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

“…to which women internalize our culture's valuation of slimness, and it is the extent to which the valuation is internalized that predicts eating-disorder-related pathology such as body dissatisfaction, drive for thinness, and some bulimic characteristics (Stormer & Thompson 1996; Stice, 2001).”

“Negative mood and emotional distress further increase the reward value of food(1) and trigger binge-eating attacks in bulimic-type eating disorders.(2) The impulsivity model of binge eating is a common theoretical model that has influenced neuroimaging research in bulimic-type eating disorders.”

“According to the dual-pathway model of eating pathology, body dissatisfaction promotes unhealthy dieting behaviors and may therefore play an important role in the onset of AN (Stice, 2001; Stice, Marti, & Durant, 2011).”

“In support of these assertions, self-report dieting scales were positively related to subsequent increases in bulimic pathology in four prospective studies (Killen et al., 1994, 1996; Stice, 2001; Stice & Agras, 1998).”

“In this study, we tested a general sociocultural model of eating disorders (e.g., Phan & Tylka, 2006; Stice, 2001) using a large sample of female African American undergraduates.”

“Depressive symptoms and negative affect have been found to predict increases in bulimic symptoms and psychopathology associated with BN (Stice, 2001; Cooley & Toray, 2001; Killen, Taylor, Hayward, Haydel, Wilson, Hammer, Kraemer, Blair-Greiner, & Strachowski, 1996; Stice & Agras, 1998; Stice, Burton, & Shaw, 1994).”

“, 1998, 2008a) and increases in bulimic symptoms (Johnson and Wardle, 2005; Stice, 2001; Wertheim et al., 2001).”

“Empirical support for dieting as a risk factor for eating disorders has been derived from a number of prospective studies.(22,24,25,28,32)”

“This restriction of food intake is proposed to increase the likelihood of binge eating, which then triggers purging behaviors (e.g., vomiting, laxative use) to counteract the possible weight gain effects associated with binge eating (Stice, 2001, 2002).”

“, 1995; Thompson & Stice, 2001) and have been found to prospectively predict the onset of eating disorder symptoms (Stice, 2001; Stice & Agras, 1998).”

“Such social comparisons and body surveillance come to represent potent social evaluative threats and frequently elicit body dissatisfaction because sociocultural body ideals are nearly impossible to actualize (Aspen et al., 2013; Pallister & Waller, 2008; Stice, 2001).”

“We chose the BSQ because body dissatisfaction is considered to be a key risk factor for the development of eating disorders (Stice, 2001) and because the BSQ has been used in other prevention studies to identify HR participants (e.g., Zabinski et al., 2001).”

“A substantial body of research has provided evidence for an association between negative affect and eating disorders (see Stice, 2002 for a review) and negative affect has been conceptualized as a risk factor for disordered eating among males and females (Ricciardelli & McCabe, 2004; Stice, 2001).”

“The 9-item Body Dissatisfaction Scale (Stice, 2001) assessed dissatisfaction with various body parts over the past year.”

“We hypothesized that, consistent with etiological models of eating disorders, elevated restraint would be associated with increased BMI and disordered eating [8, 9], while mindful eating and intuitive eating would link to decreased BMI and disordered eating.”

“Depressive symptoms, such as negative affect, positively predict disordered eating among women (Stice, 2001).”

“The program addresses the eating disorder risk factors of internalization of social appearance ideals and appearance comparisons, which have been prospectively linked with increases in body dissatisfaction, dieting, bulimic symptoms and disordered eating (Stice, 2001; Paxton et al. 2006).”

“However, the contribution of BI disturbance to the development of dysfunctional eating behaviour and attitude has been extensively documented (Cooley & Toray, 2001; Stice, 2001, 2002; Stice & Shaw, 2002).”

“Distress- or discomfort-induced eating, including binge eating, is an available response to negative emotions (Arnow et al., 1995; Stice, 2001; Stice et al., 2002; Van Strien and Ouwens, 2007) as is overeating in vulnerable individuals (Van Strien et al.”

“To illustrate the multilevel model for partially clustered data, we reanalyzed data from Stice, Shaw, Burton, and Wade (2006), which evaluated the Body Project, a dissonance-based eating disorder prevention intervention.”

