CP – Samenvatting Artikelen Week 1
Zanella & Lee (2022)
Introduction:
Eating disorders and disordered eating behaviours have increased substantially worldwide, with
estimates suggesting a rise of over 30% in recent decades. These behaviours range from:
1. Subclinical concerns:
Regarding eating, body shape and weight.
2. Clinically diagnosed disorders:
Prevalence=4-16%, predominantly in females.
Such as:
Anorexia nervosa (AN)= a psychological disorder characterized by perceptual distortions
of body image, weight gain fixations, excessive exercise and starvation with restrictive
food intake
Bulimia nervosa (BN)= characterised by recurrent binge eating episodes accompanied by
purging behaviours, such as self-induced vomiting
Binge eating
Obesity
Due to their serious physical, psychological and social consequences, eating disorders represent a major
public health concern. Zanella and Lee (2022) conducted an integrative review in order to identify the
principal psychological, social, cognitive and neurobiological theories explaining the development and
maintenance of disordered eating. Seven major theories were identified:
1. Self-esteem theory
2. Interpersonal theory
3. Emotion regulation theory
4. Executive function theory
5. Social neuroscience theory
6. Theory of mind
7. Transdiagnostic theory
Important correlates influencing the perpetuation of dysfunctional eating behaviour:
- Depression
- Anxiety
- Social norms
- Family functioning
The authors also emphasised significant research gaps, particularly regarding causal directionality and
the lack of integrative, multi-theory models.
1. Self-esteem theory and body dissatisfaction:
- Self-esteem theory constitutes one of the most central frameworks within the literature on
disordered eating. It states that individuals with low self-esteem maintain exacerbated body
shape concerns, resulting in disturbed eating behaviour.
, - Self-esteem= an individual’s overall evaluation of self. An individuals subjective appraisal of
their self-worth and self-confidence, and the extent to which an individual upholds positive
or negative views about themselves.
- Low self-esteem and disordered eating:
Extensive research demonstrates that low self-esteem is strongly associated with both
clinical and subclinical disordered eating behaviours.
VB: Individuals diagnosed with AN or BN typically report the lowest levels of self-esteem,
suggesting a persistent relationship between negative self-evaluations and eating
pathology. Importantly, this relationship appears to be present across cultures and age
groups.
- Body dissatisfaction:
A key construct within self-esteem theory. Research consistently shows that subjective
dissatisfaction with body shape and weight is associated with lower self esteem. It is one of
the strongest predictors of disordered eating (rather than objective measures such as body
mass index).
Body dissatisfaction often functions as a mediator between self-esteem and maladaptive
eating behaviours.
- Relationship between body dissatisfaction and low self-esteem:
Findings regarding the direction of this relationship remain inconsistent:
o Low self-esteem increased body dissatisfaction predicts disordered eating.
o Body dissatisfaction undermines self-esteem and thereby increases behaviours
such as binge eating.
o Bidirectional vs. reciprocal:
Body dissatisfaction+low self-esteem disordered eating, or disordered eating
body dissatisfaction and low self-esteem, or do they both influence each other.
2. Interpersonal theory and emotion regulation theory:
- Interpersonal theory emphasises the role of social relationships and interpersonal stressors
in the development of disordered eating.
- Social factors as mediator:
Dysfunctional eating behaviours may emerge as maladaptive coping responses to
interpersonal conflict, social rejection or fear of negative evaluation. In this way social
factors act as a mediator of the impact of social anxieties upon problematic eating.
- Effect of interpersonal stress:
Experimental evidence indicates that exposure to interpersonal stress increases eating-
related urges and negative self-cognitions, particularly among individuals with bulimic
symptoms. These findings suggest that social stressors play a direct role in triggering
maladaptive eating patterns.
- The effect of social factors on dysfunctional eating behavior is exacerbated by individual
differences to stress reactivity in conjunction with the regulation of emotionality.
3. Emotion regulation theory:
- Closely related to interpersonal theory, emotion regulation theory focuses on individual
differences in stress reactivity and emotional control. Disordered eating is conceptualized as
a strategy for managing overwhelming or aversive emotional states.
