Structure and validity of the Clinical Perfectionism Questionnaire in female adolescents.

BACKGROUND: Perfectionism is a transdiagnostic risk factor across psychopathology. The Clinical Perfectionism Questionnaire (CPQ) was developed to assess change in order to provide clinical utility, but currently the psychometric properties of the CPQ with adolescents is unknown. AIMS: To assess the factor structure and construct validity of the CPQ in female adolescents. METHOD: The CPQ was administered to 267 females aged 14-19 years of age. Confirmatory factor analysis (CFA) was used to examine the validity of the two-factor model and a second-order factor model. Pearson correlations were used to evaluate the relationships between the CPQ and a wide range of measures of perfectionism, psychopathology and personality traits. RESULTS: The study demonstrated internal consistency, construct validity and incremental validity of the CPQ in a sample of female adolescents. The CFA in the present study confirmed the two-factor model of the CPQ with Factor 1 relating to perfectionistic strivings and Factor 2 representing perfectionistic concerns. The second-order two factor model indicated no deterioration in fit. CONCLUSIONS: The two-factor model of the CPQ fits with the theoretical definition of clinical perfectionism where the over-dependence of self-worth on achievement and concern over mistakes are key elements. The CPQ is suitable for use with female adolescents in future research that seeks to better understand the role of perfectionism in the range of mental illnesses that impact youth.

Adolescents who engage exclusively in healthy weight control behaviors: Who are they?

BACKGROUND: Little is known about the exclusive adoption of healthy weight control behaviors in the absence of unhealthy weight control behaviors among adolescents. The current study aimed to determine (i) the prevalence of the exclusive adoption of healthy weight control behaviors, (ii) the pattern of eating behaviors and physical activity reported by those engaging exclusively in healthy weight control behaviors, and (iii) the socio-demographic and psychosocial factors associated with the exclusive use of healthy weight control behaviors among adolescents. METHODS: In a large and diverse population-based sample of US adolescents (N = 2793) who participated in EAT 2010 (Eating and Activity in Teens) the current study examined the exclusive use of healthy weight control behaviors, which included healthy eating behaviors (eating more fruits and vegetables, eating less high-fat foods, eating less sweets, drinking less soda, and being aware of portion sizes) and engaging in physical activity for the purpose of weight management. Data were analyzed using multinomial logistic regression in STATA. RESULTS: Overall, 24.0% of girls and 29.2% of boys exclusively used healthy weight control behaviors in the absence of unhealthy weight control behaviors. The exclusive use of healthy weight control behaviors was more prevalent among girls who were not overweight (27.5%) as compared to girls who were overweight (21.0%) or obese (17.5%), controlling for age, socio-economic status, and ethnicity/race. In addition, the exclusive use of healthy weight control behaviors was more prevalent among girls and boys who had lower body dissatisfaction, higher self-esteem and lower depressive symptoms. CONCLUSION: Findings indicate that psychosocial health and body satisfaction may be important targets for promoting the exclusive use of healthy weight control behaviors among adolescents.

The Activity Support Scale for Multiple Groups (ACTS-MG): Child-reported Physical Activity Parenting in African American and Non-Hispanic White Families.

This study aimed to assess the psychometric properties of a child-report, multidimensional measure of physical activity (PA) parenting, the Activity Support Scale for Multiple Groups (ACTS-MG), in African American and non-Hispanic white families. The ACTS-MG was administered to children aged 5 to 12 years. A three factor model of PA parenting (Modeling of PA, Logistic Support, and Restricting Access to Screen-based Activities) was tested separately for mother's and fathers' PA parenting. The proposed three-factor structure was supported in both racial groups for mothers' PA parenting and in the African American sample for fathers' PA parenting. Factorial invariance between racial groups was demonstrated for mother's PA parenting. Building on a previous study examining the ACTS-MG parent-report, this study supports the use of the ACTS-MG child-report for mothers' PA parenting. However, further research is required to investigate the measurement of fathers' PA parenting across racial groups.

Maternal depression and childhood obesity: a systematic review.

OBJECTIVE: Maternal depression is prevalent and has been associated with parenting practices that influence child weight. In this systematic review we aimed to examine the prospective association between maternal depression and child overweight. METHODS: We searched four databases (PsycINFO, PubMed, Embase, and Academic Search Premier) to identify studies for inclusion. We included studies with a prospective design with at least one year follow-up, measuring maternal depression at any stage after childbirth, and examining child overweight or obesity status, body mass index z-score or percentile, or adiposity. Two authors extracted data independently and findings were qualitatively synthesized. RESULTS: We identified nine prospective studies for inclusion. Results were examined separately for episodic depression (depression at a single measurement occasion) and chronic depression (depression on multiple measurement occasions). Mixed results were observed for the relationship between episodic depression and indicators of child adiposity. Chronic depression, but not episodic depression, was associated with greater risk for child overweight. CONCLUSIONS: While chronic depression may be associated with child overweight, further research is needed. Research is also needed to determine whether maternal depression influences child weight outcomes in adolescence and to investigate elements of the family ecology that may moderate the effect of maternal depression on child overweight.

