Examining orthorexia nervosa: Using latent profile analysis to explore potential diagnostic classification and subtypes in a non-clinical sample.

Orthorexia nervosa (ON) is a proposed psychological disorder characterized by a pathological preoccupation with healthy eating. The purpose of the current study was to clarify the relationships between ON and related forms of psychopathology. In addition, we sought to explore whether there may be subtypes of ON and if ON is associated with BMI, gender, or social media use. The sample included 333 undergraduate students (72% female, Mage = 20.91) who completed measures of ON, eating disorder (ED) symptoms, obsessive compulsive disorder (OCD), obsessive compulsive personality disorder (OCPD), and health anxiety. Latent profile analysis detected three distinct groups with high ON scores. The ON/ED combined group (n = 16) was characterized by high levels of psychopathology, particularly in the areas of ON and eating disorder symptoms. In comparison, the ON/ED combined, without weight/shape concerns group (n = 35) had fewer body-related concerns. The ON only group (n = 23) reported minimal ED pathology. Regression analyses revealed those in the ON only group were more likely to be male, while the ON/ED group was associated with higher BMI. Being in the ON/ED combined, without weight/shape concerns was associated with viewing and sharing healthy eating content on social media. Our findings suggest that ON has the most overlap with ED pathology as compared to OCD, OCPD, and health anxiety, and that there may be three subtypes of ON. The first two share significant overlap with ED symptomatology while the third appears relatively distinct, characterized by less disordered eating and fewer positive emotions related to healthy eating. Future research should examine these subtypes more closely to determine whether they are clinically meaningful, potentially requiring different interventions.

Exploring two models of emotion regulation: how strategy use, abilities, and flexibility relate to well-being and mental illness.

BACKGROUND AND OBJECTIVES: The process model of emotion regulation (ER) focuses on strategies used to manage emotions, while the abilities model emphasizes the extent one adaptively responds to negative emotions. We sought to clarify the relationships between components of ER based on both of the abilities (i.e., dysregulation) and process (i.e., strategy use) models, as well as ER flexibility (i.e., choosing the optimal strategy for a given situation) with well-being (happiness, flourishing), internalizing symptoms (depression, anxiety), and disordered eating. Gender differences were explored. DESIGN AND METHOD: Participants included 612 undergraduate students (Mage = 20.24) who completed questionnaires measuring ER, well-being, and mental illness. Structural equation modeling was used on cross-sectional data to explore the associations between ER and psychological outcomes. RESULTS: Dysregulation was associated with reduced well-being and greater psychopathology. In terms of strategy use, reappraisal was related to greater well-being and fewer internalizing symptoms, while the opposite relationships were found for suppression. Suppression was also linked to disordered eating. ER flexibility was related to well-being for men only. Further, dysregulation had the largest association with all outcomes. CONCLUSIONS: Findings suggest that ER abilities may underlie other components of ER and are most central to mental health and illness.

Influence of Anxiety on Baseline Cognitive Testing and Symptom Reporting in Adolescent Student Athletes.

Anxiety symptoms are commonly endorsed by student athletes. This study examined the possible influence of anxiety on baseline cognitive testing and symptom reporting in a large sample of adolescent student athletes. Participants were 37,945 adolescent student athletes from the state of Maine who completed baseline testing using ImPACT®. ImPACT includes an evaluation of cognitive functioning and a questionnaire assessing the presence and severity of common post-concussion symptoms. Participants were divided into high and low anxiety groups based on endorsement of anxiety-like symptoms. Student athletes in the high anxiety group were more likely to be girls and to have a greater lifetime history of treatment for mental health problems and headaches (ps < 0.001). The high anxiety group scored slightly lower on cognitive tests (Cohen ds = 0.15-0.26) and reported a much greater amount of baseline pre-season symptoms (Cohen d = 3.38). More than eight of 10 youth in the high anxiety group (82.7%) met International Statistical Classification of Diseases and Related Health Problems-10th Revision (ICD-10) symptom criteria for at least a mild form of the postconcussional syndrome compared with less than two of 10 (18.4%) in the low anxiety group. Students in the high anxiety group had slightly lower scores on neurocognitive testing, but the differences were not practically meaningful; however, they endorsed dramatically more physical, cognitive, and emotional symptoms. Anxiety can mimic the ICD-10 postconcussional syndrome in adolescent student athletes at baseline, when they have not been injured.

Momentary predictors of binge eating: An attachment perspective.

