Studies indicate an attentional bias towards food in binge-eating disorder (BED), however, more evidence on attentional engagement and disengagement and processing of multiple attention-competing stimuli is needed. This study aimed to examine visual attention to food and non-food stimuli in BED. In n = 23 participants with full-syndrome and subsyndromal BED and n = 23 individually matched healthy controls, eye-tracking was used to assess attention to food and non-food stimuli during a free exploration paradigm and a visual search task. In the free exploration paradigm, groups did not differ in initial fixation position. While both groups fixated non-food stimuli significantly longer than food stimuli, the BED group allocated significantly more attention towards food than controls. In the visual search task, groups did not differ in detection times. However, a significant detection bias for food was found in full-syndrome BED, but not in controls. An increased initial attention towards food was related to greater BED symptomatology and lower body mass index (BMI) only in full-syndrome BED, while greater maintained attention to food was associated with lower BMI in controls. The results suggest food-biased visual attentional processing in adults with BED. Further studies should clarify the implications of attentional processes for the etiology and maintenance of BED.

Objective: The aim of this study was to develop, evaluate, and standardize a short form of the well-established Eating Disorder Examination-Questionnaire (EDE-Q). The newly developed EDE-Q8 was required to reflect the originally postulated structure of the EDE-Q. Method: Data were drawn from two nationwide representative population surveys in Germany: a survey conducted to develop the EDE-Q8 in 2009 (N = 2520); and a survey conducted in 2013 (N = 2508) for the evaluation and calculation of EDE-Q8 percentiles. Results: The EDE-Q8 had excellent item characteristics, very good reliability and a very good model fit for the postulated second-order factorial structure. Furthermore, a strong correlation between the EDE-Q8 and a 13 item short form of the Eating Attitudes Test was observed. Discussion: The EDE-Q8 appears to be particularly suitable in epidemiological research, when an economical assessment of global eating disorder psychopathology is required.

Die vorliegende Literatursichtung belegt, gerade im Lichte neuen Störungswissens und für neue diagnostische Kategorien, die Notwendigkeit, die Wirksamkeit bestehender Therapieformen zu erhöhen und/oder neue Behandlungen für Essstörungen, speziell für Bulimia Nervosa und Binge Eating-Störung, zu entwickeln. Ein wesentlicher Erkenntnisgewinn wird zudem von einer systematischen Analyse des therapeutischen Prozesses sowie von Moderatoren und Mediatoren erwartet. Darüber hinaus stellen die Dissemination evidenzbasierter Therapiemethoden in die Praxis und eine Überprüfung gestufter Behandlungsmodelle wichtige Aufgaben zukünftiger Forschung dar. / The consideration of existing literature, especially in light of new knowledge of eating disorders and new diagnostic categories, highlights the necessity to increase the efficacy of current forms of therapy, and to develop novel therapies for eating disorders. This pertains, in particular, to bulimia nervosa and binge eating disorder. A considerable gain in knowledge is to be expected from a systematic analysis of the therapeutic process as well as the moderators and mediators. Furthermore, dissemination of evidence-based treatment methods in practical settings and an examination of stepped care models are important avenues of future research.

Eating and feeding disturbances are prevalent yet understudied health conditions in youth. They are characterized by aberrant eating behaviors, cognitive and emotional dysfunctions, and dysregulated body weight. The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition defines several feeding and eating disorders with a common onset in youth; however, data on their clinical validity at young ages are lacking. Further non-normative eating behaviors exist, but their clinical relevance needs elucidation. This Special Issue compiles state-of-the-art reviews and empirical research on the presentation, development, course, and maintenance of diverse eating and feeding disturbances as a prerequisite for delineating evidence-based interventions for treatment and prevention.

