Michael Levine's Eating Disorders Prevention/Sociocultural Factors Newsletter
NO. 71: (i) Professional Issues; (ii) Technology; (iii) Dis/Embodiment; (iv) COVID-19 & EDs; (v) DE (n = 3); (vi) Comorbidity, Part 1 (n = 2); and (vii) Nature of EDs, Part 9 (n = 2)
Colleagues (N now = 1225 in 48 countries),
Please (a) continue to send me any and all announcements (e.g., conferences, awards, webinars, prevention resources, your recent publications); and (b) pass along the following to anyone who would like to join this free email list, or who may be interested in joining
PREVENTION-FOCUSED JOB OPPORTUNITY
Full-time 1-2-Year (or more) Research Coordinator at the
Eating Anxiety Treatment (EAT) Lab at the University of Louisville
Under the direction of [our own] Dr. Cheri Levinson (USA)
Facilitating a School-Based Eating Disorder A Prevention Program (the Body Project)
Application Deadline: Rolling, ending November 1, 2024
Start Date: As Soon as Available
Received via a 23 September 2024 everything-is-advocacy email from Ms. Abigail McCarthy, B.S., Lead Research Coordinator, on behalf our own Dr. Cheri Levinson (USA; see #5 and #6 below), Founder and Director of the Eating Anxiety Laboratory at the University of Louisville.
ML NOTE 1: Dr. Levinson, her colleagues at the EAT Lab, and I would appreciate it if you would pass this opportunity along to (a) any and all people who might be qualified and interested, and/or (b) those who mentor, supervise, and otherwise work with such people.
ML NOTE 2: In my opinion, in the less than 10 years since she obtained her Ph.D., Dr. Cheri Levinson has emerged as one of the world’s foremost scientist-practitioner-mentors in the field of clinical psychology/clinical science. Thus, for those of you who are undergraduates or recent college/university graduates and/or who are teaching/mentoring such people, I call your attention to Dr. Levinson's statement below (which I have put in bold-for-emphasis) that this [Research Coordinator "position] is ideal for someone wanting to go to graduate school in a health-related field."
[Announcement sent by Ms. McCarthy; bold-for-emphasis added by ML]
Full time Research Coordinator at the EAT Lab:
Dr. Levinson, the Director of the Eating Anxiety Treatment (EAT) Lab at the University of Louisville (UofL), is hiring a full-time research coordinator.
The position will involve working with middle and high school students through a Jewish Heritage Fund for Excellence (JHFE) funded study that entails facilitating a school-based eating disorder prevention program (the Body Project) and work on several other studies, including several clinical trials.
This role will require communication with school counselors to schedule body project sessions, providing self-report questionnaires to students, leading body project sessions during students’ health classes, managing body project data, leading body project trainings, and communication with lab members to gather volunteers for body project sessions. This role will also involve working on grant proposals and publications, conducting diagnostic assessments, assisting with data preparation, assisting with institutional review board protocols, assisting with our ongoing NIH funded studies as needed, and working with a large interdisciplinary team at UofL.
The study coordinator will work very closely with Dr. Levinson and her team on a day-to-day basis.
Opportunities for involvement in publications and presentations at national conferences are available. Minimum experience is a bachelor’s degree in psychology or a related field. Research experience is a must. This position is ideal for someone wanting to go to graduate school in a health-related field. This is a one to two-year position with potential for renewal depending on funding and performance.
Interested applicants should send their CV, a cover letter, and names and contact for 3 references to Dr. Levinson at cheri.levinson@louisville.edu. More information on the EAT lab here: www.louisvilleeatlab.com.
Deadline is rolling and will end Nov 1 or when the position is filled. Start date is as soon available.
PROFESSIONAL DEVELOPMENT OPPORTUNITY
Reasons Eating Disorders Center presents its
3rd Annual ConnectED Virtual Learning Day!
