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.

Comparison of a qualitative canine C-reactive protein test to a quantitative test and traditional markers of inflammation - Short communication.

Qualitative tests for C-reactive protein (CRP) are available for use in dogs, and provide a rapid in-house method of detecting acute inflammation. The aim of this study was to compare results from a qualitative CRP lateral flow test (Teco CRP FASTest) to those obtained from a quantitative CRP ELISA and to traditional methods of detecting inflammation, including total leukocyte and neutrophil numbers, presence of immature neutrophils and a left shift, presence or absence of toxic changes in neutrophils and plasma fibrinogen concentration in whole blood and serum samples collected from 113 client-owned dogs. More dogs had CRP FASTest positive results than had quantitatively increased CRP (ELISA) or increases in traditional methods used for measuring inflammation. Few dogs had increases in markers of inflammation but no elevated CRP. The qualitative CRP FASTest was found to be a sensitive test for detecting increased CRP concentration and was positive more frequently than were traditional markers of inflammation.

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.

A Patient-Centered Approach to Collecting and Displaying Patient Identifiers.

Patient identifiers such as name, date of birth, or gender are the first line of defense to ensure the accuracy of the health data displayed in health information exchange. Health data display is the impetus for clinical decisions and patient outcomes and directly correlates with promoting interoperability and health information exchange. Therefore, constant monitoring of quality metrics is imperative for clinical leaders to keep a pulse on what is happening within their organizations. However, the electronic health records (EHRs) designer should also take precautions to ensure the visualizations are not misleading, given that EHRs have been shown in some studies to lead to increased patient safety events.

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.

Publication bias is present in blood and marrow transplantation: an analysis of abstracts at an international meeting.

Publication bias is the preferential publication of research with positive results, and is a threat to the validity of medical literature. Preliminary evidence suggests that research in blood and marrow transplantation (BMT) lacks publication bias. We evaluated publication bias at an international conference, the 2006 Center for International Blood and Marrow Transplant Research (CIBMTR)/American Society for Blood and Marrow Transplantation (ASBMT) "tandem" meeting. All abstracts were categorized by type of research, funding status, number of centers, sample size, and direction of the results. Publication status was then determined for the abstracts by searching PubMed. Of 501 abstracts, 217 (43%) were later published as complete manuscripts. Abstracts with positive results were more likely to be published than those with negative or unstated results (P = .001). Furthermore, positive studies were published in journals with a mean impact factor of 6.92, whereas journals in which negative/unstated studies were published had an impact factor of only 4.30 (P = .02). We conclude that publication bias exists in the BMT literature. Full publication of research, regardless of direction of results, should be encouraged and the BMT community should be aware of the existence of publication bias.

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.

Young women's dialectical responses to fitspiration and thinspiration: A qualitative study.

With the popularity of image-based social media platforms like Instagram, researchers have begun to study relationships between social media and body image. Much of this research has used quantitative research methods, which cannot capture the rich, inner experiences of individuals. Given the dearth of qualitative research on what young women internally experience when viewing "Thinspiration" or "Fitspiration," this study used the consensual qualitative research (CQR) method, with the aim of capturing in their own words what young women feel and think in response to viewing fitspiration and thinspiration. Twelve young women viewed Fitspiration and Thinspiration profiles and were interviewed about these and similar everyday experiences. The CQR analytic team identified 10 general, 18 typical, and 11 variant domains (i.e., topic areas). An example general domain was "body image," under which the category "body dissatisfaction," fell; by viewing Thinspiration or Fitspiration, these young women were reminded how they are dissatisfied with how they see their own body or were prompted to believe others are reminded of this when viewing such content. An example typical domain was "diet/disordered eating"; several participants associated Thinspiration or Fitspiration with diet or disordered eating. From five of the 10 general domains emerged what we call an emergent dialectical theory of social media and body image. When viewing Thinspiration or Fitspiration, young women often seemed to feel or think two seemingly opposite things simultaneously within the topic areas of attainability, emotional reactions, social comparison, body image, and health.

