Liesbet Boone

Fostering Self-Endorsed Motivation to Change in Patients with an Eating Disorder: The Role of Perceived Autonomy Support and Psychological Need Satisfaction

OBJECTIVE Although several studies have established the beneficial effects of self-endorsed forms of motivation for lasting therapeutic change, the way patients with an eating disorder can be encouraged to volitionally pursue change has received less attention. On the basis of Self-Determination Theory, this longitudinal study addressed the role of an autonomy-supportive environment and psychological need satisfaction in fostering self-endorsed motivation for change and subsequent weight gain. METHOD Female inpatients (n = 84) with mainly anorexia nervosa and bulimia nervosa filled out questionnaires at the onset of, during, and at the end of treatment regarding their perceived autonomy support from parents, staff members, and fellow patients, their psychological need satisfaction, and their reasons for undertaking change. Furthermore, the body mass index (BMI) of the patients at the onset and end of treatment was assessed by the staff. Path analyses were used to investigate the relations between these constructs. RESULTS At the start of treatment, perceived parental autonomy support related positively to self-endorsed motivation through psychological need satisfaction. Perceived staff and fellow patients autonomy support related to changes in self-endorsed motivation over the course of treatment through fostering change in psychological need satisfaction. Finally, relative increases in self-endorsed motivation related to relative increases in BMI throughout treatment in a subgroup of patients with anorexia nervosa. DISCUSSION These results point to the importance of an autonomy-supportive context for facilitating self-endorsed motivation.

Longitudinal association between child stress and lifestyle

OBJECTIVE Psychosocial stress has been linked with an unhealthy lifestyle but the relations direction remains unclear. Does stress induce sleeping problems, comfort food consumption, and lower physical activity, or do these unhealthy lifestyle factors enhance stress? This study examined the bidirectional stress-lifestyle relation in children. METHOD The relation between stress and lifestyle was examined over 2 years in 312 Belgian children 5-12 years old as part of the Childrens Body Composition and Stress study. Stress-related aspects were measured by questionnaires concerning negative events, negative emotions, and behavioral problems. The following lifestyle factors were assessed: physical activity (by accelerometers), sleep duration, food consumption (sweet food, fatty food, snacks, fruits and vegetables), and eating behavior (emotional, external, restrained). Bidirectional relations were examined with cross-lagged analyses. RESULTS Certain stress aspects increased physical activity, sweet food consumption, emotional eating, restrained eating, and external eating (βs = .140-.319). All relations were moderated by sex and age: Dietary effects were mainly in the oldest children and girls; stress increased physical activity in the youngest, whereas it tended to decrease physical activity in the oldest. One reversed direction effect was found: Maladaptive eating behaviors increased anxiety feelings. CONCLUSIONS Relations were mainly unidirectional: Stress influenced childrens lifestyle. Stress stimulated eating in the absence of hunger, which could facilitate overweight. Consequently, families should realize that stress may influence childrens diet, and problem-solving coping skills should be acquired. In contrast to recent findings, stress might also stimulate physical activity in the youngest as positive stress coping style.

Self-critical perfectionism and binge eating symptoms: a longitudinal test of the intervening role of psychological need frustration

Although abundant research has shown that self-critical perfectionism relates to binge eating symptoms, fewer studies have addressed the role of intervening processes that might explain why this is the case. Grounded in self-determination theory, we hypothesized that self-critical perfectionism would relate to an increased risk for binge eating symptoms because it engenders frustration of the psychological needs for autonomy, competence, and relatedness. This hypothesis was tested in a sample of 566 adolescents (72% female; mean age = 13.3 years) using a 3-wave longitudinal study with a 6-month interval. Structural equation modeling analyses showed that self-critical perfectionism related to increases in psychological need frustration which, in turn, predicted increases in binge eating symptoms. Structural relations were found to be equivalent for males and females. Theoretical and clinical implications of these findings are discussed.

