PhD Candidate, University of Nottingham
Eating disorders take more lives than all mental disorders, and hospitalizations are increasing at alarming rates in women, men, and children. I investigate subtle ways people process different types of information to see how this may predict their eating disorder levels. I do this by mainly using two technologies, eye-tracking and fMRI. Eye-tracking is a device that is mounted to a computer screen, and by sending an infrared light into the eye, is able to track exactly where a person looks, for how long, and patterns of processing information. fMRI is able to measure the functional activation of the brain with different types of stimuli. You know when you wiggle your toes, how the blood rushes into that are being used? Well, depending on what one is doing or thinking about, the blood also rushes into the areas of the brain that are being activated. fMRI is able to pick up this activation, and locate where the activation is, and according to which types of information the person is seeing or processing. In addition to using these two methods to understand the underlying mechanisms of eating disorder, I also develop current, relevant assessment applications to assess and predict these key mechanisms in a visual way. In a nutshell, I use and develop different types of new ways to investigate which underlying mechanisms play a part in maintaining and developing an eating disorder. I hope my work will go toward reducing deaths and increasing both prevention and recovery of eating disorders.
Abstract: Because no single report has examined risk factors that predict future onset each type of eating disorder and core symptom dimensions that crosscut disorders, we addressed these aims to advance knowledge regarding risk factor specificity. Data from 3 prevention trials that targeted young women with body dissatisfaction ( = 1,272; age = 18.5, = 4.2) and collected annual diagnostic interview data over 3-year follow-up were combined to identify predictors of subthreshold/threshold anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and purging disorder (PD). Negative affect and functional impairment predicted onset of all eating disorders. Thin-ideal internalization, body dissatisfaction, dieting, overeating, and mental health care predicted onset of subthreshold/threshold BN, BED, and PD; positive thinness expectations, denial of cost of pursuing the thin ideal, and fasting predicted onset of 2 of these 3 disorders. Similar risk factors predicted core eating disorder symptom onset. Low BMI and dieting specifically predicted onset of subthreshold/threshold AN or low BMI. Only a subset of factors showed unique predictive effects in multivariate models, likely due to moderate correlations between the risk factors ( = .14). Results provide support for the theory that pursuit of the thin ideal and the resulting body dissatisfaction, dieting, and unhealthy weight control behaviors increase risk for binge/purge spectrum eating disorders, but suggest that youth who are inherently lean, rather than purposely pursuing the thin ideal, are at risk for AN. Impaired interpersonal functioning and negative affect are transdiagnostic risk factors, suggesting these factors should be targeted in prevention programs. (PsycINFO Database Record
Pub.: 07 Oct '16, Pinned: 26 Aug '17
Abstract: This study examined the changes in body image and weight in young women with an adolescent eating disorder, relative to women without an eating disorder (noED).Three diagnostic groups, anorexia nervosa (AN; n = 10), bulimia nervosa (BN; n = 27), and binge eating disorder (BED; n = 42) and three comparison groups (noED; n = 659 each) were compared on body mass index (BMI) and self-reported current body size, ideal body size, and weight dissatisfaction. Dependent variables were examined 2 and 1 year before the onset, the onset year, and 1 and 2 years after the onset of the eating disorder in a model that was adjusted for ethnicity and BMI.BMI was lower in the AN group at all time points except 2 years before onset. AN girls evidenced a significantly stronger relation between BMI and current self-ratings and weight dissatisfaction than noED girls. BMI did not differ between the BN group and the noED group. Girls with BN reported larger current body sizes and greater weight dissatisfaction across all time points. The BED group had higher BMI than the noED group across time. BED girls reported greater current body size ratings and weight dissatisfaction than the noED girls. Girls with AN, BN, or BED did not differ from the noED girls on body ideal ratings.Body weight seems to influence perception of body size more so for girls with AN than for noED girls. No support was found for an accelerated weight gain over time for BN. Weight may increase over time for the BED group relative to the noED group, but larger studies are needed. Across all three groups, ideal body size appears to be unrelated to diagnostic status. Rather, the risk for developing an eating disorder appears to arise from size overestimation and related weight dissatisfaction.
Pub.: 13 Oct '04, Pinned: 26 Aug '17
Abstract: To determine the role of social comparison for body dissatisfaction in bulimia nervosa (BN). Previous research suggested that exposure to media content idealizing thin body shape decreases body satisfaction, particularly in women with eating disorder symptoms. This might be due to the negative outcome of social comparisons with media models, and women with eating disorders might be particularly susceptible because they engage in upward social comparison more frequently than women without these symptoms. However, no study has yet explored both upward (i.e., toward more attractive others) and downward (i.e., toward less attractive others) social comparisons and their impact on body dissatisfaction in a clinical eating disorder and healthy controls.We presented patients with BN (n = 20) and healthy controls (HC) (n = 22) with slides comprising a digitized image of their own body alongside comparison bodies with higher and lower body mass indices (BMIs) while measuring their eye movements.As hypothesized, patients with BN fixated longer on comparison bodies with lower BMIs than controls, with the reverse pattern for high BMI bodies. This gaze pattern suggests that upward comparisons were more prevalent in the BN group. Furthermore, upward comparisons were related to a drop in body satisfaction in the BN group.Disadvantageous social comparison strategies might be related to body dissatisfaction and therefore to the maintenance of BN.
