Publications by authors named "Jennifer E Wildes"

55 Publications

Perceived Facilitators and Barriers to Engaging with a Digital Intervention among Those with Food Insecurity, Binge Eating, and Obesity.

Nutrients 2021 Jul 19;13(7). Epub 2021 Jul 19.

Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.

Interventions that address binge eating and food insecurity are needed. Engaging people with lived experience to understand their needs and preferences could yield important design considerations for such interventions. In this study, people with food insecurity, recurrent binge eating, and obesity completed an interview-based needs assessment to learn facilitators and barriers that they perceive would impact their engagement with a digital intervention for managing binge eating and weight. Twenty adults completed semi-structured interviews. Responses were analyzed using thematic analysis. Three themes emerged. Participants shared considerations that impact their ability to access the intervention (e.g., cost of intervention, cost of technology, accessibility across devices), ability to complete intervention recommendations (e.g., affordable healthy meals, education to help stretch groceries, food vouchers, rides to grocery stores, personalized to budget), and preferred intervention features for education, self-monitoring, personalization, support, and motivation/rewards. Engaging people with lived experiences via user-centered design methods revealed important design considerations for a digital intervention to meet this population's needs. Future research is needed to test whether a digital intervention that incorporates these recommendations is engaging and effective for people with binge eating and food insecurity. Findings may have relevance to designing digital interventions for other health problems as well.
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http://dx.doi.org/10.3390/nu13072458DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8308534PMC
July 2021

Predicting probable eating disorder case-status in men using the Clinical Impairment Assessment: Evidence for a gender-specific threshold.

Eat Behav 2021 08 20;42:101541. Epub 2021 Jul 20.

Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA.

The Clinical Impairment Assessment (CIA) is a widely used self-report measure of the psychosocial impairment associated with eating-disorder symptoms. Past studies recommended a global CIA score of 16 to identify clinically significant impairment associated with a probable eating disorder (ED). However, to date, research on the properties of the CIA has been conducted in majority-women samples. Preliminary research on gender differences in CIA scores suggested men with EDs report less impairment on the CIA relative to women with EDs. Thus, the purpose of this study was to test if a different impairment threshold is needed to identify cases of men with EDs. We hypothesized that a lower CIA threshold, relative to that identified in majority-women samples, would most accurately identify men with EDs. Participants (N = 162) were men from our university-based and general community-based ED participant registry who completed the CIA and Eating Disorder Diagnostic Scale. Both precision-recall and receiver operating characteristic curves assessed what CIA global score threshold most accurately identified men with EDs. Both analytic approaches indicated that a CIA global score of 13 best predicted ED case-status in men. Consistent with past research, men with a clinically significant ED appear to report lower impairment on the CIA. Results have implications for screening and assessing for substantial ED-related impairment in men. Additionally, past research using the CIA to identify men with EDs may have under-identified men with clinically significant symptoms.
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http://dx.doi.org/10.1016/j.eatbeh.2021.101541DOI Listing
August 2021

Brain-gut psychotherapies: Promising tools to address gastrointestinal problems in patients with eating disorders.

Int J Eat Disord 2021 06 19;54(6):1063-1067. Epub 2021 May 19.

Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA.

Gastrointestinal (GI) problems are common in individuals with eating disorders (EDs) and associated with distress, impairment, and increased healthcare utilization. GI symptoms may be exacerbated by meals and other interventions central to ED recovery thereby contributing to negative clinical outcomes. Informed by models emphasizing the role of the brain-gut axis in the expression of GI symptoms, this article describes a program of research to adapt "brain-gut psychotherapies" for EDs. First, the role of the brain-gut axis in GI symptoms is described, and evidence-based brain-gut psychotherapies are reviewed, with an emphasis on cognitive behavioral therapy for GI disorders and gut-directed hypnotherapy. Next, future directions for research in EDs to (a) understand the impact of GI symptoms on illness course and outcome; (b) clarify target engagement; (c) evaluate brain-gut psychotherapies; and (d) optimize intervention reach and delivery are described. We present a conceptual model that emphasizes GI-specific anxiety and altered gut physiology as targets of brain-gut psychotherapies in EDs, and discuss several issues that need to be addressed in designing clinical trials to test these interventions. We also describe how engagement with multidisciplinary stakeholders and use of digital tools could speed translation from the laboratory to clinical settings.
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http://dx.doi.org/10.1002/eat.23555DOI Listing
June 2021

Integrating User-Centered Design and Behavioral Science to Design a Mobile Intervention for Obesity and Binge Eating: Mixed Methods Analysis.

JMIR Form Res 2021 May 10;5(5):e23809. Epub 2021 May 10.

Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, United States.

Background: Accounting for how end users engage with technologies is imperative for designing an efficacious mobile behavioral intervention.

Objective: This mixed methods analysis examined the translational potential of user-centered design and basic behavioral science to inform the design of a new mobile intervention for obesity and binge eating.

Methods: A total of 22 adults (7/22, 32% non-Hispanic White; 8/22, 36% male) with self-reported obesity and recurrent binge eating (≥12 episodes in 3 months) who were interested in losing weight and reducing binge eating completed a prototyping design activity over 1 week. Leveraging evidence from behavioral economics on choice architecture, participants chose treatment strategies from 20 options (aligned with treatment targets composing a theoretical model of the relation between binge eating and weight) to demonstrate which strategies and treatment targets are relevant to end users. The process by which participants selected and implemented strategies and their change in outcomes were analyzed.

Results: Although prompted to select one strategy, participants selected between 1 and 3 strategies, citing perceived achievability, helpfulness, or relevance as selection reasons. Over the week, all practiced a strategy at least once; 82% (18/22) struggled with implementation, and 23% (5/22) added a new strategy. Several themes emerged on successes and challenges with implementation, yielding design implications for supporting users in behavior change. In postexperiment reflections, 82% (18/22) indicated the strategy was helpful, and 86% (19/22) planned to continue use. One-week average within-subject changes in weight (-2.2 [SD -5.0] pounds) and binge eating (-1.6 [SD -1.8] episodes) indicated small clinical improvement.

