Poster Session I Abstracts



Poster Session I Abstracts


Thursday, June 8
5:45 p.m. – 7:15 p.m.
Forum Hall Foyer BC, Second Floor


T001: A Test of a State-Based, Self-Control Theory of Binge Eating in Adults with Obesity

Carolyn Pearson Carter, PhD, University of Minnesota, Minneapolis, Minnesota, Tyler Mason, PhD, Neuropsychiatric Research Institute, Fargo, North Dakota, Li Cao, MS, Neuropsychiatric Research Institute, Fargo, North Dakota, Andrea Goldschmidt, PhD, Brown University, Providence, Rhode Island, Jason Lavender, PhD, Neuropsychiatric Research Institute, Fargo, North Dakota, Ross Crosby, PhD, Neuropsychiatric Research Institute, Fargo, North Dakota, Scott Crow, MD, University of Minnesota, Minneapolis, Minnesota, Scott Engel, PhD, Neuropsychiatric Research Institute, Fargo, North Dakota, Stephen Wonderlich, PhD, Neuropsychiatric Research Institute, Fargo, North Dakota, Carol Peterson, PhD, University of Minnesota, Minneapolis, Minnesota

It has been theorized that state levels of self-control depletion (as caused by negative affect and restraint) may lead to binge eating behavior when individuals also endorse momentary expectancies that eating will make them feel better. Given commonalities in precipitants of binge eating across populations, the current study tested this state-based, self-control theory in a sample of adults with obesity using ecological momentary assessment (EMA). Fifty obese adults completed a two-week EMA protocol during which they provided pre-eating episode ratings of negative affect, restraint, and eating expectancies, as well as post-eating episode ratings of loss of control and overeating experienced during the eating episode (used to define episodes of binge eating). Generalized estimating equations (GEE) supported the proposed theory and identified a 3-way interaction between within-person pre-eating episode variables, such that higher self-control depletion (e.g., higher restraint and higher negative affect) was predictive of binge eating episodes only when individuals also endorsed higher momentary expectancies that eating would make them feel better (B = .07, p = .023). To our knowledge, this is the first empirical test of this theory, highlighting the impact of momentary self-control depletion and eating expectancies on binge eating in obese adults. These findings suggest the potential utility of including strategies that target eating expectancies and self-control depletion in interventions for eating- and weight-related problems.


T002: Interpersonal Relationships and Eating Disorders: Development and Validation of a New Measure - The IR-ED

Stephen Jones, MSc; BSc, University of Sheffield, Sheffield, Yorkshire, Glenn Waller, BA, MPhil; DPhil; FAED, University of Sheffield, Sheffield, Yorkshire, Bronwyn Raykos, PhD, Centre for Clinical Interventions, Perth, Western Australia, Anthea Fursland, PhD, Centre for Clinical Interventions, Perth, Western Australia, Susan Byrne, DPhil; PhD, School of Psychology, The University of Western Australia, Perth, Western Australia

It is commonly contended that interpersonal relationships can drive and maintain eating pathology. However, existing measures of such interpersonal problems are only weakly associated with eating pathology, suggesting that those existing models are not sufficiently specific to eating disorders. This paper reports on the international development of a new, brief measure to assess interpersonal problems specifically associated with problematic eating - the Interpersonal Relationships and Eating Disorders (IR-ED) scale. The sample consisted of 531 individuals from the UK. Each completed an online survey of their interpersonal relationship status (the IR-ED), along with measures of eating pathology, general interpersonal problems, fear of negative evaluation, anxiety and depression. IR-ED items were generated by a team of Australian and UK clinicians and academics. Principal component analysis demonstrated three main factors within the IR-ED - Food-related isolation; Avoidance of Body Evaluation; and Food-related Interpersonal Tension – measured using only 15 items. Those scales had strong test-retest reliability and internal consistency, and were moderately associated with a more generic measure of interpersonal problems (the longer IPP-32 scale). The IR-ED was more consistently associated with eating pathology than the IPP-32. Furthermore, the IR-ED scales were superior at distinguishing individuals in different weight status categories, and at distinguishing those individuals who reported any history of eating disorder. The IR-ED is a robust and reliable measure, with greater clinical validity of existing, generic measures of interpersonal problems when working with eating pathology. It is therefore a potentially useful tool for psychological formulation and treatment for individuals experiencing interpersonal problems and pathological eating.


T003: Increased Psychological Symptoms at the Conclusion of AN treatment: True Exacerbation of Distress or an Artifact of Baseline Denial and Minimization?

Lisa Hail, MA, University of California San Francisco & Fairleigh Dickinson University, San Francisco, California, Katharine L. Loeb, PhD, FAED Fairleigh Dickinson University, San Francisco, California, Stuart B. Murray, PhD; PsyD, University of California San Francisco, San Francisco, California, Daniel Le Grange, PhD, FAED, University of California San Francisco, San Francisco, California

Much has been written about the diagnosis of anorexia nervosa in children and adolescents being a challenging pursuit given the unintentional and strategic denial and minimization that is characteristic of this disorder, along with the developmental limitations of youth. Despite these challenges, self-reported symptoms measured via the Eating Disorder Examination (EDE) are a frequent way in which treatment outcomes are evaluated. While weight status (Criterion A) can be evaluated objectively, the psychological symptoms of Fear of Weight Gain, Feeling Fat, and the Importance of Weight and Shape, which inform Criteria B and C, rely on the child’s willingness to disclose symptoms and an ability to introspect. Thus, relying on youth self-reported symptoms to evaluate treatment outcome may not capture the full impact of treatment if these diagnostic items were underreported at baseline. It is hypothesized that a subset of patients will appear to have an exacerbation of psychological symptoms based on the difference between pre- and post-treatment scores on the diagnostic items as an artifact of initial minimization. In a sample of youth with anorexia spectrum presentations who were participating in a research based treatment study (N=48; 87.4% Female; Age: 9-18, M=13.7), 21.3% reported an increase in psychological symptoms at the end of treatment (EOT). Being older, a potential proxy for cognitive maturation, was a significant predictor of reporting increased symptoms (F (1, 45) = 10.009, p = .003). However, neither percent expected body weight at EOT, a proxy for severity of illness (F (1, 45) = 2.251, p = .140), nor change in weight status (i.e., above or below 85% of expected body weight; F (1, 45) = 3.051, p = .088) were significant predictors of this pattern. These findings suggest that a reported exacerbation of symptoms at EOT may not be due to an objective increase in severity but rather an artifact of initial denial and minimization exacerbated by a potential lack of insight.


T004: Predictors of Weight Restoration in a Family-Based Partial Hospitalization Program

Johnny Berona, MS, University of Michigan, Ann Arbor, Michigan, Rebekah Richmond, BA, Medical University of South Carolina, Charleston, South Carolina, Renee Rienecke, PhD, Medical University of South Carolina, Charleston, South Carolina

Evidence-based outpatient treatments for anorexia nervosa (AN) such as family-based treatment (FBT) have been successfully adapted for implementation in partial hospitalization program (PHP) settings. However, less is known about predictors of favorable PHP treatment outcomes such as weight restoration. This study sought to identify predictors of weight gain across two weeks of PHP within 102 PHP patients with AN (n=79) or EDNOS-AN subtype (n=23). Patients and their parents completed the Eating Disorders Examination (EDE), Mini International Neuropsychiatric Interview (MINI), and the Family Questionnaire (FQ) to assess parental expressed emotion (EE). Most patients were female (92.2%), Caucasian (93.1%), and from intact families (78.4%) with a mean (SD) age of 16.3 (2.9), illness duration of 18.3 (20.1) months, BMI of 17.61 (2.1), 82.9% (7.4) expected body weight, and global EDE score of 2.9 (1.6). Prevalent MINI diagnoses were mood disorders (38.2%) and anxiety disorders (43.1%). Curvilinear latent growth curve models displayed good fit (TLI=.99, CFI=.99, RMSEA=.07). Covariates included mood and anxiety diagnoses, binge eating, purging, and expressed emotion. Anxiety disorder (b=1.33, p < .01) and high parental EE (b=.07, p < .01) were associated with lower baseline BMI. Mood disorder (b=-.11, p < .001) and high parental EE (b=-.004, p = .042) predicted significantly slower weight gain. Binge/purging pathology was not associated with baseline or change in BMI. The relatively short time span of two weeks may have limited our ability to detect relationships. Overall, the pattern of findings suggests that it is feasible to implement FBT principles in a PHP setting and some previously identified predictors of weight restoration (e.g. internalizing psychopathology, parental EE) are informative across settings even within acute, brief treatment. Future studies should replicate and extend these findings over longer time frames and with larger samples with more demographic and clinical heterogeneity.


T005: Who Women Compare to in their Everyday Lives and the Impact of those Comparisons on their Body Image

Jasmine Fardouly, PhD; BSc, Macquarie University, Sydney, NSW, Rebecca Pinkus, PhD; BSc, University of Sydney, Sydney, NSW, Lenny Vartanian, PhD; BSc, UNSW Australia, Sydney, NSW

Appearance comparisons are an important socio-cultural factor influencing body dissatisfaction among young women. There are a variety of different types of people (i.e., targets) that women can compare themselves to (e.g., celebrities, close friends) and comparisons to these different groups may differentially impact women’s body image and mood. However, little is known about the frequency and outcome of appearance comparisons to different targets in women’s everyday lives. We conducted an Ecological Momentary Assessment study in which female undergraduate students (n = 150) completed a brief online survey at five random times every day for five days. In this survey, participants were asked if they had made an appearance comparison. If they had, they were also asked who they compared themselves to (i.e., family member, close friend, acquaintance, stranger, celebrity/model), how they rated compared to that person (i.e., more attractive, less attractive), and how attainable that person’s appearance is to them. All participants then completed state measures of mood, appearance satisfaction, and intention to diet and exercise. Participants reported comparing their appearance most often to strangers and acquaintances, then close friends and celebrities, and rarely to female family members. The appearance of close friends and family were rated to be the most attainable, followed by strangers and acquaintances, and then celebrities. Appearance comparisons to celebrities were associated with less appearance satisfaction and a less positive mood than comparisons to all other target groups. These findings suggest that celebrities may be particularly harmful appearance comparison targets in women’s everyday lives and that the perceived attainability of a celebrity’s appearance may influence the outcome of comparisons to that target group.


T006: Binge Eating and Attention Deficits

Daniel Stein, MD, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, No, Roni Halevy-Yosef, PhD, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, No, Eytan Bachar, PhD, Hadassah Medical Center, Jerusalem the Hebrew University at Jerusalem, Jerusalem, No, Lilach Shalev-Mevorach, PhD, School of Education, Tel Aviv University, Tel Aviv, No

The study of the associations of attention deficit hyperactivity disorder (ADHD) with binge/purge type eating disorders (B/P EDs) has gained considerable interest in recent years. ADHD and EDs involving binge-eating may share common clinical features, including impulsivity, emotional and behavioral dysregulation, and lack of self-awareness. Consequently, it has been suggested that inattention and/or impulsivity may foster binge eating. In this study we sought to explore whether objective attention deficits which go beyond the shared symptomatology of ADHD and B/P EDs would be related to binge-eating. For this purpose, we conducted a three-group design, including a binge-eating group (n=51), a non-binge eating group (n=59) and a control group (n=58). Patients with EDs were assessed following the stabilization of their weight and ED symptomatology. The attention battery included diagnostic assessment of ADHD, neuropsychological assessment of attention, and self-report questionnaires. Comorbid symptoms (depression, anxiety and obsessionality) were also monitored. No association was found between binge-eating and attention deficits according to the neuropsychological assessment. Nonetheless, patients with binge- eating scored higher on the self-report ADHD questionnaires compared with the non-binge eating group. Patients with anorexia nervosa B/P type had the highest rates of ADHD symptomatology and were the only subgroup showing sustained neuropsychological attention deficits. Lastly, significant correlations were found between self-reported ADHD, ED and comorbid symptomatlogy. The results of this study suggest that binge eating is not associated with objective attention deficits. Engaging with binge-eating and purging behaviors on a regular basis, may foster a disorganized lifestyle, potentially increasing the risk of subjective self-reported attention difficulties.


T007: Labeling and Defining Difficult-to-treat Anorexia Nervosa: A Systematic Review and Critical Analysis

Catherine Broomfield, BSc; Student; Bachelor (Honours), University of Sydney, Sydney, New South Wales, Kristin Stedal, PhD, Oslo University Hospital, Oslo, Oslo, Paul Rhodes, PhD; Associate Professor, University of Sydney, Sydney, New South Wales, Stephen Touyz, PhD; Professor, University of Sydney, Sydney, New South Wales

With Anorexia Nervosa (AN) having various presentations, attention has been directed towards particularly durable forms of the condition in both research and clinical contexts. A major hinder in terms of advancing the field, however, is the inconsistent labelling and defining of this subgroup. This has two implications; First, the inconsistent recruitment of participants when researching this sample of AN, and second, the misdiagnosing of individuals who may or may not have a durable course of the disease. The aim of the current systematic review was to provide an unbiased overview of the current labels and criteria used for defining difficult-to-treat presentations of AN. In accordance with PRISMA guidelines, a literature search was conducted using four electronic databases (PsycINFO, MEDLINE, Web of Science and Scopus) in order to identify 37 records that met the standards stipulated by the criteria. Data extraction included explicit labelling, the definition or criteria used to describe the subgroup, along with participant age, sample size and study design. It was found that the terms chronic and severe and enduring were the most commonly used adjectives when referring to this subgroup. In terms of criteria, duration of illness, and the number of previously failed treatment attempts were the most common defining features within the literature. It is the aim of the authors to inspire further research into what is the most appropriate label and defining features for the subgroup in order to move towards a better approach and outcome for the individuals affected.


T008: Intensive Multi-Family Therapy for Adolescents Suffering from Eating Disorders - Does It Work?

Eve Lishner, CPsychol; PhD, Department of Clinical Neuroscience, Stockholm, Stockholm

Intensive multi-family therapy (I-MFT) is a brief program that helps adolescents suffering from ED and their families cope with the ED, and aid them on their way to recovery. The aim of this study is to investigate if I-MFT (5 days) has an effect on ED symptoms and the parents’ control over the eating of their adolescents. Basic information was collected and the patients and their families filled in several questionnaires before and after treatment (patient and family satisfaction, EDEQ, Parents versus Eating Disorder). So far, 25 families (78 participants) participated in the first 5 I-MFT groups. Average age of patients was 14, average BMI was 17. Parents reported high satisfactions from treatment. Both the patients and their siblings reported medium satisfaction, with siblings reporting higher satisfaction than the patients. The EDEQ showed lower eating concerns of the patients after treatment (M = 2.75, SD = 1.30) than before treatment (M = 3.09, SD = 1.58). No differences were found in the parameters of restraint, shape concerns, weight concerns and the global EDE. The parents’ estimation of their capability to fight the ED was higher, (t = -4.85, p<.001) after treatment, than before treatment. A quick intervention after the onset of the eating disorder can be crucial for recovery. I- MFT is a short and intensive treatment that shows immediate affect and involves the whole family. Data is collected in this study to see if there are long-term effects.


T009: Who Completes the Screening Phase of an Online Eating Disorders-Prevention Program? A Cluster Analysis Approach

Tiffany Meliolo, PhD, Centre d’Études et de Recherches en Psychopathologie et Psychologie de la Santé, Toulouse, Toulouse, Stephanie Bauer, PhD, Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Heidelberg, Markus Moessner, PhD, Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Heidelberg, Chloé Chambart, MA, Centre d’Études et de Recherches en Psychopathologie et Psychologie de la Santé, Toulouse, Toulouse, Marie Chantepie, MA, Centre d’Études et de Recherches en Psychopathologie et Psychologie de la Santé, Toulouse, Toulouse, Henri Chabrol, MD; PhD, Centre d’Études et de Recherches en psychopathologie et Psychologie de la Santé, Toulouse, Toulouse, Rachel Rodgers, PhD, Department of Counseling and Applied Educational Psychology Northeastern University, Boston, Massachusetts

In recent years, several eating disorders (ED) Internet-based prevention programs have been developed such as ProYouth, a program aiming to promote mental health and provide early identification and prevention of ED. While recent studies have suggested that ED Internet-based programs may have great potential for enhancing the prevention of ED, little is known regarding the characteristics of individuals who enroll in these programs. Therefore, the aims of the current study were (a) to identify the typology of college students who completed the screening questionnaire of ProYouth and (b) to examine whether the resulting profiles differ in terms of their subsequent enrollment in ProYouth. A sample of 676 college students, mainly women (n = 582, 86%) completed the online screening (Mage = 21.3, SD = 2.5). Participants were invited to complete a brief questionnaire assessing several ED-related symptoms: body perception, compensatory behaviors, weight concerns and anxiety/depressive symptoms. Cluster analysis revealed two profiles among those who completed the online screening questionnaire: A low and a high ED symptoms group. An analysis of variance indicated significant group differences regarding ED and anxiety/depressive symptoms (p < .001). Furthermore, rates of enrollment in ProYouth were significantly different between the two groups (p < .001), with the high ED symptoms group more likely to enroll. These findings suggest that ProYouth might be successful in targeting participant at-risk of ED. Given the high number of college students who completed the screening questionnaire, and the reach of the program, ProYouth shows promise as a tool for enhancing the awareness of ED symptoms among college students. To our knowledge, this study is the first to identify profiles students engaging with an ED Internet-based prevention program disseminated among French college students. Further clarification of the successfulness of ProYouth in reducing ED symptoms is needed.


T010: Subgrouping Users of a Specialized App for Eating Disorders: Who is Using Mobile Technology for their Eating Disorder?

Athena Robinson, PhD, Stanford University, Palo Alto, California, Shiri Sadeh-Sharvit, PhD, Stanford University, Palo Alto, California, Alison Darcy, PhD, Stanford University, Palo Alto, California, Jane Paik-Kim, PhD, Stanford University, Palo Alto, California, Eric Neri, PhD, Stanford University, Palo Alto, California, Molly Vierhile, BA, Stanford University, Palo Alto, California, Jenna Tregarthen, PGDip, Recovery Record Inc, Palo Alto, California, James Lock, MD; PhD, Stanford University, Palo Alto, California

The use of smartphone applications (apps) for the management of eating disorders (ED) is an area of growing clinical interest given its potential for patient access, stigma reduction, cost-effectiveness and dissemination. Specialized apps may represent users’ attempts to use technology to address their ED, with or without accompanying traditional face-to-face treatment. Delineating the profile characteristics of users may augment understanding of ED app users and propel further research on whether such characteristics are clinically meaningful for etiological and treatment purposes. This study explored how users of Recovery Record (RR) clustered into subgroups based on their self-reported ED symptoms. Participants (N=1280) were 77.4% non-hispanic white and 91.3% female with a mean age of 27 years (range 15-65) and mean BMI of 27. All participants self-initiated RR use, and reported not being in an evidence based form of treatment for their ED. A hierarchical cluster analysis distinguished 5 groups of participants who differed based on gender, age, current ED symptoms (including binge eating, compensatory behavior, degree of restraint), duration of ED symptoms, and measures of perceived suitability and predicted helpfulness of the RR app. Results indicated that the RR clusters resembled symptoms depicted by the DSM-5 ED categories (including mild binge eating disorder, mild and moderate bulimia nervosa, and unspecified ED). Aggregate participant ratings of suitability and helpfulness of the RR app in addressing their ED were 7.1 and 6.4 out of 10, respectively. Mean number of RR food records logged over the previous month were M=96 (SD=255). While these groups warrant further study and replication, findings enhance our understanding of the clinical presentations of individuals who are not presenting for traditional forms of treatment. Such data may inform the development and evaluation of app-based ED platforms that could meet the needs of unique patient groups.


T011: Difficulties with Emotion Regulation as a Predictor of Subjective Binge Eating Episodes

Molly Atwood, BA; MA, Student, Ryerson University, Toronto, Ontario, Stephanie Cassin, BA; MA; PhD, Ryerson University, Toronto, Ontario

Explanatory theoretical models of binge eating highlight that this disordered eating behaviour functions to regulate or escape from negative affect. Indeed, negative affect is the most commonly cited antecedent of objective binge episodes (OBEs) in women with AN, BN, BED, and non-clinical women, and recent evidence suggests that increases in negative affect also precede subjective binge episodes (SBEs). Some women are vulnerable to engaging in OBEs, in part, because they lack adaptive emotion regulation skills; however, less is known about the relationship between difficulties with emotion regulation and SBEs. The present study examined whether women who report SBEs experience greater general difficulties regulating emotions than non-binge eating controls, and whether these difficulties explain unique variance in SBE frequency beyond negative affect. Female undergraduate students (N = 111) aged 17 to 30 years (M = 19.41, SD = 2.43) completed the Eating Disorder Examination Questionnaire, Difficulties with Emotion Regulation Questionnaire, and Depression Anxiety Stress Scales. Approximately 32% (n = 36) of the sample reported engaging in SBEs over the previous month; 28% (n = 31) met criteria for regular (i.e., once per week) occurrence. As compared to non-binge eating controls (n = 27), women who reported regular SBEs demonstrated greater emotion dysregulation (F[1,56] = 6.79, p = 0.012). Controlling for negative affect, a hierarchical regression analysis showed that DERS total score significantly predicted frequency of SBEs (F[4,109] = 6.89, p = 0.000); the model accounted for 20.2% of the variance. A multiple regression analysis, with DERS subscales entered simultaneously as predictors, showed that difficulty inhibiting impulsive behaviour when distressed uniquely predicted SBE frequency (B = 0.35, p = 0.027); lack of emotional clarity also approached significance (B = 0.24, p = 0.051). Findings suggest that difficulty with emotion regulation may play a role in maintaining subjective binge eating.


T012: Can Taking an Online Survey Reduce Eating Disorder Risk Factors in College Students? Evaluation of a Minimal Prevention Strategy

Jennifer L. O'Flynn, MEd, Northeastern, Boston, Massachusetts, Chloe Richard, BA, Northeastern, Boston, Massachusetts, Debra L. Franko, PhD; FAED, Northeastern, Boston, Massachusetts, Rachel F. Rodgers, PhD, Northeastern, Boston, Massachusetts

The extant literature suggests that self-assessment alone may change risky health behaviors. To date, however, this has not been applied to eating disorder prevention. The purpose of the present study was to examine the effect of a brief online survey on the report of eating disorder symptoms. Undergraduate students were recruited to take two online surveys. At baseline, participants were randomly assigned to a control or intervention group. Participants in the control group completed a well-established personality test and the intervention group completed the intervention survey assessing eating disorder symptoms using the Eating Disorder Examination Questionnaire (EDE-Q). Approximately 2.5 months later all participants were invited to complete the intervention survey (including the EDE-Q). To date, 283 participants have fully completed both surveys who range from 18 – 24 years of age (M=19.81, Md = 20), including 216 females (76.3%) and 65 males (23%). Preliminary findings revealed that participants in the intervention group showed decreased eating disorder symptoms at follow-up, with statistically significant decreases in eating concerns (p < .01), shape concerns (p < .01), restraint (p < .05) and weight concerns (p < .01) from Time 1 to Time 2. A Mann_Whitney U Test revealed that at Time 2 levels of restraint were significantly lower in the intervention group compared to the control group (p < .01). These preliminary findings suggest that online self-assessment of eating disorder symptoms might constitute a useful prevention strategy and fill an important gap in low-cost minimal interventions for eating disorders. Future research should aim to clarify the mechanisms underlying the intervention in order to maximize these effects and conduct the study with a larger sample to examine robustness of this finding.


T013: Dissemination of a Dissonance-Based Body Image Program in Church Settings: A Pilot Study

Kerstin Blomquist, PhD, Furman University, Greenville, South Carolina, Kate Baule, Student, Furman University, Greenville, South Carolina, Carolyn Becker, PhD, Trinity University, San Antonio, Texas

The Body Project is a cognitive-dissonance-based program that increases body satisfaction and reduces disordered eating in females up to one year. However, the Body Project has only been disseminated in colleges and, more recently, a primary healthcare facility and to predominantly (early-to-late) adolescents. Adult women are often overlooked in body image programs yet report significant body dissatisfaction and disordered eating. Although few venues afford opportune settings for intervening with adult women, the church serves as a regular meeting place for many women in the southeast. This study employed a community-based-participatory-research approach to disseminate a modified version—Holy Bodies Initiative—for women in church settings. We hypothesized that women in Holy Bodies Initiative would report increased body satisfaction and reduced disordered eating relative to waitlist-controls. Using the train-the-trainer model, church leaders were trained to lead groups. Adult women (n=14) participated in Holy Bodies Initiative and completed a battery of assessments at baseline, post, and 6-month follow-up. Waitlist-controls (n=31) completed assessments at the same time points. Preliminary results indicate that the intervention significantly increased body satisfaction (p≤.001) and significantly reduced global eating pathology (p=.004), thin-ideal internalization (p=.026), appearance comparison (p=.001), and body surveillance (p=.003) at post-intervention relative to controls. However, these effects were no longer significant at 6-months, and no differences were found for negative affect. Our findings provide mixed support for dissemination of a cognitive-dissonance-based body image program to adult women in church settings.


T014: Treatment Outcome in a Family-Based Partial Hospitalization Program: Three-month Follow-up

Renee Rienecke, PhD, Medical University of South Carolina, Charleston, South Carolina, Rebekah Richmond, BA, Medical University of South Carolina, Charleston, South Carolina

The current study assessed ED symptoms and comorbid psychopathology in patients enrolled in a family-based partial hospitalization program (PHP) three months after discharge. Thirty-one adolescents and young adults (mean age = 16.32, SD = 3.78) (n = 20 AN, n = 8 OSFED AN-type, n = 3 BN, n = 2 ARFID) and their parents (n = 41) completed questionnaires at baseline, end of treatment (after approximately five weeks in PHP; M = 27.39 treatment days), and three months post-discharge. Patients completed the Eating Disorder Examination Questionnaire (EDE-Q) and a measure of depression; parents completed the Parent Versus Anorexia Scale (PVA), assessing parental self-efficacy, and the Family Questionnaire (FQ), assessing expressed emotion. Remission status was classified as reaching 95% of expected body weight (EBW) and having an EDE-Q global score within one standard deviation of established population norms. Partial remission was defined as reaching either one of these criteria. EDE-Q global score did not change from end of treatment to follow-up, nor did depression symptoms. Patients’ %EBW was significantly higher at follow-up (M = 93.99, SD = 7.07) than at end of treatment (M = 99.81, SD = 7.49), t(29) = -7.63, p < .001. Twenty-four patients (80%) reached at least 95% of their EBW. Twenty-two (71%) met full criteria for remission, seven (22.6%) met partial criteria for remission, and two (6.5%) did not meet any remission criteria. Mothers reported significant improvement in their emotional overinvolvement subscale of the FQ, t(19) = 3.67, p = .002. Findings suggest that symptom improvement found at the end of treatment in a PHP is maintained at three months post-discharge, and that full remission can be reached and maintained after a relatively short stay in treatment.


T015: Objective Predictors of Outcome at One-Year Follow-up in Recently Weight-Restored Females with Anorexia Nervosa

Marwan El Ghoch, MD, Department of Eating and Weight Disorders, Villa Garda Hospital, Garda (VR), Verona, Simona Calugi, PhD, Department of Eating and Weight Disorders, Villa Garda Hospital, Garda (VR), Verona, Riccardo Dalle Grave, MD, Department of Eating and Weight Disorders, Villa Garda Hospital, Garda (VR), Verona

We aimed to investigate the association between objective clinical parameters at inpatient treatment discharge and normal weight maintenance (BMI≥18.5 kg/m2) and resumption of menses at one-year follow-up, in patients with anorexia nervosa (AN). In three different studies anthropometric, body composition and physical activity variables were assessed by DXA scan and Sense Wear Armband in two samples of 54 and 32 patients (mean age: 25.2±7.3 and 22.5±7.0 years, respectively), who had restored normal body weight (mean BMI: 19.8±0.8 and 19.2±1.0 kg/m2, respectively) at the end of a specialist inpatient treatment. These variables were compared between participants who had maintained normal weight and/or resumed regular menses and those who did not, one year after inpatient discharge. Two major findings were revealed. First, patients who maintained normal weight at one-year follow-up had higher BMI at inpatient discharge (20.2±0.7 kg/m2) with respect to those who had lost weight (19.4±0.6 kg/m2, p<0.001), and the risk of relapse was associated with a higher BMI at the time of inpatient discharge, as confirmed by logistic regression analysis (Exp[B] = 5.27, P = 0.002). Second, patients who resumed regular menses with respect to those who were still amenorrheic at one-year follow-up were characterized by higher total body fat percentage (27.7±5.7% vs. 23.7±5.8%, p=0.019), and lower daily steps (12347.2±4437.1 vs. 17775.6±5396.1, p=0.004) at inpatient discharge, as confirmed by logistic regression analysis [(OR=1.14, 95% CI 1.001-1.303, P=0.049) and (OR=0.80, CI 95% 0.66-0-97, P=0.026)], indicating that a small increase in total body fat percentage (~1%) and decrease in daily steps (~1,000 steps) substantially increased the probability to have regular menses by 14% and 20% respectively. These data support the use of objective measures to predict the outcome of anorexia nervosa.


T016: Mechanisms and Moderators in Third-Wave Treatments for Binge Eating Spectrum Disorders: A Systematic Review

Jennifer Barney, BA, Drexel University, Philadelphia, Pennsylvania, Helen Burton-Murray, BA, Drexel University, Philadelphia, Pennsylvania, Stephanie Manasse, MS, Drexel University, Philadelphia, Pennsylvania, Cara Dochat, BA, Drexel University, Philadelphia, Pennsylvania, Adrienne Juarascio, PhD, Drexel University, Philadelphia, Pennsylvania

A growing body of evidence supports the efficacy of third-wave psychotherapies for binge eating spectrum disorders (i.e. bulimia nervosa (BN) & binge eating disorder (BED)). Given recent calls for increased research focused toward experimental therapeutics, a review of the current available research related to how and why these treatments are working to produce change is necessary. We systematically reviewed current literature to (1) determine how many third-wave treatment studies for BN and BED assess moderators and mechanisms of action, (2) identify which moderators emerge and whether significant mechanisms of action are consistent with the putative mechanisms of the third-wave model being tested, and (3) make future recommendations for treatment research investigating third-wave treatment models for BN and BED. PsycINFO and Google Scholar databases were used to identify clinical trials of third-wave treatments for BN or BED and each article was examined for use of mediator and moderator analyses in relation to treatment outcome. 33 studies met inclusion criteria for the review. Few studies included any assessment of mechanisms of action and those that did used subpar analysis methods (e.g. 20 studies only reported pre-post changes in process measures). Only 1 study used formal mediation analyses and generally found support for hypothesized mechanisms of action. Overall, findings of pre-post change data related to process measures were largely consistent with existing third-wave theories, but inconsistencies in measurement tools, study designs, data analytic procedures, and underlying theories of the third wave approaches limit the ability to draw strong conclusions from this body of research. Similar patterns emerged with moderators of outcome, with few studies including this type of analysis (n=4). Minimal research has tested mechanisms of action and moderators of outcome in third wave treatments for BN and BED. To improve treatment, more focused and consistent research is needed to examine how and for whom treatments work.


