The case for investigating a bidirectional association between insomnia symptoms and eating disorder pathology

This is the peer reviewed version of the following article: Christensen KA, Short NA. The casefor investigating a bidirectional association between insomniasymptoms and eating disorder pathology.Int J Eat Disord.2021;54:701–707.https://doi.org/10.1002/eat.23498, which has been published in final form at https://doi.org/10.1002/eat.23498. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.Many people with eating disorders (EDs) report symptoms of insomnia (i.e., frequent difficulty falling asleep, staying asleep, and/or early morning wakening) and sleep problems have been linked to alterations in eating behaviors; however, mechanisms of these bidirectional associations remain poorly understood and under researched. This is a problem because higher insomnia symptom severity is a risk factor for the onset and perpetuation of anxiety, mood, trauma, and substance use disorders and, potentially, ED symptoms. Furthermore, insomnia symptoms may hinder recovery and increase relapse rates following successful psychotherapy. In this article, we describe potential mechanisms underlying bidirectional associations between insomnia and eating psychopathology that may contribute to the etiology and maintenance of both disorders. We suggest novel directions for future research to characterize the association between dysregulated sleep and ED symptoms and to evaluate impacts of insomnia symptoms on relapse and recovery for people with co-occurring pathology. Finally, we discuss options for testing the incorporation of existing evidence-based treatments for insomnia disorder (e.g., Cognitive-Behavioral Therapy for Insomnia) with ED care. Overall, insomnia symptoms present a promising intervention point for ED treatment that has not been systematically tested, yet would be highly feasible to address in routine clinical care

A theoretical review of interpersonal emotion regulation in eating disorders: Enhancing knowledge by bridging interpersonal and affective dysfunction

This work is licensed under a Creative Commons Attribution 4.0 International License.Individuals with eating disorders (EDs) frequently report interpersonal and affective dysfunction. A useful lens for uniting these ideas is through the framework of interpersonal emotion regulation (IER), which consists of the ways others assist a distressed individual and how this shapes his or her subsequent emotional, behavioral, and cognitive responses. In this theoretical review, we provide an overview of the rationale for exploring IER and review IER processes in this population using the framework of the Process Model of Emotion Regulation. Finally, we offer suggestions for next steps in conducting research. IER offers a parsimonious way to explore social and emotional constructs related to ED pathology and may provide potential targets for prevention and intervention in these difficult-to-treat disorders.NIMH grant K23MH11286

A preliminary systematic review and meta-analysis of randomized-controlled trials of cognitive remediation therapy for anorexia nervosa

Cognitive remediation therapy (CRT) for anorexia nervosa (AN) was developed as an adjuvant treatment to target set-shifting and central coherence inefficiencies important in AN and to ultimately improve clinical outcomes of those with AN. The primary aim of this preliminary systematic review and meta-analysis was to determine the effect of CRT for AN relative to control treatments in randomized-controlled trials (RCTs) on neuropsychological inefficiencies at end-of-treatment. Secondary aims were to assess the effect of CRT for AN on dropout, eating-disorder-related, and other psychological outcomes at end-of-treatment. Systematic review and meta-analytic procedures were conducted in accordance with PRISMA Guidelines. RCTs evaluating CRT for AN compared to a control treatment were identified via ProQuest, PsycINFO, PubMed, and SCOPUS. Seven RCTs and one quasi-RCT of CRT for AN were included. RCT quality ratings ranged from fair (n = 3) to good (n = 4). Random-effects meta-analysis was conducted using Hedge's g. Study heterogeneity was assessed using I2 and publication bias was assessed with Begg's adjusted-rank correlation and the trim-and-fill method. CRT was not associated with improvement in central coherence compared to control treatments at end-of-treatment (g = 0.25, 95% CI = −0.35, 0.85, k = 3). Set-shifting outcomes were mixed due to heterogeneity of set-shifting measures across studies. CRT may prevent dropout; yet, more studies are needed to draw conclusions. CRT did not confer advantage over control treatments for eating-disorder-related and other psychological outcomes at end-of-treatment. Future RCTs of CRT for AN should use precise measures to assess constructs (particularly for set shifting), increase sample size, and implement longitudinal follow-up. (Word Count: 247 words)

Multi-method assessment of palatable food exposure in women with and without eating disorders

