Publications by authors named "Kara A Christensen"

16 Publications

  • Page 1 of 1

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

An empirical evaluation of the diagnostic threshold between full-threshold and sub-threshold bulimia nervosa.

Eat Behav 2021 08 13;42:101540. Epub 2021 Jul 13.

University of Kansas, United States of America.

Previous research has failed to find differences in eating disorder and general psychopathology and impairment between people with sub- and full-threshold bulimia nervosa (BN). The purpose of the current study was to test the validity of the distinction between sub- and full-threshold BN and to determine the frequency of objective binge episodes and inappropriate compensatory behaviors that would best distinguish between sub- and full-BN. Community-recruited adults (83.5% female) with current sub-threshold (n = 105) or full-threshold BN (n = 99) completed assessments of eating-disorder psychopathology, clinical impairment, internalizing problems, and drug and alcohol misuse. Receiver operating characteristic curve analysis was used to evaluate whether eating-disorder psychopathology, clinical impairment, internalizing problems, and drug and alcohol misuse could empirically discriminate between sub- and full-threshold BN. The frequency of binge episodes and inappropriate compensatory behaviors (AUC = 0.94) was "highly accurate" in discriminating between sub- and full-threshold BN; however, only objective binge episodes was a significant predictor of BN status. Internalizing symptoms (AUC = 0.71) were "moderately accurate" at distinguishing between sub- and full-BN. Neither clinical impairment (AUC = 0.60) nor drug (AUC = 0.56) or alcohol misuse (AUC = 0.52) discriminated between groups. Results suggested that 11 episodes of binge eating and 17 episodes of inappropriate compensatory behaviors optimally distinguished between sub- and full-BN. Overall, results provided mixed support for the distinction between sub- and full-threshold BN. Future research to clarify the most meaningful way to discriminate between sub- and full-threshold is warranted to improve the criterion-related validity of the diagnostic system.
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http://dx.doi.org/10.1016/j.eatbeh.2021.101540DOI Listing
August 2021

Measurement invariance of the Eating Pathology Symptoms Inventory (EPSI) in adolescents and adults.

Eat Behav 2021 08 2;42:101538. Epub 2021 Jul 2.

Recovery Record, Inc., San Francisco, CA, USA.

Adolescence is a common period for eating disorder (ED) onset. The availability of psychometrically sound measures of ED psychopathology enables clinicians to accurately assess symptoms and monitor treatment outcomes continuously from adolescence and adulthood. The purpose of this study was to assess if the Eating Pathology Symptoms Inventory (EPSI) is invariant across adolescents and adults. Participants (N = 29,821) were adolescent (n = 5250) and adult (n = 24,571) users of the Recovery Record (RR) mobile phone application who provided EPSI responses through the application. Measurement invariance testing was conducted to assess invariance of the EPSI Body Dissatisfaction, Restricting, Excessive Exercise, Purging, Cognitive Restraint, and Binge Eating scales across adolescents (age 13 through 17) and adults (age 18 and older). Findings indicated that all EPSI factors administered in the RR app replicated in both adolescent and adult users. The EPSI factor structure was largely equivalent in adolescents and adults, demonstrating evidence for configural and metric invariance, as well as some evidence for scalar invariance. Our results indicated that EPSI scales measured the same constructs across development. Clinicians and researchers may benefit from utilizing the EPSI to measure ED psychopathology in adolescents and for continued progress monitoring into adulthood.
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http://dx.doi.org/10.1016/j.eatbeh.2021.101538DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8518978PMC
August 2021

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

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

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

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

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

Evaluating associations between fitspiration and thinspiration content on Instagram and disordered-eating behaviors using ecological momentary assessment: A registered report.

Int J Eat Disord 2021 07 9;54(7):1307-1315. Epub 2021 Apr 9.

Research Design and Analysis Unit, Lifespan Institute, University of Kansas, Lawrence, Kansas, USA.

Introduction: Greater use of appearance-focused social media, such as Instagram, is associated with increased body dissatisfaction and eating disorder (ED) symptoms; however, questions remain about the mechanism connecting social media use to disordered-eating behaviors (DEBs). The proposed study evaluates how and for whom exposure to fitspiration or thinspiration on Instagram is associated with DEBs.

Methods: We will evaluate a hypothesized pathway from Instagram use to disordered-eating mediated by negative affect. We will test how individual differences in internalized weight stigma, trait self-esteem, and trait self-comparison moderate the pathway from social media use to negative affect. We will recruit 175 undergraduate women who report engaging in DEBs on average at least once per week over the past 3 months. Participants will complete a 7-day ecological momentary assessment protocol, during which they will report their Instagram use, affect, and engagement in DEBs.