When or why does perfectionism translate into eating disorder pathology? A longitudinal examination of the moderating and mediating role of body dissatisfaction.

Although research has shown that perfectionism is associated with eating disorder pathology, the role of body dissatisfaction in this association is less clear. In this study, we examined the possible moderating and mediating role of body dissatisfaction in the relation between perfectionism and increases in eating disorder pathology. Both possible roles were tested in a sample of 455 adolescent girls (mean age = 13.25 years) using a 3-wave longitudinal study. We only found support for the moderation hypothesis, with girls high on both perfectionism and body dissatisfaction exhibiting the highest levels of eating disorder symptoms. Implications of these findings are discussed.

Cross-lagged associations between children's stress and adiposity: the Children's Body Composition and Stress study.

Objective The public health threats stress and adiposity have previously been associated with each other. Longitudinal studies are needed to reveal whether this association is bidirectional and the moderating factors. Methods In the longitudinal Children’s Body Composition and Stress study, 316 children (aged 5–12 years) had measures of stress (questionnaires concerning negative life events, problem behavior, and emotions) and adiposity (body mass index, waist-to-height ratio, and fat percentage) in three waves at 1-year intervals. The bidirectionality of the association between stress and adiposity was examined using cross-lagged analyses. We tested moderation by cortisol and life-style (physical activity, screen time, food consumption, eating behavior and sleep duration). Results Adiposity (body mass index: &bgr; = 0.48 and fat percentage: &bgr; = 0.18; p < .001) were associated with subsequent increased stress levels, but stress was not directly related to subsequent increases in adiposity indices. Cortisol and life-style factors displayed a moderating effect on the association between stress and adiposity. Stress was positively associated with adiposity in children with high cortisol awakening patterns (&bgr; = 0.204; p = .020) and high sweet food consumption (&bgr; = 0.190; p = .031), whereas stress was associated with lower adiposity in the most active children (&bgr; = −0.163; p = .022). Conclusions Stress is associated with the development of children’s adiposity, but the effects depend on cortisol levels and life-style factors. This creates new perspectives for multifactorial obesity prevention programs. Our results also highlight the adverse effect of an unhealthy body composition on children’s psychological well-being.

Too strict or too loose? Perfectionism and impulsivity: the relation with eating disorder symptoms using a person-centered approach.

Although both perfectionism (i.e. personal standards perfectionism and evaluative concerns perfectionism) and impulsivity have been shown to be implicated in eating disorders, no previous studies have examined the interplay between both personality dimensions in their association with eating disorder symptoms. This is the first study to investigate the relationship between empirically derived personality subtypes based on perfectionism and impulsivity and eating disorder symptoms (i.e., dietary restraint, and concerns over eating, weight and shape). Cluster analysis was used to establish naturally occurring combinations of perfectionism and impulsivity in adolescent boys and girls (N=460; M age=14.2 years, SD=.90). Evidence was obtained for four personality profiles: (1) a resilient subtype (low on perfectionism and impulsivity), (2) pure impulsivity subtype (high on impulsivity only), (3) pure perfectionism subtype (high on perfectionism only), and (4) combined perfectionism/impulsivity subtype (high on both perfectionism and impulsivity). Participants in these four clusters showed differences in terms of eating disorder symptoms in that participants with a combination of high perfectionism and high impulsivity (rather than the presence of one of these two characteristics alone) had the highest levels of ED symptoms. These findings shed new light on extant theories concerning ED.

