Self-Objectification, Disordered Eating and Sexual Orientation in Men.

The interplay between disordered eating, depressive symptoms and self-objectification differs between genders and sexual orientations, and merits further study in homosexual and heterosexual men. We examined disordered eating, depressive symptoms and self-objectification in a sample of Israeli heterosexual and homosexual men. Participants were 215 men aged 19-65, 108 of whom were classified by the Kinsey scale as being heterosexual and 107 as homosexual. They completed online measures of self-objectification, disordered eating and depressive symptoms. Heterosexual men reported lower levels of disordered eating and self-objectification than homosexual men, however the difference in depressive symptoms was not statistically significant. Correlations between disordered eating, self-objectification and depressive symptoms when controlling for age, BMI and number of children were all significant, with similar patterns of association for heterosexual and homosexual men. Self-objectification partially mediated the association between sexual orientation and disordered eating. However, contrary to our hypothesis, sexual orientation (homosexual/heterosexual) did not moderate the association between disordered eating and self-objectification. The tendency of homosexual men towards self-objectification is linked to unhealthy eating habits. Self-objectification helps explain the propensity of homosexual versus heterosexual men to develop disordered eating and possibly eating disorders. It should therefore be targeted in prevention and in therapy.

"Women Friendly": A Childbirth Preparation Intervention in Israel for Women with Symptoms of Post-Traumatic Stress Disorder.

Pregnant women with symptoms of post-traumatic stress disorder (PTSD), who have experienced traumatic events such as sexual abuse and traumatic births, are particularly vulnerable to experiencing extreme fear of childbirth complications during labor and traumatic deliveries. In this commentary, we review the literature on this group of women and their specific needs during pregnancy and childbirth. We present a childbirth preparation intervention for pregnant women with PTSD symptoms, "Women Friendly", designed in Israel and gradually becoming available in the community and Israeli hospitals. This intervention is intended for women with high levels of fear of childbirth who are unmotivated or unable to undergo traditional psychotherapy that focuses on exposure to and processing of past traumatic event(s). It is based on birth-oriented thinking, principles of positive psychology, and trauma-informed care. In addition to the five sessions offered to pregnant women, medical staff are provided with 19 training sessions on the "Women Friendly" approach. Qualitative and quantitative research should examine the effectiveness of this intervention. Should results be encouraging, this intervention could be more widely implemented in Israel and abroad and applied in broader contexts, such as gynecological check-ups and medical examinations, interventions, and surgery.

Relational attitudes in adolescent girls with and without a diagnosis of anorexia nervosa or atypical anorexia nervosa.

BACKGROUND: People with eating disorders experience interpersonal difficulties, but little research explores relational attitudes in this population. We examined sense of relational entitlement towards parents, pathological concern, and psychological distress in adolescent girls with and without anorexia nervosa (AN) or atypical anorexia nervosa (AAN). METHODS: Questionnaires assessing sense of entitlement towards parents, pathological concern, and symptoms of depression and anxiety were completed by 85 girls with and 100 girls without AN/AAN (mean age 15.06 ± 1.41). The AN/AAN group also completed a measure of ED pathology. RESULTS: Eating pathology, pathological concern and symptoms of depression and anxiety were positively associated with both restricted and inflated sense of entitlement towards parents. AN/AAN participants scored significantly higher than controls on restricted and inflated sense of entitlement, pathological concern and symptoms of depression and anxiety. Restricted sense of entitlement and pathological concern partially mediation the association between AN/AAN and symptoms of depression and fully mediated the association between AN/AAN and anxiety. Within the AN/AAN group, pathological concern and symptoms of depression explained a large proportion of the variance in ED pathology. CONCLUSIONS: Adolescent AN/AAN takes a heavy toll on emotional and social health, perhaps in part because crucial aspects of relational mutuality fail to develop. Teens with AN/AAN tend to over-focus on their parents' needs at the expense of their own needs. They also have impaired capacity to realistically appraise expectations from their parents, tending to feel over- and/or under-entitled to need fulfillment. These relational attitudes are associated with symptoms of depression and anxiety and should be addressed in therapy.

