Publications by authors named "Caroline Christian"

27 Publications

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Eating disorder and social anxiety symptoms in Iranian preadolescents: a network analysis.

Eat Weight Disord 2021 Nov 17. Epub 2021 Nov 17.

Department of Psychological and Brain Sciences, University of Louisville, Life Sciences Building, Louisville, KY, 40292, USA.

Purpose: Network studies of eating disorder (ED) symptoms have identified central and bridge symptoms in Western samples, yet few network models of ED symptoms have been tested in non-Western samples, especially among preadolescents. The current study tested a network model of ED symptoms in Iranian preadolescents (ages 9 to 13), as well as a model of co-occurring social anxiety disorder (SAD) and ED symptoms.

Method: Preadolescent boys (n = 405) and girls (n = 325) completed the Children Eating Attitudes Test-20 and Social Anxiety Scale for Children. We estimated two network models (ED and ED/SAD networks) and identified central and bridge symptoms, as well as tested if these models differed by sex.

Results: We found that discomfort eating sweets were the most central symptoms in ED networks. Concern over being judged was central in networks including both ED and SAD symptoms. Additionally, concern over being judged was the strongest bridge symptoms. Networks did not differ by sex.

Conclusion: Future research is needed to test if interventions focused on bridge symptoms (i.e., concern over being judged) as primary intervention points target comorbid ED-SAD pathology in preadolescents at risk for ED and SAD.

Level Of Evidence: Level III; Evidence obtained from well-designed observational study, including case-control design for relevant aspects of the study.
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http://dx.doi.org/10.1007/s40519-021-01329-8DOI Listing
November 2021

Using individual networks to identify treatment targets for eating disorder treatment: a proof-of-concept study and initial data.

J Eat Disord 2021 Nov 4;9(1):147. Epub 2021 Nov 4.

Department of Psychological and Brain Sciences, University of Louisville, Life Sciences Building, Louisville, KY, 40292, USA.

Background: Eating disorders (EDs) are severe mental illnesses, with high morbidity, mortality, and societal burden. EDs are extremely heterogenous, and only 50% of patients currently respond to first-line treatments. Personalized and effective treatments for EDs are drastically needed.

Methods: The current study (N = 34 participants with an ED diagnosis collected throughout the United States) aimed to investigate best methods informing how to select personalized treatment targets utilizing idiographic network analysis, which could then be used for evidence based personalized treatment development. We present initial data collected via experience sampling (i.e., ecological momentary assessment) over the course of 15 days, 5 times a day (75 total measurement points) that were used to select treatment targets for a personalized treatment for EDs.

Results: Overall, we found that treatment targets were highly variable, with less than 50% of individuals endorsing central symptoms related to weight and shape, consistent with current treatment response rates for treatments designed to target those symptoms. We also found that different aspects of selection methods (e.g., number of items, type of centrality measure) impacted treatment target selection.

Conclusions: We discuss implications of these data, how to use idiographic network analysis to personalize treatment, and identify areas that need future research.

Trial Registration: Clinicaltrials.gov, NCT04183894. Registered 3 December 2019-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04183894 . NCT04183894 (ClinicalTrials.gov identifier).
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http://dx.doi.org/10.1186/s40337-021-00504-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8567590PMC
November 2021

Network Analysis of PTSD Symptoms in a Sample of Polyvictimized Youth.

J Trauma Dissociation 2021 Oct 18:1-15. Epub 2021 Oct 18.

Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA.

Polyvictimization (i.e., the experience of multiple types of victimization) increases the risk for post-traumatic stress disorder (PTSD) relative to single-type victimization. Network analysis has been used to conceptualize PTSD among children and adolescents exposed to specific types of victimization (e.g., maltreatment, natural disasters), but not among those theorized to be at highest risk of poor outcomes (i.e., polyvictimized youth). The current study used network analysis to enhance our understanding of PTSD symptoms in a diverse sample of adolescents exposed to polyvictimization. Data were drawn from the Longitudinal Studies on Child Abuse and Neglect, a multi-site study of children and adolescents living in the United States (ages 0-18). Using indicators of seven different types of age-16 victimization, -means cluster analysis identified a subgroup of polyvictimized youth. A PTSD symptom network was estimated for polyvictimized youth, with depersonalization, self-blame, and sadness emerging as central symptoms. Regression analyses indicated that depersonalization prospectively predicted age-18 anxiety symptoms, = .033. Central symptoms did not predict age-18 PTSD or depression symptoms. To date, this is the first network study on a polyvictimized sample. While preliminary, our findings suggest that dissociation and self-blame may be central to polyvictimized youth and that dissociation may represent an important prevention target for anxiety.
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http://dx.doi.org/10.1080/15299732.2021.1989115DOI Listing
October 2021

The unique and moderated relationships across repetitive negative thinking and disordered eating behaviors in adolescent girls.

Eat Behav 2021 Dec 3;43:101560. Epub 2021 Sep 3.

University of Louisville, Department of Psychological & Brain Sciences, United States of America. Electronic address:

Objective: Repetitive negative thinking (RNT) is associated with eating disorder (ED) symptoms, but few studies have evaluated how RNT may relate to specific ED behaviors (e.g., fasting, binge eating). Furthermore, little research has examined RNT in adolescent girls, a critical population for ED development. Concern over mistakes perfectionism (i.e., preoccupation with and overvaluation of errors) and social appearance anxiety are transdiagnostic risk factors for EDs that may be amplified by RNT, contributing to the development of ED behaviors.

