Categories or dimensions? Towards a transdiagnostic treatment of eating psychopathology / ¿Categorías o dimensiones? Hacia un tratamiento transdiagnóstico de la psicopatología alimentaria

The purpose of this research was to contrast the categorial and dimensional approaches within the eating disorders area. Research on the eating problems categorical model reveals vast evidence against its validity: excessive comorbidity, inadequate coverage, diagnostic migration, residual categories, false positives and negatives, etc. The dimensional conceptualization of the eating psychopathology study would achieve more accurate findings by considering eating problems according to the degree in which they manifest, avoiding diagnostics based on arbitrary cut-off points and facilitating the analysis of eating psychopathology at early age, as well as following symptom evolution throughout development. Based on the dimensional model, transdiagnostic perspective has received empirical support, which endorses the use of the transdiagnostic treatment aimed to underlying psychological mechanisms, such as negative affect and emotional dysregulation.ResumenEl propósito de la presente investigación fue contrastar los enfoques categorial y dimensional dentro del área de los trastornos alimentarios. La investigación sobre el modelo categorial de los problemas alimentarios revela un amplio cúmulo de pruebas en contra de su validez, como comorbilidad excesiva, cobertura inadecuada, migración diagnóstica, categorías residuales, falsos positivos y negativos, etc. El estudio de la psicopatología alimentaria desde una conceptuación dimensional permitiría obtener hallazgos más precisos, al considerar a los problemas alimentarios según el grado en el que se presentan, evitar diagnósticos basados en puntos de corte arbitrarios, facilitar su análisis a edad temprana, así como seguir la evolución de los síntomas a lo largo del desarrollo. Apoyada en el modelo dimensional, la perspectiva transdiagnóstica ha recibido respaldo empírico que fundamenta su uso en el tratamiento de los mecanismos psicológicos subyacentes a las problemáticas alimentarias, como el afecto negativo y la desregulación emocional.

Further support for the validity of the social appearance anxiety scale (SAAS) in a variety of German-speaking samples

Purpose Eating disorders (ED) and social anxiety disorder are highly comorbid with potentially shared symptoms like social appearance anxiety (SAA) referring to a fear of being negatively evaluated by others’ because of overall appearance. SAA constitutes a risk factor for eating psychopathology and bridges between EDs and social anxiety disorder. Methods The present studies examined internal consistency, factor structure, test–retest reliability, gender and age invariance, convergent validity and differences between individuals with and without an ED of a German version of the social appearance anxiety scale (SAAS) in four independent samples (n1 = 473; n2 = 712; n3 = 79; n4 = 33) including adolescents and patients with EDs. Results Consistently, the SAAS showed excellent internal consistency (ωs ≥ 0.947) and a one-factorial structure. Convergent validity was shown via high correlations of the SAAS with social anxiety (e.g., social interaction anxiety r = 0.642; fear of negative evaluation rs ≥ 0.694), body image disturbance measures (e.g., shape concerns rs ≥ 0.654; weight concerns rs ≥ 0.607; body avoidance rs ≥ 0.612; body checking rs ≥ 0.651) and self-esteem (r = −0.557) as well as moderate correlations with general eating psychopathology (e.g., restrained rs ≥ 0.372; emotional r = 0.439; external eating r = 0.149). Additionally, the SAAS showed gender and age invariance and test–retest reliability after 4 weeks with r = 0.905 in Study 2 and was able to discriminate between individuals with and without an ED in Study 4. Conclusion Hence, the German version of the SAAS can reliably and validly assess SAA in female and male adolescents or adults with or without an ED. Additionally, the SAAS might be used in a therapeutic context to especially target patient groups suffering from EDs with comorbid social anxiety. Level of evidence Level III: Evidence obtained from cohort or case-control analytic studies.

