Promoting Resilience to Improve Disordered Eating (PRIDE): A case series of an eating disorder treatment for sexual minority individuals.

OBJECTIVE: Despite the increased risk for eating disorders (EDs) among sexual minority (SM) individuals, no ED treatments exist specifically for this population. SM stress and appearance-based pressures may initiate and/or maintain ED symptoms in SM individuals; thus, incorporating strategies to reduce SM stressors into existing treatments may help address SM individuals' increased ED risk. This mixed-methods study evaluated the feasibility, acceptability, and preliminary efficacy of Promoting Resilience to Improve Disordered Eating (PRIDE)-a novel ED treatment for SM individuals. METHODS: N = 14 SM individuals with an ED diagnosis received 14 weekly sessions integrating Enhanced Cognitive Behavioral Therapy for EDs (CBT-E) with techniques and principles of SM-affirmative CBT developed to address SM stressors. Participants completed qualitative interviews and assessments of ED symptoms and SM stress reactions at baseline (pretreatment), posttreatment, and 1-month follow-up. RESULTS: Supporting feasibility, 12 of the 14 (85.7%) enrolled participants completed treatment, and qualitative and quantitative data supported PRIDE's acceptability (quantitative rating = 3.73/4). By 1-month follow-up, 75% of the sample was fully remitted from an ED diagnosis. Preliminary efficacy results suggested large and significant improvements in ED symptoms, clinical impairment, and body dissatisfaction, significant medium-large improvements in internalized stigma and nonsignificant small-medium effects of sexual orientation concealment. DISCUSSION: Initial results support the feasibility, acceptability, and initial efficacy of PRIDE, an ED treatment developed to address SM stressors. Future research should evaluate PRIDE in a larger sample, compare it to an active control condition, and explore whether reductions in SM stress reactions explain reductions in ED symptoms. PUBLIC SIGNIFICANCE: This study evaluated a treatment for SM individuals with EDs that integrated empirically supported ED treatment with SM-affirmative treatment in a case series. Results support that this treatment was well-accepted by participants and was associated with improvements in ED symptoms and minority stress outcomes.

A longitudinal study of potentially traumatic events and binge-purge eating disorder onset in children.

Although the association between childhood trauma and subsequent binge-purge spectrum eating disorders (BP-EDs) is established in adult samples, little is known about the temporal association between potentially traumatic life events and BP-ED onset in children. Using longitudinal data from the U.S.-nationwide Adolescent Brain Cognitive Development (ABCD) study with children aged 9-10 at baseline, logistic regression with complex sampling assessed the longitudinal association of exposure to potentially traumatic events (PTEs) at baseline and meeting BP-ED criteria one year later. Children exposed to PTEs prior to baseline had 1.91 times greater odds of being diagnosed with a BP-ED one year later (95% CI: 1.26 - 2.90; p = .004), compared to those who had not experienced a PTE. The current study extends previous cross-sectional research to show a significant temporal association between childhood PTEs before ages 9-10 and the subsequent onset of BP-EDs one year later. Future research should consider specific timing of PTE exposure as well as examining children diagnosed with restrictive eating disorders.

Validation of a Farsi version of the Eating Disorder Examination Questionnaire (F-EDE-Q) in adolescents and university students from Iran.

BACKGROUND: Although the Farsi version of the Eating Disorder Examination-Questionnaire (F-EDE-Q) is frequently utilized to assess disordered eating in Iran, its factor structure, reliability, and validity have not been investigated in Iranian samples, which is the aim of the current investigation. METHOD: Using convenience sampling, this study recruited 1112 adolescents and 637 university students to complete disordered eating and mental health-focused questionnaires, including the F-EDE-Q. RESULTS: Confirmatory factor analyses of the 22 attitudinal items in the F-EDE-Q indicated that a brief seven-item, three-factor model (i.e., Dietary Restraint, Shape/Weight Overvaluation, Body Dissatisfaction with Shape and Weight) was the only factor structure that fit the data well for either sample. This brief version of the F-EDE-Q was invariant across gender, body weight, and age. Adolescent and university participants with higher weight reported higher average scores on each of the three subscales. Subscale scores showed good internal consistency reliability in the two samples. Further, supporting convergent validity, subscales were significantly associated with measures of body image-related preoccupation and bulimia symptoms, as well as measures of other theoretically related constructs including depressive symptoms and self-esteem. CONCLUSION: Findings suggest that this brief, validated measure will enable researchers and clinical providers to appropriately assess disordered eating symptoms in adolescent and young adult Farsi-speaking populations.

