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.

Pet Attachment and the Interpersonal Theory of Suicide.

Background: Pet ownership is often assumed to have mental health benefits, but the effect of pets on suicide risk has a scant literature. Aims: Using the interpersonal theory of suicide, we examined the relationships between perceived burdensomeness (PB), thwarted belongingness (TB), overall attachment to one's pet, pet attachment avoidance or anxiety, and suicide risk. The following three hypotheses were investigated: (1) Higher attachment would be indirectly associated with lower suicide risk via lower TB and lower PB; (2) attachment would be associated with higher suicide risk, as conditioned on attachment avoidance/anxiety; and (3) attachment avoidance/anxiety would be associated with higher suicide risk via higher TB/PB. Method: Undergraduates (N = 187) completed surveys, and indirect effect and conditional effect analyses were utilized. Results: Overall attachment was associated with lower PB, which was associated with lower suicide risk. The relationship between overall attachment and suicide risk was not conditional upon attachment anxiety/avoidance. Attachment avoidance was associated with increased levels of TB, which was associated with increased suicide risk. Attachment anxiety was associated with increased suicide risk via TB and PB. Limitations: We used a university sample that had limited access to pets. Conclusions: Findings suggest that pet ownership may provide mixed associations with suicide risk.

Facial femininity and perceptions of eating disorders: A reverse-correlation study.

Eating disorders are prevalent in college students but college students are not accurate in identifying the presence of eating disorders (ED) especially when race is involved. Much has been researched about diagnostic ability in vignette form, but little outside of this. For example, it is not known how facial features, such as perceived femininity, may affect observers' beliefs about the likelihood of disordered eating depending on race. In the present study, we examined how biases regarding facial appearance and disordered eating may differ depending on the race of face images. Using a technique called reverse correlation, we estimated the image templates associated with perceived likelihood of disordered eating using both White and Black Faces. Specifically, we recruited 28 college students who categorized White and Black faces according to perceived likelihood of an eating disorder diagnosis in the presence of image noise. Subsequently, we asked Amazon Mechanical Turk participants to categorize the resulting race-specific face templates according to perceived ED likelihood and femininity. The templates corresponding to a high likelihood of an ED diagnosis were distinguished from low-likelihood images by this second independent participant sample at above-chance levels. For Black faces, the templates corresponding to a high likelihood of an ED diagnosis were also selected as more feminine than low-likelihood templates at an above-chance level, whereas there was no such effect found for White faces. These results suggest that stereotyped beliefs about both femininity and the likelihood of disordered eating may interact with perceptual processes.

The roles of weight stigma, emotion dysregulation, and eating pathology in suicide risk.

Using an interpersonal theory of suicide and affect regulation framework, we investigated the relationships between perceived burdensomeness, thwarted belongingness, weight stigmatization, emotion dysregulation, eating pathology, and suicide risk. Three main hypotheses were investigated. First, we predicted a positive linear relationship between weight stigmatization and risk. Second, an indirect effect of weight stigmatization on risk via perceived burdensomeness and thwarted belongingness was posited. Third, we hypothesized that weight stigmatization would indirectly affect suicide risk via emotion dysregulation and eating pathology. Undergraduates (N = 156) completed online surveys. Linear regressions and indirect effect analyses were performed. Weight stigmatization was directly, positively associated with increased suicide risk. Weight stigmatization indirectly affected suicide risk via perceived burdensomeness but not thwarted belongingness. Higher stigmatization was associated with higher levels of perceived burdensomeness, which was associated with higher risk. An indirect effect of weight stigmatization on suicide risk through emotional dysregulation emerged. Higher weight stigmatization was associated with higher emotional dysregulation, which was associated with higher suicide risk. When all models were combined, only an indirect effect via perceived burdensomeness remained. Our findings may have clinical and public health implications for suicide prevention among people with weight stigma-related risk factors.

The interaction of sociocultural attitudes and gender on disordered eating.

