Many current measures of eating disorder (ED) symptoms have 1 or more serious limitations, such as inconsistent factor structures or poor discriminant validity. The goal of this study was to overcome ...these limitations through the development of a comprehensive multidimensional measure of eating pathology. An initial pool of 160 items was developed to assess 20 dimensions of eating pathology. The initial item pool was administered to a student sample (N = 433) and community sample (N = 407) to determine the preliminary structure of the measure using exploratory and confirmatory factor analyses. The revised measure was administered to independent samples of patients recruited from specialty ED treatment centers (N = 158), outpatient psychiatric clinics (N = 303), and students (N = 227). Analyses revealed an 8-factor structure characterized by Body Dissatisfaction, Binge Eating, Cognitive Restraint, Excessive Exercise, Restricting, Purging, Muscle Building, and Negative Attitudes Toward Obesity. Scale scores showed excellent convergent and discriminant validity; other analyses demonstrated that the majority of scales were invariant across sex and weight categories. Eating Pathology Symptoms Inventory scale scores had excellent internal consistency (median coefficient alphas ranged from .84-.89) and reliability over a 2- to 4-week period (mean retest r = .73). The current study represents one of the most comprehensive scale development projects ever conducted in the field of EDs and will enhance future basic and treatment research focused on EDs.
Objectives
Restrictive eating disorders (EDs) occur across the weight spectrum, but historically more focus has been given to anorexia nervosa (AN) than atypical anorexia nervosa (atypAN). AtypAN's ...relegation to a diagnosis in the “other specified feeding and eating disorder” (OSFED) category and paucity of research surrounding atypAN invariably implies a less clinically severe ED. However, a growing body of research has begun to question the assumption that atypAN is less severe than AN. The current review and meta‐analysis aimed to provide a comprehensive review to compare atypAN and AN on measures of eating disorder psychopathology, impairment, and symptom frequency to test whether atypAN is truly less clinically severe than AN.
Methods
Twenty articles that reported on atypAN and AN for at least one of the variables of interest were retrieved from PsycInfo, PubMed, and ProQuest.
Results
For eating‐disorder psychopathology, results indicated that differences were nonsignificant for most indicators; however, atypAN was associated with significantly higher shape concern, weight concern, drive for thinness, body dissatisfaction, and overall eating‐disorder psychopathology than AN. Results indicated that atypAN and AN did not significantly differ on clinical impairment or the frequency of inappropriate compensatory behaviors, whereas there was a significantly higher frequency of objective binge episodes in AN (vs. atypAN).
Discussion
Overall, findings indicated that, in contrast to the current classification system, atypAN and AN were not clinically distinct. Results underscore the need for equal access to treatment and equal insurance coverage for restrictive EDs across the weight spectrum.
Public Significance
The current meta‐analysis found that atypAN was associated with higher drive for thinness, body dissatisfaction, shape concern, weight concern, and overall eating‐disorder psychopathology than AN; whereas AN was associated with higher frequency of objective binge eating. Individuals with AN and atypAN did not differ on psychiatric impairment, quality‐of‐life, or frequency of compensatory behaviors, highlighting the need for equal access to care for restrictive EDs across the weight spectrum.
Resumen
Objetivo
Los trastornos alimentarios restrictivos ocurren en todo el espectro de peso, pero históricamente se ha dado más importancia a la anorexia nerviosa (AN) que a la anorexia nerviosa atípica (ANA). El hecho de relegar la anorexia nerviosa atípica a un diagnóstico en la categoría de "otro trastorno de la ingestión de alimentos y de la conducta alimentaria" (OSFED) y la escasez de investigación en torno a la anorexia atípica, implica invariablemente un trastorno de la conducta alimentaria clínicamente menos grave. Sin embargo, un creciente cuerpo de investigación ha comenzado a cuestionar la suposición de que ANA es menos grave que AN. La revisión actual y el metanálisis tuvieron como objetivo proporcionar una revisión exhaustiva para comparar ANA y AN en las medidas de psicopatología de los trastornos alimentarios, el deterioro y la frecuencia de los síntomas para probar si ANA es realmente menos grave clínicamente que AN.