Posttraumatic stress disorder, traumatic events, and longitudinal eating disorder treatment outcomes: A systematic review.

OBJECTIVE: Many individuals diagnosed with an eating disorder (ED) have been exposed to traumatic events, and some of these individuals are diagnosed with posttraumatic stress disorder (PTSD). Although theorized by researchers and clinicians, it is unclear whether traumatic event exposure or PTSD interferes with outcomes from ED treatment. The objective of the current study was to systematically review the literature on traumatic events and/or PTSD as either predictors or moderators of psychological treatment outcomes in EDs. METHOD: A PRISMA search was conducted to identify studies that assessed the longitudinal association between traumatic events or PTSD and ED outcomes. Eighteen articles met the inclusion criteria for review. RESULTS: Results indicated that traumatic event exposure was associated with greater ED treatment dropout, but individuals with a traumatic event history benefited from treatment similarly to their unexposed peers. Findings also indicated that traumatic events may be associated with greater symptom relapse posttreatment. DISCUSSION: Given the limited number of studies examining PTSD, results are considered very tentative; however, similar to studies comparing trauma-exposed and nontrauma-exposed participants, individuals with PTSD may have similar treatment gains compared to individuals without PTSD, but individuals with PTSD may experience greater symptom relapse posttreatment. Future researchers are encouraged to examine whether trauma-informed care or integrated treatment for EDs and PTSD mitigates dropout from treatment and improves symptom remission outcomes. Furthermore, researchers are encouraged to examine how the developmental timing of traumatic events, self-perceived impact of trauma, and cumulative trauma exposure may be associated with differential ED treatment outcomes. PUBLIC SIGNIFICANCE: Eating disorders (EDs), trauma, and posttraumatic stress disorder (PTSD) often co-occur. Individuals with traumatic event exposure and/or PTSD demonstrate greater ED symptoms; it is unclear whether these individuals benefit similarly in ED treatment to their peers. The current study found that individuals with traumatic event exposure are more likely to drop out of treatment but benefit from treatment with similar symptom remission. Traumatic history was associated with greater relapse posttreatment.

Muchas personas diagnosticadas con un trastorno de la conducta alimentaria han experimentado eventos traumáticos y algunas de estas personas son diagnosticadas con trastorno de estrés postraumático (TEPT). Aunque los investigadores y los clínicos teorizan, no está claro si la exposición traumática o el TEPT interfieren con los resultados del tratamiento del trastorno de la conducta alimentaria. El objetivo del presente estudio fue revisar sistemáticamente la literatura sobre experiencias traumáticas y / o TEPT como predictores o moderadores de los resultados del tratamiento psicológico en los trastornos alimentarios. Se realizó una búsqueda en PRISMA para identificar estudios que evaluaran la asociación longitudinal entre el trauma o el TEPT y los resultados del trastorno alimentario. Dieciocho artículos cumplieron con los criterios de inclusión para la revisión. Los resultados indicaron que la exposición al trauma infantil se asoció con un mayor abandono del tratamiento, pero las personas con antecedentes de trauma infantil se beneficiaron del tratamiento de manera similar a sus compañeros no expuestos. Los hallazgos también indicaron que el trauma infantil puede estar asociado con una mayor recaída de los síntomas después del tratamiento. Debido al número limitado de estudios que examinan el TEPT, los resultados son provisionales; sin embargo, hay algunas pruebas de que los individuos con TEPT también muestran un patrón similar, de modo que las ganancias son equivalentes a las de los compañeros no diagnosticados en el tratamiento, pero pueden divergir para experimentar una mayor recaída de los síntomas después del tratamiento. Se alienta a los futuros investigadores a examinar si la atención informada sobre el trauma o el tratamiento integrado para los trastornos alimentarios y el TEPT mitiga el abandono del tratamiento y mejora los resultados de remisión de los síntomas. Además, se alienta a los investigadores a examinar cómo el momento del desarrollo del trauma, el impacto autopercibido del trauma y la exposición acumulativa al trauma pueden estar asociados con los resultados diferenciales del tratamiento del trastorno de la conducta alimentaria.