Method: The current study (N = 332 female high school students) explored RNT in an adolescent sample and tested whether RNT was uniquely associated with fasting/binge eating and moderated the relationships between social appearance anxiety/perfectionism and fasting/binge eating.

Results: RNT was not associated with fasting and did not significantly moderate the relationship between social appearance anxiety/perfectionism and fasting. RNT was positively associated with binge eating but did not moderate the relationship between social appearance anxiety/perfectionism and binge eating.

Conclusions: RNT may contribute differentially to specific ED behaviors such as fasting and binge eating during ED development. If replicated in prospective data, these findings suggest targeting RNT in adolescence may decrease binge eating.
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http://dx.doi.org/10.1016/j.eatbeh.2021.101560DOI Listing
December 2021

Network investigation of eating disorder symptoms and positive and negative affect in a clinical eating disorder sample.

Int J Eat Disord 2021 07 5;54(7):1202-1212. Epub 2021 Apr 5.

Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA.

Objective: Growing literature suggests that emotions influence the maintenance of eating disorder (ED) symptoms. However, most research has studied the relationship between ED symptoms and affect broadly (i.e., negative affect [NA], positive affect [PA]), rather than examining models comprised of multiple specific affective states (e.g., upset, proud).

Method: The current study (N = 196 individuals with EDs) used network analysis to examine the most interconnected (i.e., central) NA and PA states in EDs and test the complex associations between specific NA, PA, and ED symptoms. We estimated two networks: one with affective states only and another with affective states and ED symptoms.

Results: Feeling distressed, afraid, attentive, and determined were the most central symptoms in the affect-only network. ED symptoms related to overvaluation of weight and shape, including affect-based ED symptoms (i.e., guilt about eating), were central in the network of affect and ED symptoms. Guilt about eating and shame were central bridge symptoms across affect and ED symptom clusters, meaning that they were each strongly connected across clusters, and may represent important pathways among affect and ED symptoms.

Discussion: Limitations include the cross-sectional and between-person nature of these analyses, from which we cannot derive causal or within-persons processes. Clinical interventions that target central and bridge symptoms (e.g., fear, shame) may disrupt the reinforcing cycle of NA in EDs that may contribute to ED behaviors. Future research should examine relationships among affective states and ED symptoms in longitudinal and intraindividual network models to develop more effective treatments for EDs.
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http://dx.doi.org/10.1002/eat.23511DOI Listing
July 2021

A network analysis of eating disorder symptoms and co-occurring alcohol misuse among heterosexual and sexual minority college women.

Addict Behav 2021 07 8;118:106867. Epub 2021 Feb 8.

Department of Psychological and Brain Sciences, University of Louisville, United States. Electronic address:

Eating disorders and alcohol misuse are common problems among college women. Individually, both have high prevalence rates and are associated with a significant economic burden. Yet eating disorders and alcohol misuse also frequently present simultaneously, which may increase symptom severity and related impairment. These associations are especially important to test in sexual minority populations, as symptoms may present differently, and the prevalence and personal cost of these disorders may be even higher for this group. The present study (N = 1072 undergraduate college women) used network analysis to identify pathways, central symptoms, and bridge symptoms across alcohol misuse and eating disorder symptoms. A network comparison test was used to determine if the network structure differed between heterosexual women (n = 923) and sexual minority women (n = 149). For the overall network, cognitive restraint, excessive exercise, and frequency of binge drinking, were the most central symptoms. Bridge symptoms included drinking in the morning, purging, alcohol-related guilt, and muscle building. Heterosexual and sexual minority women did not differ significantly in network structure or global strength. Regardless of sexual orientation, prevention efforts for eating disorders and alcohol misuse among college women should target central and bridge symptoms.
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http://dx.doi.org/10.1016/j.addbeh.2021.106867DOI Listing
July 2021

Latent profile analysis of impulsivity and perfectionism dimensions and associations with psychiatric symptoms.

J Affect Disord 2021 03 2;283:293-301. Epub 2021 Feb 2.

University of Louisville, Department of Psychological & Brain Sciences, USA. Electronic address:

Background: Impulsivity and perfectionism are transdiagnostic personality factors that have been studied extensively and shown to relate to externalizing and internalizing pathology respectively. Typically, these personality factors are antithesized, with impulsivity characterized by lack of control and perfectionism characterized by rigid overcontrol.

Methods: The current study (N = 1,353 undergraduate students) used latent profile analysis to identify subgroups based on impulsivity and perfectionism dimensions and tested the relations of these subgroups with the symptomatology of ten prevalent types of psychopathology (depression, worry, social anxiety, attention-deficit hyperactivity disorder inattentive subtype, attention-deficit hyperactivity disorder impulsive-hyperactive subtype, alcohol use, obsessive-compulsive disorder, posttraumatic stress disorder, restrictive eating pathology, and binge eating pathology).

