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- Anorexia nervosa versus bulimia nervosa: differences based on retrospective correlates in a case-control studyPublication . Machado, Bárbara César; Gonçalves, Sónia F.; Martins, Carla; Brandão, Isabel; Roma-Torres, António; Hoek, Hans W.; Machado, Paulo P.Objective This study is the result of two Portuguese case– control studies that examined the replication of retrospective correlates and preceding life events in anorexia nervosa (AN) and bulimia nervosa (BN) development. This study aims to identify retrospective correlates that distinguish AN and BN Method A case–control design was used to compare a group of women who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for AN (N = 98) and BN (N = 79) with healthy controls (N = 86) and with other psychiatric disorders (N = 68). Each control group was matched with AN patients regarding age and parental social categories. Risk factors were assessed by interviewing each person with the Oxford Risk Factor Interview. Results Compared to AN, women with BN reported significantly higher rates of paternal high expectations, excessive family importance placed on fitness/keeping in shape, and negative consequences due to adolescent overweight and adolescent objective overweight. Discussion Overweight during adolescence emerged as the most relevant retrospective correlate in the distinction between BN and AN participants. Family expectations and the importance placed on keeping in shape were also significant retrospective correlates in the BN group.
- Adult attachment in eating disorders mediates the association between perceived invalidating childhood environments and eating psychopathologyPublication . Gonçalves, Sónia; Vieira, Ana Isabel; Rodrigues, Tânia; Machado, Paulo P.; Brandão, Isabel; Timóteo, Sertório; Nunes, Patrícia; Machado, BárbaraThis study aimed to evaluate the associations between perceived invalidating childhood environments, attachment in intimate relationships and eating psychopathology, to explore how these variables interact with each other, and to explore potential mediators to this pattern of association in a clinical eating disorder (ED) sample. One hundred thirty-seven ED outpatients were evaluated with the Invalidating Childhood Environments Scale (ICES), the Eating Disorder-15 (ED-15) and the Experiences in Close Relationships Inventory (ECR). Paternal invalidation was associated to the ED-15 total score through avoidance of proximity and anxiety over abandonment, while maternal invalidation was only associated to the ED-15 total score through avoidance of proximity. Our results highlight the potential role of the perception of an invalidating family environment in the development of eating pathology and of difficulties in intimate relationships. These results endorse the relevance of address parental invalidation and promote adequate emotion regulation strategies and interpersonal competencies in the context of intimate relationships.
- Maternal child-feeding practices and associations with maternal and child characteristicsPublication . Gonçalves, Sónia; Lima, Virgínia; Machado, Bárbara; Machado, PauloWe evaluated associations between maternal child-feeding practices and maternal (age, body mass index [BMI], education, disordered eating) and child (age, BMI, emotional and behavioral) characteristics in 412 mothers and their children using the Parental Feeding Practices, the Child Behavior Checklist, and the Eating Disorders Examination Questionnaires. Maternal BMI was positively correlated with covert control feeding practices. Younger maternal age and lower maternal educational level were associated with increased maternal pressure to eat and overt control in their child-feeding practices. Maternal disordered eating behaviors were associated with increased restriction and covert control in their child-feeding practices. Maternal monitoring during child feeding was associated with lower levels of the child’s problems with internalization and externalization. Finally, maternal feeding practices that involved covert control were related to higher eating restriction by the mother on herself and more maternal concern about her child’s weight. Our findings suggest that maternal feeding practices such as overt and covert control are related to both maternal and child factors. Clinicians must become aware that these maternal feeding practices can model children’s eating behavior and disrupt children’s self-regulation of food intake; however, maternal monitoring during child feeding seems to be related to children’s well-being.
