Manipulation of Negative Social Evaluative Fears on Body Dissatisfaction and Eating Behaviors: Does Fear of Social Evaluation Lead to Disordered Eating?

Social anxiety and eating disorders are highly comorbid. Researchers have suggested that there may be shared vulnerabilities that underlie the development of these disorders. Two of these proposed vulnerabilities are fear of negative evaluation and social appearance anxiety (i.e., fear of negative evaluation specifically focused on one’s appearance). Regarding disordered eating, previous self-report research has found that social appearance anxiety may be especially relevant for body dissatisfaction, whereas fear of negative evaluation may be relevant for drive for thinness. In the current study I manipulated fear of negative evaluation and social appearance anxiety using a speech task in 160 undergraduate females. Results indicated that participants in the fear of negative evaluation condition increased food consumption, whereas participants high in trait social appearance anxiety and in the social appearance anxiety condition experienced the highest amounts of state body dissatisfaction. Participants in both conditions experienced elevated state social anxiety. Additionally, I found that restraint interacted with fear of negative evaluation to produce eating. These results are discussed within an emotion regulation framework. Overall, these results support the idea that fear of negative evaluation and social appearance anxiety are shared vulnerabilities for eating and social anxiety disorders, but that the way these variables interact with the environment and with other individual differences may lead to disorder specific behaviors. Clinicians may want to consider incorporating exposures that evoke evaluation fears into treatments for individuals with disordered eating

Exploring Gender Differences in Eating Disorder Risk Factors

Body dissatisfaction, social appearance anxiety, and thinness and restricting expectancies are well-established risk factors for eating disorder pathology. Little research has examined the differences in said risk factors by gender. Gender-based research has been further limited by only looking at cisgender identities (e.g., cisgender women and men). Understanding this relationship between gender and these factors can be an important consideration for the greater sociocultural factors that affect our society and eating disorders, and therefore should also influence our treatment of them. Current study examined differences in social appearance anxiety, body dissatisfaction, and thinness and restricting expectancies upon college-aged students (N = 2719). Study used analysis of variance (ANOVA) to compare means in TREI, SAAS, and EPSI body dissatisfaction across gender identities. Also conducted post-hoc analyses with Bonferroni correction for multiple comparison. There were significant differences across gender identities in TREI, EPSI, and SAAS (ps \u3c .001). Overall, cis men demonstrate lower levels of body dissatisfaction, social appearance anxiety, and thinness and restricting expectancies as compared to cis women and trans individuals. Trans individuals demonstrate elevated scores on risk factors as compared to cis men and cis women except on SAAS. Suggest that cis women and trans individuals experience similar levels of heightened anxiety around appearance-based judgment

Social Appearance Anxiety is Strongly Related to Eating Disorder Symptoms regardless of Age in both Clinical Eating Disorder and Nonclinical Cases

Eating disorders (EDs) are serious mental illnesses that often develop in adolescence and persist in adulthood. Social appearance anxiety (SAA; fear of appearance-based judgment) is a risk factor for EDs and related to ED symptoms. SAA is more prevalent in non-clinical adolescents than non-clinical adults, yet no research has investigated the relationship between SAA and ED symptoms across age. The present study tested if age moderated the relationship between SAA and drive for thinness (DT), bulimic symptoms, and body dissatisfaction in a clinical ED sample (N=952, 28.5%), a nonclinical sample (N=1,693; 51.7%), and the full sample (N = 3,273). In the clinical ED sample, there was a significant interaction between age and SAA on DT, such that SAA and DT were more strongly related in older participants (b=.43, p\u3c.001), compared to younger participants (b=.25, p\u3c.001). Age did not moderate the relationship between SAA and ED symptoms in the overall sample or nonclinical sample (p\u3e.05), and results indicate SAA is strongly related to all three domains of ED symptoms regardless of age (bs=.25-.62, ps\u3c.001). These results support SAA as a core factor in EDs across all age groups. Interventions focused on SAA may be used with people of all ages and levels of ED symptoms to improve outcomes. Future studies should examine the associations between SAA and ED symptoms across all developmental stages and duration of illness. Future research should test the influence of social media and technology on the relationship between SAA and ED symptoms across different age groups.https://ir.library.louisville.edu/uars/1014/thumbnail.jp

Exploring Mindfulness as an Illness Pathway Between Eating Disorder and Post-Traumatic Stress Disorder Symptoms

