Bio

Honors & Awards


  • Dissertation Research Award, American Psychological Association (2018)

Professional Education


  • Doctor of Philosophy, University of Kansas (2019)
  • Master of Arts, University of Kansas (2014)
  • Bachelor of Arts, Emory University (2010)
  • B.A., Emory University, Psychology, Spanish (2010)
  • M.A., University of Kansas, Clinical Psychology (2014)
  • Ph.D., University of Kansas, Clinical Psychology, minor in Quantitative Psychology (Statistics) (2019)

Stanford Advisors


Research & Scholarship

Current Research and Scholarly Interests


My research interests are broadly in eating and mood disorders. My research program is comprised of two primary lines of research. First, I am interested in elucidating the mechanisms of eating and internalizing disorders, with an emphasis on understanding the neural mechanisms of these disorders. Second, I study novel methods of diagnosis and classification of eating disorders and eating behaviors, especially dietary restraint. A long-term goal of my research is to leverage findings to improve treatments for those with eating disorders.

Publications

All Publications


  • A systematic review and meta-analysis of attentional bias toward food in individuals with overweight and obesity. Appetite Hagan, K. E., Alasmar, A., Exum, A., Chinn, B., Forbush, K. T. 2020: 104710

    Abstract

    Attentional bias to food stimuli may contribute to the etiology and/or maintenance of overweight and obesity. We conducted a literature review and meta-analysis per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify the effect size associated with attentional bias to palatable food in persons with overweight/obesity across the age spectrum. Included studies measured attentional bias to food stimuli using two reaction-time tasks (dot-probe, emotional Stroop), eye-tracking methodology, and/or event-related potentials. Meta-analysis showed that persons with overweight/obesity did not differ from persons with a healthy weight on any of the following: automatic and maintained attention to food stimuli measured by the dot-probe task (Hedge's gautomatic?=?-0.355, 95% CI?=?-0.383, 0.486; and Hedge's gmaintained?=?0.006, 95% CI?=?-0.187, 0.199); attentional bias to food stimuli measured by the emotional Stroop task (Hedge's g?=?0.184, 95% CI?=?-0.283, 0.651); and attentional bias to food images on gaze-direction and gaze-duration bias eye-tracking metrics (Hedge's gdirection?=?0.317, 95% CI?=?-0.096, 0.729; and Hedge's gduration?=?0.056, 95% CI?=?-0.296, 0.407). Systematic review of preliminary event-related potentials research suggested automatic, but not maintained, attention to food images in persons with overweight/obesity. Limitations of past attentional bias research in overweight/obesity, such as poor reliability of measures and lack of consideration of moderators, such as binge eating and degree of overweight/obesity, preclude the ability to draw firm conclusions. We recommend implementation of empirically based methods for improving psychometric properties of attentional bias measures and examination of potential moderators so that the field can understand whether attentional bias to food is truly greater in overweight/obesity.

    View details for DOI 10.1016/j.appet.2020.104710

    View details for PubMedID 32298701

  • A preliminary systematic review and meta-analysis of randomized-controlled trials of cognitive remediation therapy for anorexia nervosa. Eating behaviors Hagan, K. E., Christensen, K. A., Forbush, K. T. 2020; 37: 101391

    Abstract

    Cognitive remediation therapy (CRT) for anorexia nervosa (AN) was developed as an adjuvant treatment to target set-shifting and central coherence inefficiencies important in AN and to ultimately improve clinical outcomes of those with AN. The primary aim of this preliminary systematic review and meta-analysis was to determine the effect of CRT for AN relative to control treatments in randomized-controlled trials (RCTs) on neuropsychological inefficiencies at end-of-treatment. Secondary aims were to assess the effect of CRT for AN on dropout, eating-disorder-related, and other psychological outcomes at end-of-treatment. Systematic review and meta-analytic procedures were conducted in accordance with PRISMA Guidelines. RCTs evaluating CRT for AN compared to a control treatment were identified via ProQuest, PsycINFO, PubMed, and SCOPUS. Seven RCTs and one quasi-RCT of CRT for AN were included. RCT quality ratings ranged from fair (n = 3) to good (n = 4). Random-effects meta-analysis was conducted using Hedge's g. Study heterogeneity was assessed using I2 and publication bias was assessed with Begg's adjusted-rank correlation and the trim-and-fill method. CRT was not associated with improvement in central coherence compared to control treatments at end-of-treatment (g = 0.25, 95% CI = -0.35, 0.85, k = 3). Set-shifting outcomes were mixed due to heterogeneity of set-shifting measures across studies. CRT may prevent dropout; yet, more studies are needed to draw conclusions. CRT did not confer advantage over control treatments for eating-disorder-related and other psychological outcomes at end-of-treatment. Future RCTs of CRT for AN should use precise measures to assess constructs (particularly for set shifting), increase sample size, and implement longitudinal follow-up. (Word Count: 247 words).

