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 Poster Session I
Thursday, April 23, 2015
6:30 – 8:00 p.m.
BED & Obesity
T1
Longitudinal Associations Between Overweight and Binge Eating from Adolescence to
Early Adulthood
Andrea Goldschmidt, PhD, The University of Chicago, Chicago, Illinois, USA; Melanie Wall, PhD,
Columbia University, New York, New York, USA; Tse-Hwei Choo, MS, Columbia University, New York,
New York, USA; Katie Loth, PhD, University of Minnesota, Minneapolis, Minnesota, USA; Dianne
Neumark-Sztainer, PhD, MPH, RD, FAED, University of Minnesota, Minneapolis, Minnesota, USA
Being overweight in adolescence is a major risk factor for binge eating, which is associated with multiple
adverse health outcomes. However, not all overweight youth go on to develop eating pathology, which
highlights the need to identify risk factors specific to this subset of the pediatric population. The current
study sought to examine predictors of binge eating among overweight, community-based boys and girls
involved in Project EAT (Eating Among Teens and Young Adults) who were followed over a 10-year
period. Participants reported on binge eating, weight-related teasing, depressive symptoms, body
satisfaction, and weight status at 5-year intervals spanning early/middle adolescence (Time 1), late
adolescence/early young adulthood (Time 2) and early/middle young adulthood (Time 3). Using logistic
regression, we found that weight-related teasing at Time 1 (p=.003) and depressive symptoms at Time 2
(p=.03) predicted new onset binge eating at Time 3. There was a trend towards increases in depressive
symptoms from Time 1 to Time 2 (p=.08) and, separately, from Time 2 to Time 3 (p=.08) to predict new
onset binge eating at Time 3. Overall, results suggest that specific psychosocial factors are associated with
elevated risk for binge eating among youth who are already overweight. Our findings support onset and
maintenance models which suggest that binge eating may develop as a mean of modulating negative
affect, particularly as related to distressing interpersonal experiences (e.g., appearance-based teasing).
Preventive interventions targeting overweight youth may benefit from incorporating a focus on coping
with teasing experiences and reducing depressive symptoms.
Learning Objectives:
• Identify risk factors for binge eating among overweight adolescents
• Understand how risk factors apply to onset and maintenance models of binge eating
• Translate findings to interventions for preventing binge eating in overweight youth
T2
Suicidal Ideation and Behaviors Among Adolescents Receiving Bariatric Surgery: A CaseControl Study
Jeanne McPhee, BA, Columbia University Medical Center, New York State Psychiatric Institute, New
York, New York, USA; Eve Freidl, MD, Columbia University Medical Center, New York, New York, USA;
Julia Eicher, BA, Columbia University, New York, New York, USA; Jeffrey L. Zitsman, MD, New York
Presbyterian Hospital, New York, New York, USA; Michael J. Devlin, MD, Columbia University Medical
Center, New York, New York, USA; Robyn Sysko, PhD, New York State Psychiatric Institute, New York,
New York, USA
Suicide risk may be elevated following bariatric surgery; however, unlike in adults, little is known about
suicidal ideation and behaviors (history or attempts) among adolescents undergoing such surgery. This
study examined the prevalence and correlates of suicidal ideation and behavior (SI/B) in a population of
adolescents receiving weight loss surgery. Among 206 adolescents receiving either laparoscopic adjustable
gastric banding or gastric sleeve resections, retrospective chart and record review identified 31 (15.0%)
with SI/B before and/or after surgery. Specifically, at program enrollment pre-surgery, 16 adolescents
reported a history of a suicidal ideation and 7, a history of suicide attempt. While enrolled in the program,
7 participants were hospitalized for suicidal ideation or suicide attempt. Post-surgery, 1 adolescent
completed suicide. Cases with SI/B were matched by gender and age with a group of adolescents reporting
current or past psychiatric treatment, and with a group of adolescents reporting no psychiatric treatment.
At the pre-surgical psychiatric evaluation, a greater proportion of adolescents with SI/B (64.5%) met
criteria for current DSM-IV diagnoses compared to those with a history of psychiatric treatment (35.5%)
and to those with no such treatment (12.5%) [Χ2(2) = 18.3, p< 0.001]. Pre-surgery, adolescents with SI/B
also reported lower health-related quality of life compared to those who had never received psychiatric
treatment, but did not differ from those with a history of psychiatric treatment [F(2, 84) = 4.2, p = 0.02].
Further analyses will examine whether SI/B influences post-surgery weight loss trajectories. We conclude
that, like in adults, a notable subset of adolescents receiving bariatric surgery have pre- or post-operative
risk of SI/B which appears related to other measures of psychosocial functioning. It is therefore critical
that clinicians evaluate and monitor adolescent patients undergoing bariatric surgery for suicidal ideation
and behaviors.
Learning Objectives:
• Assess the risk of suicidal ideation and behaviors in adolescents receiving bariatric surgery.
• Identify correlations (if any) between suicidal ideation or psychiatric treatment history and postsurgery weight loss trajectories in adolescents who have undergone weight-loss surgery.
• Explain the relationship between suicidal ideation and behaviors with other DSM-IV Axis I
diagnoses and quality of life measures.
T3
Alcohol Use, Disinhibition, and Treatment Outcome in Overweight and Obese Adults
Colleen Kase, BA, Drexel University, Philadelphia, Pennsylvania, USA; Amani D. Piers, BS, Drexel
University, Philadelphia, Pennsylvania, USA; Katherine Schaumberg, PhD, Drexel University,
Philadelphia, Pennsylvania, USA; Evan M. Forman, PhD, Drexel University, Philadelphia,
Pennsylvania, USA; Meghan L. Butryn, PhD, Drexel University, Philadelphia, Pennsylvania, USA
There is a wealth of evidence supporting the link between alcohol use and disinhibition, as well as
between disinhibition and obesity, but less is known about how these concepts intersect. The current
investigation explored the relationship between alcohol use, disinhibition, and treatment outcome in a
sample of overweight and obese adults (N = 175) enrolled in a 56-week behavioral weight loss treatment.
Participants who met criteria for substance abuse at baseline were excluded from the study. Participants
completed three 24-hour food recalls at baseline. Registered dieticians conducted the recalls and
calculated grams of nutrients, including alcohol, per day for each participant. Participants were classified
as “heavy drinkers” (n=16), “low-risk drinkers” (n =73), or “non-drinkers” (n=86) based on National
Institute on Alcohol Abuse and Alcoholism criteria. Participants also completed the Weight and Lifestyle
Inventory, Three-Factor Eating Questionnaire, and Beck Depression Inventory at baseline. Non-drinkers,
low-risk drinkers, and heavy drinkers did not differ in terms of binge frequency, dieting history, or
depression at baseline, nor did they differ significantly in terms of weight loss at end of treatment. Lowrisk drinkers had slightly lower baseline BMIs than non-drinkers (p < .05). Heavy drinkers were
disproportionately male (p < .05) but were otherwise demographically similar to the rest of the sample.
Heavy drinking was associated with elevated eating-related internal disinhibition at baseline (p < .05) and
a higher rate of attrition by end of treatment (p < .05) compared to the remainder of the sample. These
findings suggest that while low-risk drinking is not a barrier to successful weight loss treatment, heavy
drinking may make successful treatment more difficult. Heavy drinkers present an increased attrition risk
and, given that recent research has suggested a link between internal disinhibition and weight regain, they
may be at higher risk for weight regain after treatment.
Learning Objectives:
• Summarize the similarities and differences between heavy alcohol users, low-risk users, and nonusers in a sample of overweight and obese adults in terms of disinhibition and weight loss
treatment outcome
• Identify heavy alcohol users as being at higher risk for study attrition and potentially weight
regain in the context of behavioral weight loss treatment
• Recognize that low-risk alcohol use is likely not a barrier to successful weight loss treatment
T4
Is the Eating Disorder Inventory Suitable for Screening Binge Eating Disorder?
Ulla Kärkkäinen, MSc, University of Helsinki, Helsinki, Helsinki, Finland; Linda Mustelin, PhD, MD,
University of Helsinki, Helsinki, Helsinki, Finland; Sohvi Lommi, MSc, University of Helsinki, Helsinki,
Helsinki, Finland; Anu Raevuori, PhD, MD, University of Helsinki, Helsinki, Helsinki, Finland; Jaakko
Kaprio, PhD, MD, University of Helsinki, Helsinki, Helsinki, Finland; Anna Keski-Rahkonen, PhD, MD,
MPH, FAED, University of Helsinki, Helsinki, Helsinki, Finland
Background We assessed whether the Eating Disorder Inventory (EDI) is suitable for screening BED in
young women from the general population. Method Young women (N=2835) from the 1975-79 birth
cohorts of Finnish twins were assessed by questionnaires, including subscales of the EDI (Bulimia, Drive
for Thinness, Body Dissatisfaction, and Perfectionism). For a subset of women (N=548), we established
DSM-5 diagnoses of BED. Based on the interviews, 16 women had lifetime DSM-5 BED. We calculated the
sensitivity and specificity and conducted receiver operating characteristic (ROC) analysis by comparing
the area under the curve (AUC) of various EDI subscales. Results Three subscales of the EDI had
acceptable screening properties. The best screen for DSM-5 BED was the global score of three subscales
(Bulimia, Drive for Thinness, Body dissatisfaction) with an AUC of 0.86, sensitivity of 87% and specificity
of 76%. The subscales used individually that were not statistically significantly worse were Bulimia (AUC
0.83; sensitivity 80%, specificity 78% at cutoff >=2), Drive For Thinness (AUC 0.82, sensitivity 87%,
specificity 72% at cutoff ≥7), and Body Dissatisfaction (AUC 0.81, sensitivity 93%, specificity 60% at cutoff
≥8). Conclusion EDI is a versatile instrument well suited for screening BED among young women.
Learning Objectives:
• EDI is suitable for screening BED among young women.
• Bulimia was worse subscale for screening BED.
• Drive for Thinness and Body Dissatisfaction were not suitable subscales for screening BED used
individually.
T5
Do We Need to Communicate More Openly About Weight Management Options With our
Patients with BED?
Michele M. Laliberte, PhD, St. Joseph's Healthcare & McMaster University, Hamilton, Ontario, Canad;
Amrita Ghai, MA, St. Joseph's Healthcare, Hamilton, Ontario, Canada; Laura Davis, RD, St. Joseph's
Healthcare, Hamilton, Ontario, Canada
CBT for eating disorders was not developed for patients with binge eating disorder (BED) specifically in
mind, and CBT-E has continued with a trans-diagnostic approach to treatment. While CBT has been
demonstrated as effective in treating BED, this study investigated the impact of two different approaches
to psychoeducation about weight management. Participants were 62 individuals diagnosed with BED
who completed group-based CBT treatment in an outpatient hospital setting. Thirty-four individuals
received the traditional “non-dieting” education about weight, encouraging normalized eating and the
acceptance of one’s natural weight. The remaining 27 individuals were provided a review of, and choice in
pursuing, four weight management options (normalized eating; a moderate calorie reduced diet; weight
loss medication; and bariatric surgery). Lifestyle implications, research on the impact on binge eating,
and the current understanding of both short and long-term success in weight loss were presented for each
of the weight management options. Both groups received similar nutritional education, self-monitoring,
and skills teaching for managing practical, emotional and interpersonal triggers. A comparison of groups
prior to treatment indicated that there were no differences in frequency of binge eating (mean of 4/week),
body mass index (BMI), or on measures of drive for thinness, bulimia, body dissatisfaction, depression or
self-esteem. Following treatment, there was no significant difference between groups in frequency of
binge eating (77.6% binge free) or BMI. However, the patients receiving psychoeducation on weight
management options self-reported significantly better body satisfaction, self-esteem and less depression,
drive for thinness and concern over loss of control over eating. The findings suggest that open
communication and informed choice about weight management options is related to better psychological
outcomes than the single option, “non-dieting” approach.
Learning Objectives:
• Understand differences between weight-management approaches that may be communicated to
patients with BED
• Assess the association between the communication of various weight-management approaches
and BED treatment outcomes
• Reflect on whether open communication about various weight management approaches may be
beneficial in the treatment of BED
T6
Binge Eating Severity Improvement in Response to Dose of Behavioral Treatment for
Obesity
Aviva Ariel, BA, University of Florida, Gainesville, Florida, USA; Danielle Lespinasse, MS, University of
Florida, Gainesville, Florida, USA; Stacey Maurer, MS, University of Florida, Gainesville, Florida, USA;
Samantha Minski, MS, University of Florida, Gainesville, Florida, USA; Manal Alabduljabbar, MS,
University of Florida, Gainesville, Florida, USA; Renee Degener, BS, University of Florida, Gainesville,
Florida, USA; Melissa Laitner, MS, University of Florida, Gainesville, Florida, USA; Eliza Warren, BA,
University of Florida, Gainesville, Florida, USA; Michael Perri, PhD, University of Florida, Gainesville,
Florida, USA
We evaluated the effects of three doses of behavioral lifestyle intervention for obesity on participants’
binge eating symptoms. We analyzed binge eating severity (Binge Eating Scale) at baseline (M ±SE: 14.86
± .0.35) and post-treatment (9.11 ± 0.39) in 572 women and men (78.7% female; M ±SD: baseline BMI =
36.4 ± 3.9 kg/m2, age = 52.7 ± 11.2 years) across four treatment conditions (HIGH = 24 weight-loss
induction sessions over 6 months; MODERATE = 16 sessions; LOW = 8 sessions; CONTROL = 8 sessions
of diet education without written self-monitoring) using a repeated measures ANOVA and Bonferroniadjusted post hoc analyses. Multiple imputation using SPSS missing values procedures was used to
account for missing data (overall percentage of missing data = 9.8%). The baseline prevalence of selfreported binge eating in the sample was 34.8%, with 25.5% of the participants (n = 146) reporting
“moderate” binge eating and an additional 9.3% (n = 53) reporting “severe” binge eating. A significant
Time X Treatment Condition interaction effect was observed, F range (df = 3,568) = 3.15–6.42, p < .025,
partial ƞ2 range = .016–.033. Additionally, mean change in binge eating severity differed significantly
between treatment conditions, F range (df = 3,571) = 166.22–315.04, p < .05, such that participants in the
MODERATE and HIGH treatment conditions experienced significantly greater reductions in binge eating
severity than participants in the CONTROL condition (ps < .005). These results suggest that a moderate
or greater dose of behavioral weight-loss treatment is required to produce significant improvements in
participants’ binge eating severity.
Learning Objectives:
• Analyze the response of binge eating severity to varying doses of behavioral treatment for obesity
• Evaluate the dose of behavioral treatment for obesity needed to significantly improve binge eating
severity
• Describe the prevalence of binge eating in a population of obese adults seeking weight-loss
treatment
T7
Feasibility and Acceptability of Chromium for Binge Eating Disorder
Lauren Breithaupt, BS, George Mason University, Fairfax, Virginia, USA; Margarita Sala, BA,
Southern Methodist University, Dallas, Texas, USA; Robert Hammer, PhD, University of North Carolina
at Chapel Hill, Chapel Hill, North Carolina, USA; Cynthia Bulik, PhD, FAED, University of North
Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Maria La Via, MD, University of North
Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Kimberly Brownley, PhD, University of
North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
The purpose of the current study was to investigate the feasibility and acceptability of a chromium
picolinate (CrPic) intervention for binge eating disorder (BED). Chromium is an essential element that
affects insulin sensitivity and serotonin functioning. Chromium supplementation has been widely studied
for glucose regulation in patients with type-2 diabetes mellitus and related metabolic conditions and for
mood regulation in patients with atypical depression. We recently conducted the first pilot trial of
chromium supplementation in binge eating disorder (BED). Given the novelty of chromium
supplementation for BED, more information is needed regarding general interest in alternative therapies,
barriers to participation, and feasibility of study adaptation. Twenty-one (of 24 randomized) overweight
adults with BED completed a 6-month placebo-controlled study of CrPic and a 3-month follow-up visit,
during which feasibility and acceptability questionnaires were completed. The results from the study were
overwhelmingly positive. Participants felt the study was helpful in terms of symptom improvement and
reported no barriers to treatment. No study participants dropped out due to negative side effects, and only
one individual from the study raised concerns about the uncertainty of long-term effects of chromium.
Treatment group, patient age, and other demographics did not influence responses on the questionnaires.
The results of the study indicate that chromium supplementation for the treatment of BED appears to be
feasible and acceptable to study participants, and that individuals appear generally interested in the use of
alternative therapies. Given the nominal concerns reported by participants, these findings encourage
further studies of chromium supplementation in BED and suggest that such studies would likely achieve
high rates of enrollment and retention.
Learning Objectives:
• Describe the rationale for the use of chromium for binge eating disorder
• Assess the role of chromium for binge eating disorder treatment
• Assess the feasibility and acceptability of chromium for binge eating disorder treatment
T8
Maladaptive Eating Behaviors Associated with Lower Dietary Adherence Following
Bariatric Surgery
Matthew Sullivan, BA, Tufts Medical Center, Boston, Massachusetts, USA; Helen Stevens, PsyD, Pacific
Graduate School of Psychology-Stanford PsyD Consortium, Palo Alto, California, USA; Sarah Adler,
PsyD, Stanford University School of Medicine, Stanford, California, USA; Athena Robinson, PhD,
Stanford University School of Medicine, Stanford, California, USA; Alison Darcy, PhD, Stanford
University School of Medicine, Stanford, California, USA; Debra Safer, MD, Stanford University School
of Medicine, Stanford, California, USA
While bariatric surgery is the most effective treatment for severe obesity, up to 30% of patients experience
suboptimal weight loss outcomes. Poor adherence to the recommended post-operative diet has been
shown to predict poorer weight loss, as have maladaptive eating behaviors such as loss of control, grazing
(i.e., eating small amounts of food in an unplanned and repetitious way), and emotional eating. Little is
known about the specific maladaptive eating behaviors that influence post-operative dietary adherence.
Post-bariatric patients were administered an online survey to examine behavioral correlates of dietary
adherence. Of the 539 respondents, 274 had undergone gastric bypass at least 1 year prior. Participants
were 95.6% female, 51.1 ±8.4 years of age, and 88.7% Caucasian with a % Excess Weight Loss (%EWL) of
72.2±39.0, a current Body Mass Index (BMI) of 32.6±8.0 kg/m2, and a mean dietary adherence of 4.5±
2.5 on a 9-point Likert scale. Correlations between dietary adherence and 22 maladaptive eating-related
behaviors were examined. Six variables were at least moderately correlated with dietary adherence
(Pearson’s r > 0.5): grazing (r=-.57), mindless eating (r=-.57, loss of control eating (r=-.52), after dinner
eating more than one feels is best (r=-.518), eating foods off plan (r=-.557), and capitulating (r=-.57). A
linear regression model showed these 6 items significantly predicted lower dietary adherence [F(5, 26) =
60.0 p < 0.001], accounting for approximately 54% of the variance (adjusted R2= .53). Of note, loss of
control was removed from the model due to high multicollinearity with eating foods off plan and after
dinner overeating. These finding offer preliminary data regarding the presence and strength of
associations between lower post-operative dietary adherence and specific maladaptive eating behaviors.
Such data may inform future investigations and interventions to optimize weight loss outcomes for poor
dietary adherers post bariatric surgery.
Learning Objectives:
•
•
•
Describe the role of post-bariatric dietary adherence as a predictor of weight loss outcome.
Describe which post-bariatric maladaptive eating behaviors are most highly associated with postbariatric dietary adherence.
Understand the importance of addressing dietary adherence and associated maladaptive eating
behaviors to improve weight loss outcomes after bariatric surgery.
T9
Caregiver Binge Eating And Restrictive Feeding Styles: The Mediating Role Of Negative
Emotion Regulation Strategies
Jaclyn Saltzman, MPH, University of Illinois, Urbana, Illinois, USA; Janet Liechty, PhD, MSW, LCSW,
University of Illinois, Urbana, Illinois, USA; Kelly Bost, PhD, MS, University of Illinois, Urbana, Illinois,
USA; Barbara Fiese, PhD, University of Illinois, Urbana, Illinois, USA
Use of negative emotion regulation strategies is associated with binge eating in adults, and caregiver use
of unhealthy feeding practices with children. However, the impact that both binge eating and emotion
regulation strategies have on child feeding practices has not been explored. This study examined the
mediating and moderating role of emotion regulation strategies, between caregiver binge eating and child
feeding practices. Participants were caregivers of preschoolers (n=396), who participated in a larger study
on pediatric obesity (N=477). They completed the Eating Disorder Diagnostic Scale (EDDS), the Coping
with Childrens’ Negative Emotions Scale (CCNES), and the Comprehensive Feeding Practices
Questionnaire (CFPQ). An index of binge eating with loss of control was constructed from 7 items on the
EDDS, and composite scores for Positive and Negative emotion regulation strategies were constructed
from the CCNES. Overall, 36% of caregivers reported at least one binge eating behavior. Binge eating was
correlated with the restriction for weight control subscale of the CFPQ (r[443]=0.136, p=0.004), as well
as negative (r[459]=0.18, p<.0001), and positive emotion regulation strategies (r[459]=-0.128, p=.006).
Negative emotion regulation was correlated with restriction for weight control (r[437]=0.26, p<.0001),
but positive emotion regulation was not (r[437]=-0.07, p=0.14). Model testing revealed that binge eating
predicted use of restrictive feeding practices (β=.0258, p=.046), and that the model was still significant
when negative emotion regulation strategies was added as a mediator (β=.035, p=.007), not as a
moderator (R2=.08, ΔR2=.0052, p=.14). This study found that caregiver binge eating led to use of
negative emotion regulation strategies, which led to use of restrictive feeding practices. Attempts to
modify caregivers’ feeding practices may be more effective if caregivers’ own eating behaviors and
emotion regulation strategies are taken into account.
Learning Objectives:
• Following the training, participants will be able to describe the prevalence of binge eating
behaviors among a community sample of caregivers of preschoolers in the Midwest (n=477).
• Following the training, participants will be able to, examine the role of emotion regulation on the
relationship between caregiver binge eating and caregiver feeding practices for preschoolers.
• Following the training, participants will be able to discuss the importance of taking caregiver
emotion regulation and eating behaviors into account prior to implementing interventions to
impact child eating behaviors.
T10
The Interaction Between Mood and Food Consumption in Overweight Girls with and
without Loss of Control Eating
Setareh O'Brien, BA, The University of Chicago, Chicago, Illinois, USA; Alexandria Goodyear, BA, The
University of Chicago, Chicago, Illinois, USA; Marian Tanofsky-Kraff, PhD, MA, FAED, Uniformed
Services University Health Sciences, Bethesda, Maryland, USA; Denise Wilfley, PhD, FAED, Washington
University in St. Louis, St. Louis, Missouri, USA; Andrea Goldschmidt, PhD, The University of Chicago,
Chicago, Illinois, USA
While negative mood is believed to play a central role in loss of control (LOC) eating in both children and
adults, little is known about the effects of acute mood stressors on actual food consumption in overweight
children. Furthermore, research relying on self-report data shows that children in the general population
also eat in response to negative mood, suggesting that emotional eating may be more broadly prevalent
among children. The current study examines differences in the effect of an acute mood trigger on food
consumption for overweight children with and without LOC eating. Overweight girls aged 6 to 12 years,
with and without reported LOC eating in the past 3 months, participated in a laboratory-based study of
eating behavior. The children completed two standardized buffet meals at separate visits, one after
viewing a sad film clip and one after viewing a neutral film clip. Participants reporting LOC (n=23) were
compared to participants reporting no LOC (control, CON; n=23). A repeated measures ANCOVA for
food-intake in grams demonstrated a trend towards an interactional effect of LOC status and mood
condition, F(1, 41) = 3.89, p = .06, such that CON participants consumed a larger volume of food in the
sad condition than in the neutral condition, whereas LOC participants demonstrated no differences in
volume of food consumed between the two mood conditions. When we considered only LOC participants
with objective binge episodes (n=7), the finding was statistically significant, F(1, 27) = 6.75, p = .02.
Results suggest that eating more food in response to an acute mood trigger, or emotional eating, may be a
common reaction among overweight girls who do not endorse LOC. Overweight children who do endorse
LOC appear less sensitive to the effects of an acute stressor. We speculate that these children may respond
to only certain types of stressors, or may exhibit a delayed response after ruminating on stressors.
Learning Objectives:
• Understand the constructs of loss of control eating and binge eating, as well as their health
implications in children.
• Summarize current theory regarding the relationship between mood and loss of control eating.
• Describe the effect of an acute mood trigger on food consumption for children who do and do not
endorse loss of control eating, and interpret how this finding may fit in with current literature.
T11
The Prevalence of DSM-IV Eating Disorders by BMI Category in a General Population
Sample
Alexis Duncan, PhD, MPH, Washington University in St. Louis, St. Louis, Missouri, USA; Melissa MunnChernoff, PhD, Washington University in St. Louis, St. Louis, Missouri, USA; Heather Berlin, Student,
Washington University in St. Louis, St. Louis, Missouri, USA
Studies have reported high rates of eating disorders (ED) among clinical samples of obese individuals;
however, rates of ED among obese individuals in the general population are unknown. The objective of
this study was to estimate the prevalence of lifetime and 12-month DSM-IV ED by body mass index (BMI)
category using data from the National Comorbidity Survey Replication. We used chi-square analyses to
determine whether the weighted prevalence of anorexia nervosa (AN), bulimia nervosa (BN), binge eating
disorder (BED) and non-diagnostic binge eating (nDBE) differed by BMI category (underweight, normal
weight, overweight, obese) and among obese respondents by obesity class (I, III, and III). Obese
individuals had the highest rates of lifetime and 12-month BED and nDBE; the lowest rates were observed
among those of normal weight (omnibus p-values < .05). Among individuals in obesity class III, the
prevalence of any lifetime ED was 6.14% and that of any 12-month ED was 3.62%, compared to 1-2%
among individuals in obesity classes I and II (omnibus p-value < .01 for both comparisons). Although,
rates of all forms of lifetime and 12-month ED were highest in obesity class III compared to classes I and
II, differences only reached statistical significance for BED (p = .02) and nDBE (p < .01). Obese
individuals in the general population have higher rates of BED and nDBE than those who are not obese,
primarily due to elevated rates among those with the most severe obesity; however, these rates are
substantially lower than those reported in clinical samples.
Learning Objectives:
• describe the distribution of eating disorders by BMI category
• assess the association between eating disorders and obesity class
• contrast rates of eating disorders among obese individuals in the general population with rates
among treatment seeking obese persons
T12
Demographic and Clinical Profiles in an Adult Study Population With Moderate to Severe
Binge Eating Disorder: A Pooled Analysis of 2 Phase 3, Randomized, Double-Blind,
Placebo-Controlled Trials
Susan McElroy, MD, Lindner Center of HOPE, Mason, Ohio, USA; James Hudson, MD, ScD, McLean
Hospital/Harvard Medical School, Belmont, Massachusetts, USA; Maria Gasior, MD, PhD, Shire
Development LLC, Wayne, Pennsylvania, USA; Barry Herman, MD, Shire Development LLC, Wayne,
Pennsylvania, USA; Jana Radewonuk, MS, Shire Development LLC, Wayne, Pennsylvania, USA; Carlos
Grilo, PhD, Yale University School of Medicine, New Haven, Connecticut, USA
Understanding the characteristics of individuals with binge eating disorder (BED) may help clinicians
identify BED in their patients. In this summary, baseline demographic and clinical characteristics of
adults with BED were pooled from 2 identical phase 3 double-blind trials of lisdexamfetamine dimesylate
(LDX) vs placebo (PBO). Eligible adults (18–55 years) had moderate to severe BED (≥3 binge eating [BE]
days/week); body mass index (BMI) 18–45 kg/m2; Clinical Global Impression–Severity (CGI-S) scores ≥
4; and no greater than mild, well-controlled hypertension. Baseline BED severity assessments included
BE days and episodes per week, CGI-S score, and Yale-Brown Obsessive Compulsive Scale for Binge
Eating (Y-BOCS-BE) score. Medical assessments included BMI, vital signs, and laboratory tests. In the
pooled safety analysis set (PBO, n=372; LDX, n=373), most participants were white (PBO, 75.5%; LDX:
75.1%), female (PBO, 84.9%; LDX, 86.9%), <40 years old (PBO, 51.6%; LDX, 55.2%), and had a BMI ≥30
kg/m2 (PBO, 68.3%; LDX, 68.1%). Mean ± SD BMI with PBO and LDX was 33.20±6.279 and 33.76±6.241
kg/m2, respectively. In the pooled full analysis set (PBO, n=360; LDX, n=364), mean ± SD BE days/week
and BE episodes/week were 4.71±1.321 and 6.28±3.233 with PBO and 4.72±1.272 and 6.41±3.207 with
LDX; 25.8% of PBO and 27.5% of LDX participants had severe BED (>7 BE episodes/week). CGI-S scores
indicated that most participants were moderately (PBO, 50.8%; LDX, 54.4%) or markedly (PBO, 39.2%;
LDX, 38.2%) ill. Mean ± SD Y-BOCS-BE scores were 21.52±4.785 with PBO and 21.46±4.669 with LDX.
Mean ± SD levels of total cholesterol (mmol/L), triglycerides (mmol/L), and hemoglobin A1c (%) were
5.036±0.9526, 1.269±0.6404, and 5.18±0.414 with PBO and 5.053±0.9685, 1.307±0.7361, and
5.26±0.429 with LDX. Overall, most participants were female and, as expected based on
inclusion/exclusion criteria, had moderate to severe BED. Most participants were obese; approximately
one third were not.
Learning Objectives:
• Describe the demographic characteristics of participants with moderate to severe BED
• Understand the psychiatric characteristics of participants with moderate to severe BED
• Be aware of the medical characteristics of participants with moderate to severe BED
T13
Dietary Patterns of Patients with Binge Eating Disorder or Bulimia Nervosa, with and
without Night Eating Syndrome
Yael Latzer, DSc, FAED, Haifa University, Haifa, New York, USA; Adi Elron -Yutal, MA, Haifa
University, Haifa, Israel, Israel
Bulimia nervosa (BN) and Binge eating disorder (BED) are two eating disorders (EDs) which involve
binge eating behavior as a primary symptom. Night eating syndrome (NES) is conceptualized as a delay in
the circadian pattern of food intake, manifested by two core criteria: evening hyperphagia (EH) and/or
nocturnal ingestions (NI). It is unclear whether the frequency of binge episodes, the amount of calories
consumed, and the macronutrient composition are similar between subjects with BED or BN with and
without NES. The purpose of the current study was to compare the dietary patterns of patients with BED
or BN, with and without NES, in terms of timing and frequency of binge episodes, caloric intake and
macronutrient composition. A cross-sectional study, included 56 women, aged 18-60, who seek
treatment for EDs were recruited during the years 2009-2013. Participants diagnosed with BED or BN
(with or without NES) kept seven-day, 24-hour diaries that assessed time and amount of food
consumption, completed demographic, Eating Disorder Examination-Questionnaires and the Beck
Depression Inventory. The food diaries were analyzed by "Tzameret" software system. A linear regression
model was fitted for each dependent variable. Interactions between the study group and age or BMI were
also included. For each model in which the study group variable was the only significant variable, an
independent samples t-test or a Mann-Whitney U test was performed. Of 56 participants, 33 (58.9%)
were diagnosed with BED or BN (BE), and 23 (41.1%) were diagnosed with BED or BN, in addition to NES
(BE+NES). Patients with BE+NES reported a significantly higher frequency of binge days and binge
episodes during the week, as well as higher energy consumption and fat consumption of daily intake, BE
without NES. Our findings indicated that patients who have NES+BE have higher levels of eating
pathology than patients with BE alone. It is suggested that NES among patients with BED or BN may not
represent just a variant of BED or BN, but rather a separate entity, which leads to a more severe disorder.
Furthermore, it highlights the importance of early assessment of the presence of NES among patients with
BED or BN, and suggests that the treatment of patients who are diagnosed with both disorders should be
more intensive and focused on establishing regulated eating patterns.
Learning Objectives:
• To study the dietary patterns of patients with BED or BN, with and without NES.
• To understand the diagnostic criteria of NES within ED patients
• To highlights the importance of early assessment of the presence of NES among patients with
BED or BN.
T14
Psychiatric Diagnoses and Clinical Features in a Group of Turkish Bariatric Surgery
Candidates: Are There Any Differences Between Men and Women?
Basak Yucel, MD, Istanbul University, Istanbul Medical School, Istanbul, Turkey; Ozlem Sertel Berk,
PhD, Istanbul University, Istanbul, Turkey; Ezgi Deveci, MA, Isik University, Istanbul, Turkey
Patients seeking bariatric surgery have high prevalence of psychiatric disorders. Many of them have had a
lifetime history of mood and anxiety disorders and some of them have also personality disorders. The
purpose of this study is to investigate Axis I and II diagnoses among a group of bariatric surgey cadidates
in terms of sex differences and some clinical features in a group of Turkish patients. Consecutive 84
bariatric surgery candidates (53 women/31 men; age: mean/sd:40.13-11.84; Body Mass Index mean/sd:
51.19-7.70) formed the sample. They were evaluated through the Structured Cinical Interviews for DSM
Axis I (SCID-I) and Axis II Disorders (SCID-II) and a semi-structured interview. Percentage of physical
illness, previous psychiatric treatment, family obesity history, stres-related eating were significantly
higher in women than in men. The frequency percentage of women who had at least one Axis I disorder
was 72.5% whereas it was 26.9 % for males. This difference was highly significant. Most prevailing
disorders were past and current major depression in both women (59.5% and 26.2%, respectively) and
men (22% and 3.7% respectively). According to SCID-II, almost 30 % of the patients had one personality
disorder; most prevalent one was borderline personality disorder for all participitants (10.7%). Although
males had higher percentages of SCID-II diagnosis, this difference was not significant. The present
findings indicate that clinicians should pay attention to an increased prevalence of Axis I disorders,
particularly past and current major depression in women comparing to men seeking bariatric surgery. On
the other hand, relatively higher frequency of Axis II disorders in men than in women may play a role
especially during post-operative follow-up period in terms of these male patients’compliance to new life
conditions and treatment requirements.
Learning Objectives:
• Describe the axisI and II diagnosis comorbidity among a group of bariatric surgery candidates
• Evaluate the differences of psychiatric diagnosis between women and men in who seek bariatric
surgey
• Assess the various clinical features in terms of sex differences in a group of bariatric surgery
candidates in a different culture.
T15
Differences in Threshold and Subthreshold Depressive Symptoms by Loss of Control (LOC)
Eating Episode Type among Adolescents at Risk for Type 2 Diabetes (T2D)
Courtney Pickworth, BA, National Institutes of Health, Bethesda, Maryland, USA; Lauren Shomaker,
PhD, FAED, Colorado State University, Fort Collins, Colorado, USA; Nichole Kelly, PhD, National
Institutes of Health, Bethesda, Maryland, USA; Katherine Thompson, BS, National Institutes of Health,
Bethesda, Maryland, USA; Anne Altschul, BS, National Institutes of Health, Bethesda, Maryland, USA;
Rachel Ress, BS, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA; Anna
Vannucci, MS, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA; Lisa
Shank, MS, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA; Rachel
Radin, MS, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA; Natasha
Schvey, PhD, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA; Jennifer
Bakalar, MS, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA; Sheila
Brady, RN, National Institutes of Health, Bethesda, Maryland, USA; Andrew Demidowich, MD,
National Institutes of Health, Bethesda, Maryland, USA; Ovidiu Galescu, MD, National Institutes of
Health, Bethesda, Maryland, USA; Marian Tanofsky-Kraff, PhD, FAED, Uniformed Services University
of the Health Sciences, Bethesda, Maryland, USA; Jack Yanovski, MD, PhD, FAED, National Institutes
of Health, Bethesda, Maryland, USA
Youth with LOC eating often report depressive symptoms. It remains unclear if those with objective
(OBE) vs. subjective binge (SBE) episodes differ in symptom presentation. We studied LOC (Eating
Disorder Examination) and depressive symptoms (Kiddie Schedule for Affective Disorders and
Schizophrenia) in 119 adolescent girls (62% Black) during the baseline phase of a T2D prevention trial.
Girls were at risk for T2D by being overweight or obese (MBMI-z 2.0±0.5), and had a T2D family history
and elevated depressive symptoms (Center for Epidemiological Studies-Depression Scale [CESD]≥16).
17% of girls reported OBE (with or without SBE), 25% SBE only, 18% objective overeating only, and 40%
no LOC/overeating. Covariates were age, race, height, lean mass, and body fat. In analysis of covariance,
CESD scores did not differ by group, p>.05. In a series of logistic regressions (no LOC as reference), girls
with OBE and SBE were more likely to have past major depressive disorder (OBE OR=5.96, p=0.02; SBE
OR=5.85, p=0.01). OBE girls were also more likely to have past threshold inattention (OR=10.63,
p<0.01), subthreshold guilt (OR=5.67, p=0.03) and psychomotor retardation (OR=14.81, p=0.001), and
subthreshold and threshold anhedonia (OR=7.05, p=0.01; OR=5.23, p=0.04). SBE girls were more likely
to have past subthreshold psychomotor retardation (OR=6.84, p=0.006), threshold depressed mood
(OR=9.53, p<0.01), inattention (OR=16.35, p<0.001), and suicidal ideation (OR=8.95, p<0.01), and
subthreshold and threshold fatigue (OR=13.85, p<0.01; OR=6.36, p<0.001). For current symptoms, OBE
girls were more likely to report subthreshold psychomotor retardation than no LOC girls (OR=5.13,
p=0.02); no differences were observed for those with SBE. Results suggest that, in adolescent girls at-risk
for T2D, depressive phenotype may differ by LOC episode type. Prospective data are needed to determine
if specific depressive symptoms predict disordered eating, obesity, or metabolic problems.
Learning Objectives:
• Determine whether depressive scores vary by binge eating episode type
• Assess if chances of current threshold and subthreshold depressive symptoms vary by binge
eating episode type
• Assess if chances of past threshold and subthreshold depressive symptoms vary by binge eating
episode type
T16
Satisfaction, Feasibility, and Outcomes of a Binge Eating Intervention
Suzanne Mazzeo, PhD, FAED, Virginia Commonwealth University, Richmond, Virginia, USA;
Marilyn Stern, PhD, University of South Florida, Tampa, Florida, USA; Marian Tanofsky-Kraff, PhD,
FAED, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA; Laura
Thornton, PhD, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA; Melanie
Bean, PhD, Virginia Commonwealth University, Richmond, Virginia, USA; Allison Palmberg, MS,
Virginia Commonwealth University, Richmond, Virginia, USA; Nichole Kelly, PhD, Uniformed Services
University of the Health Sciences, Bethesda, Maryland, USA; Janet Lydecker, PhD, Yale University,
New Haven, Connecticut, USA; Rachel Gow, PhD, Virginia Commonwealth University, Richmond,
Virginia, USA; Cynthia Bulik, PhD, University of North Carolina-Chapel Hill, Chapel Hill, North
Carolina, USA
This investigation examined satisfaction, feasibility, and preliminary outcomes of a binge eating
intervention for adolescent and young adult women. Participants were 58 diverse adolescents and young
adults (age 13-22) randomized into a DBT-based intervention (LIBER8, n = 34) or a weight management
group (n = 24). Participants completed assessments of eating behavior at baseline, immediately following
the intervention, and at 3-month follow-up. Participants and therapists also completed “session
satisfaction” and “therapist feasibility” surveys following each meeting. Descriptive statistics indicated
high satisfaction with LIBER8: 76% indicated the topics were helpful, 59% believed homework assigned
was helpful, and 72% reported having fun. In addition, 99% and 84% indicated comfort with group
leaders and other members, respectively. Lastly, 81% endorsed being “very satisfied” with the sessions
overall. Similarly positive results emerged from LIBER8 therapist feasibility surveys: 61% reported they
were able to cover all content, 65% believed topics were appropriate, and 69% believed the group
members appeared to understand the content. Therapists identified areas of improvements such as,
“cover loss of control/emotional eating more often in earlier sessions,” and some sessions were repetitive.
Lastly, paired t-tests indicated significant reductions in objective and subjective binge episodes, and
objective overeating (measured using the overeating module of the EDE) for both groups from baseline to
post assessment, as well as from baseline to follow-up. Yet, no differences between the active intervention
and control group were noted. The observed high satisfaction and feasibility of the developed intervention
and reductions in loss of control eating episodes show promise in treating binge eating and provide
insight into multiple options for treating this challenging eating concern.
Learning Objectives:
• Describe the satisfaction and feasibility of a DBT-based binge eating intervention.
• Describe preliminary findings and results of a DBT-based binge eating intervention in
comparison to a weight-management control group.
• Become more familiar with binge eating interventions and future directions in the treatment of
binge and loss of control eating.
T18
The Effect of Food Exposure and Hedonic Hunger on Cognitive Performance
Allison Tipton, Drexel University, Philadelphia, Pennsylvania, USA; Lisa Shank, MS, Uniformed Services
University of the Health Sciences, Bethesda, Maryland, USA; Na Young Kim, Drexel University,
Philadelphia, Pennsylvania, USA; Bradley Appelhans, PhD, Rush University Medical Center, Chicago,
Illinois, USA; Meghan Butryn, PhD, Drexel University, Philadelphia, Pennsylvania, USA; Stephanie
Malamas, Drexel University, Philadelphia, Pennsylvania, USA; Michael Lowe, PhD, Drexel University,
Philadelphia, Pennsylvania, USA
Continuous exposure to highly palatable foods is common in today’s food environment. However, few
studies have examined whether exposure to palatable food influences cognitive performance in
susceptible individuals. Therefore, this study examined cognitive performance in the presence of palatable
food in individuals with varying levels of hedonic hunger. A sample of 98 undergraduates
(Mage=19.9±1.5y; MBMI=23.5±4.5 kg/m2; 57.3% Caucasian) scored in the upper (PFS-H) or lower (PFSL) tertile on the Power of Food Scale (PFS), a measure of hedonic hunger. During a laboratory visit in
which food was present (FP) or absent (FA), participants completed the Conners Continuous Performance
Test, 2nd Edition to assess cognitive performance. Seven participants were excluded from analysis due to
issues with the CPT-II. All analyses controlled for hunger. Participants in the FP condition committed
more omission errors (M = 5.3, SD = 9.8) than those in the FA condition (M = 3.1, SD = 6.9; p = .04).
Participants in the PFS-H group committed more commission errors (M = 16.9, SD = 7.5) than the PFS-L
group (M = 12.9, SD = 6.5; p = .02). Similarly, the PFS-H group had had higher hit reaction time standard
error (M = 5.7, SD = 2.6) than the PFS-L group (M = 5.1, SD = 1.6; p = .05). No differences emerged for hit
reaction time, and the interaction between food exposure and PFS group was not significant for any
variable. These results suggest that both food exposure and hedonic hunger level, but not their
interaction, may influence cognitive performance. Specifically, those in the FP condition demonstrated
greater inattention than those in FA, indicating that food may serve as a distraction for all individuals.
Additionally, those in the PFS-H group displayed greater impulsivity and inattention across both
conditions, regardless of palatable food exposure. Future research should continue to examine individual
differences in the effects of exposure to palatable food.
Jennifer Thomas 2/20/15 12:35 AM
Comment [1]: This one goes in the “BED and Obesity” section, so at least It’s in the right order here. So perhaps you could make it T18 and then re-­‐number the remaining posters accordingly? Learning Objectives:
• Investigate the impact of exposure to palatable food on cognitive performance.
• Assess whether individuals high in hedonic hunger are more affected (in terms of
performance) by the presence of palatable food then those low in hedonic hunger.
• Investigate impacts of continuous exposure to highly palatable food outside of
weight/gain obesity, including cognitive impacts.
Biology and Medical Complications
T19
Association of Val66Met Polymorphisms of Brain Derived Neurotrophic Factor Gene with
Eating Disorder-related Characteristics in Young Japanese women
TETSUYA ANDO, PhD, MD, National Institute of Mental Health, National Center of Neurology and
Psychiatry, Kodaira, Tokyo, Japan; Yuhei Ichimaru, PhD, MD, Department of Nutrition, School of
Home Economics and Science, Tokyo Kasei University, Itabashi-ku, Tokyo, Japan
Background: Brain-derived neurotrophic factor (BDNF) is an endogenous peptide that plays established
roles in neuronal survival, differentiation, synaptic plasticity, appetite and weight regulations, and may be
involved in patho-physiology of eating disorders. Objective: The purpose was to determine whether
functional Val66Met SNP of BDNF gene is associated with anthropometric measures, circulating BDNF,
lipids concentrations and insulin resistance, or psychological measures relevant to eating disorders in
non-clinical young women. Design: A cross-sectional study comparing outcome measures between
BDNF was used. The participants of the study include 308 woman Japanese volunteers [university
students, mean age, 20.4 ± 0.7 (S.D)] without a history of eating disorders. The main outcome measures
were anthropometric measures, fasting serum concentrations of BDNF, glucose and lipid metabolism,
Eating Disorder Inventory-2 (EDI-2), measures of depression and, anxiety and Temperament and
Character Inventory (TCI). Results: The minor allele (Met) frequency for Val66Met SNP of the BDNF
was 0.442. The Met66Met genotype showed significantly lower body weight (P=0.024), lean mass
(P=0.025) serum BDNF concentration (P=0.015) and had tendency of lower body height (P=0.048)
compared with Val66Val + Val66Met genotypes. There was no difference in body mass index and % body
fat. The Met66 allele was related to lower scores in the Bulimia subscale of the EDI-2 (P=0.022). The
Val66Met SNP was not related to the scores of anxiety and depression or Harm Avoidance subscale of
TCI. Conclusion: Our findings suggest that Met66 allele of the BDNF gene Val66Met SNP is associated
with smaller size, lower basal BDNF concentrations and less tendency of bulimia in young Japanese
women, which may be related to the restricting subtype of anorexia nervosa.
Learning Objectives:
• Describe the role of brain-derived neurotrophic factor and its gene variant in eating disorders.
• Assess the role of brain-derived neurotrophic factor gene variant in eating disorder-related
characteristics in young women.
• Assess the effect of brain-derived neurotrophic factor gene variant on serum BDNF concentration.
T20
P Wave Dispersion in Adolescents with Anorexia Nervosa: A Predictor Of Atrial
Fibrillation And Possible Cause Of Sudden Death.
Nuray Kanbur, MD, Hacettepe University, Department of Pediatrics, Division of Adolescent Medicine,
Ankara, Sıhhiye, Turkey; Sinem Akgül, MD, PhD, Hacettepe University. Department of Pediatrics,
Division of Adolescent Medicine, Ankara, Sıhhiye, Turkey; İlker Ertuğrul, MD, Hacettepe University,
Department of Pediatrics, Pediatric Cardiology, Ankara, Sıhhiye, Turkey; Tevfik Karagöz, MD,
Hacettepe University, Department of Pediatrics, Pediatric Cardiology, Ankara, Sıhhiye, Turkey; Orhan
Derman, MD, Hacettepe University, Department of Pediatrics, Division of Adolescent Medicine, Ankara,
Sıhhiye, Turkey
Amongst all psychiatric conditions, AN has the highest risk of mortality which has more commonly been
associated to cardiac causes. P wave dispersion (Pd) is an electrocardiographic marker calculated from the
ECG. Studies have shown that a prolonged Pd interval is a risk factor for the development of atrial
fibrillation. Both atrial fibrillation and atrial flutter have been reported in adolescent patients with AN.
The aim of this study was to evaluate Pd in adolescents with AN at diagnosis and compare the results to a
healthy age-matched control group. The retrospective medical charts of 47 adolescents diagnosed with AN
were included in the study. The control group included adolescents with functional chest pain with no
diagnosis of a cardiac disease evaluated by a pediatric cardiologist and were matched to cases based on
sex and age. The mean age for patients with AN and the control was 14.9±1.56 and 14.6±1.78, respectively.
As expected BMI was significantly lower in the AN group (15.8±2.7) when compared with the controls
(21.4±3.4) (P<0.01). Comparison of Pd between AN patients and controls showed a statistically
significant higher Pd in AN patients (72 ±16.3 msec) when compared to the control group (43.8
±9.5msec) (P<0.01). A lower heart rate in the AN group (65± 13.9bpm) was also significant when
compared to the control (78 ±13.8 bpm), (P < 0.01). Six (12.7%) patients with AN, and one (2.1%) patient
in the control group had a QTc greater than 0.44 sec. Increased clinical disease severity reflected by lower
body mass index and higher weight loss rate (weight loss in kg/duration of loss) in the patients with AN
had no affect on Pd. This is the first case–control study of adolescents with AN to examine Pd in the acute
phase of illness. This study shows that Pd is significantly increased in AN subjects emphasizing that atrial
pathologies must also be considered in the initial medical evaluation and also as a possible cause of
sudden death in AN.
Learning Objectives:
• Cardiac pathologies in AN along with P wave dispersion and its clinical interpretation will be
discussed.
• According to the study it will be explained that comparison of P-wave dispersion between AN
patients and controls showed a statistically significant higher p-wave dispersion value in AN
patients.
• Clinical implications of this result such as increased risk of at atrial fibrillation will be discussed
T21
Patients With Eating Disorders Are At Increased Risk For Autoimmune Diseases
Anu Raevuori, MD, PhD, FAED, University of Helsinki, Helsinki, Finland; Jari Haukka, PhD, University
of Helsinki, Helsinki, Finland; Outi Vaarala, MD, PhD, National Institute of Health and Welfare,
Helsinki, Finland; Mika Gissler, MD, PhD, MPH, National Institute of Health and Welfare, Helsinki,
Finland; Jaana Suvisaari, MD, PhD, National Institute of Health and Welfare, Helsinki, Finland;
Marjut Grainger, Student, National Institute of Health and Welfare, Helsinki, Finland; Milla Linna,
MD, PhD, University of Helsinki, Helsinki, Finland; Jaana Suokas, MD, PhD, Helsinki University
Central Hospital, Helsinki, Finland
Research suggests autoimmune processes to be involved in psychiatric disorders. We aimed to address the
prevalence and incidence of autoimmune diseases in a large Finnish patient cohort with anorexia nervosa,
bulimia nervosa, and binge eating disorder. Patients (N = 2342) treated at the Eating Disorder Unit of
Helsinki University Central Hospital between 1995 and 2010 were compared with general population
controls (N = 9368) matched for age, sex, and place of residence. Data of 30 autoimmune diseases from
the Hospital Discharge Register from 1969 to 2010 were analyzed using conditional and Poisson
regression models. Of patients, 8.9% vs. 5.4% of control individuals had been diagnosed with one or more
autoimmune disease (OR 1.7, 95% CI 1.5-2.0, P<0.001). The increase in endocrinological diseases (OR
2.4, 95% CI 1.8-3.2, P<0.001) was explained by type 1 diabetes, whereas Crohn's disease contributed most
to the risk of gastroenterological diseases (OR 1.8, 95% CI 1.4-2.5, P<0.001). Higher prevalence of
autoimmune diseases among patients with eating disorders was not exclusively due to endocrinological
and gastroenterological diseases; when the two categories were excluded, the increase in prevalence was
seen in the patients both before the onset of the eating disorder treatment (OR 1.5, 95% CI 1.1-2.1, P =
0.02) and at the end of the follow-up (OR 1.4, 95% CI 1.1-1.8, P = 0.01). We observed an association
between eating disorders and several autoimmune diseases with different genetic backgrounds. Our
findings support the link between immune-mediated mechanisms and development of eating disorders.
Future studies are needed to further explore the risk of autoimmune diseases and immunological
mechanisms in individuals with eating disorders and their family members.
Learning Objectives:
• Describe the comorbidity of autoimmune diseases and bulimia nervosa
• Describe the comorbidity of autoimmune diseases and anorexia nervosa
• Describe the comorbidity of autoimmune diseases and binge eating disorder
T22
Oral Health Knowledge of Eating Disorder Treatment Providers
Lisa Bennett Johnson, MS, Student, MCPHS University/Forsyth School of Dental Hygiene, Boston,
Massachusetts, USA; Linda Boyd, EdD, RD, MCPHS University/Forsyth School of Dental Hygiene,
Boston, Massachusetts, USA; Lori Rainchuso, MS, MCPHS/Forsyth School of Dental Hygiene, Boston,
Massachusetts, USA
Problem Statement: Individuals with eating disorders require significant preventive, and/or restorative
dental treatment as a result of this disorder, and many lack access to appropriate oral care during
treatment. Purpose: The aim of this study was to assess oral health knowledge among professionals who
specialize in treating eating disorders, and identify to what extent their education, and training addresses
oral health care delivery, and recommendations for individuals with eating disorders. Methods: A
research instrument was developed by comparing question agreement between six experts; a question
with item agreement average of 0.80 was deemed valid, and included in the survey and then piloted by an
unrelated group of experts (n=6). A descriptive, exploratory survey of licensed behavioral, and medical
health providers assessed level of oral health related education, knowledge, and treatment
recommendations. An invitation to participate in a web-based survey was sent via electronic newsletters,
and/or list-servs to three professional eating disorder organizations. An inability to track the use of
electronic media within the study time frame precluded an exact number for the study population,
however the proportion of respondents directly corresponds to the framework of the eating disorder
treatment team. Results: Of the 107 respondents who completed surveys, a majority (64.4%) reported
dissatisfaction with their level of oral health education, and 19.5% reported no oral health education.
