DEVELOPMENT AND VALIDITY OF THE DISORDERED EATING ATTITUDE SCALE (DEAS)

The aim of this study was to develop and validate the Disordered Eating Attitude Scale to measure disordered eating attitudes, defined as abnormal beliefs, thoughts, feelings, behaviors, and relationship regarding food. Exploratory factor analysis was performed and internal consistency assessed in a sample of female university students (N=196). Convergent validity was acceptable based on statistically significant correlations with the Eating Attitude Test-26 and Restraint Scale. Known-groups validity was determined by comparing the student sample`s mean scores against scores of an eating disorder group (N=51). The Disordered Eating Attitude Scale comprises 25 questions and five subscales explaining 54.3% of total variance. The total scores differentiated student, bulimia, and anorexia groups. The scale should prove useful for evaluating eating attitudes in various population groups and eating disordered patients.

Changing attitudes, beliefs and feelings towards food in bulimic patients

Eating attitudes are defined as beliefs. thoughts, feelings and behaviors towards food. Bulimia nervosa (BN) is ail eating disorder, in which the eating, attitudes are Seriously disturbed. Studies that evaluated nutritional aspects of BN focus mainly oil food intake, dietary restriction and binge eating. while the follow-up Studies evaluate mainly clinical symptoms. The objective of this study was to evaluate eating attitudes of patients with BN. during and after cognitive-behavioral intervention. Thirty nine (39) BN female patients received cognitive behavioral treatment with a Multidisciplinary team and had eating attitudes assessed by a questionnaire developed for this research. Frequencies of the attitudes assessed were compared at baseline. after 12 weeks and 24 weeks of treatment. After treatment, patients had less distorted beliefs about food, less guilty after eating ""forbidden"" foods and they felt more tranquil while caring outside home. Other negative behaviors, as dietary restriction, the desire of not cat, being angry when feeling hungry and using the food to relive stress. persisted. Eating attitudes of patients with BN are hard to be changed in a short-term. More attention to this disease`s component and new approaches to treatment are needed in order to have a better recovery.

Does the tendency to act impulsively underlie binge eating and alcohol use problems? An empirical investigation

The co-occurrence of problem drinking and binge eating and purging has been well documented. However, there has been relatively little investigation of etiological models that may influence the development of this  co-occurrence. This study tests the hypotheses that impulsivity is heightened in eating disordered women compared with controls, and that women with comorbid bulimia and alcohol use disorders show higher impulsivity than bulimic-only women. The Impulsivity scale, BIS/BAS scales, State Anxiety Inventory, and a behavioural measure of reward responsiveness (CARROT) were administered to 22 women with bulimia, 23 women with comorbid bulimia and alcohol abuse/dependence, and 21 control women. As hypothesised, eating disordered women scored higher than controls on several self-report measures of impulsivity and sorted cards faster during a financially rewarded trial on the behavioural task. Also, as predicted, comorbid women scored higher than bulimic women on the Impulsivity scale. These findings suggest that individual differences in impulsiveness and a tendency to approach rewarding stimuli may contribute to developing these disorders.

Negative affect as a mediator between body dissatisfaction and extreme weight loss and muscle gain behaviors

Negative affect has been found to mediate the relationship between body dissatisfaction and bulimia. However, it is unknown if this relationship also applies to disordered eating, excessive exercise and strategies to increase muscle for men or women. The aim of this study was to investigate whether negative and positive affect mediate the relationship between body dissatisfaction, and these body change strategies. Respondents were 93 men and 97 women (age range: 18-25 years), who completed measures of body dissatisfaction, positive and negative affect and body change strategies to lose weight or increase muscles. Body dissatisfaction was associated with strategies to lose weight, dietary restraint and bulimia for both genders. Negative affect mediated the relationship between dissatisfaction with muscles and strategies to lose weight, dietary restraint and bulimia for women only. The results confirm previous findings related to the association between negative affect and disordered eating for women. They also demonstrate the need to further investigate the impact of negative affect on body change strategies, particularly among men, and those strategies related to increasing muscles.

A prospective study of extreme weight change behaviors among adolescent boys and girls.