“For instance, antecedents of beauty ideals proposed by the Tripartite Influence Model (Stice, 2001; Thompson, Coovert, & Stormer, 1999) such as the influence of parents, peers and the media, require examination with regard to their influence on athletic-ideal internalization (Keery, van den Berg, &…”

“In order to resolve dissonance, participants decrease their investment in the thin-ideal, which should reduce other risk factors implicated in the development of ED pathology (see Stice, 1994; Stice, 2001).”

“…Clinical and Health Psychology, Ghent University, BE Corresponding author: Adriaan Spruyt (Adriaan.Spruyt@UGent.be) dieting behavior, negative affect, and the causation and maintenance of eating disorders (American Psychiatric Association, 2013; Fairburn & Harrison, 2003; Stice, 2001, 2002).”

“There is mounting evidence that elevated body dissatisfaction is a risk factor for eating disorders (1–3) and that this relation is mediated by increases in dieting and negative affect (29).”

“The dual pathway model further specifies that failures in dietary restraint promote negative affect, which in turn fosters binge-eating as a method of alleviating low mood symptoms (12).”

“Dieting is also proposed to increase depressive symptoms by means of both failures at weight control, and direct effects of caloric deprivation on mood (Stice, 2001).”

“Retrospective [2], cross-sectional [3, 4] and prospective studies [5] have found that being teased about weight is associated with body dissatisfaction, an established risk factor for eating disorders [6–8].”

“it; as a result of these pressures, women often internalize an unrealistically thin standard of beauty (e.g., Stice 1994, 2001; Stice et al. 1996; Thompson et al. 1999).”

“…eating, binge eating and fewer health-promoting behaviors such as physical activity and consumption of fruits and vegetables (Holsen, et al., 2001; Stice, 2001; Stice and Bearman, 2001; Neumark-Sztainer et al., 2006). ter Bogt et al. (2006) report that body image is a better predictor of…”

“…shown more of an inconsistent relationship with bulimia (e.g., Calam & Waller, 1998; Joiner, Heatherton, & Keel, 1997a), although recent meta-analytic work concluded that the weight of the evidence supports perfectionism as a potential risk and maintenance factor for eating pathology (Stice, 2001).”

“These data correspond to other studies suggesting that these family history correlates may be less salient for AN than BN (Fairburn et al. 1997; Stice & Agras, 1998 ; Field et al. 1999 ; Stice, 2001).”

“(Stice, 2001) that give rise to dieting in early teens as a”

“For example, a systematic variation in emotion and mood has been documented throughout the binge–purge cycle (Kenardy, Arnow, & Agras, 1996), affective lability has been shown to more strongly predict binge eating than depression (Greenberg & Harvey, 1987), and negative affective states have been linked to binge eatin…”

“Some experimental and prospective studies that have measured self-reported dieting tendencies suggest that dieting is associated with excessive food intake, bulimic pathology, and weight gain (e.g., Polivy & Herman, 1985; Stice, 2001; Stice, Cameron, Killen, Hayward, & Taylor, 1999).”

“The program was based on the dual pathway model of bulimic symptoms (Stice, 2001; Stice, Ziemba, Margolis, & Flick, 1996) and cognitive dissonance theory (Festinger & Carlsmith, 1959).”

“…internalization among gay men, DB programs were developed from the dual-pathway model to target thin-ideal internalization for young women (Stice et al., 1996; Stice, 2001) and have become one of themore innovative and promising classes of eating disorder prevention programs (Stice & Shaw, 2004).”

“There seems to be a general consensus in the literature that dieting contributes to binge eating (Bulik, Sullivan, Carter, & Joyce, 1997; Herman & Polivy, 1996; Hsu, 1990; Mussell et al., 1997; Nevonen & Broberg, 2000; Polivy & Herman, 1985, 1993; Schlundt & Johnson, 1990; Stice, 2001; Stice & Agras, 1998; Wilson, 199…”

“Participants’ body dissatisfaction was assessed using the Body Dissatisfaction Scale [24], which asks individuals to rate satisfaction with nine body parts on a Likert scale, from “extremely satisfied” to “extremely dissatisfied.”

“A number of factors, including stress, access to palatable food, negative emotions, and food restriction, have been shown to precipitate BE among those with BN (Anestis et al., 2010; Mathes et al., 2009; Stice, 2001).”

