Examining orthorexia nervosa: Using latent profile analysis to explore potential diagnostic classification and subtypes in a non-clinical sample.

Orthorexia nervosa (ON) is a proposed psychological disorder characterized by a pathological preoccupation with healthy eating. The purpose of the current study was to clarify the relationships between ON and related forms of psychopathology. In addition, we sought to explore whether there may be subtypes of ON and if ON is associated with BMI, gender, or social media use. The sample included 333 undergraduate students (72% female, Mage = 20.91) who completed measures of ON, eating disorder (ED) symptoms, obsessive compulsive disorder (OCD), obsessive compulsive personality disorder (OCPD), and health anxiety. Latent profile analysis detected three distinct groups with high ON scores. The ON/ED combined group (n = 16) was characterized by high levels of psychopathology, particularly in the areas of ON and eating disorder symptoms. In comparison, the ON/ED combined, without weight/shape concerns group (n = 35) had fewer body-related concerns. The ON only group (n = 23) reported minimal ED pathology. Regression analyses revealed those in the ON only group were more likely to be male, while the ON/ED group was associated with higher BMI. Being in the ON/ED combined, without weight/shape concerns was associated with viewing and sharing healthy eating content on social media. Our findings suggest that ON has the most overlap with ED pathology as compared to OCD, OCPD, and health anxiety, and that there may be three subtypes of ON. The first two share significant overlap with ED symptomatology while the third appears relatively distinct, characterized by less disordered eating and fewer positive emotions related to healthy eating. Future research should examine these subtypes more closely to determine whether they are clinically meaningful, potentially requiring different interventions.

Food-based social comparisons influence liking and consumption.

This study examined the effects of food-based social comparisons on hedonic ratings and consumption of a meal. Participants were randomly assigned to one of three experimental conditions in which they were led to believe that they got a worse meal, a better meal, or the same meal as another participant. They then tasted and rated their own meal. Subsequent liking and ad lib food consumption were measured. Participants who were told that another person got a better meal than they did (upward comparison) liked their meal less than if they were told that another person received either the same meal as they did or a worse meal (downward comparison). Similarly, participants who were in the upward comparison condition ate less food than if they were in the control or downward comparison conditions. Consumption was mediated by liking. The results suggest that being told that someone else is eating a meal that is higher or lower in hedonic value than one's own meal induces hedonic contrast and influences liking and consumption.

What is restrained eating and how do we identify it?

Defining and measuring such qualities as restrained eating or dieting may require more than simply administering questionnaires and assuming that we are identifying the population that we wish to study. Different questionnaires may identify different types of restrained eaters, and even deciding what restrained eating consists of is a complicated endeavor. We discuss how to define and measure restrained eating, specifying key attributes, and acknowledging the problems inherent in relying on self-report instruments. We conclude that given the difficulties in defining such constructs as restrained eating, we need to specify more clearly exactly what our research questions are, in order to be sure that we are identifying the populations with the attributes necessary to answer those questions.

Orthorexia nervosa: A review of psychosocial risk factors.

Orthorexia nervosa (ON) is a condition described as a pathological obsession with healthy eating. This paper will review the prevalence of ON and how ON is measured. The primary objective is to critically analyze findings on the psychosocial risk factors associated with ON, to consider its relation to other mental disorders, and to offer directions for future research. The key words "orthorexia" and "orthorexia nervosa" were searched in the databases PsycINFO and MEDLINE/PubMed. This paper reviewed peer-reviewed articles published up until December 31st, 2018. Quality assessment was conducted on each study reviewed. Results identified psychometric problems with the most common measure of ON. Gender and self-esteem were generally found to be unrelated to ON. Perfectionism, obsessive-compulsive traits, psychopathology, disordered eating, history of an eating disorder, dieting, poor body image, and drive for thinness were positively associated with greater ON. Findings between ON and the following risk factors were mixed: age, SES, BMI, belonging to a health-related field, exercise engagement, vegetarianism/veganism, body dissatisfaction, and alcohol, tobacco, and drug use. We discuss how the literature on risk factors informs understanding the nature of psychopathology of ON. Strengths and limitations of studies are reviewed and directions for future research are identified. Suggestions are made for more psychometrically valid assessment measures of ON that include questions about impairment, so that ON etiology can be accurately studied.

