Elizabeth R. Didie

The Power of Food Scale. A new measure of the psychological influence of the food environment.

This paper describes the psychometric evaluation of a new measure called the Power of Food Scale (PFS). The PFS assesses the psychological impact of living in food-abundant environments. It measures appetite for, rather than consumption of, palatable foods, at three levels of food proximity (food available, food present, and food tasted). Participants were 466 healthy college students. A confirmatory factor analysis replicated the three-factor solution found previously by Capelleri et al. [Capelleri, J. C., Bushmakin, A. G., Gerber, R. A., Leidy, N. K., Sexton, C., Karlsson, J., et al. (in press). Discovering the structure of the Power of Food Scale (PFS) in obese patients. International Journal of Obesity, 11, A165]. The PFS was found to have adequate internal consistency and test-retest reliability. The PFS and the Restraint Scale were regressed on four self-report measures of overeating. The PFS was independently related to all four whereas the Restraint Scale was independently related to two. Expert ratings of items suggested that the items are an acceptable reflection of the construct that the PFS is designed to capture. The PFS may be useful as a measure of the hedonic impact of food environments replete with highly palatable foods.

Multiple types of dieting prospectively predict weight gain during the freshman year of college

The freshman year of college is a period of heightened risk for weight gain. This study examined measures of restrained eating, disinhibition, and emotional eating as predictors of weight gain during the freshman year. Using Lowes multi-factorial model of dieting, it also examined three different types of dieting as predictors of weight gain. Sixty-nine females were assessed at three points during the school year. Weight gain during the freshman year averaged 2.1 kg. None of the traditional self-report measures of restraint, disinhibition, or emotional eating were predictive of weight gain. However, both a history of weight loss dieting and weight suppression (discrepancy between highest weight ever and current weight) predicted greater weight gain, and these effects appeared to be largely independent of one another. Individuals who said they were currently dieting to lose weight gained twice as much (5.0 kg) as former dieters (2.5 kg) and three times as much as never dieters (1.6 kg), but the import of this finding was unclear because there was only a small number of current dieters (N = 7). Overall the results indicate that specific subtypes of dieting predicts weight gain during the freshman year better than more global measures of restraint or overeating.

Factors That Influence the Decision to Undergo Cosmetic Breast Augmentation Surgery

BACKGROUND This study examined the factors that motivate women to seek cosmetic breast augmentation surgery. METHODS Twenty-five breast augmentation surgery candidates completed measures of body image dissatisfaction, sociocultural influences on physical appearance, marital and sexual satisfaction, and self-report questionnaires that assessed other motivations for surgery. Thirty physically similar women who were not interested in breast augmentation also completed the measures. RESULTS Replicating previous studies, breast augmentation candidates, compared with controls, reported greater dissatisfaction with their breasts. The two groups, however, did not differ on overall body image dissatisfaction or greater awareness or internalization of sociocultural influences on physical appearance. Breast augmentation patients reported more positive sexual functioning compared with controls. CONCLUSIONS Overall, breast augmentation patients appeared to be motivated by their feelings about their breasts rather than direct or indirect influence from external sources, such as romantic partners or sociocultural representations of beauty. These findings provide new information on the motivations behind breast augmentation and dispute several stereotypes about the factors that influence the pursuit of this surgery.

Clinical features of body dysmorphic disorder in adolescents and adults

Body dysmorphic disorder (BDD) usually begins during adolescence, but its clinical features have received little investigation in this age group. Two hundred individuals with BDD (36 adolescents; 164 adults) completed interviewer-administered and self-report measures. Adolescents were preoccupied with numerous aspects of their appearance, most often their skin, hair, and stomach. Among the adolescents, 94.3% reported moderate, severe, or extreme distress due to BDD, 80.6% had a history of suicidal ideation, and 44.4% had attempted suicide. Adolescents experienced high rates and levels of impairment in school, work, and other aspects of psychosocial functioning. Adolescents and adults were comparable on most variables, although adolescents had significantly more delusional BDD beliefs and a higher lifetime rate of suicide attempts. Thus, adolescents with BDD have high levels of distress and rates of functional impairment, suicidal ideation, and suicide attempts. BDDs clinical features in adolescents appear largely similar to those in adults.

Modular Cognitive-Behavioral Therapy for Body Dysmorphic Disorder: A Randomized Controlled Trial

There are few effective treatments for body dysmorphic disorder (BDD) and a pressing need to develop such treatments. We examined the feasibility, acceptability, and efficacy of a manualized modular cognitive-behavioral therapy for BDD (CBT-BDD). CBT-BDD utilizes core elements relevant to all BDD patients (e.g., exposure, response prevention, perceptual retraining) and optional modules to address specific symptoms (e.g., surgery seeking). Thirty-six adults with BDD were randomized to 22 sessions of immediate individual CBT-BDD over 24 weeks (n=17) or to a 12-week waitlist (n=19). The Yale-Brown Obsessive-Compulsive Scale Modified for BDD (BDD-YBOCS), Brown Assessment of Beliefs Scale, and Beck Depression Inventory-II were completed pretreatment, monthly, posttreatment, and at 3- and 6-month follow-up. The Sheehan Disability Scale and Client Satisfaction Inventory (CSI) were also administered. Response to treatment was defined as ≥30% reduction in BDD-YBOCS total from baseline. By week 12, 50% of participants receiving immediate CBT-BDD achieved response versus 12% of waitlisted participants (p=0.026). By posttreatment, 81% of all participants (immediate CBT-BDD plus waitlisted patients subsequently treated with CBT-BDD) met responder criteria. While no significant group differences in BDD symptom reduction emerged by Week 12, by posttreatment CBT-BDD resulted in significant decreases in BDD-YBOCS total over time (d=2.1, p<0.0001), with gains maintained during follow-up. Depression, insight, and disability also significantly improved. Patient satisfaction was high, with a mean CSI score of 87.3% (SD=12.8%) at posttreatment. CBT-BDD appears to be a feasible, acceptable, and efficacious treatment that warrants more rigorous investigation.