In healthy relationships people trust another person to fulfill some but not all their needs. It is maladaptive to expect the fulfillment of all needs (inflated entitlement) or of no needs (restricted entitlement). Restricted entitlement generally masks frustration and an unconscious wish for need fulfillment, so that restricted and inflated entitlement can co-occur. We examined to what degree 85 adolescent girls with a restricting ED and 100 without an ED felt entitled to need fulfillment by their parents, and to what extent they sacrificed their own needs for their parents'. Girls with an ED reported higher levels of both restricted and inflated entitlement from their parents than the other girls, and reported placing their parents' needs before their own more often. The more restricted and/or inflated their entitlement was, the more they tended to place their parents' needs before their own, to have severe ED symptoms and to feel depressed and anxious. Teens with EDs may over-focus on their parents' needs at the expense of their own and feel they deserve to have all or none of their needs fulfilled by their parents. These relational attitudes are associated with symptoms of depression and anxiety and should be addressed in therapy.

Too healthy for their own good: orthorexia nervosa and compulsive exercise in the community.

BACKGROUND: The similarities and differences between orthorexia nervosa symptoms (ONs) and the symptoms and correlates of eating disorders listed in the DSM-5 need to be elucidated. ONs were examined in a volunteer community sample in conjunction with compulsive exercise, disordered eating, as well as emotional and behavioral correlates of eating disorders. METHODS: Participants were 561 adult volunteers (93 men, 17.09%) aged 19-72 (M = 32.7 ± 11), recruited via social media networks. Participants self-reported on the following measures online: Düsseldorf Orthorexia Scale, Compulsive Exercise Test, Retrospective Child Feeding Questionnaire, Experiences in Close Relationships, Difficulties in Emotional Regulation Scale, Toronto Alexithymia Scale, and Eating Disorder Examination Questionnaire 13. Data were downloaded and analyzed in SPSS26 and Amos26. RESULTS: A theoretical model of the connections between the study variables was tested via SEM and confirmed. The profiles of participants with high, average and low levels of ONs were compared. Participants with the highest levels also scored highest for compulsive exercise, insecure attachment, alexithymia, emotion regulation difficulties, weight and shape concerns, body dissatisfaction, restriction, bingeing, purging and parental feeding practices of concern about child's weight and restricting and monitoring the child's intake of calorie-rich foods. DISCUSSION: High levels of ONs are related to disordered eating attitudes and behaviors, as well as to emotional and behavioral correlates of eating disorders. It is unclear to what extent these ONs are distinguishable from symptoms of other eating disorders listed in the DSM-5. Longitudinal studies may help to elucidate distinct trajectories and risk factors for ON. LEVEL OF EVIDENCE: Level III, case-control analytic study.

Conceptualizing eating disorder recovery research: Current perspectives and future research directions.