Conclusions: Applying user-centered design and basic behavioral science yielded design insights to incorporate personalization through user choice with guidance, which may enhance engagement with and potential efficacy of digital health interventions.
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http://dx.doi.org/10.2196/23809DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8145081PMC
May 2021

Food insecurity associated with elevated eating disorder symptoms, impairment, and eating disorder diagnoses in an American University student sample before and during the beginning of the COVID-19 pandemic.

Int J Eat Disord 2021 07 22;54(7):1213-1223. Epub 2021 Apr 22.

Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA.

Objective: This study tested the association between food insecurity and eating disorder (ED) pathology, including probable ED diagnosis, among two cohorts of university students before and during the beginning of the COVID-19 pandemic.

Method: Students (n = 579) from a large Midwestern American university completed self-report questionnaires assessing frequency of ED behaviors, ED-related impairment, and individual food insecurity as measured by the Eating Disorder Diagnostic Scale 5, Clinical Impairment Assessment, and Radimer/Cornell, respectively. Chi-square tests and MANOVA with post-hoc corrections were conducted to compare demographic characteristics, ED pathology, and probable ED diagnosis prevalence between students with and without individual food insecurity.

Results: Partially supporting hypotheses, MANOVA indicated significantly greater frequency of objective binge eating, compensatory fasting, and ED-related impairment for students with food insecurity compared with individuals without food insecurity. Chi-squared tests showed higher prevalence of ED diagnoses among individuals with food insecurity compared with those without food security (47.6 vs. 31.1%, respectively, p < .01, NNT = 6.06), specifically bulimia nervosa and other specified feeding and eating disorder. There were no differences in food insecurity before or during the beginning of the COVID-19 pandemic.

Discussion: Consistent with prior literature, food insecurity was associated with elevated ED psychopathology in this sample. Findings emphasize the importance of proper ED screening for college students vulnerable to food insecurity and EDs.
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http://dx.doi.org/10.1002/eat.23517DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8250281PMC
July 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

Moving from "I know it when I see it" to an empirical classification of severe and enduring anorexia nervosa: Commentary on Wonderlich et al. (2020).

Int J Eat Disord 2020 08 4;53(8):1315-1317. Epub 2020 Jun 4.

Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA.

Severe and enduring anorexia nervosa (SE-AN) is well known to clinicians who treat eating disorders, especially in adults, yet an empirically validated definition of SE-AN is lacking. Current approaches to delineating SE-AN rely on expert opinion, and there is little consensus regarding the criteria that distinguish SE-AN from other clinical presentations or the thresholds that define the boundaries of severity and enduringness. Empirical classification techniques and clinical staging frameworks that incorporate biomarkers offer intriguing alternatives to expert consensus in refining the definition of SE-AN. Empirical approaches, such as latent class analysis and taxometric analysis, have contributed to advances in eating disorders classification, including support for distinctions between eating disorder classes. Likewise, clinical staging models are being applied to other psychiatric disorders and offer a framework for incorporating biological indices of illness progression, such as neurocognitive changes, into a definition of SE-AN. Though some of these methods (e.g., biomarkers) are a long way from being realized, the need for an evidence-based approach to classifying SE-AN is clear. Without it, the challenges outlined by Wonderlich et al. (International Journal of Eating Disorders, 2020) will be difficult to resolve, and the burden of SE-AN on patients, their loved ones, and the healthcare system will continue.
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http://dx.doi.org/10.1002/eat.23321DOI Listing
August 2020

Workforce Diversity in Eating Disorders: A Multi-Methods Study.

West J Nurs Res 2020 12 8;42(12):1068-1077. Epub 2020 Apr 8.

Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA.

Despite growing recognition of the importance of workforce diversity in health care, limited research has explored diversity among eating disorder (ED) professionals globally. This multi-methods study examined diversity across demographic and professional variables. Participants were recruited from ED and discipline-specific professional organizations. Participants' (n = 512) mean age was 41.1 years (SD = 12.5); 89.6% (n=459) of participants identified as women, 84.1% (n = 419) as heterosexual/straight, and 73.0% (n = 365) as White. Mean years working in EDs was 10.7 years (SD = 9.2). Qualitative analysis revealed three themes resulting in a theoretical framework to address barriers to increasing diversity. Perceived barriers were the following: "stigma, bias, stereotypes, myths"; "field of eating disorders pipeline"; and "homogeneity of the existing field." Findings suggest limited workforce diversity within and across nations. The theoretical model suggests a need for focused attention to the educational pipeline, workforce homogeneity, and false assumptions about EDs, and it should be tested to evaluate its utility within the EDs field.
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http://dx.doi.org/10.1177/0193945920912396DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7541546PMC
December 2020

Past, current, and future willingness to engage with treatment targets: Applying user-centered design to inform the design of a mobile behavioral intervention.

Int J Eat Disord 2020 04 29;53(4):611-617. Epub 2020 Feb 29.

Center for Behavioral Intervention Technologies, Northwestern University, Chicago, Illinois, USA.

Objective: User-centered design can improve engagement with and the potential efficacy of behavioral interventions, but is underutilized in health care. This work demonstrates how design methodologies can inform the design of a mobile behavioral intervention for binge eating and obesity.

Method: A needs assessment was conducted with end-users (N = 22 adults with obesity and recurrent binge eating [≥12 episodes in 3 months] who were interested in losing weight and addressing binge eating), which included assessing participants' past/current and future willingness to engage with 20 treatment targets for managing binge eating and weight. Targets focused on improving dietary intake, increasing physical activity, and reducing overvaluation of weight and/or shape, unhealthy weight control practices, and negative affect.

