Effects of cognitive distraction on the regulation of human eating behaviour

In humans, what, when, and how much is eaten is the result of a complex interplay between physiological and psychological dietary controls. The need to identify how these different influences interact is integral to understanding how eating behaviour is regulated in a range of different contexts. In particular, one phenomenon that remains poorly understood is why eating while distracted is associated with increased food intake. The aim of this thesis is to attempt to identify the nature of the potential process that underlies this phenomenon. In Part I, the relationship between dietary strategy, allocation of attention, and amount eaten is explored in three experiments. The results confirm that intake can be predicted by how attention is directed during a meal. Furthermore, contrary to previous accounts that view overeating as a passive behaviour, this research suggests that individuals may choose to direct their attention strategically in order to control their intake. In Part II, four experiments investigate the possibility that the mechanism underlying the relationship between attention and intake is related to a process akin to ‘sensory-specific satiety’. This term describes the hedonic shift in the sensory properties of a food that occur as it is eaten and which is believed to be important in meal termination. The results suggest that distraction is associated with an attenuation of the rate at which ‘desire to eat’ (both generally and specifically for the food being eaten) declines. Furthermore, although declining pleasantness is reported to remain influential in determining eating cessation when distracted, this response is somewhat inhibited, occurring after a greater amount of food has been consumed. Based on this, the conclusion drawn is that the deficit underlying overeating is one of attention, and that this may lead to overeating by undermining the rate at which satiety develops

Predictors of psychological well-being among treatment seeking transgender individuals

Research has yet to identify specific predictors of poor psychological well-being and quality of life in transgender people. This study aimed first to explore the predictive value of five factors known to be associated with poor psychological well-being in cis- and transgender people; age, self-esteem, victimisation, interpersonal problems, and body dissatisfaction. Second, to investigate the mediatory role of self-esteem and social support. Two hundred and eight participants (104 transgender and 104 cisgender controls), matched by age and gender, completed measures of these predictor variables, along with general psychopathology and functional quality of life. The results indicate that in the transgender group, greater psychopathology and greater depression were predicted by younger age (psychopathology only), lower self-esteem, greater body dissatisfaction, and greater interpersonal problems. In the cisgender group, only lower self-esteem and greater interpersonal problems were significant predictors of these factors. For quality of life, lower self-esteem and greater interpersonal problems were significant predictors of low quality of life in both groups. Self-esteem but not social support mediated the above relationships. Overall, self-esteem and interpersonal problems appear to be crucial factors that influence well-being. Those providing treatment to transgender people should pay more attention to these areas

It’s not all about the baby: Post-partum weight loss as a motivator for breastfeeding initiation and continuation

This paper was published in the journal Appetite and the definitive published version is available at https://doi.org/10.1016/j.appet.2016.08.095. This paper was also presented at the British Feeding and Drinking Group, London, UK, 7th-8th April 2016

Experiences and psychological wellbeing outcomes associated with bullying in treatment-seeking transgender and gender-diverse youth

This paper is in closed access until 11 June 2020.Purpose: Bullying in the adult transgender population is well documented, but less is known about bullying among transgender and gender-diverse (TGD) youth. Studies have begun to explore experiences of bullying and the associated psychological distress in TGD youth; however, they often fail to distinguish among the separate groups within LGBT samples. This study sought to explore the prevalence, nature, and outcomes of bullying in TGD youth attending a transgender health service in the United Kingdom (UK), taking into account birth-assigned sex and out and social transition status. Methods: Prior to their first appointment at a specialist gender clinic, participants completed a brief sociodemographic questionnaire, a questionnaire assessing experiences and outcomes of bullying, and a clinically-validated measure of anxiety and depression (Hospital Anxiety and Depression Scale). Results: A total of 274 young TGD people aged 16 to 25 years participated in the study. The majority of participants (86.5%) reported having experienced bullying, predominantly in school. Bullying was more prevalent in birth-assigned females and in out individuals, and commonly consisted of homophobic/transphobic (particularly in socially-transitioned individuals) or appearance-related (particularly in out individuals) name-calling. Individuals who reported having experienced bullying showed greater anxiety symptomology and also self-reported effects on anxiety, depression, and self-esteem. Birth-assigned females also reported greater effects on family relationships and social life. Conclusion: These findings indicate very high levels of bullying within the young TGD population attending a transgender health service in the UK, which affects wellbeing significantly. More intervention work and education need to be introduced in schools to reduce the amount of bullying

