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Dysfunctional exercise is a common, debilitating symptom across eating disorders (ED). We examined the cross-sectional and longitudinal associations between experiences of exercise and ED behaviors and cognitions in an adolescent, population-based sample. Adolescents (n = 4,054) self-reported whether they exercised to control shape and weight (exercise for weight loss [EWL]), and, if so, whether they exercised even when injured, and whether exercise interfered with life functioning (driven exercise) at age 14 years, allowing delineation of three exercise-based groups: no-EWL, EWL, and driven exercise. Participants also reported ED cognitions at age 14 years along with other ED behaviors (fasting, purging, binge eating) at ages 14 and 16 years. Sex-stratified regression approaches were employed to examine relationships between these exercise categories at age 14 and ED behaviors and cognitions at ages 14 and 16. Cross-sectionally, those in the driven exercise group, compared to the no-EWL group, consistently reported higher levels of ED cognitions and behaviors, with those in the EWL group also reporting higher levels of some ED cognitions and behaviors relative to the no-EWL group. Those in the EWL and driven exercise groups at age 14 also demonstrated a higher prospective likelihood of fasting (boys and girls) and purging (girls only) at age 16, relative to those in the no-EWL group at age 14. Results inform our understanding of EWL and driven exercise and the developmental timing of ED behaviors in adolescence and point toward the potential utility of targeted prevention for young people who report EWL. [ABSTRACT FROM AUTHOR]

• The Tripartite Influence Model is supported among bisexual and lesbian women. • Bisexual women may experience more peer appearance pressures than lesbian women. • Thin-ideal internalization may be particularly harmful for bisexual women. This cross-sectional study explored similarities and differences between heterosexual, bisexual, and lesbian women in levels of, and relationships between, the following constructs using a Tripartite Influence Model framework: family, peer, and media appearance pressures, thin- and muscular-ideal internalization, and eating disorder (ED) pathology. Self-identified heterosexual (n = 1,528), bisexual (n = 89), and lesbian (n = 278) undergraduate women completed the Sociocultural Attitudes Towards Appearance Questionnaire-4 and the Eating Disorder Examination-Questionnaire. Sexual orientation differences in appearance pressures, appearance-ideal internalization, and ED pathology were examined via analysis of variance tests. Relationships between these variables were examined with multi-group path analyses, controlling for age, race/ethnicity, and body mass index. Compared with lesbian women, heterosexual and bisexual women reported higher levels of peer appearance pressures. Paths from peer appearance pressures and thin-ideal internalization to shape/weight overvaluation and body dissatisfaction were strongest for bisexual women. Overall, results indicate notable similarities between heterosexual, bisexual, and lesbian women. However, preliminary evidence for potential differences highlights the importance of examining variation in ED risk between sexual minority subgroups. [ABSTRACT FROM AUTHOR]

Objectification theory posits that internalization of societal perspectives about the female body leads to increased body surveillance, which can result in body-related shame and subsequent eating disorder (ED) behaviors. Preliminary research indicates that these associations may be complex in nature. This study examined temporal relations among body surveillance, body shame, and eating disorder symptoms in the context of a dissonance-based body image intervention and through 14-month follow-up. College women ( N = 285) completed assessments at baseline, post-intervention, and at 8-week, 8-month, and 14-month follow-up. Cross-lag panel analyses revealed that changes in body surveillance significantly mediated the association between body shame and ED symptoms over time. Alternatively, body shame did not change over time and was not a significant mediator of associations between body surveillance and ED symptoms longitudinally. Results indicate that the ameliorative effects of dissonance-based interventions may be due to reductions in body surveillance, rather than decreased body shame. [ABSTRACT FROM AUTHOR]