Results: Multi-level modeling will be used to assess moderated mediation. Results from this study will provide increased specificity about how Instagram usage is linked to eating pathology and who may be most vulnerable to experiencing distress.

Discussion: Information about negative affect from Instagram and engagement in DEBs could contribute to the development of Just-In-Time Interventions for problematic social media use.
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http://dx.doi.org/10.1002/eat.23518DOI Listing
July 2021

The case for investigating a bidirectional association between insomnia symptoms and eating disorder pathology.

Int J Eat Disord 2021 05 4;54(5):701-707. Epub 2021 Mar 4.

Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.

Many people with eating disorders (EDs) report symptoms of insomnia (i.e., frequent difficulty falling asleep, staying asleep, and/or early morning wakening) and sleep problems have been linked to alterations in eating behaviors; however, mechanisms of these bidirectional associations remain poorly understood and under researched. This is a problem because higher insomnia symptom severity is a risk factor for the onset and perpetuation of anxiety, mood, trauma, and substance use disorders and, potentially, ED symptoms. Furthermore, insomnia symptoms may hinder recovery and increase relapse rates following successful psychotherapy. In this article, we describe potential mechanisms underlying bidirectional associations between insomnia and eating psychopathology that may contribute to the etiology and maintenance of both disorders. We suggest novel directions for future research to characterize the association between dysregulated sleep and ED symptoms and to evaluate impacts of insomnia symptoms on relapse and recovery for people with co-occurring pathology. Finally, we discuss options for testing the incorporation of existing evidence-based treatments for insomnia disorder (e.g., Cognitive-Behavioral Therapy for Insomnia) with ED care. Overall, insomnia symptoms present a promising intervention point for ED treatment that has not been systematically tested, yet would be highly feasible to address in routine clinical care.
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http://dx.doi.org/10.1002/eat.23498DOI Listing
May 2021

A single-case multiple baseline design for treating insomnia in eating disorders: The TIRED study.

Int J Eat Disord 2021 04 18;54(4):652-659. Epub 2020 Dec 18.

Department of Applied Behavioral Science, University of Kansas, Lawrence, Kansas, USA.

Objective: The purpose of this trial is to evaluate the novel use of an empirically supported treatment for sleep problems for people with residual insomnia disorder following ED treatment.

Method: Participants (N = 6) will complete a single-case multiple baseline study using Brief Behavioral Treatment for Insomnia (Buysse et al., Archives of Internal Medicine, 171, 2011, 887-895; Troxel et al., Behavioral Sleep Medicine, 10, 2012, 266-279). Participants will complete pre- and post-treatment evaluations of insomnia severity, sleep efficiency, daytime fatigue, ED symptoms, depressive symptoms, and anxiety symptoms. Throughout treatment, participants will complete daily diaries of sleep indices (sleep latency, wake after sleep onset, total sleep time, and sleep efficiency).

Results: The primary outcome will be treatment effects on insomnia severity, measured by the Insomnia Severity Index. Secondary outcomes include sleep efficiency and daytime fatigue. Exploratory outcomes include ED-related impairment and symptoms, anxiety symptoms, and depression symptoms. We will provide subject-level graphs of sleep indices and ED symptoms throughout treatment. Additionally, treatment effects will be examined at one- and three-month follow-up.

Discussion: Although insomnia treatments have been evaluated in other psychiatric disorders, there has yet to be a study examining behavioral interventions for insomnia in EDs. Results of this study will inform the development and application of interventions for residual insomnia symptoms in this population.
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http://dx.doi.org/10.1002/eat.23450DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8428790PMC
April 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

Multi-method assessment of palatable food exposure in women with and without eating disorders.

Eur Eat Disord Rev 2020 09 6;28(5):594-602. Epub 2020 Jul 6.

TEDp (Temple Eating Disorders Program), Temple University, 1701 North 13th Street, Philadelphia, Pennsylvania, 19122, USA.

Objective: Eating disorders (EDs) are characterized by dysregulated responses to palatable food. Using a multi-method approach, this study examined responses to palatable food exposure and subsequent ad libitum eating in women with binge-eating disorder (BED: n = 64), anorexia nervosa (AN: n = 16), and bulimia nervosa (BN: n = 35) and 26 healthy controls (HCs).

