Bárbara César Machado

International comparisons of behavioral and emotional problems in preschool children: Parents' reports from 24 societies

International comparisons were conducted of preschool childrens behavioral and emotional problems as reported on the Child Behavior Checklist for Ages 1½–5 by parents in 24 societies (N = 19,850). Item ratings were aggregated into scores on syndromes; Diagnostic and Statistical Manual of Mental Disorders–oriented scales; a Stress Problems scale; and Internalizing, Externalizing, and Total Problems scales. Effect sizes for scale score differences among the 24 societies ranged from small to medium (3–12%). Although societies differed greatly in language, culture, and other characteristics, Total Problems scores for 18 of the 24 societies were within 7.1 points of the omnicultural mean of 33.3 (on a scale of 0–198). Gender and age differences, as well as gender and age interactions with society, were all very small (effect sizes < 1%). Across all pairs of societies, correlations between mean item ratings averaged .78, and correlations between internal consistency alphas for the scales averaged .92, indicating that the rank orders of mean item ratings and internal consistencies of scales were very similar across diverse societies.

Behavioral/Emotional Problems of Preschoolers: Caregiver/Teacher Reports From 15 Societies

This study tested societal effects on caregiver/teacher ratings of behavioral/emotional problems for 10,521 preschoolers from 15 societies. Many societies had problem scale scores within a relatively narrow range, despite differences in language, culture, and other characteristics. The small age and gender effects were quite similar across societies. The rank orders of mean item ratings were similar across diverse societies. For 7,380 children from 13 societies, ratings were also obtained from a parent. In all 13 societies, mean Total Problems scores derived from parent ratings were significantly higher than mean Total Problems scores derived from caregiver/teacher ratings, although the size of the difference varied somewhat across societies. Mean cross-informant agreement for problem scale scores varied across societies. Societies were very similar with respect to which problem items, on average, received high versus low ratings from parents and caregivers/teachers. Within every society, cross-informant agreement for item ratings varied widely across children. In most respects, results were quite similar across 15 very diverse societies.

Prevalence and correlates of picky eating in preschool-aged children: A population-based study.

OBJECTIVE The present study, conducted with a population-based preschool children sample, aimed to examine the prevalence rates of picky eating according to the presence of the avoidance or restriction of food intake, searching for picky-eating correlates. METHODS 959 children from 1.5 to 6years old were evaluated by their parents and caregivers/teachers. Picky eating was assessed by CBCL 1.5-5 and C-TRF, following Cano et al.s (2015) procedure. RESULTS The prevalence of picky eating was 25.1%. The comparison of the picky-eating group and the non-picky-eating group indicated that picky eating was more common in older children and in children from lower-income families with younger parents. Significant associations were found between picky eating, pregnancy and birth delivery complications. Emotional and behavioral problems were also found to differentiate picky eaters and non-picky eaters using DSM-5-oriented subscales. The results of a binary logistic regression analysis revealed that children with somatic complaints and attention problems were more likely to be picky eaters. DISCUSSION Picky eating in preschool children should be considered together with sociodemographic features, pregnancy and delivery issues, and the presence of emotional and behavioral problems. Our results support the possibility that picky eating, as a specific eating pattern, could also be part of a broader pattern of behavioral problems in children.

The Moderating Role of Purging Behaviour in the Relationship Between Sexual/Physical Abuse and Nonsuicidal Self-Injury in Eating Disorder Patients.

This study sought to examine predictors of nonsuicidal self-injury (NSSI) in eating disorder patients and to evaluate the moderating role of purging behaviours in the relationship between a theorised predictor (i.e. sexual/physical abuse) and NSSI. Participants in this study were 177 female patients with eating disorders (age range = 14-38 years) who completed semistructured interviews assessing eating disorder symptoms and eating disorder-related risk factors (e.g. history of sexual and physical abuse, history of NSSI and feelings of fatness). Results revealed that 65 participants (36.7%) reported lifetime engagement in NSSI, and 48 participants (27.1%) reported a history of sexual/physical abuse. Early onset of eating problems, lower BMI, feeling fat, a history of sexual/physical abuse and the presence of purging behaviours were all positively associated with the lifetime occurrence of NSSI. The relationship between sexual/physical abuse before eating disorder onset and lifetime NSSI was moderated by the presence of purging behaviours, such that the relationship was stronger in the absence of purging. These findings are consistent with the notion that purging and NSSI may serve similar functions in eating disorder patients (e.g. emotion regulation), such that the presence of purging may attenuate the strength of the association between sexual/physical abuse history (which is also associated with elevated NSSI risk) and engagement in NSSI behaviours.

Dysfunctional eating behaviour, psychological well-being and adaptation to pregnancy: A study with women in the third trimester of pregnancy.

This study evaluated the prevalence and predictors of dysfunctional eating. Women in the third trimester of pregnancy participated in this study (N = 105). Dysfunctional eating was associated with a higher body mass index, enhanced negative body image, more somatic symptoms, poorer marital relationships, more negative attitudes regarding pregnancy and the baby and more emotional problems. A higher body mass index prior to the pregnancy, higher weight gain during pregnancy and a more negative perception of body image predicted dysfunctional eating. Clinicians must be aware of the presence of dysfunctional eating during pregnancy to prevent relevant physiological and psychosocial consequences during this stage.

