C. Alix Timko

Craving Facebook? Behavioral addiction to online social networking and its association with emotion regulation deficits.

AIMS To assess disordered online social networking use via modified diagnostic criteria for substance dependence, and to examine its association with difficulties with emotion regulation and substance use. DESIGN Cross-sectional survey study targeting undergraduate students. Associations between disordered online social networking use, internet addiction, deficits in emotion regulation and alcohol use problems were examined using univariate and multivariate analyses of covariance. SETTING A large University in the Northeastern United States. PARTICIPANTS Undergraduate students (n = 253, 62.8% female, 60.9% white, age mean = 19.68, standard deviation = 2.85), largely representative of the target population. The response rate was 100%. MEASUREMENTS Disordered online social networking use, determined via modified measures of alcohol abuse and dependence, including DSM-IV-TR diagnostic criteria for alcohol dependence, the Penn Alcohol Craving Scale and the Cut-down, Annoyed, Guilt, Eye-opener (CAGE) screen, along with the Young Internet Addiction Test, Alcohol Use Disorders Identification Test, Acceptance and Action Questionnaire-II, White Bear Suppression Inventory and Difficulties in Emotion Regulation Scale. FINDINGS Disordered online social networking use was present in 9.7% [n = 23; 95% confidence interval (5.9, 13.4)] of the sample surveyed, and significantly and positively associated with scores on the Young Internet Addiction Test (P < 0.001), greater difficulties with emotion regulation (P = 0.003) and problem drinking (P = 0.03). CONCLUSIONS The use of online social networking sites is potentially addictive. Modified measures of substance abuse and dependence are suitable in assessing disordered online social networking use. Disordered online social networking use seems to arise as part of a cluster of symptoms of poor emotion regulation skills and heightened susceptibility to both substance and non-substance addiction.

Psychological Inflexibility and Symptom Expression in Anorexia Nervosa

The purpose of this article is to outline a model of anorexia nervosa (AN) as a disorder of psychological inflexibility, motivated by an insatiable desire for prediction and control with related intolerance for uncertainty. We describe preliminary data that provide initial support for this conceptualization and point to the ways in which mindfulness and acceptance-based strategies might be particularly useful for treating AN. This article is not intended to be an exhaustive literature review, rather a conceptual framework to guide future research and treatment development.

Pro-Eating Disorder Communities on Social Networking Sites: A Content Analysis

The purpose of this study was to assess the number of pro-ana groups on social networking sites and to analyze their content. A general inductive approach was used to analyze the content. Two main themes emerged from the content analysis: social support and eating disorder specific content. Themes were similar across all groups; however, a linguistic analysis indicated differences between groups on the two different networking sites. There was an absence of content typically found on Internet sites. Pro-ana groups on social networking sites are focused on social interactions, and lack eating disorder specific content found on Internet sites.

Acceptance and Commitment Therapy as a Novel Treatment for Eating Disorders: An Initial Test of Efficacy and Mediation.

Eating disorders are among the most challenging disorders to treat, with even state-of-the-art cognitive-behavioral treatments achieving only modest success. One possible reason for the high rate of treatment failure for eating disorders is that existing treatments do not attend sufficiently to critical aspects of the disorder such as high experiential avoidance, poor experiential awareness, and lack of motivation. These variables are explicit targets of Acceptance and Commitment Therapy (ACT). The current study examined the efficacy of an ACT-based group treatment for eating disorders by examining whether the addition of ACT groups to treatment-as-usual (TAU) at a residential treatment facility for eating disorders would improve treatment outcomes. TAU patients received an intensive residential treatment, while ACT patients received these services but additionally attended, depending on diagnosis, either ACT for anorexia nervosa groups or ACT for bulimia nervosa groups. Although individuals in both treatment conditions demonstrated large decreases in eating pathology, there were trends toward larger decreases among those receiving ACT. ACT patients also showed lower rates of rehospitalization during the 6 months after discharge. Overall, results suggest that ACT is a viable treatment option for individuals with eating pathology and further outcome research is warranted.