Pub.: 08 Aug '09, Pinned: 26 Aug '17
Abstract: We investigated body-related attentional biases in eating disorders by testing whether individuals with anorexia nervosa (AN, n = 19) and bulimia nervosa (BN, n = 18) differ from healthy controls (HC, n = 21) in their bias for attending to a photo of their own body (self-photo) relative to a photo of a matched control participant's body (other photo). In a modified dot-probe task, self- and other photos served as cues on the left and the right of the screen. After 1 of 2 time intervals, 1 of the photos was singled out by a surrounding frame, and participants had to saccade toward it. Saccade latency was used as an index of covert attention to the cue photos. In the AN group, saccades were faster when the self-photo was the target than when the other photo was the target. In the BN group, there was a numerically opposite but nonsignificant pattern. Cues did not affect saccade latencies in healthy controls. The bias for self-photos correlated with body dissatisfaction in the AN group. This is the first evidence of an attentional bias for self-photos over other photos in the AN group and for fundamental attentional differences between AN and BN.
Pub.: 04 Aug '10, Pinned: 26 Aug '17
Abstract: Body dissatisfaction is an important risk and maintaining factor for eating disorders. The aim of the present study was to experimentally test the effects of two emotion regulation strategies - acceptance and rumination - on media-induced body dissatisfaction in eating disorders.After watching pictures of thin models, women with anorexia nervosa (AN; n = 39) and bulimia nervosa (BN; n = 39) were encouraged to either use emotional acceptance or rumination to cope with their feelings. Body dissatisfaction and mood were repeatedly assessed.Acceptance significantly improved body dissatisfaction in women with BN. Rumination led to a significant increase of body dissatisfaction in both eating disorder groups. Results were independent from mood changes.Findings highlight the importance ruminative thinking may have in the aggravation of dissatisfaction with the own body in AN and BN. Results suggest that emotional acceptance is a useful strategy to regulate body dissatisfaction after exposure to thin-ideal media in BN.
Pub.: 05 Aug '16, Pinned: 26 Aug '17
Abstract: Body dissatisfaction plays a key role in the maintenance of eating disorders, and selective attention might be crucial for the origin of body dissatisfaction. A. Jansen, C. Nederkoorn, and S. Mulkens (2005) showed that eating disorder patients attend relatively more to their own unattractive body parts, whereas healthy controls attend relatively more to their own attractive body parts. In 2 studies, we investigated whether this bias in selective attention is causal to body dissatisfaction and whether an experimentally induced bias for attractive body parts might lead to increased body satisfaction in women who are highly dissatisfied with their bodies.We used a between-subjects design in which participants were trained to attend to either their self-defined unattractive body parts or their self-defined attractive body parts by use of an eye tracker.State body and weight satisfaction.Inducing a temporary attentional bias for self-defined unattractive body parts led to a significant decrease in body satisfaction and teaching body-dissatisfied women to attend to their own attractive body parts led to a significant increase in body satisfaction.Selective attention for unattractive body parts can play a role in the development of body dissatisfaction, and changing the way one looks may be a new way for improving body dissatisfaction in women.
Pub.: 11 May '11, Pinned: 26 Aug '17
Abstract: The development of eating disorders is associated with a body-related attentional bias. Although eating disorders are especially prevalent in adolescence, so far, no study has analyzed gaze patterns and state body image in response to viewing one's own body in youth. To fill this gap, the present study aimed to examine a body-related attentional bias and state body satisfaction in adolescents with various forms of eating disorders. Girls with anorexia nervosa, restrictive type (AN-R; n = 30), anorexia nervosa, binge eating/purging type (AN-BP; n = 26), bulimia nervosa (BN; n = 22), clinical controls with anxiety disorders (n = 20) and healthy controls (n = 43) looked at photographs of their own and a peer's body, while their spontaneous eye movements were recorded. After stimulus presentation, state body satisfaction and individual attractiveness ratings for areas of the presented stimuli were assessed. An analysis of variance revealed that participants of all subgroups showed an attentive preference for unattractive areas of one's own body. Girls with AN-R attended significantly longer to unattractive body areas than both control groups and significantly shorter to attractive body areas than healthy controls. State body dissatisfaction was more prominent in all eating disorder subgroups, with significantly lower scores in BN compared to AN-R. In general, the higher the state body dissatisfaction, the stronger was the deficit orientation on one's own body. The attentional bias towards unattractive body areas, which is most pronounced in AN-R, indicates that interventions aiming to modify distorted attention might be promising in the prevention and treatment of eating disorders in adolescence.