BACKGROUND: How we research eating disorder (ED) recovery impacts what we know (perceive as fact) about it. Traditionally, research has focused more on the "what" of recovery (e.g., establishing criteria for recovery, reaching consensus definitions) than the "how" of recovery research (e.g., type of methodologies, triangulation of perspectives). In this paper we aim to provide an overview of the ED field's current perspectives on recovery, discuss how our methodologies shape what is known about recovery, and suggest a broadening of our methodological "toolkits" in order to form a more complete picture of recovery. BODY: This paper examines commonly used methodologies in research, and explores how incorporating different perspectives can add to our understanding of the recovery process. To do this, we (1) provide an overview of commonly used methodologies (quantitative, qualitative), (2) consider their benefits and limitations, (3) explore newer approaches, including mixed-methods, creative methods (e.g., Photovoice, digital storytelling), and multi-methods (e.g., quantitative, qualitative, creative methods, psycho/physiological, behavioral, laboratory, online observations), and (4) suggest that broadening our methodological "toolkits" could spur more nuanced and specific insights about ED recoveries. We propose a potential future research model that would ideally have a multi-methods design, incorporate different perspectives (e.g., expanding recruitment of diverse participants, including supportive others, in study co-creation), and a longitudinal course (e.g., capturing cognitive and emotional recovery, which often comes after physical). In this way, we hope to move the field towards different, more comprehensive, perspectives on ED recovery. CONCLUSION: Our current perspectives on studying ED recovery leave critical gaps in our knowledge about the process. The traditional research methodologies impact our conceptualization of recovery definitions, and in turn limit our understanding of the phenomenon. We suggest that we expand our range of methodologies, perspectives, and timeframes in research, in order to form a more complete picture of what is possible in recovery; the multiple aspects of an individual's life that can improve, the greater number of people who can recover than previously believed, and the reaffirmation of hope that, even after decades, individuals can begin, and successfully continue, their ED recovery process.

How we research eating disorder (ED) recovery impacts what we know (perceive as fact) about it. In this paper we aim to provide an overview of the ED field's current perspectives on recovery, discuss how our methodologies shape what is known about recovery, and suggest a broadening of our methodological "toolkits" in order to form a more complete picture of recovery. To do this, we (1) provide an overview of commonly used methodologies (quantitative, qualitative), (2) consider their benefits and limitations, (3) explore newer approaches, including mixed-methods, creative methods (e.g., Photovoice, digital storytelling), and multi-methods (e.g., quantitative, qualitative, creative methods, psycho/physiological, behavioral, laboratory, online observations), and (4) propose a potential future research model with a multi-methods design, incorporating different perspectives (e.g., increasing recruitment of diverse participants, including supportive others in study co-creation), and a longitudinal course (e.g., capturing cognitive recovery, which often comes after physical). In this way, we seek to expand our picture of what is possible in recovery; the multiple aspects of an individual's life that can improve, the greater number of people who can recover than previously believed, and the reaffirmation of hope that, even after decades, individuals can begin and continue their ED recovery process.

Sense of Relationship Entitlement of Aging Parents Toward Their Offspring (SRE-ao)-A New Concept and Measurement Tool.

Our sense of entitlement influences our interactions and attitudes in a range of specific relational contexts, one of them being aging parents' relationships with their adult children. This study aimed to examine the factor structure of the Sense of Relational Entitlement-aging parents toward their offspring (SRE-ao), an 11-item questionnaire that assesses aging people's sense of relational entitlement toward their children, and examine the associations of its subscales with related personality and mental health constructs. One thousand and six participants (24.6% men), aged 65-99, with at least one child, completed the SRE-ao, Brief Symptom Inventory, Loneliness Scale, and General Belongingness scale. The SRE-ao demonstrated good construct structure using confirmatory factor analysis. Both SRE-ao subscales (restricted and inflated sense of entitlement) were significantly and positively associated with anxiety, depression, somatization and sense of loneliness and negatively with sense of belonging. When all variables were entered into a regression model, age, anxiety, and low sense of belonging, but not sense of loneliness, positively predicted both restricted and inflated sense of entitlement. Somatization negatively predicted inflated sense of entitlement. The SRE-ao is a reliable and valid scale that can be used in clinical practice and research to enhance our understanding of parent-child relationships throughout the lifespan.

Associations of self-repression with disordered eating and symptoms of other psychopathologies for men and women.

