The Effect of Attachment Theory in the Development of Eating Disorders: Can Symptoms Be Proximity-Seeking?

The relationship between attachment theory, proximity seeking behaviors and the development of eating disorders was investigated in three groups of adolescent females from various settings; 44 individuals with eating disorders, 28 clinical controls, and 36 non-clinical controls. The Inventory of Parent and Peer Attachment and the Parental Attachment Questionnaire were both used in this study and both found that the clinical groups demonstrated a weaker sense of attachment quality compared to their non-clinical counterparts. This study also expands upon John Bowlby's concept of proximity seeking, to offer a possible explanation of the function for eating disorder symptomatology. A new measure, the Proximity-Seeking Scale, found that self-reported changes in both the physical and psychological proximity needs of those with eating disorders had transpired since the clinical diagnosis of the disorder.     

Eating Disorders Among a Community-based Sample of Chilean Female Adolescents

The purpose of this study was to explore the prevalence and correlates of eating disorders among a community-based sample of female Chilean adolescents. Data were collected through structured interviews with 420 female adolescents residing in Santiago, Chile. Approximately 4% of the sample reported ever being diagnosed with an eating disorder. Multivariate logistic regression analyses revealed that those with higher symptoms of anxiety and who had tried cigarettes were significantly more likely to have been diagnosed with an eating disorder. Findings indicate that Chilean female adolescents are at risk of eating disorders and that eating disorders, albeit maladaptive, may be a means to cope with negative affect, specifically anxiety.     

Aging male symptomatology and eating behavior

Objective: The literature on eating disorders in older males is still very limited. We assessed the relationship between aging male symptomatology and eating behavior in middle-aged and older men.

Method: We distributed anonymous questionnaires to men aged 40–75?years living in or near Innsbruck, Austria, covering demographic items, current eating disorder symptoms (as defined by DSM-5), and associated measures of eating pathology, body image, and sports activity (including exercise addiction). We also administered the Aging Males’ Symptoms scale (AMS), and classified respondents as “high-AMS” (AMS score ≥37; N?=?82) or “low-AMS” (AMS score <37; N?=?386).

Results: High-AMS men reported a significantly higher mean current BMI, a greater prevalence of eating disorder symptoms, higher scores on the Eating Disorder Examination Questionnaire, greater risk of exercise addiction, and more negative body image than low-AMS men.

Discussion: We found a marked association between aging-male symptomatology and eating-disorder symptomatology in aging men. Our findings suggest that clinicians should carefully inquire about eating disorder symptoms in men aged 40 and above reporting aging-male symptomatology. Importantly, several men in the study reported “purging” via excessive exercise (as opposed to the more common methods of vomiting or use of laxatives or diuretics), and therefore this should be a subject of inquiry in clinical evaluations. To pursue these findings, subsequent studies of eating disorders in older men should consider assessing endocrinological measures, particularly testosterone levels, and should use longitudinal designs.     

Drug abuse and eating disorders: prevention implications.

This article explores the relationship between drug and alcohol abuse and eating disorders in a sample of adolescent females using a self-report methodology. An Eating Disorders Risk (EDR) Scale is adopted and correlated with drug and alcohol use, other forms of deviance, family and peer relationships, and depression. The findings support the concept of a generalized theory of addictions based on psychosocial, family, and peer factors. Family and peer prevention applications and a need for further research on the correlates of depression are discussed.     

Eating Disorder Treatment as a Process of Mind–Body Integration: Special Challenges for Women

The concept of body image remains too focused on internal representation and not enough on internal experiencing. Body image is but one expression of the more foundational body self. When an eating disorder is conceptualized as an attempt to manage an impaired sense of body self (and associated disregulation), the ultimate goal of treatment becomes embodiment. The eating disordered body must be worked with as an actual as well as symbolic body and understood within its own developmental trajectory. The gender-specificity of eating disorders is explored by focusing on three particular bodily challenges for females in our society: (1) Women are more likely than men to unconsciously use their bodies as repositories for their dissociated need and desire, (2) girls’ bodies are mirrored in a more distorted and overstimulating manner than boys’ and (3) because girls are the same biological sex as their usual primary caretakers, they are more likely to be used as narcissistic extensions. A clinical example is presented, illustrating the influence of these female bodily challenges on the development of body self and eating disorders and how these issues play out in treatment. An intensive clinical focus on the patient’s and therapist’s body states allows for the desomatization and integration of dissociated affect, resulting in a more integrated body–mind self and a decreased need for an eating disorder.     

Ethnic differences in eating disorder symptoms among college students: the confounding role of body mass index.