A FREE one-day virtual conference (Includes up to 5 complimentary Continuing Education credits)
Friday, October 4th, 2024 from 10:30 am to 5:00 pm Central Time | 8:30 am - 3:00 pm Pacific | 11:30 am - 6:00 pm Eastern | 3:30 pm - 10:00 pm UTC
Featuring [our own] Dr. Nichole Hawkins (USA) and Four Others
We are excited to invite you for a FREE one day virtual event on Friday, October 4th, 2024 from 10:30am to 5:00pm Central Time to learn from Eating Disorder Thought Leaders nationwide.
Click here to see the Conference program.*
Our offering to you includes 5-complimentary Continuing Education credits.
Click Register to complete the registration form.
ConnectED was formed with recognition of the need to Connect clinical care professionals who are interested in expanding their knowledge about Eating Disorders. Whether you are a seasoned Eating Disorders professional or if you are just getting started, ConnectED’s Virtual Learning Day is jampacked with evidence-based therapeutic techniques and how to apply them to the specialized treatment of Eating Disorders. Let’s get connectED across the nation, while learning tools and techniques that you can take into your practice to better serve our patients with Eating Disorders.
*Featuring presentations by
Jamie Jones M.Ed, NCC, LPC-S, Program Director, The New Orleans Institute for Trauma and Compulsive Behaviors, River Oaks Hospital | [our own] Nicole Hawkins, PhD, CEDS-S, Chief Executive Officer at the Center for Change| Mishell Hashmi, PsyD, St. Louis Behavioral Medicine Institute, Director of the Eating Disorder Program and Licensed Clinical Psychologist | Marie Robles, RD, LDN, CEDS, Lead Dietitian at the River Oaks Eating Disorder Treatment Center | Anna Governale, LMFT, Reasons’ Director of Inpatient and Residential Services
Research Publication Categories in This Newsletter
(i) Professional Issues; (ii) Technology; (iii) Dis/Embodiment; (iv) COVID-19 & EDs; (v) DE (n = 3); (vi) Comorbidity, Part 1 (n = 2); and (vii) Nature of EDs, Part 9 (n = 2)
CONGRATULATIONS to our own
Drs. Kyle Ganson (Canada) and Douglas Bunnell (USA) for publication of the Professional Issues article in #1.
Dr. Cheri Levinson (USA) and colleagues, including Ms. Anna Marie Ortiz (USA; first author, #5) and Dr. Jamie-Lee Pennesi (Australia; #6), for publication of the Disordered Eating research articles in #5 and #6.
Dr. Stephen Touyz (Australia) and colleagues for publication of the Disordered Eating research article in #7.
Dr. Caitlin Martin-Wagar (USA) and colleague for publication of the Comorbidity research article in #8.
Dr. Sarah Racine (Canada) and colleagues for publication of the Comorbidity research article in #9.
Professional Issues
1. Ganson, K. T., & Bunnell, D. W. (2024). Building the representation of male mental health professionals in eating disorder treatment. Eating Disorders: The Journal of Treatment & Prevention. Advance online publication. https://doi.org/10.1080/10640266.2024.2405291
Email address for correspondence: kyle.ganson@utoronto.ca
ABSTRACT. Male mental health professionals (e.g., social workers, psychologists) are a minority of providers in eating disorder treatment spaces, and there is a drastic need to increase their representation in this clinical area. This Last Word outlines the barriers that impede male mental health professionals from specializing in eating disorder treatment, such as masculine gender norms, and provides four specific recommendations to enhance training, hiring, retention, and the development of male mental health professionals in the treatment of people with eating disorders.
These recommendations include, developing gender awareness, specialized training, talking about gender, and gender and relationships. Building the representation of male mental health professionals in eating disorder treatment may reduce stigma and myths about these disorders and have positive impacts on clients across genders.