Respondents consider their knowledge of clients risk for oral disease as average or above (84%), and
ranked tooth erosion as the greatest reason for oral care (63%) while dry mouth led in the rankings for
least significant (33%). Referral for oral care was found to be more common after reports of complication
(55%). Conclusions: Eating disorder professionals may lack understanding of associated oral risk factors,
and current oral guidelines. Oral care providers should be considered for inclusion within the eating
disorder treatment team.
Learning Objectives:
• Discuss oral risk factors associated with eating disorders.
• Recognize the impact of eating disorders and associated behaviors on oral health beyond that of
enamel erosion.
• Analyze current oral health guidelines for clients with an eating disorder.
Body Image
T23
Affective Antecedents and Consequences of Fasting at the Week-Level in Anorexia Nervosa
Erica Goodman, BA, University of North Dakota, Grand Forks, North Dakota, USA; Kyle De Young,
PhD, University of North Dakota, Grand Forks, North Dakota, USA
Negative affect predicts dietary restriction in individuals with anorexia nervosa (AN). However, little is
known about affective states following dietary restriction in this group and whether fasting predicts
subsequent affect. This study examined the prospective association of affective states and fasting (not
eating for at least 8 consecutive waking hours due to weight and shape concerns) in individuals (N = 16;
94% women) with AN (56% AN binge eating/purging type) recruited from the community and followed
naturalistically for 12 consecutive weeks. Participants reported the number of days during which they
fasted and their positive and negative affect at the end of each week for 12 consecutive weeks, resulting in
180 participant-weeks of data (6.25% missing data). Cross-lagged generalized estimating equations and
generalized linear models tested whether affective states predicted fasting the subsequent week and if
fasting predicted affective states the subsequent week while controlling for previous week fasting and
affective states, respectively. Negative affect predicted fasting the subsequent week at a trend level
(β=.023, Wald Χ2=3.222, p=.073); positive affect did not predict fasting (β=.011, Wald Χ2=1.260, p=.262).
Fasting predicted positive affect the subsequent week (β=.770, Wald Χ2=3.991, p=.046) but not negative
affect (β=.118, Wald Χ2=.651, p=.420). These findings are consistent with previous research regarding
antecedent negative affect for dietary restriction in AN. Further, this study documents for the first time
that fasting predicts subsequent positive affect in AN. This provides insight into the complex nature of
how fasting may be reinforced in those with AN: while one may engage in fasting in response to feeling
down, fasting may also be reinforced by increased positive affect after the fast. Future research should
investigate affective states more proximal to fasting, including during the fast itself, using ecological
momentary assessment.
Learning Objectives:
• Describe what affective states appear to occur before and after fasting in anorexia at the week
level
• Explain if positive affect seems to be related to fasting in anorexia
• Discuss what future research should aim to look at in terms of affect and fasting in anorexia
T24
Body Image Across The Life-Span: Is There A Distinct Effect Of Age Group On Body Image
Concerns?
Maribel Plasencia, BA, Butler Hospital and Brown University, Providence, Rhode Island, USA;
Lisa Smith Kilpela, PhD, Trinity University, San Antonio, Texas, USA; Phillippa C. Diedrichs, PhD,
University of the West of England, Bristol, England, United Kingdom (Great Britain); Carolyn Black
Becker, PhD, FAED, Trinity University, San Antonio, Texas, USA
Past research on body image has largely focused on younger female populations, despite the fact body
image concerns are likely to endure throughout the life-span. The purpose of this study was to analyze
various body image variables in a sample of women ages 18 to 87 (N = 914), analyzed by group based on
age (18-29; 30-45; 46-60; 61 and older). In line with prior research, we hypothesized that the youngest
cohort would report significantly higher drive for thinness (DT) than older groups, acknowledging that
such a difference may no longer exist given that pressure to conform to the thin-ideal in older women has
likely increased over the past decade. Additionally, as research has indicated that self-objectification (SO)
may be more prominent in younger populations, we hypothesized that the youngest cohort would report
significantly higher SO than the three older cohorts. Though findings on aging appearance anxiety (AAA)
are mixed, we predicted AAA would be highest in women ages 30 to 60 and decline in the oldest sample;
research has found a relationship of aging anxiety to appearance investment in middle-aged women in
addition to finding women over 73 feel free from appearance norms. Lastly, we predicted that body areas
satisfaction (BAS) would not differ by age group, as previous literature has found no differences across the
life-span. Analyses revealed that DT significantly differed by age, F(3, 758) = 2.66, p = .047. Planned
contrasts revealed that the youngest age group (M = 3.57, SD = 1.49) reported significantly higher DT
than the older age groups (M = 3.29, SD = 1.33; t(388) = 3.17, p = .002). As predicted, BAS did not
significantly differ between groups, p = .065. Contrary to hypotheses, AAA and SO did not differ by age
(ps = .244 and .497, respectively). However, linear regression analyses indicated that AAA, β = .12, p <
.001; and BAS predict ED pathology, β = -.55, p < .001, indicating the importance of these body image
concerns among women of all ages.
Learning Objectives:
• To analyze how body image concerns differ by age.
• To understand the role of self-objectification in the development of ED pathology.
• To provide research on aging appearance anxiety across the life-span.
T25
Examining Relations between Dimensional Perfectionism, Body Weight/Shape Problems,
and Binge Eating Using a Weekly Repeated Measures Methodology in a Multilevel
Modeling Framework
Stacy Lin, BA, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA;
Mary Higgins, MA, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA;
Anna Bardone-Cone, PhD, FAED, University of North Carolina at Chapel Hill, Chapel Hill, North
Carolina, USA
Dimensional perfectionism has been associated with disordered eating but it is unclear whether it may
interact with state-level stressors to further increase individuals’ vulnerability to engaging in these
behaviors. This study aimed to examine relations between dimensional perfectionism, weekly body weight
and shape problems, and weekly binge eating. Undergraduate women (N=406; Age: M=18.6 years,
SD=.97 years; 92.4% Caucasian, 3.2% Asian, 2% Hispanic, 1.2% African American, 1.1% other
race/ethnicities) at a Midwestern university completed a baseline questionnaire assessing dimensional
perfectionism [Socially Prescribed Perfectionism (SPP) and Self-Oriented Perfectionism (SOP)]. Once a
week for 11 weeks after baseline, participants completed questionnaires assessing binge eating (EDIBulimia) and body weight/shape problems over the past week. We used multilevel models to separate
between- and within-person effects of body weight/shape problems on binge eating and to investigate
whether perfectionism dimensions moderate the relation between body weight/shape problems and binge
eating in a diathesis-stress framework. Effects of SPP and SOP were assessed in separate analyses, and
models assumed that weekly repeated measures were nested within individuals. Both between- and
within-person effects of weekly body weight/shape problems significantly predicted weekly binge eating,
such that more body weight/shape problems were associated with more binge eating (SPP model: gamma
between-person=1.42 and gamma within-person=.39, ps<.0001; SOP model: gamma betweenperson=1.52 and gamma within-person=.40, ps<.0001). SPP significantly predicted binge eating, with
individuals higher in SPP reporting more binge eating (gamma=.02, p<.05). SOP was not significantly
associated with binge eating. Neither SPP nor SOP moderated the relation between body weight/shape
problems and binge eating. Results highlight the importance of investigating trait- and state-level risks for
disordered eating.
Learning Objectives:
• Describe how the between- and within-person effects of weekly problems with body weight and
shape relate to weekly binge eating.
• Consider how trait-level dimensional perfectionism is associated with state-level weekly binge
eating.
• Understand how multilevel models help researchers analyze nested repeated measures data and
assess interactions between trait- and state-level predictors of disordered eating.
T26
Body Image Dissatisfaction, Trait Anxiety, and Self-esteem Among Men
Tamas Domotor Szalai, MA, Semmelweis University, Institute of Behavioural Sciences, Budapest,
Hungary;Edit Czegledi, PhD, Semmelweis University, Institute of Behavioural Sciences, Budapest,
Hungary; Bernadett Babusa, PhD, Semmelweis University, Institute of Behavioural Sciences, Budapest,
Hungary
Psychological correlates and behavioral consequences of male body image dissatisfaction became into the
focus of research in the past few decades. The aim of the study was to examine the relationship between
male body dissatisfaction, trait anxiety, and self-esteem. Participants were 239 male undergraduate
students. The mean age was 20.3 years (SD=2.78). Measures: bodybuilding activity, dissatisfaction with
body height, Body Shape Questionnaire – SF14, Muscle Appearance Satisfaction Scale, Rosenberg SelfEsteem Scale, Trait Anxiety Scale, importance of body appearance.One-third of the participants (n=80)
engaged in bodybuilding activity. Body dissatisfaction showed a significant association with self-esteem
and trait anxiety in the non-bodybuilder group (r=|.22|–|.34|, p<0.01). In the bodybuilder group only
weight- and muscle dissatisfaction had significant association with self-esteem and trait anxiety (r=|.36|–
|.50|, p<.01).According to the results of the structural equation modeling, trait anxiety was associated
with higher levels of height- (β=.18, p=.006), weight- (β=.31, p<.001), and muscle dissatisfaction (β=.37,
p<.001). Only muscle dissatisfaction had a significant relationship with self-esteem (β=-.10, p=.049).
Importance of body appearance predicted higher weight dissatisfaction (β=.15,p=.021). Bodybuilders
were significantly more satisfied with their muscles (β=-.13, p=.043),and had higher levels of self-esteem
(β=-.10, p=.035) compared to non-bodybuilders. Trait anxiety showed the strongest direct relationship
with self-esteem (β=-.67, p<.001). The explained variance of the model is 54.8%.Results indicated
different patterns in the relationship between body dissatisfaction, self-esteem, and trait anxiety among
bodybuilders and non-bodybuilders. The relationship between body dissatisfaction and self-esteem can be
partially explained by trait anxiety. Further studies should focus on the moderator role of trait anxiety in
male body dissatisfaction. Keywords: males, body image dissatisfaction,trait anxiety, self-esteem,
structural equation modeling
Learning Objectives:
• Describing the relatinship between male body dissatisfaction, trait anxiety and self-esteem.
• Gaining insight of the effect of weight- and muscle dissatisfaction on self-esteem at young
bodybuilders.
• Assessing differences between the characteristics of bodybuliders and not bodybuilders related to
self-esteem and trait anxiety.
T27
The Revolting Body and Self: An Examination of Self-disgust in Anorexia and Bulimia
Nervosa
Jessica Moncrieff-Boyd, BA, The University of Western Australia, Perth, Western Australia, Australia;
Sue Byrne, PhD, DPhil, MRCPsych, The University of Western Australia, Perth, Western Australia,
Australia; Kenneth Nunn, PhD, MBBS, The Children's Hospital at Westmead, Sydney, New South Wales,
Australia; Karina Allen, PhD, MPsych, BA, The Eating Disorders Service, Maudsley Hospital The
University of Western Australia, London, United Kingdom (Great Britain)
Self-disgust is an emotion that involves extreme feelings of revulsion and abhorrence directed towards the
self, the body and one’s actions. While self-disgust has received relatively little empirical attention, recent
qualitative investigations of emotional experiences in eating disorders have indicated that feelings of
disgust and self-disgust have the potential to drive core clinical behaviours such as food restriction and
compensatory methods. This study evaluated levels of self-disgust among individuals with clinically
diagnosed eating disorders in comparison to healthy individuals using a revised self-report measure. 52
individuals with Anorexia and Bulimia Nervosa and 60 undergraduate females completed the Self-Disgust
Scale for Eating Disorders, as well as measures of disgust sensitivity, self-esteem and affective symptoms.
Preliminary results indicated that individuals with eating disorders exhibit significantly greater levels of
self-disgust in comparison to healthy individuals. Such findings provide initial evidence for the salience of
self-disgust among individuals with eating disorders. The results of this study have clinical and theoretical
implications for our understanding of Anorexia and Bulimia Nervosa, and suggest that feelings of disgust
and revulsion directed at the body and self could be associated with core features of eating disorders such
as restriction, purging and body viewing avoidance.
Learning Objectives:
• Develop an understanding of self-disgust as an emotional experience
• Recognise the salience of self-disgust in Anorexia and Bulimia Nervosa
• Consider associations between self-disgust and certain core eating disorder behaviours
T28
Sociocultural influences on drive for thinness and body dissatisfaction in postpartum
women
Meghan Lovering, MA, Northeastern University, Boston, Massachusetts, USA; Rachel Rodgers, PhD,
Northeastern University, Boston, Massachusetts, USA; Jessica Edwards George, PhD, Northeastern
University, Boston, Massachusetts, USA; Debra Frank, PhD, FAED, Northeastern University, Boston,
Massachusetts, USA
Jennifer Thomas 2/20/15 12:37 AM
Comment [2]: This one goes in the Body Image section, so again it’s in the correct order here. Perhaps it could just be numbered consecutively (i.e., T27), which will change all the subsequent numbers. Pregnancy and childbirth result in dramatic changes in a woman’s body shape and weight, which can be
associated with body image concerns. This study explored sociocultural pressures that mothers experience
related to post-pregnancy weight and body image. We examined the relationship between pressures from
media/family/peer/partners with body dissatisfaction and drive for thinness, as they might be mediated
by internalization of the thin-ideal. Women who gave birth during the last 12 months (N=250) completed
an online survey. Participants were on average 32.42 years old (SD=3.8) and 60% reported this was their
first child. Measures included a sociocultural pressures scale modified for the postpartum experience and
standard assessments of thin-ideal internalization, body dissatisfaction, and drive for thinness. Analyses
revealed that the level of perceived pressure to lose post-pregnancy weight was correlated with: thin-ideal
internalization, r(219) = .30, p < .001; body dissatisfaction, r(219) = .35, p < .001; drive for thinness,
r(217) = .45, p < .001; and target date for goal weight, r(216) = .22, p = .001. Linear regression analyses
indicated that sociocultural pressures to regain a pre-pregnancy figure, thin-ideal internalization, and
target date for goal weight were all independent and significant predictors of body dissatisfaction, p <
.001, and drive for thinness, p < .001, explaining 33% and 30% of the variance, respectively.
Bootstrapping analyses revealed a significant indirect effect of sociocultural pressures on body
dissatisfaction through thin-ideal internalization, ß= .99, 95% CI [.17-1.80]. Similarly, the indirect effect
of sociocultural pressures on drive for thinness through thin-ideal internalization was significant, ß=
.7832, 95% CI [.17-1.39]. Findings suggest that women may experience strong sociocultural pressures to
attain an unrealistic body shape and size during the post-pregnancy period, and may be an appropriate
group for targeted prevention.
Learning Objectives:
• Following the training, participants will be able to describe the sociocultural pressures
experienced by young mothers to quickly achieve an unrealistically thin and toned body shape
• Following the training, participants will be able to summarize the role internalization of the thinideal plays in the development of body dissatisfaction and drive for thinness in postpartum
mothers
• Following the training, participants will be able to identify predictors of body dissatisfaction and
drive for thinness in postpartum women
Children and Adolescents
T29
Factors Related to Therapeutic Alliance in a Group of Adolescents Treated for ED.
Dominique Meilleur, Université de Montréal, Dépt. Psychologie; Jade Pelletier-Brochu, Université de
Montréal, Catherine Lalancette, Université de Montréal; Danielle Taddeo, CHU Sainte-Justine,
Montréal; Jean-Yves Frappier, CHU Sainte-Justine, Montréal
The aim of this study was to evaluate the influence of motivation to change and intensity of symptoms of
ED measured at the beginning of inpatient treatment on the strength of therapeutic alliance at the end of
hospitalization. The sample was constituted of 42 female adolescents (12- 17 yo) treated for ED on an
inpatient unit in a University Children’s Health Centre. Participants (83% AN-R, 10% AN-B, 7% B)
completed measures assessing their perception of the quality of the therapeutic alliance (Working Alliance
Inventory- S, WAI-S) with assigned therapist, eating disorders symptomatology (Eating Disorders Risk
Composite of the Eating Disorder Inventory -3, EDRC-EDI3), and their motivation to change (Anorexia
Nervosa Stage of Change Questionnaire, ANSOCQ) at their arrival at the hospital and at the end of
treatment. The scores on the motivation to change questionnaire (ANSOCQ-T1, p= .002) and on the
Eating Disorders Risk Composite of the EDI-3 (EDRC- T1, p < .05) were correlated with the quality of the
therapeutic alliance at the end of treatment (WAI-S -T2). An analysis of regression showed that the stage
of motivation to change at T1 was the best predictor of the AT-T2, accounting for 22,2% of the variance
(model of 1 factor). The quality of the therapeutic alliance at T2 was positively correlated (p = .02) with
the improvement of the symptoms of ED (measured by the difference between EDRC-EDI3 -T1 and
EDRC-EDI3-T2) at the end of hospitalization. Considering those results, motivation to change seems to
be a good clinical target for the inpatient treatment of adolescents with ED.
Learning Objectives:
• Describe the link between motivation to change and the quality of therapeutic alliance in a group
of adolescents with ED at the end of hospitalization
• Describe the link between intensity of symptoms of ED and the quality of therapeutic alliance in a
group of adolescents with ED at the end of hospitalization
• Examine the relation between therapeutic alliance and the improvement of the symptoms of ED
at the end of hospitalization in a group of adolescents .
T30
Association Between Attention-Deficit/Hyperactivity Disorder Symptom Trajectories
Across Childhood and Adolescence and the Development of Disordered Eating in Late
Adolescence
Zeynep Yilmaz, PhD, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA;
Kristin N. Javaras, PhD, DPhil, University of North Carolina at Chapel Hill, Chapel Hill, North
Carolina, USA; Jessica H. Baker, PhD, University of North Carolina at Chapel Hill, Chapel Hill, North
Carolina, USA; Paul Lichtenstein, PhD, Karolinska Institutet, Stockholm, Sweden; Henrik Larsson, PhD,
Karolinska Institutet, Stockholm, Sweden; Cynthia M. Bulik, PhD, FAED, University of North Carolina
at Chapel Hill, Chapel Hill, North Carolina, USA
Attention-deficit/hyperactivity disorder (ADHD) is characterized by inattention, hyperactivity, and
impulsivity. Disordered eating is reported to be prevalent among adolescents with ADHD, suggesting a
possible mechanistic link between ADHD and disordered eating. Although both inattention and
hyperactivity/impulsivity have been linked to different aspects of disordered eating cross-sectionally, no
study has explored how the trajectories of specific attention-related problems across childhood and
adolescence relate to disordered eating during adolescence. We examined the effect of childhood to
adolescent inattention (AT) and hyperactivity/impulsivity (H/I) trajectories on late adolescent disordered
eating behaviors in the Swedish Twin Study of CHild and Adolescent Development (TCHAD). We used
growth mixture models to characterize the trajectories of DSM-IV AT symptoms and (separately) DSM-IV
H/I symptoms, assessed at three time points from middle childhood to late adolescence. We then used the
resulting AT and H/I trajectories to predict Eating Disorder Inventory (EDI) Bulimia, Drive for Thinness,
and Body Dissatisfaction subscales in late adolescence. We observed two different trajectories (High =
high symptoms at all time points; Low = low symptoms at all time points) for AT and for H/I. The High
(vs. Low) H/I trajectory predicted a significant or near significant increase in scores for each EDI
subscale. In contrast, AT trajectory was not a significant predictor of EDI scores after adjusting for H/I
trajectory. There were no significant sex differences in the relationships between AT or H/I trajectory and
EDI scores. Our results suggest that individuals who experience hyperactivity/impulsivity symptoms
throughout childhood and adolescence are more likely to have disordered eating during adolescence;
however, the clinical significance of this increased risk requires further investigation.
Learning Objectives:
• Review the comorbidity of ADHD and disordered eating
• Evaluate the impact of different childhood inattention and hyperactivity/impulsivity trajectories
on adolescent disordered eating
• Explore the role of sex differences in the relationship between childhood ADHD symptoms and
adolescent disordered eating
T31
Overeating With and Without Loss of Control: Associations with Weight status, Weightrelated Characteristics and Psychosocial Health
Katie Loth, PhD, MPH, RD, Department of Psychiatry, University of Minnesota, Minneapolis,
Minnesota, USA; Rich MacLehose, PhD, School of Public Health, University of Minnesota, Minneapolis,
Minnesota, USA; Andrea Goldschmidt, PhD, Department of Psychiatry, University of Chicago, Chicago,
Illinois, USA; Jerica Berge, PhD, MPH, Department of Family Medicine,University of Minnesota,
Minneapolis, Minnesota, USA; Dianne Neumark-Sztainer, PhD, MPH, RD, FAED, School of Public
Health, University of Minnesota, Minneapolis, Minnesota, USA; Emily Pisetsky PhD, Department of
Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA
Overeating is a critical area to study because of the problematic behavioral and health outcomes
associated with this eating disturbance. However, it is not understood whether objective overeating is
associated with adverse outcomes, or if overeating must be accompanied by loss of control to yield these
significant associations. Thus, this study aimed to: 1) assess the prevalence of different types of eating
episodes [non-pathological, overeating, and overeating with loss of control (LOC-eating)] within a sample
of adolescents, and 2) explore associations between these eating episodes and weight-related outcomes
and psychosocial well-being. Study participants were racially/ethnically and socioeconomically diverse
adolescents [girls (n=1112) and boys (n=955)] with a mean age of 14.5 years. Overeating was reported by
9.2% of girls and 6.7% of boys and LOC-eating was reported by 3.6% of girls and 1.4% of boys. Overall,
significant differences in weight-related outcomes by type of eating episode were observed. Adolescents
with LOC-eating were more likely to be overweight, have dieted in the past year, be trying to lose weight
and report high weight importance, as compared to those who reported overeating and non-pathological
eating. Adolescents who reported overeating were more likely to experience these same negative weightrelated outcomes than those with non-pathological eating. Adolescents with LOC-eating had significantly
lower body satisfaction and self-esteem and higher depressive symptoms as compared to youth who
reported overeating and non-pathological eating. In sum, overeating, with or without loss of control, was
found to be associated with adverse weight-related outcomes and poor psychosocial well-being. Findings
further indicated that adolescents who reported LOC-eating were at greatest risk for adverse weightrelated and psychosocial outcomes suggesting that loss of control is an important indicator of severity of
overeating episodes among adolescents.
Learning Objectives:
• Describe the prevalence of different types of eating episodes (non-pathological, overeating, and
overeating with loss of control) within a diverse, population-based sample of adolescents.
• Identify adverse weight-related and psychosocial outcomes associated with different types of
eating episodes.
• Discuss whether loss of control is an important indicator of severity of overeating episodes among
adolescents.
T32
Eating Disorder Attitudes and Behaviors and BMI in High-Risk, Pre-Adolescent Females
Dayton Richards Walsh, MA, University of Rochester, Rochester, New York, USA; Mary Tantillo, PhD,
FAED, University of Rochester, Rochester, New York, USA; Laura Wray-Lake, PhD, University of
Rochester, Rochester, New York, USA; Mandi Burnette, PhD, University of Rochester, Rochester, New
York, USA
Minority girls are underrepresented in empirical research. This study examines eating disorder attitudes
and behaviors (EDABs) and the relationship to childhood maltreatment (DHS record) and BMI in a
sample of girls entering adolescence to increase the chances of early identification of eating disorder (ED)
pathology. Data come from a high-risk, community-based sample of pre-adolescent girls (N=61, mean age
=10.75, range: 9-13, SD=0.93, 65.6% African American). Girls were from low-income families; almost
1/3rd came from homes where annual income is less than $10,000 (n=18, 29.5%). About half (52.5%,
n=32) had a documented history of maltreatment according to DHS records. The children’s version of the
Eating Attitudes Test (ChEAT; Maloney et al., 1988, 1989) assessed a range of eating disorder symptoms
characteristic of individuals clinically diagnosed with an ED. Levels of EDABs (M=7.87, SD= 7.96) were
consistent with results from other similarly aged samples. However, the percentage of girls scoring >20
(suggested clinical cutoff) on the ChEAT was almost two times (11.48%, n= 7) as high other studies (e.g.,
Maloney et al., 1989). BMI and ChEAT score were positively correlated (r=.341, p<.05). BMIs were
significantly higher among girls with a history of maltreatment (M = 24.37, SD=6.19, t=2.22, p<.05).
Study findings support the idea that EDABs are present in girls from low-income, minority populations.
Mean ChEAT levels are similar to other samples but a larger percentage of girls have EDABs above the
clinical cutoff. Mean BMI levels were in the 95th percentile for age. Results suggest that as BMI increases,
endorsement of ED symptoms increases. These results add to a very small body of research on EDs in
minority girls. Results have implications for further studies as well as clinical intervention.
Learning Objectives:
• Understand that eating disorder attitudes and behaviors are present in girls from low-income,
minority populations.
• Describe the relationship between eating disorder attitudes and behaviors and BMI in girls who
have experienced childhood maltreatment.
• Recognize that BMIs may be significantly higher among pre-adolescent girls who have
experienced maltreatment.
T33
Picking and Nibbling in Children and Adolescents with Eating Disorders
Andrea Kass, MA, University of Chicago, Chicago, Illinois, USA, Erin Accurso, PhD, University of
Chicago, Chicago, Illinois, USA; Andrea Goldschmidt, PhD, University of Chicago, Chicago, Illinois,
USA; Seeba Anam, MD, University of Chicago, Chicago, Illinois, USA; Catherine Byrne, BA, University
of Chicago, Chicago, Illinois, USA; Kate Kinasz, BA, University of Chicago, Chicago, Illinois, USA;
Alexandria Goodyear, BA, University of Chicago, Chicago, Illinois, USA; Setareh O'Brien, BA,
University of Chicago, Chicago, Illinois, USA; Daniel Le Grange, PhD, FAED, University of Chicago,
Chicago, Illinois, USA
Picking and nibbling (PN) is characterized by eating in an unplanned and repetitious manner. PN is
prevalent among adults with eating disorders (EDs), but no studies have examined this behavior in youth
with EDs. This is the first study to assess the prevalence of PN and its association with ED pathology
among children and adolescents with EDs. Four hundred fifty-four youth (M age=15.4±2.2y) presented to
an outpatient ED research-clinical program or for randomized controlled trials evaluating ED treatments.
The Eating Disorder Examination (EDE) was used to assess ED pathology, including the presence of PN.
One hundred ninety-one patients (42.1%) endorsed PN in the past 28 days. Compared to those who did
not endorse PN, patients who endorsed PN were older (p<0.001) and had a higher BMI percentile
(p=0.006). Of those who endorsed PN, 36.3% met criteria for anorexia nervosa (AN), 60.9% for bulimia
nervosa (BN), 28.8% for subclinical AN (subAN), and 46.9% for other ED not otherwise specified
(EDNOS) diagnoses. Controlling for age and BMI percentile, the presence of PN was significantly
different by ED diagnosis (p=0.047); patients with BN were more likely to endorse PN than patients with
AN (p=0.003) or subAN (p=0.001), but not more likely than patients with other EDNOS diagnoses
(p=0.33). PN was not significantly associated with EDE subscale or global scores, objective or subjective
binge eating, objective overeating, compensatory behaviors, or eating in secret, after controlling for age
and BMI percentile. PN was associated with eating more afternoon snacks (p=0.009) but not with eating
other snacks or meals. Consistent with extant research in adult clinical populations, PN is prevalent
among children and adolescents with EDs, is not associated with ED behaviors or pathology, and is
associated with increased afternoon snacking. Thus, though prevalent in youth with EDs, these results
support past research showing no association between PN and ED symptoms or pathology.
Learning Objectives:
• Understand the construct of picking and nibbling and its prevalence among youth with eating
disorders
• Describe the association between picking and nibbling and eating disorder diagnoses and
pathology
• Contextualize results regarding picking and nibbling among youth with eating disorders within
the extant literature evaluating this behavior among adults with eating disorders
Comorbidity
T34
Compulsive Exercise In Patients With Anorexia Nervosa And Bulimia Nervosa:
Comparison With Healthy Controls In Physical Activity And Impact On Short-Term
Outcomes Of Inpatient Treatment
Sandra Schlegl, PhD, DiplPsych, MSc, Department of Psychiatry and Psychotherapy, München, Bayern,
Germany; Nina Dittmer, DiplPsych, Schoen Klinik Roseneck, Prien am Chiemsee, Bayern, Germany;
Svenja Hoffmann, MSc, Department of Clinical Psychology and Psychotherapy, Bamberg, Bayern,
Germany; Ulrich Voderholzer, MD, MSc, Schoen Klinik Roseneck, Prien am Chiemsee, Bayern, Germany
The aims of the study were to identify similarities and differences in physical activity between healthy
subjects, patients with anorexia nervosa (AN) and patients with bulimia nervosa (BN), to identify
predictors of compulsive exercise, and to examine whether compulsive exercise is a predictor of shortterm outcomes of inpatient treatment. A total of N = 371 subjects were assessed. 226 patients were
recruited from four inpatient clinics with specialized units for eating disorders (EDs) (AN: n = 151, BN: n
= 75). Healthy controls (n = 145) were recruited from high schools and a university. Participants were
aged between 13 and 55 years (M = 21.99; SD = 7.43). They filled in the following self-rating scales:
Compulsive Exercise Test (CET), Exercise Motivation Inventory-2, Eating Disorder Inventory-2 (EDI-2),
Obsessive Compulsive Inventory-Revised, Brief Symptom Inventory-18 and Beck-Depression-InventoryII. For the patients in one of the clinics (AN: n = 99; BN: n = 39) there were data on EDI-2 at both
admission and discharge. Of the total sample, 248 subjects (66.9%) reported that they exercise regularly.
Average duration per week (hours) was M = 5.13 (SD = 4.24) (range: 1- 30h). Compulsive exercise was
significantly higher in patients with EDs than in healthy controls (CET Total: M = 1.98; SD = 0.64), with
no differences between patients with AN (M = 2.71; SD = 1.04) and BN (M = 2.72; SD = 0.88). In the total
sample, a combination of 10 predictors explained 75.8% of the variance in compulsive exercise, the most
relevant of them being weight management, drive for thinness, enjoyment and body dissatisfaction.
Furthermore, compulsive exercise was shown to be a significant predictor of short-term outcomes (EDI-2
change) in AN patients (R2 = 6.5%), but not in BN patients. In summary, compulsive exercise seems a
highly relevant symptom in both AN and BN patients, but seems to be a negative predictor of short-term
outcomes of inpatient treatment for patients with AN only.
Learning Objectives:
• Following the training, participants will be able to describe similarities and differences in physical
activity between healthy subjects, patients with anorexia nervosa (AN) and patients with bulimia
nervosa (BN).
• Following the training, participants will be able to name predictors of compulsive exercise.
• Following the training, participants will be able to predict the impact of compulsive exercise on
short-term outcomes of inpatient treatment.
Diagnosis, Classification and Measurement
T35
Empirically Defining Rapid Response to Intensive Treatment to Maximize Prognostic
Utility for Bulimia Nervosa and Purging Disorder
Danielle MacDonald, MA, Ryerson University & University Health Network, Toronto, Ontario, Canada;
Kathryn Trottier, PhD, University Health Network & University of Toronto, Toronto, Ontario, Canada;
Traci McFarlane, PhD, University Health Network & University of Toronto, Toronto, Ontario, Canada;
Marion Olmsted, PhD, FAED, University Health Network & University of Toronto, Toronto, Ontario,
Canada
Rapid response (RR) to eating disorder treatment has been identified as a predictor of remission at posttreatment and subsequent follow-up, but its definition has varied widely. The most empirically valid
definition of RR may be one that best discriminates between outcomes, and although empirical methods
have been used to define RR thresholds in outpatient settings, RR to intensive treatment has not been
investigated. This study used signal detection methods to determine the optimal threshold for defining RR
to day hospital treatment. Participants were 158 patients with bulimia nervosa or purging disorder who
completed at least 6 weeks of day hospital treatment. Receiver operating characteristic (ROC) analysis
was used to determine the threshold of binge and/or vomit episodes in the initial phase of treatment that
discriminated between remission (i.e., ≤1 episode in last 2 weeks and ≤1 episode in first month follow-up)
and nonremission after treatment. ROC analysis identified four thresholds: ≤3 episodes in the first four
weeks of treatment; ≤1 episode in the first two weeks; >99.7% reduction in the first four weeks; and
>95.7% reduction in the first two weeks. Compared to nonrapid responders, rapid responders had higher
remission rates and fewer binge/vomit episodes at the end of treatment using all definitions. Convergent
validity for the first definition (≤3 episodes in four weeks) was demonstrated by lower 6- and 12-month
relapse rates for rapid responders. Additionally, this definition suggested that for those who make a good
response, speed of response is important, with rapid responders exhibiting higher remission rates than
slow responders. These findings support ≤3 episodes in the first 4 weeks of intensive treatment as an
empirical definition of rapid response. They also suggest that early change is an important prognostic
indicator, and that encouraging patients to make early and dramatic behavioral improvements may
benefit their long term recovery.
Learning Objectives:
• Classify rapid versus nonrapid responders to intensive treatment.
• Predict remission and relapse based on rapid response status.
• Consider how rapid reponse classification can be used as an indicator of prognosis.
T36
Inhibitory Control in Patients with Bulimia Nervosa Under Low and High Cognitive
Demand Conditions.
Kerttu Petenberg, MA, University of Tartu, Tartu, Tartumaa, Estoni; Kirsti Akkermann, PhD,
University of Tartu, Tartu, Tartumaa, Estonia; Kairi Kreegipuu, PhD, University of Tartu, Tartu,
Tartumaa, Estonia
It has been demonstrated that bulimia nervosa (BN) patients have difficulties in inhibitory control. The
purpose of this study was to measure inhibitory control difficulties in patients with BN in relation to food
and body stimuli under low and high cognitive demand conditions defined by either 1500 or 1000 ms as
an interstimulus interval in an emotional Go/No-Go task. The sample consisted of 42 women, of those 21
were BN patients from the inpatient unit and 21 were age matched healthy controls (HC). 11 BN patients
and 11 HC completed the Go/No-Go task under low cognitive demand conditions while 10 BN patients
and 10 HC completed the same task under high cognitive demand conditions. BN patients tested with
seperate emotional Go/No-Go tasks did not differe according to BIS-11 scores. Results show that under
low cognitive demand BN patients are slower in reaction times than HC but there are no differences in
commission errors. Under high cognitive demand BN patients are faster in reaction times but they also
make significantly more commission errors compared to HC. Independent of the cognitive demand all the
participants reacted faster to food related stimuli than neutral stimuli. However, BN patients also reacted
faster to body related stimuli than neutral stimuli. The results remained significant when depression
scores (measured with MADRS) were taken into account. Thus, results of this study indicate that
inhibitory control difficulties in BN patients are specially pronounced when they are under high cognitive
demand situation. BN patients differentiate from HC when body related stimuli are presented indicating
disorder specificity of the used Go/No-Go task. As food stimuli are significant to everyone the significance
attached to body images could indicate the presence of attentional bias that is maintaining the eating
disorder.
Learning Objectives:
• Describe differences in inhibitory control difficulties in patients with bulimia nervosa under low
and high cognitive demand conditions.
• Describe attentional bias to disorder specific stimuli that is maintaining the disorder.
• Consider the importance of the parametric characteristics of emotional Go/No-Go task used to
measure inhibitory control difficulties.
T37
Behavioral Intolerance of Uncertainty and Eating Disorder Behaviors in a Non-Clinical
Sample
Rachel Mashal, Student, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Andrew
Grotzinger, BA, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Tom Hildebrandt,
PsyD, BS, FAED, Icahn School of Medicine at Mount Sinai, New York, New York, USA
Intolerance of uncertainty (IU) is the tendency to react negatively to uncertain events. Self-reported IU
has been observed in eating disorder patients, yet behavioral measures of IU remain relatively
unexplored. This study is the first attempt to examine food-based behavioral IU. Forty-five (32 female)
healthy adolescents, of ages 11-22 (M = 18.43, SD = 2.81), participated in the study. Participants
completed two computerized, behavioral measures of IU. The general task asked participants to guess
which jar colored beads were being drawn from based on known ratios of beads in the jars. The eating
specific task replaced pictures of beads with that of food. Higher numbers of items drawn before guessing
indicate a higher IU. The outcome was the difference between food items and regular beads picked.
Participants also completed the Eating Disorder Questionnaire (EDE-Q), Intolerance of Uncertainty Scale
(IUS), and Disgust Scale Revised (DS-R). Bayesian analysis with diffuse priors was used to test different
models based on the Deviance Information Criterion (DIC), and the Posterior Predictive p-value. The final
model (PPP = .501) included gender, IUS, the core disgust sub-scale from the DS-R, the shape concern
sub-scale from the EDE-Q, and an interaction between IUS and shape. Results revealed significant
median point estimates for IUS, β = -.35, 95% Credibility Interval (CI) [-.65, -.06], p = .009; core disgust,
β = .89, 95% CI [-0.04, 1.81], p = .031; and the interaction term, β = .13, 95% CI [-0.01, .28], p = .038. The
significant interaction was due to a stronger relationship between shape concerns and the outcome at high
levels of IUS, relative to low levels of IUS. These findings suggest that our novel, food-based behavioral
measure of IU is associated with eating disorder symptoms, and that this effect is exacerbated at higher
levels of self-report IU. Thus, those with eating disorder symptoms display higher behavioral IU when the
uncertainty is food-specific.
Learning Objectives:
•
•
•
Assess the utility of a food-based behavioral measure of intolerance of uncertainty
Determine whether eating disordered behaviors and thoughts relate specifically to food-based
behavioral intolerance of uncertainty, relative to general intolerance of uncertainty
Analyze the relationship between self-report intolerance of uncertainty, and two different form of
behavioral intolerance of uncertainty
T38
An Exploration of Various Conceptualizations of Pathological Exercise and Their
Relationship to Eating Disorders
Hayley Cunningham, Student, Furman University, Greenville, South Carolina, USA; Silas Pearman,
PhD, MA, BA, Department of Health Sciences, Furman University, Greenville, South Carolina, USA;
Timothy Brewerton, MD, FAED, Dept. of Psychiatry & Behavioral Sciences, Medical University of South
Carolina, Charleston, South Carolina, USA
It is widely recognized that exercise can assume pathological characteristics. The present study compares
several validated instruments that evaluate this behavior as a dependence, addiction, compulsion,
obligation, or symptom of an eating disorder (ED). Using Amazon Mechanical Turk © as well as
promotion through social media and other mechanisms, 1,497 adults (608 men, 885 women, 4 other)
completed a set of previously validated surveys that assess exercise behavior and pathological exercise,
including the Godin Leisure-Time Exercise Questionnaire (GLTEQ), the Exercise Dependence Scale-21
(EDS-21), the Exercise Addiction Inventory (EAI), the Compulsive Exercise Test (CET), the Obligatory
Exercise Questionnaire (OEQ), the Commitment to Exercise Scale (CES), and an exercise specific
adaptation of the Dimensional Obsessive-Compulsive Scale (DOCS). Subjects also completed the Eating
Disorders Examination Questionnaire (EDE-Q), and DSM-5 ED diagnoses were determined according to
published guidelines. Respondents designated “At Risk” by the EDS-21 or EAI or who scored at least 2 SD
above the mean in at least 1 other measure were classified as “Pathological Exercisers.” Pearson
correlation coefficients, independent-samples t-tests, χ2 tests, and 1-way ANOVA’s were calculated using
SPSS 21.0. 14.6% of those with an EDE-Q ED were placed in the Pathological Exercisers category (v. 7.4%
with no ED, χ2, p = .000). 77.8% of Pathological Exercisers had an EDE-Q ED (v. 63.9% in the entire
sample, χ2, p = .000). Those with secondary pathological exercise demonstrated a more compulsive
profile than those with primary pathological exercise and experienced a greater negative emotional
response when unable to exercise. Response patterns also differed between ED diagnoses. The varying
nature of pathological exercise necessitates a broad theoretical perspective in assessment and treatment
that is tailored to the individual.
Learning Objectives:
• Compare and contrast the characteristics of primary and secondary pathological exercise.
• Differentiate between and appraise previously-validated measures of pathological exercise.
• Recognize the necessity of assessment and treatment methods that take into account the high
level of variation that exists between individuals with pathological exercise.
T39
Patient Experience of Receiving a Diagnosis of an Eating Disorder.
Nimisha Joshi, MA, BA, City University, London, England, Middlesex, United Kingdom (Great Britain);
David Viljoen, CPsychol, MSc, MSc, Hertfordshire Partnership Foundation University Trust,
Hertfordshire, England, Hertfordshire, United Kingdom (Great Britain); Julianna Challenor, DPsych,
BA, City University, London, England, London, United Kingdom (Great Britain)
The notion of diagnosis has shown to have a profound influence within mental health and there continues
to be ongoing debate and controversy regarding diagnosing and the medical model. The recent launch of
the DSM-5 has raised significant concerns regarding lowering diagnostic thresholds in order to focus on
individual experiences rather than medical explanations. However, research has not yet fully explored
patients’ views on diagnoses. The purpose of this study was to address this gap and explore patients’
experiences of receiving a diagnosis of an eating disorder. Ten female participants were recruited from an
adult community eating disorders service in the UK. All participants had received an eating disorder
diagnosis and were interviewed using a semi-structured schedule. Transcribed interviews were
qualitatively analysed using the principles of Interpretative Phenomenological Analysis. Four master
themes emerged from the data: ‘Living with an unknown condition’ reflected the challenges in the early
stages and the day-to-day ‘trauma’ and ongoing battle of living with an unlabelled condition. ‘Perception
of a lack of compassion in delivering diagnoses’ demonstrated the lack of compassion by professionals
when patients received the diagnosis. ‘Living with the diagnostic label’ suggested that participants
perceived their diagnoses as difficult and embarrassing labels that could not be erased and they
considered it to be a life sentence. Patients also felt that the diagnoses did not fully capture their lived
experience. ‘A pathway to recovery’ demonstrated how the diagnosis offered patients an explanation for
their behaviour which helped them to understand it better. Patients felt that the diagnoses enabled a
stronger self, direction and access to support. This study extended knowledge in the field and has
highlighted compassion as an important component when delivering diagnoses to patients. The impact of
receiving and living with a diagnosis of an eating disorder should be considered throughout the
assessment and treatment process. Further implications for clinical practice were highlighted and areas
for further research were also identified.
Learning Objectives:
• Reflect on the importance of showing compassion when delivering a diagnosis of an eating
disorder.
• Discuss patients’ experiences of receiving a diagnosis of an eating disorder.
• Reflect on the impact of living with a diagnostic label of an eating disorder.
T40
Letting Survivors Speak: How Should We Define Recovery and Why Does it Matter? A
Qualitative Investigation
Emily S. Rogers, MA, BA, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Jennifer B.
Webb, PhD, MA, BA, University of North Carolina Charlotte, Charlotte, North Carolina, USA; Suman A.
Ambwani, PhD, MA, BA, Dickinson College, Carlisle, Pennsylvania, USA
The lack of consensus regarding what constitutes recovery from eating disorders (EDs) contributes to
difficulties in determining appropriate treatment outcome measures for research and clinical practice.
Debate persists about the importance of physical, behavioral, and psychological recovery components and
whether “full recovery” is possible. The present qualitative study sought to clarify definitions of ED
recovery via semi-structured interviews with women who had recovered from EDs (n = 10). Interviews
were transcribed and analyzed using Interpretive Phenomenological Analysis, which was conducted in
multiple stages with several consulting psychologists to enhance rigor. Three universally endorsed
superordinate themes emerged that encompassed participants’ recovery experiences and definitions:
Power Over the ED, New Relationship to the Body, and Freedom from ED Identity. These themes were
further clarified by subordinate themes accounting for variation in individual participants’ experiences.
For example, participants universally described abstinence from ED behaviors, but differed in the extent
to which they still experience ED thoughts and urges (Power Over the ED). Similarly, all participants’
definitions included a New Relationship to the Body, but participants differed in whether they “Loved”
their bodies or “Accepted” them. Participants universally included physical and behavioral components to
a recovery definition, aligned with current research. However, among participants, the distinguishing
feature of “full recovery” was separation from the illness identity. These data emphasize the need to
incorporate psychological and emotional components to recovery definitions, and lend support toward a
growing movement within the research community. Future investigations using recovered voices could
further clarify a definition, while simultaneously empowering survivors and inspiring patients.
Learning Objectives:
• Understand the negative impacts of existing conflicts in definitions of recovery.
• Describe empirical findings supporting an ED survivor-driven definition of recovery that
incorporates physical, behavioral, and psychological components
• Describe the potential benefits of incorporating ED survivors in future research investigations
T41
What Does Eating Disorders Examination Questionnaire (EDE-Q) Measure in a Group of
Turkish Adolescents?: The Revised Factor Structure of the Turkish Version of the EDE-Q
Ozlem Sertel Berk, PhD, Istanbul University, Faculty of Letters, department of Psychology, Istanbul,
Turkey; Basak Yucel, MD, Istanbul University, Faculty of Medicine, Department of Psychiatry, Istanbul,
Turkey
Currently, eating disorders (ED) turn out to be rapidly increasing in Turkish adolescent population
especially in the last decade. Literature reveals that in non-western, developing countries like Turkey,
adolescents suffer from atypical symptoms of ED as well as typical symptoms. Therefore the evaluation of
the unique experience of ED symptoms becomes extremely important from a cross-cultural perspective.
Based on this need, this study aimed to evaluate the factor structure of the Turkish version of The Eating
Disorders Examination Questionnaire (EDE-Q-TR) in comparison with the original version. Participants
were 925 primary and high school students from various regions of Istanbul with whom the validation of
EDE-Q-TR was conducted in a previous study. Mean age was 15. 52 (SS=1.88) and 68% were female.
Unlike the original version with four factors and 22 items, the factor analysis with Principal Axis
Factoring and oblique rotation resulted in four factor but 19 item structure, named as “affect”, “body
dissatisfaction”, “restraint” and “appearance” components with Cronbach’s alphas of .93, .81, .86, and .79,
respectively. Their correlations with General Health, Body Image Satisfaction Questionnaires, and Eating
Attitudes Test were moderate, as expected. Factor scores also increased as Body Mass Index increased.
The confirmatory factor analysis indicated good fit values for EDE-Q-TR in all indices (i.e., X2/df=3.54,
RMSEA=0.05, GFI=0.95, ECVI=0.63), whereas those values were poor for the original factor structure
(i.e., X2/df=10.21, RMSEA=0.10, GFI=0.84, ECVI=2.24). These results reveal that EDE-Q-TR which
originally measures eating, weight, shape concerns and restraint eating also seems to evaluate affection,
dissatisfaction and body appearance in a valid and reliable fashion. With this revised factor structure,
EDE-Q-TR is promising for understanding the experience and predictors of EDs in a Euro-Asian culture
like Turkey within a cross-cultural perspective.
Learning Objectives:
•
•
•
Compare varying components of eating disorder symtomatology between western and nonwestern countries using the same tool of symptom assessment
Comprehend different aspects of eating disorder experience from a cross cultural perspective
Determine the predictors of the unique experience of eating disorders symptomatology in a nonwestern euro-asian culture.
T42
Assessment of the Reinforcing Value of Exercise and Exercise-Induced Changes in Affect
among Pathological Exercisers and Non-Pathological Exercisers: Preliminary Results
Lauren Holland, MS, Florida State University, Tallahassee, Florida, USA;Pamela Keel, PhD, FAED,
Florida State University, Tallahassee, Florida, USA
Pathological exercise (PE) is a common feature of individuals with eating disorders (ED) and represents a
key maintaining factor of eating pathology. This study sought to determine whether exercise is perceived
as more reinforcing to women with PE compared to normal exercisers, as measured by a greater
willingness to work for exercise. In addition, the study examined whether women with PE report greater
changes in positive or negative affect following exercise compared to women without PE. Women with PE
(n= 13) and women without PE (n=17) completed a computerized progressive ratio task to earn running
time on a treadmill. The reinforcing value of exercise was measured by the participant’s breakpoint on the
PR task. In addition, participants completed self-report measures of affect before and after 30 minutes of
running on a treadmill at a standardized intensity (75% max HR). Results indicated that women with PE
worked significantly harder to earn time exercising than women without PE (t (28) = -4.16, p<.001). In
regard to affect, women with PE reported significantly higher baseline levels of negative affect (t (10.5) = 2.9, p=.02) and showed a significantly greater decrease in negative affect following exercise compared to
women without PE (t (10.7) = -2.22, p<.05). However, there were no group differences in baseline positive
affect or changes in positive affect. This provides preliminary evidence that individuals with PE may
experience exercise as more reinforcing than normal exercisers, through its ability to modulate affect.
These findings have important treatment implications, such that treatment of individuals with PE should
focus on identifying and implementing alternative means to regulate affect.
Learning Objectives:
• Describe differences in the reinforcing effect of exercise between women with pathological
exercise and women without pathological exercise.
• Describe differences in baseline values of negative affect and changes in negative affect following
exercise between women with pathological exercise and women without pathological exercise.
• Discuss treatment implications for women with pathological exercise.
T43
Being Male and Reporting More Self-stigma of Seeking Psychological Treatment Predicts
An Increased Likelihood of Having an Undiagnosed Eating Disorder
Scott Griffiths, BS, University of Sydney, Sydney, New South Wales, Australia; Jonathan Mond, PhD,
FAED, Macquarie University, Sydney, New South Wales, Australia; Zhicheng Li, BS, University of
Sydney, Sydney, New South Wales, Australia; Sanduni Gunatilake, Student, University of Sydney,
Sydney, New South Wales, Australia; Stuart Murray, PhD, University of California, San Diego, San
Diego, California, USA; StephenTouyz, PhD, FAED, University of Sydney, Sydney, New South Wales,
Australia
Objective. Most eating disorders are undiagnosed and diagnosis likely is influenced by sex, stigma
associated with help-seeking, and their interaction. The current study examined whether sex and the selfstigma of seeking psychological help would predict an increased likelihood of having an undiagnosed
eating disorder. Method. A multi-national sample of 448 individuals with diagnosed eating disorders
and 176 individuals with undiagnosed eating disorders were recruited. Self-reported diagnostic status was
cross-validated with symptom data. A logistic regression analysis was conducted with sex and self-stigma
of seeking psychological help among the predictors and participants’ diagnostic status as the outcome
variable. Results. Very high levels of eating disorder and comorbid psychopathology were observed in
both diagnosed and undiagnosed subgroups. Being male and greater self-stigma of seeking help were
strongly and independently associated with an increased likelihood of being undiagnosed. Further, sex
and self-stigma interacted, such that the association between self-stigma and the probability of being
undiagnosed was stronger for males. Discussion. Consistent with clinical impression and anecdotal
evidence, the findings suggest that males and individuals experiencing high levels of self-stigma are
overrepresented among undiagnosed cases of eating disorders. Interventions are needed to address
negative beliefs about help-seeking among individuals with eating disorders, particularly males.
Learning Objectives:
• Assess sex differences in rates of eating disorder diagnosis
• Assess the role of self-stigma of seeking psychological help on eating disorder diagnosis
• Acquire targets for intervention- and prevention-related research that aims to improve rates of
eating disorder diagnosis
T44
Validity of the Compulsive Exercise Test in Screening for Eating Psychopathology among
Competitive Athletes
Carolyn Plateau, MA, Loughborough University, Leicester, Leicestershire, United Kingdom (Great
Britain); Jon Arcelus, PhD, Leicester Eating Disorders Service Bennion Centre, Leicester Glenfield
Hospital, Leicester, Leicestershire, United Kingdom (Great Britain); Caroline Meyer, PhD, University of
Warwick, Coventry, Warwickshire, United Kingdom (Great Britain)
This study had two main aims. First, to evaluate the criterion validity of the athlete version of the
Compulsive Exercise Test (CET-A) by determining it’s associations with levels of eating psychopathology
among a sample of athletes. Second, to present a cut-off value for the CET-A, which could be used to
identify athletes with elevated levels of eating psychopathology. A sample of 547 athletes completed the
CET-A and Eating Disorders Examination Questionnaire (EDE-Q). The sample included 15 athletes who
were currently seeking treatment for an eating disorder. Significant, positive associations were observed
between the Avoidance of Negative Affect, Weight Control Exercise and Global scores on the CET-A with
EDE-Q scores. Receiver Operating Curve (ROC) analysis indicated that a cut-off score of 10.00 on the
CET-A could successfully distinguish between athletes with and without a current eating disorder, and
represented the optimal trade-off between specificity (.80) and sensitivity (.79). Relative risk statistics
revealed that athletes scoring above 10.00 on the CET-A were nearly 4 times more likely to have a
diagnosis of an eating disorder than those who scored below this cut-off. The CET-A may be a useful tool
for identifying the early signs and symptoms of eating psychopathology among athletes and points to the
need for further assessment of those who score above 10.00 on the measure. Future research with the
CET-A should explore the predictive value of the measure in detecting eating psychopathology in this
group.
