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Objective: Research suggests that both compulsive exercise and eating disordered behaviors increase during college. Despite strong cross‐sectional associations between compulsive exercise and eating disorders, it is unknown if compulsive exercise is a variable risk factor for eating disorders or simply a correlate. It was hypothesized that increases in compulsive exercise would significantly and prospectively predict increases in overall number of eating disorder symptoms over the study period. Method: A total of 265 first year college students who did not meet criteria for a full or subthreshold eating disorder diagnosis at Time 1 (age M = 18.15; SD = 0.42; 122 female [46%] at Time 1) completed reports of compulsive exercise and eating disorder symptoms via online questionnaires at four timepoints over the 9‐month 2021–2022 academic year (76% retention rate). Hypotheses were tested using a bivariate latent change score model. Results: Hypotheses were not supported. Change in compulsive exercise did not predict change in number of eating disorder symptoms. Change in number of eating disorder symptoms also did not predict change in compulsive exercise. Conclusions: Compulsive exercise did not emerge as a variable risk factor for the development of eating disorder symptoms among first year college students. The relationship between these behaviors should be investigated at different developmental timepoints, such as early adolescence, and potential third variables that may explain the observed co‐occurrence should be explored. Public significance: This study investigated whether increases in compulsive exercise predicted increases in number of eating disorder symptoms among first year college students. Compulsive exercise did not significantly predict number of eating disorder symptoms. Additional research is warranted to clarify the relationship between compulsive exercise and eating disorder symptoms. [ABSTRACT FROM AUTHOR]

Objective: The development of novel treatments for anorexia nervosa (AN) requires a detailed understanding of the biological underpinnings of specific, commonly occurring symptoms, including compulsive exercise. There is considerable bio‐behavioral overlap between AN and obsessive‐compulsive disorder (OCD), therefore it is plausible that similar mechanisms underlie compulsive behavior in both populations. While the association between these conditions is widely acknowledged, defining the shared mechanisms for compulsive behavior in AN and OCD requires a novel approach. Methods: We present an argument that a better understanding of the neurobiological mechanisms that underpin compulsive exercise in AN can be achieved in two critical ways. First, by applying a framework of the neuronal control of OCD to exercise behavior in AN, and second, by taking better advantage of the activity‐based anorexia (ABA) rodent model to directly test this framework in the context of feeding pathology. Results: A cross‐disciplinary approach that spans preclinical, neuroimaging, and clinical research as well as compulsive neurocircuitry and behavior can advance our understanding of when, why, and how compulsive exercise develops in the context of AN and provide targets for novel treatment strategies. Discussion: In this article, we (i) link the expression of compulsive behavior in AN and OCD via a transition between goal‐directed and habitual behavior, (ii) present disrupted cortico‐striatal circuitry as a key substrate for the development of compulsive behavior in both conditions, and (iii) highlight the utility of the ABA rodent model to better understand the mechanisms of compulsive behavior relevant to AN. Public Significance: Individuals with AN who exercise compulsively are at risk of worse health outcomes and have poorer responses to standard treatments. However, when, why, and how compulsive exercise develops in AN remains inadequately understood. Identifying whether the neural circuitry underlying compulsive behavior in OCD also controls hyperactivity in the activity‐based anorexia model will aid in the development of novel eating disorder treatment strategies for this high‐risk population. [ABSTRACT FROM AUTHOR]

Objective: To identify ketamine's dosing schedule that ameliorates voluntary food restriction, hyperactivity and body weight loss of adult mice undergoing activity‐based anorexia (ABA), an animal model of anorexia nervosa. Method: Female and male C57BL6 mice underwent three cycles of ABA, starting from mid‐adolescence. ABA vulnerability was compared within and across two groups of animals: those injected intraperitoneally with 30 mg/kg ketamine for three consecutive days (30mgKetx3) during the second ABA in late adolescence (ABA2) or with vehicle only (Vx3). Results: Vx3 females and males exhibited individual differences in wheel running and weight retention during first ABA in mid‐adolescence (ABA1), ABA2, and third ABA in adulthood (ABA3). Their wheel running correlated with anxiety‐like behavior. During ABA1 and ABA3, weight gain of Vx3 females (but not males) after food consumption correlated negatively with food‐anticipatory activity (FAA) preceding the feeding hours, indicating that females with higher levels of running restrict feeding more and persistently. This paradoxical relationship confirms earlier findings of ABA females without ketamine treatment, capturing the maladaptive behaviors exhibited by individuals diagnosed with anorexia nervosa. By contrast, 30mgKetx3 had an effect on both sexes of reducing hyperactivity during the feeding hours acutely and reducing anxiety‐like behavior's contribution to running. For females, only, 30mgKetx3 acutely improved the extent of compensatory food consumption relative to FAA and improved weight retention during ABA3, 12 days post ketamine in adulthood. Discussion: Sub‐anesthetic ketamine evokes behavior‐specific ameliorative effects for adult mice re‐experiencing ABA, supporting the notion that multiple doses of ketamine may be helpful in reducing relapse among adults with anorexia nervosa. Public Significance Statement: This study examined whether ketamine reduces anorexia‐like behaviors in adult mice. Three daily sub‐anesthetic ketamine injections suppress wheel running during and leading up to the hours of food availability and enable animals to compensate better for weight loss associated with excessive exercise by eating more. These findings suggest that ketamine may help adult females diagnosed with anorexia nervosa but also point to sex‐ and age‐related differences in the action of ketamine. [ABSTRACT FROM AUTHOR]

Objective: Although exercise is generally considered healthy, many individuals engage in maladaptive exercise (e.g., compulsive in nature). Several definitions of maladaptive exercise exist, leading to multiple, varied assessment tools; assuming homogeneity across these assessments contributes to low consensus in etiological models. Method: We used a Jaccard Index to quantify content overlap among 15 commonly‐used self‐report instruments measuring maladaptive exercise, with 31 features identified across 224 items. Results: The most common features were exercise to control weight/shape and to avoid negative affect (both included in 9/15 instruments), or compensate for calories consumed (8/15 instruments). Overlap among instruments was low (.206) and no features were common across all instruments. Conclusions: Findings generally support theoretical models of exercise in eating pathology. However, instruments most commonly used to assess maladaptive exercise measure heterogenous content. Careful consideration should be taken when comparing findings derived from differing instruments, when synthesizing literature on maladaptive exercise, and when selecting instruments to measure specific maladaptive exercise features. Public Significance: Many, varied, tools exist for the assessment of maladaptive exercise (e.g., compulsive or compensatory) in the context of eating disorders. Assuming homogeneity across tools contributes to low consensus in the field. We used a Jaccard Index to quantify content overlap among 15 self‐report instruments measuring maladaptive exercise. The most commonly used instruments measure heterogenous content. Careful consideration should be taken when synthesizing literature and selecting instruments to use in research. [ABSTRACT FROM AUTHOR]