Method: Participants were exposed to palatable food followed by an ad libitum eating opportunity. Affective and psychophysiological responses were measured before and during the task.

Results: Participants with EDs reported greater negative affect, particularly fear, following the food cue exposure, whereas HCs reported no change. BN and BED groups reported greater urge to binge after the food cue exposure, whereas AN and HC groups reported no change. Respiratory sinus arrhythmia levels, skin conductance and tonic skin conductance levels increased during food exposure for all groups. Across baseline and during the food exposure, the BED group had lower respiratory sinus arrhythmia levels relative to the BN and HC groups. The BED group consumed significantly more palatable food than the AN group.

Conclusions: 'Palatable' food stimuli elicited more negative affect, particularly fear, in individuals with EDs; and this, rather than psychophysiological responses, distinguishes individuals with EDs from those without.
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http://dx.doi.org/10.1002/erv.2746DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8048030PMC
September 2020

A theoretical review of interpersonal emotion regulation in eating disorders: enhancing knowledge by bridging interpersonal and affective dysfunction.

J Eat Disord 2020 1;8:21. Epub 2020 Jun 1.

Department of Psychiatry and Behavioral Sciences, University of Minnesota, 2450 Riverside Ave, F253, Minneapolis, MN 55454 USA.

Individuals with eating disorders (EDs) frequently report interpersonal and affective dysfunction. A useful lens for uniting these ideas is through the framework of interpersonal emotion regulation (IER), which consists of the ways others assist a distressed individual and how this shapes his or her subsequent emotional, behavioral, and cognitive responses. In this theoretical review, we provide an overview of the rationale for exploring IER and review IER processes in this population using the framework of the Process Model of Emotion Regulation. Finally, we offer suggestions for next steps in conducting research. IER offers a parsimonious way to explore social and emotional constructs related to ED pathology and may provide potential targets for prevention and intervention in these difficult-to-treat disorders.
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http://dx.doi.org/10.1186/s40337-020-00298-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7262763PMC
June 2020

A preliminary systematic review and meta-analysis of randomized-controlled trials of cognitive remediation therapy for anorexia nervosa.

Eat Behav 2020 04 3;37:101391. Epub 2020 May 3.

Department of Psychology, University of Kansas, Lawrence, KS 66049, United States of America.

Cognitive remediation therapy (CRT) for anorexia nervosa (AN) was developed as an adjuvant treatment to target set-shifting and central coherence inefficiencies important in AN and to ultimately improve clinical outcomes of those with AN. The primary aim of this preliminary systematic review and meta-analysis was to determine the effect of CRT for AN relative to control treatments in randomized-controlled trials (RCTs) on neuropsychological inefficiencies at end-of-treatment. Secondary aims were to assess the effect of CRT for AN on dropout, eating-disorder-related, and other psychological outcomes at end-of-treatment. Systematic review and meta-analytic procedures were conducted in accordance with PRISMA Guidelines. RCTs evaluating CRT for AN compared to a control treatment were identified via ProQuest, PsycINFO, PubMed, and SCOPUS. Seven RCTs and one quasi-RCT of CRT for AN were included. RCT quality ratings ranged from fair (n = 3) to good (n = 4). Random-effects meta-analysis was conducted using Hedge's g. Study heterogeneity was assessed using I and publication bias was assessed with Begg's adjusted-rank correlation and the trim-and-fill method. CRT was not associated with improvement in central coherence compared to control treatments at end-of-treatment (g = 0.25, 95% CI = -0.35, 0.85, k = 3). Set-shifting outcomes were mixed due to heterogeneity of set-shifting measures across studies. CRT may prevent dropout; yet, more studies are needed to draw conclusions. CRT did not confer advantage over control treatments for eating-disorder-related and other psychological outcomes at end-of-treatment. Future RCTs of CRT for AN should use precise measures to assess constructs (particularly for set shifting), increase sample size, and implement longitudinal follow-up. (Word Count: 247 words).
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http://dx.doi.org/10.1016/j.eatbeh.2020.101391DOI Listing
April 2020

The posited effect of positive affect in anorexia nervosa: Advocating for a forgotten piece of a puzzling disease.

Int J Eat Disord 2019 09 30;52(9):971-976. Epub 2019 Jul 30.

Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey.