Eating disorders are among the most common psychopathologies on college campuses. Research on ethnic differences in eating disorder symptoms and prevalence has resulted in conflicting conclusions. Some studies find that particular ethnic groups have a higher prevalence of a symptom; others find that members of that ethnic group have a lower prevalence of the same symptom. The authors explored the role of body mass index (BMI), one potential confound. They used a reliable measure of eating disorder symptoms to assess differences between Hispanic, Asian, and non-Hispanic White college women from two separate samples. After controlling for BMI, ethnic differences in eating disorder symptoms of concern about weight and shape disappeared, but differences in restrained eating remained. Inconsistent findings in the ethnic-difference literature on eating disorders may result from systematic group differences in BMI. Implications for college health programs, counseling, and case finding are discussed.     

Eating disorders and body image of undergraduate men

Eating disorders and body dissatisfaction among undergraduate men are less documented and researched than are eating disorders and body dissatisfaction among undergraduate women. OBJECTIVE AND PARTICIPANTS: In this study, the authors examined these issues in undergraduate men to identify similarities and differences between this population and undergraduate women. METHODS: In a random sample of undergraduates, the authors categorized respondents by gender and by presence or absence of an eating disorder. The authors compared undergraduate men with an eating disorder with (1) undergraduate women with an eating disorder and (2) undergraduate men without an eating disorder. RESULTS: The patterns of responses suggest that undergraduate men with an eating disorder are preoccupied with body shape and tone but not necessarily with losing weight. CONCLUSIONS: The authors discuss implications for future prevention as well as clinical and research efforts based on male symptoms within the diagnostic category of bulimia nervosa and eating disorder, not otherwise specified.     

The College Health Advisor and the College Age Adoptee

Abstract

Eating disorders are among the most common psychopathologies on college campuses. Research on ethnic differences in eating disorder symptoms and prevalence has resulted in conflicting conclusions. Some studies find that particular ethnic groups have a higher prevalence of a symptom; others find that members of that ethnic group have a lower prevalence of the same symptom. The authors explored the role of body mass index (BMI), one potential confound. They used a reliable measure of eating disorder symptoms to assess differences between Hispanic, Asian, and non-Hispanic White college women from two separate samples. After controlling for BMI, ethnic differences in eating disorder symptoms of concern about weight and shape disappeared, but differences in restrained eating remained. Inconsistent findings in the ethnic-difference literature on eating disorders may result from systematic group differences in BMI. Implications for college health programs, counseling, and case finding are discussed.     

An Empirical Study of Personality Disorders Among Treatment-Seeking Problem Gamblers

The primary aims of this study were to examine the prevalence of personality disorders in problem gamblers, to explore the relationship between personality disorders and problem gambling severity, and to explore the degree to which the psychological symptoms highlighted in the biosocial developmental model of borderline personality disorder (impulsivity, distress tolerance, substance use, PTSD symptoms, psychological distress and work/social adjustment) are associated with problem gambling. A secondary aim was to explore the strength of the relationships between these symptoms and problem gambling severity in problem gamblers with and without personality disorder pathology. Participants were 168 consecutively admitted problem gamblers seeking treatment from a specialist outpatient gambling service in Australia. The prevalence of personality disorders using the self-report version of the Iowa Personality Disorders Screen was 43.3 %. Cluster B personality disorders, but not Cluster A or C personality disorders, were associated with problem gambling severity. All psychological symptoms, except alcohol and drug use, were significantly higher among participants with personality disorder pathology compared to those without. Finally, psychological distress, and work and social adjustment were significantly associated with problem gambling severity for problem gamblers with personality disorder pathology, while impulsivity, psychological distress, and work and social adjustment were significantly associated with problem gambling severity for those without personality disorder pathology. High rates of comorbid personality disorders, particularly Cluster B disorders, necessitate routine screening in gambling treatment services. More complex psychological profiles may complicate treatment for problem gamblers with comorbid personality disorders. Future research should examine the applicability of the biosocial developmental model to problem gambling in community studies.     

Eating Disorders and Body Image of Undergraduate Men

Eating disorders and body dissatisfaction among undergraduate men are less documented and researched than are eating disorders and body dissatisfaction among undergraduate women. Objective and Participants: In this study, the authors examined these issues in undergraduate men to identify similarities and differences between this population and undergraduate women. Methods: In a random sample of undergraduates, the authors categorized respondents by gender and by presence or absence of an eating disorder. The authors compared undergraduate men with an eating disorder with (1) undergraduate women with an eating disorder and (2) undergraduate men without an eating disorder. Results: The patterns of responses suggest that undergraduate men with an eating disorder are preoccupied with body shape and tone but not necessarily with losing weight. Conclusions: The authors discuss implications for future prevention as well as clinical and research efforts based on male symptoms within the diagnostic category of bulimia nervosa and eating disorder, not otherwise specified.     

