Internet-Based Treatment of Body Dysmorphic Disorder: Feasibility, Evaluation, and Self-Report Data.

ABSTRACT: Initial findings indicate the effectiveness of internet-based interventions for body dysmorphic disorder (BDD). In order to substantiate these findings, a seven-module guided internet-based intervention was created and examined. We report the mixed data of participants with clinical and subclinical BDD of the treatment group (n = 18). We investigated the feasibility, the quality of the program content, the design and usability, and its effects on symptom severity and related psychopathology. Adherence to the intervention was low and dropout rate high (55.6%). The program content, perceived website usability, and visual aesthetic were rated high. Credibility and expectancy were on a medium level. Satisfaction with appearance improved significantly in the intention-to-treat analysis (d = 0.58). In sum, symptom-related outcomes and program evaluation showed a positive trend albeit the study conduction was difficult. Future programs should investigate the role of additional motivation strategies and more flexible support addressing the known treatment barriers.

An empirically derived recommendation for the classification of body dysmorphic disorder: Findings from structural equation modeling.

Body dysmorphic disorder (BDD), together with its subtype muscle dysmorphia (MD), has been relocated from the Somatoform Disorders category in the DSM-IV to the newly created Obsessive-Compulsive and Related Disorders category in the DSM-5. Both categorizations have been criticized, and an empirically derived classification of BDD is lacking. A community sample of N = 736 participants completed an online survey assessing different psychopathologies. Using a structural equation modeling approach, six theoretically derived models, which differed in their allocation of BDD symptoms to various factors (i.e. general psychopathology, somatoform, obsessive-compulsive and related disorders, affective, body image, and BDD model) were tested in the full sample and in a restricted sample (n = 465) which indicated primary concerns other than shape and weight. Furthermore, measurement invariance across gender was examined. Of the six models, only the body image model showed a good fit (CFI = 0.972, RMSEA = 0.049, SRMR = 0.027, TLI = 0.959), and yielded better AIC and BIC indices than the competing models. Analyses in the restricted sample replicated these findings. Analyses of measurement invariance of the body image model showed partial metric invariance across gender. The findings suggest that a body image model provides the best fit for the classification of BDD and MD. This is in line with previous studies showing strong similarities between eating disorders and BDD, including MD. Measurement invariance across gender indicates a comparable presentation and comorbid structure of BDD in males and females, which also corresponds to the equal prevalence rates of BDD across gender.

Impulsivity and negative mood in adolescents with loss of control eating and ADHD symptoms: an experimental study.

The aim of the study was to experimentally examine the reactivity of mood and impulsivity to negative mood induction in adolescents with loss of control (LOC) eating and adolescents with attention deficit hyperactivity disorder (ADHD) symptoms. The study included eighty-eight adolescents with LOC eating, ADHD symptoms, and control. Participants self-reported on mood and participated in a stop signal task before and after negative mood induction with Cyberball. Groups did not differ in impulsivity at baseline (p > .05). The LOC group presented with greater increase of negative mood than the ADHD group, and with greater increase of impulsivity than both other groups from pre- to post-Cyberball (p < .05). Stronger reactivity of negative mood and impulsivity in LOC eating corroborates findings in adults that the concepts' association might be specific to binge eating disorder. Additionally, findings add to previous results showing emotion regulation deficits in LOC eating. Future research should examine the concepts' impact on actual eating behavior including binge eating.

Psychosocial risk factors of loss of control eating in primary school children: a retrospective case-control study.

OBJECTIVE: To provide a comprehensive investigation of the retrospective correlates of loss of control (LOC) over eating in children close to the onset of their first LOC eating episodes. METHOD: A community-based, case-control design was used to compare matched groups of 60 children with and without LOC eating. Retrospective correlates were assessed using a child-adapted version of the Oxford Risk Factor Interview. RESULTS: Children with LOC eating revealed greater levels of exposure to parental problems, (e.g., underinvolvement, arguments, and depression of family members) and dieting-related risk factors than children without LOC eating. Predictors of LOC eating were risk correlates parental underinvolvement, and critical comments by the family and the critical life event change of school. DISCUSSION: Results underline the influence of parental behavior and the impact of dieting behavior on the development of non-normative eating in middle childhood.