BACKGROUND: Disordered eating has been found to be associated with constructs involving self-repression, such as selflessness (the tendency to relinquish one's needs for others'), and concern for appropriateness (an alertness to information about social comparison and tendency to vary one's behavior in different social situations). This study aimed to examine associations between these self-repression variables and symptoms of general psychopathology for women and men in a community sample. METHODS: Two hundred and thirty-six participants (92 men) aged 18-76 (M = 29.11 ± 10.10) volunteered to complete online measures of disordered eating, concern for appropriateness (cross-situational variability and attention to social comparison information), selflessness, and symptoms of depression, anxiety and somatization. Structural equation models were built to assess pathways between the study variables for men and women separately. RESULTS: A MANOVA 2*7 design showed that women scored significantly higher than men on measures of selflessness, disordered eating and depression. For men, selflessness scores were positively and significantly associated only with depression scores. Cross-situational variability scores were positively associated with depression, somatization and anxiety scores. For women, selflessness scores were positively and significantly associated with depression, disordered eating, somatization and anxiety scores. Cross-situational variability scores were positively and significantly associated with depression, anxiety and somatization scores but not with disordered eating scores. Attention to Social Comparison Information scores were positively and significantly associated only with disordered eating scores. CONCLUSIONS: Self-repression is more closely linked to psychopathology in women than in men. For men, self-suppression seems to be associated with symptoms of internalizing disorders, but not disordered eating. Even for women, it appears that self-repression is not connected exclusively with disordered eating, but with symptoms of psychopathology in general. Future research should explore why self-suppression plays such a central role in women's psychopathology.

Associations between pathological eating, relational attitudes and satisfaction in romantic relationships.

OBJECTIVE: Women with disordered eating report low satisfaction from romantic relationships. We wished to examine whether this may be explained in part by a restricted or inflated sense of relational entitlement, pathological concern and low authenticity levels. METHOD: A community sample of 170 women aged 18-60 (M = 24.89 + 6.22), who had experienced a meaningful romantic relationship, completed questionnaires online. These included measures of disordered eating (EDE-Q), sense of relational entitlement (SRE-R), pathological concern (PCQ), relational authenticity (AIRS) and basic relational needs satisfaction (BNSRS). Structural equation model (SEM) was employed to assess the mediating effect of the SRE-R, PCQ and AIRS on the association between ED symptoms and BNSRS. RESULTS: Participants with high EDE-Q scores tended to score high on inflated and restricted SRE-R, PCQ, AIRS and BNSRS. SRE-R, PCQ and AIRS scores mediated the negative association between EDE-Q and BNSRS scores. CONCLUSIONS: An imbalanced sense of relational entitlement, pathological concern and inauthenticity seem to underlie the dissatisfaction that women with disordered eating experience from romantic relationships. Since these relational characteristics seem to take a high toll on the intimate relationships, it is important to encourage healthy eating attitudes and assertiveness within romantic relationships, in life and in therapy. LEVEL OF EVIDENCE: Level III: evidence obtained from well-designed cohort or case-control analytic studies.

Refining the Assessment of Entitlement in Romantic Relationships: The Sense of Relational Entitlement Scale-Revised (SRE-R).

Objective: A subjective sense of entitlement is strongly evoked in the context of romantic relationships. A pathological sense of entitlement results from believing a partner should fulfill all one's needs and wishes (inflated) or that the expression of genuine needs is illegitimate (restricted). This study aimed to validate a revised, improved version of the Sense of Relational Entitlement scale entitled the Sense of Relational Entitlement scale-Revised (SRE-R). We hypothesized it would have good factor structure and convergent validity, and that attachment dimensions and relationship indices would predict both inflated and restricted subscales. Method: The SRE-R was completed by 854 Israeli adults (8.3% males) aged 31.94 ± 8.02. A subset (n = 629) also completed measures of attachment (ECR-S) and 447 completed measures of relational authenticity, pathological concern, and relational obsessions and compulsions. Results: CFA confirmed two factors, inflated and restricted sense of relational entitlement. Relational obsessive-compulsive symptoms and pathological concern predicted an inflated sense of entitlement, and attachment avoidance, pathological concern, and authenticity in relationships predicted a restricted sense of entitlement. Discussion: The SRE-R is a valid and useful tool to assess sense of entitlement in romantic relationships and should be examined in diverse samples and cultures.