Anorexia nervosa (AN) is a complex and life-threatening eating disorder. Current models of AN onset and maintenance have largely focused on the role of negative affect, while fewer models have described the role of positive affect (PA). Given that these theoretical models have informed current treatment approaches, and that treatment remains minimally effective for adults with AN, we advocate that targeting PA is one avenue for advancing maintenance models and by extension, treatment. We specifically propose that AN may arise and be chronically and pervasively maintained as a function of dysregulated PA in response to weight loss and weight loss behaviors (e.g., restriction, excessive exercise), to a degree that is not accounted for in existing models of AN. We present evidence from multiple domains, including biological, behavioral, and self-report, supporting the hypothesis that PA dysregulation in AN contributes to the maintenance of the disorder. We conclude with several specific avenues for treatment development research as well as a call for future work elucidating the biological correlates of PA.
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http://dx.doi.org/10.1002/eat.23147DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7176354PMC
September 2019

Emotional feeding as interpersonal emotion regulation: A developmental risk factor for binge-eating behaviors.

Int J Eat Disord 2019 05 15;52(5):515-519. Epub 2019 Feb 15.

Department of Psychology, The Ohio State University, Columbus, Ohio.

Emotional feeding is an interpersonal emotion regulation strategy wherein people provide food to others as a means of influencing the recipient's emotional response. Parental emotional feeding has been linked to higher levels of emotional eating in children and adolescents using cross-sectional, retrospective, and prospective designs; however, there is little research on emotional feeding as a developmental risk factor for emotional eating and binge-eating behaviors in adolescence and adulthood. This Idea Worth Researching article explores the rationale for studying emotional feeding as a lifespan construct and its potential implications for understanding eating disorder pathology. Specifically, it offers suggestions for examining emotional feeding as a predictor of emotional eating and binge-eating behavior across the lifespan, assessing potential intergenerational transmission pathways, and researching similarities in feeding styles and emotional eating across a variety of relationships beyond the parent-child dyad.
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http://dx.doi.org/10.1002/eat.23044DOI Listing
May 2019

Habitual reappraisal in context: peer victimisation moderates its association with physiological reactivity to social stress.

Cogn Emot 2017 02 14;31(2):384-394. Epub 2015 Dec 14.

d Department of Psychology , University of Washington , Seattle , WA , USA.

Although the emotion regulation strategy of reappraisal has been associated with adaptive outcomes, there is a growing evidence that it may not be adaptive in all contexts. In the present study, adolescents reported their use of habitual reappraisal and their experiences with peer victimisation, a chronic stressor that is associated with reduced well-being in this population. We examined how these variables predicted physiological reactivity (vagal withdrawal and changes in pre-ejection period) during a social stressor (i.e., Trier Social Stress Task). In line with previous research, at high levels of victimisation, habitual reappraisal predicted adaptive physiological reactivity (i.e., greater vagal withdrawal). Conversely, at low levels of victimisation, habitual reappraisal predicted maladaptive physiological reactivity (i.e., blunted vagal withdrawal). These findings were specific to parasympathetic reactivity. They suggest that habitual reappraisal may exert different effects on parasympathetic reactivity depending on the presence of stressors, and highlight the importance of examining the role of contextual factors in determining the adaptiveness of emotion regulation strategies.
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http://dx.doi.org/10.1080/02699931.2015.1103701DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4907884PMC
February 2017

Loneliness mediates the relationship between emotion dysregulation and bulimia nervosa/binge eating disorder psychopathology in a clinical sample.

Eat Weight Disord 2014 Dec;19(4):509-13

Department of Psychology, The Ohio State University, 181 Psychology Building, 1835 Neil Ave, Columbus, OH 43210, USA.

Emotion dysregulation has been linked to binge eating disorder (BED) and bulimia nervosa (BN) although the mechanisms by which it affects BN/BED psychopathology are unclear. This study tested loneliness as a mediator between emotion dysregulation and BN/BED psychopathology. A treatment-seeking sample of 107 women with BN or BED was assessed for loneliness (UCLA Loneliness Scale), emotion dysregulation (Difficulties in Emotion Regulation Scale), and BN/BED psychopathology (Eating Disorder Examination) before treatment. Hierarchical linear regressions and bootstrapping mediation models were run. Greater overall emotion dysregulation was associated with greater BN/BED psychopathology, mediated by loneliness (95 % CI 0.03, 0.09). Emotion dysregulation, however, did not mediate between loneliness and BN/BED psychopathology (95 % CI −0.01, 0.01). Targeting loneliness may effectively treat emotional aspects of BN/BED in women.
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http://dx.doi.org/10.1007/s40519-013-0083-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5670737PMC
December 2014
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