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Aims: Quantitative research and clinical observations have long supported a link between the eating disorders and disturbances of self / identity. However, less is known about the process of how this comes about, and little qualitative research has been conducted in the area. The current study therefore aimed to gain an in-depth understanding of the experience of self and eating disorder, using a qualitative approach. The study focused upon the experiences of women, in order to keep the sample homogenous, and sought to explore the following: How women with an eating disorder view and describe themselves; their thoughts and experiences concerning why they view themselves this way; and their thoughts and experiences regarding whether they think there is a link between their view of themselves and their eating disorder. Method: Semi-structured interviews were carried out with four women who had been diagnosed with, and were undergoing treatment for, an eating disorder. Verbatim transcripts of the interviews were then analysed using Interpretative Phenomenological Analysis (IPA). Results: The analysis produced four master themes. These were, "I'm always questioning, who am I?": 'Experiencing a fragile sense of self'; 'The influences of others on self perception'; "Just made me feel better about myself": 'Strategies employed to manage the sense of self'; and "I can't rise above my childhood": 'The enduring influence of early experiences on self'. A description of these master themes and the related subordinate themes is presented. Conclusion: The results of the analysis are considered in light of existing theory and their clinical implications.

Maladaptive interpersonal functioning is considered typical of eating disorders. The present thesis aimed to add to existing knowledge of interpersonal functioning in the eating disorders in terms of both symptomatology and treatment. In Study 1, relationships were found between eating disorder attitudes and several types of poor interpersonal functioning. These associations were present when controlling for depression and anxiety. Study 2 found that generalised interpersonal problems were more likely to be reported by women with bulimic disorders than comparison women, apart from problems with being too open, which were more likely to be reported by comparison women. In Study 3, individuals with self identified eating disorders were found to have poorer problem solving skills in specific interpersonal situations than healthy controls, generating less means to solve the problem, with these means being significantly less effective and less specific than those generated by healthy controls. In Study 4, the experience of an invalidating childhood environment was explored as a potential predictor of adult interpersonal problems in the eating disorders. Viewing the expression of emotions as a sign of weakness was a mediator of the relationship between having a more invalidating mother and adult eating concern in a nonclinical population. In Study 5, the interpersonal experiences of patients with bulimic disorders are explored using qualitative methodology. They report a range of problems characterised by social avoidance, social anxiety, non-assertiveness, and a difficulty with being genuine in relationships. In Study 6, patients reported their experiences of interpersonal psychotherapy for bulimic disorders. In general, they experienced the therapy as positive and beneficial. They express that it helped them address a range of interpersonal problems, and reduced but did not cure their eating disordered behaviours. Patients liked that therapy focused on both interpersonal relationships and eating. In Study 7, interpersonal psychotherapists discussed their perceptions of the modified therapy. They identified several factors as being related to outcome, such as the existence or willingness to build a support network, motivation to change, a clear interpersonal problem identified in the patient, level of depression, duration of the eating disorder and keeping therapy focused on the interpersonal. Results of these studies suggest that those with higher levels of eating disorder related attitudes and behaviours often have significant problems with interpersonal functioning. This thesis supports the use of interpersonal psychotherapy as a viable treatment approach to the eating disorders. It also supports the use of the modified version of the therapy, which addresses eating as well as interpersonal functioning.

Compulsive exercise has been observed as a significant feature of the eating disorders throughout their history. It has variously been conceptualised as primarily an analogue of purgation, an emotion regulation strategy, an addiction, or an obsessivecompulsive behaviour, with evidence supporting each to varying degrees. The importance of compulsive exercise is underlined by the finding that it often precedes the onset of an eating disorder and is one of the last symptoms to subside. In addition, it is associated with a longer length of hospitalisation and higher rates of relapse. As a result, compulsive exercise is now recognised as a significant factor in the aetiology, development and maintenance of the eating disorders across diagnoses. Yet despite the importance of compulsive exercise and previous recommendations to target it, no clear conceptual model of compulsive exercise exists upon which an intervention could be based. This thesis has three broad aims: (1) critically review the evidence for and against factors implicated in the maintenance of compulsive exercise and propose a new theoretically coherent and empirically derived model of compulsive exercise that could be used to inform future cognitive-behavioural interventions; (2) develop and provide preliminary validation for a new measure of compulsive exercise; and (3) present six studies utilising the new measure of compulsive exercise to empirically test some of the relationships suggested by the proposed model. Main findings: The resulting Compulsive Exercise Test (CET) is a new multidimensional measure of compulsive exercise, consistent with the proposed cognitive-behavioural conceptualisation, and demonstrating good psychometric properties. Utilising the CET, the empirical chapters demonstrate that compulsive exercise was associated with (a) elevated levels of eating-disordered cognitions and increased frequency of eating-disordered behaviours, (b) avoidanceoriented coping and a range of difficulties in regulating emotions, and (c) perfectionism (particularly the self-critical dimension). Implications: The current findings provide preliminary support for the proposed cognitive-behavioural maintenance model of compulsive exercise. This may inform clinical interventions and prevention programs designed to address compulsive exercise, as well as enhancing current treatment efficacy by providing specific targets for intervention. In addition, the new measure of compulsive exercise is potentially a useful screening tool in formulating the maintenance of an individual's exercise behaviour, and is further a potentially useful research and outcome tool.