Laboratory snack food intake, negative mood, and impulsivity in youth with ADHD symptoms and episodes of loss of control eating. Where is the missing link?

To compare laboratory food intake, negative mood and trait impulsivity and their association with attention deficit hyperactivity disorder (ADHD) and loss of control (LOC) eating in youth (middle childhood to early adolescence). Ninety 10-14 year old youths with symptoms of ADHD, symptoms of LOC eating, and control participants took part in a laboratory snack food meal after having rated trait impulsivity. Negative mood was self-reported pre and post snack food meal, while representativeness of eating behavior and liking of the food was assessed post laboratory snack food meal. The ADHD group consumed more snack food than the other groups. Food intake was not influenced by negative mood or trait impulsivity. All groups exhibited a decrease in negative mood from pre to post food intake that was not accounted for by level of hunger or liking of the food. The greater food intake of the ADHD group compared to the other groups may contribute to the development of overweight and therefore be in accordance with the high co-morbidity reported between ADHD and obesity in youth. The influence of impulsivity and negative mood on food intake could not be shown, which corroborates a recent review on the association of negative mood and bingeing in adults but needs further assessment, particularly in the younger age groups.

Mealtime family interactions in home environments of children with loss of control eating.

Experimental and self-report studies have shown that parents have a strong influence on their normal or overweight children's eating behavior, i.e. through parental feeding behavior or communication. Studies in children with loss of control (LOC) eating that have investigated this relationship are scarce, and ecologically valid observational studies are missing. This study examined family functioning at mealtimes in home environments in 43 families of a child with LOC eating and 31 families of a child without LOC eating; the children were 8-13 years old. Familial interactions, child eating behavior, and parental mealtime behavior were assessed using the Mealtime Family Interaction Coding System, observation of bite speed of the child, and self-report questionnaires. Less healthy patterns of communication (U=201.53, p<.01) and interpersonal involvement (U=207.54, p<.01) and more maladaptive overall family functioning (U=233.52, p<.05) were observed but not self-reported in families of a child with LOC eating compared to those without LOC eating. Children with LOC eating (M=4.73, SD=1.88) ate faster than controls (M=3.71, SD=1.19; p<.05), with highest bite speed in a group with high recurrent LOC eating (p<.01). The results indicate that maladaptive patterns of family functioning during family mealtimes are present in LOC eating in children and are associated with the child's eating behavior. Parent-child communication training should be tested as an intervention for children with LOC episodes.

Personality and psychopathology in children with and without loss of control over eating.

BACKGROUND: In children with loss of control (LOC) over eating, recent research has revealed evidence for distinct personality features, such as more impulsivity. The aim of this study was to assess parent- and child-report personality profiles in children with and without LOC over eating and to relate these profiles to general and eating-disorder psychopathology. METHOD: A total of 120 children (60 with LOC over eating; 68 girls) aged 8 to 13 years were recruited from the community. Clinical interview, self-report, and parent-report questionnaires were administered to assess personality as well as both general and eating-disorder psychopathology. RESULTS: The group with LOC over eating showed lower self-directedness and cooperativeness compared to the group without LOC. The children with LOC were significantly more impulsive. Personality dimensions were significantly correlated with greater general but not eating-disorder psychopathology and frequency of LOC over eating. CONCLUSION: A distinct pattern of personality traits in children with LOC over eating was found that is partly in line with research on binge-eating disorder, bulimia nervosa, and obesity in adulthood. The findings suggest that longitudinal studies should examine whether certain patterns of personality in children with LOC over eating account for differences in psychopathology later in life.