Elizabeth Rieger

Attentional biases in eating disorders: A visual probe detection procedure

OBJECTIVE To investigate attentional biases for body shape and weight-related stimulus words among subjects with anorexia nervosa, bulimia nervosa, and control subjects classified using a measure of dietary restraint. METHODS A visual probe detection task was used to assess attention toward stimulus words reflecting either a thin or a large physique and positively or negatively valenced emotion words. RESULTS In comparison to controls, subjects with eating disorders detected target probes more slowly when they appeared in the same location as had stimulus words connoting a thin physique. In addition, there was a trend toward faster detection or target probes that appeared in the same location as had stimulus words connoting a large physique. Neither of these effects were observed among restrained eaters. DISCUSSION Our results extend prior work suggesting information-processing biases for body shape and weight-related stimuli among persons with eating disorders.

An eating disorder-specific model of interpersonal psychotherapy (IPT-ED): Causal pathways and treatment implications

Several studies support the efficacy of interpersonal psychotherapy (IPT) in the treatment of eating disorders. Treatment outcomes are likely to be augmented through a greater understanding, and hence treatment targeting, of the mechanisms whereby IPT induces therapeutic gains. To this end, the present paper seeks to develop a theoretical model of IPT in the context of eating disorders (IPT-ED). After providing a brief description of IPT, the IPT-ED model is presented and research supporting its theorized mechanisms is summarized. This model proposes that negative social evaluation plays a pivotal role as both a cause (via its detrimental impact on self evaluation and associated affect) and consequence of eating disorder symptoms. In the final section, key eating disorder constructs (namely, the developmental period of adolescence, clinical perfectionism, cognitive dysfunction, and affect regulation) are re-interpreted from the standpoint of negative social evaluation thereby further explicating IPTs efficacy as an intervention for individuals with an eating disorder.

Development of an instrument to assess readiness to recover in anorexia nervosa.

OBJECTIVE The degree to which patients with anorexia nervosa demonstrate readiness to recover from their illness has received scant theoretical or empirical attention. Investigating the prevalence and degree of amotivation for recovery in anorexia nervosa, its role in outcome, and the effectiveness of interventions designed to enhance readiness to recover necessitates the existence of a reliable and valid measure of motivational issues relevant to the disorder. The present study aimed to develop and evaluate an instrument for assessing readiness to recover in anorexia nervosa, namely, the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ), a 23-item self-report questionnaire based on Prochaska and DiClementes stages of change model. METHOD Seventy-one inpatients with anorexia nervosa participated in the study. On several occasions during their admission, participants completed the ANSOCQ as well as questionnaires assessing readiness to recover, anorexic symptomatology, general distress, and social desirability. RESULTS The ANSOCQ demonstrated good internal consistency (.90) and 1-week test-retest reliability (.89). Various aspects of validity were also supported, such as significant relationships with other instruments assessing readiness to recover and the prediction of weight gain during different periods of treatment. DISCUSSION The results suggest that the ANSOCQ is a psychometrically sound instrument that may prove useful in investigating the role of readiness to recover in anorexia nervosa.

A comparison of eating, exercise, shape, and weight related symptomatology in males with muscle dysmorphia and anorexia nervosa.

In the context of the lack of nosological clarity surrounding muscle dysmorphia, this paper aims to compare the symptomatic profile of muscle dysmorphia and anorexia nervosa in males whilst using measures sensitive to indexing male body image concerns. Twenty-one male muscle dysmorphia patients, 24 male anorexia nervosa patients, and 15 male gym-using controls completed the Eating Disorder Examination-Questionnaire, the Muscle Dysmorphia Disorder Inventory, the Compulsive Exercise Test, and a measure of appearance-enhancing substance use. Men with muscle dysmorphia and anorexia nervosa demonstrated widespread symptomatic similarities spanning the domains of disturbed body image, disordered eating, and exercise behaviour, whilst differences were consistent with the opposing physiques pursued in each condition. Furthermore, correlational analyses revealed significant associations between scores on muscle dysmorphia and eating disorder measures. The present findings provide moderate support for the notion that muscle dysmorphia may be nosologically similar to anorexia nervosa.

Increased plasticity of the bodily self in eating disorders

BACKGROUND The rubber hand illusion (RHI) has been widely used to investigate the bodily self in healthy individuals. The aim of the present study was to extend the use of the RHI to examine the bodily self in eating disorders (EDs). METHOD The RHI and self-report measures of ED psychopathology [the Eating Disorder Inventory - 3 (EDI-3) subscales of Drive for Thinness, Bulimia, Body Dissatisfaction, Interoceptive Deficits, and Emotional Dysregulation; the 21-item Depression, Anxiety and Stress Scale (DASS-21); and the Self-Objectification Questionnaire (SOQ)] were administered to 78 individuals with an ED and 61 healthy controls. RESULTS Individuals with an ED experienced the RHI significantly more strongly than healthy controls on both perceptual (i.e. proprioceptive drift) and subjective (i.e. self-report questionnaire) measures. Furthermore, both the subjective experience of the RHI and associated proprioceptive biases were correlated with ED psychopathology. Approximately 23% of the variance for embodiment of the fake hand was accounted for by ED psychopathology, with interoceptive deficits and self-objectification significant predictors of embodiment. CONCLUSIONS These results indicate that the bodily self is more plastic in people with an ED. These findings may shed light on both aetiological and maintenance factors involved in EDs, particularly visual processing of the body, interoceptive deficits, and self-objectification.