INTRODUCTION: According to attachment theory, individuals who are preoccupied with the possibility of rejection are prone to emotion dysregulation, which research has found to be related to disordered eating. The current study examined naturalistic momentary relationships between binge eating, depressive symptoms, emotion dysregulation, and attachment anxiety. METHOD: Participants were 55 undergraduate women who owned a mobile phone and who had binge eaten at least once during the past 28 days. All participants were screened to confirm the presence of binge eating and then completed trait measures of attachment anxiety. Participants then received seven text messages per day for 14 days. Texts contained links to state measures of depressive symptoms, state emotion dysregulation, and recent binge eating. RESULTS: Momentary depressive symptoms predicted subsequent binge eating. Aspects of emotion dysregulation (i.e., nonacceptance of emotional responses and difficulty modulating one's emotions) mediated the relationship between attachment anxiety and binge eating. DISCUSSION: Depressed mood often triggers binge eating. Additionally, attachment anxiety seems to predict binge eating through emotion dysregulation. Interventions for binge eating should address both attachment anxiety and emotion dysregulation in order to maximize therapeutic benefit.

Attention-deficit/hyperactivity disorder and eating disorders across the lifespan: A systematic review of the literature.

Attention-deficit/hyperactivity disorder (ADHD) and eating disorders are common and concerning mental health disorders. There is both empirical and theoretical support for an association between ADHD and eating disorders or disordered eating. This systematic review aims to summarize the extant literature on the comorbidity of ADHD and eating disorders across the lifespan, including the influences of sex, age, eating disorder diagnosis, and potential mediators. A total of 37 peer-reviewed studies on diagnosed ADHD and eating disturbances were identified through key research databases. Twenty-six studies supported a strong empirical association between ADHD and eating disorders or disordered eating. The systematic review findings suggest that children with ADHD are at risk for disordered eating, while adolescents, emerging adults, and adults are at risk for both eating disorders and disordered eating. Methodological considerations, future research, and clinical implications are discussed.

Eating- and weight-related factors associated with depressive symptoms in emerging adulthood.

Research suggests that eating- and weight-related disturbances (EWRDs) are key factors associated with depressive symptoms. However, it is unclear how EWRDs, and to a greater extent body appreciation, are associated with depressive symptoms among emerging adults. This study investigated the association between EWRDs, body appreciation, and depressive symptoms among emerging adults. Female (n=473) and male (n=135) emerging adults completed measures of restrained eating, emotional eating, external eating, drive for muscularity, body appreciation, and depressive symptoms. Hierarchical multiple regression analyses, performed separately for women and men, found that restrained eating was significantly related to depressive symptoms among both genders, whereas emotional and external eating were significantly associated with depressive symptoms in women only. Body appreciation was negatively associated with depressive symptoms in both genders. The findings highlight the need for clinicians to assess for EWRDs and promote positive body appreciation among emerging adults.

Family Functioning and Dysfunctional Eating Among Italian Adolescents: The Moderating Role of Gender.

The first aim of this study was to examine the association between different dimensions of family functioning and dysfunctional eating in a sample of Italian adolescent boys and girls. The second aim was to investigate whether gender moderates the relationship between family functioning and dysfunctional eating. Seven hundred and twenty seven adolescents (500 boys and 227 girls) with ages ranging from 15 to 18 years completed a survey of self-report measures. Findings from hierarchical multiple regression analysis suggested that aspects of family functioning such as flexibility, cohesion, disengagement, enmeshment, rigidity and chaotic were related to dysfunctional eating in adolescents. Additionally the results indicated differences between boys and girls, in particular dysfunctional eating in adolescent boys seemed to be more affected by dimensions of enmeshment and disengagement than dysfunctional eating in girls. This research highlights the important role of various aspects of family functioning in relation to dysfunctional eating in adolescents.

The Strengths Assessment Inventory-Youth Version: An evaluation of the psychometric properties with male and female justice-involved youth.

Strengths constitute an important element of developmental assessments. It is consistent with evidence-based practice to use assessment tools that adequately measure a given construct and are appropriate for use with their targeted population. The Strengths Assessment Inventory-Youth Version (SAI-Y; Rawana & Brownlee, 2010)-a self-report measure of personal strengths, self-concept, and emotional functioning-was administered to 230 male and female adolescent offenders. Confirmatory factor analyses revealed that the SAI-Y's factor structure demonstrated an acceptable fit overall, while some factors fit the data well, and fewer factors displayed a questionable fit. A majority of scale scores were found to exhibit good reliability for both sexes, with three empirical scale scores demonstrating poor reliability. In addition, scores on the SAI-Y also achieved satisfactory convergent and divergent validity. Total strength scores were significantly correlated in the expected direction with most theoretically related measures of emotional and behavioral functioning (e.g., self-esteem, treatment readiness, antisocial attitudes). Lastly, moderate gender effects and small ethnicity differences in response patterns were found. This was the first validation study of the SAI-Y with a justice-involved sample and the results suggest it is an appropriate measure for use with both male and female justice-involved young persons in detention and in the community. (PsycINFO Database Record

The effect of physical activity on depression in adolescence and emerging adulthood: a growth-curve analysis.