Trauma, Post-Traumatic Stress Disorder, and Mental Health Care of Asylum Seekers.

Asylum seekers in Israel from East Africa frequently experienced traumatic events along their journey, particularly in the Sinai Peninsula, where they were subjected to trafficking and torture. Exposure to trauma has implications for rights that are contingent on refugee status. This retrospective chart review aimed to characterize the types of traumas experienced by 219 asylum seekers (149 men) from Eritrea and Sudan who sought treatment at a specialized mental health clinic in Israel, and to compare the mental health of trauma victims (n = 168) with that of non-trauma victims (n = 53). About 76.7% of the asylum seekers had experienced at least one traumatic event, of whom 56.5% were diagnosed with post-traumatic stress disorder (PTSD). Most reported traumas were experienced en route in the Sinai, rather than in the country of origin or Israel. Few clinical differences were observed between trauma victims and non-trauma victims, or between trauma victims with and without a PTSD diagnosis. Our findings emphasize the importance of accessibility to mental and other health services for asylum seekers. Governmental policies and international conventions on the definition of human trafficking may need to be revised, as well as asylum seekers' rights and access to health services related to visa status.

Eating for numbing: a community-based study of trauma exposure, emotion dysregulation, dissociation, body dissatisfaction and eating disorder symptoms.

OBJECTIVE: The current study tests the relationship between eating disorder (ED) symptoms and trauma exposure. The mechanisms via which trauma is related to ED symptoms have not been sufficiently examined. This study examines the complex role of dissociation and emotional dysregulation in the context of trauma, BMI, ED symptoms and body dissatisfaction (BD). We hypothesized that dissociation and emotional dysregulation would mediate the relationship between trauma exposure and ED symptoms/BD. We further hypothesized that BMI would play a moderating role in this association. METHOD: A community sample of 229 (16.2% male) participants, with a mean age of 29.08 ± 10.68 reported online on traumatic events (Life Events Checklist), dissociation (Dissociative Experiences Scale-II), emotional dysregulation (Difficulties in Emotional Regulation Scale), ED symptoms (Eating Disorders Examination-Questionnaire) and BD (Figure Rating Scale). RESULTS: Participants reported experiencing a mean of 2.87 ± 2.27 traumatic events, with a relatively high percentage (~86%) reporting at least one. The most commonly reported traumatic events were transportation accidents and physical assault. Although frequency of traumatic events did not directly predict ED symptoms, BMI, dissociation, emotional dysregulation and BD did. An SEM model showed that traumatic events predicted ED symptoms indirectly through dissociation, emotional dysregulation and BMI. Dissociation and emotional dysregulation predicted ED symptoms directly. BMI also moderated the association between traumatic events and both ED symptoms and BD. CONCLUSIONS: Therapists treating patients with high BMI or obesity should be aware of these relationships and investigate the possibility that trauma and/or PTSD may underlie the presenting disordered eating or eating disorder.

Intergenerational Transmission of Child Feeding Practices.

This study assessed the relationships between parents' retrospective recollections of their mothers' child feeding practices (CFP), current disordered eating (DE) and current CFP (how they now feed their children). 174 Israeli parents (136 mothers, 38 fathers; 40.1 ± 6.9 years of age) of children between the ages of 2 and 18, living at home, completed questionnaires online assessing demographics, retrospective recollections of the CFP that their mothers used when they were children, current CFP and current DE. Specific aspects of retrospectively recalled maternal CFP were significantly associated with the same aspects of current CFP. Current DE mediated the association between retrospectively recalled maternal CFP and current CFP and moderated the association between current concern about child's weight and pressure for child to eat. Results highlight that the way adults pass on their feeding practices to their children is strongly influenced by their childhood recollections of their mothers' concern about their weight, pressure for them to eat or restriction of their food intake. People often strive to behave differently from their parents, especially in the realm of food and eating. However, our findings suggest that parental CFP can become entrenched and can be passed on to our children.