Learning Objectives:
• Describe the association between compulsive exercise and eating psychopathology in athletes
• Assess the validity of the Compulsive Exercise Test (Athlete version) in detecting eating
psychopathology in athletes
• Understand how the CET-A could be utilised within the sports context to identify the early signs
and symptoms of eating psychopathology in athletes.
T45
Exploratory and Confirmatory Factor Analysis of the Eating Disorder Examination
Questionnaire
Devin Rand-Giovannetti, BA, University of Hawaii at Manoa, Honolulu, Hawaii, USA; David Cicero,
PhD, University of Hawaii at Manoa, Honolulu, Hawaii, USA; Janet Latner, PhD, University of Hawaii
at Manoa, Honolulu, Hawaii, USA
The Eating Disorder Examination Questionnaire (EDE-Q) is a widely used measure of eating pathology.
One limitation of this measure is that the 4-factor structure suggested by test-makers was theoretically
derived and has not been empirically supported. The lack of validation of these subscales could threaten
the internal validity of research using this measure. Furthermore, gaining an understanding of the
structure of this measure can help to clarify the nature and core symptoms of eating disturbances. The
purpose of this study is to examine the factor structure of the EDE-Q and to compare the goodness-of-fit
of our model with other published models. Nine hundred and eighty-one college students completed the
EDE-Q. Participants were randomly assigned for inclusion in an exploratory factor analysis (EFA; n=490)
and a confirmatory factor analysis (CFA; n=491). Participants were 69% female and ranged in age from 16
to 48 (mean age=20.33 years; SD=3.68). Participants were 39% Asian, 30% Multi-ethnic, 21% White, 3%
Pacific Islander, and 7% Other. The 22 attitudinal items of original four subscales were subjected to an
EFA in Mplus as ordinal variables with a Weighted Least Squares Mean and Variance adjusted extraction.
Three factors were extracted and rotated with an oblique method. The three extracted factors correspond
to themes of 1) drive for eating control, 2) negative self-evaluation/preoccupation, and 3) shape/weight
concerns. A CFA was conducted on the second half of the sample in which items were specified to load on
the factor on which they had the highest loading in the EFA. This three-factor model fit the data well and
fit better than alternative 1, 2, 3, and 4 factor models that have been suggested in previous research.
Factor analysis of the EDE-Q revealed an alternative factor structure to that suggested by the test-makers.
The present study overcomes some methodological limitations of previous research and provides a
superior fit to other models tested.
Learning Objectives:
• Gain an understanding of the core symptoms of eating disturbances.
• Examine the underlying factor structure of the EDE-Q.
• Compare the factor structure of the EDE-Q to other published models.
T46
Exploratory Analysis of an Affect Motivated Exercise Scale
Krystal Badillo, Student, University of North Dakota, Grand Forks, North Dakota, USA;
Kyle De Young, PhD, BA, University of North Dakota, Grand Forks, North Dakota, USA
Research indicates that the tendency to exercise in response to negative affect (NA) moderates the
relationship between obligatory exercise and eating psychopathology. The purpose of this study was to
evaluate the validity of a new affect-motivated exercise measure. Participants (N=315, 84% women)
completed the Eating Disorder Examination-Questionnaire (EDE-Q), the Obligatory Exercise
Questionnaire (OEQ), Reasons for Exercise Inventory (REI), and the newly created measure: the Affect
Motivated Exercise Scale (AMES). Three factors provided the best solution: (1) general NA motivated
exercise, (2) eating, shape, and weight related NA motived exercise, and (3) positive affect motivated
exercise. Cronbach α for factors 1, 2, and 3 indicated high internal consistency with α’s of .97, .96, and .96,
respectively. Higher general NA motivated exercise (factor 1) scores were associated with higher Global
EDE-Q scores (r=0.26, p<.001), which is consistent with previous research. Multiple linear regression
analyses indicated that eating, shape, and weight NA motivated exercise (factor 2) scores uniquely
predicted higher global EDE-Q scores (b=.316, t=4.13, p<.001) beyond that predicted by the OEQ, the
seven dimensions of the REI, and the remaining two factors of the AMES. The results indicate that the
AMES is an internally consistent measure that appears to be identifying unique and important
dimensions of exercise motivation that are not measured by the OEQ or REI. Further, these preliminary
findings highlight the relevance of affect for understanding the relationship between exercise and eating
psychopathology. Future research should establish test-retest reliability and the predictive validity of the
AMES.
Learning Objectives:
• Examine exercise, specifically affect motivated exercise and the role it may play in individuals
eating pathology.
• Establish the reliability of a novel affect motivated exercise scale and summarize these motives
into three different factors.
• Detect relationships between different elements of psychopathology and affect motivated exercise
within these expressions of pathology.
T47
Pica and Rumination Disorder: The Understudied Feeding Disorders – Frequencies from
Consecutive Intakes to an Outpatient Eating Disorder Clinic
Andrea S Hartmann, PhD, University of Osnabrück, Insitute of Psychology, Osnabrück, Lower Saxony,
German; Helen B Murray, BA, Massachusetts General Hospital Eating Disorders Clinical and Research
Program, Boston, Massachusetts, USA; Kamryn T Eddy, PhD, FAED, Massachusetts General Hospital &
Harvard Medical School, Boston, Massachusetts, USA; Jennifer J Thomas, PhD, FAED, Massachusetts
General Hospital & Harvard Medical School, Boston, Massachusetts, USA
Little is known about pica and rumination disorder, both newly classified as DSM-5 feeding and eating
disorders. Each has medical and psychosocial consequences, and often goes undetected due to
nondisclosure. Available data stem from case reports, ethnographic research in Africa, and studies of
United States (US) sub-populations (e.g., pregnant women, children). We examined the frequency of pica
and rumination behavior among consecutive intakes to an outpatient eating disorder clinic in the
Northeastern US. Prior to initial evaluation, patients answered self-report questions about pica (adapted
from the Diagnostic Interview Schedule for Children-IV (Shaffer et al 2000) supplemented by DSM-5
criteria) and rumination (adapted from the ROME III Diagnostic Questionnaire for Pediatric Functional
Gastrointestinal Disorders (Caplan et al., 2005) supplemented by DSM-5 criteria) via electronic survey. In
the ongoing study, 41 of 52 patients (79%) have completed questionnaires to date, and given consent for
their data to be used in research (100 anticipated intakes by April 2015). Patients had a mean age of 27.9
years (range = 11 to 78) and 83% were female (n = 34). Of these, only 2% (n = 1) met criteria for
rumination disorder based on ROME III, though a formal diagnosis could not be made due to DSM-5
trumping rules. No patients met DSM-5 criteria for pica, though 7% (n =3) endorsed consumption of
“non-pica” substances such as ice (n = 2) and uncooked pasta (n = 1). As expected, DSM-5 pica and
rumination disorder were rare. This may be due to low base rates of feeding disorders, stigma, or nonpresentation to eating disorder clinics. An increase in frequency and presentation for treatment may be
anticipated with DSM-5 recognition that these disorders can occur across the lifespan. Further
investigation about their natural course as well as whether and how pica and rumination are best treated
is needed.
Learning Objectives:
• Describe diagnostic tools for assessing pica and rumination disorder, newly classified as DSM-5
feeding and eating disorders
• Assess the frequency of pica and rumination behavior in an outpatient eating disorder treatment
setting, and the potential comorbidity between feeding and eating disorders
• Gain insight into potential new clinical and research directions in both disorders
Epidemiology
T48
Prevalence of Purgative Behaviors in Mexican Women over a 20-year Period
Mayaro Ortega-Luyando, BA, Universidad Nacional Autónoma de México, Mexico City, Mexico; Juan
Manuel Mancilla-Díaz, PhD, FAED, Universidad Nacional Autónoma de México, Mexico City, Mexico;
Georgina Alvarez-Rayón, PhD, Universidad Nacional Autónoma de México, Mexico City, Mexico;
Adriana Amaya-Hernández, PhD, Universidad Nacional Autónoma de México, Mexico City, Mexico;
María Leticia Bautista-Díaz, BA, Universidad Nacional Autónoma de México, Mexico City, Mexico;
María Trinidad Ocampo, BA, Universidad Nacional Autónoma de México, México City, Mexico
During the last years purgative behaviors related to eating disorders have become a relevant topic among
health professionals due to its elevated risk of death and chronicity. In fact some authors have suggested
the diagnostic category of Purging Disorders (PD). The estimated lifetime prevalence of PD is similar to
Anorexia Nervosa and Bulimia Nervosa and more common than Binge Eating Disorder. To our knowledge
few investigations have studied this phenomenon in Latin population. Therefore the aim of this study was
to assess in Mexican women the prevalence of purgative behaviors (self-induced vomiting and misuse of
laxatives or diuretics) in three frequency levels: low, medium and high. Additionally was determined how
these prevalence rates have changed in a 20-year period. The sample was conformed by 2738 college
women aged among 17 to 29 years (M= 19.95, SD= 1.92). Data was collected from 1994 to 2013 and was
divided in two periods (Time 1: 1994-2003 and Time 2: 2004-2013) to know if there are statistical
differences between the first 10 years versus the second 10-year period. Purgative behaviors were
measured using some items of the Eating Attitudes Test (EAT-40) and of Bulimia Test (BULIT). Crosstabulations were carried out to estimate the prevalence of each period, and Chi square tests to determine
statistical differences. Results showed no statistical differences over time in self-induced vomiting (T1=
1.27% vs. T2 0.29%, p>.05) neither in laxatives and diuretics (1.27% vs. 1.28% p>.05) in medium and high
frequency level, but in low frequency level both purgative behaviors showed a significant increase in the
second period of time (89% vs. 94% p<.001). It is concluded that purgative behaviors in Mexican women
have remained fairly stable over 20 years and prevalence rates are lower than those reported in American
and Australian population. Research sponsored by CONACyT (131865-H) granted to Dr. Juan Manuel
Mancilla-Díaz.
Learning Objectives:
• Discuss if Purging Disorder should be included in the DSM as new eating pathology.
• Discuss if cultural features are directly related in prevalence rates.
• Debate the clinical relevance of purgative behaviors.
T49
Prevalence of Food Allergies in Females with Eating Disorders
Shawn Lehmann, MS, The Renfrew Center, Philadelphia, Pennsylvania, USA; Taylor Ludman, BA, The
Renfrew Center, Philadelphia, Pennsylvania, USA; Eleanor Benner, MA, The Renfrew Center,
Philadelphia, Pennsylvania, USA; Trish Carney, MS, RDN, LDN, The Renfrew Center, Philadelphia,
Pennsylvania, USA
Several case studies have documented the complex, interacting nature of food allergies and disordered
eating. Individuals with food allergies often must abide by specific dietary restrictions and food
avoidances that may solely or in conjunction with other predicating factors contribute to the development
and/or maintenance of an eating disorder (ED). Despite preliminary investigations of this apparent
association, there is an absence of empirical research documenting rates of food allergies in a clinical
sample of individuals with an ED. The current study examined patient health information obtained upon
admission to a psychiatric inpatient eating disorder facility to determine prevalence of food allergies in a
large clinical sample of adolescent and adult females (ages 14-54, M age = 23.42) seeking treatment for an
ED (N=247). Documented food allergy information verified by patient’s healthcare providers was used in
primary analyses. Approximately 13.36% of patients reported at least one food allergy, corresponding to
9.80% of adolescents and 14.29% of adults, with 6.88% endorsing two or more food allergies. The most
common allergies reported were fruit (6.48%), nuts and seeds (3.24%), and shellfish (2.83%). There were
no significant differences in rate or types of food allergies between ED diagnoses. However, exploratory
analyses revealed that approximately 79.1% of individuals with a food allergy had comorbid anxiety or
mood disorder diagnoses. Overall prevalence in the current sample is comparably higher than those
reported in the 2007-2010 National Health and Nutrition Examination Survey (NHANES), in which
8.96% of participants reported a food allergy that was not medically verified, suggesting the actual rate is
likely much lower. Due to the cross-sectional nature of the current study, future research should examine
the direction of association between food allergies and ED development and maintenance.
Learning Objectives:
• Compare rates of medically validated food allergies in a clinical ED sample to rates of selfreported allergies in national surveys.
• Identify associated factors of food allergies and eating disorders such as age and comorbid anxiety
and mood disorders.
• Consider potential nutritional and therapeutic interventions for eating disorder patients with a
food allergy.
Gender, Ethnicity and Culture
T50
Boys and Girls with Eating Disorders: How Do They Differ at Presentation for Treatment?
Kathryn Kinasz, BA, University of Chicago, Pritzker School of Medicine, Chicago, Illinois, USA;
Erin Accurso, PhD, MS, BA, University of Chicago, Department of Psychiatry and Behavioral
Neuroscience, Chicago, Illinois, USA; Andrea Kass, MA, BA, University of Chicago, Department of
Psychiatry and Behavioral Neuroscience, Chicago, Illinois, USA; Daniel Le Grange, PhD, MA, BA,
FAED, University of Chicago, Department of Psychiatry and Behavioral Nueroscience, Chicago, Illinois,
USA
Though it is understood that boys struggle with eating disorders (EDs), little is known about how boys
differ from girls with EDs. This study aimed to compare boys and girls who present for treatment with
EDs on demographics, DSM-5 diagnoses, ED pathology, and comorbidities. Participants included 510
youth, age <19y, with a DSM-5 ED who presented for treatment at an outpatient ED Program between
1999 and 2011. The final sample included 49 males (M age= 14.2 ± 2.67y) and 461 females (M age= 15.4 ±
2.23y). Participants completed diagnostic interviews and self-report measures to assess diagnosis and
comorbid pathology. Gender differences were evaluated using independent t-tests and chi-squared tests.
Boys presented significantly younger than girls for ED treatment (p<.001), had higher % expected body
weight (%EBW) (p=.043), and were more likely to be non-white (p=.008). Girls were more likely to
present with AN and BN, while boys were more likely to present with Other Specified Feeding or Eating
Disorder (p=.001). Only 3.3% of girls and no boys met criteria for Binge Eating Disorder (p=.244). Girls
showed more severe pathology on measures of weight concern (p<.000), eating concern (p<.000),
restraint (p<.001), and global ED pathology (p<.001). There were no significant differences between
genders on presence of mood disorders (p=.051), anxiety disorders (p=.74), behavioral disorders
(p=.099), or self-esteem (p=.61). Results suggest that while boys may present younger with higher %EBW
and less severe pathology, they do not differ from their female counterparts in terms of self-esteem and
comorbidities. Understanding these differences offers a more robust understanding of the psychological
concerns associated with EDs in each gender, which may inform treatment targets.
Learning Objectives:
• Describe differences between adolescent males and adolescent females who present for eating
disorder treatment in terms of demographics, comorbidities, self-esteem, and eating disorder
pathology
• Discuss potential clinical implications of gender in eating disorder assessment and treatment
• Compare boys and girls on eating disorder diagnoses using DSM-5 criteria
T51
Depression, Anxiety, and Body Shame as Risk Factors in Predicting Bulimic Symptoms in
African American and Caucasian Women
M. K. Higgins, MA, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,
Stacy Lin, BA, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Anna
Bardone-Cone, PhD, FAED, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,
USA
Although African Americans experience bulimic symptoms at comparable or elevated rates than their
Caucasian counterparts, eating disorder research has largely neglected this population. The goal of this
study was to identify risk factors of bulimic symptoms among undergraduate African American and
Caucasian women using bivariate and moderator analyses. Previous research has supported a link
between negative affect (e.g., depression, anxiety) and bulimic symptoms, but largely in Caucasian
samples. We tested both depression and anxiety as predictors of bulimic symptoms and examined body
shame as a potential moderator of the relationship between negative affect and bulimic symptoms.
Female undergraduates completed identical surveys at Time 1 (N = 276; 179 Caucasians, 97 African
Americans) and five months later at Time 2 (N = 226; 156 Caucasians, 70 African Americans) with
questions about depression, anxiety, body shame, and bulimic symptoms (EDE-Q binge eating frequency,
BULIT-R). Among African Americans and Caucasians, anxiety and depression were significantly
positively associated with both measures of bulimic symptoms (i.e., binge eating frequency from the EDEQ and the BULIT-R score; all ps < .001). However, body shame did not combine with depression or
anxiety to predict the highest levels of bulimic symptoms among Caucasians five months later. In
contrast, among African Americans, only the combination of high anxiety and high body shame
longitudinally predicted the highest levels of bulimic symptoms and binge eating episodes; the
combination of high depression and high body shame did not. These findings elucidate a moderator
model of bulimic symptoms for African American women, but not Caucasians. Cultural differences and
implications leading to these differential results will be discussed.
Learning Objectives:
• Describe the role of body shame and anxiety as predictors of bulimic symptoms among female
African American undergraduates
• Apply culturally-relevant interventions to disrupt the relationship between anxiety and bulimic
symptoms among African American females
• Understand cultural differences between African American and Caucasian women that may lead
to these differential findings
T52
An Exploration of Appearance and Health-Related Messages Aimed Towards Pregnant
Women
Leah Boepple, BA, University of South Florida, Tampa, Florida, USA; (Joel) Kevin Thompson, PhD,
University of South Florida, Tampa, Florida, USA; Emily Choquette, University of South Florida
Tampa, Florida, USA
Little research has been conducted examining culturally-defined appearance and health-standards set for
pregnant women. This study explored the appearance and health-related messages aimed towards
pregnant women, present in the most recent issues of the three pregnancy-themed magazines (e.g., Fit
Pregnancy, Pregnancy & Newborn, Pregnancy Magazine) with the highest circulation ratings. Two
independent raters coded the images and text present in both advertisements and articles. All of the
women present in the magazines had, with the exception of their stomachs, thin-body types, and were
conventionally attractive. Thirty-eight percent of ads promoted appearance-related products (i.e.,
maternity clothes, cocoa butter for stretch marks); 10.37% marketed exercise-related products (i.e.,
jogging pants for pregnant women); 8.49% advertised products for post-partum weight-loss (i.e., postpartum “belly reducer” stomach wrap); 16.03% endorsed general health-related products (i.e., prenatal
vitamins); 17.92% were coded as sexualizing women’s bodies. Fifty-eight percent emphasized (i.e., model
in a short, tight dress that shows off stomach) or presented solely an image of a woman’s stomach; and
23.58% presented an image of a woman with some exposed skin in the top-half of her body (i.e., an
advertisement for a stomach wrap featuring a woman wearing yoga pants and a bra). Twenty-nine percent
of articles highlighted appearance-related messages (i.e., steps for brightening skin during pregnancy);
11% focused on post-partum weight-loss; 17% promoted tips for either healthy-eating during pregnancy or
a “healthy” recipe (e.g., grilled fruit salad); 12% emphasized benefits of exercising during pregnancy; 23%
explored general health-related messages (i.e., prenatal depression, benefits of breast-feeding). Results
indicate that appearance-related messages aimed towards pregnant women may be problematic,
especially for readers who are at-risk or managing eating disorder symptoms. Results will be further
explored and implications will be discussed.
Learning Objectives:
• Discuss appearance-standards set for pregnant women.
• Assess problematic messages aimed towards pregnant women regarding their bodies.
• Discuss health (eating and exercise) standards set for pregnant women.
T53
Patterns of Motivation and Psychopathology in Chinese Patients with Eating Disorders
Yue Huang, MA, University of Hawaii at Manoa, Honolulu, Hawaii, USA; Jue Chen, PhD, MD,
Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China;
Ai-Ai Cao, MS, Shanghai Changning Mental Health Center, Shanghai, China; Kelly Vitousek, PhD,
University of Hawaii at Manoa, Honolulu, Hawaii, USA
The study explored motivational patterns and related psychopathology to examine resistance to change in
Chinese eating disorder (ED) patients. A total of 84 Chinese ED patients, including 39 with anorexia
nervosa (AN), 25 with bulimia nervosa (BN), and 20 with eating disorder not otherwise specified
(EDNOS), participated in the baseline assessment at treatment intake, and 67% of the sample remained in
treatment at the one-month follow-up assessment. Both assessments involved completing an interview
with the research psychiatrist and self-report questionnaires on motivational factors and clinical
symptoms. The research psychiatrist and each participant’s attending psychiatrist also evaluated
resistance to change at each assessment. All Western-developed measures showed acceptable to excellent
internal consistency. Motivational measures demonstrated satisfactory convergent and concurrent
validity, poor predictive validity, and sensitivity to change over time. Patients identified insufficient selfefficacy, avoidance functions, and egosyntonicity as major motivational barriers to change, and their
attending psychiatrists perceived a similar pattern but a higher level of resistance. Patients also endorsed
more costs than benefits from their disorder, significant shape and weight concerns, and mild to moderate
depression. At baseline, BN patients were more resistant and AN patients less symptomatic compared to
the other two groups, respectively. BN patients showed the greatest improvement in motivation and
psychopathology over a month of treatment, followed by EDNOS patients and by AN patients. No
significant group differences existed at follow-up. Subgroup analysis revealed significantly lower scores in
AN patients with low weight concern (LWC) but similar scores in AN patients with high weight concern
(HWC) on resistance and symptom measures compared to BN patients at baseline. At follow-up, LWC AN
patients showed no improvement while HWC AN patients moderate improvement on the above measures
despite greater weight gain in the former, but HWC AN patients still perceived more benefits of EDs than
the other three groups. Finally, motivational factors and clinical symptoms demonstrated a positive crosssectional relationship and a correspondence in change over time for all participants.
Learning Objectives:
• Compare patterns of motivation and psychopathology in Chinese eating disorder patients to their
Western counterparts
• Differentiate Chinese anorexic patients with low weight concern from those with high weight
concern in clinical practice
• Utilize the relationship between motivation and psychopathology to improve patient outcomes in
the treatment of eating disorders
T54
Religiosity, Spirituality And The Development Of Disordered Eating
Stephen Touyz, PhD, FAED, University of Sydney, Sydney, NSW, Australi, Daniel Akrawi, Student,
University of Western Sydney, Sydney, NSW, Australia; Roger Bartrop, MD, MBBS, MRCPsych,
University of Western Sydney, Sydney, NSW, Australia; Ursula Potter, PhD, University of Sydney,
Sydney, NSW, Australia
Over the past four decades, the prevalence of eating disorders and abnormal eating patterns have
increased dramatically particularly in Western societies. Furthermore, the rates of subclinical syndromes
are considerably higher than clinical rates. It is therefore increasingly important to examine factors which
may protect against the onset of such disorders. Despite the growing literature on the putative benefits of
women with higher rates of religious attendance having fewer psychological disorders, and those
endorsing religious values coping better with cancer, there has been a dearth of research on this topic
pertaining to eating disorders. The aim of this study was to explore the links between
religiosity/spirituality in 100 undergraduate psychology students and disordered eating. Participants were
administered the Eating Disorder Examination Questionnaire 6.0 , Eating Disorder Inventory 3,
Depression, Anxiety and Stress Scale (DASS) and the Spirituality, Religiousness and Personal Beliefs
section of the WHOQOL SRPB field instrument. The implications of the findings obtained will be critically
reviewed as to whether spirituality/religiosity is in fact a protective factor for eating disorders and what
implications this may have for future prevention strategies.
Learning Objectives:
• Describe some of the risk factors and protective factors for eating disorders.
• Critically evaluate connections between spirituality/religiosity and eating disorders.
• Appraise implications of connections between spirituality/religiosity and eating disorders for
future prevention strategies.
Neuroscience (including Neuroimaging)
T56
Activity-based Anorexia in the Socially Monogamous Prairie Vole
Jessica Amacker, Student, Northeastern University, Boston, Massachusetts, USA; Elizabeth Lawson,
MD, Massachusetts General Hospital, Boston, Massachusetts, USA; Jennifer Thomas, PhD, FAED,
Massachusetts General Hospital, Boston, Massachusetts, USA; Kamryn Eddy, PhD, FAED,
Massachusetts General Hospital, Boston, Massachusetts, USA; Jason Yee, PhD, Northeastern
University, Boston, Massachusetts, USA
Anorexia nervosa (AN) is a life threatening disorder characterized by food restriction, severe weight loss,
and often hyperactivity and social withdrawal. Animal models may be useful in elucidating mechanisms
involved in AN, and the goal of this research is to develop a model of AN in the socially monogamous
prairie vole. Core symptoms of AN can be reproduced by the activity-based anorexia (ABA) model most
commonly used in rats. When exposed to food restriction and free access to activity wheels rats show selfstarvation, weight loss, and a dramatic increase in running activity, paralleling the presentation of AN in
humans. The socially monogamous prairie vole (Microtus ochrogaster) is a rodent that exhibits humanlike autonomic regulation (i.e. high parasympathetic tone) and human-like social behavior (i.e. social
monogamy), offering the potential to model the affective and social components of AN. Preliminary
evidence demonstrated that, like rats, prairie voles display a dramatic increase in running activity and
weight loss following food restriction. Increases in running activity were at times accompanied by
dramatic decreases in food consumption, even within the context of a restricted feeding schedule.
Furthermore, social isolation was necessary to fully evoke the dramatic increases in running activity and
weight loss characteristic of the ABA model. Our data demonstrate that the descent into an AN-like state
in the prairie vole is possible and requires 3 ‘hits’: unlimited access to exercise, restricted feeding, and
social isolation. Future work will examine the use of daily oxytocin administrations to ameliorate
symptoms produced by the ABA model. Using a food odor fMRI paradigm we will image awake voles prior
to feeding at three timepoints: before food restriction, prior to daily oxytocin administrations, and after
daily oxytocin administrations. Findings will inform the potential use of oxytocin in treatment strategies
for AN.
Learning Objectives:
• Describe the activity-based anorexia (ABA) model in the prairie vole (Microtus ochrogaster),
which exhibits human-like autonomic regulation and social behavior
• Describe the potential to model the affective and social components of AN in prairie voles
• Assess the potential use of oxytocin in treatment strategies for anorexia nervosa
T57
Gastric Sensations in Patients with Anorexia Nervosa Potentiate Activity to Food Images in
Brain Regions Underlying Anxiety and Nociception
Kara Kerr, MS, Laureate Institute for Brain Research; University of Tulsa, Tulsa, Oklahoma, USA;
Scott Moseman, MD, Laureate Psychiatric Clinic and Hospital, Tulsa, Oklahoma, USA; Jason Avery,
PhD, Laureate Institute for Brain Research, Tulsa, Oklahoma, USA; Jennifer Dobson, PhD, Laureate
Institute for Brain Research, Tulsa, Oklahoma, USA; Kaiping Burrows, PhD, Laureate Institute for
Brain Research, Tulsa, Oklahoma, USA; Jerzy Bodurka, PhD, Laureate Institute for Brain Research;
University of Oklahoma, Tulsa, Oklahoma, USA; Kyle Simmons, PhD, Laureate Institute for Brain
Research; University of Tulsa, Tulsa, Oklahoma, USA
Research in our laboratory has previously demonstrated that patients with restricting-type anorexia
nervosa (AN) exhibit abnormal activity in the dorsal mid-insula during stomach interoception, and that
this activity is correlated with clinical measures of anxiety and eating disorder symptomatology. These
findings suggest a role for visceral hypersensitivity in the pathophysiology of AN. Based on this evidence
we hypothesized that AN patients’ perceptions of their stomach sensations would modulate their brain
responses to food stimuli. Weight-restored adolescent and young adult females with AN and healthy
control (HC) females first completed an interoception task during which they made ratings of the
intensity of the sensations in their stomach. Next, they performed a food/non-food picture perception
task while undergoing fMRI. fMRI analyses were conducted to identify brain regions where the
relationship between stomach intensity ratings during the interoception task and brain activity while
viewing food pictures differed between AN and HC participants. Results revealed a positive correlation
between AN patients’ stomach intensity ratings and activity in both the left anterior insula and the right
posterior insula in response to food stimuli, while HC participants displayed a negative correlation in both
regions. Notably, previous research has demonstrated that the left anterior insula is involved in anxiety,
and the right posterior insula is involved in pain perception. Thus, as patients with AN experience more
intense sensations from their stomachs, the perception of food stimuli engenders greater activity in brain
regions underlying anxiety and nociception. These findings support the idea that visceral hypersensitivity
is related to eating behaviors in individuals with AN.
Learning Objectives:
• Describe past research suggesting a role for visceral hypersensitivity in the pathophysiology of
anorexia nervosa
• Identify brain regions where activity in response to food stimuli is modulated by stomach
sensations in patients with anorexia nervosa
• Interpret the current findings in the context of the wider research literature
T58
The Clinical Significance of the Volume of the Right Posterior Insula in Anorexia Nervosa
Nandini Datta, BS, Duke University, Durham, North Carolina, USA; Ryan Wagner, PhD, Duke
University, Durham, North Carolina, USA; Philip Kragel, MA, Duke University, Durham, North
Carolina, USA; Adrian Angold, MRCPsych, Duke University, Durham, North Carolina, USA; Lori
Keeling, MA, Duke University, Durham, North Carolina, USA; Rhonda Merwin, PhD, Duke University,
Durham, North Carolina, USA; Adrian Angold, MRCPsych, Duke University, Durham, North Carolina,
USA; Kevin LaBar, PhD, Duke University, Durham, North Carolina, USA; Nancy Zucker, PhD, Duke
University, Durham, North Carolina, USA
Body image disturbance remains a poorly understood and persistent feature of anorexia nervosa (AN)
that motivates dangerous weight loss behaviors. Study of the structure of the insular cortex may help
elucidate the nature of body image disturbance in anorexia nervosa (AN). The insular cortex is purported
to map the condition of the body. However to date, there is no neurobiological marker of illness severity in
AN in general, or of body image disturbance specifically. Investigation goals were: 1) to examine the
relationship of insular volume structure to body image disturbance, 2) to probe the clinical significance of
insular cortex volume in relationship to illness severity, 3) and to investigate developmental or weightrelated changes. MRI structural data were collected from 23 adolescents with a history of AN and 22 age,
race, and BMI-matched healthy controls. We employed manual tracing of insular cortex structures
(bilateral anterior and posterior regions) to examine research questions. Body image disturbance was
significantly positively associated with volume of the right posterior insular cortex, but negatively
associated with right anterior insula – a pattern that differed significantly from controls. Right posterior
insula volume was positively associated with duration of illness, negatively associated with length of
recovery, but was not associated with BMI, time at lowest BMI, or other weight-associated parameters.
Right posterior insula volume showed a significant age by clinical status and age squared by clinical status
interactions. These results indicate that the clinical group showed a markedly different trajectory of insula
volume relative to controls in right posterior insula and that these volume differences were clinically
significant relative to illness severity and body image disturbance. Implications for a better understanding
of the nature of body image disturbance in AN will be discussed.
Learning Objectives:
•
•
•
Better assess the role of the insular cortex.
Better understand the nature of body image disturbance in Anorexia Nervosa.
Better understand the specificities of how the insular cortex is involved in the maintenance and
development of Anorexia Nervosa.
T59
Preliminary Investigation on the Neural Correlates of Reversal Learning in Adolescents
with Anorexia Nervosa
Tom Hildebrandt, PsyD, BS, FAED, Icahn School of Medicine at Mount Sinai, New York, New York,
USA; Andrew Grotzinger, BA, Icahn School of Medicine at Mount Sinai, New York, New York, USA;
Kurt Schulz, PhD, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Rebecca Greif,
PsyD, Icahn School of Medicine at Mount Sinai, New York, New York, USA
The present study sought to compare the neurological correlates of food-based reversal learning in an
adolescent sample of 6 anorexia nervosa (AN), and 9 healthy control (HC) participants, ages 11 to 22 (M =
17.15, SD = 2.53). During the first phase of the reversal learning task one conditioned stimulus (i.e., a
colored square), stimulus A, was intermittently paired with food-reward (i.e., 15 M&Ms), while another
stimulus, stimulus B, was not. In the second phase of the experiment the contingencies switched; stimulus
B was occasionally presented with food, while stimulus A was always presented alone. Throughout the
task, participants used a 9-point expectancy scale (1 = Definitely Not, 9 = Definitely Yes) to indicate the
degree to which they expected to see food following presentation of the conditioned stimulus. The task
was completed in an fMRI, and blood oxygen level dependent (BOLD) responses were used as indicators
of neurological activation. Analyses will be completed in SPM8, and will compare BOLD responses
between stimulus A and stimulus B within both phases, and within stimuli across the first and second
phase of the experiment. Behavioral expectancy responses will be entered as parametric modulators for
the first-level of analyses, and BMI will be included as a covariate, in order to control for nutritional
status, for the second-level (i.e., group) comparisons. Results are expected to indicate that AN
participants are characterized by increased anterior insula, amygdala and ventral striatum reactivity in
response to food-reward across both phases of the task. In addition, we expect AN participants to exhibit
continued activation in the anterior insula, amygdala and ventral striatum in response to stimulus A
during the second phase of the experiment, indicative of failure to extinguish food expectancy (i.e.,
cognitive inflexibility). These findings may help inform novel interoceptive interventions that target
dysregulation in the noted areas of the brain.
Learning Objectives:
• Determine the neural correlates of reactivity to food-reward in anorexia nervosa and healthy
control participants
• Assess the neural correlates of expected cognitive inflexibility in anorexia nervosa participants
• Analyze the role of the insula, ventral striatum, and amygdala as regions of interest (ROIs) in a
novel investigation of reversal learning in adolescents with anorexia nervosa
T60
Measuring Central Coherence and Set Shifting in Anorexia Nervosa: The Navon Figures
Task
Jenna Blumberg, BSc, The University of Western Australia, Perth, Western Australia, Australi;
Karina Allen, PhD, MPsych, BSc, FAED, The Eating Disorders Service, Maudsley Hospital, The
University of Western Australia, London, United Kingdom (Great Britain); Susan Byrne, PhD, DPhil,
MPsych, BS, FAED, The University of Western Australia, Perth, Western Australia, Australia
People with eating disorders (EDs) are reported to have set-shifting difficulties, strengths in local or
detailed information processing and weak central coherence or global processing. This study aimed to
explore the validity of a novel, brief, global, neurocognitive task which has not previously been utilised in
an ED population, the Navon Figures Task (NFT). The NFT is substantially quicker to administer than
traditional neurocognitive tasks. Twenty women with anorexia nervosa (AN) and 20 healthy control
women completed the Rey-Osterrieth Complex Figures Task (RCFT) to measure global/local processing
strategies and completed the Wisconsin Card Sorting Test (WCT) to measure of set-shifting ability. The
NFT was used as a measure of both set-shifting ability and central coherence. Consistent with previous
findings, women with AN showed a tendency towards poorer performance on the RCFT and WCT than
healthy control women. Scores on the NFT and RCFT were significantly, positively and strongly correlated
in both the AN and healthy control samples, as were scores on the NFT and WCT. This indicates that the
NFT has good concurrent validity with the other measures. These preliminary findings support the use of
the NFT as a sensitive and practical measure in assessing central coherence and set-shifting abilities in
EDs. Using measures like the NFT may potentially enhance our understanding of neurocognitive traits in
AN and may help guide our treatment approaches to AN in the future.
Learning Objectives:
• To understand the neurocognitive profiles of people with AN
• To become familiar with the use of a new, novel neurocognitive task which has not previously
been utilised in an eating disorders population.
• To understand how measures like the Navon Figures Task may potentially enhance our
understanding of neurocognitive traits in anorexia nervosa and may help guide our treatment
approaches in the future.
T61
Prenatal Testosterone Exposure and Decreased Risk for Binge Eating: Ovarian Hormones
as Key Underlying Mechanisms
Kristen Culbert, PhD, Michigan State University, East Lansing, Michigan, USA, Sarah Racine, PhD,
Ohio University, Athens, Ohio, USA; S. Marc Breedlove, PhD, Michigan State University, East Lansing,
Michigan, USA; Cheryl Sisk, PhD, Michigan State University, East Lansing, Michigan, USA; Pamela
Keel, PhD, FAED, Florida State University, Tallahassee, Florida, USA; Michael Neale, PhD, Virginia
Commonwealth University, Richmond, Virginia, USA; Steven Boker, PhD, University of Virginia,
Charlottesville, Virginia, USA; S. Alexandra Burt, PhD, Michigan State University, East Lansing,
Michigan, USA; Kelly Klump, PhD, FAED, Michigan State University, East Lansing, Michigan, USA
Recent data suggest that elevated prenatal testosterone exposure may be protective against disordered
eating (e.g., binge eating) in young adulthood. However, the mechanisms underlying these effects remain
unknown. Animal data strongly suggest that prenatal testosterone exposure alters eating behavior in
females by decreasing sensitivity to ovarian hormones. Although this possibility has yet to be investigated
for binge eating (BE) in women, fluctuations in ovarian hormones significantly predict changes in BE
across the menstrual cycle, with increases during the mid-luteal phase due to high levels of both estradiol
and progesterone. If prenatal testosterone decreases BE via its effects on ovarian hormones, then elevated
prenatal testosterone exposure would be expected to: 1) attenuate fluctuations in BE across menstrual
cycle phases and 2) decrease the predictive effects of ovarian hormones on changes in BE across the
menstrual cycle. This study was the first to examine these possibilities using a sample of 61 female twins
(ages 18-23) drawn from the Michigan State University Twin Registry. Prenatal testosterone was
indirectly examined via finger-length ratios [index (2D)/ring (4D) finger; lower 2D:4D indicative of
higher prenatal testosterone]. Daily saliva samples were assayed for estradiol and progesterone. BE was
assessed with a well-validated self-report measure. As predicted, women exposed to higher levels of
prenatal testosterone showed little-to-no change in BE across the menstrual cycle, and no significant
hormone-binge eating associations were observed. In contrast, women exposed to lower levels of prenatal
testosterone experienced significant fluctuations in BE across the menstrual cycle, with elevated scores
during the mid-luteal phase, and menstrual cycle changes in ovarian hormones predicted changes in BE.
Together, results indicate that prenatal testosterone exposure may reduce risk for BE by decreasing
sensitivity to the effects of ovarian hormones.
Learning Objectives:
• Evaluate the role of prenatal testosterone exposure in differential risk for binge eating in women
• Discuss the role of ovarian hormones in changes in binge eating across the menstrual cycle
• Consider the complex interplay between individual differences in prenatal testosterone exposure
and responsiveness to ovarian hormone effects on binge eating risk
Personality and Cognition
T62
Planning Binge Episodes: A Viable Construct For Examining Binge Eating Severity?
Stephanie Manasse, BA, Drexel University, Philaelphia, Pennsylvania, USA; Evan Forman, PhD, Drexel
University, Philadelphia, Pennsylvania, USA; Adrienne Juarascio, PhD, Drexel University, Philadelphia,
Pennsylvania, USA; Meghan Butryn, PhD, Drexel University, Philadelphia, Pennsylvania, USA
Given lack of research exploring the sometimes planned (versus impulsive) nature of binge eating, the
current study sought to examine the association the degree of planning of binge episodes with with
executive function, frequency of binge episodes, and eating disorder (ED) pathology in individuals with
binge eating disorder (BED). We developed a brief measure that examined the extent to which 1)
individuals anticipate the occurrence of a binge episode over two hours in advance and 2) take behavioral
steps (e.g., shopping for binge foods, setting aside time) to facilitate the occurrence of the binge episode.
The Eating Disorders Examination (EDE), a neuropsychological battery, the Difficulties in Emotion
Regulation Scale, and measure of binge planning was administered to women with BED (current n=17;
data collection ongoing) prior to entry into a group treatment for BED. Preliminary analyses indicated
that binge planning was very highly correlated with number of objective binge episodes (r = .68, p < .01),
EDE Eating concern (r = .51, p = .04), and EDE Weight Concern (r = .45, p = .07). In addition, binge
planning was strongly associated with perseverative errors on a set-shifting task (r = .41, p = .14) and
(negatively) with risk-taking (r = -.67, p < .01). Lastly, binge planning was negatively associated with
emotional awareness (r = -.49, p < .05), and emotional acceptance (r = -.36, p = .14). These exploratory
analyses indicated that increased planning of binge episodes is associated with greater ED pathology,
cognitive rigidity, and decreased emotion regulation capabilities. Poor emotion regulation skills may lead
to the anticipation and planning of a binge episode to modulate negative affect. Thus, binge planning may
be a viable construct for examining binge eating severity and could provide further clarity on potential
binge eating subtypes. Future research should focus on the development of a psychometrically sound
measure of binge planning.
Learning Objectives:
• Describe the severity correlates of binge planning in individuals with binge eating disorder
• Explain how emotion regulation deficits may relate to binge planning
• Describe the role of set-shifting and risk-taking in binge planning
T63
The Relationship Between Perfectionism And Cognitive Style In Adults And Adolescents
With Anorexia Nervosa
Samantha Lloyd, MSc, BSc, King's College London, Institute of Psychiatry, London, United Kingdom
(Great Britain); Kate Tchanturia, PhD, DClinPsy, FAED, King's College London, Institute of Psychiatry,
London, United Kingdom (Great Britain); Ulrike Schmidt, MD, PhD, FAED, King's College London,
Institute of Psychiatry, London, United Kingdom (Great Britain)
Few studies have investigated the relationship between temperamental traits and cognitive style in
Anorexia Nervosa (AN). The temporality of this relationship across the lifespan of AN is also poorly
understood and is important in improving our understanding of the role of these features in the
development and / or maintenance of the disorder. The aim of this study was to explore the relationship
between perfectionism and cognitive style (cognitive rigidity, attention to detail) using self report
measures (Frost Multi-dimensional Perfectionism Scale, Detail and Flexibility Questionnaire) in a large
sample of adults and adolescents with AN, (n = 80) compared with healthy control adults and adolescents
(n = 80). Very strong associations were found between perfectionism and both cognitive rigidity (p = <
0.01, d = 1.82) and attention to detail (p = < 0.01, d = 1.38). A significant group effect was observed, with
stronger associations in the AN group relative to HCs (d = 0.61, 0.48 respectively). Age was not found to
have an effect on this association. In adults, retrospectively reported childhood perfectionism also
significantly predicted both current cognitive rigidity (p < 0.01, d = 2.22) and attention to detail (p < 0.01,
d = 1.92), with significant group effects of moderate size observed (d = 0.64, 0.76 respectively). This
study found evidence of strong links between self-reported perfectionism and cognitive style, which were
more pronounced in those with AN. The finding of an association across a large age range supports the
existence of a common mechanism involved in the development of these characteristics in childhood,
which then persists in maintaining such features of the disorder in adulthood. These findings highlight
the importance of considering both personality and cognitive features of the disorder together in order to
more fully understand the development and maintenance of the disorder. Furthermore, interventions
which jointly target temperamental and cognitive features and address associations between the two
aspects of the disorder may be associated with increased effectiveness.
Learning Objectives:
• Describe associations between perfectionism and cognitive style in AN and consider the
temporality of these associations.
• Consider factors which contribute to these associations.
• Consider the treatment implications of these findings.
T64
Exploring the Impact of Perfectionism on Eating Disorder Symptoms and Affective
Problems in a Clinical Sample of Adolescents
Chelsea Hilsendager, PhD, Children's Hospital Colorado, Aurora, Colorado, USA; Mindy Solomon, PhD,
Children's Hospital Colorado, Aurora, Colorado, USA; Guido Frank, MD, Children's Hospital Colorado,
Aurora, Colorado, USA; Jennifer Hagman, MD, FAED, Children's Hospital Colorado, Aurora, Colorado,
USA; Alexandra Romero, PsyD, Children's Hospital Colorado, Denver, Colorado, USA; Ashley Kroon
Van Diest, MS, Children's Hospital Colorado, Denver, Colorado, USA
More research is needed to understand if perfectionism contributes to eating disorder symptoms and
comorbid psychopathology, including anxiety and depression, above and beyond other personality traits.
This study assessed whether or not perfectionism accounted for unique variance in eating disorder
symptoms and affective problems when controlling for other emerging personality characteristics in a
clinical sample of adolescents. Participants were 265 adolescents (13 to 18-years-old) admitted to an
eating disorders program in the United States. Measures were select subscales of the Eating Disorders
Inventory – 3 and the Millon Adolescent Clinical Inventory (MACI) Personality subscales. Hierarchical
multiple regression was used to test the study hypotheses. At the first step of the multiple regression,
MACI scores were entered. The model was statistically significant F (12, 252) = 5.62, p < .001 and
explained 17.4% of the variance in eating disorder symptoms. After adding perfectionism scores at step
two, the model explained 20.7% (F (13, 251) = 6.30, p < .001) of the variance in eating disorder
symptoms. In the final model, the Beta weight for perfectionism scores was higher than all other
predictors (b = .22, p < .001). The same process was completed with affective problems as the outcome
variable. The first model was statistically significant F (12, 253) = 30.43, p < .001 and explained 57% of
the variance in affective problems. After adding perfectionism at step two, the model explained 61% (F
(13, 252) = 33.28, p < .001) of the variance in affective problems. Consistent with the first model, the Beta
weight for perfectionism was higher than all other predictors (b = .24, p < .001). In this clinical sample
of adolescents, perfectionism was a significant predictor of eating disorder symptoms and affective
problems when controlling for other emerging personality characteristics. Additionally, perfectionism was
the strongest predictor of both eating disorder symptoms and affective problems. These results suggest
interventions aimed at attenuating maladaptive perfectionism are warranted. Future research should
address the efficacy of such interventions and whether changes in perfectionism decrease eating disorder
symptoms and improve comorbid psychopathology.
Learning Objectives:
•
•
•
Describe the literature pertaining to perfectionism and eating disorders.
Examine how perfectionism accounts for unique variance in eating disorder symptoms and
comorbid psychopathology.
Explore treatment interventions aimed at ameliorating maladaptive perfectionism.
Prevention
T65
The Experience of Stigma in Individuals with Eating Disorders, Parents and Siblings:
Results of Three Online Surveys.
Rachel Bryant-Waugh, DPhil, MSc, BSc, FAED, Great Ormond Street Hospital, London, United
Kingdom (Great Britain); Shereen Haffejee, MRCPsych, Surrey and Borders Partnership Child and
Adolescent Eating Disorders Service, Epsom, Surrey, United Kingdom (Great Britain); Jonathan Kelly,
BSc, Beat Eating Disorders Charity, Norwich, Norfolk, United Kingdom (Great Britain); Susan
Ringwood, BA, FAED, Beat Eating Disorders Charity, Norwich, Norfolk, United Kingdom (Great
Britain); Juliet Rosewall, DClinPsy, South West London and St Georges NHS, London, London, United
Kingdom (Great Britain); LucyWatson, BSc, Great Ormond Street Hospital, London, London, United
Kingdom (Great Britain)
Stigma can be defined as negative attitudes and behaviours of the public towards by people grouped
common characteristics. Research has shown that individuals with eating disorders can experience
stigmatising attitudes and behaviours. The aim of the project presented here was to investigate
experiences of stigma in three different groups: individuals with an eating disorder and parents and
siblings of people with an eating disorder. The intention was to explore respondents’ views about others’
understanding of an eating disorder, how they thought they had been perceived and treated by others
because of the eating disorder and whether or not this caused any difficulty. A further aim was to collate
suggestions for reducing stigma based on personal experience. Three parallel surveys were posted on the
website of a well-known UK eating disorder charity. Respondents were asked to identify their status as
sufferer, parent/carer, or sibling before proceeding with the questionnaire. Items were phrased to be
relevant to each of the three groups, but tapped the same constructs to allow for comparisons in response
patterns. Items included optional fixed responses derived from a literature review about the nature and
effects of stigma as well as possibilities for open responses. Total numbers of respondents of 394, 188 and
250 completed the individual, parent and sibling surveys respectively. Descriptive data will be presented
highlighting similarities and differences. Examples of common shared perceptions are that others view
eating disorders as self-inflicted and that individuals with eating disorders are viewed as responsible for
their difficulties. High numbers of respondents across all groups rated peers and friends highest in
relation to holding stigmatizing attitudes. Suggestions for improvements broadly fell into three categories:
improving awareness, education and understanding. The surveys demonstrate that the majority of
families are significantly negatively affected by the experience of eating disorders stigma.
Learning Objectives:
• Learn about the nature and extent of the experience of stigma by individuals with eating disorders
and their families
• Access increased awareness of the specific consequences of stigma in those affected by an eating
disorder personally or in a family member.
• Identify areas of unmet need in the fight against stigma associated with eating disorders
T66
Might Participating in a Control Group Improve Eating Disorder Symptoms?
Rachel Rodgers, PhD, Northeastern University, Boston, Massachusetts, USA; Debra Franko, PhD,
FAED, Northeastern University, Boston, Massachusetts, USA; Pamela Naab, PhD, Northeastern
University, Boston, Massachusetts, USA; Alice Lowy, MA, Northeastern University, Boston University,
Boston, Massachusetts, USA
It has been suggested that simply completing a survey designed to assess rather than produce change may
actually decrease symptoms and modify behavior, and support has been found for this phenomenon in
areas such as alcohol abuse. However, to date, these effects have not been explored in eating disorders. In
order to bridge this gap, the aim of the present study was to conduct a meta-analysis of the effects of
completing an assessment questionnaire on subsequent self-reported eating disorder symptoms and risk
factors. We conducted a systematic review of controlled prevention and intervention studies aiming to
decrease eating disorder symptoms. Effect sizes of change in self-reported symptoms and risk factors
among the control group were calculated. The systematic review identified 168 studies that fit our criteria
from which control group data could be extracted. Preliminary analyses (138 studies included) revealed
small but significant (all ps <.000) effect sizes for all eating disorder symptoms including: body
dissatisfaction (95 studies) ES = .10 , 95% CI [ .08- .12]; dieting and restriction (69 studies) ES = .15, 95%
CI [.13 - .18]; bulimia (44 studies) ES= .11, 95% CI [.07-.14]; disordered eating (39 studies), ES = .15, 95%
CI [.11-.20]; weight concerns ( 21 studies) ES= .13, 95% CI [.07- .18]; and shape concerns (11 studies), ES
= .15, 95% CI [.08-.23]. While these effects are small, they are nonetheless significant from a public health
perspective, and suggest the potential usefulness of developing stepped intervention models with minimal
interventions as a first step. Future research should aim to identify the moderators of these effects and
clarify the mechanisms of action.
Learning Objectives:
• To recognize the impact of assessment on behavior.
• To describe the magnitude of changes in eating disorder symptoms and risk factors in control
groups.
• To appraise the research and practice implications of changes in eating pathology following
assessment.
T67
Universal Prevention Program for Unhealthy Weight-control Behaviors and Sedentary
Lifestyle in Mexican Adolescents.
Teresita de Jesús Saucedo-Molina, PhD, MPsych, BS, Instituto de Ciencias de la Salud. Universidad
Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico; Luz Alejandra Oliva Macías, Student,
Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico; Martín Villarreal Castillo,
BSc, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico; Ivonne Sánchez
Trigueros, Student, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico; José
Anguiano, BS, Instituto Tecnológico Latinoamericano, Pachuca, Hidalgo, Mexico; Rebeca Guzmán
Saldaña, PhD, MPsych, CPsychol, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo,
Mexico; Amanda Peña Irecta, MSc, BS, Universidad Autónoma del Estado de Hidalgo, Pachuca,
Hidalgo, Mexico; T. Lorena Fernández Cortés, MSc, BS, Universidad Autónoma del Estado de Hidalgo,
Pachuca, Hidalgo, Mexico
Unhealthy weight control behaviors during adolescence may contribute to eating disorders or to muscle
dysmorphic and sedentary lifestyle may increase the risk for several important chronic diseases later in
life. The main purpose of this project was to evaluate the impact of a universal prevention program for
unhealthy weight-control behaviors and sedentary lifestyle in high school adolescents from Hidalgo,
Mexico. Our approach was focused on healthy weight management through the promotion of appropriate
weight related behaviors, proper nutritional knowledge and eating and physical activity. Using some
psychoeducational strategies and some strategies of the cognitive dissonance theory, a detailed and
scripted manual was developed for the intervention. A pre-post test design was carried out in a sample of
775 adolescents (379 males, 396 females) between 15 to 19 years old (X=16.165; SD=1.01) Three valid and
reliable-self questionnaires were used. In females was applied the Brief Questionnaire for Risky Eating
Behaviors (BQREB) and the Drive for Muscularity Scale (DMS) in males. In both was applied the
International Physical Activity Questionnaire (IPAQ). Instead the results did not showed a decreased in
the risk percentages of developing drive for muscularity in males, analysis confirmed a significant
decrease in average value pre-post test (t=1.925, gl 338, p<0.05). In females, findings demonstrated a
diminished in the risk percentage of developing an eating disorder as well as a significant decreased in
average value pre-post test (t= 9.741, gl 395, p<0.01). A statistically significant increase in the minutes of
physical activity by weak was found both in males (t=7.708, gl 379, p<0.001) and in females (t= 4.366, gl
396, p<0.001). The findings suggest that the program for unhealthy weight-control behaviors and
sedentary lifestyle may be equally effective for Mexican males and females high school students.
