Michael Levine's Eating Disorders Prevention/Sociocultural Factors Newsletter
NO. 165: (i) Epidemiology (n = 3); (ii) Fat Talk; (iii) Family Factors; (iv) Binge Eating, Part 2 (n = 3); and (v) Nature, Course, and Correlates of EDs, Part 7 (n = 3)
Colleagues (N now = 1387 in 50 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.
EVERYTHING IS ADVOCACY
Addressing the Stigma and Limited Narratives of Eating Disorders in South Korea
[our own] Jeannie Park (South Korea) reportS from the front lines
Received 15 July 2025 via an everything-is-advocacy email from our own Jeannie Park (South Korea).
ML NOTE 1: Jeannie and I would appreciate if you would (a) contact her directly (rabbitsubmarinecol@gmail.com) if you have any advice, ideas, and/or other forms of support you can offer her as she engages in her important advocacy work.
ML NOTE 2: If you are interested in an inspiring example of how “the personal is the political is the personal”, see all 14 of her essays written for our own Dr. June Alexander’s (Australia) Life Stories Diary Newsletter (https://lifestoriesdiary.com). These essays are available at https://lifestoriesdiary.com/contributors/jeannie-park/.
[Jeannie writes:]
I'm reaching out now to share a public statement recently released by our grassroots collective in Korea, Rabbits in Submarines, in response to the July 11 KBS broadcast Children Who Can’t Swallow. I collaborated closely with the producers, and while the program marked a significant step in raising public awareness, it also reflected the lingering stigma and narrative constraints that continue to shape how eating disorders are portrayed.
In our statement, we addressed these limitations—but above all, we condemned the government’s ongoing failure to act. Korea still has no national strategy, no prevalence data, and no functioning care infrastructure. Psychiatric professionals, too, have often failed to uphold ethical or inclusive standards. That’s why we are calling not only for systemic reform, but for the leadership of those with lived experience in shaping every step—from policy design to public education. Without that, the cycle of misrecognition and neglect will only continue.
You can read the full statement here:
Child and Adolescent Eating Disorders Can No Longer Be Ignored
We hope this message resonates beyond our borders.
Warm regards,
Jeannie Park | Author, Swallowing Practice | Founder, Rabbits in Submarines Collective | Seoul, South Korea
REQUEST FOR SURVEY PARTICIPATION BY AND/OR ASSISTANCE RECRUITING
Health Professionals Currently Working with Patients Managing Chronic Health Conditions
from our own Dr. Kristen Murray, School of Medicine and Psychology, The Australian National University
for a study entitled
Healthcare Training Needs for Body Image in Patients with Chronic Health Problems
Received this morning (California time) 17 July 2025 via an email from our own Dr. Kristen Murray (Australia).
ML NOTE 3: Dr. Murray and I would appreciate it if you would (a) participate in this study if you and eligible; and (b) pass this request along to any and all who might be interested in participating in this survey and qualified to do so, or who work with such people.
ML NOTE 4: Of course, participation in this study is voluntary. AND there are at least 200 qualified people who are members of this Newsletter Group. Just sayin’ . . . .
[Dr. Murray writes; bold in the original:]
Invitation to Participate in Healthcare Training Needs for Body Image in Patients with Chronic Health Problems
We hope this email finds you well. We are a team of researchers from the Australian National University and University of Canberra. We are writing to invite you to take part in a current project seeking to identify training needs for body image concerns among healthcare professionals working in Australia, New Zealand, Canada, the United Kingdom and the United States of America. We are seeking the involvement of diverse health professionals including:
Dietitians
Exercise physiologists
Nurses and midwives
Occupational therapists
Psychologists
Physicians (e.g., GPs etc)
Physiotherapists
Social workers
More specifically, we are seeking health professionals currently working with patients managing chronic health conditions (e.g., cancer, arthritis, and diabetes) to complete a 15–20-minute survey via Qualtrics asking about your current practice, beliefs and approaches to body image, barriers to body image practice, and your training needs in this area. The project is led by a multidisciplinary team of researchers from the Australian National University and University of Canberra and seeks the views of clinicians working across a range of conditions so that we can understand support needs which are sensitive to the scope and role of diverse health professionals.
Participation is voluntary and anonymous, and ethical aspects of this project have been approved by the ANU Human Research Ethics Committee (Protocol No. H/2024/0488).
