Sociocultural correlates of eating pathology in college women from US and Iran.

Objective: The buffering role of the hijab as a protective factor against eating pathology has been questioned in countries where wearing the hijab is compulsory, such as Iran; and, cross-cultural comparisons of body image in Iranian and Western women are sparse. Consequently, we examined sociocultural correlates of eating pathology in US and Iranian women. Method: College women from the US (n = 709) and Iran (n = 331) completed the Eating Disorder Examination-Questionnaire (EDE-Q) and the Sociocultural Attitude Toward to Appearance Questionnaire-4 (SATAQ-4). Prior to examining main hypotheses, we evaluated whether the scales perform similarly (i.e., establish measurement invariance) by culture. Results: The EDE-Q and SATAQ-4 were not invariant by culture indicating that the scales performed differently across groups, so separate analyses were conducted in each sample. Thin-ideal internalization and pressures for thinness were significant positive predictors of eating pathology in both US and Iranian women. Conclusion: Both pressures for thinness and thin-ideal internalization appear to be relevant to eating pathology in women from both cultures. However, there may be important cross-cultural differences in the interpretation or experience of these constructs. Further understanding of this measurement non-invariance and the ways in which Iranian women may be uniquely impacted by Western values of appearance is a critical next step.

Emphasizing the "Cultural" in Sociocultural: A Systematic Review of Research on Thin-Ideal Internalization, Acculturation, and Eating Pathology in US Ethnic Minorities.

A large body of research suggests that thin-ideal internalization is a robust predictor of eating pathology in women and, to some degree, in men. Recent research is exploring the relationships between thin-ideal internalization and culture-specific factors that may be salient to women and men who live in the US but are marginalized based on racial or ethnic background, such as acculturation. This systematic review summarizes published articles examining the relationships among thin-ideal internalization, acculturation-related constructs (including assimilation, marginalization, biculturalism, and acculturative stress), and eating pathology in US adults. Following the PRISMA method, 15 empirical studies met inclusion criteria. Although existing literature was sparse and conflicting in large part due to heterogeneity in acculturation measures, results yielded some support for positive correlational relationships between acculturative stress, thin-ideal internalization, and eating pathology for both men and women (in 4 out of 5 relevant studies). Research on other aspects of acculturation (eg, integration, assimilation) is mixed, with some existing research suggesting a positive relationship and other research finding no statistically significant relationship. Future research would particularly benefit from a gold-standard, multidimensional transcultural measure of acculturation to examine how the acculturation process relates to thin-ideal internalization and eating pathology in ethnic and racial minorities in the US.

Disordered Eating in Asian American Women: Sociocultural and Culture-Specific Predictors.

Asian American women demonstrate higher rates of disordered eating than other women of color and comparable rates to European American women. Research suggests that leading sociocultural predictors, namely, pressures for thinness and thin-ideal internalization, are predictive of disordered eating in Asian American women; however, no known studies have tested the intersection of sociocultural and culture-specific variables (e.g., ethnic identity, biculturalism, and acculturative stress) to further elucidate disordered eating risk in this vulnerable, understudied group. Accordingly, this project used path analysis to simultaneously examine the role of sociocultural and culture-specific effects on disordered eating in Asian American college women (N = 430). Self-report measures assessing disordered eating, sociocultural (pressures for thinness, thin-ideal internalization), and culture-specific (ethnic identity, biculturalism, acculturative stress) variables revealed that a number of sociocultural and culture-specific factors are predictive of disordered eating. Consistent with prior research, heightened perceived pressures for thinness and thin-ideal internalization were predictive of disordered eating, and thin-ideal internalization partially mediated the relationship between pressures for thinness and disordered eating. Acculturative stress predicted disordered eating and fully accounted for the inverse relationship between biculturalism and disordered eating. Overall, findings highlighted the salience of sociocultural predictors for disordered eating in Asian American women and identified biculturalism and acculturative stress as culture-specific contributors that may uniquely impact vulnerability to disordered eating in Asian American women. Thus, the combined consideration of sociocultural and culture-specific factors may be important in disordered eating research and in the development of individualized treatment plans for Asian American women.

Ethnicity, eating pathology, drive for muscularity, and muscle dysmorphia in college men: a descriptive study.