This is the peer reviewed version of the following article: Christensen, KA, French, MN, Chen, EY. Multi-method assessment of palatable food exposure in women with and without eating disorders. Eur Eat Disorders Rev. 2020; 28: 594– 602. https://doi.org/10.1002/erv.2746, which has been published in final form at https://doi.org/10.1002/erv.2746. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.Objective Eating disorders (EDs) are characterized by dysregulated responses to palatable food. Using a multi-method approach, this study examined responses to palatable food exposure and subsequent ad libitum eating in women with binge-eating disorder (BED: n = 64), anorexia nervosa (AN: n = 16), and bulimia nervosa (BN: n = 35) and 26 healthy controls (HCs). Method Participants were exposed to palatable food followed by an ad libitum eating opportunity. Affective and psychophysiological responses were measured before and during the task. Results Participants with EDs reported greater negative affect, particularly fear, following the food cue exposure, whereas HCs reported no change. BN and BED groups reported greater urge to binge after the food cue exposure, whereas AN and HC groups reported no change. Respiratory sinus arrhythmia levels, skin conductance and tonic skin conductance levels increased during food exposure for all groups. Across baseline and during the food exposure, the BED group had lower respiratory sinus arrhythmia levels relative to the BN and HC groups. The BED group consumed significantly more palatable food than the AN group. Conclusions ‘Palatable’ food stimuli elicited more negative affect, particularly fear, in individuals with EDs; and this, rather than psychophysiological responses, distinguishes individuals with EDs from those without

A single-case multiple baseline design for treating insomnia in eating disorders: The TIRED study

This is the peer reviewed version of the following article: Christensen, KA, Forbush, KT, Elliott, BT, Jarmolowicz, DP. A single-case multiple baseline design for treating insomnia in eating disorders: The TIRED study. Int J Eat Disord. 2021; 54: 652– 659. https://doi.org/10.1002/eat.23450, which has been published in final form at https://doi.org/10.1002/eat.23450. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.Objective The purpose of this trial is to evaluate the novel use of an empirically supported treatment for sleep problems for people with residual insomnia disorder following ED treatment. Method Participants (N = 6) will complete a single-case multiple baseline study using Brief Behavioral Treatment for Insomnia (Buysse et al., Archives of Internal Medicine, 171, 2011, 887–895; Troxel et al., Behavioral Sleep Medicine, 10, 2012, 266–279). Participants will complete pre- and post-treatment evaluations of insomnia severity, sleep efficiency, daytime fatigue, ED symptoms, depressive symptoms, and anxiety symptoms. Throughout treatment, participants will complete daily diaries of sleep indices (sleep latency, wake after sleep onset, total sleep time, and sleep efficiency). Results The primary outcome will be treatment effects on insomnia severity, measured by the Insomnia Severity Index. Secondary outcomes include sleep efficiency and daytime fatigue. Exploratory outcomes include ED-related impairment and symptoms, anxiety symptoms, and depression symptoms. We will provide subject-level graphs of sleep indices and ED symptoms throughout treatment. Additionally, treatment effects will be examined at one- and three-month follow-up. Discussion Although insomnia treatments have been evaluated in other psychiatric disorders, there has yet to be a study examining behavioral interventions for insomnia in EDs. Results of this study will inform the development and application of interventions for residual insomnia symptoms in this population

Do the SCOFF items function differently by food-security status in U.S. college students?: Statistically, but not practically, significant differences

Despite food insecurity (FI) being associated with eating disorders (EDs), little research has examined if ED screening measures perform differently in individuals with FI. This study tested whether items on the SCOFF performed differently as a function of FI. As many people with FI hold multiple marginalized identities, this study also tested if the SCOFF performs differently as a function of food-security status in individuals with different gender identities and different perceived weight statuses. Data were from the 2020/2021 Healthy Minds Study (N = 122,269). Past-year FI was established using the two-item Hunger Vital Sign. Differential item functioning (DIF) assessed whether SCOFF items performed differently (i.e., had different probabilities of endorsement) in groups of individuals with FI versus those without. Both uniform DIF (constant between-group difference in item-endorsement probability across ED pathology) and non-uniform DIF (variable between-group difference in item-endorsement probability across ED pathology) were examined. Several SCOFF items demonstrated both statistically significant uniform and non-uniform DIF (ps < .001), but no instances of DIF reached practical significance (as indicated by effect sizes pseudo ΔR2 ≥ 0.035; all pseudo ΔR2's ≤ 0.006). When stratifying by gender identity and weight status, although most items demonstrated statistically significant DIF, only the SCOFF item measuring body-size perception showed practically significant non-uniform DIF for perceived weight status. Findings suggest the SCOFF is an appropriate screening measure for ED pathology among college students with FI and provide preliminary support for using the SCOFF in individuals with FI and certain marginalized identities

