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

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

Impulsivity Symptoms as Core to the Developmental Externalizing Spectrum

Impulsivity is posited to be a key part of the externalizing spectrum during childhood, but this idea has received minimal empirical attention. The goal of the present investigation was to utilize network analysis to determine whether behavioral impulsivity symptoms are key components of the externalizing network across several developmental periods from preschool into adolescence. Participants were 109 preschoolers (64 % male) ages 3 to 6, 237 children (59 % male) ages 6 to 9, 372 children (59 % male) ages 10 to 13, and 357 adolescents (59 % male) ages 13 to 17 and their parents. Parents completed ratings of Attention-Deficit/Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD) symptoms on a well-validated rating scale. Network analyses indicated that ADHD and ODD were somewhat differentiated in preschool, becoming united by behavioral impulsivity symptoms during early childhood, and then differentiating into inattention versus externalizing clusters later during childhood and in adolescence. Behavioral impulsivity symptoms were core to the externalizing spectrum across most developmental periods, but core inattentive and ODD symptoms were also identified in line with progressive differentiation. These results suggest the increasing importance of impulsivity symptoms across development, explaining externalizing comorbidity and potentially serving as a viable target for childhood interventions for externalizing problems

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

A Network Analysis of Developmental Change in ADHD Symptom Structure from Preschool to Adulthood

Although there is substantial support for the validity of the diagnosis of attention-deficit/hyperactivity disorder (ADHD), there is considerable disagreement about how to best capture developmental changes in the expression of ADHD symptomatology. This article examines the associations among the 18 individual ADHD symptoms using a novel network analysis approach, from preschool to adulthood. The 1,420 participants were grouped into four age brackets: preschool (ages 3–6, n = 109), childhood (ages 6–12, n = 548), adolescence (ages 13–17, n = 357), and young adulthood (ages 18–36, n = 406). All participants completed a multistage, multi-informant diagnostic process, and self and informant symptom ratings were obtained. Network analysis indicated ADHD symptom structure became more differentiated over development. Two symptoms, often easily distracted and difficulty sustaining attention, appeared as central, or core, symptoms across all age groups. Thus, a small number of core symptoms may warrant extra weighting in future diagnostic systems

Assessing the Straightforwardly-Worded Brief Fear of Negative Evaluation Scale for Differential Item Functioning Across Gender and Ethnicity

The Brief Fear of Negative Evaluation Scale (BFNE; Leary Personality and Social Psychology Bulletin, 9, 371–375, 1983) assesses fear and worry about receiving negative evaluation from others. Rodebaugh et al. Psychological Assessment, 16, 169–181, (2004) found that the BFNE is composed of a reverse-worded factor (BFNE-R) and straightforwardly-worded factor (BFNE-S). Further, they found the BFNE-S to have better psychometric properties and provide more information than the BFNE-R. Currently there is a lack of research regarding the measurement invariance of the BFNE-S across gender and ethnicity with respect to item thresholds. The present study uses item response theory (IRT) to test the BFNE-S for differential item functioning (DIF) related to gender and ethnicity (White, Asian, and Black). Six data sets consisting of clinical, community, and undergraduate participants were utilized (N=2,109). The factor structure of the BFNE-S was confirmed using categorical confirmatory factor analysis, IRT model assumptions were tested, and the BFNE-S was evaluated for DIF. Item nine demonstrated significant non-uniform DIF between White and Black participants. No other items showed significant uniform or non-uniform DIF across gender or ethnicity. Results suggest the BFNE-S can be used reliably with men and women and Asian and White participants. More research is needed to understand the implications of using the BFNE-S with Black participants

The core symptoms of bulimia nervosa, anxiety, and depression: A network analysis.

