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Associations between disordered eating, internalization of beauty ideals, and self-esteem have been mainly studied in a unidirectional way. Therefore, this study explored the potential bidirectional associations between these three aspects, in a sample of 303 adolescents aged 12 to 15 (140 females and 163 males), in a 16-month longitudinal prospective study. Participants self-reported disordered eating, internalization of beauty ideals, and self-esteem. Autoregressive cross-lagged analyses showed bidirectional associations between self-esteem and disordered eating and unidirectional links between internalization of beauty ideals and disordered eating and lower self-esteem. All cross-lagged effects were equivalent across genders, except that the effect of internalization of beauty ideals at baseline on disordered eating 4 months later was higher for females. Temporal stability was moderate for all measures. These results contribute toward completing explanatory models of these problems and suggest that interventions based on the critique of esthetic ideals and on strengthening self-esteem should be implemented in early adolescence.

Aims: As eating disorders have severe consequences, they require prevention. We aimed to compare maladaptive beliefs related to eating disorders by following two programs based on media literacy in adolescents at post-test intervention, and after 6 and 12month-follow-ups. The Male and Female Nutrition and Media Literacy Model preventive program (NUT+MEF+MEM+ML in Spanish) and the Theater Alive program are both based on the same contents, the former being presented in a multimedia and interactive format and the latter in a drama format. Both were compared to a control group without intervention, whose participants received usual classes before the assessments.Method: Participants were 178 adolescents in the second year of compulsory secondary education from fours schools of Terrassa (Catalonia, Spain). All participants in each school were assigned to the same group, depending on school schedules. A mixed 3 (group: Theater Alive, NUT+MEF+MEM+ML, control)×3 (time: post-test, 6-month-follow-up, 12-month-follow-up) factorial design was used to evaluate the effect on maladaptive beliefs measured using a CE-TCA tool.Results: When compared to the control group, both Theater Alive (d=0.88) and NUT+MEM+MEF+ML (d=0.60) obtained lower scores over time, the latter being not statistically significant.Discussion: The Theater Alive program may produce an effect of cognitive dissonance that might eliminate the discrepancy between the contents of the play and those that are internalized, thus modifying maladaptive beliefs. Participants in the Theater Alive program, as actors in front of an audience, had to defend certain content that was rehearsed over and over again to the point until it became internalized. [ABSTRACT FROM AUTHOR]

We aimed to assess the association of several risk factors for eating disturbances in adolescents. Participants were 448 girls and boys aged 12–15 years. Being female, higher body mass index, internalisation of standard of appearance, perfectionism, body dissatisfaction, number of lifetime addictive behaviours and lower self-esteem were associated with higher eating disturbance scores, whereas frequency of sedentary behaviours and physical activity were not (R2 ⩾ 41%). Findings suggest the need to guide prevention efforts towards the broad spectrum of individual potentially modifiable factors. A non-specific comprehensive perspective may be adequate to prevent problems related to weight, body image and drug use. [ABSTRACT FROM AUTHOR]