Results: Participants' past and current use of targets varied. For all targets except those addressing unhealthy weight control practices, on average, participants had increasing levels of willingness to try targets. Among participants not currently using a target, at least some were willing to use every target again.

Discussion: Findings inform ways to personalize how users begin treatment. Furthermore, this study exemplifies how user-centered design can inform ways to ensure that digital interventions are designed to meet end-users' needs to improve engagement and clinical impact.
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http://dx.doi.org/10.1002/eat.23252DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7271441PMC
April 2020

User-centered design for technology-enabled services for eating disorders.

Int J Eat Disord 2019 10 16;52(10):1095-1107. Epub 2019 Jul 16.

Center for Behavioral Intervention Technologies, Northwestern University, Chicago, Illinois.

Objective: Technology-enabled services frequently have limited reach and suboptimal engagement when implemented in real-world settings. One reason for these implementation failures is that technology-enabled services are not designed for the users and contexts in which they will be implemented. User-centered design is an approach to designing technologies and services that is grounded in information from the stakeholders who will be using or impacted by them, and the contexts for implementation. The purpose of this article is to present user-centered design methods that can be applied to technology-enabled services for eating disorders.

Method: We provide an overview of the user-centered design process, which is iterative and involves stakeholders throughout. One model is presented that depicts six phases of a user-centered design process: investigate, ideate, prototype, evaluate, refine and develop, and validate.

Results: We then review how user-centered design approaches can be applied to designing technology-enabled services for patients with eating disorders, and we integrate a hypothetical case example that demonstrates the application of these techniques to designing a technology-enabled service for binge eating. Most of the user-centered design techniques can be implemented relatively quickly, allowing us to rapidly learn what stakeholders want and to identify problems before devoting time and resources to developing and delivering technologies and services.

Discussion: Through this work, we show how designing services that fit into the patterns and routines that stakeholders already are doing can ensure that services are relevant to stakeholders and meet their needs, potentially improving engagement and clinical impact.

Resumen: Los servicios habilitados tecnológicamente frecuentemente tienen un alcance limitado y un involucramiento subóptimo cuando son implementados en escenarios del mundo real. Una razón para estas fallas de implementación es que los servicios habilitados tecnológicamente no están diseñados para los usuarios y contextos en los que serán implementados. El diseño centrado en el usuario es un abordaje para diseñar tecnologías y servicios que está basado en información de las partes interesadas que estarán haciendo uso o impactados por ellos, y los contextos para implementación. El propósito de este estudio es presentar métodos de diseños centrados en el usuario que pueden ser aplicados a servicios habilitados tecnológicamente para trastornos de la conducta alimentaria. Ofrecemos una visión general del proceso de diseño centrado en el usuario, que es iterative e involucra a las partes interesadas a lo largo de todo el proceso. Hemos presentado un modelo que describe seis fases de un proceso de diseño centrado en el usuario: investigar, idear, crear prototipos, evaluar, refinar y desarrollar, y validar. Luego revisamos cómo estos abordajes de diseño centrado en el usuario pueden ser aplicados para diseñar servicios habilitados tecnológicamente para pacientes con trastornos de la conducta alimentaria, e integramos un ejemplo de caso hipotético que demuestra la aplicación de estas técnicas para diseñar un servicio habilitado tecnológicamente para comer en atracones. Muchas de las técnicas de diseño centrado en el usuario pueden ser implementadas relativamente rápido, lo que nos permite aprender rápidamente lo que las partes interesadas quieren e identificar los problemas antes de dedicarles tiempo y recursos al desarrollo y entrega de tecnologías y servicios. A través de este trabajo, mostramos cómo el diseño de servicios que se ajustan a los patrones y rutinas que las partes interesadas ya están haciendo puede garantizar que los servicios sean relevantes para los interesados y que satisfagan sus necesidades, lo que podría mejorar la participación y el impacto clínico.
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http://dx.doi.org/10.1002/eat.23130DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265747PMC
October 2019

Mixture Modeling to Characterize Anorexia Nervosa: Integrating Personality and Eating Disorder Psychopathology.

J Am Psychiatr Nurses Assoc 2021 May-Jun;27(3):231-239. Epub 2019 Jul 10.

Jennifer E. Wildes, PhD, University of Chicago, Chicago IL, USA.

Efforts to examine alternative classifications (e.g., personality) of anorexia nervosa (AN) using empirical techniques are crucial to elucidate diverse symptom presentations, personality traits, and psychiatric comorbidities. The purpose of this study was to use an empirical approach (mixture modeling) to test an alternative classification of AN as categorical, dimensional, or hybrid categorical-dimensional construct based on the co-occurrence of personality psychopathology and eating disorder clinical presentation. Patients with AN ( = 194) completed interviews and questionnaires at treatment admission and 3-month follow-up. Mixture modeling was used to test whether indicators best classified AN as categorical, dimensional, or hybrid. A four-latent class, one-latent dimension mixture model that was variant across groups provided the best fit to the data. Results suggest that all classes were characterized by low self-esteem and self-harming and suicidality tendencies. Individuals assigned to Latent Class 2 (LC2; = 21) had a greater tendency toward being impulsive and easily angered and having difficulties controlling anger compared with those in LC1 ( = 84) and LC3 ( = 66). Moreover, individuals assigned to LC1 and LC3 were more likely to have a poor outcome from intensive treatment compared with those in LC4 ( = 21). Findings indicate that the dimensional aspect within each class measured frequency of specific eating disorder behaviors but did not predict treatment outcomes. These results emphasize the complexity of AN and the importance of considering how facets of clinical presentation beyond eating disorder behaviors may have different treatment and prognostic implications.
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http://dx.doi.org/10.1177/1078390319862029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7081379PMC
July 2019

Self-report measures of loss of control over eating: Psychometric properties in clinical and non-clinical samples.

