PhD Candidate, University of Nottingham
Using and developing relevant technology to assess and predict mechanisms of eating disorders
Eating disorders have one of the highest mortality rates of all mental illnesses, and hospitalizations are increasing at alarming rates in women, men, and children. My research is focused on utilizing implicit methods (fMRI, eye-tracking, etc.), and also developing current, relevant technology to assess and predict those underlying mechanisms which play a part in maintaining and developing an eating disorder.
Abstract: The Tripartite Influence Model posits that parents, peers and media influences mediated by internalization and appearance social comparison are predictors of body dissatisfaction, a key risk factor for eating disorders. However, the Tripartite Influence Model has not been tested in Brazil where the people are known to have high levels of body image and appearance concerns. This study aimed to test an adapted Tripartite Influence Model of body dissatisfaction and disordered eating behaviors among Brazilian women. A sample of 741 undergraduate students (Mage = 23.55 years, SD = 4.09) completed measures of sociocultural influences, internalization of body ideal, social appearance comparison, body dissatisfaction, muscularity dissatisfaction, disordered eating and body change behaviors. Structural equation modeling analyses indicated that the proposed etiological model for Brazilian women has good fit indexes (χ(2)(2064) = 6793.232; p = 0.0001; χ(2)/gl = 3.29; CFI = 0.82; PCFI = 0.79; RMSEA = 0.056 [IC90% = 0.053-0.057]). Parent and media influences were related with both internalization and social comparison, while peer influence with social comparison. A full mediation model was found, with both internalization and social comparison contributing to body dissatisfaction. Finally, body dissatisfaction was associated with disordered eating behaviors. The findings inform the importance of considering cultural aspects that influence body image and eating behaviors, and highlight the validity of the proposed etiological model for Brazilian women, that can be used for research and clinical purposes.
Pub.: 10 May '17, Pinned: 03 Jul '17
Abstract: Green tea extract (GTE) has various health promoting effects on animals and humans. However, the effects of perinatal exposure to GTE on the behavioral aspects of offspring have not been elucidated thus far. GTE was provided for pregnant female mice at concentrations of either 20 or 50 g/L, beginning the day of conception until the third week after delivery, postnatal day 22 (PD 22). Mice pups were subjected to behavioral testing to assess sensory motor reflexes, locomotion, anxiety, and learning on various postnatal days.Perinatal exposure to GTE resulted in a significant reduction in body weight, as well as earlier body hair appearance and opening of the eyes. Sensory motor reflexes exhibited faster responses and significant stimulatory effects in pups exposed to GTE. During the adolescent period, male and female offspring exhibited increased locomotor activity (on PD 22), reduced anxiety and fear (on PD 25), and enhanced memory and learning abilities (on PD 30), all in both GTE treated groups. All blood counts (RBCs, WBCs, Hb, and platelets), and glucose, cholesterol, triglyceride, and low density lipoprotein concentrations were significantly lower in the GTE-treated pups; however, there was no effect on high density lipoprotein levels.Our data provide evidence that the high dose of GTE (50 g/L) had higher anxiolytic properties and positive effects on locomotor activities and sensory motor reflexes, as well as learning and memory of the offspring than the low dose of GTE (20 g/L).
Pub.: 02 Jun '17, Pinned: 03 Jul '17
Abstract: Adolescent boys must cope with physical changes that hamper their ability to form a positive body image. Sociocultural messages influence the concepts of body image, personal appearance, and weight, encouraging men to develop lean and muscular bodies. The current study examined adolescent boys' body image and its relationship to their subjective well-being (SWB) and the effect of the parent-adolescent relationship on body image and SWB. Participating in the research were 107 adolescent boys in Israel, aged 13 to 18 years. Four questionnaires were utilized: demographic, body mass index, Body Investment Scale, and Personal Well-Being Index. The findings indicate a significant, medium positive correlation between SWB and body image. After controlling for the variable of parent-adolescent relationship, the correlation weakened, indicating that the parent-adolescent relationship has no effect on adolescent boys' SWB and body image. Body image was reported to be a predictor of SWB.
