Nicholas A. Troop

Social comparison and submissive behaviour in eating disorder patients

Animal analogues of anorexia nervosa suggest that submissive behaviour and social defeat may be implicated in the onset of wasting diseases. Data from human sufferers of anorexia nervosa and bulimia nervosa are also consistent with the presence of submissive behaviours and perceived low social rank (e.g. low self-esteem, helplessness, and feelings of shame). A total of 101 patients with eating disorders completed the Submissive Behaviour Scale and the Social Comparison Rating Scale, and their responses were compared with 101 age- and sex-matched student controls. Patients with eating disorders reported significantly higher levels of submissive behaviour and a more unfavourable social comparison than did student controls. Furthermore, levels of submissive behaviour and unfavourable social comparison were significantly related to severity of eating disorder symptoms, even after taking account of depressive symptoms and other psychopathology. These preliminary results suggest that ranking theory may have some application to eating disorders. Further research is required to determine whether rank plays a specific role in eating disorders (beyond the increased rates of depression which also occur in eating disorders) and, if so, what is its precise role.

Disgust sensitivity in eating disorders: A preliminary investigation

BACKGROUND Disgust is a basic emotion that has been relatively neglected in psychiatry in general and in eating disorders in particular. Nevertheless, there are features of disgust and its more complex derivatives (e.g., shame) which suggest that disgust may have a role to play in eating disorders. METHOD Seventy-four patients with a DSM-IV diagnosis of anorexia nervosa, bulimia nervosa, eating disorder not otherwise specified, and obese binge eater were compared with 15 control subjects on their levels of disgust sensitivity. RESULTS Overall, eating disorder patients did not appear to be more sensitive to disgust-eliciting stimuli than comparison subjects, although there was a tendency for patients to be more disgusted by body products. However, drive for thinness and bulimia scores were related to higher levels of disgust sensitivity to food, death, and magical contagion. General psychopathology did not appear to be related to levels of disgust sensitivity. DISCUSSION Although patients are not more sensitive than controls to the disgust-eliciting stimuli measured, disgust still has a positive relationship to eating disorder symptoms. Future studies will need to examine more precisely what this relationship might be.

The Effects of Stress on Body Weight: Biological and Psychological Predictors of Change in BMI

Objective: To investigate individual differences in the effects of stress on BMI.

Eating disorders in males: A comparison with female patients

It is controversial whether males and females with eating disorders differ in a relevant way. We present a comparison of 30 male and 30 female patients assessed at The Maudsley Hospital in 2.5 years. Of the male group 33 per cent were anorexic, 50 per cent were bulimic, and 17 per cent met criteria for an eating disorder not otherwise specified. The female sample was matched to the males by diagnosis. Male and female patients are essentially similar, in particular there are no differences in severity of eating disorder. However, homosexuality appears to be more frequent among males. Moreover, males with an eating disorder show a stronger psychiatric co-morbidity and a higher rate of suicide attempts. Copyright (C) 2000 John Wiley and Sons, Ltd and Eating Disorders Association.

Shame, depressive symptoms and eating, weight and shape concerns in a non-clinical sample

Shame has been shown to be related both to symptoms of depression and eating pathology. However, the independence of this relationship has not yet been established. The purpose of the present study was to determine whether the relationship between shame and eating disorder symptoms was independent of the relationships of these variables with depression. Seventy non-clinical female participants completed measures of eating disorderrelated concerns using the Eating Disorder Examination — Questionnaire version (EDE-Q), depressive symptoms using the Beck Depression Inventory (BDI-II) and two measures of shame, the Other As Shamer Scale (OAS) and the Test of Self-Conscious Affect (TOSCA). Despite a strong association between BDI-II and EDE-Q scores and a moderate relationship between the shame measures, the two measures of shame showed some specificity in their relationships with symptom measures. The OAS was independently related to levels of BDI-II scores while the TOSCA was independently related to scores on the EDE-Q. There are a number of differences between the two measures of shame used in this study. The fact that each was differentially related to eating concerns and depressive symptoms may give clues as to which aspects of shame are important in each of the two types of pathology.