- Risk factors and antecedent life events in the development of anorexia nervosa: a portuguese case-control studyPublication . Machado, Bárbara César; Gonçalves, Sónia; Martins, Carla; Hoek, Hans W.; Machado, Paulo P.Objective: The aetiology of anorexia nervosa (AN) is considered to be multifactorial. This study aims to identify potential risk factors for AN and whether these factors are specific to AN or precede the development of psychiatric disorders in general and to identify specific life events in the 12 months immediately preceding the onset of eating disorder (ED) symptoms. Method: A case-control design was used to compare a group of women who meet Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for AN (N= 86) with healthy controls (N= 86) and with a group of controls with other psychiatric disorders (N= 68), each group matched to the AN patients by age and parental socioeconomic status bands. Risk factors were assessed by interviewing each person with the Oxford Risk Factor Interview. Results: Women with AN reported significantly higher rates of perfectionism, negative attitudes toward parents’ shape and weight, significant concern about feeling fat and a family history of AN or bulimia nervosa. Critical comments about weight, shape or eating was the most notable event in the year preceding AN onset. Discussion: Perfectionism and a family history of ED emerged as the most convergent findings in the development of AN, along with being critical toward parents’ shape and weight, and feeling fat. Critical comments about appearance and eating seem to be an important precipitating factor in AN onset
- Eating disorders and non-suicidal self-injury: Structural equation modelling of a conceptual modelPublication . Vieira, Ana Isabel; Machado, Bárbara C.; Moreira, Célia S.; Machado, Paulo P.P.; Brandão, Isabel; Roma‐Torres, António; Gonçalves, SóniaEvidence suggests several risk factors for both eating disorders (ED) and nonsuicidal self‐injury (NSSI), but the relationships between these factors are not well understood. Considering our previous work and a conceptual model, this cross‐sectional study aimed to assess the relationships among distal and proximal factors for the presence of NSSI in ED. We assessed 245 ED patients with the Oxford Risk Factor Interview for ED. Structural equation modelling revealed that both distal and proximal factors were related to the presence of NSSI in ED, disclosing a mediating role of the proximal factors. Stressful life events mediated the relationship between childhood sexual abuse, peer aggres-sion, and both ED and NSSI. Childhood physical abuse was related to ED and NSSI via substance use, negative self‐evaluation, and suicide attempts. Find- ings provided support for the conceptual model and highlight the possible mechanisms by which psychoso cial factors may lead to ED and NSSI.
- Eating and weight/shape criticism as a specific life-event related to bulimia nervosa: a case control studyPublication . Gonçalves, Sónia; Machado, Bárbara César; Martins, Carla; Machado, Paulo P. P.The present study aims to evaluate the occurrence of life events preceding the onset of eating problems in bulimia nervosa patients. A case-control design was used involving the comparison of 60 female subjects who meet DSM-IV criteria for bulimia nervosa with 60 healthy control subjects and 60 subjects with other psychiatric disorders. The RFI (Fairburn et al., 1998) subset of factors that represent exposure to life events in the 12 months immediately before the development of eating problems was used. Women with bulimia nervosa reported higher rates of major stress, criticism about eating, weight and shape and also a great number of antecedent life events during the year preceding the development of eating problems than the healthy control group. However, when compared with the general psychiatric control group only the exposure to critical comments about weight, shape or eating emerged as a specific trigger for bulimia nervosa. Our findings support the fact that eating and shape/weight criticism in the year preceding the development of eating disturbance seems to be specifically related to bulimia nervosa.
- Putative risk factors for non-suicidal self-injury in eating disordersPublication . Vieira, Ana Isabel; Machado, Bárbara C.; Machado, Paulo P. P.; Brandão, Isabel; Roma-Torres, António; Gonçalves, SóniaEvidence suggests a common association between eating disorders (EDs) and non-suicidal self-injury (NSSI). The present study aimed to investigate the potential risk factors for NSSI among ED patients. We assessed 245 ED patients with the Oxford Risk Factor Interview for ED. The results showed that 33% of ED patients reported NSSI in their lifetime. NSSI appeared to occur more frequently among binge eating/purging type ED patients than among patients with other ED and to be related to a more severe eating pathology. A younger age at the onset of eating problems, more negative self-evaluation, suicide attempts, substance abuse, parents’ low weight, family tension at mealtime, parental alcohol problems, childhood abuse, peer aggression, and negative antecedent life events were more common among patients with co-occurring EDs and NSSI than among patients without NSSI. The results may inform the risk assessment and treatment of NSSI in EDs in the early detection period.