Eating Disorder Examination Questionnaire (EDE-Q-13): expanding on the short form.

OBJECTIVE: The Eating Disorders Examination-Questionnaire (EDE-Q) is widely used but time-consuming to complete. In recent years, the advantages and disadvantages of several brief versions have therefore been investigated. A seven-item scale (EDE-Q-7) has excellent psychometric properties but excludes items on bingeing and purging. This study aimed to evaluate a thirteen-item scale (EDE-Q-13) including items on bingeing and purging. METHOD: Participants were 1160 (188 [11.4%] males) community volunteers of mean age 28.79 ± 9.92. They completed the full EDE-Q in Hebrew, as well as measures of positive body experience, social and emotional connection, life satisfaction, positive and negative affect and positive eating. The six EDE-Q items about bingeing and purging, recoded to correspond to the response categories of the other EDE-Q questions, were added to the EDE-Q-7, resulting in the EDE-Q-13. RESULTS: Confirmatory factor analysis confirmed the hypothesized EDE-Q-13 structure, including the bingeing and purging subscales. Strong positive correlations were found between the EDE-Q-13 and the original EDE-Q scores. The EDE-Q-13 showed convergent validity with related measures. CONCLUSIONS: The EDE-Q-13 in Hebrew is a brief version of the EDE-Q that includes bingeing and purging subscales and has satisfactory psychometric properties. Its use in clinical and research contexts is encouraged.

Two to Tango? The Dance of Maternal Authority and Feeding Practices with Child Eating Behavior.

The purpose of this study was to elucidate the relationship between maternal feeding practices and children's eating problems. Mothers of 292 children aged 5.9 ± 1.1, 50% boys, reported online on parental authority, overt and covert control of the child's food choices, child feeding practices, and their child's problematic eating behavior. Structural equation modelling yielded a model with excellent indices of fit (χ(2)(52) = 50.72, p = 0.56; normed fit index (NFI) = 0.94; root mean square error of approximation (RMSEA) = 0.001). The model showed that an authoritarian maternal authority style was associated with overt control, which was associated with maternal tendency to pressure children to eat and with maternal restriction of highly processed or calorie-rich snack foods. These, in turn, were positively associated with the child's satiety response, food fussiness, and slow eating, and negatively with the child's enjoyment of food. In contrast, a permissive maternal authority style was associated with covert control of the child's eating, concern over the child being overweight, and the restriction of highly processed and calorie-rich snack foods, which were in turn positively associated with the child's emotional overeating and the child's food responsiveness. The model seems to tap into two distinct patterns of mother-child feeding and eating dynamics, apparently related to children with opposing appetitive tendencies.

The Eating Disorders Recovery Questionnaire: psychometric properties and validity.

PURPOSE: There is no standardized measurement of recovery from an eating disorder (ED). We examined the psychometric properties and construct validity of the "Eating Disorders Recovery Questionnaire" (EDRQ), which defines recovery beyond symptoms to include self-acceptance, social emotional and physical health. METHODS: Twenty-eight recovery-related items were administered to 978 people (9.5% men) aged 18-76. 172 participants had a current ED diagnosis (AN, BN or BED), 104 had a past ED diagnosis (AN, BN, BED or > one diagnosis), 105 had another past or present ED, and 579 had no lifetime ED. Participants also completed the Eating Disorders Examination Questionnaire, Dresden Body Image Questionnaire-35, Positive and Negative Affect Schedule-Short Form, Patient Health Questionnaire-9, Satisfaction with Life Scale and Positive Eating Scale. RESULTS: Exploratory and confirmatory factor analyses yielded four factors (CFI = 0.93, RMSEA = 0.07): lack of symptomatic behavior, acceptance of self and body, social and emotional connection, and physical health. Group comparisons showed that currently ill women scored lower on EDRQ and positive indices and higher on negative indices than controls and previously ill women. Previously ill women scored similarly to controls on ED symptomatology, positive body experiences, depression, and positive and negative affect but had lower BMI, life satisfaction and positive eating. The EDRQ-EDEQ correlation was r = 0.67, indicating both overlap and distinct variance. CONCLUSION: The EDRQ is a valid, reliable measure of ED recovery, defined more broadly than symptom remission. We recommend its incorporation into a standardized operationalization of recovery and its use by consumers, carers and service providers to monitor ED recovery status. LEVEL OF EVIDENCE: Level III, case-control analytic study.