T017: The Gothenburg Anorexia Nervosa Study: A Randomized Control Trial Comparing Individual Cognitive Behavioural Therapy and Family Based Therapy

Erika Nyman-Carlsson, BSc, Doctoral Student, Faculty of Medicine, Örebro University, Örebro, Stockholm, Lauri Nevonen, Associated professor, Faculty of medicine, Örebro University, Örebro, Stockholm, Claes Norring, CPsychol; Professor, Department of clinical neuroscience, Karolinska Institute, Stockholm, Stockholm, Ingemar Engström, Professor, Faculty of medicine, Örebro university, Örebro, Stockholm, Sanna Aila Gustafsson, Doctor in medicine, Faculty of medicine, Örebro university, Örebro, Örebro, Gunilla Paulsson-Karlsson, PhD, Department of clinical neuroscience, Karolinska Institute, Stockholm, Gothenburg, Karolin Lindberg, CPsychol; Doctoral student, Department of clinical neuroscience, Karolinska Institute, Stockholm, Stockholm

Until today no specific psychotherapeutic treatment has been proven to hold consistent superiority in the treatment of adult Anorexia Nervosa (AN). The aim of the study was to evaluate the efficacy of individual cognitive behaviour therapy (CBT) and Family Based Therapy (FBT) for young adults with AN. Two questions were sought to be answered: Are these treatments effective for young adult patients with AN? Are there any differences between these treatments related to outcome? Young adults with AN, aged 17-25 (n=74) and their parents were consecutively assigned to the study, which is a randomized controlled trial. They were consecutively recruited from the waiting list at a specialized treatment unit in Gothenburg, Sweden. They were randomized to either CBT or FBT, each therapy with a maximum length of 18 months. Assessment was made pre- and post-treatment and at 18 months follow-up. Primary outcome measure is BMI. Secondary outcomes are measures of eating related psychopathology and depression. There are no missing data at any time point except for four study dropouts. Analysis of the data showed that both groups changed from pre to post and sustained the improvements on all measures at 18 months follow up. There were no significant differences between the two treatments. The primary outcome, mean BMI, went from underweight to normal weight in both groups. At post treatment and at follow-up about 80 % of the patients were in full remission in both groups. The secondary outcomes showed large effect sizes from pre- to post treatment.


T018: Sexual Functioning Predicts Long Term Outcome of Eating Disorders Patients: A Two Year Follow up Study

Giovanni Castellini, MD; PhD, University of Florence, Florence, APO AE, Lorenzo Lelli, MD, University of Florence, Florence, APO AE, Valdo Ricca, MD, University of Florence, Florence, APO AE

Eating disorders (EDs) patients often report severe sexual dysfunctions. However, only few studies have provided longitudinal information on sexual functioning in patients with EDs. The aim of the present study was to evaluate the role of sexual functioning in predicting the outcome of EDs patients. A total of 32 patients with Anorexia Nervosa (AN) and 24 with Bulimia Nervosa (BN) were assessed at baseline, at one year follow-up after a standard individual cognitive behavioral therapy (CBT), and one year after this first follow up. Subjects were studied by means of a clinical interview and several self-reported questionnaires, including the Female Sexual Function Index (FSFI), the Eating Disorder Examination Questionnaire (EDE-Q), the Beck Depression Inventory (BDI), Spielberg’s State–Trait Anxiety Inventory (STAI), Symptom Checklist-90 (SCL-90). After treatment, both patients with AN and BN showed a significant improvement in the FSFI total score and all FSFI subscales (all p<0.01), without significant differences between groups. For both AN and BN groups, patients who met recovery at first follow up had higher FSFI total scores (p=0.001 and p=0.031 respectively). In AN group patients reporting higher FSFI total score and regular menses at first follow up were more likely to show recovery at the second follow up. The results of the present study challenges a concept of recovery in EDs, exclusively based on weight restoration or behavioral changes. A psychopathological assessment including sexual functioning and core psychopathology might identify the residual pathological condition, and it is able to provide information regarding the long term recovery process.


T019: Brief, Intensive CBT for Normal Weight Eating-Disordered Outpatients: Australian Case Series

Mia Pellizzer, BPsych(Hons), PhD Candidate, Flinders University, Adelaide, South Australia, Tracey Wade, BSc; MPsych; PhD Flinders University, Adelaide, South Australia, Glenn Waller, BA; MPsych; DPhil, University of Sheffield, Sheffield, Sheffield

This case series design investigates the outcome of using Intensive Cognitive Behavioural Therapy (CBTi) with people who have eating disorders (where body mass index [BMI] > 17.5). CBTi, a 10-session therapy, was developed by Waller, Turner, and Tatham and is designed to be delivered by novice therapists, thus overcoming cost and accessibility barriers to treatment. Participants completed a 4-week wait-list control condition in which they received information only. Assessments were conducted at baseline, beginning and end of treatment, and at 1- and 3- month follow-up. There were significant improvements in the eating disorder psychopathology such that by post-treatment and follow-up mean scores fell below clinical cut-offs in both completer (N = 13) and intent-to-treat (ITT; N = 27) analyses. In addition, objective binges significantly reduced from baseline to mid-treatment, post-treatment, and follow-up in both completer and ITT analyses with moderate to large effect sizes. In the completer sample, large effect sizes were observed for reductions in vomiting at all points; however statistical significance was not reached. For ITT analyses small, non-significant reductions in vomiting were found. Depression, anxiety, and stress symptoms also demonstrated significant moderate to large reductions at post-treatment and follow-up for both groups. Thus far, CBTi looks to be a promising short outpatient intervention for eating disorders where BMI > 17.5. However there was a high loss to treatment (51.9%), and so the design was modified to explore whether wait-lists affect treatment engagement, with participants randomized to either a 4-week wait control period or starting therapy the week after initial assessment. Preliminary results of this new design will be reported. Further investigation of CBTi will be required in randomised controlled investigations in order to make more robust conclusions about its efficacy.


T020: Therapist Autonomy Support and Autonomous Motivation in Outpatient Eating-Disorder Treatment

Howard Steiger, PhD; FAED, Douglas Mental Health University Institute, Montreal, Quebec, Jeanne Sansfaçon, MD, Douglas Mental Health University Institute, Montreal, Quebec, Lise Gauvin, PhD, Université de Montréal, Montreal, Quebec, Lea Thaler, PhD, Douglas Mental Health University Institute, Montreal, Quebec, Mimi Israël, MD; FAED, Douglas Mental Health University Institute, Montreal, Quebec, Danaëlle Cottier, Student, Douglas Mental Health University Institute, Montreal, Quebec, Esther Kahan, BSc, Douglas Mental Health University Institute, Montreal, Quebec, Erika Rossi, BA, Douglas Mental Health University Institute, Montreal, Quebec, Emilie Fletcher, BA, Douglas Mental Health Institute, Montreal, Quebec

Self-determination theory (SDT), an empirically supported theory of human motivation, has been applied to diverse clinical problems. According to SDT, autonomy-supportive therapist actions help patients become self-motivated for treatments of various kinds. Patients’ autonomous motivation, in turn, is associated with superior therapy outcomes. Recent data suggest that these tendencies apply also to the in- and outpatient treatment of adults with Anorexia and Bulimia Nervosa. To further explore associations among therapist stance, patient motivation and clinical outcome in the eating disorders, we measured changes in motivational status occurring between the beginning and end of time-limited (15-16 week) segments of outpatient therapy in 83 adults with Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, or Other Specified Feeding and Eating Disorders. At a mid-point in treatment, we measured the extent to which patients perceived their individual and group therapists, and their relatives and peers, as being autonomy supportive. Motivation was assessed using the Autonomous and Controlled Motivations for Therapy Questionnaire (ACMTQ) and autonomy support was assessed using the Health Care Climate Questionnaire (HCCQ). Linear regression analyses revealed that individuals with lower initial autonomous motivation showed largest increases in autonomous motivation (between the start and end of therapy) when they perceived their individual and group therapists to have been autonomy supportive. Furthermore, regardless of diagnosis, higher autonomous motivation at later points in therapy was associated with more-pronounced reductions in eating and shape concerns, restraint, and total Eating Disorders Examination Questionnaire (EDEQ) score. These findings provide further evidence to support the concept that clinicians’ autonomy support can optimize therapy for adults suffering eating disorders.


T021: Loss-of-Control Eating and Impulsivity Moderate the Relationship between Triggers and Dietary Lapses: An EMA Investigation

Stephanie Manasse, MS, Drexel University, Philadelphia, Pennsylvania, Leah Schumacher, MS, Drexel University, Philadelphia, Pennsylvania, Stephanie Goldstein, MS, Drexel University, Philadelphia, Pennsylvania, Ross Crosby, PhD, Neuropsychiatric Research Institute, Fargo, North Dakota, Meghan Butryn, PhD, Drexel University, Philadelphia, Pennsylvania, Evan Forman, PhD, Drexel University, Philadelphia, Pennsylvania

Empirical tests of the prediction that changes in internal states would lead to dietary lapses (unintended breaks of eating restraint) have yielded mixed results, potentially because this relation would only be evident for those high in impulsivity or with loss-of-control (LOC) eating. The current study examined impulsivity (inhibitory control, the ability to withhold an automatic response, and negative urgency, the tendency to act rashly while in distress) and LOC eating as moderators of the relation between affective and physical states and the likelihood of dietary lapses in overweight and obese adults (n=190) completing 2 weeks of ecological momentary assessment at the beginning of an obesity intervention. Generalized estimating equations indicated that for those without LOC, overall greater levels of irritation, loneliness, and boredom were associated with higher lapse likelihood, while for those with LOC eating, likelihood of lapse was elevated regardless of overall levels of negative affect (bs = -.74- -.45, ps<.05). The relation between momentary increases in stress and lapse was more pronounced for those with poorer inhibitory control (b=.001, p=.01), and the relation between increases in loneliness and subsequent lapse likelihood was strongest for those higher in negative urgency (b=.32, p =.03). Interestingly, the relation between increases in hunger and subsequent lapse was strongest for those lower in negative urgency (b=-.23, p<.01). Results suggest that those with LOC appear to be at greater risk for dietary lapses even if overall levels of negative affect are low. Impulsivity may strengthen the relationship between affective states and subsequent lapses, while increases physical states may be predictive of lapses for those lower in impulsivity. With replication, results could point towards tailoring the provision of weight control strategies based on LOC status and impulsivity level.


T022: Psychological Characteristics and Eating Psychopathology Associated with Severity Classification in Women with Anorexia Nervosa

Verónica Vázquez-Velázquez, PhD, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico, Mexico City, Ingrid Rocha-Velis, MPsych, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico, Mexico City, Sylvana Stephano-Zúñiga, MD, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico, Mexico City, Marcela Rodríguez-Flores, MSc, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico, Mexico City, Valeria Soto-Fuentes, MPsych, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico, Mexico City, Eduardo García-García, MD, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico, Mexico City

The aim of this study was to describe the behavioral and psychological traits common in patients with anorexia nervosa (AN) depending on the level of body mass index (BMI) severity. Patients were identified in the service of an Eating Disorders Clinic in an Internal Medicine Hospital in Mexico City. Clinical diagnosis was made to establish disordered eating behavior and BMI was also obtained. All patients answered the Eating Disorder Inventory-2 (EDI-2), which measures eating psychopathology divided into eleven scales: Drive for thinness, Bulimia, Body dissatisfaction, Ineffectiveness, Perfectionism, Interpersonal distrust, Interoceptive awareness, Maturity fears, Ascetism, Impulse Regulation and Social Insecurity. Level of severity was established for each patient according to DSM-5 criteria of AN: Mild (BMI > 17), Moderate (BMI 16-16.99), Severe (BMI 15-15.99), Extreme (BMI < 15). The frequency for each group was: 105 patients for Mild AN, 33 Moderate, 15 Severe and 39 Extreme. Using ANOVA analysis the four groups were compared. Results shows that there are no differences in any of the EDI-2 scales except for Drive for thinness (Mild 13.7±6.9, Moderate 8.9±7.3, Severe 8.8±8.2, Extreme 8.2±7.4; F=8.203, p<.001) and Body dissatisfaction (Mild 16.6±8, Moderate 11.4±6.4, Severe 11.4±8.8, Extreme 12.8±6.3; F=6.329, p<.001). In both scales, the Mild AN group had higher scores compared to the other levels of severity. We conclude that regardless of the severity of BMI, women with AN have the same behavioral, psychological traits and eating psychopathology and that Mild AN even have a higher degree of drive for thinness and body dissatisfaction. This underscores the importance of early diagnosis and not bias the judgment of medical and psychological attention depending on the weight/BMI (via severity) of the patient. It is advisable that a lower weight is not the main condition to define the need for supervision and the convenience of immediate diagnosis and treatment.


T023: Features of Binge Eating Associate with Weight Trajectories and Psychological Distress in Adolescence and Young Adulthood

Linda Mustelin, MPH; MD; PhD, University of Helsinki, Helsinki, Helsinki, Cynthia Bulik, PhD, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, Jaakko Kaprio, MD; PhD, University of Helsinki, Helsinki, Helsinki, Anna Keski-Rahkonen, MPH; MD; PhD, University of Helsinki, Helsinki, Helsinki

Binge eating increases the risk of obesity, but the distribution of binge eating and related behaviors in the population has not been comprehensively studied. How such behaviors associate with long-term weight development is also incompletely known. We investigated features of binge eating and their association with body mass index (BMI) and psychological distress in a longitudinal community-based cohort. We assessed features of binge eating among men (n=2423) and women (n=2825) from the community-based longitudinal FinnTwin16 cohort (born 1975-1979). Seven items related to binge eating were extracted from the Eating Disorder Inventory-2 and were assessed at a mean age of 24. BMI was assessed at ages 16, 17, 18, 24, and 34. We used linear mixed models to assess the association of features of binge eating with BMI trajectories from age 16 to 34. We also assessed the association of binge-eating features with psychological distress, as measured with the General Health Questionnaire at ages 24 and 34. We found that more than half of our participants reported at least one binge-eating feature; clustering of several features in one individual was less common, particularly among men. All individual binge-eating features were associated with higher BMI in both sexes. Their clustering was consistently associated with steeper BMI trajectories from age 16 to 34, as well as with more psychological distress both cross-sectionally and prospectively, independent of BMI. This was true both for men and women. Features of binge eating were associated with BMI in a cumulative manner: those reporting more of these behaviors had higher mean BMI and steeper BMI trajectories. Binge-eating features also predicted increased psychological distress.


T024: What Do I Look Like? Perceptual Confidence in Bulimia Nervosa

Samantha Wilson, BA; Student, Université de Montréal, Montréal, Québec, Frederick Aardema, PhD, Université de Montréal, Montréal, Québec, Kieron O'Connor, PhD, Université de Montréal, Montréal, Québec

Previous studies have reported mixed results regarding perceptual body size distortion in eating disorders. The purpose of the present study was to investigate the relationship between perceptual confidence and body image disturbance in bulimia nervosa (BN). Body checking has been associated with body image disturbance and is conceptually comparable to compulsive checking as observed in obsessive compulsive disorder (OCD). Recent research suggests that checking in OCD may be associated with low cognitive and perceptual confidence rather than actual deficits in these areas. Given the similarities that exist between BN and OCD, it was hypothesized that perceptual confidence may be relevant in BN as well. Twenty-one women with BN and 24 healthy controls (HC) completed a body checking task. During this task, participants were asked to estimate the size of several body parts and then asked to assess their degree of confidence in the accuracy of these estimations. Confidence was assessed a second time following body checking of a selected body part. Repeated measures ANOVA revealed a main effect of time F(1, 43) = 9.47, p = .004 as well as a time by group interaction F(1, 43) = 5.07, p = .03. Post hoc analyses indicated that there was no significant difference between groups with regards to confidence at baseline F(1, 43) = .5, p = .48, but that there was a statistically significant decrease in confidence in the BN group post-checking F(1, 43) = 7.78, p = .008. Satisfaction regarding the selected body part did not change as a result of body checking F(1, 43) = .06, p = .81. Furthermore, significant correlations were observed between the change in perceptual confidence and general body checking behaviours (r = -.43, p = .003) as well as a novel eating disorders-specific measure of the tendency to distrust sensory information (r = -.35, p = .019). These findings suggest that body image disturbance in BN may be due to low confidence in perceptual abilities. Like compulsive checking in OCD, body checking may paradoxically decrease confidence regarding one’s appearance.


T025: Relationship between Desired Weight and Eating Disorder Pathology in Youth

Hope Boyd, BA, University of Chicago, Chicago, Illinois, Andrea Kass, PhD, University of Chicago, Chicago, Illinois, Erin Accurso, PhD, University of California, San Francisco, San Francisco, California, Andrea Goldschmidt, PhD, Brown University, Providence, Rhode Island, Jennifer Wildes, PhD, University of Chicago, Chicago, Illinois, Daniel Le Grange, PhD, University of California, San Francisco, San Francisco, California

Preference for a smaller body size has been associated with body dissatisfaction and disordered eating. Discrepancies between actual (i.e., current) and desired weight have also been associated with heightened eating disorder (ED) behaviors. However, no study has examined desired weight in relation to ED pathology in a clinical population. Given that desired weight may impact weight restoration and normalization of eating patterns, we tested the relationship between desired weight and ED pathology, and between actual-desired weight discrepancies and ED pathology in youth with anorexia nervosa (AN) or bulimia nervosa (BN). Participants were 340 youth ages 7-18y (mean age=15.61±2.14y) presenting to an outpatient ED clinical research program. Height and weight were measured, and youth completed the EDE. Desired weight percentage was calculated as (desired weight/expected body weight)x100. Weight difference percentage was calculated as (current weight–desired weight)x100. Participants’ mean desired weight percentage was 90.41% and mean weight difference percentage was 4.13%. Youth with AN wanted to be a lower percentage of their expected body weight than youth with BN (desired weight percentage for AN=84.20%; BN=96.66%; p<.001). However, weight difference percentages showed youth with AN, on average, wanted to gain 5.28% of their body weight and youth with BN wanted to lose 13.60% (p<.001). Thus, youth with AN wanted to be a smaller size than youth with BN, but had smaller differences between current and desired weight. Both desired weight percentage and weight difference percentage were associated with restraint and eating, weight, and shape concerns, controlling for ED diagnosis, age, and sex (ps<.001), but there were no significant associations with objective binge eating or purging (ps≥.05). The association with elevated ED pathology suggests desired weight may be an important intervention target and should be studied as a prognostic indicator of treatment outcome.


T026: Attentional Underpinnings of Preoccupation with Body Image and Body Weight: An ERP Study

Kirsti Akkermann, PhD, University of Tartu, Tartu, APO AE, Helen Uusberg, MA, University of Tartu, Tartu, APO AE, Krista Peet, MA, University of Tartu, Tartu, APO AE, Andero Uusberg, PhD, University of Tartu; Stanford University, Tartu, California

Misjudging one’s body and preoccupation with body image and weight is one of the key mechanisms in the etiology of eating disorders. We conducted EEG study to investigate the attentional underpinnings of this risk factor in a social comparison setting. 36 women (age M=20.31, SD=2.01; BMI M=21.70, SD=2.56) varying in self-reported preoccupation with body image and weight viewed a series of digitally size-modified images (from -10% to +10% in 2% intervals) of themselves and a size-matched model with the task to compare each image to their actual body size (“smaller/bigger than me”). The 50% psychometric threshold was used to estimate perceived body size. Late Positive Potential (LPP) was considered an index of attentional deployment towards the stimuli. The dynamics of later event related potential (ERP) components suggest that at more deliberate processing stages highly preoccupied women attended selectively to modifications of their own body size images. Specifically, during the P3 window, their brain responses were increased in response to enlarged (+4% to +10%), and during the LPP window also in response to reduced (-10% to -4%) images of themselves, but not of the model. In women with low preoccupation the body size differentiation occurred later, was independent of stimulus identity, and apparent only for enlarged images. Increased preoccupation with one`s body image and weight enhanced the tendency to overestimate one’s body size in relation to the model. Thus, preoccupation with body image and weight increased LPP differences between body sizes for the images of the self, but not for the images of the model. Collectively, these results indicate that preoccupation with body image and weight involves an attentional bias towards one’s own body that may interfere with adequate social comparisons and further result in biases in body size perception.


T027: Gold Standard Assessment in the Real World: AN, Atypical AN, and ARFID

Helene Keery, PhD, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, Beth Brandenburg, MD, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, Sarah Eckhardt, PhD, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, Julie Lesser, MD, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, Amy Beadle, BA, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, Robert Juenemann, BS, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, Amanda Nickel, MPH, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, Daniel Le Grange, PhD, University of California San Francisco, San Francisco, California

The purpose of this study is to describe the prevalence of eating disorder diagnoses and clinical characteristics of patients presenting for eating disorder treatment at a Children’s Hospital. Participants (N=124), ages 7-18, were evaluated and consented at initial presentation to the eating disorder service. Of the 124 participants, 45.2% met DSM-V criteria for ARFID, 21.8% for AN, 16.1% for Atypical Anorexia, 7.3% for UFED, 4.8% for BN, 1.6.% for BED, 1.6% for Purging Disorder, and <1% for subthreshold BN and BED. Given the high prevalence of restrictive eating disorders (n=103), we compared baseline characteristics for AN (n=27), Atypical AN (n=20), and ARFID (n=56). Continuous data were analyzed using medians and interquartile ranges, and significance was assessed using an alpha of 0.05. The AN (median=15) and Atypical AN (m=15) participants did not differ on age, and both were significantly older than ARFID (m=13). Participants with ARFID (m=84.6) and AN (m=84) had significantly lower %EBW compared to participants with Atypical AN (m=101.6). AN and Atypical AN did not differ on measures of self-esteem (RSE) or perfectionism (CPQ). The ARFID group did report significantly higher self-esteem and lower perfectionism than AN and Atypical AN patients. Similarly, AN (m=18; m=2.54) and Atypical AN (m=24; m=2.39) did not differ from one another on the Clinical Impairment Assessment or EDE Global Scale. Both CIA and EDE Global scores were significantly higher in the ARFID group (m=9; m=0.15, respectively). CDI-2 Total T score only differed between the Atypical AN (m=68) and ARFID (m=51.5) groups. Results highlight similarities in psychopathology for AN and Atypical AN despite difference in their %EBW. Also of note, levels of psychopathology were lower in ARFID despite being equally low in weight when compared to AN. These findings are important in terms of targeting assessment and treatment of patients with restrictive eating disorders.


T028: Emotional Bodily Experience Questionnaire: Expanding the Comprehension of Eating Disorders Psychopathology

María Gaete, DClinPsy; DiplPsych; PhD, Universidad de Chile, Santiago, Región Metropolitana

The purpose of the present investigation was to develop, validate, and get the psychometric properties of Emotional Bodily Experience Questionnaire (EBEQ), which is based on a phenomenological frame of understanding the eating disorders (EDs) psychopathology. In brief, Emotional Bodily Experience (EBE) is understood here as a multi-dimensional and dynamic phenomenon which conveys coherence and internal consistence to the self. EDs symptoms express a loss of the subjective experience of the body, and an objectification of it that give them relief from negative affects and emotions (Embodied Defense Model). Using an iterative process, a first study was aimed at achieving content validity and the theoretical structure (ThS) of EBEQ which comprises a three-dimensional structure that assess cross-situationally: levels of attention to the body, levels of attention to the environment and affect intensity of different bodily-related situations. A second study, tested the preliminary ThS of EBEQ in a sample of 402 non-clinical adult population (250 females (62%) and 152 males (37%), mean age of 23.9 (SD=7.77)) leading to a final factorial structure (FFS) with 27 items and 6 scales. A third study assessed internal reliability, and construct validity of the FFS. Results showed good internal reliability, good convergent validity with the Scale of Body Connection (SBC), meaningful associations with related mental health measurements (depression, somatization, and EDs), and ability to distinguish between non-clinical and EDs samples, as well as between genders groups. This new assessment tool seems a promising first step in contributing to the comprehension of the emotional bodily experience and its adaptive and maladaptive forms to further develop better shaped psychotherapeutic strategies for EDs treatment.


T029: Hunger and Satiety: How Bodily Awareness, Attentional focus on the body, and Affect Intensity is related to BMI and EDs?

Maria Gaete, DClinPsy; DiplPsych; PhD, University of Chile, Santiago, Región Metropolitana

Attentional focus on the body (AfB) is an inherent aspect of bodily awareness (BA). The present study is aimed at exploring the association between bodily awareness (BA), attentional focus on the body (AfB), affect intensity (AI) of hunger (Hs) and satiety sensations (Ss) and BMI and EDs symptoms. By means of a cross-sectional study a sample from general population (n=402), which consisted of 250 females (62%) and 152 males (37%), with a mean age of 23.9 (SD=7.77) was assessed by the Scale of Body Connection (SBC), the Emotional Bodily Experience Questionnaire (EBEQ), and the Eating Disorders Examination Questionnaire (EDEQ). Results show AfB of Hs significant and negatively associated to AI of Hs, and AfB to Ss to be significant and positively associated to AI of Ss. BMI scores show to be significant and negatively correlated with BA (r= -.152, p<0.05), significant and negatively correlated with AfB to Hs (r= -.140, p<0.05), significant and positively correlated with AfB to Ss (r=.166, p<0.01). ED symptoms show to be significant and positively correlated with Body Disconnection subscale of SBC (r=.220, p<0.01), significant and positively correlated with AfB to Hs (r=.133, p<0.05), significant and negatively correlated with AI of Ss (r= -.165, p<0.01), significant and positively correlated with AfB to Ss (r=.225, p<0.01). Overall results show that the more attention to the body when feeling hunger the more unpleasant Hs is felt, and that the more attention to the body when feeling satiety the more pleasant Ss is felt. Higher BMI shows to be associated with avoidance of unpleasant Hs and with focusing on Ss. Higher levels of EDs symptoms shows to be associated with focusing both on unpleasant Hs and on Ss that is felt as unpleasant.


T030: Measuring the Beliefs that Maintain Binge Eating: Psychometric Properties of a Brief Metacognitive Questionnaire in both a Clinical and Non-Clinical Sample

Amy Burton, BSc, University of Sydney, Sydney, NSW, Maree Abbott, MPsych; PhD, University of Sydney, Sydney, NSW

Binge eating is a distressing behaviour that occurs in individuals with Bulimia Nervosa, Binge Eating Disorder and atypical eating disorders. It is also a difficult symptom to treat. It has been suggested that specific metacognitive beliefs about food, eating and bingeing may play a key role in the maintenance of binge eating behaviour. The Eating Beliefs Questionnaire (EBQ-18) provides a brief self-report assessment tool measuring three types of metacognitive beliefs: positive, negative and permissive beliefs about food and eating. This study aimed build on past research by validating the factor structure and psychometric properties of the EBQ-18 using both a clinical and non-clinical sample. This study also aimed to establish diagnostic cut-offs and normative data for groups of patients diagnosed with eating disorders. A sample of 420 participants (380 non-clinical, 50 with a diagnosed eating disorder) completed a battery of questionnaires including the EBQ-18 and other measures of eating disorder symptoms and relevant constructs. A subset of clinical participants with a diagnosed eating disorder completed the test-battery before and after receiving a psychological treatment (N=27), and a subset of 95 non-clinical participants completed the test battery again after an interval of two-weeks. Results of a Confirmatory Factor Analysis provided support for a three-factor solution. EBQ-18 scores were found to correlate with binge eating episode frequency and measures of eating disorder symptoms and related psychopathology. The EBQ-18 was found to be a valid and reliable measure, with excellent internal consistency, good test-retest reliability and sensitivity to treatment in both clinical and non-clinical samples. This study provides valuable information about the utility of the EBQ-18 as a measure for use in both clinical and research settings.


T031: Netherlands Eating Disorder Registry First Wave of Data Collection: Receiving Treatment for Eating Problems, Just a Matter of Time?

Rita Slof-Op 't Landt, PhD, Rivierduinen Eating Disorders Ursula, Leiden, Zuid-Holland, Jésus de la Torre y Rivas, MSc, WEET Patient and Family organization for Eating Disorders, IJsselstein, Utrecht, Eric van Furth, PhD, Rivierduinen Eating Disorders Ursula, Leiden, Zuid-Holland

Little is known about people with eating disorders who do not receive treatment. Do these people differ in severity of eating disorder psychopathology, comorbid symptoms and/or quality of life? Through the Netherlands Eating Disorder Registry 765 persons (age 13-64 years, 99% women) who currently or in the past have (had) eating problems or an eating disorder, were recruited. They were divided into four groups: current eating problems and ever treatment (n=500), current eating problems and never treatment (n=98), past eating problems and ever treatment (n=146), past eating problems and never treatment (n=21). Non-parametric tests were used to examine if there were differences between these groups in age, duration of eating problems, eating disorder psychopathology (EDEQ total score, BMI, eating binges, self-induced vomiting, laxative use, excessive exercise), symptoms of anxiety, symptoms of depression and quality of life. People with current eating problems who never received treatment were on average younger, had a shorter duration of eating problems and a higher lowest BMI ever. This group reported more eating binges and laxative use in the past month than people with current or past eating problems who did receive treatment. No differences were found between the groups for self-induced vomiting and laxative use ever. For the EDEQ total score, symptoms of anxiety, symptoms of depression and quality of life, people with current eating problems (with or without treatment) scored worse than people with past eating problems. In conclusion, people who did not receive treatment for their eating disorder have a similar severity in eating disorder psychopathology, comorbid symptoms and quality of life compared to the people who did receive treatment. The chance of a person receiving treatment seems higher if the duration of eating problems is longer and/or the person is becoming older.


T032: Feasibility, Acceptability and Preliminary Efficacy of a Smartphone-Based Aftercare Intervention Following Inpatient Treatment of Patients with Eating Disorders - a Pilot Randomized Controlled Trial

Sandra Schlegl, DiplPsych; MSc; PhD, Department of Psychiatry and Psychotherapy, Munich, Bayern, Christina Neumayr, MSc, Schön Klinik Roseneck, Prien, Bayern, Tabea Bauman, MD, Schön Klinik Roseneck, Prien, Bayern, Bernhard Backes, DiplPsych, Schön Klinik Roseneck, Prien, Bayern, Nicolas Stoetter, MSc, Schön Klinik Roseneck, Prien, Bayern, Jenna Tregarthen, MA, Recovery Record Inc., San Francisco, California, Ulrich Voderholzer, MD, Schön Klinik Roseneck, Prien, Bayern

The aims of the pilot study are to evaluate the feasibility, acceptability and preliminary efficacy of a smartphone-based aftercare intervention following inpatient treatment of patients with eating disorders. 40 female patients (DSM-V anorexia nervosa or bulimia nervosa) (aged: 13-60 years) are randomized either to receive an 8-week smartphone-based aftercare intervention (German version of “Recovery Record”) with therapist feedback as an adjunct to treatment as usual (TAU) or to TAU alone. Therapist feedback will be provided in-app twice per week in the first 4 weeks and once per week in the last 4 weeks. Eating disorder symptoms will be assessed at baseline (discharge of inpatient treatment) and after 8 weeks. Secondary outcome measures include patient satisfaction, adherence to the smartphone-based intervention, and post-discharge health care utilization. The recruitment and intervention period will be between October 2016 and February 2017. Results on feasibility, acceptability and preliminary efficacy will be presented at the conference. This study will be the first to examine a smartphone-based aftercare intervention following inpatient treatment of patients with eating disorders. Results may elucidate the extent to which a guided smartphone-based aftercare intervention is accepted by eating disorder patients and whether this novel intervention can support symptom stabilization or continued improvement after inpatient treatment.