Pub.: 20 Jun '17, Pinned: 03 Jul '17
Abstract: (1) To investigate the course of body image in patients with spinal cord injury (SCI) during their first inpatient rehabilitation stay; and (2) to explore the association between demographic and injury-related variables and body image and the association between body image and psychological distress.Longitudinal inception cohort study.Rehabilitation center.Of the 210 people admitted for their first inpatient SCI rehabilitation program (between March 2011 and April 2015), 188 met the inclusion criteria. Of these, N=150 (80%) agreed to participate.Not applicable.The Body Experience Questionnaire was used to measure 2 dimensions of body image: alienation and harmony.Mean scores on the Body Experience Questionnaire alienation subscale decreased significantly during the rehabilitation program. Mean scores on the Body Experience Questionnaire harmony subscale did not increase significantly but showed a trend in the hypothesized direction. The 2 subscales showed weak correlations with demographic and injury-related variables. The 2 subscales together explained 16% and 14% of the variance of depression and anxiety, respectively, after correction for demographic and injury-related variables.During participants' first inpatient rehabilitation stay after SCI, body image progressed toward a healthier state. Body image explains part of the variance in depression and anxiety, and the entire rehabilitation team should be targeting interventions to improve body image.
Pub.: 29 Jan '17, Pinned: 03 Jul '17
Abstract: Background: A crucial but often overlooked impact of early life exposure to trauma is its far-reaching effect on a person's relationship with their body. Several domains of body experience may be negatively influenced or damaged as a result of early childhood trauma. Objective: The aim of this study was to investigate disturbances in three domains of body experience: body attitude, body satisfaction, and body awareness. Furthermore, associations between domains of body experience and severity of trauma symptoms as well as frequency of dissociation were evaluated. Method: Body attitude was measured with the Dresden Body Image Questionnaire, body satisfaction with the Body Cathexis Scale, and body awareness with the Somatic Awareness Questionnaire in 50 female patients with complex trauma and compared with scores in a non-clinical female sample (n = 216). Patients in the clinical sample also filled out the Davidson Trauma Scale and the Dissociation Experience Scale. Results: In all measured domains, body experience was severely affected in patients with early childhood trauma. Compared with scores in the non-clinical group, effect sizes in Cohen's d were 2.7 for body attitude, 1.7 for body satisfaction, and 0.8 for body awareness. Associations between domains of body experience and severity of trauma symptoms were low, as were the associations with frequency of dissociative symptoms. Conclusions: Early childhood trauma in women is associated with impairments in self-reported body experience that warrant careful assessment in the treatment of women with psychiatric disorders.
Pub.: 27 Jun '17, Pinned: 03 Jul '17
Abstract: Prior research suggests that the construct of emotional instability may be salient to bulimia nervosa (BN), but no study to date has used ecological momentary assessment (EMA) to examine its temporal association with binge eating and purging. In the current study, 133 women with DSM-IV BN used portable digital devices to provide multiple daily negative affect (NA) and positive affect (PA) ratings and record eating disorder behaviors over 2 weeks. Two state-of-the art indices quantified affective instability: probability of acute change (PAC), which represents the likelihood of extreme affective increases, and mean squared successive difference (MSSD), which represents average change over successive recordings. For extreme affective change, results revealed that on bulimic behavior days, extreme NA increases were less likely after bulimic behaviors than before them, and extreme increases in PA were more likely after bulimic behaviors than during the same time period on non-bulimic behavior days. However, average NA instability (i.e., MSSD) was (a) greater on bulimic behavior days than non-bulimic behavior days, (b) greater after bulimic behaviors than during the same time period on non-bulimic behavior days, and (c) greater after bulimic behaviors than before them. Results lend support to the notion that bulimic behaviors are negatively reinforcing (i.e., via post-behavior acute affective changes), but also indicate that these behaviors may exacerbate overall affective dysregulation. These findings may improve understanding of BN maintenance and inform the development of novel interventions or refinement of existing treatments.
Pub.: 26 Apr '17, Pinned: 21 Jun '17
Abstract: Appearance-related stress may result from appearance-focused events such as seeing one's reflection, seeing media images, and shopping for clothes. The purpose of this study was to examine the prospective association between momentary appearance-related stress and eating disorder (ED) behaviors (i.e., binge eating and vomiting) among women with anorexia nervosa (AN) using ecological momentary assessment (EMA). We hypothesized that appearance-related stress at Time 1 would predict binge eating and vomiting at Time 2, and that this prospective association would be mediated by momentary anxiety at Time 2 (controlling for anxiety at Time 1).Women with AN completed a 2-week EMA protocol involving repeated daily assessments of experiences and behaviors.Momentary appearance-related stress preceded binge eating and vomiting, and momentary anxiety mediated the prospective association between appearance-related stress and ED behaviors.Targeted momentary interventions delivered in the natural environment that address appearance-related stress may have utility in the treatment of ED behaviors.