Learning Objectives:
• Analyze the importance of linking healthy eating behaviors and psychical activity in a universal
prevention program for high school Mexican students
•
•
Demonstrate how students are more likely to adopt healthy eating behaviors when they learn
about these behaviors through fun participatory activities rather than through lectures.
Participants will be able to discuss the usefulness of linking diverse types of strategies in a
prevention program
T68
Instagram Use and Disordered Eating : The Protective Potential of Media Literacy
Tiffany Melioli, MA, Université Toulouse Ii Le Mirail, Toulouse, Midi-Pyrénées, France;
Marilou Girard, MA, Université De Toulouse Ii Le Mirail, Toulouse, Midi-Pyrénées, France; Yasmina El
Jazouli, BA, Université Toulouse Ii Le Mirail, Toulouse, Midi-Pyrénées, France; Nina Gonzalez, BA,
Université Toulouse Ii Le Mirail, Toulouse, Midi-Pyrénées, France; Amandine Valla, BA, Université
Toulouse Ii Le Mirail, Toulouse, Midi-Pyrénées, France; Henri Chabrol, MD, PhD, Université De
Toulouse Ii Le Mirail, Toulouse, Midi-Pyrénées, France; Rachel Rodgers, PhD, Northeastern University,
Boston, Massachusetts, USA
Western society promotes an ultra-slender body ideal which is widely broadcast, namely by the media and
peers among young women, and more recently by a conjunction of both through social media. While
exposure to idealized media images has been shown to be associated with disordered eating, to date, little
is known regarding the effects of image-based social media such as Instagram on body image and
disordered eating. In addition, media literacy (the aptitude to analyze, evaluate and understand media)
has been proposed to mitigate the effects of media exposure. The aim of the present study was therefore to
examine the relationship between Instagram use and body image and eating concerns, and to explore the
moderating role of media literacy in that relationship. A sample of 170 French adolescent girls, aged 1418, completed a questionnaire assessing their frequency and nature of Instagram use, disordered eating
symptoms, body dissatisfaction and media literacy. Findings revealed that Instagram use frequency was
associated with drive for thinness, r = .215, p < .05, and daily Instagram use was associated with body
dissatisfaction, r = .212, p < .05. Media literacy was negatively correlated with bulimic symptoms, r = .213, p < .01. Furthermore, media literacy was found to moderate the relationship between Instagram use
frequency and both drive for thinness and body dissatisfaction, p < .05, such that among individuals with
higher levels of media literacy, the relationship between Instagram use and body dissatisfaction and drive
for thinness was weaker. These findings suggest that Instagram use might contribute to body image
dissatisfaction and disordered eating and that media literacy buffer against these effects. Further
clarification of the effects of Instagram exposure and the potential protective role of media literacy is
needed in order to increase our understanding of the role of social media and inform prevention
interventions.
Learning Objectives:
• Describe the relationship between disordered eating, body image and Instagram use
• Describe the moderating role of media literacy in the relationship between disordered eating and
Instagram use
• Identify potential protective factor of disordered eating through social media
T69
Characterization Of A Latin Sample Of Girls Of Low-Middle Income Background From
Public Schools: Food Intake, Activity, Eating Disorder Behaviors And Psychopathology Of
Participants Of The Brazilian “New Moves” Version.
Karin Louise Lenz Dunker, PhD, MD, Federal University of São Paulo, São Paulo, Brazil, Angélica
Medeiros Claudino, PhD, MD, FAED, Federal University of São Paulo, São Paulo, Brazil
Characterize personal and behavioral factors related to the development of eating disorders and obesity in
a sample of girls from low-middle income background who are students of public schools and participate
in a randomized controlled trial testing an adapted version of the program New Moves to the Brazilian
reality. Baseline data collected among 140 girls (12-15 years) assessed body mass index (BMI), level of
activity, intake of fruit/vegetables, soda pop and sweetened drinks, meals (eg. breakfast) as well as binge
eating, weight control behaviors, body dissatisfaction and self-esteem. About one third (33.6%) were
overweight or obese, and 62,9% in the normal weight range. Also, 34.3% showed some level of body
dissatisfaction, and 62.9% had mean self-esteem. Another third of the girls (35.7%) spent more than 4
hours/day watching TV per day, and half of them (54.7%) spent 3 or more hours/day on computer or
cellular phone. Average intake of fruits and vegetables were 3.3 portions/day, 26.4% drink pop soda and
40.1% drink sweetened beverages one to five times per day, and 38.6% ate breakfast 3 times or less per
week. Considering girls that tried to control weight last month (32.8%), some of them used unhealthy
weight control methods like skipping meals (19.3%), dieting or fasting (20.7%) and throwing-up (3.5%);
23.6% of them reported binge eating behavior and 19.3% described lack of control. Disturbed eating
behaviors and body dissatisfaction, sedentary activity, inadequate food intake and weight control methods
in this sample of adolescent girls point to their increased risk to develop eating disorders and weight
problems and suggest they might benefit from the intervention New Moves which they are participating,
as most of the variables are discussed in program.
Learning Objectives:
• Learn about characteristics of adolescent girls from low/middle income background who are at
increased risk to develop eating disorders or weight problems
• Compare results related to level of body dissatisfaction, activity, disordered eating behaviors,
inadequate food intake and weight control methods with worldwide population.
• Revise how topics of the program New Moves adapted to this population can improve the
identified problems that increase this risk.
Risk factors for Eating Disorders
T70
Peer Commentary Predicts Bulimic Symptoms at 10-year Follow-up
Kelly Klein, MS, Florida State University, Tallahassee, Florida, USA, Tiffany Brown, MS, Florida State
University, Tallahassee, Florida, USA; Pamela Keel, PhD, FAED, Florida State University, Tallahassee,
Florida, USA
Prior studies have documented the influence of peers on disordered eating, with strong cross-sectional
associations between peer discussion of weight (i.e., “fat talk”) and increased pathological eating attitudes
and behaviors, particularly in college-aged women. However, longitudinal research is needed to clarify the
temporal relationship between peer factors and disordered eating, and this work should expand to include
other demographic groups (e.g., men and older women). Therefore, the present study sought to determine
how peer commentary predicts bulimic symptoms at 10-year follow-up, utilizing secondary analyses of
data from a longitudinal study of health and eating patterns (N=2059; 71% women). Three cohorts
originally established in 1982, 1992, and 2002 were assessed in 2002 and again in 2012, when
participants were in their 30’s, 40’s, and 50’s. In a multivariate regression model, peer commentary at
baseline uniquely predicted bulimic symptoms 10 years later (p=0.007), controlling for baseline bulimic
symptoms, BMI, sex, and age. Age and sex were tested as moderators of the peer commentary effect;
neither interaction was significant (p=0.16 and p=0.29, respectively). These results demonstrate the
potentially lasting influence of peer discussion of weight and eating behavior on pathological eating.
Further, the prospective association between peer commentary and bulimic symptoms was present across
women and men of different ages, speaking to the importance of considering peer influences in wider
demographic groups. Overall, findings support preventative efforts targeted at reducing the pervasive
nature of peer discussion of weight and eating.
Learning Objectives:
• Determine the ability of peer comments on weight/eating to predict bulimic symptoms at 10-year
follow up.
• Determine whether age or sex moderates the association between peer comments on
weight/eating and bulimic symptoms at 10-year follow up.
• Understand the implications of these results for eating disorder preventative efforts.
T71
A Test of an Interactive Model of Binge Eating among Undergraduate Men
Allison Minnich, MS, BA, North Dakota State University, Fargo, North Dakota, USA;
Kathryn Gordon, PhD, North Dakota State University, Fargo, North Dakota, USA; Jill Holm-Denoma,
PhD, University of Denver, Denver, Colorado, USA; Wendy Troop-Gordon, PhD, North Dakota State
University, Fargo, North Dakota, USA
Past research has shown that a combination of high perfectionism, high body dissatisfaction, and low selfesteem is predictive of binge eating in college women (Bardone-Cone et al., 2006). In the current study,
we examined whether this triple interaction model is applicable to men. Male undergraduate college
students from a large Midwestern university (n=302) completed self-report measures online at two
different time points, a minimum of eight weeks apart. Analyses revealed a significant interaction between
the three risk factors, such that high perfectionism, high body dissatisfaction, and low self-esteem at Time
1 were associated with higher levels of Time 2 binge eating symptoms. The triple interaction model did not
predict Time 2 anxiety or depressive symptoms, which suggests model specificity. These findings offer a
greater understanding of the interactive nature of risk factors in predicting binge eating symptoms among
men.
Learning Objectives:
• Identify perfectionism, body dissatisfaction, and self-esteem as risk factors for disordered eating.
• Summarize the nature of the triple interaction in predicting binge eating in men.
• Describe the specific nature of the triple interaction model in predicting binge eating as opposed
to anxiety or depression.
T72
The Role of Emotion Regulation Strategies in the Relationship between Behavioral
Inhibition and Emotional Eating
Eleanor Benner, MA, La Salle University, Philadelphia, Pennsylvania, USA; Jessica Oddo, MA, La Salle
University, Philadelphia, Pennsylvania, USA; Anastasia Sokol, MA, La Salle University, Philadelphia,
Pennsylvania, USA; Edie Goldbacher, PhD, La Salle University, Philadelphia, Pennsylvania, USA;
LeeAnn Cardaciotto, PhD, La Salle University, Philadelphia, Pennsylvania, USA
Behavioral inhibition (BI), the ability to inhibit behavior in punishment and non-reward situations, is
inversely associated with emotional eating (EE), although mechanisms underlying this association are less
clear. The purpose of this study was to examine whether non-acceptance of emotions (NA) and limited
access to emotion regulation (ER) strategies, two ER deficits associated with lower BI and greater EE,
mediated the relationship between BI and EE. Data were collected from 151 college students (M age=
20.62 (6.45) yrs.; 20% male) via online self-report questionnaires (i.e., BIS subscale of the BIS/BAS to
assess BI; Nonacceptance and Strategies subscales of the Difficulties in Emotion Regulation Scale to
assess NA and ER strategies; Emotional Eating Scale (EES) total and subscales to assess EE). Results of
mediation analyses using bias-corrected bootstrapping demonstrated that the indirect effect of BI on EES
total through ER strategies was significant (b= .35, [99% BC CI= .046-.880]), reflecting mediation by ER
strategies. The κ2 was .06, reflecting a small to medium effect size. The direct effect of BI on EES total was
not significant (b = -.04, [99% BC CI= -1.196-1.113]). Similarly, analyses with the EES subscales
demonstrated significant indirect effects of BI through ER Strategies on EES-Anger (b=.190, [99% BC
CI=.032-.438]) and EES-Anxiety (b=.107, [99% BC CI=.012-.281]), but not EES-Depression. The κ2 was
.074 (Anger) and .06 (Anxiety), reflecting a small to medium effect size. Consistent with results of
analyses with the total EES score, there was no significant direct effect of BI on EES-Anger, EES-Anxiety,
or EES-Depression. Analyses with NA as the mediator demonstrated no significant indirect effect of BI on
EE through NA, suggesting no mediation by NA. Results suggest that behavioral inhibition is associated
with greater levels of emotional eating (particularly eating in response to anxiety and anger), and that this
relationship is fully mediated by one’s access to effective emotion regulation strategies.
Learning Objectives:
• Describe the association between behavioral inhibition and emotional eating.
•
•
Discuss the potential role of access to effective emotion regulation strategies in the relation
between behavioral inhibition and emotional eating.
Discuss the potential role of acceptance of emotions in the relation between behavioral inhibition
and emotional eating.
T73
Overvaluation Of Body Shape/Weight And Engagement In Non-Compensatory WeightControl Behaviors In Eating Disorders: Is There A Reciprocal Relationship?
Nassim Tabri, PhD, Carleton University, Ottawa, Ontario, Canada, Helen Murray, BA, Massachusetts
General Hospital, Boston, Massachusetts, USA; Jennifer Thomas, PhD, FAED, Massachusetts General
Hospital/Harvard Medical School, Boston, Massachusetts, USA; Debra Franko, PhD, FAED,
Massachusetts General Hospital and Northeastern University, Boston, Massachusetts, USA; David
Herzog, MD, FAED, Harvard Medical School, Boston, Massachusetts, USA; Kamryn Eddy, PhD, FAED,
Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
Overvaluation of body shape/weight is thought to be the core psychopathology underlying eating
disorders. According to the transdiagnostic cognitive-behavioral model of eating disorders, overvaluation
propels engagement in non-compensatory weight-control behaviors. In turn, these behaviors lead to
binge eating and/or maintenance of low weight thereby reinforcing overvaluation. We investigated the
reciprocal relationship between overvaluation and engagement in non-compensatory weight-control
behaviors (defined in two ways: restrictive eating and compulsive exercise) among women diagnosed with
anorexia nervosa or bulimia nervosa (N = 246). Participants completed follow-up clinical interviews in
which eating disorder symptoms and behaviors were assessed over two years. Results indicated that
participants who overvalued their shape/weight on a given week were more likely to engage in restrictive
eating (OR: 1.74, p < .01) and compulsive exercise (OR: 1.67, p < .01) during the following week compared
to participants who did not overvalue their shape/weight. Also, participants who engaged in moderate
(OR: 1.48, p < .05) or severe (OR: 2.65, p < .01) restrictive eating on a given week were more likely to
overvalue their shape/weight during the following week compared to participants who did not engage in
restrictive eating. Likewise, participants who engaged in moderate (OR: 1.53, p < .05) or severe (OR: 2.12,
p < .01) compulsive exercise on a given week were more likely to overvalue their shape/weight during the
following week compared to participants who did not engage in compulsive exercise. These findings held
true regardless of participants’ shape/weight concerns (i.e., body image disturbance and fat phobia) and
baseline eating disorder diagnosis. Our findings support the transdiagnostic cognitive-behavioral model
of eating disorders and suggest that targeting non-compensatory weight-control behaviors in treatment
may help alleviate overvaluation of body shape/weight as well as shape/weight concerns.
Learning Objectives:
• Describe the link between individuals’ overvaluation of their body shape/weight and their
engagement in non-compensatory weight-control behaviors (e.g., restrictive eating).
• Contrast overvaluation of shape/weight with shape/weight concerns (e.g., fat phobia) in relation
to engagement in non-compensatory weight-control behaviors (e.g., restrictive eating).
• Recognize that targeting non-compensatory weight-control behaviors in treatment may help
alleviate overvaluation of body shape/weight as well as shape/weight concerns.
T74
Does Leptin Predict Outcome in Anorexia Nervosa?
Jonathan Hersch, BA, Columbia Center for Eating Disorders, New York, New York, USA, Lindsay
Bodell, MS, Florida State University, Tallahassee, Florida, USA; Laurel Mayer, MD, FAED, Columbia
University College of Physicians and Surgeons, New York, New York, USA
We have shown that percent body fat, after acute normalization of weight in women with anorexia
nervosa (AN) is associated with outcome one year following hospital discharge. This study aims to
evaluate whether leptin, a hormone produced by fat cells and reflective of body fat stores, is also
associated with outcome at one year. Participants were 54 women hospitalized for acute treatment of AN.
After gaining to and maintaining a BMI of > 19.5kg/m2 for at least 2 weeks, body composition by total
body MRI and fasting leptin level were assessed. Following discharge, patients were asked to return to
the clinic at the end of one year for a brief clinical assessment and weight. Treatment outcome was
determined by BMI. Patients who maintained a BMI > 18.5 kg/m2 were considered “success,” and
“failure” was assigned to patients whose BMI was < 18.5 kg/m2. Using independent samples t-tests,
demographic, body composition and leptin levels were compared between the “success” and “failure”
groups. Binary logistic regression was also constructed to evaluate the relationship between pre-discharge
leptin level and outcome at one year. Data from 46 participants was available for analysis. Twenty-four
participants met the outcome criteria for success and 22 for failure. Compared to the “failure group,” the
“success” group may have been slightly younger (23+4 vs 26+6 yrs old, p=0.09) and had a somewhat
shorter duration of illness (6+3yrs vs 9+8yrs, p=0.08). Pre-hospital discharge BMI was not different
between the groups (20.5+0.57 vs 20.3+0.73, p=0.20), but percent body fat was higher in the “success”
(27+4%) compared to “failure” (23+5%) group (p=0.003). In the “success” group, both leptin (16+18
ng/ml) and leptin normalized for fat mass (0.99+0.97 ng/ml/kg) levels were significantly higher
compared to the “failure” group (leptin: 6.3+6.4 ng/ml p=0.02, leptin/fat mass: 0.47+0.43 ng/ml/kg,
p=0.03). In a series of binary logistic regressions, both pre-discharge leptin (p=0.04) and leptin/fat mass
(p=0.02) but not BMI (p=0.20) significantly predicted treatment outcome at one year. In weight-restored
women with AN, higher absolute leptin and leptin levels normalized for body composition prior to
hospital discharge are associated with better outcome in the year following treatment.
Learning Objectives:
• Following the presentation, participants will be able to define the role leptin plays in satiety and
appetite, and from where it is primarily derived.
• Participants will be able to identify the relationship between leptin levels, body fat percentage,
and clinical outcome of anorexia nervosa inpatients one year following discharge.
• Participants will be able to evaluate the potential benefit in identifying low circulating leptin
levels at discharge as a predisposing factor for relapse in anorexia nervosa.
T75
Physical Appearance Comparisons Related to Severity in Hospitalized Patients with Eating
Disorders
Ashley Carpenter, MA, Towson University, Towson, Maryland, USA; Colleen Schreyer, PhD, Johns
Hopkins University, Baltimore, Maryland, USA; Saniha Makhzoumi, MA, University of Maryland,
Baltimore County, Baltimore, Maryland, USA; Janelle Coughlin, PhD, Johns Hopkins University,
Baltimore, Maryland, USA; Angela Guarda, MD, Johns Hopkins University, Baltimore, Maryland, USA
Social comparison theory posits that people compare themselves to others to assess whether they meet
their own pre-determined physical appearance standards. Research suggests that appearance-focused
social comparisons are associated with body dissatisfaction and eating disordered behaviors in nonclinical
college students. There is scarce data on physical appearance comparisons in clinical populations with
eating disorders (ED). This study aimed to examine differences in physical appearance comparisons
among ED diagnoses and the relation of these comparisons to disordered eating behavior. Participants (N
= 282) admitted to an integrated inpatient-partial hospital ED specialty unit were diagnosed using the
SCID with AN-restricting type (AN-R; n = 79), AN-purging type (AN-P; n =121) or BN (n = 82). Physical
appearance comparisons were assessed at admission using the Physical Appearance Comparisons Scale
(PACS). Participants were also assessed on frequency of eating disordered behaviors and clinical indices
(e.g. BMI). Physical appearance comparison scores were higher in participants with BN compared to
those with AN-R; and compared to pure restrictors, patients with purging behaviors had elevated PACS
scores, p’s < .01. Additionally, physical appearance comparisons score predicted higher recent frequency
of vomiting, laxative use, exercise, restricting, and chew spit behaviors, when controlling for admission
BMI (all p’s < .01). These results indicate that the likelihood of engaging in physical appearance
comparisons may vary by ED diagnosis, that elevated PACS scores are a possible marker of illness severity
and that future treatment interventions should explore targeting physical appearance social comparisons
in patients with eating disorders.
Learning Objectives:
• Define the concept of physical appearance comparisons.
• Identify how physical appearance comparisons differ among eating disorder diagnoses.
•
Specify how physical appearance comparisons relate to disordered eating behavior severity.
T76
Gonadal Hormones Affect Reversal Learning in Adolescent Anorexia Nervosa
Andrew Grotzinger, BA, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Tom
Hildebrandt, PsyD, BS, FAED, Icahn School of Medicine at Mount Sinai, New York, New York, USA;
Natalie Stern, Student, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Rebecca
Greif, PsyD, BA, Icahn School of Medicine at Mount Sinai, New York, New York, USA
The present study investigated the relationship between dysregulated gonadal steroid hormone function
in anorexia nervosa (AN), and cognitive inflexibility assessed using a food-reward reversal learning
paradigm. A total sample of 29 female participants, ages 11 to 22 (M = 16.39, SD = 2.64), included 14
individuals with AN restricting subtype, and 15 healthy controls (HC). Reversal learning task performance
was measured using three behavioral learning based outcomes: win-staying, lose-shifting, and
perseverance. Win-stay and lose-shift response assessed local changes in positive and negative feedback
reactivity, respectively. Perseverance measured longer-term cognitive flexibility. Blood samples were
collected on-site, and assessed for levels of progesterone and estradiol. Results revealed two significant
three-way interactions between progesterone, estradiol, and group (i.e., AN vs. HC) predicting win-stay
rates during the second half of the task, β = .11, Wald’s χ2 = 8.54, p = .003; and lose shift outcomes during
the acquisition phase, β = -.07, Wald’s χ2 = 5.39, p = .020. Inspection of the means suggested that higher
estradiol concentrations were associated with worse learning for AN participants, but had only a small,
positive effect for HCs. Conversely, high progesterone concentrations predicted worse learning for HCs,
and better learning for AN participants, in part via attenuation of the negative effect of estradiol. These
results suggest that hormone dysregulation, which is likely exacerbated by low weight characteristic of
AN, contributes to cognitive deficits seen in the population. Our results have implications for hormone
replacement therapies as a potential treatment option, as well as for endocrine models of the disorder.
Learning Objectives:
• Assess levels of estradiol and progesterone in anorexia nervosa and healthy control participants
• Determine whether estradiol and progesterone have a distinct interactive effect between anorexia
nervosa and healthy control participants (i.e., three-way interaction) predicting reversal learning
outcomes
• Add to the literature to inform endocrine models of anorexia nervosa
T77
Does Parental Divorce Enhance the Heritability of Body Dissatisfaction? An Attempted
Replication of a Gene-Environment Interaction
Shannon O'Connor, MA, Michigan State University, East Lansing, Michigan, USA; Jessica VanHuysse,
PhD, Michigan State University, Flint, Michigan, USA; Kelly Klump, PhD, FAED, Michigan State
University, East Lansing, Michigan, USA; Matt McGue, PhD, University of Minnesota, Minneapolis,
Minnesota, USA; William Iacono, PhD, University of Minnesota, Minneapolis, Minnesota, USA
Previous research suggests that parental divorce moderates genetic influences on body dissatisfaction.
Specifically, the heritability of body dissatisfaction was found to be higher in children of divorced as
compared to children from non-divorced families, suggesting possible gene-environment interaction
effects. However, prior research is limited to a single, self-report measure of body dissatisfaction, the
Body Dissatisfaction subscale of the Minnesota Eating Behaviors Survey (MEBS). The primary aim of the
present study was to examine whether these findings extend to body dissatisfaction as measured using
figural rating scales that index body dissatisfaction using discrepancies between current versus ideal
perceived body size. Participants were 1,538 female twins from the Minnesota Twin Family Study (MTFS),
ages 16-20 (M= 17.88 years, SD = .69). The Body Rating Scale (BRS) was used to assess body
dissatisfaction. In contrast to prior studies, there were no significant differences in BRS scores between
the divorced and non-divorced groups. Twin modeling results also did not replicate previous results, as
heritability estimates in the divorced group were not significantly greater than estimates in the nondivorced group. Reasons for the non-replication are unclear, however they may be related to differences in
constructs measured by the MEBS body dissatisfaction scale versus the BRS. In particular, the BRS may
more strongly tap weight perceptions (i.e., comparisons between current and ideal size that may or may
not include dissatisfaction) than dissatisfaction with owns body size/shape per se. Future research should
examine this possibility and explore differential gene x environment interactions using diverse measures
of body dissatisfaction.
Learning Objectives:
• Describe how genetic and environmental factors may interact to increase risk for body
dissatisfaction
• Assess parental divorce as a moderator of the heritability of body dissatisfaction as measured
using a figural rating scale
• Describe differences in the constructs measured by a self-report questionnaire of body
dissatisfaction versus body dissatisfaction as assessed using a figural rating scale
T78
The Impact of Dieting Status on the Relationship Between Three Types of Impulsivity and
Responsiveness to Food Environment
Megan Strowger, BS, Student, USciences, Philadelphia, Pennsylvania, USA; Julia M. Hormes, PhD, MA,
BA, University at Albany, State University of New York, Albany, New York, USA; C. Alix Timko, PhD,
MA, BS, Usciences and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
A third of adults self-identify as dieting to lose weight. Those who are high in impulsivity may struggle
more with weight loss, particularly if they are also highly responsive to the food environment. This study
sought to examine whether dieters who are higher in impulsivity will be more likely to endorse a higher
appetite for palatable food. We hypothesized that dieting status would moderate the relationship between
non-planning and attentional aspects of impulsivity and responsiveness to food environment. Participants
were men and women recruited from two large universities in the Northeast (N = 647). They completed a
number of questionnaires including the Power of Food Scale and the Barratt Impulsivity Scale (BIS). A
series of three regressions with interaction analyses were conducted, one with each subscale of the BIS.
Results indicated that there was a significant interaction between dieting status and motor impulsivity
(R²change= .01, F(1,637)= 9.19, p=.003) such that dieters with moderate [t(637) = 4.37, p < .001] and
high [t(637) = 5.68, p< .001] motor impulsivity were more susceptible to the food environment than
those not dieting or dieters with low impulsivity. There was also a significant interaction between dieting
status and attentional impulsivity (R²change= .01, F(1,637)= 8.76, p= .003) such that dieters with
moderate [t(637) = 4.62, p< .001] and high [t(637) = 5.61, p< .001] attentional impulsivity were more
susceptible to the food environment than those not dieting or dieters with low impulsivity. There was no
significant interaction between dieting status on non-planning impulsivity. Overall, dieting status
moderated the relationship between two types of impulsivity and susceptibility to the food environment.
Implications for dieting and weight loss – specifically reducing specific types of impulsivity within the
larger contexts of behavioral weight loss programs or treatments for BED.
Learning Objectives:
• Describe three types of impulsivity
• Elucidate the role of dieting status in the relationship between impulsivity and responsiveness to
food environment
• Clarify why non-planning impulsivity may not have as large as impact on responsiveness to food
environment
T79
An Empirical Examination of the Mislabeling of Fat as an Emotion in Women with
Disordered Eating Symptoms.
Yichelle Zhang, MPhil, The University of Sydney, Sydney, New South Wales, Australia;
Stephen Touyz, PhD, FAED, The University of Sydney, Sydney, New South Wales, Australia; Bruce
Burns, PhD, The University of Sydney, Sydney, New South Wales, Australia; Maree Abbott, PhD, The
University of Sydney, Sydney, New South Wales, Australia; Lenny Vartanian, PhD, The University of
New South Wales, Sydney, New South Wales, Australia
“I feel fat” is a common statement both women, and increasingly men, make. Clinical observations
indicate that these feelings of fat are experienced more intensely and frequently in those who suffer from
an eating disorder. However, fat is not an emotion that one can “feel”. According to body displacement
theory, the propensity to mislabel fat as an emotion is driven by affect and physical bodily sensations such
as fullness, but there has been little empirical evidence to validate this. Thus the purpose of the current
study aimed to investigate this phenomenon by examining the impact of negative and positive emotions,
and the feeling of fullness on the propensity to mislabel such emotions and/or sensations as feelings of fat
in a sample of university women with low levels of disordered eating (i.e. sub-clinical (SC) group), or no
disordered eating (i.e. healthy controls). Using a 2x4 experimental design, negative and positive emotions,
and the physical sensation of feeling full was induced in both the SC and healthy control groups. Results
show that women in both SC and healthy control groups increased their feelings of fat as a result of the
physical sensation of feeling full. But this only resulted in a corresponding increase in depression in the
SC group and not the healthy control group. This suggests there is a tendency to substitute feeling full
with feelings of fat irrespective of the presence of disordered eating symptoms. However, corresponding
increases in negative affect was only present in the SC group. Furthermore, feelings of fat increases as the
level of disordered eating symptoms increase, and this feeling is highly correlated with the Eating
Disorder Examination Questionnaire (EDE-Q). This suggests feelings of fat may be a more stable
characteristic than that observed in clinical settings, and at high levels of disordered eating symptoms,
extreme feelings of fat are experienced.
Learning Objectives:
• Examine whether emotions and physical bodily sensations (such as fullness) impact the
mislabeling of fat as a feeling in those with disordered eating symptoms.
• Investigate the intensity to which individuals with disordered eating feel fat.
• Investigate the relationship between an individual's feeling of fat and the intensity in which they
experience eating disorder symptoms.
Treatment of Eating Disorders I (child and adolescent)
T80
“Refeeding Labs” and Their Necessity: A Retrospective Review of the Cost and Utility of
Screening Lab Studies for Refeeding Syndrome in Adolescent Patients with Eating
Disorders
Jonathan Kole, MD, MA, BA, Brown University, Hasbro Children's Hospital, Butler Hospital,
Providence, Rhode Island, USA; Kelly Fitzgerald, BA, The Warren Alpert Medical School, Brown
University, Providence, Rhode Island, USA; Kathryn Erickson-Ridout, MD, PhD, Department of
Psychiatry and Human Behavior, Butler Hospital, Providence, Rhode Island, USA; Samuel Ridout, MD,
Department of Psychiatry and Human Behavior, Butler Hospital, Providence, Rhode Island, USA;
Abigail Donaldson, MD, Division of Adolescent Medicine, Hasbro Children’s Hospital, Providence,
Rhode Island, USA; Brian Alverson, MD, Department of Pediatrics, Hasbro Children's Hospital,
Providence, Rhode Island, USA
The aims of our study were to identify the rate at which adolescent patients admitted for treatment of
eating disorders develop refeeding syndrome (RFS) or other electrolyte or vital sign abnormalities .
Secondarily we sought to determine the cost and impact of these labs on patient care. We performed a
retrospective chart review of adolescent patients hospitalized for medical complications of concurrent
eating disorders at a tertiary children's referral hospital from October 2010 to April 2014. Reviewers
collected demographic data, vital signs, diagnostic laboratory data, relevant historical data, therapeutic
interventions, and clinical outcomes. Costs of lab work were estimated using the hospital’s fixed
laboratory charges to Medicaid patients. There are 200 patient encounters that meet inclusion criteria.
Our analysis of all included charts showed that among the 1295 serum tests of phosphate and magnesium
levels there were no instances of critical levels of magnesium (Mg) or phosphate (Phos) concerning for
RFS (Mg<1mEq/L, Phos<1mg/dL). Of the 1350 serum potassium levels collected, there were 2 with
severe low potassium of <2.5 mEq/L (0.14% of tests). Using conservative cost estimates and tallies of
laboratory testing, we estimate a total cost of these labs over 3.5 years was $606,562.33. Only 3 of 76
patient encounters reviewed included any electrolyte supplementation and none slowed/stopped calorie
advance. To our knowledge, this study is the largest and most comprehensive review of the efficacy of
routine laboratory testing in adolescent patients with eating disorders. This initial analysis suggests that
electrolyte and liver panels offer little information guiding treatment, and the cost of testing likely
outweighs the benefit of screening. With careful advancement of calories, our data do not support
laboratory screening for RFS in these patients.
Learning Objectives:
• Following this presentation, participants will be able to better to estimate the incidence of
refeeding syndrome in their adolescent patients with eating disorders.
• They will also gain new insight on the costs and benefits of serum labs in patients with eating
disorders hospitalized for nutritional rehabilitation.
• Finally, participants will be better informed as to the appropriate application of current guidelines
on screening labs for refeeding syndrome.
T81
Can we beat Eating Disorders? Promising Preliminary Results from Vienna
Beate Wimmer-Puchinger, PhD, Vienna Women's Health Programme, Vienna, Austria; Karin
Waldherr, MSc, DSc, Ferdinand Porsche Distance Learning University of Applied Sciences, Vienna,
Austria
Prevention of eating disorders is one of the major aims of the Viennese Women’s Health Programme since
it’s establishment in November 1998. Purpose of the current study thus was to examine time trends in risk
factors for eating disorders among adolescents in Vienna. Secondary analyses of data from two
independent surveys in Viennese schools in the years 1999/2000 and 2011/12 were conducted. In both
years cluster-sampling was applied with schools as the unit. Pupils and parents gave informed consent
and the education authority of the City of Vienna endorsed the surveys. Questionnaires at the two time
points included the Eating Disorder Inventory and some identical questions regarding eating behavior.
For the current study subsamples comparable regarding age, school-type and school districts were
selected. Girls and boys aged 14 and 15 years from high schools in districts 2, 19 and 22 of Vienna were
eligible (1999/2000: 110 girls, 63 boys; 2011/12: 168 girls, 115 boys). Time trends were examined using
logistic regression analysis, analysis of variance for independent samples, Mann-Whitney U-tests and
contingency table analysis as applicable. Analyses were conducted separately for girls and boys with a =
0.05 as global significance level. For girls frequency of weighing and scores in the EDI-subscales body
dissatisfaction, bulimia, drive for thinness and interoceptive awareness decreased significantly between
1999/2000 and 2011/12. For boys, however, drive for thinness increased significantly and a trend for
increasing body dissatisfaction was observed. There was no correlation between BMI and EDI subscales in
2011/12. Results for girls are promising, but the study is of an exploratory nature and has several
limitations (e.g., generalizability to other age groups, school-types and districts; explanations for the
observed trends). Further research is needed to examine time trends and hypotheses about potential
explanations.
Learning Objectives:
• name time trends in disordered eating behaviors and risk factors for eating disorders in general
• Describe the comprehensive prevention strategies of the Viennese Women’s Health Programme
• name results of the study
T82
Transitions of Adolescents with Eating Disorders: How Well Are We Doing?
Jean Someshwar, MD, Childrens National Health System, Washington, District of Columbia, USA;
Brooke Bokor, MD, MPH, Childrens National Health System, Washington, District of Columbia, USA;
Tomas Silber, MD, FAED, Childrens National Health System, Washington, District of Columbia, USA;
Lisa Tuchman, MD, MPH, Childrens National Health System, Washington, District of Columbia, USA
With a mean age of diagnosis of 18 years, eating disorders patients often require health care transition
between the pediatric and adult health care systems during the course of their treatment and recovery. A
paucity of literature exists around health care transition of eating disorders patients, and limited studies
suggest inconsistencies and barriers in the transition process. We sought to determine whether
adolescent medicine clinical programs have specific health care transition (HCT) protocols for eating
disorders patients and whether protocols are consistent with current guidelines outlined by the 2011
Clinical Report on HCT within a medical home outlining six core elements. We invited all 27 adolescent
medicine fellowship directors in the United States and Canada to anonymously participate in a 55 item
internet survey assessing current services for eating disorders patients, current transition practice for all
patients and specifically for eating disorders patients; perceived barriers to health care transition, and
perceived needs for transition support. 16 program directors (59% response rate) participated. 44% of
the programs reported having a formalized transition protocol for any patients, and only two programs
out of 16 reported a specific eating disorders transition protocol. 75% of respondents (n=12/16) stated
that they would consider implementing a formalized transition protocol for eating disorders patients.
Respondents rated insurance issues and patient reluctance to leave pediatric care as the most significant
barriers to health care transition in eating disorders patients. Only two programs reported currently
having a care coordinator to assist with health care transition of these patients to adult care although most
respondents (n=14/16) perceived a care coordinator as helpful in support of transition. While many
programs report having general health care transition services for their patients, current eating disorder
transitions are planned on an individual basis without systematization. Development of specific eating
disorder protocols could meet unique needs of eating disorder patients, and future research needs to be
done for patients that participate in programs with transition protocols, and those that do not.
Learning Objectives:
• Describe current health care transition practice in eating disorders patients.
• Identify barriers in health care transition of eating disorders patients.
• Identify perceived needs for successful health care transition for eating disorders patients.
T83
A Longitudinal Rotation in Eating Disorder Assessment and Management for Residents in
Psychiatry
Vinay Reddy, MD, MS, Western Michigan University School of Medicine, Kalamazoo, Michigan, USA;
Jennifer Vinch, MD, Wayne State University College of Medicine, Detroit, Michigan, USA
We have developed a prototype of a longitudinal rotation for residents in general Psychiatry who have a
special interest in the assessment and management of patients with eating disorders. The goals and
objectives for the rotation are based on the Accreditation Committee for Graduate Medical Education
(ACGME) requirements for residency training in psychiatry and on the ACGME core competencies
(patient care, medical knowledge, practice-based learning and improvement, interpersonal and
communication skills, professionalism, and systems-based practice). A future resident in this rotation
would be given a block of time (minimum of 1/2 day) each week for the duration of the residency to
participate in this rotation, be expected to provide care for a panel of patients with eating disorders from
beginning to end of residency, and be expected to participate with other providers, including nonphysician providers, in case discussions and treatment plans for these patients. In addition, the resident
would be encouraged to participate in, and ultimately to lead, scholarly activities involving eating disorder
diagnosis, assessment, and management. We were unable to fulfill all goals of the prototype rotation,
partly because of time constraints and availability, but we were able to implement several aspects of the
plan, particularly longitudinal encounters with patients with eating disorders. The model we built can
provide added training in eating disorder management for those trainees who are interested in the field
and may also help general psychiatry residents develop basic skills in the field.
Learning Objectives:
• Appraise current training in eating disorder management for general psychiatry residents
• Develop resources and training opportunities for psychiatry residents interested in eating
disorder diagnosis and treatment
• Employ non-physician providers (therapists, dietitians) and non-psychiatric physicians in the
treatment of eating disorders and collaboration with psychiatrists in the field
T84
Peer Support for Eating Disorders: A Pilot Open Trial of Peer Support for Children and
Adolescents with Eating Disorders
Stephanie Wade, PhD, MPsych, University of Western Australia, Perth, Western Australia, Australia;
Hunna Watson, PhD, Princess Margaret Hospital for Children, Perth, Western Australia, Australia;
Jemma Caswell, BA, Body Esteem Program, Perth, Western Australia, Australia
The current pilot study aimed to evaluate the effectiveness of a brief peer support intervention for
adolescents with eating disorders, run within an established specialist hospital service. Peers are defined
in this context to reflect individuals who have experienced overcoming an eating disorder. The peer
support intervention was designed to run concurrently with the hospital program, with focus on removing
the additional barriers to recovery, such as low motivation for recovery, that are not specifically targeted
by traditional health systems. Participant groups of inpatients, day-patients and outpatients each
attended two structured group sessions, and completed pre- and post-group questionnaires. Quantitative
and qualitative analyses comparing pre- to post-group ratings revealed a significant decrease in
participant's feelings of stigma associated with having an eating disorder; a significant increase in hope
and motivation for recovery and a better future; and improved trust and acceptance of the hospital
treatment they were currently receiving. The presentation will also cover the experiences of the peer
workers who facilitated the groups, and the attitudes of the hospital staff towards peer support.
Learning Objectives:
• Describe peer support
• Describe the benefits and limitations of peer support for adolescents with eating disorders
• Understand the rigorous screening and training protocol necessary for implementation of peer
workers in an established health care system
Treatment of Eating Disorders II (adult)
T85
Weight Suppression Predicts and Moderates Treatment Outcomes for Binge Eating
Disorder
Carlos Grilo, PhD, Yale University School of Medicine, New Haven, Connecticut, USA
This study examined the prognostic significance of weight suppression in obese patients with BED
participating in a randomized controlled trial testing cognitive-behavioral therapy (CBT), behavioral
weight loss (BWL), and sequenced CBT-BWL. 125 participants (mean age 45, 67% female, 77% white)
with BED and obesity (mean BMI = 39) were randomly assigned to one of the three manualized
treatments delivered in groups: CBT (N=45), BWL (N=45), or sequenced CBT-BWL (N=35). Assessments
were performed reliably by doctoral research clinicians at baseline, throughout- and post-treatment, and
6- and 12-month follow-ups after completing treatments with structured interviews and established
measures. Weight suppression was defined, per previous studies with bulimia nervosa, as the difference
between current weight and highest past weight at adult height. For two primary outcomes (binge eating
and percent weight loss), separate mixed models were fitted with weight suppression as predictor,
treatment (CBT, BWL, CBT-BWL) as between subject factor, time as within-subject factor, the
interactions among time, weight suppression and treatment, with baseline score as covariate. For bingeeating outcomes, weight suppression had a significant main effect and significant interaction with
treatment; higher weight suppression was associated with higher binge eating frequency in CBT-BWL
treatment. Weight suppression also had a significant main effect and significant interaction with
treatment for percent weight loss; higher weight suppression was associated with less percent weight loss
in CBT-BWL treatment. In contrast to weight suppression effects, weight cycling history neither predicted
nor moderated outcomes. These findings extend previous reports of the negative prognostic significance
of weight suppression for bulimia nervosa outcomes to patients with co-morbid obesity and BED
receiving different behavioral and cognitive-behavioral interventions.
Learning Objectives:
• Following the training, participants will be able to recognize available behavioral and cognitivebehavioral treatments for binge eating disorder.
• Following the training, participants will be able to describe weight suppression.
• Following the training, participants will be able to recognize the predictive effects of weight
suppression on different behavioral and cognitive-behavioral treatment for binge eating disorder
T86
Co-occurrence of Non-Suicidal Self-Injury Within Eating Disorders: The Importance of
Concurrent Treatment
Denise Styer, PsyD, MA, BA, Alexian Brothers Behavioral Health Hospital, Hoffman Estates, Illinois,
USA; Jenny Conviser, PsyD, MS, BS, Alexian Brothers Behavioral Health Hospital, Hoffman Estates,
Illinois, USA;Delia Aldridge, MD, Alexian Brothers Behavioral Health Hospital, Hoffman Estates,
Illinois, USA;Jason Washburn, PhD., MA, BA, Alexian Brothers Behavioral Health Hospital, Hoffman
Estates, Illinois, USA;
Historically, it was not uncommon for clinicians in the eating disorder community to perceive nonsuicidal self-injury as merely another symptom of the eating disorder. When an individual entered
treatment for an eating disorder, that is what was treated – the eating disorder. However, many
individuals with eating disorders also exhibit various other maladaptive coping behaviors in conjunction
with their eating disorder (i.e., non-suicidal self-injury and substance use). The purpose of this study is to
demonstrate the importance of working with the individual on all facets of their struggles, including and
beyond their eating disorder. In particular, the co-occurrence of non-suicidal self-injury is especially
important. Since eating disorders have the highest rate of suicide out of all mental health disorders, safety
is of utmost concern. Non-suicidal self-injury is a risk factor for suicide. Individuals who also engage in
substance use, increase these risks even further. This study is a representation of an acute behavioral
health hospital’s partial eating disorder program. The subjects ranged in ages from 12 – 60, including
both males and females. Upon admission to the program, patients are assessed for the co-occurrence of
other maladaptive behaviors besides their eating disorder (i.e., self-injury, substance use, and anxiety). It
is our goal to work with the individual as a whole and simultaneously treat these maladaptive behaviors.
By doing so, it is our belief that the individual will learn to better manage their thoughts, situations, and
feelings and decrease their maladaptive coping behaviors. In reviewing the latest 6 months of our data,
42.8% out of 813 eating disorder patients reported engaging in at least one instance of non-suicidal selfinjury; 28.9% report using substances and 17.6% met criteria for a drug or alcohol use disorder. This data
purports the need to concurrently address co-occurring symptoms in the treatment of eating disorders.
Learning Objectives:
• Describe the importance of concurrent treatment between eating disorders and non-suicidal selfinjury
• Participants will understand the risk factors of eating disorders and non-suicidal self-injury.
• Participants will learn the similarities between eating disorders and non-suicidal self-injury.
T87
The NOURISHED study (Nice Outcomes for Referrals with Impulsivity, Self Harm and
Eating Disorders): a pilot RCT of Mentalization Based Therapy for Eating Disorders (MBTED) against Specialist Supportive Clinical Management for Eating Disorders (SSCM-ED):
Paul Robinson, MD, MA, University College London, London, England, United Kingdom (Great Britain)
Alexandra Bogaardt, MSc, Barnet Enfield and Haringey Mental Health Trust, London, England, United
Kingdom (Great Britain); Jennifer Hellier, MSc, Kings College London, London, England, United
Kingdom (Great Britain); Ajay Clare, MSc, Barnet Enfield and Haringey Mental Health Trust, London,
England, United Kingdom (Great Britain)
The NOURISHED (Nice Outcomes for Referrals with Impulsivity, Self Harm and Eating Disorders) is the
first Randomised Controlled Trial of a modification of Mentalization Based Therapy (MBT) specifically for
Eating Disorders (MBT-ED) against a standard treatment SSCM, also modified for all eating disorders
(SSCM-ED). The study was held over 4 years in 3 sites in the UK. Results of the RCT and due to be
released at the end of 2014. This presentation focuses on the process of mounting the trial. Recruitment
of study sites was challenging, with several units agreeing to participate and then withdrawing. Training
of therapists and supervisors in MBT was also difficult but was achieved. Training and recruitment of
patients to the study took longer than expected, and the final number of patients recruited was less than
hoped for. Nevertheless, 2 new types of therapy for eating disorders complicated by borderline features
were developed. Initial assessment results showed that the patients were severely unwell, almost all
fulfilling DSN IV criteria for BPD, and, hence difficult to treat. The experience of obtaining funding for
and running the project will be useful for clinicians and scientists aiming to mount a similar trial. In this
presentation the obstacles to mounting the study, and how they were overcome will be described. The
study is presented as a Pilot and Feasibility study which will inform the design of a definitive RCT
comparing the two therapies. Details of the therapies will also be provided.
Learning Objectives:
• To appreciate the challenges in mounting a large Randomised Controlled Trial in patients with
eating disorder complicated by borderline PD features.
• To design a study in which the difficulties encountered in the Pilot can be overcome
• To learn about two new therapies for eating disorders
T88
Training and effectiveness of Guided Self-help CBT for Bulimia Nervosa: a Preliminary
Study in Chiba Improving Access to Psychological Therapists (iapt) Project
Michiko Nakazato, MD, PhD, FAED, Chiba University Graduate School of Medicine, Chiba, Japan;
Rikukage Setsu, MD, Chiba University Graduate School of Medicine, Chiba, Japan; Kenichi Asano, PhD,
Chiba University Graduate School of Medicine, Chiba, Japan; Noriko Numata, MA, Chiba University
Graduate School of Medicine, Chiba, Japan; Mari Tanaka, BA, Chiba University Graduate School of
Medicine, Chiba, Japan; Hanae Ibuki, BA, Chiba University Graduate School of Medicine, Chiba, Japan;
Yoshiyuki Hirano, PhD, Chiba University Graduate School of Medicine, Chiba, Japan; Masaomi Iyo,
MD, PhD, Chiba University Graduate School of Medicine, Chiba, Japan; Eiji Shimizu, MD, PhD, Chiba
University Graduate School of Medicine, Chiba, Japan
This study aims to investigate the implementation and dissemination of a CBT training course for
clinicians in Chiba, to show the effectiveness of CBT with Getting Better Bite by Bite (GBBB) (Schmidt &
Treasure, 1993) in Japanese version. Chiba CBT Training Course is a Japanese adaptation of the
Improving Access to Psychological Therapies Project and the first post-qualification CBT training course
in Japan. Since 2010, Chiba CBT training course has been set up in order to enhance the therapeutic
skills required for CBT for eating disorders (Eds). The training course has been open to clinicians
regardless of their profession, and it was inspired and influenced by the Improving Access to
Psychological Therapies (IAPT) in UK. Our training course so far has treated more than 100 patients with
anxiety disorders or EDs. For the training of CB therapists, we provide evidence-based guided self-help
CBT (gsh CBT) programme for BN (Schmidt et al, 2007). CBT was delivered by trainees in the CBT
training program. As a course requirement, they attended 60-minute weekly group supervision sessions
and 30-minute fortnightly individual supervision sessions so that both supervisors and other trainees
could support and assist them in planning future sessions. Supervisors also checked the quality of
trainees’ CBT on the basis of the Cognitive Therapy Scale-Revised. The primary outcome measure for
BN was self-reported bulimic symptoms, as measured by the Severity Scale of the Bulimic Inventory Test,
Edinburgh (BITE-SS; Henderson et al., 1987). Patients were recruited by clinical referrals from both
Chiba University Hospital and other local psychiatric hospitals/clinics. Written informed consent was
obtained from all participants. Our CBT program for BN was based on Maudsley’s model, Getting Better
Bite by Bite (Schmidt & Treasure, 1993). The primary outcome measure was the severity score of the
BITE-SS. The average BITE-SS score significantly decreased throughout the course of the study. The
results demonstrated that gshCBT delivered by the trainees could lead to significant reductions in bulimic
symptom severity in BN.
Learning Objectives:
• describe the implementation and dissemination of a CBT training course for eating disorders
• investigate the effectiveness of gsh CBT with Getting Better Bite by Bite (GBBB) in Japan
• discuss about how to improve clinician's skills in CBT training course
T89
Stronger Than Ever Before: A Qualitative Study of Posttraumatic Growth Through Eating
Disorder Recovery
Emily S. Rogers, MA, BA, The University of Pennsylvania, Philadelphia, Pennsylvania, USA; Jennifer B.
Webb, PhD, MA, BA, University of North Carolina, Charlotte, Charlotte, North Carolina, USA; Suman A.
Ambwani, PhD, MA, BA, Dickinson College, Carlisle, Pennsylvania, USA
The eating disorder (ED) treatment and research communities are plagued by hopelessness due to poor
prognoses and treatment outcomes for those with EDs. The present qualitative study sought to explore
potential positive ED outcomes by investigating the possibility of transformative psychological growth
(Posttraumatic Growth; PTG) resulting from experience and recovery from an ED. Purposive sampling
was used to recruit a sample of women in recovery from EDs who reported having experienced growth
subsequent to their illness recovery (N = 10). Participants engaged in semi-structured qualitative
interviews documenting their illness and recovery experiences. Interviews were transcribed verbatim and
analyzed using Interpretive Phenomenological Analysis. Strategies to enhance rigor were employed
including the use of multiple coders. Analyses revealed three superordinate themes that captured
participants’ descriptions of growth through recovery: New Relationship to the Self, New View of Life, and
Interpersonal Growth. Among the most richly supported subthemes were participants’ descriptions of
strengthened identity, increased personal strength, newfound perspective, and greater empathy.
Participants reported that recovering from their EDs contributed to strong connections with themselves,
others, and the world, which they had always lacked. In this way, feelings of awareness, engagement, and
gratitude represented PTG, or, growth above and beyond what the women had been able to achieve prior
to their illness. This novel application of a PTG framework to ED recovery bridges ED Recovery
Movement research and traditional PTG research, strengthening each separate body of literature. The
results offer an important starting point toward documenting the potential for growth and long-lasting
recovery and thereby enhancing hope among those part of the ED treatment community.
Learning Objectives:
• Understand the shared theoretical foundations of Posttraumatic Growth research and Recovery
Movement research
• Describe the empirical findings from a preliminary investigation of Posttraumatic Growth
through Eating Disorder recovery
• Describe the potential benefits of broadening the conversation about ED recovery to include the
possibility for meaningful growth
T90
Bright Light Therapy for the Treatment of Night Eating Syndrome
Ashley McCune, MA, University of Missouri-Kansas City, Kansas City, Missouri, USA
The purpose of this study was to examine the effect of an open label bright light therapy (BLT)
intervention on night eating behaviors as well as secondary outcomes of mood and sleep quality. It was
hypothesized that night eating symptoms, depression, and sleep would significantly improve over the
course measurement. A total of 15 participants completed the 14-day trial of BLT. The average age was
42.2 years (SD = 15.03). Participants completed an average of 13.4 days of light therapy with an average
duration of light therapy of 60.08 minutes per day. On average, participants had been struggling with
night eating behaviors for13.73 years (SD = 14.12). Within this sample, 66.7% of participants met full
threshold criteria for NES and 33.3% met sub-threshold criteria. Results showed statistically significant
reductions in mean scores on measures assessing night eating symptoms (NESS), depression (BDI), and
sleep (ISI). NESS scores decreased on average 9.47 points. Mean BDI scores decreased an average of
9.60 points and mean ISI scores decreased 5.40 points. In addition, participants reported a 47%
reduction of weekly nocturnal ingestions (t = 2.68, p = .02) from pre- to post-treatment, decreasing from
an average from 3.47 times per week before treatment to 1.83 times per week after treatment. This study
was one of the first steps in advancing the chronobiological treatment literature by testing the efficacy of
bright light therapy to improve symptoms of night eating syndrome.