Objective Technology assisted guided self-help has been proven to be effective in the treatment of bulimia nervosa (BN). The aim of this study was to determine predictors of good long-term outcome as well as drop-out, in order to identify patients for whom these interventions are most suitable. Methods One hundred and fifty six patients with BN were assigned to either 7 months internet-based guided self-help (INT-GSH) or to conventional guided bibliotherapy (BIB-GSH), both guided by e-mail support. Evaluations were taken at baseline, after 4, 7, and 18 months. As potential predictors, psychiatric comorbidity, personality features, and eating disorder psychopathology were considered. Results Higher motivation, lower frequency of binge eating, and lower body dissatisfaction at baseline predicted good outcome after the end of treatment. Lower frequency of binge eating predicted good outcome at long-term follow-up. Factors prediciting drop-out were higher depression and lower self-directedness at baseline. Conclusion Technology assisted self-help can be recommended for patients with a high motivation to change, lower binge-eating frequency and lower depression scores. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Aim The objective of the study was to analyse shared commonalities and differences between bulimia nervosa (BN) and certain impulse-related disorders, namely compulsive buying (CB) and gambling disorder (GD), with respect to general psychopathology and personality traits. Methods A total of 188 female patients [50 BN without comorbid CB (BN−CB), 49 BN with comorbid CB (BN+CB), 53 GD and 36 CB] and 50 comparison non-psychiatric women participated in the current study. All patients were diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, Fourth revised edition, the Temperament and Character Inventory-Revised, and other clinical indices. Results A positive-growing trend was observed in psychopathology and personality traits across the four clinical groups. Comorbid BN with CB was associated with highest eating psychopathology and social anxiety. On Novelty Seeking, the CB, GD and BN+CB were similar to each other, whereas BN−CB presented a distinct profile. Moreover, the BN+CB group displayed more dysfunctional personality traits and higher general psychopathology. The clinical groups demonstrated overall higher levels of psychopathology compared with the control group. Conclusions The results of this study demonstrate that disorders with impulsive traits (CB, GD, BN+CB and BN−CB) follow a linear trend in general psychopathology and specific personality traits, but differ along specific personality and psychopathological dimensions. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Background: Attention-deficit/hyperactivity disorder (ADHD) has commonly been described in psychiatric disorders. Although several studies have found positive associations between abnormal eating patterns during childhood and ADHD, there is a lack of studies on ADHD and Eating Disorders (ED). The aims of this exploratory study were 1) to assess the ADHD symptoms level in ED and to ascertain whether there are differences among ED subtypes; 2) to analyze whether the presence of ADHD symptoms is associated with more severe eating disorder symptoms and greater general psychopathology; and 3) to assess whether the ADHD symptoms level is associated with specific temperament and character traits. Methods: 191 female ED patients were included. Assessment was carried out with the EDI-2, ASRS-v1.1, the SCL-90-R and the TCI-R. Results: The ADHD symptoms level was similar in bulimia, eating disorder not otherwise specified and binge eating subtypes, and lower in anorexic patients. Obsessiveness and Hostility were significantly positively associated with ADHD symptoms. A path model showed that ADHD was associated with high Novelty Seeking and low Self-Directedness, whereas ED severity was influenced by ADHD severity and low Self-Directedness. Conclusions: Bingeing/purging ED subtypes have a high ADHD symptoms level, also related with more severe eating, general and personality psychopathology [ABSTRACT FROM AUTHOR]

Background/Aims: There is ample consensus that there is a neurophysiological basis for eating disorders (ED). Traits of personality translate into behavioral traits, purging being a well-defined transversal example. The direct implication of steroid hormones on ED has seldom been studied, despite their effects on behavior. Methods: After psychological interview analysis, 57 ED female patients (31 purgative and 26 nonpurgative) and 17 female controls were studied. Metabolic parameters and analysis of androgen, estrogen and glucocorticoid hormones were determined in parallel to the psychopathological profile (EDI-2 and SCL-90-R) and anthropometric measurements. Results: Psychometric tests showed clear differences between ED and controls, but there were few hormonal-metabolic significant differences. In purgative ED there were repeated (significant) positive correlations with corticosteroid-binding globulin (CBG) and negative correlations with sex hormone-binding globulin (SHBG) versus eating and general psychopathology. In nonpurging ED there were positive correlations for deoxycortisol, free fatty acids and albumin and negative for aspartate aminotransferase and psychopathological traits. Conclusion: The data suggest that CBG/corticosteroids and sexual hormones/SHBG are involved in purging behavior and its psychopathology and severity scores. Correlations of selected psychometric data and the CBG/SHBG levels in purging may eventually result in clinical markers. This approach may provide additional clues for understanding the pathogenesis of ED. Copyright © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