“In addition, in only one of the previous longitudinal studies with girls has how consistently these pressures are perceived by adolescents been reported (Stice, 2001).”

“…2: CURRENT STUDY OVERVIEW Longitudinal research suggests that dieting is a potent risk factor for the development of bulimic symptoms and subthreshold/threshold bulimia nervosa (Field et al, 1999; Killen et al., 1994; Killen et al., 1996; Stice, 2001; Stice & Agras, 1998; Stice et al., 2002).”

“69), and predictive validity (Buss & Plomin, 1984; Stice, 2001).”

“In support of this hypothesis, prospective research has found that negative affect predicts later increases in bulimic symptoms (Stice, 2001; Stice, Akutagawa, Gaggar, & Agras, 2000; Tyrka, Waldron, Graber, & Brooks-Gunn, 2002) and onset of binge eating and compensatory behaviors (Stice & Agras, 1998; Stice, Killen, H…”

“negative emotions is also one pathway in the etiology of bulimia nervosa and binge eating (Allen, Byrne, La Puma, McLean, & Davis, 2008; Pearson, Riley, Davis, & Smith, 2014; Stice, 2001; Stice, Presnell, & Spangler, 2002).”

“…of body image disturbance or eating problems have been developed and tested during the last decade, emphasizing the influence of sociocultural factors (Keery, van den Berg, & Thompson, 2004; Muris, Meesters, Blom, & Mayer, 2005; Ricciardelli, McCabe, Holt, & Finemore, 2003; Stice, 2001).”

“…Hilbert & Tuschen-Caffier, 2007; Stice & Agras, 1998; Stice, Presnell, & Spangler, 2002), as does support for the dual-pathway model of binge eating, which integrates and highlights the two distinct (restraint and affect-regulation) routes to binge eating (Stice, 2001; Stice et al., 2001, 1998).”

“In the general population, dietary restraint can promote depressive symptoms due to potential failed efforts at dieting (Stice, 2001).”

“In his dual pathway model of bulimic pathology, Stice (2001) hypothesized that elevated pressure to be thin fosters body dissatisfaction in individuals with bulimia.”

“Five measures were shown to have at least minimal treatment sensitivity (i.e., evidence of change from “pre” to “post” treatment) in a youth or adolescent sample: the EDDS, the BITE, the Children’s Eating Attitudes Test (ChEAT; Maloney, McGuire, & Daniels, 1988), the Body Checking Questionnaire (BCQ; Reas, Whisenhunt,…”

“That is, on their own, repeated messages that one is not thin enough may increase dissatisfaction with the body (e.g., Stice, 2001).”

“As such, researchers have looked to additional factors that place adolescents who experience body dissatisfaction at risk for developing bulimic symptoms (Stice, 2001).”

“Two studies using statistical modelling have shown that dieting is one of several factors that are predictive of binge-eating psychopathology onset (Stice & Agras, 1998; Stice, 2001).”

“The construct of affect has been linked to a variety of psychological treatment outcomes (8,9).”

“In prospective studies, restrained eating also predicted increases in weight in a US sample of 13–17 year olds (Stice, 2001), and similar findingswere obtained for US pre-adolescent and adolescents over 3-years-time (Field et al.”

“Past empirical research documents the important role that the internalization of a thin body ideal can play in the development of body dissatisfaction and eating issues among women (Smolak and Striegel-Moore 2001; Stice 2001; Stice and Agras 1998; Stice et al. 1994; Stice and Shaw 1994; Stice and Whitenton 2002; Thomp…”

“The present study sought to address this research eed by examining girls’ eating attitudes, body dissatisfaction, and diposity within a network of related variables known collectively s the sociocultural model (Stice, 2001).”

“However, low self-worth, low self-esteem, and negative affect have been associated with young adolescents’ body image discrepancy in particular and dissatisfaction with their lives in general (Gilliland et al. 2007; Mirza et al. 2011; Stice 2001).”

“For instance, turning to the ED literature, the dual pathway model of bulimia nervosa (67,68) describes one pathway where weight and shape concerns (i.”

“…development of body dissatisfaction, sociocultural models initially tested within American samples have emphasized mass media, family, and peers as purveyors of societal messages about physical appearance and attractiveness ideals, particularly for females (e.g., Stice 2001; Thompson et al. 1999).”