Learning Objectives:
• Describe the role of bright light therapy in the treatment of night eating syndrome
• Describe Night Eating Syndrome
• Describe circadian rhythm in relation to night eating syndrome
T91
Crossing the Finish Line: A Narrative Inquiry into the Role of Exercise in Treatment and
Recovery of Anorexia Nervosa
Sarah Young, DClinPsy, University of Sydney- Doctor of Clinical Psychology/PhD candidate, Sydney,
New South Wales, Australia; Paul Rhodes, PhD, MPsych, University of Sydney, Sydney, New South
Wales, Australia; Stephen Touyz, PhD, MPsych, FAED, University of Sydney, Sydney, New South Wales,
Australia; Phillipa Hay, PhD, MBBS, FAED, University of Western Sydney, Sydney, New South Wales,
Australia
The current study explored the role of exercise in the treatment and recovery process of Anorexia Nervosa
(AN). 24 female participants completed the study: 10 women currently in treatment for AN; 7 partially
recovered and 7 fully recovered, according to strict criteria. Participants undertook a structured interview
assessing eating disorder psychopathology and a semi-structured interview where they were invited to
share their story of their illness, with a focus on exercise. They also completed a self-report questionnaire,
the Compulsive Exercise Test. Narrative inquiry analyses revealed exercise can be a significant part of the
individual’s life in various stages - premorbidly, during the illness, in treatment and recovery processes.
Analyses demonstrated important themes including: rapid transformation into compulsive exercise
during AN; importance of containment processes during treatment; appropriate limit setting and
accountability in early stages of recovery; and the resumption of healthy exercise in full recovery. Results
were developed into a model of exercise depicting these themes. The Compulsive Exercise Test results
were used to triangulate the qualitative findings. Clinical implications to support re-integrating healthy
exercise in treatment include the use of psycho-education and structured exercise interventions in
treatment services. The findings emphasize the need for further clinical guidelines to ensure consistency
in management of compulsive exercise in AN patients. Ongoing interpersonal and therapeutic support is
also required for patients to re-establish healthy exercise in recovery.
Learning Objectives:
• Describe the current conceptualisation of compulsive exercise in the development and
maintenance of eating disorders
• Discuss the role of exercise within treatment and recovery processes of anorexia nervosa,
informed by qualitative and quantitative methodology
• Examine the clinical implications and significance of re-establishing healthy exercise in recovery
from anorexia nervosa
T92
Feasibility, Acceptability, and Preliminary Efficacy of an Acceptance-Based Behavioral
Group Treatment for Binge Eating Disorder
Adrienne Juarascio, PhD, Drexel University, Philadelphia, Pennsylvania, USA; Stephanie Manasse, MS,
Drexel University, Philadelphia, Pennsylvania, USA; Hallie Espel, BS, Drexel University, Philadelphia,
Pennsylvania, USA; Leah Schumacher, BS, Drexel University, Philadelphia, Pennsylvania, USA;
Stephanie Kerrigan, BA, Drexel University, Philadelphia, Pennsylvania, USA; Evan Forman, PhD,
Drexel University, Philadelphia, Pennsylvania, USA
The goal of the current study is to examine the feasibility and acceptability of an group Acceptance-based
Behavioral Treatment (ABBT) for binge eating disorder (BED) in a small open trial and to assess
preliminary outcomes. Additional data collection is ongoing. Participants (n=14, projected n=20) were all
women between the ages of 20-59 (M=29.93, SD= 8.26), with an average BMI of 35.58 (SD=13.51).
Participants reported high acceptability of the treatment program both on self-report measures (M=3.91
out of 5.00; SD=0.83) and in post-treatment interviews, and post-treatment retention rates were high at
85.7%. During the ten-week group treatment program, participants showed very large reductions in binge
episodes (baseline mean binge episodes per month: 23.16, SD=6.49, post-treatment: 4.33, SD=8.60;
t(11)=7.27, p<.01, d=2.10) and depression as measured by the Beck Depression Inventory-II (baseline
BDI=18.16, SD=11.74, post-treatment BDI=10.50, SD=12.81, t(11)=3.59, p<.01, d=1.05) and trended
towards increases in quality of life (baseline QOLI: -0.52, SD= 0.66, post treatment QOLI= 1.06,
SD=0.59, t(11)=-1.82, p<.01, d=-.64). Participants additionally demonstrated decreases in psychological
inflexibility as measured by the Acceptance and Action Questionnaire (baseline AAQ= 30.58, SD= 9.61,
post-treatment AAQ= 24.50, SD=10.59, t(11)=2.22, p<.05, d=.64), increases in emotional clarity as
measured by the Difficulties in Emotion Regulation Scale (baseline DERS Clarity= 13.75, SD= 2.00, posttreatment DERS Clarity= 16.41, SD=4.48, t(11)=-2.27, p<.05, d=-.66) and trended towards an improved
ability to obtain psychological distance from distressing internal experiences as measured by the Drexel
Defusion Scale (baseline DDS= 22.63, SD= 8.54, post-treatment DDS= 30.36, SD=9.17, t(11)=-1.81, p<.10,
d=-.52). Preliminary results support the feasibility, acceptability, and efficacy of this novel treatment
approach and indicate that additional research on ABBT for BED is warranted.
Learning Objectives:
• Describe how an acceptance-based behavioral treatment program could be applied to binge eating
disorder
• Report on the feasibility and acceptability of a group acceptance-based behavioral treatment for
adults with binge eating disorder
• Describe the preliminary efficacy of the acceptance-based behavioral treatment program
T93
Mothers with Eating Disorders' Experiences of Feeding Their Children
Katherine Kalinowski, MSc, BA, City University, London, United Kingdom (Great Britain); David
Viljoen, CPsychol, MSc, MSc, BA, Hertfordshire Partnership University Foundation NHS Trust, Welwyn
Garden City, Hertfordshire, United Kingdom (Great Britain); Fran Smith, DPsych, City University,
London, United Kingdom (Great Britain)
According to existing literature, mothers with eating disorders report feeling guilty, depressed and
anxious, as a result of their disorder and its effect on their ability to parent. They express a variety of
difficulties in feeding their children, the most common being the needs of their child conflicting with the
desires of the eating disorder. The children of mothers with eating disorders are considered an ‘at risk’
group for feeding disorders, developmental disturbances and the eventual development of eating
disorders themselves. Previous research has attributed this to both the child’s internalization of the
mother’s eating behaviour and the child’s reaction to the mother’s distress regarding food, shape and
weight. The purpose of this study was to address a gap in the literature and explore mothers with eating
disorders’ subjective experiences of feeding their children. Eight participants were interviewed using
qualitative methods. The interviews captured the essences of the mothers’ experiences of feeding their
children, while the semi-structured nature allowed for a flexible exploration. The data was transcribed
verbatim and analysed according to the principles of Interpretive Phenomenological Analysis. One
overarching theme was identified across all participants, namely, a ’conflict between the eating disorder
and the role of parenting'. In addition, four constituent themes emerged: 'guilt regarding the interaction
of the eating disorder and the children'; 'either extremely rigid or none existent boundaries between the
eating disorder, mother and child'; 'contradictory parenting regarding the ability to act as a role model
while having double standards'; and 'the fear of transgenerational transmission of the eating disorder'.
Each of these themes had two sub-themes that expressed in further detail the mothers’ understanding of
their experiences. This study extended knowledge in the field and highlighted the importance of
addressing the additional parenting complexities that mothers with eating disorders face. The findings
concur with the literature and suggest that feeding your children, as a mother with an eating disorder, is a
significant and challenging phenomenon. Recommendations were made for treatment advances and areas
for further research were highlighted.
Learning Objectives:
• Describe the issues for mothers with eating disorders pertaining to the complexities of feeding
their children.
• Reflect on the complexities that mothers with eating disorders face when feeding their children
and the implications for clinical practice during assessment and treatment.
• Reflect on the implications for further research.
T94
Meanings of Body Image in Patients who have been Discharged from a Psychological
Treatment for Eating Disorders
Claudia Cruzat-Mandich, PhD, MA, MA, BA, Universidad Adolfo Ibáñez, Santiago, Región
Metropolitana, Chile; Constance Haemmerli Delucchi, MA, BA, Universidad del Desarrollo, Santiago,
Región Metropolitana, Chile; Fernanda Díaz Castrillón, MA, BA, Universidad Adolfo Ibáñez, Santiago,
Región Metropolitana, Chile
The diagnostic criterion of distortion of body image in eating disorders has been in review in the last time.
We have considered that what is relevant in this kind of disorders are the attitudes toward the image
and/or the level of concern that these patients have regarding to this. This research aims to know the
meanings that women, who completed their psychological treatment, after suffering from an eating
disorder, have about their body image. Qualitative methodology, with an exploratory, descriptive and
relational design was used. 4 (3 Chilean and 1 Spanish) in-depth interviews were conducted and the data
analysis was based on the cases raised by the Grounded Theory. The results show that the body ceases to
be a centerpiece in their lives, now they aspire to have a healthy body and modify his conception of
beauty. They feel that healthy eating is the one that nourishes the body and beauty would be more related
to their personality and health, and not only with their body and thinness. These changes involve the
achievement of body-mind integration, the feeling of a light body, without conflicts, and an acceptance of
their body image. The body becomes an ally that is appreciated and cared. These findings suggest the need
to investigate differently the different components of the body image and the way in which these patients
experience their body; these could contribute to the treatment and prevention of future relapses.
Learning Objectives:
• Following the training, participants will be able to know the meanings that women with ED (who
completed their psychological treatment) have about their body image.
• Following the training, participants will be able to understand the relevance to investigate
differently the components of the body image and the way in which these patients experience
their body because these could contribute to the treatment and prevent
• Following the training, participants will be able to understand that the relevance in this kind of
disorders are the attitudes toward the image and/or the level of concern that these patients have
regarding to this.
Poster Session II
Friday, April 24, 2015
6:15 – 7:45 p.m.
BED & Obesity
F1
Uncontrolled Eating, Not Cognitive Restraint, is Associated with Severe Obesity
Grace Kennedy, BA, Boston Children's Hospital, Boston, Massachusetts, USA; Tracy Richmond, MD,
MPH, Boston Children's Hospital, Boston, Massachusetts, USA; Stavroula Osganian, MD, ScD, Boston
Children's Hospital, Boston, Massachusetts, USA; Henry Feldman, PhD, Boston Children's Hospital,
Boston, Massachusetts, USA; Jennifer Cheng, MD, MPH, Boston Children's Hospital, Boston,
Massachusetts, USA; Sarahde Ferranti, MD, MPH, Boston Children's Hospital, Boston, Massachusetts,
USA; Nirav Desai, MD, Boston Children's Hospital, Boston Children's, Massachusetts, USA; Kendrin
Sonneville, ScD, RD, University of Michigan at Ann Arbor, Ann Arbor, Michigan, USA
Both cognitive restraint and uncontrolled eating have been linked to weight gain, yet little is known about
how these constructs present in adolescents with severe obesity (BMI >/120% of 95th percentile for age
and sex when younger than 18 years old or BMI>/35 when 18 years or older) compared to those who are
overweight or non-severely obese. Restraint theory posits that people who restrict food intake may
actually experience weight gain due to a cycle of restrained and disinhibited eating. We sought to examine
the association between cognitive restraint (i.e. purposely restricting food consumption for weight loss)
and uncontrolled eating (e.g. eating in the absence of hunger, loss of control when eating) with weight
status category (overweight/[non-severe] obese/ severely obese) in a group of overweight to severely
obese youth. The Three Factor Eating Questionnaire-18 (TFEQ-18) was used to assess cognitive restraint
and uncontrolled eating. Participants were 55 overweight/obese youth (24% Non-Hispanic White, 38%
African-American, 19% Latino/a, and 19% Multi-racial) ages 13-26 (mean: 17.9 SD: 3.2) years enrolled in
the POOL Research Registry at Boston Children’s Hospital. We used logistic regression adjusted for age,
gender, and race/ethnicity to examine the association between cognitive restraint and uncontrolled eating
with weight status category. In separate unadjusted models, neither cognitive restraint (p= 0.72) nor
uncontrolled eating (p=0.06) were significantly associated with weight status category. When cognitive
restraint and uncontrolled eating were modeled simultaneously in a fully adjusted model, uncontrolled
eating (OR: 1.16, 95% CI: 1.01-1.32) but not cognitive restraint (OR: 0.99, 95% CI: 0.82-1.20) was
associated with severe obesity. Findings suggest that uncontrolled eating, but not cognitive restraint, may
increase risk for severe obesity.
Learning Objectives:
• Describe the association of cognitive restraint with weight status category (overweight/ [nonsevere] obese/ severely obese).
• Describe the association of uncontrolled eating with weight status category (overweight/ [nonsevere] obese/ severely obese).
• Describe the association of cognitive restraint and uncontrolled eating with weight status category
(overweight/ [non-severe] obese/ severely obese).
F2
Bone Health in Bulimia Nervosa: The Effect of Weight Suppression
Melissa Riegel, BA, New York State Psychiatric Institute at Columbia University Medical Center, New
York, New York, USA; Alexandra McGlade, BA, New York State Psychiatric Institute at Columbia
University Medical Center, New York, New York, USA; Jenny Gilbert, BA, Department of Psychology at
Drexel University, Philadelphia, Pennsylvania, USA; Adi Cohen, MD, Columbia University Medical
Center, New York, New York, USA; Amanda Brown, PhD, New York State Psychiatric Institute at
Columbia University Medical Center, New York, New York, USA; Michael Lowe, PhD, FAED,
Department of Psychology at Drexel University, Philadelphia, Pennsylvania, USA; Laurel Mayer, MD,
FAED, New York State Psychiatric Institute at Columbia University Medical Center, New York, New
York, USA
Jennifer Thomas 2/19/15 11:17 PM
Comment [3]: I have Alexandra McGlade as the first author. Did the authors request this change in authorship order? Poster Session II – Friday, April 24, 6:15 pm to 7:45 pm Background: Poor bone health secondary to significant weight loss, nutritional deficiencies, and
menstrual irregularities is a well-known complication of Anorexia Nervosa. Despite the potential presence
of nutritional deficiencies and menstrual irregularities in women with Bulimia Nervosa (BN), bone health
has not been well characterized in this population. Additionally, the impact of significant weight loss is of
current interest in BN, as it has been associated with increased severity of symptoms and outcome. This
study aimed to examine the effect of significant weight loss, defined as weight suppression (WS), on bone
health in women with BN.
Methods: Participants were 27 women with BN, aged 18 - 43 years. WS was defined as the difference
between lifetime highest weight and current weight, and participants were divided into two groups: Low
WS (10 lbs or less; n=12) and high WS (20 lbs or more; n=15). Total body, lumbar spine, right hip and
right forearm bone mineral density (BMD) were measured by dual-energy x-ray absorptiometry. Groups
were compared using independent samples t-test (SPSS, v.21.0).
Results: The low and high WS groups were of similar age (28±9 vs.23+5 yrs, p=ns), BMI (24.9±5.0 vs.
22.2 ± 3.0 kg/m2, p=ns), and binge-purge frequency (5.8±5.1 vs.5.2±5.7 times per week, p=ns). Mean
duration of illness was possibly higher (p=0.08) in low (12.5±8.8 yrs) compared to high WS (7.3+4.9 yrs)
group. Mean weight suppression was significantly different between the groups (4.2±3.7 lbs vs
43.3+39.1lbs, p=0.002). All participants were menstruating regularly, with the exception of one in the
high WS group who reported irregular periods.
Neither total body nor regional BMD was significantly different between the low and high WS groups:
total body:1.1±0.08 g/cm2 vs 1.1±0.10 g/cm2, p=0.66, lumbar spine: 1.03 ± 0.14 g/cm2 vs 1.0 ± 0.12
g/cm2, p=0.51, right hip: 0.9 ± 0.09 g/cm2 vs 1.0 ± 0.14 g/cm2, p=0.58, and forearm: 0.6 ± 0.07 g/cm2
vs 0.6 ± 0.04 g/cm2, p=0.33.
Conclusions: In this preliminary sample, weight suppression does not appear to impact BMD in women
with BN.
Learning Objectives:
•
•
•
Learn more about bone health in patients with bulimia nervosa
Assess the role of weight suppression level on bone health
Compare differences in bone health between patients with bulimia nervosa and anorexia nervosa
F3
Role of Cognitive-Affective Vunrabilities in Binge Eating Disorder
Lilya Sitnikov, PhD, Stanford University, Stanford, California, USA; Kelly Rohan, PhD, University of
Vermont, Burlington, Vermont, USA
The current study investigated cognitive-affective vulnerabilities that may be implicated in the
maintenance of Binge Eating (BE) in Binge Eating Disorder (BED): brooding rumination, distress
tolerance, and mood-related expectancies for eating. The study aimed to compare women meeting DSM-5
criteria for BED as established by the Eating Disorder Examination (EDE) vs. controls and examine facets
of emotion regulation in relation to markers of current BE severity among women with BED. Participants
were 38 women with BED and 36 age- and weight-matched female controls (M age = 24.7, SD = 10.2; M
BMI = 25.9, SD = 4.8). Measures assessing emotion regulation included the Ruminative Response ScaleBrooding Rumination (RSS-B), the Distress Tolerance Scale (DTS), the Difficulties with Emotion
Regulation Scale (DERS), and the Eating Expectancies Inventory-Negative Affect Scale (EEI-NA). BE
severity was assessed with the Binge Eating Scale (BES), the Eating Disorder Examination Questionnaire
(EDE-Q), and the Emotional Eating Scale (EES). As expected, women with BED endorsed higher
brooding rumination, more positive expectancies that eating serves to ameliorate negative affect, had
lower distress tolerance, and displayed greater difficulties with emotion regulation than controls (p <
.05). Regression models were used to examine RRS-B, DTS, and EEI-NA scores (entered as a block) as
Jennifer Thomas 2/20/15 12:01 AM
Comment [4]: The formatting is different on this one – can you update to be consistent with the others? predictors of binge eating severity, frequency, and emotional eating. Only RSS-B scores were associated
with greater binge eating severity (b = .40, t (33) = 2.47, p <.05) whereas expectancies that eating reduces
negative affect were associated with more frequent BE episodes and (b = 1.84, t (34) = 2.05, p = .05) and
greater urge to eat in response to depression (b = 1.35, t (34) = 2.87, p<.01). Surprisingly, better distress
tolerance was also associated with more frequent BE episodes in women with BED (b = 3.76, t (34) = 2.51,
p<.01). Findings highlight the importance of considering trans-diagnostic processes in BED as well as
assessing and addressing emotion dysregulation as part of BED treatment.
Learning Objectives:
• To examine group differences in proposed cognitive and affective vulnerability processes between
individuals with BED and non-eating disordered control participants
• Test if women with BED score higher on measures of emotion dysregulation, ruminative
brooding, distress tolerance (i.e., demonstrate lower distress tolerance), and perceive themselves
as having fewer strategies to cope with negative mood relative to non-e
• To examine the relationships between cognitive and affective processes and binge eating severity
among BED individuals.
F4
CBT for Binge Eating Disorder: What We Communicate About Weight Control Matters
Michele M. Laliberte, PhD, St. Joseph's Healthcare & McMaster University, Hamilton, Ontario, Canada;
Amrita Ghai, MA, St. Joseph's Healthcare, Hamilton, Ontario, Canada; Laura Davis, RD, St. Joseph's
Healthcare, Hamilton, Ontario, Canada
Evidence-based psychoeducation about weight control has always been a pivotal part of CBT for eating
disorders. With the growing interest in treating patients with binge eating disorder (BED), the “nondieting” stance that had traditionally characterized the eating disorder field came under question. Weight
loss was seen as a desirable goal in the treatment of patients with BED, the majority of who are obese.
Building upon a small body of research looking at the role of weight control beliefs, this study examines
the impact of CBT treatment on weight control beliefs, and the relationship of weight control beliefs on
treatment outcome variables. Sixty-two individuals referred to a hospital-based outpatient eating
disorders program and diagnosed with BED, participated in this study. All participants completed a 25week, group-based CBT treatment program for eating disorders. Two weight control beliefs were
measured pre- and post- treatment: 1) the belief that one can and should control one’s weight; and 2) the
belief in striving for a healthy lifestyle and accepting one’s “natural” weight. Also measured were
treatment outcome variables of interest. Results suggest that treatment significantly influenced patients’
weight control beliefs and that change in these beliefs was associated with an improvement in outcome
variables such as body image, depression, self-esteem, drive for thinness and bulimia. For patients who
recovered from their eating disorder, the relationship between weight control beliefs and depression, body
image and self-esteem was highly significant. These findings suggest that what we communicate in
treatment about weight control may have significant implications for treatment outcome.
Learning Objectives:
• Describe distinctions between various weight control beliefs
• Assess the relationship between weight control beliefs and symptoms of disordered eating, body
image dissatisfaction, and depressed mood
• Appreciate how communication about weight control beliefs may impact eating disorder
treatment outcome
F5
Cognitive-Affective Vulnerabilities, Sad Mood, and Caloric Intake in Women with BED
Lilya Osipov, PhD, FAED, Stanford University, Stanford, California, USA; Kelly Rohan, PhD, University
of Vermont, Burlington, Vermont, USA
Theoretical accounts of Binge Eating Disorder (BED) functionally link negative affect and binge eating,
yet empirical studies yield mixed findings. The current study investigated cognitive-affective vulnerability
processes that may a) increase re-activity to or intensify transient sad mood; and/or b) interfere with use
of adaptive emotion regulation strategies thus facilitating binge eating in response to dysphoric mood in
women with BED who display these vulnerabilities. Brooding rumination, distress tolerance, and moodrelated expectancies for eating were examined as predictors of caloric intake, guilt, and loss of control
(LOC) in response to a personally-relevant dysphoric mood induction in 38 women meeting DSM-5
criteria for BED and 36 female controls (M age = 24.7, SD = 10.2; M BMI = 25.9, SD = 4.8). All
participants completed the Ruminative Response Scale-Brooding Rumination Subscale (RSS-B), the
Distress Tolerance Scale (DTS), and the Eating Expectancies Inventory-Negative Affect Scale (EEI-NA).
Sad mood, LOC, and guilt were rated on a visual analogue scale (VAS) at pre- post-sad mood induction,
and post-“taste task”. Overall, BED patients consumed more calories and reported greater LOC as well as
a greater sense of guilt in response to the taste task relative to control participants (p < .05). Neither RRSB nor DTS scores predicted pre- to post-mood induction change in sad mood (p < .05). Contrary to our
expectations, there were no direct, indirect, or interactive (i.e., RRS-B x EEI-NA or DTS x EEI-NA) effects
of any of the three cognitive-affective vulnerabilities on caloric consumption, LOC, or VAS guilt scores (p
> .5) for BED women. In controls, better distress tolerance and stronger expectancies that eating
alleviates negative affect were associated with decreased caloric intake on the taste task after mood
induction. Findings highlight the need to elucidate the relation between mood states and binge eating in
women with BED. Other theoretically-relevant factors that contribute to the cognitive and behavioral
features of BED are discussed.
Learning Objectives:
• To replicate and extend past findings on the association between experimentally- induced sad
mood and caloric consumption, perceived loss of control, and guilt ratings in women with BED
versus control participants
• Test whether brooding rumination and distress tolerance increase reactivity to sad mood
induction in terms of pre- to post-change in sad mood, which in turn leads to higher caloric
intake, loss of control, and/or guilt in in women with binge eating disord
• Evaluate main and interactive effects of brooding rumination, distress tolerance, and negative
reinforcement eating expectancies on caloric intake, loss of control, and guilt ratings of women
with BED who underwent a sad mood induction
F6
Preliminary Evaluation of Secretive Eating in a Population of Candidates Seeking Bariatric
Surgery
Leah Hecht, BA, Illinois Institute of Technology, Chicago, Illinois, USA; Andrea E. Kass, MA, The
University of Chicago, Chicago, Illinois, USA; Lindsay Sycz, MA, Roosevelt University, Chicago, Illinois,
USA; Kristen Anderson, MA, The University of Chicago, Chicago, Illinois, USA; Sara Desai, MA, The
University of Chicago, Chicago, Illinois, USA; Andrea Goldschmidt, PhD, The University of Chicago,
Chicago, Illinois, USA
Disordered eating behaviors, including binge eating, are common in patients undergoing bariatric surgery
and may be associated with poorer weight loss success following surgery. Secretive eating (SE), which
involves hiding eating from others, is often associated with binge eating; however, this behavior has not
been studied in patients seeking bariatric surgery. Given that weight-related stigmatization is commonly
experienced by severely obese patients undergoing weight loss surgery, a better understanding of the
prevalence and correlates of SE in bariatric populations is needed. Thus, this study aims to conduct a
preliminary examination of SE and its relation to eating disorder symptoms and comorbid pathology in a
sample of individuals seeking bariatric surgery. Data were drawn from 26 morbidly obese adults
presenting to a multidisciplinary weight loss surgery clinic. Objectively measured height and weight were
used to calculate body mass index (BMI). Participants also completed the Eating Disorder Examination
Questionnaire, Beck Depression Inventory-II, and the Rosenberg Self-Esteem Scale. Chi-square and t-test
analyses were used to evaluate differences between those who did and did not endorse SE. Seven
participants (27%) reported engaging in SE over the previous 28 days. Compared to those who did not
endorse SE, those who endorsed SE had significantly higher eating concerns (p=0.035) and shape
concerns (p=0.034), but did not differ on dietary restraint, weight concerns, the presence of binge eating,
depressive symptoms, self-esteem, or BMI (ps>0.05). These preliminary results suggest SE may be
associated with the presence of body shame and shame around eating. Additional data, which are
currently being collected, may further clarify the nature of SE in adults seeking bariatric surgery.
Furthermore, future work to understand the function of SE and its impact on bariatric surgery outcomes
may inform intervention targets.
Learning Objectives:
• Describe the construct of secretive eating.
• Assess the relation between secretive eating and other adverse psychological factors among
individuals who are morbidly obese and seeking bariatric surgery.
• Discuss the implications of assessing secretive eating behaviors for their potential impact on
weight loss success following surgery.
F7
Reward Related Attentional Biases in Overweight, Obesity, and Binge Eating: The TRAILS
Study.
Nienke Jonker, MSc, University of Groningen, Groningen, Netherlands; Klaske Glashouwer, PhD,
University of Groningen, Groningen, Netherlands; Frédérique Smink, MD, MSc, Parnassia Psychiatric
Institute, The Hague, Zuid Holland, Netherlands; Hans Hoek, MD, PhD, University Medical Center
Groningen, Groningen, Netherlands; Peter de Jong, PhD, University of Groningen, Groningen,
Netherlands
Individual differences in sensitivity to reward have been linked to several externalizing behavioral
problems, and knowledge about the role of this trait in overeating might provide implications to improve
the currently available treatment options. Thus far, brain imaging and self-report studies have provided
inconclusive evidence about the potential role of reward sensitivity in overeating. However, often these
studies use BMI as outcome measure to indicate the degree of overeating. The present study tests the
hypothesis that general reward sensitivity is related to overeating (i.e., binge eating episodes) while this
may not be reflected in BMI due to other influencing factors that operate independently of reward
sensitivity. Participants (N=715) in the current study are a focus cohort of a large prospective population
study of Dutch adolescents (www.trails.nl). Data collection was part of the third (T3; Mage=15.9, SD=0.61)
and fourth (T4; Mage=18.7, SD=0.56) data wave. During the third wave participants performed a validated
spatial cueing task (Derryberry & Reed, 2002) which indexes automatic and voluntary, attentional
engagement and disengagement to reward related cues. Cues that signal reward will be more salient for
individuals who are sensitive to reward, and this task thus provides a good behavioral measure of reward
sensitivity. Additionally, BMI was measured on both T3 and T4 from which adjusted BMI’s were
calculated, and a dichotomous score of whether participants had binge eating episodes was available from
T4. Results show that attentional biases to cues that signal reward were indeed not related to BMI at
baseline, BMI three years later, or the change in BMI over three years. The power of the current study
allows us to conclude this with high certainty. Results with regard to the relationship between reward
related attentional bias and binge eating episodes have not yet been analyzed but will be discussed during
the conference.
Learning Objectives:
• describe the cognitive-motivational trait reward sensitivity.
• indicate what the relation between reward sensitivity and BMI and the relation between reward
sensitivity and binge eating episodes is.
• evaluate whether studying reward sensitivity in relation to overeating provides an opportunity to
potentially increase the effectiveness of treatments and/or may be a relevant focus for preventive
interventions.
F8
Eye Gaze Tracking Reveals Distinct Temporal Patterns of Attention to Food Images Among
Adults with and without Binge Eating
Kristin von Ranson, PhD, FAED, University of Calgary, Calgary, Alberta, Canada; Mallory Frayn,
Student, University of Calgary, Calgary, Alberta, Canada; Avery Popien, BA, University of Calgary,
Calgary, Alberta, Canada; Christopher R. Sears, PhD, University of Calgary, Calgary, Alberta, Canada
The purpose of this study was to investigate differences in attention to food between young adults with
binge eating (BE) episodes versus those without BE. We used an eye gaze tracking paradigm because it
provides a continuous measure of attention and greater external validity than other measures of
attentional bias. Although it has been established that those with anorexia nervosa and bulimia nervosa
show an attentional bias to food stimuli (Brooks et al., 2011), this study was the first to use eye tracking to
examine attentional patterns of non-clinical participants reporting BE alone. Participants’ eye fixations
were tracked and recorded throughout an 8-second presentation of a complex, real-world scene. There
were 125 scenes (e.g., kitchens, parties) that contained high-, low-calorie foods, both, or no food items.
High-calorie foods included high fat meats, sweet foods, and salty snack foods. Low-calorie foods included
salad, fruits, and vegetables. The sample consisted of 27 adults with self-reported past-month BE (82%
female; M age 21.6+3.4; M BMI 24.4+4.9) and 30 adults without BE (70% female; M age 21.7+2.2; M BMI
22.0+3.4), recruited from university and community populations. To lessen the risk of biasing
participants’ responses to eye-tracking, BE presence or absence was assessed following the completion of
eye-tracking data collection with responses to the Questionnaire on Eating and Weight Patterns Revised.
Data analysis involved mixed-model factorial analyses of variance. Overall, BE participants attended to
both high- and low-calorie food items more than controls throughout the 8-sec presentations.
Furthermore, the BE group sustained their attention to food items over time, unlike controls. The
attentional bias of the BE group suggests that individuals’ attention to food may reinforce the
maintenance of BE behavior; alternatively, it may reflect an existing bias toward food exhibited by people
who BE.
Learning Objectives:
• Describe the potential contributions of attentional research related to subthreshold eating
disorders.
• Appraise the utility of examining the time course of attention among those with versus without
binge eating when presented with food images.
• Assess the importance of high-calorie versus low-calories foods in distiguishing adults with binge
eating from those without binge eating.
F9
The Mindful Eating Cycle: Treatment for Binge Eating Disorder
Kari Anderson, LPC, MS, Green Mountain at Fox Run, Ludlow, Vermont, USA
Binge eating disorder is by far the most prevalent eating disorder, affecting nearly 3% of the general
public and 30% of obese individuals seeking treatment. Binge eating disorder results in major health
consequences including depression, obesity, and chronic disease which come with great personal and
economic cost. Binge eating disorder goes largely undetected due to the secrecy and shame attached to
the behavior. Unfortunately, binge eating disorder may not be differentiated from obesity and is subject to
traditional weight loss strategies, often further complicating its course. Although public health officials are
wary, treating the eating behavior from a non-restrictive approach may produce favorable long-term
results in the overall health of these individuals. Mindfulness-based treatments are effective with the
binge eating population due to their focus on self-regulatory processes. The researcher of this study
hypothesized that mindfulness-based treatment through a framework called The Mindful Eating Cycle
would not only target the eating behavior, but the motivation driving it. A 10-week treatment program
was designed and tested on thirty eight morbidly obese adult women with binge eating disorder.
Participants went from a range of severe binge eating to a non-bingeing level on the Binge Eating Scale.
Other significant improvements were found in levels of mindfulness, depression, anxiety, and dietary
choices. In a one year follow up, three respondents returned to severe binge eating. All three reported
participating in restrictive weight loss methods. Screening and referral programs in mental and primary
health care could shift the course of binge eating disorder.
Learning Objectives:
• List the six decision points in The Mindful Eating Cycle and describe how they intervene on binge
eating.
• Describe how to use principles of Self Determination Theory as a non-restrictive approach for
changing eating behavior.
• Identify mindfulness based therapeutic techniques that are easily integrated into clinical practice.
F10
Emotion Regulation Difficulties as a Predictor of Binge Eating Episodes: Further Support
for the Trans-diagnostic Theory of Eating Disorder Pathology
Kristen Henkel, BS, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Carey
Schwartz, MA, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Bryn Miller, BA,
Icahn School of Medicine at Mount Sinai, New York, New York, USA; Tom Hildebrandt, PsyD, FAED,
Icahn School of Medicine at Mount Sinai, New York, New York, USA
Binge Eating Disorder (BED) and Bulimia Nervosa (BN) share a core eating disturbance marked by
persistent objective binge eating episodes (OBEs). The presence of OBEs can be conceptualized as a transdiagnostic feature of eating pathology, although tests of the trans-diagnostic nature of this symptom
requires not just the expression of the symptom, but also equivalent links to theoretically driven
constructs across diagnoses. It has been previously theorized that difficulties in emotion regulation
predict binge eating episodes, particularly in BED and BN. The purpose of the current study is to identify
possible predictors of objective binge eating episodes in a diagnostically diverse sample of individuals who
report OBEs. The current study utilized baseline data from participants (N=49) enrolled in two
randomized control trials; 24 participants with BN and 25 participants with BED. Controlling for
diagnosis, gender, and scores of the Body Checking Questionnaire-Gender Neutral (BCQGN), a series of
Bayesian regression models identified Difficulties in Emotion Regulation Scale (DERS) score to be
predictive of average objective binge episodes over 3 months [β=0.198, (SD=0.116), p= 0.030, CI= -0.015,
0.460]. This relationship was robust across diagnostic categories with no evidence of significant
moderation. The results of the best fitting model suggest that binge eating is strongly related to difficulties
in emotion regulation and supports a model whereby binge eating offers a trans-diagnostic symptom set
uniquely tied to emotion regulation among treatment seeking binge eating populations. Implications for
the trans-diagnostic theory of eating disorders will be discussed
Learning Objectives:
• Identify possible predictors of objective binge eating episodes in individuals with Bulimia Nervosa
and Binge Eating Disorder
• Explain the role of emotion regulation difficulties in eating disorder pathology
• Describe the trans-diagnostic theory of eating disorders
Biology and Medical Complications
F11
Renal Injury in Pediatric Anorexia Nervosa: a Neglected but Real Matter of Concern.
Sebastien J. Bergeron, MD, Sainte-Justine University Hospital Center, Montreal, Quebec, Canada;
Chantal Stheneur, MD, PhD, Sainte-Justine University Hospital Center, Montreal, Quebec, Canada;
Anne-Laure Lapeyraque, MD, Sainte-Justine University Hospital Center, Montreal, Quebec, Canada;
Marc Sznajder, MD, Sainte-Justine University Hospital Center, Montreal, Quebec, Canada
Although somatic complications of anorexia nervosa (AN) have been well documented, little is known
about its renal effects which remain underestimated and rarely investigated, especially in the pediatric
population. In the literature, all formulas calculating the glomerular filtration rate (GFR) seem to
overestimate it in a malnourished population, Cockroft-Gault being the most reliable. The purpose of this
study was to evaluate the renal function of adolescent patients with AN, highlight factors affecting it and
compare formulas calculating the GFR. We conducted a monocentric retrospective study, reviewing the
files of all patients hospitalized in the course of their eating disorder in our milieu in 2013. We focused our
analysis on patients with the restrictive type of AN. Data were clustered into three categories: (1) medical
history of the eating disorder, (2) growth parameters and vital signs upon admission, (3) blood tests
including serum creatinine, urea and electrolytes levels. Cockroft-Gault, Schwartz and Mayo Clinical
Quadratic (MCQ) equations were used to calculate the GFR. Among the 51 patients, 45% had a GFR under
90 mL/min/1,73 m2 with Cockroft-Gault, 4% with Schwartz and 4% with MCQ. Linear regressions
showed a strong association linking the standard deviations (SD) of the minimal weight and the minimal
body mass index (BMI) to a lower GFR, whatever the formula. Furthermore, the lowest value of heart rate
in hospital was significantly associated with a lower GFR with Cockroft-Gault only. Dehydration was not
the sole factor responsible for the renal dysfunction, as GFR values on days 0 and 5 did not differ
significantly. We could not establish a significant relationship with age, duration of the disease, lowest
blood pressure in hospital and blood tests. That is, renal complications should be a medical concern in
anorexic adolescent patients, especially with very low minimal weight/BMI (both reported in SD) and
heart rate upon admission.
Learning Objectives:
• Determine the prevalence of renal injury in adolescent patients with anorexia nervosa, using
different formulas calculating the glomerular filtration rate.
• Identify factors associated to renal injury in this specific population.
• Recognize the importance of screening for renal injury in these patients and its limitations.
F12
A Double Blind, Randomized Pilot Trial of Chromium Picolinate for Binge Eating Disorder:
Effects on Glucose Regulation
Margarita Sala, BS, Southern Methodist University, Dallas, Texas, USA; Lauren Breithaupt, BS, George
Mason University, Fairfax, Virginia, USA; Robert M. Hamer, PhD, University of North Carolina at
Chapel Hill, Chapel Hill, North Carolina, USA; Cynthia M. Bulik, PhD, FAED, University of North
Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Maria La Via, MD, University of North
Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Kimberly A. Brownley, PhD, University of
North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
This study evaluated whether chromium picolinate (CrPic) supplementation improves glucose regulation
in binge eating disorder (BED). Overweight adults with BED were randomized to high (HIGH, 1000
mcg/day, n=8) or moderate (MOD, 600 mcg/day, n=9) dose of CrPic or placebo (PL, n=7) for 6 months.
Subjects completed an oral glucose tolerance test (OGTT) at baseline, 3 months, and 6 months. Nineteen
participants completed all study visits, with 17 having complete OGTT (5 HIGH, 7 MOD, 5PL). Fixed
effects models were used to estimate mean change in glucose area under the curve (AUC), insulinAUC, and
insulin sensitivity index (ISI). The analyses revealed a significant group X time interaction (p<0.04) for
glucoseAUC, which increased significantly in the PL group at 6 months (p<0.02) but decreased significantly
at 6 months in the MOD group (p<0.03). From baseline to 6 months, glucoseAUC increased 12.6% in the
PL group, decreased 10.1% in the MOD group, and increased 6.5% in the HIGH group. InsulinAUC
increased significantly over time (main effect, p<0.02). From baseline to 6 months, insulinAUC increased
58.0% in the PL group, increased 9.5% in the MOD group, and increased 32.9% in the HIGH group. ISI
decreased significantly over time (main effect, p<0.03); from baseline to 6 months, ISI decreased 42.6%
in the PL group, increased 13.6% in the MOD group, and decreased 24.1% in the HIGH group. As
anticipated, a moderate dose of CrPic was associated with improved glycemic control and placebo was
associated with decreased glycemic control. It was unexpected that the improved glycemic control seen in
the MOD group was not seen in the HIGH group. A possible explanation for this result is the limited
statistical power of this study due to a small number of subjects. Additional adequately powered studies
are warranted to evaluate CrPic supplementation for glycemic control in individuals with BED who are at
increased risk of metabolic disease.
Learning Objectives:
• Describe the comorbidity of binge eating disorder and metabolic disease
• Describe the role that chromium may play in glucose regulation in individuals with binge eating
disorder
• Describe some of the biomarkers for glucose regulation
F13
Composition and Diversity of the Intestinal Microbiota in Acute Anorexia Nervosa and
Changes During Refeeding: a Pilot Study
Susan Kleiman, BS, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA;
Hunna Watson, PhD, MPsych, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,
USA; Emily Bulik-Sullivan, Student, Kenyon College, Gambier, Ohio, USA; Eun Young Huh, MS, FAED,
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Lisa Tarantino, PhD,
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Cynthia Bulik, PhD,
FAED, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Ian Carroll, PhD,
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
The relevance of the gut-brain axis to psychopathology is of interest in anorexia nervosa (AN) patients, as
the intestinal microbiota plays a critical role in metabolic function and weight regulation. We
hypothesized that the composition and diversity of the intestinal microbiota would change during
hospital-based renourishment of patients with AN and that differences from healthy controls (HC) would
be evident. We characterized the composition and diversity of the intestinal microbiota in AN patients at
admission to the UNC Center of Excellence for Eating Disorders for inpatient treatment (PRE: <75%
IBW) (n=16) and in a subset at discharge (POST: ~85% IBW) (n=10). We compared PRE vs. POST
samples in AN patients, and both time points were compared to HC (n=15). The PRE stool sample was the
first produced after intake. The POST sample was collected upon achieving 85% IBW or at discharge. HC
were recruited from a previous study. Genomic DNA was isolated from stool samples, and bacterial
composition was characterized by 454 pyrosequencing of the 16S rRNA gene. Sequencing results were
processed by the Quantitative Insights Into Microbial Ecology pipeline. In AN patients, there were
significant global changes from PRE to POST in taxa abundance at the phyla and genus levels, as well as
in beta (between-sample) diversity, suggesting that refeeding has an impact on the intestinal microbiota.
During refeeding, there were significant decreases in abundance of the family Eubacteriaceae and genus
Oscillospira and a significant increase in abundance of Ruminococcus species, which support findings of
associations between microbial taxa and BMI. Substantial differences in abundance were also found
between AN patients and HC at all taxonomic levels. PRE and POST-treatment, AN patients had
significantly lower alpha (within-sample) diversity than HC, which is of note as a richer, more diverse
microbiota is associated with a healthy gut. Future studies will allow more detailed exploration into
association of microbial measures with metabolic changes during refeeding and biological indices of
recovery.
Learning Objectives:
• Describe the role of the intestinal microbiota in metabolic function and weight regulation.
• Discuss changes in composition/diversity of gut bacteria in AN patients over the course of
hospital-based refeeding.
• Explain how the composition/diversity of gut bacteria differs between healthy controls and AN
patients both before and after inpatient treatment.
F14
Electrocardiographic Changes in Patients with Anorexia Nervosa Restrictive Subtype
Antonio Baño-Rodrigo, Md, Phd, Hospital Infantil Universitario Niño Jesus, Madrid, Spain;
Eduardo Paolini-Ramos, Phd, Hospital Infantil Universitario Niño Jesus, Madrid, Spain; Montserrat
Graell Berna, Md, Phd, Faed, Hospital Infantil Universitario Niño Jesus, Madrid, Spain; Amalia
Tamariz-Martel, Md, Phd, Hospital Infantil Universitario Niño Jesus, Madrid, Spain; Patricia FrancoGonzalez, Phd, Hospital Infantil Universitario Niño Jesus, Madrid, Spain; Gonzalo Morande-Lavin, Md,
Phd, Faed, Hospital Infantil Universitario Niño Jesus, Madrid, Spain; Rebeca Espinosa-Gaubeca, Phd,
Universidad Nacional Autonoma De Mexico (Unam), D.F., Mexico
The purpose of the study was to evaluate changes in the electrocardiogram of adolescent females with
anorexia nervosa restrictive subtype. Electrocardiographic studies were performed in 124 female
patients with the diagnosis of anorexia nervosa restrictive subtype (ANR), with ages ranging from 9.4 to
28.8 years (15.5 ± 2.3; mean ± s.d.). All of them with body mass index (BMI) below 19 (15.2 ± 2 kg/m²). A
control group of 92 healthy adolescent males of same age (9.3 to 27.4 years; 15 ± 2.7 years), and normal
BMI (20.6 ± 2.3 kg/m²) was also studied. Evaluated measures were: Heart rate (HR); PR, QRS and QTc
(msec); P, QRS and T wave axis; and voltages of P wave (in lead II), and R wave in leads L, V1, V5 and V6.
Results showed that in ANR, the HR was significantly reduced compared to controls (p<0.001). Length of
PR, QRS and QTc were similar in both considered groups. R voltages in leads L, V1, V5 and V6 were
significantly diminished compared to controls (p<0.01). Twenty one (17%) patients showed nonspecific
abnormalities of repolarisation consisting in flattening or inversion of ST-T segment. It is concluded that
ANR produces significant changes in the electrocardiogram. Bradycardia, right QRS axis deviation, ST-T
abnormalities and low voltages are frequent findings, and statistically significant compared to control
electrocardiograms. These abnormalities should be followed up along the clinical course of the patient in
order to evaluate the severity of the process.
Learning Objectives:
•
•
•
Describe electrocardiographic alterations in anorexia nervosa
TO evaluate cardiac manifestations of anorexia nervosa
To identify comorbidity in anorexia nervosa
Body Image
F15
Evaluating The Dove Self Esteem Project Body Image Website For Parents: Results From A
Randomised Controlled Trial With Mother-Daughter Dyads
Phillippa Diedrichs, PhD, University of the West of England, Bristol, Avon, United Kingdom (Great
Britain); Kirsty Garbett, MSc, University of the West of England, Bristol, Avon, United Kingdom (Great
Britain); Melissa Atkinson, PhD, University of the West of England, Bristol, Avon, United Kingdom
(Great Britain); Fiona Kate Barlow, PhD, University of Queensland, Brisbane, Queensland, Australia;
Chris Sibley, PhD, University of Auckland, Auckland, New Zealand; Heidi Williamson, DPsych,
University of the West of England, Bristol, Avon, United Kingdom (Great Britain); Nichola Rumsey,
PhD, University of the West of England, Bristol, Avon, United Kingdom (Great Britain)
Parents are a key influence on adolescents’ girls body image and eating behaviours. The Dove Self Esteem
Project website (selfesteem.dove.co.uk) contains evidence-informed articles and interactive activities
designed to “arm parents with the right tools” to help their daughters foster positive body image. This
efficacy study aimed to evaluate the impact of mothers’ brief exposure to the website on a range of
outcomes for them and their daughters aged 11-13. Mother-daughter dyads (N=235 dyads) from nine
towns across the UK were randomised to 1 of 3 conditions; mothers viewed the website for 30 minutes in
a controlled setting either “as usual” (website condition) or by following a personalised pathway tailored
to their needs (tailored website condition), or mothers were not exposed to the website (control
condition). Mothers and daughters completed standardised self-report measures of body image and
associated risk factors at 2-weeks post-exposure and 6-weeks follow-up. Structural equation modelling
using path analyses, controlling for baseline scores, showed mothers in the tailored condition experienced
significant improvements in body image and were more likely to seek support for body image issues at
follow-up. Daughters whose mothers viewed the website “as-usual” or via a tailored pathway had
significantly higher self-esteem at follow-up, and daughters whose mothers viewed the website “as usual”
were more likely to seek additional support for eating problems and experienced reduced negative affect
at follow-up. There were no significant differences on body image among daughters at post or follow-up.
Overall, the website had excellent acceptability among mothers and tailoring the website content
appeared to increase mothers' engagement with the website. Results suggest that mothers’ brief exposure
to the website can result in significant improvements to their own body image and to their daughters’ selfesteem. In addition, the website prompts mothers and daughters to seek additional support for body
image or eating problems. The Dove Self Esteem Project Website appears to be a promising tool for
promoting positive body image and self-esteem among mothers and their daughters.
Learning Objectives:
• Describe the role of parents in influencing children’s body image and associated risk factors.
• Assess the effectiveness of a body image website for parents on outcomes for mothers and their
adolescent daughters.
• Identify the advantages and disadvantages of brief online body image interventions.
F16
The Moderation Effect Of Weight Influenced Self-Esteem On The Relationship Between
Body Mass Index And Eating Disorder Psychopathology
Ana Pinto Bastos, MSc, University of Minho, Braga, Portuga; Eva Conceição, PhD, University of Minho,
Braga, Portugal, Portugal; Ana Rita Vaz, PhD, University of Minho, Braga, Portugal; Paulo P.P.
Machado, PhD, FAED, University of Minho, Braga, Portugal
Self-esteem based on weight and body shape is a central characteristic for eating disorders (ED) diagnosis
but little is known about how the perception of weight moderates the relationship between weight and ED
psychopathology. This study aims to: 1) investigate the moderating effect of weight-influenced selfevaluation in the relationship between BMI and ED psychopathology; 2) provide psychometric properties
of The Weight Influenced Self-Esteem Questionnaire–WISE-Q for the Portuguese population. WISE-Q
measures the influence of weight and body shape negative perceptions in the multiple dimensions of selfesteem and generates 2 subscales: Expected subscale (measures the impact of weight gain in areas related,
such as appearance, self-control, physical shape); and Generalized subscale (measures its impact on not
weight related areas, such as performance, social/moral conduct and personality. A total of 884 students
recruited from university campus participated in this study and completed the WISE-Q and the Eating
Disorder Examination-Questionnaire – EDE-Q to assess ED symptoms. Moderation analysis showed that
the relationship between BMI and ED is stronger when moderated by WISE expected variable, i.e., the
higher the overall self-esteem influenced by perceptions of weight/body shape, the greater the impact of
the BMI on eating psychopathology, F(1,827)=8.15, R2=.01, p<.01. Our results demonstrated that WISEQ has good psychometric properties showing good internal consistency, for the global scale and subscales
(Cronbach’s alpha =.91–.98); good convergent validity with significant correlations between the WISE-Q
and EDE-Q scales. Our data suggest the importance of weight influenced self-esteem in understanding of
the relationship between BMI and ED psychopathology. WISE-Q showed to be good self-report measure
to evaluate the negative influence of weight and body shape perceptions in several dimensions of selfesteem on Portuguese students.
Learning Objectives:
• Describe the moderation effect of weight influenced self-esteem on the relationship between BMI
and eating disorder psychopathology
• Assess the importance of this questionnaire as self-report measure to evaluate the negative
influence of weight and body shape perceptions in multiple dimensions of self-esteem
• Understand the importance of this moderation analysis with the cognitive-behavioral model of
the eating disorders
F17
Body Image, Exercise Dependence And Drive For Muscularity In Bodybuilders And Sports
Men
Xochitl López Aguilar, PhD, Universidad Nacional Autónoma de México, Mexico, Mexico; Alma Diana
García Nava, Student, UNAM, Mexico, Mexico; Rosalia Vázquez Arévalo, PhD, UNAM-FES Iztacala,
Mexico, Mexico; Juan Manuel Mancilla Díaz, PhD, FAED, UNAM-FES Iztacala, Mexico, Mexico; Ma.
Trinidad Ocampo Téllez Girón, Student, UNAM-FES Iztacala, Mexico, Mexico
The aim of this study was to assess body shape, exercise dependence and drive for muscularity in men
Mexican with different sports. The sample consisted for 99 men, divided into three groups: weightliffers
or bodybuilders (n = 34, M of age= 27.57, SD = 6.63) , sports men (n = 30, M of age = 22.06, SD = 3.97)
and controls (n = 35, M of age= 22,074, SD = 4.04), with an age range of 17-39 years. Who responded to
a battery of questionnaires: Exercise Dependence Scale (EDS-21), Body Shape Questionnaire ( BSQ ) and
Drive for Muscularity (DMS). The results show that weightlifters group exceeded the cutoff point of DMS,
also showed significantly higher scores with respect to sports men and control group in the factors:
tolerante from EDS (F = 20.43, p ≤ .0001), promuscularity from BSQ (F = 5.16, p ≤ .001), muscleoriented activities (F = 17.45, p ≤ .0001) and muscle-oriented behaviors (F = 53, p ≤ .0001) from DMS
and influence of the muscular figure from CIMEC (F = 17.72, p ≤ .001). In time factor from EDS, the
group of sports men showed significantly higher scores than the other groups. We conclude that
weightlifters men have more symptoms of muscle dysmorphia and athletes exercise more behavior
exercise dependence (Grant sponsor: PAPIIT IN3095912-3).
