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AN ABSTRACT OF THE THESIS OF MICHELLE OSTIEN, for the Master of Science degree in FOOD AND NUTRITION, presented on November 20, 2008, at Southern Illinois University Carbondale. TITLE: SIMILARITIES AND DIFFERENCES IN FEMALES WITH REGARDS TO PERFECTIONISM IN THOSE WITH ANOREXIA NERVOSA, HIGH BMI (BINGE EATERS VS. NON-BINGE EATERS), AND THOSE SEEKING A HEALTHIER LIFESTYLE MAJOR PROFESSOR: Dr. Sharon Peterson One in five women in the United States struggle with an eating disorder or distorted eating patterns (National Institute of Mental Health, 2001). Perfectionism, one of the risk factors for developing an eating disorder, is a trait that many of these women have in common. While much research has been done on perfectionism in women with anorexia nervosa and bulimia nervosa, few studies have looked at perfectionism in women with binge eating disorder (Pratt, Telch, Labouvie, Wilson, & Agras, 2001). Our study sought to further understand the similarities and differences of the total and individual components of perfectionism in females seeking a healthier lifestyle, high BMI binge eaters, high BMI non-binge eaters, and anorexics. Our study found that the first component of the perfectionism scale (representing self-oriented perfectionism) was found to be significant between groups (p=0.002). When comparing females seeking a healthier lifestyle to high BMI binge eaters, females seeking a healthier lifestyle were more likely to answer "no", while high BMI binge eaters were more likely to answer "yes" (p=0.006). When comparing females seeking a healthier lifestyle to anorexics, females seeking a healthier lifestyle were more likely to answer "no" when compared to anorexics (p=0.033). When comparing high BMI binge eaters to high BMI non-binge eaters, high BMI binge eaters were also more likely to answer "yes" to this question when compared to high BMI non-binge eaters (p=0.048). Compared to 76.9% (N=10) of female anorexics, 74.4% (N=32) of female high BMI binge eaters, 50.0% (N=32) of female high BMI non-binge eaters, and 31.2 % (N=5) of females seeking a healthier lifestyle answered "yes" to perfectionism component one, which represented self-oriented perfectionism. Anorexics had the greatest tendency for perfectionism, followed by binge eaters, and then non-binge eaters. This study demonstrated that self-oriented perfectionism is the greatest indicator of perfectionism between subject groups and that perfectionism does exist in binge eaters.

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Objective: Weight bias has strong associations with psychopathology in overweight and obese individuals. However, self-evaluative processes, as conceptualized in the process model of self-stigma, and implications for other health-related outcomes, remain to be clarified. Design and Methods: In a representative general population sample of N = 1158 overweight and obese individuals, the impact of core self-evaluation as a mediator between weight bias internalization and mental and global health outcomes as well as between weight bias internalization and health care utilization, was examined using structural equation modeling. Results: In overweight and obese individuals, greater weight bias internalization predicted lower core self-evaluation, which in turn predicted greater depression and anxiety, lower global health, and greater health care utilization. These mediational associations were largely stable in subsample analyses and after controlling for sociodemographic variables. Conclusions: The results show that overweight and obese individuals with internalized weight bias are at risk for impaired health, especially if they experience low core self-evaluation, making them a group with which to target for interventions to reduce self-stigma. Weight bias internalization did not represent a barrier to health care utilization, but predicted greater health care utilization in association with greater health impairments.

Binge eating disorder is characterized by excessive consumption of highly palatable food within short periods of time accompanied by loss of control over eating. Extensive evidence provides support for the consideration of binge eating disorder as an addiction-like disorder. In this study, we wanted to determine whether rats undergoing an operant binge-like eating procedure could develop maladaptive forms of conditioned feeding behaviors. For this purpose, we trained male rats to self-administer either a sugary, highly palatable diet (Palatable rats) or a chow diet (Chow rats) for 1 hour/day. Following escalation and stabilization of palatable food intake, we tested both Chow and Palatable rats in a i) conditioned place preference, a ii) second-order schedule of reinforcement and, finally, a iii) cue-induced suppression of feeding. In the conditioned place preference task, Palatable rats spent significantly more time in the compartment which was paired with the palatable food when compared to Chow controls. Furthermore, in the second-order schedule of reinforcement task, Palatable rats exhibited active lever responding 4- to 6-fold higher than Chow control rats. Finally, in the conditioned suppression of feeding test, while Chow control subjects reduced responding by one-third in the presence of the conditioned punishment, Palatable rats persevered in responding despite the aversive cue. These results further characterize our animal model of binge-like eating and provide additional evidence for the addictive properties of highly palatable food.