T033: A Better Perfect? Associations between Adaptive and Maladaptive Perfectionism Subtypes and Eating Disorder and Affective Symptoms in Anorexia Nervosa

Ann Haynos, PhD, University of Minnesota, Minneapolis, Minnesota, Linsey Utzinger, PsyD, Stanford University School of Medicine, Stanford, California, Jason Lavender, PhD, Neuropsychiatric Research Institute, Fargo, North Dakota, Ross Crosby, PhD, Neuropsychiatric Research Institute, Fargo, North Dakota, Li Cao, MS, Neuropsychiatric Research Institute, Fargo, North Dakota, Carol Peterson, PhD, University of Minnesota, Minneapolis, Minnesota, Scott Crow, MD, University of Minnesota, Minneapolis, Minnesota, Stephen Wonderlich, PhD, Neuropsychiatric Research Institute, Fargo, North Dakota, Scott Engel, PhD, Neuropsychiatric Research Institute, Fargo, North Dakota, James Mitchell, PhD, Neuropsychiatric Research Institute, Fargo, North Dakota, Daniel Le Grange, PhD, University of California, San Francisco, San Francisco, California, Andrea Goldschmidt, PhD, Warren Alpert Medical School of Brown University Providence, Rhode Island

Perfectionism is hypothesized to play a critical role in the etiology and maintenance of anorexia nervosa (AN). Emerging evidence suggests that perfectionism can be differentiated into discrete dimensions constituting maladaptive facets (i.e., excessive evaluative concerns and parental pressures) and adaptive facets (i.e., high personal standards and organization). However, there has been little investigation into whether maladaptive and adaptive facets of perfectionism predict distinct outcomes in this group. In this study, a latent profile analysis was conducted using data from adults with AN (N = 118). Subscales of the Frost Multidimensional Perfectionism Scale were used to categorize participants in terms of adaptive and maladaptive perfectionism. Generalized linear models compared groups on eating disorder attitudes and behaviors, and on state affect-related dimensions, measured at baseline and through ecological momentary assessment. Four perfectionism subgroups were identified: (a) Low Perfectionism group; (b) High Adaptive group; (c) Moderate Maladaptive group; and (c) High Maladaptive group. Perfectionism subgroup predicted overall eating disorder symptoms (p < .001), purging frequency (p = .005), restrictive eating frequency (p < .001), body checking frequency (p < .001), depressive symptoms (p < .001), anxiety symptoms (p < .001), mean negative affect (p = .001), and mean positive affect (p < .001). The Low Perfectionism group exhibited the lowest severity on all measures; the High Adaptive group demonstrated low affective disturbances (i.e., low anxiety and negative affect; high positive affect) but elevated eating disorder symptoms (i.e., high global eating disorder symptoms, restrictive eating, body checking). These results support the validity of the differentiation between adaptive and maladaptive forms of perfectionism and the link between both dimensions of perfectionism and specific clinical symptoms in AN.


T034: Cognitive Biases in Anorexia Nervosa: How Hard is it to Call into Question Our Own Ideas? A Case-Control Study

Elena Tenconi, PhD; PsyD, Department of Neuroscience, University of Padova, Padova, Italy, Elisa Bonello, PsyD, Deparment of Neuroscience, University f Padova, Padova, Italy, Daniela Degortes, PhD; PsyD, Department of Neuroscience, University of Padova, Padova, Itlay, Alberto Polloniato, MD, Department of Neuroscience, University of Padova, Padova, Italy, Paolo Santonastaso, MD, Department of Neuroscience, University of Padova, Padova, Italy, Angela Favaro, MD; PhD, Department of Neuroscience, University of Padova, Padova, Italy

The purpose of the study is to investigate a specific type of cognitive bias in anorexia nervosa (AN) patients using the Bias Against Disconfirmatory Evidence Task (BADE). Biased reasoning processes may contribute to psychopathology and functional disabilities inducing perceptual distortion, inaccurate judgment and illogical interpretation. To date, most of the studies have specifically addressed schizophrenia and other psychotic disorders but also anorexia nervosa shows some form of delusion-like beliefs, especially concerning body image and nutrition. The study sample consisted of fifty patients diagnosed with lifetime anorexia nervosa, according to DSM-5 criteria, recruited from the Eating Disorders Unit of the Hospital of Padova, Italy, and thirty-seven healthy controls recruited from the general population. All participants were measured in weight and height, and the weight history was investigated by means of a semi-structured interview. A broad neuropsychological and clinical test battery was employed to assess executive functions, visuospatial abilities, emotional processing and psychopathology. The BADE test and its different indices (Bias Against Confirmatory Evidence, BACE and Liberal Acceptance, LA) were employed to assess cognitive bias and the ability to rethink our own position and ideas. The samples differed significantly on BADE score (AN mean score 2.3±2.1 vs. HC mean score 3.2±1.7; t=2.2; p=.03) but they did not differ on both BACE (respectively 5.2±2.5 vs. 4.8±1.7; t=0.8; p=.4) and LA scores (respectively 0.8±0.8 vs. 1.0±0.8; t=1.0; p=.3). A sub-group of patients (N= 22) followed up after 12 months showed a positive correlation between BADE score and clinical outcome (body mass index). BADE, BACE and LA scores did not correlate with any clinical and neuropsychological outcomes. This is the first study specifically addressing cognitive bias and thinking process characteristics in anorexia nervosa: our findings have many interesting scientific and clinical implications to be discussed.


T035: Clinical Characteristics in an Italian Sample of Eating Disorder Outpatients with and Without a History of Overweight and Obesity in Childhood and Adolescence

Romana Schumann, CPsychol, Centro Gruber, Bologna, Italy, Romana Schumann, CPsychol, Centro Gruber, Bologna, Italy, Donatella Ballardini, MD, Centro Gruber, Bologna, Italy, Valentina Fasoli, CPsychol, Centro Gruber, Bologna, Italy, Chiara Mazzoni, CPsychol, Centro Gruber, Bologna, Italy, Elena Dapporto, RD, Centro Gruber, Bologna, Italy, Livia Pozzi, RD, Centro Gruber, Bologna, Italy

Obesity has been recognized as an antecedent factor in the development of eating disorders. The aim of this retrospective study was to evaluate the presence of pre-existing overweight/obesity and its effects on the clinical issues in 691 outpatients with eating disorder (EDO) of a Specialized Multidisciplinary Treatment Center and in 63 healthy controls (HC). The assessment includes an interdisciplinary semi structured interview and psychometric questionnaires of which were considered: Eating Attitudes Test (EAT), Eating Disorder Inventory-3(EDI-3), Three Factor Eating Questionnaire (TFEQ). Non-parametric statistics (Mann-Whitney test) and chi square test were conducted, using SPSS program. There was a significant difference between EDO and the HC in relation to the presence of history of overweight /obesity (EDO: 44.4% (n=307); HC: 20.6% (n=13); p = 0.000), dieting behaviour (≥ 3 diets) previous eating disorder onset (EDO: 56.7% (n=382); HC: 6.3% (n=4); p = 0.000). The comparison between EDO with and without overweight/obesity (EDO-PrevOb Vs EDO-NoPrevOb) highlights: higher duration of illness (p = 0.000) and higher number of previous treatments (p = 0.028). In EDO-PrevOb we found higher psychometric scores: EDI-3 Bulimia p = 0.029; EDI-3 Body dissatisfaction p = 0.003; EDI-3 Eating Disorder Risk p = 0.007; TFEQ Cognitive Restriction p = 0.006; TFEQ Hunger p = 0.000; TFEQ Disinhibition p = 0.000). In EDO-NoPrevOb EAT Oral Control score is higher (p = 0.000). EDO-PrevOb and EDO-NoPrevOb do not differ in age of illness onset and psychiatric comorbidity. In conclusion overweight/obesity are widespread in EDs, as shown in international literature. The evaluation of our results shows that EDO-PrevOb seem to have more severe symptomatology in eating behavior and in food, body and shape concerns which need to be considered for the treatment project to obtain a personalized and specialized therapeutic program.


T036: Remission Rates in a Partial Hospitalization Family-Based Treatment Program for Anorexia Nervosa

Renee Rienecke, PhD, Medical University of South Carolina, Charleston, South Carolina, Rebekah Richmond, BA, Medical University of South Carolina, Charleston, South Carolina

The purpose of this study was to investigate whether family-based treatment (FBT) adapted for a partial hospitalization program (PHP) is effective in helping patients reach remission status for adolescents and young adults with AN and OSFED AN-type. Parents were involved in treatment in several ways, including choosing patients’ food while in the program and attending daily meals in the program with their child. Forty-two patients (M = 16.10 years old, SD = 3.18) with AN (n = 34) and OSFED AN-type (n = 8) completed the Eating Disorder Examination (EDE) as well as questionnaires assessing eating disorder and other symptomatology at baseline and end of treatment. Remission status was classified as reaching 92% of expected body weight (EBW) and having an EDE global score within one standard deviation of population norms. Partial remission was defined as reaching either one of these criteria. The average length of stay in the program was approximately five weeks (M = 26.90 treatment days, SD = 10.13). At end of treatment in the PHP, 35.7% (n = 15) met full remission criteria, 50% (n = 21) met partial remission criteria, and 14.3% (n = 6) met criteria for neither. Significant differences were found between remission status groups in end of treatment depression, self-esteem, and eating disorder rituals and preoccupations (p’s < 003). There were no significant differences in age, duration of illness, length of stay in treatment, or baseline eating disorder symptomatology between groups (p’s > .09) with the exception of baseline EBW (F(2, 39) = 3.69, p = .03) and adolescent depression (F(2, 26) = 3.98, p = .03). Post hoc analyses demonstrated both remission groups had significantly higher baseline EBW and less severe depression symptoms than those who did not meet any remission criteria. Results suggest FBT adapted for a PHP is effective in bringing about full and partial remission, with remission rates similar to some outpatient studies of manualized FBT.


T037: Comparison of the Effects of Blind versus Open Weighing Practices upon Rates of Weight Gain and Patient Satisfaction among Individuals with Anorexia Nervosa

Matthew Shear, MPH; MD, Weill Cornell Medicine, White Plains, New York, Sean Kerrigan, MD, Weill Cornell Medicine, White Plains, NY, New York, Evelyn Attia, MD, Weill Cornell Medicine, White Plains, New York

Anorexia nervosa is a serious psychiatric illness associated with significant morbidity and mortality. Despite the seriousness of this condition, few data are available regarding the optimal components of care, and weight restoration protocols vary at different treatment programs. The purpose of this study is to compare the effects of blind versus open weighing practices upon rates of weight gain and patient satisfaction among individuals with acute anorexia nervosa treated on a specialized inpatient unit. We examined patients meeting DSM-5 criteria for anorexia nervosa admitted to the inpatient eating disorders unit at New York-Presbyterian Hospital (New York/USA). Data were collected during two 90-day periods with no overlap of clinical sample. During the first period, patients (n=45) were not informed of their daily weights (i.e., weighed blind), while during the second period, patients (n=51) were informed of their daily weights (i.e. weighed open). Study participants included both males and females, ranging in age from 12 to 63 years. The average rates of weight change were not significantly different between the two groups. Patients weighed blind gained weight at an average rate of 0.25kg/day (SD=.10), while patients weighed open gained weight at an average rate of 0.24kg/day (SD=.14) However, patient satisfaction, measured using the Press Ganey patient satisfaction survey, was significantly higher among patients who were weighed blind (mean score=85.7, SD=1.16) compared with those who were weighed open (mean score=77.7, SD=9.53).


T038: Body Checking in Patients with Anorexia Nervosa: A Longitudinal Outcome Study

Simona Calugi, PhD, Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Verona, Marwan El Ghoch, MD, Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Verona, Riccardo Dalle Grave, MD, Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Verona

The aims of this study were i) to evaluate the trajectories of change over time of body checking in patients with anorexia nervosa (AN) treated with inpatient enhanced cognitive behaviour therapy (CBT-E) including specific procedures to address body checking and ii) to examine body checking and its change as a potential predictor of change of eating disorder and general psychopathology. Sixty-six adult patients with AN received inpatient CBT-E in a community-based eating disorder clinic. Body mass index (BMI), Eating Disorder Examination (EDE), Brief Symptom Inventory (BSI) and Body Checking Questionnaire (BCQ) scores were recorded at admission, end of treatment, 6- and 12-month follow-up. Using non-linear trajectories we found that inpatient CBT-E produced significant increase of BMI, improvement of eating disorder and general psychopathology, and reduction of body checking behaviours, with similar trajectories of change characterized by initial improvement during treatment, weak deterioration after discharge, and subsequent stabilization. Predictor analysis indicated that the change of BCQ score from baseline to end of treatment predicted EDE weight concern and global scores at the end of treatment, and EDE shape concern and BSI at 12-month follow-up these findings suggest that inpatient CBT-E produced a significant and lasting decrease of body checking that affected eating disorder and general psychopathology.


T039: Temptation, Habit, Weight Loss and Cardio-Metabolic Health in Individuals with Obesity. Manualized Cognitive Remediation Enabled Cognitive-Behavioural Therapy (CR-CBT): A Randomised Controlled Intervention Trial

Jayanthi Raman, PhD, University of Technology Sydney UTS, Ultimo, NSW 2007, Sarah Glastras, MBBS, Department of Endocrinology, Diabetes & Metabolism, Royal North Shore Hospital, St Leonards, NSW 2065, Lawrence Lam, PhD, University of Technology Sydney UTS, Ultimo, NSW 2007, Caleb Ferguson, PhD, University of Technology Sydney UTS, Ultimo, NSW 2007, Hui Chen, MBBS; PhD, University of Technology Sydney UTS, Ultimo, NSW 2007, Elizabeth Denney-Wilson, PhD, University of Technology Sydney UTS, Ultimo, NSW 2007

Obesity, a significant risk factor for cardio-metabolic diseases, develops when an individual’s energy intake exceeds energy expenditure over a period of time. Increased exposure to cues of highly palatable food in our current obesogenic environment contributes to dietary lapses through unhelpful habits or yielding to temptation. Recent evidence has shown an association between obesity and neurocognitive deficits, especially in executive function. Although many habit and temptation-resistance/ prevention strategies heavily rely on neurocognitive processes, available treatments assume that our thinking skills that allow us to process information (i.e.,attend to details, plan, organize, make decisions and act appropriately upon information) are available as ready resources during and after treatment. A recent randomized controlled trial (RCT) led by the author on the cognitive remediation in individuals with obesity (CRT-O) showed 68% of those in the CRT-O group achieved a weight loss of 5% or more compared to only 15% of the controls (Cohen’s d = 1.2) at the 3 month follow-up. Binge eating also reduced in the CRT-O group (Cohen’s d = 0.83). Given the results of our previous trial, we have designed a novel 3 arm RCT (n=140), that pioneers a CRT enabled cognitive behavioural group therapy (CR-CBT) to address the two hallmark features of obesity: habit and temptation. Measurement points are at baseline, end of treatment and at 6 months post treatment. Expected primary outcomes are clinically significant weight loss ( ≥5%) and weight loss maintenance at the 6 month follow-up. Secondary outcomes are key features associated with cardio-metabolic diseases, i.e., blood pressure, blood cholesterol, BNP biomarkers and insulin resistance. Other secondary outcomes are neurocognitive function, unhealthy eating habits, temptation self-report, health related quality of life (HRQoL), mood and stress. Results of the previous CRT-O and preliminary data of the current study testing the CR-CBT intervention model will be presented. The success of this project could bring significant health benefits to individuals with obesity and facilitate community-wide cheap, convenient and scalable treatment options.


T040: Symptoms of Attention Deficit Hyperactivity Disorder (ADHD) and Disordered eating: A Moderated-Mediation Model Assessing the Role of Mood, Eating in Response to Internal Hunger and Satiety Signals and Perceived Self-Efficacy to Cope Effectively with Life

Panagiota Kaisari, PhD Student, School of Psychology, University of Birmingham, UK, Birmingham, West Midlands, Colin Dourish, DSc; PhD, P1vital, Manor House, Howbery Park, Wallingford, Oxfordshire, OX10 8BA, UK, Oxfordshire, Oxfordshire, Suzanne Higgs, PhD, School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK, Birmingham, West Midlands

This study investigated the potential relationships between core symptoms of ADHD and disordered eating (DE) and assessed for first time, whether mood and/or reliance on internal hunger and satiety signals mediate any of the observed relationships. The potential influence of the perceived self-efficacy (SE) to cope effectively with life challenges on the direction and/or strength of any relationship between ADHD, mood and DE was also investigated. 237 individuals (27.4% male) participated in an online study. Symptoms of ADHD were assessed using the CAARS–S: SV. A number of validated questionnaires were used to assess DE (e.g., EAT-26, the BES). A composite measure based on the sum score of the Hospital Anxiety and Depression scale and the Perceived Stress Scale was created to evaluate the mediating role of mood. The Reliance on Hunger/Satiety cues sub-scale of the Intuitive Eating Scale assessed eating in response to internal signals. SE was assessed via the General Self-Efficacy Scale. Principal component analysis reduced the DE measures to two components: "binge/disinhibited eating" and "restrictive eating". Mediation analyses, controlling for important confounds (age, gender, BMI, socio-economic status, comorbidities, alcohol use and ADHD medication) revealed that both inattentive and hyperactive/impulsive symptoms of ADHD related to both two components of DE. However, only the inattentive symptoms were found to be directly related to binge/disinhibited eating b=0.36, BCa CI [0.02, 0.70]. Eating in response to internal hunger and satiety signals was a significant mediator of the relationship between inattentive symptoms of ADHD and DE (p<0.05). Mood was a significant mediator of the relationship between ADHD symptomatology and DE (p<0.05). SE moderated the pathways between mood and binge/disinhibited eating (p<0.05), suggesting that individuals with ADHD may use binge eating as a coping mechanism.


T041: Using Network Analysis to Elucidate the Relationships among Binge-Eating Disorder Symptoms and Associated Psychopathology

Christine Peat, PhD, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, Laura Thornton, PhD, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, Tosha Smith, PhD, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, Cheri Levinson, PhD, University of Louisville, Louisville, Kentucky, Henrik Larsson, PhD, Karolinska Institutet, Stockholm, Stockholm, Andreas Birgegard, PhD, Karolinska Institutet, Stockholm, Stockholm, Cynthia Bulik, PhD, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

Debate remains regarding the interrelationships between the core symptoms of binge-eating disorder (BED) and associated psychopathological symptoms (e.g., depression, anxiety). Network analyses allow for a nuanced exploration of these symptom interrelationships. The current study conducts a network analysis of BED symptoms and related psychopathology in an effort to elucidate which symptoms are central to BED and which might be considered more peripheral. We also aim to identify symptoms that might bridge BED and anxiety and depression symptoms given their significant comorbidity. The analysis population includes men and women who met BED criteria in the Swedish quality assurance database, Stepwise, between 2005 and 2013 (N > 300). Three separate network analyses will be conducted: one in the entire selected sample (N > 300), one in those diagnosed with comorbid mood disorders (~37%), and one in those diagnosed with comorbid anxiety disorders (~56%). Analyses will include all items from the Eating Disorders Examination Questionnaire and the Comprehensive Pathological Rating Scale, a self-report scale designed to assess a range of psychopathological symptoms including anxiety and depression. Network models will be conducted in R using the qgraph package and parcor package. We will include statistical indices, called measures of centrality (e.g., betweenness, closeness, and strength), to identify which items are at the core of the networks. We will also calculate stability analyses to test the stability of our networks. Results obtained from these analyses go beyond what is currently achievable with more standard analyses such as structural equation modeling because we can identify specific central symptoms and a detailed exploration of how BED symptoms and associated psychopathology interact. Such information would be highly valuable in determining treatment foci and developing tailored interventions.


T042: Grazing Prevalence and Associations with Psychopathology, Quality of Life and Treatment Outcomes in Eating Disorders and Obesity

Andreea Heriseanu, BSc, University of Sydney, Sydney, NSW, Phillipa Hay, MBBS; PhD; FAED, Western Sydney University, Sydney, NSW, Stephen Touyz, PhD; FAED, University of Sydney, Sydney, NSW

Both eating disorders and obesity present with a variety of eating behaviours. To date, research into atypical eating patterns in these populations has focused primarily on binge eating, however, other overeating processes are also involved. Grazing is an atypical eating behaviour of recent interest, which has been associated with negative outcomes following weight loss treatments in obese samples. To better understand this pattern of eating, a systematic review was conducted. This review aimed to critically examine the existing research informing the prevalence of grazing, its treatment outcomes, and psychopathological correlates in adults with eating disorders and/or obesity in both treatment and community settings. A systematic electronic database search (Medline, PsycInfo, Embase, CINAHL and Web of Science) of published studies was undertaken. A total of 40 studies were included, of which 28 provided grazing prevalence estimates in obesity (which ranged from 8.33% to 59.84% at pre-treatment, 1.12% to 59.18% post-treatment, and 14.06% to 38.60% in community samples), while seven provided grazing prevalence estimates in eating disorders (bulimia nervosa: 58.68% to 62.00% pre-treatment and 32% at post-treatment follow-up; binge eating disorder pre-treatment: 44.02% to 89.86%; anorexia nervosa pre-treatment: 34.3%). There is mixed evidence to suggest that grazing (especially a “compulsive” subtype including a sense of loss of control) is associated with worse weight loss treatment outcomes in obesity studies, with the presence of other eating psychopathology, as well as with lower mental health-related quality of life, and more depression and anxiety symptoms. The results of this review highlight the need for further investigation of the impact of grazing, especially considering “compulsive” vs. “non-compulsive” subtypes, in clinical and non-clinical samples, using validated instruments.


T043: Body Composition and Menstrual Status in Patients with a History of Anorexia Nervosa

Laura Winkler, MD, Centre for Eating Disorders, Odense University Hospital, Odense, Denmark, Jacob Stampe Frølich, MD, Centre for Eating Disorders, Odense University Hospital, Denmark, Odense, Denmark, René Klinkby Støving, MD; PhD; professor, Centre for eating disorders, Odense University Hospital, Denmark, Odense, Denmark

Objective: To study the association between body composition measures and menstrual status in a large sample of adult patients with a history of anorexia nervosa and to calculate the predicted probability of resumption of menstrual function. Furthermore, to establish whether fat percentage is superior to body mass index in predicting the resumption of menses. Method: 113 adult women with a history of anorexia nervosa underwent a dual energy x-ray absorptiometry (DXA) scan and completed questionnaires regarding medication prescription and menstrual function. Results: Fifty percent of patients were expected to resume their menstrual function at a body mass index of 19 kg/m2 or a fat percentage of 23%. Twentyfive percent of patients were expected to resume their menstrual function at body mass index 14 kg/m2 or fat percentage 11%. Fat percentage and body mass index were equally capable of predicting the resumption of menses. Body composition measures only account for a few of numerous factors involved in the resumption of menses. Our regression model had a R2 value of 0.14, indicating that only 14% of the variation in menstrual recovery could be explained by the variables included. Discussion: Fat percentage and body mass index were positive predictors of the resumption of menses, however, body composition measured by DXA was not superior to body mass index in predicting menstrual recovery, which is of great clinical relevance as body mass index is easier and cheaper to obtain.


T044: Body Image, BMI and Eating Behavior in a Sample of Adolescent Males

Emilia Manzato, MD, Psychiatrist, University of Ferrara, Ferrara, APO AE, ferrara, Gianna Di Loreto, Psychologist, Associazione " la vita oltre lo specchio", pisa, APO AE, ferrara, Carla Piccione, psychologist, Casa di cura S. Rossore, Pisa, APO AE, pisa, Valentina Giust, Student, University of Ferrara, ferrara, APO AE, ferrara, Giovanni Gravina, MD, Casa di cura S. Rossore,SISDCA, ferrara, APO AE, pisa

The aim of the multicentric study is to investigate some possible correlations between body image, BMI, eating behavior and psychological functions such as alexithymia and self-esteem. The study analyzed a sample of 250 male students, recruited in some high schools in Ferrara and Pisa (Italy), 14-20 years old, (mean age 16, 83-SD 1.107). A structured interview and the following test were administered: Body Uneasiness Test (BUT), Eating Attitude Test (EAT-26), Toronto Alexithymia Scale (TAS 20), Rosenberg self-esteem scale, Figure Rating Scale (FRS - Stunkard 1983), Muscle Silhouette Measure (MSM - Buchanan et al. 2005) and a photographic test with silhouettes with increasing BMI. The results showed: 8% of the whole sample was underweight, 65% normal weight, 13% overweight and 4% obese; 12% underestimate their own weight and 20% overestimate their own weight. In the whole sample are detected high scores for 9.2% of subjects at BUT, 8.8% at EAT26 and 12.4% at TAS 20; 93.2% of subjects shows low self-esteem at Rosenberg Scale. The highest BUT score appears correlated with positivity at EAT26. Only 33% of the sample show in FRS test a good congruence between the perceived silhouette and the desired silhouette. In MSM test 51.2% of the whole sample (particularly 82% of normal weight subjects) should like higher muscularity. In our sample, the risk of altered eating behavior seems better predicted by body discomfort, and not by alexithymia or low self-esteem.


T045: "What I Think I Look Like": A Photographic Study of Perceived Body Image in Patients with Eating Disorders

Michael Nakhla, BA, Penn State College of Medicine, Hershey, Pennsylvania, Martha Peaslee Levine, MD, Penn State College of Medicine, Hershey, Pennsylvania

Eating disorders, anorexia nervosa and bulimia nervosa, and Body Dysmorphic Disorder are conditions defined by body image distortion. This study aimed to visualize the degree of perceived body image disturbance and dysmorphia in patients struggling with eating disorders and correlate this with measures of body dissatisfaction, body preoccupation, and self-esteem. 20 participants with previously diagnosed eating disorders were photographed. Their full-body images were digitally altered using Adobe Photoshop, as directed by the patients, to render photo representations of their perceived body image (what they think they look like) and their idealized body image (what they want to look like). The differences between the two representations were measured in pixels. This measurement was compared to scales the patients completed, which examined self-esteem, body shame, and dysmorphia. 11 healthy controls completed the same tasks to provide comparison data. The patient group exhibited a statistically significant percent pixel change between perceived and idealized body image in all measured body areas: width at face, shoulder, neck, hip, and thigh. The patient group exhibited significantly more body shame, worse self-esteem, and a higher degree of body dysmorphia. 13 of the 20 patients exhibited a severe degree and 5 of the 20 exhibited a moderate degree of body dysmorphia, as measured by the Body Dysmorphic Disorder Modification of the Yale-Brown Obsessive Compulsive Scale. These 18 patients demonstrated significant differences between perceived and ideal body image in all body areas as compared to the other two patients who displayed a mild degree of body dysmorphia. Patients who exhibited more severe dysmorphia demonstrated a greater difference between their perceived and idealized body image and proportionally lower self-esteem and greater body shame. The overlap of symptomatology between BDD and ED suggests comorbidity or dual diagnosis in eating disorder patients.


T046: New Ways of Measuring Perception of and Satisfaction with Own Body Size in Women

Helen Bould, MRCPsych; BA BM BCh; MA University of Oxford, Oxford, Oxfordshire, Katherine Noonan, MA; MBBS, University of Oxford, Oxford, Oxfordshire, Ian Penton-Voak, PhD, University of Bristol, Bristol, Bristol, Andy Skinner, PhD, University of Bristol, Bristol, Bristol, Marcus Munafo, PhD, University of Bristol, Bristol, Bristol, Rebecca Park, MRCPsych; PhD, University of Oxford, Oxford, Oxfordshire, Matthew Broome, MBBS; MRCPsych, University of Oxford, Oxford, Oxfordshire, Catherine Harmer, PhD, University of Oxford, Oxford, Oxfordshire

Body dissatisfaction is a risk factor for eating disorders, low mood and subsequent weight gain. In order to fully understand and develop new treatments for it, we need new methods of measuring both its perceptual and cognitive components. We developed new methods of measuring the perceptual component (using reality-based avatars), quick measures of explicit dissatisfaction using Visual Analogue Scales, behavioural measures, and measures of implicit beliefs using Implicit Association Tests (IAT) and a Lexical Decision Task (LDT). We compared them with existing measures of body dissatisfaction, the Body Shape Satisfaction Scale and the Eating Disorders Examination Questionnaire, using both regression and factor analysis. We recruited 93 healthy 18-30 year old women with a BMI of 18-25. We found women were accurate at representing their size using reality-based avatars (regression with measured BMI: 1.21 (95% Confidence Intervals 0.94, 1.48), p<0.0001; test-retest correlation: 0.88:); and the discrepancy between real and ideal own size correlated with other measures of body satisfaction (e.g. regression with EDEQ -0.48 (95% Confidence Intervals -0.66, -0.29), p<0.0001). Brief VAS measures of size and satisfaction with size correlated highly with existing questionnaire measures of satisfaction, as did a behavioural measure of how women would feel wearing different outfits, and the word IAT. The LDT did not correlate with existing measures of satisfaction or size. Factor analyses of the different measures supported these results. These novel measures have potential to be used as quicker, more scalable measures of perceived size and satisfaction with own size. The implicit tasks may also capture beliefs which patients may not be aware of, or may wish to conceal, and may have potential as early markers of response to treatment.


T047: Introducing the New Male Body Scale and Male Fit Body Scale as Measures of the Ideal Body Related to Eating Disorder Tendencies

Christina Ralph-Nearman, BS; MSc; Student; PhD Candidate, University of Nottingham, Nottingham, Nottingham, Ruth Filik, BSc; PhD, University of Nottingham, Nottingham, Nottingham

The aim of the current study was to develop, test, and re-test two new male body satisfaction scales; The Male Body Scale (consisting of emaciated to obese figures) and the Male Fit Body Scale (consisting of emaciated to very muscular figures). 103 male participants were given the two newly-developed scales along with the existing Stunkard Figure Rating Scale (SFRS), for comparison. Firstly, they were asked which of the nine body figures on each scale most represented their current body figure. They were then asked to use the scales to indicate their ideal body figure. They then indicated which of the scales overall: SFRS, our new Male Body Scale (MBS), or our new Male Fit Body Scale (MFBS) represented their current body figure, and finally which represented their ideal body figure overall. They then completed the Eating Disorder Examination Questionnaire (EDE-Q 6.0), and their Body Mass Index (BMI), fat, and muscularity percentage were calculated. This was followed by a re-test and manipulation check two to six weeks later. Participants’ scores on the EDE-Q 6.0, BMI, fat- and muscularity-percentage were all highly related to their current body figure choice for all three scales. However, only the new MFBS Ideal figure choice was significantly related to eating disorder tendencies and body measures, whilst the new MBS was highly related to body measures. Importantly, the SFRS ideal choice was not significantly related to any of the measures. Participants also indicated that the new Body Scales most accurately represented their current and ideal body figure, rather than the SFRS, and the MFBS results revealed that 85.5% showed body dissatisfaction, desiring a larger, more muscular body. Results validate the new gender-relevant scales, reveal muscularity-ideal body choice, and inform male-focused eating disorder research.


T048: Impact on Readmissions: Implementing Family Based Treatment in a Specialist Eating Disorder Service

Kim Hurst, PhD, Griffith University, Gold Coast, Qld, Hayley Thompson, BSc, Griffith University, Gold Coast, Qld, Heather Green, DPsych, Griffith University, Gold Coast, Qld, Jodie Watkins, DClinPsy, Griffith University, Gold Coast, Qld, Nigel Collings, Psychiatrist, University of Queensland, Brisbane, Qld

Anorexia Nervosa (AN) treatment is frequently associated with high costs often due to the use of hospitalisation. The Gold Coast Eating Disorder Program (EDP) Australia has delivered outpatient Family Based Treatment (FBT) since 2009. This study compared retrospective data of 20 female adolescent patients diagnosed with AN, 10 who received treatment as usual (TAU) prior to the implementation of FBT with 10 treated by the EDP with FBT. A series of independent samples t-test was undertaken to compare readmission rates to both the medical ward and psychiatric ward from pre to post implementation of FBT. Results indicate that since the implementation of FBT there has been a significant reduction of readmission rates to the medical ward t(18) = 1.29, p = .01 from pre (M = 0.90, SD = 1.66) to post (M = 0.20, SD = 0.42) and a significant reduction in the number of psychiatric admissions t(18) = 4.33, p < .001, [pre (M = 1.3, SD = 0.95), post (M = 0, SD = 0)]. Comparative analyses of an additional 40 female adolescents AN patients treated with FBT are also described. This comparative clinical data supports the current literature regarding the efficacy of FBT for the treatment of adolescents with AN, specifically that adolescents who receive guided assistance from their parents recover more quickly from AN and require less hospital admissions when FBT is provided.