Int J Eat Disord 2018 11 28;51(11):1252-1260. Epub 2018 Sep 28.

Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois.

Objective: Research evidence supports the clinical significance of subjective feelings of loss of control over eating; however, limited attention has been given to how this construct is assessed. Two measures have been developed in recent years (i.e., Eating Loss of Control Scale [ELOC] and Loss of Control over Eating Scale [LOCES]), but further validation in clinical and non-clinical samples is needed.

Method: The current study evaluated the psychometric properties, including factor structure, criterion validity, and measurement invariance of the ELOC and LOCES across two groups: (a) a clinical sample of individuals with eating disorders (n = 106) and (b) a non-clinical sample of college students (n = 321).

Results: Confirmatory factor analyses indicated that the 16-item version of the ELOC and 7-item brief version of the LOCES provided good fit to the data in both samples. These measures were highly correlated (r = .83-.87) and associated with binge-eating and related psychopathology. The ELOC demonstrated partial invariance between men and women and between the clinical and non-clinical samples. The LOCES-brief demonstrated full invariance between men and women and partial invariance between the clinical and non-clinical samples.

Discussion: Findings suggest that the 16-item ELOC and 7-item LOCES are reliable measures of severity of loss of control eating in clinical and non-clinical samples. Given the brevity of the LOCES-brief and evidence for measurement invariance across sex, it is recommended over the ELOC in heterogeneous samples. Future research is needed to confirm the validity of these measures across individuals with and without eating disorders.
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http://dx.doi.org/10.1002/eat.22957DOI Listing
November 2018

Relationship between desired weight constructs and eating disorder severity following treatment for anorexia nervosa.

Int J Eat Disord 2018 08 7;51(8):870-878. Epub 2018 May 7.

Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois.

Background: Desired weight is an indicator of illness severity in youth with anorexia nervosa (AN), but its impact on eating disorder symptoms over time and in adults is unknown. This study examined longitudinal associations between two desired weight constructs (desired weight percentage, weight difference percentage) and eating disorder severity and body mass index (BMI) in patients aged 16-62 years old with AN presenting for inpatient or day hospital treatment.

Method: Participants (N = 160) completed the Eating Disorder Examination and measures of height and weight at treatment admission, discharge, and 3, 6, and 12 months post-discharge. Desired weight percentage was calculated as [desired BMI(desired weight in kg/height in meters )/healthy BMI] × 100. weight difference percentage was calculated as [(actual weight-desired weight)/actual weight] × 100.

Results: At admission, participants were approximately 78.6% of a healthy BMI and desired to be 81% of a healthy BMI. During the year following treatment, participants were 89% of a healthy BMI, but wanted to be 86% of a healthy BMI. Individuals with lower desired weight percentage (wanting to be a lower percentage of a healthy BMI) or higher weight difference percentage (wanting to lose a larger percentage of weight) at treatment admission endorsed greater eating disorder severity across time. Additionally, individuals with higher desired weight percentage or weight difference percentage had higher BMIs at intake, and greater increases in BMI over time.

Discussion: Results highlight that desired weight constructs represent correlates of illness severity in AN and may inform an individual's likely weight trajectory during and after treatment.
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http://dx.doi.org/10.1002/eat.22879DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6222021PMC
August 2018

Relationship between desired weight constructs and eating disorder severity following treatment for anorexia nervosa.

Int J Eat Disord 2018 08 7;51(8):870-878. Epub 2018 May 7.

Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois.

Background: Desired weight is an indicator of illness severity in youth with anorexia nervosa (AN), but its impact on eating disorder symptoms over time and in adults is unknown. This study examined longitudinal associations between two desired weight constructs (desired weight percentage, weight difference percentage) and eating disorder severity and body mass index (BMI) in patients aged 16-62 years old with AN presenting for inpatient or day hospital treatment.

Method: Participants (N = 160) completed the Eating Disorder Examination and measures of height and weight at treatment admission, discharge, and 3, 6, and 12 months post-discharge. Desired weight percentage was calculated as [desired BMI(desired weight in kg/height in meters )/healthy BMI] × 100. weight difference percentage was calculated as [(actual weight-desired weight)/actual weight] × 100.

Results: At admission, participants were approximately 78.6% of a healthy BMI and desired to be 81% of a healthy BMI. During the year following treatment, participants were 89% of a healthy BMI, but wanted to be 86% of a healthy BMI. Individuals with lower desired weight percentage (wanting to be a lower percentage of a healthy BMI) or higher weight difference percentage (wanting to lose a larger percentage of weight) at treatment admission endorsed greater eating disorder severity across time. Additionally, individuals with higher desired weight percentage or weight difference percentage had higher BMIs at intake, and greater increases in BMI over time.

Discussion: Results highlight that desired weight constructs represent correlates of illness severity in AN and may inform an individual's likely weight trajectory during and after treatment.
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http://dx.doi.org/10.1002/eat.22879DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6222021PMC
August 2018

Associations Between Neural Reward Processing and Binge Eating Among Adolescent Girls.

J Adolesc Health 2018 01 17;62(1):107-113. Epub 2017 Oct 17.

Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.

Purpose: Neuroimaging studies suggest that altered brain responses to food-related cues in reward-sensitive regions characterize individuals who experience binge-eating episodes. However, the absence of longitudinal data limits the understanding of whether reward-system alterations increase vulnerability to binge eating, as theorized in models of the development of this behavior.

Methods: Adolescent girls (N = 122) completed a functional magnetic resonance imaging monetary reward task at age 16 years as part of an ongoing longitudinal study. Self-report of binge eating was assessed using the Eating Attitudes Test at ages 16 and 18 years. Regression analyses examined concurrent and longitudinal associations between the blood-oxygenation-level-dependent response to anticipating and winning monetary rewards and the severity of binge eating while controlling for age 16 depressive symptoms and socioeconomic status.

