Detlef Caffier

Social comparison and its relation to body dissatisfaction in bulimia nervosa: evidence from eye movements.

Objective: To determine the role of social comparison for body dissatisfaction in bulimia nervosa (BN). Previous research suggested that exposure to media content idealizing thin body shape decreases body satisfaction, particularly in women with eating disorder symptoms. This might be due to the negative outcome of social comparisons with media models, and women with eating disorders might be particularly susceptible because they engage in upward social comparison more frequently than women without these symptoms. However, no study has yet explored both upward (i.e., toward more attractive others) and downward (i.e., toward less attractive others) social comparisons and their impact on body dissatisfaction in a clinical eating disorder and healthy controls. Methods: We presented patients with BN (n = 20) and healthy controls (HC) (n = 22) with slides comprising a digitized image of their own body alongside comparison bodies with higher and lower body mass indices (BMIs) while measuring their eye movements. Results: As hypothesized, patients with BN fixated longer on comparison bodies with lower BMIs than controls, with the reverse pattern for high BMI bodies. This gaze pattern suggests that upward comparisons were more prevalent in the BN group. Furthermore, upward comparisons were related to a drop in body satisfaction in the BN group. Conclusions: Disadvantageous social comparison strategies might be related to body dissatisfaction and therefore to the maintenance of BN. BISS = Body Image State Scale; BMI = body mass index; BN = bulimia nervosa; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; EDE-Q = Eating Disorder Examination Questionnaire; HC = healthy controls.

Emotion suppression but not reappraisal increases desire to binge in women with binge eating disorder.

For each dependent variable, a 2 (group) ! 3 (instruction) ! 2 (time) repeated-measures ANCOVA with BMI as a covariate was computed. When statistically justified, additional 2 (group) ! 2 (time) ANCOVAs for each instruction were computed. All clips significantly increased sadness ratings (all F 1 62.2 and p ! 0.01). DTB increased from baseline to post-film in the EG after watch and suppress instructions, but not after the reappraise instruction. For HC, no changes occurred. Even when controlling for BDI, the 3-way interaction remained significant (F 2, 88 = 3.96, p = 0.023). Regarding parasympathetic activation, HF-HRV decreased in the EG in response to the watch and the suppress instruction, while under these conditions there was an increase in the HC. Under the reappraise instruction, no changes in HF-HRV occurred, but LF-HRV decreased in HC and slightly increased in the EG. No substantial results were found on the sympathetic branch (cardiac interbeat interval, skin conductance level, finger pulse transit time; table 1 ). Compared to HC, the EG scored significantly lower on ERQ reappraisal (F 1, 48 = 5.63, p = 0.022; EG: 3.89 8 0.27, HC: 4.88 8 0.27) and significantly higher on ERQ suppression (F 1, 48 = 13.1, p = 0.001; EG: 3.57 8 0.27, HC: 2.09 8 0.27), TAS global , (F 1, 48 = 18.3, p ! 0.000; EG: 49.3 8 10.1, HC: 39.3 8 5.95), TAS identification (F 1, 48 = 15.6, p ! 0.000; EG: 18.1 8 1.17, HC: 11.1 8 1.19) and TAS describing (F 1, 48 = 12.2, p = 0.001; EG: 15.2 8 0.66, HC: 11.7 8 0.67). There were no significant differences on the TAS thinking (F 1, 48 = 0.992, p = 0.324; EG: 16.7 8 0.70, HC: 15.7 8 0.72) and no significant correlations of self-report questionnaires with DTB. The results of the ERQ revealed that women with BED dispositionally suppress more and reappraise their emotions less than HC. As experimental data shows, contrary to reappraisal, suppression leads to increased food craving and a decrease in parasympathetic activation in women with BED. When instructed to watch or suppress, the HC reacted with an increase in parasympathetic activation, which may function as an adaptive reaction to the sadness-evoking film [16] . Such adaptation does not seem to be necessary during execution of reappraisal, which already aims at a shift of attention. By contrast, reappraisal makes some cognitive demands upon women with BED, as shown in the sympathetic increase (LF-HRV) from baseline to post-film. This could be due to the fact that it may be difficult to reappraise emotions without recognizing the link with sadness itself, as indicated by BED women’s higher alexithymia scores. A possible criticism is the lack of randomization of the film clips and instructions. Randomization of clips would have produced loss of statistical power due to the production of very heterogeneous physiological data. However, empirical data showed that these film clips were able to induce sadness on a comparable level [17] . Instructions were presented in a fixed order because we reasoned that participants would not indulge in suppression once they had experienced the alleviating effect of reappraisal. A further limitation concerns the assessment of control emotions. While results remained unaffected when controlling for BDI Several studies have suggested that negative emotions may have a causal impact on the occurrence of binge eating [1–5] in binge eating disorder (BED). Furthermore, emotion regulation (ER) is known to influence the course of emotional experience [6, 7] , and there is some evidence of ER deficits in BED patients [8, 9] . We therefore tested the causal role of ER as a mediator in the link between negative emotions and desire to binge (DTB). The experimental group (EG) consisted of 27 women with a DSM-IV [10] diagnosis of BED, and the control group (HC) consisted of 25 healthy overweight women [for exclusion and inclusion criteria, see 11 ]. Groups did not differ significantly on age (means 8 SD; EG: 42.7 8 11.6 years, HC: 38.3 8 13.8 years; F 1, 51 = 1.57, n.s.), but the EG had a significantly higher BMI (EG: 36.7 8 3.89, HC: 33.8 8 6.53; F 1, 51 = 14.5, p ! 0.000) and Beck Depression Inventory (BDI) score (EG: 14.7 8 7.80, HC: 3.0 8 2.70; F 1,51 = 50.6, p ! 0.000). Women in the EG had 4.00 8 2.61 binges per week over the past 6 months. Participants watched 3 sadness-inducing film clips [12] , each preceded by a different instruction: (1) watch the clip; (2) watch the clip and suppress; (3) watch the clip reappraise upcoming emotions [13] . DTB was computed by the sum of the items: ‘At the moment, I would really like to eat something; I could not resist a savory meal; I am hungry; I would eat more than I usually do’ (Cronbach’s 6 0.84). Sadness and DTB were rated on a Likert scale ranging from 1 (not at all) to 8 (extremely). Cardiac interbeat interval (ms), skin conductance level, finger pulse transit time, high-frequency heart rate variability (HF-HRV), and low-frequency HRV (LF-HRV) were assessed continuously. After each instruction (60 s), participants rated levels of sadness and DTB. After watching the clip, they re-rated sadness and then watched a still image of the last scene of the clip for 2 min. Then they rated DTB again. After a 2-min interval in front of a black screen, participants received the next instruction followed by the next clip. Corresponding to the assessments of DTB, the physiological baseline was computed by averaging measurement taken over the time before the instructions (in minutes), and postfilm physiology by the averaged first and second half of the still film images. Habitual ER strategies were assessed by the Emotion Regulation Questionnaire (ERQ) [14] and the Toronto Alexithymia Scale [TAS; 15 ]. Received: May 29, 2009 Accepted: August 12, 2009 Published online: March 17, 2010