Results: The latent profile analysis identified four meaningful subgroups: high perfectionism, high impulsivity, combined impulsivity and perfectionism, and low impulsivity and perfectionism. The combined group was the most prevalent, comprising almost half of the sample. Further, the perfectionism group had the highest scores for obsessive-compulsive disorder, worry, and restrictive eating pathology, the impulsivity group had the highest scores for alcohol use disorder, and the combined group had the highest or second-highest scores across all types of psychopathology.

Limitations: Limitations include the undergraduate sample, self-report, cross-sectional study design, and high bivariate residuals.

Conclusions: These findings suggest impulsivity and perfectionism can co-occur. Further, the co-occurrence of these personality traits may heighten risk for psychopathology and help explain comorbidity across internalizing and externalizing disorders. Future research should continue to investigate the presentation, prevalence, and treatment for individuals high in both perfectionism and impulsivity.
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http://dx.doi.org/10.1016/j.jad.2021.01.076DOI Listing
March 2021

Latent profile analysis of impulsivity and perfectionism dimensions and associations with psychiatric symptoms.

J Affect Disord 2021 03 2;283:293-301. Epub 2021 Feb 2.

University of Louisville, Department of Psychological & Brain Sciences, USA. Electronic address:

Background: Impulsivity and perfectionism are transdiagnostic personality factors that have been studied extensively and shown to relate to externalizing and internalizing pathology respectively. Typically, these personality factors are antithesized, with impulsivity characterized by lack of control and perfectionism characterized by rigid overcontrol.

Methods: The current study (N = 1,353 undergraduate students) used latent profile analysis to identify subgroups based on impulsivity and perfectionism dimensions and tested the relations of these subgroups with the symptomatology of ten prevalent types of psychopathology (depression, worry, social anxiety, attention-deficit hyperactivity disorder inattentive subtype, attention-deficit hyperactivity disorder impulsive-hyperactive subtype, alcohol use, obsessive-compulsive disorder, posttraumatic stress disorder, restrictive eating pathology, and binge eating pathology).

Results: The latent profile analysis identified four meaningful subgroups: high perfectionism, high impulsivity, combined impulsivity and perfectionism, and low impulsivity and perfectionism. The combined group was the most prevalent, comprising almost half of the sample. Further, the perfectionism group had the highest scores for obsessive-compulsive disorder, worry, and restrictive eating pathology, the impulsivity group had the highest scores for alcohol use disorder, and the combined group had the highest or second-highest scores across all types of psychopathology.

Limitations: Limitations include the undergraduate sample, self-report, cross-sectional study design, and high bivariate residuals.

Conclusions: These findings suggest impulsivity and perfectionism can co-occur. Further, the co-occurrence of these personality traits may heighten risk for psychopathology and help explain comorbidity across internalizing and externalizing disorders. Future research should continue to investigate the presentation, prevalence, and treatment for individuals high in both perfectionism and impulsivity.
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http://dx.doi.org/10.1016/j.jad.2021.01.076DOI Listing
March 2021

Social appearance anxiety moderates the relationship between thin-ideal internalization and eating disorder symptoms cross-sectionally and prospectively in adolescent girls.

Eat Weight Disord 2021 Aug 26;26(6):2065-2070. Epub 2020 Oct 26.

Department of Psychological and Brain Sciences, University of Louisville, 317 Life Sciences Building, Louisville, KY, USA.

Purpose: The sociocultural theory of eating disorders (EDs) posits that thin-ideal internalization may interact with social risk factors to influence ED development. Social appearance anxiety (SAA) is a potential social risk factor for EDs that may influence the relationship between thin-ideal internalization and EDs.

Methods: The current study (N = 525 adolescent females) examined whether SAA moderated the relationship between thin-ideal internalization and ED symptoms cross-sectionally and prospectively across one month.

Results: The interaction between thin-ideal internalization and SAA on ED symptoms was significant in both models, such that when SAA was higher, there was a significantly stronger relationship between thin-ideal internalization and ED symptoms. We also found that SAA uniquely, prospectively predicted ED symptoms.

Conclusion: These results suggest that adolescents with high SAA and high thin-ideal internalization are more likely to exhibit higher ED symptoms. SAA both prospectively predicts ED symptoms and may amplify the relationship between thin-ideal internalization and EDs. This research highlights SAA as a social risk factor for ED development in adolescents. Interventions focused on SAA may optimize ED prevention in this population.

Level Of Evidence: Level IV, evidence obtained from multiple time series with or without the intervention.
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http://dx.doi.org/10.1007/s40519-020-01050-yDOI Listing
August 2021

What are the emotions underlying feeling fat and fear of weight gain?

J Affect Disord 2020 12 12;277:146-152. Epub 2020 Aug 12.

Department of Psychological & Brain Sciences, University of Louisville, Life Sciences Building 317, Louisville, KY 40292, United States.

Background: Eating disorders (EDs) are most always accompanied by cognitive-affective comorbidities, such as anxiety and depression. In addition to these common comorbidities, EDs are unique in that they are characterized by affective symptoms centered on body image and weight. Two of these primary, yet understudied, affective symptoms are feelings of fatness and fears of weight gain, which are theorized to be maintaining symptoms of EDs and are highly common in those with EDs. Despite the importance of these symptoms, there is no research characterizing which cognitive-affective symptoms contribute to feelings of fatness and fears of weight gain.