The Impeding Role of Self-Critical Perfectionism on Therapeutic Alliance During Treatment and Eating Disorder Symptoms at Follow-up in Patients with an Eating Disorder

This study examines the impeding role of self-critical perfectionism at onset of treatment on therapeutic alliance during treatment and eating disorder symptoms at follow-up in patients with an eating disorder. Participants were 53 female patients with a mean age of 21.1 years treated for an eating disorder in a specialized inpatient treatment unit. Self-critical perfectionism was assessed at admission, therapeutic alliance was assessed during treatment (after three months of treatment), and eating disorder symptoms were assessed at admission, after three months and one year later. Self-critical perfectionism negatively related to treatment alliance with the therapist. Although self-critical perfectionism was not directly predictive of subsequent changes in eating disorder symptoms, it was indirectly related to less reduction in body dissatisfaction through the therapeutic alliance. These results point to the importance of self-critical perfectionism in the therapeutic alliance and in changes in body image problems. Treatment implications are discussed.

Children’s stress influences their diet, physical activity and adiposity: longitudinal behavioural and hormonal pathways

consumption (BMI, p=0.020) or high cortisol awakening response (waist, p=0.030). Physical activity was a protective moderator: stress decreased adiposity in children with high physical activity (fat%, p=0.025). In the other direction, high BMI (p<0.001), high fat% (p<0.001) and psychological eating behaviour (p=0.014) also increased stress. High cortisol (overall levels, awakening response and diurnal slope) was associated with an unhealthy diet especially with the sweet foods.

Children's stress: associations with lifestyle and obesity

Introduction: the relationship between psychiatric symptoms and cancer has sparked a lot of interest in the scientific community. The available literature is mostly on the impact of cancer diagnosis. However, little is known about the patients psychological status before that. Studies in this area show that cancer patients often present depressive symptoms before the diagnosis of neoplastic disease, probably due to cytokine production by the tumors. Low concentrations of cytokines would be sufficient to change the patient’s emotional state. Case description: to alert clinicians to the possibility that psychiatric symptoms may be a signal of underlying cancer disease, especially in patients above 50 years without psychiatric history, we present the following case. A woman of 53 years, followed in the Portuguese Institute of Oncology of Coimbra since October 2009 for mixed adenocarcinoma of the lung (stage IB). Approximately 1 month later, in November 2009, she was referred to psychiatric consultation because of depressive symptoms and complains since 1 year before. She also reported history of thyroid goiter, emphysema, and depressive episode occurred 10 years begore. Since the cancer was diagnosed, depression has shown a fluctuating evolution. Various therapeutic settings were made, being currently medicated with venlafaxine 225 mg, trazodone 150 mg AC i.d., and lorazepam 2.5 mg i.d.. Comment: the emergence of psychiatric symptoms, especially in patients above 50 years, should alert the physician to the presence of a possible hidden cancer, especially in the case of patients without psychiatric history.Introduction: Stress has been hypothesized to be involved in obesity development. Apart from a direct pathway through cortisol, stress may indirectly facilitate obesity by influencing other lifestyle factors: stressed persons may consume more comfort foods, may have a more sedentary behaviour and may suffer from sleep problems. Methods: In 326 Belgian children (5-12y) of the ChiBS study, the longitudinal relation between stress and body composition was examined over two years. Stress was measured by salivary cortisol (4 samples/day, 2 days) and questionnaires concerning negative life events, problem behaviour and emotions. For body composition, BMI, waist-to-height and fat% estimation by air displacement were used. Furthermore, physical activity, screentime, food consumption, eating behaviour and sleep duration were measured as lifestyle factors. Cross-lagged analyses with Mplus and moderation by cortisol and lifestyle factors were tested. Results: Children with higher stress scores had a less healthy lifestyle. They had an unhealthier diet especially due to more sweet food consumption, performed more emotional eating, were less active and slept less. Two years later, these stressed children maintained the same unhealthy life style except that they were more physical active instead of less. Salivary cortisol and lifestyle were moderators in the stress-obesity relation: stressed children had also more overweight or a higher fat percentage, but only when they had an unhealthier lifestyle or higher cortisol. Discussion: These results confirm that stress can deteriorate lifestyle and cortisol homeostasis already in childhood and that these changes make them vulnerable to overweight. Consequently, obesity prevention should target both lifestyle and stress.