 0.01). Although the results of this study provide some support for the effectiveness of self-compassion in promoting healthy emotions, thoughts, and reactions in response to sprint performance-based biomechanical feedback, a moderated regression analysis between the first and fourth sprint time variables revealed that self-compassion was not a moderator for change in sprint performance (R 2 = 0.64, ΔR 2 = 0.10, p > 0.05). These findings suggest that there are likely longer-term benefits of athletes using self-compassion to cope with biomechanical feedback, but that any benefits might be limited in a short series of sprint trials.

"More than just another physical activity program": exploring the GUM program for at-risk adolescent girls.

Physical activity (PA) levels among adolescent girls continue to steadily decline, especially for those classified as 'at-risk'. To mitigate these trends, Girls United and on the Move (GUM) was created as a dual-component PA and psychosocial program. The primary purpose of this study was to explore participant experiences within GUM, with a secondary purpose of qualitatively informing future PA programs for 'at-risk' adolescent girls. Semi-structured interviews (N = 30) were conducted with a purposeful sample of girls from the GUM program. An inductive thematic analysis was utilized to analyze verbatim transcripts. Two themes were generated from the data: 1) Girls uplifting girls, outlining the importance of a girls-only environment and introducing opportunities for alternative PAs, and 2) finding balance between the physical and psychological, detailing the importance of the dual-component program. These findings provide support for the acceptability of an integrated psychosocial and PA program for at-risk adolescent girls.

Exploring the Effectiveness of an Integrated Physical Activity and Psychosocial Program Targeting At-Risk Adolescent Girls: Protocol for the Girls United and on the Move (GUM) Intervention Study.

BACKGROUND: Adolescents are highly susceptible to negative self-perceptions, likely due to their social cues and environment. The presence of these negative self-perceptions has been shown to adversely impact levels of physical activity (PA). Although PA has the ability to foster improved self-perceptions, the rates of PA among adolescents continue to descend, with girls appearing to be most susceptible to these declines. At-risk adolescent girls, who may experience a number of negative preceding lifestyle conditions, may be exceptionally vulnerable to declines in PA. There are a high number of adolescent girls from low-income and abusive households in British Columbia, Canada, thus indicating a need for a program to relay the importance of PA and healthy lifestyle behaviors. OBJECTIVE: This paper aims to describe the protocol of the Girls United and on the Move (GUM) pragmatic intervention, an integrated PA and psychosocial program aimed at improving self-compassion, social connectedness, and overall self-perceptions among at-risk adolescent girls. METHODS: Using a quasi-experimental mixed methods approach, the GUM intervention was conducted in 5 schools in British Columbia, Canada. Adolescent girls aged 11 to 15 years who were identified as at risk were included in the study. The 9-week intervention, co-delivered by a PA/health promotion-trained researcher and a registered social worker, involved a PA component and a psychosocial component with evidence-based topics addressing the concerns of the adolescent girls. The following outcomes were evaluated: PA, self-compassion, social support, leader supportiveness, and sport enjoyment and commitment. Program acceptability and satisfaction was also examined. Outcome measures were assessed at baseline (week 1), week 6, and postintervention (week 9), and interview data concerning program acceptability and satisfaction were collected at postintervention from a subsample of participants. RESULTS: A total of 101 participants were invited to participate in the GUM intervention. Reporting of the results is projected for the fall of 2020. CONCLUSIONS: It is anticipated that the GUM intervention will enhance PA while also improving self-compassion, social connectedness, and overall self-perceptions among at-risk adolescent girls. The findings of this research will contribute to the literature concerning PA and various psychosocial factors that impact the physical and mental health of at-risk adolescent girls. TRIAL REGISTRATION: Clinicaltrials.gov NCT03567200; https://clinicaltrials.gov/ct2/show/NCT03567200. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/15302.

The role of growth and maturation during adolescence on team-selection and short-term sports participation.