- Stress reactivity= interpreting external situations as unmanageable and precarious.
, - People who experience diminished self-esteem during self or social evaluations as well as
feelings of anxiety during interpersonal conflicts have difficulty regulation emotional stress
reactivity and overall affect.
- Emotion regulation patterns appear to differ between eating disorder subtypes:
o BN:
Individuals with BN are more likely to use binge eating and compensatory
behaviours to numb or escape negative emotions.
o AN:
Whereas individuals with AN often engage in extreme dietary restriction to enhance
perceived control, self regulation and emotional regulation.
- Despite these differences, both groups exhibit significant difficulties regulating emotions in
response to interpersonal stress.
4. Transdiagnostic theory:
- Transdiagnostic theory provides a unifying framework for understanding eating disorders by
proposing that different diagnostic categories share common underlying psychological
mechanisms.
- Overevaluation of body shape and weight:
This is central to this model, and described as a common dominator in the different
diagnostic categories. The overevaluation of body shape and weight disproportionately
influences self-worth and behavior across the eating disorder spectrum.
- Empirical evidence supports the transdiagnostic nature of psychological, cognitive and
neurological factors such as:
o Body dissatisfaction
o Perfectionism
o Over-vigilance and inhibition
o Cognitive rigidity
o Feelings of ineffectiveness
o Commonalities in neural processing of social concepts (self-perception and social
evaluation).
o Similar executive dysfunction
- Importantly, these shared mechanisms can explain both restrictive and binge-type eating
behaviours, highlighting the clinical relevance of transdiagnostic treatment approaches.
5. Executive function theory:
- Executive function theory focuses on higher-order cognitive processes involved in self-
regulation, including:
o Basic facets:
Updating
Inhibitory control:
Plays a critical role in development and maintenance of disordered eating.
Cognitive flexibility
o Specific functions:
Problem solving
Working memory
Attention control
Emotion regulation
, Planning
Decision making
Processing speed
- Impairments in executive functioning are frequently observed in individuals with eating
disorders and are considered transdiagnostic risk factors. They are thought to contribute to
excessive or inefficient regulation of eating behavior.
- Meta-analytic evidence suggests that individuals with AN show small to moderate executive
functioning impairments, whereas individuals with BN exhibit moderate to large
impairments across multiple domains. These impairments differed significantly from healthy
controls, but were only present in a small subset of inpatients. More research is needed to
investigate the association.
- Causal directionality:
A major issue within executive function research concerns causal directionality: it remains
unclear whether:
o EF deficit higher vulnerability ED:
Executive functioning deficits precede the onset of disordered eating and increase
vulnerability
o ED EF deficit:
Or whether prolonged disordered eating leads to cognitive impairments.
o EF deficit ED:
Some evidence suggests a bidirectional relationship, with executive functioning both
influencing and being influenced by eating behaviour.
6. Social neuroscience theory:
- Social neuroscience theory examines neural mechanisms underlying social cognition,
particularly self-perception and social evaluation.
- Neuroimaging studies demonstrate that individuals with eating disorders display atypical
activation in brain regions associated with social processing, including frontal and temporo-
parietal areas. This suggests that altered neural processing of social information may
contribute to persistent body image disturbances.
- Notably, similarities in neural responses have been observed between individuals with AN
and BN during tasks involving self- and other-evaluations. These findings further support the
transdiagnostic conceptualization of eating disorders.
7. Theory of mind (ToM):
- Theory of mind= the capacity to infer others’ mental states, beliefs and emotions.
- Research examining theory of mind in eating disorders has produced mixed results. Meta-
analytic evidence suggests that individuals with AN exhibit significant deficits in perspective-
taking and emotion recognition, whereas individuals with BN show minimal or no
impairments. However, some studies report difficulties in BN but not AN. Due to these
inconsistencies, the authors conclude that theory of mind impairments cannot yet be
considered a definitive characteristic of eating disorders and require further empirical
investigation.
Correlates of disordered eating:
In addition to the seven core theories, several psychological and social correlates of disordered eating
are discussed.
