Understanding the impact of attachment insecurity on PTSD symptoms among male Veterans and military personnel.

Attachment insecurity (i.e., attachment anxiety and attachment avoidance) has been found to contribute to PTSD symptom severity in Veterans. However, little is known of the unique contribution of attachment insecurity on individual PTSD symptom clusters. In a community sample of 106 combat-deployed Veterans, active duty service members, and reservists, this study examined: (1) the relationships between childhood family experience, combat experience, attachment insecurity, and PTSD symptom clusters, and (2) the influence of attachment insecurity on PTSD symptom clusters. Results revealed significant correlations between attachment anxiety and all PTSD symptom clusters (rs = .22 -.43) and attachment avoidance and PTSD symptom clusters, except the avoidance cluster (rs = .21 -.36). Four multiple regression analyses were employed to address the second study aim. Childhood family experiences predicted negative alterations in cognitions and mood (ß = -.30) and alterations in arousal and reactivity (ß = -.20). Further, combat experience significantly predicted each symptom cluster of PTSD (ßs = .03 -.44). In the second step, attachment anxiety and attachment avoidance were added to each model. Attachment anxiety and attachment avoidance predicted negative alterations in cognitions and mood (ßs = .22 and .35) and alterations in arousal and reactivity (ßs = .27 and .17). Inconsistent with previous research, attachment insecurity did not predict symptoms of avoidance. These results highlight the impact of attachment among a diverse sample of trauma exposed individuals and may provide insights for clinical implications and therapeutic approaches when working with Veterans and military personnel high in attachment insecurity.

From fad to FAD: A theoretical formulation and proposed name change for "drunkorexia" to food and alcohol disturbance (FAD).

"Drunkorexia" is a term that has been used to describe behaviors such as restricting food intake in anticipation of alcohol consumption to offset total caloric intake, and/or to enhance the intoxicating effect of alcohol consumption. Scattered studies over the past few years have indicated the potential problematic nature of the intersection of these behaviors, yet there remain significant gaps in the operationalization of the construct, limiting research progress. In this article, we articulate limitations of the current research, including problems with the definition of the construct and a lack of theoretical guidance. We suggest a broader and more accurate phrase to guide future work with this phenomenon: Food and alcohol disturbance (FAD). Additionally, we suggest adapting Fairburn's transdiagnostic theoretical model for FAD. It is hoped these changes might provide a roadmap for future work in this area on risk factors and adaptations of current preventive and treatment approaches to focus on this emerging form of eating disturbance.

Unification of the food and alcohol disturbance literature: A systematic review.

Food and alcohol disturbance (FAD) reflects the functional relationship between disordered eating and alcohol use. There are two motivations underlying FAD - to enhance the effects of alcohol and/or to compensate for alcohol-related calories. Yet, most FAD studies have failed to adequately measure the motives underlying these behaviors, leading to inconsistent and imprecise findings. The aim of the current systematic review was to thematically consolidate FAD research findings by motive, identify limitations of the existing literature, and highlight next steps for FAD researchers. Eighty-one publications, presenting data from 38,536 participants, were included in the current review. Prevalence rates for the caloric compensation and alcohol enhancement motives range from 5.6% - 88.7% and 4.7% - 81.7%, respectively. Alcohol use and disordered eating were the primary correlates of FAD for both motives, and alcohol-related consequences were positively associated with both FAD motives cross-sectionally. Major limitations of the literature include inconsistent operationalization and imprecise measurement of FAD. Primary recommendations include adopting the terminology of and operationalization of FAD presented here, ensuring attention to FAD motive in developing and testing research questions, and moving beyond cross-sectional studies. Findings from this review can be used to contribute to more rigorous and unified FAD research.

Impulsivity, trauma history, and interoceptive awareness contribute to completion of a criminal diversion substance use treatment program for women.