Método
Veinte artículos que informaron sobre ANA y AN para al menos una de las variables de interés se recuperaron de PsycInfo, PubMed y ProQuest.
Resultados
Para la psicopatología del trastorno alimentario, los resultados indicaron que las diferencias no fueron significativas para la mayoría de los indicadores; sin embargo, ANA se asoció con una preocupación de forma significativamente mayor, preocupación por el peso, impulso por la delgadez, insatisfacción corporal y psicopatología general del trastorno alimentario que AN. Los resultados indicaron que ANA y AN no difirieron significativamente en el deterioro clínico o la frecuencia de comportamientos compensatorios inapropiados, mientras que hubo una frecuencia significativamente mayor de episodios de atracones objetivos en AN (frente a ANA).
Discusión
En general, los hallazgos indicaron que, en contraste con el sistema de clasificación actual, ANA y AN no eran clínicamente distintos. Los resultados subrayan la necesidad de un acceso equitativo al tratamiento y una cobertura de seguro igual para los trastornos de la conducta alimentaria restrictivos en todo el espectro de peso.
Attentional bias to food stimuli may contribute to the etiology and/or maintenance of overweight and obesity. We conducted a literature review and meta-analysis per the Preferred Reporting Items for ...Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify the effect size associated with attentional bias to palatable food in persons with overweight/obesity across the age spectrum. Included studies measured attentional bias to food stimuli using two reaction-time tasks (dot-probe, emotional Stroop), eye-tracking methodology, and/or event-related potentials. Meta-analysis showed that persons with overweight/obesity did not differ from persons with a healthy weight on any of the following: automatic and maintained attention to food stimuli measured by the dot-probe task (Hedge's gautomatic = −0.355, 95% CI = −0.383, 0.486; and Hedge's gmaintained = 0.006, 95% CI = −0.187, 0.199); attentional bias to food stimuli measured by the emotional Stroop task (Hedge's g = 0.184, 95% CI = −0.283, 0.651); and attentional bias to food images on gaze-direction and gaze-duration bias eye-tracking metrics (Hedge's gdirection = 0.317, 95% CI = −0.096, 0.729; and Hedge's gduration = 0.056, 95% CI = −0.296, 0.407). Systematic review of preliminary event-related potentials research suggested automatic, but not maintained, attention to food images in persons with overweight/obesity. Limitations of past attentional bias research in overweight/obesity, such as poor reliability of measures and lack of consideration of moderators, such as binge eating and degree of overweight/obesity, preclude the ability to draw firm conclusions. We recommend implementation of empirically based methods for improving psychometric properties of attentional bias measures and examination of potential moderators so that the field can understand whether attentional bias to food is truly greater in overweight/obesity.
Researchers have identified a specific behavior pattern labeled “drunkorexia” to describe recurrent inappropriate compensatory behaviors (e.g., fasting and self-induced vomiting) to avoid weight gain ...from consuming alcohol (referred to as ICB-WGA). Several studies have investigated the prevalence of these behaviors among college students, but few have tested whether this behavior pattern is more strongly related to substance use or disordered eating, which may have future implications for eating disorder and substance abuse research fields. The aim of this project was to test: (1) whether disordered eating or alcohol use adds incremental validity to the prediction of ICB-WGA when controlling for the other variable and (2) the effect of sex on ICB-WGA. College participants (N=579; 53% female) completed the Eating Pathology Symptoms Inventory (EPSI), the Alcohol Use Disorders Identification Test (AUDIT), and several questions designed to measure ICB-WGA. Results indicated that EPSI Restricting and Body Dissatisfaction scales were not significant predictors of ICB-WGA, whereas the AUDIT and EPSI Cognitive Restraint, Excessive Exercise, Purging, and Binge Eating scales significantly predicted ICB-WGAs. Results indicated that disordered eating and alcohol use both added incremental validity to the prediction of ICB-WGA; however, ICB-WGA was more strongly related to disordered eating, and this was particularly true for women. Our findings suggest that individuals engaging in ICB-WGA may be at-risk for future development of both eating and substance disorders. Notably, our findings highlight the need for future research to focus on trans-diagnostic prevention programs that target mechanisms that underlie both disordered eating and substance misuse.