Learning Objectives:
• Assess body shape, exercise dependence and drive for muscularity in men Mexican with different
sports
• Describe the differences between athletes and bodybuilders
• Evaluate the assimilation model musculature in males
Jennifer Thomas 2/20/15 12:05 AM
Comment [5]: Muscularity? Jennifer Thomas 2/20/15 12:50 AM
Comment [6]: Builders? Jennifer Thomas 2/20/15 12:51 AM
Comment [7]: Suzanne, can you check whether these are typos, and if they aren’t, contact the authors to suggest a revised title w/o misspellings? I see that their first language may be Spanish rather than English. F18
Applying Participatory Research Methods and a User-Centered Design Process to
Promoting Positive Body Image Culture
Stephanie Peters, MS, PGSP-Stanford PsyD Consortium, Palo Alto, California, USA; Megan Jones,
PsyD, MS, Stanford University School of Medicine, Vienna, Austria
This study explored the feasibility of a dissonance-based media prototype targeting body image culture
in university dormitories. To date no research has examined social marketing interventions to improve
body image culture for these settings; thus, effective and easily disseminated social marketing media for
this topic is needed. User-centered design approaches improve public health intervention outcomes by
involving future users in the intervention development process, which subsequently improves the endproduct acceptability and uptake. Participatory research methods can be challenging to implement as
there is a paucity of research iteratively describing how to balance both feedback from users with sound
research-informed practice. This study applied user-centered design and participatory research methods
through first establishing an evidence-based intervention concept, cognitive dissonance, and using usercentered design methods to further focus the intervention prototypes. The concept for the “I am My
Potential ” project emerged from discussion with stakeholders. Participatory-design procedures
involved: 1) preliminary focus groups to elicit relevant concepts, 2) rapid prototyping and prototype
testing, and 3) secondary focus groups to select final intervention. Individual participants were randomly
selected for focus groups through both dorm events and student survey. Qualitative evaluation
demonstrated that it is feasible to develop and implement dissonance-based media prototype targeting
improving negative body image culture in college dormitories. This study provides a model of how to
apply user-centered design and participatory research methods to the first stages of research and have
broad relevance in the field of eating disorder research and health promotion.
Learning Objectives:
• Report important components of a media intervention aiming to improve population health.
• Describe steps and stages for developing a dissonance-based poster intervention in a university
setting.
• Compare examples of developed media posters that employ dissonance-base messages targeting
improving body image culture.
F19
Body Dissatisfaction As A Mediator Of The Weight Status-Sexual Functioning Relationship
Patricia van den Berg, PhD, MPH, University of Texas Medical Branch, Galveston, Texas, USA;
Catherine Hansen, MD, MPH, University of Texas Medical Branch, Galveston, Texas, USA; Marissa
Tsao, MD, University of Texas Health Sciences Center at Houston, Houston, Texas, USA; Tristi Muir,
MD, University of Texas Medical Branch, Galveston, Texas, USA; Jeffrey R Temple, PhD, University of
Texas Medical Branch, Galveston, Texas, USA
Previous studies have shown inconsistent relationships between weight status and sexual function among
women. The aim of this anonymous survey study was to examine the relationship between weight status
and sexual functioning among a sample of adult women, and to determine whether body image mediates
this relationship. Participants included 194 women (66% Caucasian; 14% Black or African-American; 15%
Hispanic; 5% Asian-American) recruited from an outpatient gynecology clinic. The average age was 38.8
years (SD=12.6). Twenty two percent of the sample was overweight (BMI = 25 - 29.9), and 31% was obese
(BMI > 30). Self-administered questionnaires were completed anonymously. Valid and reliable scales
assessed body dissatisfaction (Eating Disorders Inventory – Body Dissatisfaction scale) and female sexual
functioning (Female Sexual Function Index). Height and weight were self-reported. Mediation methods
proposed by Preacher and Hayes were used. BMI was strongly associated with body dissatisfaction, which
was negatively associated with sexual functioning. There was a significant indirect effect of BMI on sexual
functioning, through body dissatisfaction (estimate= -.1072, 95% CI: -0.2129, -0.0125), controlling for age
and race, but no significant direct effect of BMI on sexual functioning. Body dissatisfaction was a
significant mediator between BMI and sexual functioning. No direct relationship was found between BMI
and sexual functioning, which is in agreement with previous research on sexual functioning and BMI in
women conducted with community samples. Future research should examine the effect of body image
treatments on sexual functioning.
Learning Objectives:
• Describe the association between weight status and sexual functioning in existing literature.
• Understand the relationship of body image to sexual functioning among women.
• Evaluate body image as a mediator of the relationship between weight status and sexual
functioning in a sample of women.
F20
Excessive Skin and Sexual Function in Women after Bariatric Surgery: Relationship with
Psychological Variables and Weight Regain
Sofia Ramalho, MSc, University of Minho, School of Psychology, Braga, Portugal; Ana Pinto Bastos,
MSc, University of Minho, School of Psychology, Braga, Portugal; Cátia Silva, MSc, University of
Minho, School of Psychology, Braga, Portugal; Ana Rita Vaz, PhD, University of Minho, School of
Psychology, Braga, Portugal; Isabel Brandão, MD, Faculty of Medicine, University of Porto; Hospital of
São João, Porto, Portugal, Portugal; Paulo PP Machado, PhD, University of Minho, School of
Psychology, Braga, Portugal; Eva Conceição, PhD, University of Minho, School of Psychology, Braga,
Portugal
This study aims to explore the relationship between overall daily impairment related to the presence of
excessive skin, body image, depressive symptomatology, sexual functioning and weight regain in a sample
of women after bariatric surgery. This cross-sectional study assessed 61 women with excessive skin who
underwent to bariatric surgery for more than 6 months (M=19.02; SD=9.98) (BMI = 30.45 ±5.35kg/m2)
using a sociodemographic and semi-structured interview, and a set of self-report measures to access
impairment associated with the surplus skin, sexual functioning, concerns with body image and
depressive symptoms. Mann-Whitney and t-test were used for group comparison.Path analysis using
AMOS for SPSS (R) was conducted to explore the relationships between the variables under study. Path
analysis showed a good fit to the data (χ2= 2.837,df= 4,p= .585; CFI = 1.000, TLI = 1.058, IFI = 1.02,
RMSEA = .000), suggesting that sexual functioning and overall daily impairment caused by excessive skin
was associated with concerns with body image and depressive symptoms, which is related to weight
regain. Sexual dysfunction was associated with more depressive symptoms (t = 3.10, df = 59, p <.01), body
image issues (t = 2.10, df = 59, p <.05), and more weight regained (U = 332.00, p <.05) than their
counterparts. These data stress the importance of considering relationships of sexual intimacy and body
image to optimize psychological and weight outcomes after bariatric surgery.
Learning Objectives:
• Describe the localization and the consequences at several contexts of excessive skin in women
after bariatric surgery.
• Discuss the relationship between overall daily impairment related to the presence of excessive
skin, body image, depressive symptomatology, sexual functioning and weight regain in women
after bariatric surgery.
• Compare women undergone bariatric surgery with and without sexual dysfunction in relation to
depressive symptoms, body image and percentage of weight regain.
F21
Take a Look at the Bright Side: Effects of Positive Body Exposure on Visual Attention in
Body Dissatisfied Women
Klaske Glashouwer, PhD, University of Groningen / Accare, Center for Eating Disorders, Groningen /
Smilde, Groningen, Netherlands; Nienke Jonker, MSc, University of Groningen, Groningen,
Netherlands; Karen Thomassen, MSc, University of Groningen, Groningen, Netherlands; Peter de Jong,
PhD, University of Groningen, Groningen, Netherlands
Body image disturbance is considered an important factor in the onset and maintenance of eating
disorders and has been linked to dysfunctional selective visual attention towards one’s body. In
comparison to normal controls, individuals high on eating disorder symptoms showed a decreased
attention to their own ‘beautiful’ body parts and an increased attention to their own ‘ugly’ body parts. The
present study was designed to examine whether dysfunctional viewing patterns can be changed by
positive body exposure leading to an improvement of body dissatisfaction. 29 highly body dissatisfied
women with a normal weight and 14 satisfied controls were exposed to pictures of their own body and
control bodies. Eye movement registration was used to assess selective visual attention. Then, dissatisfied
individuals were randomly assigned to a 5-session positive body exposure training condition (n=16) or a
no treatment control group (n=13) and after the training they were assessed again. Preliminary analyses
confirm prior findings and show that dissatisfied women indeed looked longer at their own ‘ugly’ than at
their ‘beautiful’ body parts compared to satisfied women. Post-training data are currently being analyzed
and will be presented in full at the ICED. Furthermore, clinical and theoretical implications will be
discussed during the conference. These results will help to determine whether positive body exposure is f
Learning Objectives:
• Reflect on which working mechanisms might underlie the effect of body exposure on body image
disturbance
• Describe the impact of body exposure on visual attention in body dissatisfied women
• Discuss the theoretical and clinical implications of study results for the treatment of eating
disorders
Children and Adolescents
F22
Maternal Feeding Practices And Verbalizations As Predictors Of Body Dissatisfaction In
Children.
Blanca Elizabeth Jiménez-Cruz, DPsych, Faculty of Psychology, National Autonomous University of
Mexico, Mexico City, Mexico; Cecilia Silva, DPsych, FAED, Faculty of Psychology, National Autonomous
University of Mexico, Mexico City, Mexico
Several studies have shown an association between body dissatisfaction among children and an increased
risk for developing an eating disorder; therefore it is important to identify which factors contribute to
body dissatisfaction among children. One possibility is that mother’s attitudes and behaviors promote
negative attitudes in children about their own weight. In order to explore the relationship between
maternal feeding practices, maternal verbalizations about body weight and physical appearance and body
dissatisfaction in their children, participated 113 dyads mother-child (aged 7 to 11 years; 35 normalweight, 42 overweight and 36 obese). We used the Body Figures Instrument designed by Collins (1991) to
assess body dissatisfaction in the group of children. For the group of mothers we used the Child Feeding
Questionnaire (Birch et al., 2001) to assess concern about child weight, restriction and pressure to eat,
and two questionnaires constructed ex profeso for this research, one to assess the overt and covert control
and another to assess maternal verbalizations about body weight and physical appearance directed toward
their child. A stepwise regression showed that body dissatisfaction of children was significantly predicted
by children’s body weight and maternal concern about child weight. However, maternal concern about
child weight was significantly associated with the restrictive feeding practices and verbalizations that
mothers performed, and an ANOVA showed that these maternal behaviors were directed mainly towards
obese children, contributing to greater body dissatisfaction in them than in normal weight children. These
results suggest that maternal concern about child weight leads to restrictive behaviors and verbalizations
about physical morphologies that contribute to body dissatisfaction in their children, increasing the
possibilities that they acquire negative attitudes and behaviors related to their own feeding practices.
Learning Objectives:
• Describe the relation between maternal concern about child weight and maternal feeding
practices.
• Describe the difference between maternal feeding practices directed toward normal-weight and
obese children.
• Assess the relation between maternal feeding practices and body dissatisfaction in children.
F23
Weight Bias, School Climate, And The Academic Experience For K-12 Students: A
Qualitative Study Of Classroom Teachers
Erica Kenney, DSc, MPH, Harvard School of Public Health, Boston, Massachusetts, USA;
Morgan Redman, BA, Harvard School of Public Health, Boston, Massachusetts, USA; Kendrin
Sonneville, DSc, MS, RD, University of Michigan School of Public Health, Ann Arbor, Michigan, USA; S.
Bryn Austin, DSc, MS, FAED, Harvard School of Public Health, Boston, Massachusetts, USA
Weight bias is pervasive in U.S. schools, with serious public health implications, and weight-related
bullying in youth raises the risk of developing an eating disorder. The purpose of this qualitative study
was to explore teachers’ perceptions of overweight students and their academic performance. Twenty
teachers were recruited via snowball sampling from K-12 public schools across the U.S. and interviewed
using a standard protocol. Teachers’ views of how students’ weight impacts academic performance,
behavior, and social life and the role of school climate were elicited. Qualitative content analysis was
conducted to identify key themes. Half of the mostly female sample taught high school, while 25% each
taught elementary and middle school. Preliminary analysis has shown wide variation in teachers’
reporting of weight-based discrimination among students: some teachers are extremely concerned while
others perceive no problem. The following themes also emerged: 1) obese students are believed to have
low self-esteem, which is seen as causing poorer academic achievement and social life and 2) obese
students are perceived to adopt one of two personality types (shy or “class clown”) to deflect attention
from their weight, suggesting some potential stereotyping of obese students. Most teachers believed
obesity was a concern at their school and considered it important for obese students to lose weight. Many
teachers reported shrinking school resources for health promotion, describing ad hoc initiatives in their
schools to fill this gap that may be ineffective and stigmatizing (e.g.,“Biggest Loser” competitions). We
identified a perception among teachers that obesity hampers students’ academic achievement. Our results
also indicate a need for dissemination of inexpensive, non-stigmatizing health promotion resources.
Additional research in a broader sample should evaluate strategies to improve school climate and reduce
weight bias.
Learning Objectives:
• Describe key school climate issues facing students perceived as obese
• Identify potential areas for technical assistance for schools in reducing bias and promoting health
• Explain different teacher perceptions of how student weight does or does not impact academic
performance
F24
Social Functioning and Cognitive Proficiency in Anorexia Nervosa
Nandini Datta, BS, Duke University, Durham, North Carolina, USA; Ryan Wagner, PhD, Duke
University, Durham, North Carolina, USA; Nancy Zucker, PhD, Duke University, Durham, North
Carolina, USA
Individuals suffering from Anorexia (AN) have demonstrated deficits in social affect perception and are
described as exhibiting impairments in social functioning. To date, the role of deficits in social perception
as contributing to social proficiency is limited. Further, motivation in AN to have intimate relationships
and the association of information processing biases with this motivation are unexplored. Understanding
key barriers to social functioning can be of therapeutic benefit both in the treatment context and as a
reinforcing alternative to symptoms. The present study examined: 1) the value of friendship in AN, 2) the
association of biases information processing on the valuation of friendships, and 3) the association of
biases information processing on social functioning. Data were collected from adult females with AN,
weight restored females with a history of AN, and healthy controls. The AN group endorsed a stronger
need for friendships on self-report measures (p=.01), consistent with the view that individuals with AN
desire close relationships above and beyond healthy controls. The data also show a significant interaction
by group between performance on a detail-oriented cognitive task (Embedded Figures Task) and overall
friendship quality (Cambridge Friendship Questionnaire) (p=.04). Those with AN showed a direct
relationship between their cognitive proficiency and enjoyment of close relationships: Faster reaction
times on the Embedded Figures Task were associated with a greater valuation of friendship. This
relationship was non-significant in both healthy controls and weight-restored individuals. Additional
research is needed to determine why a detailed processing style was found related to a higher valuation of
friendship in the clinical group. Ultimately this investigation of social perception lends to an increasingly
complex and precise conceptualization of AN, one in which core symptoms of dietary restriction and
extreme weight loss could be attempts to mollify loneliness or misguided attempts to improve
interpersonal functioning.
Learning Objectives:
• Begin to understand the role of social perception and interpersonal functioning in Anorexia
Nervosa.
• Better understand the relationship between cognitive proficiency and friendship valuation in
Anorexia Nervosa, and how that differs from weight resorted and healthy comparison groups.
• Better understand the dynamic conceptualization of Anorexia Nervosa.
F25
The Impact Of Topiramate Initiation On The Development Of Eating Disorders In
Adolescents: A Case Series
Jocelyn Lebow, PhD, University of Miami, Miami, Florida, USA; Kyle Cedermark, MD, Mayo Clinic,
Rochester, Minnesota, USA; Jeffrey Chuy, MD, University of Miami, MIami, Florida, USA; Katlyn Cook,
BS, Mayo Clinic, Rochester, Minnesota, USA; Leslie Sim, PhD, Mayo Clinic, Rochester, Minnesota, USA
The weight-loss and appetite-suppressant side effects of topiramate, an antiepileptic agent, are well
established. Topiramate has been studied as a treatment for binge eating disorder and obesity to eliminate
cravings and to facilitate weight loss. In studies of topiramate use with children and adolescents appetite
reduction and/or weight loss was reported in 10-40% of samples. Given the well-known effects of human
starvation and weight loss on physical and psychological functioning, it is possible that topiramate may
trigger eating disorder (ED) symptoms in certain vulnerable individuals. Moreover, in light of data
suggesting a potential comorbidity between migraine and ED, already susceptible migraine patients may
be at a greater risk for the development of an ED with topiramate therapy. Further, previous case reports
have described ED relapse following topiramate initiation in adult patients. This case series expands on
these findings by describing 7 adolescent and young adult patients (M age = 16.7 yrs., SD = 2.4) who were
diagnosed with an ED after the initiation of topiramate for migraine or chronic headache. Of these
patients, 5 were diagnosed with eating disorder not otherwise specified, 1 with bulimia nervosa and 1 with
anorexia nervosa. All 7 patients reported dietary restriction. Three also reported vomiting and 2 reported
binge eating. Four patients reported that ED symptoms predated topiramate initiation, 2 reported
topiramate use predated ED onset, and 1 reported unclear symptom onset. All patients reported that the
appetite suppressant effects of the medication increased their rate of weight loss and exacerbated ED
behaviors and cognitions. All cases required ED treatment, and for the majority of the patients ED
symptoms interfered with headache interventions. Implications for treatment, including the importance
of screening for history of ED symptoms prior to initiating topiramate will be discussed.
Learning Objectives:
• Describe the potential shared risk factors between migraine/chronic headache and eating
disorders
• Identify risk factors for eating disorder development in patients using topiramate for
migraine/headache
• Explain the potential mechanisms through which topiramate triggers weight loss and the
potential development/exacerbation of eating disorders.
Comorbidity
F26
Affect Dysregulation as a Mediator of the Relationship between Childhood Trauma and
Comorbid Substance Use Disorders and Bulimia Nervosa
Brianna Crawford, PhD, Emily Program, St. Paul, Minnesota, USA; Stephen Wonderlich, PhD, FAED,
Neuropsychiatric Research Institute, Fargo, North Dakota, USA; Ross Crosby, PhD, FAED,
Neuropsychiatric Research Institute, Fargo, North Dakota, USA; Li Cao, MS, Neuropsychiatric
Research Institute, Fargo, North Dakota, USA; Heather Simonich, MA, Neuropsychiatric Research
Institute, Fargo, North Dakota, USA; ScottEngel, PhD, Neuropsychiatric Research Institute, Fargo,
Dakota, USA
Substance use disorders rank among the most common forms of comorbidity associated with eating
disorders and are purported to negatively impact the course of illness. A significant body of research has
been devoted to investigating the etiology of eating disorders and their comorbid conditions. One factor
that has received research attention is that of childhood maltreatment. The current study sought to
examine affect dysregulation as a mediator of the relationship between childhood trauma and comorbid
substance use disorder and bulimia nervosa. Mediation analyses using a bootstrapping procedure were
conducted on data collected from 125 female participants with DSM-IV diagnosed bulimia as part of a
larger study focused on the daily experiences of women with bulimia. Frequency and severity of childhood
trauma (physical, emotional, and/or sexual abuse) were measured by the Childhood Trauma Interview,
while the presence of a lifetime substance use disorder (lifetime alcohol use disorder, lifetime drug use
disorder) was indicated by findings of the Structured Clinical Interview for DSM-IV Axis I Disorders
(SCID-I/P). Affect dysregulation, serving as the proposed mediator, was measured by the Affect Scale of
the Diagnostic Interview for Borderlines (DIB-R). Findings suggest that a relationship exists between
childhood trauma and the development of drug use disorders, but not alcohol use disorders, in individuals
with bulimia nervosa through indirect and/or direct pathways. Specifically, affect dysregulation serves as
a mediator of the relationship between childhood sexual abuse and comorbid drug use disorders and as an
indirect pathway for the relationship between both childhood physical and emotional abuse and drug use
disorders. Overall, affect dysregulation appears to function as an important mechanism in the
development of comorbid drug use disorders and bulimia nervosa in individuals with a history of
childhood trauma.
Learning Objectives:
• Describe the comorbidity of bulimia and substance use disorders
• Understand how childhood trauma functions as a risk factor for the development of
psychopathology, including bulimia nervosa and substance use disorders
• Understand how affect dysregulation mediates the relationship between childhood trauma
experiences and comorbid drug use disorders and bulimia
F27
Disordered Eating Attitudes and Behaviors in Adolescents with Chronic Pain
Leslie Sim, PhD, Mayo Clinic, Rochester, Minnesota, USA; Swathi Damadoran, BS, Mayo Clinic,
Rochester, Minnesota, USA; Karen Weiss, PhD, Mayo Clinic, Rochester, Minnesota, USA; Jocelyn
Lebow, PhD, University of Miami, Miami, Florida, USA
Adolescents with chronic pain (e.g. abdominal pain, migraine) -- defined as debilitating pain lasting
longer than 6 months -- often experience reduced appetite, restrictive eating, vomiting and/or weight loss
due to physical symptoms or side effects from medication/treatment. As a result, they may be at risk for
developing eating disorders (ED). Further, ED symptoms in this population may contribute to greater
emotional and behavioral challenges which may interfere with pain rehabilitation. As such, this study
examined the prevalence of ED symptoms in adolescents attending a hospital-based, pediatric pain
rehabilitation program. In addition, adolescents who scored in the highest quartile on a standardized
screening measure of EDs were compared to low-scoring adolescents on psychiatric symptoms, functional
disability, and pain-related cognitions. Out of 174 consecutively admitted adolescents (mean age = 15.78;
sd = 2.0), 26 (15%) (73.1%female) scored above the clinical cutoff on the Eating Attitudes Test – 26 (EAT26). T-tests were conducted on 48 adolescents who scored in the highest quartile (raw score = 15-44) and
50 adolescents who scored in the bottom quartile of the sample (raw score = 0-4). High scoring
adolescents on the EAT-26 showed significantly higher scores on standardized self-report measures of
anxiety, depression, self- and socially-oriented perfectionism, and pain catastrophizing. There were no
significant differences between the groups on self-reported functional disability. These findings suggest
the prevalence of eating disorder symptoms in adolescents with chronic pain is similar to that found in a
community sample of adolescents. Of concern, patients with comorbid chronic pain and symptoms of EDs
may exhibit higher levels of psychological impairment. Because ED symptoms and associated
psychopathology may interfere with pain rehabilitation, it is imperative that adolescents with chronic pain
are adequately screened and treated for disordered eating.
Learning Objectives:
• Identify potential risk factors for disordered eating in adolescents with chronic pain
• Describe the prevalence of disordered eating attitudes and behaviors in adolescents with chronic
pain
• Recognize the comorbidity of disordered eating and chronic pain and the importance of screening
for disordered eating in adolescents with chronic pain
F28
Restraint Feeds Stress: The Relationship Between Eating Disorder Symptoms, Stress
Generation, and the Interpersonal Theory of Suicide
Dorian Dodd, BA, BS, Miami University Dept. of Psychology, Oxford, Ohio, USA; April Smith, PhD, MS,
BA, Miami University Dept. of Psychology, Oxford, Ohio, USA; Lauren Forrest, BS, Miami University
Dept. of Psychology, Oxford, Ohio, USA; Lindsay Bodell, MS, Florida State University, Tallahassee,
Florida, USA
In the present study, the interpersonal psychological theory of suicide (IPTS) is used as a framework to
examine the elevated risk for suicide experienced by individuals with eating disorders (EDs) compared to
the general population. Specifically, we examine whether ED behaviors lead to feelings of
burdensomeness and low belongingness – two important constructs of the IPTS. Further, informed by
research on stress generation, we test whether ED behaviors have an indirect effect on burdensomeness
and/or belongingness, through negative life events (i.e. if ED behaviors lead to increases in negative life
events, which in turn contribute to feelings of burdensomeness and low belongingness). At two time
points (approximately one month apart), undergraduates (N=186) completed self-report questionnaires
assessing ED symptoms, negative life events, depression, anxiety, burdensomeness, and belongingness.
Participants were majority female (78.0%) and Caucasian (76.3%); the mean age was 18.7 years (SD = 1.2
years). When controlling for Time 1 (T1) depression, anxiety, and negative life events, T1 dietary restraint
significantly predicted Time 2 (T2) negative life events, t = 3.01, p = .003, r partial = 0.23. Furthermore, T1
dietary restraint indirectly influenced perceived burdensomeness [95% CI = 0.55 – 2.15] and low
belongingness [95% CI = 0.45 – 1.79], through its effect on negative life events. Thus, dietary restraint
may contribute to stress generation, and in turn exacerbate feelings of burdensomeness and low
belongingness – two key constructs of the IPTS. Greater understanding of factors that contribute to
suicide risk among individuals with EDs could lead to more effective and targeted suicide interventions
for this at-risk population.
Learning Objectives:
• Discuss the elevated suicide risk associated with eating disorders and use the interpersonal
psychological theory of suicide as a framework for understanding suicide risk
• Describe the stress generation hypothesis and discuss research regarding stress generation in
individuals with eating disorders
• Summarize findings regarding the relationships between eating disorder symptoms, negative life
events, and feelings of burdensomeness and belongingness
Diagnosis, Classification and Measurement
F29
Parent Versions Of The Eating Disorder Examination Interview And Questionnaire:
Internal Consistency And Item Response Theory
Amy Parter, BA, Fairleigh Dickinson University, Teaneck, New Jersey, USA; Katherine L. Loeb, PhD,
Fairleigh Dickinson Univeristy, Teaneck, New Jersey, USA; Robert E. McGrath, PhD, Fairleigh
Dickinson Univeristy, Teaneck, New Jersey, USA; Lisa Hail, MA, Fairleigh Dickinson University,
Teaneck, New Jersey, USA; Christopher Fairburn, MD, FAED, University of Oxford, Edinburgh,
England, United Kingdom (Great Britain)
Multiple informant methods have shown to improve case identification in youth with psychopathology,
and are hypothesized to be helpful in identifying eating disordered behavior in youth. The Eating Disorder
Examination (EDE) and the Eating Disorder Examination Questionnaire (EDE-Q) are considered to be
the gold standards for assessing eating disorder pathology and have been adapted in a parent version
(PEDE; PEDE-Q) to benefit from the use of parents as informants of clinically significant symptoms in
youth. This study examines the reliability of the four subscales (Restraint, Eating Concern, Shape
Concern, Weight Concern) of the PEDE and PEDE-Q in a research-based treatment-seeking sample of
children and adolescents with anorexia nervosa-spectrum clinical presentations. (N=59; mean age13.7;
84.7% female). Cronbach’s alpha for three subscales of the PEDE-Q were adequate: Restraint, 0.81
(n=46); Eating Concern, 0.61 (n=50); Weight Concern, 0.82 (n=49). Internal consistency for the PEDE
was not adequate as indicated by the coefficient α of 0.31 for the Restraint subscale (n=51) and 0.59 for
the Eating Concern subscale (n=52). Missing data precluded the planned analysis of the Shape Concern
subscale of the PEDE-Q and Shape and Weight concern subscales of the PEDE. These findings suggest
greater reliability of the PEDEQ than the PEDE in assessing this sample of youth with eating disordered
behaviors. Preliminary Rasch analysis of the items will be presented with an emphasis on their capacity to
discriminate across the continuum of disordered eating behaviors.
Learning Objectives:
• Describe the reliability of a new assessment measure for youth with eating disorders.
• Discuss the importance of multiple informants in identifying clinically eating disordered behavior
in youth.
• Apply item response theory to the PEDE and PEDEQ.
F30
An Exploration Of Appearance-Related Pressures, Appearance Ideal Internalization, And
Muscularity Concerns Among Adolescent Boys In Japan And India
Richa Sharma, MPH, BSc, Tata Institute of Social Sciences, Mumbai, Maharashtra, India; Hemal
Shroff, PhD, MA, Tata Institute of Social Sciences, Mumbai, Maharashtra, India; Yuko Yamamiya, PhD,
Temple University Japan, Minato-ku, Tokyo, Japan; Kevin Thompson, PhD, University of South
Florida, Tampa, Florida, USA; Lauren Schaefer, MA, University of South Florida, Tampa, Florida, USA;
Satoshi Shimai, PhD, Japanese Red Cross Toyota College of Nursing, Toyota, Aichi, Japan; Luis Ordaz,
Student, University of South Florida, Tampa, Florida, USA
Sociocultural appearance-related pressures and appearance ideal internalization have been extensively
studied in female populations and found to be strongly related with disordered eating and poor body
image. Limited research among adult and adolescent males indicates that sociocultural influences are
related to drive for muscularity and strategies to enhance bulk and gain weight. However, few studies
have examined these relationships among adolescent boys from non-Western backgrounds. The purpose
of the current study was to assess the psychometric properties of the Sociocultural Attitudes Towards
Appearance Questionnaire-4 (SATAQ-4), a measure of sociocultural influence on appearance ideals,
within samples of adolescent boys from two Asian countries, India and Japan. In addition, the
relationships between appearance-related pressures, appearance internalization, and muscularity
concerns were assessed within each sample. Participants were 984 Japanese and 408 Indian adolescent
boys drawn from grades 10-12 in urban areas of both countries. Participants completed measures to
assess appearance internalization and sociocultural pressures, strategies to gain weight, and drive for
muscularity. Exploratory factor analysis indicated slight differences in the factor structure of the SATAQ4 in Japanese and Indian boys, suggesting avenues for refinement to the scale in future work with Asian
populations. Correlational analyses revealed positive associations between media pressures and drive for
muscularity in both samples. Internalization of a muscular ideal was also associated with greater
engagement in strategies to gain weight and higher drive for muscularity in both Japanese and Indian
boys. Overall, results suggest that sociocultural factors relate to young Asian males’ cognitions and
behaviors regarding attainment of the muscular ideal.
Learning Objectives:
• Understand differences in appearance ideal internalization among adolescent boys in two Asian
countries
• Describe sociocultural influences that affect adolescent boys' muscularity concerns.
• Describe relationships between appearance pressures, internalization and strategies to gain
weight and bulk among Asian adolescent boys.
F31
Timing Of Eating Disorder Behaviors And Affective Experiences In Anorexia Nervosa: An
Ecological Momentary Assessment Study
Jason Lavender, PhD, Neuropsychiatric Research Institute, Fargo, North Dakota, USA; Ross Crosby,
PhD, FAED, Neuropsychiatric Research Institute, Fargo, North Dakota, USA; Stephen Wonderlich, PhD,
FAED, Neuropsychiatric Research Institute, Fargo, North Dakota, USA; Daniel Green, BA,
Neuropsychiatric Research Institute, Fargo, North Dakota, USA; Andrea Goldschmidt, PhD, University
of Chicago, Chicago, Illinois, USA; Jo Ellison, PhD, Neuropsychiatric Research Institute, Fargo, North
Dakota, USA; Scott Engel, PhD, Neuropsychiatric Research Institute, Fargo, North Dakota, USA; James
Mitchell, MD, FAED, Neuropsychiatric Research Institute, Fargo, North Dakota, USA; Scott Crow, MD,
FAED, University of Minnesota, Minneapolis, Minnesota, USA; Carol Peterson, PhD, University of
Minnesota, Minneapolis, Minnesota, USA; Daniel Le Grange, PhD, FAED, University of California, San
Francisco, San Francisco, California, USA
Studies of the temporal features of affective experiences and eating disorder (ED) behaviors in ED
samples have revealed that the experience of affective states and the occurrence of particular ED
behaviors may differ across hours of the day and days of the week. This study used ecological momentary
assessment (EMA), a real-time, naturalistic method, to examine timing of positive affect (PA) and
negative affect (NA) and ED behaviors in anorexia nervosa (AN). Women with AN (N = 118) completed a
two-week EMA protocol during which they provided multiple daily reports on affect and ED behaviors. A
series of mixed effects models and general estimating equations were used to examine the association
between timing (i.e., time of day, day of week) and (a) level of negative and positive affect and (b)
occurrence of ED behaviors (i.e., binge eating, vomiting, meal skipping). Results revealed a significant
pattern of slightly increasing PA and slightly decreasing NA across the day. NA did not vary across day of
week, although there was a significant effect of day of week for PA. Pairwise comparisons revealed that the
significant effect was accounted for by higher PA on Saturday versus Sunday. For ED behaviors, binge
eating and vomiting were more likely to occur later in the day, while meal skipping was more likely to
occur earlier in the day. In contrast, results revealed no significant differences in frequencies of any of the
ED behaviors across the days of the week. Overall, these results suggest the relevance of timing of affective
states and ED behaviors in AN, particularly within days. Of note, these findings contrast with results
found using similar methods in bulimia nervosa, suggesting the presence of differing factors across EDs
that may influence timing of affective experiences and ED behaviors in these disorders. Understanding
such temporal features may have relevance for the treatment of AN, particular in terms of momentarybased interventions.
Learning Objectives:
• Review prior research on timing of eating disorder behaviors
• Describe the nature of and benefits of ecological momentary assessment
• Examine the temporal features eating disorder behaviors in anorexia nervosa and address
associated clinical implications
F32
Using The Theory Of Planned Behaviour To Assess Motivation To Recover From Anorexia
Nervosa
Lisa Dawson, PhD, The University of Sydney, Sydney, NSW, Australia; Barbara Mullan, PhD, Curtin
University, Perth, WA, Australia; Kirby Sainsbury, PhD, Curtin University, Perth, WA, Australia; Paul
Rhodes, PhD, The University of Sydney, Sydney, NSW, Australia; Stephen Touyz, PhD, FAED, The
University of Sydney, Sydney, NSW, Australia
Motivation in anorexia nervosa (AN) has been almost exclusively measured using the Transtheoretical
Model of Change (TTM), despite criticisms of this model. In other areas of psychology, alternative models
have been proposed to explain motivation. In Health Psychology, the Theory of Planned Behaviour (TPB)
is a widely used and supported model. The aim of the current study was to determine the appropriateness
of the TPB for understanding intentions to recover from AN and to develop a purpose-designed TPB
measure to assess this. Two studies were conducted – in the first study eight women who had recovered
from chronic AN were interviewed about their experiences of recovery. The interview data was
subsequently used to inform the development of a purpose-designed questionnaire to measure the
components of the TPB in relation to recovery. In the second study, the resultant measure was
administered to 67 females with a current diagnosis of AN, along with measures of eating disorder
psychopathology, psychological symptoms, and an existing measure of motivation to recover (based on
the TTM). Data from the interview study confirmed that the TPB is an appropriate model for
understanding the factors that influence motivation to recover from AN. The results of the questionnaire
study indicated that the pre-intention variables of the TPB accounted for large proportions of variance in
the intention to recover (72%), and more specifically the intention to eat normally and gain weight (51%).
Self-efficacy was the strongest predictor of intention to recover, while attitudes were more important in
the prediction of the intention to eat normally/gain weight. The positive results suggest that the TPB is an
appropriate model for understanding and predicting motivation in AN. Implications for theory and
practice are discussed.
Learning Objectives:
• Describe the Theory of Planned Behaviour
• Evaluate the appropriateness of using the Theory of Planned Behaviour to measure motivation to
recover in anorexia nervosa
• Apply the Theory of Planned Behaviour to measuring intentions to recover from anorexia nervosa
F33
Psychometric Properties and Validation of the Sociocultural Attitudes Towards
Appearance Questionnaire-4 (SATAQ-4) with a Sample of Japanese Adolescent Girls
Yuko Yamamiya, PhD, Temple University Japan, Minato-ku, Tokyo, Japan; Kevin Thompson, PhD,
University of South Florida, Tampa, Florida, USA; Hemal Shroff, PhD, MA, Tata Institute of Social
Sciences, Mumbai, Maharashtra, India; Lauren Schaefer, Student, University of South Florida, Tampa,
Florida, USA; Satoshi Shimai, PhD, Japanese Red Cross Toyota College of Nursing, Toyota, Aichi,
Japan; Richa Sharma, MPH, BSc, Tata Institute of Social Sciences, Mumbai, Maharashtra, India; Luis
Ordaz, Student, University of South Florida, Tampa, Florida, USA
Research has consistently demonstrated that appearance ideal internalization and appearance-related
pressures are strongly related with poor body image and disordered eating in Western societies. The
SATAQ-4 is a five-factor measure containing subscales to assess thin ideal and muscular ideal
internalization, as well as appearance-related pressures from peers, family, and media. Studies have
documented substantive influence of the media and appearance ideal internalization among samples in
Asian countries as well. The SATAQ-4 has been validated in several samples of adolescent and adult
women from Western countries and demonstrated excellent psychometric properties across samples. The
aim in the current study was to examine the factor structure, reliability, and validity of the translated
SATAQ-4 in a sample of Japanese adolescent girls. The participants were 946 high school students from
Aichi, Japan in grades 10-12. They were asked to complete the SATAQ-4, as well as questionnaires
assessing engagement in strategies to lose weight, engagement in strategies to gain weight, and teasing
from peers and parents, and drive for muscularity. Exploratory factor analysis of the SATAQ-4 indicated
that the five-factor structure was largely replicated in the current sample with the exception of two crossloading items. SATAQ-4 subscales exhibited good reliability, with Cronbach’s alphas of .78 or higher.
Significant moderate relationships were found among the SATAQ-4 subscales. Appearance ideal
internalization and appearance pressures were also found to be correlated with experiences of appearance
teasing, strategies to lose and/or gain weight, and drive for muscularity. The results suggest that the
SATAQ-4 is a reliable and well-validated instrument to use among Japanese female samples to assess the
impact of sociocultural influences on body image.
Learning Objectives:
• Examine the factor structure of the SATAQ-4 in a large sample of Japanese adolescent girls.
• Examine the reliability and validity of the SATAQ-4 in a large sample of Japanese adolescent girls.
• Examine levels of appearance-ideal internalization and appearance-related pressures in a large
sample of Japanese adolescent girls.
F34
Psychophysiological Measures of Disgust Diverge From Self-Reported Disgust in
Adolescent Anorexia Nervosa
Andrew Grotzinger, BA, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Rachel
Ojserkis, MA, BA, Fordham University, Bronx, New York, USA; Tom Hildebrandt, PsyD, BS, FAED,
Icahn School of Medicine at Mount Sinai, New York, New York, USA
Anorexia nervosa (AN) is characterized by persistent food avoidance in spite of low weight. Preliminary
work suggests that disgust, which has evolutionary roots as a mechanism of protecting humans from
ingesting harmful substances, may play a role in chronic food avoidance. Self-report measures of disgust
presume that individuals are able to accurately identify emotional experiences. Given the welldocumented symptoms of alexithymia in patients with AN, self-report measures of disgust may fail to
accurately assess the construct in this population. This study tested the hypothesis that self-reported
disgust is a poor predictor of physiological disgust responses to food stimuli in a sample of 14 adolescent
females with AN and 15 healthy control participants (HC), ages 11 to 22 (M = 16.39, SD = 2.64). A foodbased reversal learning paradigm assessed associations formed between neutral stimuli (colored squares)
and food reward (M&M candies). While completing the task, electromyography (EMG) recordings were
obtained from the levator labii (disgust), zygomaticus (pleasure), and corrugator (negative affect) muscle
to provide a psychophysiological measure of emotion. Spikes in activation at all three muscle sites were
then computed for the food-reward stimulus, and compared to scores on the Disgust Scale-Revised (DSR). Controlling for spikes in activation at the other two muscle sites, AN participants were significantly
more likely than HCs to react with disgust (i.e., levator labii spikes) to a food-related stimulus, F(1, 25) =
8.24, p = .003. However, there were no significant group differences on the DS-R total or subscale scores,
p’s ≥ .210. In addition, scores on the DS-R were not significantly correlated with physiological disgust for
AN participants, r(11) = .15, p = .623. These findings suggest psychophysiological measures of emotion
may provide a more accurate assessment of disgust reactions in AN than self-report measures.
Learning Objectives:
• Compare disgust reactions to food via electromyography in anorexia nervosa and healthy control
participants
• Compare disgust sensitivity on a self-report questionnaire between anorexia nervosa and healthy
control participants
• Assess convergence, or lack thereof, between self-reported disgust and psychophysiological (i.e.,
EMG) disgust
F35
Is “Drunkorexia” an Eating Disorder, Substance Use Disorder, or Both?
Tyler Hunt, BS, The University of Kansas, Lawrence, Kansas, USA; Kelsie Forbush, PhD, The University
of Kansas, Lawrence, Kansas, USA
The media has identified a specific behavior pattern termed “drunkorexia” to describe recurrent
inappropriate compensatory behaviors (such as fasting and self-induced vomiting) to avoid weight gain
from consuming alcohol (ICB-WGA). Despite the facetious name, this behavior pattern is associated with
significant psychosocial impairment. Several studies have investigated the prevalence of these behaviors
among college students, but few have tested whether this behavior pattern is more strongly related to
substance use or disordered eating, which may have future implications for diagnostic classification and
nosology. This project aimed to identify whether: (1) ICB-WGA is more strongly related to disordered
eating or to substance abuse pathology and (2) disordered eating or alcohol use adds incremental validity
to the prediction of ICB-WGA when controlling for the other variable. Participants were college students
(N=579; 53% female) recruited from an introductory psychology course. Participants completed the
Eating Pathology Symptoms Inventory (EPSI), the Alcohol Use Disorders Identification Test (AUDIT),
and several questions designed to measure ICB-WGA. Results from hierarchical linear regression
indicated that the EPSI Restricting and Body Dissatisfaction scales were not significant predictors of ICBWGA, whereas the AUDIT and EPSI Cognitive Restraint, Excessive Exercise, Purging, and Binge Eating
scales significantly predicted ICB-WGAs. After including disordered eating behaviors in the regression
model, the AUDIT explained an additional 11% of the variance in predicting ICB-WGA. Moreover, AUDIT
scores mediated (explained) the relation between binge eating and ICB-WGA. After including the AUDIT
in the regression model, disordered eating scales explained an additional 24% of the variance in
predicting ICB-WGA. Our findings suggest that ICB-WGA is significantly associated with both disordered
eating behaviors and alcohol misuse among college students, indicating that these individuals may be atrisk for future development of both full-threshold eating and substance disorders. Notably, our findings
highlight the need for future research to focus on trans-diagnostic prevention programs that target
mechanisms that underlie both disordered eating and substance misuse.
Learning Objectives:
• Define recurrent inappropriate compensatory behaviors to avoid weight gain from alcohol
consumption (ICB-WGA) and describe what is known about the prevalence and correlates of this
behavioral pattern.
• Explain whether ICB-WGA is more strongly related to disordered eating or substance use, and
whether disordered eating or alcohol use adds incremental validity to the prediction of ICB-WGA
when controlling for the other variable.
• Understand how targeting mechanisms that underlie both disordered eating and substance
misuse may improve treatment and prevention approaches for eating and substance use
disorders.
F36
Severe and Enduring Eating Disorders (SEED-AN and SEED-BN): Qualitative Studies Of
Symptoms And Life Experiences Of Patients With 20 Plus Years History Of Anorexia
Nervosa And 8 Plus Years Of Bulimia Nervosa.
Paul Robinson, MD, MA, MBBS, University College London, London, England, United Kingdom (Great
Britain)Rozalia Kukuscka, MSc, Barnet Enfield and Haringey Mental Health Trust, London, England,
United Kingdom (Great Britain); Giulia Guidetti, BS, University of Parma, Parma, Emilia-Romana,
Italy; Jessica Jackson, MSc, University College London, London, England, United Kingdom (Great
Britain); Gerard Leavey, PhD, University of Ulster, Coleraine, Ulster, United Kingdom (Great Britain)
Patients who develop serious eating disorders but fail to recover after several years are considered to have
Severe and Enduring Eating Disorders (SEED). In this study, we interviewed 7 patients, 5 female and 2
male, with SEED-AN (Anorexia Nervosa) lasting 20-40 years (mean 31.6 years), BMI range 13 to 18.5
(mean 15.7) and analysed the transcribed interviews using qualitative methodology. Statements were
given open and selective codes after which memos, narrative statements and overall narratives were
constructed and theoretical aspects derived. Their symptoms had most impact in psychological and social
realms, although they did report severe physical problems, some life threatening leading to frequent
hospital admission. They had difficulty spending money on new things, feeling unworthy of such objects.
Socially, they were severely isolated, with negligible social networks. None had an intimate relationship.
Only one had a paid job, the others being unemployed or volunteers, and they would visit museums or
cinemas on their own. In the psychological realm, participants described depression and hopelessness
with thoughts of suicide, and continuing preoccupations with body image and food, while somehow
achieving a sense of pride at their endurance and survival in spite of the Eating Disorder. Relationships
with family were difficult, with a perceived lack of support, and criticism of the illness and their attempts
to get treatment. In spite of these predominantly negative aspects patients described experiences of
achievement, calm and identity arising from the eating disorder which contributed to a remarkable
resilience and “staying power” that the patients shared. SEED-AN presents multiple problems and
challenges health services to address their social, psychological and occupational difficulties, as well as
dealing with the physical effects of the disorder. In a smaller study of 4 patients with Bulimia Nervosa for
8 or more years, there were marked problems in realms other than the physical. Relationship avoidance,
social isolation and difficulties in relationships with family were especially apparent. Both Anorexia
Nervosa and Bulimia Nervosa can be Severe and Enduring and management presents significant
challenges for treatment and support services which have not yet been addressed.
Learning Objectives:
• Define Severe and Enduring Eating Disorders (SEED-AN and SEED-BN) in terms of length of
history and physical, psychological and social morbidity
• Appreciate the extent of bio-psycho-social morbidity suffered by patients with SEED-AN and
SEED-BN
• Imagine interventions that might alleviate some of these symptoms.
Epidemiology
F37
Examining Cohort Effects in the Ten-Year Course of Eating Pathology in Women
K. Jean Forney, MS, Florida State University, Tallahassee, Florida, USA; Lauren Holland, MS, Florida
State University, Tallahassee, Florida, USA; Tiffany Brown, MS, Florida State University, Tallahassee,
Florida, USA; Pamela Keel, PhD, FAED, Florida State University, Tallahassee, Florida, USA
Levels of eating pathology vary at discrete periods of time (cohort effects), yet it is unknown if the
differences in levels of eating pathology influence the course of eating pathology over time (cohort effects
in change across time). The present study compared the trajectory of eating pathology from baseline
(mean age = 20), to 10 year follow-up, (mean age = 30), using cohorts of women established in 1982 (n =
506), 1992 (n= 456), and 2002 (n= 383). Participants completed questionnaires, including the Eating
Disorders Inventory Drive for Thinness and Bulimia subscales at baseline and again 10 years later. At
baseline, cohorts varied in Drive for Thinness (F(2, 1334) = 3.28, p = .04) and Bulimia scores (F(1, 1334)
= 10.44, p < .001). Significant Cohort X Time interactions for both Drive for Thinness (F(2, 1344) = 9.88,
p < .001) and Bulimia scores (F(2, 1342) = 13.12, p < .001) indicate that eating pathology trajectories
differed by cohort. Follow-up analyses indicate that the 1982 cohort experienced a steeper decrease in
drive for thinness compared to the 1992 (F(1, 1344) = 9.76, p < .01) and 2002 (F(1, 1344) = 17.91, p <
.001) cohorts, while the 1992 and 2002 cohorts did not differ from one another (F(1, 1344) = 1.49), p =
.22). Similarly, the 1982 cohort experienced a greater decrease in bulimic symptoms compared to the 1992
(F(1, 1342) = 21.89, p < .001) and 2002 cohorts (F(1, 1342) = 15.81, p < .001), who did not differ from one
another (F(1, 1342) = .22, p = .64). Notably, neither drive for thinness (F(2, 1334) = 1.70, p = .18), nor
bulimic symptoms varied across cohorts at follow-up (F(1, 1334 = 1.70, p = .81). Results suggest that while
levels of eating pathology vary across time in women in their 20’s, these differences do not last at 10 year
follow-up. It may be that the factors that influence variation in eating pathology across discrete time
points in women are restricted to that sociohistorical period.
Learning Objectives:
• Following the training, participants will be able to describe cohort differences in eating pathology.
• Following the training, participants will be able to describe the differences in the trajectories of
drive for thinness across time.
• Following the training, participants will be able to describe differences in the trajectories of
bulimic symptoms across time.
F38
Associations Between Disordered Eating Behaviors And Both Sociodemographic And
Psychological Variables In Mexican College Students In Their Freshmen Year.
Concepcion DiazdeLeon-Vazquez, MSc, BSc, Private practice, Mexico City, Mexico; Claudia UnikelSantoncini, PhD, MPsych, FAED, National Institute of Psychiatry “Ramon de Fuente Muñiz", Mexico
City, Mexico; Jose Alberto Rivera-Marquez, PhD, MSc, Metropolitan Autonomous University, Mexico
City, Mexico
The aim of this study was to analyze associations between disordered eating behaviors (DEB) and both
sociodemographic and psychological variables in Mexican college students in their freshmen year. A
cross-sectional study was conducted by the Metropolitan Autonomous University (UAM) and the National
Institute of Psychiatry “Ramon de Fuente Muñiz” (INPRFM). A sample of 892 subjects from both sexes
(502 women and 390 men) with an average age of 19.7 ± 2.9 years was included in de study. A set of
questionnaires was used to measure DEB, body dissatisfaction (BD), internalization of the aesthetic body
thin ideal (ITI), drive for muscularity (DM), self-esteem (SE), body mass index (BMI), excessive physical
activity (EPA), dysfunctional relationship with father and mother (DRP and DRM) and socioeconomic
status (SES). All questionnaires were previously validated for Mexican populations. Informed consent
from the students and verbal consent from the professor in charge of the participating groups were
obtained. Data were analyzed using STATA 11. Multivariate analysis was performed through multinomial
regression models. DEB was present in 6.1% of women and 4.1% in men. Among women ITI, SE, BMI and
EPA increased the risk of DEB by 25, 3, 2 and 4 times, respectively. Among men, ITI and DM increased
the risk of DEB by 16 and 5 times, respectively. No other association proved to be statistically significant.
Further analysis in the study of predisposing conditions for eating disorders in college students is needed.
Gender-specific assessment instruments should be employed, as the predisposing conditions for DEB vary
between men and women.
Learning Objectives:
• To analyze associations between disorders eating behaviors and sociodemographic and
psychological variables among women and men university students in Mexico.
• To estimate the prevalence of disordered eating behaviors in college students from Mexico.
• To propose gender-specific assessment instruments for the evaluation of predisposing conditions
for disordered eating behaviors.
Gender, Ethnicity and Culture
F39
Are Disordered Eating Measures Reliable Over Time in Men?
Brittany Bohrer, BS, University of Kansas, Lawrence, Kansas, USA; Kelsie Forbush, PhD, University of
Kansas, Lawrence, Kansas, USA; Lindsay Hilderbrand, Student, Purdue University, West Lafayette,
Indiana, USA
The majority of disordered eating self-report measures were developed and validated in primarily young
female samples; however, this is not the only population in which disordered eating occurs.
Approximately 10 to 30% of all individuals with eating disorders are male, yet because measures often
have not been tested among male participants, it is unclear whether the psychometric properties of
commonly used disordered eating measures are equivalent in men vs. women. The purpose of this study
was to compare the test-retest reliability of common disordered eating self-report measures in men vs.
women. Students enrolled at a large Midwestern university (N=226; 57.96% female) completed selfreport measures of body dissatisfaction, restrained eating, disinhibited eating, and bulimic symptoms at
baseline and two-to-four weeks later. Pearson’s r was used to compute test-retest correlations for each
disordered eating measure. Next, we compared the magnitude (size) of correlations between men and
women by transforming Pearson’s r into Fisher’s z, and using meta-analytic techniques to test whether zvalues were significantly different between sexes. The majority of disordered eating measures had testretest reliabilities at or above the recommended benchmark of .70 in women, but 14 out of 20 measures
had extremely low reliability in men (r’s=.43 to .68). Sex-based comparisons indicated that the Restraint
Scale and EDE-Q Eating Concern and Weight Concern scales demonstrated significantly lower reliability
in men vs. women. Likewise, several measures of bulimic symptoms were significantly more reliable over
time in women compared to men (e.g., EAT-26, BULIT-R, DEBQ External Eating, EDI-3 Bulimia, TFEQ
Disinhibition, and TFEQ Hunger). Results highlight the clinical utility of several eating pathology
measures for assessing symptom change over time among men (e.g., MBAS and EAT-26) as well as point
to the need for additional research to identify and correct for sources of gender unreliability inherent in
certain eating pathology measures.
Learning Objectives:
• Compare the reliability of common eating pathology measures between men and women
• Recognize gender differences in reliability among common disordered eating measures
• Evaluate clinical utility of eating pathology measures for assessing symptom change over time
among men
F40
Eating Disorder Correlates In Native American Women: Comparison With Caucasian And
Hispanic Women
Elizabeth McLaughlin, MS, University of New Mexico, Albuquerque, New Mexico, USA; Jane Ellen
Smith, PhD, University of New Mexico, Albuquerque, New Mexico, USA; Katherine Belon, MS,
University of New Mexico, Albuquerque, New Mexico, USA; Jeremiah Simmons, MPH, University of
New Mexico, Albuquerque, New Mexico, USA; Kelsey Serier, BS, University of New Mexico,
Albuquerque, New Mexico, USA
This study sought to provide more information on eating disordered behaviors among Native American
women. Little research has been done on eating disorders in Native American women, despite evidence
that eating disorders occur in this population at rates equivalent to other populations. Some research has
shown that Native American women have higher rates of disordered eating behaviors such as binge eating
and unhealthy compensatory behaviors. In this study, a sample of Native American college women (N =
69), along with samples of Caucasian women (N = 315) and Hispanic women (N = 342), completed
assessments of bulimic symptomatology, binge eating, restrictive eating/dieting, shape and weight
concerns, body dissatisfaction, and demographic information. Caucasian women had a significantly lower
average BMI compared to both Native American and Hispanic women; Native American and Hispanic
women did not differ significantly from each other. Native American and Hispanic women reported a
moderate level of acculturation to Anglo American culture. Despite their higher BMIs, Native American
women were similar to White and Hispanic women regarding their endorsement of bulimic behavior,
shape and weight concerns, and body dissatisfaction. Native American women selected ideal figures for
themselves that were larger than those selected by either white or Hispanic women. Native American
women also reported less restrictive eating/dieting than white women, though their levels did not differ
from the levels reported by Hispanic women. These results demonstrate an acceptance of higher body
weights among Native American women; this may serve to protect Native American women against some
symptoms of disordered eating.