This paper describes the process of constructing a questionnaire for "Specific Cognitions related to Eating Disorders" (CE-TCA in Spanish), which measures specific cognitions that commonly take place in patients suffering eating disorders, and provides evidence regarding its psychometric properties. The final 26-item version was administered to four population samples: college students (n= 125), adolescent boys (n= 124), adolescent girls (n= 107), and eating disorder female patients (n= 40). High levels of internal consistency (α⩾ 0.90) and test-retest reliability indices at two weeks and six months (r⩾ 0.80) were obtained. CE-TCA scores showed an adequate convergent validity with EAT-40 and CIMEC scores (r⩾ 0.50). Furthermore, CE-TCA scores predicted EAT-40 scores six months later. Therefore, CE-TCA has proven to be a valid and reliable questionnaire for measuring specific cognitions associated with eating disorders, both in a clinical and community populations. [ABSTRACT FROM AUTHOR]

Objective To compare the importance given to self/other standards by eating disorder (ED) patients and healthy controls. Methods A total of 392 individuals (240 consecutively referred and 152 healthy controls) took part in this study. All subjects were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria and were female patients. Participants completed the Family Style, Self-Expectations and Emotional related subscales of the Cross-Cultural Questionnaire. Results Three domains (namely, family standards, self-achievement and physical appearance) were associated with ED. Family standards scores discriminated for the presence of an ED (area under receiver operating characteristic curve equals 0.89), the main predictors being a higher level of importance of physical appearance ( p < .001), family standards ( p = .029) and conflicts with parents about physical appearance ( p < .001). Higher self-standards, in physical appearance, were more relevant in bulimia nervosa and ED not otherwise specified, whereas higher family standards were more associated with anorexia nervosa. Conclusions High self-standards and social standards are common features in ED. The parallelism that ED may establish between reaching them and their life success may have a crucial role as a developing and maintaining factor in ED. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objectives: The aims of our study were to examine the lifetime prevalence of obesity rate in eating disorders (ED) subtypes and to examine whether there have been temporal changes among the last 10 years and to explore clinical differences between ED with and without lifetime obesity. Methods: Participants were 1383 ED female patients (DSM-IV criteria) consecutively admitted, between 2001 and 2010, to Bellvitge University Hospital. They were assessed by means of the Eating Disorders Inventory-2, the Symptom Checklist-90-Revised, the Bulimic Investigatory Test Edinburgh and the Temperament and Character Inventory-Revised. Results: The prevalence of lifetime obesity in ED cases was 28.8% (ranging from 5% in anorexia nervosa to 87% in binge-eating disorders). Over the last 10 years, there has been a threefold increase in lifetime obesity in ED patients ( p < .001). People with an ED and obesity had higher levels of childhood and family obesity ( p < .001), a later age of onset and longer ED duration; and had higher levels of eating, general and personality symptomatology. Conclusions: Over the last 10 years, the prevalence of obesity associated with disorders characterized by the presence of binge episodes, namely bulimic disorders, is increasing, and this is linked with greater clinical severity and a poorer prognosis. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Background: Most studies on the Eating Disorder Examination Questionnaire (EDE-Q) focus exclusively on women. Aims: To examine the internal consistency and convergent validity of the EDE-Q in Spanish undergraduate men and to compare the results with those obtained previously in college samples of Spanish women and American men. Methods: 269 college men, aged 18-30 years, answered the EDE-Q, Eating Disorder Inventory (ED1-2), and Body Shape Questionnaire (BSQ). Results: The four subscale scores and the global score of the EDE-Q achieved acceptable internal consistency (α ≥ .65), and evidence on convergent validity with EDI-2 and BSQ was obtained (r ≥ .41). Average scores, standard deviations, and percentile ranks for the raw EDE-Q subscales and data on the occurrence of binge eating and compensatory behaviors are presented. Most values were lower than those found in previous studies with Spanish undergraduate women and American undergraduate men. Discussion: Lower scores in EDE-Q subscales provide country differences between Spain and United States and support the existence of gender differences in eating disorders attitudes. These data should help clinicians and researchers to interpret the EDE-Q scores of college men in Spain. [ABSTRACT FROM AUTHOR]