Integrating evidence-based PTSD treatment into intensive eating disorders treatment: a preliminary investigation.

PURPOSE: Given data suggesting common co-occurrence and worse outcomes for individuals with eating disorders (EDs) and post-traumatic stress disorder (PTSD), it is critical to identify integrated treatment approaches for this group of patients. Past work has explored the feasibility and initial efficacy of intervention approaches that draw on evidence-based treatments for both EDs and PTSD; however, this work remains limited in scope. In the current study, we explored the feasibility and naturalistic outcomes of PTSD treatment delivered within the context of intensive ED treatment. METHOD: Participants were 57 adult men and women with DSM-5 EDs and comorbid PTSD who completed a course of either Prolonged Exposure (PE; n = 22) or Cognitive Processing Therapy (CPT; n = 35) (Msessions = 10.40; SD = 5.13) and weekly validated measurements of clinical symptoms while enrolled in ED programming. RESULTS: Multi-level models for PTSD symptoms indicated a significant linear effect of time, such that participants demonstrated significant decreases over time in PTSD symptoms, regardless of treatment modality. CONCLUSION: Our preliminary investigation provides support for the feasibility and efficacy of an integrated approach to treating EDs and PTSD. It is critical for future work to undertake randomized tests of this integrated approach using large, heterogeneous samples. LEVEL OF EVIDENCE: Level IV, multiple time series with intervention.

Internalization of muscularity and thinness ideals: Associations with body dissatisfaction, eating disorder symptoms, and muscle dysmorphic symptoms in at risk sexual minority men.

OBJECTIVE: In the tripartite influence model, appearance-ideal internalization is identified as a prominent risk factor for the development of body dissatisfaction and subsequent eating disorder (ED) behaviors. For men, prior research has emphasized the importance of both thin-ideal internalization and muscular-ideal internalization in explaining later ED behaviors and muscle dysmorphia (MD) symptoms. Previous research in heterosexual men has shown that the associations between muscular-ideal internalization and ED or MD symptoms may depend on whether the individual has also internalized the thin ideal. However, this interaction has not been examined in research with sexual minority men (SMM). METHOD: The current study collected self-report data from 452 at risk SMM (i.e., endorsed body dissatisfaction), with ages ranging from 18 to 35 years. Linear regression models were conducted to test the interaction effects between thinness and muscularity internalization on ED symptoms, MD behaviors, and general body dissatisfaction. Simple slopes and the Johnson-Neyman technique were used to investigate significant interaction terms. RESULTS: Thin- and muscular-ideal internalization were positively associated with muscular appearance intolerance and dietary restriction with no significant interaction. Muscular drive for size was highest when both muscularity internalization and thinness internalization were high. Muscular-ideal internalization was positively associated with both cognitive restraint and general body dissatisfaction, but only at lower levels of thinness internalization. DISCUSSION: Given the interacting association between thinness and muscularity internalization and aspects of body dissatisfaction, attitudes, and behavior, prevention and intervention programs for EDs and MDs in SMM should seek to dismantle both thinness and muscularity internalization. PUBLIC SIGNIFICANCE STATEMENT: Internalizing-or adopting as one's own-the ideal of a body with low body fat and high muscularity has been shown to lead to muscle dysmorphia and eating disorder symptoms in men. The current study examines whether the combination of thin-ideal and muscular-ideal internalization is associated with worse symptoms than either facet alone in sexual minority men. Treatment efforts in sexual minority men should address both types of internalization.

Confirmatory Factor and Measurement Invariance Analyses of the Drive for Muscularity Scale in Sexual Minority Men and Women.

The Drive for Muscularity Scale (DMS) is a commonly used measure used to assess the pursuit of muscularity. However, the factor structure of this measure has yet to be confirmed in a sample of sexual minority women. Moreover, the invariance of this measure across gender has also yet to be explored. The aim of the present study was, therefore, to conduct a confirmatory factor analysis (CFA) of the DMS in samples of both cisgender sexual minority men and women, and subsequently evaluate the measurement invariance by gender. The sample consisted of 962 cisgender sexual minority young adult men (N = 479) and women (N = 483). A series of CFAs were conducted, assessing both the one-factor and two-factor solutions of the DMS, with and without the inclusion of item 10 ("I think about taking anabolic steroids"). Across cisgender sexual minority young adult men and women, the 14-item two-factor solution demonstrated most appropriate fit, although the 15-item two-factor solution was also adequate among only women. Measurement invariance analyses indicated that the 14-item two-factor DMS can be used in samples of both cisgender sexual minority men and women. The present study was novel in exploring the factor structure of the DMS in sexual minority women and measurement invariance by gender; however, future research is needed to further corroborate these findings and assess measurement invariance by sexual orientation and race.