Technology and Public Policy
2. Benbow, D. I. (2024). ‘Don’t panic, don’t panic’: An analysis of a purported pro-eating disorder website/online content moral panic and legal and policy responses. Information & Communications Technology Law. Advance online publication. https://doi.org/10.1080/13600834.2024.2404283
Full text available for download, perhaps for a limited time, at: https://www.tandfonline.com/doi/full/10.1080/13600834.2024.2404283#abstract
Email address for correspondence: d.benbow@sheffield.ac.uk
ABSTRACT. It has been argued that newspaper responses to pro-eating disorder websites, within the United Kingdom (UK), constitute a moral panic. It is feared that moral panics may spur rash legal/policy responses. My analysis indicates that the consideration of pro-eating disorder websites by British newspaper journalists and others does not constitute a moral panic. I argue that the misuse of the moral panic concept exemplifies the dominance of emotivism within contemporary culture and may trivialise potential online harms and serve as an apologia for surveillance/digital capitalism.
I contend that pro-eating disorder websites are potentially harmful and assess legal and policy responses, such as the Online Safety Act 2023 and the advancement of the digital commons. I also contend that the increase in the number of people suffering with eating disorders within the UK should be addressed by devoting more resources for research into, and the prevention and treatment of, eating disorders.
Dis/Embodiment
3. Machorrinho, J., Veiga, G., Marmeleira, J., & Duarte Santos, G. (2024). Echoes of a living body: A mind-body approach on how women victims of intimate partner violence experience their bodies. Health Care for Women International. Advance online publication. https://doi.org/10.1080/07399332.2024.2404544
Email address for correspondence: jipm@uevora.pt
ABSTRACT. Intimate partner violence (IPV) against women is a worldwide health problem. IPV impact on women’s embodiment remains embedded in their narratives. However, the subjective complexity of victims’ embodiment and its impact on healthcare still urges to be understood. We aimed to understand (i) how women victims of IPV experience their bodies and (ii) the impact of IPV in their embodiment.
From a thematic analysis of six interviews with women victims, four themes arouse: Living body, Reaction to adversities, Impact of violence and Identity. Participants revealed a tendency to perceive negative bodily sensations, the body as restrictive of their ability to react to illnesses and other adversities, and impacts on health and decision-making processes. We encourage healthcare providers to be responsive to the feelings of physical and psychological exhaustion experienced by victims and highlight the potential of promoting positive bodily experiences in the support given to women.
COVID-19 and Eating Disorders
4. Sonne, H., Kildegaard, H., Strandberg-Larsen, K., Rasmussen, L., Wesselhoeft, R., & Bliddal, M. (2024). Eating disorders in children, adolescents, and young adults during and after the COVID-19 pandemic: A Danish nationwide register-based study. International Journal of Eating Disorders. Advance online publication. https://doi.org/10.1002/eat.24295
Full text available for download at: https://onlinelibrary.wiley.com/doi/full/10.1002/eat.24295
ABSTRACT. Objective: To assess incidence rates of clinically diagnosed eating disorders among Danish youth before, during, and after the COVID-19 pandemic. Method: This study used a population-based time series analysis with individual-level data from Danish healthcare registries.
Participants included all Danish individuals aged 6–24 years from January 1, 2015, to December 31, 2023. Monthly incident cases of any eating disorder, anorexia nervosa, and bulimia nervosa were analyzed using interrupted time-series analysis. We estimated the cumulative number of excess cases of incident eating disorder diagnoses and risk ratios (RR) associated with the pandemic and post-pandemic periods compared with pre-pandemic predictions.
Results: The study population encountered a mean of 1,310,542 individuals during the study period. The study included 11,693 individuals diagnosed with an eating disorder, median age 17 (IQR 14–20 years). Incident cases increased during the pandemic (RR 1.29, 95% CI 1.15–1.45) and normalized post-pandemic (RR 1.07, 95% CI 0.91–1.25) compared with pre-pandemic predictions. Similar patterns were seen for anorexia and bulimia. Increases were significant for ages 13–16 (RR 1.19, 95% CI 1.02–1.38), 17–19 (RR 1.51, 95% CI 1.25–1.83), and 20–24 (RR 1.35, 95% CI 1.12–1.64). Post-pandemically, a continued increase was observed only for ages 20–24 (RR 1.32, 95% CI 1.02–1.71).
Conclusions: The study documents a temporary increase in diagnosed eating disorders among Danish youths during the COVID-19 pandemic, with rates later returning to pre-pandemic levels. These results provide insights into the pandemic's impact on adolescents and youths.
