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

“There is empirical support for several theories of loss of control eating in pediatric samples, including the interpersonal (Elliott et al., 2010), cognitive behavioral (Allen, Byrne, & McLean, 2012; Decaluwe & Braet, 2005), and dual pathway (Goossens, Braet, & Bosmans, 2010; Stice, 2001) models.”

“…and established body dissatisfaction (a) as a risk factor for bulimic symptomatology and subclinical eating problems (e.g., Polivy & Herman, 2002; Stice, 2001; Striegel-Moore & Bulik, 2007), (b) as normative among girls and women (e.g., Mazzeo, 1999), and (c) to have markedly increased over the…”

“[28] E.”

“and eating pathology compared to low global self-esteem (Ricciardelli & McCabe, 2001b; Saling et al., 2005; Shaw et al., 2004; Stice, 2001).”

“Extant cross-sectional and longitudinal data indicate that dietary restraint is a significant predictor of binge eating (Jacobi, Hayward, de Zwaan, Kraemer, & Agras, 2004; Polivy, Heatherton, & Herman, 1988; Stice & Agras, 1998; Stice, 2001).”

“2006) whereas others have reported that poor body image is associated with more disordered eating and fewer health-promoting behaviors such as physical activity and consumption of fruits and vegetables (Holsen et al. 2001; Stice, 2001 ; Stice & Bearman, 2001 ; Neumark-Sztainer et al. 2006).”

“A clear clinical application of CGM in clarifying the association between self-control and glucose is in the study of bulimia, where dietary restraint is thought to play a central role (63).”

“Research on individuals with Binge Eating Disorder and Bulimia Nervosa has identified a dietary-negative affect subtype characterized by both dietary restraint and negative affect (Grilo, Masheb, & Wilson, 2001; Masheb & Grilo, 2008; Stice, 2001).”

“We used the 34-item Body Shape Questionnaire (BSQ; Cooper, Taylor, Cooper, & Fairburn; 1987) to assess body dissatisfaction, and the 10-item Ideal-Body Stereotype Scale-Revised (IBSSR; Stice, Ziemba, Margolis, & Flick, 1996) for thin-ideal internalization. Research indicates that BSQ scores differ for patients with ED…”

“Data from an 8-year prospective study suggested one body dissatisfaction pathway to ED onset which was amplified by depressive symptoms, and one self-reported dieting pathway in girls who were more satisfied with their bodies [21,22].”

“For example, prospective longitudinal data have demonstrated that increases in negative affect predict the onset of bulimic symptoms in adolescent females.(1,2) Similarly, studies using ecological momentary assessment (EMA) to examine statespecific associations between mood and bulimic symptoms have shown that increas…”

“Similar to weight-related teasing, prospective studies involving adolescent girls have found that elevated body dissatisfaction at baseline is associated with dieting behaviors at eight-month follow-up ( Wertheim et al, 2001 ) and 20 months later, ( Stice, 2001 ) and with binge eating 24 months later ( Stice et al, 20…”

“Whereas this model has been evaluated using either cross-sectional or limited longitudinal data (e.g., Stice, 2001; Stice et al., 1996; Stice, Killen, et al., 1998, Stice, Shaw, et al., 1998), our study is the first known empirical examination of these relations over a 4-year period.”

“The dual-pathway model of bulimia nervosa (BN) also positions depressive symptoms as one pathway to binge eating and purging [22], and this model has been validated in male and female participants [23-25].”

“Given that stress may lead to negative affect (e.g., Watson, 1988), which has been shown to result in increased bulimic behaviors (e.g., Goldschmidt et al., 2014; Stice, 2001; Stice & Agras, 1998), we expected FNE to relate to increases in food intake.”

“Instead, they may look for shortcuts to obtain a sense of well-being and they may engage in binge eating as a compensatory, yet derivative, way to restore positive affect and deal with stress (Heatherton & Baumeister, 1991; Ryan et al., 2006; Stice, 2001).”