This study examined changes in extreme weight change attitudes and behaviors (exercise dependence, food supplements, drive for thinness, bulimia) among adolescent boys and girls over a 16 month period. It also investigated the impact of body mass index, puberty, body image, depression and positive affect on these attitudes and behaviors 16 months later. The participants were 847 young adolescents (411 boys, 436 girls). Participants completed questionnaires evaluating the above variables on three occasions, eight months apart. Girls obtained higher scores on exercise dependence, drive for thinness and bulimia. Changes in depression and body image importance were the strongest predictors of changes in these extreme attitudes and behaviors among boys; changes in depression, body dissatisfaction and body image importance were the strongest predictors for girls. The need for gender specific educational and intervention programs for adolescents are discussed.

Motivational processes associated with unhealthy body change attitudes and behaviours

Objective
The relationship between approach–avoidance motivational processes and unhealthy body change attitudes and behaviours was investigated.
Method
Self-reported sensitivity to rewards (SR) and sensitivity to punishments (SP) were measured for a convenience sample of 130 women, aged 18 to 40 years, along with measures of disordered eating symptomatology and exercise dependence.
Results
Together, SR and SP significantly predicted variance in drive for thinness (21%), bulimia (17%), and obligatory exercise (7%). These relationships were partly mediated by internalization of the thin ideal, body comparison, and subjective importance of achieving one's ‘ideal’ body and of avoiding one's ‘worst possible’ body. Interestingly, body dissatisfaction partly mediated the relationships involving SP but not SR.
Discussion
The results suggest that an underlying sensitivity to punishments, but not rewards, can manifest as a ‘fear of fatness’. Both of these motivational traits can increase the salience of self evaluations, and thus indirectly contribute to unhealthy body change attitudes and behaviours.

A longitudinal study of body change strategies of fitness center attendees

This study evaluated predictors of strategies to change weight and muscles among men and women who attend fitness centers. A questionnaire was completed by 107 men (mean age = 39.17, SD = 13.14), and 151 women (mean age = 35.31, SD = 11.38) who regularly attended fitness centers at two points in time, one year apart. The only unique predictor of body change strategies over time for men was body dissatisfaction predicting drive for thinness; for women, body dissatisfaction predicted strategies to lose weight, drive for thinness, use of food supplements to lose weight and levels of bulimia. Media messages also predicted drive for thinness and bulimia among women. These findings would suggest that attendance body dissatisfaction is an important factor predicting other normative and health risk behaviors among fitness center attendees, particularly women at a fitness center over a 12 month period was not generally associated with adverse health risk behaviors.

Body dissatisfaction and body change strategies among adolescents : a longitudinal investigation

This thesis examined body dissatisfaction and body change behaviors among adolescent girls and boys from a biopsychosocial framework. The contribution of biological, psychological and sociocultural factors were examined in relation to body dissatisfaction, weight loss, weight gain and increased muscle tone behaviors among early adolescent girls and boys. In particular, pubertal maturation, body mass index (BMI), perception of body shape and size and psychological factors, such as depression, anxiety, ineffectiveness, self-esteem and perfectionism, were examined as possible factors that may precipitate or maintain body dissatisfaction and engagement in body change strategies. The sociocultural factors evaluated were the quality of family and peer relationships, as well as the influence of family and peers in predicting the adoption of specific body change strategies. The specific mechanisms by which these influences were transmitted were also examined. These included perceived discussion, encouragement and modelling of various body change strategies, as well as perceived teasing about body shape and size. A number of separate cross-sectional and longitudinal studies were conducted to examine the above relationships and identify the factors that contribute to weight loss, weight gain and increased muscle tone behaviors in adolescents. Study 1 examined the psychometric properties and principal components structure of the Bulimia Test Revised (BULIT-R; Thelen, Farmer, Wonderlich, & Smith, 1991) to assess its applicability to adolescent samples. Study 2 investigated the nature of body dissatisfaction and weight loss behaviors among 603 adolescents (306 girls and 297 boys) using a standardised questionnaire. This preliminary study was conducted to ascertain whether variables previously found to be relevant to adolescent girls, could also be related to the development of body dissatisfaction and weight loss behaviors among adolescent boys. Studies 3 and 4 described the development and validation of a body modification scale that measured weight loss, weight gain and increased muscle tone behaviors. Studies 5 and 6 were designed to modify an Excessive Exercise Scale developed by Long, Smith, Midgley, and Cassidy (1993) into a shorter form, and validate this scale with an adolescent sample. Study 7 investigated the factors that contribute to weight loss, weight gain and increased muscle among adolescent girls and boys both cross-sectionally and longitudinally (over one year). Structural equation modelling was used to examine associations among self-reported body dissatisfaction, body change strategies and a range of biological, psychological and sociocultural variables both cross-sectionally and longitudinally. Overall, the results suggested that both girls and boys experience body dissatisfaction and engage in a number of different body change strategies in order to achieve an ideal size. A number of gender similarities and differences were identified in the expression of body dissatisfaction and the adoption of body change strategies for both girls and boys. Girls were more likely than boys to report body dissatisfaction and engage in weight loss behaviors, while boys were more likely than girls to engage in weight gain and increased muscle tone behaviors. Generally, the same factors were found to contribute to weight loss, and more specifically, bulimic symptomatology, ad weight gain in both adolescent girls and boys. While a combination of biological, psychological and sociocultural factors contributed to bulimic symptomatology, only biological and psychological factors were found to contribute to weight gain in adolescents. The most notable gender differences were found in the model of increased muscle tone. Sociocultural and biological factors contributed to increased muscle tone behaviors in girls, while sociocultural and psychological factors were implicated in these behaviors in adolescent boys. With the exception of the model of increased muscle tone for boys, body dissatisfaction was a consistent factor in the adoption of body change behaviors. Consistent with previous investigations, the present thesis provides empirical support for the need to examine the etiology and maintenance of such concerns and behaviors from a multifaceted perspective.