Objective To assess the relationship between childhood sexual and physical abuse, and key attitudinal and behavioural aspects of eating disorders (ED). Method Participants included 708 female undergraduates in a Spanish public university, aged from 18 to 30. Abuse was measured by the Traumatic Life Events Questionnaire, and ED by the Eating Disorders Examination Questionnaire (EDE-Q). Results 14.3% of the sample had suffered childhood sexual abuse (CSA) and 3.8% childhood physical abuse (CPA). With respect to ED attitudinal features, we observed an increased Weight Concern score among CSA survivors. No association was found between this kind of abuse and disordered eating behaviours, after adjusting for depression, anxiety, self-esteem, body mass index, age and socioeconomic status. An inverse relationship was found between CPA and ED attitudes measured by EDE-Q (Restraint, Weight Concern, Shape Concern and the Overall Score), whereas no association was found with the behavioural aspects of eating disturbances. Discussion After controlling for different risk factors, CSA appears to be related to an increased Weight Concern, whilst other ED attitudinal features and behaviours do not seem to be related to childhood abuse. The inverse relationship found is discussed. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objective To determine if male and female eating disorders differ in clinics, psychopathology and personality traits when compared with a healthy group. Methods Sixty male and 60 female eating disorder individuals (16% anorexia nervosa, 42% bulimia nervosa and 42% eating disorder not otherwise specified), matched for age and diagnostic, were compared with 120 healthy-eating participants (60 male and 60 female participants). All were diagnosed according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Assessment measures included Eating Disorder Inventory-2, Symptom Checklist-Revised and Temperament and Character Inventory-Revised, as well as other clinical and psychopathological indices. Results Male eating disorder participants reported significant lower laxative abuse ( p = 0.020) and significant higher vomiting episodes ( p = 0.019) than female eating disorder participants. Differences on drive for thinness, body dissatisfaction and some Symptom Checklist-Revised scales were found across genders in eating disorder participants. Male eating disorder participants scored significantly lower than female participants with eating disorders on harm avoidance, reward dependence and cooperativeness. Conclusions Although eating disorder clinical features were similar across genders, male eating disorder participants had less body image concern and general psychopathology than female eating disorder participants. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objective: To explore the psychometric properties of the Cross-Cultural Questionnaire (CCQ), a new self-report tool for assessing factors of risk and maintenance for eating disorders (ED). Method: Data was collected during a multi-centre case-control study. The sample included 854 ED patients and 784 healthy participants from the UK, Spain, Austria, Slovenia and Italy. Exploratory factor analyses examined the factor structure of each section of the CCQ, and Cronbach's alpha coefficients valued the internal consistency of each derived scale score. Logistic regression and receiver operating characteristic (ROC) curve procedure assessed the screening accuracy and predictive validity of the empirical factors. Results: Based on a total of 127 items, nine dimensions emerged, with satisfactory internal consistency and high congruence between countries. CCQ scores demonstrated satisfactory accuracy for discriminating between ED cases and controls (area under the ROC curve = 0.88). Most of the items achieved discriminative accuracy. Conclusions: This study offers preliminary evidence that the CCQ, available in five languages, is a useful and valid tool to assess factors of risk and maintenance for EDs. Copyright © 2010 John Wiley & Sons, Ltd. Key Practitioner Message: • The CCQ is a new self-report questionnaire for assessing factors of risk and maintenance for eating disorders. • The CCQ is available in five languages (Spanish, English, German, Italian and Slovenian) and is free of charge for research purposes. • CCQ scores demonstrated satisfactory accuracy for discriminating between ED cases and controls. [ABSTRACT FROM AUTHOR]