Disordered Eating
5. Ortiz, A. M. L., Butler, R. M., & Levinson, C. A. (2025). Personalized assessment of eating disorder cognitions during treatment: A new measure of cognitive pathology change. Journal of Affective Disorders, 368, 329-336. https://doi.org/10.1016/j.jad.2024.09.103
Email address for correspondence: annamarie.ortiz@louisville.edu
ABSTRACT. Objective: Modifying cognitive distortions, or thinking errors, is crucial in eating disorders (ED) treatment. To address the lack of a personalized measure for ED cognitions, the Thought Inventory was developed. The study aimed to establish its feasibility and validity, identify thinking error contents and types, examine changes in belief of irrational thoughts, and investigate associations with change in ED symptoms. Hypotheses, procedure, and planned analyses were pre-registered to ensure transparency.
Methods: Participants (N = 55) completed the Thought Inventory, the Eating Disorder Examination Questionnaire, the Eating Pathology Symptom Inventory, the Frost Multidimensional Perfectionism Scale, the Beck Depression Inventory, and the Penn State Worry Questionnaire at pre-and post-ten weeks of treatment. Using the Thought Inventory, participants collaborated with study therapists to identify ED-related thinking errors and rate the degree of belief in these thoughts on a scale of 0 to 100 %.
Results: Cognitions primarily contained self-judgments, food rules, and concern over shape, while catastrophizing/fortune telling, emotional reasoning, and should/must statements were the most common types of thinking errors. Belief in cognitions significantly decreased over treatment and change in thought belief was positively associated with change in ED symptoms. Conclusion: The Thought Inventory shows promise as a personalized measure. Future research should explore whether ED cognitions, assessed in this manner, are a mechanism of change in ED treatment.
6. Sandoval-Araujo, L. E., Pennesi, J.-L., & Levinson, C. A. (2024). Shame, guilt, and pride moderate the relationship between social appearance anxiety and eating disorder symptoms. Journal of Psychopathology and Behavioral Assessment. Advance online publication. https://doi.org/10.1007/s10862-024-10170-z
Full text available for download at: https://link.springer.com/article/10.1007/s10862-024-10170-z#citeas
ABSTRACT. Eating disorders (EDs) and social anxiety disorder (SAD) are highly comorbid. Research to date suggests that social appearance anxiety (SAA), or fear of negative evaluation based on appearance is a type of social anxiety most related to EDs. Additionally, shame, guilt, and pride have each been shown to play a role in both EDs and SAD; however, they are yet to be explored as potential moderators of the relationship between SAA and ED symptoms.
The current study tests if shame, guilt, and pride moderate the relationship between SAA and ED symptoms. Using an aggregate dataset of clinical and non-clinical samples (N = 1911), linear regressions were used to examine shame, guilt, and pride as moderators of the relationship between SAA and ED symptoms. We found that the relationship between SAA and ED symptoms was moderated by shame, guilt, and pride, such that at high levels of shame or guilt and low levels of pride, SAA was associated with increased ED symptoms.
These findings suggest that shame and guilt may amplify, and pride may minimize, the relationship between SAA and ED symptoms. This research highlights the importance of assessing for high levels of SAA, shame, and guilt, and low levels of pride, independently, and in combination, to identify individuals at highest risk for developing ED symptoms. Future research should explore whether interventions targeting those with most at risk combinations helps to reduce ED symptoms.
7. Pehlivan, M. J., Okada, M., Miskovic-Wheatley, J., Barakat, S., Touyz, S., Simpson, S. J., Griffiths, K., Holmes, A., & Maguire, S. (2024). Eating disorder risk among Australian youth starting a diet in the community. Appetite. Advance online publication. https://doi.org/10.1016/j.appet.2024.107685
Full text available for download at: https://www.sciencedirect.com/science/article/pii/S0195666324004884
ABSTRACT. Dieting is a potent risk factor for eating disorder (ED) symptoms and development, which typically occur in late adolescence. However, as diets are often motivated by body image concerns (another core ED risk factor), dieters may already carry heightened ED risk. Thus, the current study aimed to document ED risk among young people starting a diet in the community. Young people (16-25 years) starting or intending to start a self-initiated diet (N = 727) provided data via a screener questionnaire, assessing containing sociodemographic factors, past and current ED symptoms and behaviours.