Integrative Analysis of a Large Real-World Cohort of Small Cell Lung Cancer Identifies Distinct Genetic Subtypes and Insights into Histologic Transformation.

Small cell lung cancer (SCLC) is a recalcitrant neuroendocrine carcinoma with dismal survival outcomes. A major barrier in the field has been the relative paucity of human tumors studied. Here we provide an integrated analysis of 3,600 "real-world" SCLC cases. This large cohort allowed us to identify new recurrent alterations and genetic subtypes, including STK11-mutant tumors (1.7%) and TP53/RB1 wild-type tumors (5.5%), as well as rare cases that were human papillomavirus-positive. In our cohort, gene amplifications on 4q12 are associated with increased overall survival, whereas CCNE1 amplification is associated with decreased overall survival. We also identify more frequent alterations in the PTEN pathway in brain metastases. Finally, profiling cases of SCLC containing oncogenic drivers typically associated with NSCLC demonstrates that SCLC transformation may occur across multiple distinct molecular cohorts of NSCLC. These novel and unsuspected genetic features of SCLC may help personalize treatment approaches for this fatal form of cancer. SIGNIFICANCE: Minimal changes in therapy and survival outcomes have occurred in SCLC for the past four decades. The identification of new genetic subtypes and novel recurrent mutations as well as an improved understanding of the mechanisms of transformation to SCLC from NSCLC may guide the development of personalized therapies for subsets of patients with SCLC. This article is highlighted in the In This Issue feature, p. 1501.

Comprehensive genomic profiling and treatment patterns across ancestries in advanced prostate cancer: a large-scale retrospective analysis.

BACKGROUND: Men of African ancestry experience the greatest burden of prostate cancer globally, but they are under-represented in genomic and precision medicine studies. Therefore, we sought to characterise the genomic landscape, comprehensive genomic profiling (CGP) utilisation patterns, and treatment patterns across ancestries in a large, diverse, advanced prostate cancer cohort, to determine the impact of genomics on ancestral disparities. METHODS: In this large-scale retrospective analysis, the CGP-based genomic landscape was evaluated in biopsy sections from 11 741 patients with prostate cancer, with ancestry inferred using a single nucleotide polymorphism-based approach. Admixture-derived ancestry fractions for each patient were also interrogated. Independently, clinical and treatment information was retrospectively reviewed for 1234 patients in a de-identified US-based clinicogenomic database. Prevalence of gene alterations, including actionable gene alterations, was assessed across ancestries (n=11 741). Furthermore, real-world treatment patterns and overall survival was assessed in the subset of patients with linked clincogenomic information (n=1234). FINDINGS: The CGP cohort included 1422 (12%) men of African ancestry and 9244 (79%) men of European ancestry; the clinicogenomic database cohort included 130 (11%) men of African ancestry and 1017 (82%) men of European ancestry. Men of African ancestry received more lines of therapy before CGP than men of European ancestry (median of two lines [IQR 0-8] vs one line [0-10], p=0·029). In genomic analyses, ancestry-specific mutational landscapes were observed, but the prevalence of alterations in AR, the DNA damage response pathway, and other actionable genes were similar across ancestries. Similar genomic landscapes were observed in analyses that accounted for admixture-derived ancestry fractions. After undergoing CGP, men of African ancestry were less likely to receive a clinical study drug compared with men of European ancestry (12 [10%] of 118 vs 246 [26%] of 938, p=0·0005). INTERPRETATION: Similar rates of gene alterations with therapy implications suggest that differences in actionable genes (including AR and DNA damage response pathway genes) might not be a main driver of disparities across ancestries in advanced prostate cancer. Later CGP utilisation and a lower rate of clinical trial enrolment observed in men of African ancestry could affect genomics, outcomes, and disparities. FUNDING: American Society for Radiation Oncology, Department of Defense, Flatiron Health, Foundation Medicine, Prostate Cancer Foundation, and Sylvester Comprehensive Cancer Center.

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.