Disordered eating and drinking behaviours : the role of sensitivity to reward and punishment

Examines whether the personality traits of sensitivity to reward and punishment as defined by Jeffrey Gray contributed to the prediction of disordered eating and hazardous alcohol use. Studies were conducted in both subclinical and clinical populations. Heightened sensitivity to reward contributed to the prediction of hazardous alcohol use and heightened sensitivity to punishment contributed to the prediction of disordered eating in women. Women with comorbid bulimia and alcohol dependence were more behaviourally sensitive to reward than normal controls.

Childhood sexual abuse and adolescent eating disorder : findings from the Victorian Adolescent Health Cohort study

Objective: To examine the relationship between childhood sexual abuse (CSA) before the age of 16 years and later onset of bulimia and anorexia nervosa symptoms in females.

Design: A longitudinal cohort study of adolescents observed from August 1992 to March 2003. The cohort was defined in a 2-stage cluster sample using 44 Australian schools in Victoria.

Setting: Population based.

Participants: A total of 1936 persons participated at least once and survived to the age of 24 years, including 999 females. The mean (SD) age of females at the start of follow- up was 14.91 (0.39) years; and at completion, 24.03 (0.55) years.

Main Exposure: Self-reported CSA before the age of 16 years was ascertained retrospectively at the age of 24 years.

Outcome Measures: Incident Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition)–defined partial syndromes of anorexia and bulimia nervosa were identified between waves 4 (mean age, 16.3 years) and 6 (mean age, 17.4 years) using the Branched Eating Disorder Test.

Results: The incidence of bulimic syndrome during adolescence was 2.5 (95% confidence interval, 0.80-8.0) times higher among those who reported 1 episode of CSA and 4.9 (95% confidence interval, 1.9-12.7) times higher among those who reported 2 or more episodes of CSA, compared with females reporting no episodes, adjusted for age and background factors. The association persisted after adjusting for possible confounders or mediators measured 6 months earlier, including psychiatric morbidity and dieting behavior. There was little evidence of an association between CSA and partial syndromes of incident anorexia nervosa.

Conclusion: Childhood sexual abuse seems to be a risk factor for the development of bulimic syndromes, not necessarily mediated by psychiatric morbidity or severe dieting.

Psychosocial predictors of eating disorder risk in overweight and obese treatment-seeking adolescents

This study explored eating disorder risk factors and possible psychosocial predictors of this risk in overweight and obese treatment-seeking adolescents. Prior to commencing treatment 108 overweight and obese adolescents aged 11 to 17 years (M = 14.31, SD = 1.57; 55% female) completed self-report measures of psychosocial factors. Females reported elevated levels of bulimic tendencies, body dissatisfaction, drive for thinness (p ≤ .001) and males reported elevated body dissatisfaction (p < .001). Age, sex and BMI-for-age z-score explained 15% (p < .001) of the variance in eating disorder risk and psychosocial predictors an additional 25%. Sex did not have a moderating effect on these relationships (p = .21). Among overweight and obese treatment-seeking adolescents, those experiencing lower self-esteem and elevated depression and anxiety symptomatology are at increased eating disorder risk. This highlights the need to consider psychosocial factors in preventing and treating overweight and obesity.

