Publications by authors named "Brittany K Bohrer"

10 Publications

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Validation of the factor structure of the Eating Pathology Symptoms Inventory in an international sample of sexual minority men.

Eat Behav 2021 08 26;42:101511. Epub 2021 Apr 26.

University of Melbourne, Department of Psychology, Parkville, VIC 3010, Australia.

Sexual minority individuals are at greater risk for the development of eating-disorder (ED) psychopathology. Despite the importance of understanding ED symptoms in sexual minority men, most ED measures were developed and validated in heterosexual, young adult, white women. The psychometric properties of ED measures in diverse populations remain largely unknown. The purpose of this study was to test: 1) whether the eight-factor structure of the Eating Pathology Symptoms Inventory (EPSI) replicated in sexual minority men and 2) group-level mean differences between gay and bisexual men on the eight EPSI scales. International participants (N = 722 sexual minority men from 20 countries) were recruited via the Grindr smartphone application. Confirmatory factor analysis (CFA) was completed using a weighted least square mean and variance adjusted estimator. Group differences in eating pathology between gay and bisexual men were tested using independent samples t-tests. The CFA model fit was good on all fit indices (CFI/TLI > 0.90, RMSEA < 0.06). Gay and bisexual men only differed on the EPSI Binge Eating scale. The results of this investigation suggest that the EPSI may be a useful tool for understanding eating pathology in this population. Using psychometrically sound assessment tools for sexual minority men is a vital piece of treatment planning and clinical decision making. The current study fills an important gap in the clinical and research literature by testing the validity and psychometric properties of a commonly used ED measure in sexual minority men.
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http://dx.doi.org/10.1016/j.eatbeh.2021.101511DOI Listing
August 2021

Development and initial validation of the Eating Pathology Symptoms Inventory-Clinician-Rated Version (EPSI-CRV).

Psychol Assess 2020 Oct 27;32(10):943-955. Epub 2020 Jul 27.

Department of Psychiatry and Behavioral Neuroscience, University of Chicago.

Proper assessment and diagnosis of eating disorders (EDs) are critical to determine to whom prevention and treatment efforts should be targeted, the extent to which treatment is working, and when an individual has recovered. Although existing ED diagnostic interviews have numerous strengths, they also have certain limitations, including poor internal consistency, low discriminant validity, and poor factor-structure replicability. The purpose of the current study was to address problems of past ED diagnostic interviews through the creation of a new clinician-rated interview-the Eating Pathology Symptoms Inventory-Clinician-Rated Version (EPSI-CRV). The EPSI-CRV was designed to measure dimensional constructs assessed in the self-report version of the EPSI and generate current Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013) diagnoses. Participants were community-recruited adults with a DSM-5 ED (N = 257). Participants completed self-report and interview-based measures of eating, mood, and anxiety disorders and self-report measures of psychiatric impairment. The EPSI-CRV demonstrated evidence for interrater reliability, convergent and discriminant validity, and a good-fitting factor structure. EPSI-CRV dimensions showed concurrent validity for distinguishing among ED diagnoses. Baseline EPSI-CRV dimensions significantly predicted psychiatric impairment at baseline but not at 1-year follow-up. Although some scales had lower internal consistency than ideal, internal consistency values were similar to those of other established diagnostic measures. The EPSI-CRV appears to represent a promising new interview that can be used across a variety of clinical and research settings. Interested readers can access the EPSI-CRV and relevant training materials here: https://kuscholarworks.ku.edu/handle/1808/29616. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/pas0000820DOI Listing
October 2020

Recovery as a process: Exploring definitions of recovery in the context of eating-disorder-related social media forums.

Int J Eat Disord 2020 08 6;53(8):1219-1223. Epub 2020 Jan 6.

Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.

Objective: Online forums related to eating disorders (EDs) represent sources of support for recovery, and comments on these platforms might therefore highlight aspects of recovery that have been previously neglected in research. Reddit, an online discussion platform, hosts several ED-related forums. Due to the unique benefits of examining ED-related social media comments, we aimed to use a qualitative approach to conduct an exploratory study to examine users' conceptualizations of recovery from an ED.