Methods: The current study (N=168 individuals with an ED) tested cross-sectional and prospective models of cognitive-affect variables (negative affect, guilt, shame, fear of negative evaluation, anxiety sensitivity, and depression) to identify which thoughts and emotions were uniquely associated and prospectively predicted feelings of fatness and fear of weight gain.

Results: Depression both cross-sectionally and prospectively predicted feeling fat over and above all other forms of affect. Fears of negative evaluation and depression were uniquely associated with fears of weight gain, and shame prospectively predicted fear of weight gain.

Limitations: Variables were self-reported, and the sample primarily consisted of women. Fear of weight gain and feelings of fatness were assessed using single items.

Conclusions: This research suggests that depression may be an important intervention target when individuals with an ED report feeling fat. Additionally, treatment targeting fear of negative evaluation, depression, and shame may decrease fears of weight gain.
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http://dx.doi.org/10.1016/j.jad.2020.08.012DOI Listing
December 2020

Eating disorder symptoms and core eating disorder fears decrease during online imaginal exposure therapy for eating disorders.

J Affect Disord 2020 11 21;276:585-591. Epub 2020 Jul 21.

Department of Psychological and Brain Sciences, 317 Life Sciences, University of Louisville, 317 Life Sciences, Louisville, KY 40292, United States.

Background: Few evidence-based treatments for eating disorders (EDs) exist. Imaginal exposure therapy is a key component of effective treatment for anxiety disorders and post-traumatic stress disorder. However, imaginal exposure has not been systematically tested as a treatment for EDs. The current study aimed to develop and test online imaginal exposure as a treatment for EDs.

Methods: The current study tested a four-week trial of online imaginal exposure for EDs (N = 229 participants with EDs recruited globally). Participants completed diagnostic interviews and four sessions of weekly online imaginal exposure, in which they wrote about and imagined a core ED fear (identified with a therapist). Participants completed measures of ED symptoms and fears (i.e., fear of weight gain, food) at pre-imaginal exposure, post-imaginal exposure, and six-month follow-up. Participants were recruited and participated in the protocol from November 2016 to October 2018.

Results: All primary outcomes (ED symptoms, ED fears) significantly decreased at study completion and six-month follow-up with medium-to-large effect sizes. State anxiety across the exposure and follow-ups significantly decreased, specifically from initial sessions to follow-up. Worry, but not depression, significantly decreased.

Limitations: This study was an open case trial and did not include a control condition.

Conclusions: Significant decreases in ED symptoms and fears occurred during the course of imaginal exposure treatment. Online imaginal exposure is a feasible treatment for EDs and is associated with decreases in core ED symptomatology, which are comparable in magnitude to decreases seen from other evidence-based treatments. A future randomized-controlled trial is needed.

Clinical Trials Registration: ClinicalTrials.gov identifier NCT03712748.
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http://dx.doi.org/10.1016/j.jad.2020.07.075DOI Listing
November 2020

Central and Peripheral Symptoms in Network Analysis are Differentially Heritable A Twin Study of Anxious Misery.

J Affect Disord 2020 09 21;274:986-994. Epub 2020 May 21.

University of Louisville.

Background: Evidence suggests that depression and anxiety disorders are genetically based. Although symptoms of these internalizing disorders tend to correlate, the degree to which the related symptoms are heritable is unclear. This overlap has been conceptualized as Anxious Misery and existing research examining similar constructs of negative affect has revealed moderate heritability. However, it is unclear if some symptoms that characterize these constructs are more heritable than others. Modeling the symptom structure of Anxious Misery and examining which symptoms are most heritable may have implications for etiological models of internalizing disorders. Accordingly, the present study employed network analysis to explore the relationships across symptoms of Anxious Misery and to test if central symptoms in the network, compared to more peripheral symptoms, differ in their heritabilities.

Methods: Twin pairs (N = 1,344 pairs) with a mean age of 39 years (SD = 16 years) completed measures of anxiety and neuroticism to represent the Anxious Misery network.

Results: Panic-related symptoms were the most central in the network and were the most heritable, with genetic factors accounting for up to 59% of phenotypic variance. Peripheral symptoms were less heritable, accounting for as little as 21% of phenotypic variance. The degree of symptom heritability was strongly correlated with the degree of centrality of a symptom in the network (r = .53).

Limitations: Reliance on two self-report measures to represent Anxious Misery limits the generalizability of the findings.

Conclusions: Central and peripheral symptoms of an Anxious Misery network may differ in degree of heritability.
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http://dx.doi.org/10.1016/j.jad.2020.05.045DOI Listing
September 2020

Avoidance coping during mealtimes predicts higher eating disorder symptoms.

Int J Eat Disord 2020 04 29;53(4):625-630. Epub 2020 Feb 29.

Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA.

Objective: Eating disorders (EDs) are characterized by significant anxiety during mealtime that contributes to food avoidance and weight loss. Individuals with EDs commonly use avoidance coping (e.g., distraction) to tolerate meals and comply with meal plans. Although this strategy may be effective short term, a large body of anxiety literature suggests that avoidance can lead to worsening of psychological symptoms long term.

Method: The current study (N = 66 individuals diagnosed with ED) used ecological momentary assessment (EMA) to examine the short-term and long-term associations of avoidance coping on ED symptoms.