Sexual orientation and disordered eating in women: a meta-analysis.

PURPOSE: Homosexuality is a clear risk factor for disordered eating in men; however, for women, research has yielded contradictory results. We conducted a meta-analysis to examine the association between sexual orientation and disordered eating in women. METHODS: PRISMA guidelines were used. Studies comparing disordered eating between lesbians and heterosexual women were identified using PsycNet database and Google Scholar. Twenty-one studies met inclusion criteria. Overall disordered eating, restricting, binging and purging were examined for heterosexual, lesbian, bisexual and 'mostly heterosexual' women. RESULTS: Whereas there was no significant difference in overall disordered eating between lesbians and heterosexual women, lesbians reported restricting less and binging more than heterosexual women. Bisexual women were more likely than lesbian women to restrict food intake and purge, and more likely than heterosexual women to have overall disordered eating and restrict food intake. "Mostly heterosexual" women were more likely than heterosexual women to restrict food intake, binge and purge. CONCLUSIONS: Women of different sexual orientations show distinct patterns of disordered eating. Bisexual and "mostly heterosexual" women appear to be particularly at risk. Stress resulting from binegativity and rigid views of sexuality in a dichotomous society, rather than sexual orientation itself, may be associated with disordered eating in women. Findings should be viewed with caution because there were few studies with bisexual and "mostly heterosexual" women. This study elucidates the nature of the association between disordered eating and sexual orientation. Findings provide a possible explanation for previous inconsistencies, since opposing trends for different behaviors cancel each other out. LEVEL OF EVIDENCE: Level I, systematic review and meta-analysis.

Attachment, Sense of Entitlement in Romantic Relationships, and Sexual Revictimization Among Adult CSA Survivors.

Insecure attachment orientations are disproportionately frequent in child sexual abuse (CSA) survivors and have been found to mediate some of the effects of CSA on adult interpersonal and romantic difficulties, including sexual revictimization (SR). A sense of relational entitlement (SRE) has received growing attention in psychological discourse and research in recent years. It reflects both adaptive (assertive) and pathological (restricted or inflated) attitudes to the assertion of needs and rights and has not been studied in adult CSA survivors. The purpose of this study was to examine associations between CSA, attachment orientations, SR, and SRE. Sixty-seven Israeli women aged 25 ± 3.95 years (30 adult CSA survivors and 37 healthy female controls with no history of CSA) completed a demographic questionnaire and self-reported measures of adult attachment orientations, sense of entitlement in romantic relationships, and adult SR. CSA survivors reported greater attachment anxiety and attachment avoidance, more restricted SRE, and higher revictimization rates than control women. No difference was found between the groups in inflated SRE. In the CSA but not the control group, anxious and avoidant attachment orientations were significantly and negatively associated with assertive SRE. Insecure (anxious and avoidant) attachment fully mediated the association between CSA and restricted SRE. Our findings suggest that the interplay between insecure attachment and CSA is related to a sense of impaired assertive entitlement and elevated restricted entitlement in adult CSA survivors. This entitlement pattern can be destructive to survivors' romantic relationships and should be addressed in therapy.

Attitudes towards eating disorders clinicians with personal experience of an eating disorder.

