A Controlled Community Study of Distress and Resilience in Women Diagnosed with Fibromyalgia and Systemic Lupus Erythematosus.

This study examines psychological and physical influences on the distress and well-being of patients with chronic rheumatic diseases. The study aims were to (1) evaluate the relative contribution of objective disease activity and psychological factors on the wellbeing of patients with systemic lupus erythematosus (SLE); (2) to compare the psychological distress of SLE patients to fibromyalgia (FM) patients and healthy controls, and to (3) characterize subgroups of patients by performing cluster analysis using psychological variables. Participants were ascertained from closed forums and social media channels resulting in 41 women with a diagnosis of SLE, 47 with a diagnosis of FM, and 77 healthy controls (HC). Hierarchical linear regression for well-being of SLE patients found that most of the variance was accounted for by social support. Cluster analysis performed on the entire sample identified two clusters, a distressed group tending to Type D personality, anxiety and depression, low in well-being and social support, and a resilient group; the proportion of resilient individuals was highest in the HC intermediate in the SLE group and lowest in the FM group. The importance of psychological variables vs disease severity in these two rheumatic diseases for wellbeing is demonstrated by these results. The results suggest that psychological interventions that enhance the experience of social support in medical settings, might benefit patients with both diseases, and be of particular importance to the well-being of patients who are more distressed.

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

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

Correction: AVPR1a and SLC6A4 Gene Polymorphisms Are Associated with Creative Dance Performance.

[This corrects the article DOI: 10.1371/journal.pgen.0010042.].

The Eating Disorders Recovery Questionnaire: psychometric properties and validity.

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

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

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

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

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

The development of temperament and character during adolescence: The processes and phases of change.

We studied the pattern of personality development in a longitudinal population-based sample of 752 American adolescents. Personality was assessed reliably with the Junior Temperament and Character Inventory at 12, 14, and 16 years of age. The rank-order stability of Junior Temperament and Character Inventory traits from age 12 to 16 was moderate (r = .35). Hierarchical linear modeling of between-group variance due to gender and within-group variance due to age indicated that harm avoidance and persistence decreased whereas self-directedness and cooperativeness increased from age 12 to 16. Novelty seeking, reward dependence, and self-transcendence increased from age 12 to 14 and then decreased. This biphasic pattern suggests that prior to age 14 teens became more emancipated from adult authorities while identifying more with the emergent norms of their peers, and after age 14 their created identity was internalized. Girls were more self-directed and cooperative than boys and maintained this advantage from age 12 to 16. Dependability of temperament at age 16 was mainly predicted by the same traits at earlier ages. In contrast, maturity of character at age 16 was predicted by both temperament and character at earlier ages. We conclude that character develops rapidly in adolescence to self-regulate temperament in accord with personally valued goals shaped by peers.

"Silence! The body is speaking" - a correlational study of personality, perfectionism, and self-compassion as risk and protective factors for psychosomatic symptoms distress.

The current study examined the role of personality traits on psychosomatic distress (PD) and tested the hypothesis that the association between perfectionism and PD would be moderated by self-compassion. One hundred and seventy-three community volunteers, of whom 24.9% were men, mean age 31.52 ± 13.29, reported online on the DS14, a measure of Type D personality, on the TCI-140, a measure of temperament and character, on the Frost multidimensional perfectionism scale, on the short form of the self-compassion scale and on the SOMS-7 for psychosomatic symptoms. We defined psychosomatic distress as the product of the symptom count and severity rating score of the SOMS-7. The hierarchical linear regression model that included all the personality variables as well as the interaction term between self-compassion and perfectionism accounted for 25% of the variance in PD. The interaction between perfectionism and self-compassion entered into the model in the last block was highly protective. High self-compassion moderated the effect of perfectionism on PD. Our finding correspond with the notion that personality can enhance PD but can also mitigate it. Protective personality traits, such as self-compassion, might be good targets for psychological intervention.

Potential Risk and Protective Factors for Eating Disorders in Haredi (ultra-Orthodox) Jewish Women.

Little is known scientifically about eating disorders (EDs) in the Haredi (Jewish ultra-Orthodox) community. This paper aims to describe Haredi culture, review available peer-reviewed research on EDs in the Haredi community and discuss possible risk and protective factors for these disorders in a culturally informed way. A literature search for 2009-2019 yielded 180 references of which only nine were studies on ED in the Haredi community. We describe these and use them as a basis for discussion of possible risk and protective factors for ED in Haredi women. Risk factors may include the centrality of food, poverty, rigid dress codes, the importance of thinness for dating and marriage, high demands from women, selflessness and early marriage and high expectations from women. Protective factors may include faith, Jewish laws governing eating and food that encourage gratitude and mindful eating, and body covering as part of modesty laws that discourage objectification. Ways of overcoming the current barriers to research in the Haredi community should be sought to advance ED prevention and treatment in this population.