- Depression and anxiety:
Zanella & Lee (2022)
Introduction:
Eating disorders and disordered eating behaviours have increased substantially worldwide, with
estimates suggesting a rise of over 30% in recent decades. These behaviours range from:
1. Subclinical concerns:
Regarding eating, body shape and weight.
2. Clinically diagnosed disorders:
Prevalence=4-16%, predominantly in females.
Such as:
Anorexia nervosa (AN)= a psychological disorder characterized by perceptual distortions
of body image, weight gain fixations, excessive exercise and starvation with restrictive
food intake
Bulimia nervosa (BN)= characterised by recurrent binge eating episodes accompanied by
purging behaviours, such as self-induced vomiting
Binge eating
Obesity
Due to their serious physical, psychological and social consequences, eating disorders represent a major
public health concern. Zanella and Lee (2022) conducted an integrative review in order to identify the
principal psychological, social, cognitive and neurobiological theories explaining the development and
maintenance of disordered eating. Seven major theories were identified:
1. Self-esteem theory
2. Interpersonal theory
3. Emotion regulation theory
4. Executive function theory
5. Social neuroscience theory
6. Theory of mind
7. Transdiagnostic theory
Important correlates influencing the perpetuation of dysfunctional eating behaviour:
- Depression
- Anxiety
- Social norms
- Family functioning
The authors also emphasised significant research gaps, particularly regarding causal directionality and
the lack of integrative, multi-theory models.
1. Self-esteem theory and body dissatisfaction:
- Self-esteem theory constitutes one of the most central frameworks within the literature on
disordered eating. It states that individuals with low self-esteem maintain exacerbated body
shape concerns, resulting in disturbed eating behaviour.
, - Self-esteem= an individual’s overall evaluation of self. An individuals subjective appraisal of
their self-worth and self-confidence, and the extent to which an individual upholds positive
or negative views about themselves.
- Low self-esteem and disordered eating:
Extensive research demonstrates that low self-esteem is strongly associated with both
clinical and subclinical disordered eating behaviours.
VB: Individuals diagnosed with AN or BN typically report the lowest levels of self-esteem,
suggesting a persistent relationship between negative self-evaluations and eating
pathology. Importantly, this relationship appears to be present across cultures and age
groups.
- Body dissatisfaction:
A key construct within self-esteem theory. Research consistently shows that subjective
dissatisfaction with body shape and weight is associated with lower self esteem. It is one of
the strongest predictors of disordered eating (rather than objective measures such as body
mass index).
Body dissatisfaction often functions as a mediator between self-esteem and maladaptive
eating behaviours.
- Relationship between body dissatisfaction and low self-esteem:
Findings regarding the direction of this relationship remain inconsistent:
o Low self-esteem increased body dissatisfaction predicts disordered eating.
o Body dissatisfaction undermines self-esteem and thereby increases behaviours
such as binge eating.
o Bidirectional vs. reciprocal:
Body dissatisfaction+low self-esteem disordered eating, or disordered eating
body dissatisfaction and low self-esteem, or do they both influence each other.
2. Interpersonal theory and emotion regulation theory:
- Interpersonal theory emphasises the role of social relationships and interpersonal stressors
in the development of disordered eating.
- Social factors as mediator:
Dysfunctional eating behaviours may emerge as maladaptive coping responses to
interpersonal conflict, social rejection or fear of negative evaluation. In this way social
factors act as a mediator of the impact of social anxieties upon problematic eating.
- Effect of interpersonal stress:
Experimental evidence indicates that exposure to interpersonal stress increases eating-
related urges and negative self-cognitions, particularly among individuals with bulimic
symptoms. These findings suggest that social stressors play a direct role in triggering
maladaptive eating patterns.
- The effect of social factors on dysfunctional eating behavior is exacerbated by individual
differences to stress reactivity in conjunction with the regulation of emotionality.
3. Emotion regulation theory:
- Closely related to interpersonal theory, emotion regulation theory focuses on individual
differences in stress reactivity and emotional control. Disordered eating is conceptualized as
a strategy for managing overwhelming or aversive emotional states.