•ICB-WGA was more strongly related to disordered eating than alcohol use in women.•ICB-WGA was equally related to disordered eating and alcohol use in men.•Both disordered eating and alcohol use added incremental validity to ICB-WGA.•Prevention protocols should consider addressing ICB-WGA differently for each sex.
Objective: Diagnosis is a cornerstone of clinical practice for mental health care providers, yet traditional diagnostic systems have well-known shortcomings, including inadequate reliability, high ...comorbidity, and marked within-diagnosis heterogeneity. The Hierarchical Taxonomy of Psychopathology (HiTOP) is a data-driven, hierarchically based alternative to traditional classifications that conceptualizes psychopathology as a set of dimensions organized into increasingly broad, transdiagnostic spectra. Prior work has shown that using a dimensional approach improves reliability and validity, but translating a model like HiTOP into a workable system that is useful for health care providers remains a major challenge. Method: The present work outlines the HiTOP model and describes the core principles to guide its integration into clinical practice. Results: Potential advantages and limitations of the HiTOP model for clinical utility are reviewed, including with respect to case conceptualization and treatment planning. A HiTOP approach to practice is illustrated and contrasted with an approach based on traditional nosology. Common barriers to using HiTOP in real-world health care settings and solutions to these barriers are discussed. Conclusions: HiTOP represents a viable alternative to classifying mental illness that can be integrated into practice today, although research is needed to further establish its utility.
What is the public health significance of this article?
Redefining a taxonomy of psychopathology according to data results in dimensions, not categories, that can be organized hierarchically-with at least six higher level spectra near the top of the model and more specific lower level components and traits at the bottom. This approach may improve case conceptualizations and align more closely with transdiagnostic treatments, while also specifying more narrow targets for intervention. A case illustration shows how the HiTOP model can be used in clinical practice today, although additional research is needed to fully assess the utility of this approach for providers and patients.
The Hierarchical Taxonomy of Psychopathology (HiTOP) is a scientific effort to address shortcomings of traditional mental disorder diagnoses, which suffer from arbitrary boundaries between ...psychopathology and normality, frequent disorder co‐occurrence, heterogeneity within disorders, and diagnostic instability. This paper synthesizes evidence on the validity and utility of the thought disorder and detachment spectra of HiTOP. These spectra are composed of symptoms and maladaptive traits currently subsumed within schizophrenia, other psychotic disorders, and schizotypal, paranoid and schizoid personality disorders. Thought disorder ranges from normal reality testing, to maladaptive trait psychoticism, to hallucinations and delusions. Detachment ranges from introversion, to maladaptive detachment, to blunted affect and avolition. Extensive evidence supports the validity of thought disorder and detachment spectra, as each spectrum reflects common genetics, environmental risk factors, childhood antecedents, cognitive abnormalities, neural alterations, biomarkers, and treatment response. Some of these characteristics are specific to one spectrum and others are shared, suggesting the existence of an overarching psychosis superspectrum. Further research is needed to extend this model, such as clarifying whether mania and dissociation belong to thought disorder, and explicating processes that drive development of the spectra and their subdimensions. Compared to traditional diagnoses, the thought disorder and detachment spectra demonstrated substantially improved utility: greater reliability, larger explanatory and predictive power, and higher acceptability to clinicians. Validated measures are available to implement the system in practice. The more informative, reliable and valid characterization of psychosis‐related psychopathology offered by HiTOP can make diagnosis more useful for research and clinical care.
