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Overvaluation of body shape/weight and engagement in non-compensatory weight-control behaviors in eating disorders: is there a reciprocal relationship?

Published online by Cambridge University Press:  21 May 2015

N. Tabri ,
H. B. Murray ,
J. J. Thomas ,
D. L. Franko ,
D. B. Herzog  and
K. T. Eddy
N. Tabri
Affiliation:
Department of Psychiatry, Massachusetts General Hospital Eating Disorders Clinical and Research Program, Boston, MA, USA Department of Psychiatry, Harvard Medical School, Boston, MA, USA
H. B. Murray
Affiliation:
Department of Psychiatry, Massachusetts General Hospital Eating Disorders Clinical and Research Program, Boston, MA, USA
J. J. Thomas
Affiliation:
Department of Psychiatry, Massachusetts General Hospital Eating Disorders Clinical and Research Program, Boston, MA, USA Department of Psychiatry, Harvard Medical School, Boston, MA, USA
D. L. Franko
Affiliation:
Department of Psychiatry, Massachusetts General Hospital Eating Disorders Clinical and Research Program, Boston, MA, USA Northeastern University, Boston, MA, USA
D. B. Herzog
Affiliation:
Department of Psychiatry, Harvard Medical School, Boston, MA, USA
K. T. Eddy*
Affiliation:
Department of Psychiatry, Massachusetts General Hospital Eating Disorders Clinical and Research Program, Boston, MA, USA Department of Psychiatry, Harvard Medical School, Boston, MA, USA
*
*Address for correspondence: Dr K. T. Eddy, Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, 2 Longfellow Place, suite 200, Boston, MA 02114, USA. (Email: keddy@mgh.harvard.edu)
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Abstract

Background.

Overvaluation of body shape/weight is thought to be the core psychopathology underlying eating disorders, which propels engagement in non-compensatory weight-control behaviors. In turn, these behaviors lead to binge eating and/or maintenance of low weight thereby reinforcing overvaluation. The present study investigated the reciprocal relationship between overvaluation and engagement in non-compensatory weight-control behaviors (defined in two ways: restrictive eating and compulsive exercise) among women diagnosed with anorexia nervosa or bulimia nervosa (N = 237).

Method.

Participants completed clinical interviews in which weekly eating disorder symptoms and behaviors were assessed over 2 years.

Results.

Overvaluation on a given week was associated with greater engagement in non-compensatory weight-control behaviors during the following week. Further, engagement in non-compensatory weight-control behaviors on a given week was associated with greater overvaluation during the following week. These findings held true regardless of participants’ shape/weight concerns (feelings of fatness and fat phobia), and eating disorder diagnosis.

Conclusions.

Our data provide empirical support for key aspects of the transdiagnostic cognitive-behavioral model of eating disorders and suggest that targeting non-compensatory weight-control behaviors in treatment may help alleviate overvaluation and shape/weight concerns.

Keywords

Anorexia nervosabody imagebulimia nervosacognitive-behavioral therapyeating disorders
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 14 , October 2015 , pp. 2951 - 2958
Copyright
Copyright © Cambridge University Press 2015 