Trauma exposure and eating disorders: Results from a United States nationally representative sample.

OBJECTIVE: Sexual assault, child abuse, and combat have been linked to eating disorders (EDs). However, noninterpersonal trauma is relatively understudied, and therefore it is unknown whether noninterpersonal trauma is associated with EDs. Furthermore, most previous studies do not account for multiple trauma exposures, or the relative association of traumatic events with EDs in the same statistical model. METHOD: Multinomial regression was used to examine the association of lifetime ED diagnosis (anorexia nervosa [AN], bulimia nervosa [BN], binge eating disorder [BED]) with trauma type (sexual interpersonal, other interpersonal, war/combat, and noninterpersonal) in a nationally representative dataset of US adults in bivariate and multivariable (i.e., with all trauma types) models. RESULTS: Sexual interpersonal trauma was significantly positively associated with AN and BED in bivariate and multivariable models. In the multivariable model, only BED was found to be equally associated with sexual interpersonal, other interpersonal, and noninterpersonal trauma. DISCUSSION: These results indicate a strong positive association between sexual trauma and EDs, even when controlling for experiences of other trauma events. Future research should examine longitudinal mediators between trauma and EDs, especially sexual trauma, to identify what factors may explain this relationship. PUBLIC SIGNIFICANCE STATEMENT: Individuals with eating disorders often experience traumatic events but it is unclear whether specific trauma types are more or less common in this population. This study found that only events such as rape and sexual assault are associated with anorexia nervosa, but that most trauma types are associated with binge eating disorder. Therefore, the relationship between trauma and binge eating disorder may function differently than other eating disorders.

Psychiatric comorbidity of eating disorders in children between the ages of 9 and 10.

BACKGROUND: Eating disorders exhibit high comorbidity with other psychiatric disorders, most notably mood, substance use, and anxiety disorders. However, most studies examining psychiatric comorbidity are conducted in adolescents and adults. Therefore, the comorbidity among children living with eating disorders is unknown. The aim of this study was to characterize co-occurring psychiatric disorders with eating disorders in a US sample of children aged 9-10 years old utilizing the Adolescent Brain Cognitive Development study. METHODS: The analytic sample included 11,718 children aged 9-10 years. Anorexia nervosa, bulimia nervosa, binge eating disorder, and other specified feeding and eating disorder subtype diagnoses were examined. Statistical analyses were conducted using complex sampling. Odds ratios and 95% confidence intervals were calculated comparing the likelihood of being diagnosed for a psychiatric disorder when having an eating disorder, as compared to children without an eating disorder, children diagnosed with major depressive disorder, and children diagnosed with posttraumatic stress disorder using binary logistic regression. RESULTS: Co-occurring psychiatric disorders were substantially higher in children with eating disorders as compared to children without eating disorders, but not as compared to children diagnosed with major depressive disorder or posttraumatic stress disorder. The most common comorbidities for the eating disorder group were anxiety disorders (71.4%), attention deficit/hyperactivity disorder (47.9%), disruptive/impulse control disorders (45.0%), mood disorders (29.6%), and obsessive-compulsive disorder (28.8%), largely in line with previous research. CONCLUSIONS: This study extends prior research finding high rates of comorbidity in eating disorders, specifically with anxiety, mood, and disruptive/impulse control disorders. Clinicians assessing for psychiatric disorders should be aware that eating disorders can occur in children 9 and 10 years old and are associated with severe comorbidity. Referrals for specialty mental health care should be considered.

Integrating minority stress theory and the tripartite influence model: A model of eating disordered behavior in sexual minority young adults.