The nature and presentation of eating pathology in ethnically diverse men are not well defined. This study examined associations among ethnicity, body image, and eating pathology in nonclinical college men (N = 343). Analysis of variance analyses indicated that markers of eating, weight, and shape concerns differed by ethnicity: Asian and Hispanic/Latino men reported more pathological levels than European and African American men. Hierarchical multiple regression analyses indicated that ethnicity moderated the relationship between drive for muscularity and body checking, which was strongest for Asian men. Results increase awareness of how ethnicity interacts with body image and eating pathology, which underscores the need for individualized, culturally sensitive treatment for ethnically diverse men.

Social anxiety and eating disorder comorbidity and underlying vulnerabilities: Using network analysis to conceptualize comorbidity.

OBJECTIVE: Eating disorders (EDs) and social anxiety disorder (SAD) are highly co-occurring. This comorbidity is extremely relevant, given that individuals with comorbid ED-SAD are less likely to seek and/or benefit from ED treatment. METHOD: We used network analysis to conceptualize ED-SAD comorbidity in a sample of 2,215 participants with a primary diagnosis of ED, SAD, or no known diagnosis. We used novel network analyses methods to select symptoms for our models, identify potential illness pathways (i.e., bridge symptoms) between disorders and underlying vulnerabilities (e.g., perfectionism, social appearance anxiety), and to compare across sample types (e.g., clinical vs. nonclinical). We also tested several novel network analyses methods aimed at the following methodological concerns: (a) topological concerns (i.e., which items should be included in NA models), (b) how to use empirical indices to quantify bridge symptoms and (c) what differences in networks across samples mean. RESULTS: We found that difficulty with drinking beverages and eating in public were bridge symptoms between ED and SAD. We also found that feeling nervous about one's appearance was a bridge symptom. CONCLUSIONS: We identified public eating and drinking as bridge symptoms between EDs and SAD. Future research is needed to test if interventions focused on public eating and drinking might decrease symptoms of both EDs and SAD. Researchers can use this study (code provided) as an exemplar for how to use network analysis, as well as to use network analysis to conceptualize ED comorbidity and compare network structure and density across samples.

Eating Disorder Quality of Life Scale (EDQLS) in ethnically diverse college women: an exploratory factor analysis.

BACKGROUND: Extant research suggests that disordered eating is common in college women and is associated with decreased quality of life. The Eating Disorder Quality of Life Scale (EDQLS) examines impairment to disordered eating-related quality of life, but has not been validated in college women. Accordingly, the purpose of this study was to examine the reliability, validity, and factor structure of the EDQLS in a diverse sample of 971 college women. METHOD: Students from a large United States university completed questionnaires examining disordered eating and the EDQLS online. RESULTS: The EDQLS demonstrated excellent internal consistency and good convergent validity with the Eating Disorder Examination Questionnaire (EDEQ). Contrary to the original 12-domain design of the EDQLS, principal component analyses suggested five factors that mapped onto the following constructs: (1) Positive Emotionality; (2) Body/Weight Dissatisfaction; (3) Disordered Eating Behaviors; (4) Negative Emotionality; and (5) Social Engagement. However, 15 of the 40 items loaded onto multiple factors. CONCLUSIONS: Total scores on the EDQLS are reliable and valid when used with diverse samples of college women, but some revisions are needed to create subscales than can justifiably be used in clinical practice.

Sociocultural and identity predictors of body dissatisfaction in ethnically diverse college women.

Emerging research suggests that ethnic identity and American identity are associated with mental health in ethnic minorities and European Americans, respectively. Furthermore, although ethnic identity is associated with diminished body dissatisfaction in minority women, the relationship between American identity and body dissatisfaction is unexplored in all ethnic groups. Accordingly, this study examined the relationships among ethnic identity, American identity, thin-ideal internalization, pressures for thinness, and body dissatisfaction in 1018 ethnically diverse college women. Ethnic identity negatively predicted body dissatisfaction for African Americans, and attenuated the relationship between pressures for thinness and body dissatisfaction for African Americans and Asian Americans, but not European Americans or Latina Americans. Results for American identity were inconclusive. Findings suggest that ethnic identity may be a protective factor against eating pathology for Asian American and African American women.

