Introduction: We examined the factor structure of Acute Suicidal Affective Disturbance (ASAD) in individuals with eating disorders. ASAD is a proposed diagnosis with four symptoms: rapidly increasing ...suicidal intent, social or self-alienation, hopelessness regarding the previous symptoms, and overarousal. Methods: Patients with eating disorders (N = 378) completed self-report symptom questionnaires at admission to a partial hospitalization program for eating disorders. Using proxy measures, we conducted a confirmatory factor analysis (CFA) of the one-factor model of ASAD. Results: Initial model fit was poor. We iteratively revised the model to include theoretically-justified correlated residuals (i.e., those between items intended to measure the same ASAD symptom). After these modifications, model fit remained mediocre. We next conducted a multiple-group CFA to compare ASAD between individuals with the restricting subtype of anorexia nervosa (the “ANR” model, n = 145) and individuals with binge/purge disorders (i.e., bulimia nervosa and the binge-purge subtype of anorexia nervosa; the “BP” model, n = 234). The final model had mediocre fit with partial invariance between subgroups; the ASAD factor mean was higher in the BP model. We additionally tested a bifactor model, with similar findings. Limitations: Our use of proxy measures of ASAD items may have resulted in imprecise measurement of ASAD symptoms, pointing to the importance of future research using validated measures of ASAD. Conclusions: We found moderate support for ASAD in an eating disorder sample, with invariance between eating disorder phenotypes. Our findings suggest that the ASAD diagnosis may not fully generalize to eating disorder samples.
•Acute Suicidal Affective Disturbance (ASAD) is a proposed diagnosis for suicidality.•Individuals with eating disorders (ED) are at high risk for suicide.•Confirmatory factor analysis of ASAD in an ED sample had only mediocre fit.•ASAD may provide a poor description of acute suicidality in people with ED.•Poor interoception may explain differences in acute suicidality in people with ED.
The diagnostic operationalization of personality disorders is at the crossroads. The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5), includes 2 separate systems for the ...diagnosis of personality disorders (PDs)-1 that is purely categorical (Section II) and 1 that is primarily dimensional (Section III). The International Classification of Diseases (11th ed.) will use a dimensional approach for the diagnosis of PDs. The Minnesota Multiphasic Personality Inventory 2-Restructured Form (MMPI-2-RF) PD Spectra scales were developed as measures of both the traditional and the alternative and scientifically supported systems. The current study examined the criterion and construct validity of these scales in a sample of 343 psychiatric patients. Patients completed the MMPI-2-RF, a measure of traditional personality disorders, a measure of the DSM-5 alternative model of personality disorder traits, and a measure of the 5-factor model of personality. Overall, with the exception of the Narcissistic and the Obsessive-Compulsive PD Spectra scales, the criterion and construct validity findings were quite supportive of these scales. Implications of these findings are discussed.
Public Significance Statement
The current study examined the validity associated with a new set of personality disorder scales for a commonly used psychological test instrument, the Minnesota Multiphasic Personality Inventory 2-Restructured Form (MMPI-2-RF). With two important exceptions, the results were generally supportive of the validity of the various personality disorder scales, which should be of interest to psychologists who use the MMPI-2-RF clinically.
Gastrointestinal symptoms are common within eating disorders and gastrointestinal-specific anxiety is a posited maintenance factor. The present study sought to validate a modified version of an ...existing measure of gastrointestinal-specific anxiety and hypervigilance in a sample with elevated eating pathology. Esophageal-specific terms in the Esophageal Hypervigilance and Anxiety Scale were modified to measure any gastrointestinal symptoms as a general measure of gastrointestinal-specific anxiety and hypervigilance. Three hundred eighty-two undergraduate students (83.5% female, 87.4% White) with elevated eating pathology completed a questionnaire battery that also measured gastrointestinal symptoms, general anxiety sensitivity, and lower gastrointestinal-specific anxiety on two occasions. Analyses were preregistered at Open Science Framework. Confirmatory factor analysis indicated a two-factor solution (anxiety and hypervigilance) fit the data best. Internal consistency and 2-week test-retest reliability were good for subscale scores. Subscale scores exhibited large associations with a measure of lower gastrointestinal-specific anxiety but did not exhibit the hypothesized relationships with general anxiety sensitivity. Subscale scores were at least moderately correlated with measures of gastrointestinal symptoms and somatic symptom severity, with some exceptions (hypervigilance with nausea/vomiting, postprandial fullness/early satiety, bloating). Subscale scores exhibited negligible associations with discriminant validity measures. Results suggest that gastrointestinal-specific anxiety and hypervigilance are separable in samples with elevated eating pathology. The Anxiety and Hypervigilance subscale scores showed good reliability in a sample with elevated eating pathology. Correlations with measures of gastrointestinal symptoms and gastrointestinal-specific anxiety generally demonstrated good convergent and discriminant validity. We recommend researchers use subscale scores, rather than total score, in future research on gastrointestinal symptoms associated with eating pathology.
