Thesis (Ph. D.)--University of Texas at Austin, 2000. / Vita. Includes bibliographical references (leaves 297-310). Available also in a digital version from Dissertation Abstracts.

Thesis (M.A.)--East Carolina University, 2009. / Presented to the faculty of the Department of Psychology. Advisor: Susan McCammon. Title from PDF t.p. (viewed May 3, 2010). Includes bibliographical references.

Thesis (Psy. D.)--Wheaton College, 2006. / Abstract. Includes bibliographical references (leaves 61-66).

According to the American Society of Plastic Surgeons (2006), the number of cosmetic procedures has increased to over 10 million in 2005, showing a 38% increase from 2000. This increase in cosmetic surgery prevalence is paralleled by a surge in reality cosmetic makeover television programming, such as Extreme Makeover and Dr. 90210. No research to date has assessed the potential relationships between reality media viewership and body image, eating pathology, or cosmetic surgery attitudes. The tripartite model of core influence (Thompson et al., 1999) is presented as a theoretical framework for conceptualizing the link between media influences, internalization, body image dissatisfaction, and outcomes such as eating disorder symptomatology and cosmetic surgery attitudes. The current study examines the relationships between reality cosmetic makeover viewership, cosmetic surgery attitudes, body image, and eating disorder symptomatology in a sample of 2057 college females. Viewership of reality cosmetic surgery shows was significantly related to more favorable cosmetic surgery attitudes, perceived pressure to have cosmetic surgery, past attainment of a cosmetic procedure, overall body dissatisfaction, thin ideal internalization, eating disorder symptomatology, and a decreased fear of surgery. Although the current study is correlational, it provides a framework for future hypothesis testing and elucidates the link between contemporary media influences, body dissatisfaction, eating disturbance, and cosmetic surgery attitudes and behaviors.

While dieting is relatively normative in our society, it is controversial within the fields of eating disorders and obesity. Dieting for weight loss has been touted by the obesity prevention field as a solution to the growing obesity epidemic, yet a body of research in the eating disorders field has also implicated it in the etiology and maintenance of eating pathology. Thus, a divergence in approaches toward dieting has emerged, with both prodieting and anti-dieting messages being recommended. Little is known, however, about the impact of these two types of messages on immediate and short-term psychological functioning and weight control intentions and behaviors. The current study sought to explore this gap in the extant literature by conducting an experimental study that evaluated the two messages. Undergraduate women (N=139) were randomly assigned to either a pro-dieting, anti-dieting, or no-dieting (control) message condition. Psychological functioning and weight control variables were assessed at baseline, posttest, and a two-week follow-up. Results indicated that the pro-dieting message resulted in significantly greater post-test perceived pressure to lose weight, dieting intentions, and thin-ideal internalization intentions while the anti-dieting message yielded significantly lower post-test bulimic intentions. Healthy eating behavior significantly increased from baseline to follow-up in the pro-dieting condition while there were no changes in the other two conditions. Post-test perceived pressure was found to fully mediate the relationship between diet message and post-test dieting, bulimic, thin-ideal internalization, and healthy eating intentions as well as follow-up healthy eating behavior. Trait thin-ideal internalization levels moderated the relationship between diet message and post-test perceived pressure and thin-ideal internalization intentions. Exploratory analyses revealed that overweight participants in the pro-dieting condition increased significantly from pre to post-test on state body dissatisfaction and had the highest level of post-test perceived pressure compared to all other groups. Nonoverweight participants in the pro-dieting condition also had significantly greater posttest perceived pressure to lose weight than both weight status groups in the other two conditions. Findings are discussed in the context of the prevention goals of the obesity and eating disorders fields. Limitations of the study and directions for future research are offered.

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I föreliggande studie har unga flickors attityder till ätande över tid studeras, samt sambandet mellan föräldrars attityder till mat och ätande och deras döttrars attityder. Detta gjordes genom frågeformulären Children´s Eating Attitudes Test (ChEAT) och Eating Attitudes Test (EAT), från IDA-projektet (Identification of Dieting in Adolescent girls) som delades ut i 40 olika skolor i Uppsala län år 1995 samt 2000. Resultatet visade att det var elva procent av 14åringarna som låg i riskzonen (riskbeteende = 16-72 p) för att utveckla ett stört ätbeteende, medan det inte var någon utav nioåringarna som låg i riskzonen (M 9år = 1,88 M 14 år = 4,35p=.001). Inget signifikant samband mellan varken mammans och flickornas ätbeteende eller pappans och flickornas ätbeteende kunde ses. För att problem med ätstörningar hos ungaflickor ska minska tycker författarna att det är viktigt att föräldrar informeras om hur tidigt deras barn blir medvetna om kroppsideal samt matfrågor. Det är också mycket viktigt att dessa flickor, som är i riskzonen för att utveckla ett stört ätbeteende, fångas upp innan de har utvecklat en faktisk klinisk ätstörning. Som sjuksköterskor är det viktigt att ha bred kunskapom ätstörningar och dess symtom för att på ett tidigt stadium uppmärksamma flickor som drabbats.

