Ellen E. Fitzsimmons-Craft

Explaining the relation between thin ideal internalization and body dissatisfaction among college women: The roles of social comparison and body surveillance

Sociocultural models of disordered eating lack comprehensive explanations as to how thin ideal internalization leads to body dissatisfaction. This study examined two social psychological theories as explanations of this relation, namely social comparison and objectification theories, in a sample of 265 women attending a Southeastern university. Social comparison (both general and appearance-related) and body surveillance (the indicator of objectification) were tested as mediators of the relation between thin ideal internalization and body dissatisfaction using bootstrapping analyses. Results indicated that body surveillance was a significant specific mediator of this relation; however, neither operationalization of social comparison emerged as such. Results serve to elaborate upon the sociocultural model of disordered eating by providing a more comprehensive understanding of the processes by which thin ideal internalization manifests itself in body dissatisfaction. The current findings also highlight the importance of targeting body surveillance in clinical settings.

Social psychological theories of disordered eating in college women: Review and integration

Because peer interaction, weight/shape, and self-concept formation are particularly salient to college women, the implications of social psychological theories may be especially far-reaching during the college years. College women may be particularly vulnerable to the effects of social comparison, objectification, and uses and gratifications theories, which describe social-cognitive mechanisms that provide an individual with information regarding her own view of her body and how she perceives that others perceive her body. The current paper will review and integrate findings related to these three theories of disordered eating in college women in an effort to present a more comprehensive understanding of the social psychological mechanisms that play a role in the development and maintenance of such pathology for this group of young women. Limitations of and future directions for research on these theories will be discussed, as will their potential integration with other factors that contribute to disordered eating and implications for treatment and prevention.

Objectified body consciousness in relation to recovery from an eating disorder.

In Western society, the feminine body has been positioned as an object to be looked at and sexually gazed upon; thus, females often learn to view themselves as objects to be observed (i.e., objectified body consciousness (OBC)). This study examined the relation between OBC and eating disorder recovery by comparing its components across non-eating disorder controls, fully recovered, partially recovered, and active eating disorder cases. Results revealed that non-eating disorder controls and fully recovered individuals had similarly low levels of two components of OBC, body surveillance and body shame. Partially recovered individuals looked more similar to those with an active eating disorder on these constructs. The third component of OBC, control beliefs, and a conceptually similar construct, weight/shape self-efficacy, did not differ across groups. Results provide support for the importance of measuring aspects of self-objectification, particularly body surveillance and body shame, across the course of an eating disorder.

Subjective and objective binge eating in relation to eating disorder symptomatology, negative affect, and personality dimensions.

OBJECTIVE The current study explored the clinical meaningfulness of distinguishing subjective (SBE) from objective binge eating (OBE) among individuals with threshold/subthreshold bulimia nervosa (BN). We examined relations between OBEs and SBEs and eating disorder symptoms, negative affect, and personality dimensions using both a group comparison and a continuous approach. METHOD Participants were 204 adult females meeting criteria for threshold/subthreshold BN who completed questionnaires related to disordered eating, affect, and personality. RESULTS Group comparisons indicated that SBE and OBE groups did not significantly differ on eating disorder pathology or negative affect, but did differ on two personality dimensions (cognitive distortion and attentional impulsivity). Using the continuous approach, we found that frequencies of SBEs (not OBEs) accounted for unique variance in weight/shape concern, diuretic use frequency, depressive symptoms, anxiety, social avoidance, insecure attachment, and cognitive distortion. DISCUSSION SBEs in the context of BN may indicate broader areas of psychopathology.

Examining social physique anxiety and disordered eating in college women. The roles of social comparison and body surveillance

Social physique anxiety has been found to be associated with disordered eating. However, what is not yet known is what behaviors college women may engage in that strengthen this relation. In the current study, we examined two possible moderating factors, social comparison and body surveillance. We examined whether these moderators might also generalize to trait anxiety, as well. Participants were 265 women attending a Southeastern university. Social comparison (both general and appearance-related) and body surveillance were tested as moderators of the relation between social physique anxiety and disordered eating. Results indicated that general social comparison, appearance-related social comparison, and body surveillance significantly moderated this relation. Individuals who were high in social physique anxiety and who reported high levels of general or appearance-related social comparison or body surveillance reported much higher levels of disordered eating than those with high social physique anxiety and low levels of these behaviors. Results indicated that only the trait anxiety×body surveillance interaction was significant in identifying elevated disordered eating. Results provide information regarding who may experience high levels of disordered eating in association with social physique anxiety, which has clinical implications including the conceptualization of social comparison and body surveillance as safety behaviors.

The Inter-relationships between Vegetarianism and Eating Disorders among Females

When individuals with a suspected or diagnosed eating disorder adopt a vegetarian diet, health care professionals might worry that this choice could function as a socially acceptable way to legitimize food avoidance. Yet only limited research has examined vegetarianism in relation to eating disorders. Our study objectives were to compare individuals with and without an eating disorder history and individuals at different stages of eating disorder recovery on past and current vegetarianism and motivations for and age at becoming vegetarian. Participants were females seen at some point for an eating disorder (n=93) and controls who never had an eating disorder (n=67). Recruitment and data collection for this cross-sectional study occurred in 2007-2008. χ(2) analyses and analyses of variance and covariance were used to examine the research questions. Compared with controls, individuals with an eating disorder history were considerably more likely to ever have been vegetarian (52% vs 12%; P<0.001), to be currently vegetarian (24% vs 6%; P<0.01), and to be primarily motivated by weight-related reasons (42% vs 0%; P<0.05). The three recovery status groups (fully recovered, partially recovered, and active eating disorder) did not differ significantly in percentiles endorsing a history of vegetarianism or weight-related reasons as primary, but they differed significantly in current vegetarianism (33% of active cases, 13% of partially recovered, 5% of fully recovered; P<0.05). Most perceived that their vegetarianism was related to their eating disorder (68%) and emerged after its onset. Results shed light on the vegetarianism-eating disorders relation and suggest intervention considerations for clinicians (eg, investigating motives for vegetarianism).