BACKGROUND: During adolescence, deselection from sport occurs during team try-outs when month of birth, stage of growth and maturation may influence selection. AIM: The purpose of this study was to identify differences in growth and maturity related factors between those selected and deselected in youth sports teams and identify short-term associations with continued participation. SUBJECTS AND METHODS: Eight hundred and seventy participants, aged 11-17 years, were recruited from six sports try-outs in Saskatchewan, Canada: baseball, basketball, football, hockey, soccer and volleyball. Two hundred and forty-four of the initial 870 (28%) returned for follow-up at 36 months. Chronological (years from birth), biological (years from age at peak height velocity (APHV)) and relative (month of birth as it relates to the selection band) ages were calculated from measures of date of birth, date of test, height, sitting height and weight. Parental heights were measured or recalled and participant's adult height predicted. Reference standards were used to calculate z-scores. Sports participation was self-reported at try-outs and at 36-month follow-up. RESULTS: There was an over-representation of players across all sports born in the first and second quartiles of the selection bands (p < 0.05), whether they were selected or deselected. z-scores for predicted adult height ranged from 0.1 (1.1) to 1.8 (1.2) and were significantly different between sports (p < 0.05). Height and APHV differences (p < 0.05) were found between selected and deselected male participants. In females only weight differed between selected and deselected female hockey players (p < 0.05); no further differences were found between selected and deselected female participants. Four per cent of deselected athletes exited sports participation and 68% of deselected athletes remained in the same sport at 36 months, compared with 84% of selected athletes who remained in the same sport. CONCLUSIONS: It was found that youth who attended sports team's try-outs were more likely to be born early in the selection year, be tall for their age, and in some sports early maturers. The majority of both the selected and deselected participants continued to participate in sport 36 months after try-outs, with the majority continuing to participate in their try-out sport.

Exploring Self-Compassion and Versions of Masculinity in Men Athletes.

Despite a growing emphasis on self-compassion in sport, little research has focused exclusively on men athletes. The purpose of this research was to explore the interaction of self-compassion and diverse versions of masculinity on the psychosocial well-being of men athletes. The authors sampled 172 men athletes (Mage = 22.8 yr) from a variety of sports, using descriptive methodology with self-report questionnaires. Self-compassion was related to most variables (e.g., psychological well-being, fear of negative evaluation, state self-criticism, internalized shame, reactions to a hypothetical sport-specific scenario) in hypothesized directions and predicted unique variance beyond self-esteem across most of those variables, as well as moderated relationships between masculinity and both autonomy and attitudes toward gay men. In addition, self-compassion was differentially related to inclusive and hegemonic masculinity. Our findings support self-compassion as a promising resource for men athletes to buffer emotionally difficult sport experiences.

"I'll do anything to maintain my health": How women aged 65-94 perceive, experience, and cope with their aging bodies.

We explored how physically active women perceived, experienced, and coped with their aging bodies, and examined their perceptions of the utility of self-compassion to manage aging body-related changes. Findings from a thematic analysis of interviews with 21 women aged 65-94 revealed that they were appreciative of how their bodies worked and accepting of their physical limitations, yet concurrently critical of their body's functionality and appearance. Participants engaged in physical activity and healthy eating to maintain their health and body functionality, yet also used diet, hair styling, anti-aging creams, makeup, physical activity, and clothing to manage their appearances. To assess their bodies (in)adequacies, they engaged in upward or downward social comparisons with others their age. Participants perceived self-compassion for the aging body to be idealistic and contextual. Findings highlight the importance of health and body functionality in influencing the cognitive, emotional, and behavioral management of the aging body.

Intrapersonal characteristics of body-related guilt, shame, pride, and envy in Canadian adults.

This study examined differences in body-related shame, guilt, pride, and envy based on intrapersonal characteristics of sex, age, and weight status in 527 Canadian adults. Compared to men, women reported significantly higher shame and guilt contextualized to the body. No sex differences were observed for envy or pride. Middle-aged adults reported higher shame and lower pride compared with young adults, whereas no age differences were observed with body-related guilt. Meanwhile, shame and guilt were highest for individuals who had overweight or obese weight status, and pride was highest in individuals with average weight status. Overall, effect sizes were small and there were no significant interaction effects between sex, age, and weight status across body-related emotions. Further research is needed to capture similarities and differences of body-related self-conscious emotions between intrapersonal characteristics, to aid the development of intervention strategies to manage this important dimension of body image.

Beyond the body: insights from an Iyengar yoga program for women with disability after breast cancer.

Lymphedema, pain, and range of motion restrictions after breast cancer remain underexplored, and few interventions have been developed for these women. Together with a yoga instructor, our interdisciplinary research team developed a yoga program for women with lymphedema after breast cancer (n = 13). Qualitative interviews and participants' journals show that there were a number of benefits to the yoga program. Themes outlining these are (1) understanding arm morbidity; (2) becoming aware of posture; and (3) countering fatigue. More surprisingly, perhaps, the participants also described the ways in which yoga furthered their understandings of loss associated with disability, the fourth theme, and showed that yoga enhanced their experiences of embodiment, the final theme. Finally, we assert that our research demonstrates the potential for qualitative research connected to the evaluation of interventions and that it demonstrates the blurring of traditional boundaries between interventions and data collection.