Learning Objectives:
• Discuss the prevalence of eating disorder correlates in Native American, Hispanic, and Caucasian
women.
• Contrast the body dissatisfaction and weight/shape concerns of Native American, Hispanic, and
Caucasian women.
• Differentiate Native American women and Caucasian women on the prevalence of dieting/weight
loss behavior.
F42
Appearance Standards for Women of Color Present in a Sample of Popular Magazines
Leah Boepple, BA, University of South Florida, Tampa, Florida, USA; Joel (Kevin) Thompson, PhD,
University of South Florida, Tampa, Florida, USA
Images present in advertisements reinforce societal attitudes and constraints regarding appearance
standards. Physical features common in White women (i.e., light skin, straight hair, thin lips) have
historically set the standard for mainstream beauty. This study examined the appearance standards set for
women of color, present in popular American magazines. These images may serve as a source for
messages on culturally-defined beauty standards for women of color in our society. The seventeen
Suzanne Burnett 2/23/15 2:24 PM
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magazines with the highest circulation and geared towards women were selected for coding (e.g., Ladies’
Home Journal, Women’s Health, Ebony). Two independent raters coded all the images of women featured
in the magazines. White women comprised 69.35% of women's images featured in magazines, Black
women comprised 7.99%; Hispanic women comprised 4.7%; and Asian women comprised 2.24%. Eightyfour percent of Black women had either light or medium-toned skin; 80.95% of Asian women had lighttoned skin; and 89.13% of Hispanic women had light-toned skin. Twenty percent of Black women had hair
coded as natural (i.e., kinky/curly and brown/black), while 3.31% had hair coded as artificially lightened,
and 43.58% had hair coded as artificially straightened. Seventy-one percent of women of color had a
smaller facial feature consistent with mainstream beauty standards, however the majority of women
(57.32%) had a mixture of small and wide facial features. Results indicate that appearance standards for
women of color mimic physical features commonly found in White women. These standards may devalue
non-White standards of beauty, and have a negative impact on the body image and self-esteem of Women
of Color who do not fit this definition of beauty. Results will be further explored and implications will be
discussed.
Learning Objectives:
• Describe specific appearance standards set for Women of Color.
• Assess the difference and similarities in appearance standards set for Women of Color and white
women.
• Assess societal messages regarding appearance norms for Women of Color.
F43
The Relationship Between Sexual Objectification, Sociocultural Standards of Beauty, and
Religiosity in African American Women
Sara Aslan, MA, University of Missouri-Kansas City, Kansas City, Missouri, USA; Laurel Watson, PhD,
University of Missouri-Kansas City, Kansas City, Missouri, USA
The purpose of this study is to better understand religious attendance and importance as it moderates the
relationship between sexual objectification and internalization of sociocultural standards of beauty within
a sample of 260 undergraduate African American women. To date, no research has been performed in this
area. It is important for clinicians to utilize culturally specific coping mechanisms when working with
diverse clients. These coping mechanisms may be highly important in reducing the chances of
internalization of particular sociocultural standards of beauty, and therefore reducing the link to such
established connections as disturbances in increased body surveillance, body shame, appearance anxiety,
disordered eating (Watson, Ancis, White & Nazari, 2013), drive for thinness, and body dissatisfaction
(Griffiths et al., 2000). A moderation analysis was performed and results indicated that religious
importance and attendance weakened the relationship between sexually objectifying experiences and
internalized sociocultural standards of beauty. Thus, when treating African American women in
particular, a clinician’s knowledge of religiosity may be considerably beneficial to the client and possibly
aid in the reduction of further developing ailments such as eating disorders.
Learning Objectives:
• To assist clinicians in the knowledge of culturally specific coping mechanisms that can be utilized
when working with ethnically diverse clients.
• To add to the literature and clinical knowledge of sexual objectification and internalization of
sociocultural standards of beauty within African American women, while utilizing the lens of
objectification theory.
• To aid in further understanding the sociocultural standards of beauty within Westernized
societies as it relates to ethnically diverse women.
F44
Combatting Eating Disorder Stereotypes Using a Short-Term Poster Intervention
Mary Duffy, Student, University of Saint Joseph, West Hartford, Connecticut, USA; Kristin Henkel,
PhD, University of Saint Joseph, West Hartford, Connecticut, USA
The purpose of this study was to examine the effect of a short-term passive intervention on nursing
students’ inaccurate beliefs about eating disorders. Under-diagnosis of eating disorders in children,
males, and minority groups is a significant barrier to care for many struggling with eating disorders. Much
of this issue can be attributed to endorsement of eating disorder stereotypes by medical professionals. The
sample for this study was 134 female, undergraduate nursing students, recruited from their major
courses. Before and after a week-long, campus-wide poster campaign designed to combat eating disorder
stereotypes, participants completed questionnaires assessing their perceptions of individuals with eating
disorders: stereotypes and causes. Data were analyzed using multivariate analyses with Bonferroni
adjusted alpha levels to examine each individual dependent variable. Pre-test to post-test, there was a
significant reduction in the belief that people with eating disorders are almost always women (F(1,203) =
5.917, p = .016, η2 = 0.028). There was also a pre-test to post-test increased attribution to biological and
genetic factors (F(1,203) = 5.863, p = .016, η2 = 0.028) and a decreased attribution to society’s thin ideal
(F(1,203) = 7.138, p = .008, η2 = 0.034) as causal factors for eating disorders. The intervention had no
significant effect on participants' stereotypical beliefs about race and age in the eating disorder
population. Implementing a poster intervention for a longer period of time and testing different messages
in future studies may produce more significant results. The ability of a short-term passive intervention to
influence beliefs about eating disorders shows promise for this low-cost technique in reducing eating
disorder associated stigma and stereotype endorsement among medical professionals.
Learning Objectives:
•
•
•
Identify accurate and inaccurate beliefs about groups at risk for eating disorders (gender,
race/ethnicity, and age) and about causal factors in eating disorders
Utilize low-cost, short-term intervention strategies to reduce stereotypical beliefs about eating
disorders
Recognize the importance of providing medical professionals with accurate training about eating
disorders
F45
Ethnic and American Identity as Correlates of Eating Pathology in College Women
Liya Rakhkovskaya, BS, University of Nevada, Las Vegas, Las Vegas, Nevada, USA; Cortney Warren,
PhD, FAED, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
According to popular racial and cultural formation theories, ethnic identity is defined as the process of
identifying with the culture and practices one’s ethnic group, while American identity is defined as the
process of identifying with the culture and practices of the United States. Ethnic identity and American
identity are positively associated with mental health in ethnic minority and European American
individuals, respectively. Furthermore, a growing body of research suggests that Ethnic identity is
associated with diminished eating pathology in minority women. However, the protective effects of Ethnic
identity against eating pathology are unexplored in European American women. In addition, the
relationship between American identity and eating pathology is unexplored in all ethnic groups.To expand
our understanding of these constructs, this study examined the relationships between Ethnic identity,
American identity, thin-ideal internalization and eating pathology in 1018 ethnically diverse college
women. Participants completed questionnaires online for course credit. Results indicated that Ethnic
identity moderated the relationship between thin-ideal internalization and eating pathology for African
Americans and Asian Americans (but not for European Americans or Latinas), such that the relationship
was weaker for women with strong Ethnic identity. In contrast, American identity did not predict or
moderate eating pathology. Nevertheless, American identity was a significant positive correlate with
eating pathology and/or thin-ideal internalization in all ethnic groups. Overall, these findings suggest that
Ethnic identity serves as a protective factor against eating pathology, while American identity may be a
factor of risk, and that Ethnic identity and American identity are related but distinct constructs.
Learning Objectives:
• Increase understanding of ethnic and American identity
• Explore protective effects of ethnic identity against eating pathology
• Explore the relationship between American identity and eating pathology
Innovative Uses of Technology
F46
Family-Based Treatment Without Borders: Assessing the Feasibility of Using Telemedicine
as a Platform for Anorexia Nervosa Treatment Delivery
Alexandria Goodyear, BA, University of Chicago, Chicago, Illinois, USA; Kristen Anderson, LCSW,
University of Chicago, Chicago, Illinois, USA; Catherine Byrne, BA, University of Chicago, Chicago,
Illinois, USA; Setareh O'Brien, BA, University of Chicago, Chicago, Illinois, USA; Daniel Le Grange,
PhD, FAED, University of Chicago, Chicago, Illinois, USA
Family-Based Treatment (FBT) is a promising evidence-based therapy for adolescents with anorexia
nervosa (AN), and early intervention is associated with the most promising outcomes. Currently, FBT
therapists are clustered within urban settings, leaving few evidence-based treatment options for those
living in areas underserved by trained clinicians. In order to effectively treat AN, there is a need to
increase access to care for populations living in remote or rural areas. The current study aims to broaden
the availability of evidence-based treatment for AN by determining the feasibility of conducting FBT via
telemedicine, i.e. videoconference. To date, the study has completed the first wave of recruitment (N = 5)
and participants, aged 14 -17 (M = 16.0), and their families have begun FBT. To gain a better
understanding of the population that may pursue treatment via telemedicine, a clinical overview of our
current patients is provided. Duration of illness at baseline ranged from 6 to 60 months (M = 18.6) and
the mean percent of expected body weight was 88.4%. All patients met DSM-5 criteria for AN or atypical
AN. The male to female ratio of enrolled patients was 1:4. All patients currently live within the state of
Illinois and the mean distance from our clinic was 75.8 miles. This study is currently in its early stages and
as more data is gathered, we aim to better understand the long-term outcomes and feasibility of
conducting FBT via telemedicine and learn more about effective ways to overcome accessibility as a
barrier to successful eating disorder treatment. As early intervention is a critical component of effective
AN treatment, there is a strong need to determine the success of a telemedicine platform for treatment
delivery in order to improve the physical and psychological health of adolescents with AN.
Learning Objectives:
• Following the presentation, participants will be able to acquire an understanding of a novel AN
treatment approach.
• Following the presentation, participants will be able to understand the current population
(sample) for this study.
• Following the presentation, participants will be able to understand the preliminary findings of the
effectiveness of conducting FBT via telemedicine.
F47
No Automatic Approach Tendencies Towards High Caloric Food In Anorexia Nervosa.
Renate Neimeijer, MSc, University of Groningen, Groningen, Netherlands; Peter de Jong, PhD,
University of Groningen, Groningen, Netherlands
Dysfunctional automatic information processing might be crucial in the persistence of Anorexia Nervosa
(AN). Specifically, (the absence of) automatic approach tendencies might be crucial in AN patients'
success in minimizing their caloric intake. The aim of the present studies was to investigate the role of
(the absence of) automatic approach tendencies (AAT) for food in AN. Using an Affective Simon Task
manikin version (AST-manikin) Study I (n= 87) showed that before treatment, patients have less
automatic approach tendencies for food items than healthy controls. Supporting the relevance of the
absence of the common AAT towards food in the maintenance of AN, the AAT was normalized in treated
individuals at 1 year follow up. In Study II (n=57), a Stimulus Response Compatibility task (SRC) as well
as an AST-manikin was used to measure automatic approach tendencies towards food. In the AST, food is
task irrelevant, and is therefore taken to mimic situations in which food is not relevant for people's
current goals (e.g., a person is shopping) but in which people may nevertheless be automatically seduced
(e.g., by the smell of food) to approach food. In the SRC on the other hand, food is task relevant and in
this task participants are asked to categorize stimuli in terms of food/non-food. Hence this task seems
more closely related to situations where a person is actively thinking of whether to avoid or approach
particular food items (e.g., in the canteen during lunch). Results showed that food items do not only fail to
elicit AAT in AN patients when a person is actively thinking of whether to avoid or approach food, but also
fail to elicit AAT when food is irrelevant for their current goal. Results of both studies converge to the
conclusion that the absence of automatic approach tendencies may be involved in the persistence of
Anorexia Nervosa. Theoretical and practical implications will be discussed.
Learning Objectives:
• Following the training participants will be able to conclude how automatic approach tendencies
play a role in the course of anorexia nervosa
• Following the training participants will be able to differentiate between situations where
automatic approach tendencies are involved and how these could be measured
• Following the training participants will be able to describe what the knowledge about automatic
information processing in eating disorders implicates for treatment
F48
Mobile Application-Based Cognitive Bias Modification Training To Reduce Anxiety And
Rejection Sensitivity In Eating Disorders
Peter Musiat, PhD, King's College London, Institute of Psychiatry, London, United Kingdom (Great
Britain); Valentina Cardi, PhD, King's College London, Institute of Psychiatry, London, United Kingdom
(Great Britain); Janet Treasure, PhD, MD, FAED, King's College London, Institute of Psychiatry,
London, United Kingdom (Great Britain)
The aim of this study was to investigate the feasibility and efficacy of a mobile application-based cognitive
bias modification training for reducing anxiety and rejection sensitivity in individuals suffering from
eating disorders. Research on cognitive processing in anorexia nervosa (AN) suggests that anxiety
symptoms and interpersonal difficulties are maintained by biased cognitive processing of social stimuli.
Cognitive Bias Modification Training (CBMT) includes computerized trainings to target unhelpful
cognitive biases and has been shown to be effective in clinical populations with anxiety and mood
disorders. Twenty-five individuals with AN were recruited and completed baseline assessments on
depression, eating disorder symptomatology, emotional self-awareness, and feelings of rejection.
Following the baseline assessment, participants received a mobile device with the CBMT application. The
application includes a range of cognitive bias assessments, as well as two cognitive bias modification
tasks. Over a period of two weeks, participants were asked to complete five training sessions with the
application, before attending a follow-up assessment. Pilot data from a non-technology mediated trial
suggests that CBMT can significantly shift attentional bias towards positive stimuli, increase positive
interpretation of ambiguous stimuli, and reduce anxiety and rejection sensitivity. The study using mobile
application-based CBMT is currently undergoing and results will be presented.
Learning Objectives:
• understand challenges of translating cognitive bias modification training into a mobile
application
• appraise the feasibility and efficacy of cognitive bias modification training for anorexia nervosa
• evaluate the clinical implications and potential of cognitive bias modification training for eating
disorders
F49
Virtual Reality Technology In Cue Exposure Therapy For The Treatment Of Eating
Disorders: An Overview Of Current Research
Marta Ferrer-Garcia, PhD, Universitat de Barcelona, Barcelona, Spain; José Gutiérrez-Maldonado,
PhD, Universitat de Barcelona, Barcelona, Spain
This presentation offers an overview of current research into the use of virtual reality (VR) technology for
cue exposure therapy in patients with eating disorders (ED). VR is commonly defined as a computergenerated environment that simulates physical presence and enables the person to interact in real time
with three-dimensional scenarios recreating reality or imaginary worlds. These features make VR a
suitable technology for application in a wide range of fields, from entertainment to health care. The
ability of VR to simulate real life situations has led clinicians to use it to enhance exposure therapy in
psychological interventions. VR allows patients to face the feared or problematic situation in a safe
context and allows therapists to exert strict control over the exposure, while maintaining high ecological
validity. In the late 1990s, the first VR applications for the treatment of body image disturbance in
patients with ED appeared. Today, its use has spread to the study of other aspects of disturbed eating
behavior. Cue-exposure therapy with response prevention has been proposed as an effective treatment
for bingeing and purging behavior in patients with bulimia nervosa (BN). Exposure to contexts, foods and
emotions related with binges are considered to elicit high levels of food craving and anxiety, which trigger
the binge episode. Systematic, controlled exposure to high risk situations may extinguish the conditioned
response of craving and, consequently, prevent binges. The widespread application of exposure-based
interventions is hampered by logistical and generalization problems, but exposure by means of VR
overcomes these limitations. The rationale of using VR-based cue-exposure therapy in ED will be
discussed, and a study of the use of VR in an exposure treatment for bingeing behavior in patients with
BN and binge eating disorders will be presented.
Learning Objectives:
• Extend the knowledge about virtual reality technology and its use in the treatment of eating
disorders
• Extend the knowledge about the effectiveness of cue exposure therapy for the treatment of
bulimia nervosa
• Describe how virtual reality technology can enhance cue exposure therapy for binge behavior
treatment
Neuroscience (including Neuroimaging)
F50
Neural Processing of High and Low Calorie Food Pictures in Anorexia Nervosa: An
Investigation using Magnetoencephalography
Lauren Godier, MSc, BSc, Department of Psychiatry, University of Oxford, Oxford, Oxfordshire, United
Kingdom (Great Britain); Rebecca Park, MB, MRCPsych, PhD, BSc, Department of Psychiatry,
University of Oxford, Oxford, Oxfordshire, United Kingdom (Great Britain); Jessica Scaife, PhD, BSc,
Department of Psychiatry, University of Oxford, Oxford, Oxfordshire, United Kingdom (Great Britain);
Sven Braeutigam, PhD, Oxford Centre for Human Brain Activity, University of Oxford, Oxford,
Oxfordshire, United Kingdom (Great Britain)
Recent theories for understanding food reward have suggested separable elements of implicit ‘liking’
(hedonic pleasure) and ‘wanting’ (motivational salience) in driving eating behaviour, which can be in
conflict with conscious desires or preferences. Using a behavioural task we have previously found that
individuals with AN not only consciously prefer but also implicitly ‘want’ high calorie food less and low
calorie foods more as compared to controls, an inversion of the normal response . This suggests that
under-consumption of high calorie food and overconsumption of low calorie foods in AN may be driven
by aberrant motivational salience towards these foods. Further understanding of the neural processes
underpinning these aberrancies is required to inform treatment development. This study aimed to
investigate the neural processing of high and low calorie food pictures and is the first to use
magnetoencephalography (MEG), which allows the direct measurement of neural activity in real time.
MEG data were acquired using the 306-channel device at the Oxford Centre of Human Brain Activity, and
compared across three groups: 13 female participants currently suffering from restricting-type AN, 14
female participants recovered from restricting-type AN, and 16 female healthy control participants.
During a 10-minute food pictures task participants viewed 40 high and low calorie food pictures, which
were randomised and repeated three times. Attention to the pictures was assessed with a reaction time
task, and eye-tracking data. Preliminary time-series analysis of the MEG data suggest an increase in
neuronal activity at early latency observed over posterior parts of the brain in response to both calorie
conditions in patients, but not in the recovered and control groups. This abnormal activity appears to
reflect early, preconscious attention guided processes, and might be a potential biomarker to characterise
aberrancies in the neural processing of food reward in AN.
Learning Objectives:
• Describe the differences in the neural processing of high and low calorie foods in those with
experience of AN compared to controls.
• Evaluate the link between behavioural measures of attention, and neural processing of high and
low calorie food pictures.
• Discuss the implications of aberrant neural processing of food reward in AN in light of previous
behavioural and neural findings.
F51
Exploring The Relationship Between Perfectionism, Obsessionality And Neurocognitive
Traits In Anorexia Nervosa
Jenna Blumberg, BSc, MS, The University of Western Australia, Perth, Western Australia, Australia;
Karina Allen, PhD, MPsych, FAED, The Eating Disorders Service, Maudsley Hospital, The University of
Western Australia, London, United Kingdom (Great Britain); Susan Byrne, PhD, DPhil, MPsych, BSc,
FAED, The University of Western Australia, Perth, Western Australia, Australia
While a relationship between perfectionism, obsessionality and anorexia nervosa (AN) has been
established in the literature, it is currently unclear what specific factors may account for this relationship.
Recent evidence has suggested that certain neurocognitive deficits may be associated with eating disorder
symptomatology, especially in AN. These deficits primarily relate to weak central coherence and poor set
shifting and may also account for perfectionism and obsessionality in AN samples. This study aimed to
determine if neurocognitive traits (set-shifting and central coherence) could account for perfectionism
and obsessionality in AN, and to determine if these relationships differ the binge purge (AN-BP) and
restrictive (AN-R) subtypes. Ninety woman with AN participated in this study as party of the Strong
Without Anorexia Nervosa (SWAN) Study, a randomised controlled trial in Australia. Participants
completed the Rey Complex Figure and Wisconsin Card Sorting Task before commencing treatment.
Regression Analyses indicated that neurocognitive traits (set-shifting and central coherence) do not
account for the variance in perfectionism and obsessionality in AN. Finally, there were no significant
differences between the ANR type and ANBP type on their performance on the neurocognitive tasks. It
seems that neurocognitive traits cannot explain perfectionism and obsessioanlity in this sample of AN
women. These findings may have important implications for certain treatment approaches that
specifically target neurocognitive traits in AN.
Learning Objectives:
• To understand the relationship between perfectionism, obsessionality and neurocognitive traits in
anorexia nervosa.
• To consider the treatment implications for specifically targeting neurocognitive traits in AN.
• To understand the relationship between perfectionism, obsessionality and neurocognitive traits in
anorexia nervosa subtypes (binge purgeand restrictive subtypes).
F52
Endocannabinoid Receptor 1 Dysregulation in Weight Restored Women with Anorexia
Nervosa
Tom Hildebrandt, PsyD, FAED, Icahn School of Medicine at Mount Sinai, New York, New York, USA;
Beata Planeta-Wilson, MS, Yale University, New Haven, Connecticut, USA; Richard E Carson, PhD,
Yale University, New Haven, Connecticut, USA; Yiyun Huang, PhD, Yale university, New Haven,
Connecticut, USA; Stefani Corsi-Travali, MA, New York University, New York, New York, USA;
Patrycja Klimek, BA, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Robert
Pietrzak, PhD, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA; Daniele
Piomelli, PhD, University of California, Irvine, California, USA; Alexander Neumeister, PhD, New York
University, New York, New York, USA
Decreased (eCB1) endocannabinoid receptor 1 binding is associated with disturbances in feeding, affect,
and the starvation state of (AN) anorexia nervosa. We used positron emission tomography to investigate
eCB1 receptor binding in (AN-WR) weight restored patients with AN. We investigated 1 male and 12
female patients recently weight restored (3-12 months) (age = 25.41, SD =5.97) and 13 (BMI) body mass
index and ethnicity matched controls (age = 26.08, SD=6.84). Statistical parametric mapping and
volume-of-interest analyses were performed using eCB1 ligand [11C]OMAR. Whole brain and region-ofinterest analyses indicated that women with AN had significantly elevated [11C]OMAR VT values,
including amygdala (p < .01, d = 1.42), insula (p < .01, d=1.22), and ventral striatum (p < .01, d=1.34).
Plasma anadanamide levels were lower among AN-WR (p < .01, d = 1.22). [11C]OMAR VT was
significantly correlated with clinical impairment symptom measures of lifetime stress, eating behavior,
and body image disturbance, and relapse. Weight restored women with AN have evidence of significant
dysregulation in eCB tone compared to BMI matched controls and this dysregulation was correlated with
symptom expression and clinical outcomes.
Learning Objectives:
• Compare the endocannabinoid binding in weight restored anorexia patients versus healthy
controls
• Describe the role of symptom severity in endocannabinoid dysregulation
• Discuss gender differences in eCB1 and its potential role in pathophysiology of AN
F53
fMRI Correlates of Emotion Dysregulation in Women with Bulimia Nervosa
Tom Hildebrandt, PsyD, FAED, Icahn School of Medicine at Mount Sinai, New York, New York, USA;
Patrycja Klimek, BA, Icahn School of Medicine at Mount Sinai, New York, New York, USA;
Rebecca Greif, PsyD, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Eleanna
Varangis, BA, University of North Carolina, Chapel Hill, North Carolina, USA; Katharine Loeb, PhD,
Fairleigh Dickinson University, Teaneck, New Jersey, USA; King-Wai Chu, PhD, James J. Peterson
Veterans Affairs Medical Center, Bonrx, New York, USA; Kim Goldstein, MA, Icahn School of Medicine
at Mount Sinai, New York, New York, USA; Erin Hazlett, PhD, Icahn School of Medicine at Mount Sinai,
Bronx, New York, USA
The affect regulation model posits that negative affect precedes binge eating and that the bingeing
behavior aims to reduce this negative affect. However, research suggests that negative affect also follows
binge episodes and reduces after purging behaviors in (BN) bulimia nervosa. Furthermore, there is noted
variability in affective states throughout the binge/purge cycle, highlighting a more general deficit in
emotion processing and regulation. Brain imaging studies reported altered serotonin binding in regions
associated with emotional functioning (e.g., OFC; orbitofrontal cortex) in BN patients. The purpose of the
study was to examine differences in brain activation to emotional stimuli in BN compared with clinical
diagnoses associated with emotional dysregulation, such as (PTSD) post-traumatic stress disorder and
(BPD) borderline personality disorder. Sixteen women with BN completed an emotional image rating task
while undergoing an fMRI scan, and a diagnostic interview. During the computer task, participants
viewed positive, negative, and neutral pictures from the international affective picture system (IAPS),
while performing a rating task. Participants were presented with 4 runs, each of which consisted of a
presentation of 24 unique pictures (8 positive, 8 negative, 8 neutral), which were repeated once, followed
by a three-choice response prompt to rate the valence of the picture, and finally a fixation cross. The fMRI
data indicated a significant correlation between reduced OFC activation to unpleasant pictures and the
level of PTSD symptoms (r = .616). However, there were no differences in (OFC) orbitofrontal cortex
activation across blocks between women with only BN and women with comorbid BPD. The results
suggest that BN comorbid with PTSD may have specific deficits in OFC function, and therefore warrants
further investigation.
Learning Objectives:
• Assess the neurobiological relationship between comorbidities involving emotional dysregulation
and bulimia
• Differentiate the activation of orbitofrontal cortex in women with bulimia and comorbid posttraumatic stress disorder and borderline personality disorder symptoms
• Understand the impact of psychophysiology on our understanding of psychopathology
F54
Neuropsychological Profiles of Males with Anorexia Nervosa
Krisin Stedal, PhD, LP, Oslo University Hospital, Ullevål, Oslo, Norway
The identification of neurocognitive difficulties in females with AN has emphasized the importance of the
potential neurodevelopmental factors of this illness, and the need for treatments which are tailored to
ameliorate these challenges. However, these difficulties do not seem to be present in all cases, and it is
unknown whether males with AN display a similar neuropsychological profile to that of females. The
purpopse of this study was to explore the neuropsychological profile of males with a clinical diagnosis of
AN.The participants were selected from a database of 331 ED patients – out of which ten were males with
a diagnosis of AN. Mean age of the included patients was 15 years and 9 months. Mean BMI percentile for
age was 5.5 (SD 9.5). The participants were assessed with a neuropsychological test battery and
psychometric measures to assess eating disorder psychopathology, anxiety, obsessive-compulsive
symptoms and depression. Mean z scores were generated for the following domains: (i) executive
functioning; (ii) visuospatial memory; (iii) verbal fluency and (iv) central coherence. Neuropsychological
test score plots were generated for each of the ten participants. The patients displayed a broad spectrum
of neuropsychological strengths and weaknesses, and a discrepancy between the visual and verbal
performance was apparent for the majority of the participants. The study illustrates the individual
variability of neuropsychological test results and highlights the importance of using caution when
generalizing findings from whole group statistical analyses.
Learning Objectives:
• Explore the neuropsychological profiles of males with Anorexia nervosa
• Emphasize the importance of using caution when generalizing results from whole group statistical
analyses
• Highlight the potential discrepancy between verbal and visuospatial skills in patients with
Anorexia nervosa
Personality and Cognition
F55
Perfectionism in Anorexia Nervosa: novel performance based evidence
Samantha Lloyd, MSc, BSc, King's College London, Institute of Psychiatry, London, United Kingdom
(Great Britain); Jenny Yiend, PhD, King's College London, Institute of Psychiatry, London, United
Kingdom (Great Britain); Ulrike Schmidt, MD, PhD, FAED, King's College London, Institute of
Psychiatry, London, United Kingdom (Great Britain); Kate Tchanturia, PhD, DClinPsy, FAED, King's
College London, Institute of Psychiatry, London, United Kingdom (Great Britain)
Existing research into perfectionism in Anorexia Nervosa (AN) is limited by a reliance upon self-report
measures. This study used novel performance based measures to investigate whether there is behavioural
evidence for elevated perfectionism in AN. 100 participants took part in the study – 50 with a diagnosis of
AN and 50 healthy controls (HCs). Participants completed two performance based tasks assessing
perfectionism – a text replication task and a bead sorting task – along with self-report measures of
perfectionism. Significant group differences were observed on the tasks. In the text replication task the
AN group took significantly longer to reproduce a passage of text and geometric shapes compared with
healthy controls (p = 0.03, d = 0.43). In the bead sorting task, significantly more participants in the AN
group chose to check their work compared with the HC group (p = 0.04, d = 0.41) and took significantly
longer checking than those in the HC group (p = 0.02, d = 0.48). This study provides novel empirically
tested evidence of elevated performance based perfectionism in AN compared with a healthy control
group. Treatment implications of these findings are explored.
Learning Objectives:
• Describe the evidence for perfectionism in AN using novel experimental measurement. ·
• Consider associations between self report and behavioural measures of perfectionism.
• Consider the research and clinical implications of these findings.
F56
Anorexia Nervosa In Children And Adolescents - Associations Between Cognitive Functions
And Anorexia Nervosa Symptomatology, Co-Morbidity, Duration Of Illness And
Disposition To An Eating Disorder
Gry Kjaersdam Telléus, PhD, PsyD, MSc, Dept of Clin Medicine, Aalborg University/ Psychiatry,
Aalborg University Hospital, Aalborg, North Jutland Region, Denmark
Objective: Currently, there is only limited knowledge about the associations between cognitive functions
and Anorexia Nervosa symptoms, co-morbidity, duration of illness and familial disposition to an eating
disorder. In the largest case-control study regarding the cognitive profiles of children and adolescents
with Anorexia Nervosa conducted to date, deficits in a number of cognitive functions were previously
found. The aim of the study was to investigate the associations between the detected cognitive deficits and
Anorexia Nervosa symptomatology in children and adolescents with Anorexia Nervosa. It was
hypothesised that the cognitive deficits in juvenile patients with Anorexia Nervosa would be associated
with various aspects of Anorexia Nervosa symptomatology. A second hypothesis was that a significant
associations between the cognitive deficits and co-morbidity, duration of illness and disposition to an
eating disorder would be found. Method: Eating disorder symptoms, somatic conditions, co-morbidity,
predisposition and cognitive functions were examined in this multi-centre study. Children and
adolescents (N=94) between the ages of 10.6 and 17.9 years (mean age 14.9 years, SD 1.8) who were
suffering from recent-onset Anorexia Nervosa participated in the study. The patients were severely ill at
the time of assessment and had an average BMI of 15.8 (SD 1.8). Results: The findings of this study
Include a significant correlation between verbal memory and shape concern. The study findings also
revealed that Anorexia Nervosa-symptomatology significantly increased with age. However, no
association between cognitive deficits and various Anorexia Nervosa-symptomatological factors, comorbidity, duration of illness or predisposition to an eating disorder was found in children and
adolescents with Anorexia Nervosa. Conclusions: This result indicates that the disease variables are
related to neither intelligence nor specific cognitive functions. The significant correlation between age and
Anorexia Nervosa-symptomatology, suggest that the eating disorder more severely affects older patients
with Anorexia Nervosa.
Learning Objectives:
• Characterize the association between cognition and Anorexia Nervosa-symptomatology
• Assess the association between age and Anorexia Nervosa-symptomatology
• Improve our understanding of the association between cognition and disease variables in patients
with Anorexia Nervosa
F57
Nonsuicidal Self-Injury And Eating Pathology: An Investigation Of Associated Eating
Disorder Symptoms
Jennifer Buchman-Schmitt, BA, Florida State University, Tallahassee, Florida, USA; Mirela Tzoneva,
BS, Florida State University, Tallahassee, Florida, USA; Lindsay Bodell, MS, BA, Florida State
University, Tallahassee, Florida, USA; Pamela Keel, PhD, Florida State University, Tallahassee, Florida,
USA
The association between Eating Disorders (EDs) and nonsuicidal self-injury (NSSI) has been well
established in the literature, with most studies suggesting increased risk of NSSI in individuals with
Bulimia Nervosa (BN) and Anorexia Nervosa (AN) – Binge/Purge Subtype (Favaro & Santonastaso,
2000). However, less is known about the relationship between NSSI and specific ED symptoms or
whether certain personality traits may mediate associations. The present study examined the association
between NSSI and binge eating, individual compensatory behaviors (e.g., self-induced vomiting, fasting,
etc.) and the use of multiple (two or more) compensatory behaviors. In addition, we examined
perfectionism as a potential mediator of associations. Data from self-report surveys of a large community
sample (N = 2,355; 67.4% women) were analyzed using logistic regression, and mediation was tested
using the Sobel test for each significant association. The full model was statistically significant, χ2 (9,
2,355) = 93.05, p < .001, indicating that the model was able to distinguish between participants who
reported and did not report NSSI. Binge eating, vomiting, use of multiple compensatory behaviors, and
purging by means of laxatives, diet pills or diuretics were all significantly associated with NSSI, whereas
fasting and compulsive exercise were not. The strongest predictor of NSSI was the use of multiple
compensatory behaviors (OR = 2.54). Further, perfectionism mediated the observed relationships
between ED symptoms and NSSI (z = 2.38 – 4.26, p < .02). Perfectionism-focused treatment approaches
may be particularly relevant for patients with joint NSSI and ED symptoms.
Learning Objectives:
• Examine associations between specific eating disorder symptoms and nonsuicidal self-injury.
•
•
Determine if perfectionism accounts for the relationship between eating disorder symptoms and
nonsuicidal self-injury.
Use the results to inform treatment approaches for individuals who present with nonsuicidal selfinjury and eating disorder symptoms.
Prevention
F58
Is Intuitive Eating the Same as Flexible Control? Their Links to Each Other and Well-being
Could Provide an Answer
Tracy Tylka, PhD, Ohio State University, Columbus, Ohio, USA; Rachel Calogero, PhD, FAED,
University of Kent, Canterbury, United Kingdom (Great Britain)
Research has found that rigid dietary restraint is linked to higher psychological distress, including eating
disorders and disinhibited eating, and lower adjustment. Two approaches have been touted as healthier
alternatives: flexible control and intuitive eating, but have never been compared. Flexible control is eating
what is enjoyed, as long as portion control is employed and calories consumed are monitored. Intuitive
eating is responding to hunger and satiety cues to determine when to eat. This study’s purpose was to
evaluate flexible control and intuitive eating’s connections to each other, rigid dietary restraint, BMI, and
psychological well-being (adjustment and distress). Participants included U.S. community women and
men who were recruited via an online website. They completed validated measures of intuitive eating,
flexible control, rigid dietary restraint, psychological distress (negative affect, food preoccupation, binge
eating, poor interoceptive awareness) and adjustment (life satisfaction, positive affect, and body
appreciation). After deleting inattentive respondents, data were analyzed (N=382, 192 women, 190 men;
Mage=33.8 years, SD=11.08). Findings revealed that intuitive eating and flexible control were inversely
related and distinct constructs. More specifically, intuitive eating was related to higher psychological
adjustment and lower psychological distress, rigid dietary restraint, and BMI. Flexible control was related
to higher rigid restraint (sharing 42% variance) and psychological distress, and unrelated to psychological
adjustment and BMI. After controlling age, BMI, and flexible control, intuitive eating continued to predict
lower distress and higher adjustment. These results suggest that intuitive eating is not the same as flexible
control, and that perhaps “flexible” control may be an oxymoron in the context of eating behavior.
Discussion centers on the implications of this distinction between intuitive eating and flexible control for
the promotion of healthy eating attitudes and behavior.
Learning Objectives:
• Differentiate between intuitive eating and flexible control as eating behaviors and answer the
question posed in the title that intuitive eating and flexible control are distinct constructs.
• Associate intuitive eating with lower psychological distress (i.e., negative affect, food
preoccupation, poor interoceptive awareness, and binge eating), lower BMI, and higher
psychological adjustment (i.e., positive affect, body appreciation, life satisf
• Challenge the current societal conceptualization of flexible control as an adaptive eating behavior,
because flexible control is linked to higher rigid dietary restraint and higher psychological distress
and is unrelated to BMI and psychological adjustment
F59
Reaching the Masses: Large Scale Dissemination of an Eating Disorder Prevention
Program
Marisol Perez, PhD, Arizona State University, Tempe, Arizona, USA
A large dissemination trial of the Body Project within a university setting is currently ongoing and
designed to reach 7500 women per academic year, for a 5 year period. We will discuss our university-wide
initiatives and a variety of strategies used to promote local implementation. In this presentation, initial
data from Body Project participants on participation rates will be presented. Initial data from group
leaders on adherence, fidelity, self-efficacy, perceived competency, and leadership skills will be presented.
Finally system-level program evaluation results from various stakeholders in the organization will be
discussed. Key issues, lessons learned, and next steps for maximizing impact and sustainability will be
addressed.
Learning Objectives:
• Describe several strategies to promote local implementation of an eating disorder prevention
program within a university setting.
• Understand how organization-level implementation strategies impact program evaluation across
stakeholders.
• Discuss issues related to dissemination and implementation of eating disorder prevention
programs
F60
The Importance of Education in the Prevention of Eating Disorders for People with
Diabetes Mellitus and their Families
Claudia Pieper, PhD, MPsych, MD, FAED, Brazilien Diabetes Society, Rio de Janeiro, Brazil; Simone
Freitas, MA, DiplPsych, FAED, Clinic of Studies and Treatment of Eating Disorders and Obesity CETTAO, Rio de Janeiro, Brazil; Alexandra M. de Araujo, DPsych, FAED, Clinic of Studies and
Treatment of Eating Disorders and Obesity - CETTAO, Rio de Janeiro, Brazil
Objective:Evaluate the usefulness and effectiveness of a specific educational material for parents of
adolescents with diabetes mellitus (DM) in early detection of eating disorders (ED).
Sumary:The prevalence of ED in adolescents with DM is increasing. According to studies, about 30% of
youth with DM 1 has BN (1% in the range between 9 and 13 years, 14% between 12 and 18 years and 34%
between 16 and 22 years). In a reference hospital, IEDE, in Rio de Janeiro, we realized in educational and
clinical practice, that the symptoms of ED appear after the diagnosis of DM and with the early insulin
treatment. The intensive treatment of insulin to avoid critical complications of DM promotes weight gain
and the consequent dissatisfaction with body image. Insulin restriction is a symptom of calorie purging
that is unique to people with DM1, especially in order to control weight. This ED, called Diabulimia, may
increase early clinical complications of DM. In the year following the publication of our book called
“Diabulimia :a dangerous combination”, we seek to alert parents and families about the problem, using 3
chapters of the book as an educational tool in the early detection and prevention of ED in this patients (n
= 24, average age of 13, 4 years). We starting from 3 educational sessions of 1 hour and a half long. The
meetings were performed with a Endocrinologist and 2 Psychologists with reading of these chapters:
“Better understanding diabetes; Eating Disorder:do you really know what it is?;Diabulimia-a new ED?”
,with the participation of parents (n= 24) and question session. After 15 days we did a fourth meeting for
applying a questionnaire that aimed to recognize symptoms of Diabulimia in their children. Results:
16,66% was positively diagnosed with omission or negligence of insulin doses.It was possible to forward
these young people for a multidisciplinary and specific treatment for ED, in addition to the management
and control of DM. Conclusion: It is very important to know how to recognize earlier the warning signs
of ED in people with diabetes. Signs and symptoms of BN, especially omission of insulin dose, are often
not recognized by health professionals, and it is very important to inform parents about this fact.
Education and Prevention in DM and ED is the basis for proper treatment and it is one of the
cornerstones for a better quality of life.
Learning Objectives:
• present the contents of the book "Diabulimia: a dangerous combination" as a tool for the
education of parents and relatives of patients with diabetes mellitus
• inform health professionals and the lay public in general about the importance of early
recognition of the signs and symptoms of eating disorders in young people with Type 1 diabetes
• help parents in the prevention of omission or decreasing the dose of insulin in young people with
DM type 1
F61
Dismantling Prevention: Comparison Of Media Literacy And Appearance Comparison
Interventions With A Healthy Eating Behaviour Active Control
Siân McLean, BSc, La Trobe University, Melbourne, Victoria, Australia; Susan Paxton, PhD, FAED, La
Trobe University, Melbourne, Victoria, Australia; Eleanor Wertheim, PhD, La Trobe University,
Melbourne, Victoria, Australia
School-based interventions show promise for prevention of body dissatisfaction. Little research, however,
has examined the active components that contribute to improvements. Specifically, research is needed to
add to our understanding of the theoretical pathways underpinning intervention effects. Thus, we aimed
to conduct a dismantling study of the Happy Being Me prevention intervention to examine the effects of
media literacy (ML) and appearance comparison (AC) prevention components on body dissatisfaction.
Participants were 208 female grade seven students (Mage= 13.0, SD = 0.4) randomly allocated by class to
a ML-based intervention (n = 82), AC-based intervention (n = 64) or healthy eating behaviour (HEB)
active control (n = 62). Self-report measures of body dissatisfaction, internalisation of the thin-ideal,
appearance comparison, appearance conversations, fear of negative appearance evaluation, dietary
restraint, peer weight-teasing, and media literacy were completed at baseline and post-program.
Improvements were revealed for appearance conversations and fear of negative appearance evaluation in
the AC group relative to both the ML and HEB groups. For the media literacy-realism measure both the
ML and AC groups improved relative to the HEB group, whereas for the media literacy-similarity measure
the ML group improved relative to the AC group. Effect sizes were small to moderate. Significant main
effects for time were demonstrated for internalisation, appearance comparison, and peer weight-teasing.
This study has provided valuable preliminary evidence for the specific elements of intervention programs
that are effective for particular outcomes. The findings contribute to our understanding of the ways in
which media literacy and appearance comparison intervention components produce positive effects in
body dissatisfaction prevention.
Learning Objectives:
• Differentiate specific intervention content in media literacy and appearance comparison
interventions
• Analyse the effectiveness of school-based prevention on risk factors for body dissatisfaction
• Assess the relative importance of media literacy and appearance comparison prevention modules
to improvements in risk factor outcomes
F62
The Female Athlete Body Project (FAB): Preliminary 12 Month Results
Tiffany Stewart, PhD, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA; Carolyn
Becker, PhD, FAED, Trinity University, San Antonio, Texas, USA; Lisa Smith Kilpela, PhD, Trinity
University, San Antonio, Texas, USA
Hongmei Han, MS, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA; Heather
Brady, MS, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA; Nicole Wesley, BS,
Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA; Shelly Ragusa, RD, Pennington
Biomedical Research Center, Baton Rouge, Louisiana, USA; Morgan Briggs, BA, Trinity University, San
Antonio, Texas, USA; Jennifer White, BA, Trinity University, San Antonio, Texas, USA; Lauren Splawn,
Student, Trinity University, San Antonio, Texas, USA; Shelly Mullenix, MS, Louisiana State University,
Baton Rouge, Louisiana, USA; Jamie Meeks, RD, Louisiana State University, Baton Rouge, Louisiana,
USA; Athena Argyropoulos, MS, American University, Washington D.C., District of Columbia, USA;
Marc Powell, BS, Trinity University, San Antonio, Texas, USA
Research suggests that female athletes are at risk for Relative Energy Deficiency in Sport (RED-S),
disordered eating behaviors, and body image concerns, all of which further increase athletes’ risk for the
development of clinical eating disorders (EDs), injuries, and long-term health consequences including
osteoporosis and reproductive difficulties. Despite this risk, there are limited efforts devoted to the
prevention of RED-S or EDs within the female athlete population. The present study is a 3-site
randomized controlled trial (1 RO1 MH094448-01), funded by the National Institutes of Mental Health
(NIMH) investigating the efficacy of an ED prevention program, the Female Athlete Body Project (FAB),
among female collegiate athletes (target N = 500). Athletes were randomized from the three sites to either
the FAB program or a brochure waitlist control condition using group (cluster) randomization based on
teams (basketball, cheerleading, cross country, field hockey, golf, gymnastics, lacrosse, soccer, softball,
swimming and diving, tennis, track, and volleyball). Participants completed self-report assessments and
telephone interviews at baseline, post-intervention, 6, 12, and 18-month follow-up time points. This study
has recruited 396 participants (FAB=180, Control=216) to date. The present poster will show the 12
month follow-up results from this ongoing trial. Preliminary results indicate that athletes randomized to
the FAB program experienced a significantly greater reduction in weight concern, internalization of the
thin ideal, internalization of the sport-specific thin ideal, eating restraint, and improved knowledge of the
Female Athlete Triad (now called RED-S) compared to the athletes in the control arm of the study. Of
note is that the sample had significantly lower baseline scores for shape concern and eating concern on
the EDE-Q than the norm for collegiate athlete populations. This may be due to floor effects.
Learning Objectives:
• Describe why prevention programs are needed for female athletes for eating disorders and
relative energy deficiency in sport.
• Describe the objectives of the Female Athlete Body Project (FAB).
• Describe preliminary results and conclusions from the Female Athlete Body Project (FAB).
F63
Impact and Future Direction of a College-Based Eating Concerns Mentors (ECM) Program
Eva-Molly Dunbar, BA, PhD, University of Rhode Island, Kingston, Rhode Island, USA
The increase in prevalence of eating disorders in the U.S., especially on college campuses, has led to the
creation of many eating disorder prevention programs. Despite the increase in awareness of the impact of
eating disorders on college campuses, optimal prevention and support mechanisms, as well as systematic
measurement of existing mechanism’s effectiveness, are lacking. A new college-based program, “The
Eating Concerns Mentors (ECM),” program was developed to provide peer-based support for students
who are struggling with body image difficulties and eating concerns, as well as for individuals concerned
about friends/family members' eating disorder symptoms. The program uses a cognitive dissonance based
model and peer mentoring to change participants’ eating disordered attitudes and behaviors. Crucially,
the effectiveness of ECM’s Body Image Program was evaluated. Participants were 32 undergraduate
college students. Students who took the Body Image Program showed decreases in eating disorder risk
factors (e.g., fat-talk attitudes and behaviors), and an increase in self-efficacy. The importance of collegelevel eating disorder prevention and support programs, and predictive features of such programs,
specifically involving peer mentoring, are highlighted. An analysis of how the present assessment
measures may serve as a model for the evaluation of future eating disorder prevention programs is
presented. Future direction includes discussion of how the ECM program is being adapted and expanded
upon at another large State University. The new ECM program incorporates the Transtheoretical Model of
Behavior Change (TTM) for the prevention of eating disorders and support for healthy attitudes and
behaviors. The importance of the novel addition of the TTM to the ECM program will be highlighted.
Learning Objectives:
• Assess the use of the cognitive dissonance model paired with peer mentoring in eating disorder
prevention programs.
• Discuss utilization of the Transtheoretical Model of Behavior Change (TTM) for prevention of
eating disorders and support for healthy attitudes and behaviors.
• Understand the importance of program evaluation research to assess the effectiveness of this Peer
Mentor focused program and explain how it could be applied broadly to evaluate such future
programs.
Risk Factors for Eating Disorders
F64
Self-Weighing Throughout Adolescence: Prevalence, Cross-Sectional Associations And
Contemporaneous Changes With Biological, Cognitive, Psychological, And Behavioral
Outcomes
Carly Pacanowski, PhD, RD, University of Minnesota, Minneapolis, Minnesota, USA; Loth Katie, PhD,
RD, University of Minnesota, Minneapolis, Minnesota, USA; Peter Hannan, MS, University of
Minnesota, Minneapolis, Minnesota, USA; Jennifer Linde, PhD, University of Minnesota, Minneapolis,
Minnesota, USA; Dianne Neumark-Sztainer, PhD, MPH, RD, FAED, University of Minnesota,
Minneapolis, Minnesota, USA
Self-weighing is a weight control strategy increasingly encouraged by the obesity field; yet, concerns about
psychological well-being have been raised by the field of eating disorders. This study examined
relationships between self-weighing and weight, psychological well-being, and unhealthy weight control
behaviors (UWCBs) over a 10-year period in adolescents transitioning to young adulthood.
Anthropometric and psychosocial data were collected from a diverse sample of study participants (n =
1,868) at three time points in Project EAT. Level of agreement with the statement “I weigh myself often”
was assessed at each time point along with pertinent outcomes: weight, weight disparity (difference
between ideal and actual weight), body satisfaction, weight concern, self-esteem, depression and UWCBs.
Data were analyzed cross-sectionally and longitudinally, examining contemporaneous change in selfweighing and each outcome. In females (n = 1,058) statistically significant correlations (ps <0.001) were
found at every time point between frequency of self-weighing and weight concern (rs = 0.30, 0.34, 0.34),
self-esteem (rs = -0.18, -0.19, -0.15) and UWCBs (rs ranging from 0.18 – 0.30). In males (n = 810),
significant correlations were found between self-weighing and weight concern at every time point (rs =
0.24, 0.27, 0.28). Contemporaneous change analyses followed a similar pattern; increases in endorsement
of self-weighing were significantly (ps < 0.001) related to decreases in body satisfaction and self-esteem,
and increases in weight concern, depression and UWCBs in females, and increases in weight concern and
UWCBs in males. These findings suggest that self-weighing is not an innocuous behavior. Though future
studies of self-weighing and psychological outcomes are warranted, studies using self-weighing as an
intervention are encouraged to exclude at-risk individuals and repeatedly assess well-being.
Learning Objectives:
• Examine associations between self-weighing and psychological well-being and weight control
behaviors in adolescence and young adulthood.
• Understand how self-weighing may have a different impact on males and females.
• Assess changes in self-weighing and changes in psychological well-being and weight control
behaviors in males and females over a 10-year period.
F65
Negotiating Interpersonal Dominance And Submission: An Experience Sampling
Investigation Of Social Perception, Negative Affect, And Binge-Eating Behavior.
Suman Ambwani, PhD, Dickinson College, Carlisle, Pennsylvania, USA; Michael Roche, MS, The
Pennsylvania State University, State College, Pennsylvania, USA; Alyssa Minnick, MA, University of
Pennsylvania, Philadelphia, Pennsylvania, USA; Aaron Pincus, PhD, The Pennsylvania State
University, State College, Pennsylvania, USA
Etiological and maintenance models for disordered eating highlight the salience of negative affect and
interpersonal dysfunction. The present study employed a 14-day experience sampling procedure to assess
the impact of negative affect and interpersonal perceptions on binge-eating behavior. Young adult women
(N = 40) with recurrent binge-eating and significant clinical impairment recorded their mood,
interpersonal behavior, and eating behaviors at six semi-random intervals daily through the use of
personal digital assistants. Multilevel modelling was employed to assess associations among interpersonal
features, negative affect, and binge-eating behaviour across multiple levels of analysis. Results indicate
that interpersonal problems moderated the relationship between negative affect and binge-eating.
Interpersonal problems also intensified the association between momentary interpersonal perceptions
and binge-eating behavior. Specifically, for individuals with interpersonal submissiveness problems,
interactions that were perceived as cold-dominant or warm-submissive were associated with increased
binge-eating. Conversely, those with interpersonal dominance problems experienced an increased risk of
binge-eating when faced with dominant-warm and submissive-cold interactions. Although momentary
negative affect was associated with binge-eating behavior, average levels of negative affect over the
experience sampling period were not, suggesting there may be important differences in how dispositional
versus momentary experiences of negative affect are associated with binge-eating. Present findings offer
several possibilities for attending to affective and interpersonal functioning in clinical practice.
Learning Objectives:
• Understand the interpersonal circumplex model and its relevance for eating disorder research.
• Understand the application and utility of experience sampling procedures for studying
interpersonal behavior, mood, and patterns of disordered eating.
• Describe and critically evaluate empirical findings on interpersonal perception, interpersonal
problems, negative affect, and binge-eating across a 14-day experience sampling protocol among
young women with recurrent binge-eating.
F66
Stress And Inflammatory Dysfunctionin Anorexia Nervosia And Bulimia Nervosa.
