Resilience eDBT: Development and Usability Evaluation of a Dialectical Behavior Therapy Skills Training App for Eating Disorders.

OBJECTIVE: Dialectical behavior therapy (DBT) is an evidence-based treatment for disorders characterized by recurrent binge eating. Yet, access to specialized treatment like DBT remains limited. To increase the accessibility of DBT, we developed a DBT skills training app (Resilience: eDBT) for the management of eating disorder (ED) symptoms. This paper delineates the developmental process of Resilience and tests its usability. METHODS: Descriptive information on the development and features of Resilience is provided, including its framework, content structure and delivery formats, functionality, data storage procedure, and privacy protocols. Usability was assessed via a mixed methods approach in 10 symptomatic individuals. Qualitative data were organized based on an existing framework, which included six themes: usability, visual design, user engagement, content, therapeutic persuasiveness, and therapeutic alliance. RESULTS: Resilience demonstrated good usability via a Systems Usability Scale score of 85.5, which exceeded the recommended cutoff of 68. Positive aspects of the app, according to interview data, were the ease of use and the visual design, while the addition of peer support was suggested as an opportunity for improvement. DISCUSSION: A novel DBT-based app may serve as an acceptable, low-intensity option or adjunct to traditional treatment for targeting ED symptoms that emerge in daily life. However, notable limitations include the small sample size and the single time point at which the usability assessment was conducted.

Enhancing inferences and conclusions in body image focused non-experimental research via a causal modelling approach: A tutorial.

Causal inference is often the goal of psychological research. However, most researchers refrain from drawing causal conclusions based on non-experimental evidence. Despite the challenges associated with producing causal evidence from non-experimental data, it is crucial to address causal questions directly rather than avoiding them. Here we provide a clear, non-technical overview of the fundamental concepts (including the counterfactual framework and related assumptions) and tools that permit causal inference in non-experimental data, intended as a starting point for readers unfamiliar with the literature. Certain tools, such as the target trial framework and causal diagrams, have been developed to assist with the identification and reduction of potential biases in study design and analysis and the interpretation of findings. We apply these concepts and tools to a motivating example from the body image field. We assert that more precise and detailed elucidation of the barriers to causal inference within one's study is arguably a key first step in the enhancement of non-experimental research and future intervention development and evaluation.

A randomized controlled trial of an online single session intervention for body image in individuals with recurrent binge eating.

OBJECTIVE: Theoretical models highlight body image disturbances as central to the maintenance of eating disorders, with empirical evidence finding negative body image to be a robust predictor of treatment nonresponse, relapse and symptom persistence. Accessible, scalable, and inexpensive interventions that can effectively target negative body image across the eating disorders are needed. We developed an online single session intervention (SSI) for negative body image and evaluated its acceptability and efficacy in a randomized controlled trial in individuals with recurrent binge eating. METHOD: Participants with recurrent binge eating were randomly assigned to the SSI (n = 99) or a waitlist (n = 101). Assessments were conducted at baseline, 4 week follow-up, and 8 week follow-up. RESULTS: 81% of participants accessed the SSI, demonstrating reasonable uptake. However, issues with attrition were apparent; a 32% study dropout rate was observed at posttest, while a 58% dropout rate was observed at follow-up. 87% of participants who completed satisfaction measures would recommend the SSI. SSI participants experienced greater improvements in negative body image at both 4 (d = -0.65) and 8 week (d = -0.74) follow-up. Significant between-group effects were also observed on most other secondary symptom measures, though no differences were found for motivations and help-seeking beliefs and intentions. CONCLUSION: Body image-focused self-guided SSIs for recurrent binge are largely accepted by those who are retained in the trial, but are associated with significant attrition. Although SSIs are not intended to replace standard treatment, they may help with short-term symptom management and could play an important role in eating disorder care. PUBLIC SIGNIFICANCE: Single session interventions (SSI) are a potentially accessible, scalable, and cost-effective way to deliver evidence-based treatment content to people with eating disorders. This study shows that an online (SSI) designed to target body image among people with recurrent binge eating is accepted and produced short-term symptom relief.