Introduction: In the US, women are one of the fastest-growing segments of the prison population and more than a quarter of women in state prison are incarcerated for drug offenses. Substance use criminal diversion programs can be effective. It may be beneficial to identify individuals who are most likely to complete the program versus terminate early as this can provide information regarding who may need additional or unique programming to improve the likelihood of successful program completion. Prior research investigating prediction of success in these programs has primarily focused on demographic factors in male samples. Methods: The current study used machine learning (ML) to examine other non-demographic factors related to the likelihood of completing a substance use criminal diversion program for women. A total of 179 women who were enrolled in a criminal diversion program consented and completed neuropsychological, self-report symptom measures, criminal history and demographic surveys at baseline. Model one entered 145 variables into a machine learning (ML) ensemble model, using repeated, nested cross-validation, predicting subsequent graduation versus termination from the program. An identical ML analysis was conducted for model two, in which 34 variables were entered, including the Women's Risk/Needs Assessment (WRNA). Results: ML models were unable to predict graduation at an individual level better than chance (AUC = 0.59 [SE = 0.08] and 0.54 [SE = 0.13]). Post-hoc analyses indicated measures of impulsivity, trauma history, interoceptive awareness, employment/financial risk, housing safety, antisocial friends, anger/hostility, and WRNA total score and risk scores exhibited medium to large effect sizes in predicting treatment completion (p < 0.05; ds = 0.29 to 0.81). Discussion: Results point towards the complexity involved in attempting to predict treatment completion at the individual level but also provide potential targets to inform future research aiming to reduce recidivism.

The impact of floatation therapy on body image and anxiety in anorexia nervosa: a randomised clinical efficacy trial.

Background: Body image disturbance and anxiety are core features of anorexia nervosa (AN), a psychiatric disorder with one of the highest mortality rates. This study examined the efficacy of a novel non-pharmacological treatment, floatation-REST (Reduced Environmental Stimulation Therapy) on body image disturbance and anxiety in inpatients with AN. Methods: This parallel group randomised controlled trial compared floatation-REST vs. care as usual in women and girls hospitalised for treatment of AN in Tulsa, Oklahoma, USA. Participants were randomised on a 2:1 ratio to receive eight, twice-weekly, 60-min floatation-REST sessions for 4 weeks, in addition to care as usual, or to receive care as usual. The primary outcome was the average change in body dissatisfaction from pre- to post-float as measured by the Photographic Figure Rating Scale. The secondary outcome was the average change in anxiety from pre- to post-float as measured by the state version of the State Trait Anxiety Inventory. Longitudinal effects of floatation-REST on body dissatisfaction were also examined. All analyses were conducted using the intention-to-treat principle. Planned linear mixed models tested the effect of floatation-REST vs. care as usual. The trial was preregistered (clinicaltrials.govNCT03610451). Findings: Between March 16, 2018 and February 25, 2021, 133 participants were screened for eligibility, and 86 were consented. Eighteen were excluded after consent, for a final randomisation sample of 68 participants (45 floatation-REST; 23 care as usual). There were two session by condition interactions on body dissatisfaction (p = 0.00026) and state anxiety (p < 0.0001), such that the floatation-REST group exhibited acute (i.e., pre- to post-session) reductions in body dissatisfaction (floatation-REST group mean change (Δm) = -0.43; 95% CI -0.56 to -0.30, p < 0.0001, Cohen's d = 0.23), and acute reductions in anxiety (floatation-REST group Δm = -15.75; 95% CI -17.95 to -13.56, p < 0.0001, Cohen's d = 1.52); however, the care as usual group exhibited no significant changes. With regard to longitudinal results, there was a significant time by treatment interaction between baseline and immediately post intervention (p = 0.012) and baseline and six-month follow up (p = 0.0019). At immediately post intervention, there was a trending reduction in body dissatisfaction for the floatation-REST group (Δm = -0.41, 95% CI -0.86 to 0.03, p = 0.068) and care as usual group (Δm = 0.61; 95% CI -0.04 to 1.27, p = 0.070). At six-months post-intervention, the floatation-REST group exhibited lower body dissatisfaction (Δm = -0.91; 95% CI -1.37 to -0.45, p = 0.0020, Cohen's d = 0.53) whereas the care as usual group reported no change in body dissatisfaction (Δm = 0.35; 95% CI -0.28 to 0.98, p = 0.96) relative to baseline. There were no adverse events related to the trial during the study. Interpretation: Our findings suggest that Floatation-REST decreased body dissatisfaction compared to care as usual acutely after each float session and at six-month follow-up. Floatation-REST has potential utility for the treatment of body image disturbance and anxiety in AN. These results may be limited by some generalisability concerns given the recruitment of a modest sample receiving inpatient treatment at a single site. Funding: The William K. Warren Foundation.