- The moderating role of purging behaviour in the relationship between sexual/physical abuse and nonsuicidal self-injury in eating disorder patientsPublication . Gonçalves, Sónia; Machado, Bárbara César; Silva, Cátia; Crosby, Ross D.; Lavender, Jason M.; Cao, Li; Machado, Paulo P. P.This study sought to examine predictors of nonsuicidal self-injury (NSSI) in eating disorder patients and to evaluate the moderating role of purging behaviours in the relationship between a theorised predictor (i.e. sexual/physical abuse) and NSSI. Participants in this study were 177 female patients with eating disorders (age range = 14–38 years) who completed semistructured interviews assessing eating disorder symptoms and eating disorder-related risk factors (e.g. history of sexual and physical abuse, history of NSSI and feelings of fatness). Results revealed that 65 participants (36.7%) reported lifetime engagement in NSSI, and 48 participants (27.1%) reported a history of sexual/physical abuse. Early onset of eating problems, lower BMI, feeling fat, a history of sexual/ physical abuse and the presence of purging behaviours were all positively associated with the lifetime occurrence of NSSI. The relationship between sexual/physical abuse before eating disorder onset and lifetime NSSI was moderated by the presence of purging behaviours, such that the relationship was stronger in the absence of purging. These findings are consistent with the notion that purging and NSSI may serve similar functions in eating disorder patients (e.g. emotion regulation), such that the presence of purging may attenuate the strength of the association between sexual/physical abuse history (which is also associated with elevated NSSI risk) and engagement in NSSI behaviours. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.
- Psychometric properties of the Portuguese version of the invalidating childhood environment scalePublication . Vieira, Ana Isabel; Gonçalves, Mónica; Machado, Bárbara César; Rodrigues, Tânia; Machado, Paulo P. P.; Brandão, Isabel; Timóteo, Sertório; Nunes, Patrícia; Gonçalves, SóniaPurpose The current study aimed to examine the psychometric properties of the Portuguese version of the invalidating childhood environment scale (ICES) in a non-clinical and clinical sample of eating disorder (ED) patients. This study also investigated the between-sample differences regarding invalidating parental behaviors and family styles and explored the associations between invalidating childhood environments and eating pathology. Methods A sample of 410 high school and college students and 101 patients with a diagnosis of ED completed self-report measures. Principal component analyses and confirmatory factor analyses were conducted to examine the factor structure of the ICES. The internal consistency and the between-sample differences and associations between invalidating childhood environments and eating pathology were also tested. Results Principal component analyses and confirmatory factor analyses indicated a two-factor solution for each parent. The ICES demonstrated high internal consistency and was able to differentiate between non-clinical and clinical samples. The perception of parental invalidation was higher in ED patients, and the clinical sample presented higher scores in the chaotic and perfect family styles and lower scores in the validating family style, in comparison with the non-clinical sample. Both maternal invalidation and invalidating styles were significantly associated with a higher ED symptomatology. Conclusions The Portuguese version of the ICES revealed adequate psychometric properties. Considering the relationship between invalidation in family and eating pathology, the ICES may be useful in clinical practice, especially among ED patients. Level of Evidence Level V, cross-sectional descriptive study.
- Romantic relationships and nonsuicidal self-injury among college students: the mediating role of emotion regulationPublication . Silva, Eliana; Machado, Bárbara César; Moreira, Célia S.; Ramalho, Sofia; Gonçalves, SóniaNonsuicidal self-injury (NSSI) is an increasing health problem among college students. Research about risk factors behind the development of this behavior has been limited. This study aims to test whether emotion regulation mediates the connection between romantic relationships and NSSI. Participants were 566 college students (72.8% female) between 18 and 35 years old. Eighty participants (14.1%) reported having injured themselves. Emotion regulation fully mediated the associations between NSSI and four important subdomains of romantic relationships, namely, avoidance of intimacy, anxiety over abandonment, violence victimization, and violence perpetration. We specified a model that evidences the mediating role of the emotion regulation between romantic relationships (romantic attachment and intimate partner violence) and NSSI. This study makes a unique contribution by assessing the pathway through which romantic relationship functioning impact NSSI.