OBJECTIVE: The Tripartite Influence Model posits that social agents emphasize a thin ideal for women and a muscularity ideal for men. There is a gap in the literature of how sociocultural body ideal internalization affects overall disordered eating symptoms in men and specifically drive for muscularity in women. METHOD: The sample consisted of 1,929 participants (44.2% men) who completed online surveys. It was predicted that internalization would be a stronger predictor for overall disordered eating in women and for muscularity in men. RESULTS: Women with high internalization had increased disordered eating symptoms in comparison to men, whereas for men, increased internalization was linked to more drive for muscularity, as compared with women. CONCLUSIONS: It is important to emphasize, however, that men still exhibited higher rates of disordered eating symptoms when they had increased internalization and women exhibited an increased drive for muscularity when they had higher internalization.

Bulimic symptoms and interpersonal functioning among college students.

Integrating interpersonal theory and the stress generation hypothesis, two studies investigated the association between bulimic symptoms and interpersonal distress and the mechanism underlying this association. In Study 1, 36 pairs of female roommates completed self-report questionnaires in a laboratory while Study 2 recruited 539 undergraduate men and women to participate in a longitudinal online study by completing self-report measures at two time points. Multilevel modeling revealed that targets' bulimic symptoms predicted roommates' intention to continue living with them in Study 1. Greater bulimic symptoms predicted lower intention. In Study 2, bulimic symptoms had a direct and an indirect effect on interpersonal distress, with reassurance-seeking as a mediator in the indirect effect. Findings replicated previous studies showing that bulimic symptoms generate further distress and, in our studies, interpersonal distress specifically. Moreover, reassurance-seeking was a newly identified mechanism underlying this association. These findings provide support for the usefulness of interpersonal theory and the stress generation hypothesis as a framework for understanding bulimic symptomatology. Clinicians may find it useful to target reassurance-seeking behaviors during the treatment of bulimic symptoms in order to improve treatment outcomes.

Nurses' perceptions and experiences of mentoring.

Pre-registration education programmes provide nursing students with the skills and knowledge to become safe and proficient practitioners. Assessment of students' competence is a fundamental part of these programmes and mentors play a crucial role. Mentors are registered nurses who have completed an appropriate mentorship programme in an approved higher education institution, and their main role includes teaching, supervising and assessing students' clinical competence. The role can be demanding and stressful, and mentors must maintain their workloads while supporting students. This article reports the results of the qualitative findings of a survey of mentorship practices ( Brown et al 2012 ). The findings suggest that mentors value support from link lecturers and practice education facilitators, especially when they experience difficulties with nursing students who do not have the required competencies to pass their placement.

What influences mentors to pass or fail students.

The aim of the study was to establish mentorship practice in relation to the University of the West of Scotland pre-registration nursing students. Surveys were sent to 4,341 mentors, with a 41 per cent response rate. Results show that 18 per cent of participants had passed a failing student. A number of factors influenced mentors' decisions, which to some extent echo findings from previous research. However, this study provides new perspectives on failing to fail and considers the supportive role of universities in relation to mentors and students' practice placements. The knowledge derived from this study will help inform mentoring and mentorship practice to ensure only safe and competent practitioners gain entry to the register.

Developing disaster management modules: a collaborative approach.

Disasters, whether natural or human induced, can strike when least expected. The events of 9/11 in the US, the 7/7 bombings in the UK, and the anthrax incident in the US on 10th October 2001 indicate that there is a need to have a nursing workforce who is able to respond effectively to mass casualty events and incidents involving chemical, biological, radiological and nuclear substances. Multi-agency collaboration is one of the fundamental principles of disaster preparedness and response. It was therefore necessary to take a similar multi-agency collaborative approach to develop modules on the management of mass casualty events and incidents involving hazardous substances. The modules are offered to registered nurses and registered paramedics. They can be taken independently or as part of a BSc in nursing or health pathway, on a part-time basis. Since the commencement of the modules in September 2004, registered paramedics and registered nurses who work in a wide range of specialties have accessed them.