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1. Associations between household income and disordered eating differ across sex and racial identity in a population‐based sample of adults

   https://doi.org/10.1002/eat.23948  

   Mikhail, Megan E. ; Ackerman, Lindsay S. ; Anaya, Carolina ; Culbert, Kristen M. ; Burt, S. Alexandra ; Klump, Kelly L. ( March 2023 , International Journal of Eating Disorders)

   Most research on socioeconomic status (SES) and eating disorders (EDs) has focused on young White women. Consequently, little is known regarding how SES may relate to EDs/disordered eating in older adults, men, or people with different racial identities. We examined whether associations between SES and EDs/disordered eating differed across age, sex, and racial identity in a large, population‐based sample spanning early‐to‐later adulthood.

   Analyses included 2797 women and 2781 men ages 18–65 (M_age = 37.41, SD = 7.38) from the population‐based Michigan State University Twin Registry. We first examined associations between SES and dimensional ED symptoms, binge eating (BE), and self‐reported ED diagnoses across age and sex in the full sample. We then examined the impact of racial identity on associations by conducting within‐ and between‐group analyses among Black and White participants.

   In the full sample, lower SES was associated with significantly greater odds of BE and lifetime EDs in men, but not women, across adulthood. The association between lower SES and greater BE risk was stronger for Black men than for White men, though significant in both groups. Conversely, Black women showed apositiveassociation between SES and dimensional ED symptoms that significantly differed from effects for Black men and White women.

   Associations between socioeconomic disadvantage and EDs/disordered eating may be particularly robust for men in adulthood, especially men with a marginalized racial identity. Oppositely, Black women may encounter social pressures and minority stress in higher SES environments that could contribute to somewhat heightened ED risk.

   Little is known regarding how associations between socioeconomic status (SES) and eating disorders (EDs) may differ across age/sex or racial identity. We found lower SES was associated with greater odds of a lifetime ED or binge eating in men only, with a particularly strong association between lower SES and binge eating for Black men. Results highlight the importance of examining how SES‐ED associations may differ across other aspects of identity.

    

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2. Comparing self‐harming intentions underlying eating disordered behaviors and nonsuicidal self‐injury : Replication and extension in adolescents

   https://doi.org/10.1002/eat.24043  

   Kline, Kiki M. ; Jorgensen, Saskia L. ; Lawson, W. Cole ; Ohashi, Yuri‐Grace B. ; Wang, Shirley B. ; Fox, Kathryn R. ( August 2023 , International Journal of Eating Disorders)

   Eating disorder (ED) behaviors are often characterized as indirect forms of self‐harm. However, recent research has found less clear demarcations between direct self‐harming behaviors (e.g., nonsuicidal self‐injury [NSSI], suicidal behaviors) than previously assumed. The aim of this study was to replicate findings of this prior research on adult populations in adolescents with a history of restrictive eating.

   A total of 117 adolescents between ages 12–14 were included in the study. Participants reported the presence and frequency of binge eating, compensatory, restrictive eating, and NSSI. Participants also reported thoughts of and intentions to hurt and kill themselves when engaging in each behavior on average. Thet‐tests and linear effects models were conducted to compare self‐harming thoughts and intentions across behaviors.

   Participants reported at least some intent to hurt themselves physically in the moment and in the long‐term when engaging in all ED behaviors and NSSI, and reported engaging in these behaviors while thinking about suicide. Direct self‐harming knowledge and intentions were most frequently reported with NSSI and longer‐term knowledge and intentions via NSSI and restrictive eating. Additionally, participants reported some suicidal thoughts and intentions across behaviors.

   This study replicates prior research, suggesting that adolescents engage in ED behaviors and NSSI with non‐zero self‐harming and suicidal thoughts and intentions. ED behaviors and NSSI may better be explained on a continuum. Implications include the recommendation of safety planning during ED treatment.

   This study highlights the overlap between eating disorder (ED) behaviors, nonsuicidal self‐injury (NSSI), and suicide. Though clear distinctions typically exist for motives of self‐harming behavior between ED behaviors (i.e., indirect, in the long run) and NSSI (i.e., direct, in the moment), this research suggests that intentions for self‐harming and suicide may exist on a continuum. Clinical ED treatment should consider safety planning as part of routine interventions.

    

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3. Implicit attitudes toward eating stimuli differentiate eating disorder and non‐eating disorder groups and predict eating disorder behaviors

   https://doi.org/10.1002/eat.22843  

   Smith, April R. ; Forrest, Lauren N. ; Velkoff, Elizabeth A. ; Ribeiro, Jessica D. ; Franklin, Joseph ( February 2018 , International Journal of Eating Disorders)

   The current study tested whether people with and without eating disorders (EDs) varied in their implicit attitudes toward ED‐relevant stimuli. Additionally, the study tested whether implicit evaluations of ED‐relevant stimuli predicted ED symptoms and behaviors over a 4‐week interval.