For more information about the study or to participate, click here: https://anu.au1.qualtrics.com/jfe/form/SV_2i3PJjnDIALU6BU
If you know of other healthcare professionals who meet eligibility criteria and who might be interested in taking part, please feel free to forward this email.
Dr Kristen Murray (she/her) | Associate Professor and Clinical Psychologist, School of Medicine and Psychology | ANU College of Health & Medicine, Room 115, Building 39 | 39 Science Road | The Australian National University | Email: kristen.murray@anu.edu.au | W: psychology.anu.edu.au
Research Publication Categories in This Newsletter
(i) Epidemiology (n = 3); (ii) Fat Talk; (iii) Family Factors; (iv) Binge Eating, Part 2 (n = 3); and (v) Nature, Course, and Correlates of EDs, Part 7 (n = 3)
CONGRATULATIONS to our own
Dr. Anthea Fursland (Australia) and colleagues, including distinguished scientist-practitioner Dr. Susan Byrne (Australia), for publication of the Epidemiology commentary in #1.
Drs. Kyle Ganson (Canada), Jason Lavender (USA), and Jason Nagata (USA) and colleague for publication of the Epidemiology research article in #2.
Dr. Karen Patte (Canada) and colleagues for publication of the Epidemiology research article in #3.
Drs. Andrea Goldschmidt (USA), Kathryn Smith USA), and Tyler B. Mason (USA) and colleagues for publication of the Binge Eating research article in #6.
Drs. April Smith (USA; see also #11), Thomas Joiner (USA), and Pamela Keel (USA) and colleagues for publication of the Binge Eating research article in #7.
Dr. K. Jean Forney (USA) and colleague for publication of the Binge Eating research article in #8.
Dr. Gemma Sharp (Australia) and colleagues for publication of the Eating Disorders research article in #10.
Shruti Kinkel-Ram (USA), Taylor Stanley (USA), Marley Billman Miller (USA), and Drs. Lindsay Bodell (Canada) and April Smith (USA) and colleague for publication of the Eating Disorders research article in #11.
EPIDEMIOLOGY
ML NOTE 5: The article described below in #1 is a response to the following, as presented in 17 June 2025 in Substack Newsletter NO. 153 (#3). Dr. Hiba Jebeile (Australia) is a member of this Newsletter Group.
Melville, H., Lister, N. B., Libesman, S., Seidler, A. L., Cheng, H. Y., Kwan, Y. L., Garnett, S. P., Baur L. A., & Jebeile, H. (2025). The prevalence of eating disorders and disordered eating in adults seeking obesity treatment: A systematic review with meta-analyses. International Journal of Eating Disorders. Advance online publication. https://doi.org/10.1002/eat.24483. [Full text available for download at: https://tinyurl.com/4v8j3v7a]
1. Byrne, S. M., McClelland, J., & Fursland, A. (2025). The overlooked burden of atypical anorexia nervosa: Commentary on Melville et al. (2025). International of Eating Disorders. Advance online publication. https://doi.org/10.1002/eat.24507
Full text available for download at: https://tinyurl.com/776hnrrz
ABSTRACT. Obesity and eating disorders (EDs) have historically been viewed as distinct conditions; however, emerging evidence suggests a significant overlap, particularly among individuals seeking obesity treatment. While binge-eating disorder (BED) is commonly identified in this population, restrictive EDs such as atypical anorexia nervosa (atypical AN) can go largely undetected. This paper comments on findings from Melville et al.'s systematic review of 85 studies assessing ED prevalence in adults with high Body Mass Index (BMI) seeking obesity treatment.
We highlight the striking absence of atypical AN diagnoses despite substantial evidence supporting its prevalence in broader populations. We explore several reasons for this under-recognition, including the definitional ambiguities of atypical AN in the DSM-5, limitations of assessment tools that emphasize binge eating, and weight stigma that tends to mask restrictive eating as “normal” dieting. The implications are significant: failure to identify atypical AN may lead to delayed or inappropriate care and reinforce harmful stereotypes that restrictive EDs only affect underweight individuals.
We argue for greater clinical vigilance, the refinement and clarification of diagnostic criteria and the development of validated tools for detecting atypical AN, particularly in higher-weight individuals. Clinicians, particularly those providing weight loss interventions, should be trained to identify restrictive eating irrespective of BMI and prioritize behaviors and psychological impairment over weight status. Recognizing atypical AN as a serious, underdiagnosed condition is critical to ensuring ethical, equitable and effective care across the weight spectrum, in both ED and weight-loss treatment settings.