T049: Psychopathology and Expressed Emotion in Parents of Patients with Eating Disorders: Relation to Patient Symptom Severity

Rebekah Richmond, BA, Medical University of South Carolina, Charleston, South Carolina, Renee Rienecke, PhD, Medical University of South Carolina, Charleston, South Carolina

The purpose of the current study was to examine the relation between parental psychopathology, expressed emotion and patient symptom severity. One hundred twenty-six parents of 79 patients receiving treatment for an eating disorder completed measures of expressed emotion (Family Questionnaire) and general psychopathology (SCL-90-R), and patients competed a measure of eating disorder psychopathology (EDE-Q). Mothers reported higher scores on the critical comments (M = 22.25, SD = 5.54) and emotional overinvolvement (M = 29.10, SD = 3.70) subscales of expressed emotion than fathers (M = 19.73, SD = 5.44; M = 25.88, SD = 4.73, respectively). Both mothers and fathers scored higher on general psychopathology compared to nonpatient population means. Maternal psychopathology, particularly maternal obsessive-compulsive symptoms and global symptom severity, was found to be associated with patient symptom severity. Mothers high on emotional overinvolvement had higher parental psychopathology than mothers low on emotional overinvolvement; maternal critical comments and paternal expressed emotion were not related to parental psychopathology. Although it may be expected that parents suffering from their own psychopathology may be under more stress and could show higher levels of expressed emotion toward an ill child, findings suggest that parental psychopathology and parental expressed emotion may be different constructs that need to be addressed separately in treatment. Maternal obsessive-compulsive symptoms are associated with patient symptomatology and may be a useful clinical target in treatment.


T050: Symptoms of Attention Deficit Hyperactivity Disorder (ADHD) among Adult Eating Disorder Patients

Nils Erik Svedlund, MD, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Stockholm county, Claes Norring, PhD, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Stockholm county, Ylva Ginsberg, MD; PhD, Dep. of Clin. Neuroscience and Med. Epid. and Biostatistics, Karolinska Institute, Stockholm, Stockholm county, Yvonne von Hausswolff-Juhlin, MD; PhD ,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Stockholm county

The objective of this study was to explore the prevalence and types of self-reported ADHD symptoms in an unselected group of eating disorder patients assessed in a specialized eating disorder clinic. In total 1165 adults with an eating disorder were assessed with a battery of standardized instruments, for measuring inter alia ADHD screening, demographic variables, eating disorder symptoms and psychiatric comorbidity. Almost one third of the patients scored above the screening cut off indicating a possible ADHD, with up to two-fold differences between bingeing/purging and restricting eating disorder diagnoses. Presence of binge eating, purging, loss of control over eating and non-anorectic Body Mass Index were related to results indicating a possible ADHD. Psychiatric comorbidity correlated to ADHD symptoms without explaining the differences between eating disorder diagnoses.


T051: Eating Patterns in Adolescents with Type 1 Diabetes - Associations with Metabolic Control, Insulin Omission, and Eating Disorder Psychopathology

Line Wisting, PhD, Oslo University Hospital, Regional Department for Eating Disorders, Oslo, Oslo, Deborah Lynn Reas, PhD, Oslo University Hospital, Regional Department for Eating Disorders, Oslo, Oslo, Lasse Bang, MA, Oslo University Hospital, Regional Department for Eating Disorders, Oslo, Oslo, Torild Skrivarhaug, MD; PhD, Oslo University Hospital, Department of Pediatric Medicine, Oslo, Oslo, Knut Dahl-Jørgensen, MD; PhD, Oslo University Hospital, Department of Pediatric Medicine, Oslo, Oslo, Øyvind Rø, MD; PhD, Oslo University Hospital, Regional Department for Eating Disorders, Oslo, Oslo

The purpose of this study was to investigate eating patterns among adolescents with type 1 diabetes (T1D), and associations with eating disorder psychopathology, insulin omission due to weight and shape concerns, and metabolic control (blood glucose – as measured by HbA1c). The sample consisted of 104 adolescents (62 females) with T1D, with an average age of 15.7 years (SD 1.8). Mean age at T1D onset was 9.6 years (SD 3.5), mean zBMI was .4 (SD 0.8), and mean HbA1c was 8.6 (SD 1.3). The Child Eating Disorder Examination (ChEDE) assessed the frequency of breakfast, lunch, and dinner consumption in addition to core eating disorder (ED) pathology. T1D clinical data was obtained from the Norwegian Childhood Diabetes Registry. Significant gender differences were found, with a lower proportion of females than males consuming breakfast on a daily basis over the past week (73.8% vs 97.7%, respectively, x2 = 8.86 (1), p = .003). A similar proportion of males and females (approximately 48%) consumed lunch on a daily basis. Likewise, approximately 90% of both genders consumed dinner on a daily basis over the past 7 days. Among females, less frequent breakfast consumption was significantly associated with higher global ChEDE scores, shape concerns, self-induced vomiting, binge eating, intentional insulin omission, and HbA1c. Less frequent lunch consumption was also significantly associated with higher HbA1c (Spearman rho = -.44, p < .001). Additionally, skipping dinner was significantly associated with increased dietary restraint, eating concerns, age, self-induced vomiting, and insulin omission, with small-to-medium sized effect sizes ranging from rhos= -.27 to -.32. Among males, no significant bivariate associations were found. These findings suggest that the pattern and frequency of meal consumption may be addressed clinically to improve metabolic control and subsequent risk of somatic complications among adolescent females with T1D.


T052: Mental Capacity to Consent to Treatment and the Association with Outcome – a Longitudinal Study in Anorexia Nervosa Patients

Isis Elzakkers, MSc; MD Altrecht Eating Disorders Rintveld, Zeist, Utrecht, Unna Danner, PhD, Altrecht Eating Disorders Rintveld Utrecht University, Zeist, Utrecht, Lot Sternheim, PhD, Utrecht University, Department of Psychology, Utrecht, Utrecht, Daniel MacNeish, PhD, Utrecht University, Department of Methodology and Statistics, Utrecht, Utrecht, Hans Hoek, MD; PhD, Parnassia Psychiatric Institute, The Hague, The Hague, Zuid Holland, Annemarie van Elburg, MD; PhD, Altrecht Eating Disorders Rintveld Utrecht University, Zeist, Utrecht

Mental capacity to consent to treatment can be reduced in patients with anorexia nervosa (AN). However, relevance of diminished mental capacity to course of the disorder is unknown. In this study we aim to examine the prognostic relevance of diminished mental capacity in AN. A longitudinal study was conducted in 70 adult female severe AN patients. At baseline mental capacity was assessed by psychiatrists and clinical and neuropsychological data (decision making) were collected. One third of patients was found to display diminished mental capacity to consent to treatment. The total group was divided into two groups: one with full mental capacity (n=46) and one with diminished mental capacity (n=24). After one and two year clinical and neuropsychological assessments were repeated and remission and admission rates were calculated. Patients with diminished mental capacity had a less favourable outcome with regard to remission and were admitted more frequently. Their appreciation of illness remained hampered. Decision making did not improve in comparison to patients with full mental capacity. We conclude that patients with diminished mental capacity do less well in treatment and display decision-making deficiencies that do not ameliorate with weight improvement. Further research is needed to look into the role of emotion dysregulation in the hampered decision making and diminished mental capacity.


T053: One Size Fits All: Dieting is a Unitary Construct

Kelsey Hagan, MA, University of Kansas, Lawrence, Kansas, Kelsie Forbush, PhD, University of Kansas, Lawrence, Kansas

Dieting is associated with the future development of eating disorders (EDs). Nevertheless, greater understanding of the structure of dieting behavior is important because certain types of dieting may be differentially associated with ED risk. One theory of dieting is Lowe’s Three-Factor Model of Dieting, which posits that dieting consists of three dimensions: (1) history of dieting; (2) current dieting; and (3) weight suppression (the difference between a person’s highest and current body weight in pounds). Although each proposed dimension represents a clinically relevant aspect of dieting behavior, few previous studies have tested the underlying structure of dieting. This study is significant as the first to test Lowe’s Three-Factor Model. We hypothesized that the Three Dimensional Model would be empirically supported. Exploratory factor analysis (EFA) was used to test whether dieting formed distinct factors (dimensions) in a representative community sample of adults (N=407; 47.4% female). Structural equation modeling (SEM) was used to validate the best-fitting factor structure and to test associations among dieting dimensions, ED risk, and body mass index. A one-factor model demonstrated the best fit to the data. Notably, ED risk significantly increased with dieting, whereas body mass index was not significantly associated with dieting. Our results suggested that dieting could be conceptualized as a unitary construct that confers risk for the future development of EDs. Findings also indicated that dieting was not associated with body weight, which supports results of other studies showing poor efficacy of self-led dieting for producing meaningful weight loss. Healthcare professionals should consider inquiring about dieting status (both current and past) and weight suppression as a part of routine medical care to help identify those at risk for EDs and to promote a greater focus on engagement in healthful eating, regardless of weight-loss goals or outcomes.


T054: Transitioning from DSM-IV to DSM-5: A Systematic Review of Eating Disorder Prevalence Assessment

Camilla Lindvall Dahlgren, MA; PhD, Oslo University Hospital, Oslo, Oslo, Line Wisting, MA; PhD, Oslo University Hospital, Oslo, Oslo

The purpose of this study was to systematically review the literature on assessment of eating disorder prevalence during the DSM-IV era (1994-2013). A PubMed search was conducted targeting articles on prevalence, incidence and epidemiology of eating disorders. The review was performed in accordance with PRISMA guidelines, and was limited to DSM-IV based eating disorder diagnoses published between 1994 and 2015. A total of 74 studies fulfilled inclusion criteria and were included in the study. Results yielded evidence of over 40 different assessment instruments used to assess eating disorder prevalence, with the EAT-40 being the most commonly used screening instrument, and the SCID being the most frequently used interview. The vast majority of studies employed two-stage designs, closely followed by clinical interviews. Observations of higher prevalence rates were found in studies employing self-reports compared to two-stage designs and interviews. Eating disorder prevalence rates have varied significantly during the DSM-IV era, and are dependent on assessment methods used and samples investigated. Following the transition to the DSM-5, eating disorder prevalence will change, warranting novel approaches to assessment and treatment planning. Examples of such approaches will be discussed during the presentation.


T055: Eating Pathology and Misuse of Erectile Dysfunction Drugs Among Sexual Minority Men

Amanda Bruening, BA; MA, Arizona State University, Tempe, Arizona, Marisol Perez, BA; PhD, Arizona State University, Tempe, Arizona

Body-image disturbance is a well-established psychosocial issue among men who have sex with other men (MSM). Nearly a third of MSM report being dissatisfied with their appearance, often wishing to be more muscular. Self-objectification theory suggests that the focus on body monitoring, self-comparison, and body shame carry into the areas of sexual functioning. Given that sexual dysfunction is commonly reported across eating disorder subtypes and that MSM may objectify themselves to a greater degree than their heterosexual peers, MSM may be at greater risk for seeking unhealthy solutions to cope with heightened body dissatisfaction and sexual dysfunction. As sexual prowess is closely associated with a masculine identity among MSM, misuse of erectile dysfunction medication (EDM) may be one way to cope with negative body image during moments of physical intimacy. The current study aimed to analyze the association between eating pathology and recreational use of EDMs among sexual minority undergraduate men. A preliminary, epidemiological analysis was performed using the American College Health Association’s National College Assessment (ACHA-NCHA), which surveyed 523 colleges between Fall 2008 and Spring 2011. Out of 20,721 sexual minority men sampled, 354 (1.7%) reported misuse of EDMs within the past year. Results showed that the odds of EDM misuse nearly tripled among those who also used diet pills (B = 1.08, Standard Error [SE] = 0.19, Odds Ration [OR] = 2.94, p > 0.001) and doubled among those who also induced vomiting or used laxatives (B = 0.71, SE = 0.21, OR = 2.03, p = 0.001). These findings provide a basis for exploring important secondary ramifications of body-image disturbance among sexual minority men.


T056: Sociocultural Pressures for Thinness and Disordered Eating Among Lesbian and Straight Women: The Impact of Sexual Orientation and Female Identity Centrality

Sarah Horvath, BS, Ohio University, Athens, Ohio, Sarah Racine, PhD, Ohio University, Athens, Ohio, Rebecca Totton, MA, Ohio University, Athens, Ohio, Kimberly Rios, PhD, Ohio University, Athens, Ohio

It is often assumed that sociocultural pressures for thinness are less salient in lesbian subculture and, as such, lesbian women may be protected from disordered eating. However, research examining this hypothesis has been inconsistent. One gap in the current literature relates to the influence of identity centrality, or how central one’s sexual orientation identity or female identity is to her overall self-concept. It is possible that identifying strongly as lesbian protects women from sociocultural pressures for thinness and disordered eating, whereas identifying strongly as heterosexual and/or female has the opposite effect. The current study examined:1) differences between lesbian (n = 160) and straight (n = 158) women on societal appearance ideals and disordered eating; and 2) relationships between both sexual orientation identity centrality and female identity centrality with these variables. After accounting for group differences on age and education, scores on the Sociocultural Attitudes towards Appearance Questionnaire and Eating Pathology Symptoms Inventory subscales were not significantly different between lesbian and straight women. For straight women, sexual orientation identity centrality was significantly correlated with media pressures, excessive exercise, binge eating, and purging, and female identity centrality was significantly correlated with body dissatisfaction. In contrast, the only significant correlation for lesbian women was between sexual orientation centrality and excessive exercise. Although a lack of group differences may suggest that lesbian women are still subject to the same hetero-normative pressures for appearance, lesbian women who identify strongly as lesbian and/or female may not be as vulnerable to disordered eating as straight women with strong identities. Future research should investigate how identity centrality and sociocultural pressures for thinness might interact to impact disordered eating in lesbian and straight women.


T057: Gender Dysphoria and Eating Disorders: The Effects of Treating Female to Male Transgender Adolescents

Danielle Gonzales, PsyD, University of California, San Diego, San Diego, California, Ana Ramirez, PhD, University of California, San Diego, San Diego, California, Michelle Jones, PhD, University of California, San Diego, San Diego, California, Jessie Menzel, PhD, University of California, San Diego, San Diego, California, Roxie Rockwell, PhD, University of California, San Diego, San Diego, California

Body dissatisfaction is considered to be the primary distress experienced by those struggling with an eating disorder (Fairburn, 2008). Similarly, the negative evaluation and distress of one’s physical appearance and incongruence between the assigned biological sex and gender identity is now classified as Gender Dysphoria (DSM-5, 2013). Current literature suggests that body dissatisfaction plays a crucial role in gender dysphoria and ultimately leaves individuals at greater risk for developing an eating disorder (Jones, Haycraft, Murjan, Arcelus, 2016). Several studies have observed the occurrence of these two conditions, however, these studies have typically focused on adults who desire to transition from male to female (MtF). This case study, in contrast, describes four cases of female to male (FtM) transgender adolescents who met the DSM-5 criteria for Anorexia Nervosa in regards to emotion regulation (DERS), symptoms of depression (BDI), and Multidimensional Assessment of Interoceptive Awareness (MAIA). The findings of this pilot study suggest that FtM adolescents with Anorexia Nervosa score statistically significantly higher on EDE-Q, BDI, and DERS when compared to general population. The data also yielded FtM adolescents with Anorexia Nervosa score statistically significantly lower on MAIA when compared to non-clinical adolescent population. This pilot study will suggest specialized treatment considerations for transgender youth seeking treatment for Anorexia Nervosa.


T058: Decision Making Impairment: A Shared Vulnerability in Obesity, Gambling Disorder and Substance use Disorders?

Nuria Mallorqui-Bague, MS; MSc; CPsychol; PhD; Hospital Universitari Bellvitge-Idibell-CiberObn, Hospitalet de Llobregat, Barcelona, Susana Jimenez-Murcia, DClinPsy; PhD, Hospital Universitari Bellvitge-Idibell-Ciberobn, Hospitalet del Llobregat, Barcelona, Ana B Fagundo, PhD, Hospital Universitari Bellvitge, Hospitalet del Llobregat, Barcelona, Iris Tolosa-Sola, MSc, Hospital Universitari Bellvitge- Idibell, Hospitalet de Llobregat, Barcelona, Rafael de la Torre, MD; PhD, IMIM (Hospital del Mar Medical Research Institute), Barcleona, Barcelona, Jose M Fernández-Real, MD; PhD, Universitat de Girona- Hospital Trueta, Girona, Girona, Felipe F Casanueva, MD, Complejo Hospitalario U. de Santiago, Santiago de Compostela, a Coruña, Cristina Botella, PhD, University Jaume I, Castellón, Castellón, Gema Frühbeck, MD, University of Navarra, Navarra, Navarra, Francisco J Tinahones, MD, Hospital Clínico Universitario Virgen de Victoria, Málaga, Andalucia, Maria Lozano-Madrid, MSc, Hospital Unversitari Bellvitge-Idibell, Hospitalet de Llobregat, Barcelona, Indira Borrás, Student, Hospital Universitari BellvitgeHospitalet de Llobregat, Barcelona, Fernando Fernández-Aranda, DClinPsy; PhD, Hospital Universitari Bellvitge-Idibell-CiberObn, Hospitalet de Llobregat, Barcelona

Addictions are associated with decision making impairments. The present study explores decision making in Substance use disorder (SUD), Gambling disorder (GD) and Obesity (OB) when assessed by Iowa Gambling Task (IGT) and compares them with healthy controls (HC). For the aims of this study, 591 participants (194 HC, 178 GD, 113 OB, 106 SUD) were assessed according to DSM criteria, completed a sociodemographic interview and conducted the IGT. SUD, GD and OB present impaired decision making when compared to the HC in the overall task and task learning, however no differences are found for the overall performance in the IGT among the clinical groups. Results also reveal some specific learning across the task patterns within the clinical groups: OB maintains negative scores until the third set where learning starts but with a less extend to HC, SUD presents an early learning followed by a progressive although slow improvement and GD presents more random choices with no learning. Decision making impairments are present in the studied clinical samples and they display individual differences in the task learning. Results can help understanding the underlying mechanisms of OB and addiction behaviors as well as improve current clinical treatments.


T059: Psychopathology Profiles of Dark Personality Traits among Women with Bulimia Nervosa

Tyler Mason, PhD, Neuropsychiatric Research Institute, Fargo, North Dakota, Kathryn Smith, PhD, Neuropsychiatric Research Institute, Fargo, North Dakota, Ross Crosby, PhD, Neuropsychiatric Research Institute, Fargo, North Dakota, Scott Engel, PhD, Neuropsychiatric Research Institute, Fargo, North Dakota, James Mitchell, MD, Neuropsychiatric Research Institute, Fargo, North Dakota, Stephen Wonderlich, PhD, Neuropsychiatric Research Institute, Fargo, North Dakota

We examined associations between two dark personality traits (i.e., narcissism and callousness) and psychopathology among women with BN. This study was guided by several research questions. First, are dark personalities associated with degree of eating disorder psychopathology and treatment history? Second, are dark personality traits in BN associated with co-occurring forms of psychopathology? Third, are dark personality traits associated with interpersonal, affective, and behavioral functioning in daily life? Fourth, are dark personality traits associated with adverse childhood experiences? Women with BN completed measures of ED and co-ocurring psychopathology, personality, trauma, and treatment history. Then, women participated in a 2-week ecological momentary assessment (EMA) protocol where participants reported on interpersonal stressors, affect, and maladaptive behaviors. Neither callousness nor narcissism were associated with interview assessed severity of ED psychopathology or treatment history. Regarding co-occurring psychopathology, both callousness and narcissism were associated with past month DSM-IV substance dependence. EMA data revealed an association between callousness and increased anger/hostility, cognitive dissociation, laxative use, driven exercise, breaking things, and shoplifting in daily life. EMA data also revealed that narcissism was related to more negative affect, anger/hostility, cognitive dissociation, interpersonal stress, drunkenness, and risky sexual behavior in daily life. Neither callousness nor narcissism were associated with childhood trauma, but callousness was associated with less minimization/denial of childhood maltreatment experiences. Overall, results showed that dark personality traits were not associated with severity of BN. However, these traits were associated with co-occurring psychopathology and various momentary and daily behaviors as well as negative affective and interpersonal experiences in everyday life.


T060: The Role of DAT1 and COMT in Moderating Risks for Disordered Eating in Adolescence Associated with Peer Relationships.

Vanja Rozenblat, BA; MPsych; PhD Candidate, The University of Melbourne, Parkville, VIC, Laura Gorrie, BA, with Honours in Psychology, The University of Melbourne, Parkville, VIC, Isabel Krug, PhD, The University of Melbourne, Parkville, VIC, The ATP Consortium, PhD, The Australian Temperament Project, The Royal Children's Hospital, Parkville, VIC

The present study investigated the extent to which genes involved in dopaminergic signalling moderate the relationship between peer involvement and disordered eating. Participants were 542 individuals (48.5% female) from the Australian Temperament Project (ATP) who provided self-report assessments of peer relationships (Berndt’s Interaction Frequency Scale and Positive Friendship Qualities Scale) at age 11-12 years, and eating disorder symptomatology (Eating Disorder Inventory-2 Bulimia and Drive for Thinness scales) at age 15-16 years. DNA was collected by buccal swabs at 15-16 years and genotyped for common variants in dopamine transporter (DAT1) and catechol o-methyltransferase (COMT). Contrary to expectations however, greater contact frequency with peers increased risk for bulimic behaviour, and friendship quality increased risk for bulimic and drive for thinness behaviours. No significant gene x environment interactions were detected, although there was evidence of a COMT x DAT1 interaction to predict drive for thinness scores (p = 0.012). Results remained significant when controlling for ethnicity and socio-economic status, however did not withstand adjustment for multiple testing. Results from this study suggest an unusual risk relationship in which positive peer involvement, including quality and frequent contact, may play a role in disordered eating behaviours and attitudes. However, results do not suggest that genes involved in dopaminergic signalling moderate these relationships.


T061: Listen, I am Afraid of Gaining Weight! Testing a New Anxiety-Based Etiological Model for Anorexia Nervosa

Anne Kathrin Schwenzfeier, BSc; MSc, Ruhr-University Bochum, Bochum, North Rhine-Westphalia, Mike Rinck, DSc; professor, Radboud University Nijmegen, Nijmegen, Nijmegen, Eni Sabine Becker, DSc; professor, Radboud University Nijmegen, Nijmegen, Nijmegen, Tanja Legenbauer, DSc; professor, Ruhr-University Bochum, Bochum, North Rhine-Westphalia

Although anorexia nervosa (AN) and anxiety disorders share great comorbidity, little interest has been raised for the predictive power of anxiety. We argue that anxiety represents a crucial factor in the etiology of AN by biasing the focus of attention. Hence, we strive to I) assess the predictive value of trait and specific anxieties on eating disordered behavior (ED) and aim to II) test whether (induced) anxiety influences the course of AN through biased attention. First, a questionnaire-based study was conducted in a non-clinical (NCC) sample (14-25 years old) and adolescent ED patients of the LWL-university hospital for child and adolescent psychiatry (Hamm, Germany). 354 participants (301 NCC, 53 with ED) took part in the present study. ED symptoms were assessed by means of the Eating Disorder Examination Questionnaire (EDEQ), anxiety with the State Trait Anxiety Inventory, Fear of Negative Evaluation Scale, Fear of Positive Evaluation Scale and the Social Appearance and Anxiety Scale. Trait anxiety, specific anxieties and BMI regressed hierarchically on each of the EDEQ subscales revealed that trait anxiety, social appearance anxiety and fear of negative evaluation are key predictors for all EDEQ subscales (range from R2 = .273 - .494). In particular, social appearance anxieties had the greatest impact on EDEQ subscales (range ß = .318 - .482). In contrast, BMI was only predictive for weight and shape concerns and added only 1% in explained variance. In a second step, the causal role of anxiety for AN is studied experimentally in a group of AN patients, depressed patients and healthy controls. We induce anxiety to test whether anxiety biases the focus of attention and whether biased attentional processes represent a mediating factor between trait anxiety and AN symptomatology. Following this talk, participants will be introduced to a new etiological model that highlights the specific role and potential significance of considering anxiety in the course of AN.


T062: Differences in Psychological Profile and Eating Behavior of Mothers of Women With and Without Eating Disorders

Verónica Vázquez-Velázquez, PhD, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico, Mexico City, Ingrid Rocha-Velis, MPsych, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico City, Lucy Reidl-Martínez, PhD, Universidad Nacional Autónoma de México, Mexico City, Mexico City, Eduardo García-García, MD, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico City

The aim of this study was to identify differences in the psychological profile and eating behavior of mothers of women with anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED) or without an eating disorder (Non-ED). One hundred and thirty three mothers were classified on the basis of their daughters eating disorder: 30 mothers of daughters with AN (45.2±5.5 years, Body Mass Index [BMI] 26.3±4.1), 30 with BN (Mothers 47.6±5.1 years, BMI 26.0±6.5), 19 with BED (50.3±4.5 years, BMI 29.3±4.1), and 54 without ED (Mothers 47.4±5.4 years, BMI 23.9±3.3). They completed the following questionnaires: Beck’s Anxiety and Depression Inventories, Toronto Alexithymia Scale, Eating Disorder Inventory-2, Three Factor Eating Questionnaire, and a Corporal Figures Scale to evaluate body figure satisfaction. Discriminant analyses were performed to compare the profiles among the four groups. Mothers of daughters with AN reported more dissatisfaction with their daughter’s body than those of daughters with BN, BED and without ED; they also reported higher anxiety symptoms than the other groups. Mothers of daughters with BN had higher drive for thinness and more social insecurity than mothers of daughters with BED; they also had higher BMI, body dissatisfaction and inefficacy than mothers of healthy daughters. Mothers of girls with BED had greater BMI, depressive symptoms, body dissatisfaction and inefficacy than mothers of daughters without an ED. Mothers of daughters without ED had normal BMI and higher education level than the other three groups of mothers. We conclude that the different psychological profiles and eating behaviors of mothers are associated with the absence or presence of a specific ED.


T063: Mechanisms Underlying the Compulsive Behaviour of Anorexia Nervosa

Caitlin Lloyd, BSc, University of Bristol, Bristol, Somerset, Maria Øverås, DClinPsy, Regional Unit for Eating Disorders, Oslo University Hospital, Oslo, Østlandet, Øyvind Rø, MD; PhD, Regional Unit for Eating Disorders, Oslo University Hospital, Oslo, Østlandet, Bas Verplanken, PhD, University of Bath, Bath, Somerset, Anne Haase, PhD, University of Bristol, Bristol, Somerset

To understand whether the goal-directed system deficits and heightened negative reinforcement processes implicated in compulsive behaviour are relevant to Anorexia nervosa (AN), this study aimed to determine whether trait anxiety (TA) and compulsive behaviour typical of Obsessive Compulsive Disorder (OCD; OCD-type compulsions) predict AN pathology and eating, exercise and body-related compulsions of AN (AN compulsions). Female AN sufferers (n = 30) and healthy women (n = 32) completed measures of TA, OCD-type compulsions and AN compulsions. Bootstrapped mediated logistic regression analyses tested whether TA predicted the presence of AN compulsions via AN diagnosis, and whether OCD-type compulsions predicted AN diagnosis through AN compulsions. TA predicted AN compulsions being present (Odds Ratio (OR) = 1.09, 95% Confidence Interval (CI) [1.04-1.14]) and AN diagnosis (OR = 1.44, 95% CI [1.18-1.77]) but AN diagnosis did not mediate the TA-AN compulsions relationship. OCD-type compulsions predicted AN diagnosis (OR = 1.34, 95% CI [1.15-1.55]) and presence of AN compulsions (OR = 1.17, 95% CI [1.05-1.31]) but AN compulsions did not mediate the effects of OCD-type compulsions on AN diagnosis. Upon reflection AN diagnosis and AN compulsion measures were concluded to share underlying constructs, which invalidated mediation analyses. This supports AN being a compulsive disorder but prevented discerning whether compulsive AN behaviour arises from, or contributes to, other symptoms of the disorder. This in turn prevented endorsing or rejecting deficient goal-directed system, and heightened negative reinforcement, explanations of AN aetiology, with further studies required for this purpose.


T064: Orthostatic Changes and Electrolyte Imbalances in Adolescent Inpatients with Eating Disorders: Comparison between Acute and Chronic Malnutrition in a Refeeding Protocol

Yung-Chieh Chang MSC; MD, Medical College of Wisconsin, Milwaukee, Wisconsin, Margaret Thew, MSN, Medical College of Wisconsin, Milwaukee, Wisconsin, Kyndal Hettich, RD, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, M Susan Jay, MD, Medical College of Wisconsin, Milwaukee, Wisconsin, Melodee Nugent, MA, Medical College of Wisconsin, Milwaukee, Wisconsin, Pippa Simpson, PhD, Medical College of Wisconsin, Milwaukee, Wisconsin

The purpose was to compare acute and chronic malnutrition outcomes in acute medical stabilization of eating disorder inpatients. A retrospective chart review of inpatient consultations to Adolescent Medicine for disordered eating from March 2013 to December 2015 was conducted. Patients 10-19 years of age using DSM-IV diagnostic criteria for eating disorders with complete inpatient diet history were included. A standardized inpatient refeeding protocol was utilized, and data obtained included demographics, chronicity of malnutrition (acute weight loss ≤ 3 months vs. chronic > 3 months), vitals, body mass index (BMI), orthostatic changes, and comprehensive metabolic panel. Outcomes were primarily electrolyte imbalances (hypokalemia, hypophosphatemia, hypomagnesemia) and orthostatic changes; secondarily daily caloric intake (kcal/day and kcal/kg/day) and weight changes. Of the total 79 consults, 38 study subjects met study criteria; 87% female, median age 15.4 years (range 10.1-17.9), 68% diagnosed using DSM-IV criteria with Anorexia Nervosa, restrictive type., Median BMI was 15.8 kg/m2 (range 13.1-22.1), percent median BMI was 80.4% (range 68.9-115.8%), and median weight loss was 3 months (range 0.3-24). At admission, patients with chronic malnutrition had longer duration of eating disorder behavior (p =0.033), longer duration of weight loss (p≦0.001) and lower monthly weight loss percent (p≦0.001). During refeeding, patients with chronic vs. acute malnutrition had higher incidence of electrolyte imbalance (44.4% vs. 5%, p=0.007), with a lower incidence of orthostatic changes (6.7%vs. 38.9%, p<0.046). No difference with daily calorie intake, body temperature, body weight and lowest heart rate were noted within the two groups. We conclude that those with chronic malnutrition resulted in more refeeding-electrolyte imbalance, whereas those with acute malnutrition demonstrated more orthostatic changes during the refeeding process.