Acculturative Stress, Self-Esteem, and Eating Pathology in Latina and Asian American Female College Students.

OBJECTIVE: The overarching purpose of this study was to explore the relationships among acculturative stress, self-esteem, and eating pathology in Asian American and Latina female college students. METHOD: Participants (N = 638, mean age = 19.88) completed self-report measures of the variables of interest online. RESULTS: Bivariate correlations indicated that for women of both ethnic groups, acculturative stress was negatively correlated with self-esteem and positively correlated with eating pathology. Multigroup structural equation modeling indicated that for Asian American and Latina women, self-esteem partially mediated the relationship between acculturative stress and eating pathology. However, self-esteem did not serve as a significant moderator of this relationship for either ethnic group. CONCLUSION: Overall, data suggest that acculturative stress is associated with increased eating pathology and self-esteem may mediate this relationship. These relationships suggest that assessment of eating pathology and self-esteem may be indicated for women presenting clinically with acculturative stress concerns.

Media exposure and associated stress contribute to eating pathology in women with Anorexia Nervosa: Daily and momentary associations.

OBJECTIVE: We examined whether media exposure and media-induced stress contributed to eating disorder behaviors immediately and over the course of a day in women with anorexia nervosa (AN). METHOD: Women with AN (N = 118) completed a 2-week ecological momentary assessment protocol during which they reported on exposure to food, shape, or weight-related media, associated stress, and eating behaviors. RESULTS: Food, weight, or shape-related media exposure alone did not predict more frequent daily eating disorder behaviors. However, stress associated with media exposure was prospectively associated with a greater likelihood of binge eating and vomiting at the next assessment point. In addition, media-induced stress increased the probability of restrictive eating and fluid intake, vomiting, and laxative abuse across the day. DISCUSSION: Media-induced stress may contribute to increased eating disorder behaviors in women with AN, as women who saw a media image and reported this experience as stressful were more likely to engage in momentary binge eating or vomiting. Reducing stress associated with viewing media images could be a potential target for therapeutic intervention with disordered eating. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:617-621).

Psychometric properties of the Body Checking Questionnaire in college women.

While the Body Checking Questionnaire (BCQ; Reas et al., 2002) is the most commonly-used measure of body checking behaviors, findings on the factor structure in nonclinical samples are mixed. This study investigated the factor structure and psychometric properties of the BCQ among nonclinical college women. In Study 1 (n=326), an exploratory factor analysis indicated factors corresponding to (a) behavioral and (b) visual checking. In Study 2 (n=1013), a confirmatory factor analysis revealed adequate fit for these factors, better than the original or total score solutions. Scales based upon the two factors demonstrated good internal consistency, convergent validity with measures of eating pathology, and sensitivity for detecting at-risk eating pathology. Results suggest an alternate two-factor solution that differs from the original three-factor solution.

Perception matters for clinical perfectionism and social anxiety.

Despite research documenting a relationship between social anxiety and perfectionism, very little research has examined the relationship between social anxiety and clinical perfectionism, defined as the combination of high personal standards and high maladaptive perfectionistic evaluative concern. In the current studies we examined whether clinical perfectionism predicted social anxiety in a large sample of undergraduates (N=602), in a clinical sample of participants diagnosed with social anxiety disorder (SAD; N=180), and by using a variance decomposition model of self- and informant-report of perfectionism (N=134). Using self-report, we found that an interaction of personal standards and evaluative concern predicted both social interaction anxiety and fear of scrutiny, but not in the theorized direction. Specifically, we found that self-report of low standards and high evaluative concern was associated with the highest levels of social anxiety, suggesting that when individuals with SAD hold low expectations for themselves combined with high concerns about evaluation, social anxiety symptoms may increase. Alternatively, when an informants' perspective was considered, and more consistent with the original theory, we found that the interaction of informant-only report of personal standards and shared-report (between both primary participant and informant) of concern over mistakes was associated with self-reported social anxiety, such that high concern over mistakes and high personal standards predicted the highest levels of social anxiety. Theoretical, clinical, and measurement implications for clinical perfectionism are discussed.

Translation and validation of a Spanish version of the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4).