Weight-related teasing in the school environment: associations with psychosocial health and weight control practices among adolescent boys and girls.

Weight-related teasing has been found to be associated with low self-esteem, depressive symptoms, body dissatisfaction, and weight control behaviors in adolescents. While research has typically examined weight-related teasing directed towards the individual, little is known about weight-related teasing at the school level. This study aimed to determine the association between the school-level prevalence of weight-related teasing and psychosocial factors, body dissatisfaction and weight control behaviors in adolescents. Adolescents (N = 2,793; 53.2% female) attending 20 US public middle and high schools were surveyed as part of the Eating and Activity in Teens (EAT) 2010 study. Generalized estimating equations were used to estimate the association between school-level weight-related teasing and health variables, controlling for individual-level weight-related teasing, clustering of individuals within schools, and relevant covariates. A greater school-level prevalence of weight-related teasing was associated with lower self-esteem and greater body fat dissatisfaction in girls, and greater depressive symptoms in boys, over and above individual-level weight-related teasing. Dieting was associated with the school-level prevalence of weight-related teasing in analysis adjusted for covariates in girls, but not following adjustment for individual-level weight-related teasing. Unhealthy weight control behaviors, extreme weight control behaviors, and muscle-enhancing behaviors were not associated with the school-level prevalence of weight-related teasing in girls or boys. Findings from the current study, in conjunction with previous findings showing associations between weight-related teasing, psychological concerns, and weight control behaviors, highlight the importance of implementing strategies to decrease weight-related teasing in schools.

Family ecological predictors of physical activity parenting in low-income families.

Physical activity (PA) parenting, or strategies parents use to promote PA in children, has been associated with increased PA in children of all ages, including preschool-aged children. However, little is known about the circumstances under which parents adopt such behaviors. This study examined family ecological factors associated with PA parenting. Low-income parents (N = 145) of preschool-aged children (aged 2 to 5 years) were recruited from five Head Start centers in upstate New York. Guided by the family ecological model (FEM), parents completed surveys assessing PA parenting and relevant family and community factors. Hierarchical regression analysis identified independent predictors of PA parenting. Parent depressive symptoms, life pressures that interfere with PA and perceived empowerment to access PA resources were associated with PA parenting. Community factors, including neighborhood play safety and social capital, were not independently associated with PA parenting in the multivariate model. Together, family ecological factors accounted for a large proportion of the variance in PA parenting (R (2) = .37). Findings highlight the need to look beyond cognitive predictors of PA parenting in low-income families and to examine the impact of their broader life circumstances including indicators of stress.

An evaluation of the transdiagnostic cognitive-behavioural model of eating disorders.

OBJECTIVE: To determine if the relationships between additional maintaining factors and core eating disorder maintaining mechanisms outlined in the cognitive-behavioural model of eating disorders are transdiagnostic. METHOD: Patients (n = 1451) diagnosed with anorexia nervosa, bulimia nervosa (BN) or eating disorder not otherwise specified completed the Eating Disorder Examination Questionnaire, Eating Disorder Inventory-2 and Personality Assessment Inventory prior to entering treatment. RESULTS: Multi-group structural equation modelling results suggested that low self-esteem, overevaluation of weight and shape, and mood intolerance processes were transdiagnostic. However, some differences between diagnostic groups were observed. Dietary restraint was only positively associated with binge eating in BN, interpersonal difficulties were only associated with dietary restraint in eating disorder not otherwise specified and perfectionism was not associated with core eating disorder maintaining mechanisms in BN. DISCUSSION: A mixture of transdiagnostic and disorder-specific processes was implicated in the maintenance of eating disorders, although longitudinal research is needed to validate results.

Reciprocal influence of alliance to the group and outcome in day treatment for eating disorders.

