Rosalyn A. Griffiths

Body figure perceptions and eating attitudes among Australian schoolchildren aged 8 to 12 years

OBJECTIVE How widespread is the desire for thinness among preadolescent Australian children and are there gender differences? METHOD Two hundred forty-four children from Grades 3 to 6 completed the childrens version of the Eating Attitudes Test (ChEAT), reported whether they had ever wanted to be thinner or tried to lose weight, and selected pictures ranging from thin to fat to depict their current and ideal body images. RESULTS Fifty percent of girls and 33% of boys have wanted to be thinner, and 40% and 24%, respectively, have attempted to lose weight. Percentages of girls and boys scoring above the ChEAT screening threshold for anorexia risk were 14% and 8%, respectively. ChEAT scores, attitudes and behaviors, and current and ideal figure perceptions were significantly related to body mass index (BMI). DISCUSSION Attitudes and behaviors were consistent with recent U.S. and Israeli findings that concerns about being overweight are prevalent among 8- to 12-year-olds. High ChEAT scores among Grade 3 children raised the question of whether very young children adequately understand this questionnaire.

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.

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.

Measuring self‐esteem in dieting disordered patients: The validity of the Rosenberg and Coopersmith contrasted

OBJECTIVE In order to ascertain the most appropriate measure of self-esteem for dieting disordered patients, this study contrasted the construct and convergent validities of two widely used measures. In addition, dieting disordered subgroups were compared on levels of self-esteem. METHOD One hundred and seventeen male and female patients diagnosed with anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified completed the Rosenberg Self-Esteem Scale (SES), the Coopersmith Self-Esteem Inventory (SEI), and measures of dieting disorder pathology and depression. RESULTS No significant differences among the three dieting disorder subgroups were found. In determining convergent validity, regression analyses indicated that the SES was a significant predictor of dieting disorder psychopathology whereas the SEI was not. Of the two self-esteem measures, only the SES showed evidence of convergent validity. DISCUSSION The results suggest that the SES has sounder construct and convergent validity than the SEI. Hence, the SES may be more appropriate for use with dieting disordered populations.

Conscious and preconscious processing of food, body weight and shape, and emotion‐related words in women with anorexia nervosa

OBJECTIVE The present study was conducted to extend prior research on attention toward food and body weight and shape-related stimuli in women with eating disorders. METHOD A modified Stroop color-naming task was completed by women with anorexia nervosa and by control females subdivided on a measure of dietary restraint. Eating disorder-relevant word categories included words connoting fatness, words connoting thinness, low caloric density food words, high caloric density food words, and neutral, control words. Valence effects were controlled for by including positively and negatively valenced emotion words. Stimuli were presented under both unmasked and masked conditions. RESULTS Using unmasked stimuli, patients with anorexia nervosa, but not unrestrained or restrained eaters, had delayed color-naming latencies for both thin and fat word categories and, to a lesser extent, for high caloric density food words. No differences were observed with masked stimuli. DISCUSSION Our findings suggest that both thinness and fatness are especially salient to women with anorexia. The lack of effects for emotion words suggests that these findings do not reflect a valence effect. We found no evidence for preconscious attentional biases in the masked condition.

Restrained eating and sociocultural attitudes to appearance and general dissatisfaction

Objective: This study investigated the influence of sociocultural factors in a non-dieting disordered population. Relationships between restrained eating and the awareness and internalization of sociocultural attitudes towards appearance; and between restrained eating and the personality traits, perfectionism and general dissatisfaction, were examined. Method: Eighty-two female Australian-born university students completed four questionnaires: the Eating Attitudes Test (EAT), Revised Restraint Scale (RRS), Sociocultural Attitudes Towards Appearance Scale (SATAQ), Setting Conditions for Anorexia Nervosa Scale (SCANS). Results: Significant positive relationships were found between restrained eating and (a) abnormal eating attitudes, (b) awareness and internalization of sociocultural attitudes towards appearance, and (c) general dissatisfaction with oneself and life. There was no significant relationship between restrained eating and perfectionism. Post hoc analyses revealed a significant relationship between general dissatisfaction and the awareness and internalization of sociocultural pressures. Discussion: The study highlighted differences in psychopathology between dieting disordered and non-dieting disordered populations, and suggested that females who practice dietary restraint were aware of and internalize concepts about thinness and beauty. Furthermore, the findings suggested that it is not just exposure to these ideals but the acceptance of them that leads to restrained eating. Copyright