OBJECTIVE: The goal of this study was to create a Spanish version of the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4) and examine its factorial validity, reliability, and convergent validity in a sample of women from Spain. METHOD: Two hundred and sixty female college students from Spain completed the Spanish version of the SATAQ-4 and measures for eating pathology. RESULTS: Internal consistency was high; data from EFA and CFA supported the original five-factor structure; and results showed good convergent validity with measures of body-image and eating problems. DISCUSSION: Results strongly support the psychometric properties of the Spanish version of SATAQ-4 and its use to examine perceived pressure for thinness from parents, peers and the media; and thin- and muscular/athletic-ideal internalization in Spanish-speaking adult women.

Self-objectification, body self-consciousness during sexual activities, and sexual satisfaction in college women.

Few studies examine the mechanisms that link body image to sexual satisfaction in women. Using the tenets of objectification theory, this study investigated the relationships between body surveillance, body shame, body self-consciousness during sexual activities, and sexual satisfaction in an ethnically diverse sample of American female college students (N=368), while controlling for relationship status and body mass index. Results based on self-report measures of these constructs suggested that body shame and body self-consciousness during sexual activity were negatively correlated with sexual satisfaction. Additionally, path analysis indicated that body surveillance predicted increased body self-consciousness during sexual activity, partially mediated by body shame. Body self-consciousness, in turn, predicted decreased sexual satisfaction. Overall, study findings highlight the negative consequences of body image concerns for women's sexual satisfaction.

Ethnic identity, thin-ideal internalization, and eating pathology in ethnically diverse college women.

Although much research suggests that ethnic identity is positively correlated with psychological health for ethnic minority women, research examining ethnic identity's relationships to thin-ideal internalization, weight concerns, and eating concerns is sparse. Consequently, this study examined these relationships in European American, African American, Latina, and Asian American college women (N=816). As expected, univariate analyses of variance indicated that European American women scored lowest on ethnic identity and highest on eating and weight concerns, whereas African American women scored lowest on thin-ideal internalization. Hierarchical regression analyses indicated that ethnic identity was negatively associated with eating and weight concerns, while body mass index and thin-ideal internalization were positively associated. Ethnic identity moderated the relationship between thin-ideal internalization and eating concerns such that the relationship was stronger for participants with lower ethnic identity. These results suggest ethnic identity may be a direct or interactive protective factor against eating concerns in ethnically diverse college women.

The influence of social anxiety on the body checking behaviors of female college students.

Social anxiety and eating pathology frequently co-occur. However, there is limited research examining the relationship between anxiety and body checking, aside from one study in which social physique anxiety partially mediated the relationship between body checking cognitions and body checking behavior (Haase, Mountford, & Waller, 2007). In an independent sample of 567 college women, we tested the fit of Haase and colleagues' foundational model but did not find evidence of mediation. Thus we tested the fit of an expanded path model that included eating pathology and clinical impairment. In the best-fitting path model (CFI=.991; RMSEA=.083) eating pathology and social physique anxiety positively predicted body checking, and body checking positively predicted clinical impairment. Therefore, women who endorse social physique anxiety may be more likely to engage in body checking behaviors and experience impaired psychosocial functioning.

Demographic and work-related correlates of job burnout in professional eating disorder treatment providers.

Patients with eating disorders present unique challenges to treatment providers that may contribute to job burnout. This study examined demographic and work-related correlates of three primary components of burnout (i.e., emotional exhaustion, cynicism, and lack of personal accomplishment) in a sample of 296 professional eating disorder treatment providers. Participants completed the Maslach Burnout Inventory-Human Services Survey (MBI-HSS; Maslach, Jackson, & Leiter, 1996), demographics, and a questionnaire developed by the authors measuring eating disorder-specific factors theorized to be relevant to burnout. Overall, participants reported comparable levels of emotional exhaustion but significantly less cynicism and lack of personal accomplishment relative to established norms for mental health care providers on the MBI-HSS. Analyses of variance and backward regression analyses suggested that higher levels of burnout were associated with being younger, female, and overweight; working longer hours; having less experience; and experiencing a patient's death. Conversely, working in a private practice setting, having children, and having a personal history of an eating disorder were associated with lower burnout levels. Furthermore, over 45% of participants reported that treatment resistance, ego-syntonicity, high relapse rates, worry about patient survival, emotional drain, lack of appropriate financial reimbursement, and extra hours spent working contributed to feelings burned out somewhat to very much. Overall, these data suggest that emotional exhaustion is the most common aspect of burnout experienced by eating disorder treatment providers and highlight some of the key correlates of burnout for this population, which can be used to inform prevention and intervention efforts.

