Vivienne Lewis

Eating‐disordered behavior in adolescent boys: Eating disorder examination questionnaire norms

OBJECTIVE We sought to provide normative data for the Eating Disorder Examination Questionnaire (EDE-Q) for adolescent boys. METHOD The EDE-Q was completed by 531 boys aged 12-18 years recruited from a number of schools in the Australian Capital Territory (ACT) region of Australia. Data for 1,135 female adolescents, recruited as part of the same research project, are provided for comparative purposes. RESULTS Scores on each the EDE-Q subscales and, with the exception of excessive exercise, the prevalence of each of the eating disorder behaviors assessed, were substantially higher among girls than among boys. Still, 6.0% of boys reported regular episodes of objective binge eating, 8.3% reported regular episodes of loss of control eating, 5.3% reported regular excessive exercise and 4.9% reported overvaluation of weight or shape. Eating-disordered behavior was more common among older adolescents than among younger adolescents and this was the case for both boys and girls. Reliability coefficients for the EDE-Q subscales were marginally lower in boys (0.70-0.94) than in girls (0.84-0.97). CONCLUSIONS The EDE-Q appears to be suitable for use in adolescent boys, with the qualification that eating and weight/shape control behaviors that are largely confined to males may not be adequately assessed. The lack of assessment of subjective binge eating episodes may also be problematic. There is a need for research addressing whether and to what extent different features are associated with distress and disability in boys as well as the validity of the EDE-Q assessment of these features when compared with interview assessment.

Obesity and emotional well-being in adolescents : Roles of body dissatisfaction, loss of control eating, and self-rated health

Weak or inconsistent association between obesity and impairment in emotional well‐being in population‐based samples has led to efforts to identify mediating variables. This study examined the relative importance of body dissatisfaction (BD), loss of control (LOC) eating, and self‐rated health (SRH) in mediating the association between obesity and impairment in emotional well‐being in a school‐based sample of adolescents (boys, n = 437; girls, n = 950).

A Person-by-Situation Account of Why Some People More Frequently Engage in Upward Appearance Comparison Behaviors in Everyday Life

Although the influence of stable, trait-like factors (such as trait body dissatisfaction and appearance internalization) on instances of appearance comparison has been well documented, the additive and interactive influence of contextual factors (such as ones current body satisfaction) on comparison behaviors is unknown. Therefore, the present study tested a Person×Situation model in which both state and trait body image variables interacted to predict engagement in various forms of comparison (upward, downward, and lateral). Participants included 161 women who completed a baseline measure of trait body dissatisfaction and internalization, and then completed, via an iPhone app, an ecological momentary assessment phase in which they reported momentary experiences of mood and comparison behaviors at up to 6 random times per day for 7days. Multilevel analyses revealed that upward comparisons (comparisons against more attractive people) were more likely for individuals with heightened trait and/or state negative body image, but these predictive effects of state and trait on appearance comparisons appear largely independent of each other. Furthermore, neither state nor trait body image variables were related to the other forms of comparison, and time lag at the state-level between predictor and outcome did not seem to influence the strength of these associations. Present findings are consistent with the notion that how an individual feels in the moment about their appearance may influence engagement in deleterious appearance behaviors. However, further testing is needed to confirm these causal hypotheses.

The daily frequency, type, and effects of appearance comparisons on disordered eating

Using experience sampling methodology, we examined the effects of frequency and occurrence of appearance-based comparisons on disordered eating behaviors (binge eating, restrictive behaviors, and weight-related exercise). A total of 161 Australian women (aged 18–48) completed a baseline measure of eating pathology. An iPhone application prompted participants 6 times daily for 7 days to self-report on appearance comparisons and disordered eating behaviors since the last assessment. We hypothesized that contemporaneously reported occurrences of both upward and downward appearance comparisons, when compared to noncomparison situations, and frequency of upward comparisons would predict disordered eating behaviors. In prospective (lagged) analyses, only upward comparisons (relative to noncomparison situations) significantly predicted the likelihood of disordered eating outcomes. Trait eating pathology had a direct effect on each disordered eating variable and also moderated the influence of upward appearance comparisons (relative to noncomparison assessments) on binge-eating episodes. The lack of a differentiated effect between contemporaneously reported occurrences of upward and downward comparisons suggests that both forms of comparison increase the likelihood of disordered eating. Women may benefit from preventive programs that focus on the detrimental consequences of appearance comparisons on disordered eating; such programs may equip women with strategies to help reduce the frequency of these comparisons.