The Use of Guardianship Legislation for Anorexia Nervosa: A Report of 15 Cases

Objective: This paper investigates compulsory treatment under guardianship legislation for 15 anorexia nervosa patients admitted to four eating disorders units in New South Wales (NSW), Australia, between 1991 and 1994. Method: A retrospective follow-up was conducted. This involved an analysis of sociodemographic, clinical, eating and weight history, and Guardianship Order details obtained from medical records. This small sample was compared to a larger sample of anorexia nervosa patients admitted voluntarily to a specialised eating disorder unit in NSW. Further follow-up included a structured interview using the Morgan-Russell Assessment Outcome Schedule at least 1 year after admission for compulsory treatment. Results: For those treated involuntarily, a larger number came from metropolitan Sydney and a larger percentage were unemployed, were purgers and required specialist medical consultations. A significantly higher proportion came from higher socioeconomic groups, and the duration of stay in hospital while patients were under guardianship was significantly greater. A high degree of comorbidity was noted. There were similarities between those treated involuntarily and those treated voluntarily for the source of referral, marital status and Body Mass Index on admission and discharge. Only three patients accepted a follow-up interview using the Morgan-Russell Outcome Schedule. Two of them had made a good recovery. Conclusions: It was noted that the guardianship sample comprised a more severely ill group than anorexic patients treated voluntarily. The nature of guardianship legislation compared to mental health law was discussed and advice offered to clinicians contemplating and implementing compulsory treatment.

The Short‐Term Follow‐Up Effects of Hypnobehavioural and Cognitive Behavioural Treatment for Bulimia Nervosa

This study reports the short-term (nine months) follow-up effects of eight weeks of hypnobehavioural and cognitive behavioural treatment of bulimia nervosa. Of the 78 subjects who entered treatment, 48 completed a closed follow-up of nine months duration. The results based on this sample showed that there were no differences in abstinence from bingeing and purging between the treatments and that abstinence increased over time for both treatments. Also, there were no differences between treatments on eating pathology, bulimic behaviours or general psychopathology measures in the short term. Both treatment types were equally acceptable to patients. The results were compared with other studies. It was suggested that the model for HBT is comparable in validity with the model underlying CBT and that HBT could justifiably be recommended as an alternative to CBT.

The Treatment of Bulimia Nervosa

We review treatment approaches to bulimia nervosa, with particular emphasis on methodology and research design. The following treatments are considered: behaviour therapy, cognitive behaviour therapy, pharmacological treatment, group therapy, psychoanalytic psychotherapy, self-help and support groups, hypnosis and miscellaneous (family therapy and nutritional approaches). Several directions for future research and methodological recommendations are suggested.

Eating attitudes and the body mass index of Australian schoolchildren aged 8 to 12 years

Children from upper primary grades of three Sydney schools (n=244), aged from 8 to 12 years, completed the childrens version of the Eating Attitudes Test (ChEAT) (Maloney et al., 1988), reported whether they had ever desired to be thinner and had ever tried to lose weight, and had their heights and weights measured. Results were consistent with recent Swedish, U.S.A. and Israeli findings that concerns about being overweight are prevalent among pre-adolescent children, particularly among girls. The majority of overweight children reported that they have wished to be thinner, and many have actively sought to lose weight. Of females classified as underweight, 26 per cent have wanted to be thinner and 62 per cent of these had tried to lose weight at some time. Only six females were classified as very underweight, but three said that they had wanted to be thinner and two that they had actively tried to lose weight. Results offer some support for the value of the ChEAT as a screening test but its validity with very young children is questionable.