Exploring self-compassion and eudaimonic well-being in young women athletes.

Using a mixed methods research design, we explored self-compassion and eudaimonic well-being in young women athletes. In a quantitative study (n = 83), we found that self-compassion and eudaimonic well-being were positively related (r = .76, p < .01). A model of multiple mediation was proposed, with self-compassion, passivity, responsibility, initiative, and self-determination accounting for 83% of the variance in eudaimonic well-being. In a qualitative study (n = 11), we explored when and how self-compassion might be useful in striving to reach one's potential in sport. Self-compassion was described as advantageous in difficult sport-specific situations by increasing positivity, perseverance, and responsibility, as well as decreasing rumination. Apprehensions about fully embracing a self-compassionate mindset in sport warrant additional research to explore the seemingly paradoxical role of self-compassion in eudaimonic well-being.

Body-related state shame and guilt in women: do causal attributions mediate the influence of physical self-concept and shame and guilt proneness.

Guided by the process model of self-conscious emotions, this study examined whether physical self-concept (PSC) and shame and guilt proneness were associated with body-related self-conscious emotions of state shame and guilt and if these relationships were mediated by attributions of stability, globality, and controllability. Female participants (N=284; Mean age=20.6±1.9 years) completed measures of PSC and shame and guilt proneness before reading a hypothetical scenario. Participants completed measures of attributions and state shame and guilt in response to the scenario. Significant relationships were noted between state shame and attributions of globality and controllability, and shame proneness, guilt proneness, and PSC. Similar relationships, with the additional predictor of stability, were found for state guilt. Mediation analysis partially supported the process model hypotheses for shame. Results indicate PSC and shame proneness are important in predicting body-related emotions, but the role of specific attributions are still unclear.

Applying self-compassion in sport: an intervention with women athletes.

This study investigated the effects of a self-compassion intervention on negative cognitive states and self-compassion in varsity women athletes. Athletes who self-identified as being self-critical were randomly assigned to a self-compassion intervention (n = 29) or attention control group (n = 22). The self-compassion intervention consisted of a psychoeducation session and writing components completed over a 7-day period. Measures of self-compassion, state self-criticism, state rumination, and concern over mistakes were collected pretreatment, at 1 week posttreatment, and at a 4-week follow-up. A mixed factorial MANOVA with follow-up post hoc tests demonstrated moderate-to-strong effects for the intervention at posttest and follow-up (Wilks's Λ = .566, F (8, 42) = 4.03, p < .01, η2 = .43). The findings demonstrate the effectiveness of the self-compassion intervention in managing self-criticism, rumination, and concern over mistakes. Fostering self-compassionate mind frames is a potential coping resource for women athletes dealing with negative events in sport.

Women's health-enhancing physical activity and eudaimonic well being.

In this study, we explored the role of health-enhancing physical activity (HEPA; Miilunpalo, 2001) in women's eudaimonic well being (i.e., psychological flourishing at one's maximal potential; Ryff 1989). We used a quantitative approach (N= 349) to explore the relationship between HEPA and eudaimonic well being. While HEPA was not related to eudaimonic well being, experiencing eudaimonia through HEPA contributed unique variance in eudaimonic well being beyond HEPA and experiencing hedonia through HEPA. As quality of activity was more important than quantity, a qualitative component (N = 10) provided further insight on if and how HEPA contributes to women's eudaimonic well being. Participants supported HEPA in fulfilling their potential through goal setting/striving providing bonding experiences, allowing for self-reflection, and developing a physical/able body.

Health-Enhancing Physical Activity: Associations with Markers of Well-Being.

BACKGROUND: The association between health-enhancing physical activity (HEPA) and well-being was investigated across a cross-sectional (Study 1; N=243) and a longitudinal, two-wave (Study 2; N=198) design. Study 2 further examined the role played by fulfilling basic psychological needs in terms of understanding the mechanisms via which HEPA is associated with well-being. METHODS: Women enrolled in undergraduate courses were surveyed. RESULTS: In general, greater HEPA was associated with greater well-being (Study 1; rs ranged from .03 to .25). Change score analyses revealed that increased HEPA positively predicted well-being (Study 2; R(2) adj=0.03 to 0.15) with psychological need fulfilment underpinning this relationship. CONCLUSIONS: Collectively these findings indicate that increased engagement in health-enhancing physical activity represents one factor associated with greater well-being. Continued investigation of basic psychological need fulfilment as one mechanism underpinning the HEPA-well-being relationship appears justified.