Measures of dietary restraint do not consistently predict caloric restriction, and these scales appear inadequate for differentiating between healthy and risky restraint in individuals. The current study examined the relationship between self-reported dietary restraint, recent weight loss, body mass index (BMI), and eating pathology in a college sample to determine if dietary restraint coupled with caloric restriction would prove to be a more sensitive marker of eating disorder risk than restraint alone. Participants (N=245) completed a series of measures evaluating dietary restraint, recent weight loss, and eating habits. Results suggested that dietary restraint related most consistently to eating pathology, with more nuanced results for women regarding the relations between dietary restraint, recent weight loss, and BMI. Findings provided further evidence that dietary restraint and weight loss may relate to eating pathology through independent pathways. In addition, recent weight loss may be a relevant risk factor for women at lower current BMI. [ABSTRACT FROM AUTHOR]

Objectives: Eating-related disinhibition (i.e., a tendency to overeat in response to various stimuli) is associated with weight gain and poorer long-term weight loss success. Theoretically, experiential avoidance (i.e., the desire or attempts to avoid uncomfortable internal experiences), may predispose individuals to developing negative reinforcement eating expectancies (i.e., the belief that eating will help to mitigate distress), which in turn promote disinhibition. Such relationships are consistent with an acquired preparedness model, which posits that dispositions influence learning and subsequent behavior. Drawing from this framework, the current study represents the first investigation of relations between negative reinforcement eating expectancies, experiential avoidance (both general and food-specific) and disinhibited eating. In particular, the mediating role of negative reinforcement eating expectancies in the relation between experiential avoidance and disinhibited eating was examined.Method: Participants (N=107) were overweight and obese individuals presenting for behavioral weight loss treatment who completed measures of general and food-related experiential avoidance, negative reinforcement eating expectancies, and disinhibition.Results: Experiential avoidance and negative reinforcement eating expectancies significantly related to disinhibition. Furthermore, the relation between experiential avoidance and disinhibition was mediated by negative reinforcement eating expectancies.Discussion: The current study supports an acquired preparedness model for disinhibition, such that the relation between experiential avoidance and disinhibition is accounted for by expectations that eating will alleviate distress. Findings highlight the potential role of eating expectancies in models accounting for obesity risk, and identify negative reinforcement eating expectancies as a potential treatment target for reducing disinhibition. [ABSTRACT FROM AUTHOR]

Weight suppression (WS)--the difference between an individual's highest adult weight and current weight-relates to eating pathology and weight gain; however, there are several methodological issues associated with its calculation. The current study presents four alternative methods of calculating WS and tests whether these methods differentially relate to maladaptive outcomes. Alternative methods of calculation included: (1) change in BMI units; (2) BMI category change; (3) percent change in weight; and (4) two different uses of regression residuals. A sample of undergraduate students (N=631) completed self-report measures of eating pathology, current and past weight, and teasing. Measures included the Eating Disorder Examination-Questionnaire and the Perceptions of Teasing Scale. Results indicated that components of WS, current weight and highest weight, were strongly related in the present sample. The traditional method of calculating WS was related to eating pathology, binge eating and teasing for both males and females. However, WS indices orthogonal to the highest weight did not correlate with eating pathology and teasing in both males and females; for females, WS indices orthogonal to current weight were also unrelated to eating pathology. Findings suggest that the link between WS and eating pathology is mitigated after accounting for an individual's highest weight. Future research should continue to assess the reliability and clinical utility of this construct and consider using alternative WS calculations. [ABSTRACT FROM AUTHOR]

Fasting, or going a significant amount of time without eating, has been identified as a risk factor for the development of pathological eating patterns. Findings from several studies examining the impact of fasting on subsequent eating behaviors have been mixed. The current study recruited college students to record food intake, episodes of binge eating, and use of compensatory behaviors before, throughout, and following a 24-hour fast. Participants attended an initial appointment in which they completed measures of dietary restraint and disinhibition and received instructions on self-monitoring and fasting. Participants (N=122) self-monitored their eating behaviors for 96 h, including a 24-hour fasting period. Participants did not demonstrate significant increases in disordered eating behaviors following the fast (e.g., objective binge episodes, self-defined excessive eating or compensatory behavior use). Baseline disinhibition predicted excessive eating as well as objective binge episodes both before and after fasting. Altogether, findings have implications for research seeking to further understand how fasting may contribute to the development of pathological eating patterns; specifically, it seems that the ED risk associated with fasting is derived from the behavior's interaction with other individual difference variables. [ABSTRACT FROM AUTHOR]