T065: The Introduction of a Multi Family Group in Singapore: A Pilot Study

Siobhan Kelly, DClinPsy, KK Women's & Children's Hospital, Singapore, Singapore, Elaine Chew, MBBS, KK Women's & Children's Hospital, Singapore, Singapore, Kumu Rajasegaran, MBBS, KKH, Singapore, Singapore, Jean Yin Oh, MBBS,KKH, Singapore, Singapore

FBT continues to be the most promising treatment for Child & Adolescent Anorexia Nervosa. However, research indicates there is still a proportion of family’s who do not respond to treatment and may require adjunctive or more intensive forms of treatments. Furthermore, health systems can often face challenges in meeting the resource intensity of FBT. One form of adjunctive treatment that has been explored in the literature is Multi-family-therapy (MFT). Emerging research in the use of MFT in the treatment of AN has shown promising results (Le Grange & Eisler, 2008), however there has been limited research on the effectiveness of this form of treatment in non-western populations. Our current study therefore aimed to explore the feasibility and effectiveness of MFT in our Singaporean health care system. We conducted a pilot study delivering MFT across four weekly sessions to six families. Patients were referred to the MFT group for the following reasons 1) long wait-list to commence individual FBT, 2) poor insight into the illness, 3) difficulties with high expressed emotion and 4) difficulties progressing to stage 2 of FBT treatment. Self-report questionnaires were administered pre and post the commencement of the group, and weight was taken at each of the four sessions. Qualitative feedback on the family’s experience of the group was also obtained. Results: The pilot study showed promising preliminary evidence for the usefulness of MFT in our local health care system. The qualitative feedback from families were positive, reporting improvements in understanding of the illness and particularly their child’s experience or the seriousness of the condition. For most families, the weight also showed an upward trend across the four sessions. Conclusion: MFT may be a useful treatment within the Singaporean context. However, there were many challenges faced when implementing the group structure and activities. Challenges and the possible need for adaptations will also be discussed.


T066: What’s Cookin’? - Culinary Art Therapy for Adult ED Inpatients.

Adi Stern, PhD, Hadassah Medical Center, Jerusalem, APO AE, Noa Lavi, MPH; RD, Hadassah Medical Center, Jerusalem, APO AE

Food and its significance is a core issue faced by individuals with ED. Some regard food as taboo and avoid any relationship with it. Others have an unhealthy over-involvement with food. Culinary art therapy is a novel approach derived from expressive and occupational therapies. This approach broadly perceives food and cooking as enabling participants to explore patterns, needs and relationships. Culinary therapy has great therapeutic potential for individuals with ED as the cooking process provokes strong and contradictory experiences and feelings. There is a small body of research supporting the efficacy of culinary therapy but a study with EDs has not yet been undertaken. This presentation will describe a culinary group therapy for EDs, and discuss findings from a qualitative study. Thirty-eight adults participated in five consecutive culinary groups. The main therapeutic objectives were to use food and cooking to explore attitudes and feelings towards food and eating; to recognize the use of food as a means of communication; to facilitate group process; to provide psycho-education and to improve participants’ relationship with food. Data was collected via group feedback sessions, an evaluation questionnaire and semi-structured interviews. All were transcribed and analyzed. Results highlighted two significant themes that were categorized as: interpersonal processes and intrapersonal interactions, e.g. by sharing peculiar eating habits and working in collaboration. Participants described these processes as empowering and liberating in dealing with food anxieties and enabling the re-examination of food-related cognitions. Analyzed data also revealed significant behavioral improvement, e.g. several patients were able to touch and prepare food they had avoided handling before. Others reported eating outside their safety zone and trying new dishes as a result of the intervention. Further applications and evaluations of this promising approach should be undertaken.


T067: No Interference of Reported Sexual Abuse in the Outcome of Intensive Enhanced Cognitive Behavioral Therapy for Anorexia Nervosa: A Longitudinal Study

Simona Calugi, PhD, Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Verona, Marwan El Ghoch, MD, Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Verona, Riccardo Dalle Grave, MD, Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Verona

The aim of this study was evaluate short- and long-term outcomes in patients with anorexia nervosa who reported a sexual abuse history, treated with inpatient enhanced cognitive behaviour therapy (CBT-E), a treatment who not directly address sexual abuse experiences. Sixty-six adult patients with anorexia nervosa were recruited from consecutive referrals to a community-based eating disorder clinic. Reported sexual abuse was assessed by a detailed face-to-face interview at admission, while body mass index (BMI), Eating Disorder Examination (EDE) interview, and Brief Symptom Inventory (BSI) questionnaire were recorded at admission, at the end of treatment, and at 6- and 12-month follow-up. Overall, 34.8% of the patients reported at least one incidence of sexual abuse. Demographic and clinical characteristics of patients who reported sexual abuse, compared to those who did not, were similar. Both groups showed a substantial and similar improvement on BMI, eating-disorder and general psychopathology from baseline to 12-month follow-up. The trajectories of change of BMI from baseline to end of treatment indicated a faster improvement in the group who reported abuse than in those who did not report it, but the difference disappeared at 6- and 12-month follow-up. These findings suggest that the presence of reported sexual abuse in patients with anorexia nervosa does not interfere with the response to inpatient CBT-E.


T068: Mentoring - A Novel Approach to Support Hope for Recovery in People with Eating Disorders: Findings from Two Pilot Participatory Action Research Studies

Lucie Ramjan, PhD; RN, Western Sydney University, Penrith, New South Wales, Sarah Fogarty, PhD, Western Sydney University, Penrith, New South Wales

Two pilot studies have been conducted in Australia to investigate the feasibility of mentoring support programs for individuals with eating disorders. The first pilot consisted of eleven women with anorexia nervosa (AN) (5 recovered and 6 recovering). The second pilot involved a mixed group of women with eating disorders (10 recovered and 10 recovering). Both pilot studies utilised the principles of participatory action research, in that participants were active, key stakeholders involved in the design, development and evaluation of each of the 13 week mentoring programs. A face-to-face workshop preceded the commencement of both programs. Quantitative and qualitative measures were employed to monitor well-being of participants throughout the 13 weeks (baseline, mid-point and post- program) and to evaluate benefits. Hope was measured using the validated Domain Specific Hope Scale. Other validated questionnaires included: SF-12, the Eating Disorder Quality of Life Scale (EDQoL), Kessler Psychological Distress Scale (K10), short version eating disorder examination (EDE-Q) and the Global Mentoring Relationship Questionnaire Scale (GMeRQS). Fortnightly log books and post program interviews provided general feedback on the programs. The first pilot revealed encouraging and positive qualitative findings for mentorship in recovery from anorexia nervosa (AN); with participants identifying feeling connected, understood and hopeful for recovery post program. The second pilot identified significant results between pre and post program scores for the mentees (mixed eating disorders) in increasing their overall hope and more specifically in the following hope domains: Social Relationships, Romantic Relationships, Family Life and Work. Mentoring programs are a novel approach that could be employed as an adjunct to treatment, in supporting hope for recovery from an eating disorder.


T069: The Oxford Neuroethics Gold Standard Framework for Neuromodulation ( DBS ) Applied to Severe Enduring Eating Disorders: A Working Guide for Clinicians, Researchers and Ethics Committees

Rebecca Park, BSc; MBBS; MRCPsych; PhD; FRCPsych, University of Oxford, Oxford, Oxfordshire, Jacinta Tan, DPhil; MBBS; MRCPsych, Swansea University, Swansea, Wales

Purpose: To describe a gold standard neuroethical framework to guide research ethics committees, researchers and institutional sponsors in conducting novel neurotechnological research in SE-ED to a high ethical standard. Methods: Neurosurgical interventions for psychiatric disorders have become much more refined in the last few decades due to the rapid development of neuromodulation, neuroimaging and robotic technologies. These advances have enabled less invasive, more focused techniques such as TMS, TDCS and Deep Brain Stimulation (DBS). DBS involves electrode insertion into specific neural targets implicated in pathological behaviour, which are then repeatedly stimulated at adjustable frequencies. DBS has been used for Parkinson’s disease and movement disorders since the 1960s, and over the last decade has been applied to treatment refractory psychiatric disorders, with some evidence of benefit in OCD, major depressive disorder and addictions. Recent consensus guidelines on best practice in psychiatric neurosurgery stress, however, that DBS for psychiatric disorders remains at an experimental and exploratory stage. The ethics of DBS - in particular for psychiatric conditions - is hotly debated and when applied to severe eating disorders particular issues and risks emerge. Much of this discourse surrounds the philosophical implications of competence, authenticity, personality or identity change following neurosurgical interventions but there is a paucity of applied guidance on neuroethical best practice in psychiatric DBS, and healthcare professionals have expressed that they require more. This paper is based on our current research protocol for DBS in Severe and Enduring Anorexia Nervosa (SE-AN). The protocol aims to redress this balance by providing a clear framework to guide optimal ethical practice in a clinical research setting. Summary Data and Results: We describe our neuroethical gold standard framework derived from and applied to our research trial of DBS in SE-AN. This framework provides a working guide for clinicians, researchers and ethics committees on the application of novel neurotechnological research to severe enduring eating disorders and other psychiatric conditions.


T070: Practitioners' Perspectives on Ethical Issues within the Treatment of Eating Disorders: Concept Mapping Results from a Q-sort Study.

D. Catherine Walker, PhD, Union College, Schenectady, New York, Julia M. Brooks, Student, Union College, Schenectady, New York

Most eating disorder (ED) practitioners anecdotally speak to the marked and multifaceted ethical challenges associated with working with this complex patient population. Given this pervasive issue in clinical practice, comparatively little research has examined ethical issues faced in ED treatment, with even less research available to support development of “best practices” to guide practitioners facing such ethical dilemmas. Among the few published studies on the topic, disagreement exists as to best practices, with some supporting coercing resistant patients into treatment (e.g., Tan, Stewart, Fitzpatrick, & Hope, 2010) and others warning of its harm (e.g., Ayton, Keen, & Lask, 2008; MacDonald, 2002). The current study sought to elucidate the ethical issues in treating EDs using Q-sort methodology. Q-sort allows for quantitative analysis of qualitative data and provides “concept maps” depicting themes that are present across participants’ qualitative responses. Practitioners first brainstormed ethical issues they encountered or were aware of in the treatment of EDs. Practitioners then sorted the ethical issues into related self-labeled “piles” and rated each brainstormed statement as to how significant the impact of the specific ethical issue is to the profession and then rated how frequently each ethical issue was personally encountered. Data collection is ongoing. The current sample of 45 practitioners recruited from professional listservs brainstormed 28 statements, broadly falling into themes of: 1. Autonomy vs. Beneficence; 2. Access to appropriate care; 3. Evidence-based treatment provision; 4. Insurance issues; and 5. Level of care. Each theme will be described in depth and the clinical significance and frequency ratings of the ethical issues are discussed, along with future directions toward developing and refining ethical guidelines for ED practitioners.


T071: Sex Differences in Quality of Life Impairment Associated with Body Dissatisfaction in Adolescents: A Population-Based Study.

Scott Griffiths, PhD, Australian National University, Canberra, Australian Capital Territory, Stuart Murray, PhD, University of California San Francisco, San Francisco, California, Caroline Bentley, PhD, Australian National University, Canberra, Australian Capital Territory, Kassandra Gratwick-Sarll, DPsych, Australian National University, Canberra, Australian Capital Territory, Carmel Harrison, PhD, Australian National University, Canberra, Australian Capital Territory, Jonathan Mond, PhD, Macquarie University, Sydney, New South Wales

Body dissatisfaction in male and female adults is strongly associated with quality of life impairment. Whether this is the case in adolescents, however, is unclear. This study aimed to examine the relationships of body dissatisfaction with quality of life among adolescents and to examine sex differences therein. Adolescent girls (n = 1135) and boys (n = 531) aged 12 to 18 years were recruited from secondary schools located in Australia. Students completed a survey that included measures of body dissatisfaction, eating disorder symptoms, and psychosocial- and physical-health-related quality of life. Results revealed that girls had higher levels of dissatisfaction than boys for each of the 12 body features assessed, including two features thought to be particularly relevant to boys, namely, height and body-build. No significant interactions between gender and body dissatisfaction were observed: The strength of the relationships between body dissatisfaction and quality of life impairment did not differ by gender, and this was the case for both physical-health related and psycho-social quality of life domains. For both girls and boys, the associations of body dissatisfaction with quality of life impairment persisted after controlling for eating disorder symptoms, BMI, and other covariates. Implications include that, while levels of body dissatisfaction remain higher in girls than in boys, the adverse impact of body dissatisfaction on adolescents’ quality of life is equally strong for boys as for girls. This impact entails impairment in both physical and psychosocial quality of life domains and does not appear to be accounted for by an association between body dissatisfaction and eating disorder pathology. The findings support the need to conceive of body dissatisfaction as a public health concern in its own right – mirroring concerns previously established in studies of adults.


T072: Not Just a Girl's Problem: the Relationship between Disordered Eating Pathology, Sense of Coherence and Body Image among Adolescent Boys in Israel.

Yael Latzer, DSc, Faculty of Social Welfare, Haifa University Rambam Medical Center, Haifa, Haifa, Israel, Zohar Spivak- Lavi, PhD, Faculty of social wefare and health sciences, Haifa university, Haifa, Israel, Haifa, Israel, Irit Chen-Tsafay, MA, Emek ysreel colege, Emek Ysreel, Israel, Orna Tzischinsky, DSc, Emek Yzreel colege, Emek Yzreel, Israel

Disordered eating pathology (DEP) is well documented mainly among adolescent girls. Recently, it has become more prevalent among adolescent boys. The aims of the study were: to describe the levels of DEP among a non-clinical sample of Jewish adolescent boys in Israel and to assess the role that body image and sense of coherence play in DEP in males. The sample consisted of 256 boys, grades 7-12, mean age 15.08 ± 1.35, mean BMI 21.05±3.43. They completed questionnaires measuring: Sense of Coherence (SOC), Body Shape (BSQ), and DEP. Findings revealed relatively lower overall levels of DEP among this sample (9.8%) compared to similar sample of girls (22.7%) in Israel and (17%) in US. Additionally, higher level of scene of coherence was associated with lower levels of DEP (EAT-26 r=-.203, p<0.001; EDI-DT r=-.291, p<0.001), and high levels of BSQ were associated with higher levels of DEP (EAT-26: r=0.541, p<0.001; EDI-DT: r=0.736, p<0.001). Regression analysis suggested that BSQ is an intermediate factor between SOC and DEP (β=.546, p<0.001(. that is, higher SOC is associated with higher levels of BSQ and lower levels of DEP. These results demonstrate a relatively high prevalence of DEP among adolescent boys and emphasize that they are less at risk than girls for the development of EDs, but at risk nevertheless. Results emphasize the role of body image and a SOC to DEP.


T073: Disordered Eating Pathology among Adolescent Girls in Israel: the Role of Sense of Coherence and Body Image

Yael Latzer, DSc, Faculty of Social Welfare, Haifa University, Rambam Medical Center, Haifa, Haifa, Israel, Orna Tzischinsky, DSc, Emek yzreel colege, Emek yzreel, Israel, Zohar Spivak Lavi, PhD, aculty of Social Welfare and Health Sciences, Haifa University, Israel, Haifa, Israel

Over 50% of adolescent girls exhibit Disordered Eating Pathology (DEP) and body image disturbances, which are considered risk factors for Eating Disorders (EDs). Empirical studies have demonstrated that empowerment variables are important psychological contributors to the understanding of EDs and DEP. The aims of the study were: to describe the current levels of DEP among non-clinical sample of Jewish adolescent girls in Israel, and to assess the role that body image and a sense of coherence plays in DEP. The sample consisted of 248 adolescents girls, grades 7-12, mean age 14.8 ± 1.48, who completed questionnaires measuring: Sense of Coherence (SOC), Body Shape (BSQ), and DEP. Finding revealed relatively higher overall levels of DEP in this sample (22.7%) compared to a similar population 10 years ago (16.9%) and as compared to other western countries (17%). Additionally, higher levels of a sense of coherence were associated with lower levels of DEP (r=-0.29, p<0.01 for EDI-DT and r=-0.19, p<0.01 for EAT-26).  Regression analysis suggested that higher levels of coherence significantly predict lower levels of DEP (R=0.213, p<0.001), and that Body Shape is a partial mediator (R=0.417, p<0.000), according to the Sobel test.   These results demonstrate a raise in the prevalence of DEP in adolescent girls in Israel in the last 10 years, and emphasize the role of body image and a sense of coherence in mitigating ED symptoms.


T074: Percentile 5th, 10th, or 10th+ in Children and Adolescents with Anorexia Nervosa - Clinical Diagnostic Practice vs. Numerical Guidelines 

Loa Clausen, CPsychol; MPsych; PhD, Centre for Child and Adolescent Psychiatry, Aarhus University Hospital Risskov, Risskov, Central Denmark Region, Susanne Bergmann Andersen, MSc, Centre for Child and Adolescent Psychiatry, Aarhus University Hospital Risskov, Risskov, Central Denmark Region, Pil Lindgreen, MSc; RN; Student; PhD Student, Centre for Child and Adolescent Psychiatry, Aarhus University Hospital Risskov, Risskov, Central Denmark Region, Kristian Rokkedal, MD, Centre for Child and Adolescent Psychiatry, Aarhus University Hospital Risskov, Risskov, Central Denmark Region

The cut off for underweight in Anorexia Nervosa among children and adolescents is not easily determined. DSM-5 refers to Center for Disease Control (CDC) suggesting BMI-for-age below the 5th percentile as the numerical cut off guideline corresponding to BMI 18.5 for adults. The 5th percentile has also been suggested as cut off in the upcoming ICD-11 criteria for Anorexia Nervosa. Knowing the use of and need for a clear cut off and fixed numerical guidelines, we expect the 5th percentile to be used as the cut off for underweight in research on children and adolescents as BMI 18.5 is now used as the pathological cut off in research including adults. The evidence for this cut off is, however, sparse and in contrast to a) the relaxing of the weight criteria for adults done between DSM-IV and DSM-5 (from BMI 17.5 to 18.5), b) the recommendation of early intervention among children and adolescents, and c) the clinical practice which in some countries is to use the 10th percentile. In our study, a sub-sample of girls with a clinical diagnosis of Anorexia Nervosa (F50.0 and F50.1) was extracted from a sample of all 480 girls below 18 years treated in a specialized eating disorder center from 1997-2013. A cross sectional study comparing patients with a BMI-for-age below the 5th percentile with patients between the 5th and 10th percentile and patients above percentile 10 was conducted including data from initial assessment. Analyses are still in progress. Differences on eating disorder symptoms and scores on the Eating Disorder Examination will be presented and results discussed in relation to the researchers' need for more fixed and numerical guidelines as well as the clinicians' need for and use of more individualized clinical judgment.


T075: The Relationship between Excessive Dietary Restriction and Compulsive Exercise: An Examination of Specific Compulsions as Mediating Mechanisms

Shelby Martin, BS; Student; Doctoral Student, Ohio University, Athens, Ohio, Sarah Racine, PhD, Ohio University, Athens, Ohio

Excessive dietary restriction and rigid, rule-driven exercise are two symptoms of anorexia nervosa (AN) that can be characterized as compulsive in nature. Indeed, obsessive-compulsive disorder (OCD) is often comorbid with AN, and AN symptom progression has been found to exacerbate OCD tendencies. OCD is also positively associated with compulsive exercise, independent of restriction. However, OCD is a multidimensional disorder composed of various symptom presentations. Currently, it is unclear what specific compulsions may account for the association between dietary restriction and compulsive exercise often see in AN. The current study examined whether specific OCD compulsions (i.e., checking, ordering, cleaning) mediated the association between dietary restriction (measured by the Eating Pathology Symptoms Inventory Restricting subscale) and compulsive exercise (measured by the Commitment to Exercise Scale). Participants were female (n = 310) and male (n = 220) undergraduates. After controlling for sex and body mass index, both checking and ordering significantly mediated the association between dietary restriction and compulsive exercise, while cleaning did not. Since mean levels of OCD compulsions and compulsive exercise were higher in males than females, we examined sex differences in mediation results. Moderated mediation analyses revealed that the indirect effect of dietary restriction on compulsive exercise through compulsions was only significant for females. Thus, among females, dietary restriction may exacerbate OCD compulsions, which may then be manifested as compulsive exercise in individuals at risk for an eating disorder. Given our focus on compulsions, future research should explore specific obsessions that may link various disordered eating symptoms. Examining the efficacy of OCD interventions for eating disorder symptoms may also help advance current treatment options.


T076: Self-Image and Risk of Suicide in Eating Disorders

Andreas Birgegård, PhD, Karolinska Institute, Stockholm, Stockholm, Mikael Andersén, MSc, Uppsala University, Uppsala, Uppsala

Eating disorders (ED) are associated with increased suicide risk, detecting which is key to prevention. An important domain in ED, shown to be associated with symptoms, treatment dropout, and outcome, is self-image, as operationalized in the Structural Analysis of Social Behavior (SASB) model. SASB is a circumplex organizing self-directed behaviors along an Affiliation (love vs. hate) and an orthogonal Autonomy (set free vs. control) dimension. In a recent study, SASB related to health care registry-based suicide attempts in different ED diagnoses. Methodology in that study ensured high specificity but risked lower sensitivity in suicide variables, and with such a high-threat outcome, research is needed on additional variables related to suicide risk. Using clinical patient assessments, we aimed to study associations between SASB self-image and clinician-rated as well as self-rated suicidality at presentation and as predicted over 12 months. Adult patients (N=551) from a Swedish clinical database included 19% anorexia, 32% bulimia, 7% binge ED, and 42% other specified feeding and ED, and 3% males. We ran separate regression models for these diagnostic groups using SASB questionnaire data, also controlling for general psychiatric and ED symptoms, and in longitudinal models including baseline of each outcome. Results showed that SASB alone was associated with suicidality at presentation (9-67% variance explained) and predictively over 12 months (7-29% variance), and in the majority of models explained additional variance beyond baseline and clinical variables. Both Affiliation and Autonomy related to dependent variables in diagnosis-specific patterns. The findings have implications for both theory and detection tools for suicide risk, as well as suggesting intervention targets to mitigate risk in treatment based on the well-validated SASB theory.


T077: Abnormal Immune Functions and Eating Disorders: An Observational Study

Agnes Ayton, MSc; FRCPsych, Oxford Health NHS Foundation Trust, Oxford, Oxfordshire, Alessandro Bruno, MD, Oxford Health, Oxford, Oxfordshire, Oana Ciobanasu, MD, Oxford Health NHS Foundation Trust, Oxford, Oxfordshire, Nadia Hitchen, MBChB, Oxford Health NHS Foundation Trust, Oxford, Oxfordshire, Radhika Sholapurkar, Student, Oxford University, Oxford, Oxfordshire

There has been an increasing interest in the role of immune processes in the origin of mental disorders, including mood disorders and schizophrenia. A recent study also found an increased risk for autoimmune diseases in patients with eating disorders, but the link is not well established. The purpose of the present study was to evaluate the frequency of diseases associated with immune abnormalities in routine clinical practice. This was an observational study investigating the frequency of ICD-10 lifetime diagnoses in patients open to a specialist eating disorder service in Oxford. We included consecutive patients with a diagnosis of an eating disorder within an 18 months period. Information was collected from both the electronic health records and the GP records. Data were analysed by using SPSS. One hundred and sixty patient records were analysed; 93% were female. One hundred and one patients had anorexia nervosa/atypical anorexia nervosa (mean age: 27.9±10.7 ys), 45 bulimia/atypical bulimia nervosa (mean age: 29.1±11.3 ys) and 14 had binge eating disorder (mean age: 37.8±14.1 ys). The overall rate of comorbid diseases involving abnormal immune reaction was 31.6% affecting multiple organ systems. Twelve percent involved the respiratory system, 8.3% was dermatological, and 4.4% was endocrine. There was no significant difference between the main eating disorder categories. This study confirms that there is an association between eating disorders and immune abnormalities affecting multiple organ systems, which may have implications for understanding pathomechanisms and for potential new treatments. Larger studies are warranted to explore the nature of this association.


T078: Examining the Validity of Exercise Measures for Adult Patients with Anorexia Nervosa.

Sarah Young, DClinPsy/PhD candidate, University of Sydney, Sydney, New South Wales, Stephen Touyz, MPsych; PhD; FAED, University of Sydney, Sydney, New South Wales, Caroline Meyer, PhD, The University of Warwick, Coventry, CV4 7AL, Jon Arcelus, MD; PhD, University of Nottingham, Nottingham, NG1 5BH, Paul Rhodes, PhD, University of Sydney, Sydney, New South Wales, Sloane Madden, MBBS; PhD; FAED, Sydney Children's Hospital Network, Sydney, New South Wales, Kathleen Pike, MS; PhD; FAED, Columbia University, New York, New York, Evelyn Attia, MD; FAED, Columbia University, New York, New York, Ross Crosby, PhD, FAED; Neuropsychiatric Research Institute, Fargo, North Dakota, Jackie Wales, BA, Leicestershire Adult Eating Disorders Service, Glenfield Hospital, Leicester, Leicestershire, Phillipa Hay, MBBS; PhD; FAED, Western Sydney University, Sydney, New South Wales

Compulsive exercise is a key feature of anorexia nervosa (AN), but limited research has evaluated the various exercise assessment instruments commonly used in the field. The current study assessed the concurrent validity of the exercise section of the Eating Disorder Examination (EDE) and Eating Disorder Examination-Questionnaire (EDE-Q), with the Compulsive Exercise Test (CET) and other exercise self-report measures in outpatients with AN. The study also aimed to validate the CET in an adult clinical sample. 78 adults with AN (4 males) participated in the current study, all of whom were recruited for the randomized controlled trial “Taking a LEAP forward in the treatment of anorexia nervosa”. Prior to treatment, participants completed the EDE interview and a set of self-report questionnaires- the EDE-Q, CET, Commitment to Exercise Scale (CES), Exercise Beliefs Questionnaire (EBQ) and Reasons for Exercise Inventory (REI). We performed a series of correlational and regression analyses. On the EDE, exercise days and exercise time per day were positively associated with each other and with all CET subscales (except Lack of exercise enjoyment), CES mean, EBQ total and REI total. Exercise time per day positively correlated with the EDE global score. The CET demonstrated good to excellent reliability in this sample, and good concurrent validity with the EDE, EDE-Q, CES, EBQ and REI. The CET also accounted for the greatest variance in eating disorder psychopathology when compared with other self-report measures. Although further research is needed to evaluate the CET’s factor structure in a large clinical sample, the CET has demonstrated strong clinical utility in adults with AN.


T079: Do Emotional Responses to Food Images Differ between People with Diverse Eating Disorders?

Nasim Foroughi, PhD, Western Sydney University, Sydney, NSW, Phillipa Hay, PhD; FAED, Western Sydney University, Sydney, NSW, Sloane Madden, PhD; FAED, Eating Disorder Unit, Children’s Hospital at Westmead, Sydney, NSW, Simon Clarke, FAED, fracp, Adolescent Medical Unit, Westmead Hospital, Sydney, NSW, Australia., Sydney, NSW, Stephen Touyz, PhD; FAED, University of Sydney, Sydney, NSW, Michael Kohn, PhD; FAED, University of Sydney, Sydney, NSW

The purpose of this study was to investigate the negative and positive emotional responses to images of food in women suffering from different types of eating disorders (EDs). We compared the emotional responses to food images in women with Anorexia Nervosa (AN), Atypical AN, Bulimia Nervosa (BN), Binge Eating Disorder (BED), and an aged-matched healthy Control group. Adolescents and adult women aged ≥ 14 years old with (n=139) and without (n=41) a history of an ED were recruited. The participants were asked to rate 16 images of different foods evoking fear, disgust, and happiness (n=16) and 4 neutral images. The images were shown to participants at half-minute intervals and were rated using three separate visual analogue scales (one per image). The Control group was significantly happier, less fearful, and less anxious prior to viewing the food images compared to women with an ED. The negative emotive responses of fear and disgust were significantly greater (p<.001) in the ED participants compared to the Control group controlling for age and BMI; however, groups did not differ in terms of happiness. The emotional responses towards food images were not significantly different within the ED groups. These findings highlight the importance of considering basic emotive responses when discussing food consumption and diet in people with EDs of all body weights. As people recover from anorexia nervosa they may continue to have strong negative emotive responses to food requiring ongoing psychological therapy.


T080: Level of Impairment in Anorexia Nervosa-Restricting Type versus Binge-Eating/Purging Type

Oyvind Ro, MD; PhD, Regional Department for Eating Disorders, Oslo University Hospital, Norway, Oslo, Norway, Deborah L. Reas, PhD, Regional Department for Eating Disorders, Oslo University Hospital, Norway, Oslo, Norway

This study investigated AN subtype differences in ED-specific impairment (global, personal, social, cognitive) and ED pathology in a treatment-seeking sample of 128 patients (BMI < 18.5) with restricting (AN-R) or binge-eating/purging (AN-BP) subtype. Based on average weekly (1 x per week) occurrence of either binge eating ( > 4 OBEs during past 28 days) or purging behavior (> 4 episodes of self-induced vomiting or laxative use during past 28 days), 74 (59%) patients were categorized as AN-R and 54 (42.2%) AN-BP. After controlling for a significantly higher BMI among AN-BP vs AN-R (15.7 vs. 15.2, p = .049), preliminary findings showed significantly greater ED pathology across EDE-Q subscales and the global EDE-Q score (all p’s < .001). In line with the subtyping scheme, AN-BP also demonstrated significantly more self-induced vomiting, laxative use, and binge eating (p’s < .001) than AN-R, but groups did not differ in terms of excessive exercise (p = .520). There were no significant AN subtype differences on eating disorder-specific impairment (global, personal, social, or cognitive) assessed by the Clinical Impairment Assessment (CIA) (all p’s > .100). We found significant differences between AN-R and AN-BP in terms of ED pathology, yet similar levels of eating disorder-related impairment.


T081: 'Holy Anorexia' - Relevant or Relic?

Pyry Sipilä, MD, Department of Public Health, University of Helsinki, Helsinki, NA, Gulnara Harrasova, MD, Department of Public Health, University of Helsinki, Helsinki, NA, Linda Mustelin, MPH; MD; PhD, Department of Public Health, University of Helsinki, Helsinki, NA, Jaakko Kaprio, MD; PhD, Institute for Molecular Medicine Finland FIMM, Helsinki, NA, Anna Keski-Rahkonen, MPH; MD; PhD, Department of Public Health, University of Helsinki, Helsinki, NA

Since medieval times, an association between religiosity and anorexia nervosa has been suggested, but few systematic studies have addressed this question. We conducted a nationwide study by screening women (N=2,825) from the 1975–79 birth cohorts of Finnish twins for lifetime DSM-5 anorexia nervosa (N=92). Parental religiosity was assessed by self-report when the women were aged 16 years. The women self-reported their religiosity at ages 16 and 22–27 years. Parental religiosity did not increase the risk of lifetime anorexia nervosa, and neither did religiosity of the women themselves in adolescence. In early adulthood, a J-shaped curve was compatible with the data, indicating increased risk both at low and high levels of religiosity, but the confidence intervals reached null. Religiosity was weakly negatively correlated with body dissatisfaction. We also found evidence for socioregional variation in the association of religiosity with lifetime anorexia nervosa. To our knowledge, this is the first population study to directly address religiosity and anorexia nervosa. We found no evidence for a significant association of religiosity with anorexia nervosa, either at the personal or family level, although some regional differences are possible. Furthermore, we could not exclude a modest protective association of religiosity with body dissatisfaction. Despite compelling case descriptions of ‘holy anorexia’, religiosity does not appear to be a central risk factor in the development of anorexia nervosa.

T082: Reincorporating Healthy Exercise into the Treatment Plan: What to Evaluate and When?