Objective: Individuals with eating disorders (EDs) often engage in maladaptive exercise (e.g., feeling driven, or to "compensate" for eating) which maintains eating pathology. Maladaptive exercise has been theorized to help individuals with EDs regulate emotions by enhancing positive affect (PA) and reducing negative affect (NA) associated with binge episodes and poor body image. However, no research has considered the presence of non‐maladaptive exercise or evaluated this theory in binge‐spectrum EDs. Methods: This study evaluated affective trajectories pre‐ and post‐exercise and examined exercise type (maladaptive or non‐maladaptive) as a moderator. We recruited adults with binge‐spectrum EDs (N = 107; n = 84 endorsed exercise) to complete a 7‐ to 14‐day ecological momentary assessment protocol assessing NA (anxiety, guilt, and sadness), PA (excitement and cheerfulness), and exercise. Results: There was a significant quadratic trajectory of PA pre‐exercise, suggesting that the upward trajectory of PA leveled out as it moved closer to an exercise episode. Exercise type significantly moderated the cubic trajectory of PA post‐exercise, such that the upward trajectory of PA accelerated in the hours following non‐maladaptive exercise episodes while the downward trajectory of PA accelerated in the hours following maladaptive exercise episodes. No trajectories of NA demonstrated significant effects. Conclusions: Pre‐exercise trajectories of PA may reflect positive expectancies around exercise. Post‐exercise trajectories of PA suggest that non‐maladaptive exercise promotes increased PA. Future research should evaluate when, and for whom, exercise serves to regulate affect and examine other momentary risk factors of exercise in EDs. Public Significance: Individuals with EDs often engage in maladaptive exercise (e.g., feeling driven, or to "compensate" for eating). Maladaptive exercise has been theorized to help individuals with EDs regulate emotions. This study evaluated affective trajectories pre‐ and post‐exercise and examined whether exercise type (maladaptive or non‐maladaptive) changed these trajectories. Pre‐exercise trajectories of PA may reflect positive expectancies around exercise. Post‐exercise trajectories of PA suggest that non‐maladaptive exercise promotes increased PA. [ABSTRACT FROM AUTHOR]

Objective: To close the chasm between theory about families containing a parent with an eating disorders (EDs) history and lack of selective or indicated prevention programming for such families with an older child or adolescent who is, genetically, at high risk. Method: A search of four major databases for January 2000 through September 2022 yielded no publications that (a) identified genetically high‐risk families with offspring ages 10 through 18; (b) devised a prevention program for the family; and (c) evaluated program effects on risk/protective factors. To rectify this gap, research on three lines of family‐based prevention is reviewed: (1) programs for adolescents at genetic risk for depression or anxiety; (2) the Stanford‐Dresden project for adolescents at high risk for anorexia nervosa; and (3) Sadeh‐Sharvit et al.'s work concerning the Parent‐Based Prevention program for mothers with an EDs history and a child under age 5. Results: The significant challenges for innovative prevention programming should be addressed by experts in effective EDs, depression, and anxiety prevention, and in family‐based treatment (FBT) for EDs, collaborating with people from genetically vulnerable families. Innovative programming should focus on robust risk factors for EDs, adaptive expression of non‐specific risk factors (e.g., temperament), and strengthening family functioning. Discussion: The field is overdue for development of prevention programs designed for older children or adolescents who are at risk because a parent has an ED. Evidence‐based prevention programs for EDs and for depression and anxiety, as well as parent‐based prevention informed by FBT, provide a springboard for addressing this gap. Public Significance: The foundation of theory and research is available for stakeholders to develop prevention programming that closes the huge gap between theory and research about families that are genetically vulnerable for eating disorders versus the complete lack of prevention programming for such families that have an older child or adolescent at high risk. [ABSTRACT FROM AUTHOR]

Objective: We aimed to evaluate the feasibility, acceptability, and potential impact of a tele‐guided digital‐based intervention based on the addictive appetite model of recurrent binge eating. Method: Female college students with bulimia nervosa (BN) or binge‐eating disorder (BED) (n = 22) received a 6‐week guided intervention targeting addictive processes and emotion regulation. The feasibility of the intervention was evaluated, and the outcomes were assessed at baseline, the end of the intervention, and 1‐month follow‐up. Results: Of the participants, 86.4% (n = 19) completed the intervention. The self‐help materials were viewed 6.03 ± 3.06 times per week, and the duration of using the self‐help materials was 113.16 ± 160.19 min/week. The intervention group experienced a significant reduction with a moderate effect on binge eating at the end of the intervention (Hedges' g = 0.58), and the effects lasted through follow‐up (Hedges' g = 0.82). Discussion: The results suggest that the digital intervention targeting a maintenance mechanism of recurrent binge eating was feasible and acceptable for patients with BN and BED, proving the potential for symptom improvement. Public significance: The addictive appetite model provides the framework for new interventions to improve treatments for BN and BED. This study found that the digital intervention based on the model was feasible and acceptable for patients with BN and BED. [ABSTRACT FROM AUTHOR]

The aim of this case series was to examine engagement in and outcomes of family-based treatment (FBT) for adolescents with DSM-5 atypical AN, that is, adolescents who were not underweight at presentation. Consecutive referrals for FBT of adolescents with atypical AN to a specialist child and adolescent eating disorder program were examined. Engagement in treatment (i.e., dose of treatment, completion rate), and changes in psychological symptomatology (i.e., eating disorder symptoms, depressive symptoms, self-esteem, obsessive compulsiveness), weight, and menstrual function were examined. The need for additional interventions (i.e., hospitalization and medication), and estimated remission rates were also examined. The sample comprised 42 adolescents aged 12-18 years (88% female). Engagement in FBT was high, with 83% completing at least half the treatment dose. There were significant decreases in eating disorder and depressive symptoms during FBT (p

Objective: The Compulsive Exercise Test (CET) was developed to assess compulsive exercise in patients with eating disorders (EDs), but originally validated in a nonclinical sample, and psychometric properties were only investigated in small clinical samples. Therefore, the aim of this study was to examine its psychometric properties in a large clinical sample of adolescent and adult inpatients with anorexia nervosa and bulimia nervosa. Method: A sample of 2,535 German female inpatients with EDs completed the CET and other instruments at admission and discharge. Factor structure (confirmatory [CFA] and exploratory factor analyses [EFA]), internal consistency and construct validity, measurement invariance across age and diagnostic groups, group comparisons of means, as well as sensitivity to change during treatment were assessed. Results: The CET showed high internal consistency, very good construct validity, and sensitivity to change. CFA indicated a better fit of four‐factor and three‐factor solutions compared to the original five‐factor model. However, subsequent EFA identified an optimum for a five‐factor model. Only three subscales were satisfactorily invariant to measurement, but not the CET total score. Only small differences in scores between patient groups were observed. Discussion: Results support internal consistency, construct validity, and sensitivity to change, whereas factor structure remains inconclusive, questioning the theoretical basis of the CET. There is limited support for using the lack of enjoyment subscale, and only moderate support for using the rigidity subscale in patients with EDs. It is recommended to further explore and/or revise the original CET, including investigation in other samples, for example, male samples. [ABSTRACT FROM AUTHOR]

