The cognitive‐interpersonal model of disordered eating: A test of the mediating role of alexithymia

Giles, Sarah; Hughes, Elizabeth K.; Fuller‐Tyszkiewicz, Matthew; Krug, Isabel

doi:10.1002/erv.2720

Cited by 11 publications

(14 citation statements)

References 50 publications

(81 reference statements)

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“…Sixth, there are limitations in the conceptualisation of the model such that the current variables may not fully explain the variance in NSSI and ED symptoms indicating other contributing factors. Future research may, therefore, continue to assess variables related to both problem behaviours, including other variables that have recently been implicated in both ED and NSSI, such as rejection sensitivity [ 19 ], social rank [ 19 ], and alexithymia [ 62 ].…”

Section: Discussionmentioning

confidence: 99%

A new integrative model for the co-occurrence of non-suicidal self-injury behaviours and eating disorder symptoms

et al. 2021

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Objective The high co-occurrence of non-suicidal self-injury (NSSI) behaviours and eating disorder (ED) symptoms suggests these conditions share common aetiological processes. We assessed a new integrative model of shared factors for NSSI and ED symptoms, where affect dysregulation, impulsivity, self-esteem, and body dissatisfaction mediated the relationship between insecure attachment and maladaptive schemas and NSSI and ED symptoms. A further aim of the study was to assess whether the model behaved similarly across a clinical eating disorder (ED) and a community sample. Method 123 females with a lifetime ED diagnosis and 531 female individuals from the community completed an online survey, which included measures assessing the variables of interest. A cross-sectional single time point analysis was used. Results Invariance testing indicated that the model was structurally non-invariant (different across groups). The proposed integrative model was a good fit for the ED group, but for the community sample only a revised model reached an acceptable fit. Both attachment and maladaptive schemas, included early in the model, were implicated in the pathways leading to ED and NSSI symptoms in the ED and community groups. In the community group, impulsivity, a mediator, was a shared predictor for NSSI and bulimic symptoms. No other mediating variables were shared by NSSI and ED symptoms in the two groups. Overall, the proposed model explained slightly more variance for the ED group relative to the community group in drive for thinness (R2 = .57 vs .51) and NSSI (R2 = .29 vs .24) but less variance in bulimic symptoms (R2 = .33 vs .39). Conclusion We conclude that the current model provides only limited support for explaining the comorbidity between NSSI and ED symptoms. It is vital to consider both common (e.g., attachment and maladaptive schemas) and specific factors (e.g., impulsivity) to better understand the pathways that lead to the co-occurrence of NSSI and ED symptoms. A new integrative model assessed whether emotion dysregulation, impulsivity, self-esteem, and body dissatisfaction were mediators in the relationship between insecure attachment and maladaptive beliefs about the world and the self and subsequent eating disorder and self-harm symptoms. A further aim was to assess whether the proposed model differed between a clinical eating disorder and a community sample. All participants were female and included 123 patients with a lifetime eating disorder and 531 individuals from the community. Participating individuals completed an online survey at one timepoint, which included measures assessing the variables of interest. The findings of the current study indicated that the proposed model was a good match for the clinical eating disorder sample, but for the community sample only a revised model yielded acceptable statistical fit. Both insecure attachment and maladaptive beliefs about the world and the self, included early in the model, were indirectly related to eating disorder and self-harm symptoms for both the eating disorder and the community groups. Impulsivity, a mediator, was the only shared predictor for self-harm, and bulimic symptoms in the community group. We conclude that the current model provides only limited support for explaining the comorbidity between self-harming behaviours and disordered eating symptoms.

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Section: Discussionmentioning

confidence: 99%

A new integrative model for the co-occurrence of non-suicidal self-injury behaviours and eating disorder symptoms

et al. 2021

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“…Some researchers suggest that the appearance of alexithymia in EDs could instead be a product of general distress [ 72 , 73 ]. There is some support for the effects of alexithymia on ED symptomatology being explained by anxiety and depression [ 74 ] -although see [ 75 ]. The original authors of the TAS-20 assert that the test has relative stability, reflecting personality traits that maintain consistent trends despite fluctuations in state psychopathology [ 70 ].…”