Pub.: 08 Jun '17, Pinned: 21 Jun '17
Abstract: Prominent theories emphasize key roles for the insular cortex in the central representation of interoceptive sensations, but how this brain region responds dynamically to changes in interoceptive state remains incompletely understood. Here, we systematically modulated cardiorespiratory sensations in humans using bolus infusions of isoproterenol, a rapidly acting peripheral beta-adrenergic agonist similar to adrenaline. To identify central neural processes underlying these parametrically modulated interoceptive states, we used pharmacological functional magnetic resonance imaging (phMRI) to simultaneously measure blood-oxygenation-level dependent (BOLD) and arterial spin labelling (ASL) signals in healthy participants. Isoproterenol infusions induced dose-dependent increases in heart rate and cardiorespiratory interoception, with all participants endorsing increased sensations at the highest dose. These reports were accompanied by increased BOLD and ASL activation of the right insular cortex at the highest dose. Different responses across insula subregions were also observed. During anticipation, insula activation increased in more anterior regions. During stimulation, activation increased in the mid-dorsal and posterior insula on the right, but decreased in the same regions on the left. This study demonstrates the feasibility of phMRI for assessing brain activation during adrenergic interoceptive stimulation, and provides further evidence supporting a dynamic role for the insula in representing changes in cardiorespiratory states. This article is part of the themed issue ‘Interoception beyond homeostasis: affect, cognition and mental health’.
Pub.: 10 Oct '16, Pinned: 20 Jun '17
Abstract: Anorexia nervosa (AN) and body dysmorphic disorder (BDD) frequently co-occur, and have several overlapping phenomenological features. Little is known about their shared neurobiology. The aim of the study was to compare modular organization of brain structural connectivity. Method We acquired diffusion-weighted magnetic resonance imaging data on unmedicated individuals with BDD (n = 29), weight-restored AN (n = 24) and healthy controls (HC) (n = 31). We constructed connectivity matrices using whole-brain white matter tractography, and compared modular structures across groups.AN showed abnormal modularity involving frontal, basal ganglia and posterior cingulate nodes. There was a trend in BDD for similar abnormalities, but no significant differences compared with AN. In AN, poor insight correlated with longer path length in right caudal anterior cingulate and right posterior cingulate.Abnormal network organization patterns in AN, partially shared with BDD, may have implications for understanding integration between reward and habit/ritual formation, as well as conflict monitoring/error detection.
Pub.: 19 Jul '16, Pinned: 20 Jun '17
Abstract: Body dysmorphic disorder (BDD) and anorexia nervosa (AN) are both characterized by distorted perception of appearance. Previous studies in BDD suggest abnormalities in visual processing of own and others' faces, but no study has examined visual processing of faces in AN, nor directly compared the two disorders in this respect.We collected functional magnetic resonance imaging data on 60 individuals of equivalent age and gender in each of three groups--20 BDD, 20 weight-restored AN, and 20 healthy controls (HC)--while they viewed images of others' faces that contained only high or low spatial frequency information (HSF or LSF). We tested hypotheses about functional connectivity within specialized sub-networks for HSF and LSF visual processing, using psychophysiological interaction analyses.The BDD group demonstrated increased functional connectivity compared to HC between left anterior occipital face area and right fusiform face area (FFA) for LSF faces, which was associated with symptom severity. Both BDD and AN groups had increased connectivity compared to HC between FFA and precuneous/posterior cingulate gyrus for LSF faces, and decreased connectivity between FFA and insula. In addition, we found that LSF connectivity between FFA and posterior cingulate gyrus was significantly associated with thoughts about own appearance in AN.Results suggest similar abnormal functional connectivity within higher-order systems for face processing in BDD and AN, but distinct abnormal connectivity patterns within occipito-temporal visual networks. Findings may have implications for understanding relationships between these disorders, and the pathophysiology underlying perceptual distortions.