The nature of the alliance-outcome relationship is still emerging. This study examined the reciprocal influence of change in alliance to the group and change in urge to restrict in eating-disordered individuals attending a group-based day treatment. Participants (N = 238) were a transdiagnostic or mixed diagnostic sample of eating-disordered individuals consecutively admitted to a day treatment program. On a weekly basis, participants completed a measure of alliance to the group of patients with whom they attended multiple group therapies each week. After each meal, they rated the intensity of their urge to restrict food intake, and the intensity ratings were averaged per week. Latent change score analysis was used to assess the reciprocal relationship between prior change in alliance to the group with subsequent change in urge to restrict, and prior change in urge to restrict with subsequent change in alliance to the group across each participant's first 9 weeks in the program. A reciprocal causal model was a good fit to the data. Prior growth in alliance to the group was significantly associated with subsequent reduction in urge to restrict, and concurrently, prior reduction in urge to restrict was significantly associated with subsequent growth in alliance to the group. Alliance to the group and individual outcomes are dynamically related and changing constructs represented by a reciprocal causal model. Clinicians may improve group treatment by assessing alliance to the group and outcomes repeatedly, being aware of their interplay, and structuring interventions based on the mutual causal effects of change in each.

Does self-esteem mediate the relationship between interpersonal problems and symptoms of disordered eating?

It has been proposed that interpersonal problems play a role in the maintenance of disordered eating because of an adverse effect on self-esteem, which in turn encourages the pursuit of achievement in the valued domain of weight and shape. This study aimed to identify the types of interpersonal problems that are associated with disordered eating and to determine whether self-esteem mediates the relationship between interpersonal problems and eating disorder symptoms. Female university students (n = 227) completed the Inventory of Interpersonal Problems-32, Eating Disorder Examination Questionnaire and Rosenberg Self-Esteem Scale. Regression analysis identified two forms of interpersonal problems that were associated with disordered eating: difficulties being sociable and being too dependent on the opinion of others. Self-esteem mediated the relationship between interpersonal problems and overevaluation of weight and shape but did not mediate the relationship between interpersonal problems and dietary restraint.

Examining cognitive and behavioural symptoms across binge/purge profiles in adolescents with eating disorders.

Binge eating and purging profiles may vary in adolescents with eating disorders and this may potentially be a function of a range of cognitive and behavioural constructs. The aim was to determine whether cognitive and behavioural symptoms differed among purging profiles in 229 adolescent females (M age = 15.45). Differences were examined in three binge/purge profiles; (i) regular objective binge eating and purging (OBEP, n = 63), (ii) regular subjective binge eating and purging (SBEP, n = 41), and (iii) purging in the absence of any binge eating (P-noBE, n = 110). Adolescents with objective or subjective binge eating had significantly higher global eating disorder scores and eating, shape, and weight concerns than those without binge eating, but not more frequent compensatory behaviours. There were no significant differences on dietary restraint. The group with objective binge eating (OBEP) had significantly higher eating concerns and self-induced vomiting than adolescents with subjective binge eating (SBEP). Future research is required to understand the reasons for elevated symptoms in the OBE-P group, since the size of binge episodes is not thought to be a salient factor in binge eating. In contrast to the literature, we did not find support for a special relevance of dietary restraint to the purging only presentation (P-noBE), rather it was a universal characteristic of all binge/purge presentations. Eating concerns may be an important target in adolescents with objective binge symptoms. Future research should examine if treatment targeted at different binge/purge profiles improves efficacy of treatment in adolescents.

The factor structure of the eating disorder examination in clinical and community samples.

OBJECTIVE: To assess the factor structure of the Eating Disorder Examination (EDE) in three different samples and to compare the goodness-of-fit of five models of EDE data. METHOD: The EDE was administered to eating disordered (n = 158), treatment-seeking obese (n = 170) and non-eating disordered community-based (n = 329) participants. Confirmatory factor analysis was used to compare the validity of the original four-factor EDE model with that of three-, two-, and one-factor models. RESULTS: None of the tested models provided a "good fit" to the data in any sample, with the exception of a brief one-factor model in the eating disorder group. Estimations of internal consistency, reliability, and validity were superior for the one-, two-, and three-factor models compared to the four-factor model in all samples. DISCUSSION: Overall, there was more support for a one-factor model of EDE data than for a multi-factorial model. It may be more appropriate to use Global EDE scores than individual subscale scores for research purposes.

The family context of low-income parents who restrict child screen time.