Eating disorders (EDs) and post-traumatic stress disorder (PTSD) have high rates of comorbidity. One shared protective factor for PTSD and ED symptoms is mindfulness. However, research on how mindfulness relates to ED-PTSD comorbidity is limited. Thus, the current study used network analysis to explore aspects of mindfulness as illness pathways bridging (i.e., connecting) symptoms among comorbid ED and PTSD symptoms. We hypothesized that mindfulness would negatively relate to ED and PTSD symptoms. Participants (N=709 undergraduate students) completed self-report ED, PTSD, and mindfulness measures. Network analysis was conducted using R. Five symptoms were identified as being the most central. These were, in order of strength, being able to describe one’s feelings, not criticizing oneself for emotions, difficulty concentrating, feeling very upset after being reminded of a stressful experience, and desire to lose weight. Bridge expected influence (EI) was stable. We identified three bridge symptoms: noticing bodily sensations while walking, not criticizing oneself for emotions, and rarely running on automatic. Noticing bodily sensations while walking was positively connected to ED and PTSD symptoms, while not criticizing oneself for emotions and rarely running on automatic were negatively connected to ED and PTSD symptoms. Awareness of bodily sensations may heighten the co-occurrence of ED and PTSD symptoms, while not criticizing one’s emotions and rarely running on automatic may weaken the co-occurrence of these symptoms. Promoting certain aspects of mindfulness may be effective in weakening relations among co-occurring PTSD and ED symptoms and may enhance better treatment outcomes. Further investigation could focus on the impacts of these relationships longitudinally

Shame is the Shared Maintenance Factor in an Eating Diosrder-Anxiety Symptom Comorbidity Model in Female Adolescents

Anxiety and eating disorders are highly comorbid (Hudson et al., 2007). The presence of comorbid anxiety along with eating disorders is likely to increase severity of the disorder, chronicity, and treatment resistance (Blinder et al., 2006). A better understanding of how this comorbidity is maintained will aid with the development of precision interventions and improvements in treatment outcomes. The present study (N= 70 adolescent females; ages 13-15) explores how maintenance factors for eating disorders (concern over mistakes [CM; the excessive worry of making errors], shame, and social appearance anxiety [SAA; the fear of being negatively judged based on one’s appearance]) relate to eating disorder and anxiety symptoms in a comorbidity model The path model included SAA, CM, and shame around eating in association with anxiety and eating disorder symptoms. The model displayed excellent fit: CFI = 1.00; TLI: 1.00, RMSEA: 0.00. Shame was significantly associated with both anxiety (b*= 0.26; p= .033) and eating disorder symptoms (b*= 0.40; p = 0.012). Interestingly, CM was only significantly associated with anxiety (b*= 0.34; p = 0.008) but not eating disorder (p= 0.135) symptoms. Further, SAA was only significantly associated with eating disorder (b*= 0.55; p\u3c 0.001) but not anxiety (p= 0.135) symptoms. It was found that only shame served as a shared maintenance factor between eating disorder and anxiety symptoms in adolescent females. Interestingly, concern over mistakes was uniquely associated with anxiety, while social appearance anxiety was uniquely associated with eating disorder symptoms. Current research supports that those with eating disorders exhibit generalized shame, beyond just their eating behavior (Keith, Gillanders & Simpson, 2009). It is thus possible that shame maintains both eating disorder and anxiety symptoms by fueling avoidance behaviors in a variety of situations. Thus, targeting shame can potentially help alleviate this comorbidity and future research should explore how shame is maintained.https://ir.library.louisville.edu/uars/1046/thumbnail.jp

Body Trust Moderates the Relationship between Physical & Emotional Awareness & Eating Disorders in Adolescents