Treatment Within an Adult Mental Health Day Program: Examining Psychosocial Outcomes.

Day hospital programs provide stabilization, medication optimization, and therapeutic intervention for individuals experiencing acute psychiatric illnesses. The current study investigated treatment impact within an adult day hospital setting in a large Canadian general acute care hospital. A total of 196 patients were sampled in a naturalistic design. Participants filled out measures at admission and discharge, including the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the World Health Organization Disability Assessment Schedule 2.0, the Behavior and Symptom Identification Scale-24, the Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form, and the Emotion Regulation Questionnaire (ERQ). Paired sample t-tests revealed significant improvements from admission to discharge on all but one measure, the ERQ Suppression scale. Overall, patients improved during treatment in terms of psychopathology and disability, and perceived quality of life. When the emotion regulation strategy of reappraisal was increasingly used over the duration of the treatment, improvements were observed in symptomatology, quality of life, and enhanced functionality. This article highlights the impact of therapeutic interventions received within a Canadian day hospital program.

Are there different types of dieters? A review of personality and dietary restraint.

We review the research on the association between personality and dietary restraint as measured by commonly-used self-report assessment instruments (Restraint Scale, TFEQ, DEBQ, and EDE-Q). In order to expand our understanding of the potentially different types of dieters, we examine the different personality profiles that emerge from existing studies of restraint and personality, including associations between restraint and body dissatisfaction and body focus, self-esteem, neuroticism, sensation seeking, impulsivity, perfectionism and narcissism. This research provides some preliminary evidence that different measures of restraint are associated not only with different eating behaviours, but that they capture different personality profiles.

Adolescent and young adult women's opinions of common eating disorder prevention messages.

We examined young women's opinions of five common eating disorder (ED) prevention themes in terms of persuasiveness and impact on behavioral intentions. Video-taped prevention themes were rated by female adolescents and young adults (ages 13-25) with and without eating disorders. Overall, younger participants found the prevention messages less persuasive than older participants. Controlling for age, clinical participants found the messages to be less persuasive than did non-clinical participants. Clinical participants reported no change in their behavioral intentions after watching the videos, whereas non-clinical participants reported a lower intention to diet and make body comparisons after viewing the messages. Presenter ratings (attractiveness, credibility, thinness) also positively predicted individuals' opinions of the messages. The findings suggest that younger adolescents and women who already display signs of disordered eating may be hard to persuade through ED prevention messages, and further research is needed to improve their impact among these groups.

A Randomized controlled trial of motivational interviewing + self-help versus psychoeducation + self-help for binge eating.

OBJECTIVE: Motivational Interviewing (MI) is a collaborative therapy that focuses on strengthening a person's internal motivation to change. Research suggests that MI may be helpful for treating binge eating; however, findings are limited and little is known about how MI for binge eating compares to active therapy controls. The present study aimed to build on current research by comparing MI as a prelude to self-help treatment for binge eating with psychoeducation as a prelude to self-help treatment for binge eating. METHOD: Participants with full or subthreshold DSM-IV Binge Eating Disorder or nonpurging Bulimia Nervosa were randomly assigned to receive either 60 minutes of MI followed by a self-help manual (n = 24) or 60 minutes of psychoeducation followed by a self-help manual (n = 21). Questionnaires were completed pre- and postsession, and at 1 and 4 months postsession. RESULTS: MI significantly increased readiness to change and confidence in ability to control binge eating, whereas psychoeducation did not. No group differences were found when changes in eating disorder attitudes and behaviors were examined. DISCUSSION: MI offers benefits for increasing motivation and self-efficacy. However, it may not be a uniquely effective treatment approach for reducing binge eating.

Binge eating in bariatric surgery candidates: The role of insecure attachment and emotion regulation.

Binge eating has a high prevalence among bariatric patients and is associated with post-surgical weight gain. This study examined the potential mediating role of emotion regulation difficulties in the relation between attachment insecurity and binge eating among this population. Participants were 1388 adult pre-bariatric surgery candidates from an accredited bariatric surgery assessment centre in Toronto, Ontario. Participants completed measures of psychological functioning, including attachment style and emotion regulation. Mediation analyses revealed that difficulties with emotion regulation mediated a positive association between insecure-anxious attachment and binge eating. An insecure-avoidant attachment was found to have a non-significant association with binge eating when examining the total effect. However, when difficulties with emotion regulation were controlled for in the model to examine its role as a mediator, this association became significant, and emotion regulation difficulties also mediated the relationship between attachment avoidance and binge eating. These findings suggest that difficulties in emotion regulation may be an important clinical issue to address in order to reduce binge eating in adult bariatric surgery candidates.