Implicit Family Process Rules in Eating-Disordered and Non-Eating-Disordered Families

Family environment has been shown to be one of the factors related to the presence of eating disorders among young-adult females. Clinical experience and theories about eating disorders postulate that implicit family rules are an intricate part of family process that may have a great effect on the creation and maintenance of such problems. This study compared implicit family process rules (specifically rules pertaining to kindness; expressiveness and connection; constraining thoughts, feelings, and self; inappropriate caretaking; and monitoring) in families with a young-adult female diagnosed with an eating disorder—either anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified—and families with a young-adult female without an eating disorder diagnosis. One hundred two families (51 eating disordered and 51 comparison) participated in the study. Mothers, fathers, young-adult female children, and siblings completed the Family Implicit Rules Profile ( Harper, Stoll, & Larson, 2007 ). Results indicated that eating-disordered families are governed by a greater proportion of constraining family rules than are non-eating-disordered families. Additionally, eating-disordered youth reported a lower proportion of facilitative family rules and a higher proportion of constraining family rules than did parents and siblings. Theoretical, research, and clinical implications are discussed.     

Gender differences in gambling preferences and problem gambling: a network-level analysis

Most gambling studies have a gender-blind research approach, although a large body of scientific evidence suggests that gambling in females is on the rise and that males and females have different gambling behaviours and experience specific gambling-related harm. This study addressed these gender differences using a network analysis, an innovative approach considering disorders/concepts as dynamic systems of interacting symptoms/items. Data on gambling activities, problem gambling, substance use and mental health were collected in a representative sample of French adult gamblers (n = 8805). The study capitalized on the network analysis directly to compare associations of specific gambling activities with gambling disorder symptoms separately for both genders. The network analysis revealed that problem gambling was strongly associated with gambling machines among females, whereas it was related to sports betting, poker and casino games among males. The networks that included substance use and mental health showed that substance use was related to specific gambling activities. These findings confirm the links between various gender-specific gambling patterns and problem gambling and suggest a need to consider these gender differences to improve prevention efforts. More broadly, the present study further supports the importance of gender differences for gambling research and policy.     

Management of Allergic Respiratory Disease by the Nurse Practitioner

The results of several studies have established the validity of the SCOFF questionnaire (a 5-question screening tool for eating disorders), but researchers need to explore further replicability using the US version in the graduate school population. In this study, the authors asked 335 graduate students attending the Northwestern student health clinic on the Chicago campus to complete a written survey anonymously. A total of 305 (91%) patients completed the survey. The sensitivity and specificity for the SCOFF was 53.3% and 93.2%, respectively. This produced a PPV (the proportion who tested positive on the screen and actually had an eating disorder) of 66.7% and an NPV (the proportion of those who tested negative on the screen and actually did not have an eating disorder) of 88.7%. More than 80% of respondents were dissatisfied with their shape and weight, with over one third having a moderate to severe body image disturbance. The SCOFF is an easy instrument to administer that health care providers can use to screen for eating disorders in the primary care setting.     

Eating disorders in graduate students: exploring the SCOFF questionnaire as a simple screening tool

The results of several studies have established the validity of the SCOFF questionnaire (a 5-question screening tool for eating disorders), but researchers need to explore further replicability using the US version in the graduate school population. In this study, the authors asked 335 graduate students attending the Northwestern student health clinic on the Chicago campus to complete a written survey anonymously. A total of 305 (91%) patients completed the survey. The sensitivity and specificity for the SCOFF was 53.3% and 93.2%, respectively. This produced a PPV (the proportion who tested positive on the screen and actually had an eating disorder) of 66.7% and an NPV (the proportion of those who tested negative on the screen and actually did not have an eating disorder) of 88.7%. More than 80% of respondents were dissatisfied with their shape and weight, with over one third having a moderate to severe body image disturbance. The SCOFF is an easy instrument to administer that health care providers can use to screen for eating disorders in the primary care setting.     

Comparison of Treatment Response among GLB and non-GLB Street Living Youth

Researchers have found that adolescents who identify as gay, lesbian, or bisexual (GLB) are at a higher risk for increased substance use and mental health symptoms. The current study is a secondary analysis of two clinical trials for street-living youth. This analysis examines self-identification as GLB as a moderator of treatment effects and addresses whether street-living GLB youth respond differently to a therapeutic intervention than non-GLB street-living youth. Comparisons were made of treatment outcomes on two categories of variables (drug use and mental health symptoms) among 244 homeless GLB and non-GLB identified adolescents. Overall, GLB and non-GLB adolescents showed similar reductions in drug use and mental health symptoms. However, compared to non-GLB adolescents, GLB adolescents showed greater improvement in reduction of drug use and internalizing and depressive symptom scores. While both groups reported less drug use and fewer mental health symptoms from baseline to post-intervention, GLB youth's scores improved more drastically. Implications of using the identified treatment intervention are discussed.     

