Publication Guide: Eating Disorders

Below are some citations and abstracts from publications from the library’s database :

Allen, M. S., & Celestino, S. (2018). Body image mediates an association between personality and mental health. Australian Journal of Psychology, 70(2), 179–185.

Personality and body image have been identified as important correlates of mental and physical health. This study sought to explore whether body image mediates the association between the major dimensions of trait personality and self‐reported mental and physical health. In total, 451 Australian adults (121 men, 331 women; Mage= 21.88 ± 7.65 years) completed questionnaires at a single time‐point. After controlling for some demographic and anthropometric factors (e.g., body mass index), neuroticism was associated with all components of body image and mental and physical health. Extraversion, openness, and conscientiousness were associated with mental health and some components of body image. Multiple mediator models identified body image discrepancy and appearance evaluation as mediating the association between personality (neuroticism, extraversion, and conscientiousness) and mental health. No significant mediation effects were observed for physical health, and mediation effects were not moderated by participant gender. These findings provide evidence that personality relates to self‐reported mental health, in part, through the variance shared with body image.

Baker, J. H., Johnson, N. K., Munn-Chernoff, M. A., Lichtenstein, P., Larsson, H., Maes, H. H., & Kendler, K. S. (2018). Illicit drug use, cigarette smoking, and eating disorder symptoms: associations in an adolescent twin sample. Journal of Studies on Alcohol and Drugs, 79(5), 720–724.

Objective: Twin studies have shown that genetic factors in part explain the established relation between alcohol use (i.e., problematic use or abuse/dependence) and eating disorder symptoms in adolescent and adult females. However, studies have yet to elucidate if there are similar shared genetic factors between other aspects of substance involvement, such as illicit drug use and repeated cigarette smoking. Method: For those sex-specific phenotypic correlations above our threshold of .20, we used a behavioral genetic design to examine potential shared genetic overlap between self-reported lifetime illicit drug use and repeated cigarette smoking and the eating disorder symptoms of drive for thinness (DT), bulimia (BU), and body dissatisfaction (BD), as assessed with the Eating Disorder Inventory-II, in 16- to 17-year-old female and male twin pairs. Results: Only phenotypic correlations with illicit drug use met our threshold for twin modeling. Small to moderate genetic correlations were observed between illicit drug use and BU in both girls and boys and between illicit drug use and DT in girls. Conclusions: Similar etiological factors are at play in the overlap between illicit drug use and certain eating disorder symptoms in girls and boys during adolescence, such that genetic factors are important for covariance. Specifically, illicit drug use was associated with bulimia nervosa symptoms in girls and boys, which parallels previous substance use research finding a genetic overlap between alcohol use and bulimia nervosa symptoms. Future research should prospectively examine developmental trajectories to further understand the etiological overlap between substance involvement and eating disorder symptoms.

Bannatyne, A. J., & Abel, L. M. (2015). Can we fight stigma with science? The effect of aetiological framing on attitudes towards anorexia nervosa and the impact on volitional stigma. Australian Journal of Psychology, 67(1), 38–46.

The present study experimentally investigated the way in which exposure to various aetiological explanations of anorexia nervosa (AN) differentially affected stigmatisation and behavioural intention outcomes. University students (N= 161) were randomly assigned to read one of four aetiological vignettes presenting the causes of AN as biological/genetic, socio‐cultural, environmental, or multifactorial. Results indicate that those who received a socio‐cultural explanation made stronger socio‐cultural causal attributions, fewer biological/genetic causal attributions, and were significantly less willing to sign a health insurance petition for AN. Unexpectedly, the multifactorial group considered individuals with AN as more responsible and blameworthy for their condition. Overall, findings were comparative with previous research and partially support the propositions of attribution theory. Results also suggest that by conceptualising the aetiology of AN as biological or genetic, or at least increasing one’s knowledge of these contributing factors, it may be possible to decrease the level of blame‐based stigma associated with AN.

Bannatyne, A., & Stapleton, P. (2018). Eating disorder patient experiences of volitional stigma within the healthcare system and views on biogenetic framing: a qualitative perspective. Australian Psychologist, 53(4), 325–338.

Research has consistently indicated that fear of stigma is a pertinent factor when understanding the poor prevalence of treatment seeking among individuals with mental illness, particularly eating disorders (EDs). The purpose of this study was to investigate the treatment experiences of ED sufferers within an Australian context, in addition to exploring patient views on framing EDs as biogenetic conditions, given the increased understanding and presentation of EDs as biologically based conditions. Semi‐structured online data collection was conducted with 35 Australian women with a history of an ED (54.3% in treatment, 45.7% in “recovery” or “recovered”). The data were evaluated using a three‐phased coding system, allowing findings to emerge from significant themes inherent within the raw data (thematic analysis). Treatment was perceived as traumatic, punitive, blaming, lacking in understanding/education, and overemphasised the physical dimensions of the illness. The experience of volitional stigma in the healthcare system was frequent and expected, and for many sufferers had adverse effects. Biogenetic framing was perceived to be more likely to reduce (rather than exacerbate) stigma, particularly perceptions of volition and personal responsibility. Although reductions in blame and responsibility were welcomed, there was concern that biogenetic explanations could negatively impact recovery by endorsing genetic fatalism and encouraging self‐fulfilling prophecies via genetic essentialism. Overall, findings highlight that attention to volitional stigma within the health system is required (particularly education) and that aetiological framing (with caution and sensitivity) is perceived to be a feasible stigma reduction method by ED sufferers.

