Eating disorders affect an estimated 1 million Canadians per year and have the highest mortality rate of all mental illnesses (Statistics Canada, 2016; Arcelus, Mitchell, & Wales, 2011). Research suggests that those who fall under the transgender umbrella are at a higher risk for developing mental health concerns, and more specifically disordered eating practices (Dhejne, Vlerken, Heylens, & Arcelus, 2016). Despite this the existing literature on this population is lacking, with little research going outside of the gender binary. Majority of the existing literature is limited in looking at individual case studies seeking to prove that transgender folks can struggle with disordered eating, rather than bring attention to the experiences of transgender individuals within eating disorder treatment and recovery. The purpose of this study was to expand on the current literature by bringing in the voices of lived experience. Semi-structured interviews were conducted with individuals, over the age of 18, who identify their gender as falling under the transgender umbrella who have participated in a form of eating disorder recovery for a minimum of one year. Through a thematic analysis, commonalities were uncovered between the participants stories leading to the identification of five themes: the connection between gender identity and eating disorder development, the impact of LGBTQ+ beauty standards, discrimination within the healthcare system, the use of the internet, and the role of community in recovery. The findings suggest there is a strong connection between transgender identity and the development of eating disorder behaviours that create an experience vastly different than the cisgendered reality in which the treatment programs are based. To address these differences the participants provided guidance towards recommendation for practitioners and treatment including: mandated training on both transgender identities and eating disorders, the development of supportive and inclusive environments, the creation of a transgender specific eating disorder treatment program. Further, topics for future research to deepen the understanding of the experiences shared within the study included: impact of online eating disorder support for trans and non-binary individuals, the variance in experience between binary transgender and non-binary identities within treatment, and the impacts of race and ethnicity on the experiences of transgender individuals. / Thesis / Master of Social Work (MSW)

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.

In the United States, eating disorders affect approximately 20 million women annually (National Institutes of Health, 2011). With such a high prevalence, ensuring help-seeking in individuals with eating disorders is critical. A previously-supported eating disorder prevention approach includes cognitive dissonance intervention (CDI). CDI’s purpose is to change a person’s behavior to reflect their attitude or cognition. While true self intervention has not been with previously been applied to eating disorders, it has been efficacious in improving psychological risk factors associated with eating disorder risk. The current study combined true self and CDI to test a more holistic prevention tool (i.e. combining psychological and cognitive approaches to prevention). Specifically, the current study compared the combination prevention to true self intervention only, CDI only, and a control condition to examine outcomes of body satisfaction, eating disorder pathology, psychological outcomes, and help-seeking intentions. Overall, evidence did not support the preventions’ combined prevention superiority to control within the entire sample. When exploring individuals at risk of an eating disorder, however, CDI was significantly better than true self in reducing binge episodes and self-esteem. Furthermore, the combination prevention was significantly better than true self at increasing self-esteem. The following results warrant more research exploring other potential preventions to increase positive psychological outcomes. Moreover, future research should explore more options for increasing help-seeking intentions.

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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.

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.

This study extended earlier research supporting discrepancy theory by including a multidimensional conceptualization of gender including attitudes, behaviors, and characteristics. Analyses revealed that gender discrepancy when assessed multidimensionally or unidimensionally (as in past research) was not significantly related to eating disordered symptomatology.

Desire to eat, hunger, feeling of having enough to eat, and fullness were measured in 11 eating disorder patients in treatment for less than two months, 7 eating disorder patients in treatment for more than two months, and 11 controls. The experimental group was female patients with a DSM-IV diagnosis of Anorexia Nervosa, Bulimia Nervosa, or eating disorder not-otherwise-specified. The experimental and control groups ate a test meal two hours after a preload. The groups answered four questions about desire to eat, hunger, feeling of having enough to eat, and fullness, before they ate, halfway through their meal, immediately upon finishing the meal, and 15 minutes after finishing their meal. The groups were required to eat 100% of the meal provided. The difference in data between the experimental and control groups was not statistically significant. The experimental group that had been in treatment longer than two months had means closer to the control group than the other experimental group who had been in treatment less than two months. This may suggest that the experimental group who had been in treatment more than two months was starting to regain a more normal sense of hunger and satiety. However, a repeat study with a larger sample size would be needed to prove that statement.

Binge eating disorder (BED) is the most prevalent of all eating disorders and is characterized by recurrent episodes of eating a large amount of food in the absence of control. There have been various kinds of research of BED, but the phenomenon remains poorly understood. This thesis reviews the results of research on BED to provide a synthetic view of the current general understanding on BED, as well as the neural correlates of the disorder and treatments. Research has so far identified several risk factors that may underlie the onset and maintenance of the disorder, such as emotion regulation deficits and body shape and weight concerns. However, neuroscientific research suggests that BED may characterize as an impulsive/compulsive disorder, with altered reward sensitivity and increased attentional biases towards food cues, as well as cognitive dysfunctions due to alterations in prefrontal, insular, and orbitofrontal cortices and the striatum. The same alterations as in addictive disorders. Genetic and animal studies have found changes in dopaminergic and opioidergic systems, which may contribute to the severities of the disorder. Research investigating neuroimaging and neuromodulation approaches as neural treatment, suggests that these are innovative tools that may modulate food-related reward processes and thereby suppress the binges. In order to predict treatment outcomes of BED, future studies need to further examine emotion regulation and the genetics of BED, the altered neurocircuitry of the disorder, as well as the role of neurotransmission networks relatedness to binge eating behavior.