Marina Diaz-Marsa, MD, PhD, FAED, Hospital Clinico San Carlos Madrid, Spain., Madrid, Spain;
Aida Navalón, DiplPsych, Hospital Clínico San Carlos Madrid, Madrid, Spain; Karina S. MacDowell,
MD, Hospital 12 de Octubre. Madrid, Madrid, Spain; Juan Carlos Leza, PhD, Departamento de
Farmacología. Facultad de medicina, UCM, Madrid, Madrid, Spain; Alberto Rodríguez Quiroga, MD,
Hospital Clínico San Carlos, Madrid, Spain; Christian Prado, MD, Hospital Clinico San Carlos, Madrid,
Spain; Jose Luis Carrasco, PhD, Departamento de psiquiatría y psicología, Facultad de medicina, UCM,
Madrid, Spain
The links between stress response, serotonin function, HPA axis and inflammatory mechanisms in ED
have also been suggested in a number of studies. In our study, inflammatory parameters in white blood
cells were investigated in 26 female patients with ED and 25 healthy control subjects matched for sex, age
and ethnicity. Patients were free of medication for at least two weeks at the time of the study. Results
showed a significant increase in plasma levels of the proinflammatory cytokine IL1b and the protein
expression of cyclooxygenase 2 (COX2) in peripheral mononuclear blood cells (PMBCs) in ED patients
compared with controls. As well as a significant increase of the oxidative-nitrosative marker TBARS
(Thiobarbituric Acid Reactive Substances) in plasma. These findings were associated with increased
expression of the alpha7 subunit of the nicotinic receptor (a7nAChR) in PMBC in ED patients
independent of plasma cotinine levels.These results suggest that a pro-inflammatory and oxidant
phenotype might be present in ED patients. Further research on cellular inflammatory and antiinflammatory pathways might be oriented to investigate differences between ED subtypes and to search
for new potential targets for pharmacological treatment.
Learning Objectives:
• Relate eating disorders and inflammatory and anti-inflammatory markers
• Assess a new line of investigation, which is showed in this study
• Analyze relevant biological factors in diagnostic and treatment of eating disorders
F67
Examining Motivation To Change For Individual Eating Disorder Symptoms: Predicting
Naturalistic Symptom Change Over 12 Weeks.
Lindsey Hovrud, BS, University of North Dakota, Grand Forks, North Dakota, USA; Kyle De Young,
PhD, University of North Dakota, Grand Forks, North Dakota, USA
This study examined the relationship between motivation to change individual eating disorder symptoms
and naturalistic symptom frequency over 12 weeks. Participants (n=109) from the community with eating
disorders (i.e. anorexia nervosa, bulimia nervosa, binge eating disorder, or purging disorder) completed
assessments including a modified version of the University of Rhode Island Change Assessment and the
Eating Disorder Examination Questionnaire at baseline, week 6 and week 12. Cross-lagged generalized
estimating equations indicated that, when controlling for motivation to change binge eating (BE) more
frequent BE predicted more contemplation to change (Wald Χ2=4.09, OR=1.01, p=.043) and more
concern about maintaining changes in BE (Wald Χ2=5.21, OR=1.01, p=.022) 6 weeks later. Higher
contemplation to change BE predicted higher action scores 6 weeks later (Wald Χ2=8.25, OR=1.34,
p=.004); however, higher contemplation also predicted more frequent BE when controlling for baseline
BE frequency (Wald Χ2=8.11, OR=1.52, p=.004). When controlling for baseline purging frequency, higher
contemplation (Wald Χ2=7.47, OR=1.80, p=.006) and concern about maintaining changes in purging
(Wald Χ2=9.19, OR=2.03, p=.002) also predicted more frequent purging, and higher action predicted less
frequent purging (Wald Χ2=6.09, OR=0.61, p=.014) 6 weeks later. Thus, more frequent BE and purging
predicted greater contemplation to change, and concern over maintaining change to, these behaviors, and
more contemplation predicted more frequent BE and purging. These results are indicative of the difficulty
experienced by individuals considering changing their behaviors. It is intriguing that action predicted
change to purging but not binge eating. Future research should identify whether skill deficits underlie the
lack of confidence individuals experience with regard to maintaining their behavior change in both
treatment and naturalistic samples.
Learning Objectives:
• Examine the association between changes in individual eating disorder symptom frequency and
motivation to change states.
• Analyze how motivation to change states predict changes in eating disorder symptom frequency.
• Discuss how motivation to change and symptom frequency at baseline predicts results 6 weeks
later.
F68
Peer Commentary as a Moderator of the Relation between Body Dissatisfaction and
Disordered Eating
Erin E. Reilly, MA, University at Albany, SUNY, Albany, New York, USA; Lisa M. Anderson, BA,
University at Albany, SUNY, Albany, New York, USA; Sasha Dmochowski, MA, University at Albany,
SUNY, Albany, New York, USA; Lauren E. Knauf, BA, University at Albany, SUNY, Albany, New York,
USA; Drew A. Anderson, PhD, University at Albany, SUNY, Albany, New York, USA
Extending previous work, the current study endeavored to test specific types of peer commentary as
moderators of the relation between body dissatisfaction and disordered eating behavior. Undergraduates
(N = 500, 63.6% female) completed the Body Dissatisfaction, Drive for Thinness, and Bulimia subscales
of the EDI-2, as well as items assessing the frequency of peer criticism about weight, teasing about weight
and shape, and encouragement to diet. Six moderation analyses were conducted, as the three types of
commentary were assessed in relation to two outcomes— drive for thinness and bulimic symptoms; all six
full models were significant at the p < .01 level. Peer criticism had a significant main effect on bulimic
symptoms (b = -1.8532, p < .05), and the interaction between body dissatisfaction and criticism was also
significant (b = -.0959, p < .01). Peer teasing about weight showed a similar pattern, as the variable had a
significant main effect on bulimic symptoms (b = .9142, p < .01), and interaction effect with body
dissatisfaction (b = .0515, p < .05). These interactions suggested that the relation between body
dissatisfaction and bulimic symptoms was strengthened at higher levels of criticism and teasing. On the
other hand, encouragement to diet significantly predicted drive for thinness (b = .7993, p < .01), and
showed a significant interaction with body dissatisfaction (b = -.0599, p < .05) in the same model. The
results suggest that the valence of peer commentary may have differential effects across symptoms of
disordered eating, as interactions between “negative” (i.e., criticism and teasing) commentary and body
dissatisfaction were relevant to bulimic symptoms, whereas encouragement to diet interacted with body
dissatisfaction to predict higher drive for thinness. Future work should build upon the current findings, in
an effort to better understand and incorporate the nuances of the peer context into treatment and
prevention efforts for disordered eating.
Learning Objectives:
•
•
•
Understand the need to investigate factors that interact with body dissatisfaction to increase
eating disorder risk.
Describe why peer environment may be an apt moderator of the relation between body
dissatisfaction and eating disordered behavior.
Develop a more nuanced understanding of peer influences and the need to include them in efforts
related to treatment and prevention of eating pathology.
F69
Social Support, Perceived Stress, And Bulimic Behaviors: A Mediation Model.
Mun Yee Kwan, MS, North Dakota State University, Fargo, North Dakota, USA; Kathryn Gordon, PhD,
North Dakota State University, Fargo, North Dakota, USA
Interpersonal functioning is an important factor associated with the onset and maintenance of eating
disorders. Individuals with bulimia nervosa exhibit deficits in various aspects of interpersonal
functioning, including more negative social interactions and conflicts, less social competence, less support
figures, and lower social support satisfaction than individuals without eating psychopathology. This
prospective study examined the mechanism by which social support affects bulimic behaviors through
stress perception. A total of 297 undergraduate students (43.6% men) completed the Multidimensional
Scale of Perceived Social Support and the Bulimia Test-Revised at baseline assessment. They returned to
complete the Perceived Stress Scale and the Eating Disorder Examination-Questionnaire at follow-up
assessment four weeks after baseline assessment. After controlling for baseline bulimic symptoms,
bootstrapped mediation analysis revealed a mediation effect of stress perception on the relationship
between social support and bulimic behaviors (indirect effect = 1.05, 95% CI = -0.40 to -0.01). Results
indicated that social support predicted lower perceived stress, which was associated with lower bulimic
behaviors. Findings are consistent with existing literature and suggest that lowering perception of stress
by increasing social support may be helpful in eating disorder prevention programs among undergraduate
students.
Learning Objectives:
• Examine the mechanism of how social support helps to decrease bulimic symptoms.
• Describe the role of interpersonal factors in disordered eating.
• Describe the relationship between stress and disordered eating.
F70
Body Image Dissatisfaction And Sociocultural Influences In Argentine Female Adolescents
With And Without Eating Disorders
Guillermina Rutsztein, PhD, CPsychol, Universidad de Buenos Aires, Buenos Aires, Ciudad Autónoma de
Buenos Aires, Argentina; Brenda María Murawski, CPsychol, Universidad de Buenos Aires - CONICET
(Consejo Nacional de Investigaciones CyT), Buenos Aires, Ciudad Autónoma de Buenos Aires,
Argentina; Jesica Custodio, CPsychol, Universidad de Buenos Aires - CONICET (Consejo Nacional de
Investigaciones CyT), Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina; Luciana Elizathe,
PhD, CPsychol, Universidad de Buenos Aires - CONICET (Consejo Nacional de Investigaciones CyT),
Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
The aim of this study was to evaluate and compare body image dissatisfaction, thin-ideal internalization
and other psychological features of eating disorders in Argentine female adolescents with eating disorder
(ED), adolescents at risk of eating disorder (RED) and adolescents with neither risk nor eating disorder
(NED). The sample included 200 girls aged between 13 and 19 years from Buenos Aires: 167 high school
students and 33 patients who were receiving treatment at specialized centers. Participants voluntarily
completed the fol­lowing self-administered instruments: Sociodemographic and Specific Symptoms of
Eating Disorders Questionnaire, Contour Drawing Rating Scale, Cuestionario de Influencia del Modelo
Estético Corporal-26 (Questionnaire of influence of the Aestetic Corporal Model-26, CIMEC-26) and
Eating Disorder Inventory-3 (EDI-3). The sample was evaluated through a semistructured interview
based on the Eating Disorder Examination (EDE) in order to form three groups: adolescents with ED
(n=46), adolescents at risk of ED (n=17) and adolescents with neither risk nor ED (n=137). Regarding
body image dissatisfaction, ED group revealed higher scores than NED group. RED group was not
significantly different from the other two groups. However, sociocultural influences were higher in both
ED and RED group than in NED group. In most of the EDI-3 subscales, RED group was: 1) not different
from ED group in Drive for Thinness, Bulimia and Body Dissatisfaction; 2) not different from either ED or
NED groups in Interpersonal Insecurity, Interpersonal Alienation, Interoceptive Deficits, Emotional
Dysregulation and Perfectionism; and 3) not different from NED group in Low Self-Esteem, Personal
Alienation and Asceticism. In conclusion, female adolescents at risk of ED, show intermediate features
between ED and NED groups that can lead to the development of an ED (continuum of ED). These
findings reveal the importance of including body image dissatisfaction, thin-ideal internalization and
healthy eating behaviors in workshops aimed at preventing ED.
Learning Objectives:
• Describe the continuum of eating disorders in female adolescents from Buenos Aires, Argentina
• Assess the degree of body image dissatisfaction, thin-ideal internalization and other psychological
features of eating disorders in female adolescents with eating disorder, adolescents at risk of
eating disorder and with neither risk nor eating disorder.
• Discuss the role of the sociocultural influences across the continuum of eating disorders
F71
Perfectionism Across A Continuum Of Eating Disorders In Adolescent Girls From Buenos
Aires
Maria Luz Scappatura, CPsychol, Universidad de Buenos Aires, Buenos Aires, Ciudad de Buenos Aires,
Argentina; Brenda Maria Murawski, CPsychol, Universidad de Buenos Aires, Buenos Aires, Ciudad de
Buenos Aires, Argentina; Guillermina Rutsztein, PhD, Universidad de Buenos Aires, Buenos Aires,
Ciudad de Buenos Aires, Argentina
Several studies have shown evidence of a continuum across eating disorders. The aim of this study was to
analyze and compare habits, eating attitudes and perfectionism in adolescent girls with eating disorder
(ED), adolescents at risk of eating disorder (EDR) and adolescents without eating disorder or risk (NED).
The sample included 200 women between 13 and 19 years of age: 167 students of high schools from
Buenos Aires and 33 ED patients recruited from clinics specialized in treatment of ED. Three groups were
formed according to the presence of ED or ED risk (which was evaluated through a semistructured
interview based on the Eating Disorder Examination (EDE): adolescents with ED (n= 46), adolescents at
risk for ED (n= 17) and adolescents without ED neither risk (n= 137). Participants completed a
Sociodemographic and specific symptoms of eating disorders questionnaire, Eating Disorder Inventory-3
(EDI 3) and Almost Perfect Scale-Revised (APS-R). Overall, the results support the continuum theory of
ED. Adolescents from EDR group had intermediate scores on perfectionism and most EDI- 3 scales. Also,
the maladaptive perfectionism percentage in EDR group was intermediate (17.60%) showing no
significant differences between the other two groups. Furthermore, the results support the dysfunctional
nature of one of the components of perfectionism (Discrepancy), in which there were no differences
between EDR and ED adolescents [F (2, 196) = 16.908, p = .001]. The presence of psychological
characteristics associated with the development of ED in nonclinical adolescent population (EDR),
reinforces the importance of making efforts to prevent ED in school contexts.
Learning Objectives:
• Describe role of perfectionism as a risk factor of eating disorders
• Discuss role of perfectionism across a continuum of eating disorders
• Distinguish adaptive and maladaptive aspects of perfectionism in eating disorders
F72
Peer Influence as a Predictor of Symptomatology Associated to Eating Disorders in Women
Adriana Amaya-Hernández, PhD, Universidad Nacional Autónoma de México, Mexico City, Mexico;
Juan Manuel Mancilla-Díaz, PhD, FAED, Universidad Nacional Autónoma de México, Mexico City,
Mexico; Georgina Leticia Alvarez-Rayón, PhD, Universidad Nacional Autónoma de México, Mexico
City, Mexico; Mayaro Ortega-Luyando, BA, Universidad Nacional Autónoma de México, Mexico City,
Mexico; Rosalia Vázquez-Arévalo, PhD, Universidad Nacional Autónoma de México, Mexico City,
Mexico; Xochitl López-Aguilar, PhD, Universidad Nacional Autónoma de México, Mexico City, Mexico;
María Trinidad Ocampo, BA, Universidad Nacional Autónoma de México, Mexico City, Mexico
Peers are considered potentially influential on behaviors, attitudes and cognitions, since they provide
emotional support and information about the world and themselves, peers allow to test and to adopt
independent family values and give a sense of belonging. Therefore, the aim of this study was to analyze
the peer influence (messages, interactions and likability) on symptomatology associated with eating
disorders in adolescents and adult women. The sample was conformed by 168 women who were classified
in two groups, the first group with 78 adolescents among 14 and 17 years old; while the second was
composed by 90 adult women with a range of age among 18 and 23 years. Participants answered the
Eating Attitudes Test, the Body Image Questionnaire and the Inventory of Peer Influence on Eating
Concerns; besides height and weight were obtained. The multiple linear regression analysis for the group
of adolescents showed that the body mass index (BMI) and especially the three scales of peer influence
(messages, interactions and likability) predicted body dissatisfaction (57.1% of variance) and
symptomatology associated with anorexia nervosa (27.5% of variance); in the same way, in the group of
adult women BMI and peer influence explained 40.4% of the variance of symptoms associated with
anorexia nervosa and 71.2% of the variance in body dissatisfaction. It is concluded that peer influence has
a stronger prediction on symptomatology associated to eating disorders in adults than in adolescent
women, a possible explanation is that the higher age, the greater thin-ideal internalization; in addition,
peers have influence over body satisfaction of adolescents and adult women and in a minor proportion
modifies cognitions and behaviors to change the body shape (Sponsor by CONACYT 131865 Granted to
Juan Manuel Mancilla-Díaz PhD).
Learning Objectives:
• Analyze differences in peer influence and body dissatisfaction between adolescents and adult
women.
• Know the contribution of peers in the development of body dissatisfaction in women.
• Know the contribution of peers in the development of symptomatology associated to anorexia
nervosa in women.
F73
Stimulant Use, Eating Disorder Pathology, Mood, Anxiety, And Stress In A Population Of
College-Age Women At High Risk For Or With Eating Disorders.
Elise Gibbs, BA, PGSP-Stanford PsyD Consortium, Palo Alto, California, USA; Andrea E. Kass, MA,
Washington University in St. Louis, Department of Psychology, St. Louis, Missouri, USA; Dawn Eichen,
PhD, Washington University in St. Louis, Department of Psychology, St. Louis, Missouri, USA; Ellen E.
Fitzsimmons-Craft, PhD, Washington University in St. Louis, Department of Psychology, St. Louis,
Missouri, USA; Mickey Trockel, PhD, Stanford University School of Medicine, Department of
Psychiatry, Stanford, California, USA; Denise E.Wilfley, PhD, FAED, Washington University School of
Medicine, Department of Psychiatry, St. Louis, Missouri, USA; C. Barr Taylor, MD, Stanford University
School of Medicine, Department of Psychiatry, Stanford, California, USA
College is a high-risk period for the development of an eating disorder (ED) and dangerous substance use
behavior. The non-medical use of attention-deficit/hyperactivity disorder (ADHD)-specific stimulants has
become increasingly common on college campuses. Given that suppressed appetite is a side effect of these
stimulants, it is possible that those at high risk for the development of an ED or with an ED may turn to
this widely accessible drug to aid in weight loss efforts. As such, examining the use of stimulants in this
population is imperative. The current study examined associations between stimulant use and ED
pathology, mood, anxiety, and stress in college-age women at high risk for or with an ED. Participants
were 450 women who completed self-report measures of drug use, ED pathology, and comorbid
pathology. Ten percent (n=45) of the sample endorsed a history of stimulant use. Compared to women
who had never used stimulants, stimulant users were more likely to be White than non-White (p=.001)
and have a lower body mass index (p<.001). Individuals with an ED were not more likely to use
stimulants than those at high risk for an ED (p=.096). Controlling for age, race, and parents’ highest level
of education, women who used stimulants reported higher weight and shape concerns (p=.003), global
ED pathology (p=.001), and ED-related clinical impairment (p=.001) than non-users. Compared to non-
users, users also reported greater depressive symptoms (p<.001), state anxiety (p=.001), trait anxiety
(p<.001), and perceived stress (p=.004). These findings suggest that stimulant use is associated with ED
and comorbid pathology among individuals at high risk for or with an ED. Though our data preclude
knowing the specific motivation for stimulant use in our sample, screening for stimulant use and EDrelated pathology may improve identification of college-age women who may be engaging in high-risk and
potentially maladaptive behaviors and inform prevention efforts.
Learning Objectives:
• Understand the prevalence of stimulant use in a college-age female population at high risk for or
with eating disorders
• Identify the need to screen for stimulant use among ED populations (clinical and high-risk)
• Discuss the implications of these findings for improving future screening and prevention efforts
on college campuses
F74
Dysregulated Personality Characteristics Independently Related to Self-Harm Behaviors in
Patients with a History of Childhood Sexual Abuse
Sandy Tadrous, MA, Fuller Graduate School of Psychology, Pasadena, California, USA; Christopher
Keiper, MA, Fuller Graduate School of Psychology, Pasadena, California, USA; Timothy Arentsen, PhD,
Memphis Veteran's Affairs Medical Center, Pasadena, California, USA; Joseph Barsuglia, PhD, West
Los Angeles Veteran's Affairs Healthcare System, Los Angeles, California, USA; Patricia Pitts, PhD, The
Bella Vita Clinic, Los Angeles, California, , USA; Alexis Abernethy, PhD, Fuller Graduate School of
Psychology, Pasadena, California, USA
The relationship of emotionally dysregulated and overcontrolled personality clusters in eating disorders
(EDs) with self-harm behaviors has not been explored while considering the risk factor of childhood
sexual abuse (CSA). The current study posited that CSA history would be related to self-harm behaviors,
confirming prior risk factor research. It also hypothesized that patients with emotionally dysregulated
personality characteristics would have self-harm behaviors beyond that explained by sexual abuse history;
overcontrolled personality characteristics were not hypothesized to be associated with self-harm
behaviors while controlling for CSA history. The study sample was comprised of 116 participants with an
ED (bulimia nervosa = 46%; anorexia nervosa = 33%; ED-NOS = 21%; Age, M = 27.94, SD = 10.17;
Gender = 90.5% female) who completed self-report measures including the Self-Harm Inventory, Eating
Disorder Inventory, and Eating Disorder Questionnaire upon admission to a treatment program in
Southern California. Correlational analysis revealed that CSA history was significantly associated with
self-harm behaviors (r2 = .45, p < .001). Two regression models demonstrated that emotional
dysregulation and overcontrol independently accounted for engagement in self-harm behaviors while
controlling for the effect of CSA history. However, when personality characteristics were combined in a
regression model controlling for CSA, it revealed that only emotional dysregulation accounted for
significant variance in self-harm behaviors (ΔR2 = .25, β = .50). Overcontrolled personality characteristics
were not associated with self-harm (ΔR2 = .00, β = .02) in this model. This indicated that over and above
a history of sexual abuse, emotional dysregulation contributed to self-harm behaviors. This finding
suggests that targeting personality characteristics in ED treatment is invaluable for identifying those at
risk for self-harm behaviors, even when other risk factors for self-harm are salient.
Learning Objectives:
• Personality characteristics in eating disorders have been categorized into 3 clusters: High
functioning/perfectionistic, overcontrolled, and emotionally dysregulated. Emotional
dysregulation has been positively related with sexual abuse history.
• Sexual abuse as a child is a putative risk factor of moderate potency in the etiology of eating
disorders, and may be a causal risk for development of self-injurious behaviors in this population.
• Emotional dysregulation is positively associated with self-harm behaviors over and above the
relationship explained by sexual abuse history alone, while overcontrolled characteristics do not
seem to contribute to self-harm.
F75
Running Away From Emotion: The Interaction Of Obligatory Exercise And Lack Of
Emotional Awareness
Alexandra Thiel, BA, University of North Dakota, Grand Forks, North Dakota, USA; Kyle De Young,
PhD, University of North Dakota, Grand Forks, North Dakota, , USA
Obligatory exercise, or the experience of compulsive thoughts and attitudes towards exercise, is associated
with eating disorder (ED) pathology among certain subsets of the population. The compulsive natures of
obligatory exercise and ED pathology may each serve as inefficient emotion regulation strategies.
Emotional awareness is a vital component of emotion regulation, and is a skill that individuals with EDs
often lack. Therefore, this study tested whether a lack of emotional awareness distinguishes individuals
for whom obligatory exercise is or is not associated with eating pathology. College-age participants (N =
292, 84% women) completed the Obligatory Exercise Questionnaire, the awareness subscale of the
Difficulties in Emotional Regulation Scale, and the Eating Disorder Examination-Questionnaire (EDE-Q).
Multiple regression analyses tested whether lack of emotional awareness moderated the relationship
between obligatory exercise and Global EDE-Q scores. The interaction term significantly improved the
model (DR2 = .02, F(2,288) = 5.83, p = .016) and indicated that only individuals lacking emotional
awareness who engaged in obligatory exercise reported more ED psychopathology. A significant
interaction in a logistic regression analysis indicated that obligatory exercise was only associated with a
higher risk of binge eating in the past 4 weeks among those who lack emotional awareness (Wald c2 =
4.95, p = .026, OR = 1.01). Results suggest that obligatory exercise may put individuals who lack
emotional awareness at risk for ED pathology, perhaps because these individuals have difficulty
identifying, understanding, and reappraising their compulsive attitudes and guilty feelings toward
exercise. For these individuals, obligatory exercise may serve as an inefficient method to regulate their
unidentifiable emotions, and they may be more likely to use other ED psychopathology (e.g., binge eating)
for the same purpose.
Learning Objectives:
• Describe the relationship between obligatory exercise and eating disorder development.
• Discuss the role of emotional awareness in the development of eating disorders.
• Assess the interaction between obligatory exercise and lack of emotional awareness as it affects
risk for eating disorder pathology.
F76
Friendship Satisfaction Predicts Body Mass Index at 10-Year Follow-up
Charlotte Grillot, MA, Florida State University, Tallahassee, Florida, USA; Kelly Klein, MS, Florida
State University, Tallahassee, Florida, USA; Pamela Keel, PhD, Florida State University, Tallahassee,
Florida, USA
Previous research has demonstrated that friendship quality affects body dissatisfaction, dieting, and
disordered eating. Other parallel lines of research have established strong associations between friends’
body weights. Still, little is known about the relationship between friendship quality and weight, or the
temporal order of this association. Thus, the present study sought to investigate the direction of this
relationship by determining the influence of friendship satisfaction on body mass index (BMI) at 10-year
follow-up. Secondary analyses were performed of self-report survey data from a longitudinal study of
health and eating patterns at two time points ten years apart (N=2059; 71.2% women). Lower friendship
satisfaction at baseline prospectively predicted higher BMI at 10-year follow-up (p=0.001). This
relationship held in a multivariate regression model even after controlling for gender, baseline BMI, and
age. The prospective association between lower friendship satisfaction and higher BMI suggests that
friendship satisfaction might have the potential to improve weight maintenance, and associated health
outcomes, over time. Future research should explore how weight maintenance interventions, and
potentially weight loss programs, could improve outcomes by addressing friendship quality. Additional
research should seek to elucidate the mechanisms through which friendship satisfaction influences BMI.
Learning Objectives:
•
•
•
Discuss associations between friendship quality and known risk factors for eating pathology.
Determine the ability of friendship satisfaction to predict body mass index at 10-year follow up.
Understand the implications of these results for including friends in weight interventions.
F77
Restriction Related to Alcohol Use Contributes to Eating Disorder Risk
Sasha Dmochowski, MA, University at Albany, State University of New York, Albany, New York, USA;
Erin E. Reilly, MA, University at Albany, State University of New York, Albany, New York, USA; Lisa M.
Anderson, MA, University at Albany, State University of New York, Albany, New York, USA; Lauren E.
Knauf, BA, University at Albany, State University of New York, Albany, New York, USA; Drew A.
Anderson, PhD, University at Albany, State University of New York, Albany, New York, USA
Certain types of compensatory eating behaviors surrounding alcohol consumption may serve as potential
risks for the development of eating disorder symptomatology (e.g. Bryant, Darkes & Rahal, 2012). In the
current study, a sample of undergraduates (N=280, 60% female) completed the Compensatory Eating
Behaviors and Response to Alcohol Consumption Scale (CEBRACS; Rahal, 2011), which assesses four
types of compensatory behaviors— Alcohol Effects (i.e. modifying drinking behavior for effect
enhancement), Bulimia (i.e. endorsing purging/laxative/diuretic use), Dietary Restraint & Exercise, and
Restriction— before, during, and after self-reported alcohol use. Participants also reported eating disorder
symptoms using the Eating Disorders Diagnostic Scale (EDDS; Stice, 2004). A linear regression analysis
of all four CEBRACS factors found that, for females, only the Restriction subscale (i.e., skipping meals
before or after drinking to make up for the number of calories in alcohol) significantly predicted total
eating disorder symptoms on the EDDS (b = .255, p = .002). Dietary compensation directly related to
alcohol use may thus be a marker for more general problematic eating behaviors.
Learning Objectives:
• Identify what type of eating compensation surrounding alcohol use is most predictive of eating
disorder risk
• Discuss compensatory eating and drinking behaviors unique to females
• Understand nuances in compensatory behaviors directly related to alcohol use
Treatment of Eating Disorders I (child and adolescent)
F78
Experienced Carers Helping Others (ECHO): a Pragmatic Three-arm Multi-centre Parallel
Group Pilot Randomised Controlled Trial to Examine a Psycho-Educational Intervention
for Adolescents with Anorexia Nervosa and Their Caregivers
Charlotte Rhind, MSc, BSc, King's College London, Institute of Psychiatry, London, United Kingdom
(Great Britain); Rebecca Hibbs, PhD, MSc, BSc, King's College London, Institute of Psychiatry, London,
United Kingdom (Great Britain); Elizabeth Goddard, PhD, MSc, King's College London, Institute of
Psychiatry, London, United Kingdom (Great Britain); Ulrike Schmidt, MD, MRCPsych, FAED, King's
College London, Institute of Psychiatry, London, United Kingdom (Great Britain); Nadia Micali, MD,
MRCPsych, PhD, FAED, University College London, Institute of Child Health, London, United Kingdom
(Great Britain); Simon Gowers, MD, MRCPsych, University of Liverpool, Liverpool, United Kingdom
(Great Britain); Gillian Todd, MSc, South London and Maudsley NHS Foundation Trust, London,
United Kingdom (Great Britain); Pamela Macdonald, PhD, MSc, King's College London, Institute of
Psychiatry, London, United Kingdom (Great Britain); Kate Tchanturia, DClinPsy, FAED, King's College
London, Institute of Psychiatry, London, United Kingdom (Great Britain); Janet Treasure, MD,
MRCPsych, PhD, King's College London, Institute of Psychiatry, London, United Kingdom (Great
Britain)
Experienced Carers Helping Others (ECHO) is a psycho-education and skills training intervention based
on the cognitive interpersonal maintenance model of anorexia nervosa (AN) and developed to meet some
of the complex unmet needs of caregivers. The addition of the ECHO intervention to standard inpatient
care has proven effective for patients with severe AN and their caregivers. The aim of this study was to
explore the use of the addition of two variants of ECHO to standard outpatient care for adolescents with
anorexia nervosa at an early stage of illness. Patients aged 13-21 years with a primary diagnosis of AN and
their caregivers (typically parents) were recruited from 38 National Health outpatient eating disorder
services in the UK. Families were randomised to ECHO with guidance (a book, DVDs, and 10 telephone
coaching sessions), ECHO (a book and DVDs), or treatment as usual. Patient (n = 149) and caregiver (n =
226) outcomes were measured at 6 and 12 months follow-up. Preliminary analysis showed a trend for
both variants of ECHO to produce similar improvements in BMI at 6 and 12 months follow-up, distress at
6 months follow-up and a reduction in AN symptomatology at 12 months follow-up, as measured by the
Short Examination of Eating Disorders. ECHO also produced a trend for reduced caregiver
accommodating and enabling behaviours at 6 months follow-up. These findings suggest that sharing
information and skills with caregivers at the early stage of illness may be beneficial for patient outcomes.
ECHO delivered without the addition of telephone coaching may be the preferred variant at this stage of
AN treatment. Further outcomes and cost-effectiveness of the intervention remain to be evaluated.
Learning Objectives:
• Describe the theoretical basis for the Experienced Carers Helping Others (ECHO) intervention
and the methodology for a pilot randomised controlled trial to explore its use for adolescents with
anorexia nervosa at the early stage of illness.
• Summarize the primary intervention outcomes for patients and caregivers.
• Discuss the strengths, limitations and further development of information sharing and skillsbased interventions for caregivers of someone with an eating disorder at the different stages of
illness.
F79
Predictors of Non-Response to Family-Based Treatment for Adolescents with Anorexia
Nervosa
Avtalya Feldman, BS, Stanford University, Palo Alto, California, USA; Sarah Forsberg, PsyD, Stanford
University, Palo Alto, California, USA; Susan Bryson, MS, Stanford University, Palo Alto, California,
USA; Alison Darcy, PhD, Stanford University, Palo Alto, California, USA; James Lock, MD, PhD, FAED,
Stanford University, Palo Alto, California, USA; Daniel Le Grange, PhD, FAED, University of California
San Francisco, San Fracisco, California, USA; Stewart Agras, MD, Stanford University, Palo Alto,
California, USA
To date, none of the randomized control trials (RCT) for adolescents with anorexia nervosa (AN) have
explored the predictors of non-response to Family-Based Treatment (FBT) or treatment for AN more
broadly. This study, therefore, examines baseline (BL) predictors of non-response to FBT in adolescents
with AN in three RCTs of FBT for adolescent AN (N=214). There is no consensus on the definition of nonresponse, thus, three a-priori definitions were chosen with the aim of exploring this question more
broadly. These were: 1) Percent expected body weight (%EBW) less than 87% at end of treatment (EOT)
[N= 39], which was the upper weight cutoff for inclusion in these RCTs, 2) %EBW less than 95% at EOT
(N=94), the cutoff used to define remission, and 3) Less than 5 lbs of weight gain by week 4 of treatment
(N=90), an established early predictor of recovery at EOT. Participants completed validated semistructured assessments including the Eating Disorder Examination (EDE), Kiddie-Schedule for Affective
Disorders and Schizophrenia (KSADS), Yale-Brown-Cornell Eating Disorder Scale (YBC-EDS), and
Children’s Yale-Brown Obsessive Compulsive Scale (CYBOCS). In addition, we looked at demographic
variables (age, ethnicity, family composition, socioeconomic status) and markers of illness severity
(duration of illness, %EBW, purging status, and comorbidity). The relationship between the a-priori BL
variables and definitions of non-response will be assessed through use of signal detection analysis (SDA).
Results from this study may inform modifications to standard FBT and aid in identification of individuals
who may require such adaptations or other interventions at the outset of treatment.
Learning Objectives:
• Identify individual and family baseline characteristics that predict end of treatment non-response
to Family Based Treatment for adolescents with anorexia nervosa
• Ideintify individual and family baseline characteristics that predict early non-response to Family
Based Treatment for adolescents with anorexia nervosa
•
Ideintify individual and family baseline characteristics that predict inability to achieve remission
with Family Based Treatment for adolescents with anorexia nervosa
F80
Demographics and Outcomes of Patients with Eating Disorders Treated in Residential Care
Martin Fisher, MD, FAED, North Shore - Long Island Jewish Health System, Cohen Children's Medical
Center of NY, New Hyde Park, New York, USA; Henretty Jennifer, PhD, Center for Discovery, Los
Alamitos, California, USA; Victor Fornari, MD, FAED, North Shore - Long Island Jewish Health System,
Zucker Hillside Hospital, New Hyde Park, New York, USA; Lindsay Moskowitz, PhD, North Shore Long Island Jewish Health System, Zucker Hillside Hospital, New Hyde Park, New York, USA; Sara
Levine, MD, Greenwich Adolescent Medicine, Greenwich, New York, USA; Joan Malizio, RN, North
Shore - Long Island Jewish Health System, New Hyde Park, New York, USA; Joanna Stein, MPH, North
Shore - Long Island Jewish Health System, Manhasset, New York, USA
The purpose of this study was to describe the demographics and outcomes of the patients treated in the 10
residential facilities of the Center for Discovery (in California, Washington, and Connecticut) over an 8
year period. There have been few previous studies of residential care. Data was collected on admission
and discharge of all patients treated in each of the Center for Discovery facilities from 2006 through 2013.
The data were entered into a database in 2014 and descriptive statistics were calculated from the first
admission for all patients (n=1501). The 1501 patients had a mean age of 18.2 ± 7.2 years, 93.5% were
female, and they were in treatment at the facilities for a mean of 43.8 ± 23.5 days. Diagnoses were
categorized as anorexia nervosa-restricting type (AN-R, n=526) anorexia nervosa – purging type (AN-P,
n=229), bulimia nervosa (BN, n=506), eating disorder not otherwise specified (EDNOS, n=186) and binge
eating disorder (BED, n=7). The 755 patients with anorexia nervosa (AN-R and AN-P) had a mean body
mass index (BMI) of 16.5 and mean % ideal body weight (IBW) of 83.0% on admission and a mean BMI of
18.7 and mean % IBW of 92.5% on discharge. Patients with AN gained a mean of 11.5 pounds in the
program. The 735 patients with purging disorders (BN and AN-P) were reported to be purging a mean of
3.24 times per day on admission and 0.03 times per day on discharge, for the prior 30 days. The 1501
total patients had a mean of 1.1 in-patient admissions and 0.95 residential/partial/IOP admissions prior
to treatment at the facilities and 86% had received out-patient treatment. The mean Global Assessment
of Functioning (GAF) Score for the 1501 patients was 35.3 (±8.7) on admission and 45.9 (±10.7) on
discharge; the GAF scores did not differ statistically by diagnosis. This study population of 1501 patients
with a mean age of 18.2 years treated in the residential facilities of the Center for Discovery between 2006
and 2013 had a mean length of stay of 6 ¼ weeks. Those with anorexia nervosa increased their mean BMI
from 16.6 to 19.9 and mean % IBW from 83.4% to 94.7% while those with purging disorders decreased
their purging from 3.25 to 0.02 times per day. Mean GAF scores for all patients increased from the mid
30s to the upper 40s. These data demonstrate the effectiveness of residential treatment for both
adolescents and adults with eating disorders.
Learning Objectives:
• To demonstrate effectiveness of residential treatment in the care of patients with eating disorders
• To differentiate between the outcomes for patients with anorexia nervosa and patients with
bulimia nervosa who are treated in residential care
• To evaluate differences in the care of adults and adolescents with eating disorders treated in
residential facilities
F81
Clinical Response Predictors To An Intensive Ambulatory Program For Eating Disorders
Patients In Bogota, Colombia
Juanita Gempeler, CPsychol, Equilibrio, Bogota, Colombia; Maritza Rodriguez, MSc, MD, Equilibrio,
Bogota, Colombia; Adriana Rogeliz, MD, Equilibrio, Bogota, Colombia; Camila Patiño, MSc, CPsychol,
Equilibrio, Bogota, Colombia; Catalina Ayala, MD, Equilbrio, Bogota, Colombia; Erazo Carolina, MD,
Equilibrio, Bogota, Colombia
There is not enough data to predict the probability of an early response to an intensive ambulatory
treatment (IAP) in patients with eating disorders. (ED). OBJECTIVE: Identify subgroups of ED patients
assisting to an IAP, according to therapeutic objectives after 4 weeks of treatment, and clinical
characteristics at the beginning of treatment. METHOD: Data from the first phase of IAP of 105 women
11 to 30 years old, diagnosed with AN and BN (DSM V) were analyzed. Predictor variables: age, eating
symptoms chronicity, comorbidities, family dysfunction, sexual or physical abuse history, suicide attempt,
self-injury behavior, BMI at admission and previous hospitalizations. Primary outcome measure:
treatment response (good: when patients with AN were able to stop the descending weight curve, achieved
restoration of weight between 300 to 500 grams per week and achievement of flexibility in eating
patterns, stabilizing weight, and more than 70% reduction in binges and/or purges behaviors from
baseline in BN patients). RESULTS: 56 women with AN (26 AN-R, 26 AN-P and 6 incomplete forms) and
49 with BN. 65.7% under 18 years of age. 54.3% achieved good response, 21% were referred for
hospitalization. Among baseline clinical characteristics associated with poor treatment response: BMI
below 15, (Chi2 16.5, p<0.000), family dysfunction (Chi2 4.32, p <0,03), hospitalization discharge (Chi2
12.4, p<0.021), OCD (Chi2 4.38, p<0.04) and PTSD (Chi2 3.66, p< 0.05). Nor age neither symptom
chronicity, comorbidities or other study variables had effect in predicting treatment outcome.
CONCLUSSIONS: Findings suggest that low weight at the beginning of treatment is a critical variable for
early treatment response, even if a vital risk is not present. Results suggest that the presence of OCD,
PTSD or family dysfunction can interfere negatively, and have to be managed.
Learning Objectives:
• identify variables associated to early response to treatment in AN and BN
• identify the complexity of clinical intervention in ED
• Identify the importance of a complete assessment before starting treatment in ED
F82
Service Effectiveness Evaluation Of The Maudsley Intensive Treatment Programme for
Adolescents with Restrictive Eating Disorders
Mima Simic, MRCPsych, MD, MSc, The Maudsley Hospital, London, United Kingdom (Great Britain);
Katrina Hunt, DClinPsy, BSc, The Maudsley Hospital, London, United Kingdom (Great Britain); Ivan
Eisler, PhD, BSc, FAED, The Maudsley Hospital, London, United Kingdom (Great Britain); Jessica Neil,
BSc, The Maudsley Hospital, London, United Kingdom (Great Britain); Freya Corfield, PhD, BSc, MSc,
Thea Maudsley Hospital, London, United Kingdom (Great Britain)
Evidence for the effectiveness of day treatment programmes as an alternative to inpatient treatment for
eating disorders is starting to emerge. The Intensive Treatment Programme (ITP) at the Maudsley
Hospital was developed for young people who did not respond to outpatient treatment alone and needed
an additional more intensive input. The ITP was designed to focus on tackling the mediators and
moderators associated with the maintenance of restrictive eating disorders. Treatment consists of CBT,
DBT, Cognitive Remediation Therapy and Multi Family Therapy based groups as well as supported meals
and parents’ skills coaching. The purpose of this study was to evaluate, through both quantitative and
qualitative measures, the outcomes for the 99 young people who have been discharged from the
programme since its start in September 2010. Young people completed self-report measures on admission
and discharge from the programme and participated in qualitative interviews to review their subjective
experience of the programme. Initial analysis shows that 92% of young people who commenced the
programme remained engaged, attended the ITP for an average of 27 therapeutic days and gained a mean
of 0.6kg per week. The percentage median BMI changed, on average, from 78% to 83% before they were
transferred back to outpatient treatment to complete recovery. Only 17% of these young people were
admitted for inpatient treatment from the ITP. Significant improvements were found on self-report
measures of mood (MFQ), eating disorder symptomatology (EDE-Q), emotion regulation (DERS), selfesteem (RSE) and quality of life (EDQLS). Qualitative interviews with young people indicated high levels
of patient satisfaction with the programme and improvements in family communication, alongside
suggested areas for the programme’s improvement. In addition predictors of good outcomes from the
programme were analysed and will be presented.
Learning Objectives:
• To appraise whether an intensive day treatment programme is a viable alternative to inpatient
treatment for adolescents with severe restrictive eating disorders who do not respond to
outpatient treatment
• To evidence significant improvements in physical health and psychological wellbeing achieved
through a range of treatment interventions delivered in small groups
• To evaluate satisfaction levels of young people and their families of this intensive day treatment
programme
F83
Incorporating Family-Based Treatment Principles into a Partial Hospitalization Program
Setting
Renee Hoste, PhD, University of Michigan, Ann Arbor, Michigan, USA;Rebekah Richmond, BA,
University of Michigan, Ann Arbor, Michigan, USA
The purpose of the current study is to review efforts to utilize family-based treatment (FBT) principles in a
partial hospitalization program (PHP) setting. Increasing research evidence suggests that FBT is the most
effective form of treatment currently available for adolescents with anorexia nervosa, and preliminary
evidence suggests that it may be effective for adolescents with bulimia nervosa. Developed as a weekly
outpatient treatment, FBT’s efficacy has led to its adaptation for use in other treatment settings, such as
partial hospitalization or intensive outpatient programs. Although FBT cannot be replicated in these
treatment settings, FBT principles can be borrowed and implemented. Multiple considerations arise
when attempting to incorporate FBT principles into more intensive treatment settings while remaining
true to the intent of the original treatment approach. Areas to be considered include the nature and
degree of parental involvement, managing parental anxiety, addressing meal noncompliance, transfer of
skills to the home environment, and confidence of the staff and treatment team. Preliminary results for
30 patients and 43 parents suggest that significant improvements are found in weight gained, scores on
the Eating Disorders Examination-Questionnaire, depression, self-esteem, maternal expressed emotion,
parental self-efficacy, and functional impairment for both patients and parents during an average length
of stay of six weeks (all p’s < .01). Findings from the current study suggest that FBT principles can be
successfully incorporated into a higher level of care and that patients and parents see symptomatic
improvements in a relatively short period of time.
Learning Objectives:
• Describe challenges of incorporating FBT into a higher level of care
• Identify ways to address these challenges
• Report outcome data for patients in an FBT-based partial hospitalization program
F84
Japanese Medical Doctor’s Attitude Survey Of Treatment Refusal In Eating Disorders
Yosiyuki Takimoto, PhD, MD, Department of Biomedical Ethic, The University of Tokyo, Tokyo, Japan;
Kazuhiro Yoshiuchi, PhD, MD, Department of Stress Science and Behavioral Medicine, The University of
Tokyo, Tokyo, Japan
Background: In eating disorder, especially anorexia nervosa (AN), there are frequently treatment refusal,
which is one of the leading causes of difficulty in eating disorders treatment. Aims: We aimed to
investigate medical doctor’s thoughts and managements, and elucidate ethical problems of treatment
refusal in AN. Methods: Two hundred-thirteen medical doctors of all members in Japan Society For
Eating Disorder were candidates for this research. An anonymous self-completed questionnaire about
management of treatment refusal cases in AN were conducted. Results: The rate of collection was 25.8%
(55/213). In a physical crisis situation of AN, if patient’s family hope to adopt compulsory treatment, 9580% medical doctors selected compulsory hospitalization therapy. In contrast, if patient’s family hope to
respect patient self-determination, 69-65% medical doctors selected compulsory hospitalization therapy.
In affording a physical situation of AN, even if patient’s family hope to adopt compulsory treatment, 70%
medical doctors selected ambulatory therapy. Conclusions: In Japan, physical conditions in AN tended
Suzanne Burnett 2/23/15 2:27 PM
Deleted: 5
to affect medical doctor’s decision about management of treatment refusal. In other words, Japanese
medical doctors were apt to put great value on the principles of beneficence.
Learning Objectives:
• Understand ethical dilemma in anorexia nervosa treatment
• Describe eating disorder treatment in the context of Asian culture
• Gain knowledge in the criterion to decide to treat refusal of care
Treatment of Eating Disorders II (child and adolescent)
F85
Speeches In Anorexia And Bulimia Nervosa: A Qualitative Study About The Disorder
Experiencing
Claudia Cruzat-Mandich, PhD, MA, MA, BA, Universidad Adolfo Ibáñez, Santiago, Región
Metropolitana, Chile; Fernanda Díaz Castrillón, MA, BA, Universidad Adolfo Ibáñez, Santiago, Región
Metropolitana, Chile; Rosa Behar Astudillo, MD, Universidad de Valparaíso, Valparaíso, Región de
Valparaiso, Chile; Javiera Aylwin Navarro, Student, Universidad Adolfo Ibáñez, Santiago, Región
Metropolitana, Chile; Andrea García Troncoso, BA, Universidad del Desarrollo, Santiago, Región
Metropolitana, Chile; Marcelo Arancibia Meza, Student, Universidad de Valparaíso, Valparaíso, Región
de Valparaíso, Chile
Suzanne Burnett 2/23/15 2:27 PM
Deleted: 7
Distinctive discursive characteristics related to the experience of an eating disorder (ED) in anorectic and
bulimic patients have been observed. A descriptive-analytical-qualitative design based on the Grounded
Theory model was used. The sample was intentional, and 15 patients were included, 7 anorectics and 8
bulimics, according DSM-IV-TR diagnostic criteria. Data were collected by a depth interview pattern and
analysed by an open codification. The results shows differences in perception of the following categories
in anorectic in contrast to bulimic patients were detected: sickness notion (discomfort with diagnostic
reception and lack of motivation for treatment versus assumption and acceptance of therapeutic
implications), meanings associated to food intake (traumatic versus pleasant experience), body
conception (thinness as body beauty ideal and dissociated body from the self), self image (body
dissatisfaction, on one hand related to alexithymia, lack of assertiveness, perfectionism, and impulsivity
on the other) and relationships with their parents (an overprotective versus critical mother; an absent in
opposition to a detached and idealized/feared father). Although ED patients often transit from one
diagnostic to another, in their speeches exists some differences related to core ED issues.
Learning Objectives:
• Following the training, participants will be able to describe some differences and similarities
between Anorexia and bulimia nervosa
• Following the training, participants will be able to understand that although ED patients often
transit from one diagnostic to another, in their speeches exists some differences and it has
implications in the treatments
• Following the training, participants will be able to know some differences between AN and BN in
sickness notion, meanings associated to food intake , body conception , self image and
relationships with their parents.
F86
Improvements in Binge Eating in Bulimia Nervosa during a Brief Course of Light Therapy
appear Independent of Improvements in Negative Affect
Kyle De Young, PhD, University of North Dakota, Grand Forks, North Dakota, USA; Mary Zander, MA,
University of North Dakota, Grand Forks, North Dakota, USA; Terra Towne, MA, University of North
Dakota, Grand Forks, North Dakota, USA; Nicole Johnson, Student, University of North Dakota, Grand
Forks, North Dakota, USA
Researchers have found that light therapy (LT) decreases binge eating (BE) in bulimia nervosa (BN). BE
episodes are more likely to occur during periods of heightened negative affect. Because LT improves
Suzanne Burnett 2/23/15 2:27 PM
Deleted: 8
depressed mood even in non-clinically depressed individuals, the purpose of this study was to test
whether improvements in BE following initiation of LT are explained by improvements in negative affect.
Nine women (M[SD] age = 23.0[4.7] years) meeting DSM-5 criteria for BN participated in this 6-week,
within-subjects trial. Participants completed a 2-week baseline followed by a 2-week course of LT and
then a 2-week return to baseline. Participants reported their affect using the Positive and Negative Affect
Schedule (PANAS; plus the guilt, sadness, and fatigue facets) and the occurrence of eating disorder
behaviors (including BE) nightly via the Internet. They also completed the Change in Eating Disorder
Symptoms (CHEDS) scale at weeks 0, 2, 4, and 6. Generalized estimating equations (GEE) and
generalized linear models tested main effects of LT. Time-lagged GEE tested whether changes in negative
affect accounted for changes in next day BE after accounting for LT. In total, there were 242 participantdays of data. BE days were less frequent during (38.6%) than before/after LT (53.1%; Wald Χ2=5.58,
p=.018), indicating a main effect of treatment. This was confirmed by a decrease in the CHEDS BE scale
at week 4 (immediately post-LT) that increased by week 6 (i.e., after two weeks without LT; F(1,7)=10.69,
p=.014, ηp2 =.60). Negative affect also decreased during LT (Wald Χ2 = 7.23, p = .007), driven by
decreases in fatigue, while sadness and guilt remained unchanged. Changes in negative affect did not
account for the LT effect, although each facet uniquely predicted BE. Caution should be exercised in
generalizing these results due to the small sample size; however, these preliminary results indicate that LT
decreases BE in BN independent of its effects on negative affect.
Learning Objectives:
• Consider the potential mechanisms of light therapy on binge eating in bulimia nervosa.
• Discuss the evidence that negative affect is the mediator of light therapy on bulimia nervosa.
• Explain that the effect of light therapy on bulimia nervosa appear to be specific to binge eating.
F87
Dietary Fat Preference in Individuals With and Without an Eating Disorder
Janet Schebendach, PhD, RD, New York State Psychiatric Institute, Columbia University Medical
Center, New York, New York, USA; Laurel Mayer, MD, FAED, New York State Psychiatric Institute,
Columbia University Medical Center, New York, New York, USA; Evelyn Attia, MD, FAED, New York
State Psychiatric Institute, Columbia University Medical Center, New York, New York, USA; Joanna
Steinglass, MD, FAED, New York State Psychiatric Institute, Columbia University Medical Center, New
York, New York, USA; Allegra Broft, MD, FAED, New York State Psychiatric Institute, Columbia
University Medical Center, New York, New York, USA; Michael Devlin, MD, FAED, New York State
Psychiatric Institute, Columbia University Medical Center, New York, New York, USA; B. Timothy
Walsh, MD, FAED, New York State Psychiatric Institute, Columbia University Medical Center, New
York, New York, USA
The eating behavior of patients with eating disorders suggests preferential intake of low fat foods;
however, there are limited data on measured food preference in this population. The Geiselman Food
Preference Questionnaire-I© (FPQ) is a validated instrument that uses a two group (high fat, low fat) by
three group (high sugar, high complex carbohydrate, high protein) design to determine preference for 72
foods. The mean hedonic rating of high fat foods divided by the mean hedonic rating of low fat foods
yields a fat preference score. A score >100 indicates a preference for high fat foods; a score <100 indicates
a preference for low fat foods. One hundred ninety-five participants (88 AN, 38 BN, and 69 NC)
completed the FPQ. One-way ANOVA was conducted and results indicated a significant difference in fat
preference scores across the diagnostic groups (F[2,192] = 12.696, p< 0.001). AN and BN participants
endorsed lower fat preference (82.8 +/- 32.2, and 91.5 +/- 26, respectively) while controls endorsed
higher fat preference (104.4 +/- 18.2). Post hoc comparisons (Tukey HSD) found a significant difference
in fat preference scores between the AN and NC groups (p< 0.001), and the BN and NC groups (p< 0.05);
ns difference was observed between AN and BN participants (p= 0.214). Fat preference did not differ
between AN subtypes (p= 0.259), and fat preference scores failed to correlate with underweight status (%
IBW) in AN participants (r= 0.186, p= 0.362). Hedonic ratings of food preference suggest that, when
compared to healthy controls, both AN and BN patients have a decreased preference for high fat foods.
Food preference measured by the FPQ coincides with the clinical manifestation of fat avoidance in
patients with eating disorders.
Suzanne Burnett 2/23/15 2:27 PM
Deleted: 9
Learning Objectives:
• Describe characteristics of food choice in patients with anorexia nervosa and bulimia nervosa.
• Compare food choice between individuals with and without an eating disorder.
• Describe the methodology used in the Geiselman Food Preference Questionnaire.