Public Significance Statement
The present study supports the preliminary reliability and validity of a measure of gastrointestinal-specific anxiety and hypervigilance in individuals with elevated eating pathology. The two subscale scores (Anxiety and Hypervigilance) have sufficient stability over time and were related to conceptually similar measures and not related to dissimilar measures.
Objective
Although much empirical attention has been devoted to emotion regulation (ER) in individuals with eating disorders, little is known about ER across a wide age range and among different ED ...subtypes. The current study sought to examine ER in a sample of eating disorder patients.
Method
A total of 364 adults and adolescents with anorexia nervosa restricting subtype (AN‐R), anorexia nervosa binge/purge subtype (AN‐BP), or bulimia nervosa (BN) were assessed with the Difficulties in Emotion Regulation Scale (DERS).
Results
Older ages were associated with higher DERS total, nonacceptance, goals, and impulsivity scores. When controlling for age, patients with BN and AN‐BP had higher overall DERS scores than those with AN, and there were some differences among diagnostic subtypes on specific facets of ER.
Conclusions
These results indicate that treatments for emotion dysregulation may be applied across eating disorder diagnoses and ages, and inform how these strategies apply to different diagnostic groups.
Partial hospital programmes (PHPs) have demonstrated efficacy in the treatment of eating disorders (EDs); however, few programmes have examined long‐term outcomes across diagnoses, including subtypes ...of anorexia nervosa (AN). The present study examined the effectiveness of PHP for adult patients (n = 243) with AN‐restricting subtype (n = 79), AN binge/purge subtype (n = 46), and bulimia nervosa (n = 118). These patients tended to have long‐standing courses of illness (43%, illness duration >7 years) and high levels of psychiatric comorbidity (92.2%). Patients completed questionnaires at admission, discharge, and follow‐up, M (SD) = 11.50 months (5.29). Through follow‐up, all diagnoses demonstrated significant improvements in weight, ED psychopathology, and comorbid symptoms, with some exceptions for the AN binge/purge group. In exploratory analyses, 49% of patients met criteria for full or partial remission at discharge and 37% at follow‐up. Results provide support for the effectiveness of PHP in improving ED outcomes in a severe sample through longer‐term follow‐up.
The purpose of the current study was to evaluate the validity of scores on the Eating Concerns (EAT) scale on the recently released Minnesota Multiphasic Personality Inventory-3 (MMPI-3), which aims ...to assess for problematic eating behaviours. It was hypothesised that the EAT scale scores would be correlated with binge eating, purging, restrictive eating, weight and body shape concerns. Participants were 396 university students, who completed a series of well-validated eating disorder measures. The EAT scale scores evidenced moderate to large correlations with many symptom dimensions of EDs, including binge eating, purging, restrictive eating and weight and shape concern, thus, supporting the hypotheses and showing evidence for criterion validity. Hierarchical regression analyses also revealed incremental validity for the EAT scale above and beyond other MMPI-3 Specific Problems scale scores. Overall, scores on the new MMPI-3 EAT scale were associated with positive support for validity in a university population and seem promising as a good screening measure for eating pathology.
Objective
Anxiety is thought to influence the development and maintenance of eating disorders (EDs). However, little is known about how, specifically, anxiety influences ED symptoms and vice versa. ...Network analysis identifies how symptoms within and across disorders are interconnected. In a network, central nodes (i.e., symptoms) have the strongest relations to other nodes and are thought to maintain psychopathology. Bridge nodes are symptoms in one diagnostic cluster that are strongly connected to symptoms in another diagnostic cluster and are thought to explain comorbidity. We identified central and bridge nodes in a network of ED symptoms and trait anxiety features.
Method
We estimated a regularized partial correlation network in patients with mixed EDs (N = 296). ED symptoms were assessed with the Eating Disorder Examination–Questionnaire. Trait anxiety was assessed with the Trait subscale of the State–Trait Anxiety Inventory. Items to include in the network were selected with a statistical algorithm to ensure that all nodes represented unique constructs. Central and bridge nodes were identified with empirical calculations.
Results
Central ED nodes were dietary restraint, as well as overvaluation of and dissatisfaction with shape and weight. The central trait anxiety node was low feelings of satisfaction. The strongest ED bridge node was avoidance of social eating. The strongest trait anxiety bridge node was low self‐confidence.
Discussion
Avoidance of social eating and low self‐esteem may be routes through which EDs and trait anxiety are linked.