Target-user preferences, motivations, and acceptance for a dialectical behaviour therapy smartphone application for eating disorders.

PURPOSE: Evidence shows that dialectical behavioural therapy (DBT) is efficacious for eating disorders (ED), yet few people have access to specialized treatments like DBT. Translating key DBT skills for delivery via a smartphone application may broaden the dissemination of evidence-based interventions. However, prior to developing a DBT-based app, it is crucial to gather information on target-user needs and preferences. Assessing overall acceptance and identifying predictors of acceptance, informed by the UTAUT framework, is also important. This process ensures not only a demand for such an app, but also that users receive content and features tailored to their needs. METHOD: This study aimed to understand target-user preferences of DBT-based apps for EDs by assessing willingness to engage, overall acceptance levels, and preferred functionality/content delivery modes (n = 326 symptomatic participants). RESULTS: Eighty-eight percent indicated they would be willing to use a DBT-based ED app if it were available. Acceptance levels of a DBT app were high (64%), which was uniquely predicted by performance expectancy (perceptions of how beneficial an intervention is) and facilitating conditions (expectations of technological infrastructure and support in interventions) in path analysis. Content perceived as important to contain were emotion regulation techniques, tailored intervention strategies, and psychoeducation. CONCLUSION: Findings generate important information about target-user preferences of a DBT-based app for EDs, highlighting necessary design principles for apps of this kind. Level of evidence Level V, cross-sectional descriptive study.

Body appreciation predicts lower levels of orthorexia nervosa symptoms: Prospective findings.

Recent evidence shows that negative body image may be a potential risk factor for symptoms of orthorexia nervosa (ON). However, whether positive body image plays a protective role against symptoms of ON remains unclear. Although prior research has established associations between body appreciation (a core component of positive body image) and ON symptoms, this research is limited to cross-sectional designs, precluding inferences of temporal precedence. Thus, the present study overcomes this limitation by testing whether body appreciation prospectively predicts ON symptoms. Data were analysed from 1253 adult women (M age = 34 years (SD = 9.4), 81.3% Caucasian) who completed the Orthorexia Nervosa Inventory (ONI) and Body Appreciation Scale 2-Short Form (BAS2-SF) at baseline (T1) and at three-month follow-up (T2). Multiple linear regressions were used to test whether body appreciation scores at T1 predicted ONI subscale scores (behaviours, emotions, and impairments) at T2. Results revealed that higher body appreciation scores at T1 significantly predicted decreased scores on each ONI subscale at T2, though effect sizes were small. Findings provide preliminary evidence that body appreciation may protect against ON symptoms. If replicated, efforts to address ON symptoms may be enhanced by promoting body appreciation.

Bidirectional relationships between muscularity-oriented disordered eating and mental health constructs: a prospective study.

Muscularity-oriented disordered eating (MODE) is a novel class of eating behaviors characterised by abnormal dietary alterations aimed towards building lean muscle. Although traditionally shown to affect men, emerging evidence suggests that increasingly more women are striving for the muscular and lean ideal, resulting in engagement of MODE behaviors. Prior research examining MODE in women is limited, yet emerging evidence from cross-sectional studies have established associations between MODE and poor mental health indices in this population. However, the temporal order of these associations in women is not yet known. Thus, the current study examined possible bi-directional associations between MODE behaviors and common mental health outcomes (depression, anxiety, loneliness). Adult women completed online study measures at baseline (Time 1 [T1]; n = 1760) and three-month follow-up (Time 2 [T2]; n = 1180). Cross-lagged panel models were computed to test for possible bi-directional relationships between MODE and the relevant mental health constructs. Findings showed that higher MODE levels at T1 significantly predicted increased depressive and anxiety symptoms (but not loneliness) at T2, and loneliness at T1 (but not depression/anxiety) significantly predicted MODE at T2. Effect sizes were small, so findings should be interpreted with this in mind. This is the first study to establish temporal relationships between MODE and mental health outcomes in adult women. Findings suggest that clinicians may benefit from inquiring about MODE behaviors for proper screening, assessment, and intervention, and potentially addressing loneliness to decrease risk of MODE.