Results: Distraction during meals predicted a reduction in anxiety in the short term, and both distraction and avoidance of emotions predicted increases in excessive exercise in the short term. Distraction and avoidance of emotions predicted increases in bulimic symptoms 1 month after completion of EMA.

Discussion: These results are consistent with prior literature on avoidance and suggest that avoidance coping during meals may contribute to the increase of ED behaviors in the long term. Coping strategies that encourage approach and tolerance of difficult thoughts and emotions (e.g., acceptance-based strategies) rather that avoidance coping may promote longer-term symptom reduction.
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http://dx.doi.org/10.1002/eat.23254DOI Listing
April 2020

A network investigation of core symptoms and pathways across duration of illness using a comprehensive cognitive-behavioral model of eating-disorder symptoms.

Psychol Med 2021 04 7;51(5):815-824. Epub 2020 Jan 7.

Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States of America.

Background: In the past decade, network analysis (NA) has been applied to psychopathology to quantify complex symptom relationships. This statistical technique has demonstrated much promise, as it provides researchers the ability to identify relationships across many symptoms in one model and can identify central symptoms that may predict important clinical outcomes. However, network models are highly influenced by node selection, which could limit the generalizability of findings. The current study (N = 6850) tests a comprehensive, cognitive-behavioral model of eating-disorder symptoms using items from two, widely used measures (Eating Disorder Examination Questionnaire and Eating Pathology Symptoms Inventory).

Methods: We used NA to identify central symptoms and compared networks across the duration of illness (DOI), as chronicity is one of the only known predictors of poor outcome in eating disorders (EDs).

Results: Our results suggest that eating when not hungry and feeling fat were the most central symptoms across groups. There were no significant differences in network structure across DOI, meaning the connections between symptoms remained relatively consistent. However, differences emerged in central symptoms, such that cognitive symptoms related to overvaluation of weight/shape were central in individuals with shorter DOI, and behavioral central symptoms emerged more in medium and long DOI.

Conclusions: Our results have important implications for the treatment of individuals with enduring EDs, as they may have a different core, maintaining symptoms. Additionally, our findings highlight the importance of using comprehensive, theoretically- or empirically-derived models for NA.
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http://dx.doi.org/10.1017/S0033291719003817DOI Listing
April 2021

Emotion regulation difficulties, but not negative urgency, are associated with attention-deficit/hyperactivity disorder and eating disorder symptoms in undergraduate students.

Eat Behav 2020 01 13;36:101344. Epub 2019 Nov 13.

University of Louisville, Department of Psychological & Brain Sciences, United States of America.

Eating disorders and attention deficit/hyperactivity disorder (ADHD) are highly comorbid. The majority of research on this comorbidity has focused on impulsivity, which is a shared vulnerability between ADHD and eating disorders characterized by binge eating. Less is known about which shared factors may contribute to the co-occurrence of other eating disorders (i.e., anorexia nervosa, restricting subtype) and ADHD. Furthermore, little research has focused on other potential overlapping vulnerabilities, though deficits in emotion regulation have been implicated as an additional shared vulnerability. The current study (N = 306 undergraduate students) uses path analysis to examine if emotion regulation difficulties and negative urgency (i.e., impulsivity during negative mood state) are unique or shared vulnerabilities for ADHD symptoms (inattention, hyperactivity-impulsivity) and eating disorder symptoms (bulimic symptoms, drive for thinness). Emotion regulation difficulties were uniquely associated with all dimensions of ADHD and eating disorder symptoms, and negative urgency was uniquely associated with global eating disorder symptoms, bulimic symptoms, and drive for thinness. These results suggest that emotion regulation difficulties are a shared vulnerability factor for the development of diverse presentations of ADHD and eating disorder symptoms, and may be an important prevention target. Additionally, our results support a unique relationship between negative urgency and drive for thinness. Future research should examine these associations prospectively and experimentally to determine directionality and inform preventative interventions for ADHD and eating disorders.
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http://dx.doi.org/10.1016/j.eatbeh.2019.101344DOI Listing
January 2020

Exploring Mechanisms of Action in Exposure-Based Cognitive Behavioral Therapy for Eating Disorders: The Role of Eating-Related Fears and Body-Related Safety Behaviors.

Behav Ther 2019 11 12;50(6):1125-1135. Epub 2019 Feb 12.

University of Louisville.

Evidence-based cognitive behavioral therapy for eating disorders includes a component of exposure therapy, which involves patients confronting feared eating and body-related stimuli while preventing safety behaviors. With recent research demonstrating that eating-related fears and safety behaviors are central to eating disorder pathology, there is increased emphasis on improving the efficacy of exposure therapy in eating disorders. Doing so will require a better understanding of important mechanisms of action in this treatment. The present study explored how changes during treatment in eating-related fears and avoidance as well as body-related safety behaviors influence overall treatment outcomes. Individuals with eating disorders (N = 71) receiving exposure-based treatment completed measures of global eating disorder severity at admission and discharge. Hypothesized mechanisms of action were also assessed at admission and discharge as well as at a 2-week time point after beginning treatment. Path modeling analyses showed that decreased eating-related cognitions (feared concerns about eating) and emotions (anxiety about eating) at the 2-week time point were prospectively predictive of lowered global eating disorder symptom severity at discharge. Additionally, reduced body checking and avoidance behaviors after 2 weeks of treatment were also associated with lower eating disorder severity at discharge. These findings highlight the importance of exposure-based therapy in eating disorders and the need to uniquely address eating-related fears and safety behaviors.
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http://dx.doi.org/10.1016/j.beth.2019.01.008DOI Listing
November 2019

Eating disorder core symptoms and symptom pathways across developmental stages: A network analysis.

