A prospective test of the dual pathway model of bulimic pathology: mediating effects of dieting and negative affect

“Moreover, a technique for prospectively testing all linkages in a mediational model evaluated this account with data from the third study (Stice, 2001).”

“Second, elevations in dieting have been found to predict subsequent increases in bulimic symptoms [27] and eating pathology [8], onset of bulimic symptoms [51,52,54,55], and onset of threshold and subthreshold eating disorders [62,63].”

“These two paper-and-pencil questionnaires and their revisions have received extensive examination, with adult and child-adolescent samples, and have demonstrated strong internal consistencies, testretest reliabilities, predictive validity, and convergent validity (i.e., they correlate significantly with other measures…”

“redictors of eating disorders and related disordered eating ehaviors [7–9].”

“Accordingly, researchers in the past few years have invested an enormous amount of effort in attempts to define, measure, and evaluate formative influences that may lead to the onset of such disturbances (Shisslak & Crago, 2001; Stice, 2001; Stice & Hoffman, 2004; Wertheim, Paxton, & Blaney, 2004).”

“…affect regulation has gained considerable influence for understanding the function of binge eating (Aldao, Nolen-Hoeksema, & Schweizer, 2010; Stice, 2001; Wedig & Nock, 2010), and this model has contributed to a focus on both affective antecedents and consequences in the…”

“…addition, the negative impact of body dissatisfaction has been demonstrated in longitudinal studies in which it has been identified as a reliable predictor of the increases in use of dieting and disordered eating symptoms and clinical eating disorders (e.g., Killen et al., 1996; Stice, 2001, 2002).”

“The dual pathway model of bulimic pathology (Stice, 2001; Stice, Akutagawa, Gaggar, & Agras, 2000) postulates two alternative pathways from body dissatisfaction to binge eating mediated by dieting and negative affect respectively.”

“eating disorders for women [74, 85–88], and potentially harmful muscle-enhancing and disordered eating behaviors for men [89].”

“, 2005; McKnight, 2003) and no prospective studies have used analytic procedures that can identify interactions between risk factors that may reflect qualitatively distinct risk pathways, which is important because certain etiologic theories posit that there are multiple risk pathways to the development of eating diso…”

“Stice and colleagues have conducted a great deal of work on their dual pathway model of the development of bulimia, finding strong support for the role of negative affect in the development of bulimia [37,39,40], and for the role of depression and negative affect in binge eating [41,42].”

“82), convergent validity (with self-reported caloric intake), and predictive validity for future increases in bulimic symptoms (Stice, 2001; van Strein, Frijters, Bergers, & Defares, 1986).”

“We investigated a range of factors that have been theorized to increase risk for eating disorders in several univariate and multivariate etiologic models (e.g., Hohlstein, Smith, & Atlas, 1998; Lavender et al., 2016; McCarthy, 1990; Stice, 2001).”

“, 1999) and weight gain (Field et al., 2003; Stice, 2001)—an effect that has also occurred in prospective studies of adults (French et al.”

“90), and predictive validity in adolescent samples (Stice, 2001).”

“…a reliable antecedent of binge eating in binge eating disorder (BED; Wegner et al., 2002; Chua et al., 2004; Hilbert et al., 2007; Stein et al., 2007) and binge/purging behavior in bulimia nervosa (BN; Stice, 2001; Waters et al., 2001; Smyth et al., 2007; Crosby et al., 2009; Smyth et al., 2009).”

“These factors were also concurrently associated with body dissatisfaction, which in turn predicted increases in dieting and negative affect (Stice, 2001; Stice & Whitenton, 2002; but see Bearman, Presnell, Martinez, & Stice, 2006).”

“The findings of many studies have supported the hypothesis that dieting and negative affect are common precursors of binge eating (Stice, 2001); the results of some of these studies are described next.”

“…assimilation of affect and dietary restraint models (McManus & Waller, 1995; Meyer et al., 1998), and subsequent models have been integrated to include both dietary restraint and affect or emotion regulation-based models (Stice, 2001; Stice & Agras, 1999; Stice et al., 2001; Waters et al., 2001).”