2. Ganson, K. T., Testa A, Lavender, J. M., & Nagata, J. M. (2025). Prescription weight loss medication use and eating disorder psychopathology among adolescent boys and young men from Canada and the United States. Eating Behaviors, 58, 102013. https://doi.org/10.1016/j.eatbeh.2025.102013
Full text available for download at: https://tinyurl.com/57s5c575
ABSTRACT. This study aimed to identify the prevalence of prescription weight loss medication use among boys and men, describe the sociodemographic differences between those who did and did not report use, and explore differences in eating disorder attitudes and behaviors between those who did and did not report use. Data from 1543 boys and men from Canada and the United States aged 15 to 35 were analyzed. The prevalence of prescription weight loss medication use in the past 12 months was estimated. Fisher's exact tests and independent samples t-tests were used to determine the differences in sociodemographic identifiers and eating disorder attitudes and behaviors between those who did and did not use prescription weight loss medication.
Among the sample, 1.2 % (n = 19) reported use of prescription weight loss medication in the past 12 months. Those who reported use of prescription weight loss medication were significantly older and had significantly higher body mass index compared to those who did not report use. Any loss of control while eating, binge eating, and purging via vomiting in the past 28 days were all more common among those who reported the use of prescription weight loss medication. Eating disorder psychopathology was also significantly higher among those who reported the use of prescription weight loss medication.
These preliminary findings underscore that eating disorder attitudes and behaviors may be more prevalent among boys and men who use prescription weight loss medication, emphasizing the need for more research to understand these novel findings.
3. Zheng, L., Pickett, W., Liu, J., Leatherdale, S. T., & Patte, K. A. (20250). Measurement invariance of a brief disordered eating scale in a large sample of secondary school students in Canada. Journal of Eating Disorders, 13(1), 132. https://doi.org/10.1186/s40337-025-01332-9
Full text available for download at: https://tinyurl.com/39739chn
ABSTRACT. Background: For use in population-level surveys, there is a need for brief measures of disordered eating (DE) that demonstrate validity among diverse adolescents. This study aimed to (1) assess the measurement invariance of a short DE scale among high school students in Canada, and (2) estimate differences in scale scores across student sociodemographic subgroups.
Methods: We used student-level survey data collected during the 2021/2022 school year in the COMPASS study. The sample included 24,639 students in grades 9–12 from 69 secondary schools in Alberta, British Columbia, and Ontario, Canada. Multi-group confirmatory factor analysis was applied to assess measurement invariance (i.e., configural, metric, scalar, and strict invariance) of the 6-item DE scale, and one-way ANOVA and mixed linear regression were implemented to estimate scale score differences across population subgroups (by grade, gender, race and ethnicity, family affluence, and weight status).
Results: Results demonstrated full measurement invariance of the DE scale across student sociodemographic subgroups. Higher sum scale scores indicated greater engagement in DE thoughts or behaviours. Students in higher school grade (e.g., grade 12), transgender and gender diverse youth, and cisgender girls reported higher DE scores compared to their grade 9 and cisgender boy peers. Elevated DE scores were also observed among adolescents of Middle Eastern and Another or Multiethnic identity, students with less affluent households, and those with higher body weights, relative to their White, more affluent, and relatively lower weight peers, respectively.
Conclusions: Results indicate the DE scale measures the same construct across various subgroups of adolescents, providing confidence that differences in scale scores found by grade, gender, race and ethnicity, affluence, and weight reflect actual differences in DE rather than artifactual differences in scale interpretation. This scale warrants additional psychometric testing as a promising brief DE measure suitable for large population-level youth surveys. Our results provide important new evidence from a large contemporary sample of adolescents demonstrating elevated risk of DE among specific subgroups and emphasizing the need for targeted interventions.
FAT TALK
4. Calisto, J., Salazar, C., Seco, M., Vergara-Barra, P., & Leonario-Rodriguez, M. (2025). Women report worse metrics of positive body image and fat talk: Findings of an exploratory study in a Chilean sample. Fat Studies. Advance online publication. https://doi.org/10.1080/21604851.2025.2518767
Full text available for download at: https://tinyurl.com/mr29ny2b
ABSTRACT. This study aimed to investigate the correlation between a positive body image and fat talk, along with the influencing factors shaping their relationship within a cohort of Chilean participants. A cross-sectional exploratory study was undertaken, with variables drawn from the Body Appreciation Scale (BAS) and the Fat Talk Questionnaire (FTQ). Body image distortion was gauged through anthropometric measurements juxtaposed with Standard Figural Stimuli (SFS).