Bulimia nervosa (BN) is characterized by recurrent engagement in eating disorder behaviors despite negative consequences, potentially reflecting aberrant stimulus-response or reward-learning ...processes. Indeed, frontostriatal circuitry involved in reward learning is altered in persons with BN and preliminary research suggests reward learning is impaired in persons with BN. Additional research on reward learning in BN and its association with eating disorder symptom expression is warranted to further the field's understanding of potential pathophysiological mechanisms of BN. To this end, the probabilistic reward learning task (PRLT) was administered to unmedicated women with BN (n = 15) and demographically matched psychiatrically healthy women (n = 18). Contrary to our hypotheses, results demonstrated that women with BN showed greater reward learning during the PRLT relative to healthy comparison women when covarying for symptoms of depression, social anxiety, and mania. Exploratory analyses showed that binge-eating frequency was inversely associated with reward learning in women with BN; however, results should be interpreted with caution due to the small sample size. Together, results suggest that women with BN do not have deficits in implicit reward learning. Given the preliminary nature of this investigation, larger-scale studies are needed to further examine reward learning in current BN and could compare reward learning using general (e.g., monetary) and disorder-specific (e.g., food) reinforcers. Further work is needed to confirm the inverse association between reward learning and binge eating.
•Preliminary evidence suggests reward learning is impaired in bulimia nervosa (BN).•BN group showed greater reward learning than healthy comparison group.•Reward learning and binge-eating frequency inversely associated in BN.•Further study of reward learning and its relation to BN symptoms in larger samples is warranted.
Objective
This study tested the association between food insecurity and eating disorder (ED) pathology, including probable ED diagnosis, among two cohorts of university students before and during the ...beginning of the COVID‐19 pandemic.
Method
Students (n = 579) from a large Midwestern American university completed self‐report questionnaires assessing frequency of ED behaviors, ED‐related impairment, and individual food insecurity as measured by the Eating Disorder Diagnostic Scale 5, Clinical Impairment Assessment, and Radimer/Cornell, respectively. Chi‐square tests and MANOVA with post‐hoc corrections were conducted to compare demographic characteristics, ED pathology, and probable ED diagnosis prevalence between students with and without individual food insecurity.
Results
Partially supporting hypotheses, MANOVA indicated significantly greater frequency of objective binge eating, compensatory fasting, and ED‐related impairment for students with food insecurity compared with individuals without food insecurity. Chi‐squared tests showed higher prevalence of ED diagnoses among individuals with food insecurity compared with those without food security (47.6 vs. 31.1%, respectively, p < .01, NNT = 6.06), specifically bulimia nervosa and other specified feeding and eating disorder. There were no differences in food insecurity before or during the beginning of the COVID‐19 pandemic.
Discussion
Consistent with prior literature, food insecurity was associated with elevated ED psychopathology in this sample. Findings emphasize the importance of proper ED screening for college students vulnerable to food insecurity and EDs.
•We evaluate psychometric properties of common self-report eating disorder measures.•Self-report eating disorder measures are valid and reliable among weight groups.•Self-report eating disorder ...measures can be used in obese populations.
Disordered eating measures were developed and validated in primarily normal weight samples; thus, it is unclear if the psychometric properties are equivalent across weight groups. This study evaluated the reliability and validity of self-reported disinhibited eating and dietary restraint measures in a community-recruited sample of overweight individuals (N = 201) and obese individuals (N = 101) and normal weight matched controls. Coefficient alpha and average inter-item correlations were used to test internal consistency reliability. Correlations between lifetime disordered eating behaviors and measures of dietary restraint and disinhibited eating were used to test convergent validity. Disordered eating measures included: Eating Disorders Examination Questionnaire (EDE-Q), Three Factor Eating Questionnaire (TFEQ), Dutch Eating Behavior Questionnaire (DEBQ), Eating Disorders Inventory-3 (EDI-3), and Restraint Scale. Correlations between lifetime disordered eating behaviors and measures of non-disordered-eating-related psychopathology were used to test discriminant validity. Results indicated that most measures demonstrated acceptable internal consistency reliability across groups, with the exception of the Restraint Scale. Significantly higher convergent correlations between lifetime history of fasting and TFEQ Cognitive Restraint emerged for the overweight vs. obese group, and the magnitude of discriminant correlations between lifetime history of binge eating and the Inventory of Depression and Anxiety Symptoms (IDAS) Well Being scale was stronger in the normal weight vs. overweight group. Findings suggest the majority restrained and disinhibited eating measures are reliable and valid among weight groups, and are suitable to use in overweight and obese populations.
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