PURPOSE: This study explores the perspectives and opinions towards ED clinicians with lived experience of ED. METHODS: Three hundred and eighty-five ED clinicians and 124 non-clinicians from 13 countries, between 18 and 76 years of age completed an online survey about attitudes towards ED clinicians with a personal ED history. Almost half the respondents (n = 242, 47.5%) reported a lifetime ED diagnosis. Survey items included ten multiple-choice and three open questions about clinician disclosure, employer hiring practices, and perceived advantages and disadvantages of clinicians with a personal ED history practicing in the ED field. Multiple-choice responses from clinicians with and without a personal ED history were compared with responses from non-clinicians with and without a personal ED history. Open questions were examined using thematic analysis. RESULTS: Clinicians with no ED history, whose responses often differed from both ED-history groups (clinicians and non-clinicians), were more likely to indicate that clinicians with an ED should not generally treat ED patients, and that clinicians should self-disclose their ED history to employers but not to their patients. Thematic analysis of the open-ended questions revealed that advantages of having clinicians with an ED history include a deep experiential understanding and the ability to be empathic and non-judgmental, whereas disadvantages include the lack of objectivity and the risk of clinicians being triggered. CONCLUSION: Further research informing guidelines for ED clinicians with a personal ED history, their colleagues and employers are needed to protect and empower the significant minority of ED professionals with "lived experience" of EDs. LEVEL OF EVIDENCE: Level III, case-control analytic study.

A longitudinal study of maternal feeding and children's picky eating.

This study aimed to estimate the rate of persistent picky eating (PE) in children 3-8 years of age, and to characterize children with PE and their mothers. From a base sample of 1055 mothers of children 3.4 ± 1.3 years old, we selected those who described their children as picky eaters (PEs; n = 185, 17.5%) for a longitudinal study. 109 PE dyads participated, as well as a matched comparison group of dyads without PE (n = 106). At T1 mothers self-reported on trait anxiety, perfectionism, attachment style; as well as on the child's behavioral problems, their temperament, and their executive function. The participants were re-evaluated twice, at two-year intervals (T2 and T3). At T2 the mothers self-reported on their personality, on their child feeding practices, and reported their child's eating behavior. At T3 the mothers self-reported on their feeding style and the children self-reported on a pictorial frequent food questionnaire. PE persisted throughout T2 and T3 in 22.5% of T1 PE children in the longitudinal study, or in 3.94% of the base sample. The child characteristics that distinguished the PE and non-PE groups at T1 predicted 9-10% of the variance of T3 PE. Maternal feeding practices at T2 contributed 1-2% to the explained variance. It can be concluded that for the overwhelming majority of children, PE is a passing phase. Maternal feeding practices have limited long-term influence on children's PE. Unless PE is persistent and severe, parents would best be advised to relax their feeding efforts.

Weight gain, feeding and eating in the first year of life of babies of smoking and non-smoking mothers.

Babies of mothers who smoke during pregnancy tend to be born underweight but are at risk for pediatric obesity. Maternal feeding practices, maternal disordered eating, and child temperament were assessed as potential mediators of early weight gain in babies of smoking and non-smoking mothers. The BMIs of babies of 88 smoking and 107 non-smoking mothers were recorded at birth and reported one year later. Mothers self-reported on disordered eating and child feeding practices, and on their infants' temperament. Babies of smoking mothers had lower BMI at birth but not at age one. For babies of non-smoking but not for those of smoking mothers, BMI at birth predicted BMI at age one. Smoking mothers' disordered eating and pressure for children to eat predicted their babies' BMI at age one. In the non-smoking group only, there were significant correlations between babies' temperamental difficulties and babies' BMI at age one. In contrast to non-smoking mothers, smoking mothers tend to pressure their babies to eat, and not to feed them in response to their distress. This interim picture may provide insight into the transition of the children of smoking mothers from underweight newborns to children classified as overweight.