Results: Greater ventromedial prefrontal cortex and caudate responses to winning money were correlated with greater severity of binge eating concurrently but not prospectively.

Conclusions: This study is the first to examine longitudinal associations between reward responding and binge eating in community-based, mostly low-socioeconomic status adolescent girls. Ventromedial prefrontal cortex response to reward outcome-possibly reflecting an enhanced subjective reward value-appears to be a state marker of binge-eating severity rather than a predictor of future severity.
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http://dx.doi.org/10.1016/j.jadohealth.2017.08.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5742026PMC
January 2018

Identification and regulation of emotions in adults of varying weight statuses.

J Health Psychol 2019 06 5;24(7):941-952. Epub 2017 Feb 5.

2 Clinical Neuroscience Research Unit, Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, USA.

Comparing individuals of varying weight statuses on their identification and regulation of emotions may increase our understanding of mechanisms that drive excess weight gain and highlight more precise weight regulation targets. In Study I ( N = 1333), adults with obesity had reduced self-reported attention to and repair of emotions compared to adults with overweight or normal weight. In Study II ( N = 85), adults with obesity had deficits in assessor-administrated tasks of strategic emotional intelligence (i.e. understanding and using emotional information for self-management). Problems identifying and regulating emotions could impact emotion regulation processes that lead to problematic behaviors associated with eating and weight gain.
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http://dx.doi.org/10.1177/1359105316689604DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5882581PMC
June 2019

Associations between Race and Eating Disorder Symptom Trajectories in Black and White Girls.

J Abnorm Child Psychol 2018 04;46(3):625-638

Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.

Epidemiological research suggests racial differences in the presentation of eating disorder symptoms. However, no studies have examined associations between race and eating disorder symptom trajectories across youth and adolescence, which is necessary to inform culturally sensitive prevention programs. The purpose of the current study was to examine the trajectories of eating disorder symptoms from childhood to young adulthood and to examine whether race was associated with trajectory group membership. Data were drawn from 2,305 Black and White girls who participated in a community-based longitudinal cohort study (Pittsburgh Girls Study) examining the development of psychopathology. The child and adult versions of the Eating Attitudes Test assessed self-reported eating disorder symptoms at six time points between ages 9 and 21 years. Growth mixture modeling was used to examine developmental trajectories of dieting, bulimia/food preoccupation, and total eating disorder symptom scores. Given potential confounds with race and disordered eating, financial strain (i.e., receiving public assistance) and weight were included as covariates. Four to six distinct developmental patterns were found across eating disorder symptoms, including none, increasing, decreasing, or increasing-decreasing trajectories. Black girls had a greater likelihood of being in the decreasing trajectories for dieting, bulimia/food preoccupation, and total eating disorder symptom scores. White girls were more likely to follow increasing trajectories of dieting and total eating disorder symptom scores compared to Black girls. These results highlight the importance of examining the influence of racial background on eating disorder symptoms and the potential need for differences in the timing and focus of prevention interventions in these groups.
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http://dx.doi.org/10.1007/s10802-017-0322-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6063089PMC
April 2018

Relationship between desired weight and eating disorder pathology in youth.

Int J Eat Disord 2017 08 21;50(8):963-969. Epub 2017 Apr 21.

Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois.

Objective: Individuals with eating disorders (ED), particularly anorexia nervosa (AN), and bulimia nervosa (BN), often wish to reduce their body weight in pursuit of a thin ideal, but no study has examined the relation between desired weight and ED pathology in a clinical population of youth. Given the potential impact of desired weight on normalization of eating patterns and weight restoration, we examined the relation between desired weight and ED pathology in youth with AN or BN.

Methods: Participants were 340 youth presenting to an outpatient ED clinical research program. Height and weight were measured, and youth completed the Eating Disorder Examination. Desired weight was operationalized as "desired weight percentage" (calculated as a percentage of expected body weight [EBW]) and "weight difference percentage" (actual weight minus desired weight, divided by actual weight and multiplied by 100).

Results: Youth with AN desired to be a lower percentage of their EBW than youth with BN (p < .001). However, youth with AN, on average, wanted to gain 5.28% of their body weight and youth with BN wanted to lose 13.60% (p < .001). Desired weight percentage and weight difference percentage were associated with greater ED psychopathology, controlling for ED diagnosis, age, and sex (ps < .001).

Discussion: Desired weight is associated with elevated ED psychopathology. Weight goals may shift as individuals progress through treatment; if they do not, then desired weight may be an important indicator of a lack of psychological progress.
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http://dx.doi.org/10.1002/eat.22720DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5545974PMC
August 2017

Intermittent explosive disorder and eating disorders: Analysis of national comorbidity and research samples.

Compr Psychiatry 2017 05 2;75:62-67. Epub 2017 Mar 2.

Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA.

Objective: Clinical studies suggest comorbidity between eating disorders and aggressive behaviors. This study examined the pattern of comorbidity between intermittent explosive disorder (IED) and eating disorders (ED).

Methods: Data were analyzed from both the adult and adolescent samples of the National Comorbidity Survey-Replication (n = 19,430) and a clinical research sample (n = 1,642).

Results: Lifetime prevalence of Any ED was elevated in IED vs. non-IED for both the community and clinical research samples. Though anorexia nervosa displayed no relationship with IED in either sample, bulimia nervosa was associated with IED in the community sample and binge eating disorder was associated with IED in both the community and clinical research samples. Onset of IED preceded onset of Any ED in at least 70% of comorbid IED/ED cases in both community and clinical research samples. Associations of IED with Any ED and bulimia nervosa in the community sample, and associations of IED with binge eating disorder in the clinical research sample, remained significant after controlling for other psychiatric disorders.