Enhancing positive body image: An evaluation of a cognitive behavioral therapy intervention and an exploration of the role of body shame

ABSTRACT This study investigated the effectiveness of a 6-week cognitive-behavioral group intervention in promoting the development of positive body image. The study also examined if, in accordance with the objectification theory, participants who reported higher levels of body shame would (a) report higher levels of body dissatisfaction, and (b) demonstrate less improvement in response to the Positive Bodies program. A total of 52 women aged 17–54 years completed self-report measures of self-esteem, body area satisfaction, body image quality of life, body shame, and self-surveillance at the commencement and conclusion of the program. The results provided preliminary support for the overall effectiveness of the program. Contrary to predictions, higher body shame was associated with greater improvements in indicators of body image over time. Further comparisons with a control or treatment comparison group are required; however, the results support benefits for individuals with body dissatisfaction, particularly those reporting higher levels of body shame.

Do women with greater trait body dissatisfaction experience body dissatisfaction states differently? An experience sampling study

The present study evaluated the relation of key features of state body dissatisfaction experiences - inertia, instability from moment-to-moment, and average level across time-points - to trait body dissatisfaction and/or eating disorder risk. Participants included 161 women who completed measures of trait body dissatisfaction and disordered eating pathology, and then completed reported state body dissatisfaction and contextual influences (binge eating, dietary restraint, exercise, and appearance comparison behaviors) 6 times daily for 7 days. Results indicated that individuals with elevated trait body dissatisfaction were reliably different from those with healthier body image in terms of average state body dissatisfaction ratings, but not for inertia or instability. State mean and trait body dissatisfaction uniquely predicted eating pathology, although their predictive accuracy for clinical caseness was comparable. Cost vs. benefit of using state body image data for understanding trait body image and eating pathology is discussed.

When Is Buff Enough? The Effect of Body Attitudes and Narcissistic Traits on Muscle Dysmorphia:

The present study investigated the relationship between narcissistic personality traits, body attitudes, and muscle dysmorphia. Participants were 117 men, aged 18 to 58 years, identifying as men who currently weight train (n = 78), former weight trainers (n = 28), or who had never weight trained (n = 11). Results indicated that male body attitudes were significantly associated with indications of muscle dysmorphia. Moreover, men who currently weight trained reported more positive body attitudes than former weight trainers. Specifically former weight trainers reported significantly more negative body attitudes compared with men who currently weight train if training frequency was reported as once per week or less. No significant association was found between narcissism and muscle dysmorphia. Furthermore, there were no significant differences between current and former weight trainers in levels of narcissism or muscle dysmorphia. These results highlight avenues for further investigation and the importance of understanding the complexity of body image issues in men in clinical practice.

Early life loss and trauma: eating disorder onset in a middle-aged male - a case study

The onset of an eating disorder in middle-age men is poorly researched as are eating disorders in men generally. Therefore, life events that influence eating disorders in men, including delayed onset of an eating disorder remains unknown. Given the limited understanding of males with eating disorders and limited access to large samples of men with eating disorders, an in-depth analysis of a single case of a male in middle age with an eating disorder was chosen to gain insight and understanding into this phenomenon. A Life History approach explored the case of Joseph (pseudonym), who was diagnosed at age 44 years with an Eating Disorder Not Otherwise Specified. Data were collected through (a) life course open-ended questioning through interviews, (b) written statements, and (c) comments on transcripts. Three themes emerged, loss and unworthiness, becoming bigger, and wanting to change reflecting eating behaviors associated with attachment disruption, loss and trauma, body dissatisfaction, and negative affect. Later in life, an emotional “tipping point” precipitated an eating disorder. Results indicate traumatic loss leading to early attachment disruption as influential in Joseph’s delayed onset of an eating disorder. The value of thorough narrative life histories during therapy when eating disorders occur late in life is discussed as well as the significance for men.