Body image dissatisfaction and eating-related psychopathology in trans individuals: a matched control study

High levels of body dissatisfaction have already been reported in the trans population; however, the root of this dissatisfaction, and its association with eating disordered behaviours, has not been studied in-depth. This study aims to assess eating disorder risk by comparing 200 trans people, 200 people with eating disorders and 200 control participants' scores on three subscales of the Eating Disorders Inventory-2 (EDI-2) and to further explore dissatisfaction in the trans participants using the Hamburg Body Drawing Scale (HBDS). The results showed that overall participants with eating disorders scored higher than trans or control groups on all EDI-2 measures, but that trans individuals had greater body dissatisfaction than control participants and, importantly, trans males had comparable body dissatisfaction scores to eating disordered males. Drive for thinness was greater in females (cis and trans) compared with males. In relation to HBDS body dissatisfaction, both trans males and trans females reported greatest dissatisfaction not only for gender-identifying body parts but also for body shape and weight. Overall, trans males may be at particular risk for eating disordered psychopathology and other body image-related behaviour

Non-Suicidal Self-Injury in Trans People: Associations with Psychological Symptoms, Victimization, Interpersonal Functioning, and Perceived Social Support

Introduction. There is a paucity of systematic research in the area of non-suicidal self-injury (NSSI) in trans people. Aims. To investigated the prevalence of non-suicidal self-injury in trans people and the associations with intra- and interpersonal problems. Methods. Participants were 155 untreated individuals with a diagnosis of Transsexualism (according to ICD-10 criteria) attending a national gender identity clinic. Main Outcome Measures. All participants completed the Self-Injury Questionnaire, The Symptom Checklist-90-Revised, The Rosenberg Self-Esteem Scale, The Hamburg Body Drawing Scale, The Experiences of Transphobia Scale, The Inventory of Interpersonal Problems-32 and The Multidimensional Scale of Perceived Social Support. Results. The sample consisted of 66.5% trans women and 33.5% trans men and 36.8% of them had a history of engaging in NSSI. The prevalence of NSSI was significantly higher in trans men (57.7%) compared to trans women (26.2%). Trans individuals with NSSI reported more psychological and interpersonal problems and perceived less social support compared to trans individuals without NSSI. Moreover, the probability of having experienced physical harassment related to being trans was highest in trans women with NSSI (compared to those without NSSI). The study found that with respect to psychological symptoms, trans women reported significantly more intrapersonal and interpersonal symptoms compared to trans men. Finally, the results of the regression analysis showed that the probability of engaging in NSSI by trans individuals was significantly positively related to a younger age, being trans male and reporting more psychological symptoms. Conclusions. The high levels of NSSI behavior and its association with interpersonal and interpersonal difficulties and lack of social support needs to be taken into consideration when assessing trans individuals. The effect of cross-sex hormones and sex reassignment surgery on psychological functioning, including NSSI behavior, as part of the transitional journey of trans individuals should be explored in future studies

Risk factors for non suicidal self injury among trans youth

Background: Previous research has reported high levels of non-suicidal self-injury (NSSI) in trans populations and younger age has been identified as a risk factor. Aims: To explore the prevalence of NSSI in a large group of young trans people, and to identify risk factors for this group. Main Outcome Measures: Socio-demographic variables and measures of NSSI (The Self-Injury Questionnaire), Psychopathology (Symptom Checklist 90 Revised), Self-esteem (Rosenberg Self Esteem Scale), victimization (Experiences of transphobic victimization), Interpersonal functioning (Inventory of Interpersonal Problems) and social support (Multidimensional Scale of Perceived Social Support). Methods: Two hundred and sixty eight young people attending a national gender clinic completed questionnaires assessing presence and frequency of NSSI and levels of general psychopathology, depression, anxiety, interpersonal problems, self-esteem, social support, transphobia, and information on hormone treatment. Results: A life-time presence of NSSI was identified in 46.3% of patients and 28.73% reported currently engaging in NSSI (within at least the last few months). Analyses showed that those with a life-time presence of NSSI had significantly greater general psychopathology, lower self-esteem, had suffered more transphobia, and experienced greater interpersonal problems than those without NSSI. Findings were similar when comparing current versus non-current NSSI. Overall, natal males reported less social support than natal females, but current NSSI was more common in natal females. Regression analyses confirmed that natal female gender and greater general psychopathology predicted both current and life-time NSSI. Further analyses confirmed that general psychopathology itself could be predicted by transphobic experiences, low self-esteem, and interpersonal problems, but not by the use of cross sex hormones. Conclusions: These findings confirm that NSSI is common in trans youth and emphasise the need for interventions, which decrease transphobia, increase social support and help trans youth navigate their relationships with others in order to reduce psychopathology and NSSI