Muscle dysmorphia and the DSM‐V conundrum: Where does it belong? A review paper

OBJECTIVE Muscle dysmorphia is a relatively recently identified psychological condition that, since its inception, has been variously conceptualized as an eating disorder and subsequently as a type of body dysmorphic disorder within the somatoform disorders. This review aims to inform and encourage ongoing debate surrounding the diagnostic placement of this disorder. METHOD We present a review and synthesis of the extant literature with a view to informing future decisions regarding the conceptualization of muscle dysmorphia. RESULTS The validity of muscle dysmorphia as a clinical entity has been empirically demonstrated. While the condition bears little semblance to somatization as currently conceptualized, the research suggests a strong conceptual similarity with anorexia nervosa. However, future research needs to utilize more appropriate measures of male eating disorder pathology. Muscle dysmorphia is also inclusive of obsessive compulsive features that are typical to those seen in eating disorder presentations. DISCUSSION We suggest that muscle dysmorphia be reanalyzed through the lens of an eating disorder spectrum. Recognition of muscle dysmorphia as an eating disorder may offer more clinical utility in recognizing the male experience of eating disorder pathology and also help reduce the number of current male cases falling into the EDNOS category.

Cross-cultural research on anorexia nervosa : Assumptions Regarding the role of body weight

OBJECTIVE To critically examine two assumptions guiding cross-cultural research on the weight concerns of anorexia nervosa: (1) that weight concerns are specific to contemporary, Western manifestations of the disorder and (2) that the dissemination of Western values regarding thinness is primarily responsible for the development of anorexia nervosa in non-Western contexts. METHOD A review of theoretical and empirical literature on cross-cultural aspects of anorexia nervosa and the medical records of 14 Asian patients treated for eating disorders in Sydney, Australia. RESULTS AND DISCUSSION Regarding the first assumption: It is argued that weight concerns when defined as weight loss that is positively valued (rather than a fat phobia) is a defining characteristic of anorexia nervosa and is not limited to contemporary, Western cases of the disorder. Regarding the second assumption: It is argued that the occurrence of anorexia nervosa in non-Western contexts cannot be solely attributed to the acceptance of Western thinness ideals because values and practices intrinsic to non-Western cultures are also likely to be etiologically relevant.

Investigating adolescent stress and body image.

Adolescent stress is clearly implicated in the development of mental health problems. However, its role in dysfunctional body image, which rises markedly in adolescence, has not been investigated. The present study examined the link between stress and body image, as well as self-esteem and depressive symptoms, in 533 high school students in grades 7 to 10. Results indicated that stress accounts for a sizeable proportion of variance in body image, and the best exploratory model included stress, self-esteem, and gender. Further, specific domains of stressors related to body image differently: peer pressure and school attendance were significant correlates of body image in both genders, while future uncertainty and romantic relationships were significant for males alone. Grade differences in primary variables were also evident for females. This study helps to elucidate the role of adolescent stress in dysfunctional body image and provides insight for future prevention and intervention programs in schools.

Persistent Body Image Disturbance following Recovery from Eating Disorders

OBJECTIVE Individuals with an eating disorder experience the rubber hand illusion (RHI) significantly more strongly than healthy controls on both perceptual (proprioceptive drift) and subjective (self-report embodiment questionnaire) measures. This heightened sensitivity to visual information about the body, and/or reduced somatosensory information processing about the body, suggest an increased malleability of the bodily self. The aim of the present study was to explore whether this is a state phenomenon or a persisting individual trait that outlasts the period of acute eating disorder. METHOD The RHI and self-report measures of eating disorder psychopathology (EDI-3 subscales of Drive for Thinness, Bulimia, Body Dissatisfaction, Interoceptive Deficits, and Emotional Dysregulation; DASS-21; and the Self-Objectification Questionnaire) were administered to 78 individuals with an eating disorder, 28 individuals recovered from an eating disorder, and 61 healthy controls. RESULTS Proprioceptive drift in recovered individuals was intermediate between the acutely ill and HC groups. Subjective report of the strength of the illusion in recovered individuals was similar to acutely ill individuals. DISCUSSION These results suggest that increased malleability of the bodily self persists, at least partially, following recovery and may be a trait phenomenon in people with eating disorders. Those with a lifetime history of an eating disorder may have heightened sensitivity to visual information about the body and reduced somatosensory information processing of the body.

Muscle dysmorphia symptomatology during a period of religious fasting: a case report.

We present a case of muscle dysmorphia in a Muslim male, whose muscle dysmorphia symptomatology markedly escalated during a period of religious fasting, in which abstinence from food and liquid during daylight hours was endorsed. This case represents the first attempt to delineate the relative centrality of eating versus exercise practices in muscle dysmorphia presentations, and suggests that the maintenance of muscle dysmorphia is inclusive of a central eating component, irrespective of exercise status, lending support to the notion of conceptualising muscle dysmorphia within an eating disorder spectrum. Implications and further research are discussed.