Eating disorders are serious mental illnesses associated with high mortality rates and health complications. Prior research has found increased rates of eating pathology in sexual minority (SM; e.g., lesbian, gay, bisexual) individuals compared to sexual majority (i.e., heterosexual) individuals. Two prominent models have potential to explain these differences: the tripartite influence model and minority stress theory. While both models separately have promise for explaining the pathway of eating disordered behavior in SM individuals, research has indicated that both models have unexplained variance. Therefore, a comprehensive, integrative model could further explain unique variance. 479 men and 483 women between 18 and 30 years old were recruited through Qualtrics; all participants endorsed attraction to same-gender partners. Two models were estimated by gender using structural equation modeling. For men and women, community involvement accelerated the positive association of heterosexist discrimination with internalized homophobia. Minority stressors were associated with dissatisfaction and muscularity behavior, indicating the importance of incorporating minority stress. For women, community involvement accelerated both the association of pressures with muscularity internalization and the association of muscularity-based dissatisfaction with muscle building behaviors. If confirmed by prospective studies, this model could help refine prevention and intervention efforts with this vulnerable population.

Intimate partner violence and muscularity-building behavior in latino sexual minority men.

Intimate partner violence (IPV) has been associated with increased prevalence of eating disorders. In men, disordered eating is often related to the muscularized ideal. Sexual minority men (SMM; e.g., gay, bisexual, etc.) are at higher risk for eating disorders and Latino SMM may be at particularly high risk; however, IPV and eating pathology has yet to be examined in this population. Therefore, the aim of this study is to elucidate the association between IPV and muscularity-related dissatisfaction and muscularity-oriented behavior in Latino SMM. Participants were 81 Latino SMM. Thirty participants (37% of the sample) met the cutoff score for experiencing IPV in the past month. In bivariate analyses, IPV was associated with muscularity-oriented behavior, but not muscularity-related dissatisfaction. In multivariable analyses, IPV was negatively associated with muscularity-related dissatisfaction with a small effect size and positively associated with muscularity-oriented behavior with a large effect size. It may be that SMM engage in muscle building behavior to increase self-esteem, regulate affect, or better physically protect themselves from their abusive partner. Future research should investigate motivation for muscle building behavior in individuals experiencing IPV.

Confirmatory factor and measurement invariance analyses of the Eating Disorder Examination Questionnaire in sexual minority men and women.

OBJECTIVE: The present study aimed to investigate the factor structure of the Eating Disorder Examination Questionnaire (EDE-Q) in a large sample of cisgender sexual minority men and women, and subsequently, to evaluate measurement invariance by gender. METHOD: The sample consisted of 962 sexual minority adult men (n = 479) and women (n = 483) who completed online self-report surveys. Confirmatory factor analysis was conducted using two previously supported factor structures (Friborg et al.'s four-factor model and Grilo et al.'s brief three-factor model) as well as the original four-factor structure of the EDE-Q. RESULTS: Results indicated that the best fitting models were Friborg et al.'s four-factor model (CFI = .974, RMSEA = .098, SRMR = .0 70) and Grilo et al.'s brief three-factor model (CFI = .999, RMSEA = .049, SRMR = .017). The model fit of both factor structures were nearly identical when examined separately for men and women. The original four-factor structure could not be supported in this sample. Measurement invariance analyses further indicated that the best fitting models were invariant by gender in sexual minority individuals. Internal consistency was adequate for all subscales of Friborg et al.'s and Grilo et al.'s models. DISCUSSION: The present study provides support for the use of the EDE-Q in sexual minority men and women. Additionally, findings demonstrate that the EDE-Q performs similarly in sexual minority men and women. Future research is needed to further evaluate measurement invariance of the EDE-Q by sexual orientation, gender identity, and race.

Appearance discrimination and binge eating among sexual minority men.

Sexual minority men (SMM) face substantial disparities in rates of binge eating compared to heterosexual individuals, underscoring the need to study risk factors for the development of binge eating amongst SMM. One potential explanation for this disparity in binge eating is minority stress theory, which posits that minority groups face stressors, such as discrimination, due to their stigmatized position in society. Additionally, specific domains of discrimination may confer different levels of risk for binge eating. Therefore, the current study examined the association of various forms of discrimination, including appearance-based discrimination, and binge eating in a sample of SMM. A sample of 200 SMM (analytic sample of N = 187) from the greater Boston area completed self-report questionnaires assessing frequency of different forms of perceived discrimination (appearance, sexual orientation, race, etc.) and binge eating. A hierarchical binary logistic regression model was used to examine the association of different forms of discrimination with binge eating. 9% of the sample reported binge eating. Appearance-based discrimination was the most common form of discrimination (47%), and was significantly associated with binge eating, over and above all other forms of discrimination and sociodemographic variables, OR = 1.71, 95% CI = [1.24, 2.35], Wald χ2 (1) = 10.65, p = .001. Findings suggest that appearance-based discrimination may be related to binge eating in SMM. Clinicians may consider assessing appearance-based discrimination among SMM patients.