An inflexible adherence to food rules mediates the longitudinal association between shape/weight overvaluation and binge eating.

Understanding factors that account for the persistence of binge eating is necessary for developing effective early intervention and treatment approaches. The cognitive-behavioral model of eating disorders proposes that judgements of self-worth contingent upon weight and shape encourage adoption of multiple demanding rules related to food, eating and dieting, in turn increasing vulnerability to binge eating. However, there is limited longitudinal evidence supporting this hypothesized sequence of events. This study tested whether the longitudinal association between shape/weight overvaluation and binge eating is mediated by an inflexible adherence to food rules. Participants were 1760 adult women recruited from an online eating disorder platform who were invited to complete study measures at baseline (T1), 3-month follow-up (T2), and 6-month follow-up (T3). Path analysis was conducted to test the hypothesized associations. Missing data were handled using multiple imputation techniques. A significant indirect effect emerged, in that higher overvaluation scores at T1 predicted increased inflexible adherence to food rules at T2, which in turn predicted increased binge eating symptoms at T3. Findings offer support for the predictions outlined by the cognitive-behavioral model of eating disorders and highlight clear targets for early intervention and treatment.

Current evidence on the efficacy of mental health smartphone apps for symptoms of depression and anxiety. A meta-analysis of 176 randomized controlled trials.

The mental health care available for depression and anxiety has recently undergone a major technological revolution, with growing interest towards the potential of smartphone apps as a scalable tool to treat these conditions. Since the last comprehensive meta-analysis in 2019 established positive yet variable effects of apps on depressive and anxiety symptoms, more than 100 new randomized controlled trials (RCTs) have been carried out. We conducted an updated meta-analysis with the objectives of providing more precise estimates of effects, quantifying generalizability from this evidence base, and understanding whether major app and trial characteristics moderate effect sizes. We included 176 RCTs that aimed to treat depressive or anxiety symptoms. Apps had overall significant although small effects on symptoms of depression (N=33,567, g=0.28, p<0.001; number needed to treat, NNT=11.5) and generalized anxiety (N=22,394, g=0.26, p<0.001, NNT=12.4) as compared to control groups. These effects were robust at different follow-ups and after removing small sample and higher risk of bias trials. There was less variability in outcome scores at post-test in app compared to control conditions (ratio of variance, RoV=-0.14, 95% CI: -0.24 to -0.05 for depressive symptoms; RoV=-0.21, 95% CI: -0.31 to -0.12 for generalized anxiety symptoms). Effect sizes for depression were significantly larger when apps incorporated cognitive behavioral therapy (CBT) features or included chatbot technology. Effect sizes for anxiety were significantly larger when trials had generalized anxiety as a primary target and administered a CBT app or an app with mood monitoring features. We found evidence of moderate effects of apps on social anxiety (g=0.52) and obsessive-compulsive (g=0.51) symptoms, a small effect on post-traumatic stress symptoms (g=0.12), a large effect on acrophobia symptoms (g=0.90), and a non-significant negative effect on panic symptoms (g=-0.12), although these results should be considered with caution, because most trials had high risk of bias and were based on small sample sizes. We conclude that apps have overall small but significant effects on symptoms of depression and generalized anxiety, and that specific features of apps - such as CBT or mood monitoring features and chatbot technology - are associated with larger effect sizes.

Infant and preschool attachment, continuity and relationship to caregiving sensitivity: findings from a new population-based Australian cohort.