Young Children's Ritualistic Compulsive-Like Behavior and Executive Function: A Cross Sectional Study.

The goal of this study was to test whether the development of executive function in young children could add to the explained variance in child ritualistic behavior beyond child and maternal traits previously found to have explanatory power. Routinized, ritualistic behavior is common and normative in young children between the ages of 2 and 5, after which it subsides. In this cross-sectional study, maternal reports on 1345 children between the ages of 2 and 6 included child variables such as temperament, fears, and behavioral problems. Mother's characteristics included perfectionism, her attachment style, and trait anxiety. The sample included ultra-orthodox families, an understudied minority, and thus it was possible to compare their ritualistic behavior with that of children from other rearing environments. Ultraorthodox children had more ritualistic behavior than age-matched children. This finding offers support for an environmental influence on level of ritualistic behavior in children. For the entire sample, we found that young children's ritualistic behavior was associated with shy and emotional temperament, fears, pervasive developmental behavioral problems, and that executive function delays in shifting and emotion regulation had an additional contribution. Ritualistic child behavior was only weakly related to maternal variables. The results were consistent with a maturational process for the trajectory of ritualistic behavior, rather than with an environmentally induced behavior. The development of executive function may be the process mediating the decline of ritualistic behavior over development.

My Sister Myself: A Controlled Study of the Relationship Between Women with a Lifetime Diagnosis of Anorexia Nervosa and Their Sisters.

This study focused on the quality of the relationship between women with a lifetime anorexia nervosa (AN) diagnosis and their sisters, in the context of family functioning. Participants were 112 sister pairs including a woman with a lifetime diagnosis of AN, and 356 sister pairs with no history of an eating disorder. Participants completed the Sibling Relationship Questionnaire, Family Environment Scale and Eating Attitudes Test-26. We hypothesised that sister relationships would be less favourably assessed by women with an AN diagnosis than by their sisters, and less favourably assessed overall in the AN sister pairs than in the healthy sib-pair controls. These hypotheses were confirmed. Also, the AN sisters viewed the family as less cohesive and more conflicted than their non-affected sisters. For the AN sisters, there was an inverse relationship between level of current pathology and how favourably they viewed the sister relationship. Sister relationships may suffer during AN and improve as the pathology recedes. This would mean that the quality of sister relationships has clinical significance and may serve as an indicator of recovery. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

Show me your friends, and I shall show you who you are: the way attachment and social comparisons influence body dissatisfaction.

Women with attachment insecurity have greater eating disorder symptoms and poorer prognosis. Socio-cultural agents, such as peers and family, are predictive of the development of body image dissatisfaction (BID). The present study examines the association of insecure attachment styles and direct and indirect social comparisons of body image to women's BID and drive to thinness. Two hundred and eighty three women aged 18-42 years completed online self-reports concerning attachment styles, body mass index (BMI), drive for thinness, body image satisfaction, the Figure Rating Scale (FRS), as well as a modified FRS comparing self to mother, to sister closest in age and to best friend. Hierarchical Linear Models reveal that anxious-ambivalent, but not avoidant attachment style, along with indirect and direct comparisons to best friend and to sister influence drive for thinness and body dissatisfaction, even after controlling for BMI and age. Of all social comparisons, feeling one's best friend is thinner than yourself is the most detrimental to body ideal.

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

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

The psychometric properties of the Retrospective Child Feeding Questionnaire in Hebrew.

The objective of this study was to develop the Retrospective Child Feeding Questionnaire (RCFQ), and to assess its structural validity. In its original version, the CFQ was constructed to measure current practices of maternal feeding of children. For the present study, the CFQ was translated into Hebrew by translation, independent back-translation, and revision, and was then reworded to assess a retrospective assessment of maternal child feeding practices by adults. A large community sample of volunteers (N=406) was recruited and administered the RCFQ, and self-reported on body satisfaction, disordered eating, and body mass. The structural validity of the RCFQ was established by exploratory and confirmatory factor analysis for men and women. Some measure of construct validity is provided by correlational analysis. The RCFQ is structurally robust, and useful in assessing early influences on adult BMI, eating behavior, and body dissatisfaction.

Nothing gained: an explorative study of the long-term effects of perceived maternal feeding practices on women's and men's adult BMI, body image dissatisfaction, and disordered eating.