Perceptual illusions in eating disorders: rigid and fluctuating styles

This study investigated perceptual styles in anorexia nervosa (AN) and bulimia nervosa (BN) using a perceptual set task. We hypothesised that, consistent with personality style research. AN patients might be more rigid in style than those with BN or no eating disorder. We found that once an illusion had been established, participants with AN and BN showed more illusions than non-ED women. However, while AN patients responded rigidly, giving the same response repeatedly, BN patients were more likely to change their responses. The study suggests interesting differences to be followed up in future research. Differences in rigid and fluctuating perceptual styles may have implications for understanding the phenomenology of eating disorders, and have implications for treatment.

Childhood social arena and cognitive sets in eating disorders

OBJECTIVE While there is much evidence to suggest that women with eating disorders experience difficulties in the social domain, little has been done to establish whether such difficulties play a causal role or the extent to which these involve cognitive factors. The purpose of this report is to determine whether difficulties in certain aspects of the childhood social arena are reported as existing prior to developing an eating disorder. METHOD A sample of 43 women with a history of eating disorders and 20 women with no such history were interviewed retrospectively about their feelings and experiences of loneliness, shyness and inferiority in childhood and adolescence. RESULTS Women with a history of anorexia nervosa of the binge/purge subtype reported higher levels of loneliness, shyness and feelings of inferiority in adolescence than did women with no history of an eating disorder, and women with a history of bulimia nervosa reported higher levels of shyness. However, this was not true for earlier childhood where such feelings did not differ significantly between groups. This difference could not be accounted for by current depressive disorder, recovery from the eating disorder or level of victimization in adolescence. CONCLUSION There are a number of differences in the aetiology of subtypes of eating disorder. The present results suggest that cognitive styles pertaining to the social arena in adolescence, and prior to the onset of any eating disorders, may play a causal role in the development of anorexia nervosa of the binge/purge subtype, but not anorexia nervosa of the restricting subtype.

Doubly disabled: diabetes in combination with an eating disorder.

We present a series of patients with both an eating disorder and diabetes mellitus and compare these to a group of non-diabetic patients from the same clinic. Significantly more of the diabetic patients had previous attempts at treatment for their eating disorder. A high incidence of diabetic complications was noted with clear implications, both clinically and economically, for early intervention. The incidence of childhood trauma was lower in the diabetic than the non-diabetic group. In the majority of patients, diabetes developed before the eating disorder, suggesting that diabetes itself may provide the vulnerability and increase the risk of developing an eating disorder. Early intervention in diabetic clinics may prevent the development of serious eating disorders.

Online longitudinal survey research: viability and participation

This article explores the viability of conducting longitudinal survey research using the Internet in samples exposed to trauma. A questionnaire battery assessing psychological adjustment following adverse life experiences was posted online. Participants who signed up to take part in the longitudinal aspect of the study were contacted 3 and 6 months after initial participation to complete the second and third waves of the research. Issues of data screening and sample attrition rates are considered and the demographic profiles and questionnaire scores of those who did and did not take part in the study during successive time points are compared. The results demonstrate that it is possible to conduct repeated measures survey research online and that the similarity in characteristics between those who do and do not take part during successive time points mirrors that found in traditional pencil-and-paper trauma surveys.

Multidimensionality of intrusion and avoidance: alternative factor models of the Impact of Event Scale

Previous research using exploratory factor analysis of the Impact of Event Scale (Horowitz et al., 1979) has suggested structures that are not consistent with the original two-factor model. IES data from 485 emergency service personnel who had experienced traumatic events during the course of their work were submitted to confirmatory factor analysis to test seven alternative factor models of the IES. This study is one of the most comprehensive analyses of the IES to date, investigating both theoretically and empirically derived models. The model of best fit was a four-factor model with a single second-order factor. This model comprised four first-order factors including intrusion, avoidance, numbing and sleep disturbance factors all subsumed by a second-order general distress factor. These results provide support for the multidimensionality of both intrusion and avoidance symptoms following traumatic experiences. Researchers and practitioners in the field of traumatic stress should be made aware of the assessment and treatment implications of this multidimensional structure