Method: We extracted public comments mentioning recovery that were posted on three ED-related online forums on Reddit between March 2017 and August 2017. We thematically analyzed the data corpus using an inductive approach to examine how recovery is defined in the context of ED-related online communities.

Results: Two superordinate themes ("Recovery as a Process," "Psychosocial Factors") and three subordinate themes emerged (within the "Psychosocial Factors" theme: cognitive/affective, behavioral/physical, social).

Discussion: The data support a definition of recovery that includes positive aspects of well-being and quality of life. Furthermore, the data highlight that recovery is experienced as an ongoing process that is unique to each individual.
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http://dx.doi.org/10.1002/eat.23218DOI Listing
August 2020

Is the diagnostic threshold for bulimia nervosa clinically meaningful?

Eat Behav 2018 01 8;28:16-19. Epub 2017 Dec 8.

University of Kansas, Department of Psychology, 1415 Jayhawk Blvd., Lawrence, KS 66045, United States. Electronic address:

The DSM-5 differentiates full- and sub-threshold bulimia nervosa (BN) according to average weekly frequencies of binge eating and inappropriate compensatory behaviors. This study was the first to evaluate the modified frequency criterion for BN published in the DSM-5. The purpose of this study was to test whether community-recruited adults (N=125; 83.2% women) with current full-threshold (n=77) or sub-threshold BN (n=48) differed in comorbid psychopathology and eating disorder (ED) illness duration, symptom severity, and clinical impairment. Participants completed the Clinical Impairment Assessment and participated in semi-structured clinical interviews of ED- and non-ED psychopathology. Differences between the sub- and full-threshold BN groups were assessed using MANOVA and Chi-square analyses. ED illness duration, age-of-onset, body mass index (BMI), alcohol and drug misuse, and the presence of current and lifetime mood or anxiety disorders did not differ between participants with sub- and full-threshold BN. Participants with full-threshold BN had higher levels of clinical impairment and weight concern than those with sub-threshold BN. However, minimal clinically important difference analyses suggested that statistically significant differences between participants with sub- and full-threshold BN on clinical impairment and weight concern were not clinically significant. In conclusion, sub-threshold BN did not differ from full-threshold BN in clinically meaningful ways. Future studies are needed to identify an improved frequency criterion for BN that better distinguishes individuals in ways that will more validly inform prognosis and effective treatment planning for BN.
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http://dx.doi.org/10.1016/j.eatbeh.2017.12.002DOI Listing
January 2018

Is the diagnostic threshold for bulimia nervosa clinically meaningful?

Eat Behav 2018 01 8;28:16-19. Epub 2017 Dec 8.

University of Kansas, Department of Psychology, 1415 Jayhawk Blvd., Lawrence, KS 66045, United States. Electronic address:

The DSM-5 differentiates full- and sub-threshold bulimia nervosa (BN) according to average weekly frequencies of binge eating and inappropriate compensatory behaviors. This study was the first to evaluate the modified frequency criterion for BN published in the DSM-5. The purpose of this study was to test whether community-recruited adults (N=125; 83.2% women) with current full-threshold (n=77) or sub-threshold BN (n=48) differed in comorbid psychopathology and eating disorder (ED) illness duration, symptom severity, and clinical impairment. Participants completed the Clinical Impairment Assessment and participated in semi-structured clinical interviews of ED- and non-ED psychopathology. Differences between the sub- and full-threshold BN groups were assessed using MANOVA and Chi-square analyses. ED illness duration, age-of-onset, body mass index (BMI), alcohol and drug misuse, and the presence of current and lifetime mood or anxiety disorders did not differ between participants with sub- and full-threshold BN. Participants with full-threshold BN had higher levels of clinical impairment and weight concern than those with sub-threshold BN. However, minimal clinically important difference analyses suggested that statistically significant differences between participants with sub- and full-threshold BN on clinical impairment and weight concern were not clinically significant. In conclusion, sub-threshold BN did not differ from full-threshold BN in clinically meaningful ways. Future studies are needed to identify an improved frequency criterion for BN that better distinguishes individuals in ways that will more validly inform prognosis and effective treatment planning for BN.
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http://dx.doi.org/10.1016/j.eatbeh.2017.12.002DOI Listing
January 2018

New Horizons in Measurement: a Review of Novel and Innovative Approaches to Eating-Disorder Assessment.