Non-suicidal self-injury and suicidality in trans people: a systematic review of the literature

Literature has described high levels of mental health problems among trans people, such as depression, resulting in increased levels of non-suicidal self-injury (NSSI) behaviour and suicidality (suicidal thoughts, suicide attempts and suicide rates). With the aim of systematically reviewing the available literature in this field, this study identifies thirty-one papers that explore the rates of NSSI and suicidality in trans people. From reviewing the literature, it was revealed that trans people have a higher prevalence of NSSI and suicidality compared to the cisgender (non-trans) population. There appear to be some gender differences within these rates, with trans men at a greater risk for NSSI behaviour. Prevalence rates differ depending on the different stages of transition, but they are still overall greater than the cisgender population. The study concludes that trans individuals are at a greater risk of NSSI behaviour and suicidality than the cisgender population, and discusses risk factors and the need to develop effective preventative interventions

Systematic review and meta-analysis of prevalence studies in transsexualism

BACKGROUND: Over the last 50 years, several studies have provided estimates of the prevalence of transsexualism. The variation in reported prevalence is considerable and may be explained by factors such as the methodology and diagnostic classification used and the year and country in which the studies took place. Taking these into consideration, this study aimed to critically and systematically review the available literature measuring the prevalence of transsexualism as well as performing a meta-analysis using the available data. METHODS: Databases were systematically searched and 1473 possible studies were identified. After initial scrutiny of the article titles and removal of those not relevant, 250 studies were selected for further appraisal. Of these, 211 were excluded after reading the abstracts and a further 18 after reading the full article. This resulted in 21 studies on which to perform a systematic review, with only 12 having sufficient data for meta-analysis. The primary data of the epidemiological studies were extracted as raw numbers. An aggregate effect size, weighted by sample size, was computed to provide an overall effect size across the studies. Risk ratios and 95% confidence intervals (CIs) were calculated. The relative weighted contribution of each study was also assessed. RESULTS: The overall meta-analytical prevalence for transsexualism was 4.6 in 100,000 individuals; 6.8 for trans women and 2.6 for trans men. Time analysis found an increase in reported prevalence over the last 50 years. CONCLUSIONS: The overall prevalence of transsexualism reported in the literature is increasing. However, it is still very low and is mainly based on individuals attending clinical services and so does not provide an overall picture of prevalence in the general population. However, this study should be considered as a starting point and the field would benefit from more rigorous epidemiological studies acknowledging current changes in the classification system and including different locations worldwide. Copyright © 2015 Elsevier Masson SAS. All rights reserved

Levels of depression in transgender people and its predictors: Results of a large matched control study with transgender people accessing clinical services

Background Depression is a serious disorder which significantly impacts wellbeing and quality of life. Studies exploring mental wellbeing in the transgender population are mostly limited by small, non-homogenous samples and lack of matched controls. This study aimed to address these limitations and explore depression rates in a large sample of transgender people, compared with matched controls from the general population, as well as factors predicting depression in those taking cross-sex hormone treatment (CHT) compared to those not. Methods Transgender individuals (n=913) completed a measure of depression, measures which predict psychopathology (self-esteem, victimization, social support, interpersonal problems), and information regarding CHT use. Participants were matched by age and experienced gender with adults from the general population who had completed the measure of depression. Results Individuals were categorized as having no, possible or probable depressive disorder. Transgender individuals not on CHT had a nearly four-fold increased risk of probable depressive disorder, compared to controls. Older age, lower self-esteem, poorer interpersonal function and less social support predicted depressive disorder. Use of CHT was associated with less depression. Limitations Participants were attending a national gender identity service and therefore represent only a sub-group of transgender people. Due to the cross-sectional design, longitudinal research is required to fully confirm the finding that CHT use reduces depression. Conclusion This study confirms that non-treated transgender individuals have an increased risk of a depressive disorder. Interventions offered alongside gender affirming treatment to develop interpersonal skills, increase self-esteem and improve social support may reduce depression and prepare individuals for a more successful transition