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- 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.
- 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.
- 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.
- 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.
- Avoidant/restrictive food intake disorder symptoms in children: associations with child and family variablesPublication . Gonçalves, Sónia; Vieira, Ana Isabel; Machado, Bárbara César; Costa, Renata; Pinheiro, Joana; Conceição, EvaThis study sought to determine the frequency of possible cases of avoidant/restrictive food intake disorder (ARFID) in a Portuguese sample of school-aged children and to assess the associations with child’s internalizing problems, BMI z-score and body dissatisfaction, and parents’ eating habits, attitudes and practices. We assessed 330 children through child’s and parents’measures. Fifty-one (15.5%) children were possible cases of ARFID based on their symptom’s presentation. There were no association between sex and possible cases of ARFID, and no significant differences between possible cases of ARFID and nonpossible cases of ARFID regarding age. Lower BMI z-score and anxiety/depression were associated with possible cases of ARFID.
- The role of the perception of family environment in relation to body dissatisfaction, disordered eating and difficulties in close relationshipsPublication . Gonçalves, Sónia; Moreira, Célia; Gonçalves, Mónica; Vieira, Ana Isabel; Machado, Bárbara CésarPurpose Invalidating childhood environments have been characterised as those in which caregivers do not validate a child’s personal experiences and the communication of emotions is considered inappropriate, being either ignored or punished. The current study assessed the relationships among invalidating childhood environments, body dissatisfaction, disordered eating and difficulties in close relationships in a sample of college students. Methods In this study, 362 non-clinical participants with ages ranging from 17 to 25 years (M = 20.02, SD = 1.51) completed self-report measures. Results Difficulties in close relationships, body dissatisfaction and disordered eating were significantly higher in invalidating families than in validating families. Invalidating childhood environments were associated with higher body dissatisfaction and disordered eating, and both associations were mediated by difficulties in close relationships. Finally, body dissatisfaction mediates the effects of BMI and difficulties in close relationships on eating disorder symptoms. Conclusions Perceived experiences of invalidation in childhood may be associated with eating disorder symptomatology. In addition, difficulties in close relationships during adulthood possibly contribute to the emergence of eating disorder symptoms. Level of Evidence Level V, descriptive study.