This study examined the influence of physical activity on the trajectory of depression from adolescence through emerging adulthood (EA). Using data from the National Longitudinal Study of Adolescent Health (Waves I to IV), latent growth curve modeling was performed to assess how physical activity and gender influenced depression across adolescence and EA. Higher levels of physical activity in mid-adolescence were associated with lower levels of depression during mid-adolescence and slower inclines and declines in depression over time. Boys had lower levels of depression in mid-adolescence and slower inclines and declines in depression over time compared to girls. Findings provide evidence that current theories on understanding depression and mental health prevention programs may be enhanced by the inclusion of physical activity.

The protective role of optimism and self-esteem on depressive symptom pathways among Canadian Aboriginal youth.

Aboriginal youth are at disproportionate risk for depression and substance use problems. Increasingly, developmental theories have shifted from focusing on vulnerabilities to protective factors for adolescent depression. In particular, theories emphasizing protective factors are relevant when understanding the mental health of Aboriginal youth. However, it is unclear which factors protect against depressive symptomatology among Aboriginal adolescents to promote optimal development. Using multilevel growth curve modeling, the present study had three main objectives. First, we aimed to model the developmental trajectory of depressive symptoms using a sample of off-reserve Aboriginal youth from a national Canadian dataset (ages 12-23). Second, we sought to examine the relationship between alcohol use behaviors, self-esteem, optimism, and the trajectories of depressive symptoms. Lastly, we investigated whether self-esteem and optimism mediated the relationship between alcohol use and depressive symptoms. Gender differences were also examined within each of the study objectives. A sample of off-reserve Aboriginal youth (N = 283; 48.3% male) was selected from cycles 4-7 of the National Longitudinal Survey of Children and Youth. Heavy drinking was a risk factor for depressive symptoms, while self-esteem and optimism were key protective factors for depressive symptoms among early adolescent Aboriginal youth. Further, the developmental trajectory of depressive symptoms among Canadian Aboriginal youth differed for boys and girls once accounting for risk and protective factors. Thus, it is valuable to integrate the protective role of self-esteem and optimism into developmental theories of depression and mental health intervention programs for early adolescent Aboriginal youth.

What do we know about suicidality in autism spectrum disorders? A systematic review.

Suicidality is a common and concerning issue across development, and there is a plethora of research on this topic among typically developing children and youth. Very little is known, however, about the nature of suicidality among individuals with autism spectrum disorders (ASDs). The purpose of the current study was to undertake a systematic literature review to assess the current state of the research literature to examine the prevalence of suicidality among individuals with ASD, related demographic and clinical profiles, and associated risk and protective factors. A literature search using key terms related to suicidality and ASD yielded 10 topical studies that were evaluated for the study objectives. Suicidality was present in 10.9-50% of the ASD samples identified in the systematic review. Further, several large-scale studies found that individuals with ASD comprised 7.3-15% of suicidal populations, a substantial subgroup. Risk factors were identified and included peer victimization, behavioral problems, being Black or Hispanic, being male, lower socioeconomic status, and lower level of education. Only one study reported on protective factors, and this is identified as a significant gap in the literature. Several methodological weaknesses were present in the current literature, such as lack of appropriate comparison groups and little to no use of empirically validated measures for ASD diagnosis and suicide assessment. Additional research is necessary to understand better how this unique population experiences and expresses suicidal tendencies. Recommendations for future research are discussed.

Trajectories of depressive symptoms from adolescence to young adulthood: the role of self-esteem and body-related predictors.

Although depression is a common issue among youth, it is unclear how important developmental factors, such as body mass index (BMI), self-esteem, and eating-and weight-related disturbances relate to the development of depression across adolescence and into young adulthood. Gender differences in these relationships and the specific nature of these relationships among adolescent boys and young men require further study. Using multilevel growth curve modeling, this study examined the effects of BMI, self-esteem, and eating- and weight-related disturbances (i.e., body dissatisfaction and weight management effort) and their interactive effects with gender on the developmental trajectory of depressive symptoms using the Canadian-based National Longitudinal Survey of Children and Youth (N = 4,359 ages 12-21, 48.7 % female). On average, depressive symptoms decreased slightly at ages 12 through 14, began to increase from ages 14 through 17, and then began to decrease through age 21. Adolescent girls were at increased risk for depressive symptoms throughout adolescence and young adulthood compared to boys. This effect was compounded by low levels of self-esteem across adolescence and young adulthood. Engaging in weight management effort was associated with lower initial levels of depressive symptoms in early adolescence. The study's findings contribute to basic etiologic research regarding the trajectory of depressive symptoms in adolescence and young adulthood suggesting that mid-adolescents may be most vulnerable to depression compared to other adolescent age groups. The findings also underscore the importance of fostering positive self-esteem among adolescent girls and young women to prevent depression and exploring the protective effect of specific weight management strategies in future research.