BACKGROUND: Here, we report new prevalence and temporal stability data for child attachment and parental caregiving behaviour, from infancy (1 year) to preschool (4 years). METHODS: Attachment (SSP) and caregiving data (MBQS) were from observations of parents and their infants and preschoolers, who represent the third generation of participants within an Australian longitudinal cohort. RESULTS: At 1 year (n = 314 dyads) and at 4 years (n = 368 dyads), proportions assessed secure were 59% and 71%, respectively. Proportions assessed avoidant were 15% and 11%; ambivalent 9% and 6%, and disorganised 17% and 12%, at 1 and 4 years. Continuity of attachment pattern was highest for the infant secure group. Of dyads initially classified disorganised in infancy, 36% remained so at the preschool assessment. Attachment and caregiving continuities across the infancy-preschool period were highest for the stable secure attachment group and lowest for the stable insecure attachment group. Loss of secure attachment to mother by age 4 years correlated with decreased maternal caregiving sensitivity, and acquisition of secure status by age 4 was associated with increased maternal sensitivity. We found no difference in caregiving sensitivity scores for mothers and fathers for female and male preschool children. CONCLUSIONS: The contemporary infant and preschool attachment proportions we report here closely mirror the patterns of those reported in prior decades, with an inclination towards secure base relationships. Our findings alert practitioners anew to the responsiveness of early attachment status to change in caregiving responsiveness and support ongoing investment in early identification of disorganised attachment.

The efficacy of mindfulness apps on symptoms of depression and anxiety: An updated meta-analysis of randomized controlled trials.

Mindfulness apps have become popular tools for addressing symptoms of depression and anxiety. Since the publication of earlier meta-analyses evaluating the efficacy of mindfulness apps for depression and anxiety symptoms, over 20 randomized controlled trials (RCTs) have been conducted. There is a need for an updated meta-analysis that quantifies the effects of mindfulness apps on these symptoms and tests for potential moderators.. Random effects meta-analyses were conducted on 45 RCTs. Small, significant effect sizes were found for symptoms of depression (Ncomp = 46, N = 5852, g = 0.24, 95% CI = 0.17, 0.31, NNT = 13.57) and anxiety (Ncomp = 48, N = 6082, g = 0.28, 95% CI = 0.21, 0.35, NNT = 11.47) in favour of mindfulness apps over control groups. This effect was not explained by symptom deterioration in participants allocated to control groups. Effects remained stable when restricting analyses to lower risk of bias and larger sample trials. No significant moderators were observed, except trials that offered monetary compensation produced larger effects on depression. Non-significant effects were observed when comparing mindfulness apps to active therapeutic comparisons (g = -0.15 depression, g = 0.10 anxiety), though the number of studies was low. Growing evidence indicates that mindfulness apps can acutely reduce symptoms of depression and anxiety, although higher quality studies with longer follow-ups are needed.

Digital health applications for eating disorders treatment.

Eating disorders (EDs) are characterized by multifaceted etiologies, difficulties in accessing care (especially in regional locations), and variable responsiveness to treatments. Digital technologies are viewed as an important innovation in the assessment and treatment of EDs. We discuss current implementation of these innovations as well as important future directions for the field.

Predictors, mediators, and moderators of response to digital interventions for eating disorders: A systematic review.

OBJECTIVE: Digital interventions show promise as an effective prevention or self-management option for eating disorders (EDs). However, it remains unclear how, for whom, and through what mechanisms they work in this population, as a synthesis of outcome predictors, moderators, and mediators is lacking. This systematic review synthesized empirical research investigating predictors, mediators, and moderators of response to digital interventions for EDs. METHOD: Six databases were searched (PROSPERO CRD42022295565) for studies that assessed predictors, moderators, or mediators of response (i.e., uptake, drop-out, engagement, and symptom level change) to a digital prevention or treatment program for EDs. Variables were grouped into several overarching categories (demographic, symptom severity, psychological, etc.) and were synthesized qualitatively across samples without a formally diagnosed ED (typically prevention-focused) and samples with a formally diagnosed ED (typically treatment-focused). RESULTS: Eighty-six studies were included. For studies recruiting samples without a formal diagnosis (n = 70 studies), most predictors explored were statistically unrelated to outcome, although participant age, baseline symptom severity, confidence to change, motivation, and program engagement showed preliminary evidence of prognostic potential. No robust moderators or mediators were identified. Few studies recruiting samples with a formal diagnosis emerged (n = 16), of which no reliable predictors, moderators, or mediators were identified. DISCUSSION: It remains unclear how, for whom, and under what circumstances digital programs targeting EDs work. We offer several recommendations for future research with the aim of advancing understanding of client characteristics and intervention elements that signal success from this intervention modality. PUBLIC SIGNIFICANCE: Digital interventions have shown potential as an effective, scalable, and accessible intervention option for EDs. However, responsiveness varies, so advancing understanding of predictors, mediators, and moderators of outcome to digital interventions for EDs is needed. Such knowledge is important for enabling safe and efficient treatment matching, and for informing future development of effective digital interventions.