Retrospective correlates for bulimia nervosa: a matched case-control study

OBJECTIVE There have been few studies investigating the risk factors for bulimia nervosa (BN), and most have been in Anglo-Saxon countries. This study aimed to (i) replicate the uncontested retrospective correlates for BN and clarify the role of factors with inconsistent findings and (ii) evaluate the strength of these factors in a different culture. METHOD A case-control design was used to compare 60 women who met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for BN to 60 healthy controls and 60 participants with other psychiatric disorders. Retrospective correlates were assessed by interviewing each person with the Oxford Risk Factor Interview. RESULTS The primary retrospective correlates identified from the comparison of BN participants to healthy controls were general high maternal expectations, negative attitudes about parental weight and obesity in childhood and adolescence. Compared with participants with other psychiatric disorders, those with BN also reported higher rates of childhood obesity, deliberate self-harm, family conflicts, general high maternal expectations and feeling fat in childhood. CONCLUSIONS The common findings across cultures suggest that, at least, individuals subjectively experience a number of similar factors that increase risk for developing BN. In addition, the difference regarding self-harm is notable.

Eating and weight/shape criticism as a specific life-event related to bulimia nervosa: a case control study

ABSTRACT The present study aims to evaluate the occurrence of life events preceding the onset of eating problems in bulimia nervosa patients. A case-control design was used involving the comparison of 60 female subjects who meet DSM-IV criteria for bulimia nervosa with 60 healthy control subjects and 60 subjects with other psychiatric disorders. The RFI (Fairburn et al., 1998) subset of factors that represent exposure to life events in the 12 months immediately before the development of eating problems was used. Women with bulimia nervosa reported higher rates of major stress, criticism about eating, weight and shape and also a great number of antecedent life events during the year preceding the development of eating problems than the healthy control group. However, when compared with the general psychiatric control group only the exposure to critical comments about weight, shape, or eating emerged as a specific trigger for bulimia nervosa. Our findings support the fact that eating and shape/weight criticism in the year preceding the development of eating disturbance seems to be specifically related to bulimia nervosa.

Eating disorders and non-suicidal self-injury: Structural equation modelling of a conceptual model

Evidence suggests several risk factors for both eating disorders (ED) and nonsuicidal self-injury (NSSI), but the relationships between these factors are not well understood. Considering our previous work and a conceptual model, this cross-sectional study aimed to assess the relationships among distal and proximal factors for the presence of NSSI in ED. We assessed 245 ED patients with the Oxford Risk Factor Interview for ED. Structural equation modelling revealed that both distal and proximal factors were related to the presence of NSSI in ED, disclosing a mediating role of the proximal factors. Stressful life events mediated the relationship between childhood sexual abuse, peer aggression, and both ED and NSSI. Childhood physical abuse was related to ED and NSSI via substance use, negative self-evaluation, and suicide attempts. Findings provided support for the conceptual model and highlight the possible mechanisms by which psychosocial factors may lead to ED and NSSI.

Psychometric properties of the Portuguese version of the Invalidating Childhood Environment Scale

Purpose The current study aimed to examine the psychometric properties of the Portuguese version of the invalidating childhood environment scale (ICES) in a non-clinical and clinical sample of eating disorder (ED) patients. This study also investigated the between-sample differences regarding invalidating parental behaviors and family styles and explored the associations between invalidating childhood environments and eating pathology. Methods A sample of 410 high school and college students and 101 patients with a diagnosis of ED completed self-report measures. Principal component analyses and confirmatory factor analyses were conducted to examine the factor structure of the ICES. The internal consistency and the between-sample differences and associations between invalidating childhood environments and eating pathology were also tested. Results Principal component analyses and confirmatory factor analyses indicated a two-factor solution for each parent. The ICES demonstrated high internal consistency and was able to differentiate between non-clinical and clinical samples. The perception of parental invalidation was higher in ED patients, and the clinical sample presented higher scores in the chaotic and perfect family styles and lower scores in the validating family style, in comparison with the non-clinical sample. Both maternal invalidation and invalidating styles were significantly associated with a higher ED symptomatology. Conclusions The Portuguese version of the ICES revealed adequate psychometric properties. Considering the relationship between invalidation in family and eating pathology, the ICES may be useful in clinical practice, especially among ED patients. Level of Evidence Level V, cross-sectional descriptive study.

Maternaly-child feeding practices and associations with maternal and child characteristics

We evaluated associations between maternal child-feeding practices and maternal (age, body mass index [BMI], education, disordered eating) and child (age, BMI, emotional and behavioral) characteristics in 412 mothers and their children using the Parental Feeding Practices, the Child Behavior Checklist, and the Eating Disorders Examination Questionnaires. Maternal BMI was positively correlated with covert control feeding practices. Younger maternal age and lower maternal educational level were associated with increased maternal pressure to eat and overt control in their child-feeding practices. Maternal disordered eating behaviors were associated with increased restriction and covert control in their child-feeding practices. Maternal monitoring during child feeding was associated with lower levels of the child’s problems with internalization and externalization. Finally, maternal feeding practices that involved covert control were related to higher eating restriction by the mother on herself and more maternal concern about her child’s weight. Our findings suggest that maternal feeding practices such as overt and covert control are related to both maternal and child factors. Clinicians must become aware that these maternal feeding practices can model children’s eating behavior and disrupt children’s self-regulation of food intake; however, maternal monitoring during child feeding seems to be related to children’s well-being.