Danika Quensel, MSc, BHK, University of British Columbia, Kelowna, British Columbia, Cristinan M. Caperchione, PhD, University of British Columbia, Kelowna, British Columbia

Concern around compulsive exercise encourages therapists to instruct patients with eating disorders (ED) to abstain from exercise during treatment. New research has shown that healthy, prescribed exercise can benefit patient's physical, and mental health and prognosis. However, there is currently no consensus on what role exercise should play during ED recovery, a such there are no formal protocols to guide the management and reincorporation of exercise during treatment. As a result, there continues to be controversy about the role of exercise during treatment. This study explored the perceptions and beliefs of ED health professionals regarding the aspects of a patient’s health that should be considered prior to reincorporating exercise during treatment. Purposeful sampling was used to identify a panel of international health professionals with expertise in ED treatment and management (n=13). Expertise was determined through published scholarly research on exercise and EDs, and/or by current clinical work and interest in the roles of exercise within ED treatment. An interview guide based upon the research literature and project objectives guided explorative semi-structured interviews. Verbatim transcripts were analyzed using thematic analysis supported by NVivo11.2.2. Results suggested that there continues to be a lack of information and consensus regarding the protocols for reincorporating exercise during treatment. The panel recommended that a multidisciplinary team assess five main aspects of a patient’s health prior to reincorporating exercise into their recovery. The primary recommendation was to medically clear a patient prior to exercise. Secondly, observing a positive trend in weight recovery and establishing adherence to a nutritional program was advised. The experts also recommended revising a patient’s exercise history, and their activity goals. Lastly, the evaluation and review of a patient’s mental state regarding exercise, their general mental health and their ability to engage in therapy was suggested. This foundational work may help address the existing gab in knowledge surrounding the role of exercise in treatment, particularly the appropriate time to reincorporate it into the ED care continuum and lends itself to promoting healthy relationships with exercise in the long term.


T083: Is Self-Treatment a Mechanism Between Emotion Dysregulation and Eating Disorder Symptoms?

Elin Monell, MSc, Karolinska Institute, Stockholm, Stockholm, Andreas Birgegård, PhD, Karolinska Institute, Stockholm, Stockholm

Difficulties in emotion regulation demand attention as a central factor in eating disorder (ED). In a previous study using a non-clinical sample, we found significant intercorrelations between emotion dysregulation, self-image and ED symptoms, which resolved into clear statistical mediation: self-image was an intervening mechanism (mediator) between emotion dysregulation and ED symptoms. In the present study, we replicated this in a large clinical sample and expected similar mediation. Participants were Swedish ED patients from specialized ED-treatment units (N=854). Data was extracted from the Stepwise clinical database. All participants completed the Difficulties in Emotion Regulation Scale (DERS), the Structural Analysis of Social Behavior (SASB) self-image measure and the Eating Disorder Examination Questionnaire (EDE-Q). Correlations between scales were followed by simple mediation analysis with ED symptoms as outcome. The mediation model posited emotion dysregulation as the independent variable and self-image as the mediator. The model was tested in all cases and thereafter in groups divided by diagnosis. There were in general significant moderate to strong correlations between all main measures in all groups. As for the mediation analysis, the effect of emotion dysregulation on ED symptoms was mainly mediated by self-image. This indirect (mediation) effect was significant in all groups. There was no significant direct effect of emotion dysregulation on ED symptoms in any diagnostic group except in BN. The results replicated those previously found in the non-clinical sample. Results suggest that even if closely related, emotion dysregulation and self-image both contribute unique knowledge in relation to ED symptoms. Self-image as an intervening mechanism between emotion dysregulation and ED symptoms is relevant for models of the development, maintenance and treatment of ED, as well as treatment focus.


T084: Cognitive Dissonance and Imagery Rescripting: A Randomised Controlled Trial of Two Brief Interventions for Disordered Eating in a High-Risk Sample

Jamie-Lee Pennesi, BA, Flinders University, Adelaide, South Australia, Tracey, D. Wade, PhD, Flinders University, Adelaide, South Australia

The main aim of the present research is to examine the efficacy of two brief interventions with respect to the reduction of risk factors for disordered eating, namely cognitive dissonance and imagery rescripting, to a control condition in a high-risk sample of body dissatisfied young women. Specifically, the study will investigate the extent to which each intervention decreases body dissatisfaction and negative affect, and increases self-compassion. Females aged 17-25 years will be recruited from an undergraduate student population and the wider community to participate in two phases of data collection over a period of one week, including a body dissatisfaction induction, brief intervention exercise, daily home practice, and one-week follow-up. Participants will be screened for high-risk status on the Weight Concerns Scale (WCS) and only those participants meeting criteria for high-risk will be invited to complete the second phase of the research including daily home practice and follow-up. Eligible participants will be randomly allocated to one of the three conditions (cognitive dissonance, imagery rescripting, or control). State measures will be collected at baseline, pre-induction, pre- and post-intervention, and at follow-up, and trait measures will be collected at baseline and at follow-up. Moderation analyses will also examine if any baseline variables moderate the impact of the intervention conditions. The information gained from this study will help to inform the development of future prevention approaches for disordered eating.


T085: Quality of Life as a Vulnerability and Recovery Factor in Eating Disorders: A Community-Based Study

Deborah Mitchison, MPsych; MSc; PhD, Macquarie University, Sydney, NSW, Lisa Dawson, DPsych; PhD, University of Sydney, Sydney, NSW, Lucy Hand, Student, Western Sydney University, Sydney, NSW, Jonathan Mond, MPH; PhD, Western Sydney University, Sydney, NSW, Phillipa Hay, DPhil; FAED, Western Sydney University, Sydney, NSW

Emerging evidence suggests that changes in quality of life (QoL) predicts later changes in eating disorder (ED) symptoms. The objective of this study was to explore individual sufferers’ perspectives on the influence of QoL on the onset, maintenance, and/or remission of ED symptoms. Nineteen women from the community with a history of an eating disorder (n = 13 currently symptomatic; n = 6 recovered) were interviewed about their observations on the relationship between QoL and ED symptoms over time in their own lives. Interviews were audio-taped and transcribed, and then thematically analysed. Thematic analysis uncovered two major themes: 1. QoL as a Vulnerability Factor, and 2. QoL as a Recovery Factor. In relation to the first theme, the onset of ED symptoms was discussed by women in this study as having been triggered by impairment in QoL, including a general sense of lacking control in life, stress, abusive intimate relationships, poor role modelling from family, physical impairment related to obesity, peer pressure, and weight-related teasing. On the other hand, and in relation to the second theme, subsequent improvement in QoL was nominated as central to symptom improvement and recovery. QoL improvement was described by participants differently, but included increased general satisfaction in life, emotional maturation, prioritising and improving physical health, the development of a supportive intimate relationship and social relationships, and having children. Impairment in QoL may act as a trigger for the onset and maintenance of ED symptoms, whereas improvement in QoL may be central to eating disorder improvement and eventual recovery. Treatment should involve consideration of a core focus on QoL improvement as a potential ‘backdoor’ approach to improving ED symptoms.


T086: Exploring the Relationship between Emotion Regulation Strategies and Eating Psychopathology in Competitive Athletes and Non-Athletes: The Mediating Role of Compulsive Exercise

Carolyn Plateau, MA; MResl; PhD, Loughborough University, Loughborough, Leicestershire, Jon Arcelus, MRCPsych; MSc; MD; PhD; FAED, Nottingham University, Nottingham, Nottinghamshire, Caroline Meyer, PhD, University of Warwick, Coventry, Warwickshire

Compulsive exercise has been conceptualised as one maladaptive strategy of emotion regulation that has been linked with increased eating psychopathology. This study explored the links between emotion regulatory strategies and eating psychopathology among athletes and non-athletes, and investigated a potential mediating role of compulsive exercise. A sample of 465 participants (241 athletes and 224 non-athletes) aged between 18-46 years completed the Eating Disorder Examination Questionnaire (EDE-Q), the athlete version of the Compulsive Exercise Test (CET-A) and Difficulties in Emotion Regulation Scale (DERS). The findings indicated significant associations between DERS scores and CET-A scores among both non-athletes and athletes. CET-A scores were found to partially mediate the relationships between DERS subscales and EDE-Q scores among athletes and, to a lesser extent, non-athletes. Compulsive exercise is a maladaptive emotion regulation strategy that may be particularly pertinent among athletes, and may engender an increased risk for eating psychopathology in this group. The findings point towards a need to educate and support athletes in engaging with more functional emotion regulation strategies, as a means of preventing compulsive exercise and potentially eating psychopathology in this group.


T087: Modifying Automatic Processes to Influence Risk for Disordered Eating

Emily Matheson, BPsySc(Hons), Flinders University, Adelaide, South Australia, Tracey Wade, BSc; MPsych; PhD, Flinders University, Adelaide, South Australia

The current study investigated two experimental paradigms that target mechanisms at the automatic processing level; specifically attentional bias and evaluative associations. The main aim was to examine the modification of attentional bias and evaluative associations, and the subsequent impact on body dissatisfaction and negative affect. Participants were female university students (N=21) who were randomised into one of three groups: Attentional bias, evaluative conditioning, or an active control (Tetris). Initially, participants underwent an induction designed to induce body dissatisfaction and negative affect. Immediately following, participants completed a computerised experimental task, where they were trained to attend to positive appearance-related information or associate their physical appearance with positive social stimuli; meanwhile the control condition completed Tetris. Preliminary findings showed that Tetris significantly improved body dissatisfaction and negative affect, relative to the two experimental tasks. More specifically, participants’ body dissatisfaction and negative affect were unaffected by the attentional training condition, and participants’ symptomatology was exacerbated when trained to associate their physical appearance with positively valanced social cues. As data collection is continuing, results will also be reported on a larger sample. The current findings, although preliminary, suggest that the use of Tetris is worth exploring with respect to improving body dissatisfaction and negative affect. Given the positive impact of Tetris on intrusive flashbacks, attentional bias and cravings for food, beverages, caffeine and nicotine, hypotheses about the effectiveness of Tetris in this context will be explored.


T088: Body Image and Self-Compassion: Gender Differences in Adolescents

Debra L. Franko, PhD, Northeastern University, Boston, Massachusetts, Rachel Rodgers, PhD, Northeastern University, Boston, Massachusetts, Elizabeth Donovan, PhD, Northeastern University, Boston, Massachusetts, Tara Cousineau, PhD, Northeastern University, Boston, Massachusetts, Elizabeth Cook, MS, Northeastern University, Boston, Massachusetts, Alice Lowy, MA, Northeastern University, Boston, Massachusetts, Kayla Yates, BS, Northeastern University, Boston, Massachusetts, Kayla McGowan, BA, Northeastern University, Boston, Massachusetts

Background: A growing body of literature has highlighted the association between self-compassion and positive body image among young women; however, little is known about these relationships among males. As sociocultural pressures on appearance and body ideals are gendered, it is important to understand how these associations may differ among males and females. Thus, our aim was to examine gender differences in the relationships between dimensions of self-compassion and body image. Methods: A sample of 73 male and 204 female mid to late adolescents (13 to 19 years old) completed self-report measures of self-compassion and body image as part of the baseline assessment of a larger intervention study. Results: Male adolescents reported higher levels of positive self-compassion dimensions (self-kindness, common humanity, and mindfulness) and lower levels of negative dimensions (self-judgment, over-identification, and isolation) compared to females (p = .037 to p < .001). Among females, all dimensions of self-compassion were correlated with body image acceptance and appearance esteem (r = .22 to .57). However, among males, while the negative dimensions of self-compassion were associated with body image acceptance and appearance esteem (r = -.30 to -.56), of the positive dimensions, only self-kindness was associated with appearance esteem (r = .36). Discussion: These findings suggest that, contrary to females, among males positive self-compassion may not help foster positive body image. These findings may reflect gender differences in the centrality of appearance to identity and suggest that interventions aiming to improve body image through fostering positive self-compassion may be most effective among females.


T089: Descriptive Analysis of 6 Year Data of Patients with Eating Disorders in Children and Adolescents, National University Hospital, Singapore

Dr. Rajeev Ramachandran, MBBS; MD, National University Hospital, Singapore

Aim: To understand the demographics, clinical features and outcomes of paediatric and adolescent patients attending the multi-disciplinary Eating Disorder (ED) management program at the National University Hospital, Singapore. There are no previous studies in paediatric / adolescent patients from this region in this subject. Methods: The case notes of all patients (n=82) followed up by the ED Program under the adolescent medical service at the National University Hospital (NUH) Singapore between January 2011 and June 2016 were reviewed. Patient characteristics and outcomes data were abstracted and summarized. Results: The average age at onset of symptoms was 14.6 years (8.8 - 18.8 yrs). Most of our patients were female (93%). The patients were predominantly Chinese (84 %). While Malays make up 13% of the Singaporean population, they only represented 2% of our ED population. Majority (87%) of our patients had a diagnosis of Anorexia Nervosa (AN) with 9% and 5% diagnosed with eating disorder not otherwise specified (ED NOS) and Avoidant/Restrictive Food Intake Disorder (ARFID), respectively. There were no patients with Bulimia Nervosa (BN). A large proportion (57%) of patients required inpatient management, for an average length of stay of 64 days. 9% of our patients developed re-feeding syndrome during the nutritional rehabilitation, which is 15% of the admitted patients. Major depressive disorder was the most common psychiatric co-morbidity (38%). Self-harm was noted in 13%, with active suicidal ideation in 6%. 13% of our patients were discharged after full remission. We did not have any mortality in our cohort. Conclusions: Further evaluation of the lower prevalence of BN, lower representation of boys and patients of Malay background is required. Co-morbid psychiatric conditions were common, the proportion of patients requiring inpatient care was large and hospital stay was long. This could be addressed by the addition of an integrated ambulatory day therapy program and introducing family based therapy as the recommended treatment.


T090: Family Involvement in Inpatient Treatment of Anorectic Children

Maiken Fjelkegård, DClinPsy, Stockholm Center of Eating Disorders, Stockholm, Stockholm, Maiken Fjelkegård, DClinPsy, The Stockholm Center of Eating Disorders, Stockholm, Stockholm, Else Marie Olsen, MD; PhD, Associated professor, Department of Public Health, section for social medicine, University of Copenhagen, Copenhagen, Copenhagen, Yvonne von Hausswolff-Juhlin, DClinPsy, Associated professor, Stockholm Center of Eating Disorders, Stockholm, Stockholm

The question addressed in this study is whether parents actively participating in inpatient treatment affect the duration of admission time, the number of readmissions, weight gain and the need of outpatent treatment after discharge. This study is retrospective and compares two specialized inpatient units for treatment of severe anorectic young patients, one i Stockholm and one in Copenhagen. In Stockholm the parents participate in treatment in the unit, being responsible for making their child gain weight. In Copenhagen the unit´s staff is responsible for changing the patients behavior. All inpatients during the period 2012 07 01 till 2013 12 31 are included in the study and data are drawn at four points of time: date of admission, 10 weeks, 6 months and 12 months after. Patients from the two units are compared concerning baseline data and outcome. In order to evaluate if the two groups are comparable, data on structural differences between the two units and the severity of the disease are registered. 53 patients were included in Stockholm and 34 patients in Copenhagen. At start there was no difference in age or weight between the two groups. The results show that the average admission time in Stockholm was 7,6 weeks, in Copenhagen 16,6. The number of readmissions was somewhat higher in Copenhagen. There was no difference in weight gain after 1 year. The results could indicate that parental involvement in inpatient treatment of anorectic children shortens the admission time without affecting weight gain. This also implies that the children can return to school earlier as the parents can deal with food and feelings.


T091: Emotion Dysregulation across the Spectrum of Pathological Eating: Comparisons among Women with Binge Eating, Overeating, and Loss of Control

Sarah Racine, PhD, Ohio University, Athens, Ohio, Sarah Horvath, BS, Ohio University, Athens, Ohio

Etiologic and maintenance models of binge eating and eating disorders specify a role for emotion regulation difficulties. Individuals with bulimia nervosa and binge eating disorder have poorer emotion regulation than controls, and negative affect increases prior to, and decreases following, binge episodes. However, differential associations between emotion dysregulation and the two components of binge eating – overeating and loss of control (LOC) – have not been examined. This research may point to mechanisms that link emotion dysregulation to binge eating and other pathological eating behavior. The current study compared emotion dysregulation dimensions in women with objective binge eating (OBEs; n = 27), overeating only (n = 25), LOC only (n = 32), or no pathological eating (n = 137). To overcome limitations of self-report measures, we required endorsement/denial of pathological eating behaviors on both the Questionnaire on Eating and Weight Patterns-5 and the Eating Disorders Diagnostic Scale. The Difficulties in Emotion Regulation Scale (DERS) and the Emotion Regulation Questionnaire (ERQ) were used to assess emotion dysregulation. Groups differed as expected on binge eating severity, global eating disorder severity, and clinical impairment. Women with OBEs had significantly higher DERS Total, Strategies, and Impulse scores than all other groups. Women with OBEs and women with overeating had similar levels of lack of emotional clarity, whereas women with OBEs and women with LOC had similar levels of non-acceptance of emotions. Groups did not differ on ERQ Reappraisal and Suppression. Findings indicate that the combination of overeating and LOC eating is associated with greater emotion regulation difficulties, but certain facets of emotion dysregulation differentially relate to overeating and LOC. Future research should move beyond self-report to examine relations between behavioral and physiological indices of emotion regulation and binge eating components.


T092: APOLO-Teens, an Internet-based Program for Overweight/Obese Adolescents under Treatment

Sofia Ramalho, MSc, University of Minho, School of Psychology, Braga, Braga, Cátia Silva, MSc, University of Minho, School of Psychology, Braga, Braga, Diana Silva, PhD, Centro Hospitalar de São João, Porto, Porto, Helena Mansilha, MD, Centro Hospitalar do Porto, Porto, Porto, Henedina Antunes, MD; PhD, Hospital de Braga, Braga, Braga, Pedro Saint-Maurice, PhD, University of Minho, School of Psychology, Braga, Braga, Paulo Machado, PhD; FAED, University of Minho, School of Psychology, Braga, Braga, Eva Conceição, PhD, University of Minho, School of Psychology, Braga, Braga

We aim to present the study protocol and the baseline sample characterization of a Randomized Controlled Trial (RCT) to examine the effectiveness of APOLO-Teens, an internet-based program intervention to support weight loss in overweight and obese adolescents, as a supplementary tool for weight loss treatment. The intervention program protocol will be presented in detail as well as preliminary data characterizing the baseline assessment (first medical appointment). This is a RCT with two groups of overweight and obese adolescents: A control group undergoing treatment as usual (TAU) provided at public Portuguese hospitals in the north of Portugal and an intervention group (IB-CBT) with access to the internet-based program for 6 months besides TAU. In this study, a total of 120 participants, aged between 13-18 years with BMI≥25 Kg2, are being recruited. The internet-based program includes: (a) weekly cognitive-behavioral-based tasks, (b) a weekly feedback messaging system that sends a feedback statement related to information reported by the participant, and (c) interactive chat sessions with a trained psychologist. Preliminary data describes a sample where the mean age of the participants (N=30) was 15 years (SD=1.53). Most participants were male (56.3 %). Higher food preoccupation was associated with lower quality of life (rs = -0.45, p < 0.05), higher levels of stress (rs = 0.49, p < 0.05) and anxiety (rs = 0.63, p < 0.01). Female participants presented higher levels of depression when compared with male participants (U = 59.50, p < 0.05). APOLO-Teens is an intervention protocol to support weight loss interventions conducted in clinical medical centers, bridging the gap between patients and professionals. Further research is needed to investigate is baseline characteristics predict different patterns of change on weight, eating-related variables and levels of physical activity across the several assessment times.


T093: The Role of Weight Suppression and Weight Loss Rate as Factors in Psychopathology and Response to Treatment of Eating Disorders

Enrico Collantoni, MD, University of Padua, Padua, Veneto, Davide Gallicchio, MD, University of Padua, Padua, Veneto, Lucia Pedrina, MD, University of Padua, Padua, Veneto, Elisa Bonello, PsyD, University of Padua, Padua, Veneto, Tatiana Zanetti, PsyD, University of Padua, Padua, Veneto, Manuela Soave, PsyD, University of Padua, Padua, Veneto, Elena Tenconi, PhD; PsyD, University of Padua, Padua, Veneto, Paolo Santonastaso, MD, University of Padua, Padua, Veneto, Angela Favaro, MD; PhD, University of Padua, Padua, Veneto

In this study we aim to assess the role of Weight Suppression (WS) in Eating Disorders, considering it not only from a quantitative point of view (calculated as the difference between the maximum weight ever achieved in life and the actual weight) but also assessing the speed of the weight loss by using a new parameter: the Weight Loss Rate (WLR). We analysed the role of these two indexes in different eating and general psychopathological domains, considering both eating behaviours and outcome profiles. The sample consisted of 414 patients, including 62 with AN Binge Purge subtype (ANBP), 146 with AN Restrictive Subtype (ANR) and 206 with Bulimia Nervosa (BN). DSM-5 criteria have been used to code diagnosis. Data about response to treatment were available for a subsample of 201 patients (33 ANBP, 84 ANR and 84 BN). A cross-sectional design was used for the clinical symptoms detected during the initial assessment and a longitudinal design was adopted for the response to treatment analysis. No significant relationship emerged between both WS and WLR and variables collected at baseline assessment. We observed, on the contrary, a significant association between WS and weight gain at the end of treatment. Moreover, high WLR predicted remission of binge eating and compensatory behavior at the end of treatment in BN patients. Finally, we further analyzed our data in order to identify threshold values of both WS and WLR of clinical utility. The role of WS and WLR as predictive factors in the outcome of eating disorders is of great interest and these initial results remark the usefulness of collecting these data during the initial assessment in order to plan a tailored therapeutic intervention.


T094: The Development of a Body Comparison Measure: The CoSS

Victoria Laker, BSc; MSc, University Of Sheffield, Sheffield, Yorkshire, Glenn Waller, BA, MClinPsychol; DPhil; FAED University of Sheffield, Sheffield, Yorkshire

Body comparison is a common phenomenon in eating disorders, but our understanding of it is limited. This study reports on the development of a measure that addresses the full range of body comparison phenomena, and in a way that is more clinically useful than existing measures. 412 participants completed a new measure of body comparison – the Comparison of Self Scale (CoSS). They also completed existing measures of body comparison, eating disordered cognitions and behaviours, anxiety, depression, and body dissatisfaction. Test-retest reliability was tested two weeks later. Factor analysis showed that 22 of the 37 CoSS items loaded onto two factors, which resulted in two scales – Appearance comparison and Personality comparison. These scales had strong internal consistency and test-retest correlations. The CoSS correlated with another measure of body comparison and both were related to levels of eating pathology, but the CoSS was superior in accounting for depression and anxiety, and is substantially shorter. The CoSS has been shown to have strong psychometric properties, and to have superior clinical utility to existing body comparison measures. Given that it is a relatively brief measure, it can be recommended for the routine assessment of body comparison as a maintaining feature of eating disorders. Such assessment might allow clinicians to formulate cases and plan treatment for the individual with body image concerns. However, the measure awaits full clinical validation. Key words: Body image; safety behaviours; body comparison, eating disorders


T095: Sex Differences in the Relationships of Body Dissatisfaction with Quality of Life and Psychological Distress: Findings from a Nationally-Representative Sample of Adults Living in Australia

Scott Griffiths, BPsych; PhD Australian National University, Canberra, Australian Capital Territory, Deborah Mitchison, PhD, Macquarie University, Sydney, NSW, Phillipa Hay, DPhil; FAED, Western Sydney University, Sydney, NSW, Jonathan Mond, PhD, Macquarie University, Sydney, NSW, Bryan Rodgers, PhD, Australian National University, Canberra, ACT, Sian McLean, PhD, LaTrobe University, Melbourne, VIC, Robin Massey, BS, LaTrobe University, Melbourne, ACT, Susan Paxton, PhD, LaTrobe University, Melbourne, VIC

Body dissatisfaction is associated with impairment in women’s quality of life (QoL). To date, however, research has not examined the relationship of body dissatisfaction with men’s QoL, nor have sex differences in this relationship been examined. The purpose of the study was to examine these relationships among a nationally representative sample of Australian adults. A community sample of 966 male and 1,031 female adults living in Australia were recruited and completed a pen-and-paper survey that asked questions about their body dissatisfaction, mental health- and physical health-related QoL, and eating disorder symptoms. Data were analysed using three hierarchical multiple regressions and interactions between body dissatisfaction and sex were examined. Results showed that 60.4% of males and 80.0% of females reported at least some level of body dissatisfaction, and that 15.2% of males and 33.0% of females reported moderate-to-marked levels of body dissatisfaction. For both sexes, increasing levels of body dissatisfaction were associated with poorer mental and physical health-related QoL and greater psychological distress. Significant interactions between gender and body dissatisfaction were observed. Specifically, the adverse associations between body dissatisfaction and mental health-related QoL, and between body dissatisfaction and psychological distress, were more pronounced for males relative to females. These relationships were independent of the well-studied relationship between eating disorder symptoms and QoL. Stigmatisation of males who experience body dissatisfaction likely compounds males' suffering and may partially explain why highly body dissatisfied males reported greater quality of life impairment compared with women. In conclusion, body dissatisfaction is a public health problem – distinct from the eating disorders and other adverse psychological phenomena for which body dissatisfaction is commonly discussed as a risk factor. Males, historically understudied and underrepresented in body image research, warrant increased empirical attention.


T096: Does Media Literacy Protect Against Effects of Exposure to Appearance Ideal Social Media Images on Body Satisfaction in Males and Females

Siân McLean, PhD, La Trobe University, Melbourne, Victoria, Natalie Tamplin, RN, La Trobe University, Melbourne, Victoria, Susan Paxton, PhD, La Trobe University, Melbourne, Victoria

Social media is saturated with appearance ideal images. Engagement with such content has been shown to be associated with low body satisfaction. However, media literacy (critical thinking) has not been examined as a protective factor and experimental study design has been limited by issues of ecological validity. This study aimed to confirm that viewing Instagram images has a negative impact on body image using an ecologically valid design, in both males and females, and importantly to examine whether social media literacy moderated outcomes. The study was presented as an investigation of the effects of alcohol promotion on social media. Participants were 87 males (Mage = 23.3, SD = 5.4) and 154 females (Mage = 25.0, SD = 3.9) who completed measures of alcohol consumption, athlete- and thin-ideal internalisation and social media literacy. Participants viewed either alcohol related appearance ideal social media images or control social media images depicting alcohol. Appearance ideal images were gender matched. State body satisfaction was assessed before and after viewing. Desire to drink was assessed to support the cover story. Results showed that body satisfaction decreased for women who viewed appearance ideal images relative to women who viewed control images. Effects were moderated by social media literacy such that amongst women who viewed appearance ideal images, only those with low social media literacy experienced negative effects. The body satisfaction of women high in social media literacy was unaffected by viewing appearance ideal social media images. For men, there was a marginal (p = .053) effect on body satisfaction of viewing muscular ideal images but there was insufficient power to assess moderation. Outcomes of this study indicate a protective role for social media literacy skills in relation to effects of viewing appearance ideal social media images for women and support the implementation of social media literacy-based prevention for body dissatisfaction.


T097: Illness Beliefs in Youth with Eating Disorders and Their Caregivers: Concordance Rates and Implications for Treatment

Abigail Matthews, PhD, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, Claire Peterson, PhD, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

Beliefs about one’s illness are associated with treatment engagement, outcomes, and illness coping across an array of medical and mental problems. Research examining illness perceptions in pediatric eating disorders (ED) is lacking, particularly in caregivers who assume the primary treatment role in family-based therapy (FBT). As such, the aims of this study included: 1) an examination of concordance rates of illness perceptions in youth with newly diagnosed ED and their caregivers; and 2) the relation between youth and parent perceptions, ED symptom severity, comorbid symptoms, and caregiver variables. Forty-three adolescents (ages 12-18) with newly diagnosed AN (65.1%), atypical AN (30.2%), and ARFID (4.7%), and their primary caregivers completed the Brief Illness Perceptions Questionnaire at treatment outset. Compared to youth, caregivers expressed more negative beliefs regarding illness consequences (t=-3.36, p<.01), length of illness (t=-2.61, p<.01), concern about ED (t=-5.89, p<.001), and emotional impact of ED (t=-4.17, p<.001). Parents expressed greater hope that treatment could help their child with an ED (t=-3.75, p<.001). In youth, greater EDEQ, MASC, and CDI scores were associated with perceptions of greater consequences of ED, illness chronicity, and emotional impact of ED, less hope that treatment could help, and less perceived personal control over ED symptoms. In caregivers, guilt about their child’s ED was associated with perceptions of greater consequences and concern about ED and beliefs that their child had more personal control over symptoms. Interestingly, caregiver perceptions were not associated with EDEQ, MASC, or CDI scores. Given the role of illness beliefs in important treatment variables, findings from this study have important treatment implications, in both FBT and individual therapy approaches.


T098: Adolescent Eating Disorder Patients in Spain: An Examination of Psychiatric Comorbidity and Caregiver Distress as Compared to Substance use Disorder Patients

Dimitra Anastasiadou, MSc; PhD, University Oberta de Catalunya, Barcelona, Catalunya, Melissa Parks, BA; MSc, Autonomous University of Madrid, Madrid, Madrid, Agostino Brugnera, MSc, University of Bergamo, Bergamo, Lombardy, Ana Rosa Sepulveda, PhD, Autonomous University of Madrid, Madrid, Madrid, Montserrat Graell, MD; PhD, Niño Jesus University Hospital, Madrid, Madrid

Alarmingly high rates of comorbidity have been reported among eating disorder (ED) patients. Psychiatric comorbidity has been shown to affect prognosis and treatment outcome, and may influence the type of treatment selected. To date there are a shortage of studies using clinician administered interviews to assess rates of comorbidity in ED patients in Spain, particularly among adolescents. Thus, the primary aim of this study was to use a semi-structured diagnostic interview to assess rates of Axis I disorders among adolescent ED patients, comparing them to a patient group with another chronic psychiatric disorder with adolescent onset: substance use disorder (SUD). A secondary aim was to examine the relationship between psychological variables of the patients (presence of a comorbid disorder, anxiety, depression and symptom severity) and the distress (anxiety and depression) of their mothers. The cross-sectional study included 60 ED patients, 48 SUD patients, and their mothers. More than half of the patients received a diagnosis of a comorbid disorder. Internalizing problems were more common among EDs and externalizing disorders were the most common comorbidities among SUDs, which is similar to findings from other countries. Mother´s distress was associated with worse depression and symptom severity among patients. No differences were found between the level of distress experienced by mothers of a child with a comorbid disorder and those without. Furthermore, elevated anxiety or depression in mothers did not increase the likelihood that patients presented a particular primary diagnosis. Despite the fact that both disorders share certain underlying features, results show that the type of psychiatric comorbidity was specific to each illness and that the presence of a comorbid disorder was not related to differences in parental distress. Finally, results provide further support for targeting parent´s anxiety and depression in therapeutic interventions for both groups.


T099: A Systematic Review of Social Functioning in Anorexia Nervosa

Candace Jones, BS; MD Candidate Class of 2018, University of Miami Miller School of Medicine, Miami, Florida, Rishi Rikhi, BS; MD Candidate Class of 2018, University of Miami Miller School of Medicine, Miami, Florida, Edgar Alegre, BA; MD, Universidad San Martin de Porres, Lima, Lima, Ingrid Barrera, BA; PhD, University of Miami Department of Psychiatry and Behavioral Sciences, Miami, Florida

Limited studies regarding anorexia nervosa and its relation to social functioning have been conducted. Nevertheless, current literature identifies specific personality traits in patients with anorexia nervosa in relation to impaired social cognitive processing and interpersonal difficulties. This systematic review aims to evaluate clinical trials over the past 15 years regarding impaired social functioning in patients diagnosed with anorexia nervosa. The authors conducted an extensive literature search, using four databases: PsycINFO, Pubmed, MEDLINE, and EBSCO. We used the key words, “anorexia social anxiety”, “anorexia social cognition”, “anorexia interpersonal traits”, “anorexia social avoidance”, and “anorexia social emotional responses”. Thirty-two papers were included in this review, all suggesting poor social functioning divided into social inhibition/avoidance (n=16) and interpersonal impairment (n=16), with 2047 anorexia nervosa patients and a total of 6007 participants including controls and other diagnoses. Social inhibition/ avoidance clinical trial measures included social anxiety, preference of socially isolating activities, and social features of autism spectrum disorder. Interpersonal impairment clinical trial measures included alexithymia, misreading of social cues, and hypersensitivity in social relationships. These social impairment comorbidities appear independent of body image and should be recognized as separate undiagnosed conditions contributing to anorexia development and maintenance. The authors urge further clinical studies to increase clinician awareness of underlying social impairment disorders in anorexia nervosa patients, as well as to create guidelines towards improving diagnoses and treatment plans.