Addressing critical gaps in the treatment of eating disorders

Remarkable progress has been made in developing psychosocial interventions for eating disorders and other mental disorders. Two priorities in providing treatment consist of addressing the research-practice gap and the treatment gap. The research-practice gap pertains to the dissemination of evidence-based treatments from controlled settings to routine clinical care. Closing the gap between what is known about effective treatment and what is actually provided to patients who receive care is crucial in improving mental health care, particularly for conditions such as eating disorders. The treatment gap pertains to extending treatments in ways that will reach the large number of people in need of clinical care who currently receive nothing. Currently, in the United States (and worldwide), the vast majority of individuals in need of mental health services for eating disorders and other mental health problems do not receive treatment. This article discusses the approaches required to better ensure: (1) that more people who are receiving treatment obtain high-quality, evidence-based care, using such strategies as train-the-trainer, web-centered training, best-buy interventions, electronic support tools, higher-level support and policy; and (2) that a higher proportion of those who are currently underserved receive treatment, using such strategies as task shifting and disruptive innovations, including treatment delivery via telemedicine, the Internet, and mobile apps.

The empirical status of the third-wave behaviour therapies for the treatment of eating disorders: A systematic review.

Although third-wave behaviour therapies are being increasingly used for the treatment of eating disorders, their efficacy is largely unknown. This systematic review and meta-analysis aimed to examine the empirical status of these therapies. Twenty-seven studies met full inclusion criteria. Only 13 randomized controlled trials (RCT) were identified, most on binge eating disorder (BED). Pooled within- (pre-post change) and between-groups effect sizes were calculated for the meta-analysis. Large pre-post symptom improvements were observed for all third-wave treatments, including dialectical behaviour therapy (DBT), schema therapy (ST), acceptance and commitment therapy (ACT), mindfulness-based interventions (MBI), and compassion-focused therapy (CFT). Third-wave therapies were not superior to active comparisons generally, or to cognitive-behaviour therapy (CBT) in RCTs. Based on our qualitative synthesis, none of the third-wave therapies meet established criteria for an empirically supported treatment for particular eating disorder subgroups. Until further RCTs demonstrate the efficacy of third-wave therapies for particular eating disorder subgroups, the available data suggest that CBT should retain its status as the recommended treatment approach for bulimia nervosa (BN) and BED, and the front running treatment for anorexia nervosa (AN) in adults, with interpersonal psychotherapy (IPT) considered a strong empirically-supported alternative.

Development and validation of the Body, Eating, and Exercise Comparison Orientation Measure (BEECOM) among college women

We constructed and validated a measure of comparison dimensions associated with eating pathology, namely, the body, eating, and exercise comparison orientation measure (BEECOM). Participants were 441 undergraduate women. In Study 1, items were generated and refined via exploratory factor analysis, yielding three interpretable factors (i.e., body, eating, and exercise comparison orientation). Confirmatory factor analysis was then used to confirm the three-factor structure of the BEECOM and to investigate the potential presence of a higher-order factor. Given that the lower-order factors loaded strongly onto a higher-order factor, it is appropriate to use a total BEECOM score, in addition to subscale scores. Further, the BEECOMs scores yielded evidence of internal consistency and construct validity in this sample. Study 2 demonstrated two-week test-retest reliability of the BEECOM among college women. Overall, the BEECOM demonstrated good psychometric properties and may be useful for more comprehensively assessing eating disorder-related social comparison behavior.

The relationships among social comparisons, body surveillance, and body dissatisfaction in the natural environment.

We examined the relationships among social comparisons (i.e., body, eating, and exercise), body surveillance, and body dissatisfaction in the natural environment. Participants were 232 college women who completed a daily diary protocol for 2 weeks, responding to online surveys 3 times per day. When the contemporaneous relationships among these variables were examined in a single model, results indicated that comparing ones body, eating, or exercise to others or engaging in body surveillance was associated with elevated body dissatisfaction in the same short-term assessment period. Additionally, individuals with high trait-like engagement in body comparisons or body surveillance experienced higher levels of body dissatisfaction. Trait-like eating and exercise comparison tendencies did not predict unique variance in body dissatisfaction. When examined prospectively in a single model, trait-like body comparison and body surveillance remained predictors of body dissatisfaction, but the only more state-like behavior predictive of body dissatisfaction at the next assessment was eating comparison. Results provide support for the notion that naturalistic body dissatisfaction is predicted by both state- and trait-like characteristics. In particular, social comparisons (i.e., body, eating, and exercise) and body surveillance may function as proximal triggers for contemporaneous body dissatisfaction, with eating comparisons emerging as an especially important predictor of body dissatisfaction over time. Regarding trait-like predictors, general tendencies to engage in body comparisons and body surveillance may be more potent distal predictors of body dissatisfaction than general eating or exercise comparison tendencies.