Bulimia nervosa (BN) is characterized by symptoms of binge eating and compensatory behavior, and overevaluation of weight and shape, which often co-occur with symptoms of anxiety and depression. However, there is little research identifying which specific BN symptoms maintain BN psychopathology and how they are associated with symptoms of depression and anxiety. Network analyses represent an emerging method in psychopathology research to examine how symptoms interact and may become self-reinforcing. In the current study of adults with a Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM-IV) diagnosis of BN (N = 196), we used network analysis to identify the central symptoms of BN, as well as symptoms that may bridge the association between BN symptoms and anxiety and depression symptoms. Results showed that fear of weight gain was central to BN psychopathology, whereas binge eating, purging, and restriction were less central in the symptom network. Symptoms related to sensitivity to physical sensations (e.g., changes in appetite, feeling dizzy, and wobbly) were identified as bridge symptoms between BN, and anxiety and depressive symptoms. We discuss our findings with respect to cognitive-behavioral treatment approaches for BN. These findings suggest that treatments for BN should focus on fear of weight gain, perhaps through exposure therapies. Further, interventions focusing on exposure to physical sensations may also address BN psychopathology, as well as co-occurring anxiety and depressive symptoms. (PsycINFO Database Recor

Time to make a change:A call for more experimental research on key mechanisms in anorexia nervosa

Anorexia nervosa (AN) is a life‐threatening eating disorder, characterised by persistent pathological weight loss behaviours and an intense fear of weight gain and food consumption. Although there is an abundance of scientific theories on the neurobiological, psychological and sociocultural factors thought to be involved in the maintenance of AN, there is little experimental research testing these ideas. The need for theory firmly grounded in empirical evidence becomes strikingly clear when we consider that current treatments for patients with AN are limited in their effectiveness, and relapse after treatment is common

D-cycloserine augmentation of exposure-based cognitive behavior therapy for anxiety, obsessive-compulsive, and posttraumatic stress disorders: a systematic review and meta-analysis of individual participant data

Importance: Whether and under which conditions D-cycloserine (DCS) augments the effects of exposure-based cognitive behavior therapy for anxiety, obsessive-compulsive, and posttraumatic stress disorders is unclear. Objective: To clarify whether DCS is superior to placebo in augmenting the effects of cognitive behavior therapy for anxiety, obsessive-compulsive, and posttraumatic stress disorders and to evaluate whether antidepressants interact with DCS and the effect of potential moderating variables. Data Sources: PubMed, EMBASE, and PsycINFO were searched from inception to February 10, 2016. Reference lists of previous reviews and meta-analyses and reports of randomized clinical trials were also checked. Study Selection: Studies were eligible for inclusion if they were (1) double-blind randomized clinical trials of DCS as an augmentation strategy for exposure-based cognitive behavior therapy and (2) conducted in humans diagnosed as having specific phobia, social anxiety disorder, panic disorder with or without agoraphobia, obsessive-compulsive disorder, or posttraumatic stress disorder. Data Extraction and Synthesis: Raw data were obtained from the authors and quality controlled. Data were ranked to ensure a consistent metric across studies (score range, 0-100). We used a 3-level multilevel model nesting repeated measures of outcomes within participants, who were nested within studies. Results: Individual participant data were obtained for 21 of 22 eligible trials, representing 1047 of 1073 eligible participants. When controlling for antidepressant use, participants receiving DCS showed greater improvement from pretreatment to posttreatment (mean difference, -3.62; 95% CI, -0.81 to -6.43; P = .01; d = -0.25) but not from pretreatment to midtreatment (mean difference, -1.66; 95% CI, -4.92 to 1.60; P = .32; d = -0.14) or from pretreatment to follow-up (mean difference, -2.98, 95% CI, -5.99 to 0.03; P = .05; d = -0.19). Additional analyses showed that participants assigned to DCS were associated with lower symptom severity than those assigned to placebo at posttreatment and at follow-up. Antidepressants did not moderate the effects of DCS. None of the prespecified patient-level or study-level moderators was associated with outcomes. Conclusions and Relevance: D-cycloserine is associated with a small augmentation effect on exposure-based therapy. This effect is not moderated by the concurrent use of antidepressants. Further research is needed to identify patient and/or therapy characteristics associated with DCS response.2018-05-0