Women exhibited lower levels of body image positivity in comparison to men (p = 0,049), coupled with a statistically significant elevation in exposure to fat-phobic discussions (p = 0,005). Remarkably, these two variables were associated irrespective of gender, age, nutritional status, or socioeconomic status within the evaluated population.
FAMILY FACTORS
5. Zissu, B., Sher, H. & Slobodin, O. (2025). Transgenerational transmission of eating disorders: the role of eating disorder symptoms and socio-cultural attitudes. Journal of Eating Disorders, 13, 137. https://doi.org/10.1186/s40337-025-01317-8
Full text available for download at: https://tinyurl.com/2sbp9nbd
ABSTRACT. Objective: Eating disorders may be transmitted from one generation to the others through various trajectories, including genetic and epigenetic factors, parent–child relationships, and behavioral factors. In the current study, we examined whether parents' eating disorder symptoms and sociocultural attitudes toward appearance are associated with the diagnosis of an eating disorder or the level of eating disorder symptoms among female adolescents and young adults, and the nature of these associations. We also examined whether fathers' and mothers' effects on offsprings' eating disorder symptoms interact.
Method: The study included 65 triads of mothers, fathers, and their female offspring aged 11–22 (N = 195). Thirty-two offspring were diagnosed with an eating disorder and recruited from the in-patient eating disorder unit in a public hospital. The remaining 33 offspring, who formed the control group, were recruited via social media platforms.
Results: In contrast to our expectations and previous findings, mothers' and fathers' levels of eating disorder symptoms and sociocultural attitudes toward appearance were negatively associated with their offspring's eating disorder symptoms. Also, inconsistent with mental health studies that showed that the behaviors and attitudes of one parent are exacerbated or attenuated by the other parent, we failed to find an interaction effect between mothers' and fathers' variables on their offspring's level of eating disorder symptoms.
Discussion: The current study adds to the limited number of studies that focused on fathers in the transgenerational transmission of eating disorders and encourages further research on the effects of each parent and the combined effects of both in the development and maintenance of eating disorders in their offspring.
BINGE EATING, Part 2 of 4
6. Goldschmidt, A. B., Mason, T., Smith, K. E., Hipwell, A. E., Stepp, S. D., & Keenan, K. (2025). Shared and unique risk factors for binge eating and binge drinking in a community-based sample of girls. Research on Child Adolescent and Psychopathology. Advance online publication. https://doi.org/10.1007/s10802-025-01342-w
Email address for correspondence: goldscha@pitt.edu
ABSTRACT. Binge eating and binge drinking commonly onset in adolescence and frequently co-occur with one another, especially among females. Understanding shared and unique risk factors for these behaviors can inform etiological models and elucidation of common and specific prevention/intervention targets.
We analyzed self-report data from 1,994 participants of the Pittsburgh Girls Study, a population-based longitudinal study of behavioral and emotional development. We used path analysis to examine the impact of age 14 predictor variables on age 16 binge eating and drinking, adjusting for these behaviors at age 14. We hypothesized that greater negative emotionality, sensation-seeking, and impulsivity would be shared risk factors, whereas higher body mass index and thinness expectancies would be unique to binge eating, and positive alcohol expectancies would be unique to binge drinking.
Results showed little comorbidity between binge eating and drinking (1.9% at age 14; 4.4% at age 16). Of the three hypothesized shared risks, only age 14 negative emotionality was associated with both binge eating and drinking at age 16; sensation-seeking was associated with binge drinking only and impulsivity was unrelated to either outcome. None of the hypothesized unique risk factors were associated with binge eating. Contrary to hypotheses, positive alcohol expectancies were related to both binge eating and drinking.
While this study requires replication and extension to a greater spectrum of putative risk factors, findings suggest that negative emotionality and positive alcohol expectancies, but not impulse control or appearance-related factors, may be viable targets for unified prevention/treatment protocols delivered in community settings.