Eating psychopathology in ballet dancers: a meta-analysis of observational studies

Objective To assess whether ballet dancers have higher eating psychopathology mean scores than the general population. Methods Meta-analysis of cross-sectional observational studies comparing the scores of one or more of the validated eating psychopathological scales between ballet dancers and any control groups. Results Twelve studies were included in the metanalysis. Ballet dancers had a significantly higher EAT score (12 studies retrieved, SMD 0.82 [95% CI 0.44–1.19], p < 0.00001, I2 = 84)]; subgroup analysis suggested a possible role of control subjects’ choice in explaining heterogeneity. Scores on the EDI subscales of Drive for Thinness, Bulimia, and Body dissatisfaction were available from four studies; Drive for Thinness was higher in ballet dancers (SMD 0.62 [0.01, 1.22]), as well as the Bulimia scale (SMD 0.38 [0.02, 0.73], p = 0.04) and the Body Dissatisfaction scale (SMD 0.34 [0.15, 0.53]). Data on Perfectionism, Interpersonal problems, Ineffectiveness, and Maturity fears, were available from three studies. Higher scores in Perfectionism (SMD 0.68 [0.24, 1.12] p = 0.02), Interpersonal problems (SMD 0.24 [0.02, 0.47], in Inefficacy, (SMD 2.18 [1.31, 3.06]) were found for ballet dancers; on the other hand, Maturity fears scores were not significantly different between ballet dancers and controls (IV-MD = 0.15 [− 0.07, 0.36]). Seven studies reported tests not performed elsewhere. Discussion Ballet dancers show a higher level of restriction and drive for thinness than controls, and they may be, therefore, at higher risk for the development of eating disorders. Available studies do not allow the discrimination of dysfunctional eating attitudes and behaviors from adaptive responses. Level of evidence Level I (evidence obtained from systematic reviews and meta-analyses).

Emotion regulation difficulties in anorexia nervosa: associations with improvements in eating psychopathology

Background Difficulties with emotion regulation have been established as a core deficit in anorexia nervosa (AN). However, limited research has evaluated whether weight gain is associated with improvements in emotion regulation difficulties in AN and whether improvements in emotion regulation are associated with reductions in eating disorder psychopathology. The aims of this study were threefold: 1) to examine the nature and extent of emotion regulation difficulties in AN; 2) to determine whether these difficulties improved during intensive treatment for the eating disorder; and 3) to study whether improvements in emotion regulation were associated with improvements in eating disorder psychopathology. Method The participants were 108 patients who met DSM-IV-TR criteria for AN and were admitted to a specialized intensive treatment program. Self-report measures of eating disorder symptoms and difficulties with emotion regulation were administered at admission to and discharge from the program. Results Patients with the binge-purge subtype of AN reported greater difficulties with impulse control when upset and more limited access to emotion regulation strategies when experiencing negative emotions than those with the restricting subtype. Among those who completed treatment and became weight restored, improvements in emotion regulation difficulties were observed. Greater pre-to-post treatment improvements in emotional clarity and engagement in goal directed behaviours when upset were associated with greater reductions in eating disorder psychopathology during treatment. Conclusions These findings add to growing evidence suggesting that eating disorder symptoms may be related to emotion regulation difficulties in AN and that integrating strategies to address emotion regulation deficits may be important to improving treatment outcome in AN.

Emotion regulation difficulties in anorexia nervosa: associations with improvements in eating psychopathology

Background Difficulties with emotion regulation have been established as a core deficit in anorexia nervosa (AN). However, limited research has evaluated whether weight gain is associated with improvements in emotion regulation difficulties in AN and whether improvements in emotion regulation are associated with reductions in eating disorder psychopathology. The aims of this study were threefold: 1) to examine the nature and extent of emotion regulation difficulties in AN; 2) to determine whether these difficulties improved during intensive treatment for the eating disorder; and 3) to study whether improvements in emotion regulation were associated with improvements in eating disorder psychopathology. Method The participants were 108 patients who met DSM-IV-TR criteria for AN and were admitted to a specialized intensive treatment program. Self-report measures of eating disorder symptoms and difficulties with emotion regulation were administered at admission to and discharge from the program. Results Patients with the binge-purge subtype of AN reported greater difficulties with impulse control when upset and more limited access to emotion regulation strategies when experiencing negative emotions than those with the restricting subtype. Among those who completed treatment and became weight restored, improvements in emotion regulation difficulties were observed. Greater pre-to-post treatment improvements in emotional clarity and engagement in goal directed behaviours when upset were associated with greater reductions in eating disorder psychopathology during treatment. Conclusions These findings add to growing evidence suggesting that eating disorder symptoms may be related to emotion regulation difficulties in AN and that integrating strategies to address emotion regulation deficits may be important to improving treatment outcome in AN.