Treatment providers with a personal history of eating pathology: a qualitative examination of common experiences.

Using qualitative methodology, this study examined the experiences of treatment providers with a personal history of eating pathology. A total of 139 eating disorder treatment providers completed a questionnaire designed by the authors that (a) asked whether and how their personal history influences treatment of patients with eating disorders and (b) elicited feedback for other therapists. Results indicated that the large majority of participants (94%) believed that their eating disorder history positively influenced their treatment of patients (e.g., increased empathy, greater understanding of the disorder, more positive personal outlook). Conversely, only 8% identified ways in which it can negatively influence treatment (e.g., feeling personally triggered, over-identifying with patients). Feedback for other professionals included the importance of personally recovering before treating this population and monitoring one's experiences in session (e.g., notice countertransference). Continued discourse regarding the benefits and challenges of a personal history of eating pathology in treatment providers is warranted.

Body checking and avoidance in ethnically diverse female college students.

Although body checking and avoidance behaviors are common in women with eating disorders, minimal research has examined the nature or correlates of these behaviors in ethnically diverse female college students without eating disorders. Self-identified European American (n=268), Asian American (n=163), Latina (n=146), and African American (n=73) women completed self-report measures of body checking and avoidance, thin-ideal internalization, eating pathology, and clinical impairment. Results indicated that European and Asian American women reported significantly more body checking and avoidance than African American and Latina women. Generally, correlates of body checking and avoidance were consistent across ethnic groups: Regression analyses indicated that type of ethnicity predicted body checking and avoidance; and ethnicity, body checking, and body avoidance predicted eating pathology and clinical impairment. These associations suggest that body checking and avoidance are not benign behaviors in diverse nonclinical women.

Social appearance anxiety, perfectionism, and fear of negative evaluation: distinct or shared risk factors for social anxiety and eating disorders?

Social anxiety and eating disorders are highly comorbid. Social appearance anxiety (i.e., fear of negative evaluation of one's appearance), general fear of negative evaluation, and perfectionism have each been proposed as risk factors for both social anxiety disorder and the eating disorders. However, no research to date has examined all three factors simultaneously. Using structural equation modeling in two diverse samples (N=236; N=136) we tested a model in which each of these risk factors were uniquely associated with social anxiety and eating disorder symptoms. We found support for social appearance anxiety as a shared risk factor between social anxiety and eating disorder symptoms, whereas fear of negative evaluation was a risk factor only for social anxiety symptoms. Despite significant zero-order relationships, two facets of perfectionism (high standards and maladaptive perfectionism) did not emerge as a risk factor for either disorder when all constructs were considered. These results were maintained when gender, body mass index, trait negative affect, and depression were included in the model. It is possible that treating negative appearance evaluation fears may reduce both eating disorder and social anxiety symptoms.

A Spanish version of the Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3): translation and psychometric evaluation.

OBJECTIVE: The goal of this study was to translate the Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3; Thompson, van den Berg, Roehrig, Guarda, & Heinberg, 2004) into Spanish and psychometrically evaluate the comparability of the Spanish translation to the original English version. METHOD: 638 female college students from Spain and the United States completed the SATAQ-3 in Spanish and English, respectively. RESULTS: Internal consistency was high in both languages. Tests of factor equivalence suggested that the four pre-established factors of the SATAQ-3 (i.e., knowledge, perceived pressure, thin-ideal internalization, athletic-ideal internalization) were relatively similar between the two groups. Differences that emerged between groups (on items 6 and 20) were in the expected direction and appeared to be influenced by reverse-scoring or item wording. CONCLUSIONS: Results support the psychometric properties of this Spanish translation of the SATAQ-3 and support its use to measure endorsement of Western values and ideals of appearance in adult women.