Self-compassion: a potential resource for young women athletes.

Self-compassion has demonstrated many psychological benefits (Neff, 2009). In an effort to explore self-compassion as a potential resource for young women athletes, we explored relations among self-compassion, proneness to self-conscious emotions (i.e., shame, guilt-free shame, guilt, shame-free guilt, authentic pride, and hubristic pride), and potentially unhealthy self-evaluative thoughts and behaviors (i.e., social physique anxiety, obligatory exercise, objectified body consciousness, fear of failure, and fear of negative evaluation). Young women athletes (N = 151; Mage = 15.1 years) participated in this study. Self-compassion was negatively related to shame proneness, guilt-free shame proneness, social physique anxiety, objectified body consciousness, fear of failure, and fear of negative evaluation. In support of theoretical propositions, self-compassion explained variance beyond self-esteem on shame proneness, guilt-free shame proneness, shame-free guilt proneness, objectified body consciousness, fear of failure, and fear of negative evaluation. Results suggest that, in addition to self-esteem promotion, self-compassion development may be beneficial in cultivating positive sport experiences for young women.

Does controlling for biological maturity improve physical activity tracking?

UNLABELLED: Tracking of physical activity through childhood and adolescence tends to be low. Variation in the timing of biological maturation within youth of the same chronological age (CA) might affect participation in physical activity and may partially explain the low tracking. PURPOSE: To examine the stability of physical activity over time from childhood to late adolescence when aligned on CA and biological age (BA). METHODS: A total of 91 males and 96 females aged 8-15 yr from the Saskatchewan Pediatric Bone Mineral Accrual Study (PBMAS) were assessed annually for 8 yr. BA was calculated as years from age at peak height velocity. Physical activity was assessed using the Physical Activity Questionnaire for Children/Adolescents. Tracking was analyzed using intraclass correlations for both CA and BA (2-yr groupings). To be included in the analysis, an individual required a measure at both time points within an interval; however, not all individuals were present at all tracking intervals. RESULTS: Physical activity tracking by CA 2-yr intervals were, in general, moderate in males (r=0.42-0.59) and females (r=0.43-0.44). However, the 9- to 11-yr CA interval was low and nonsignificant (r=0.23-0.30). Likewise, tracking of physical activity by BA 2-yr intervals was moderate to high in males (r=0.44-0.60) and females (r=0.39-0.62). CONCLUSIONS: Accounting for differences in the timing of biological maturity had little effect on tracking physical activity. However, point estimates for tracking are higher in early adolescence in males and to a greater extent in females when aligned by BA versus CA. This suggests that maturity may be more important in physical activity participation in females than males.

The role of body-related self-conscious emotions in motivating women's physical activity.

The purpose of this study was to test a model where body-related self-conscious emotions of shame, guilt, and pride were associated with physical activity regulations and behavior. Adult women (N = 389; M age = 29.82, SD = 15.20 years) completed a questionnaire assessing body-related pride, shame, and guilt, motivational regulations, and leisure-time physical activity. The hypothesized measurement and structural models were deemed adequate, as was a revised model examining shame-free guilt and guilt-free shame. In the revised structural model, body-related pride was positively significantly related to identified and intrinsic regulations. Body-related shame-free guilt was significantly associated with external, introjected, and identified regulations. Body-related guilt-free shame was significantly positively related to external and introjected regulation, and negatively associated with intrinsic regulation. Identified and intrinsic regulations were significantly positively related to physical activity (R2 = .62). These findings highlight the importance of targeting and understanding the realm of body-related self-conscious emotions and the associated links to regulations and physical activity behavior.

Self-presentational motives in eating disordered behavior: a known groups difference approach.

OBJECTIVE: This study investigated the role of self-presentation motivation across three groups with known differences in disordered eating behavior. METHODS: Female participants (N=131) were currently in-treatment for an eating disorder (n=39), deemed at-risk (n=46), or not-at-risk for an eating disorder (n=46). All participants completed general and physique-specific measures of self-presentation motivation. RESULTS: Results revealed significant moderate differences between groups. Those not-at-risk reported lower levels of self-presentation motivation across all measures compared to those in the other groups. Those at-risk reported significantly lower scores across global measures of self-presentation motivation, but not physique-specific motives, than those in-treatment. A discriminant function analysis demonstrated that self-presentation motivation correctly classified 63.4% of cases. DISCUSSION: Results suggest that self-presentation motives may be particularly salient for individuals at-risk or in-treatment for eating disordered behavior.