Pub.: 30 Jul '15, Pinned: 20 Jun '17
Abstract: Individuals with anorexia nervosa (AN) and body dysmorphic disorder (BDD) exhibit distorted perception and negative evaluations of their own appearance; however, little is known about how they perceive others' appearance, and whether or not the conditions share perceptual distortions.Thirty participants with BDD, 22 with AN, now weight-restored, and 39 healthy comparison participants (HC) rated photographs of others' faces and bodies on attractiveness, how overweight or underweight they were, and how much photographs triggered thoughts of their own appearance. We compared responses among groups by stimulus type and by level-of-detail (spatial frequency).Compared to HCs, AN and BDD had lower attractiveness ratings for others' bodies and faces for high-detail and low-detail images, rated bodies as more overweight, and were more triggered to think of their own appearance for faces and bodies. In AN, symptom severity was associated with greater triggering of thoughts of own appearance and higher endorsement of overweight ratings for bodies. In BDD, symptom severity was associated with greater triggering of thoughts of own appearance for bodies and higher overweight ratings for low-detail images. BDD was more triggered to think of own facial appearance than AN.AN and BDD show similar behavioral phenotypes of negative appearance evaluations for others' faces and bodies, and have thoughts of their own appearance triggered even for images outside of their primary appearance concerns, suggesting a more complex cross-disorder body-image phenotype than previously assumed. Future treatment strategies may benefit from addressing how these individuals evaluate others in addition to themselves. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016)
Pub.: 27 Aug '16, Pinned: 20 Jun '17
Abstract: Eating disorders (anorexia nervosa, bulimia nervosa, and binge eating disorder) are regarded as psychiatric syndromes that have some relationship to obesity. This review describes current clinical and scientific knowledge concerning the clinical descriptions of these disorders, etiology of each disorder, diagnostic signs, and treatment approaches that have been found to be efficacious. Anorexia nervosa is a very serious eating disorder that is associated with severe medical complications. Anorexia nervosa is very difficult to successfully treat, even when intensive inpatient methods are used. Bulimia nervosa and binge eating disorder are typically less severe eating disorders and are more easily treated using outpatient therapy. Pharmacotherapy has not been found to be an effective treatment for anorexia nervosa, but it has been used successfully with bulimia nervosa and binge eating disorder. Psychotherapy approaches have been successfully employed for all three eating disorders. The review concludes with an integrative perspective that illustrates the similarities and differences of the eating disorders and obesity.
Pub.: 25 Nov '04, Pinned: 20 Jun '17
Abstract: This literature review examined the extent to which body image been assessed and treated in eating disorder treatment programs and the effectiveness of different treatments for body image change.Published reports of experimentally controlled clinical trials were examined for the use of measures and interventions that concerned body image.About one third of psychotherapy studies assessed and treated body image. Cognitive behavioral eating disorder programs for bulimia nervosa result in modest body image improvement. Pharmacotherapy seems to be less effective than CBT, though few pharmacotherapy studies assessed body image. Although cognitive restructuring is widely used, behavioral interventions and self-monitoring that target body image have not been reported by most eating disorder programs. Little information is available on body image methods in anorexia nervosa and binge-eating disorder.Given the importance of body image for the development and recovery from eating disorders, more systematic body image work should be incorporated into current treatment.
Pub.: 01 Dec '96, Pinned: 20 Jun '17
Abstract: Body image disturbance is a significant maintenance and prognosis factor in eating disorders. Hence, existing eating disorder treatments can benefit from direct intervention in patients' body image. No controlled studies have yet compared eating disorder treatments with and without a treatment component centered on body image. This paper includes a controlled study comparing Cognitive Behavioral Treatment (CBT) for eating disorders with and without a component for body image treatment using Virtual Reality techniques. Thirty-four participants diagnosed with eating disorders were evaluated and treated. The clinical improvement was analyzed from statistical and clinical points of view. Results showed that the patients who received the component for body image treatment improved more than the group without this component. Furthermore, improvement was maintained in post-treatment and at one year follow-up. The results reveal the advantage of including a treatment component addressing body image disturbances in the protocol for general treatment of eating disorders. The implications and limitations of these results are discussed below.
Pub.: 19 Mar '13, Pinned: 20 Jun '17
Abstract: Night eating syndrome is marked by substantial evening or nocturnal food intake, insomnia, morning anorexia, and depressed mood. Night eating severity has been positively associated with body mass index (BMI), binge eating frequency, and emotional eating tendencies. We conducted an online questionnaire study among students (N=729) and explored possible interactive effects between those variables. Night eating severity, binge eating frequency, BMI and emotional eating were all positively correlated with each other. Regression analyses showed that night eating severity was particularly related to more frequent binge episodes and higher BMI at high levels of emotional eating but unrelated to those variables at low levels of emotional eating. Thus, eating as a means of emotion regulation appears to be an important moderator of the relationship between night eating and both binge eating and BMI.
Pub.: 03 Dec '13, Pinned: 20 Jun '17