Attention-deficit/hyperactivity disorder–specific stimulant misuse,mood, anxiety,and stress in college-age women at high risk for or with eating disorders

ABSTRACT

Objective: To examine the misuse of attention-deficit/hyperactivity disorder (ADHD)-specific stimulants in a college population at high risk for or with clinical or subclinical eating disorders. Participants: Four hundred forty-eight college-age women aged 18–25 at high risk for or with a clinical or subclinical eating disorder. Methods: Participants completed assessments of stimulant misuse and psychopathology from September 2009 to June 2010. Results: Greater eating disorder pathology, objective binge eating, purging, eating disorder–related clinical impairment, depressive symptoms, perceived stress, and trait anxiety were associated with an increased likelihood of stimulant misuse. Subjective binge eating, excessive exercise, and dietary restraint were not associated with stimulant misuse. Conclusions: ADHD-specific stimulant misuse is associated with eating disorder and comorbid pathology among individuals at high risk for or with clinical or subclinical eating disorders. Screening for stimulant misuse and eating disorder pathology may improve identification of college-age women who may be engaging in maladaptive behaviors and inform prevention efforts.     

Two Case Studies on Family Work with Eating Disorders and Body Image Issues

This article highlights the need for clinicians who work with eating disorders and body image problems to address the deeper family issues underlying these symptoms. The authors propose an eclectic approach including family systems, structural and experiential family therapy theory as a guide. The paper begins with an overview of family therapy theories currently used in the treatment of eating disorders, and goes into greater detail about the three theories highlighted in the eclectic model proposed. The authors present two cases with actual case dialogue, demonstrating how they used this composite model. This article has both theoretical and practical implications for clinicians working in the field.     

Vulnerability and Comorbidity Factors of Female Problem Gambling

This study helps to address a deficiency of gender-specific research into problem gambling. It focuses on the gambling behaviors, family and personal histories and comorbid psychological disorders of 365 female gamblers from across Ontario, Canada, who responded to a mail-in survey. Specifically, this study looks at rates of depression and anxiety, concurrent struggles with other behaviors (such as alcohol and drug use, disordered eating, overspending and criminal activity) and abuse history reported by female gamblers. The reported rates are considerably higher than for the general female population. The findings of this study agree with previous research. They suggest that prevention strategies and treatment practices for female problem gamblers should take into account women’s mental health, addiction and trauma history as contributing factors in the development of problematic gambling.     

Listening to Words,Hearing Feelings: Links Between Eating Disorders and Alexithymia

Research suggests that eating disorders often involve difficulty with affect regulation and processing of emotions. Studies also show that many individuals with these difficulties suffer from alexithymia, or an impaired ability to use language to tolerate or process emotions. Many clients with eating disorders are highly verbal, able to talk about feelings and even have good insight into the causes of their behaviors. Yet their verbal and cognitive strengths may disguise their inability to use thoughts to manage their emotions. Such clients often have a lifelong experience of appearing more capable and competent than they feel. Self-criticism and negative self-image concretized in a negative body image are part of their eating disorder. Therapeutic exploration can increase anxiety and self-criticism, aggravating feelings of inadequacy and the concomitant need for self-soothing. Techniques that focus on affect regulation have been shown to be effective, yet a psychodynamic approach can be an important tool in such an integrative practice. In this article, clinical material and theory will illustrate some of the ways that incorporating an understanding of alexithymia into the work can enhance the use of both psychodynamic exploration of meaning and also tools to manage affect and change behavior.     

The Critical Shapes of Body Image: The Role of Culture and Family in the Production of Eating Disorders

Although research has pointed to the influence of culture and family in the etiology of eating disorders, few studies have examined how these influences conjoin in this process. This research explores how the family mediates cultural ideas about thinness and how the family conveys these messages to family members. Using a grounded theory approach, open‐ended interviews were conducted with 32 White, middle‐class women (with and without eating disorders) on the topic of body image and eating problems. In conjunction with this method, qualitative comparative analysis (QCA) was also performed to identify family characteristics, and their specific combinations, that were associated with eating disorders. The findings indicate that a critical family environment, coercive parental control, and a dominating discourse on weight in the household are salient conditions, and their specific configurations are discussed in relationship to current theoretical conceptualizations regarding the influences of culture and family in the production of eating disorders.