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Objectives Cognitive-behavioural models of eating disorders state that body checking arises in response to negative emotions in order to reduce the aversive emotional state and is therefore negatively reinforced. This study empirically tests this assumption. Methods For a seven-day period, women with eating disorders (n = 26) and healthy controls (n = 29) were provided with a handheld computer for assessing occurring body checking strategies as well as negative and positive emotions. Serving as control condition, randomized computer-emitted acoustic signals prompted reports on body checking and emotions. Results There was no difference in the intensity of negative emotions before body checking and in control situations across groups. However, from pre- to post-body checking, an increase in negative emotions was found. This effect was more pronounced in women with eating disorders compared with healthy controls. Discussion Results are contradictory to the assumptions of the cognitive-behavioural model, as body checking does not seem to reduce negative emotions. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.

This study examines putative non-sport-specific and sport-specific risk factors for eating disorders (ED) among groups of professional female athletes versus non-athletes. In detail, societal pressure to be thin, its internalisation, body dissatisfaction, sports pressure and early specialisation were investigated. The cross-sectional study included 46 aesthetic and 62 ball game sports athletes, and 108 age-matched non-athletes. Study methods comprised a clinical interview to detect ED and questionnaires. More athletes from aesthetic (17%) than from ball game sports (3%) and non-athletes (2%) suffered from ED. Aesthetic sports athletes did not differ from non-athletes in non-sport-specific factors but obtained higher levels than ball game sports athletes in sport-specific variables (p

Background Paediatric chronic pain patients are a heterogeneous group. Individuals respond differently to standardized treatment. Objectives This study aimed to identify subgroups of adolescent chronic pain patients. Methods Subgroups were identified by means of a cluster analysis (Sample A, nA = 266). The stability of clusters was tested in a cross-validation with a second sample (Sample B, nB = 108). In a third sample (Sample C, nC = 83), differences in change scores of the outcome parameters were tested between cluster subgroups 12 months after a standardized treatment. Results Five distinct cluster subgroups with pain problems differing by pain intensity, school absence, pain-related disability, passive pain coping and affective pain perception were identified. Two groups reported overall moderate pain problems and differed with regard to passive pain coping, which was low in Cluster 1 and moderate in Cluster 2. The patients in Cluster 3 reported severe pain problems, including high pain-related disability and frequent school absences. The patients in Clusters 4 and 5 reported very severe pain problems, with those in Cluster 5 reporting very frequent school absences. Cross-validation was performed to assess the accuracy of our subgrouping and indicated a stable cluster solution (κ = 0.64). The five subgroups displayed distinct patterns in treatment outcome after a standardized multidisciplinary treatment program. The mean change scores were significantly different between subgroups [F(4,78) = 5.88; p = 0.017]. Conclusions The patient subgroups that were established proved stable across samples. Depending on the subgroup classification, patients differed in changes of core outcomes. These results offer initial hints for the need for subgroup-specific treatment planning.

Background: The chronic pain grading (CPG), a standard approach to classify the severity of pain conditions in adults, combines the characteristics of pain intensity and pain-related disability. However, in children and adolescents, the CPG has only been validated in a school sample, but not in the actual target population, i.e., clinical populations with pain. Methods: In the present study, we applied the CPG to a tertiary sample of adolescents with chronic pain (n?=?1242). Construct validity, sensitivity to change and prognostic utility were examined. Results: Results indicate that most adolescents were equally classified into the three higher severity grades. Higher CPG classification was associated with more pain locations, higher pain frequency, longer pain duration, extensive use of health care and more depressive symptoms. Adolescents with a high CPG received recommendations for inpatient treatment more often; however, the prognostic utility for therapy recommendation - as operationalized in this study - was low. Sensitivity to change was assessed via reassessment at follow-up for a subsample of 490 adolescents. The majority of adolescents improved to a less severe CPG; changes were more common in the high severity range. Conslusion: The CPG may be applied to adolescent tertiary care samples and to assess outcomes in clinical trials. However, in this study it was not appropriate to assign adolescent patients to different treatment options. Future work should focus on developing a comprehensive assessment tool for assigning patients to different treatments.