BACKGROUND: The American Academy of Pediatrics recommends that parents restrict child screen time to two hours per day, but many preschool-aged children exceed this viewing recommendation. Modifying children's viewing habits will require collaborating with parents, but little is known about the factors that influence parents' capacity for effective screen-related parenting. This study aimed to identify the demographic, family and community contextual factors associated with low-income parents' restriction of child screen time. METHODS: Parents (N=146) of children (age 2-5 years) attending Head Start centers in the United States completed a self-report survey in 2010 assessing parent and child screen use (television, DVD, video, video games, and leisure-time computer use), parent restriction of child screen time, and family (parent stress, social support, and life pressures) and community (neighborhood safety and social capital) factors. RESULTS: Children were more likely to meet the American Academy of Pediatrics screen time recommendation if their parent reported high restriction of child screen time. Parent and child demographic characteristics were not associated with parents' restriction of child screen time. In multivariate analysis, less parent screen time, fewer parent life pressures, and greater social support were associated with parents' high restriction of screen time. CONCLUSION: Family contextual factors may play an important role in enabling low-income parents to restrict their children's screen time. When counseling low-income parents about the importance of restricting child screen time, practitioners should be sensitive to family contextual factors that may influence parents' capacity to implement this behavior change.

Social-cognitive predictors of low-income parents' restriction of screen time among preschool-aged children.

Parents' rules regarding child television, DVD, video game, and computer use (screen time) have been associated with lower screen use in children. This study aimed to identify modifiable correlates of this behavior by examining social-cognitive predictors of parents' restriction of child screen time. Low-income parents (N = 147) of preschool-aged children (2-6 years) completed self-administered questionnaires examining parent and child screen time, parent restriction of screen time, self-efficacy to restrict screen time, and beliefs about screen time. Structural equation modeling results indicated that greater self-efficacy to restrict screen time (ß = .29, p = .016) and greater perceived importance of restricting child screen use (ß = .55, p < .001) were associated with greater restriction of child screen use, after controlling for parent screen time. Family-based interventions that consider broader attitudinal factors around child screen time may be necessary to engage parents in restricting screen use.

The Eating Disorder Inventory-2 Perfectionism scale: factor structure and associations with dietary restraint and weight and shape concern in eating disorders.

The Eating Disorder Inventory-2 Perfectionism subscale (EDI-P) was originally construed as a unidimensional measure of perfectionism. However, research in non-clinical samples suggests that the EDI-P measures two dimensions of perfectionism: self-oriented and socially prescribed perfectionism. This study aimed to investigate the factor structure of the EDI-P in a transdiagnostic sample of females seeking treatment for an eating disorder, and to determine the unique association between EDI-P dimensions, weight and shape concern, and dietary restraint in anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified. Two hundred and ninety nine females seeking treatment for an eating disorder at an outpatient eating disorder service completed the Eating Disorder Examination and the EDI-P. Confirmatory factor analysis supported a two-factor model of the EDI-P comprising self-oriented and socially prescribed perfectionism. Self-oriented perfectionism, but not socially prescribed perfectionism, accounted for unique variance in weight and shape concern and dietary restraint in both AN and BN. Results highlight the potential importance of self-oriented perfectionism in eating disorders and support the argument that self-imposed standards are central to perfectionism in eating disorders.

Increased wait-list time predicts dropout from outpatient enhanced cognitive behaviour therapy (CBT-E) for eating disorders.

Between 30 and 70% of patients with eating disorders drop out from outpatient treatment. However, research has been unable to identify factors that consistently predict dropout from eating disorder treatment. Most studies have exclusively investigated the role that individual patient characteristics play in dropout and have ignored more process-based factors such as expectations about treatment, the therapeutic alliance, or time spent on a treatment waiting list. This study aimed to investigate the roles of both individual patient characteristics and process-based factors in dropout from outpatient treatment for eating disorders. The study involved data collected from consecutive eating disorder referrals to the only public specialist eating disorder service for youth and adults in Perth, Western Australia. The standard treatment provided at this service is Enhanced Cognitive Behaviour Therapy on an individual basis. The study involved 189 patients referred to the service between 2005 and 2010. Forty five percent of this sample dropped out of treatment. Results showed that, in this sample, two individual factors, lowest reported weight and the tendency to avoid affect, and one process-based factor, time spent on the wait list for treatment, were significant predictors of dropout. These findings are valuable because a process-based factor, such as wait-list time, may be easier to address and modify than a patient's weight history or the trait of mood intolerance. Increased resources for eating disorder services may reduce waiting list times which would help to reduce dropout and maximize treatment outcomes.

Confirmatory factor analysis of the Eating Disorder Examination-Questionnaire (EDE-Q).

OBJECTIVE: To compare the goodness-of-fit of five models of Eating Disorder Examination-Questionnaire (EDE-Q) data, in clinical and community samples. METHOD: The EDE-Q was administered to 228 eating disorder patients and 211 non-eating disordered university students. Confirmatory factor analysis was used to compare the validity of the original four EDE-Q subscales with that of brief one-factor, extended one-factor, two-factor, and three-factor models. Measurement invariance across the two samples was considered. RESULTS: The only model to provide an acceptable fit to the data was the brief one-factor model consisting of eight Weight and Shape Concern items. Scores on this scale correlated highly with the original EDE-Q subscales. CONCLUSION: The reliability of the EDE-Q may be increased if a modified scoring system is used. This complements findings from recent research with the Eating Disorder Examination (EDE).