Attachment insecurities, maladaptive perfectionism, and eating disorder symptoms: A latent mediated and moderated structural equation modeling analysis across diagnostic groups

Although 96-100% of individuals with eating disorders (EDs) report insecure attachment, the specific mechanisms by which adult insecure attachment dimensions affect ED symptomatology remain to date largely unknown. This study examined maladaptive perfectionism as both a mediator and a moderator of the relationship between insecure attachment (anxiety and avoidance) and ED symptomatology in a clinical, treatment seeking, sample. Insecure anxious and avoidant attachment, maladaptive perfectionism, and ED symptomatology were assessed in 403 participants from three medium size specialized care centres for EDs in Italy. Structural equation modeling indicated that maladaptive perfectionism served as mediator between both insecure attachment patterns and ED symptomatology. It also interacted with insecure attachment to predict higher levels of ED symptoms - highlighting the importance of both insecure attachment patterns and maladaptive aspects of perfectionism as treatment targets. Multiple-group comparison analysis did not reveal differences across diagnostic groups (AN, BN, EDNOS) in mediating, main and interaction effects of perfectionism. These findings are consistent with recent discussions on the classification and treatment of EDs that have highlighted similarities between ED diagnostic groups and could be viewed through the lens of the Trans-theoretical Model of EDs. Implications for future research and intervention are discussed.

The relationship of sex and sexual orientation to self-esteem, body shape satisfaction, and eating disorder symptomatology

There is increasing interest in understanding what role, if any, sex and sexual orientation play in body dissatisfaction, its correlates to distress, and its relationship to disordered eating. The goals of the present study were to examine: (a) differences in sex and sexual orientation in internalization of societal pressure to modify physical appearance, components of body image dissatisfaction, self-esteem, and eating disorder symptomatology and (b) whether the internalization-eating disorder symptomatology was mediated by the different components of body image dissatisfaction and low self-esteem. The present data support several key trends in the literature: men generally reported less body dissatisfaction, internalization of socio-cultural standards of beauty, drive for thinness, and disordered eating, but a greater drive for muscularity than women; results also indicated that different components of body image dissatisfaction and low self-esteem partially mediated the relationship between internalization and eating disorder symptomatology. Gay men reported significantly more body dissatisfaction, internalization, eating disorder symptomatology, drive for thinness, and drive for muscularity than heterosexual men. Compared to heterosexual women, lesbians reported increased drive for muscularity, lower self-esteem, and lower internalization; however, they did not significantly differ on body dissatisfaction, drive for thinness or disordered eating. Correlation coefficients between body shape dissatisfaction and several aspects of mental distress were significantly larger for gay men than heterosexual men; the same coefficients did not differ between lesbian women and heterosexual women. Results of path analyses indicated that the relationship between internalization and disordered eating differs for gay and heterosexual men but not for lesbian and heterosexual women. These results call attention to lesbians as a generally understudied population.

Moderators of the Relationship Between Body Image Dissatisfaction and Disordered Eating

Various affective and personality variables may impact the relationship between body dissatisfaction and disordered eating symptomatology. The current study was a post-hoc analysis examining potential moderators (depression, anxiety, and impulsivity) of this relationship in college women. Four-hundred and seventy-two (472) enrolled college women between the ages of 18 and 55 participated in this study. Moderation analyses indicated that anxiety, depression, and dieting significantly moderated the relationship between body dissatisfaction and disordered eating, whereas impulsivity did not. Findings can be used to generate hypotheses for education and prevention programs on college campuses.