Objective: Investigations into online eating disorder (ED) communities have allowed for a rich exploration of lived experiences focused on a number of aspects, such as recovery and support groups. There is a lack of understanding around compulsive exercise (CE), which is often a characterizing condition of EDs. Exploring the lived experiences of CE as discussed online could provide helpful insight towards a better understanding of CE. Therefore, the purpose of this study was to explore experiences around CE and EDs shared on social media sites. Method: Social media posts related to CE and EDs from Reddit, Twitter, Instagram, and forums were collected for 12 months. A thematic analysis of 881 posts was used to identify common themes among individuals' lived experiences with CE. Results: Five themes (and three subthemes) were identified across the social media posts: (1) seeking control, but ultimately CE takes hold, (2) burning off binges, but at what expense?, (3) recovery is a battle, but worth it, (4) is my exercise healthy?, and (5) frustration with comments about CE. Discussion: The lived experiences of CE among individuals with EDs have provided support for current definitions of CE and shared novel insight into the recovery experience. Individuals online also highlighted the need for improvement in treatment around CE specifically, and greater awareness around CE for the general public and healthcare providers. [ABSTRACT FROM AUTHOR]

Objective: Symptoms of exercise addiction, a state of compulsively engaging in intense exercise, and orthorexic eating attitudes, the obsession with eating only healthy foods, often occur together. It is assumed that some more general psychological traits underlie this association. Main aim of this report was to examine similarities and differences between orthorexic eating and addictive exercising. Method: Six hundred and eight individuals completed an online survey (mean age: 27.5, SD = 11.0 years; 76.5% women) measuring exercise addiction (Exercise Addiction inventory, EAI), orthorexic eating (Düsseldorfer Orthorexie Skala, DOS), personality domains (Big‐Five Inventory‐10), anxiety and depression (Hospital Anxiety and Depression Scale). Results: Correlations between the DOS and EAI were.43 in women and.62 in men. Structural equation models identified gender‐specific as well as behavior‐specific psychological correlates. Among women, anxiety correlated with both EAI and DOS. In addition, the DOS correlated with depression and neuroticism while the EAI correlated with conscientiousness. In men, both scales were associated with conscientiousness and the EAI also correlated with extraversion. Clusterability analysis provided no evidence for clusters based on DOS and EAI. Discussion: Present results showed a substantial correlation between addictive exercising and orthorexic eating, however, coefficients were smaller than expected and appeared higher in men. Both behaviors shared few psychological traits (anxiety in women, conscientiousness in men) thereby questioning the assumption of a similar origin. Additionally, gender‐specific psychological correlates point to the need for different disease management approaches in women and men. [ABSTRACT FROM AUTHOR]

Objective: COVID‐19 has led to disruptions in daily living and increased uncertainty about physical, financial, social, and psychological consequences, which may contribute to anxiety, eating disorder (ED) pathology, and compulsive exercise. Individual factors, such as intolerance of uncertainty, may impact risk for ED pathology and CE in response to COVID‐19 anxiety. The current study examined associations between COVID‐19 anxiety, trait intolerance of uncertainty, and COVID‐19 intolerance of uncertainty and ED pathology and compulsive exercise. Method: Undergraduate participants (N = 295) completed a series of online questionnaires between March and April of 2020. Results: COVID‐19 anxiety and intolerance of uncertainty were associated with ED pathology, but not compulsive exercise. Additionally, both trait and COVID‐19 intolerance of uncertainty moderated associations between COVID‐19 anxiety and compulsive exercise and ED pathology. COVID‐19 anxiety was more strongly related to compulsive exercise and ED pathology for individuals with lower intolerance of uncertainty. Discussion COVID‐19 anxiety may increase risk for ED pathology and may be specifically important in determining risk for ED pathology and compulsive exercise among individuals with lower intolerance of uncertainty. These results contribute to a growing body of research aimed at understanding the mental health consequences of the COVID‐19 and suggest that individual factors (e.g., anxiety and intolerance of uncertainty) are important in determining risk for ED pathology and compulsive exercise in the context of the pandemic. [ABSTRACT FROM AUTHOR]

Objective: Positive and negative influences from teammates (e.g., supportive teammate friendships, modelling of teammates' disordered eating) have been associated with athletes' eating/exercise psychopathology. However, research is yet to explore how an athlete's psychological well‐being and gender may impact upon these relationships. This study aimed to explore whether psychological well‐being mediates the relationship between teammate influences and eating/exercise psychopathology, and to determine whether gender moderates the significant mediation effects identified. Method: Athletes (N = 195, mean age 18.35 years, n = 110 female, n = 81 lean sport athletes) completed a survey three times over an 8‐month period exploring teammate influences, psychological well‐being (self‐esteem, anxiety, depression) and eating/exercise psychopathology. Mediation and moderated‐mediation analyses were conducted. Results: Higher levels of anxiety significantly mediated the positive relationships between bulimia modelling and teammate pressure with eating and exercise psychopathology. Higher levels of depression significantly mediated the positive relationship between teammate pressure and body dissatisfaction, and the negative relationship between supportive friendships and body dissatisfaction. Higher levels of self‐esteem mediated both inverse relationships between supportive friendships and a lower drive for thinness (fully) and body dissatisfaction (partially). Gender did not significantly moderate any mediation relationships. Discussion: Male and female athletes with poor psychological well‐being (i.e., high levels of anxiety or depression) are more susceptible to negative teammate influences, while athletes with good psychological well‐being (i.e., high self‐esteem) reap the protective benefits of supportive teammate friendships. Understanding the circumstances under which teammates are influential is vital for the development of targeted intervention and prevention strategies to reduce athlete eating and exercise psychopathology. [ABSTRACT FROM AUTHOR]

Objective: Exercise dependence is a set of cognitive and behavioral symptoms that constitute a reliance on exercise and is related to eating disorder (ED) symptoms. There are seven components of exercise dependence: tolerance, withdrawal, continuance, lack of control, reduction in other activities, time, and intention effects. Exercising in response to negative affect (NA) is a key feature of dysfunctional exercise in the EDs. However, it is unknown which specific components of exercise dependence relate to ED symptoms, above and beyond NA. Method: The current study (N = 168 individuals with EDs) investigated which components of exercise dependence relate to ED symptoms both cross‐sectionally and prospectively. Results: In cross‐sectional data, we found that withdrawal, tolerance, and time were associated with ED symptoms, above and beyond NA. Prospectively over 1 month, when adjusting for baseline ED symptoms and NA, we found that lack of control, withdrawal, and time positively predicted ED symptoms. Discussion: These findings inform future research on how exercise dependence relates to ED symptoms, showing that withdrawal and time are uniquely associated with ED symptoms both cross‐sectionally and over time. [ABSTRACT FROM AUTHOR]