T100: Using Fat Talk Measures with Ethnically Diverse Female and Male College Students: Measurement Equivalence and Contributions to Eating Disordered Attitudes and Behaviors

Michael R Sladek, BA; MA, Student, Arizona State University, Tempe, Arizona, Rachel H Salk, PhD, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, Renee Engeln, PhD, Northwestern University, Evanston, Illinois

Examining whether “fat talk” (engaging in negative body-related conversations) varies across ethnic groups requires establishing measurement invariance (equivalence) of available measures. This psychometric process tests whether observed group differences are attributable to true latent differences or to measurement properties (e.g., item wording) that can produce different item responses across different ethnic groups. The purpose of this study was to 1) test measurement equivalence of two brief survey assessments of fat talk for ethnically diverse female and male undergraduate students in the U.S., and 2) test whether fat talk predicts eating disordered attitudes and behaviors in a sample of ethnically diverse students. Female participants (N = 1501, Mage = 18.86, range: 18-33) completed the 13-item Negative Body Talk (NBT) Scale. Male participants (N = 1436, Mage = 19.39, range: 18-35) completed the 16-item Male Body Talk (MBT) Scale. For both measures, participants responded to example body-related comments with how often they say similar things aloud (1=never to 7=always). The NBT’s 13 items comprise two factors, Body Concerns and Body Comparison; the MBT’s 16 items comprise two factors, Muscle Talk and Fat Talk. A series of nested multiple group confirmatory factor analysis (CFA) models were used to test configural invariance (equivalence of 2-factor structures across ethnic groups), metric invariance (equivalence of factor loadings), and scalar invariance (equivalence of loadings and item intercepts). Model fit indices provided support for scalar (strong) invariance of these two measures across White, Latina/o, and Asian undergraduate students. In a follow-up study with a representative subsample of 231 women, NBT scores for Body Concerns significantly predicted eating disordered attitudes and behaviors, β = 0.22, p < .01, after adjusting for body mass index (BMI) and body dissatisfaction, ΔR2 = .03. In a similar follow-up study with 149 men, MBT scores for Muscle Talk, β = 0.29, p < .001, and Fat Talk, β = 0.45, p < .001, significantly predicted eating disordered attitudes and behaviors, after adjusting for BMI and upper body dissatisfaction, ΔR2 = .15 and .08, respectively. Women and men who more frequently engage in fat talk may be at heightened risk for disordered eating.


T101: What are Clinicians' Experiences of the Feasibility of Using the Smartphone Application Recovery Record in Interdisciplinary Eating Disorder Treatment? 

Pil Lindgreen, MSc; RN; Student; PhD Student, Centre for Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Central Denmark Region, Kirsten Lomborg, MSc; PhD; RN; Professor, Research Programme in Patient Involvement, Aarhus University Hospital, Aarhus C, Central Denmark Region, Loa Clausen, CPsychol; MPsych; PhD; Associated Professor, Centre for Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Central Denmark Region

In Denmark, more than 60.000 people have eating disorders, which can be severe, even lethal illnesses. The prospects of recovering increase when patients are engaged in treatment by performing meal self-monitoring. However, this is often difficult to maintain. As a digital, interactive alternative to pen-and-paper meal diaries, the smartphone application Recovery Record may facilitate patient self-monitoring thus improving treatment outcome. Recovery Record holds the option for patients in treatment to link with their clinician using the clinician interface of the app. When linked, the clinician is able to review patient data in-between treatment sessions and provide feedback. As the use of smartphone applications in treatment programs, psychiatry especially, is fairly new; only few studies have been conducted exploring the feasibility, user acceptance, effect on outcome as well as patient and clinician usage over time of health-related smartphone applications. Thus, our study purpose was to gain knowledge on the clinician experiences with using the smartphone application Recovery Record for self-monitoring in interdisciplinary eating disorder outpatient treatment. Clinician experiences were explored through individual interviews, focus group interviews and participant observations. 23 clinicians of different professions participated. Data was collected and analysed concurrently according to the applied approach of Interpretive Description. Thus, initial findings informed the subsequent data collection and vice versa, thus ensuring the validity and relevance of the study. Data is still being analysed, but preliminary findings include the themes; setting expectations; when support becomes control; turning setbacks into progress; when patients’ vulnerability becomes commitment; when data overload turns into guilt. Our findings may affect treatment programs by illuminating advantages and disadvantages of using Recovery Record. Furthermore, they may influence future development of and research on similar applications. The study at hand is part of a PhD project also exploring a) patient experiences with using Recovery Record, b) patient application use over time and c) correlations between application use and eating disorder symptom development.


T102: Do Bulimic Patients hear a Bulimic Voice? Comparing Critical Thoughts and Voices in Anorectic and Bulimic Patients

Greta Noordenbos,PhD, Leiden University, Leiden, Holland

Objectives: Having critical thoughts and hearing a critical inner voice is often found in anorectic patients, but what about bulimic patients? Do they also have inner critical thoughts and hear a Bulimic Voice? In this study anorectic and bulimic patients are compared concerning self-criticism and hearing a critical inner voice. Method: In a cross-sectional case-control design 92 anorectic and 38 bulimic patients participated. A survey was used with the following instruments: the Forms of Self-criticizing/Attacking and Self-reassuring Scale, the Psychotic Symptom Rating Scales and The Beliefs About Voices Questionnaire. Mann Whitney U tests and Kendall’s Tau-b correlations and a logistic regression analysis were made in SPSS. Results: Anorectic and bulimic patients did not differ in frequency and duration of hearing a critical inner voice, except for the content of the voice whereby bulimic patients reported more criticism about having binges and compensating behavior. Self-criticism was significantly related to hearing a critical inner voice in both groups. Conclusion: Not only anorectic but also bulimic patients may hear an inner voice which is very critical about their binges and compensating behaviour, body and weight. More research is necessary to study how treatment can reduce self-criticism and hearing an inner voices. Keywords: Anorexia nervosa; bulimia nervosa; inner criticism; Anorectic Voice, Bulimic Voice


T103: Cognitive Confidence in Obsessive-Compulsive Disorder and Eating Disorders: A Systematic Review

Catherine Ouellet-Courtois, BA; MSc, Université de Montréal, Montreal, Quebec, Samantha Wilson, BA, Université de Montréal, Montreal, Quebec, Kieron O'Connor, BA; MA; PhD, Université de Montréal, Institut universitaire en santé mentale de Montréal, Montreal, Quebec

Cognitive confidence refers to the extent to which individuals trust their attention, perception, and memory. Research suggests that individuals with obsessive compulsive disorder (OCD) have poor cognitive confidence. For instance, individuals with OCD may not trust their ability to remember whether they locked the door or whether they turned off the stove. Given the high rate of comorbidity and symptom similarities that exist between OCD and eating disorders (EDs), it is possible that cognitive confidence is relevant to EDs as well. In fact, it has been suggested that individuals with EDs might not be confident in their ability to correctly perceive their body shape when looking in the mirror, thus contributing to body image disturbance in this population. The objectives of this systematic review will be to (1) review the evidence regarding the extent to which individuals with OCD and EDs display poor cognitive confidence and (2) to evaluate the impact of poor cognitive confidence on these two clinical populations. To these ends, a literature search will be performed using the PsycINFO and PubMED electronic databases. The search strategy will include the following keywords: “anorexia nervosa” or “bulimia nervosa” or “eating disorders” or “obsessive-compulsive disorder” AND “cognitive confidence” or “metacognition”. This review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, and is registered in the PROSPERO database (registration number: CRD42016045906). The results of this systematic review will be synthesized to provide insight into the role and causes of poor cognitive confidence in both OCD and EDs. Clinical implications will be discussed.


T104: The Relationship between Perceived Pressure from the Media to Maintain a “healthy weight” and Eating Disorder Symptoms

Rachel Rodgers, PhD, Northeastern University, Boston, Massachusetts, Emily Choquette, MS; BA, University of South Florida, Tampa, Florida, Alice Lowy, MA, Northeastern University, Boston, Massachusetts, J. Kevin Thompson, PhD, University of South Florida, Tampa, Florida

Recently, pressures to control weight and maintain a “healthy” weight have increased in the context of large-scale obesity prevention efforts. The aim of this study was to examine the relationships between pressure to achieve healthy weight perceived from the media, and weight controllability beliefs and disordered eating. College students completed an online survey including a subscale from the new Sociocultural Influences Towards Healthy Weight Scale (SITHS) evaluating perceived pressure from the media to maintain a “healthy weight,” as well as well-validated measures of pressure from the media to attain the thin-ideal, weight controllability beliefs, and eating disorder symptoms. Data collection is ongoing, and preliminary data are available for N = 122 female college students, mean (SD) age = 20.00 (2.21), mean (SD) BMI = 23.96 (4.18). The anticipated sample size by May 2017 is N= 500. Findings revealed that perceived pressure from the media to maintain a “healthy weight” was associated with weight controllability (r = .25, p = .008) and disordered eating behaviors (r = .29, p = .002). Mediation analyses using 1000 bootstrapped samples showed a significant indirect effect of perceived pressure from the media to maintain a “healthy weight” on eating disorder symptoms, via weight controllability beliefs, estimate = .07, 95% CI [.02-.18]. In addition, multivariate regression analyses revealed that perceived media pressure to maintain a “healthy weight” and media pressure to attain the thin-ideal made independent contributions to the explained variance in eating disorder symptoms (β = .21, p = .03 and β = .20, p = .04). These findings provide initial evidence that sociocultural pressures to maintain a “healthy weight” may be associated with increased eating disorder risk, independently from pressure to attain the thin-ideal. This further supports the usefulness of examining the role of “healthy weight” pressures and weight controllability beliefs in eating disorders.


T105: Out of the Box: Supporting Families Who Have a Child with Anorexia Nervosa and Autism Spectrum Disorder

Colleen Alford, B Social Work (Hons), The Children's Hospital at Westmead, Sydney, New South Wales, Andrew Wallis, MFT, B Social Work, The Children's Hospital at Westmead, Sydney, New South Wales

There is an increasing prevalence of Autism Spectrum Disorder (ASD) being reported internationally as well as a subgroup of Anorexia Nervosa (AN) sufferers that are identified as having the socio-communicative problems that correspond to ASD as part of their AN diagnosis. Therefore an understanding of how to work with this dual diagnosis has become more critical. The complexities of working with these patients as adolescents include: balancing the pursuit of food-related flexibility with preferences for structure and routine, managing distress related to re-feeding when communication around emotions is difficult, and helping patients to re-engage successfully in adolescent tasks. An adjunct to Family Based Treatment has been developed at The Children's Hospital at Westmead, Sydney, Australia, to specifically address the needs of families who have an adolescent with ASD and AN. This has been piloted in two different forms - a parent group for parents of patients with ASD/AN, as well as a module that can be completed as part of Family Based Treatment. The adjunct covers themes such as understanding the interface of ASD and AN, balancing the need for structure and routine with flexibility, increasing communication around distress, and understanding the young person’s attachment needs. This pilot study looked at parental confidence in managing ASD and AN as well as collecting qualitative data about their experience. Parents reported that the group was very useful, particularly in the exchange of ideas with other parents around communication and flexibility.


T106: What Can We Learn from the Treatment History of Eating Disorder Patients Seeking Specialized Treatment in the Netherlands?

Jan Alexander de Vos, MSc, Human Concern foundation, center for eating disorders, Amsterdam, Noord Holland, Charlotte Ariane Bijkerk, MSc, Human Concern foundation, center for eating disorders, Amsterdam, Noord Holland, Greta Noordenbos, PhD, Leiden University, Leiden, Noord Holland

Eating disorders (ED’s) are serious mental disorders and effective treatments remain limited. To better understand ED treatments in naturalistic settings, and how these treatments are perceived by patients, we examined the treatment history of patients with an ED, who were seeking treatment in a specialized ED center in the Netherlands. Patients filled in several questionnaires as part of an intake procedure. Seventy-five percent (N = 492) of these patients had followed a mental healthcare treatment before. This group was analyzed regarding their characteristics, pathology severity and treatment history. Results show that there were almost no statistical significant differences in characteristics between patients who followed their last treatment in a primary care setting, or a specialized care setting. They had a similar average length of the ED, number of earlier followed treatments, starting age of the ED and pathology severity. More than half of the patients already had followed 3 or more treatments in their journey to recovery. Qualitative analysis showed that stagnation of the treatment and a ‘successful’ treatment outcome were the two most reported reasons for ending a treatment. A number of patients report having learned several things during their last treatment, such as developing (self-)insight and normalization of ED behavior, improved emotion regulation and self-acceptance. However, a substantial number of patients also felt that these and other aspects were not or insufficiently addressed during their last treatment. Eating disorder patients in this study were not distributed across the ‘steps’ of care, based on the severity of the disorder (i.e. number of earlier treatments, ED length, severity). This raises questions about the utility of a ‘stepped care’ approach for ED patients as currently used in The Netherlands. The main reasons for ending treatment, insufficiently addressed issues and a new application for treatment suggests that these patients were not fully or partially recovered, which is a high risk for relapse. In order to prevent relapse and re- admission full recovery is necessary.


T107: Disordered Eating and Fear of Negative Evaluation Among Emerging Adults in Recovery from Substance use Disorders

McKenzie Wilkes, PhD, Texas Tech University Center for Collegiate Recovery Communities, Lubbock, Texas, Elizabeth Trejos-Castillo, PhD, Texas Tech University, Lubbock, Texas, Nancy Bell, PhD, Texas Tech University, Lubbock, Texas, Alan Reifman, PhD, Texas Tech University, Lubbock, Texas, Cynthia D'Sauza, PhD, Texas Tech University, Lubbock, Texas

College campuses are often hostile environments for those in recovery from drugs and alcohol. Along with substance use disorders (SUDs), eating disorders (EDs) and disordered eating (DE) on college campuses are also common. People in recovery from drugs and/or alcohol are more likely to struggle with co-occurring EDs than the general population. Furthermore, treatment centers focusing on SUDs often neglect assessing and/or treating EDs all together. It is common for people in recovery from a SUD to see their DE and/or ED thoughts, patterns and behaviors as ‘normal’. In the 1980’s Rutgers University and Texas Tech University realized a need to support students in recovery on college campuses and develop the first collegiate recovery programs (CRPs). For this study, a total of 131 students in recovery from SUDs were sampled from five colleges and universities across the United States of America. The sample included 70 males and 60 females. A survey was administered including demographic information, addiction history, general health, Change in Eating Disorder Symptoms Scale (CHEDS) and the Brief Fear of Negative Evaluation. The results showed that although most of the CRP students in recovery from an SUD do not have a diagnosable ED, 31.67% of CRP women and 14.50% of CRP men scored above the ChEDS cutoff of 60 for eating disorder symptoms in the past 6 months. For CRP students in recovery from SUDs 59.32% of women reported a lifetime prevalence of eating disorder symptoms while 23.19% of men reported a lifetime history of ED symptoms. Results also indicated a significant association exists between fear of negative evaluation and DE patterns and disordered body image. Overall, the study provided evidence on the prevalence of DE within CRPs as well as the significant association between fear of negative evaluation and DE patterns and disordered body image.


T108: An Analysis of Patient Feedback about Their Treatment in An Adult Eating Disorder Day Program

Caitlin McMaster, BSc(Nutrition) (Hons), Royal Prince Alfred Hospital, Sydney, New South Wales, Jessica Aradas, BSc, Royal Prince Alfred Hospital, Sydney, New South Wales, Sarah Horsfield, BSc; MPsych, Centre for Eating and Dieting Disorders, Sydney, New South Wales, Sarah Maguire, DClinPsy; PhD, Centre for Eating and Dieting Disorders, Sydney, New South Wales, Janice Russell, MBBS, Royal Prince Alfred Hospital, Sydney, New South Wales, Susan Hart, BSc; MSc; PhD, Royal Prince Alfred Hospital, Sydney, New South Wales

Client feedback can extract valuable information regarding positive and negative client experiences, however it remains an underused tool in the evaluation and development of eating disorder services. This study involved a thematic analysis of qualitative feedback on the experience of day program treatment. Data was collected from 52 admissions at an eating disorders day program, where open-ended evaluation questions were included as part of online discharge measures. Data was coded by two researchers identifying themes and associated subthemes. The analysis resulted in the exploration of five themes including: (1) group therapy dynamics, (2) food, eating, and nutrition, (3) psychotherapy, recovery, and change, (4) client-staff interactions, and (5) specific suggestions for program improvement. The themes noted provide insight into experiences of day program treatment, highlighting that several aspects of day program treatment are dually experienced by clients as painful or difficult, as well as necessary. Specific suggestions were also noted. These findings have implications for the effective provision of eating disorder services, education of consumers and practitioners within the field, and the promotion of person-centred and collaborative care.


T109: Moving Toward a Signal Detection Strategy for Predicting Dropout In Eating Disorders

Jennifer Jordan, BA; MA; PhD, Dip Clin Psyc, University of Otago, Christchurch, Christchurch, Canterbury

This paper critically reviews the literature on dropout from eating disorders treatment and discussed the relative strength of findings. Failing to complete treatment for eating disorders is associated with significant psychosocial and physical costs to individuals, their families and to treatment services. There has been more interest recently in treatment dropout in eating disorders. Unfortunately though there are many gaps and the literature is complicated by non-replication of findings, in large part due to methodological issues including underpowered studies with small sample sizes. A summary of the results of a systematic literature review of the dropout in eating disorders from 2012-2016 was conducted, using “patient dropout” AND anorexia nervosa OR bulimia nervosa OR binge eating disorder OR eating disorders search terms. Common variables identified as contributing to dropout from treatment include client factors such demographics (age, employment status) and eating disorder symptom variables (binge purge frequency, shape concerns, drive for thinness, duration, BMI), motivational status, extent of distress, comorbidities such as social anxiety or depression, adversity; and personality traits or temperament. Therapy related factors have also been reported including client beliefs about treatment (credibility) and therapy alliance at different stages of therapy (both client and therapist) and therapy type (family therapy, individual psychotherapies, nutrition only therapies). Further studies are required to establish missing information, clarify contradictory results and verify existing findings, using standardised measures in adequately powered studies. With a more solid research base, we will be better placed to develop a prospective signal detection measure, that is, a clinically useful comprehensive measure of risk for dropout from treatment for eating disorders.


T110: Values-Guided and Emotion-Focused Behavioral Therapy for Bulimia Nervosa

Adrienne Juarascio, PhD, Drexel University, Philadelphia, Pennsylvania, Arielle Wolinsky, BA, Drexel University, Philadelphia, Pennsylvania, Helen Murray, BA, Drexel University, Philadelphia, Pennsylvania, Evan Forman, PhD, Drexel University, Philadelphia, Pennsylvania

Cognitive behavioral therapy (CBT) is the current gold-standard treatment for bulimia nervosa (BN), yet despite impressive empirical support for its effectiveness, over 50% of patients fail to achieve abstinence from binge eating and purging by the end of treatment. To improve rates of remission in BN, our team developed an innovative treatment, Values-guided and Emotion-focused Behavioral Therapy (VEBT) for BN. VEBT provides dietary and exercise-based behavioral strategies designed to replace the maladaptive dietary restraint that is a hallmark of BN in combination with many of the behavioral aspects of CBT. VEBT also emphasizes third-wave cognitive and emotional strategies utilized in treatments such as Acceptance and Commitment Therapy (e.g., values clarity and committed action) and Dialectical Behavioral Therapy (e.g., emotion regulation and distress tolerance skill development). Prior to conducting our ongoing NIMH-funded RCT comparing VEBT to CBT for male and female adults with BN, we completed a case series of three patients with full or sub-threshold BN to gather initial feasibility and acceptability data. Pilot participants received 20-sessions of treatment over the course of 18 weeks and completed assessments at pre-treatment, two mid-treatment points (post-sessions 8 and 15), post-treatment, and 6-month follow-up. Preliminary findings showed large reductions in BN symptoms (e.g., objective binge episodes pre-treatment, 10.88 (SD: 10.90), to post-treatment, 2.11 (SD=1.26)) and similarly large changes in hypothesized mechanisms of action for the novel treatment approach (e.g. food reward sensitivity as measured by the Power of Food Scale, pre-treatment, 51.33 (SD=14.18), to post-treatment, 37.00 (SD=13.52). We will provide additional data on the preliminary feasibility and acceptability of VEBT and utilize case examples to highlight novel aspects of this treatment approach.


T111: Body Talk: A Qualitative Analysis of Young Men’s Discussions about their Bodies

Farrah-Hani Imran, MBBS; Student; MRCS(IRL) MS(Plast Surg), University College Dublin, Dublin, Dublin, Farrah-Hani Imran, MBBS; Student; MBBCh MRCS MS(PlastSurg), University College Dublin, Dublin, Dublin, Lesley O'Hara, BA; MSc; PhD, University College Dublin, Dublin, Dublin, Fiona McNicholas, MBBS; MD; MRCPsych; FRCPsych, University College Dublin, Dublin, Dublin

In 2008, the National Men’s Health Policy of Ireland called for ‘a stronger evidence base to support the on-going development of policy and services for men’ and the need to develop measures ‘across different aspects of men’s health that can be monitored to evaluate changes in men’s health status over time’. Research would suggest that body image dissatisfaction is linked with negative health behaviours; however, research around body image dissatisfaction in males is limited. In Ireland, recent research would point to a growing trend of excessive exercise and use of body-building supplements amongst teenage boys but little is known about the extent and motivations of young men to engage in these behaviours and the association with positive or negative body image. With this in mind, the current study set out to explore men’s relationships with their bodies and the motivating factors influencing their diet and exercise behaviours. An exploratory study via 3 focus groups with 8 people in each was conducted, and the views expressed by the men were analysed using qualitative methods. There exists significant pressure on men to conform to particular male body image ideals, and to achieve a certain degree of masculinity both for performance and aesthetics. Pressures are perceived as originating both internally and externally, and pursued with different degrees with both positive and negative effects. A link between these pressures to conform and the impact on mental health is discussed, along with possible interventions designed to promote and maintain positive male body image and minimise any adverse effects.


T112: World Health Organization: Health Systems Response to the Management of Overweight and Obesity in Children and Adolescents in Tertiary Centres Worldwide and Comparison with Global Management of Eating Disorders Treatment

Katherine Howe, BS; MPH; DSc, Student, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, Alessandro Demaio, MBBS; MPH, PhD, World Health Organization, Geneva, République et canton de Genève

Childhood obesity negatively impacts a child’s physical and mental wellbeing, educational attainment and quality-of-life, and predisposes to early-onset noncommunicable diseases and obesity in adulthood. With a high prevalence of childhood overweight and obesity in many communities worldwide, effective measures for weight management are essential to protect the health of children and adolescents during these formative and vulnerable periods of the lifecourse. Following the publication of the Report of the Commission on Ending Childhood Obesity, the World Health Organization seeks to characterise the global health systems structuring for the management of overweight and obesity in children and adolescents and this study compares this health systems response with the management of eating disorders treatment worldwide, a major health challenge. In order to understand the current practice approaches as well as support Member States, this mixed methods study provides an overview of health systems structuring and responses to the management of overweight and obesity in children and adolescents, based on survey and interview data from clinicians and health systems managers. This study supports current guidelines under development, focusing on the management of overweight and obesity in children and adolescents, and includes quantitative and qualitative from head clinicians and program directors of 13 tertiary centres from all six WHO regions of the world. The target audience of this study include national and local policymakers, leaders of nutrition programs, organizations involved in the planning and management of nutrition actions, health managers, and health professionals in all settings. The focus of the discussion section is around the similarities and differences with eating disorders management on the global level, understanding of why health systems respond to the treatment of childhood overweight and obesity and the treatment of eating disorders in the manner of 'band-aid' solutions for these critical health issues, and reflection on societal and clinical perceptions of these conditions around the world.


T113: A Comparison of Adaptive and Maladaptive Emotion Regulation Strategies in Adolescent Anorexia Nervosa Patients versus Matched Controls

Lien Goossens, PhD, Ghent University, Ghent, Oost-Vlaanderen, Kim Van Durme, MA, Ghent University, Ghent, Oost-Vlaanderen

It was the aim of the present study to examine whether differences exist in the use of adaptive and maladaptive emotion regulation strategies in adolescent Anorexia Nervosa (AN) patients versus non-eating disordered matched controls. A clinical sample was recruited of 54 female adolescents (M age = 14.39 years) who were diagnosed with AN of the restrictive type (AN-R). Also, a control group was recruited of female adolescents who were matched with the clinical sample on age and socio-economic status. Both groups self-reported on the use of several maladaptive and adaptive emotion regulation strategies (FEEL-KJ: Fragebogen zur Erhebung der Emotionsregulation bei Kindern und Jugendlichen). Results showed significant differences between the clinical group and matched controls with regard to the use of maladaptive emotion regulation strategies. More specifically, the AN-R patients reported using the strategies of giving up, withdrawal, self-devaluation and rumination more frequently compared with the control group. Moreover, results also showed that within the clinical group, higher use of maladaptive strategies was related to worse eating disorder pathology. With regard to the use of adaptive emotion regulation strategies, significant differences between both groups were found as well. More specifically, the AN-R patients used the strategies problem oriented action, distraction, humor enhancement, acceptance, trying to forget, and cognitive problem solving less frequently compared with the control group. Findings of the present study demonstrate differences in the emotion regulation profile between adolescent girls with AN-R and those without an eating disorder. These results underscore the importance of mapping out the emotion regulation profile in the diagnostic process and focusing on both decreasing maladaptive emotion regulation strategies but also increasing adaptive strategies in the treatment of AN-R.


T114: History of Dieting in Association with Coffee, Alcohol, Tobacco and Marihuana Consumption on a Sample of ED Patients Adolescents

Maria Soto Garay, MSc, Navy Hospital "Almte Nef", Viña del Mar, Valparaiso, Maria Gaete, PhD, Centro Salud Mental y Nutrición Con_ciencia, Viña del mar, Valparaiso, Monica Sangüesa Moraga, MPsych, Navy Hospital "Almte Nef", Viña del Mar, Valparaiso

The purpose of the present study is to explore the association of dieting history and of coffee, alcohol, tobacco, and marihuana (CATM) consumption at the initial consultation of a sample of ED patients. The sample consisted of adolescents(n=73) aged from 13 to 18 years old (5 males and 68 females). By means of a Self-reporting Questionnaire, a descriptive-correlational, cross-sectional, and retrospective design was conducted in which years of dieting and CATM consumption was asked at initial consultation. Results showfor the whole sample 73,53% reporting coffee consumption, 40.58% reporting alcohol consumption, 37.68% reporting tobacco consumption, and 1.59% reporting marihuana consumption. The average of time dieting for the whole sample was 2.35 (SD=2,3). It was found significant and positive correlations between coffee and years of dieting, r=0.68 (p<0.05), alcohol and years of dieting r=0.47 (p<0.05), and marihuana and years of dieting r= 0.77 ( p<0.05). And between tobacco and years of dieting non significant correlation were found. Consumption of coffee, alcohol and marihuana in ED patients. Consumption of tobacco seems to be more permitted and used by the adolescent population.


T115: Clinical Utility of the Eating Pathology Symptoms Inventory for Measuring Eating Disorder Symptoms over Time

Brittany Bohrer, BS; MA, University of Kansas, Lawrence, Kansas, Kelsey Clark, BA, University of Kansas, Lawrence, Kansas, Victoria Perko, BA, University of Kansas, Lawrence, Kansas, Daria Sorokina, BA, University of Kansas, Lawrence, Kansas, Kelsie Forbush, BA; MA; PhD; University of Kansas, Lawrence, Kansas

To accurately assess eating disorder (ED) behaviors and track symptom changes over time, it is important to use assessment tools that show evidence for longer-term stability. Unstable measures make it difficult to understand patterns of symptom change, which complicates clinical decision-making as fluctuations may be caused by measurement error, rather than true symptom change. Existing literature suggests that although the Eating Disorder Examination-Questionnaire (EDE-Q) has shown strong ten-month stability at the full-scale level (r=.79) with similar five- and ten-month stability of the four subscales (r=.57-.82), it has lower ten-month stability of behavioral items (r=.28-.44). Moreover, there are no current studies of the stability of the Eating Disorder Inventory-3 (EDI-3) or the Eating Pathology Symptoms Inventory (EPSI), two other widely used measures of ED psychopathology. The goal of the current study, therefore, was to test the six-month stability of the EPSI in a community sample of adults with a DSM-5 ED (N=155; 81.3% female). The EPSI is a free, 45-item self-report measure that exhibits excellent psychometric properties in men and women across weight categories. Pearson’s r was used to compute stability correlations. All seven of the ED-relevant scales were significantly correlated at baseline and six-month follow-up (p<.001; note Muscle Building scale not administered). Pearson’s r ranged from .50 (Binge Eating) to .74 (Excessive Exercise). The interpretation of our results did not change after using additional indices of association (e.g., intraclass correlation). Results suggested that changes in EPSI scores likely reflect true symptom change. Given other research supporting its convergent and discriminant validity across populations, the EPSI may represent a particularly helpful tool to aid with clinical decision-making and researching the course and outcome of EDs.


T116: The Relationship between Shoplifting and Eating Disorders: Questionnaire Survey in Japanese Female Prison

Maya Yanase, BA; MD, Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Genichi Sugihara, MD; PhD, Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Takako Morita, RN, Department of Medicine, Wakayama Prison, Wakayama, Wakayama, Hiroshi Yamasaki, MD; PhD, Department of Medicine, Wakayama Prison, Wakayama, Wakayama, Toshiya Murai, MD; PhD, Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Shun’ichi Noma, MD; PhD, Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Kyoto

To explore the characteristics of eating disorders related to shoplifting behavior and identify the risk and protective factors related to recidivism of shoplifting among inmates with eating disorders. Thirty female inmates with eating disorders who were incarcerated due to shoplifting were recruited from Wakayama Prison. They were asked to receive a personal interview and to complete self-report questionnaires on demographic characteristics, shoplifting behavior, psychological characteristics and eating disorder symptomatology anonymously. Additional information was gathered by retrospective chart review. We investigated differences in psychosocial characteristics between inmates with low recidivism rate and high recidivism rate. Of the participants, inmates with high recidivism rate of shoplifting had less social support, had higher impulsivity and higher symptom severity of eating disorders compared with those with low recidivism rate. Severity of illness and lack of social support seem to have a serious impact on shoplifting behavior among eating disordered patients. These findings may contribute to clarify risk and protective factors related to shoplifting among eating disordered patients. As vulnerable populations, utmost care, specific ancillary considerations and augmented protections in research including the confidentiality of data and anonymity of the participant was ensured.