J Abnorm Psychol 2020 Feb 11;129(2):177-190. Epub 2019 Nov 11.

Department of Psychological and Brain Sciences.

Eating disorders (EDs) often develop during adolescence and early adulthood but may persist, arise, or reemerge across the life span. Research and treatment efforts primarily focus on adolescent and young adult populations, leaving large knowledge gaps regarding ED symptoms across the entire developmental spectrum. The current study uses network analysis to compare central symptoms (i.e., symptoms that are highly connected to other symptoms) and symptom pathways (i.e., relations among symptoms) across five developmental stages (early adolescence, late adolescence, young adulthood, early-middle adulthood, middle-late adulthood) in a large sample of individuals with EDs ( = 29,902; = 32,219) in two network models. Several symptoms related to overeating, food avoidance, feeling full, and overvaluation of weight and shape emerged as central in most or all developmental stages, suggesting that some core symptoms remain central across development. Despite similarities in central symptoms, significant differences in network structure (i.e., how symptom pathways are connected) emerged across age groups. These differences suggest that symptom interconnectivity (but not symptom severity) might increase across development. Future research should continue to investigate developmental symptom differences in order to inform treatment for individuals with EDs of all ages. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/abn0000477DOI Listing
February 2020

Development and validation of the eating disorder fear questionnaire and interview: Preliminary investigation of eating disorder fears.

Eat Behav 2019 12 15;35:101320. Epub 2019 Aug 15.

University of Louisville, Department of Psychological & Brain Sciences, United States of America.

Anxiety is highly characteristic of eating disorders (ED). Despite high levels of anxiety, little is known about ED specific fears. The current study developed and tested the psychometric properties of two measures of ED fears in two samples (N = 513 undergraduates; N = 129 clinical EDs): a self-report measure (Eating Disorder Fear Questionnaire; EFQ) and interview (Eating Disorder Fear Interview; EFI). We found strong support for a five-factor EFQ consisting of subscales assessing fear of weight gain, social consequences, personal consequences, physical sensations, and social eating. We found strong support for a six-factor EFI consisting of subscales assessing fear of food, weight gain, physical sensations, personal consequences, social consequences, and exercise-related fears. Both measures had adequate to strong internal consistency and convergent, divergent, incremental, and construct validity. These measures can be used to identify ED fears that can be targeted in personalized treatment. These data show that ED fears are multifaceted and heterogeneous.
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http://dx.doi.org/10.1016/j.eatbeh.2019.101320DOI Listing
December 2019

Manipulating the theoretical framing of exposure therapy for eating disorders impacts clinicians' treatment preferences.

Eat Weight Disord 2020 Oct 17;25(5):1205-1212. Epub 2019 Jul 17.

Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, 40292, USA.

Background: Exposure therapy is the most effective treatment for anxiety and related disorders and its efficacy in the eating disorders is rapidly gaining support. Despite the strong evidence behind exposure therapy, many anxiety disorder providers do not endorse the usage of exposure therapy. Limited research has explored the use of exposure therapy in eating disorder providers, as well as the impact of framing on likelihood to use exposure therapy.

Objective: The current study (N = 125 eating disorder providers) manipulated the framing of exposure to feared foods (pizza).

Methods: We framed the treatment as an exposure, behavioral experiment, or acceptance/mindfulness-based intervention. We also tested attitudes towards exposure therapy in eating disorder providers.

Results: Participants were more likely to endorse willingness to use a treatment framed as a behavioral experiment over exposure and acceptance-based framing. This effect did not vary by degree type, type of provider, years in practice, experience, or training. We also found that providers with more training, specifically in eating disorder exposure, were more likely to use exposure over acceptance-based framed intervention (and vice versa). Finally, we found that eating disorder providers had a somewhat positive view of exposure therapy.

Conclusion: Framing of the intervention impacts likelihood that providers will endorse using specific interventions. Therefore, intervention development and dissemination efforts should consider the language around the description of evidence-based treatments. Furthermore, enhanced training and education specifically with eating disorder exposure therapy may enhance the likelihood of providers utilizing exposure therapy. Level I: experimental study.
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http://dx.doi.org/10.1007/s40519-019-00751-3DOI Listing
October 2020

What is at the core of OCD? A network analysis of selected obsessive-compulsive symptoms and beliefs.

J Affect Disord 2019 10 2;257:45-54. Epub 2019 Jul 2.

University of Louisville, USA.

Background: Obsessive-compulsive disorder (OCD) is a heterogeneous condition that consists of distinct subtypes, and identification of its core symptoms may inform how to best conceptualize the heterogeneity. Accordingly, we used network analysis to evaluate which symptoms (and associations between symptoms) are most central to OCD symptoms and beliefs.

Methods: Participants consisted of a combined sample of adults with a primary diagnosis of OCD (N = 150), those with other primary diagnoses (N = 114), and an unselected nonclinical sample (N = 310). Network analysis was used to identify the most central symptoms (nodes) and associations between symptoms (edges) assessed by the Obsessive-Compulsive Inventory-Revised and the Obsessional Beliefs Questionnaire-44.