The purpose of this project is to gather an understanding of binge eating disorder and effective treatment approaches used for the reduction of binge eating symptoms for adult females. The research focus of this study will be, what are the attitudes and perspectives of binge eating disorder treatments for adult females among students who are in a masters of social work field or study. This research project utilized a post-positivist paradigm where data was gathered qualitatively through the implementation of interviews with MSW students of diverse ethnic backgrounds (e.g. Hispanics, whites, and blacks, professional and personal experiences) from California State University of San Bernardino. The researcher utilized literature review to prepare for the study execution, and participants were provided with an inform consent and debriefing statement. The researcher prepared questions, and audio recorded, transcribe, and then analyzed the interviews. Master’s students’ first-hand knowledge and perspectives contributed to a better understanding of what needs to be known in order to effectively treat binge eating disorder. The results consisted of the following themes: knowledge; basic knowledge of eating disorders, limited knowledge or awareness about binge eating disorder among adult females, no knowledge in regards to effective treatments for adult females with binge eating disorder, need for knowledge or awareness, perceptions; negative perceptions of binge eating disorder and treatments for adult females, experiences; personal and school experiences, and treatments; cognitive behavior therapy for treatment.

A plethora of research has linked negative affect with binge eating in people with binge eating disorder (BED). Cognitive behavioural therapy (CBT) and interpersonal therapy (IPT) have not traditionally addressed emotional regulation deficits. Failure to address emotional aspects of binge eating may explain why some individuals do not respond to CBT or IPT, and why many of those who do respond relapse shortly after finishing treatment. Dialectical behaviour therapy (DBT) specifically targets the inability to accurately recognise and regulate affect. Preliminary investigations have shown that DBT may be efficacious in treating BED. However, it can take up to 10 months, and a shorter intervention targeting affect regulation and recognition may produce similar effects. Four studies evaluating a ten session emotion-focussed group psychoeducational intervention for BED were conducted. In the first, 25 women diagnosed with subthreshold or full syndrome BED (using DSM-IV-TR criteria) were treated. The second study tested whether the specific components of the intervention, or the treatment as a whole, was required to produce positive outcomes in women. Study three, examined the efficacy of the treatment programme with three men diagnosed with subthreshold or full syndrome BED (also using DSM-IV-TR criteria). The fourth study compared the women's and men's response to treatment. Following the intervention with women, binge abstinence rates, comparable to those of CBT and IPT, and various other positive changes to eating and general pathology, were observed. These effects were well-maintained up to one-year later. Overall, it was concluded that the whole treatment programme was necessary to produce the optimum outcome for BED in women. A positive outcome was measured in the men, although the effects were not as dramatic as those found in the women. Suggestions for improvements, and suggestions for further research, are discussed. The results provide support for the Affect Regulation Model of BED in women and men.

Binge eating is a harmful, maladaptive behavior associated with comorbid psychopathology. Theory posits that increases in maladaptive, transdiagnostic emotions following binge eating in individuals with BN may predict the experience of comorbid symptoms. The current study served as a laboratory test of the first part of this theory: whether state increases in maladaptive emotions occur following engagement in binge eating behavior in women with BN compared with healthy controls. Women (n = 51) were recruited from the community if they met DSM-5 criteria for BN or OSFED BN (of low frequency) (n = 21) or were free of lifetime disordered eating and current psychopathology (n = 30). Participants completed questionnaires assessing eating disorder symptoms (preoccupation with weight and shape, urge to vomit), state shame, and state negative affect before and after consuming a test meal in which they were instructed to binge. Women with BN endorsed significantly greater preoccupation with weight and shape and urge to vomit following test meal consumption compared with controls. Women with BN reported significant increases in state shame, but not state negative affect, following test meal consumption, compared with controls. Results are consistent with a model indicating binge eating precipitates increases in state shame among women with BN. Given shame’s status as a transdiagnostic risk factor, future work should clarify whether state shame following binge eating predicts increases in comorbid symptoms.

The current dissertation is comprised of two studies that examined the relationship between group dynamics, attachment anxiety, and post-treatment outcomes in a sample of women (N = 102) with binge eating disorder (BED) who received Group Psychodynamic Interpersonal Psychotherapy. The first study explored the relationship between the development of group cohesion, the individuals’ level of attachment anxiety, and frequency of binge eating, symptoms of depression, and self-esteem at post-treatment. The second study explored the relationship between the interpersonal learning, individuals’ level of attachment anxiety, and outcomes. Interpersonal learning was conceptualized as the convergence between multiple perspectives of group cohesion: one’s own and the group’s perception of one’s cohesion to the group. Parallel measures of individual self-rated cohesion (CQ-I) and mean group-rated cohesion (CQ-G) were developed based on the original Cohesion Questionnaire (CQ; Piper et al., 1983) for this study. Participants were assigned to homogeneous groups composed of either high or low attachment anxiety to assess the impact of pre-treatment attachment anxiety. Findings indicated significant growth in cohesion over time, and a significant convergence in multiple ratings of cohesion. These processes did not differ significantly based on level of attachment anxiety. Growth in cohesion was related to greater reductions in binge eating for those high in attachment anxiety, while the convergence in ratings of cohesion (i.e., interpersonal learning) was related to improvements in self-esteem for individuals in both attachment anxiety conditions. The findings support the importance of group interventions for BED that are sensitive to individuals’ attachment anxiety, and that emphasize cohesiveness, and interpersonal learning to improve outcomes.