Conclusions: Individuals with IED are more likely to report lifetime prevalence of ED, particularly bulimic spectrum disorders. This finding, and the observation that the onset of IED occurs prior to the onset of ED in the majority of individuals, suggests that longitudinal studies are needed to clarify this relationship and determine whether IED is a risk factor for the development of ED. Early identification of individuals with IED or impulsive aggression may provide clinically useful information to determine most effective treatment interventions.
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http://dx.doi.org/10.1016/j.comppsych.2017.02.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5410643PMC
May 2017

Concurrent and prognostic utility of subtyping anorexia nervosa along dietary and negative affect dimensions.

J Consult Clin Psychol 2017 Mar;85(3):228-237

Department of Psychiatry, University of Pittsburgh.

Bulimia nervosa can be reliably classified into subtypes based on dimensions of dietary restraint and negative affect. Community and clinical studies have shown that dietary-negative affect subtypes have greater test-retest reliability and concurrent and predictive validity compared to subtypes based on the Diagnostic and Statistical Manual of Mental Disorders (DSM). Although dietary-negative affect subtypes have shown utility for characterizing eating disorders that involve binge eating, this framework may have broader implications for understanding restrictive eating disorders.

Objective: The purpose of this study was to test the concurrent and predictive validity of dietary-negative affect subtypes among patients with anorexia nervosa (AN; N = 194).

Method: Latent profile analysis was used to identify subtypes of AN based on dimensions of dietary restraint and negative affect. Chi-square and multivariate analysis of variance were used to characterize baseline differences between identified subtypes. Structural equation modeling was used to test whether dietary-negative affect subtypes would outperform DSM categories in predicting clinically relevant outcomes.

Results: Results supported a 2-profile model that replicated dietary-negative affect subtypes: Latent Profile 1 (n = 68) had clinically elevated scores on restraint only; Latent Profile 2 (n = 126) had elevated scores on both restraint and negative affect. Validation analyses showed that membership in the dietary-negative affect profile was associated with greater lifetime psychiatric comorbidity and psychosocial impairment compared to the dietary class. Dietary-negative affect subtypes only outperformed DSM categories in predicting quality-of-life impairment at 1-year follow-up.

Conclusions: Findings highlight the clinical utility of subtyping AN based on dietary restraint and negative affect for informing future treatment-matching or personalized medicine strategies. (PsycINFO Database Record
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http://dx.doi.org/10.1037/ccp0000164DOI Listing
March 2017

Characterizing severe and enduring anorexia nervosa: An empirical approach.

Int J Eat Disord 2017 Apr 19;50(4):389-397. Epub 2016 Dec 19.

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

Targeted approaches for the treatment of severe and enduring anorexia nervosa (SE-AN) have been recommended, but there is no consensus definition of SE-AN to inform research and clinical practice. This study aimed to take initial steps toward developing an empirically based definition of SE-AN by characterizing associations among putative indicators of severity and chronicity in eating disorders. Patients with AN (N = 355) completed interviews and questionnaires at treatment admission and discharge; height and weight were assessed to calculate body mass index (BMI). Structural equation mixture modeling was used to test whether associations among potential indicators of SE-AN (illness duration, treatment history, BMI, binge eating, purging, quality-of-life) formed distinct subgroups, a single group with one or more dimensions, or a combination of subgroups and dimensions. A three-factor (dimensional), two-profile (categorical) mixture model provided the best fit to the data. Factor 1 included eating disorder behaviors; Factor 2 comprised quality-of-life domains; Factor 3 was characterized by illness duration, number of hospitalizations, and admission BMI. Profiles differed on eating disorder behaviors and quality-of-life, but not on indicators of chronicity or BMI. Factor scores, but not profile membership, predicted outcome at discharge from treatment. Data suggest that patients with AN can be classified on the basis of eating disorder behaviors and quality-of-life, but there was no evidence for a chronic subgroup of AN. Rather, indices of chronicity varied dimensionally within each class. Given that current definitions of SE-AN rely on illness duration, these findings have implications for research and clinical practice.
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http://dx.doi.org/10.1002/eat.22651DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5386793PMC
April 2017

Application of structural equation mixture modeling to characterize the latent structure of eating pathology.

Int J Eat Disord 2017 05 12;50(5):542-550. Epub 2016 Nov 12.

Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois.

Objective: Several theoretical models describe the structure of eating disorders (EDs), and a burgeoning empirical literature has sought to identify whether eating pathology is conceptualized best as categorical (presence or absence of disorder), dimensional (continuous), or a hybrid of categories and dimensions.

Methods: This study used structural equation mixture modeling (SEMM) to identify the latent structure of EDs. Items from the Eating Pathology Symptoms Inventory (EPSI) were administered to individuals with EDs (N = 344). Select EPSI scales and body mass index were indicators in subsequent SEMM analyses. The Inventory of Depression and Anxiety Symptoms (IDAS), ED diagnoses, and select demographic variables were used as validators using chi-square or MANOVA.

Results: Categorical models fit the data better than latent dimensional or hybrid models. Latent profile 1 (LP1) was non-fat-phobic restricting anorexia nervosa; LP2, an obese, binge-eating class; LP3, non-purging bulimia nervosa; LP4, fat-phobic restricting anorexia nervosa; and LP5, multiple purging bulimia nervosa. External validation analyses indicated that LP4 and LP5 had the highest non-ED-related psychopathology.

Discussion: These findings indicate that there is substantial variability in the phenomenology of traditional DSM-based ED categories across latent profiles, and highlight the salience of certain ED phenotypes that have been debated in the literature. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:542-550).
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http://dx.doi.org/10.1002/eat.22634DOI Listing
May 2017

Alterations in emotion generation and regulation neurocircuitry in depression and eating disorders: A comparative review of structural and functional neuroimaging studies.

Neurosci Biobehav Rev 2016 Sep 12;68:911-927. Epub 2016 Jul 12.

Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States; The Center for the Neural Basis of Cognition, Pittsburgh, PA, United States.

Major depression and eating disorders (EDs) are highly co-morbid and may share liability. Impaired emotion regulation may represent a common etiological or maintaining mechanism. Research has demonstrated that depressed individuals and individuals with EDs exhibit impaired emotion regulation, with these impairments being associated with changes in brain structure and function. The goal of this review was to evaluate findings from neuroimaging studies of depression and EDs to determine whether there are overlapping alterations in the brain regions known to be involved in emotion regulation, evidence of which would aid in the diagnosis and treatment of these conditions. Our review of the literature suggests that depression and EDs exhibit common structural and functional alterations in brain regions involved in emotion regulation, including the amygdala, ventral striatum and nucleus accumbens, anterior cingulate cortex, insula, and dorsolateral prefrontal cortex. We present preliminary support for a shared etiological mechanism. Future studies should consider manipulating emotion regulation in a sample of individuals with depression and EDs to better characterize abnormalities in these brain circuits.
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http://dx.doi.org/10.1016/j.neubiorev.2016.07.011DOI Listing
September 2016

Examining weight suppression as a predictor of eating disorder symptom trajectories in anorexia nervosa.

Int J Eat Disord 2016 Aug 16;49(8):753-63. Epub 2016 Apr 16.

Department of Psychiatry, University of Pittsburgh School of Medicine and Western Psychiatric Institute and Clinic of UPMC, Pittsburgh, PA, 15213.

Objective: Research in individuals with bulimia nervosa has highlighted the clinical significance of weight suppression (WS), defined as the difference between one's highest and current weight. More recently, studies have suggested that WS also may play a role in symptom maintenance and weight gain during treatment in anorexia nervosa (AN) and that the influence of WS on AN outcomes may depend on an individual's body mass index (BMI). However, no study has investigated whether WS or the interaction between WS and BMI is associated with the longer-term course of eating pathology following treatment discharge in patients with AN.

Method: The current study examined a sample of females with AN (N = 180) who completed interviews and self-report questionnaires at discharge from intensive treatment and at 3, 6, and 12-months after discharge. Latent growth curve models tested whether WS, BMI, or the WS by BMI interaction significantly predicted the trajectory of eating disorder symptoms (i.e., Eating Disorder Examination global score, BMI, frequency of loss of control eating, frequency of purging) over the year following discharge.

Results: WS at discharge predicted change in BMI, and the interaction between WS and BMI predicted growth in eating disorder severity and purging frequency over time. Neither WS nor its interaction with BMI predicted growth in loss of control eating frequency.

Discussion: Results provide further support for the clinical significance of WS in AN symptom maintenance, but suggest that the influence of WS likely depends on an individual's BMI as well as the outcome being measured. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016; 49:753-763).
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http://dx.doi.org/10.1002/eat.22545DOI Listing
August 2016

Voluntary emotion regulation in anorexia nervosa: A preliminary emotion-modulated startle investigation.

J Psychiatr Res 2016 Jun 23;77:1-7. Epub 2016 Feb 23.

Department of Psychology, University of North Carolina-Greensboro, Greensboro, NC, USA.

Emotion regulation difficulties are implicated in the development and maintenance of anorexia nervosa (AN). However, research has been limited by an almost exclusive reliance on self-report. This study is the first to use the emotion-modulated startle paradigm (EMSP) to investigate emotional reactivity and voluntary emotion regulation in individuals with AN. Twenty women with AN viewed negative, positive, neutral, and food images and were asked to enhance, suppress, or maintain their emotional responses mid-way through picture presentation. Startle eyeblink magnitudes in response to startle probes administered prior, and subsequent, to regulation instructions indexed emotional reactivity and regulation, respectively. On emotional reactivity trials, startle magnitudes were greater for negative, positive, and food images, compared to neutral images. Participants had difficulty suppressing startle responses to negative and food images, as indicated by non-significant suppress-maintain comparisons. In contrast, startle responses to enhance and suppress cues during presentation of pleasant images were comparable and significantly lower than maintain cues. Findings converge with self-report data to suggest that patients with AN have difficulties with voluntary emotion regulation. The EMSP may be a promising trans-diagnostic method for examining emotion regulation difficulties that underlie risk for eating disorders and other psychiatric conditions.
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http://dx.doi.org/10.1016/j.jpsychires.2016.02.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4826846PMC
June 2016

Application of the Research Domain Criteria (RDoC) framework to eating disorders: emerging concepts and research.

Curr Psychiatry Rep 2015 May;17(5):30

Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic of UPMC, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA,

The Research Domain Criteria (RDoC) project was initiated by the National Institute of Mental Health as a heuristic for addressing the limitations of categorical, symptom-based psychiatric diagnoses. RDoC is conceptualized as a matrix, with the rows representing dimensional constructs or domains implicated in the expression of psychiatric symptoms and the columns representing units of analysis that can be used to assess dimensional constructs (i.e., genes, molecules, cells, circuits, physiology, behavior, and self-reports). Few studies in eating disorders have adopted an RDoC framework, but accumulating data provide support for the relevance of RDoC dimensions to eating disorder symptoms. Herein, we review findings from RDoC-informed studies across the five domains of functioning included in the RDoC matrix-negative valence systems, positive valence systems, cognitive systems, systems for social processes, and arousal and regulatory systems-and describe directions for future research utilizing RDoC to enhance study design and treatment development in eating disorders.
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http://dx.doi.org/10.1007/s11920-015-0572-2DOI Listing
May 2015

Emotion dysregulation and anorexia nervosa: an exploration of the role of childhood abuse.

Int J Eat Disord 2015 Jan 31;48(1):55-8. Epub 2014 Oct 31.