Objective: To explore the relationships between the use of food intake and activity monitoring tools with compulsive exercise, eating psychopathology, and psychological wellbeing. Method: Participants (N = 352; mean age 21.90 years) indicated their use of activity and food intake monitoring tools, and completed the Compulsive Exercise Test (CET), Eating Disorders Examination Questionnaire (EDE‐Q), and the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS). Results: Users of monitoring tools reported significantly higher CET and EDE‐Q scores than nonusers. Positive associations were detected between the frequency of activity monitoring tool use with CET and EDE‐Q scores. Participants who reported using monitoring tools primarily to manage weight and shape reported higher levels of eating and compulsive exercise psychopathology than those who reported using tools to improve health and fitness. Discussion: Features of compulsive exercise and eating psychopathology are elevated among users of food intake and activity monitoring tools; and particularly among those who report using the tools for weight and shape purposes. Longitudinal and experimental research is needed to further our understanding of these observed associations, and specifically to explore the prospective relationships between monitoring tool use, eating psychopathology, and compulsive exercise. [ABSTRACT FROM AUTHOR]

Objective: Clinical perfectionism has been found to be a risk and maintaining factor in eating disorders (EDs), compulsive exercise, and athlete burnout. This study investigated whether an unguided internet cognitive–behavioral treatment (ICBT) for perfectionism would reduce ED pathology, compulsive exercise, and burnout in individuals who engage in regular exercise. Method: Participants were randomly allocated to intervention (n = 38) or waitlist control (n =29). A generalized linear mixed model (GLMM) analysis was conducted pre and post treatment. A follow‐up analysis was conducted with the intervention group at 3 and 6 months. Results: The intervention group experienced a significant reduction in perfectionism (FMPS‐CM: F[1,117] = 17.53, p = < .001, Cohen's d = .82), ED symptomology (EDE‐Q: F[1,55] = 7.27, p = .009,Cohen's d = .53) and compulsive exercise (CET: F[1,116] = 10.33, p < .001,Cohen's d = .63). The changes attained post‐treatment were maintained within the intervention group at 3‐month (FMPS‐CM (t[1,100] = 3.67, p < . 001, Cohen's d = .85) (EDE‐Q (t[1,50] = 2.20, p = .03, Cohen's d = 1.26) and 6‐month follow‐up (FMPS (t[1,100] = 2.74, p = 007, Cohen's d = .70) (EDE‐Q (t[1,50] = 2.18, p = .03, Cohen's d = 1.26). Discussion: The results indicate unguided ICBT for perfectionism can have a significant impact on perfectionism, compulsive exercise, and ED symptomatology. [ABSTRACT FROM AUTHOR]

Abstract: Objective: This study compares different problematic eating behaviors (PEBs; objective [OBE]/subjective [SBE] binge‐eating and compulsive [CG]/noncompulsive [NCG] grazing) in relation to the severity of loss of control (LOC) and psychopathology. We also investigate LOC as a mediator between PEBs and psychopathology. Method: This cross‐sectional study assessed a group of patients before bariatric surgery (n = 163), and a group of bariatric patients 12 months or more after surgery (n = 131). Face‐to‐face assessment: Eating Disorders Examination for binge‐eating episodes; Rep(eat) for grazing. LOC was measured by five questions answered in a 5‐point Likert scale. Self‐report measures: disordered eating, grazing, negative urgency, depression, anxiety, and stress. Results: OBEs were reported by 26(8.8%), SBE by 29(9.8%), CG by 35(11.9%), and NCG by 36(12.2%) of patients. The different PEBs differed significantly in the severity of LOC (F(3,120)= 25.81, p < .001). Patients reporting OBEs scored higher and patients with NCG scored lower in most measures than patients with other PEBs. Patients with any PEBs scored higher in all self‐report measures than those not reporting any PEBs, with statistical significance reached for uncontrolled eating (F(4,288)= 20.21, p < .001), emotional eating (F(4,288)= 23.10, p < .001), repetitive eating F(4,288)= 18.34, p < .001), and compulsive grazing (F(4,288)= 27.14, p < .001). LOC was found to be a full mediator between PEBs and psychopathology. Discussion: There is no evidence that the different PEBs differ in the psychopathology severity, independently of the experience of LOC eating during the eating episodes. We show evidence for the conceptualization of different PEB, including grazing, on a continuous scale of LOC and psychopathology. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To identify the correlates of suicidal ideation (SI) in a large sample of college women with eating disorders (EDs). Method: A total of 690 female college students from 28 US colleges who screened positive for an ED, with the exception of anorexia nervosa, were assessed for SI. Univariate logistic regression analyses were performed to determine independent correlates of SI. Measures included: ED psychopathology, ED behaviors (i.e., binge eating, vomiting, laxatives, compulsive exercise), current co‐morbid psychopathology (i.e., depression, anxiety, insomnia), weight/shape concerns, ED‐related clinical impairment, and body mass index (BMI). All significant variables were included in a backward binary multivariate logistic regression model to determine which variables were most strongly associated with SI. Results: A total of 25.6% of the sample reported SI. All variables examined were significantly independently associated with SI, with the exception of compulsive exercise. Depression, anxiety, and vomiting remained as significant correlates of SI in the multivariate logistic regression model. Discussion: ED screening on college campuses should assess for suicidality, and prevention and treatment efforts should target vomiting and co‐morbid depression and anxiety symptoms to reduce risk of SI for high‐risk individuals. [ABSTRACT FROM AUTHOR]

Abstract: Objective: A 27‐year‐old male suffering from chronic anorexia nervosa was admitted for inpatient psychotherapy suffering from severe urge to be physically active. Methods: An off‐label treatment with dronabinol was initiated, to reduce his symptoms related to that urge. Several attempts to reduce symptoms including intensive psychotherapy and several psychopharmacological agents had failed in the past. Results: Following treatment with 7.5 mg dronabinol twice a day, the patient reported a significant reduction in his acute urge to be physically active. Also eating disorder‐specific cognitions and compulsive behaviors remitted. Discussion: Previous studies have applied much lower doses and showed no effect of dronabinol upon the urge to be physically active. Up to date, the patient reported no side effects, especially no psychotropic effects. Implications of this case report are discussed. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Compulsive exercise is a prominent feature for the majority of patients with Anorexia Nervosa (AN), but there is a dearth of research evaluating assessment instruments. This study assessed the concurrent validity of the exercise items of the Eating Disorder Examination (EDE) and Eating Disorder Examination-Questionnaire (EDE-Q), with the Compulsive Exercise Test (CET) and other self-report exercise measures in patients with AN. We also aimed to perform validation of the CET in an adult clinical sample. Methods The sample consisted of 78 adults with AN, recruited for the randomized controlled trial 'Taking a LEAP forward in the treatment of anorexia nervosa.' At baseline, participants completed the EDE, EDE-Q, CET, Reasons for Exercise Inventory (REI), Commitment to Exercise Scale (CES) and Exercise Beliefs Questionnaire (EBQ). Correlational and regression analyses were performed. Results EDE exercise days and exercise time per day were positively correlated with each other and with all CET subscales (except Lack of exercise enjoyment), CES mean, EBQ total and REI total. Exercise time per day was associated with a higher EDE global score. The CET demonstrated good concurrent validity with the CES, the REI and the EBQ. Of the self-reports, the CET explained the greatest variance in eating disorder psychopathology and demonstrated good to excellent reliability in this sample. Discussion The EDE and EDE-Q demonstrated good concurrent validity with the CET. Further research is required to evaluate the CET's factor structure in a large clinical sample. However, the CET has demonstrated strong clinical utility in adult patients with AN. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:533-541) [ABSTRACT FROM AUTHOR]