7. Vides-Varini, H. F., Ali, S. I., Smith, A. R., Joiner, T. E., & Keel, P. K. (2025). Examining the impact of ethnoracial status on drive for thinness and bulimic symptoms in women. Eating Behaviors, 58, 102008. https://doi.org/10.1016/j.eatbeh.2025.102008
Email address for correspondence: keel@psy.fsu.edu
ABSTRACT. Objective: We sought to examine (1) the effects of ethnoracial status on Drive for Thinness (DT) and bulimic symptoms in a large sample of women, and (2) whether the strength of the association between DT and bulimic symptoms differed among ethnoracial groups.
Method: Participants (M age = 19.59 years) from five ethnoracial groups (n = 14 American-Indian/Alaska Native, n = 233 Asian, n = 186 Black, n = 125 Hispanic White, and n = 990 non-Hispanic White), completed Eating Disorder Inventory (EDI; Garner et al., 1983) scales.
Results: EDI DT scores were significantly lower in Black women compared to both Hispanic and non-Hispanic White women. EDI Bulimia scores were significantly lower in Black women compared to Asian, Hispanic, and non-Hispanic White women. No significant differences were observed among Asian, Hispanic, or non-Hispanic White women. Ethnoracial status moderated the association between DT and Bulimia scores, with a significantly weaker association in Black women compared to Asian, Hispanic, and non-Hispanic White women.
Discussion: Findings refute misconceptions that disordered eating uniquely impacts White women and support a nuanced understanding of how ethnoracial status may influence eating disorder risk. Future work should examine sociocultural factors unique to ethnoracial subgroups to inform more targeted and effective intervention strategies.
8. Rezeppa, T. L., & Forney, K. J. (2025). Intuitive eating may underlie the link between food insecurity and binge eating in college students. Appetite, 214. Advance online publication. https://doi.org/10.1016/j.appet.2025.108147
Full text available for download at: https://tinyurl.com/3x5fzdt7
ABSTRACT. College students endorse high rates of food insecurity, a risk factor for binge eating. Intuitive eating practices are protective against disordered eating and may attenuate the relationship between binge eating and food insecurity. The current study tested domains of intuitive eating (i.e., reliance on hunger and satiety cues and eating for physical rather than emotional reasons) as moderators of the association between food insecurity severity and binge eating. Data were collected from 493 college students (90.1% non-Hispanic White; 68.6% cisgender female) between the ages of 18 and 25.
Food insecurity was positively correlated with binge eating, and the intuitive eating domains were negatively correlated with binge eating (ps < 0.01). Intuitive eating domains explained variance in binge eating beyond food insecurity severity but did not moderate the food insecurity-binge eating association (ps = 0.790 and 0.994). Instead, post hoc analyses revealed that reliance on hunger and satiety cues accounted for the relationship between food insecurity and binge eating (indirect effect 95% CI [0.04, 0.25]). Further post hoc analyses indicated that the association between food insecurity and binge eating was significant only among students with a campus meal plan (p = .005).
Taken together, findings suggest that increasing food access alone may be insufficient to reduce binge-eating risk; interventions may also need to support students in reconnecting with internal cues. Longitudinal research should examine whether improving interoceptive abilities reduces binge eating in the context of food insecurity. Findings underscore the potential utility of intuitive eating-based interventions across socioeconomic status and potential adaptations for food-insecure populations.
NATURE, COURSE, AND CORRELATES OF EDs, Part 7 of 7
9. Coughlan-Hopkins, S., & Martinelli, C. (2025). Social rejection sensitivity and its role in anorexia nervosa: A systematic review of experimental literature. Journal of Eating Disorders, 13, 134. https://doi.org/10.1186/s40337-025-01261-7
Full text available for download at: https://tinyurl.com/ms5jubas
ABSTRACT. Objective: Social rejection sensitivity (SRS) is characterised by anxious expectations of rejection, and the increased tendency to readily perceive and react intensely to rejection-based cues. It has been suggested SRS may play a role in anorexia nervosa (AN). Our review investigates whether SRS is exhibited in AN, and the cognitive mechanisms that underly this disposition. Method: We included experimental studies if they used social threat or rejection-based stimuli, reported on measures related to either cognitive, emotional, and/or behavioural responses, and compared patients with a diagnosis of AN and/or those who have recovered from the illness with healthy controls.
