Katherine Jean Forney

Objective: Gastrointestinal (GI) disturbances and eating disorder symptoms commonly co‐occur. Hypervigilance and anxiety about GI symptoms may motivate eating disorder behaviors to manage and/or avoid GI symptoms. We hypothesized that GI‐specific anxiety would be more strongly associated with dietary restriction and purging than GI‐specific hypervigilance. Further, we hypothesized that distinguishing between GI‐specific anxiety and hypervigilance would have incremental validity over using an existing measure of GI‐anxiety and related constructs initially developed for patients with irritable bowel syndrome, the Visceral Sensitivity Index. Methods: Three hundred and eighty‐two undergraduate students with elevated eating pathology (83.5% female, 87.4% White) completed questionnaires assessing GI‐specific hypervigilance and anxiety, the Visceral Sensitivity Index, and eating disorder symptoms. Participants were recruited with elevated shape/weight‐oriented eating pathology ( N = 309) and elevated avoidant/restrictive food intake disorder‐related eating pathology ( N = 73). Analyses were pre‐registered. Results: Regarding dietary restriction, the relative weight of GI‐specific anxiety did not differ from that of GI‐specific hypervigilance. Further, neither variable provided incremental validity over the Visceral Sensitivity Index in understanding restriction. Regarding purging, GI‐specific anxiety was not more strongly associated with purging than GI‐specific hypervigilance. However, GI‐specific anxiety, but not GI‐specific hypervigilance, demonstrated incremental validity over the Visceral Sensitivity Index in explaining purging. Conclusion: Distinguishing between GI‐specific hypervigilance and anxiety adds incremental validity in understanding purging but not restriction. Future research should examine whether addressing anxious cognitions about GI symptoms improves purging outcomes.

Objective: The mechanisms that facilitate prolonged dietary restriction in eating disorders, particularly in the absence of binge eating, remain poorly understood. The activity‐based anorexia model and basic science in exercise physiology suggest that moderate to vigorous physical activity leads to reduced energy intake relative to metabolic needs. This reduction in energy intake is even greater when individuals exercise in the fasted, compared to fed, state.Method: We propose a model in which moderate to vigorous physical activity facilitates increased dietary restriction within eating disorders. We propose that moderate to vigorous physical activity, regardless of motivation, reduces ghrelin, increases glucagon‐like peptide 1 and peptide YY, and reduces food reward. These mechanisms, in turn, contribute to reduced relative energy intake.Results: We review relevant rodent and human literatures to evaluate the model and identify observational and experimental research designs to test these hypotheses.Conclusion: Understanding how and when moderate to vigorous physical activity contributes to dietary restriction has important implications for tailoring eating disorder treatment.

Objectives: The internalization of socioculturally influenced body ideals, including thin‐ideal internalization and internalized weight stigma, is consistently associated with body dissatisfaction. However, the independent contributions of thin‐ideal internalization and internalized weight stigma to body dissatisfaction and the extent to which these two body ideals are distinct are unknown. The current study examined whether internalized weight stigma contributes to body dissatisfaction above and beyond the effects of thin‐ideal internalization. To further investigate the independence of these two cultural processes, the current study also tested if body size moderates the association between thin‐ideal internalization and internalized weight stigma.Methods: Data come from 430 university students (80.7% female, 87.7% white) who completed surveys for partial course credit.Results: Both thin‐ideal internalization (β = 0.202, p < 0.001) and internalized weight stigma (β = 0.638, p < 0.001) were associated with body dissatisfaction in a mutually adjusted regression model. However, the association between thin‐ideal internalization and internalized weight stigma did not differ by body size (β = 0.054, p = 0.79).Conclusions: Thin‐ideal internalization and internalized weight stigma are independent correlates of body dissatisfaction, regardless of weight status. As distinct constructs, both thin‐ideal internalization and internalized weight stigma should be targeted in the prevention and treatment of body dissatisfaction.

While prior research has found links between anxiety sensitivity (AS) and eating disorder (ED) symptoms, there has been limited research exploring how specific aspects of AS are related to specific dimensions of eating pathology. To inform candidate targets of specific aspects of AS in future interventions, the current study identified associations between AS and ED constructs in a sample of individuals with elevated eating pathology. N = 382 undergraduate students (89.3% White, 2.6% Hispanic/Latine) with elevated eating pathology completed surveys as part of a larger study. Participants completed the Anxiety Sensitivity Index-3 (ASI-3 subscales: Physical, Cognitive, and Social Concerns) and Eating Pathology Symptoms Inventory (EPSI). Separate Bonferroni-corrected regression models were run for each EPSI subscale with covariates (age, BMI, and sex) included in step 1 and ASI-3 subscales in step 2. ASI Social was associated with EPSI Body Dissatisfaction (p < .001), and ASI Cognitive was significantly associated with Binge Eating, Purging, and Muscle Building (ps < .006), above and beyond other ASI subscales. Results support that different aspects of AS are associated with different ED symptoms. Future research should explore these constructs longitudinally to inform potential targets for intervention.