Body-related film clip triggers desire to binge in women with binge eating disorder

Previous research suggests that excessive influence of shape or weight concern on self-evaluation is strongly associated with psychological functioning in women with binge eating disorder (BED). However, little is known so far about its direct influence on binge episodes. In an experimental study, 27 women with BED (DSM-IV) and 25 overweight healthy controls watched a body-related film clip. Ratings of the desire to binge and mood were assessed prior to and at the end of the film clip. Additionally, measures of heart rate, finger pulse and electrodermal activity were obtained. Main results revealed a significant increase in the desire to binge, sadness and anxiety, as well as a significant increase in non-specific skin conductance fluctuation on the body-related clip in the group of BED only. The results underline the importance of shape and weight concerns in BED.

Rumination but not distraction increases eating-related symptoms in anorexia and bulimia nervosa.

Recent models of eating disorders emphasize the importance of ruminative thinking in the occurrence of unhealthy eating behavior. Hence, the aim of the current study was to examine the influence of induced rumination and distraction on the desire to engage in eating-related symptoms in anorexia (AN) and bulimia nervosa (BN). After a sadness induction, either a ruminative or distractive emotion regulation style was encouraged in women with AN (n = 38), BN (n = 37), and non-eating disordered controls (CG; n = 36). At baseline and after the emotion regulation induction feelings of sadness, desire to abstain from eating (DTA) and desire to binge (DTB) were assessed. Main results reveal that rumination led to a significant increase of DTA in the AN group and of DTB in patients with BN. In the CG, DTA significantly decreased after distraction. Although there were significant increases in subjective sadness in the rumination condition, no changes were found in the distraction condition. The results suggest that rumination in response to sadness has a detrimental effect on eating-related symptoms in eating disorders.

Differential caloric intake in overweight females with and without binge eating: effects of a laboratory-based emotion-regulation training.