Implicit internalization of the thin ideal as a predictor of increases in weight, body dissatisfaction, and disordered eating

The freshman year of college has been identified as a time when some students experience large changes in their eating behaviors, body image, and weight. One factor that is predictive of changes in these variables is internalization of the thin ideal (i.e., the degree to which an individual has accepted societal values of thinness and applies these values to herself). However, given the limitation of self-report and previous research demonstrating the additional predictive validity implicit measurement provides, it may be important to develop an implicit paradigm for assessing internalization of the thin ideal. The Implicit Association Test is the most common implicit measurement technique. However this test is associational in nature, which reflects only one aspect of human cognition. The current study evaluates a newly-created implicit measure of internalization of the thin ideal that utilizes the Implicit Relational Assessment Procedure (IRAP). In particular, the study investigates concurrent and prospective associations between internalization of the thin ideal and disordered eating, body image dissatisfaction, and weight in a group of women at the beginning and end of their freshman year in college. Results of the study indicate that weight, disordered eating and body image dissatisfaction increased during the freshman year, and that these were predicted by implicit internalization of the thin ideal at the beginning of the year. Moreover, the new implicit measure was predictive above and beyond any predictive ability of the explicit measure. Results indicate that the thin ideal IRAP can successfully predict changes in many variables of interest at the freshman year of college, and suggest it may be a beneficial screening tool to assess at-risk freshman. This study also highlights the need for additional implicit measures in the realm of body image and disordered eating.

The development and validation of the food craving acceptance and action questionnaire (FAAQ)

Research has suggested that mindfulness and acceptance may be important factors in the development, maintenance and treatment of both obesity and eating disorders. However, very few scales exist that apply constructs of acceptance and mindfulness to eating behavior. A measure of acceptance about food related thoughts would be especially beneficial in investigating links between acceptance and problematic eating, and in better understanding mechanisms of action of effective treatments for obesity and eating disorders. The Food Acceptance and Awareness Questionnaire (FAAQ) was developed to measure acceptance of urges and cravings to eat or the extent to which individuals might try to control or change these thoughts. The FAAQ is a self-report questionnaire made up of ten items each rated on a seven-point Likert scale (1=very seldom true to 6=always true). Higher scores indicate greater acceptance of motivations to eat. The FAAQ was given to a sample of 463 undergraduate students along with several other measures of eating behavior and other psychological variables. Concurrent associations with variables theorized to be closely linked (Eating Attitudes Test, EAT; the Dutch Eating Behavior Questionnaire, DEBQ; body mass index, BMI) and not very closely linked (the Depression Anxiety Stress Scale, DASS) were evaluated in order to indicate the new scales convergent and divergent validity. These results demonstrated highly significant correlations with these measures in the expected direction, with stronger correlations for the theoretically-consistent variables than the theoretically-inconsistent variables. Exploratory factor analyses confirmed a structural two-factor model. Factor 1 seems to measure ones ability to regulate eating despite urges and cravings, and Factor 2 seems to measure desire to maintain internal control over eating thoughts. The FAAQ was also administered to a separate sample of 29 overweight or obese women enrolled in a weight loss program, and found to be predictive of weight loss. Taken together, results suggest that the FAAQ is a psychometrically sound instrument which might be a valuable tool for assessing acceptance of food related thoughts and urges.

All cravings are not created equal. Correlates of menstrual versus non-cyclic chocolate craving ☆

Chocolate cravings occur regularly in about 45% of American women. Approximately half of these women link their craving temporally to the menstrual cycle, with a significant proportion of cravings reportedly peaking around ovulation or the onset of menstruation. This study aimed to elucidate the correlates of menstrual craving versus non-cyclic craving. Questionnaires assessing the relationships between craving, eating behaviors, attitudes towards weight and shape, and general pathology were completed by 97 women. Menstrual craving was reported by 28.9% (n=28) and was associated with potentially maladaptive weight- and eating-related behaviors and attitudes, including higher body mass index, elevated dietary restraint, less flexible control over intake, and more guilt associated with the consumption of chocolate. Findings point to potential mechanisms involved in the etiology of menstrual cravings, such as the view of craving as a response to abstinence from high-calorie foods in an attempt to manage cyclically occurring weight fluctuations.