Eating disorders (EDs) have a complex relationship with interoceptive awareness (i.e., awareness of inner bodily sensations; IA). Research suggests that physical hyper-awareness and tendency to distract from bodily sensations are positively associated with ED symptoms, and body trust (i.e., experiencing one’s body as safe and trustworthy) is negatively associated with ED symptoms (Lattimore et al, 2017; Merwin et al, 2010; Duffy et al, 2020). While physical awareness (PA) and emotional awareness (EA) have been shown in nonclinical samples to be beneficial for affect regulation, similar facets of IA are associated with higher symptomatology in ED samples (Price & Hooven 2018). As such, PA/EA may not be associated with ED symptoms independently, but rather may interact with the need to distract or lack of trust in one’s body to increase ED symptoms. The current study aims to elucidate whether body trust and tendencies towards distraction moderate the relationships between physical/emotional awareness and ED symptoms. Adolescent girls (N=357) completed self-reported ED and IA measures. Hierarchical multiple linear regression analyses demonstrated that PA, distraction, and body trust were all uniquely and positively associated with ED symptoms (psp=.125). Body trust moderated the relationship between both PA/EA and ED symptoms (ps=.001, -.049), such that lower body trust was associated with a stronger association between PA/EA and ED symptoms. However, distraction did not moderate the relationship between PA or EA and ED symptoms (ps\u3e.288). These findings suggest that while both distraction and body trust are significantly correlated with ED symptoms, only body trust moderates the relationship between emotional/physical awareness and ED symptoms. Understanding these relationships may aid in the creation of treatment interventions for adolescents with EDs

Integrating clinician and patient case conceptualization with momentary assessment data to construct idiographic networks:Moving toward personalized treatment for eating disorders

Eating disorders are serious psychiatric illnesses with treatments ineffective for about 50% of individuals due to high heterogeneity of symptom presentation even within the same diagnoses, a lack of personalized treatments to address this heterogeneity, and the fact that clinicians are left to rely upon their own judgment to decide how to personalize treatment. Idiographic (personalized) networks can be estimated from ecological momentary assessment data, and have been used to investigate central symptoms, which are theorized to be fruitful treatment targets. However, both efficacy of treatment target selection and implementation with ‘real world’ clinicians could be maximized if clinician input is integrated into such networks. An emerging line of research is therefore proposing to integrate case conceptualizations and statistical routines, tying together the benefits from clinical expertise as well as patient experience and idiographic networks. The current pilot compares personalized treatment implications from different approaches to constructing idiographic networks. For two patients with a diagnosis of anorexia nervosa, we compared idiographic networks 1) based on the case conceptualization from clinician and patient, 2) estimated from patient EMA data (the current default in the literature), and 3) based on a combination of case conceptualization and patient EMA data networks, drawing on informative priors in Bayesian inference. Centrality-based treatment recommendations differed to varying extent between these approaches for patients. We discuss implications from these findings, as well as how these models may inform clinical practice by pairing evidence-based treatments with identified treatment targets

The Role of Perfectionism in the Relationship Between Thin-Ideal Internalization and Body Dissatisfaction

Research has shown a significant relationship between thin-ideal internalization and body dissatisfaction. In addition, research suggests perfectionism is an antecedent to thin-ideal internalization (Boone, 2011). When examining subtypes of perfectionism, Maladaptive Evaluative Concerns (MEC) has been shown to be related to eating disorder (ED) symptoms (Rivière, 2017) both directly and indirectly while the relationship between Personal Standards (PS) and ED symptoms is unknown, though some research suggests it may be adaptive (Bardone-Cone, 2007). Both types of perfectionism have been correlated with thin-ideal internalization and body dissatisfaction (Boone, 2010). The purpose of the present project is to examine two subtypes of perfectionism, MEC and pure PS (PPS) as moderators of the relationship between thin-ideal internalization and body dissatisfaction. Participants were N = 331 high school females participating in the Body Project (an ED prevention program). Measures used included the Frost Multidimensional Perfectionism Scale, from which the MEC and Pure PS (PPS) were used; The Eating Disorder Inventory, from which the body dissatisfaction subscale was used, and the Thin-Ideal Questionnaire. Both thin ideal and MEC were significantly associated with body dissatisfaction (t(288) = 6.080, p \u3c .001; t(292) = 6.414, p \u3c .001, respectively). However, there was not a significant interaction between thin ideal and MEC (p = .142) or between the thin ideal and PPS (p = .082). Future research should examine these factors longitudinally and in a more diverse sample.https://ir.library.louisville.edu/uars/1050/thumbnail.jp

Emotion Regulation Tendencies Moderate Momentary Associations Between Sadness, Binge Urges, and Overeating

