How evaluative pairings improve body dissatisfaction in adult women

$\bf Background$ Many young women are dissatisfied with their bodies. This study investigated the effect on current body dissatisfaction levels of a newly developed evaluative conditioning procedure that paired self-similar and self-dissimilar images of bodies with positive and neutral affective images, respectively. We hypothesized that learning the contingency that self-similar bodies predict positive affectivity is one process that could aid in explaining how these procedures function. $\bf Methods$ Adult women without disordered eating pathology participated in an online experiment with random assignment to an intervention or a control condition. All participants initially rated body images in self-similarity and were subsequently asked to categorize positive and neutral images by valence as quickly and accurately as possible. In the intervention condition, self-similar bodies systematically preceded positive images, and self-dissimilar images preceded neutral images, creating a $\textit {similar body}$ $\rightarrow$ $\it positive$ contingency. Pairings in the control condition were unsystematic such that no contingency was present. We measured categorization latencies and accuracies to infer contingency learning as well as current body dissatisfaction immediately before and after exposure to the pairings. All participants further completed measures of trait body image concerns and disordered eating psychopathology at baseline, which we examined as moderators of an expected relation between condition assignment, contingency learning, and body dissatisfaction improvements. $\bf Results$ We analyzed data from N = 173 women fulfilling the inclusion criteria. Moderated mediation analyses showed that assignment to the intervention (vs. control) condition predicted increased $\textit {similar body}$ $\rightarrow$ $\it positive$ contingency learning, which in turn predicted improved body dissatisfaction post-intervention, but only among women with higher pre-existing trait body image concerns or disordered eating levels. $\bf Conclusions$ The findings point toward the relevancy of further exploring the utility of pairing procedures. $\textit {Similar body}$ $\rightarrow$ $\it positive$ contingency learning predicted improved body dissatisfaction in individuals with normatively high body image concerns, which suggests pairing procedures could help inform future research on reducing body dissatisfaction

Gender differences in treatment outcomes for eating disorders

Eating disorders (EDs) are increasingly emerging as a health risk in men, yet men remain underrepresented in ED research, including interventional trials. This underrepresentation of men may have facilitated the development of women-centered ED treatments that result in suboptimal outcomes for men. The present study retrospectively compared pre- vs. post-treatment outcomes between age-, diagnosis-, and length-of-treatment-matched samples of $\it n$ = 200 men and $\it n$ = 200 women with Anorexia Nervosa (AN), Bulimia Nervosa (BN), Binge Eating Disorder (BED), or Eating Disorder Not Otherwise Specified (EDNOS), treated in the same setting during the same period, and using the same measurements. Compared to women, men with AN showed marked improvements in weight gains during treatment as well as in ED-specific cognitions and general psychopathology. Likewise, men with BED showed marked weight loss during treatment compared to women with BED; ED-specific cognitions and general psychopathology outcomes were comparable in this case. For BN and EDNOS, weight, ED-specific cognitions, and general psychopathology outcomes remained largely comparable between men and women. Implications for treatments are discussed

The state urge to be physically active-questionnaire (SUPA-Q)

$\bf Objective$ Many people, including patients with eating disorders (EDs), experience an increased urge for physical activity. "Trait"-like activity in patients with EDs is assessed by existing questionnaires, but there are few clinically validated assessments of a "state" urge to be physically active. Here, we developed and validated the State Urge to be Physically Active-Questionnaire (SUPA-Q). $\bf Methods$ After developing and piloting the items, $\it N$ = 126 patients with EDs (mostly anorexia nervosa and bulimia nervosa) took part in our mixed-longitudinal validation study with one primary assessment for all patients and a secondary assessment for a subsample of patients. Cronbach's α and split-half-methods served as measures of consistency and reliability. Correlations with other questionnaires were used to determine convergent and divergent validity, and confirmatory factor analysis was used for investigating factorial validity. We used paired-samples t-tests for repeated assessments to investigate change sensitivity. $\bf Results$ We found the SUPA-Q to be highly consistent, and reliable and to demonstrate convergent, divergent, and factorial validity. The comparison of SUPA-Q scores from repeated assessments within a subsample of patients demonstrated the questionnaire's change sensitivity, Cohen's $\it d$ = 0.48. Moreover, an increase in SUPA-Q scores was associated with a less positive mood, more anxiety, more body dissatisfaction, more tenseness, less feelings of control, and more stress. $\bf Discussion$ The newly developed SUPA-Q may help to accentuate the necessity to evaluate and address the acute urge to engage in physical activity in patients with EDs in clinical practice and ultimately support tailoring treatments to patients’ unique symptom patterns. The questionnaire is available at https://doi.org/10.17605/OSF.IO/G2YBC

Two of a kind?

