Not all body image constructs are created equal: Predicting eating disorder outcomes from preoccupation, dissatisfaction, and overvaluation

Autumn J. Askew, Carol B. Peterson, Scott J. Crow, James E. Mitchell, Katherine A. Halmi, W. Stewart Agras, Ann F. Haynos

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Objective: Diverse terminology has been used to operationalize body image disturbance in eating disorders. However, the differential validity of these terms and their underlying constructs to predict outcomes among heterogeneous eating disorders is unknown. This study evaluated the validity of body image constructs to predict eating disorder and negative psychological symptoms concurrently and prospectively over 2 years in a transdiagnostic clinical sample. Methods: Women with heterogeneous eating disorder diagnoses (n = 448) completed assessments at baseline, 12-month, and 24-month follow-up. Cross-sectional and cross-lagged generalized linear models examined effects of three body image constructs (i.e., weight and shape preoccupation, overvaluation, and dissatisfaction) on concurrent and subsequent outcomes (i.e., global eating disorder symptoms, binge eating, purging, fasting, self-esteem, and depression). Results: In concurrent analyses, preoccupation was significantly associated with all outcomes (ps =.01 to <.001), overvaluation with all outcomes (ps =.01 to <.001) except binge eating (p =.06), and dissatisfaction with all outcomes (ps <.001) except purging (p =.38). In prospective analyses, preoccupation predicted Eating Disorder Examination global (p =.003) and fasting (p <.001), overvaluation predicted binge eating (p =.01), and body dissatisfaction did not predict any outcomes. Discussion: Preoccupation, overvaluation, and dissatisfaction are differentially related to eating disorder and psychiatric outcomes, indicating that no one body image construct can capture clinical risk in eating disorders. Preoccupation was the most consistent concurrent and longitudinal predictor; this construct may warrant further attention in assessment and diagnosis. Further investigation of these constructs in diverse samples is encouraged.

Original languageEnglish (US)
Pages (from-to)954-963
Number of pages10
JournalInternational Journal of Eating Disorders
Volume53
Issue number6
DOIs
StatePublished - Jun 1 2020

Bibliographical note

Funding Information:
This work was supported in part by the McKnight Foundation, National Institute of Mental Health of the National Institutes of Health (Award numbers: K23MH112867 and T32MH082761), Klarman Family Foundation, Hilda and Preston Davis Foundation, and Minnesota Obesity Center. These funding agencies did not influence the design of the study, collection, analysis, and interpretation of data, or writing of the manuscript. The investigators express gratitude to the McKnight Longitudinal Study research staff at the University of Minnesota, Cornell University, and Stanford University for their contributions to this investigation, and to Dr. Ross Crosby for his consultation regarding the statistical analyses for this article.

Funding Information:
This work was supported in part by the McKnight Foundation, National Institute of Mental Health of the National Institutes of Health (Award numbers: K23MH112867 and T32MH082761), Klarman Family Foundation, Hilda and Preston Davis Foundation, and Minnesota Obesity Center. These funding agencies did not influence the design of the study, collection, analysis, and interpretation of data, or writing of the manuscript. The investigators express gratitude to the McKnight Longitudinal Study research staff at the University of Minnesota, Cornell University, and Stanford University for their contributions to this investigation, and to Dr. Ross Crosby for his consultation regarding the statistical analyses for this article.

Publisher Copyright:
© 2020 Wiley Periodicals, Inc.

Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.

Keywords

  • anorexia nervosa
  • binge-eating disorder
  • body image
  • bulimia nervosa
  • feeding and eating disorders

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

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