OBJETIVO: Las intervenciones digitales se muestran prometedoras como una opción eficaz de prevención o autocontrol de los trastornos de la conducta alimentaria (TCA). Sin embargo, sigue sin estar claro cómo, para quién y a través de qué mecanismos funcionan en esta población, ya que falta una síntesis de los predictores de resultados, moderadores y mediadores. Esta revisión sistemática sintetiza la investigación empírica que estudia los predictores, mediadores y moderadores de la respuesta a las intervenciones digitales para los TCA. MÉTODO: Se realizaron búsquedas en seis bases de datos (CRD42022295565) de estudios que evaluaron predictores, moderadores o mediadores de la respuesta (es decir, admisión, abandono, compromiso y cambio en el nivel de síntomas) a un programa digital de prevención o tratamiento de los TCA. Las variables se agruparon en varias categorías generales (demográficas, gravedad de los síntomas, psicológicas, etc.) y se sintetizaron cualitativamente en muestras sin un TCA diagnosticado formalmente (normalmente centradas en la prevención) y muestras con un TCA diagnosticado formalmente (normalmente centradas en el tratamiento). RESULTADOS: Se incluyeron 86 estudios. Para los estudios que reclutaron muestras sin un diagnóstico formal (n = 70 estudios), la mayoría de los predictores explorados no estaban estadísticamente relacionados con el resultado, aunque la edad del participante, la gravedad de los síntomas basales, la confianza en el cambio, la motivación y el compromiso con el programa mostraron evidencia preliminar de potencial pronóstico. No se identificaron moderadores o mediadores sólidos. Surgieron pocos estudios que reclutaran muestras con un diagnóstico formal (n = 16), de los cuales no se identificaron predictores, moderadores o mediadores fiables. DISCUSIÓN: Sigue sin estar claro cómo, para quién y en qué circunstancias funcionan los programas digitales dirigidos a los TCA. Ofrecemos varias recomendaciones para futuras investigaciones con el objetivo de avanzar en la comprensión de las características de los consultantes y los elementos de intervención que señalan el éxito de esta modalidad de intervención.

Longitudinal association between self-compassion and intuitive eating: Testing emotion regulation and body image flexibility as mediating variables.

OBJECTIVES: Growing evidence suggests that intuitive eating is associated with numerous positive mental health and well-being constructs. Understanding factors that predict intuitive eating is necessary for identifying practical targets to enhance this style of eating, yet research identifying such predictors is scarce. Self-compassion is one variable that could enhance intuitive eating because it involves the practice of healthy emotion regulation skills that may disrupt the tendency to turn to food to cope during distressing situations. The present study tested for a longitudinal association between self-compassion and intuitive eating. We also tested whether this association was mediated by indices of emotion regulation (i.e., global emotion regulation skill scores and body image flexibility). METHOD: Adult women (n = 3039) were invited to completed study measures at baseline (T1), 4-month follow-up (T2), and 8-month follow-up (T3). Path analyses were computed to test hypothesized indirect effects. RESULTS: A direct path from T1 self-compassion to T3 intuitive eating emerged, such that higher self-compassion levels predicted increased intuitive eating over time. However, this association was not mediated by T2 emotion regulation skills nor body image flexibility. CONCLUSION: Findings suggest that self-compassion may facilitate an intuitive eating style, which does not appear to be explained by certain emotion regulation skills.

Orthorexia nervosa symptoms prospectively predict symptoms of eating disorders and depression.