Over a third (36.9%) screened using a validated instrument were found to be at-risk of a current ED, with 10% above the clinical cut-off. Consistent with this finding, over 10% of the sample self-reported experiencing a lifetime ED, while nearly a quarter reported symptoms consistent with an ED diagnosis with no reported formal diagnosis. Findings suggest a high level of ED risk among young people starting a diet in the community and point to the need for more proactive measures targeted at this cohort (e.g., screening, monitoring). Further education on the risks of dieting and encouragement for help-seeking in young people is indicated.
Comorbidity, Part 1 of 2
8. Thompson, C. J., & Martin-Wagar, C. A. (2024). Cognitive flexibility and emotion regulation in eating disorder patients with comorbid generalized anxiety and posttraumatic stress symptoms. Eating Disorders: The Journal of Treatment & Prevention. Advance online publication. https://doi.org/10.1080/10640266.2024.2405290
Email address for correspondence: Caitlin.Martin-Wagar@umontana.edu
ABSTRACT. Research has found that difficulties in emotion regulation negatively impact mental health, whereas cognitive flexibility may promote stress resilience and positive mental health. Little is known about cognitive flexibility and emotion regulation in people with comorbid eating disorder (ED) and anxiety and stress disorders. A transdiagnostic ED population (N = 227) at an outpatient ED treatment facility completed several self-report instruments that measured cognitive flexibility, emotion regulation difficulties, posttraumatic stress disorder (PTSD) symptoms, and generalized anxiety disorder (GAD) symptoms upon admission.
We investigated cognitive flexibility and emotion regulation differences for those with an ED without comorbidity and those with various combinations of comorbidity. In a one-way between-groups ANOVA, we investigated differences in cognitive flexibility for those with GAD, PTSD, neither, and both comorbidities. We found a statistically significant difference between these groups, with mean cognitive flexibility inventory scores being the lowest in the group with both comorbidities. However, when controlling for emotion regulation, a one-way between-groups ANCOVA indicated no significant differences in cognitive flexibility between comorbidity groups F(3, 222) = 1.20, p = .31 Partial η2 = .02.
Though self-reported cognitive flexibility levels differ among ED patients with and without comorbidities, it appears that these differences are better explained by emotion regulation. Therefore, addressing emotion regulation early in treatment for all individuals with EDs, regardless of comorbidity, is recommended as a future research focus to enhance treatment outcomes. Further research is needed to understand the impact of treating emotion regulation on ED treatment engagement, dropout, and effectiveness.
9. Miller, A. E., Bicaker, E., Trolio, V., Falk, C. F., White, C., Zhu, L. Y., & Racine, S. E. (2024). Capturing the experience of borderline personality disorder symptoms in the daily lives of women with eating disorders. Journal of Psychopathology and Clinical Science. Advance online publication. https://doi.org/10.1037/abn0000953
Email address for correspondence: Sarah.Racine@mcgill.ca
ABSTRACT. Borderline personality disorder (BPD) is highly comorbid with eating disorders (EDs), and comorbid ED–BPD is associated with a worse clinical presentation and treatment outcomes. Understanding how BPD symptoms manifest in the daily lives of those with EDs and predict momentary ED symptoms has important treatment implications.
This study: (a) compared the nine BPD symptoms, assessed across 14 days, in individuals with comorbid ED–BPD, only an ED, and no ED; and (b) examined average and momentary relationships between BPD symptoms and specific ED symptoms (i.e., binge eating, purging, restriction, and maladaptive exercise) in women with EDs. Individuals with comorbid ED–BPD (n = 60), only an ED (n = 114), and controls (n = 47) completed 14 days of ecological momentary assessment.