“80 at T1), convergent validity with other measures of negative affect(25) and predictive validity for future increases in bulimic symptoms.(11)”

“These included the tripartite influence model (Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999), dual pathway model (Stice, 2001), objectification theory (Fredrickson & Roberts, 1997), and variables related to CFT and ACT.”

“The second hypothesized mechanism is that body dissatisfaction contributes to negative affect (anxiety or depression), which, in turn, is thought to increase the risk of binge eating and the use of radical compensatory behaviors, such as purging behavior [49].”

“The finding that people with high scores on these scales gain more weight over time than people with low scores (French, Jeffery, Forster, et al., 1994; Klesges, Isbell, & Klesges, 1992; Klesges, Klem, & Bene, 1989; Stice, 2001; Stice, Cameron, Killen, Hayward, & Taylor, 1999) provides suggestive evidence that these s…”

“142 Dohnt and Tiggemann well-documented (e.g., Stice, 2001 ).”

“Key words: body image, developmental issues, peer relations, physical attractiveness, psychological adjustment BODY DISSATISFACTION—researchers have consistently demonstrated its impact on dysfunctional eating behaviors, focusing especially on adolescent girls and young women (e.g., Stice, 2001).”

“For example, body dissatisfaction predicted increased rates of dieting (Shroff & Thompson, 2006; Stice, 2001; Stice, Mazotti, Krebs, & Martin, 1998) and onset of disordered eating (Johnson & Wardle, 2005; Stice & Agras, 1998).”

“Notably, thin-ideal internalization and dysfunctional beliefs about appearance have also been found to be proximal predictors of increases in body dissatisfaction (Spangler, 2002; Stice, 2001; Stice & Whitenton, 2002).”

“Tests of mediation that evaluate the putative cause, changes in the putative mediator, and changes in the putative consequence at three different sequential time points (e.g., Stice, 2001) are informative because they have taken on and ruled out some potential criticisms.”

“Mindfulness-based treatments can be conceptualized with the dual pathway model (Stice, 2001; Van Strien et al., 2005).”

“…emotions have been identified as a mediator in the relationship between body dissatisfaction and bulimic symptoms (Heywood & McCabe, 2006; Ricciardelli & McCabe, 2001; Stice, 2001), but the concept of negative emotions has been operationalized as a composite of different types of negative emotions.”

“Studies have consistently found that depression is a significant risk factor in the development of disordered eating (Pook, Conti, & Lester, 1996; Stice, 2001; Stice, Killen, Hayward, & Taylor, 1998).”

“In line with prior research [33, 50] we reported the more conservative analysis without the inclusion of 36 cases to avoid over-estimation (even minor) of structural parameters and ensure that we conducted a truly prospective test of our hypothesis [51, 53].”

“Previous research has documented the development of related constructs, such as self-consciousness, body dissatisfaction, and eating pathologies (Jones, 2004; Rankin, Lane, Gibbons, & Gerrard, 2004; Stice, 2001; Stice & Whitenton, 2002), and those studies inform the OBC literature.”

“Several studies have examined factors that predict future increases in eating disorder symptoms (e.g., Cattarin & Thompson, 1994; Keel, Fulkerson, & Leon, 1997; Johnson & Wardle, 2005; Leon, Fulkerson, Perry, Keel, & Klump, 1999; Neumark-Sztainer et al., 2006; Stice, 2001; Vogeltanz-Holm et al., 2000).”

“…symptom onset (Neumark-Sztainer et al., 2006; Stice, Killen, Hayward, & Taylor, 1998), increases in bulimic symptoms (Johnson & Wardle, 2005; Stice, 2001; Wertheim, Koerner, & Paxton, 2001), and threshold and subthreshold bulimia nervosa onset (Killen et al., 1996) over 1- to 4-year…”

“There is evidence that body dissatisfaction is associated with dietary restraint (e.g. Stice, 1994, 2001; Tiggeman, 1994; Van Strien, 1989), but the hypothesised link between dietary restraint and binge eating/overeating has met inconsistent support.”

“negative mood), precipitates binge eating, purging and unhealthy weight loss, as periods of energy restriction increase the reinforcing value of food (7,8,11,29).”