“Furthermore, the dual-pathwaymodel (Stice 2001) posits that, for female adolescents, initial pressure to be thin and thin-ideal internalization predict subsequent growth in body dissatisfaction.”

“Because body dissatisfaction plays a central role in the causation and maintenance of eating disorders (Stice, 2001; Fairburn and Harrison, 2003; American Psychiatric Association, 2013), behavioral scientists have long sought ways to measure the degree of dissatisfaction with one’s personal…”

“To date, there is no accepted prospective test of mediation but random regression growth curve modelling that includes time-varying covariates has been used to examine longitudinal mediational relationships previously (Stice, 2001).”

“These correlations are similar to those in other studies examining the dual pathway model (e.g., Duemm, Adams, & Keating, 2003; Stice, 2001).”

“The expectation that eating helps to alleviate affect might predict increases in binge eating (Stice, 2001).”

“…and the affect regulation 96 model (i.e. binge eating as reinforcer relieving negative affect; Hawkins & Clement, 97 1984; Polivy & Herman, 1985; E. Stice, 2001; E. Stice, Agras, & Hammer, 1999; Waller, 98 2000; Waters, Hill, & Waller, 2001) have been proposed to explain binge eating 99 dynamics.”

“Etiological models of eating psychopathology, namely bulimic behaviours, suggest that dietary restraint may increase one's perceptions of deprivation and lead to counterregulatory eating, predicting the onset and development of these disorders (Stice, 2001; Fairburn, 2008).”

“Stice (2001) found that adolescent girls with elevated dietary restraint scores showed greater increases in BMI over a 2-year period relative to girls with lower dietary restraint scores.”

“There is robust support for emotion regulation difficulties being core to the developmental pathway of binge eating and bulimic symptoms (Stice et al., 1998; Stice, 2001; Allen et al., 2012).”

“…examined relationships posited by the dual pathway model between negative affect, body dissatisfaction, dieting, and bulimic behaviors (Stice, 2001; Stice & Agras, 1998; Stice, Akutagawa, Gaggar, & Agras, 2000; Stice, Killen, Hayward, & Taylor, 1998b; Stice, Martinez, Presnell, &…”

“…self-esteem, body dissatisfaction, restraint eating, and the internalization of the thin body ideal promoted by the media might represent important risk factors for binge eating (Stice, 2001; Stice, Killen, Hayward, & Taylor, 1998; Stice, Marti, & Durant, 2011; Stice, Presnell, & Spangler, 2002).”

“We created an index of attitudes toward slim women by using the three relevant items from the Ideal Body Stereotype Scale-Revised (IBSS-R; Stice, 2001).”

“Recent reviews (Stice, 2002; Thompson & Stice, 2001) concluded that internalization of the thin ideal is indeed a causal risk factor for body image and eating disturbances with support from prospective and experimental studies.”

“Some of the factors identified in the current review align with the established mediating factors in the general population, including internalisation of appearance ideals [54], body dissatisfaction [54], and the overvaluation of weight and shape [55].”

“…of eating psychopathology and meta-analytic data, is recognised as the most robust causal risk factor for women’s clinical and subclinical eating disorders (Fairburn, Cooper, & Shafran, 2003; Fredrickson & Roberts, 1997; Riva, 2011; Shroff & Thompson, 2006; Stice, 2001, 2002; Stice & Shaw, 2002).”

“High internal reliability has been previously been found for use of this measure with a sample of 13- to 17-year-old girls (Stice, 2001).”

“Ideal internalization has been posited to be an important distal variable leading to ED [48], a precursor of body dissatisfaction [49], and it has been shown to be a causal risk factor in body dissatisfaction [3].”

“90), and predictive validity for bulimic symptom onset.(32) This scale had an a 5 0.”