Curr Psychiatry Rep 2017 Sep 11;19(10):76. Epub 2017 Sep 11.

Department of Psychology, University of Kansas, Fraser Hall, 1415 Jayhawk Boulevard, Lawrence, KS, 66045, USA.

Purpose Of Review: Eating disorders are serious mental-health concerns that will affect over 30 million individuals in the USA at some point in their lives. Eating disorders occur across the lifespan, in a variety of ethnicities and races, in both men and women, and across the socioeconomic spectrum. Given the prevalence and severity of eating disorders, it is important that clinicians and researchers have access to appropriate assessment tools to aid in the early identification and treatment referral, differential diagnosis, treatment planning, and progress monitoring, and to ensure valid research findings. In this review, we describe novel and innovative assessment tools that were developed within the past 5 years for utilization in research and/or clinical practice with individuals with eating disorders.

Recent Findings: We identified six multidimensional assessments for eating disorders, all of which can be administered online (with some also offering paper-and-pencil versions). Strengths of the measures included good internal consistency, test-retest reliability, and convergent validity. However, in part, due to problematic scale construction methods, certain scales had poor discriminant validity and most were developed and validated in mostly female samples. There are promising new eating disorder measures from which to choose; however, many measures continue to be limited by poor discriminant validity and need additional validation prior to incorporation into routine research and clinical practice.
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http://dx.doi.org/10.1007/s11920-017-0826-2DOI Listing
September 2017

Understanding eating disorders within internalizing psychopathology: A novel transdiagnostic, hierarchical-dimensional model.

Compr Psychiatry 2017 11 28;79:40-52. Epub 2017 Jun 28.

Children's Mercy Kansas City, United States.

Background: Several problems with the classification and diagnosis of eating disorders (EDs) have been identified, including proliferation of 'other specified' diagnoses, within-disorder heterogeneity, and frequent diagnostic migration over time. Beyond problems within EDs, past research suggested that EDs fit better in a spectrum of internalizing psychopathology (characterized by mood and anxiety disorders) than in a separate diagnostic class.

Purpose: To develop a transdiagnostic, hierarchical-dimensional model relevant to ED psychopathology that: 1) reduces diagnostic heterogeneity, 2) includes important dimensions of internalizing psychopathology that are often excluded from ED diagnostic models, and 3) predicts clinical impairment.

Procedures: Goldberg's (2006) method and exploratory structural equation modeling were used to identify a hierarchical model of internalizing in community-recruited adults with EDs (N=207).

Findings: The lowest level of the hierarchy was characterized by 15 factors that defined specific aspects of eating, mood, and anxiety disorders. At the two-factor level, Internalizing bifurcated into Distress (low well-being, body dissatisfaction, suicidality, dysphoria, ill temper, traumatic intrusions) and Fear-Avoidance (claustrophobia, social avoidance, panic symptoms, dietary restricting, excessive exercise, and compulsions). Results showed that the lowest level of the hierarchy predicted 67.7% of the variance in clinical impairment. In contrast, DSM eating, mood, and anxiety disorders combined predicted 10.6% of the variance in impairment secondary to an ED.

Conclusions: The current classification model represents an improvement over traditional nosologies for predicting clinically relevant outcomes for EDs.
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http://dx.doi.org/10.1016/j.comppsych.2017.06.009DOI Listing
November 2017

Test-Retest Reliability of Common Measures of Eating Disorder Symptoms in Men Versus Women.

Assessment 2019 04 3;26(3):419-431. Epub 2017 Apr 3.