This study aimed to explore and synthesize expert clinical knowledge on defining and managing unhealthy exercise in adolescents with AN. The Delphi methodology was used. Clinicians ( n = 25) considered experts in the treatment of AN in adolescents were recruited internationally to form the panel. The first round of the questionnaires was comprised of five open-ended questions regarding defining, assessing, and treating unhealthy exercise in adolescents with AN. Statements were derived from this data using content analysis, and included as Likert-based items in two subsequent rounds, in which panellists were required to rate their level of agreement for each item. All 25 respondents completed the three rounds of questionnaires. Consensus was achieved for 59.0% of the items included in the second and third round of questionnaires. Although consensus was not achieved, compulsive exercise was the preferred term for the panel when referring to unhealthy exercise in adolescents with AN. The panel clearly delineated features of unhealthy and healthy exercise, and endorsed a number of items considered important to assess for when evaluating exercise in this clinical population. A variety of treatment approaches and strategies reached consensus. Notably, for those who are medically stable and progressing toward recovery, the panel recommended initial exercise restriction practices and reintroducing healthy exercise behaviors, rather than exercise cessation practices. The current findings can serve as preliminary treatment guidelines. A unified approach to labeling and defining unhealthy exercise in the eating disorder literature and clinical settings is required to achieve further progress. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Fitspiration is a recent Internet trend designed to motivate people to eat healthily and to exercise. The aim of the study was to investigate disordered eating and exercise in women who post fitspiration on Instagram. Method Participants were 101 women who post fitspiration images on Instagram and a comparison group of 102 women who post travel images. Both groups completed measures of disordered eating and compulsive exercise. Results Women who post fitspiration images scored significantly higher on drive for thinness, bulimia, drive for muscularity, and compulsive exercise. Almost a fifth (17.5%) of these women were at risk for diagnosis of a clinical eating disorder, compared to 4.3% of the travel group. Compulsive exercise was related to disordered eating in both groups, but the relationship was significantly stronger for women who post fitspiration images. Discussion For some women, posting fitspiration images on Instagram may signify maladaptive eating and exercise behaviors. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2017; 50:76-79) [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Few studies have assessed symptoms of eating disorders in older men. Method We administered anonymous questionnaires to 470 men, aged 40-75 years, in and around Innsbruck, Austria, to assess eating behavior, body image, and exercise activities. We defined current eating disorder symptoms (EDS) as (1) BMI < 18.5; (2) binge eating; (3) binge eating and purging; or (4) purging without binge eating. Results Of the 470 men, 32 (6.8%) reported one of the four eating disorder symptoms. The 32 men with eating disorder symptoms, compared to the 438 men with normal eating, showed significantly greater pathology on scales assessing eating behavior, exercise addiction, satisfaction with body shape, and weight. However, the EDE-Q cutoff score for eating disturbance identified only three (9%) of the EDS men. Discussion Symptoms of disordered eating, sometimes involving purging via excessive exercise, do occur in older men, and may be missed by conventional instruments. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016; 49:953-957) [ABSTRACT FROM AUTHOR]

ABSTRACT Objective There is disagreement about the conceptualization and measurement of pathological exercise (PE). This study seeks to elucidate the nature of this phenomenon as addictive or compulsive in its primary and secondary forms. Method 1,497 adults (608 men, 885 women, 4 other) completed a set of validated surveys, including the Godin Leisure-Time Exercise Questionnaire, the Exercise Dependence Scale-21, the Exercise Addiction Inventory, the Compulsive Exercise Test (CET), the Obligatory Exercise Questionnaire, the Commitment to Exercise Scale, and an exercise specific adaptation of the Dimensional Obsessive-Compulsive Scale (ESDOCS). Participants completed the Eating Disorders Examination Questionnaire, and DSM-5 eating disorder (ED) diagnoses were determined according to published guidelines. Pearson correlation coefficients, independent samples t-tests, χ2 tests, 1-way ANOVA's, and ANCOVA's were calculated. Results All PE measures correlated highly with one another ( P < 0.001). Participants with EDs scored higher on all measures than those without ( P < 0.001), and those with bulimia nervosa had the highest scores. Participants with PE and an accompanying ED (secondary PE) scored higher than those with PE and no ED symptoms (primary ED) on the CET ( P < 0.002) and ESDOCS ( P < 0.003). Correlations between EDE-Q and PE scores were stronger among women than men. PE prevalence was 6.4% (1.4% primary PE, 5.0% secondary PE) in our heterogeneous sample. Discussion Secondary PE appears to be more compulsive while primary PE is more addictive in nature. Men and women are equally at risk for PE, but in men it is more often primary and addictive and in women it is more often secondary and compulsive. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:778-792) [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Establish the Yale-Brown obsessive compulsive scale modified for binge eating (YBOCS-BE) as a fit for purpose measure of treatment benefit in clinical trials of binge eating disorder (BED). Methods YBOCS-BE psychometric properties were evaluated with data from a Phase 2 randomized controlled trial of lisdexamfetamine dimesylate in 260 adults with BED. Assessments included: Cohen's effect size estimates of item-level sensitivity and scale-level external responsiveness; item-to-total correlations; Cronbach's alpha for internal consistency reliability; Spearman correlations against reference measures for construct validity; known-groups analyses for discriminating ability; t tests of within-group differences between baseline and post baseline visits for internal responsiveness; and multiple anchor-based approaches to estimate minimum clinically important change (MCIC). Results No significant distribution anomalies were seen. Items appear sensitive to treatment group differences. Item-to-total correlations were positive. Internal consistency is 0.81. Large correlations (>0.50) were seen between YBOCS-BE score change and the Clinical Global Impression-Improvement (CGI-I; 0.58) and score changes for the following; number of binge days (0.38), Clinical Global Impression-Severity (CGI-S; 0.57), the disinhibition (0.57) and hunger (0.52) subscales of the Three-Factor Eating Questionnaire (TFEQ), and the Barratt Impulsiveness Scale (BIS-11; 0.58). MCIC estimates range from −4 to −17. Discussion The YBOCS-BE was found to be a reliable and valid measure of an important and unique concept in BED-related clinical studies. Study limitations include using protocol-defined BED severity level and the exclusion of psychiatric comorbidities. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:994-1004). [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Compulsive exercise is a well-known feature in eating disorders. The Exercise and Eating Disorder (EED) self-report questionnaire was developed to assess aspects of compulsive exercise not adequately captured by existing instruments. This study aimed to test psychometric properties and the factor structure of the EED among women with eating disorders and a control group. Method The study included 449 female participants, including 244 eating disorders patients and 205 healthy controls. The patient group consisted of 32.4% ( n = 79) AN patients, 23.4% ( n = 57) BN, 34.4% ( n = 84) EDNOS and 9.8% ( n = 24) with BED diagnosis. Results The analyses confirmed adequate psychometric properties of the EED, with a four-factor solution: (1) compulsive exercise, (2) positive and healthy exercise, (3) awareness of bodily signals, and (4) weight and shape exercise. The EED discriminated significantly ( p < .001) between patients and controls on the global score, subscales, and individual items. Test-retest reliability was satisfactory ( r = 0.86). Convergent validity was demonstrated by high correlations between the EED and the Eating Disorder Examination Questionnaire (EDE-Q; r = 0.79). Discussion The EED is the first clinically derived, self-report questionnaire to assess compulsive exercise among ED patients. The EED offers assessment that has broader clinical utility than existing instruments because it identifies treatment targets and treatment priorities. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:983-993). [ABSTRACT FROM AUTHOR]