Objective To explore similarities and differences in clinical and personality variables across three groups: binge eating disorder (BED), bulimia nervosa-purging type (BN-P), and bulimia nervosa-non purging type (BN-NP). Method The participants were 102 female eating disorders patients (34 BED, 34 BN-P, and 34 BN-NP) consecutively admitted to the eating disorders unit, at the University Hospital of Bellvitge, and diagnosed according to DSM-IV criteria. Results BED patients were older, and more likely to have personal and family history of obesity. A gradient in psychopathological scores emerged with BN-P patients having higher pathological scores on the SCL-90-R, followed by BN-NP and BED patients. No statistically significant differences were observed in personality traits. Discussion Our data supported that eating disorders (namely BED, BN-NP, and BN-P) followed a linear trend in general psychopathology. Whereas personality may represent a shared vulnerability factor, differences in clinical severity suggest there to be a continuum with BN-P being the most severe and BED being the least severe. © 2010 by Wiley Periodicals, Inc. Int J Eat Disord 2011 [ABSTRACT FROM AUTHOR]

The objective of this study was to examine whether there is an association between individual and family eating patterns during childhood and early adolescence and the likelihood of developing a subsequent eating disorder (ED). A total of 1664 participants took part in the study. The ED cases (n 879) were referred for assessment and treatment to specialized ED units in five different European countries and were compared to a control group of healthy individuals (n 785). Participants completed the Early Eating Environmental Subscale of the Cross-Cultural (Environmental) Questionnaire, a retrospective measure, which has been developed as part of a European multicentre trial in order to detect dimensions associated with ED in different countries. In the control group, also the General Health Questionnaire-28 (GHQ-28), the semi-structured clinical interview (SCID-I) and the Eating Attitudes Test (EAT-26) were used. Five individually Categorical Principal Components Analysis (CatPCA) procedures were adjusted, one for each theoretically expected factor. Logistic regression analyses indicated that the domains with the strongest effects from the CatPCA scores in the total sample were: food used as individualization, and control and rules about food. On the other hand, healthy eating was negatively related to a subsequent ED. When differences between countries were assessed, results indicated that the pattern of associated ED factors did vary between countries. There was very little difference in early eating behaviour on the subtypes of ED. These findings suggest that the fragmentation of meals within the family and an excessive importance given to food by the individual and the family are linked to the later development of an ED. [ABSTRACT FROM PUBLISHER]

Aim: To assess lifetime substance abuse, family history of alcohol abuse/dependence, and novelty seeking in three different eating disorder groups (anorexia nervosa–restrictive; anorexia nervosa–binge eating/purging; anorexia nervosa to bulimia nervosa). Method: A total sample of 371 eating disorder patients participated in the current study. Assessment measures included the prevalence of substance abuse and family history of alcohol abuse/dependence as well as the novelty-seeking subscale of the Temperament and Character Inventory–Revised. Results: Significant differences across groups were detected for lifetime substance abuse, with anorexia nervosa–restrictive individuals exhibiting a significant lower prevalence than the anorexia nervosa to bulimia nervosa and anorexia nervosa–binge eating/ purging patients ( P < 0.01). For family history of alcohol abuse/dependence the same pattern was observed ( P = 0.04). Novelty seeking was associated with substance abuse ( P = 0.002), with the anorexia nervosa to bulimia nervosa group exhibiting significantly higher scores on the novelty-seeking scale than the other two groups ( P < 0.001). But family history of alcohol abuse/dependence was not related to novelty seeking ( P = 0.092). Conclusion: Lifetime substance abuse appears to be more prevalent in anorexia nervosa patients with bulimic features. Higher novelty-seeking scores may be associated with diagnosis cross-over. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore the differences in patterns of risk factors for body dissatisfaction and disordered eating attitudes in both female and male adolescents from Portugal and Spain. The sample included 455 adolescents aged 12–16 years ( M = 13.28, SD = 0.65) from two urban areas of each country. Body mass index, self-reported self-esteem, perfectionism, internalisation of sociocultural ideals, body dissatisfaction and disordered eating attitudes were assessed. Path analyses provided partial support for a cross-cultural model of body dissatisfaction and disordered eating in Western countries due to the presence of certain differences in the patterns of relationships across sex and country. The findings suggest the importance not only of identifying cultural specificities, even in “neighbouring” countries, but also of developing a global and comprehensive preventive approach that focuses on the influence of the ideal of beauty transmitted by Western societies. [ABSTRACT FROM AUTHOR]