Objective Intuitive eating is an eating approach that emphasizes increased focus on internal hunger and fullness cues to regulate eating behavior; thus, successful intuitive eating should curb the influence of environmental factors such as plate and portion size on consumption. The current study examined whether self-reported levels of intuitive eating moderated the influence of portion size on college students' food consumption during an afternoon meal of pasta and tomato sauce. Method Participants ( N = 137, 63.5% female) were randomly assigned to either a large plate (12-inch) or small plate (8-inch) external cue condition. All participants fasted for four daytime hours, completed the Intuitive Eating Scale, and then were asked to rate a meal of pasta and tomato sauce on different dimensions of taste. Participants were told that they could eat as much pasta as they would like. Results Higher levels of intuitive eating were associated with greater food consumption. At the mean level of intuitive eating, participants ate more pasta in the large plate condition. Furthermore, the influence of plate size on food consumption increased as levels of intuitive eating increased. Discussion Individuals who report high levels of intuitive eating may be more likely to eat an objectively larger amount of food in a permissive food environment, and may have implications for eating approaches that promote eating in response to internal hunger and fullness cues. [ABSTRACT FROM AUTHOR]

Within exposure-based trauma treatments for posttraumatic stress disorder (PTSD), imagery vividness during imaginal exposure of the traumatic memory is an understudied but potentially important predictor of treatment outcome. Further, to our knowledge, this relationship has only been studied in women to date, and never among individuals with PTSD and substance use disorders which could impact ability to produce vivid mental imagery and its impact. The current study investigated whether imagery vividness ratings during in-session exposure predicted post-treatment PTSD symptom severity in a sample of men and women with comorbid PTSD and substance use disorders, and also examined whether gender moderated this relationship. A sample of 71 participants who received an exposure-based trauma treatment were included in the analyses. PTSD symptom severity was assessed using both the Clinician Administered PTSD Scale (CAPS) and the Impact of Event Scale-Revised (IES-R). Results varied according to method of assessing PTSD symptom severity. Higher imagery vividness was associated with better treatment outcome when assessed by the CAPS, with vividness in later sessions relating more strongly to outcome than vividness in earlier sessions. With the IES-R, higher imagery vividness ratings predicted more favorable treatment outcome for men, but less favorable treatment outcomes for women. Findings are discussed in the context of using imagery vividness to maximize treatment outcomes and future research directions involving scientific replication. [ABSTRACT FROM AUTHOR]

Introduction Problematic alcohol use is highly comorbid with posttraumatic stress disorder (PTSD), and prior work has demonstrated that individuals with PTSD may self-medicate with alcohol in an effort to reduce their symptoms. The combination of impulsivity and alcohol-related expectancies influences the development of problematic drinking patterns. When examining individuals diagnosed with PTSD, PTSD-related alcohol expectancies may be particularly relevant to the etiology of problematic drinking. To date, no studies have specifically examined PTSD-specific alcohol expectancies as they relate to alcohol use severity in a clinical sample. Methods The current study examined the relationship between impulsivity, PTSD-related alcohol expectancies, and severity of alcohol use in a sample of 63 individuals diagnosed with comorbid PTSD and substance use disorders who were receiving treatment in a residential substance use treatment program. Results Results indicated that PTSD-related alcohol expectancies moderated the relationship between impulsivity and alcohol use severity. Specifically, at low to moderate levels of positive PTSD-related alcohol expectancies, impulsivity significantly predicted alcohol use severity, while impulsivity had no impact on the prediction of alcohol use severity when such expectancies were high. Additionally, the relationship between impulsivity, expectancies, and alcohol use severity was significant for positive, but not negative, PTSD-related alcohol expectancies. Conclusions Overall, these results suggest that impulsivity and PTSD-related alcohol expectancies interact to predict alcohol use severity in a comorbid PTSD and substance dependent sample. [ABSTRACT FROM AUTHOR]