Weight-Related Information Avoidance Prospectively Predicts Poorer Self-Monitoring and Engagement in a Behavioral Weight Loss Intervention.

BACKGROUND: Self-monitoring is a key component of behavioral weight loss (BWL) interventions. Past research suggests that individuals may avoid self-monitoring in certain contexts (e.g., skipping self-weighing after higher-than-usual calorie intake). However, no studies have attempted to quantify individuals' inclination to avoid information about their weight control ("weight-related information avoidance"; WIA) or prospectively examined its implications for treatment engagement and outcomes in BWL programs. PURPOSE: Characterize WIA using a validated questionnaire among adults enrolled in BWL treatment and examine whether WIA prospectively predicts self-monitoring adherence, session attendance, treatment discontinuation, or weight loss. METHODS: Participants (N = 87; MBMI = 34.9 kg/m2, 83% female) completed a measure of WIA prior to starting a 12 week, group-based BWL intervention. Participants were given digital self-monitoring tools and instructed to self-monitor their food intake daily, physical activity daily, and body weight weekly (Weeks 1-10) and then daily (Weeks 11-12). Session attendance and treatment discontinuation were recorded. Weight was measured in-clinic pretreatment and posttreatment. RESULTS: While mean WIA was low (M = 2.23, standard deviation [SD] = 0.95; potential scale range: 1-7), greater WIA predicted poorer attendance (r = -.23; p = .03) and poorer self-monitoring of physical activity (r = -.28; p = .009) and body weight (r = -.32; p = .003). WIA did not predict food monitoring (p = .08), treatment discontinuation (p = .09), or 12 week weight loss (p = .91). CONCLUSIONS: Greater WIA, as assessed via a brief questionnaire, may place individuals at risk for poorer self-monitoring and treatment engagement during BWL. Further research on the implications of WIA in the context of weight management is warranted, including evaluation of correlates, moderators, and mechanisms of action of WIA. CLINICAL TRIAL REGISTRATION: NCT03337139.

The role of sexual minority stress and community involvement on disordered eating, dysmorphic concerns and appearance- and performance-enhancing drug misuse.

Prior research has established that sexual minority (SM) individuals are more likely to experience disordered body image behaviors and concerns than heterosexual individuals. This increased risk may be explained by minority stress theory - that SM individuals are subject to SM-specific stressors, leading to health disparities - but this has not yet been fully examined. Furthermore, this theory states that SM community involvement may mitigate negative outcomes. The current study examines whether minority stress is associated with screening positive for an eating disorder, screening positive for body dysmorphic disorder, and appearance- and performance-enhancing drug misuse in a sample of SM individuals (483 women and 479 men) in the US. This study also examines whether the effect of minority stress is moderated by SM community involvement. Logistic regressions were conducted for each type of minority stress (internalized homophobia, sexual orientation concealment, and heterosexist discrimination) interacting with community involvement. After correction for multiple comparisons, all minority stressors and community involvement were positively associated with increased odds of disordered body image behaviors and concerns, with no evidence of a buffering effect for community involvement. The lack of a buffering effect is contrary to minority stress theory and may inform future prevention efforts.

The Dysmorphic Concern Questionnaire: Measurement invariance by gender and race/ethnicity among sexual minority adults.

Sexual minority adults report heightened body image disturbances, and may be more likely to meet criteria for body dysmorphic disorder (BDD) than their heterosexual counterparts. Given the poor outcomes associated with BDD, it is important to validate measures assessing dysmorphic symptoms among this at-risk group. The Dysmorphic Concern Questionnaire (DCQ) is a seven-item self-report measure intended to assess dysmorphic symptoms. The present study investigated racial, ethnic, and gender measurement invariance properties of the DCQ in a racially and ethnically diverse sample of sexual minority adults. The current results lend initial support for use of the DCQ to potentially detect BDD symptoms among White, Black, Latino, and Asian sexual minority men and women. This may inform future studies that wish to utilize the DCQ, such as investigations of mean level differences in dysmorphic concern. These findings may have important clinical applications, given the heightened risk of appearance-related concerns among diverse sexual minority adults.