Abstract: To conduct a latent profile analysis (LPA) in eating disorder (ED) patients using temperament and character (TCI-R) measures as indicators. 1312 ED patients including those with anorexia nervosa (AN), bulimia nervosa (BN) and EDNOS were assessed. The final LPA solution was validated using demographics, clinical variables, ED symptomatology (EDI-2) and impulsive behaviors. The best-fitting model consisted of a six-profile solution using the seven subscales of the TCI-R. These profiles were labeled: “self-focused”, “inhibited”, “average”, “impulsive”, “adaptive” and “maladaptive”. Validation analyses indicated that the “inhibited” and “maladaptive” profiles generally presented with the highest values for ED symptomatology and impulsive behaviors. Whereas high levels of Harm Avoidance and low levels of Novelty Seeking and Persistence characterized the “inhibited” profile, the “maladaptive” profile presented with low levels of Reward Dependence, Self-Directedness and Cooperativeness. The most favorable results on the other hand were exhibited by the “adaptive” profile, characterized by high scores on Reward Dependence, Self-Directedness, Cooperativeness and low levels on Novelty Seeking. Finally, when our six-profile solution was compared with the DSM-IV ED diagnoses, significant differences among profiles and ED diagnoses were observed. Our study shows that ED patients can be meaningfully grouped according to temperament and character. [Copyright &y& Elsevier]

Abstract: Objectives: To examine whether outpatient treatment for male patients with bulimic symptomatology is as effective as it is for females. Method: The outcome of 19 male patients was compared to that of 150 female eating disorder (ED) individuals after a group CBT treatment. Results: A reduction in ED symptomatology was observed after treatment for both genders. Main effects for gender indicated that after collapsing across the mean pre/post values, lower mean scores were found for men in the EAT-40, in the EDI-total score and in the following EDI subscales: “drive for thinness”, “body dissatisfaction” and “interoceptive awareness”. Conclusions: A group CBT treatment appears to be effective for male and female ED patients. [Copyright &y& Elsevier]

Abstract: Objectives: To assess the differences in comorbid lifetime and current substance use (tobacco, alcohol and drug use) between eating disorder (ED) patients and healthy controls in five different European countries. Method: A total of 1664 participants took part in the present study. ED cases (n =879) were referred to specialized ED units in five European countries. The ED cases were compared to a balanced control group of 785 healthy individuals. Assessment: Participants completed the Substance Use Subscale of the Cross Cultural (Environmental) Questionnaire (CCQ), a measure of lifetime tobacco, alcohol and drug use. In the control group, also the GHQ-28, the SCID-I interview and the EAT-26 were used. Results: ED patients had higher lifetime and current tobacco and general drug use. The only non-significant result was obtained for lifetime and current alcohol use. Significant differences across ED subdiagnoses and controls also emerged, with BN and AN-BP generally presenting the highest and AN-R and controls the lowest rates. The only exception was detected for alcohol use where EDNOS demonstrated the highest values. Only a few cultural differences between countries emerged. Conclusions: With the exception of alcohol consumption, tobacco and drug use appear to be more prevalent in ED patients than healthy controls. The differential risk observed in patients with bulimic features might be related to differences in temperament or might be the result of increased sensitivity to reward. [Copyright &y& Elsevier]