An evaluation of the enhanced cognitive-behavioural model of bulimia nervosa.

The original cognitive-behavioural model of bulimia nervosa (BN) has been enhanced to include four additional maintaining mechanisms: low self esteem, clinical perfectionism, interpersonal problems, and mood intolerance. These models have been used to guide cognitive-behavioural treatment for BN, but the enhanced model has yet to be directly evaluated as a whole in a clinical sample. This study aimed to compare and evaluate the original and the enhanced cognitive-behavioural models of BN using structural equation modelling. The Eating Disorder Examination and self-report questionnaires were completed by 162 patients seeking treatment for BN (N = 129) or atypical BN (N = 33). Fit indices suggested that both the original and enhanced models provided a good fit to the data, but the enhanced model accounted for more variance in dietary restraint and binge eating. In the enhanced model, low self esteem was associated with greater overevaluation of weight and shape, which, in turn, was associated with increased dietary restraint. Interpersonal problems were also directly associated with dietary restraint, and binge eating was associated with increased purging. While the current study provides support for some aspects of the enhanced cognitive-behavioural model of BN, some key relationships in the model were not supported, including the important conceptual relationship between dietary restraint and binge eating.

Avoidance of affect in the eating disorders.

The Distress Tolerance Scale (DTS) (Corstorphine, Mountford, Tomlinson, Waller, & Meyer, 2007) measures the tendency to use cognitive and behavioural strategies to manage the experience of positive and negative affect. This paper aimed to explore the factor structure of the DTS, particularly in relation to avoidance of affect. Participants were 227 female university students (non-clinical sample) and 257 clients seeking treatment for an eating disorder (clinical sample). Confirmatory factor analysis was used to test two previously proposed factor structures of the DTS in the non-clinical sample. Both of these models were found to be a poor fit to the data. Subsequently, nine items measuring avoidance of affect were analysed using exploratory factor analysis in the non-clinical sample. Three factors of avoidance of affect were identified (Behavioural Avoidance of Positive Affect, Behavioural Avoidance of Negative Affect, and Cognitive Avoidance of Affect). Confirmatory factor analysis supported this avoidance of affect model in the clinical sample. Significant correlations were observed between avoidance of affect subscales and eating psychopathology in both samples. Results suggest that the avoidance of positive emotion may be an important factor in eating disorders. It is recommended that future studies broaden their investigation of the role of emotion in eating disorders to include both negative and positive emotion.

Parents' concern about their children's weight.

OBJECTIVE: Firstly, to investigate the degree of concern parents feel about their children's weight (parental concern). Secondly, to identify factors that influence this concern, and to test a model of parental concern using structural equation modeling. SUBJECTS: A total of 347 non-overweight, overweight, and obese children (aged 6-13; Mean = 9.5, SD = 1.8) and their parents. METHODS: Children and their parents attended an assessment session during which they were weighed and measured. Parents were administered a structured interview, which included the Eating Disorder Examination, and completed the Pediatric Quality of Life Inventory (parent proxy), and the Children's Body Image Scale. RESULTS: Eighty-two percent of parents of overweight children, and 18% of parents of obese children reported little parental concern. Higher parental concern was associated with higher child Body Mass Index, less parental underestimation of child body size, and lower child health-related quality of life. CONCLUSIONS: Interventions targeting childhood obesity should aim to optimise parental concern by reducing parents' underestimation of child body size and increasing their awareness of the effects of overweight and obesity on children's health and quality of life.

MCMI-III personality complexity and depression treatment outcome following group-based cognitive-behavioral therapy.

This study investigated the association of personality disorder complexity to treatment outcome for depression following time-limited group-based cognitive-behavioral therapy. One hundred fifteen outpatients with a primary diagnosis of depression participated in the study. In this study, personality disorder complexity was determined by the degree of personality disorder comorbidity identified by the Millon Clinical Multiaxial Inventory-III (T. Millon, 1994). As predicted, analyses revealed that increasing personality disorder complexity was related to increasing baseline symptom severity and slightly poorer end-state functioning at posttreatment. However, results regarding clinically significant improvement and mean improvement in depression symptoms were less supportive of an association between personality disorder complexity and poorer treatment outcome. The implications of these findings for treatment planning are discussed.