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References

Allen, KL, Byrne, SM, Lampard, A, Watson, H, Fuesland, A (2011). Confirmatory factor analysis of the eating disorder examination-questionnaire (EDE-Q). Eating Behaviours 12, 143–151.CrossRefGoogle ScholarPubMed
Allen, KL, Byrne, SM, McLean, NJ, Davis, EA (2008). Overconcern with weight and shape is not the same as body dissatisfaction: evidence from a prospective study of pre-adolescent boys and girls. Body Image 5, 261–270.Google Scholar
APA (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn, text rev. American Psychiatric Association: Washington, DC.Google Scholar
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association: Washington, DC.Google Scholar
Ardoom, JJ, Dingemans, AE, Slof Op't Lamdt, M, Van Ruth, EF (2012). Norms and discriminative validity of the eating disorder examination questionnaire (EDE-Q). Eating Behaviours 13, 305–309.CrossRefGoogle Scholar
Carter, JC, Belwell-Weiss, CV (2011). Nonfat phobic anorexia nervosa: clinical characteristics and response to inpatient treatment. International Journal of Eating Disorders 44, 220–224.Google Scholar
Dalle Grave, R, Calugi, S, El-Ghoch, M, Conti, M, Fairburn, CG (2014). Inpatient cognitive behavior therapy for adolescents with anorexia nervosa: immediate and longer-term effects. Frontiers in Psychiatry 5, 1–7.Google Scholar
Dalle Grave, R, Calugi, S, Marchesini, G (2008 a). Compulsive exercise to control shape or weight in eating disorders: prevalence, associated features, and treatment outcome. Comprehensive Psychiatry 49, 346–352.Google Scholar
Dalle Grave, R, Calugi, S, Marchesini, G (2008 b). Underweight eating disorder without over-valuation of shape and weight: atypical anorexia nervosa? International Journal of Eating Disorders 41, 705–712.Google Scholar
Dalle Grave, R, Pauli, DD, Sartirana, M, Calugi, S, Shafran, R (2007). The interpretation of symptoms of starvation/severe dietary restraint in eating disorder patients. Eating and Weight Disorders 12, 108–103.Google Scholar
Fairburn, CG (2008). Cognitive Behaviour Therapy and Eating Disorders. Guilford Press: New York.Google Scholar
Fairburn, CG, Beglin, SJ (1994). Assessment of eating disorders: interview or self-report questionnaire? International Journal of Eating Disorders 16, 363–370.Google Scholar
Fairburn, CG, Cooper, Z, Shafran, R (2003 a). Cognitive behaviour therapy for eating disorders: a ‘transdiagnostic’ theory and treatment. Behaviour Research and Therapy 41, 509–529.Google Scholar
Fairburn, CG, Peveler, RC, Jones, R, Hope, RA, Doll, HA (1993). Predictors of 12-month outcome in bulimia nervosa and the influence of attitudes to shape and weight. Journal of Consulting and Clinical Psychology 61, 696–698.Google Scholar
Fairburn, CG, Stice, E, Cooper, Z, Doll, HA, Norman, PA, O'Connor, ME (2003 b). Understanding persistence in bulimia nervosa: a 5-year naturalistic study. Journal of Consulting and Clinical Psychology 71, 103–109.Google Scholar
Franklin, JC, Schiele, BC, Brozek, J, Keys, A (1948). Observations on human behavior in experimental semi-starvation and rehabilitation. Journal of Clinical Psychology 4, 28–45.Google Scholar
Franko, DL, Keel, PK, Dorer, DJ, Blais, MA, Delinsky, SS, Eddy, KT, Charat, V, Renn, R, Herzog, DB (2004). What predicts suicide attempts in women with eating disorders? Psychological Medicine 34, 843–853.CrossRefGoogle ScholarPubMed
Goldfein, JA, Walsh, TB, Midlarsky, E (2000). Influence of shape and weight on self-evaluation in bulimia nervosa. International Journal of Eating Disorders 27, 435–445.Google Scholar
Gowers, SG, Shore, A (2001). Development of weight and shape concerns in the aetiology of eating disorders. British Journal of Psychiatry 179, 236–242.Google Scholar
Grilo, CM, White, MA, Gueorguiva, R, Wilson, GT, Masheb, RM (2013). Predictive significant of the overvaluation of shape/weight in obese patients with binge eating disorder: findings from a randomized controlled trial with 12-month follow-up. Psychological Medicine 43, 1335–1344.CrossRefGoogle Scholar
Halmi, KA, Agras, SW, Mitchell, J, Wilson, GT, Crow, S, Bryson, SW, Kraemer, H (2002). Relapse predictors of patients with bulimia nervosa who achieved abstinence through cognitive behavioral therapy. Archives of General Psychiatry 59, 1105–1109.Google Scholar