“The interpersonal vulnerability model clearly assigns a mediating role to maladaptive ER in the relationship between insecure attachment and EP as it presumes links between (a) insecure attachment and maladaptive ER, which is conform with the attachment theory (Bowlby, 1982) and (b) maladaptive ER and EP, which is con…”

“Contents lists available at ScienceDirect Eating Behaviors that girls prefer an ultra-thin body type (Ahern, Bennet, &Hetherington, 2008; Stice, 2001), while boys prefer a lean, muscular body (Hargreaves & Tiggemann, 2004).”

“First, the theoretical targets of MS (media internalization) are informed by the dual-pathway model, developed from risk factor research with young-adult women and thus relevant to this population (Stice, 2001).”

“It is both a theoretical [21,22] and empirical risk factor for DE, with longitudinal studies supporting this [23,24].”

“Consistent with findings from select Western investigations (e.g., Stice, 2001; Stice & Agras, 1998), negative affect was a prominent risk factor for girls.”

“The responses were rated on a five-level Likert scale from “strongly agree” to “strongly disagree” and the items from this scale were summed to obtain a total score; a higher score corresponded with increased internalization of the thin ideal Body dissatisfaction (N = 4,625) was assessed using the Body Dissatisfaction…”

“This research suggests that, in addition to other important influences such as dietary restraint (see Racine, Burt, Iacono, McGue, & Klump, 2010; Stice, 2001), a primary reason people binge eat may be to reduce negative affective states (Wedig & Nock, 2010).”

“These findings provide support for conceptualizations of the development and maintenance of disordered eating that include one or more of these variables (e.g. Stice, 2001).”

“Elevated scores on dietary restraint scales are found to predict the future onset of binge eating (Stice et al., 2002), bulimic pathology (Stice, 2001), as well as general eating disorders (Killen, Taylor, Hayward, Wilson, Haydel, Hammer et al., 1994; Killen, Taylor, Hayward, Haydel, Wilson, Hammer…”

“This intervention is based on The Dual Pathway Model that hypothesizes that thin-ideal internalization increases risk for body dissatisfaction, which in turn increases risk for subsequent dieting and negative affect, which increases risk for ED onset (Stice, 2001).”

“As a result, DEB can be further reinforced because weight gain may lead to higher levels of body dissatisfaction, more intense dietary restraint, and consequently more frequent adoption of unhealthy strategies to lose weight (Stice, 2001; Stice and Shaw, 2002).”

“Our finding that suppressing emotion was associated with increased eating for overweight and obese women is in accord with Stice’s Dual-Pathway model of overeating (Gagnon-Girouard et al., 2009; Stice, 2001; Van Strien et al., 2005).”

“The IBSS-R has acceptable retest reliability (r = .63; Stice 2001), internal consistency (a = .”

“46 47 Key-words: body image-related cognitive fusion; eating psychopathology; social rank; 48 BMI; body image dissatisfaction 49 3 50 51 Introduction 52 Research has been highlighting the existence of multiple risk pathways in the 53 development of eating psychopathology (Stice, 2001).”

“Dietary restraint is one variable hypothesised to be both a binge eating risk and maintaining factor according to theoretical models, such as the dual pathway model (Stice, 2001) and the cognitive-behavioural model (CBT) (Fairburn, Cooper, & Shafran, 2003a).”

“It appears to be the case that Western cultural societal messages include the view that one means to obtain life reinforcers and feel adequate, at least for women, involves dieting and thinness (Stice, 2001).”

“Although our findings and those of others raise questions about the robustness of the moderational effect of self–esteem (Shaw, Stice, & Springer, 2004), extant research demonstrates that it is certainly an important factor in the manifestation of eating disturbance (Stice, 2001; Vohs et al., 2001).”

“ity for bulimic symptom onset [38,47].”

“Body dissatisfaction, in turn, was hypothesized to influence disordered eating through one of two pathways—affect regulation or dietary restraint (Stice, 2001a).”

“Very fruitful etiological models have identified specific thinness-related learning events, such as perceived pressure for thinness (McKnight Investigators, 2003; Stice, 2001) and the experience of being teased about one’s weight by friends and family (Gardner, Stark, Friedman, & Jackson, 2000), as important risk fact…”