A randomized clinical trial of behavioral activation and exposure-based therapy for adults with generalized anxiety disorder.

Objective: Exposure-based therapy (EXP) and behavioral activation (BA) are empirically-supported behavioral intervention techniques that target avoidance and approach behavior to alleviate symptoms. Although EXP is an established treatment for generalized anxiety disorder (GAD), the effectiveness of BA for GAD has not been directly tested or compared with that of EXP. This study examined the efficacy of EXP and BA for adults with GAD. Method: In a randomized clinical trial (clinicaltrials.gov: NCT02807480) with partial blinding in Tulsa, OK, 102 adults with GAD were allocated to manualized, 10-session EXP or BA between April 2016-April 2021. Primary analyses were intention-to-treat and included the 94 (46 EXP, 48 BA) participants who started treatment. The GAD-7 self-report scale was the primary outcome measure. Results: Similar GAD-7 declines were observed at post-treatment for EXP (d=-0.97 [95% CI -1.40 to -0.53]) and BA (d=-1.14 [95% CI -1.57 to -0.70]), and were maintained through 6-month follow-up (EXP: d=-2.13, BA: d=-1.98). Compared to EXP, BA yielded more rapid declines in anxiety and depression scores during therapy (d=0.75-0.77), as well as lower anxiety and depression scores (d=0.13-0.14) and greater participant-rated improvement (d=0.64) at post-treatment. Bayesian analyses indicated 74-99% probability of greater change in BA than EXP at post-treatment. Conclusions: BA and EXP are both effective in treating GAD, and BA may confer greater benefit during treatment. Future research is warranted to inform personalized treatment approaches.

A comparison of food and alcohol disturbance (FAD) in sorority and non-sorority women.

Objective: College students who are members of groups in which appearance and alcohol norms are highly salient may be at particular risk for engaging in food and alcohol disturbance (FAD) behaviors. This study compared demographically-matched sorority- and non-sorority members on FAD and associated behaviors. Participants: College women who self-identified as being in a sorority (n = 95) were matched with non-sorority peers (n = 95) on age, body mass index (BMI), ethnicity, and race. Methods: Participants completed an online survey assessing alcohol use, eating disorder symptoms, appearance-related peer pressure, FAD behaviors, and demographic information. Mann-Whitney U tests and generalized linear models tested hypotheses. Results: Sorority members reported more alcohol use and FAD behaviors; however, after controlling for year in school, alcohol use, and eating disorder symptoms, Greek status no longer predicted FAD behaviors. Conclusions: Differences in FAD behaviors across sorority- and non-sorority women were due to differences in alcohol consumption.

Invariance of the Eating Disorder Inventory-Drive for Thinness subscale across university and community samples.

The Eating Disorder Inventory-Drive for Thinness (EDI-DT) subscale is commonly used in research and as an eating disorder screening measure, but extant evidence is scant regarding its psychometric properties. University and community samples often are treated as interchangeable in terms of research conclusions. Given established demographic differences between these two populations, the present study tested measurement invariance of the EDI-DT across these two sample types. Two large samples of university students (n = 537; 50% female, 67% White; n = 584; 52% female, 67% White) and community participants (n = 535; 57% female, 81% White; n = 533; 63% female, 82% White) completed the EDI-DT online. Multiple group confirmatory factor analyses tested configural, metric, scalar, and strict invariance by sample type. The EDI-DT subscale was not invariant across university and community samples. Post-hoc-regularized multiple nonlinear factor analyses suggested potential item bias associated with sample type, age, and body mass index on six of the seven items. Item bias, however, appeared to be associated with minimal clinical impact. Collectively, results suggest that the EDI-DT may be functionally invariant and appropriate for use with broad populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Food and alcohol disturbance by athlete status: the roles of drive for thinness, drive for muscularity, and sex.