The relative importance of body change strategies, weight perception, perceived social support, and self-esteem on adolescent depressive symptoms: longitudinal findings from a national sample.

OBJECTIVE: This study aimed to evaluate the relative importance of body change strategies and weight perception in adolescent depression after accounting for established risk factors for depression, namely low social support across key adolescent contexts. The moderating effect of self-esteem was also examined. METHODS: Participants (N=4587, 49% female) were selected from the National Longitudinal Study of Adolescent Health. Regression analyses were conducted on the association between well-known depression risk factors (lack of perceived support from parents, peers, and schools), body change strategies, weight perception, and adolescent depressive symptoms one year later. RESULTS: Each well-known risk factor significantly predicted depressive symptoms. Body change strategies related to losing weight and overweight perceptions predicted depressive symptoms above and beyond established risk factors. Self-esteem moderated the relationship between trying to lose weight and depressive symptoms. CONCLUSION: Maladaptive weight loss strategies and overweight perceptions should be addressed in early identification depression programs.

Protective predictors of alcohol use trajectories among Canadian Aboriginal youth.

Some Aboriginal youth are at disproportionate risk of using substances and developing abuse and dependence disorders. However, not all Aboriginal youth misuse substances and limited research has examined the protective factors conferring against substance use among these youth. The present study aimed to identify protective factors related to the alcohol use trajectories from early adolescence to emerging adulthood among off-reserve Canadian Aboriginal youth. Participants (N = 330; 50.3% male) aged 12-23 were selected from cycles 2-7 of Statistics Canada's NLSCY. Multilevel modeling was employed to identify protective factors for two constructs of alcohol use. Participation in weekly activities and optimism were found to be protective for both the frequency of alcohol use and heavy drinking trajectories. Attendance of religious services was also found to be protective for heavy drinking behaviors. In contrast, positive peer relationships were a risk factor for frequency of alcohol use, but not heavy drinking. The results provide preliminary evidence of important developmental factors to integrate into substance use intervention programs targeting Aboriginal youth.

Risk and protective predictors of trajectories of depressive symptoms among adolescents from immigrant backgrounds.

Although there has been an increasing number of studies that has examined depression among adolescents from immigrant backgrounds, findings have been mixed, with some studies reporting that immigrant status is associated with risk, while others report that immigration status is linked to adequate or positive outcomes. Thus, it is important to explore how underlying predictors contribute to trajectories of depressive symptoms among adolescents from immigrant backgrounds. Using data from a nationally representative Canadian sample (N = 1,060; aged 12 to 23; 48.9% female), this longitudinal study examined the effects of risk and protective factors on trajectories of depressive symptoms using multilevel modeling. Predictors of depressive symptoms tended to be protective and suggest a universal positive influence of self-esteem, positive peer relationships, and parent-child cohesion. Host language proficiency was predictive of greater increases in depressive symptoms over time. Findings highlight the value of promoting protective factors and aspects of one's heritage among immigrant adolescents.

The relation between eating- and weight-related disturbances and depression in adolescence: a review.

Depression often emerges during adolescence and persists into adulthood. Thus, it is critical to study risk factors that contribute to the development of depression in adolescence. One set of risk factors that has been recently studied in adolescent depression research is eating- and weight-related disturbances (EWRDs). EWRDs encompass negative cognitions related to one's body or physical appearance, negative attitudes toward eating, and unhealthy weight control behaviors. However, there have been no comprehensive reviews of EWRDs and depression research that are contextualized within developmental frameworks of adolescent depression. Thus, this review will summarize research findings on the relation between EWRDs and depression in adolescence using a cognitive vulnerability developmental framework. First, a brief overview of epidemiological findings on depression is provided in order to highlight the importance of examining depression in adolescence. Second, a cognitive vulnerability developmental framework that can be used to conceptualize depression in adolescence is described. Next, theories and findings on EWRDs and depression in adolescence are summarized within this framework. Research limitations and suggestions for future research are provided. Finally, implications of this review related to the assessment, intervention, and prevention of depression in adolescence are provided.