Highlights: [•] College students completed well-known measures of body dissatisfaction. [•] Means on all measures completed were significantly higher in women than in men. [•] Clinically significant DIF was found on one item inquiring about laxative use. [Copyright &y& Elsevier]

Highlights: [•] College students completed a state body image measure before and after fasting. [•] Men reported more positive state body image overall. [•] BMI was inversely related with state body image. [•] Disinhibition was positively related to changes in body image after fasting. [•] Reports of voluntary fasting positively related to improved body image after fasting. [Copyright &y& Elsevier]

Abstract: The current study examines participants’ attributions of change in a double-blind, randomized controlled trial of problem drinkers wanting to moderate their alcohol consumption. Participants were assigned to 12 weeks of naltrexone or placebo, which was paired with either combined motivational interviewing and cognitive behavioral therapy (MBSCT) along with an enhanced medication management intervention or enhanced medication management only. Upon treatment completion, a questionnaire assessed participants’ attributions of change along with their self-efficacy in their ability to maintain treatment gains. Participants differed in strength of attributions of change and self-efficacy according to both their therapy condition and their hypothesized medication condition. Specifically, those in the MBSCT condition who hypothesized that they received placebo displayed greater confidence in continuing changes without medication compared with the other groups. How treatment condition and attributions of change relate to self-efficacy for long-term maintenance of treatment gains are discussed. [Copyright &y& Elsevier]

Abstract: Individuals who act impulsively under stress show increased risk for both problematic alcohol use and problems with food. These two issues evidence significant comorbidity; many models have explored the relation between these conditions. The current study examines the relation of trait urgency and disorder-specific expectancies to alcohol problems and eating. Previous studies have examined these variables together in females, and this investigation evaluates this model in a combined sample of men and women. The findings from this study are consistent with an acquired preparedness model, indicating that trait urgency and expectancies enhance risk for both alcohol and eating problems. Furthermore, expectancies moderate the relationship between urgency and bulimic symptoms. The relationship between urgency, expectancies, and drinking depends on gender. [Copyright &y& Elsevier]

Eating disorders (EDs) and anxiety disorders (ADs) evidence shared risk and significant comorbidity. Recent advances in understanding of anxiety-based disorders may have direct application to research and treatment efforts for EDs. The current review presents an up-to-date, behavioral conceptualization of the overlap between anxiety-based disorders and EDs. We identify ways in which anxiety presents in EDs, consider differences between EDs and ADs relevant to treatment adaptions, discuss how exposure-based strategies may be adapted for use in ED treatment, and outline directions for future mechanistic, translational, and clinical ED research from this perspective. Important research directions include: simultaneous examination of the extent to which EDs are characterized by aberrant avoidance-, reward-, and/or habit-based neurobiological and behavioral processes; improvement in understanding of how nutritional status interacts with neurobiological characteristics of EDs; incorporation of a growing knowledge of biobehavioral signatures in ED treatment planning; development of more comprehensive exposure-based treatment approaches for EDs; testing whether certain exposure interventions for AD are appropriate for EDs; and improvement in clinician self-efficacy and ability to use exposure therapy for EDs. • Eating disorders (EDs) and anxiety disorders evidence shared risk and significant comorbidity • The current paper reviews the overlap between anxiety-based disorders and EDs • We discuss how exposure-based strategies may be adapted for use in ED treatment. • We outline future research directions for exposure-based therapies in EDs. [ABSTRACT FROM AUTHOR]