Out of the loop: Taking a one-week break from social media leads to better self-esteem and body image among young women.

This study experimentally tested the effects of taking a one-week break from social media (SM) on body image and self-esteem among young women. Female undergraduate students (N = 66) were randomly assigned to either take a one-week break from SM or continue their normal use (control condition). State self-esteem and body satisfaction were measured at baseline (Time 1) and one week later (Time 2). As predicted, participants in the break condition reported higher body satisfaction and higher state self-esteem (total, performance, social, and appearance domains) at Time 2 than did those in the control condition, controlling for Time 1 scores. The benefits of taking a break from SM on body satisfaction were especially pronounced for women with higher baseline levels of thin-ideal internalization. The findings demonstrate the short-term benefits of taking a break from SM for one week on self-esteem and body image among young women.

Parent, child, and family outcomes following Acceptance And Commitment Therapy for parents of autistic children: A randomized controlled trial.

LAY ABSTRACT: Parents of autistic children commonly experience difficulties with their own mental health. This study looked at the effects of a brief group-based Acceptance and Commitment Therapy program, developed for parents of autistic children, youth, and adults. ACT focuses on increasing psychological flexibility, which is the ability to be mindful and accepting of difficult thoughts and experiences, shown to be important for mental wellness. Participants included 54 parents of autistic people, ages 3-34. Parents were randomly divided into two groups: a Treatment group that received the intervention right away, and a Waitlist group that completed the program after the Treatment group completed the trial. All parents filled out questionnaires right before the program began, and at 3, 7, and 17 weeks after randomization. Compared to the group that was waiting to participate in the program, parents in the Treatment group reported greater improvements in depression and family distress, and these improvements were still present 4 months later. Parents in the Treatment group also reported short-term improvements in their positive feelings and personal goals, compared to those waiting. Results showed that ACT may help improve some aspects of mental health for parents of autistic children, but further research is recommended.

Comparison of MI-oriented versus CBT-oriented adjunctive treatments: impacts on therapeutic alliance and patient engagement during hospital treatment for an eating disorder.

BACKGROUND: Our aim was to compare MI-oriented versus CBT-oriented adjunctive treatments to test whether an MI approach is superior in terms of improving therapeutic alliance and engagement among individuals with an eating disorder. The current study was a pilot randomized controlled trial with random allocation to either MI-oriented or a CBT-oriented adjunctive treatment group completed concurrently with a hospital-based group program for adults. Both adjunctive treatment conditions consisted of three individual therapy sessions and a self-help manual. METHODS: Sixty-five outpatients receiving hospital treatment for a diagnosed eating disorder were randomly assigned to a treatment group. Measures of working therapeutic alliance, engagement, treatment completion, and clinical impairment were completed at preadmission, mid-treatment, and at the end of treatment. RESULTS: Working alliance increased equivalently in both conditions over time in treatment. Similarly, there were no differences between conditions in terms of engagement. Regardless of therapy orientation, greater use of the self-help manual predicted lowered eating disorder risk; stronger patient ratings of therapeutic alliance predicted decreased feelings of both ineffectiveness and interpersonal problems. CONCLUSION: This pilot RCT provides further evidence that both alliance and engagement are important for treatment of an eating disorder; however, there was no clear advantage of MI over CBT as an adjunctive treatment approach to improving alliance or engagement. TRIAL REGISTRATION: ClinicalTrials.gov ID #NCT03643445 (proactive registration).

Drop-out is common among eating disorder treatment programs. Patients' engagement in treatment and a positive relationship with their therapist may both be variables that are key to predicting treatment success. In this study we examined whether integrating MI-oriented individual therapy sessions plus a self-help manual would result in improved therapeutic alliance and/or engagement for adults attending a partial day hospital treatment program for an eating disorder as compared to similar CBT-oriented treatment. The MI-oriented treatment group was based on motivational interviewing principles that emphasize empathy, overcoming resistance to change, and individual's autonomy over decisions that are in line with one's values. The CBT-oriented treatment group was based on cognitive-behavioural principles that emphasize the need to change and the consequences of symptoms of an eating disorder. Patients' ratings of the quality of their relationship with their therapist increased in both conditions over time. A stronger working alliance with one's therapist was associated with lowered feelings of ineffectiveness and interpersonal problems, which are characteristics that are common among individuals with an eating disorder. Use of a self-help manual of either type showed some benefit at predicting reduced clinical impairment.