Objective: This study examined the psychometric properties of the Yale food addiction scale (YFAS) in obese patients with binge eating disorder (BED) and explored its association with measures of eating disorder and associated psychopathology. Method: Eighty-one obese treatment-seeking BED patients were given the YFAS, structured interviews to assess psychiatric disorders and eating disorder psychopathology, and other pathology measures. Results: Confirmatory factor analysis revealed a one-factor solution with an excellent fit. Classification of 'food addiction' was met by 57% of BED patients. Patients classified as meeting YFAS 'food addiction' criteria had significantly higher levels of depression, negative affect, emotion dysregulation, eating disorder psychopathology, and lower self-esteem. YFAS scores were also significant predictors of binge eating frequency above and beyond other measures. Discussion: The subset of BED patients classified as having YFAS 'food addiction' appear to represent a more disturbed variant characterized by greater eating disorder psychopathology and associated pathology. © 2011 by Wiley Periodicals, Inc. (Int J Eat Disord 2011) [ABSTRACT FROM AUTHOR]

Objective: Compulsive exercise has been closely linked with eating disorders, and has been widely reported in both clinical and nonclinical settings. It has been shown to have a negative impact on eating disorder treatment and outcome. However, the risk factors for compulsive exercise have not been examined. This study aimed to provide a first step in identifying potential cross-sectional predictors of compulsive exercise. Method: The sample consisted of 1,488 male and female adolescents, aged 12-14 years old, recruited from schools in the United Kingdom. Participants completed measures of compulsive exercise, personality, psychological morbidity, and disordered eating attitudes during a school class period. Results: Multiple stepwise regressions showed that the strongest cross-sectional predictors of compulsive exercise were a drive for thinness, perfectionism, and obsessive-compulsiveness. Discussion: These results are discussed in terms of the role that personal factors may play in the development of compulsive exercise. © 2011 by Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Objective: To explore the associations between specific elements of compulsive exercise and both eating-disordered cognitions and eating-disordered behaviors in a nonclinical sample of young women. Method: A sample of young women (n 5 498) completed self-report measures of eating pathology (The Eating Disorders Examination Questionnaire) and a relatively new measure of Compulsive Exercise Test. Results: Specific elements of compulsive exercise were associated with elevated levels of eating-disordered cognitions and increased frequency of eating disordered behaviors. Discussion: These results support a multifunctional conceptualization of compulsive exercise, suggesting that some of the functionality of compulsive exercise may be akin to other forms of purging, and further supporting the notion of a possible functional equivalence between compulsive exercise and specific eating-disordered behaviors in terms of affect regulation. [ABSTRACT FROM AUTHOR]

Objective: We examined prevalence of substance use disorders (SUD) in women with: (1) anorexia nervosa (AN) restricting type (RAN); (2) AN with purging only (PAN); (3) AN with binge eating only (BAN); and (4) lifetime AN and bulimia nervosa (ANBN). Secondary analyses examined SUD related to lifetime purging behavior and lifetime binge eating. Method: Participants (N = 731) were drawn from the International Price Foundation Genetic Studies. Results: The prevalence of SUD differed across AN subtypes, with more in the ANBN group reporting SUD than those in the RAN and PAN groups. Individuals who purged were more likely to report substance use than those who did not purge. Prevalence of SUD differed across lifetime binge eating status. Discussion: SUD are common in AN and are associated with bulimic symptomatology. Results underscore the heterogeneity in AN, highlighting the importance of screening for SUD across AN subtypes. © 2009 by Wiley Periodicals, Inc. Int J Eat Disord 2010 [ABSTRACT FROM AUTHOR]

Objective Given the lack of reliable murine model of binge-like eating, we tried to induce this pathological behavior in mice. Method We used an experimental protocol mimicking the etiological factors involved in the development of binge eating in humans, that is, food restriction, refeeding (R-R) in presence of high palatable food, and stress (S). Results Mice subjected to at least three cycles of R-R plus S (forced swimming stress), showed a binge-like behavior evident as early as 4 h, persisting 24 h after stress application and not associated to depressive-like behavior. However, after the third R-R/S cycle, food intakes of mice returned to normal levels. Discussion (i) at least three cycles of R-R plus S are required to promote abnormal eating in mice, (ii) this is not associated to depressive-like behaviors, and (iii) the enhanced pathological behavior showed a transient nature not persisting after the third R-R/S cycle. © 2009 by Wiley Periodicals, Inc. Int J Eat Disord, 2009 [ABSTRACT FROM AUTHOR]

Objective: There is an ongoing debate about the definitions and clinical significance of night eating syndrome (NES). This study explored potential subtypes based on night eating patterns and features reported to be associated, with NES in a representative community sample of 8,250 individuals aged 15–39 years. Method: Latent class analysis was used to identify NES subtypes among 2,068 participants who reported night eating behavior. Results: A four-class solution was judged best. Two classes appear to characterize individuals who eat very late or eat a large proportion of their daily intake after 7 pm, and two other classes are characterized by high rates of depressive symptoms. Results do not support an association between night eating and obesity in young adults. Late night eating is associated with high caloric intake, high sodium intake, and low protein intake. Conclusion: Evidence supports the validity of a definition of NES based on eating very late at night. © 2008 by Wiley Periodicals, Inc. Int J Eat Disord 2008 [ABSTRACT FROM AUTHOR]

Objective: We examined the influence of thin ideal internalization on body dissatisfaction and disordered eating in Mexican girls. Method: We sampled 137 public school girls aged 12–15 from a small city in Mexico. Participants were given Spanish versions of the sociocultural attitudes toward appearance scale, two measures of body dissatisfaction, the eating attitudes test, and the attitudinal familism scale. Results: Thin ideal internalization mediated the relationship between thin ideal awareness and body dissatisfaction, and the relationship between thin ideal awareness and eating disorder symptoms. Attitudinal familism was negatively correlated with thin ideal internalization for girls outside of the normal weight range. Conclusion: Mexican girls are at risk of eating disorder symptoms, and there is support for the sociocultural model of disordered eating in this population. Hispanic family values may mark protection from thin ideal internalization in Mexican girls outside of the normal weight range. © 2008 by Wiley Periodicals, Inc. Int J Eat Disord 2008 [ABSTRACT FROM AUTHOR]