OBJECTIVE: This study investigated the association between self-identified athlete status and Food and Alcohol Disturbance (FAD) behaviors, and whether this association was moderated by drives for thinness or muscularity, and sex. PARTICIPANTS: 575 individuals (77.6% female, 40.0% identifying as athletes) recruited from a large southeastern university. METHODS: Participants completed online measures of athletic identity, drives for muscularity and thinness, FAD behaviors, and demographic variables. RESULTS: Compared to non-athletes, male athletes with higher drive for muscularity endorsed more alcohol effects behaviors; female athletes endorsed the inverse relationship. Higher drive for thinness was associated with more diet and exercise behaviors among all participants, and extreme weight control behaviors among athletes. CONCLUSIONS: Athlete status moderated the associations between drives for thinness/muscularity and FAD Alcohol Effects and Extreme Weight Control Behaviors. Regardless of athlete status, college students with higher drive for thinness are at risk for engaging in more FAD Diet & Exercise behaviors.

Reexamination of the psychometric properties of the Compensatory Eating and Behaviors in Response to Alcohol Consumption Scale (CEBRACS) and exploration of alternative scoring.

OBJECTIVE: The primary aims of this paper were to reexamine the factor structure of the 21-item Compensatory Eating and Behaviors in Response to Alcohol Consumption Scale (CEBRACS), a measure of Food and Alcohol Disturbance (FAD), and investigate an alternative scoring structure. FAD is the use of disordered eating behaviors within an alcohol use episode to compensate for alcohol-related calories and/or increase effects of alcohol. The new scoring approach captures FAD behaviors based on whether they occurred before, during, or after alcohol use. METHOD: Participants were 586 young adults (18-30 years; 77.6% female; 55.8% non-Hispanic White) who completed online questionnaires on alcohol use, disordered eating behaviors, and FAD. RESULTS: Confirmatory factor analyses did not provide unequivocal evidence for any previously proposed factor structures of the CEBRACS. Exploratory factor analysis suggested items capturing FAD "Before" drinking had a two-factor structure (i.e., Alcohol Effects and Compensatory Behaviors), items capturing FAD "During" drinking had a three-factor structure (i.e., Alcohol Effects, Diet & Exercise, and Extreme Weight Control Behaviors [EWCB]), and items capturing FAD "After" drinking had a two-factor structure (i.e., Diet & Exercise & EWCB). DISCUSSION: The CEBRACS factor structure is not consistent across samples; however, despite suboptimal fit, the original structure remains the best approach to capture FAD behaviors. The alternative scoring reflects FAD behaviors based on when they occur relative to alcohol use. The two scoring approaches provide researchers and clinicians flexibility to describe FAD behaviors in multiple ways using the CEBRACS.

Food and Alcohol Disturbance (FAD) in the U.S. and France: Nationality and gender effects and relations to drive for thinness and alcohol use.

OBJECTIVE: Food and Alcohol Disturbance (FAD), colloquially coined "drunkorexia," is a set of behaviors that encompasses restriction of calories, over-exercise, and other compensatory behaviors before, during, or after alcohol use to offset caloric intake or maximize intoxication. To date, this phenomenon has not been compared in a cross-cultural sample. METHOD: The Compensatory Eating and Behaviors Related to Alcohol Consumption Scale (CEBRACS), Eating Disorder Inventory - Drive for Thinness Subscale (EDI-DT) and Alcohol Use Disorders Identification Test of Consumption (AUDIT-C) were completed by 502 American (73% female) and 365 French (68% female) college students. RESULTS: Just over half (56.70%) of French and American (55.83%) participants engaged in FAD. Nationality was found to be a significant moderator of the relationship between alcohol use and FAD for both compensatory (p = .013) and intoxication (p = .01) purposes, such that Americans who drank more engaged in more FAD. Further, nationality moderated the relationship between drive for thinness and FAD for compensatory purposes (p = .005), but not for intoxication purposes (p = .10). At higher levels of drive for thinness French participants were more likely to engage in FAD for compenatory purposes. DISCUSSION: There is growing concern around how maladaptive eating and drinking behaviors intersect within the college population. These findings suggest that FAD is present cross-culturally, but that the relationships between predictors vary across culture. Thus, culture should be taken into consideration in the development of interventions for FAD.