(1) Background: Obesity (OB) is a frequent co-morbidity in Binge Eating Disorder (BED), suggesting that both conditions share phenotypical features along a spectrum of eating-related behaviors. However, the evidence is inconsistent. This study aimed to comprehensively compare OB-BED patients against OB individuals without BED and healthy, normal-weight controls in general psychopathological features, eating-related phenotypes, and early life experiences. (2) Methods: OB-BED patients ($\it n$ = 37), OB individuals ($\it n$ = 50), and controls ($\it n$ = 44) completed a battery of standardized questionnaires. Responses were analyzed using univariate comparisons and dimensionality reduction techniques (linear discriminant analysis, LDA). (3) Results: OB-BED patients showed the highest scores across assessments (e.g., depression, emotional and stress eating, food cravings, food addiction). OB-BED patients did not differ from OB individuals in terms of childhood traumatization or attachment styles. The LDA revealed a two-dimensional solution that distinguished controls from OB and OB-BED in terms of increasing problematic eating behaviors and attitudes, depression, and childhood adversities, as well as OB-BED from OB groups in terms of emotional eating tendencies and self-regulation impairments. (4) Conclusions: Findings support the idea of a shared spectrum of eating-related disorders but also highlight important distinctions relevant to identifying and treating BED in obese patients

Sociodemographic and clinical features of men and women with eating disorders

$\bf Introduction:$ Eating disorders (EDs) are among the most severe mental disorders in women and men, often associated with high symptom burden and significant limitations in daily functioning, frequent comorbidities, chronic course of illness, and even high mortality rates. At the same time, differences between men and women with EDs remain poorly explored. $\bf Methods:$ In this study, we compared 104 men to 104 diagnosis-matched women with EDs regarding sociodemographic and clinical features. Using latent class mixture modelling, we identified four distinct patient subgroups based on their sociodemographic features. $\bf Results:$ Men with EDs had significantly higher odds than women to belong to a "single-childfree-working" class. Moreover, while there were few overall differences in ED-related symptoms and general psychopathology between men and women, single-childfree-working men with EDs presented with higher general psychopathology symptoms than men in the other classes. $\bf Discussion:$ We discuss how considering sex and gender along with further sociodemographic differences in EDs may help to improve ED diagnosis and treatment

Factor structure of the Eating Disorder Examination-Questionnaire (EDE-Q) in adult men with eating disorders

$\bf Background$ Previous investigations on the Eating Disorder Examination-Questionnaire (EDE-Q) factor structures in men have been restricted to non-clinical settings, limiting conclusions about the factorial validity in men with eating disorders (ED). This study aimed to examine the factor structure of the German EDE-Q in a clinical group of adult men with diagnosed ED. $\bf Methods$ ED symptoms were assessed using the validated German version of the EDE-Q. Exploratory factor analysis (EFA) using principal-axis factoring based on polychoric correlations was conducted for the full sample ($\it N$ = 188) using Varimax-Rotation with Kaiser-Normalization. $\bf Results$ Horn's parallel analysis suggested a five-factor solution with an explained variance of 68%. The EFA factors were labeled "Restraint" (items 1, 3–6), "Body Dissatisfaction" (items 25–28), "Weight Concern" (items 10–12, 20), "Preoccupation" (items 7 and 8), and "Importance" (items 22 and 23). Items 2, 9, 19, 21, and 24 were excluded due to low communalities. $\bf Conclusions$ Factors associated with body concerns and body dissatisfaction in adult men with ED are not fully represented in the EDE-Q. This could be due to differences in body ideals in men, e.g., the underestimation of the role of concerns about musculature. Consequently, it may be useful to apply the 17-item five-factor structure of the EDE-Q presented here to adult men with diagnosed ED

Donor and Donation Images (DDI)

Organ transplantation is associated with significant physical and psychological burden for the recipients. Qualitative reports indicate that organ recipients develop donor and donation images (DDI)-conceptions of the donor and/or the organ. A deeper understanding of DDI is needed in the care of transplant recipients. To present the current state of knowledge, we searched for and identified DDI-related publications in PubMed and Scopus. Inclusion criteria were (1) studies addressing transplant recipients, and (2) English or German language. Twenty-one studies of individuals with transplanted hearts, lungs, or kidneys were included in this scoping review. Prevalence for DDI ranged from 6% to 52.3%. DDI occurs both before and after transplantation and includes ideas about the donor as well as whether and how the recipient’s personality may be altered by the transplanted organ. Some transplant recipients did indeed report personality changes following transplantation due to the adoption of assumed donor characteristics. One study showed a positive association between the presence of DDI and anxiety scores and one described a coping effect. DDI is understudied and should be systematically assessed to improve care for the vulnerable group of individuals undergoing organ transplantation. Current research gaps and future directions are discussed

Medical students' perspectives on LGBTQI+ healthcare and education in Germany

The healthcare needs of lesbian, gay, bisexual, trans*, queer, and intersex (LGBTQI+) persons are often overlooked, prompting national and international calls to include diversity-related competencies into medical students' training. However, LGBTQI+-focused healthcare education targets remain elusive, as surveys reveal considerable variability across national student populations. To generate empirical data and vocalize recommendations for medical education, we conducted the first nationwide online survey among 670 German medical students from 33 universities. Overall, most respondents reported low confidence regarding their medical training preparing them for LGBTQI+ patients, stated that LGBTQI+ themes were not covered during training, and agreed that the inclusion of such themes is urgently needed. In addition, we found gender and LGBTQI+ community member status to be key variables. Men scored lower in knowledge than women, while community members scored higher than non-community members. Similarly, community members reported higher comfort levels. Non-community men showed the highest levels of prejudice and efficacy beliefs, while at the same time had the lowest scores in contacts and the perceived importance of LGBTQI+-related teaching. Keeping subgroup differences in mind, we recommend that educational training should include LGBTQI+ healthcare aspects and address self-efficacy beliefs in future medical professionals to overcome LGBTQI+ healthcare disparities