Cognitive processes seem to play a vital role in eating disorders and body image. The current study, therefore, examines the impact and change of dysfunctional cognitions during a body image group therapy, which included 41 patients with an eating disorder. Dysfunctional cognitions were assessed with the 'Eating Disorder Cognition Questionnaire' both before and after treatment. Eating disorder psychopathology was also assessed. Results indicate a significant reduction of dysfunctional cognitions relating to 'body and self-esteem', 'dietary restraint', 'eating and loss of control', as well as 'internalisation and social comparison'. Furthermore, the changes in dysfunctional cognitions were associated with a reduction in eating disorder psychopathology. Body image therapy is a worthy complementation to standardised eating disorder treatment programmes as it reduces negative eating related thoughts and changes attitudes towards the body.

Binge eating disorder (BED) is characterized by frequent binge eating without compensatory behaviour and is thus often associated with obesity. Whereas for the eating disorders anorexia nervosa and bulimia nervosa, one of the main diagnostic features is a negative body image, the research criteria for BED do not include body image disturbance. Although several studies have been conducted on the occurrence of body image disturbance in BED, no review has yet summarized and integrated these findings. Therefore, the present paper reviews studies on the cognitive-affective, perceptual and behavioural components of body image. Many of the reviewed studies reveal that individuals with BED display a higher degree of weight and shape concerns than obese persons without BED. Concerning the perceptual component, no evidence exists to date that persons with and without BED differ in terms of the perception of their own body size. While many studies have examined the cognitive-affective body image component, research on the behavioural manifestations of body image disturbance is generally lacking. However, there is first evidence that persons with BED display an enhanced degree of body checking and avoidance. The results of this review indicate that body image disturbance seems to be a symptom of BED but which still requires further exploration.

Difficulties recognizing emotion have been reported for eating disordered individuals in relation to perception of emotions in others and emotional self-awareness. It remains unclear whether this is a perceptual or cognitive-affective problem. Clarification is sought and the question of a cognitive bias is addressed when interpreting facially expressed emotions. Twenty participants with bulimia nervosa (BN) and 20 normal controls (NC) were assessed for ability to recognize emotional and neutral expressions. Emotional self-awareness was also assessed. Significant differences were found for emotional self-awareness. For emotional faces, only a poorer recognition of the emotion, surprise, for BN was found. Problems with emotional self-awareness suggest a cognitive-affective disturbance in emotion recognition. Implications for therapy are discussed.

The study examined whether the extent of negative body-related thoughts and emotions evoked by looking in a mirror can be changed by cognitive-behavioural body image therapy (BIT) and whether any remaining cognitive and affective responses dropped faster after the treatment. Females with eating disorders (n = 17) looked in a mirror for 40 minutes under standardised conditions before and after BIT. A control group (CG) (n = 24) was also exposed to their own bodies twice. Cognitive and affective reactions were assessed four times during the session. Hierarchical Linear Modelling revealed that among eating-disordered patients, the entrance levels of negative thoughts and feelings were lower at post compared to pre-BIT, whereas they remained stable in the CG. The extent of reduction of the remaining body image distress was not changed after the treatment. BIT seems to be a potent treatment of negative emotions and cognitions in an in vivo situation. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association.

Preliminary evidence suggests that parental catastrophizing about their child's pain may be important in understanding both parental responses to their child's pain and the child's pain experience. However, little is known about potential differences between mothers and fathers. There were three aims of the present study addressing this lack of knowledge: (i) to investigate the three-factor structure of the German version of the Parental Pain Catastrophizing Scale (PCS-P) (Goubert et al., 2006) in mothers and fathers of children with chronic pain, (ii) to explore differences between mothers and fathers in parental catastrophizing, (iii) to investigate the contribution of parental catastrophizing on the child's chronic pain problem and pain-related parent behavior. In a sample of 128 mothers and fathers of paediatric chronic pain patients, the invariance of the PCS-P was evaluated. Results replicated the previously established three-factor structure (i.e. rumination, magnification and helplessness) in both groups. Mothers reported higher levels of catastrophizing as compared to fathers. Specifically, mothers and fathers differed on levels of rumination; the two groups did not differ in magnification and helplessness. Maternal but not paternal catastrophizing contributed significantly in explaining the child's pain intensity whereas neither mothers' nor fathers' catastrophizing were significantly related to the child's disability. Both maternal and paternal catastrophizing contributed significantly to heightened parental solicitous responses. Fathers' but not mothers' catastrophizing also contributed to heightened distracting responses. The present findings attest to the importance of maternal and paternal catastrophizing for the child's pain characteristics and pain-related parent behavior, which are both relevant for treatment conceptualization.