The posited effect of positive affect in anorexia nervosa: Advocating for a forgotten piece of a puzzling disease

Anorexia nervosa (AN) is a complex and life‐threatening eating disorder. Current models of AN onset and maintenance have largely focused on the role of negative affect, while fewer models have described the role of positive affect (PA). Given that these theoretical models have informed current treatment approaches, and that treatment remains minimally effective for adults with AN, we advocate that targeting PA is one avenue for advancing maintenance models and by extension, treatment. We specifically propose that AN may arise and be chronically and pervasively maintained as a function of dysregulated PA in response to weight loss and weight loss behaviors (e.g., restriction, excessive exercise), to a degree that is not accounted for in existing models of AN. We present evidence from multiple domains, including biological, behavioral, and self‐report, supporting the hypothesis that PA dysregulation in AN contributes to the maintenance of the disorder. We conclude with several specific avenues for treatment development research as well as a call for future work elucidating the biological correlates of PA.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151291/1/eat23147.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151291/2/eat23147_am.pd

Observations of MCG-5-23-16 with Suzaku, XMM-Newton and NuSTAR: Disk tomography and Compton hump reverberation

MCG-5-23-16 is one of the first AGN where relativistic reverberation in the iron K line originating in the vicinity of the supermassive black hole was found, based on a short XMM-Newton observation. In this work, we present the results from long X-ray observations using Suzaku, XMM-Newton and NuSTAR designed to map the emission region using X-ray reverberation. A relativistic iron line is detected in the lag spectra on three different time-scales, allowing the emission from different regions around the black hole to be separated. Using NuSTAR coverage of energies above 10 keV reveals a lag between these energies and the primary continuum, which is detected for the first time in an AGN. This lag is a result of the Compton reflection hump responding to changes in the primary source in a manner similar to the response of the relativistic iron K line.Comment: Accepted for Publication in Ap

The Compton hump and variable blue wing in the extreme low-flux NuSTAR observations of 1H0707-495

The Narrow-line Seyfert I galaxy, 1H0707-495, has been well observed in the 0.3-10 keV band, revealing a dramatic drop in flux in the iron K alpha band, a strong soft excess, and short timescale reverberation lags associated with these spectral features. In this paper, we present the first results of a deep 250 ks NuSTAR observation of 1H0707-495, which includes the first sensitive observations above 10 keV. Even though the NuSTAR observations caught the source in an extreme low-flux state, the Compton hump is still significantly detected. NuSTAR, with its high effective area above 7 keV, clearly detects the drop in flux in the iron K alpha band, and by comparing these observations with archival XMM-Newton observations, we find that the energy of this drop increases with increasing flux. We discuss possible explanations for this, the most likely of which is that the drop in flux is the blue wing of the relativistically broadened iron K alpha emission line. When the flux is low, the coronal source height is low, thus enhancing the most gravitationally redshifted emission.Comment: Submitted to MNRAS, comments are welcome. 9 pages, 5 figure

Validation of the factor structure of the Eating Pathology Symptoms Inventory in an international sample of sexual minority men

Sexual minority individuals are at greater risk for the development of eating-disorder (ED) psychopathology. Despite the importance of understanding ED symptoms in sexual minority men, most ED measures were developed and validated in heterosexual, young adult, white women. The psychometric properties of ED measures in diverse populations remain largely unknown. The purpose of this study was to test: 1) whether the eight-factor structure of the Eating Pathology Symptoms Inventory (EPSI) replicated in sexual minority men and 2) group-level mean differences between gay and bisexual men on the eight EPSI scales. International participants (N = 722 sexual minority men from 20 countries) were recruited via the Grindr smartphone application. Confirmatory factor analysis (CFA) was completed using a weighted least square mean and variance adjusted estimator. Group differences in eating pathology between gay and bisexual men were tested using independent samples t-tests. The CFA model fit was good on all fit indices (CFI/TLI > 0.90, RMSEA < 0.06). Gay and bisexual men only differed on the EPSI Binge Eating scale. The results of this investigation suggest that the EPSI may be a useful tool for understanding eating pathology in this population. Using psychometrically sound assessment tools for sexual minority men is a vital piece of treatment planning and clinical decision making. The current study fills an important gap in the clinical and research literature by testing the validity and psychometric properties of a commonly used ED measure in sexual minority men