   Participants were people without EDs (N =85) and people seeking treatment for EDs (N =92). All participants completed self‐report questionnaires and a version of the affect misattribution procedure (AMP) at baseline. The AMP indexed implicit evaluations of average body stimuli, eating stimuli, and ED‐symptom stimuli. Participants with EDs completed weekly follow‐up measures of ED symptoms and behaviors for 4 weeks.

   Contrary to predictions, the anorexia nervosa (AN) group did not differ from the no ED group on implicit attitudes toward ED‐symptom stimuli, and the bulimia nervosa (BN) group had less positive implicit attitudes toward ED‐symptom stimuli relative to the no ED group. In line with predictions, people with AN and BN had more negative implicit attitudes toward average body and eating stimuli relative to the no ED group. In addition, among the ED group more negative implicit attitudes toward eating stimuli predicted ED symptoms and behaviors 4 weeks later, over and above baseline ED symptoms and behaviors.

   Taken together, implicit evaluations of eating stimuli differentiated people with AN and BN from people without EDs and longitudinally predicted ED symptoms and behaviors. Interventions that increase implicit liking of eating‐related stimuli may reduce ED behaviors.

    

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4. Comparing self‐harming intentions underlying eating disordered behaviors and NSSI: Evidence that distinctions are less clear than assumed

   https://doi.org/10.1002/eat.23041  

   Fox, Kathryn R. ; Wang, Shirley B. ; Boccagno, Chelsea ; Haynos, Ann F. ; Kleiman, Evan ; Hooley, Jill M. ( February 2019 , International Journal of Eating Disorders)

   Eating disordered (ED) behaviors (i.e., binge eating, compensatory behaviors, restrictive eating) and nonsuicidal self‐injury (NSSI; intentional and nonsuicidal self‐harm) are highly comorbid and share several similarities, including consequent pain and physical damage. However, whereas NSSI is considered direct self‐harm, ED behaviors are considered indirect self‐harm. These distinctions stem from theoretical understanding that NSSI is enacted to cause physical harm in the moment, whereas ED behaviors are enacted for other reasons, with consequent physical harm occurring downstream of the behaviors. We sought to build on these theoretically informed classifications by assessing a range of self‐harming intentions across NSSI and ED behaviors.

   Study recruitment was conducted via online forums. After screening for inclusion criteria, 151 adults reported on their intent to and knowledge of causing physical harm in the short‐ and long‐term and suicide and death related cognitions and intentions when engaging in NSSI and specific ED behaviors.

   Participants reported engaging in ED and NSSI behaviors with intent to hurt themselves physically in the moment and long‐term, alongside thoughts of suicide, and with some hope and knowledge of dying sooner due to these behaviors. Distinctions across behaviors also emerged. Participants reported greater intent to cause physical harm in the moment via NSSI and in the long‐run via restrictive eating. NSSI and restrictive eating were associated with stronger endorsement of most suicide and death‐related intentions than binge eating or compensatory behaviors.

   Findings shed light on classification of self‐harming behaviors, casting doubt that firm boundaries differentiate direct and indirectly self‐harming behaviors.

    

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5. Residential eating disorder outcomes associated with screening positive for substance use disorder and borderline personality disorder

   https://doi.org/10.1002/eat.23028  

   Weigel, Thomas J. ; Wang, Shirley B. ; Thomas, Jennifer J. ; Eddy, Kamryn T. ; Pierce, Casey ; Zanarini, Mary C. ; Fitzmaurice, Garrett ; Busch, Alisa ( February 2019 , International Journal of Eating Disorders)

   We examined whether eating disorder (ED) outcome trajectories during residential treatment differed for patients screening positive for comorbid borderline personality disorder (BPD) and/or substance use disorders (SUDs) than those who do not.

   We examined data from patients in a residential ED treatment program. Patients completed validated self‐report surveys to screen for SUDs and BPD on admission, and the ED Examination‐Questionnaire (EDE‐Q) on admission and every 2 weeks until discharge (N= 479 females).

   Fifty‐four percent screened positive for at least one co‐occurring condition. At admission, patients screening positive for SUD and/or BPD had significantly greater eating pathology than patients screening negative for both (t[477] = 8.23,p< .001). Patients screening positive for SUD (independent of BPD screening status) had a significantly faster rate of symptom improvement during the initial 4 weeks than patients screening positive for BPD only and those with no comorbidities.

   Screening positive for SUD and/or BPD was common in residential ED treatment, and associated with more severe ED symptoms. Screening positive for SUD was associated with faster ED symptom improvement than screening positive for BPD. These findings suggest that intensive ED treatment, even in the absence of intensive SUD treatment, may enhance patient outcomes for those with SUDs.

    

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