1 University of Kansas, Lawrence, KS, USA.

Approximately 10% to 30% of individuals with eating disorders (EDs) are male, yet because measures often have not been tested among male participants, it is unclear whether the psychometric properties of ED measures are equivalent between sexes. The purpose of this study was to compare the test-retest reliability of common ED measures in men versus women. Participants ( N = 227; 58.1% female) completed self-report measures of body dissatisfaction, restrained eating, disinhibited eating, bulimic symptoms, and desire-for-muscularity at baseline and 2-to-4 weeks later. Intraclass correlations were used to compute retest correlations. Spearman's rho was used to compute retest correlations for skewed and kurtotic variables. We compared 95% confidence intervals for intraclass correlation coefficients to determine whether measures differed in reliability between sexes. Most ED measures had at least acceptable test-retest reliabilities. However, few measures of disinhibited and binge eating demonstrated good reliability in men. Results highlight the utility of several ED measures for assessing symptom change over time, and the need for additional research to identify and correct for sources of gender unreliability among ED self-report measures in men-particularly for assessing constructs that include binge-eating behavior.
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http://dx.doi.org/10.1177/1073191117700267DOI Listing
April 2019

Are common measures of dietary restraint and disinhibited eating reliable and valid in obese persons?

Appetite 2015 Apr 9;87:344-51. Epub 2015 Jan 9.

Department of Psychology, University of Kansas, Lawrence, KS 66045, USA.

Disordered eating measures were developed and validated in primarily normal weight samples; thus, it is unclear if the psychometric properties are equivalent across weight groups. This study evaluated the reliability and validity of self-reported disinhibited eating and dietary restraint measures in a community-recruited sample of overweight individuals (N = 201) and obese individuals (N = 101) and normal weight matched controls. Coefficient alpha and average inter-item correlations were used to test internal consistency reliability. Correlations between lifetime disordered eating behaviors and measures of dietary restraint and disinhibited eating were used to test convergent validity. Disordered eating measures included: Eating Disorders Examination Questionnaire (EDE-Q), Three Factor Eating Questionnaire (TFEQ), Dutch Eating Behavior Questionnaire (DEBQ), Eating Disorders Inventory-3 (EDI-3), and Restraint Scale. Correlations between lifetime disordered eating behaviors and measures of non-disordered-eating-related psychopathology were used to test discriminant validity. Results indicated that most measures demonstrated acceptable internal consistency reliability across groups, with the exception of the Restraint Scale. Significantly higher convergent correlations between lifetime history of fasting and TFEQ Cognitive Restraint emerged for the overweight vs. obese group, and the magnitude of discriminant correlations between lifetime history of binge eating and the Inventory of Depression and Anxiety Symptoms (IDAS) Well Being scale was stronger in the normal weight vs. overweight group. Findings suggest the majority restrained and disinhibited eating measures are reliable and valid among weight groups, and are suitable to use in overweight and obese populations.
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http://dx.doi.org/10.1016/j.appet.2014.12.226DOI Listing
April 2015

Clinicians' practices regarding blind versus open weighing among patients with eating disorders.

Int J Eat Disord 2015 Nov 12;48(7):905-11. Epub 2014 Dec 12.

Department of Psychology, University of Kansas, Lawrence, Kansas.

Background: Empirically supported treatments for eating disorders, such as cognitive-behavioral therapy and family-based treatment, stress the importance of weighing patients during therapy and using this information as part of treatment. However, weighing practices vary widely across eating disorders professionals, including those that purport to provide empirically supported interventions.

Objectives: To characterize clinicians' practices regarding the decision to share (open weighing) or withhold (blind weighing) weight information with patients, a topic that has received limited prior attention.

Method: Clinicians (N = 114; 85% female) who regularly treat individuals with an eating disorder completed an online survey to identify factors that might impact their decision to practice blind or open weighing.

Results: Approximately half of the clinicians reported generally using open weighing procedures (n = 53; 46.49%). Endorsement of cognitive-behavioral or family-based therapeutic orientation was not significantly associated with open weighing. However, clinicians who endorsed therapeutic modalities that do not specifically encourage open weighing were significantly more likely to engage in blind weighing. Clinicians working with clients with anorexia nervosa were significantly more likely to practice blind weighing, compared to clients with other eating disorder diagnoses, and cognitive or emotional impairment from malnutrition emerged as the strongest predictor of clinicians' decisions to practice blind weighing, controlling for all other variables.

Discussion: Development of specific training modules may be useful for improving adherence to empirically supported protocols that recommend open weighing. More importantly, however, our results highlight the need for future treatment studies to identify whether blind or open weighing is beneficial for improving patient outcomes.
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http://dx.doi.org/10.1002/eat.22369DOI Listing
November 2015
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