The possible mental health impacts of orthorexia nervosa (ON) symptoms are poorly understood, as existing research in this field has mostly employed cross-sectional designs. This study investigated whether ON symptoms prospectively predict changes in eating disorder psychopathology and general mental health. A convenience, non-clinical sample of adults (n = 313; 83 % women) completed study measures at baseline (T1) and three-month follow-up (T2). Negative binomial regressions were computed to test whether T1 ON symptoms predict changes in binge eating and driven exercise episodes. Linear regressions were computed to test whether T1 ON symptoms predict changes in eating concerns, depressive symptoms, and life satisfaction. Higher ON symptoms prospectively predicted greater number of binge eating and driven exercise episodes at T2. Higher ON symptoms predicted increased eating concerns and depressive symptoms at T2. ON symptoms did not predict changes in life satisfaction. Findings highlight possible risks associated with ON symptomatology. Efforts to better inform the public about the risks of these pathological eating patterns are needed.

Effects of Participant's Choice of Different Digital Interventions on Outcomes for Binge-Spectrum Eating Disorders: A Pilot Doubly Randomized Preference Trial.

It is unclear whether offering individuals a choice between different digital intervention programs affects treatment outcomes. To generate initial insights, we conducted a pilot doubly randomized preference trial to test whether offering individuals with binge-spectrum eating disorder a choice between two digital interventions is causally linked with superior outcomes than random assignment to these interventions. Participants with recurrent binge eating were randomized to either a choice (n = 77) or no-choice (n = 78) group. Those in the choice group could choose one of the two digital programs, while those in the no-choice group were assigned a program at random. The two digital interventions (a broad and a focused program) took 4 weeks to complete, were based on cognitive-behavioral principles and have demonstrated comparable efficacy, but differ in scope, content, and targeted change mechanisms. Most participants (79%) allocated to the choice condition chose the broad program. While both groups experienced improvements in primary (Eating Disorder Examination Questionnaire global scores and number of binge eating episodes over the past month) and secondary outcomes (dietary restraint, body image concerns, etc.), no significant between-group differences were observed. The two groups did not differ on dropout rates, nor on most indices of intervention engagement. Findings provide preliminary insights towards the role of client preferences in digital mental health interventions for eating disorders. Client preferences may not determine outcomes when digital interventions are based on similar underlying principles, although larger trials are needed to confirm this.

Functionality appreciation and its correlates: Systematic review and meta-analysis.

Functionality appreciation is a component of positive body image that refers to respecting and honoring the body for what it is capable of doing. A growing number of studies have investigated the features, correlates, and outcomes of functionality appreciation, yet a synthesis of this literature is missing. We conducted a systematic review and meta-analysis of research on functionality appreciation. Fifty-six studies were included (85 % cross-sectional). Random effects meta-analyses were performed on 21 cross-sectional correlates and on seven randomized trials of psychological interventions that assessed functionality appreciation as an outcome. Meta-analyses showed that functionality appreciation was consistently associated with fewer body image problems, lower levels of eating disorder symptoms, and better mental health and wellbeing. Functionality appreciation was unrelated to age and gender, but weakly (and negatively) related to body mass index. Preliminary evidence from prospective designs suggests that the appreciation of body functionality may promote adaptive eating patterns and prevent maladaptive eating and body image patterns over time. Psychological interventions designed to cultivate functionality appreciation in full or in part produced greater improvements in this construct than control conditions. Findings confirm that functionality appreciation is associated with numerous wellbeing constructs and could serve as a potentially useful target for intervention.

Targeting dietary restraint to reduce binge eating: a randomised controlled trial of a blended internet- and smartphone app-based intervention.