While facets of both anxiety and impulsivity appear central to the development and maintenance of bulimia nervosa (BN), specific BN behaviors may be propagated by differing profiles of risk. The current study examined associations between dimensions of anxiety and impulsivity and BN symptoms (binge eating, vomiting, laxative misuse, driven exercise), both in terms of the presence of such behaviors and their frequency. Two hundred and four women (Mage = 25.7 years) who met DSM-IV criteria for full or subthreshold BN completed self-report measures of perfectionism (Frost Multidimensional Perfectionism Scale), anxiety (Spielberger Trait Anxiety Inventory), impulsivity (Barratt Impulsiveness Scale-11; Impulsive Behavior Scale), eating disordered behaviors (Eating Disorder Examination - Questionnaire), and associated psychiatric symptoms (Michigan Assessment Screening Test/Alcohol-Drug; Maudsley Obsessive-Compulsive Inventory). Factor analysis revealed multidimensional impulsive and anxiety-related traits (5 anxiety-related factors; 7 impulsivity-related factors). In zero-sensitive regression models, different facets of impulsivity evidenced association with the presence of binge eating (risk taking), laxative misuse (impulsive spending), and fasting (difficulty concentrating), along with the frequency of vomiting (long-term planning difficulties). In contrast, anxiety-related dimensions were only associated with driven exercise (high standards) and fasting (concern over mistakes, high standards, parental expectations). Overall, impulsive and anxiety-related factors and symptoms showed distinct associations with specific eating disorder behaviors, even among those with the same diagnosis. [ABSTRACT FROM AUTHOR]

Abstract: Although several efficacious treatments for posttraumatic stress disorder (PTSD) exist, these treatments are currently underutilized in clinical practice. To address this issue, research must better identify barriers to dissemination of these treatments. This study investigated patient preferences for PTSD treatment given a wide range of treatment options in an analog sample. One hundred and sixty individuals, with varying degrees of trauma history, were asked to imagine themselves undergoing a trauma, developing PTSD, and seeking treatment. Participants evaluated seven different treatment descriptions, which depicted treatment options that they might encounter in a clinical setting. Participants rated their most and least preferred treatments along with their personal reactions to and the perceived credibility of each treatment. Participants also completed a critical thinking skills questionnaire. Participants predominantly chose exposure or another variant of cognitive–behavioral therapy as their most preferred therapy, and those who chose exclusively empirically supported treatments evidenced higher critical thinking skills. The present study contributes to a growing literature indicating that patients may be more interested in these therapies than indicated by utilization rates. The problem of underutilization of empirically supported treatments for PTSD in clinical practice may be due to therapist factors. [Copyright &y& Elsevier]

Maladaptive exercise relates to eating disorder (ED) pathology and impairment in clinical and non-clinical populations. At present, two different conceptualizations of maladaptive exercise are often studied in relation to ED pathology: compulsive exercise and exercise dependence. Compulsive exercise functions to avoid negative affect (e.g., guilt and anxiety) associated with not exercising, whereas exercise dependence is associated with tolerance to exercise benefits and avoidance of exercise withdrawal. At present, clinicians and researchers struggle to determine the most appropriate term for describing problematic exercise in individuals with ED pathology. This study aimed to directly compare these conceptualizations of maladaptive exercise in relation to severity of ED pathology. This study examined cross-sectional data. Undergraduate participants (N = 235, 78% female) with elevated ED pathology completed the Eating Disorder Examination Questionnaire (EDE-Q), Compulsive Exercise Test (CET), and Exercise Dependence Scale (EDS). Multiple linear regression analyses evaluated associations between EDE-Q and CET and EDS scores and dominance analysis determined which qualities of exercise were uniquely associated with EDE-Q scores. Results suggest that compulsive qualities of exercise, including exercise to control shape and weight and to avoid negative affect are more strongly associated with severity of ED pathology than qualities of exercise dependence. Clinicians and researchers working with ED populations can benefit from prioritizing assessments that capture compulsive qualities of exercise. Additionally, these results suggest that interventions that effectively target other compulsive behaviors (e.g., exposure and response prevention) may be promising treatment options for problematic exercise in the context of EDs. • Maladaptive exercise behaviors can be conceptualized as either compulsive or as dependent among individuals with elevated eating disorder pathology. • This study compared the extent to which compulsive exercise and exercise dependence were related to eating disorder pathology. • Compulsive qualities of exercise were more strongly associated with eating disorder pathology than qualities of exercise dependence. [ABSTRACT FROM AUTHOR]