Section: Discussionmentioning

confidence: 99%

“…Only one facet of alexithymia—difficulty identifying emotions—was associated with eating concerns. This facet is conceptualised to manifest early in the emotion cycle and has been particularly linked with EDs [ 74 , 75 , 88 ] and with broader emotion regulation difficulties, somatic complaints and psychopathology [ 9 , 89 ]. While multicollinearity was not problematic with our independent variables, the DERS and TAS-20 measures are known to share variance [ 16 , 44 ], which may have limited our ability to fully delineate effects between these variables.…”

Section: Discussionmentioning

confidence: 99%

What about males? Exploring sex differences in the relationship between emotion difficulties and eating disorders

et al. 2022

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Objective While eating disorders (EDs) are more commonly diagnosed in females, there is growing awareness that men also experience EDs and may do so in a different way. Difficulties with emotion processing and emotion regulation are believed to be important in EDs, but as studies have involved predominantly female samples, it is unclear whether this is also true for males. Methods In a sample of 1604 participants (n = 631 males), we assessed emotion processing and emotion regulation in males with EDs (n = 109) and compared results to both females with EDs (n = 220) and males from the general population (n = 522). We also looked at whether emotion processing and emotion regulation difficulties predicted various aspects of eating psychopathology and whether this was moderated by sex. We assessed emotion processing with the Toronto Alexithymia Scale, emotion regulation with the Difficulties in Emotion Regulation Scale and the Emotion Regulation Questionnaire, and eating psychopathology with the Eating Disorder Examination Questionnaire. Results We found that males with ED, like their female counterparts, suffered from emotion processing and emotion regulation deficits. We did find some sex differences, in that males with EDs tended to report more difficulties with their emotions as well as a more externally oriented thinking style compared to females with EDs. Difficulties with emotion processing and emotion regulation were strongly predictive of various aspects of eating psychopathology in both sexes. Importantly, we found that sex moderated the relationship between cognitive reappraisal and eating restraint. As such, low use of reappraisal was found to be associated with higher levels of restraint in females but not in males. Discussion Difficulties with emotion processing and emotion regulation are associated with eating psychopathology in both males and females. Reappraisal was not found to be associated with reduced eating psychopathology in males, suggesting a cautious approach to interventions targeting this strategy. Research around explanatory mechanisms and interventions must adopt a broader viewpoint including those that are traditionally overlooked in EDs.

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“…La psicopatología asociada: ansiedad, depresión, trastornos alimentarios y adicciones, facilitaría las DI. (58,59) La asertividad disminuye el estrés al facilitar la frontera propia (60) . En animales, estudios moleculares del equilibrio vasopresina/oxitocina muestran su importancia en amortiguar el estrés general y comprometer relaciones de apareamiento.…”

Section: Red Socialunclassified

Dificultades interpersonales en los trastornos alimentarios: Un modelo psiconeurobiológico explicativo/comprensivo

Behar

Cordella

2022

Rev. chil. neuro-psiquiatr.

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Background: Eating disorders (ED) are characterized by psychosocial disfunctions, like social anxiety, alexithymia and lack of assertiveness. Objective: To propose a comprehensive integrative model including neurobiology and behavior aspects. Method: A literature review on Medline/PubMed, SciELO and specialized texts databases were assessed against quality criteria. Core concepts were extracted and coherence articulated. Results: Four factors were disposed to meaning: alarm and reward system with social brain and control (inhibition/excitation) mechanisms. They were articulate in a complex psychophysiological interplay. They were associated with social behaviours achieved/not achieved during development. Food intake could operate like a pathological balance to psychopathological effects Conclusion: An explanatory/comprehensive psychoneurobiological model to understand social function in ED is proposed. This form of understanding facilitates: the connection between emerging research in eating disorders and ID; clinical decision-making and guide the prognosis and treatment alternatives.

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The cognitive‐interpersonal model of disordered eating: A test of the mediating role of alexithymia

Cited by 11 publications

References 50 publications

A new integrative model for the co-occurrence of non-suicidal self-injury behaviours and eating disorder symptoms

A new integrative model for the co-occurrence of non-suicidal self-injury behaviours and eating disorder symptoms

What about males? Exploring sex differences in the relationship between emotion difficulties and eating disorders

Dificultades interpersonales en los trastornos alimentarios: Un modelo psiconeurobiológico explicativo/comprensivo

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