Results: The most central symptoms in the network were negative appraisals of intrusive thoughts (i.e., Having intrusive thoughts means I'm out of control). Some of the strongest associations between symptoms were also observed for those pertaining to intrusive thoughts and their negative appraisal. Furthermore, central symptoms in the network predicted depression and anxiety (over and above peripheral symptoms) among those with a primary diagnosis of OCD, but not the severity of OCD symptoms.

Limitations: The approach was exploratory rather than experimental and relied solely on self-report measures of OCD symptoms and beliefs.

Conclusions: Negative appraisals of intrusive thoughts were the most central symptoms in the OCD network, and they uniquely predict co-occurring symptoms of anxiety and depression, suggesting that these symptoms should be prioritized in theoretical and treatment models of OCD.
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http://dx.doi.org/10.1016/j.jad.2019.06.064DOI Listing
October 2019

Sensor technology implementation for research, treatment, and assessment of eating disorders.

Int J Eat Disord 2019 10 13;52(10):1176-1180. Epub 2019 Jun 13.

Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky.

Sensor technology has made huge technological advances in the past decade. Many sensor technologies (e.g., wearable wristbands) have been integrated into health research with the ability to substantially improve health outcomes and reduce health care costs. Despite the rapid technological developments in sensor technology, little research has examined sensor technology in eating disorders (EDs). The overarching aim of the current article is to briefly review the literature on sensor technology and health outcomes, including EDs, and discuss several potential ideas for the application of sensor technology in the treatment, assessment, and diagnosis of EDs. We will also present data from a feasibility case study with an ED participant and healthy control providing a brief example of how wearable sensor technology might be implemented in ED research. Overall, we will discuss how sensor technology could be used to improve treatment and assessment of EDs and represents an idea in need of more research in the ED field.
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http://dx.doi.org/10.1002/eat.23120DOI Listing
October 2019

Implementation of a dissonance-based, eating disorder prevention program in Southern, all-female high schools.

Body Image 2019 Sep 11;30:26-34. Epub 2019 May 11.

University of Louisville, Department of Psychological & Brain Sciences, United States.

Adolescence represents a high-risk period for eating disorder development, and there is great need for effective prevention programs targeted at this population. The Body Project, a dissonance-based eating disorder prevention program, has robust literature showing reductions in body dissatisfaction and eating disorder symptoms. However, many additional factors (i.e., comorbid symptoms, transdiagnostic factors) have not yet been examined in relation to the Body Project. Additionally, there is little known about how to most effectively and broadly disseminate this intervention. The current study (N = 332 adolescents) examines eating disorder symptoms, comorbidities, and transdiagnostic risk factors pre- and post-Body Project and at 1-month follow-up. This study is the first examination of the effectiveness of the Body Project implemented within school programming in southern, all-female high schools. Social appearance anxiety, physical and social anxiety sensitivity, rumination, worry, perfectionism, and guilt, but not depression, cognitive anxiety sensitivity, shame, or exercise dependence, decreased pre- to post-intervention and/or 1-month follow-up. These results support the effectiveness of the Body Project in addressing eating disorder symptoms and suggest it may aid in the prevention of comorbid conditions. Additionally, the effectiveness of the intervention was comparable to past investigations, supporting its use in schools across the United States.
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http://dx.doi.org/10.1016/j.bodyim.2019.05.003DOI Listing
September 2019

Social anxiety and eating disorder comorbidity and underlying vulnerabilities: Using network analysis to conceptualize comorbidity.

Int J Eat Disord 2018 07 13;51(7):693-709. Epub 2018 Aug 13.

Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri.

Objective: Eating disorders (EDs) and social anxiety disorder (SAD) are highly co-occurring. This comorbidity is extremely relevant, given that individuals with comorbid ED-SAD are less likely to seek and/or benefit from ED treatment.

Method: We used network analysis to conceptualize ED-SAD comorbidity in a sample of 2,215 participants with a primary diagnosis of ED, SAD, or no known diagnosis. We used novel network analyses methods to select symptoms for our models, identify potential illness pathways (i.e., bridge symptoms) between disorders and underlying vulnerabilities (e.g., perfectionism, social appearance anxiety), and to compare across sample types (e.g., clinical vs. nonclinical). We also tested several novel network analyses methods aimed at the following methodological concerns: (a) topological concerns (i.e., which items should be included in NA models), (b) how to use empirical indices to quantify bridge symptoms and (c) what differences in networks across samples mean.

Results: We found that difficulty with drinking beverages and eating in public were bridge symptoms between ED and SAD. We also found that feeling nervous about one's appearance was a bridge symptom.

Conclusions: We identified public eating and drinking as bridge symptoms between EDs and SAD. Future research is needed to test if interventions focused on public eating and drinking might decrease symptoms of both EDs and SAD. Researchers can use this study (code provided) as an exemplar for how to use network analysis, as well as to use network analysis to conceptualize ED comorbidity and compare network structure and density across samples.
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http://dx.doi.org/10.1002/eat.22890DOI Listing
July 2018

Native herbivores and environmental heterogeneity as mediators of an exotic grass invasion.

