Perfectionism and eating disorder symptoms in female university students: The central role of perfectionistic self-presentation

Purpose: Numerous studies have found perfectionism to show positive relations with eating disorder symptoms, but so far no study has examined whether perfectionistic self-presentation can explain these relations or whether the relations are the same for different eating disorder symptom groups. Methods: A sample of 393 female university students completed self-report measures of perfectionism (self-oriented perfectionism, socially prescribed perfectionism), perfectionistic self-presentation (perfectionistic self-promotion, nondisplay of imperfection, nondisclosure of imperfection), and three eating disorder symptom groups (dieting, bulimia, oral control). In addition, students reported their weight and height so their body mass index (BMI) could be computed. Results: Results of multiple regression analyses controlling for BMI indicated that socially prescribed perfectionism positively predicted all three symptom groups, whereas self-oriented perfectionism positively predicted dieting only. Moreover, perfectionistic self-presentation explained the positive relations that perfectionism showed with dieting and oral control, but not with bulimia. Further analyses indicated that all three aspects of perfectionistic self-presentation positively predicted dieting, whereas only nondisclosure of imperfection positively predicted bulimia and oral control. Overall, perfectionistic self-presentation explained 10.4-23.5% of variance in eating disorder symptoms, whereas perfectionism explained 7.9-12.1%. Conclusions: The findings suggest that perfectionistic self-presentation explains why perfectionistic women show higher levels of eating disorder symptoms, particularly dieting. Thus perfectionistic self-presentation appears to play a central role in the relations of perfectionism and disordered eating and may warrant closer attention in theory, research, and treatment of eating and weight disorders

Testing the cognitive-behavioural maintenance models across DSM-5 bulimic-type eating disorder diagnostic groups: A multi-centre study

The original cognitive-behavioural (CB) model of bulimia nervosa, which provided the basis for the widely used CB therapy, proposed that specific dysfunctional cognitions and behaviours maintain the disorder. However, amongst treatment completers, only 40–50 % have a full and lasting response. The enhanced CB model (CB-E), upon which the enhanced version of the CB treatment was based, extended the original approach by including four additional maintenance factors. This study evaluated and compared both CB models in a large clinical treatment seeking sample (N = 679), applying both DSM-IV and DSM-5 criteria for bulimic-type eating disorders. Application of the DSM-5 criteria reduced the number of cases of DSM-IV bulimic-type eating disorders not otherwise specified to 29.6 %. Structural equation modelling analysis indicated that (a) although both models provided a good fit to the data, the CB-E model accounted for a greater proportion of variance in eating-disordered behaviours than the original one, (b) interpersonal problems, clinical perfectionism and low self-esteem were indirectly associated with dietary restraint through over-evaluation of shape and weight, (c) interpersonal problems and mood intolerance were directly linked to binge eating, whereas restraint only indirectly affected binge eating through mood intolerance, suggesting that factors other than restraint may play a more critical role in the maintenance of binge eating. In terms of strength of the associations, differences across DSM-5 bulimic-type eating disorder diagnostic groups were not observed. The results are discussed with reference to theory and research, including neurobiological findings and recent hypotheses

Eating disorder symptoms and the 2 × 2 model of perfectionism: Mixed perfectionism is the most maladaptive combination

Purpose: The 2 × 2 model of perfectionism (Gaudreau & Thompson, 2010) represents an important addition to the perfectionism literature, but so far has not been studied in relation to disordered eating. Method: Using the 2 × 2 model as analytic framework, this study examined responses from a convenience sample of 716 participants aged 19-68 years (71% female) investigating how self-oriented perfectionism (SOP) and socially prescribed perfectionism (SPP) predicted individual differences in eating disorder symptoms, additionally controlling for body mass index, gender, and age. Results: Results showed a significant SOP × SPP interaction indicating that the combination of high SOP and high SPP--called “mixed perfectionism”--was associated with the highest levels of eating disorder symptoms. Conclusions: The findings demonstrate the utility of the 2 × 2 model of perfectionism as an analytic framework for examining perfectionism and disordered eating. Moreover, they suggest that mixed perfectionism is the most maladaptive form of perfectionism, when it comes to disordered eating, such that having high levels of SPP combined with high levels of SOP represents the most maladaptive combination of perfectionism in terms of risk of eating disorder

A randomized trial to reduce sugar-sweetened beverage and juice intake in preschool-aged children: description of the Smart Moms intervention trial