Over the past two decades increased attention has been paid to promoting positive father involvement. Much of this effort has occurred through the development of fatherhood education programmes, ...however, examining the ways in which these programmes impact how men enact their fatherhood roles, especially those from diverse backgrounds is limited. Based on focus group data derived from ethnically diverse low-income fathers ('n' = 40), participating in a fatherhood education programme, we identified the following programme themes as integral to increasing father engagement: (1) social support from facilitators, (2) peer support among fathers, (3) feeling valued in family relationships, (4) improvements in co-parenting relationship, and (5) increased knowledge of child development. These findings provide critical information on the aspects of fatherhood programmes that men deem as most impactful to their fatherhood role and identity. The data also highlighted the positive ways in which the programme impacted fathering behaviours. Moreover, these qualitative results highlight key focus areas for practitioners, scholars, and policy makers in their continued efforts to support father involvement.
Objective
Despite the increased risk for eating disorders (EDs) among sexual minority (SM) individuals, no ED treatments exist specifically for this population. SM stress and appearance‐based ...pressures may initiate and/or maintain ED symptoms in SM individuals; thus, incorporating strategies to reduce SM stressors into existing treatments may help address SM individuals' increased ED risk. This mixed‐methods study evaluated the feasibility, acceptability, and preliminary efficacy of Promoting Resilience to Improve Disordered Eating (PRIDE)—a novel ED treatment for SM individuals.
Methods
N = 14 SM individuals with an ED diagnosis received 14 weekly sessions integrating Enhanced Cognitive Behavioral Therapy for EDs (CBT‐E) with techniques and principles of SM‐affirmative CBT developed to address SM stressors. Participants completed qualitative interviews and assessments of ED symptoms and SM stress reactions at baseline (pretreatment), posttreatment, and 1‐month follow‐up.
Results
Supporting feasibility, 12 of the 14 (85.7%) enrolled participants completed treatment, and qualitative and quantitative data supported PRIDE's acceptability (quantitative rating = 3.73/4). By 1‐month follow‐up, 75% of the sample was fully remitted from an ED diagnosis. Preliminary efficacy results suggested large and significant improvements in ED symptoms, clinical impairment, and body dissatisfaction, significant medium‐large improvements in internalized stigma and nonsignificant small‐medium effects of sexual orientation concealment.
Discussion
Initial results support the feasibility, acceptability, and initial efficacy of PRIDE, an ED treatment developed to address SM stressors. Future research should evaluate PRIDE in a larger sample, compare it to an active control condition, and explore whether reductions in SM stress reactions explain reductions in ED symptoms.
Public Significance
This study evaluated a treatment for SM individuals with EDs that integrated empirically supported ED treatment with SM‐affirmative treatment in a case series. Results support that this treatment was well‐accepted by participants and was associated with improvements in ED symptoms and minority stress outcomes.
Objective
Some individuals meet the criteria for atypical anorexia nervosa and another eating disorder simultaneously. The current study evaluated whether allowing a diagnosis of atypical anorexia ...nervosa to supersede a diagnosis of bulimia nervosa (BN) or binge‐eating disorder (BED) provided additional information on psychological functioning.
Methods
Archival data from 650 university students (87.7% female, 69.4% white) who met Eating Disorder Diagnostic Survey for DSM‐5 eating disorder criteria and completed questionnaires assessing quality of life, eating disorder‐related impairment, and/or eating pathology at a single time point. Separate regression models used diagnostic category to predict quality of life and impairment. Two diagnostic schemes were used: the DSM‐5 diagnostic scheme and an alternative scheme where atypical anorexia nervosa superseded all diagnoses except anorexia nervosa. Model fit was compared using the Davidson–Mackinnon J test. Analyses were pre‐registered (https://osf.io/2ejcd).
Results
Allowing an atypical anorexia nervosa diagnosis to supersede a BN or BED diagnosis provided better fit to the data for eating disorder‐related impairment (p = .02; n = 271), but not physical, psychological, or social quality of life (p's ≥ .33; n = 306). Allowing an atypical anorexia nervosa diagnosis to supersede a BN or BED diagnosis provided a better fit in cross‐sectional models predicting purging (p = .02; n = 638), but not body dissatisfaction, binge eating, restricting, or excessive exercise (p's ≥ .08; n's = 633–647).
Discussion
The current data support retaining the DSM‐5 diagnostic scheme. More longitudinal work is needed to understand the predictive validity of the atypical anorexia nervosa diagnosis.
Public Significance
The current study examined how changes to the diagnostic categories for eating disorders may change how diagnoses are associated with quality of life and impairment. Overall, findings suggest that the diagnostic hierarchy should be maintained.
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