The objective of the studies presented here was the prediction of adult body mass index (BMI), body image dissatisfaction, and disordered eating from recalled maternal child feeding practices. Studies 1 and 2 sampled women from the community, and found that recalled childhood feeding practices predicted both current BMI and current disordered eating. Daughters whose mothers pressured them to eat as children had lower BMIs as adults. The more a mother was concerned about her daughter's weight as a child, and the more she restricted fatty food intake, the less the woman was satisfied with her current body image. Disordered eating of adult women was positively related to their mothers' restriction of their fatty food intake as children, and negatively related to the mothers' monitoring of their food intake as children. Combining the samples and subdividing them into four BMI intervals showed that the obese women were higher on all but one of the recalled maternal child feeding practices, as well as on disordered eating and body dissatisfaction. Age was found to be positively related to BMI and drive for thinness, but not to body dissatisfaction or disordered eating, with older women having higher BMI and more drive for thinness. Study 3 sampled adult men from the community and found that recalled maternal child feeding practices predicted adult BMI and disordered eating for men, as well as for women. Considerable sex differences were found for all study variables. Recollection of maternal child feeding practices may have a formative role in the development of body image, disordered eating, and BMI for men and women, even into adulthood.

Ageism and Type D Personality: The Protective Role of Self-Esteem and Perceived Social Support.

Background: This study examined the relationship between Type D personality and ageism in young adults, and evaluated the role of protective and risk factors. Methods: Two hundred and forty-seven community volunteers (M age = 31.8 years) reported online on age-related attitudes, Type D personality, and on measures of well-being. Results: A significant correlation was found between ageist attitudes and the tendency toward Type D personality. Both Type D personality and ageism correlated negatively with all the well-being measures. Perceived social support (PSS) partially down-mediated the association between Type D personality and ageism. A three-way interaction was found among individuals with Type D personality. Low PSS and low self-esteem were associated with an elevation of ageism compared to those with low PSS and high self-esteem. Discussion: The current research suggests that self-esteem and PSS are protective against ageism, and might be good targets for psychological interventions in order to mitigate ageism, particularly among individuals with Type D personality.

Mediating roles of character traits and parenting in the relationship between maternal effortful control and children's conduct problems.

Background: Parenting practices are crucial to children's development and are important predictors of children's conduct problems. The aim of the current study was to test the mediating role of mothers' character traits on the relationship between their temperamental self-regulation and their parenting practices, and on their children's conduct problems. Method: A representative sample of 387 Israeli mothers of kindergarten children was recruited online. They completed questionnaires about their own effortful control (adult temperament questionnaire; ATQ), character traits (temperament and character inventory-revised (TCI-R), big five inventory (BFI)), and parenting practices (coping with children's negative emotions scale; CCNES), as well as conduct problems of their children (strengths and difficulties questionnaire; SDQ). Structural equation models were fitted, testing for direct and indirect connections, once with character traits drawn from the TCI and once with BFI traits. Results: In both analyses, the first model presented a significant direct effect between mothers' effortful control and children's conduct problems. When including mother's parenting and character (based on the TCI or on the BFI) in the model, the direct path became insignificant and significant mediation effects were found; specifically, the indirect path through the parenting practices, as well as the mediated mediation path through the parenting practices and character. Moreover, mediation effects were found between mothers' effortful control and parenting practices through some character traits. The selected models showed a good fit (e.g., NFI = 0.985; CFI = 0.997; RMSEA = 0.038). Discussion: Our findings emphasize the importance of the mother's mature personality characteristics, the mother's actual parental practices, and the crucial value of this path for predicting child behavior outcomes.

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

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

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

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

The psychometric properties of the Varieties of Inner Speech Questionnaire-Revised in Hebrew.

Introduction: The Varieties of Inner Speech Questionnaire-Revised (VISQ-R) is a self-report questionnaire designed to measure characteristics of inner speech. In the current study, we adapted and validated a Hebrew version of VISQ-R. Our first hypothesis was that Confirmatory Factor Analysis (CFA) of the Hebrew VISQ-R would confirm the five subscales replicating the factor structure of the original questionnaire. In addition, building on previous findings that inner speech is involved in tasks that require the executive functions we examined the relationship between VISQ-R and self-reported executive functions questionnaire (BRIEF-A). We hypothesized that correlations between subscales of the Hebrew VISQ-R would reveal covariance between BRIEF-A and some but not all inner speech subscales. Methods: 406 participants completed the Hebrew VISQ-R and 280 of them also completed the BRIEF-A. Results: As hypothesized, CFA confirmed the factor structure revealing the same 5 subscales reported in the original English version, with acceptable internal reliability. Partial support was found for the hypothesized correlations between VISQ-R and BRIEF-A, with covariance of executive functions with some subscales of inner speech (Evaluative, Other-People and Dialogic), and distinct variance with others (Condensed and Positive). Discussion: These results indicate that the Hebrew version of the VISQ-R has good psychometric properties and that it can be used in future research. The implications concerning the contribution of inner speech for people with difficulties in executive functions are discussed.