Age at onset and clinical correlates in body dysmorphic disorder.

OBJECTIVE Age at onset is an important clinical feature of all disorders. However, no prior studies have focused on this important construct in body dysmorphic disorder (BDD). In addition, across a number of psychiatric disorders, early age at disorder onset is associated with greater illness severity and greater comorbidity with other disorders. However, clinical correlates of age at onset have not been previously studied in BDD. METHODS Age at onset and other variables of interest were assessed in two samples of adults with DSM-IV BDD; sample 1 consisted of 184 adult participants in a study of the course of BDD, and sample 2 consisted of 244 adults seeking consultation or treatment for BDD. Reliable and valid measures were used. Subjects with early-onset BDD (age 17 or younger) were compared to those with late-onset BDD. RESULTS BDD had a mean age at onset of 16.7 (SD=7.3) in sample 1 and 16.7 (SD=7.2) in sample 2. 66.3% of subjects in sample 1 and 67.2% in sample 2 had BDD onset before age 18. A higher proportion of females had early-onset BDD in sample 1 but not in sample 2. On one of three measures in sample 1, those with early-onset BDD currently had more severe BDD symptoms. Individuals with early-onset BDD were more likely to have attempted suicide in both samples and to have attempted suicide due to BDD in sample 2. Early age at BDD onset was associated with a history of physical violence due to BDD and psychiatric hospitalization in sample 2. Those with early-onset BDD were more likely to report a gradual onset of BDD than those with late-onset in both samples. Participants with early-onset BDD had a greater number of lifetime comorbid disorders on both Axis I and Axis II in sample 1 but not in sample 2. More specifically, those with early-onset BDD were more likely to have a lifetime eating disorder (anorexia nervosa or bulimia nervosa) in both samples, a lifetime substance use disorder (both alcohol and non-alcohol) and borderline personality disorder in sample 1, and a lifetime anxiety disorder and social phobia in sample 2. CONCLUSIONS BDD usually began during childhood or adolescence. Early onset was associated with gradual onset, a lifetime history of attempted suicide, and greater comorbidity in both samples. Other clinical features reflecting greater morbidity were also more common in the early-onset group, although these findings were not consistent across the two samples.

Tanning in Body Dysmorphic Disorder

Tanning in body dysmorphic disorder (BDD) has not previously been studied. In this study, 200 subjects with BDD were evaluated with measures to examine the prevalence of BDD-related tanning—i.e., darkening ones skin color by direct exposure to sunlight or artificial light which is motivated by a desire to improve a perceived appearance defect (i.e., a BDD concern). We also examined clinical characteristics of individuals who engaged in BDD-related tanning. 25% (95% CI, 19.0%–31.0%) of subjects reported BDD-related tanning. Among tanners, the skin was the most common body area of concern (84.0%). All tanners experienced functional impairment due to BDD, 26% had attempted suicide, and quality of life was markedly poor. 52% of tanners had received dermatologic treatment, which was usually ineffective for BDD symptoms. Tanners were more likely than non-tanners to compulsively pick their skin. In conclusion, tanning—a behavior with well-known health risks—is a relatively frequent BDD-related behavior.

A comparison of quality of life and psychosocial functioning in obsessive-compulsive disorder and body dysmorphic disorder.

BACKGROUND Obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD) are possibly related disorders characterized by poor functioning and quality of life. However, few studies have compared these disorders in these important domains. METHODS We compared functioning and quality of life in 210 OCD subjects, 45 BDD subjects, and 40 subjects with comorbid BDD+OCD using reliable and valid measures. RESULTS OCD and BDD subjects had very poor scores across all measures, with no statistically significant differences between the groups. However, comorbid BDD+OCD subjects had greater impairment than OCD subjects on 11 scales/subscales, which remained significant after controlling for OCD severity. Comorbid BDD+OCD subjects had greater impairment than BDD subjects on 2 scales/subscales, which were no longer significant after controlling for BDD severity, suggesting that BDD severity may have accounted for greater morbidity in the comorbid BDD+OCD group. CONCLUSIONS Functioning and quality of life were poor across all three groups, although individuals with comorbid BDD+OCD had greater impairment on a number of measures. It is important for clinicians to be aware that patients with these disorders--and, in particular, those with comorbid BDD and OCD--tend to have very poor functioning and quality of life across a broad range of domains.

The Effect of Training in Reduced Energy Density Eating and Food Self-monitoring Accuracy on Weight Loss Maintenance

Background: Failure to maintain weight losses in lifestyle change programs continues to be a major problem and warrants investigation of innovative approaches to weight control.

Body image in patients with body dysmorphic disorder: evaluations of and investment in appearance, health/illness, and fitness.

Body image is an important aspect of body dysmorphic disorder (BDD) which has received little investigation. Ninety-two BDD participants who participated in one of three BDD pharmacotherapy studies completed the Multidimensional Body-Self Relations Questionnaire, which assesses attitudinal body image, specifically evaluations of and investment in appearance, health/illness, and physical fitness. Scores were compared to population norms. Compared to norms, BDD participants were significantly less satisfied with their appearance. Less satisfaction was associated with more severe BDD and greater delusionality. Men with BDD were significantly more invested in their appearance compared to male population norms. Compared to population norms, males and females with BDD felt less physically healthy and females were less invested in a healthy lifestyle. However, compared with population females, females with BDD were less alert to being ill. These findings suggest that patients with BDD differ from population norms in a number of important aspects of body image.