Ecol Evol 2017 Mar 8;7(5):1561-1571. Epub 2017 Feb 8.

Department of Biology Sonoma State University Rohnert Park CA USA.

Given that many exotic plant species throughout the world are having large ecological and economic effects, it is vital to understand the forces that mediate their success in novel landscapes. Both native herbivores and recipient ecosystems can have substantial effects on the performance of exotic plant species, and may interact with each other or vary in their effects over time. Unfortunately, few studies have evaluated the importance of these kinds of context-dependent effects. Here, we use a 17-year-old exclosure experiment stratified across a coastal grassland in northern California to address the relative importance of a reintroduced mammalian herbivore, tule elk (), and environmental heterogeneity in mediating the growth, abundance, and recruitment of a problematic grass invader, . We found that elk reduced abundance, aboveground biomass, percent cover, frequency, and seedling recruitment, but that these effects often varied among habitat types, with effects being greater in open grasslands than shrub-dominated grasslands. The performance of populations also varied significantly among habitat types, with the invader usually having the greatest success in -dominated grasslands. Our results suggest that environmental heterogeneity had much greater influence on success than elk, and that these effects were due largely to soil pH and moisture. The negative effects of elk on appeared after 4 years and did not intensify after an additional 13 years. Furthermore, despite their negative effects, these prominent herbivores did not prevent the spread of into previously uninvaded areas. Our research highlights the importance of assessing the individual and interactive effects of native herbivores and environmental heterogeneity on the success of invasive, exotic plant species. It emphasizes the reality that the negative effects of herbivores on exotic plant species will often vary across heterogeneous landscapes and may be insufficient to prevent the expansion of these invaders.
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http://dx.doi.org/10.1002/ece3.2727DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5330880PMC
March 2017

Consequences of prescribed fire and grazing on grassland ant communities.

Environ Entomol 2009 Apr;38(2):325-32

Department of Environmental Science and Policy, University of California, Davis, CA 95616, USA.

Prescribed fire and livestock grazing are used for the management and restoration of native grasslands the world over; however, the effects of these management techniques on ant communities are unclear. We examined the response of ants to these disturbances in grasslands in northern California. Twenty-four 30 by 30 m plots were established across two sites that received one of four treatments: grazing, fire, grazing and fire, or no treatment. Ants were censused using 240 pitfall traps with one preburn and two postburn samples (14 d and 1 yr after burning). We analyzed ant abundance using broadly defined groups based on feeding habit and/or habitat use and detected no grazing effect but a significant fire effect that differed by group. Immediate postfire sampling showed an increase in cryptic species (particularly Brachymyrmex depilis). One year after the fire, no response was detected for cryptic species, but burned plots had greater abundance of seed harvesters. Analysis of vegetation showed burned plots had significantly greater forb cover, which might have provided greater food resources, and also lower biomass, which might have facilitated foraging. Understanding the effects of these management tools on ant abundance complements our understanding of their effect on vegetation and assists conservation practitioners effectively manage grassland ecosystems both in California and beyond.
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http://dx.doi.org/10.1603/022.038.0204DOI Listing
April 2009

Perceived barriers to integrating social science and conservation.

Conserv Biol 2006 Dec;20(6):1817-20

Hawaii Institute of Marine Biology, PO Box 1346, Kaneohe, HI 96744, USA.

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http://dx.doi.org/10.1111/j.1523-1739.2006.00598.xDOI Listing
December 2006

Helix switching of a key active-site residue in the cytochrome cbb3 oxidases.

Biochemistry 2005 Aug;44(32):10766-75

Department of Chemistry, University of Illinois, Urbana, Illinois 61801, USA.

In the respiratory chains of mitochondria and many aerobic prokaryotes, heme-copper oxidases are the terminal enzymes that couple the reduction of molecular oxygen to proton pumping, contributing to the protonmotive force. The cbb(3) oxidases belong to the superfamily of enzymes that includes all of the heme-copper oxidases. Sequence analysis indicates that the cbb(3) oxidases are missing an active-site tyrosine residue that is absolutely conserved in all other known heme-copper oxidases. In the other heme-copper oxidases, this tyrosine is known to be subject to an unusual post-translational modification and to play a critical role in the catalytic mechanism. The absence of this tyrosine in the cbb(3) oxidases raises the possibility that the cbb(3) oxidases utilize a different catalytic mechanism from that of the other members of the superfamily. Using homology modeling, quantum chemistry, and molecular dynamics, a model of the structure of subunit I of a cbb(3) oxidase (Vibrio cholerae) was constructed. The model predicts that a tyrosine residue structurally analogous to the active-site tyrosine in other oxidases is present in the cbb(3) oxidases but that the tyrosine originates from a different transmembrane helix within the protein. The predicted active-site tyrosine is conserved in the sequences of all of the known cbb(3) oxidases. Mutagenesis of the tyrosine to phenylalanine in the V. cholerae oxidase resulted in a fully assembled enzyme with nativelike structure but lacking catalytic activity. These findings strongly suggest that all of the heme-copper oxidases utilize the same catalytic mechanism and provide an unusual example in which a critical active-site residue originates from different places within the primary sequence for different members of the same superfamily.
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http://dx.doi.org/10.1021/bi050464fDOI Listing
August 2005
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