- Stress reactivity= interpreting external situations as unmanageable and precarious.
, - People who experience diminished self-esteem during self or social evaluations as well as
feelings of anxiety during interpersonal conflicts have difficulty regulation emotional stress
reactivity and overall affect.
- Emotion regulation patterns appear to differ between eating disorder subtypes:
o BN:
Individuals with BN are more likely to use binge eating and compensatory
behaviours to numb or escape negative emotions.
o AN:
Whereas individuals with AN often engage in extreme dietary restriction to enhance
perceived control, self regulation and emotional regulation.
- Despite these differences, both groups exhibit significant difficulties regulating emotions in
response to interpersonal stress.
4. Transdiagnostic theory:
- Transdiagnostic theory provides a unifying framework for understanding eating disorders by
proposing that different diagnostic categories share common underlying psychological
mechanisms.
- Overevaluation of body shape and weight:
This is central to this model, and described as a common dominator in the different
diagnostic categories. The overevaluation of body shape and weight disproportionately
influences self-worth and behavior across the eating disorder spectrum.
- Empirical evidence supports the transdiagnostic nature of psychological, cognitive and
neurological factors such as:
o Body dissatisfaction
o Perfectionism
o Over-vigilance and inhibition
o Cognitive rigidity
o Feelings of ineffectiveness
o Commonalities in neural processing of social concepts (self-perception and social
evaluation).
o Similar executive dysfunction
- Importantly, these shared mechanisms can explain both restrictive and binge-type eating
behaviours, highlighting the clinical relevance of transdiagnostic treatment approaches.
5. Executive function theory:
- Executive function theory focuses on higher-order cognitive processes involved in self-
regulation, including:
o Basic facets:
Updating
Inhibitory control:
Plays a critical role in development and maintenance of disordered eating.
Cognitive flexibility
o Specific functions:
Problem solving
Working memory
Attention control
Emotion regulation
, Planning
Decision making
Processing speed
- Impairments in executive functioning are frequently observed in individuals with eating
disorders and are considered transdiagnostic risk factors. They are thought to contribute to
excessive or inefficient regulation of eating behavior.
- Meta-analytic evidence suggests that individuals with AN show small to moderate executive
functioning impairments, whereas individuals with BN exhibit moderate to large
impairments across multiple domains. These impairments differed significantly from healthy
controls, but were only present in a small subset of inpatients. More research is needed to
investigate the association.
- Causal directionality:
A major issue within executive function research concerns causal directionality: it remains
unclear whether:
o EF deficit higher vulnerability ED:
Executive functioning deficits precede the onset of disordered eating and increase
vulnerability
o ED EF deficit:
Or whether prolonged disordered eating leads to cognitive impairments.
o EF deficit ED:
Some evidence suggests a bidirectional relationship, with executive functioning both
influencing and being influenced by eating behaviour.
6. Social neuroscience theory:
- Social neuroscience theory examines neural mechanisms underlying social cognition,
particularly self-perception and social evaluation.
- Neuroimaging studies demonstrate that individuals with eating disorders display atypical
activation in brain regions associated with social processing, including frontal and temporo-
parietal areas. This suggests that altered neural processing of social information may
contribute to persistent body image disturbances.
- Notably, similarities in neural responses have been observed between individuals with AN
and BN during tasks involving self- and other-evaluations. These findings further support the
transdiagnostic conceptualization of eating disorders.
7. Theory of mind (ToM):
- Theory of mind= the capacity to infer others’ mental states, beliefs and emotions.
- Research examining theory of mind in eating disorders has produced mixed results. Meta-
analytic evidence suggests that individuals with AN exhibit significant deficits in perspective-
taking and emotion recognition, whereas individuals with BN show minimal or no
impairments. However, some studies report difficulties in BN but not AN. Due to these
inconsistencies, the authors conclude that theory of mind impairments cannot yet be
considered a definitive characteristic of eating disorders and require further empirical
investigation.
Correlates of disordered eating:
In addition to the seven core theories, several psychological and social correlates of disordered eating
are discussed.
- Depression and anxiety:
