General and Eating Disorder Specific Flexibility: Development and Validation of the Eating Disorder Flexibility Index (EDFLIX) Questionnaire

Findings from studies investigating cognitive flexibility in eating disorders (EDs) are inconsistent, and although neuropsychological tests are commonly used to measure these skills, they may not be particularly effective in predicting everyday functioning. Also, extant studies have largely focused on flexibility in anorexia nervosa (AN), with assessments targeting general rather than specific flexibility, and cognitive, rather than behavioral flexibility. Knowledge regarding ED specific flexibility and flexibility in bulimia nervosa (BN) and binge eating disorder (BED) is still scarce. The aim of this study was to develop and validate a novel measure assessing general and ED specific flexibility in a diagnostically diverse sample, and in healthy controls (HCs). A sample of 207 adult individuals with EDs (55% AN, 29% BN, 16% BED) and 288 HCs responded to an online, 51-item, pilot questionnaire on ED specific and general flexibility. In addition, participants completed the shift subscale from the Behavior Rating Inventory of Executive Function Adult version (BRIEF-A), and the Eating Disorder Diagnostic Scale (EDDS). A principal component analysis (PCA) in the clinical sample yielded a 36-item, three-factor solution capturing general flexibility, flexibility related to food and exercise, and flexibility concerning body shape and weight. Results showed that the measure had good to excellent internal consistency, and good convergent validity. A confirmatory factor analysis (CFA) using data from HCs revealed good fit indexes, supporting the original factor solution. A receiver operating characteristics analysis (ROC) demonstrated excellent accuracy in distinguishing scores from those with and without EDs. A cutoff score of 136 yielded the most balanced sensitivity and specificity. Significant differences in general and ED specific flexibility were found between individuals with and without EDs. Overall, HCs achieved the highest flexibility scores, followed by those with BED, BN, and AN. In sum this novel measure, the Eating Disorder Flexibility Index (EDFLIX) questionnaire, was found to be reliable and valid in the assessment of cognitive and behavioral flexibility, with results offering support for the conceptual distinction between general and ED related flexibility. The study also provides strong evidence for the discriminant validity of the EDFLIX with results revealing significant differences in flexibility in people with and without EDs. In addition, significant differences in flexibility also emerged when comparing diagnostic groups, indicating the utility of the assessment instrument for classification purposes

The association of alcohol use and positive and negative urgency to same day objective binge eating in emerging adults

IntroductionObjective binge eating and problematic alcohol use often co-occur and are common behaviors in emerging adults. Both behaviors are thought to be driven by affect regulation processes. Objective binge eating often occurs in the context of increasing or acute negative affect, and often occurs in solitude. Alcohol use in emerging adults can also be associated with negative affect regulation. However, in contrast to objective binge eating, a large body of research indicates that there are positively valenced pathways to alcohol use in this age group. Emerging adults often drink socially, to enhance enjoyment, and in the context of positive mood. We propose that one pathway to objective binge eating in this developmental period is through alcohol use itself, such that emerging adults who consume alcohol and who are more likely to act impulsively in the context of positive emotion (i.e., have high levels of positive urgency) may be more likely to binge eat following drinking.MethodsWe collected data using ecological momentary assessment in 106 undergraduates on positive and negative affect, motives for drinking and eating, and alcohol use and objective binge eating, in addition to baseline questionnaires of impulsivity.ResultsThere were no significant changes in affect prior to drinking in this sample. Alcohol use at one time point significantly increased odds of objective binge eating at a later time point in the same day. Individual differences in positive urgency, the tendency to act rashly while experiencing positive affect, were also associated with increased odds of objective binge eating that occurred after alcohol use. Individual differences in negative urgency, the tendency to act rashly after experiencing negative affect, did not have a main effect on objective binge episodes, but did interact with alcohol use to increase the odds of objective binge eating following drinking. The vast majority of drinking episodes prior to objective binge eating were social drinking episodes, and participants most commonly endorsed "to have fun" as a reason for drinking.DiscussionResults suggest that alcohol consumption may increase risk for objective binge eating in emerging adults

Psychiatric diagnoses, trauma, and suicidiality

BACKGROUND: This study aimed to examine the associations between psychiatric diagnoses, trauma and suicidiality in psychiatric patients at intake. METHODS: During two months, all consecutive patients (n = 139) in a psychiatric hospital in Western Norway were interviewed (response rate 72%). RESULTS: Ninety-one percent had been exposed to at least one trauma; 69 percent had been repeatedly exposed to trauma for longer periods of time. Only 7% acquired a PTSD diagnosis. The comorbidity of PTSD and other psychiatric diagnoses were 78%. A number of diagnoses were associated with specific traumas. Sixty-seven percent of the patients reported suicidal thoughts in the month prior to intake; thirty-one percent had attempted suicide in the preceding week. Suicidal ideation, self-harming behaviour, and suicide attempts were associated with specific traumas. CONCLUSION: Traumatised patients appear to be under- or misdiagnosed which could have an impact on the efficiency of treatment

Empathy: A Possible Moderator for Joiner\u27s Interpersonal-Psychological Theory of Suicide

The present study\u27s primary objective was to extend research examining Joiner\u27s (2005) Interpersonal-Psychological Theory of Suicide by including a measure of empathy. Empathy refers to the capability to share another being\u27s emotions and feeling. In the present study, I assessed levels of dispositional empathy as a possible moderator for the perceived burdensomeness and thwarted belongingness from Joiner\u27s theory. Empirical support strongly suggests these variables predict suicidal ideation. Because Joiner\u27s variables of thwarted belongingness and perceived burdensomeness require an individual to attempt to understand how others feel about them, levels of dispositional empathy may affect how a person interprets these variables. Due to few reports of suicidal ideation, analyses were conducted with a measure assessing reasons for living. Analyses suggested that empathy was significantly associated with reasons for living. However, empathy did not moderate the interaction between perceived burdensomeness and thwarted belongingness, as predicted

Anger and Pavlovian Bias: Integrating Laboratory Task Performance and Ecological Momentary Assessment

The majority of human behaviors is goal-directed, meaning people act in a certain way to achieve a desired outcome. However, many symptoms of psychopathology are associated with impulsive behavioral choices inconsistent with an individual’s goals. Research using laboratory tasks suggests this might be due to Pavlovian Bias, which can work against goal-orientated behavior. However, the extant literature on impulsive, maladaptive behaviors suggests that changes in affect highly impact impulsive behaviors. No research has examined the impact of mood on Pavlovian Bias. Thus, it is unknown whether changes in mood may impact one’s ability to overcome Pavlovian bias. Additionally, given the nature of laboratory tasks, it’s unclear whether these tasks have ecological validity. Therefore, the goal of this dissertation was to examine the impact of increased negative affect on Pavlovian bias and to examine if individual differences in various components of Pavlovian bias might moderate the trajectory of negative affect before and after an impulsive behavior in the real world. In Study 1, 30 individuals completed a Pavlovian Bias task before and after an anger mood induction. Results from the task revealed that while anger induction did not change one’s overall Pavlovian Bias score, individuals where more likely to make more mistakes in the Go to Avoid trials and to approach rewards after the mood induction. In Study 2, the same 30 individuals completed two-weeks of ecological momentary assessment (EMA), in which they responded to prompts assessing affect and impulsive behaviors several times a day. EMA data revealed negative mood significantly increased before and decreased after impulsive behaviors. Additionally, changes in the percent correct of Go to Avoid trials and reward sensitivity moderated the trajectory of negative affect before and after impulsive behaviors. Specifically, individuals who experienced a greater decrease in either their percent correct of Go to Avoid trials or reward sensitivity required less of an increase in negative affect before engaging in impulsive behavior. Findings from both of these studies suggest that acute changes in anger can impact one’s ability to engage in goal-orientated behaviors that are rewarding, and approach driven. Furthermore, individual differences in task performance after an anger mood induction may impact the daily experience of negative affect and impulsive behaviors

The Impact of the 2009 Red River Flood on Interpersonal Risk Factors for Suicide

Background: Natural disasters are frequently associated with increases in risk factors for suicide, yet research indicates that suicide rates tend to stay the same or decrease in the wake of disasters (e.g., Krug et al., 1999 ). Aims: The present research sought to shed light on this counterintuitive phenomenon by testing hypotheses derived from Joiner’s (2005 ) interpersonal-psychological theory of suicidal behavior, which proposes that the desire to die by suicide is the result of feeling like one does not belong and feeling like one is a burden on others. During natural disasters, community members often pull together in volunteering efforts, and it was predicted that such behaviors would boost feelings of belonging and reduce feelings that one is a burden. Methods: The present study tested these predictions in a sample of 210 undergraduate students in Fargo, North Dakota, following the 2009 Red River Flood. Results: Consistent with prediction, greater amounts of time spent volunteering in flood efforts were associated with increased feelings of belongingness and decreased feelings of burdensomeness. Conclusions: The findings in the current study are consistent with the notion that communities pulling together during a natural disaster can reduce interpersonal risk factors associated with the desire for suicide. </jats:p