Herzog, DB (1987). Schedule for eating disorders, affective disorders, and schizophrenia-lifetime version (EAT-SADS-L). Massachusetts General Hospital, MA, Unpublished Work.Google Scholar
Herzog, DB, Dorer, DJ, Keel, PK, Selwyn, SE, Ekeblad, ER, Flores, AT, Greenwood, DN, Burwell, RA, Keller, MB (1999). Recovery and relapse in anorexia and bulimia nervosa: a 7.5-year follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry 38, 829–837.Google Scholar
Keel, PK, Dorer, DJ, Franko, DL, Jackson, SC, Herzog, DB (2005). Postremission predictors of relapse in women with eating disorders. American Journal of Psychiatry 162, 2263–2268.CrossRefGoogle ScholarPubMed
Keller, MB, Lavori, PW, Friedman, B, Nielsen, E, Endicott, J, McDonald-Scott, P, Andreason, NC (1987). The longitudinal interview follow-up evaluation: a comprehensive method for assessing outcome in prospective longitudinal studies. Archives of General Psychiatry 44, 540–548.Google Scholar
Killen, JD, Taylor, CB, Hayward, C, Haydel, KF, Wilson, DM, Hammer, L, Kraener, H, Blair-Greiner, A, Strachowski, D (1996). Weight concerns influence the development of eating disorders: a 4-year prospective study. Journal of Consulting and Clinical Psychology 64, 936–940.Google Scholar
Killen, JD, Taylor, CB, Hayward, C, Wilson, DM, Haydel, KF, Hammer, LD, Simmonds, B, Robinson, TN, Litt, I, Varady, A, Kraemer, H (1994). Pursuit of thinness and onset of eating disorder symptoms in a community sample of adolescent girls: a three-year prospective analysis. International Journal of Eating Disorders 16, 227–238.Google Scholar
Lethbridge, J, Watson, HJ, Eagan, SJ, Street, H, Nathan, PR (2011). The role of perfectionism, dichotomous thinking, shape and weight overvaluation, and conditional goal setting in eating disorders. Eating Behaviors 12, 200–206.Google Scholar
Lock, J, Le Grange, D, Agras, SW, Moye, A, Bryson, SW, Jo, B (2010). Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. Archives of General Psychiatry 67, 1025–1032.Google Scholar
Muthén, LK, Muthén, BO (1998–2012). Mplus User's Guide, 7th edn. Muthén & Muthén: Los Angeles, CA.Google Scholar
Nakai, Y, Nin, K, Teramukai, S, Taniguchi, A, Fukushima, M, Wonderlich, SA (2014). Typical and atypical anorexia nervosa in a Japanese sample. International Journal of Eating Disorders 47, 130–137.Google Scholar
Peterson, CB, Crosby, RD, Wonderlich, SA, Joiner, T, Crow, SJ, Mitchell, JE, Bardone-Cone, AM, Klein, M, Le Grange, D (2007). Psychometric properties of the eating disorder examination-Questionnaire: factor structure and internal consistency. International Journal of Eating Disorders 40, 386–389.Google Scholar
Polivy, J (1996). Psychological consequences of food restriction. Journal of the American Dietetic Association 96, 589–592.Google Scholar
Shafran, R, Fairburn, CG, Nelson, L, Robinson, PH (2003). The interpretation of symptoms of severe dietary restraint. Behaviour Research and Therapy 41, 887–894.Google Scholar
Spitzer, RL, Endicott, J (1979). Schedule for Affective Disorders and Schizophrenia Lifetime Version. Biometrics Research, New York State Psychiatric Institute: New York.Google Scholar
Warshaw, MG, Dyck, I, Allsworth, J, Stout, RL, Keller, MB (2001). Maintaining reliability in a long-term psychiatric study: an ongoing inter-rater reliability monitoring program using the longitudinal interval follow-up evaluation. Journal of Psychiatric Research 35, 297–305.Google Scholar
Warshaw, MG, Keller, MB, Stout, RL (1994). Reliability and validity of the longitudinal interval follow-up evaluation for assessing outcome of anxiety disorders. Journal of Psychiatric Research 28, 531–545.Google Scholar
Wilksch, SM, Wade, TD (2010). Risk factors for clinically significant importance of shape and weight in adolescent girls. Journal of Abnormal Psychology 119, 206–215.Google Scholar
Wilson, GT, Eldredge, K, Smith, D, Niles, B (1991). Cognitive-Behavioral treatment with and without response prevention for bulimia. Behaviour Research and Therapy 29, 575–583.CrossRefGoogle ScholarPubMed
Wilson, GT, Fairburn, CG, Agras, SW, Walsh, TB, Kraemer, H (2002). Cognitive-behavioral therapy for bulimia nervosa: time course and mechanisms of change. Journal of Consulting and Clinical Psychology 70, 267–274.Google Scholar