Department of Psychology, Ohio University, Athens, Ohio; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

Objective: Theoretical models of emotion regulation difficulties in anorexia nervosa (AN) specify a role for factors that predispose to or precipitate emotion dysregulation. The current study considered whether childhood abuse (i.e., emotional, sexual, physical) might be related to emotion regulation difficulties and eating disorder symptom severity in patients with AN. Childhood abuse was hypothesized to relate to AN symptoms indirectly via emotion dysregulation.

Method: Participants were 188 patients with AN presenting to an intensive treatment facility. The Childhood Trauma Questionnaire, Difficulties in Emotion Regulation Scale, and Eating Disorder Examination were used to assess childhood abuse, emotion dysregulation, and AN symptom severity, respectively.

Results: Of the three forms of childhood abuse, reports of emotional abuse were most strongly related to emotion regulation difficulties and AN symptom severity. Mediation analyses revealed that emotion dysregulation significantly explained the relationship between childhood emotional abuse and AN symptomatology, and mediation effects did not differ by AN subtype (i.e., restricting vs. binge-eating/purging).

Discussion: Findings provide initial support for a model in which childhood emotional abuse precipitates emotion dysregulation and the development of AN. Future studies with longitudinal designs and control groups are necessary to examine the direction and specificity of these cross-sectional associations
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http://dx.doi.org/10.1002/eat.22364DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4404145PMC
January 2015

Disordered eating in obese individuals.

Curr Opin Psychiatry 2014 Nov;27(6):443-7

Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.

Purpose Of Review: This article provides an overview of current thinking about the association between disordered eating and obesity, emphasizing binge eating, binge eating disorder and food addiction as useful conceptual models.

Recent Findings: Binge eating, recurrent and persistent episodes of overeating coupled with a lack of control over eating, and binge eating disorder, the Diagnostic and Statistical Manual-5 mental disorder, have been a major focus of work to clarify the relationship between disordered eating and obesity. A second focus has been the addiction model of aberrant eating, which posits that recurrent overeating of palatable food is similar to addictive behavior and characterized by dysregulation of the dopaminergic reward system. We describe efforts to integrate these models by focusing on binge eating phenotypes as the subgroup of obese individuals characterized by disordered eating. Examples of empirical work based on these models are provided, as well as selected studies that reflect the burgeoning literature focusing on addictive and feeding behaviors across multiple domains and levels of analysis.

Summary: Research evidence to explain similarities and differences across levels of BMI and varying aspects of feeding behavior may promote the identification of novel interventions that address weight and eating problems.
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http://dx.doi.org/10.1097/YCO.0000000000000103DOI Listing
November 2014

COMT met allele differentially predicts risk versus severity of aberrant eating in a large community sample.

Psychiatry Res 2014 Dec 27;220(1-2):513-8. Epub 2014 Aug 27.

Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA.

Prefrontal dopamine (DA) transmission participates in the reinforcement of reward-driven behaviors like eating. Because catechol-O-methyltransferase (COMT) degrades DA and is expressed in the prefrontal cortex, variation in the COMT gene may modulate eating behavior. Previous studies have shown that the met allele of the COMT val158met single nucleotide polymorphism (SNP) is associated with Bulimia Nervosa (BN). The specific aim of this study was to test whether the met allele increased risk for, and severity of, eating disorder symptomatology in community volunteers. Caucasian adults (N=1003; 51.2% female) from the University of Pittsburgh Adult Health and Behavior Project (AHAB) were genotyped and completed the Eating Disorders Inventory (EDI). Logistic and Poisson regression analyses assessed genotype-dependent presence and severity of eating disorder symptomatology. The met allele was significantly associated with the presence of symptoms on the Bulimia subscale and the severity of Body Dissatisfaction scores. All EDI subscales significantly predicted BMI. To our knowledge, these are the first data indicating that the COMT met allele increases risk for some symptoms of disordered eating, while increasing severity of others, in a community sample. These novel findings may have important implications for understanding the etiology of heterogeneous disordered eating phenotypes.
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http://dx.doi.org/10.1016/j.psychres.2014.08.037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4252581PMC
December 2014

Dynamic longitudinal relations between emotion regulation difficulties and anorexia nervosa symptoms over the year following intensive treatment.

J Consult Clin Psychol 2015 Aug 1;83(4):785-95. Epub 2014 Sep 1.

Department of Psychiatry, University of Pittsburgh School of Medicine.

Objective: Emotion regulation difficulties have been implicated in theoretical models of anorexia nervosa (AN) development/maintenance, and several treatments for AN have been designed to target emotion dysregulation. However, no research has used longitudinal methodology to examine whether emotion regulation difficulties predict the maintenance of AN symptoms, or vice versa. The current study evaluated dynamic longitudinal relations between emotion dysregulation and AN symptom severity over the year following discharge from intensive treatment in order to enhance theoretical models and treatments for AN.

Method: Participants were 191 patients with AN recruited during intensive treatment. Assessments including the Eating Disorders Examination and the Difficulties in Emotion Regulation Scale were completed at discharge from treatment and at 3-, 6-, and 12-month follow-ups. Bivariate latent change score models were used to examine the direction of associations between emotion dysregulation and AN symptom severity across time.

Results: Emotion dysregulation predicted change in AN symptom severity, but the reverse relationship did not occur. Individuals with high levels of emotion dysregulation experienced an increase and subsequent maintenance of AN psychopathology, whereas low emotion dysregulation predicted a decreasing AN symptom trajectory. Importantly, these dynamic temporal relationships could not be accounted for by body mass index or depressive symptoms and were present for patients with the restricting and binge-eating/purging subtypes of AN.

Conclusions: Emotion regulation difficulties appear to be involved in the maintenance of AN symptom severity over time. Findings provide support for an increasing emphasis on emotion regulation in the development of novel treatments for AN.
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http://dx.doi.org/10.1037/ccp0000011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4345157PMC
August 2015
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