Abstract Background Obesity in young children remains a public health concern, and maternal weight is one of the strongest predictors of obesity in early childhood. However, parental adherence in interventions for young children is often low and existing programs have had mixed success. An innovative approach to treatment is needed that increases adherence among mothers and improves weight-related behaviors simultaneously in mothers and children. The objective of the Smart Moms randomized controlled trial (RCT) is to test the efficacy of a 6-month primarily smartphone-delivered program to reduce sugar-sweetened beverage and juice consumption among children ages 3–5 whose mothers are overweight or obese. This paper describes the study design and intervention. Methods/Design Mother-child dyads were eligible if the mother was overweight or obese, owned a smartphone, and if the child was between the ages of 3–5 and consumed 12 oz or more per day of sugar-sweetened beverages (SSBs) and 100 % fruit juice. Participants were randomly assigned to the Smart Moms intervention or a waitlist control group. The intervention consisted of theoretically grounded and evidence-based behavioral strategies delivered through one group session, lessons on a mobile-optimized website, and text messages. Mothers submitted self-monitoring information via text message and received regular tailored feedback emails from interventionists. The primary outcome is change in child SSB and juice consumption and a secondary outcome is change in maternal weight. Discussion This Smart Moms study was designed to determine if a low-burden intervention delivered using mobile methods and targeted towards mothers could be effective at changing child sugar-sweetened beverage intake. Results will indicate if mobile-based methods can be a feasible way to engage mothers in family-based studies and will inform successful strategies to prevent childhood obesity through parent-targeted approaches. Trial registration Clinicaltrials.gov NCT02098902 (Registered March 25, 2014)

Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial

Background Results of small trials indicate that fluoxetine might improve functional outcomes after stroke. The FOCUS trial aimed to provide a precise estimate of these effects. Methods FOCUS was a pragmatic, multicentre, parallel group, double-blind, randomised, placebo-controlled trial done at 103 hospitals in the UK. Patients were eligible if they were aged 18 years or older, had a clinical stroke diagnosis, were enrolled and randomly assigned between 2 days and 15 days after onset, and had focal neurological deficits. Patients were randomly allocated fluoxetine 20 mg or matching placebo orally once daily for 6 months via a web-based system by use of a minimisation algorithm. The primary outcome was functional status, measured with the modified Rankin Scale (mRS), at 6 months. Patients, carers, health-care staff, and the trial team were masked to treatment allocation. Functional status was assessed at 6 months and 12 months after randomisation. Patients were analysed according to their treatment allocation. This trial is registered with the ISRCTN registry, number ISRCTN83290762. Findings Between Sept 10, 2012, and March 31, 2017, 3127 patients were recruited. 1564 patients were allocated fluoxetine and 1563 allocated placebo. mRS data at 6 months were available for 1553 (99·3%) patients in each treatment group. The distribution across mRS categories at 6 months was similar in the fluoxetine and placebo groups (common odds ratio adjusted for minimisation variables 0·951 [95% CI 0·839–1·079]; p=0·439). Patients allocated fluoxetine were less likely than those allocated placebo to develop new depression by 6 months (210 [13·43%] patients vs 269 [17·21%]; difference 3·78% [95% CI 1·26–6·30]; p=0·0033), but they had more bone fractures (45 [2·88%] vs 23 [1·47%]; difference 1·41% [95% CI 0·38–2·43]; p=0·0070). There were no significant differences in any other event at 6 or 12 months. Interpretation Fluoxetine 20 mg given daily for 6 months after acute stroke does not seem to improve functional outcomes. Although the treatment reduced the occurrence of depression, it increased the frequency of bone fractures. These results do not support the routine use of fluoxetine either for the prevention of post-stroke depression or to promote recovery of function. Funding UK Stroke Association and NIHR Health Technology Assessment Programme

Parental influences on adolescent video game play: a study of accessibility, rules, limit setting, monitoring, and cybersafety

Adolescents' video gaming is increasing at a rapid rate. Yet, little is known about what factors contribute toward more hours of gaming per week, as well as what factors may limit or protect adolescents from excessive gaming. The aim of the present study was to examine associations between adolescents' accessibility to video gaming devices, the locations played (i.e., bedroom, shared rooms), parental regulation of technology use, and the amount of hours spent video gaming during the week (weekdays vs. weekends). Adolescents (N=422; age 16.3±2.0 years, 41% male) completed an online questionnaire battery, including demographics, video gaming behaviors (e.g., hours played weekdays/weekends, time of day played, devices owned, locations played, etc.), and a questionnaire measuring aspects of parents' regulation of game playing (e.g., rules, limit setting, co-gaming). Accessibility to the adolescents' own devices, but not shared devices or device portability, was predictive of hours gaming on weekdays and weekends. Location (i.e., bedroom) was associated with increased gaming across the week. Parents discussing cybersafety was predictive of lower hours of gaming (weekdays and weekends). However, limit setting, monitoring, and co-gaming showed no significant effects. Adolescents' access to their own gaming equipped devices, as well as gaming in their bedrooms, were linked to increased hours of gaming. The findings suggest that in order to curb the increase in hours gaming, parents are advised to delay the ownership of adolescents' devices, encourage use in shared rooms, and discuss aspects of cybersafety with their teenage children.Lisa J. Smith, Michael Gradisar, and Daniel L. Kin

Maternal mental health at 5 years and childhood overweight or obesity at 11 years: evidence from the UK Millennium Cohort Study

Maternal psychological distress is associated with a range of adverse child outcomes. We sought to determine whether children's exposure to medium or severe distress at 5 years was associated with increased risks of overweight and obesity when they were aged 11 years. We also investigated whether any association was attenuated after accounting for potential confounding and mediating factors