The sociocultural model of eating disorders suggests that awareness of a thin physical ideal directly affects internalization of that ideal, which in turn, directly affects body dissatisfaction. The current study evaluated the general accuracy of the sociocultural model and examined the potential for ethnicity to protect against eating disorder symptomatology by moderating the relationships between awareness and internalization and between internalization and body dissatisfaction. Spanish (n = 100), Mexican American (n = 100), and Euro-American (n = 100) female participants completed various questionnaires measuring sociocultural attitudes towards appearance and body dissatisfaction. Analysis of covariance with tests of homogeneity of slope and path analysis using maximum likelihood with robust standard errors tested the two relationships by ethnic group. Results supported the sociocultural model: there was strong evidence for the mediational effect of internalization on the relationship between awareness and body dissatisfaction. Furthermore, ethnicity moderated the relationships such that both relationships were significantly stronger for Euro-American women than for Mexican American or Spanish women. Within the Mexican American group level of acculturation also moderated these relationships. Taken together, the results of this study highlight how ethnicity can protect against the development of eating disorder symptoms. Denouncing the thin ideal, minimizing appearance as an indicator of female value, and emphasizing personal traits other than appearance as determinants of worth are important in protecting against the development of body dissatisfaction and more severe eating pathology.

Currently, there is a limited understanding of change mechanisms across all treatment approaches for eating disorders (ED), particularly with regard to group psychotherapy. This presents one of the major obstacles in the development of more effective treatments. The purpose of this study was to extend current understanding of therapeutic processes in group psychotherapy for bulimic disorders. Thirty-one women were randomly assigned to either 16-weeks of Emotion-Focused Therapy (EFT) or Motivation/Education and Skill Building (M/ESB) as part another study at a participating outpatient ED program. The goals of this study were to: (1) evaluate the relationship between in-session processes; (2) compare these processes between two group treatments; (3) examine in-session differences as a function of client activity in group EFT; (4) and identify a pathway to change. As expected, the findings demonstrated that mid therapy emotional arousal was associated with higher levels of insight, and an increase in insight overtime was associated with an increase in therapeutic alliance. Arousal was not positively correlated with alliance. There was a significant interaction between group treatment x time: clients in EFT reported gains in insight overtime, as measured by post-session change measure, whereas clients’ scores in M/ESB did not change over the course of psychotherapy. Alliance increased significantly over the course of therapy in both groups. Contrary to expectations, clients in the EFT group did not report higher levels of arousal compared to the M/ESB group. The limited sample size in the control group precludes firm conclusions about group comparisons. When examining client activity within EFT, the results demonstrated that clients that were actively engaged in the chair-tasks reported higher post-session change scores, arousal, and alliance compared to when they were in the observing role; however, there was a significant upward trend on post-session change scores regardless of the client role. The pathway to change was partially supported: the observer-rated degree of resolution scores predicted a third of variance in post-session change scores; controlling for pre-treatment outcome scores, post-session change scores predicted variance at the outcome on several EDI-3 subscales. These preliminary findings are discussed in the context of psychotherapy process literature, highlighting limitations and future directions.

Currently, there is a limited understanding of change mechanisms across all treatment approaches for eating disorders (ED), particularly with regard to group psychotherapy. This presents one of the major obstacles in the development of more effective treatments. The purpose of this study was to extend current understanding of therapeutic processes in group psychotherapy for bulimic disorders. Thirty-one women were randomly assigned to either 16-weeks of Emotion-Focused Therapy (EFT) or Motivation/Education and Skill Building (M/ESB) as part another study at a participating outpatient ED program. The goals of this study were to: (1) evaluate the relationship between in-session processes; (2) compare these processes between two group treatments; (3) examine in-session differences as a function of client activity in group EFT; (4) and identify a pathway to change. As expected, the findings demonstrated that mid therapy emotional arousal was associated with higher levels of insight, and an increase in insight overtime was associated with an increase in therapeutic alliance. Arousal was not positively correlated with alliance. There was a significant interaction between group treatment x time: clients in EFT reported gains in insight overtime, as measured by post-session change measure, whereas clients’ scores in M/ESB did not change over the course of psychotherapy. Alliance increased significantly over the course of therapy in both groups. Contrary to expectations, clients in the EFT group did not report higher levels of arousal compared to the M/ESB group. The limited sample size in the control group precludes firm conclusions about group comparisons. When examining client activity within EFT, the results demonstrated that clients that were actively engaged in the chair-tasks reported higher post-session change scores, arousal, and alliance compared to when they were in the observing role; however, there was a significant upward trend on post-session change scores regardless of the client role. The pathway to change was partially supported: the observer-rated degree of resolution scores predicted a third of variance in post-session change scores; controlling for pre-treatment outcome scores, post-session change scores predicted variance at the outcome on several EDI-3 subscales. These preliminary findings are discussed in the context of psychotherapy process literature, highlighting limitations and future directions.