Objective: To assess perfectionism dimensions in eating disorders in comparison with other psychiatric disorders and subjects from the general population. Method: The Child and Adolescent Perfectionism Scale (CAPS), the Eating Disorders Inventory (EDI-2), and the Eating Attitudes Test (EAT) were administered to a group of 108 female eating-disordered patients (75 anorexia nervosa and 33 bulimia nervosa), to a group of 86 female psychiatric patients with anxiety (N = 32), depressive (N = 38), or adaptive disorders (N = 16), and to 213 healthy female participants. Results: Both bulimic and anorexic patients scored higher on Self-Oriented Perfectionism (p < 0.001) than the other two groups but not on Socially-Prescribed Perfectionism (p = 0.054). Among patients with eating disorder, 17.6% obtained a score two standard deviations higher than the mean in the healthy comparison group on self-oriented perfectionism; this percentage was significantly higher than in the other two groups. The percentage of eating disorder patients with high socially-prescribed perfectionism was similar to that found in other psychiatric disorders. Moreover, self-oriented perfectionism was a predictor of an eating disorder. Conclusion: Self-oriented perfectionism is more specific to eating disorders than to depressive or anxiety disorders. © 2007 by Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Objective: To examine negative mood as a proximal antecedent and reinforcing condition of binge eating in binge eating disorder (BED) and bulimia nervosa (BN). Method: Using an ecological momentary assessment design, 20 women with BED, 20 women with BN, and 20 nonclinical control women were recruited from the community, provided with a portable minicomputer, and asked to rate their mood and list their thoughts at randomly-generated beep sounds and before, during, and after episodes of eating. Results: In both eating disorder groups mood before binge eating was more negative than before regular eating and at random assessment. Binge eating was followed by a deterioration of mood. The BED group revealed less antecedent negative mood than the BN group and less concomitant negative cognitions about food/eating and stress. Conclusion: Affect regulation difficulties likely lead to binge eating in both disorders, but binge eating may not be effective for regulating overall mood. © 2007 by Wiley Periodicals, Inc. Int J Eat Disord 2007. [ABSTRACT FROM AUTHOR]

Objective: We conducted a naturalistic study to examine negative affect and dissociative experiences as antecedents to binge episodes. Method: Using handheld computers, 33 women with bulimic syndromes provided ongoing self-reports on eating behaviors, affects, and dissociative experiences over 7- to 29-day intervals. Results: Multilevel modeling analyses indicated that negative affect and dissociation were elevated prior to binge episodes. In addition, antecedent effects of dissociation on bingeing were independent of those attributable to negative affect. Conclusion: Our results are consistent with models of binge eating that assign a causal role to negative mood and altered self-awareness. As such, our findings imply that binge eating is a multiply determined behavior linked to diverse cognitive and affective processes. © 2007 by Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Objective: This study examined a broad range of childhood risk factors for binge-eating disorders (bulimia nervosa or binge eating disorder, BN/BED), utilizing data that had been collected prospectively in the 10-year National Heart, Lung, and Blood Institute Growth and Health Study. Method: Forty-five women with a history of BED/BN (with onset age > 14 and <20 years) and 1,515 women who did not have a history of an eating disorder were included. Results: Signal detection analysis indicated a single pathway that identified ∼13% of the BED/BN cases. The pathway was based on an elevated level of perceived stress prior to the age of 14. Conclusion: Our findings suggest that eating disorders may have multiple and complex etiologies. This is the first study to suggest that elevated levels of perceived stress may precede the onset of binge-eating disorders. Whether this is a causal association remains a question. © 2007 by Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Objective: To conduct an in-depth study, using concept mapping, of three factors related to help-seeking for bulimia nervosa and binge eating: problem recognition, barriers to help-seeking, and prompts to help-seeking. Method: Semistructured interviews were conducted to elicit information about help-seeking with 63 women (18–62 years) with past or present bulimic behaviors. Results: Using Leximancer software, factors identified as associated with problem recognition were Changes in Behavior, Interference with Life Roles, Comments about Changes and Psychological Problems. Salient barriers to help-seeking were Fear of Stigma, Low Mental Health Literacy/Perception of Need, Shame, Fear of Change and Cost. Prompts to help-seeking were increased Symptom Severity, Psychological Distress, Interference with Life Roles, Health Problems, and Desire to Get Better. Conclusion: Results highlighted the need for awareness campaigns to reduce both self and perceived stigma by others towards bulimic behaviors, and the need to enhance awareness of available interventions for people ready to engage in treatment, to increase help-seeking. © 2007 by Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Objective: Previous studies indicate a distinction between those who use one versus multiple methods of purging, but these studies have not controlled for differences in purging frequency. The current study examined whether purging frequency or the use of multiple purging (MP) methods provides more information about eating disorder severity. Method: Existing data were reanalyzed to examine associations between facets of purging and psychological measures among women with bulimia nervosa, purging disorder, and controls. Analyses compared the use of MP methods and purging frequency as indicators of eating pathology. Results: MP methods demonstrated associations with greater eating disorder severity; purging frequency was associated with increased binge frequency and general psychopathology. Conclusion: The presence of MP methods provides more information about eating disorder severity than purging frequency, which seems to be a marker of related psychopathology. © 2007 by Wiley Periodicals, Inc. Int J Eat Disord 2007 [ABSTRACT FROM AUTHOR]

Objective: Our goal was to evaluate the addition of parent and clinician reports to the eating disorder examination (EDE) when used with children and adolescents. Method: The EDE was completed with 117 children and adolescents with eating disorders (mean age 14.95 ± 1.91 years). A slightly modified version of the EDE was completed with parents, and clinician summary scores were assigned. Repeated measures analysis was used to compare child, parent, and clinician scores. Results: In those 70 participants with anorexia nervosa (AN) or eating disorder not otherwise specified with a restrictive pattern (EDNOS-R), child scores were significantly lower than parent scores and clinician scores on restraint and weight concerns. On eating concerns and shape concerns, child scores were lower than clinician scores. Participants with bulimia nervosa (BN) or eating disorder not otherwise specified with binge eating or purging (EDNOS-BP), reported more restraint and shape concerns than parents (n = 47), but their scores did not differ from clinician ratings. No differences were seen in this group on weight concerns or eating concerns. Conclusion: Parent and clinician reports are particularly important when assessing children and adolescents with AN or EDNOS-R, but may be less critical for those with BN or EDNOS-BP. © 2007 by Wiley Periodicals, Inc. Int J Eat Disord 2007. [ABSTRACT FROM AUTHOR]