A psychometric investigation of the Sociocultural Attitudes Towards Appearance Questionnaire-4-Revised among sexual minority adults in the U.S.

The Sociocultural Attitudes Towards Appearance Questionnaire-4 Revised (SATAQ-4R) is a measure of internalization (or belief and acceptance) of muscular, thin/low body fat, and general attractiveness ideals; and of sociocultural pressures experienced from family, peers, media, and significant others to achieve the ideal body. The current study examined the psychometric properties of the SATAQ-4R scores in a sample of sexual minority (non-heterosexual) men and women. Confirmatory factor analysis was employed to examine the factor structure in men (n = 479) and women (n = 482). The original 7-factor structure was replicated, and internal reliability coefficients for the seven subscale scores were acceptable (≥ .82 α and ω). For men and women, the thin/low body fat, family, peers, media, and significant others subscales exhibited significant positive medium-to-large associations with subscale scores on the Eating Disorder Examination-Questionnaire (EDE-Q), measuring aspects of eating pathology. The muscular ideal subscale exhibited a significant large correlation with the Drive for Muscularity Scale (DMS), measuring muscularity-related concerns. Both the muscular ideal and general attractiveness ideal subscale exhibited significant small or non-significant correlations with eating pathology. In sum, the SATAQ-4R scores demonstrated acceptable reliability and structural and convergent validity in samples of sexual minority men and women.

An evaluation of the Aerie Real campaign: Potential for promoting positive body image?

This study evaluated the impact on young women's body satisfaction of an advertising campaign: Aerie Real, which included images of models who were not digitally modified. In total, 200 female students were randomly allocated to view either Aerie Real images or digitally modified images from previous campaigns. In the total sample, no condition differences appeared. However, participants with high appearance comparison reported a smaller decrease in body satisfaction after viewing the Aerie Real images as compared to those viewing previous images ( p = .003). Findings provide preliminary support for the Aerie Real campaign as less deleterious form of media for body image.

Participant and interventionist perceptions of challenges during behavioral weight loss treatment.

No prior studies have examined how interventionists' perceptions of participants' weight control challenges or the agreement between participants and interventionists on these perceptions relate to outcomes during group-based behavioral weight loss treatment. This study characterized participants' and interventionists' perceptions of, and agreement about, weight control challenges and assessed how these factors relate to weight loss. Three months into treatment, participants and interventionists independently selected three weight control challenges believed to be most relevant for each participant. Weight was measured at baseline, 3 months, and 12 months. Interventionists and participants had "no" (κ < 0) or "slight" (0 < κ< .20) agreement on most challenges. Although endorsement of certain challenges by participants and/or interventionists was related to 3- and 12-month weight losses, agreement between participants and interventionists was unrelated to weight loss at either time point. Additional research is needed to better understand the role of perceived challenges and participant/interventionist agreement about challenges on treatment outcomes.

Stigmatizing weight experiences in health care: Associations with BMI and eating behaviours.

INTRODUCTION: Individuals with overweight or obesity often experience stigmatizing weight-related interactions in health care, though how these experiences are associated with body mass index (BMI) and eating behaviour is unknown. This study had three aims: (a) characterize types and frequency of stigmatizing health care experiences, (b) assess relationships among BMI, eating behaviour, and stigmatizing experiences, and (c) examine whether internalized weight stigma mediates the relationship between stigmatizing experiences, weight, and eating behaviour. METHODS: Adults (N = 85) enrolled in behavioural weight loss completed measures of stigmatizing health care experiences, weight bias internalization, eating behaviours, and BMI. Cross-sectional correlational and mediational analyses were conducted. RESULTS: The majority (70.6%) of participants reported at least one stigmatizing health care experience in the past year. Greater amounts of stigmatizing experiences were associated with higher BMI (r = 0.32, P < .01) and greater uncontrolled (r = 0.22, P = .04) and emotional eating (r = 0.28, P < .01). Internalized weight stigma significantly mediated the relationship between stigmatizing experiences and maladaptive eating. CONCLUSION: Experiences of health care weight stigma were associated with eating behaviour and BMI. Participants with a higher BMI or greater maladaptive eating behaviours may be more susceptible to stigmatizing experiences. Reducing internalized weight stigma and health care provider stigma may improve patient health outcomes.