T117: Momentary Changes in Restraint, Affect, Body Satisfaction, and Body-Focused Attention Surrounding Binge Episodes among Women with Bulimia Nervosa

Kathryn Smith, PhD, Neuropsychiatric Research Institute, Fargo, North Dakota, Janis Crowther, PhD, Kent State University, Kent, Ohio

While findings from momentary, naturalistic investigations have clarified relationships between negative affect (NA), restriction, and binge eating, few studies have addressed cognitive phenomena surrounding binge eating. Such data may lend further insight into maintaining processes and inform future interventions. Additionally, research has implicated restraint and body dissatisfaction in bulimic symptoms, but momentary investigations of these variables among women with Bulimia Nervosa (BN) have been limited. This study examined changes in NA (and guilt, one NA facet), restraint, body-focused attention, and body dissatisfaction prior to and following objective binge eating episodes in BN. Following a baseline assessment, adult women with BN (N=23) completed a 10-day ecological momentary assessment (EMA) protocol, during which they recorded information about eating episodes, momentary affect, dietary restraint, body-focused attention, and body dissatisfaction. Results from Generalized Estimating Equations revealed that the trajectories of NA, guilt, and body-focused attention significantly increased before and decreased after binges. Restraint demonstrated a post-binge curvilinear trajectory, with levels initially increasing and subsequently declining. No significant changes were observed in body dissatisfaction. Taken together, findings support the affect regulation model of binge eating and highlight the specific role of guilt, consistent with prior research. Contrary to restraint theory, restraint appeared to be most salient after binges but diminished over time, potentially suggesting an inability to sustain cognitive control over eating. While body dissatisfaction remained stable, it may be that heightened awareness of appearance among women with BN is related to elevated NA. Overall, results suggest the potential clinical utility of addressing emotion regulation and adaptive responding to negative emotions and body-focused awareness among women with BN.


T118: Meta-Analysis of Experimental Studies of Emotion Regulation and ad Libitum Eating

Kara Christensen, MA; Student, The Ohio State University, Columbus, Ohio, Ilana Seager, MA; Student, The Ohio State University, Columbus, Ohio, Amelia Aldao, PhD, The Ohio State University, Columbus, Ohio

The present study aims to synthesize the extant experimental literature linking emotion regulation (ER) strategies to ad libitum eating. The question of how ER is linked to consumptive patterns holds particular relevance for eating disorders, which may include features of restrained and unrestrained ad libitum eating. For this meta analysis, we identified experimental studies from dissertations and peer-reviewed journals in the PsychINFO database. Our inclusion criteria included: 1) experimental paradigm in which at least one ER strategy was manipulated; 2) presence of a no regulation control group; and 3) measurable eating behavior outcome. We categorized strategies as putatively adaptive or maladaptive based on previous meta-analytic work evaluating their effectiveness and associations with psychopathology. We predicted that adaptive strategies (i.e., acceptance/mindfulness, reappraisal) would be associated with decreased ad libitum eating compared to a control condition. We also expected that maladaptive strategies (i.e., suppression, rumination) would be associated with increased ad libitum eating relative to a control condition. We coded 10 studies and calculated effect sizes between the ER and control conditions. We found that the use of adaptive strategies was associated with decreased food consumption compared to a control condition, d = -.45, SE = .20, CI = -.84, -.06, p = .02, k = 10. However, contrary to our prediction, the use of maladaptive strategies was not associated with increased food consumption compared to the control group, d = .03, SE = .24, CI = -.44, .49, p = .91, k = 7. Although preliminary, these results suggest the potential utility of encouraging the use of adaptive strategies to reduce ad libitum eating. Future work may examine how ER strategies are linked to eating patterns in clinical samples.


T119: Theory of Mind in Unaffected First-Degree Relatives of Patients with Anorexia Nervosa

Fernanda Tapajoz, DClinPsy, CONICET, Capital Federal, Buenos Aires, Sebastian Soneira, MD, Clinica de Nutricion Dr Cormillot, Capital Federal, Buenos Aires

In recent years there has been much interest in studying some clinical and biological aspects of neuropsychiatric diseases that can be used as specific markers of that disease. This so called endophenotypes would allow a better understanding of the etiology of the disease and the development of new therapeutic strategies. Patients with anorexia nervosa (AN) often present difficulties in different aspects of social cognition. These alterations are usually present before the clinical onset of the disease and persist after recovery. Previous work has documented alterations in a specific domain of social cognition called Theory of Mind (ToM). The purpose of this work was to evaluate the ToM domain in first degree relatives of patients with AN (ANFDR) in order to evaluate if this alterations (if present) could be consistent with a neuropsychological endophenotypes of the disease. This is a comparative-descriptive, cross-sectional study in which 34 women participated. We included 17 first degree relatives (mothers and sisters) of AN patients and 17 healthy controls (HCs). For the study of ToM they were administered the “Reading the mind in the Eyes” Test (RME) and the “Faux Pas” Test (FPT). Demographic and clinical aspects such as age, education level, body mass index (BMI), anxiety, depression and obsessive compulsive symptoms were also evaluated. The groups did not differ in age and educational level. Compared to the HCs, the ANFDR group showed a lower performance in the RME (p<0.01) and FPT (p<0.05). These results did not correlate with any clinical and demographic variables. The first-degree unaffected relatives of patients with AN showed alterations in the ToM tests similar to those found in AN patients. This neuropsychological profile could be genetically inherited and become a possible candidate for a specific neuropsychological endophenotypes of AN.


T120: The Impact of Exposure to Cartoons Promoting Healthy Eating on Children’s Food Preferences and Choices

Sónia Gonçalves, PhD, University of Minho, Braga, Portugal, Eva Conceição, University of Minho, Braga, Portugal, Cátia Silva, PhD, University of Minho, Braga, Portugal, Paulo Machado, PhD, University of Minho, Braga, Portugal, Emma Boyland, PhD, University of Liverpool, Liverpool, UK

Few studies have analyzed the effects of the use of cartoons in promoting healthy eating behavior in children. The present study aimed to explore whether or not a cartoon with healthy eating messages would have a positive effect on children’s (1) food preferences and attitudes; and (2) food choices. Participants (n =143, aged 4 to 8 years) were randomized to one of two groups: control (n =73) who were exposed to cartoons without any reference to food or nutritional messages, and experimental (n =70) who were exposed to cartoons with healthy eating messages. Duration of viewing was 20 minutes for each group, after which each child was given the opportunity to eat ad libitum for 10 minutes from a small selection of snack foods (2 healthy and 2 unhealthy items).  Measures of hunger, cartoon recognition and liking; attitudes to healthy eating; and food preferences were also taken. Children exposed to the cartoon containing healthy eating messages chose significantly more healthy food items than the children in the control group. These results are promising and could inform the development of health promotion campaigns for children.

 

T121: Weigh Concern as a Predictor of Early Change in Guided Self-Help Treatment for Bulimic Disorders

Ana Vaz, PhD, University of Minho, Braga, Braga, Eva Conceição, PhD, University of Minho, Braga, Braga, Nádia Monfreita, PhD, University of Minho, Braga, Braga, Daniel Sampaio, PhD, University of Lisbon, Lisbon, Lisbon, Paulo Machado, PhD, University of Minho, Braga, Braga

Early change has been consistently found as robust predictor of success in the treatment of bulimia and binge eating disorder. However, research has been sparse in identifying what predicts early change. The aim of this study is to find predictors of early change before treatment. Forty-two participants with a diagnose of Bulimia Nervosa (32) and Binge Eating Disorder (N=10) participate in a clinical trial for guided self-help. Participants were classified as early responders according to have made a reduction of at least 51% in the frequency of binge before session 3 of treatment (N=23). Participants that showed a slower response were classified as non-early responders (N=19). Assessment measure at baseline included Eating Disorder Examination Questionnaire, Outcome Questionnaire – 45 and Beck Depression questionnaire. Also, participants clinical and demographic variables were collected with a structured clinical interview. Frequencies of bulimic and purging episodes were assessed at baseline and at every session. Logistic regression was used to test predictors of early change. Results showed that weigh concern was found to be a significant predictor of early change (B=-1.40; S.E=0.67; p=0.04). Results have clinical implications for practice and highlight the importance of weight concerns as a maintaining mechanism that needs to be addressed early in treatment as a way to promote early change.

 

T122: Dose-Dependent Effect of Childhood Trauma Exposure on the Cortisol Awakening Response in Adult Patients with Eating Disorders

Alessio Maria Monteleone, MD, Department of Psychiatry, Second University of Naples, Naples, Italy, Alessio Maria Monteleone, MD, Department of Psychiatry, Second University of Naples, Naples, Italy, Umberto Volpe, MD; PhD, Department of Psychiatry, Second University of Naples, Naples, Italy, Massimiliano Nigro, MD; PhD, Department of Psychiatry, Second University of Naples, Naples, Italy, Francesca Pellegrino, MD, Department of Psychiatry, Second University of Naples, Naples, Italy, Valeria Ruzzi, MD, Department of Psychiatry, Second University of Naples, Naples, Italy, Palmiero Monteleone, Professor, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy

It is widely accepted that childhood trauma is a non-specific risk factor for the development adult eating disorders (ED), and the hypothalamic-pituitary-adrenal (HPA) axis seems to be involved in mediating such a risk. Here we explored the impact of different types of childhood trauma and of concomitant exposure to multiple childhood traumas on the cortisol awakening response (CAR) of women with anorexia nervosa (AN) or bulimia nervosa (BN).Saliva samples were collected at awakening and after 15, 30, 60 min to measure cortisol levels by 121 women (44 AN patients, 36 BN patients and 41 healthy women). Participants filled in the Childhood Trauma Questionnaire to assess childhood trauma exposure.AN and BN patients reporting childhood maltreatments exhibited an attenuated CAR compared to non-maltreated ones. In the whole ED patient group, the CAR showed a progressive impairment with the increasing number of reported trauma types. No significant differences emerged in the CAR among patients who reported different types (emotional neglect or abuse, physical neglect or abuse, sexual abuse) of childhood trauma. Although significant negative correlations emerged between the type or the number of traumas and the CAR, only the number of traumas remained significantly associated with the CAR in a stepwise multiple regression analysis. Present findings confirm that childhood trauma is associated to an impaired CAR in adult AN and BN patients and demonstrate for the first time a negative dose-dependent effect of the traumatic load on HPA axis activity. These findings may suggest an intriguing correlation between childhood trauma exposure, HPA axis functioning and adult ED development.


T123: The Influence of Impulsivity and Personality Disorder Traits on Neural Processing of Reward and Punishment in Patients with Binge Eating and Purging: An fMRI Study

Ema Toyoda-Murao, MD, Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Masanori Isobe, MD; PhD, Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Tomomi Noda, MA, Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Michiko Kawabata, MS, Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Genichi Sugihara, MD; PhD, Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Hidehiko Takahashi, MD; PhD, Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Toshiya Murai, MD; PhD, Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Shun'ichi Noma, MD; PhD, Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Kyoto

Some patients with binge eating and purging (e.g., anorexia nervosa binge-eating/purging type, bulimia nervosa) show high impulsivity or comorbid borderline personality disorder (BPD). The purpose of this study was to investigate reward and punishment neural processing in patients with binge eating and purging, and how this processing is influenced by impulsivity and BPD. Twenty-three patients with binge eating and purging and 23 healthy females (controls: CTL) performed a monetary incentive delay task during functional magnetic resonance imaging. We compared brain activation between patients with two or more impulsive behaviors (high impulsivity) (e.g., alcohol abuse, drug abuse, suicide attempts, self-harm, compulsive stealing, compulsive spending, sexual disinhibition), other patients (low impulsivity), and CTL. We also compared patients with and without a diagnosis of BPD and CTL. During loss anticipation, patients with low impulsivity had significantly higher caudate and insula activation than those with high impulsivity and CTL. Moreover, patients without BPD showed significantly higher activation in the orbitofrontal cortex than those with BPD and CTL. No differences were found during gain anticipation between any groups. These results suggest that patients with low impulsivity and those without BPD are more sensitive to potentially punishing stimuli. In addition, high impulsivity and BPD are often comorbid in patients with binge eating and purging, and patients with high impulsivity are often diagnosed with BPD. However, neurobiological differences between patients with binge eating and purging with high impulsivity and those diagnosed with BPD may exist. These potential neurobiological differences in patients with binge eating and purging advance our understanding of these disorders, which may inform the development of tailored treatment approaches.

T124: Distinct Attention Bias Patterns in Anorexia Nervosa Restricting and Binge/purge Sub Types

Tal Gilon Mann, MA, The Chaim Sheba Medical Center, at Tel Hasorner, Ramat Gan, Daniel Stein, MD, PhD, Professor, The Chaim Sheba Medical Center at Tel Hashorner, Ramat Gan, Adi Enoch, MD, PhD, The Chaim Sheba Medical Center at Tel Hashomer, Ramat Gan, Yair Bar Haim, PhD, Professor, Tel Aviv University, Tel Aviv, Sami Hamdan, PhD, Academic College of Tel Aviv-Jaffa, Tel Aviv

Previous research in patients with anorexia nervosa (AN) has shown the existence of attention bias toward threatening stimuli. Attention bias modification treatment (ABMT) targeting anxiety may serve as a potential innovative treatment for reducing general and eating-related anxiety in patients with AN. A previous study has shown an improvement in these symptoms following 5 sessions of ABMT. Our aim was to investigate whether AB would differ in patients with AN-restrictive type (AN-R) and AN binge/purge type (AN-B/P). For this purpose we tested bias for attending to threatening words, either eating disorder (ED) related or general and social anxiety evoking words, in patients with AN-R (n=32), AN-B/P (n=23) and controls (n=19). We also examine the severity of eating-related symptomatology, depression, and stress. The results of the study indicated a differential threat-related attention bias in the two AN subtypes. Accordingly, patients with AN-R showed vigilance to both ED-related and general/social anxiety, whereas patients with AN-B/P revealed the opposite pattern of avoidance from threatening stimuli of both kinds. Both groups were different from controls. The findings for AB did not correlate with the ED-related and comorbid dimensions, or with the participants' body mass index (BMI). These findings suggest an inherent different neurocognitive pattern for handling anxiety in patients with AN-R vs. AN-B/P. This may call for different ABMT interventions in both groups, because, so far, ABMT is aimed mainly to reduce vigilance.


T125: Eating Disorders and Academic Performance among College Students

Elizabeth Claydon, MA, MPH, Student, West Virginia University School of Public Health, Morgantown, West Virginia, USA, Keith Zullig, PhD, West Virginia University School of Public Health, Morgantown, West Virginia, USA

There is a paucity of research exploring the association between eating disorders (EDs) and academic performance. This study aimed to understand the effect of EDs and treatment on academic performance, with the hypothesis that those with EDs would have a higher GPA (based on characteristics like perfectionism that are associated with EDs), and treatment may improve it. Previous researches in this area have not differentiated the impact of different types of eating disorders on academic performance or have not captured an objective measure of academic performance. Other research has not controlled for key confounders, such as depression or sleep difficulties. The spring 2010 to spring 2011 National College Health Assessment data (N= 231,586) was utilized for the current study. Ordinal logistic regressions, controlling for key confounders (including depression, substance use, sleep difficulties, and student gender), analyzed the association between those diagnosed with anorexia or bulimia and GPA. Students diagnosed with anorexia and treated with medication and psychotherapy were 1.49 (95% CI 1.24, 1.80) times more likely to have a higher GPA (p<.0001) compared to students not diagnosed with anorexia. Those with bulimia were also more likely to have a higher GPA when treated with both psychotherapy and medication (OR=1.35, 95% CI 1.13, 1.61), p=0.0009) compared to students without bulimia. In contrast, those with bulimia who received other treatment had a 25% reduced likelihood of having a higher GPA (95% CI: 0.58, 0.97; p=.0285) compared to students without bulimia. Findings expand the literature concerning how EDs affect academic performance among college students. Additional research is needed to determine whether the combination of medication and psychotherapy offers the most effective way to improve academic performance among students with eating disorders. Additionally, the finding of reduced academic performance among those with BN who received “other treatment” provides some support for the need for evidence-based treatment. Based on these findings, it is critical to treat college students with EDs not only to help them medically and psychologically, but also to improve college retention and future academic success.

T126: The Role of Orexigenic and Anorexigenic Signals and Autoantibodies Reacting with Appetite-Regulating Hormones in Anorexia Nervosa and Bulimia Nervosa

Kvido Smitka, MD, PhD, Institute of Endocrinology, Laboratory of Clinical and Experimental Neuroendocrinology, Prof. Hana Papezova, MD, PhD, Eating Disorders Center, Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic, Karel Vondra, MD, PhD, Institute of Endocrinology, Laboratory of Clinical and Experimental Neuroendocrinology, Martin Hill, PhD, Institute of Endocrinology, Laboratory of Clinical and Experimental Neuroendocrinology, Vojtěch Hainer, MD, PhD, Institute of Endocrinology, Laboratory of Clinical and Experimental Neuroendocrinology, and Jara Nedvídková, PhD, Institute of Endocrinology, Laboratory of Clinical and Experimental Neuroendocrinology

The balance and interaction between orexigenic and anorexigenic hormones originating from gut, brain, and adipose tissue appear to play an important role in the regulation of food intake, energy homeostasis and growth hormone release. However, the regulation of appetite is also under control by secretion of autoantibodies. An impairment of this balance may result in anorexia nervosa (AN) and bulimia nervosa (BN). Neural pathways and gut microbiota derived signals are required for communication between the brain satiety center, gut, and adipose tissue. Our data suggest that better understanding of pathogenic mechanisms may contribute to introduction more specific analogues and monoclonal antibodies for potential treatment of eating disorders in clinical practice.


T127: rTMS in Binge Eating. Double Blind Controlled Clinical Study

Katarina Kviatkovská, Eating Disorders Center, Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic, Silvie Čerešňáková, Eating Disorders Center, Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic, Dr. Jakub Albrecht, Eating Disorders Center, Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic

High-frequency repetitive magnetic stimulation has a potential to activate cortex under the coil, to inhibit neuronal activity in distant cortex and to reduce craving. Our study aimed to show that the rTMS has the potential to contribute to biological treatment in Binge Eating Disorder. Of 34 outpatients of Eating Disorders Unit fulfilling the DSM-5 criteria of Binge Eating Disorder, 9 finally signed the informed consent and were included into double blind, placebo controlled study. Participants were randomly divided into two groups, one of which is stimulated by sham coil and the second by real rTMS. The frequency was determined to 10Hz, duration of stimulation was 20 minutes and the total number of sessions was 10. Each patient completed the questionnaire at 3 time points, before the first session, immediately after the last session and the month after the end of the treatment stimulation. We used the Food Craving Questionnaire (FCQ) to evaluate the craving level. Our preliminary data are demonstrating that rTMS was effective in reducing the level of cravings at high frequencies stimulation of the dorsolateral prefrontal cortex (DLPFC). Supported by project Progres Q27 and GAUK 173915


T128: Physical Activity Correlates with Hunger and Anxiety in Patients with Eating Disorders

Dr. Anna Yamamotova, CSc, Third Faculty of Medicine, Department of Normal, Pathological and Clinical Psychology,Charles University, Prague, Czech Republic, Josef Bulant, MSc, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic, Prof. Hana Papezova, MD, PhD, Eating Disorders Center, Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic

Patients with anorexia nervosa (AN), even when extremely underweighted, show elevated physical activity and excessively exercise. It seems inconsistent, because long-term starvation and weight loss is usually accompanied by energy loss and increased physical fatigue. This phenomenon, often described in clinical trials was only recently subjected to systematic research, especially in animal models. It is known that rodents increased physical activity with limited food availability and therefore it is assumed that hyperactivity in anorexia nervosa may reflect the mobilization of old phylogenetic patterns of behavior in predisposed individuals (Hebebrand et al., 2003). The aim of present study was to relate physical activity of patients with AN (AN = 17, BMI = 14.3 kg/m2, duration of illness 2.4 years) and bulimia nervosa (BN = 7, BMI = 19.8 kg/m2, duration of illness 2.5 years) to specific (hunger, appetite, satiation) and non-specific (anxiety, depression, fatigue, physical pain, need for sleep) symptoms of eating disorders. Patients in the 2-hour intervals (from 8 AM to 8 PM hours) recorded the intensity of the monitored items on a scale of 0 to 10. Physical activity was measured two days on the non-dominant hand using the Actiwatch Score device (Cambridge Neurotechnology, UK). Data were collected at one minute intervals and parameters obtained for the final analyses were following: average 24-hour activity, average night-time activity, the ratio of daytime and night-time activities, and the acrophase of circadian activity rhythm (assessed by cosinor analysis). AN patients did not differ from BN patients in any monitored parameters. The similarity between AN and BN groups can be partially explained by the standard daily program during hospitalization and the relatively low BMI, which may indicate relatively recent transition of patients from anorexic to bulimic phase. The intensity of hunger correlated positively with the amount of daily physical activity (r = 0.61, p = 0.003), whereas anxiety correlated with the activity negatively (r = -0.34, p = 0.08). These data suggest that excessive exercise can be an important factor in regulation of negative emotional states. Key Words: eating disorders, physical activity, hunger and anxiety. Supported by project Progres Q27 and Progres Q35


T129: Epidemiology of ADHD among Eating Disordered Patients

Tereza Stepankova, PhD, Eating Disorders Center, Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic, Dr. Alena Lambertová, Eating Disorders Center, Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic, Prof. Hana Papezova, MD, PhD, Eating Disorders Center, Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic

Although recently published meta-analytic study (Nazar et al., 2016) shows increased interest in studies related to the connection between ADHD and ED, only a few are based on empirical data. The association between these two diagnostic entities remains unclear. We are presenting data from epidemiology case-control study (N=226; 133 ED female patients/93 control) conducted at Eating Disorders Unit. Methods: In a consequential part of the study, ADHD (current and childhood symptoms) was assessed by self-report and other-report versions of a BAARS –IV questionnaire. Severity of eating pathology was assessed by EDQ (all ED patients were diagnosed according to ICD-10 criteria). In the following part of the study, detected patients underwent a structured interview (DIVA 2) and Integrated Visual and Auditory Performance Test (IVA Plus) to confirm the ADHD diagnose. Results: 37 % (49) of ED patients were detected as likely having ADHD while only 16% (15) from a healthy control group were also detected as likely having ADHD (using self- report questionnaire of current and childhood symptoms). This result shows a significant elevation (p= 0.000671169) of ADHD incidence among ED patients compare to healthy control population. The implications of the results will be discussed. Supported by project Progres Q27


T130: Hormones in Anorexia Nervosa and Physical Activity

Joseph Bulant, MSc, Eating Disorders Center, Department of Psychiatry, First Faculty of Medicine, Charles University, and General University Hospital in Prague, Prague, Czech Republic, Dr. Petra Holanová, Eating Disorders Center, Prague, Czech Republic, Dr. Anna Yamamotová, CSc, Third Faculty of Medicine, Department of Normal, Pathological and Clinical Psychology,Charles University, Prague, Czech Republic, Prof. Hana Papežová, MD, PhD, Eating Disorders Center, Department of Psychiatry, First Faculty of Medicine, Charles University, and General University Hospital in Prague, Prague, Czech Republic

Many hormones regulate hunger, appetite and satiety in order to maintain energy homeostasis. In patients with anorexia nervosa (AN) we measured the levels of ghrelin, leptin and cortisol at the admission and at the discharge and examined their association with the clinical status, including level of physical activity. Forty patients with AN participated in the study, 38 women (age = 25 years, BMI=15 kg/m2, duration of illness 6 years) and 2 men (age = 37 years, BMI=13 kg/m2, duration of illness 13.5 years). Blood samples were taken at 8am the 3rd day of hospitalization and then 3 days before the discharge. In same days, we recorded their physical activity using Actiwatch AWSC device (Cambridge Neurotechnology Ltd, UK) with one minute sampling frequency, placed on his/her non-dominant hand for 24 hours. Statistical analyzes were performed by analysis of variance (ANOVA) and orthogonal projection to latent structures (OPLS).At the time of discharge, we observed significant increase in BMI (p<0.001) and leptin (p<0.001) as expected. However, contrary to our expectation, the levels of plasma ghrelin (an orexigenic hormone that drives food-motivated behavior) also increased during the special ED program with standardized re-alimentation. This increase seems paradoxical but it may result from a long-term adaptation to the restrained eating. Increase in ghrelin negatively correlated with baseline levels of ghrelin (r = -0.84, p<0.01) and positively with baseline levels of leptin (r = 0.78, p<0.01) and BMI ((r = 0.71, p<0.01). An increase in physical activity (the 24–hour average) negatively correlated with baseline systolic (r = -0.86, p<0.01) and diastolic pressure (r = -0.87, p<0.01) while no statistically significant changes were observed in relation to cortisol, ghrelin or leptin levels. The clinical impact of the dynamic relations between neuroendocrine and nutritional parameters and physical activity deserves further characterization.Supported by project Progres Q27 and Progres Q35


T131. Media Influence on Body Ideals and Body Image Among Rural Nicaraguan Women

Tracey Thornborrow, MA, Newcastle University, Newcastle Upon Tyne, Tyne and Wear, UK Jean-Luc Jucker, DPhil; Lynda Boothroyd, DPhil, Martin Tovee, DPhil Durham University, County of Durham, UK

We investigated the influence of media exposure on body ideals and body image in a non-Western setting by comparing the responses of groups of Nicaraguan women who experienced markedly different levels of media access but otherwise inhabited a similar environment. A total of 62 women aged 14-39 were recruited from three rural villages purposively selected for their differing levels of media access. The use of figure modelling computer software allowed participants to create their ideal body size and shape in 3D. Standard psychometric measures were also administered to assess body satisfaction, attitudes towards media, thin ideal internalisation, body shape concerns, and eating behaviours. Weekly television viewing hours and viewing frequency of content type were measured to ascertain media exposure levels. Overall, women desired slimmer bodies than they possessed, but those in the high media access villages were further from their ideal than those in the low media access village. Media exposure predicted ideal upper and lower body shape, such that more media exposure was associated with a preference for fuller breasts and a curvier waistline. However, in contrast to findings from our previous studies, media exposure did not significantly predict ideal body size, based on projected BMI. Women in the higher media access villages scored lower on body satisfaction and higher on body shape concerns than those in the low media access village. Furthermore, media exposure and thin ideal internalisation significantly predicted body dissatisfaction, and disordered eating behaviours were significantly predicted by body dissatisfaction and thin ideal internalisation. These findings suggest that level of media exposure predicts body shape ideals and potentially contributes to body image concerns and disordered eating behaviours among women in rural Nicaragua.

T132: Rejection Sensitivity and Social Rank as Mediators of the Relationship between Insecure Attachment and Disordered Eating

Tara De Paoli, Student; BPsych(Hons), The University of Melbourne, Melbourne, Victoria, Australia, Francis Puccio, MPsych; PhD, The University of Melbourne, Melbourne, Victoria, Australia, Matthew Fuller-Tyszkiewicz, PhD, Deakin University, Melbourne, Victoria, Australia, Isabel Krug, PhD, The University of Melbourne, Melbourne, Victoria, Australia

The current study aimed to assess a new interpersonal model for eating disorders (EDs), in which interpersonalerejection sensitivity, appearance-based rejection sensitivity and social rank were hypothesised to mediate the relationship between insecure attachment and disordered eating. The sample comprised 122 participants with a current or lifetime ED diagnosis (99% female, age M=25 years) ascertained from different ED clinics across Melbourne and 667 healthy control participants (79% female, age M=22 years) from the community. Participants were asked to complete a number of self-report measures related to the variables of interest. Invariance testing between the ED and the healthy control groups indicated that the model was structurally variant (i.e. different between groups), however on inspection the significance and direction of effects were found to be equivalent across groups. Path analysis indicated that the overall model demonstrated good fit (RMSEA=0.060, CFI=0.973, TLI=0.956). For both the ED and the healthy control groups, direct effects were observed for: 1.) appearance-based rejection sensitivity associated with drive for thinness 2.) attachment avoidance, appearance-based rejection sensitivity, and low social rank associated with body dissatisfaction, and 3.) attachment avoidance and appearance-based rejection sensitivity associated with bulimia. However, indirect effects indicated differences between groups. For the ED group, indirect effects were found for: 1.) anxious attachment on drive for thinness (β=.233, p<.05) and body dissatisfaction (β=.271, p<.05) through appearance-based rejection sensitivity, and 2.) avoidant attachment on drive for thinness through social rank (β=.064, p<.05). For the control group, indirect effects were found for: 1.) anxious attachment on drive for thinness (β=.251, p<.05) and bulimia (β=.168, p<.05) through appearance-based rejection sensitivity, and 2.) anxious attachment on body dissatisfaction through multiple pathways involving interpersonal rejection sensitivity, appearance-based rejection sensitivity and social rank (p<.05). The results indicate that rejection sensitivity and social rank are potential mediators through which insecure attachment may influence disordered eating.


T133: Preliminary Outcomes of Family Based Treatment with Cognitive Behavioral Therapy for Perfectionism in Adolescent Anorexia Nervosa

Kim Hurst, PhD, Griffith University, Gold Coast, Qld, Melanie Zimmer-Gembeck, Professor, Griffith University, Gold Coast, Qld

The aim of this study was to evaluate the feasibility and symptom change among female adolescents with anorexia nervosa (AN) following family based treatment with an added cognitive behavioral therapy (FBT+CBT) module, which focused on perfectionism. The design was a prospective cohort study with four repeated assessments of eating disorder (ED) pathology and perfectionism. Participants were 19 adolescents with AN who completed 20 sessions FBT and 9 CBT sessions. Results were also optimistic for remission, eleven (57%) adolescents attained full remission, eight (43%) attained partial remission. There was a significant decrease in ED symptoms from pre-treatment to T3 (d = 0.78), and from pre-treatment to post-treatment (d = 0.90, respectively). Compared to pre-treatment, there were significant improvements in ED symptoms, weight and perfectionistic thinking by the third assessment (following CBT) and at the end of treatment (FBT+CBT). Female adolescents with AN showed greater improvement in ED symptom level and this was associated with greater improvement on all three measures of perfectionism (r's from .54 to .68, all p < .05). Future randomized controlled trials that directly compare the efficacy of FBT alone to FBT+CBT are necessary in addition to longer-term follow-up to further assess length and rate of disease remittance or time to relapse.

T134: Psychometric Properties and Validation of the Ontario Bariatric Eating Self-Efficacy Scale

Molly Atwood, BA; MA; Student, Ryerson University, Toronto, ON, Canada, Lauren David, BA; MA; Student, Ryerson University, Toronto, ON, Canada, Susan Wnuk, PhD, Bariatric Surgery Program, University Health Network, Toronto, ON, Canada, Sanjeev Sockalingham, MD, Bariatric Surgery Program, University Health Network, Toronto, ON, Canada, Stephanie Cassin, PhD, Ryerson University, Toronto, ON, Canada

Eating self-efficacy is a non-surgical factor that might influence outcomes following bariatric surgery. In non-surgical populations, existing measures of eating self-efficacy have been shown to predict maintenance of behavioural change, including weight loss and abstinence from binge eating. These measures typically assess confidence in the ability to control overeating in response to specific situations or emotions. However, there are no published measures of eating self-efficacy developed specifically for use in bariatric populations. The aim of the present study was to examine the psychometric properties and validity of the Ontario Bariatric Eating Self-efficacy (OBESE) scale in a sample of preoperative bariatric patients (N = 1,094) aged 17 to 74 years (M = 44.42, SD = 10.22; 80% female), recruited from the Toronto Western Hospital Bariatric Surgery Program. Patients completed the 28-item OBESE scale, which assesses: 1) confidence in one's ability to resist overeating in tempting situations (Part I), and 2) confidence in one's ability to adhere to established postoperative dietary guidelines (Part II). Patients also completed well-validated measures of eating self-efficacy (ESES), binge eating (BES), emotional eating (EES), and weight-related disability and impairment (SDS). Internal consistency was excellent for OBESE total score (a = .96), and Part I and II (a = .96 and .88, respectively). A strong relationship was found between the OBESE scale and ESES (r = .53, p = .000), providing evidence for convergent validity. Regarding concurrent validity, the OBESE scale was found to be moderately and negatively correlated with BES (r = -.34, p = .000), and Anger, Anxiety, and Depression subscales of the EES (rs = -.37, -.35, -.33, respectively; ps < .001). In a test of discriminant validity, the OBESE scale demonstrated no relationship with SDS (r = -.03, p = .407). Results suggest that the OBESE scale is a valid measure to assess eating self-efficacy among bariatric patients.