Kristin M. von Ranson

Sexual initiation: predictors and developmental trends.

Background Early initiation of sexual intercourse is associated with increased risk for acquiring sexually transmitted diseases. Goal To examine variables related to sexual initiation and developmental changes in the reasons why adolescent girls have sexual intercourse. Study Design A longitudinal study of girls recruited from an adolescent medicine clinic was performed. Results Logistic regression showed that girls who described their families as being expressive, having a moral-religious emphasis, providing supervision, and having greater maternal education, and who experienced menarche at an older age were older at sexual initiation. On the basis of contingency analyses, younger girls were less likely to report attraction or love, and more likely to report peers having sex as a reason for sexual intercourse at initiation. A generalized estimating equation analysis indicated that girls at younger ages are more likely to report curiosity, a grown-up feeling, partner pressure, and friends having sexual intercourse as reasons for intercourse. Girls at older ages are more likely to report a feeling of being in love, physical attraction, too excited to stop, drunk or high partner, and feeling romantic as reasons for having sexual intercourse. Conclusions Prevention programs should include a focus on familial characteristics and susceptibility to peer norms. They should be conducted with sensitivity to the developmental changes in intimate relationships that occur during adolescence.

Adapted Motivational Interviewing for Women With Binge Eating Disorder: A Randomized Controlled Trial

In this randomized controlled trial, 108 women with binge-eating disorder (BED) recruited from the community were assigned to either an adapted motivational interviewing (AMI) group (1 individual AMI session + self-help handbook) or control group (handbook only). They were phoned 4, 8, and 16 weeks following the initial session to assess binge eating and associated symptoms (depression, self-esteem, quality of life). Postintervention, the AMI group participants were more confident than those in the control group in their ability to change binge eating. Although both groups reported improved binge eating, mood, self-esteem, and general quality of life 16 weeks following the intervention, the AMI group improved to a greater extent. A greater proportion of women in the AMI group abstained from binge eating (27.8% vs. 11.1%) and no longer met the binge frequency criterion of the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000) for BED (87.0% vs. 57.4%). AMI may constitute a brief, effective intervention for BED and associated symptoms.

Psychotherapies provided for eating disorders by community clinicians: Infrequent use of evidence-based treatment

Abstract This study describes the psychological interventions used for eating disorders (EDs) by community practitioners. Of 573 clinicians we screened across Alberta, 130 (22.7%) had treated EDs; 118 (90.8%) were interviewed. Clinicians reported varied reasons for psychotherapy choice and diverse training experiences; the primary approaches used varied by education and field. The most common primary approach was eclectic (43.2%), followed by cognitive-behavior therapy (CBT; 22.9%). However, self-reported CBT clinicians used specific CBT techniques infrequently. Half of clinicians incorporated addictions-based techniques. These results indicate that ED treatment provided by community clinicians is varied and generally does not align with evidence-based practice guidelines.

A randomized wait-list controlled pilot study of dialectical behaviour therapy guided self-help for binge eating disorder.

This study examined the efficacy of guided self-help based on dialectical behaviour therapy (DBTgsh) for binge eating disorder (BED). Individuals (88.3% female; mean 42.8 years) were randomized to DBTgsh (n=30) or wait-list (WL; n=30). DBTgsh participants received an orientation, DBT manual, and six 20-min support calls over 13 weeks. All participants were assessed pre- and post-treatment using interview and self-report; also, DBTgsh participants were re-assessed six months post-treatment. At treatment end, DBTgsh participants reported significantly fewer past-month binge eating episodes than WL participants (6.0 versus 14.4) and significantly greater rates of abstinence from binge eating (40.0% versus 3.3%). At six-month follow-up, DBTgsh participants reported significantly improved quality of life and reduced ED psychopathology compared to baseline scores. In addition, most improvements in the DBTgsh group were maintained, although binge eating abstinence rates decreased to 30%. These preliminary positive findings indicate that DBTgsh may offer an effective, low-intensity treatment option for BED.

Eating Disorders, Substance Use Disorders, and Impulsiveness among Disordered Gamblers in a Community Sample

Disordered gambling and many eating disorders (EDs) involve recurrent loss of impulse control. We examined rates of specific EDs, ED psychopathology, substance use disorders, and their interrelationships with impulsiveness among community members with disordered gambling. Community-recruited adults with pathological (n = 95) or problem (n = 9) gambling (N = 104; 51% female) completed structured interviews and questionnaires. We observed high rates of substance dependence, lifetime EDs, and current ED psychopathology; 20.8% of women (vs 1.9% of men) had a DSM-IV ED, and 37.8% (vs 3.9%) had an ED according to proposed DSM-5 criteria. Although disordered gambling severity was not associated with ED diagnosis or severity of ED psychopathology, greater disordered gambling severity and an ED diagnosis were both associated with increased impulsiveness. These findings suggest that impulsiveness might constitute a common personality characteristic that underlies disordered gambling and EDs.