BACKGROUND: Existing internet-based prevention and treatment programmes for binge eating are composed of multiple distinct modules that are designed to target a broad range of risk or maintaining factors. Such multi-modular programmes (1) may be unnecessarily long for those who do not require a full course of intervention and (2) make it difficult to distinguish those techniques that are effective from those that are redundant. Since dietary restraint is a well-replicated risk and maintaining factor for binge eating, we developed an internet- and app-based intervention composed solely of cognitive-behavioural techniques designed to modify dietary restraint as a mechanism to target binge eating. We tested the efficacy of this combined selective and indicated prevention programme in 403 participants, most of whom were highly symptomatic (90% reported binge eating once per week). METHOD: Participants were randomly assigned to the internet intervention (n = 201) or an informational control group (n = 202). The primary outcome was objective binge-eating frequency. Secondary outcomes were indices of dietary restraint, shape, weight, and eating concerns, subjective binge eating, disinhibition, and psychological distress. Analyses were intention-to-treat. RESULTS: Intervention participants reported greater reductions in objective binge-eating episodes compared to the control group at post-test (small effect size). Significant effects were also observed on each of the secondary outcomes (small to large effect sizes). Improvements were sustained at 8 week follow-up. CONCLUSIONS: Highly focused digital interventions that target one central risk/maintaining factor may be sufficient to induce meaningful change in core eating disorder symptoms.

The independent contribution of muscularity-oriented disordered eating to functional impairment and emotional distress in adult men and women.

Muscularity-oriented disordered eating (MODE) refers to a broad cluster of pathological eating patterns driven by the pursuit of muscularity and leanness. Although increasing attention has been devoted towards understanding these symptoms in men, little work has been conducted to understand MODE in women. It is also unclear whether MODE contributes unique variance to functional impairment and emotional distress beyond thinness-oriented disordered eating symptoms. We addressed these gaps in a sample of 1,321 community-based adult women (n = 1136) and men (n = 185). Hierarchical multiple regressions revealed that MODE explained a significant proportion of unique variance in functional impairment in both men and women, even after controlling for traditional thinness-oriented disordered eating symptoms. MODE also contributed unique variance in symptoms of depression and anxiety in women, but not for men. Findings highlight the possible significance of these unique symptoms patterns geared towards the pursuit of muscularity and leanness. MODE symptoms may be a viable target in eating disorder intervention or prevention programs, although further longitudinal research is needed.

Does body appreciation predict decreases in eating pathology via intuitive eating? A longitudinal mediation analysis.

Evidence suggests that body appreciation may be a protective factor for eating pathology. However, potential explanatory mechanisms for this association are unclear, as longitudinal studies testing mediational pathways are missing. This longitudinal study tested whether intuitive eating mediates the association between body appreciation and eating pathology. Data were analyzed from 3039 women recruited from an educational platform about disordered eating, many of whom exhibited elevated symptomatology. Measures were administered at baseline (T1), four-month (T2) and eight-month (T3) follow-up. Path analyses were computed to test hypothesized indirect effects. Direct paths from T1 body appreciation to T2 intuitive eating (total and subscale scores) and T3 eating pathology/binge eating were observed. However, only one significant indirect effect emerged: higher T1 body appreciation scores predicted greater decreases in T3 eating pathology and binge eating via its effect on increasing T2 Unconditional Permission to Eat (UPE) subscale scores. Findings suggest that the features of the UPE construct (e.g., eating foods that are desired in a given moment, refusal to dichotomize foods as "good" or "bad," etc.) may be important mechanisms explaining how and why body appreciation protects against eating pathology. Efforts should be made to enhance body appreciation and intuitive eating in eating disorder prevention programs.

Negative body image components as risk factors for orthorexia nervosa: Prospective findings.

Emerging theoretical and empirical evidence indicates that negative body image might be implicated in the onset or maintenance of ON symptoms. However, existing research investigating associations between negative body image and ON is limited to cross-sectional designs and has failed to consider the independent role of distinct components of body image. To overcome these limitations, the present study examined the prospective associations between five components of body image (i.e., overvaluation, dissatisfaction, preoccupation, body checking, and body image avoidance) and ON symptoms in community-based adult women. Participants were assessed at baseline and at a three-month follow-up, with 558 women included in the final analyses. After adjusting for baseline ON symptoms, higher scores on each of the five body image components at baseline significantly predicted greater increases in ON symptoms in univariate analyses. However, in multivariate analyses, overvaluation with weight and shape was the only component of body image to uniquely predict ON symptoms. Findings suggest that certain components of negative body image may increase the risk for ON symptoms. Findings also lend support to recent proposals that ON may be better viewed as a variant of an existing eating disorder, given that both appear to share similar underlying risk factors.