A cross-sectional examination of non-suicidal self-injury, disordered eating, impulsivity, and compulsivity in a sample of adult women

Non-suicidal self-injury has been classed as having both impulsive and compulsive characteristics (Simeon & Favazza, 2001). These constructs have been related to disordered eating behaviors such as vomiting (Favaro & Santonastaso, 1998). Utilizing an international sample of adult females, this paper further explored this model, aiming to identify whether all types of disordered eating could be classified as impulsive or compulsive, and whether the impulsive and compulsive groupings reflect underlying trait impulsivity and compulsivity. The hypothesized impulsive and compulsive dimensions did not emerge from the data. Notably however, all self-injurious and disordered eating behaviors were linked to Urgency (an impulsivity facet) to varying degrees; no relationship with trait compulsivity was found. These findings are discussed, study limitations are noted, and relevance for clinical practice is outlined.

A new social-family model for eating disorders: A European multicentre project using a case-control design

OBJECTIVE: To examine a new socio-family risk model of Eating Disorders (EDs) using path-analyses. METHOD: The sample comprised 1264 (ED patients = 653; Healthy Controls = 611) participants, recruited into a multicentre European project. Socio-family factors assessed included: perceived maternal and parental parenting styles, family, peer and media influences, and body dissatisfaction. Two types of path-analyses were run to assess the socio-family model: 1.) a multinomial logistic path-model including ED sub-types [Anorexia Nervosa-Restrictive (AN-R), AN-Binge-Purging (AN-BP), Bulimia Nervosa (BN) and EDNOS)] as the key polychotomous categorical outcome and 2.) a path-model assessing whether the socio-family model differed across ED sub-types and healthy controls using body dissatisfaction as the outcome variable. RESULTS: The first path-analyses suggested that family and media (but not peers) were directly and indirectly associated (through body dissatisfaction) with all ED sub-types. There was a weak effect of perceived parenting directly on ED sub-types and indirectly through family influences and body dissatisfaction. For the second path-analyses, the socio-family model varied substantially across ED sub-types. Family and media influences were related to body dissatisfaction in the EDNOS and control sample, whereas perceived abusive parenting was related to AN-BP and BN. DISCUSSION: This is the first study providing support for this new socio-family model, which differed across ED sub-types. This suggests that prevention and early intervention might need to be tailored to diagnosis-specific ED profiles.

BODY DYSMORPHIC DISORDER IN PATIENTS WITH OBSESSIVE-COMPULSIVE DISORDER: PREVALENCE and CLINICAL CORRELATES

Background The prevalence, sociodemographic aspects, and clinical features of body dysmorphic disorder (BDD) in patients with obsessivecompulsive disorder (OCD) have been previously addressed in primarily relatively small samples. Methods We performed a cross-sectional demographic and clinical assessment of 901 OCD patients participating in the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders. We used the Structured Clinical Interview for DSM-IV Axis I Disorders; Yale-Brown Obsessive-Compulsive Scale; Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS); Brown Assessment of Beliefs Scale; Clinical Global Impression Scale; and Beck Depression and Anxiety Inventories. Results The lifetime prevalence of BDD was 12.1%. The individuals with comorbid BDD (OCD-BDD; n = 109) were younger than were those without it. In addition, the proportions of single and unemployed patients were greater in the OCD-BDD group. This group of patients also showed higher rates of suicidal behaviors; mood, anxiety, and eating disorders; hypochondriasis; skin picking; Tourette syndrome; and symptoms of the sexual/religious, aggressive, and miscellaneous dimensions. Furthermore, OCD-BDD patients had an earlier onset of OC symptoms; greater severity of OCD, depression, and anxiety symptoms; and poorer insight. After logistic regression, the following features were associated with OCD-BDD: current age; age at OCD onset; severity of the miscellaneous DY-BOCS dimension; severity of depressive symptoms; and comorbid social phobia, dysthymia, anorexia nervosa, bulimia nervosa, and skin picking. Conclusions Because OCD patients might not inform clinicians about concerns regarding their appearance, it is essential to investigate symptoms of BDD, especially in young patients with early onset and comorbid social anxiety, chronic depression, skin picking, or eating disorders. Depression and Anxiety 29: 966-975, 2012. (C) 2012 Wiley Periodicals, Inc.

Effects of eating disorders on oral fungal diversity

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)