Longitudinal Associations Between Externalizing Behavior and Dysfunctional Eating Attitudes and Behaviors: A Community-Based Study

This study investigated longitudinal associations between externalizing behavior and dysfunctional eating attitudes and behaviors. Participants were girls drawn from the community-based Minnesota Twin Family Study and assessed at ages 11, 14, and 17. Cross-sectional correlations indicated that the strength of the associations between externalizing behavior and dysfunctional eating attitudes and behaviors increased over time. Mixed-model analyses indicated that earlier externalizing behavior predicted increases in weight preoccupation, body dissatisfaction, and use of inappropriate compensatory behaviors. Earlier use of inappropriate compensatory behaviors predicted increases in externalizing behavior.

Cognitive processing of body and appearance words as a function of thin-ideal internalization and schematic activation.

To better understand how women at risk of body image disturbance respond when their body concerns are activated, we examined attentional and memory biases in undergraduate women with high thin-ideal internalization, an identified risk factor for eating disorders, following priming of body and appearance concerns. Female undergraduates (N=186) viewed photos of either sports cars or attractive swimsuit models, then completed the Lexical Decision Test, a word recall test, and questionnaires assessing thin-ideal internalization and eating disorder symptomatology. High thin-ideal internalizers did not exhibit cognitive biases predicted by cognitive models of eating disorders, even when their body and appearance concerns were primed by exposure to attractive models. Converging evidence suggests that high-risk non-clinical samples rarely exhibit cognitive biases characteristic of individuals with eating disorders, and, in fact, may actually incorporate ideal appearance into their schemas and preferentially attend to attractive stimuli.

Change in emotion regulation during the course of treatment predicts binge abstinence in guided self-help dialectical behavior therapy for binge eating disorder.

BackgroundDialectical behavior therapy (DBT), which appears to be an effective treatment for binge eating disorder (BED), focuses on teaching emotion regulation skills. However, the role of improved emotion regulation in predicting treatment outcome in BED is uncertain.MethodsThis secondary analysis explored whether change in self-reported emotion regulation (as measured by the Difficulties in Emotion Regulation Scale) during treatment was associated with abstinence from binge eating at post-treatment and 4-, 5-, and 6-month follow-up in individuals who received a guided self-help adaptation of DBT for BED. Participants were 60 community-based men and women with BED who received a self-help manual and six 20-minute support phone calls.ResultsGreater improvement in self-reported emotion regulation between pre- and post-treatment predicted abstinence from binge eating at post-treatment, 4-, 5-, and 6-month follow-up. However, some follow-up results were no longer significant when imputed data was excluded, suggesting that the effect of emotion regulation on binge abstinence may be strongest at 4-month follow-up but decline across a longer duration of follow-up.ConclusionsThis study provides preliminary support for the theoretical role played by improved emotion regulation in achieving binge eating abstinence. If this finding is replicated with larger samples, further research should identify specific techniques to help more individuals to effectively regulate their emotions over a longer duration.

Adding thin-ideal internalization and impulsiveness to the cognitive–behavioral model of bulimic symptoms

This study evaluated the cognitive-behavioral (CB) model of bulimia nervosa and an extension that included two additional maintaining factors - thin-ideal internalization and impulsiveness - in 327 undergraduate women. Participants completed measures of demographics, self-esteem, concern about shape and weight, dieting, bulimic symptoms, thin-ideal internalization, and impulsiveness. Both the original CB model and the extended model provided good fits to the data. Although structural equation modeling analyses suggested that the original CB model was most parsimonious, hierarchical regression analyses indicated that the additional variables accounted for significantly more variance. Additional analyses showed that the model fit could be improved by adding a path from concern about shape and weight, and deleting the path from dieting, to bulimic symptoms. Expanding upon the factors considered in the model may better capture the scope of variables maintaining bulimic symptoms in young women with a range of severity of bulimic symptoms.

Weight bias: a call to action

Weight-related issues (including excess weight, disordered eating and body concerns) are often considered as comprising distinct domains of ‘obesity’ and ‘eating disorders’. In this commentary we argue that the concept of weight bias is an important variable when considering wellbeing across the spectrum of weight-related issues. We make the following six points in support of this argument: i) weight bias is common and has adverse health consequences, ii) shaming individuals for their body weight does not motivate positive behaviour change, iii) internalized weight bias is particularly problematic, iv) public health interventions, if not carefully thought out, can perpetuate weight bias, v) weight bias is a manifestation of social inequity, and vi) action on weight bias requires an upstream, population-level approach. To achieve sustainable reductions in weight bias at a population level, substantive modifications and collaborative efforts in multiple settings must be initiated. We provide several examples of population-level interventions to reduce weight bias.