Emotion dysregulation is a mechanism central to the development and maintenance of various psychological disorders. Notably, men and women may differ in their experience of emotion regulation; for instance, women generally report more frequent use of problematic emotion regulation strategies. While considering the possibility that true gender differences in emotion regulation exist, it is also important to ensure that measures assessing the process of emotion regulation are not biased toward one group over the other. The current study examined differential item functioning (DIF) in a commonly used, 36-item measure of emotion dysregulation – the Difficulties in Emotion Regulation Scale (DERS). Participants ( N = 679, 48.3% women) completed the DERS. Results demonstrated statistically-significant DIF in several of the items; two items met more stringent criteria for clinically-significant DIF. Findings suggest that further evaluation of emotion regulation measures may yield insight regarding the assessment of gender differences for emotion regulation and related constructs. [ABSTRACT FROM AUTHOR]

The tripartite influence model suggests that appearance pressures from family, peers, and the media contribute to thin-ideal internalization, which leads to increased body dissatisfaction and subsequent eating disorder pathology. The tripartite influence model was initially developed and tested among primarily White samples, and emerging research suggests racial/ethnic differences in mean levels of particular model constructs. Consequently, the model's appropriateness for understanding eating disorder risk in racial/ethnic minorities warrants investigation to determine its usefulness in explicating eating disorder risk in diverse populations. Participants in the current study were White (n = 1167), Black (n = 212), Latina (n = 203), and Asian (n = 176) women from five geographically disparate college campuses in the United States. Participants completed the Sociocultural Attitudes Towards Appearance Questionnaire-4, the Multidimensional Body-Self Relations Questionnaire - Appearance Evaluation Subscale, and the Eating Disorder Examination-Questionnaire. Analysis of variance was used to compare mean levels of each construct across racial/ethnic groups. Multigroup structural equation modeling was used to assess the appropriateness of the tripartite influence model for each racial/ethnic group, and to examine differences in the strength of the model pathways across groups. There were significant mean level differences across groups for most model constructs. However, results indicated similar model fit across racial/ethnic groups, with few differences in the strength of model pathways. Findings suggest that although some groups report lower levels of proposed risk factors, the sociocultural risk processes for eating pathology identified through the tripartite influence model are similar across racial/ethnic groups of young adult women. Such information can be used to inform culturally-sensitive interventions. [ABSTRACT FROM AUTHOR]

• Many extant terms describe avoidance/intolerance of aversive internal experiences. • Substantial recurring content and similar wording across questionnaires. • Many measures assess psychological view of non-acceptance towards negative emotions. • Some terms (e.g., distress intolerance & emotion dysregulation) not truly unique. • Moderate-to-large positive correlations between most avoidance/intolerance measures. Maladaptive avoidance/intolerance of negative emotional states has been widely shown to contribute to negative outcomes. Growing interest in this construct has led to the use of multiple terms (e.g., emotion dysregulation, distress intolerance, experiential avoidance, anxiety sensitivity, negative urgency) to describe such individual differences, each with their own measurement tools. However, to date, the degree to which these terms reflect truly unique attributes is understudied. The aim of the current manuscript is to review five of the most common terms (and associated measurement tools) used to describe these patterns of avoidance/intolerance of negative emotional states to better understand areas of overlap and key differences. We used qualitative content analysis and examined correlations between measures across 114 datasets from published manuscripts (i.e., Difficulties in Emotion Regulation Scale, Distress Tolerance Scale, Acceptance and Action Questionnaire, Anxiety Sensitivity Index, UPPS Impulsive Behavior Scale–Negative Urgency Subscale; N = 28,648 administrations). Our review suggests that measurement tools for existing terms demonstrate considerable qualitative overlap and moderate-to-large positive correlations (r = 0.24–0.67). Failures to emphasize the unique features associated with each term in existing measures may have minimized the field's ability to evaluate distinct facets of avoidance/intolerance of negative emotional states and to determine whether these facets differentially predict outcomes. Image, graphical abstract [ABSTRACT FROM AUTHOR]