Results: This article identified 47 eligible studies, with risk of bias assessment indicating the research was of good quality. Main findings showed patients with AN exhibit attentional bias towards social rejection cues, negative interpretation bias during ambiguous social scenarios, and heightened negative affect during and following rejection-based experiences. Physiological blunting during and following rejection-based experiences was observed in AN with some evidence to suggest this remediates during the process of weight-restoration. demonstrating an incongruence between affective and somatic experience in active illness.
Discussion: Our results suggest females with AN display a cognitive profile that could lead to a tendency to expect rejection, readily perceive rejection and react with more intense negative affect to rejection-based cues, with limited evidence to suggest this cognitive profile persists in recovery. Our results can be interpreted through theoretical models that postulate drive for thinness may partially function to cope with anticipated or experienced rejection.
10. Lubieniecki, G., McGrath, I., & Sharp, G. (2025). A lifeline or a label? lived experience perspectives on the severe and enduring eating disorder (SEED) classification in eating disorder treatment. Journal of Eating Disorders, 13, 136. https://doi.org/10.1186/s40337-025-01335-6
Full text available for download at: https://tinyurl.com/2ku4vw7e
ABSTRACT. Objective: The classification of severe and enduring eating disorders (SEED) was introduced to acknowledge the chronic nature of eating disorders (EDs) that persist beyond standard treatment. However, concerns exist regarding its role in reinforcing prognostic pessimism, shaping clinician attitudes, and influencing patient identity and treatment trajectories. This study explores lived experience perspectives on SEED classification, examining how diagnostic language affects treatment access, psychological outcomes, and engagement with care.
Method: An online survey was employed to collect demographic and clinical history data, followed by in-depth online semi-structured interviews with 41 individuals with longstanding eating disorders across a range of diagnoses. Reflexive thematic analysis examined participants’ experiences of SEED.
Results: Three key themes emerged: [1] SEED as a paradoxical classification, with participants describing the term as both validating and restrictive; [2] SEED as a justification for treatment withdrawal, with clinicians and services interpreting the classification as an indicator of treatment futility, contributing to reduced care opportunities and systemic exclusion; and [3] redefining SEED through recovery-oriented frameworks, with participants advocating for alternative terminology, such as “longstanding eating disorder,” and treatment models prioritising harm reduction, step-down care, and sustained engagement.
Discussion: These findings suggest that SEED classification is not merely a descriptor but actively shapes treatment options, patient agency, and long-term engagement with care. The inferred association between SEED and “treatment resistance” contributed to exclusion from services and reinforced therapeutic nihilism. Participants suggested the need for person-centred, recovery-oriented language and clinical frameworks that support continued access to care rather than rigid prognostic assumptions. Further research is needed to examine how chronicity-based classifications influence clinician decision-making, resource allocation, and stigma, informing more inclusive and responsive treatment models.
11. Frietchen, R. E., Kinkel-Ram, S. S., Stanley, T. B., Billman Miller, M. G., Bodell, L., & Smith, A. R. (2025). Longitudinal investigation of pain catastrophizing, pain intensity, and suicidal ideation in women receiving residential treatment for an eating disorder. Eating Disorders: The Journal of Treatment & Prevention. Advance online publication. https://doi.org/10.1080/10640266.2025.2520573
Full text available for download at: https://tinyurl.com/257zuzut
ABSTRACT. Pain catastrophizing and pain intensity are related to suicidal thoughts and eating disorders. When individuals experience both high pain intensity and catastrophizing, they may experience higher levels of suicidal ideation (SI). Despite increased risk for SI in eating disorder (ED) populations, no research has examined the relationship between pain experience and suicidal thoughts using a longitudinal design. The current study tested the weekly relationships between pain catastrophizing and pain intensity on SI in a clinical sample of women engaged in residential ED treatment.
Female participants (N = 79; Mage = 26.44, 92.4% White, 94.9% Non-Hispanic/Latina) sought treatment at a residential ED treatment facility and completed self-report measures each week. Random intercept, random slope models were specified to test the relationship between pain intensity and pain catastrophizing on SI over eight weeks of treatment. Individuals with higher pain catastrophizing demonstrated greater severity of SI.
There were no significant effects for within-person pain catastrophizing, within-person pain intensity, or for the interaction between within-person pain catastrophizing and intensity variables on SI. Pain catastrophizing is associated with SI at the between person level across residential ED treatment. Pain catastrophizing may be an important target for the prevention or treatment of SI in at-risk populations.