Cox, R., Skouteris, H., Hemmingsson, E., Fuller-Tyszkiewicz, M., & Hardy, L. L. (2016). Problematic eating and food-related behaviours and excessive weight gain: why children in out-of-home care are at risk. Australian Social Work, 69(3), 338–347.

Emerging evidence suggests that abuse and neglect in childhood may play a role in subsequent development of obesity. One population group particularly at risk is children and young people living in out-of-home care (OOHC). Given this population is already a vulnerable group, identifying potential mechanisms by which childhood abuse and neglect increases risk for obesity is essential. A possible explanation is that problematic eating and food-related behaviours (i.e., emotional eating, compulsive eating, overeating, binge eating, stealing or hoarding food) might mediate the association between adverse childhood experiences and obesity. Hence, the overall goal of this paper was to provide a narrative review of eating and food-related difficulties for children in care and their possible association with unhealthy and excessive weight gain. This review revealed a shortage of existing empirical papers and signalled particular need for further examination of the mediating effects of problematic eating.

Hughes, E. K., Dean, C., & Allen, J. S. (2016). Measures of eating disorder symptoms, drive for muscularity, and muscle dysmorphia: Norms and typologies of Australian men. Australian Journal of Psychology, 68(4), 270–280

The study aimed to provide normative data on measures of eating disorder symptoms, drive for muscularity, and muscle dysmorphia in men, and to identify typologies based on these measures. A community sample of 284 Australian men (19–84 years) completed the Eating Attitudes Test‐26, Eating Disorder Examination‐questionnaire, Clinical Impairment Assessment Questionnaire, Drive for Muscularity Scale, and Muscle Dysmorphia Inventory. Internal consistency, means, standard deviations, and percentile ranks were calculated for each measure, and results were compared with published findings on men from North America and Germany. A cluster analysis was also conducted. Internal consistency was adequate to excellent across most measures, and scores were similar to those of men in other countries. Cluster analysis identified three typologies: men with high muscularity, shape, and weight concerns as well as high dieting and exercise dependence; men with moderate shape and weight concerns, moderate muscularity concerns, and high dieting; and men with low to moderate scores across all measures. The normative data provided will be an important resource for researchers and clinicians needing to utilise and interpret measures of eating disorder, muscle dysmorphia, and drive for muscularity with men. In addition, the typologies identified suggest that when assessing men attention should be paid to attitudes and behaviours related to both drive for muscularity and drive for thinness.

Jiang, M. Y. W., & Vartanian, L. R. (2018). A review of existing measures of attentional biases in body image and eating disorders research. Australian Journal of Psychology, 70(1), 3–17.

Cognitive theories emphasise the important role of attentional biases in the development and maintenance of body image issues and eating pathology. A wealth of research has been conducted to examine attentional biases toward body‐related information among individuals with eating pathology. However, there is considerable variability in the methods that have been used to measure attention and, importantly, these methods tap into different attentional processes. Given the multifaceted nature of attention, it is important for researchers to select the right tools to test their hypotheses. This review critically evaluates the attentional measures that have been used in previous research, primarily the modified Stroop task, dot probe task, visual search task, and eyetracking. The strengths and limitations of each measure will be discussed in order to provide a guide for researchers to further investigate the attentional mechanisms underlying body image issues and eating disorders. Overall, we recommend that researchers use a combination of eyetracking technology and specific reaction‐time measures that target the specific attentional mechanism of interest.

Keating, C., Stephens, J., Thomas, N., Castle, D. J., & Rossell, S. L. (2016). Gender differences in weight‐related and non‐weight‐related appearance concerns in a community sample. Australian Journal of Psychology, 68(1), 11–19.

This study aims to investigate body image dissatisfaction in a community sample of men and women with the purpose of identifying whether concerns are consistent with typically ‘weight‐related’ and/or ‘non‐weight’ body parts, and how concerns relate to negative emotionality. Two hundred twenty‐six participants completed an online survey battery. Women experienced greater dissatisfaction with their bodies than men, with differences in specific body parts that resulted in dissatisfaction. Women experiencing high levels of concern with appearance reported very low satisfaction with body parts commonly endorsed by individuals with anorexia nervosa (i.e., weight related), rather than body dysmorphic disorder (i.e., non‐weight related). Men reported greater negative emotionality when they endorsed very low satisfaction with one or more body parts compared to women. Both genders reported negative emotionality when concern with appearance reached high levels. Findings suggest that for women, weight‐related concerns are represented in the general community along a continuum, whereas, non‐weight related appearance concerns, i.e., concerns consistent with body dysmorphic disorder, may not exist on the same continuum. In the future, it would be useful to determine the proportion of individuals who seek mental health services related to or unrelated to negative emotionality and/or weight‐related body image concerns

Knight, A., Castelnuovo, G., Pietrabissa, G., Manzoni, G. M., & Simpson, S. (2017). Drunkorexia: an empirical investigation among Australian female university Students. Australian Psychologist, 52(6), 414–423.

