Changes in unhealthy exercise in outpatient eating disorder treatment: examining emotion avoidance mechanisms.

Unhealthy exercise (UE) is a common symptom of eating disorders (EDs) associated with elevated chronicity and relapse. Previous research suggests that UE serves an emotion regulation function, especially to reduce negative affect. UE may be especially prevalent among individuals with anorexia nervosa (AN), as UE and restrictive eating may be used to avoid unpleasant emotions. It is unclear whether changes in emotion avoidance (EA) can lead to changes in UE over time. The current study examined whether month 1 EA mediated the relation between baseline UE and month 2 UE in a clinical sample of 127 patients (Mage = 22.52 [SD = 11.75], 92.9% female) recruited from an ED outpatient treatment program. The current study also explored whether this mediation was stronger for individuals with AN than other ED diagnoses. Findings revealed that changes in EA significantly mediated the relation between changes in UE from baseline to month 2 of treatment. ED diagnosis did not moderate this relation. Findings suggest that improvements in EA may reduce UE over time. Treatment should target UE through cultivation of increased emotion acceptance.Level of evidence Level III: evidence obtained from well-designed cohort study.

Implicit and explicit motivational responses to high- and low-calorie food in women with disordered eating.

Eating disorders and their symptoms are thought to be associated with altered motivational responding to food. Binge eating may relate to increased reward reactivity, restrictive eating may be associated with increased threat and/or decreased reward reactivity, and the combination of these symptoms within an individual may be linked to motivational conflict to food. Using both implicit (i.e., physiological) and explicit (i.e., self-reported) measures, we tested these hypotheses in 88 women with binge eating only, restrictive eating only, both binge eating and restrictive eating, or no eating pathology. Participants viewed and rated high-calorie food, low-calorie food, and emotional images while startle eye blink and postauricular reflexes were measured. Arousal and craving, but not valence, ratings were significantly greater for high- than low-calorie food. Startle blink reflexes during all food images were significantly lower than during neutral images, whereas only high-calorie foods related to greater postauricular reactivity than neutral images. Eating pathology group did not predict implicit and explicit motivational reactions to food. Exploratory dimensional analyses revealed that rating low-calorie foods as lower on craving predicted endorsement of restrictive eating, while rating low-calorie foods as lower on valence and arousal, and experiencing lower postauricular reactivity to high-calorie foods minus neutral images, predicted greater frequency of restrictive eating episodes. Decreased implicit and explicit appetitive motivation to high- and low-calorie food may relate to the presence and frequency of restrictive eating. Future longitudinal research should investigate whether decreased appetitive responding to food is a risk factor for, versus consequence of, restrictive eating.

Dimensions of unhealthy exercise and their associations with restrictive eating and binge eating.

Unhealthy exercise is a core symptom of eating disorders that predicts greater chronicity and risk of relapse. A detailed conceptualization of unhealthy exercise in the context of eating disorders is only beginning to emerge, and associations between specific dimensions of unhealthy exercise and eating disorder symptoms have received little attention. The aim of the current study was to examine associations between three key dimensions of unhealthy exercise - compulsive exercise (i.e., rule-driven exercise to avoid negative affect), exercise to control weight/shape, and exercise to compensate for recent food intake - with restrictive eating and binge eating. Participants were 239 women drawn from two separate studies of emotions and eating behavior; 126 (52.7%) endorsed restrictive eating and/or objective binge eating episodes in the past three months. Unhealthy exercise dimensions were measured using the Compulsive Exercise Test and investigator-designed items, and eating disorder symptoms were assessed using the Eating Pathology Symptoms Inventory. Restrictive eating was only associated with avoidance and rule-driven exercise, whereas binge eating was significantly correlated with all unhealthy exercise variables. Multiple regression results revealed that only compensatory exercise was uniquely associated with binge eating. Unhealthy exercise consists of partially distinct dimensions with differential relations to core eating disorder symptoms. Future research should examine unhealthy exercise dimensions in patients with eating disorder diagnoses and consider whether treatments for specific unhealthy exercise forms might be beneficial.

Personality traits and appearance-ideal internalization: Differential associations with body dissatisfaction and compulsive exercise.

Thin-ideal internalization is a robust risk factor for body dissatisfaction and eating pathology. Conversely, athletic-ideal internalization is often unrelated to body dissatisfaction, but predicts compulsive exercise (i.e., rigid, rule-driven exercise that is continued despite adverse consequences). Distinct personality traits could relate to internalization of different appearance ideals, which may be associated with divergent eating disorder outcomes. Past research has shown that neuroticism is related to body dissatisfaction, whereas extraversion and conscientiousness have been associated with regular and problematic exercise. The current study examined associations among personality traits (i.e., neuroticism, extraversion, conscientiousness), appearance-ideal internalization (i.e., thin- and athletic-ideal), and eating disorder cognitions/behaviors (i.e., body dissatisfaction, compulsive exercise) among 531 college men and women. Moreover, we tested whether appearance-ideal internalization mediated the relationships between personality traits with body dissatisfaction and compulsive exercise. As expected, body dissatisfaction was positively related to neuroticism, and compulsive exercise was positively associated with extraversion. Thin-ideal internalization positively correlated with neuroticism, athletic-ideal internalization positively correlated with conscientiousness, and both thin- and athletic-ideal internalization were positively related to extraversion. After controlling for gender, body mass index, the other appearance-ideal internalization, and the remaining personality traits, the indirect effects of both neuroticism and extraversion on body dissatisfaction through thin-ideal internalization were significant. Extraversion and conscientiousness were indirectly related to compulsive exercise through athletic-ideal internalization, whereas the indirect effect of neuroticism was dependent on covariates. As such, personality traits may be related to distinct eating disorder cognitions/behaviors through internalization of specific appearance ideals.