Background: Eating disorders (EDs) are notably adverse, and previous research emphasizes that analysis of momentary triggers may be useful in determining the factors that maintain ED psychopathology. Negative affect (NA) is one momentary trigger of special interest in regard to binge eating tendencies. While current literature differs on the precise mechanisms by which NA maintains ED psychopathology, emotional regulation has been nevertheless implicated in encouraging binge eating behaviors. The present study explores correlations among sadness, binge urges, and overeating, and assesses emotional avoidance and emotional awareness as potential moderators of these relationships. Method: Participants (N = 34) with moderate to severe depression were recruited from across the United States. Participants completed baseline measures at onset followed by four ecological momentary assessments per day sent to their mobile phones for 20 days. The relationships among sadness, binge urges, and overeating were tested through multilevel modeling in R. Results: Within- and between-person sadness levels were each significantly associated with momentary urges to binge eat and overeating. Emotional awareness was nonsignificant, while emotional avoidance emerged as a significant moderator of these relationships. Discussion: These findings provide support for the affect regulation model of binge eating and for the escape theory, centralizing the role of sadness in maintenance of binge eating psychopathology. Targeting emotional avoidance and testing exposure to aversive emotions should be considered for their efficacy in treatment. Future research should assess these relationships in the ED population and more extensively analyze the interactions between NA and emotional avoidance

Eating Expectancies Moderate the Relationship Between Negative Affect and Repetitive Negative Thought in Adolescents and Emerging Adulthood in Relation to Binge Eating Symptoms

Objective: Adolescence and young adulthood are critical time periods for the development of an eating disorder (Dakanalis et al., 2017). Eating expectancies that eating helps manage negative affect (EE; learned associations that eating manages negative emotions), negative affect (NA; negative emotions, such as sadness, guilt, and fear), and repetitive negative thinking (RNT; recurrent intrusive negative thoughts about past or future events) are all predictive of eating disorder behaviors, such as binge eating (Bruce et al., 2009, Berg et al., 2017, McEvoy et al., 2019). However, it is less clear how these risk factors may impact one another to influence the development of eating disorder symptoms. Examining the interactions of EE, NA, and RNT may provide insight into whether multiple risk factors need to be considered when designing effective interventions for eating disorder symptoms. The goal of this study is to examine interactions between EE, NA, and RNT in relation to binge eating in two samples of adolescents and young adults. Methods: The current study included two community samples: 1) female adolescents aged 14-15 (n = 43), and 2) female undergraduate students aged 18-26 (n = 729). A battery of measures was administered online to participants. Measures used include the Repetitive Thought Questionnaire (McElvoy, Mahoney, & Moulds, 2010) as a measure of RNT, the eating manages negative affect subscale from the Eating Expectancies Inventory (Hohlstein, Smith, & Atlas, 1998) as a measure of eating expectancies, the negative affect subscale from the Positive Affect and Negative Affect Schedule (Watson, Clark, & Tellegen, 1988) as a measure of negative affect, and the binge eating subscale from the Eating Pathology Symptoms Inventory (Forbush et al., 2013) as a measure of binge eating. Results: In the undergraduate sample, a significant interaction (b* = .03, p = .005 partial r = .117) was found between EE and NA in relation to binge eating, such that higher levels of EE and higher levels of NA were associated with higher levels of binge eating. In addition, there was a significant interaction (b* = .096, p = .002 partial r = .104) between RNT and EE in relation to binge eating, such that higher levels of EE and higher levels of RNT were associated with higher levels of binge eating. There was no significant interaction between NA and RNT, nor was there a three-way interaction between EE, NA, and RNT in the undergraduate sample (ps \u3e .05). In the adolescent age group, there was a significant interaction (b* = .36, p = .003 partial r = .486 between NA and EE, such that higher levels of EE and higher levels of NA were associated with higher levels of binge eating. There were no significant interactions between RNT and EE or NA and RNT, nor was there was a three-way interaction between EE, NA, and RNT in the adolescent sample (ps \u3e 0.05). Discussion: We found that in undergraduates, both higher EE and NA and higher EE and RNT were more likely to be associated with higher binge eating, whereas in adolescents, only higher EE and NA was associated with higher binge eating. Adolescents had slightly different interaction between EE and NA such that higher levels of NA and lower levels of EE were more likely to have lower levels of binge eating. Cognitive bias in emotional processing are heavily associated with RNT, during adolescence these biases may not be as salient as they are in adults, which may explain lack of interaction between RNT and EE in relation to binge eating.https://ir.library.louisville.edu/uars/1026/thumbnail.jp