All BPD symptoms except affective instability were more common in individuals with comorbid ED–BPD than those with only an ED. Affective instability and paranoia/dissociation had the largest effect sizes, indicating the greatest differences across groups. Individuals with more frequent abandonment avoidance, anger, identity disturbance, paranoia/dissociation, and self-harm over the 14 days engaged in more frequent binge eating, while those with greater emptiness engaged in more frequent restriction and maladaptive exercise.
Momentary affective instability predicted an increased likelihood of binge eating, while momentary interpersonal difficulties predicted a decreased likelihood of binge eating, at the next prompt. This study highlights the importance of considering BPD symptoms in the treatment of individuals with EDs to improve their clinical outcomes and quality of life
Nature, Course, and Correlates of Eating Disorders, Part 9 of 9
10. Martini, M., Longo, P., Toppino, F., De Bacco, C., Preti, A., Abbata-Daga, G., & Panero, M. (2024). The structure of motivation: Assessing readiness to change dimensions and their predictive value with the network validation of the Italian version of the Anorexia Nervosa Stages of Change Questionnaire. European Eating Disorders Review. Advance online publication. https://doi.org/10.1002/erv.3133
Email address for correspondence: giovanni.abbatedaga@unito.it
ABSTRACT. Objective: Motivation to change is an important predictor for treatment outcomes in individuals with anorexia nervosa (AN), however, the existence and clinical relevance of distinct motivational dimensions are understudied. This study aimed to structurally validate the AN Stage of Change Questionnaire (ANSOCQ) in the Italian adult AN population to identify separate motivational dimensions and their association with clinical variables and outcomes.
Method: Inpatients and outpatients with AN (N = 300) completed the ANSOCQ and measures assessing eating and depressive psychopathology. Unique Variable Analysis and Exploratory Graph Analysis were employed to identify dimensions in the network structure of ANSOCQ. Cross-sectional associations with clinical variables were assessed in the whole sample. Predictive value on weight and psychopathology was assessed in inpatients.
Results: Two dimensions were identified, one comprising items relative to weight gain, and the second items regarding attitudes towards eating, body, and emotional problems. Feelings associated with eating resulted as most central in the network. Higher scores in the first dimension and ANSOCQ total predicted weight gain during hospitalisation. No significant predictors emerged for changes in eating psychopathology.
Discussion: These findings confirm the robust psychometric properties of ANSOCQ and provide support for the use of its subdimensions in clinical practice.
11. Uniacke, B., van den Bos, W., Wonderlich, J.., Ojeda, J., Posner, J., Steinglass, J. E., & Foerde, K. (2024). Altered learning from positive feedback in adolescents with anorexia nervosa. Journal of the International Neuropsychological Society. Advance online publication. https://doi.org/10.1017/S1355617724000237
Full text available for download at: https://tinyurl.com/3jus3244
ABSTRACT. Objective: Anorexia nervosa (AN) is characterized by severe restriction of calorie intake, which persists despite serious medical and psychological sequelae of starvation. Several prior studies have identified impaired feedback learning among individuals with AN, but whether it reflects a disturbance in learning from positive feedback (i.e., reward), negative feedback (i.e., punishment), or both, and the extent to which this impairment is related to severity and duration of illness, has not been clarified.
Method: Participants were female adolescents with AN (n = 76) and healthy teen volunteers (HC; n = 38) between the ages of 12-18 years who completed a probabilistic reinforcement learning task. A Bayesian reinforcement learning model was used to calculate separate learning rates for positive and negative feedback. Exploratory analyses examined associations between feedback learning and duration of illness, eating disorder severity, and self/parent reports of reward and punishment sensitivity.
Results: Adolescents with AN had a significantly lower rate of learning from positive feedback relative to HC. Patients and HC did not differ in learning from negative feedback or on overall task performance measures. Feedback learning parameters were not significantly associated with duration of illness, eating disorder severity, or questionnaire-based reports of reward and punishment sensitivity. Conclusion: Adolescents with AN showed a circumscribed deficit in learning from reward that was not associated with duration of illness or reported sensitivity to reward or punishment. Subsequent longitudinal research should explore whether differences in learning from positive feedback relate to course of illness in youth with AN.