From Concepts and Codes to Healthcare Quality Measurement: Understanding Variations in Value Set Vocabularies for a Statin Therapy Clinical Quality Measure.

OBJECTIVE: To understand the impact of distinct concept to value set mapping on the measurement of quality of care. BACKGROUND: Clinical quality measures (CQMs) intend to measure the quality of healthcare services provided, and to help promote evidence-based therapies. Most CQMs consist of grouped codes from vocabularies - or 'value sets' - that represent the unique identifiers (i.e., object identifiers), concepts (i.e., value set names), and concept definitions (i.e., code groups) that define a measure's specifications. In the development of a statin therapy CQM, two unique value sets were created by independent measure developers for the same global concepts. METHODS: We first identified differences between the two value set specifications of the same CQM. We then implemented the various versions in a quality measure calculation registry to understand how the differences affected calculated prevalence of risk and measure performance. RESULTS: Global performance rates only differed by 0.8%, but there were up to 2.3 times as many patients included with key conditions, and differing performance rates of 7.5% for patients with 'myocardial infarction' and 3.5% for those with 'ischemic vascular disease'. CONCLUSION: The decisions CQM developers make about which concepts and code groups to include or exclude in value set vocabularies can lead to inaccuracies in the measurement of quality of care. One solution is that developers could provide rationale for these decisions. Endorsements are needed to encourage system vendors, payers, informaticians, and clinicians to collaborate in the creation of more integrated terminology sets.

Integrating eating disorder-specific risk factors into the acquired preparedness model of dysregulated eating: A moderated mediation analysis.

Tests of the acquired preparedness model demonstrate that the personality trait of negative urgency (i.e., the tendency to act impulsively when distressed) predicts the expectation that eating alleviates negative affect, and this eating expectancy subsequently predicts dysregulated eating. Although recent data indicate that eating disorder-specific risk factors (i.e., appearance pressures, thin-ideal internalization, body dissatisfaction, dietary restraint) strengthen negative urgency-dysregulated eating associations, it is unclear whether these risk factors impact associations directly or indirectly (i.e., through eating expectancies). The current study used latent moderated structural equation modeling to test moderated mediation hypotheses in a sample of 313 female college students. Eating expectancies mediated the association between negative urgency and dysregulated eating, and the indirect effect of negative urgency on dysregulated eating through eating expectancies was conditional on level of each eating disorder risk factor. Appearance pressures, thin-ideal internalization, body dissatisfaction, and dietary restraint significantly moderated the association between eating expectancies and dysregulated eating, while only dietary restraint moderated the direct effect of negative urgency on dysregulated eating. Findings suggest that the development of high-risk eating expectancies among individuals with negative urgency, combined with sociocultural pressures for thinness and their consequences, is associated with the greatest risk for dysregulated eating.

Exploring divergent trajectories: Disorder-specific moderators of the association between negative urgency and dysregulated eating.

Negative urgency (i.e., the tendency to act impulsively when experiencing negative emotions) is a well-established risk factor for dysregulated eating (e.g., binge eating, loss of control eating, emotional eating). However, negative urgency is transdiagnostic, in that it is associated with multiple forms of psychopathology. It is currently unclear why some individuals with high negative urgency develop dysregulated eating while others experience depressive symptoms or problematic alcohol use. Investigating disorder-specific moderators of the association between negative urgency and psychopathology may help elucidate these divergent trajectories. The current study examined interactions among negative urgency and eating disorder-specific risk factors specified in the well-established dual-pathway model of bulimic pathology (i.e., appearance pressures, thin-ideal internalization, body dissatisfaction, dietary restraint). We hypothesized that these interactions would predict dysregulated eating, but not depressive symptoms or problematic alcohol use. Latent moderated structural equation modeling was used to test this hypothesis in a large (N = 313) sample of female college students. Negative urgency was significantly associated with dysregulated eating, depressive symptoms, and problematic alcohol use. However, interactions among negative urgency and dual-pathway model variables were specific to dysregulated eating and accounted for an additional 3-5% of the variance beyond main effects. Findings suggest that eating disorder-specific risk factors may shape negative urgency into manifesting as dysregulated eating versus another form of psychopathology. Future research should use longitudinal designs to further test the impact of interactions among disorder-specific risk factors and negative urgency on divergent psychopathology trajectories.

6-n-propylthiouracil taster status not related to reported cruciferous vegetable intake among ethnically diverse children.

Sensitivity to the taste of 6-n-propylthiouracil (PROP) (a bitter chemical related to the phenylthiocarbamide found in cruciferous vegetables) has been related to dietary intake or preferences of cruciferous vegetables among adults and young children but not middle-aged children or adolescents. We hypothesized that PROP taste sensitivity is related to lower reported dietary intake of cruciferous vegetables, primarily among younger children (ie, a moderating effect of child age). This study examined the relationship of PROP sensitivity to reported dietary intake across 3 days in 2 age groups of youth (9-10 and 17-18 years) while statistically controlling for physical activity, social desirability, and reporting bias. Cross-sectional design was used with a multiethnic (white, African American, Hispanic, etc) sample of 843 men and women. Children were recruited from and data were collected in local elementary and high schools that had at least 30% ethnic minority enrollment. Children providing nonplausible reports of dietary intake were deleted from the analyses. Body mass index was calculated and expressed in z scores. Energy intake and physical activity were measured by 3 telephone-conducted 24-hour dietary recalls with the Nutrient Data System for Research and 5 days of Actigraph (ActiGraph, Shalimar, Florida) activity monitor. The primary analyses included 347 students. 6-n-Propylthiouracil sensitivity was not related to intake of cruciferous vegetables. Intakes of the cruciferous vegetables were low, which may explain the lack of relationship.