Negative emotions are among the best predictors for the occurrence of binge eating attacks in binge eating disorder (BED). Evidence from self-report and experimental studies suggests that this link may be mediated by deficits in emotion regulation (ER). Therefore, the aim of the present study was to experimentally test the effects of a short laboratory-based ER training on caloric intake in BED. Thirty-nine women with BED and 42 overweight females without BED were randomly assigned to a laboratory-based ER training focusing on either expressive suppression or cognitive reappraisal. They were then given a negative mood induction with the instruction to adopt the learned ER strategy, which was followed by a bogus taste-test. Independent of group membership, caloric intake was significantly higher in the suppression compared to the reappraisal condition. Furthermore, the BED group displayed significantly higher habitual suppression and significantly lower habitual reappraisal scores than the overweight group. The data suggest that therapeutic interventions focusing on the mediation of more adaptive affect-regulation skills may be useful for the reduction of binge eating episodes.

Selective Visual Attention during Mirror Exposure in Anorexia and Bulimia Nervosa.

Objective Cognitive theories suggest that body dissatisfaction results from the activation of maladaptive appearance schemata, which guide mental processes such as selective attention to shape and weight-related information. In line with this, the present study hypothesized that patients with anorexia nervosa (AN) and bulimia nervosa (BN) are characterized by increased visual attention for the most dissatisfying/ugly body part compared to their most satisfying/beautiful body part, while a more balanced viewing pattern was expected for controls without eating disorders (CG). Method Eye movements were recorded in a group of patients with AN (n = 16), BN (n = 16) and a CG (n = 16) in an ecologically valid setting, i.e., during a 3-min mirror exposure. Results Evidence was found that patients with AN and BN display longer and more frequent gazes towards the most dissatisfying relative to the most satisfying and towards their most ugly compared to their most beautiful body parts, whereas the CG showed a more balanced gaze pattern. Discussion The results converge with theoretical models that emphasize the role of information processing in the maintenance of body dissatisfaction. Given the etiological importance of body dissatisfaction in the development of eating disorders, future studies should focus on the modification of the reported patterns.

Negative Mood Increases Selective Attention to Negatively Valenced Body Parts in Female Adolescents with Anorexia Nervosa

Objective Previous research has yielded evidence of increased attentional processing of negatively valenced body parts in women with anorexia nervosa (AN), especially for those with high depressive symptomatology. The present study extended previous research by implementing an experimental mood manipulation. Method In a within-subjects design, female adolescents with AN (n = 12) and an age matched female control group (CG; n = 12) were given a negative and a positive mood induction at a one-week interval. After each mood induction, participants underwent a 3-min mirror exposure, while their eye movements were recorded. Results After the positive mood induction, both AN and CG participants displayed longer and more frequent gazes towards their self-defined most ugly relative to their self-defined most beautiful body part. However, after the negative mood induction, only females with AN were characterized by increased attention to their most ugly compared to their most beautiful body part, while CG participants’ attention distribution was balanced. Furthermore, in the negative (but not in the positive) mood induction condition gaze frequency and duration towards the most ugly body part was significantly stronger in the AN group relative to the CG. Discussion The results emphasize the role of negative mood in the maintenance of pathological information processing of the self-body. This increased body-related negativity-bias during negative mood may lead to the persistence and aggravation of AN patients’ body image disturbance.

Children with social anxiety disorder show blunted pupillary reactivity and altered eye contact processing in response to emotional faces: Insights from pupillometry and eye movements

Cognitive models and adult research associate social anxiety disorder (SAD) with hypervigilant-avoidant processing of social information, such as eye contact. However, processing biases in childhood SAD remain mostly unexplored. We examined 10- to 13-year-old childrens eye contact processing and pupil dilation in response to happy, neutral, and angry faces in three groups: SAD (n = 31), mixed anxiety disorders (MAD; n = 30), and healthy controls (HC; n = 32). Compared to HC, SAD children showed faster first fixations on the eye region of neutral faces and shorter first fixation durations on the eye region of all faces. No differences between the two clinical groups emerged in eye movement results. SAD girls showed reduced pupil dilation in response to happy and angry faces compared to MAD and to happy faces compared to HC. SAD boys showed reduced pupil dilation in response to neutral faces compared to HC. Dimensionally, reduced pupil dilation was linked to social anxiety severity while eye movements were correlated with mixed anxiety and depressive severity. Results suggest that hypervigilant-avoidant eye contact processing and a blunted pupillary reactivity characterize children with SAD. Both transdiagnostic and disorder-specific processing biases are relevant for the understanding of childhood SAD.