Despite demonstrating eating disorder rates equivalent to White women, African American and Asian American women are less likely to seek treatment and are more likely to terminate treatment prematurely. One of the most successful programs for eating disorder prevention has only focused on surface-level cultural adaptations. Prevention literature maintains that deep-structure cultural adaptation (e.g., integrating cultural values and beliefs) can enhance outcomes for ethnic minorities. This dissertation examined the feasibility of Sustainable Adapted Treatments for Eating Disorders (SATED), a pilot intervention that included a culturally- targeted pre-treatment to an eating disorder dissonance-based intervention. A sample of 72 women (ages 18-30) were recruited via the SONA pool, student organizations, and community organizations. In Study 1, 47 women participated in focus groups (i.e., 21 African American women and 26 Asian American women). Grounded theory was used to analyze data, and this data was then used to develop a culturally-informed pre-treatment. Pre-treatment protocols (30- 45 minutes) were developed for both African American and Asian American groups and were refined prior to implementing the intervention. In Study 2, a pilot intervention, 25 women were assigned either to a pre-treatment condition, or 30-45 minute, individualized session (N = 12) or a no pre-treatment condition (N = 13) prior to completing an eating disorder DBI which took place over two 2-hour sessions. Participants completed a battery of questionnaires at baseline, post-intervention, and at 2 to 3-month follow-up. Constructs assessed included eating disorder symptomatology, attitudes towards seeking professional psychological help, and body dissatisfaction. Overall feasibility and acceptability of the pre-treatment and pilot intervention were assessed via triangulation of methods including third-party observations, in-depth interviews, and fidelity checks. Preliminary findings from the questionnaires indicated that there was a general downward trend for eating pathology across both the pre-treatment and no pre- treatment condition, except for eating restraint. Body dissatisfaction decreased for both groups from baseline to post-test, but increased at follow-up. Attitudes towards treatment-seeking increased for both groups from baseline to follow-up. Results may inform feasibility issues that accompany translational research with ethnic minorities and inform a future definitive trial.

Although previous research has shown a significant association between bulimia nervosa (BN) and drug use disorders (DUD), our knowledge of the underlying causes for this comorbidity remains limited. The purpose of the present study was to investigate possible influences on the comorbidity between BN and DUD. Subjects included 490 monozygotic and 354 dizygotic female twin pairs from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders. Multiple logistic regression analyses were used to test where putative shared correlates mediated the comorbidity between BN and DUD. Bivariate twin analyses were used to investigate the contribution of genes and environment to the correlation between BN and DUD. Regression analyses indicated a lifetime history of major depression, the personality trait of neuroticism, and childhood sexual abuse significantly mediated the associated between BN and DUD (using BN as the independent variable), while major depression, conduct disorder diagnosis, and childhood sexual abuse most significantly impacted the association when DUD was used as the independent variable. Bivariate twin analyses indicated there is additive genetic and nonshared environmental overlap between BN and DUD with genetic and unique environmental correlations of 0.39 and 0.10, respectively. Results show the reason for the association between BN and DUD is due mostly to overlapping genes with a smaller contribution from nonshared environmental influences. Major depression, the personality trait of neuroticism, and childhood sexual abuse are likely important shared correlates between BN and DUD.