Many current measures of eating disorder (ED) symptoms have 1 or more serious limitations, such as inconsistent factor structures or poor discriminant validity. The goal of this study was to overcome these limitations through the development of a comprehensive multidimensional measure of eating pathology. An initial pool of 160 items was developed to assess 20 dimensions of eating pathology. The initial item pool was administered to a student sample (N = 433) and community sample (N = 407) to determine the preliminary structure of the measure using exploratory and confirmatory factor analyses. The revised measure was administered to independent samples of patients recruited from specialty ED treatment centers (N = 158), outpatient psychiatric clinics (N = 303), and students (N = 227). Analyses revealed an 8-factor structure characterized by Body Dissatisfaction, Binge Eating, Cognitive Restraint, Excessive Exercise, Restricting, Purging, Muscle Building, and Negative Attitudes Toward Obesity. Scale scores showed excellent convergent and discriminant validity; other analyses demonstrated that the majority of scales were invariant across sex and weight categories. Eating Pathology Symptoms Inventory scale scores had excellent internal consistency (median coefficient alphas ranged from .84-.89) and reliability over a 2- to 4-week period (mean retest r = .73). The current study represents one of the most comprehensive scale development projects ever conducted in the field of EDs and will enhance future basic and treatment research focused on EDs.

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Objective-This study aimed to evaluate emotion avoidance in patients with anorexia nervosa (AN) and to examine whether emotion avoidance helps to explain (i.e., mediates) the relation between depressive and anxiety symptoms and eating disorder (ED) psychopathology in this group.Method-Seventy-five AN patients completed questionnaires to assess study variables. Rates of emotion avoidance were compared to published data, and regression models were used to test the hypothesis that emotion avoidance mediates the relation between depressive and anxiety symptoms and ED psychopathology in AN.Results-AN patients endorsed levels of emotion avoidance that were comparable to or higher than other psychiatric populations and exceeded community controls. As predicted, emotion avoidance significantly explained the relations of depressive and anxiety symptoms to ED psychopathology.Discussion-Findings confirm that emotion avoidance is present in patients with AN and provide initial support for the idea that anorexic symptoms function, in part, to help individuals avoid aversive emotional states.Close observers of eating disorder psychopathology long have noted that anorexia nervosa (AN) is associated with emotion avoidance, defined here as the desire to avoid experiencing or expressing physical sensations, thoughts, urges, and behaviors related to intense emotional states. Indeed, several clinical scholars have articulated that anorexic symptoms function, in part, to help individuals cope with or avoid aversive emotions. For example, Slade (1) hypothesized that preoccupation with food, eating, weight, and shape enables individuals with AN to avoid thinking about or confronting other potentially aversive stimuli such as adolescent conflicts, interpersonal problems, and stress and failure experiences. Similarly, Schmidt and Treasure (2) have proposed a model of AN maintenance that emphasizes the role of anorexic symptoms in facilitating avoidance of negative emotions, as well as interpersonal relationships that may trigger these emotions. Specifically, these theorists assert that the exclusive mental focus on food and eating that characterizes AN is associated with emotions becoming less salient, noting that many individuals with AN report feeling emotionally "numb" (p. 347).Several lines of research provide support for the notion that emotion avoidance is pertinent to anorexic psychopathology. For example, studies using qualitative methodology (3,4) or self-report questionnaires (5,6) to assess AN patients' perceptions of the functions served by disordered eating symptoms have reported that the illness helps affected individuals to avoid or control emotions. Research also has documented that individuals seeking treatment for AN and other eating disorders are more likely than non-psychiatric controls to endorse emotion avoidance. Specifically, Corstorphine and colleagues (7) found that women with AN, bulimia nervosa (BN), or eating disorder not otherwise specified were significantly more likely than non-psychiatric control...

Objective Elucidation of clinically relevant subtypes has been proposed as a means of advancing treatment research, but classifying anorexia nervosa (AN) patients into restricting and binge-eating/purging types has demonstrated limited predictive validity. This study aimed to evaluate whether an approach to classifying eating disorder patients based on comorbid personality psychopathology has utility in predicting treatment response and readmission in patients with AN. Method Data were collected from 154 AN patients (M[SD] age = 25.6[9.4] years; 95.5% female; 96.8% Caucasian) at admission, discharge, and three months post-discharge from intensive treatment. Latent profile analysis of personality traits assessed at admission was performed to classify participants into personality subtypes, which were then used to predict outcomes at discharge and risk of readmission. Results The best-fitting model identified three personality subtypes (undercontrolled, overcontrolled, low psychopathology) that contributed significantly to multivariate models predicting study outcomes. Undercontrolled patients were more likely to have a poor outcome at discharge than overcontrolled (OR = 3.56, p = .01) and low psychopathology patients (OR = 11.23, p <.001). Undercontrolled patients also had a greater risk of discharge against medical advice (HR = 2.08, p = .02) and readmission than overcontrolled patients (HR = 3.76, p = .009). Binge-eating/purging versus restricting subtypes did not predict discharge against medical advice or readmission in the multivariate models. Conclusions Findings support the clinical utility of personality subtypes in AN. Future work is needed to identify mechanisms that explain diminished treatment response in undercontrolled patients and to develop interventions for this high-risk group.

This case series describes the development of a novel psychotherapeutic intervention for older adolescents and adults with anorexia nervosa (AN). Emotion acceptance behavior therapy (EABT) is based on a model that emphasizes the role of anorexic symptoms in facilitating avoidance of emotions. EABT combines standard behavioral interventions that are central to the clinical management of AN with psychotherapeutic techniques designed to increase emotion awareness, decrease emotion avoidance, and encourage resumption of valued activities and relationships outside the eating disorder. Five AN patients ages 17-43 years were offered a 24-session manualized version of EABT. Four patients completed at least 90% of the therapy sessions, and three showed modest weight gains without return to intensive treatment. Improvements in depressive and anxiety symptoms, emotion avoidance, and quality of life also were observed. These results offer preliminary support for the potential utility of EABT in the treatment of older adolescents and adults with AN.