Pub.: 31 Jan '17, Pinned: 26 Aug '17
Abstract: Stress is often found to increase the preference and intake of high caloric foods. This effect is known as emotional eating and is influenced by cognitive as well as biological stress vulnerabilities. An S-allele of the 5-HTTLPR gene has been linked to decreased (brain) serotonin efficiency, leading to decreased stress resilience and increased risks for negative affect and eating related disturbances. Recently it has been proposed that a cognitive ruminative thinking style can further exacerbate the effect of this gene by prolonging the already increased stress response, thereby potentially increasing the risk of compensating by overeating high palatable foods.This study was aimed at investigating whether there is an increased risk for emotional eating in high ruminative S/S-allele carriers reflected by an increased attention bias for high caloric foods during stress.From a large (N=827) DNA database, participants (N=100) were selected based on genotype (S/S or L/L) and ruminative thinking style and performed an eye-tracking visual food-picture probe task before and after acute stress exposure. A significant Genotype x Rumination x Stress-interaction was found on attention bias for savory food; indicating that a stress-induced attention bias for specifically high-caloric foods is moderated by a gene x cognitive risk factor.Both a genetic (5-HTTLPR) and cognitive (ruminative thinking) stress vulnerability may mutually increase the risk for stress-related abnormal eating patterns.
Pub.: 18 Jul '17, Pinned: 26 Aug '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: 25 Aug '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: 25 Aug '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: 25 Aug '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: 25 Aug '17
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: 25 Aug '17
Abstract: The pathophysiology of anorexia nervosa remains obscure, but structural brain alterations could be functionally important biomarkers. The authors assessed taste pleasantness and reward sensitivity in relation to brain structure, which may be related to food avoidance commonly seen in eating disorders.The authors used structural MR imaging to study gray and white matter volumes in women with current restricting-type anorexia nervosa (N=19), women recovered from restricting-type anorexia nervosa (N=24), women with bulimia nervosa (N=19), and healthy comparison women (N=24).All eating disorder groups exhibited increased gray matter volume of the medial orbitofrontal cortex (gyrus rectus). Manual tracing confirmed larger gyrus rectus volume, and volume predicted taste pleasantness ratings across all groups. Analyses also indicated other morphological differences between diagnostic categories. Antero-ventral insula gray matter volumes were increased on the right side in the anorexia nervosa and recovered anorexia nervosa groups and on the left side in the bulimia nervosa group relative to the healthy comparison group. Dorsal striatum volumes were reduced in the recovered anorexia nervosa and bulimia nervosa groups and predicted sensitivity to reward in all three eating disorder groups. The eating disorder groups also showed reduced white matter in right temporal and parietal areas relative to the healthy comparison group. The results held when a range of covariates, such as age, depression, anxiety, and medications, were controlled for.Brain structure in the medial orbitofrontal cortex, insula, and striatum is altered in eating disorders and suggests altered brain circuitry that has been associated with taste pleasantness and reward value.
Pub.: 18 May '13, Pinned: 25 Aug '17
Abstract: Anorexia nervosa (AN) is a debilitating illness and existing interventions are only modestly effective. This study aimed to determine whether AN pathophysiology is associated with altered connections within fronto‐accumbal circuitry subserving reward processing. Diffusion and resting‐state functional MRI scans were collected in female inpatients with AN (n = 22) and healthy controls (HC; n = 18) between the ages of 16 and 25 years. Individuals with AN were scanned during the acute, underweight phase of the illness and again following inpatient weight restoration. HC were scanned twice over the same timeframe. Based on univariate and multivariate analyses of fronto‐accumbal circuitry, underweight individuals with AN were found to have increased structural connectivity (diffusion probabilistic tractography), increased white matter anisotropy (tract‐based spatial statistics), increased functional connectivity (seed‐based correlation in resting‐state fMRI), and altered effective connectivity (spectral dynamic causal modeling). Following weight restoration, fronto‐accumbal structural connectivity continued to be abnormally increased bilaterally with large (partial η2 = 0.387; right NAcc‐OFC) and moderate (partial η2 = 0.197; left NAcc‐OFC) effect sizes. Increased structural connectivity within fronto‐accumbal circuitry in the underweight state correlated with severity of eating disorder symptoms. Taken together, the findings from this longitudinal, multimodal neuroimaging study offer converging evidence of atypical fronto‐accumbal circuitry in AN. Hum Brain Mapp, 2016. © 2016 Wiley Periodicals, Inc.
Pub.: 08 Jun '16, Pinned: 25 Aug '17
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