Anecdotal claims insinuate that female Australian university students may be engaging in a new type of hazardous phenomena called “drunkorexia” (i.e., using disordered eating to compensate for planned binge drinking). However, to date, this conjecture has not been validated by empirical evidence. The primary aim of the present study was to estimate the frequency of drunkorexia behaviours in a population of non‐clinical Australian undergraduate female university students. A secondary aim was to explore whether drunkorexia may be a stand‐alone problem, separate from traditional eating disorders. One hundred and thirty‐six healthy female Australian undergraduate university students between 18 and 25 years (M=21.32, SD=2.73) completed the self‐report Compensatory Eating and Behaviors in Response to Alcohol Consumption Scale to screen for drunkorexia symptomatology. Among the study sample, 57.7% (n= 85) of Australian female university students reported drunkorexia‐type behaviours 25% of the time or more, while 27.2% (n= 37) reported no drunkorexia‐type behaviour. In addition, 16.2 8% (n= 22) of the participants reported engaging in characteristic drunkorexic behaviours to specifically offset ingested alcohol calories while not engaging in such behaviours routinely for any other reason or with any other type of food or drink. Results of this study add preliminary empirical evidence that a number of Australian female university students are employing drunkorexia‐type behaviours as a way to drink alcohol without the concern of ingested calories. Further evidence is needed to definitively conclude that drunkorexia represents a distinctive problem that is separate from traditional eating disorders.

Solmi, M., Veronese, N., Sergi, G., Luchini, C., Favaro, A., Santonastaso, P., … Stubbs, B. (2016). The association between smoking prevalence and eating disorders: a systematic review and meta‐analysis. Addiction, 111(11), 1914–1922

Cigarette smoking is associated with severe mental illness, including schizophrenia and bipolar disorder, and with morbidity and mortality, but the association with anorexia (AN), bulimia nervosa (BN) and binge eating disorder (BED) is unclear. This meta‐analysis compared the odds of smoking in eating disorders (ED) (ED = AN or BN or BED) versus healthy controls (HC) and calculated the prevalence of smokers in people with ED. Three independent authors searched PubMed, MEDLINE and Scopus from database inception until 31 December 2015 for studies reporting data on life‐time or current smoking prevalence in BED, BN and AN with or without control group. Meta‐analyses were undertaken, calculating odds ratios (ORs) of life‐time smoking in BED, BN, AN versus healthy controls (HCs) or prevalence of smoking in BED, BN and AN with 95% confidence intervals (CI). Thirty‐one studies (ED = 8517, controls = 68 335) were meta‐analysed. Compared with HCs, there were significantly more smokers among people with BN (life‐time OR = 2.165) and BED (life‐time OR = 1.792) but not AN (life‐time OR = 0.927). BED was associated with smoking the most (life‐time prevalence = 47.73%) followed by BN (life‐time prevalence = 39.4%) and AN (life‐time prevalence = 30.8%). In BN, life‐time smoking prevalence was highest in Europe. In AN, higher age moderated both life‐time and current smoking prevalence, and body mass index moderated higher life‐time smoking prevalence. In BN, female sex moderated higher life‐time smoking prevalence. People with binge eating disorder and bulimia nervosa are significantly more likely to be life‐time smokers than healthy controls, which is not the case for anorexia nervosa.

Wakeford, G., Kannis, D. L., & Statham, D. (2018). Anger rumination, binge eating, and at‐risk alcohol use in a university sample. Australian Journal of Psychology, 70(3), 269–276

Binge eating and alcohol consumption have been associated with attempts to reduce negative affect such as anger. Anger rumination has been associated with maintaining anger. The aim of the current study was to explore the association between anger rumination and binge eating and at‐risk alcohol use. Participants were 563 university students aged between 18 and 66 years who completed an online survey containing the Anger Rumination Scale (ARS), Eating Disorder Diagnosis Scale (EDDS), Alcohol Use Disorders Identification Test—Consumption (AUDIT‐C) and Depression, Anxiety, & Stress Scale (DASS‐21). The results showed that individuals who endorsed elevated levels of binge eating behaviour had increased levels of anger rumination, specifically angry afterthoughts and angry memories, compared to healthy controls. In contrast, individuals who engaged in at‐risk alcohol use without binge eating did not report significantly increased levels of anger rumination. This study highlights anger rumination as a potential factor in maintaining binge eating behaviour and suggests that screening for and addressing anger rumination may be an important component of psychological treatment. a

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