Objective: Negative affect is central to eating disorder maintenance models; identifying mechanisms underlying this link may inform specific treatment targets. The current study evaluated which emotions (i.e., distress, fear, and moral emotions) were most strongly linked to feeling fat and tested feeling fat as a longitudinal mediator of the relationship between these emotions and restricting or binge eating (https://osf.io/3d5cq/).Method: Community adults (N = 714, M[SD] age = 41.5[13.7], 84.6% female, 85.9% white) provided data at baseline, 3‐month, and 6‐month follow‐up. Relative weights analysis examined which emotion categories exhibited the strongest longitudinal relationships with feeling fat. Cross‐lagged panel models tested feeling fat as a mediator of the relationship between emotions and eating disorder behaviors.Results: Distress and moral emotions were the strongest emotional predictors of feeling fat. Feeling fat predicted binge eating (p's < 0.001), but not restricting (p's ≥ 0.832), in random effects cross‐lagged panel models. Feeling fat partially mediated the longitudinal relationship between distress and binge eating (p = 0.044); however, this effect became nonsignificant after adjusting for BMI (p = 0.354). Feeling fat did not mediate relationships between moral emotions and binge eating or between either distress or moral emotions and restricting (p's ≥ 0.638).Discussion: Feeling fat was associated with binge eating, not restricting, highlighting the importance of specificity in maintenance models. Because the mediating effect of feeling fat was accounted for by body size, factors associated with body size, such as internalized weight stigma, may be more relevant mediators of the relationship between negative emotions and eating disorder behaviors. Future research on feeling fat should adjust for body size.

Objectives: Negative urgency is associated with short‐term maintenance of binge eating and purging in unselected samples. The current study used an eating disorder sample to test the hypothesis that negative urgency maintains bulimia nervosa (BN) and purging disorder (PD) at long‐term follow‐up. It was also hypothesized that baseline differences in negative urgency between BN and PD would remain at follow‐up.Methods: Secondary analyses were conducted on a sample of women who engaged in recurrent self‐induced vomiting (n = 68; 52.9% BN; 47.1% PD). Women completed diagnostic interviews and questionnaires at baseline and at a mean (SD) of 5.95 (1.58) years follow‐up (range = 2.51–9.62; retention rate = 75%).Results: Negative urgency did not predict eating disorder diagnostic status, recovery status, or global eating pathology at follow‐up (p's = .06–.83). There were no significant differences in negative urgency across women with BN and PD at follow‐up (p = .16). However, post hoc analyses indicated that negative urgency was not stable across time (ICC = .102). Increases in negative urgency from baseline to follow‐up were associated with greater global eating pathology at follow‐up (p = .002).Conclusion: Results suggest negative urgency does not predict long‐term eating disorder maintenance. Negative urgency may not be a stable personality trait but rather an indicator of overall poor emotion regulation. Future research should confirm that changes in negative urgency predict chronic eating pathology over long durations of follow‐up in women who have increasing negative urgency across time.

ObjectiveSome individuals meet the criteria for atypical anorexia nervosa and another eating disorder simultaneously. The current study evaluated whether allowing a diagnosis of atypical anorexia nervosa to supersede a diagnosis of bulimia nervosa (BN) or binge-eating disorder (BED) provided additional information on psychological functioning.MethodsArchival data from 650 university students (87.7% female, 69.4% white) who met Eating Disorder Diagnostic Survey for DSM-5 eating disorder criteria and completed questionnaires assessing quality of life, eating disorder-related impairment, and/or eating pathology at a single time point. Separate regression models used diagnostic category to predict quality of life and impairment. Two diagnostic schemes were used: the DSM-5 diagnostic scheme and an alternative scheme where atypical anorexia nervosa superseded all diagnoses except anorexia nervosa. Model fit was compared using the Davidson-Mackinnon J test. Analyses were pre-registered ().ResultsAllowing an atypical anorexia nervosa diagnosis to supersede a BN or BED diagnosis provided better fit to the data for eating disorder-related impairment (p = .02; n = 271), but not physical, psychological, or social quality of life (p's >= .33; n = 306). Allowing an atypical anorexia nervosa diagnosis to supersede a BN or BED diagnosis provided a better fit in cross-sectional models predicting purging (p = .02; n = 638), but not body dissatisfaction, binge eating, restricting, or excessive exercise (p's >= .08; n's = 633-647).DiscussionThe current data support retaining the DSM-5 diagnostic scheme. More longitudinal work is needed to understand the predictive validity of the atypical anorexia nervosa diagnosis.Public SignificanceThe current study examined how changes to the diagnostic categories for eating disorders may change how diagnoses are associated with quality of life and impairment. Overall, findings suggest that the diagnostic hierarchy should be maintained.