Objective: Insecure attachment styles and certain personality characteristics (i.e., high levels of neuroticism) have been associated with eating pathology. However, previous research has not examined these variables simultaneously and has not examined possible mediating relationships between attachment and personality characteristics for disordered eating. Because personality characteristics have emerged as some of the most robust predictors of disordered eating, it was predicted that the link between attachment and disordered eating might be through personality styles. Method: Participants included 85 female twins and triplets who took part in the Michigan State University Twin Study. Disordered eating, attachment style, and personality characteristics were assessed. Hierarchical linear models were used to examine relationships among the variables. Results: Overall, neuroticism, and extra version to a lesser extent, mediated the relationship between insecure-resistant attachment and disordered eating. Specifically, higher scores on the neuroticism scale predicted more disordered eating and explained the relationship between insecure-resistant attachment and disordered eating. Conclusion: These results suggest that relationships between attachment style and disordered eating are indirect, in that neuroticism fully mediates associations between insecure-resistant attachment and disordered eating. © 2006 by Wiley Periodicals, Inc. Int J Eat Disord 2006 [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to determine the efficacy of cognitive-behavioral therapy (CBT) and behavioral weight loss treatment (BWLT) for overweight patients with binge eating disorder (BED). Method: Eighty obese patients meeting criteria of BED according to DSM-IV-TR were randomly assigned to either CBT or BWLT consisting of 16 weekly treatments and 6 monthly follow-up sessions. Binge eating, general psychopathology, and body mass index (BMI) were assessed before, during, and after treatment, and at 12-month follow-up. Results: At posttreatment results favored CBT as the more effective treatment. Analysis of the course of treatments pointed to a faster improvement of binge eating in CBT based on the number of self-reported weekly binges, but faster reduction of BMI in BWLT. At 12-month follow-up, no substantial differences between the two treatment conditions existed. Conclusion: CBT was somewhat more efficacious than BWLT in treating binge eating but this superior effect was barely maintained in the long term. Further research into cost effectiveness is needed to assess which treatment should be considered the treatment of choice. © 2006 by Wiley Periodicals, Inc. Int J Eat Disord 2006 [ABSTRACT FROM AUTHOR]

Objective: The purpose of this survey was to collect data on herbal use in participants with eating disorder symptoms. Method: A survey was administered to 100 participants who had either sought treatment at the Eating Disorder Institute (EDI) or had been enrolled in previous research as the result of eating disorder symptoms. Results: Of the 100 participants, 64% used an herbal product for weight loss. The mean monthly expenditure on herbs over the past year was $33.88 ± $41.10, with a range of $2–$200. Dexatrim (Chattem, Chattanooga, TN; N = 27) and St. John's Wort (N = 19) had the highest reported use. Magazines were the most common source of product information (38.3%), with health care professionals being reported less frequently as the source of information. Knowledge of ephedra-related adverse effects was variable, and depended on a previous history of use. The majority (62.3%) of herb users reported an adverse effect. Conclusion: Herbal use is frequent among those with eating disorder symptoms, often resulting in substantial financial cost. Health professionals are rarely the source of herbal information. Therefore, there is ample room for educational interventions, which may result in the safer use of herbal products. © 2006 by Wiley Periodicals, Inc. Int J Eat Disord 2006; 39:741–746 [ABSTRACT FROM AUTHOR]

Objective The purpose of the current study was to demonstrate the feasibility of studying subjects with anorexia nervosa (AN) using ecologic momentary assessment (EMA). A second goal of the current study was to conduct a preliminary investigation of a proposed model of anorexic behavior. Method Ten female participants with AN carried Palm top computers for an average of 2 weeks per participant. Each day, participants were signaled six times by the Palm top and answered questions about mood, behavior, stressful events, and self-appraisal. Results AN subjects displayed excellent compliance with the protocol. Participants completed more than 90% of the signaled recordings. The results also generally support the model of AN behavior proposed. Conclusion EMA appears to be a feasible and productive means of assessment in studying AN. © 2005 by Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Objective The current study attempted to characterize the natural course of events linking dietary restraint to urges to binge and actual binge episodes. Method Using preprogrammed, hand-held computers, 39 women with bulimia-spectrum eating disorders monitored ongoing eating episodes, dietary restraint, and binge cravings over a 7–29-day interval. Results Multilevel modeling analyses indicated that restraint was not systematically elevated before binging. However, elevated restraint preceded strong binge cravings. Conclusion Results suggest that dietary restraint may contribute to binge cravings, but may not be a direct antecedent to binge episodes. Such findings are consistent with restraint theory, which suggests that dietary restraint potentiates binging, but does not necessarily trigger its occurrence. © 2005 by Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Objective A primary objective of the current article is to investigate the relationship between impulsivity and compulsivity in patients with bulimia nervosa (BN). A second goal is to explore the relationship between impulsivity and compulsivity and related psychiatric problems. Method Two-hundred four females with BN completed several measures of impulsivity and compulsivity as well as measures of personality, substance use, eating pathology, and depression. Results Participants reported considerable variability on measures of impulsivity and compulsivity and these scores were positively correlated with each other. Impulsive-compulsive groups differed in personality, substance use, eating, and depression. Conclusion These findings suggest that impulsivity and compulsivity can coexist in BN patients and that both traits may provide useful information about comorbid problems in women with BN. © 2005 by Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Objective The current study investigates covariation bias (illusory correlation) in the perceived association between happiness and body type, as well as the association between covariation bias and eating disorder symptoms. Method Undergraduate women (n = 186) rated pictures of women on a variety of attributes, including happiness, degree of overweight, and attractiveness. Later, they were asked to judge the level of covariation between these attributes that was present in the stimuli that they had rated. Participants also completed the Eating Disorder Examination-Self-Report Questionnaire (EDE-Q). Results Participants reported that there was a negative association between weight and happiness in the stimuli that they had rated, even though the true correlation in the data was zero. This covariation bias was stronger among participants with higher levels of eating disorder symptoms. Discussion The results suggest a cognitive bias that may play a role in maintaining and enhancing concerns about shape and weight in symptomatic women. © 2005 by Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Objective Repetitive body checking and avoidance are viewed as behavioral manifestations of the core psychopathology of eating disorders (EDs). We examined select body checking and avoidance behaviors in overweight patients with binge eating disorder (BED). Method Three hundred seventy-seven overweight (body mass index [BMI] ≥ 25) treatment-seeking BED patients (80 men and 297 women) were administered measures to assess body checking and avoidance, other key behavioral features of EDs (binge eating, dietary restraint, and disinhibition), and the core psychopathology of EDs (overevaluation of weight and shape). Results The majority of participants reported regularly pinching areas of their body to check for fatness and avoided wearing clothing that made them particularly aware of their body. Significant associations emerged between checking and restraint, and conversely, between avoidance and binge eating. Both checking and avoidance were positively and significantly associated with overevaluation of weight and shape, even after controlling for their unique effects. Discussion These findings offer support to the potential role of checking and avoidance behaviors in the maintenance of BED. © 2005 by Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Background Subliminal presentation of visual abandonment cues leads to greater levels of eating, despite a lack of conscious awareness of the information involved. The current study examined whether this behavioral impact can be countered by the subliminal presentation of contradictory, counterschematic information (unification cues). Method Ninety-six nonclinical women were presented with subliminal abandonment cues, either preceded or followed by neutral or unification cues. The dependent variable was the amount eaten after the task. Results Presenting subliminal unification information before or after the subliminal abandonment cue significantly reduced the amount eaten (relative to the impact of neutral cues). Discussion These findings are consistent with a model where preconscious processing of unification cues has the effect deactivating abandonment schemas, either through inoculation or restoration. Preconscious presentation of unification cues might play a role in the broader cognitive-behavioral treatment of bulimic behaviors. © 2005 by Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]