“Frequency of dieting is also associated with negative psychological attributes such as body dissatisfaction, depression, lower selfesteem,(12,13) and negative effect.(14) Still, more than half of all adolescent girls and more than a quarter of adolescent boys report dieting(7) with dieting reported in girls as young a…”

“In particular, negative self-evaluations in relation to the thin ideal, and hence body dissatisfaction, can result in a momentary experience of negative affect (Stice, 2001).”

“…Ilies & Judge, 2003; Ilies & Judge, 2005; Leigh, 1983; MacKinnon, Johnson, Pentz, Dwyer, Hansen, Flay, & Wang, 1991; Sharkansky, King, King, Wolfe, Erickson, & Stokes, 2000; Stice, 2001; Tein, Sandler, Ayers, & Wolchik, 2006; Wolchik, West, Westover, Sandler, Martin, Lustig, Tein, & Fisher, 1993).”

“Despite this, a strength of DBI is the theoretical basis of the well-supported dual pathway model.(104) Consequently, future research should examine efficacy of DBI for indicated prevention.”

“Prospective work on the effects of thin-ideal media exposure have found that perceived pressure to be thin (such as pressure from the media) predicts increases in body dissatisfaction, which in turn predicts increases in eating pathology.(23) A meta-analysis of 25 experimental studies evaluating the immediate impact o…”

“The dietary restraint hypothesis has been incorporated within the Dual Pathway Theory [6] as one of the pathways toward the development of bulimic symptoms, particularly bingeing.”

“bulimic symptoms (Johnson & Wardle, 2005; Stice, 2001) than”

“Body dissatisfaction and dietary restraint, identified risk factors for bulimic symptoms (Stice, 2001), are present in girls as young as 6 years of age (Lowes & Tiggemann, in press).”

“…and emotion dysregulation have been implicated in the onset and maintenance of ED behaviors across diagnoses (e.g., Lavender et al., 2015; Stice, 2001), and outside of EDs, substantial research has demonstrated that neurocognitive processes are related to emotion in a variety of ways…”

“It has been suggested that negative emotions prompt binge eating episodes (Stice, 2001; Stice et al., 2002) as well as encourage overeating in vulnerable individuals (Van Strien et al., 2005).”

“Body image dissatisfaction (BID), that is, the negative evaluations of one’s physical body, shape and weight [1], has consistently been implicated in the aetiology and maintenance of eating disorders (EDs) [2–4].”

“CD prevention of EDs is based on the dual pathway model of bulimia nervosa (Stice, 2001).”

“According to the dual pathway model (Stice, 2001), reduced internalization of the thin ideal should decrease body dissatisfaction, unhealthy weight control behaviors, negative affect, and ED symptoms, as well future ED onset.”

“, 2006; Stice, Killen, Hayward, & Taylor, 1998; Stice, Davis, Miller, & Marti, 2008) and increases in bulimic symptoms (Johnson & Wardle, 2005; Stice, 2001; Wertheim, Koerner, & Paxton, 2001).”

“For example, thin-ideal internalization prospectively predicted a variety of negative outcomes, including onset of bulimic behavior (Stice & Agras, 1998), dieting (Stice, Mazotti, Krebs, & Martin, 1998), increases in body dissatisfaction (Shroff & Thompson, 2006; Stice, 2001) and compulsive exercise (Homan, 2010).”

“In past studies, this scale has demonstrated adequate internal consistency (α = .89) and test-retest reliability (r = .63) (Stice, 2001; Stice & Agras, 1998).”

“In testing this model, Stice (2001) found that in a sample of 231 high school girls, the model was supported by the data.”

“These results are largely consistent with the dual pathway model of bulimic pathology (Stice, 2001), which posits that thin-ideal internalization occurs early in the causal chain of risk factors in the prediction of bulimic symptoms.”

“data (Stice, 2001) and because these analyses provided a prospec-”

“tion and disordered eating (Heatherton and Baumeiester, 1991; Stice, 2001).”

“Several studies have found a close association between negative affect and body dissatisfaction (Sim & Zeman, 2006; Stice, 2001).”

“, fasting, taking laxatives) may lead to overeating or binge eating and result in weight gain [39].”