Enriching sociocultural perspectives on the effects of idealized body norms: Integrating shame, positive body image, and self-compassion.

Body image is an integral aspect of the psychology of the self. Idealized body images are ubiquitous in both traditional media forms (e.g., magazines, television) and social media (e.g., Facebook, Instagram). The classic sociocultural model of body image (i.e., the Tripartite Influence Model) emphasizes pathways between idealized body norms, appearance comparisons, internalization of body ideals, and body dissatisfaction and its outcomes. We summarize the model and identify some issues to be addressed in future work, particularly in light of the immense popularity of social media. We review three topics that are not included in the sociocultural model but that provide a more complete picture of the influence of societal body norms on body image: (1) body shame, (2) positive body image, and (3) self-compassion. Research on the nature, assessment, and relevance of these constructs is reviewed in detail. In terms of clinical applications of these areas of research for individuals at risk of body dissatisfaction, we suggest assessing for and targeting body shame, cultivating facets of positive body image, and teaching strategies for developing self-compassion.

Testing a self-compassion micro-intervention before appearance-based social media use: Implications for body image.

Using social media applications can lead to increased body dissatisfaction among young women, particularly when they compare themselves to such images. One intervention for combating these harmful effects may be through self-compassion, or the ability to treat oneself as a friend. The goal of this study was to determine whether a self-compassion micro-intervention could prevent increases in body dissatisfaction after comparing themselves to thin ideal images on Instagram. In an online study, 230 women (M = 25.88, SD = 0.70) completed measures of state weight and appearance dissatisfaction before completing a brief self-compassion writing task (experimental condition) or a simple sorting task (control condition). After completing the assigned tasks, participants reported state body dissatisfaction. Next, they were asked to compare themselves to pre-selected thin ideal images of a curated Instagram profile before reporting state body dissatisfaction for a final time. The results demonstrated that the self-compassion intervention led to decreased in weight dissatisfaction and appearance dissatisfaction that were maintained after Instagram use. Those in the control condition showed increased in body image concern after Instagram use. These preliminary findings suggest that a self-compassion micro-intervention may serve as an effective buffer against certain adverse effects of social media on body image.

The effect of physical appearance perfectionism and social comparison to thin-, slim-thick-, and fit-ideal Instagram imagery on young women's body image.

Body image research to date has examined the impact of thin- and fit-ideal media on women's body image, however cultural trends in Western media have recently shifted towards a curvier body type called slim-thick, which is characterized by a large butt and thighs and small waist and flat stomach. We experimentally examined the impact of forced social comparison to slim-thick-, thin-, and fit-ideal imagery on women's body image relative to a control condition, and whether physical appearance perfectionism moderated these findings. Participants were 402 female undergraduate students. Results revealed that comparison to body-ideal imagery resulted in greater weight and appearance dissatisfaction and less overall body satisfaction, relative to the control condition. Those exposed to slim-thick imagery experienced more weight and appearance dissatisfaction and less body satisfaction than those in the thin-ideal condition. Physical appearance perfectionism moderated these results, such that women who reported moderate or high levels of physical appearance perfectionism experienced greater weight and appearance dissatisfaction and lower body satisfaction in the slim-thick condition, than in the thin-ideal, fit-ideal, or control conditions. It was concluded that drive to achieve body ideals is shifting to a slim-thick body, which maybe more detrimental to women's body image than thin-ideal imagery.

Eating and body image characteristics of those who aspire to the slim-thick, thin, or fit ideal and their impact on state body image.

The slim-thick ideal is characterized by a small waist and flat stomach, but large hips, thighs, and butt. Little research to date has examined the impact of this body-ideal on women's body image. The purpose of the current study was to investigate: 1) the impact of slim-thick, thin-, and fit-ideal imagery on women's body image, 2) the body ideals women most aspire to, and 3) eating and body image characteristics of women who aspire to each ideal. Participants were 123 female undergraduate students. Results revealed that experimental exposure to slim-thick- and fit-ideal imagery resulted in lower body satisfaction. Participants reported aspiring more to the fit and slim-thick-ideal than to the thin-ideal, and rated the slim-thick-ideal as the most attractive and desirable. Women who aspired to the thin- or slim-thick-ideal reported the greatest overall disordered eating. Women who aspired to the slim-thick-ideal reported greater dietary restraint, eating, shape and weight concerns, appearance ideal internalization, body image investment, and physical appearance perfectionism than those who aspired to the fit-ideal. Findings show that beauty ideals are shifting away from the thin-ideal toward a slim-thick-ideal. Slim-thick internalization may be harmful to women's well-being and should be addressed in body image and eating disorders interventions.

Body checking induces an attentional bias for body-related cues.

OBJECTIVE: Theoretical models suggest that body checking is linked to biased cognitive processing. However, this link has not been investigated in any systematic way. The present study examined the influence of body checking on attentional bias for body-related cues by manipulating body checking behaviors in nonclinical participants. METHOD: 66 women were randomly assigned to one of three conditions: body checking, body exposure, or control. A body visual search task was used to measure attentional bias. RESULTS: Participants in the body checking condition showed speeded detection of body-related information compared to participants in the exposure and control conditions. No evidence was found for increased distraction by body-related information. Furthermore, participants in the body checking condition reported more body dissatisfaction after the manipulation than participants in the body exposure and control conditions. DISCUSSION: These results are the first to experimentally establish the link between body checking and attentional bias toward body-related cues.

Young women's body image following upwards comparison to Instagram models: The role of physical appearance perfectionism and cognitive emotion regulation.

The present study examined whether trait physical appearance perfectionism moderates young women's body image following upwards appearance comparison to idealized body images on social media, and whether cognitive coping mediates the relationship between physical appearance perfectionism and resulting body image from social comparison processes. Female undergraduate students (N = 142) were randomly assigned to either 1) compare the size of their body parts to the body parts of attractive Instagram models, or 2) an appearance-neutral control condition. All participants completed measures of trait physical appearance perfectionism, pre and post measures of state body image, and state cognitive coping processes. Appearance comparison to the models resulted in lowered confidence and increased appearance and weight dissatisfaction. High trait physical appearance perfectionism predicted lower confidence and higher weight dissatisfaction and appearance dissatisfaction, and these relationships were mediated by engagement in rumination and catastrophizing. Clinical implications of the findings are discussed.

The Effects of the COVID-19 Pandemic Lockdown on Eating, Body Image, and Social Media Habits Among Women With and Without Symptoms of Orthorexia Nervosa.

The COVID-19 pandemic is negatively impacting people's mental health worldwide. The current study examined the effects of COVID-19 lockdown on adult women's eating, body image, and social media habits. Furthermore, we compared individuals with and without signs of orthorexia nervosa, a proposed eating disorder. Participants were 143 women, aged 17-73 years (M = 25.85, SD = 8.12), recruited during a COVID-19 lockdown in Canada from May-June 2020. Participants completed self-report questionnaires on their eating, body image, and social media habits during the pandemic. The Eating Habits Questionnaire (EHQ) assessed symptoms of orthorexia nervosa. Compared to the period prior to lockdown, women with higher total orthorexia nervosa scores reported eating a lot more than usual, feeling greater pressure to diet and lose weight, thinking about food more often than usual, experiencing greater weight gain, and perceiving more pressure from social media specifically to lose weight and to exercise, compared to their healthy counterparts. We examined associations between individual EHQ subscales and perceived changes to eating and weight. Women who scored high on EHQ-Problems reported seeing more weight loss content on their social media than those who reported fewer orthorexia nervosa symptoms. Conversely, those who scored low on EHQ-Feelings reported feeling a lot less pressure to lose weight, somewhat less or a lot less pressure to lose weight or to exercise from social media specifically, and trended toward less laxative use during lockdown, compared to those who scored higher on orthorexia nervosa. And those who scored low on EHQ-Knowledge reported feeling somewhat less or a lot less pressure to lose weight than those who reported more orthorexia nervosa symptoms. Together, the findings suggest that women with symptoms of orthorexia nervosa are experiencing an exacerbation of disordered eating thoughts and behaviors during COVID-19, and that social media may be a contributing factor.