    View details for DOI 10.1016/j.eatbeh.2020.101391

    View details for PubMedID 32408265

  • Longitudinal trajectories of behavior change in a national sample of patients seeking eating-disorder treatment. The International journal of eating disorders Chapa, D. A., Hagan, K. E., Forbush, K. T., Clark, K. E., Tregarten, J. P., Argue, S. 2020

    Abstract

    Rapid response to treatment, indicated by substantial decreases in eating-disorder (ED) symptoms within the first 4-6?weeks of treatment, is the most reliable predictor of treatment outcomes for EDs. However, there is limited research evaluating short-term longitudinal trajectories of ED symptoms during treatment. Thus, it is difficult to know which aspects of ED psychopathology are slow or fast to change. The purpose of this study was to elucidate three-month trajectories of ED psychopathology during treatment and test whether ED diagnosis influenced the direction and rate of change.Participants were Recovery Record users seeking treatment for an ED (N = 4,568; 86.8% female). Participants completed the Eating Pathology Symptoms Inventory once per month for 3?months.Latent growth curve models indicated that ED diagnosis influenced the rate of ED behavior change. Anorexia nervosa was associated with faster reductions in cognitive restraint, excessive exercise, restricting, yet slower reductions in body dissatisfaction, and binge eating. Bulimia nervosa was associated with faster reductions in binge eating, cognitive restraint, excessive exercise, and purging. Binge-eating disorder was associated with faster reductions in body dissatisfaction and binge eating, yet slower reductions in restricting.Our results have implications for future research by providing initial information about the direction and rate of ED change over the course of treatment. If clinicians and researchers know which ED symptoms are slow to change, on average, across diagnostic groups, treatment protocols could be adjusted to target slow changing symptoms more quickly, and therefore improve ED treatment outcomes.

    View details for DOI 10.1002/eat.23272

    View details for PubMedID 32275088

  • Insulin Resistance and Structural Change in the Anterior Cingulate Cortex in Youth With Depression and Obesity Hagan, K., Fischer, A., Nrusimha, A., Nimarko, A., Gorelik, A., Bohon, C., Rasgon, N., Singh, M. NATURE PUBLISHING GROUP. 2019: 143?44
  • Functional Connectivity Biomarkers of Emotion Regulation That Distinguish Risk for Bipolar Versus Unipolar Depression in Clinically Asymptomatic High-Risk Youth Fischer, A., Nimarko, A., Hagan, K., Gotlib, I., Singh, M. NATURE PUBLISHING GROUP. 2019: 434?35
  • PARENTAL BONDING AND HOSTILITY: EXAMINING THE LINKS BETWEEN SEX DIFFERENCES, HOSTILITY, ANGER, AND AGGRESSION JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY Ingram, R., Balderas, J., Hagan, K., Kohnle, K. 2019; 38 (7): 568?84
  • Is all nonhomeostatic eating the same? Examining the latent structure of nonhomeostatic eating processes in women and men. Psychological assessment Racine, S. E., Hagan, K. E., Schell, S. E. 2019

    Abstract

    Nonhomeostatic eating is a complex (presumably) multidimensional construct associated with negative health outcomes. However, little research has examined the latent structure of nonhomeostatic eating processes, interrelationships among nonhomeostatic eating constructs, and differential associations between nonhomeostatic eating constructs and external correlates. This study adopted a construct validation approach to investigate these research questions in a large sample of undergraduate women and men (N = 998; 54.6% female). Exploratory and confirmatory factor analyses were conducted on items from 8 measures representing numerous nonhomeostatic eating process constructs (e.g., binge eating, loss of control [LOC] over eating, "food addiction"). The 7-factor retained solution included the following: (1) emotional eating, (2) external eating, (3) LOC over eating, (4) overeating, (5) distress over nonhomeostatic eating, (6) hedonic hunger, and (7) food addiction. LOC over eating was the nonhomeostatic eating factor most strongly related to other factors (M rs = .71 and .65 in women and men, respectively). Factor score multiple regressions conducted separately by sex indicated that distress over nonhomeostatic eating was related to body mass index, depressive symptoms, and eating-related clinical impairment in both women and men. In women, food addiction demonstrated unique associations with depressive symptoms, emotion dysregulation, and clinical impairment, whereas overeating uniquely predicted these outcomes in men. This is the first comprehensive analysis of the latent structure of nonhomeostatic eating processes and associations with external correlates, and results suggest that LOC over eating, distress over nonhomeostatic eating, food addiction (in women), and overeating (in men) exhibited the strongest relations with psychosocial impairment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

    View details for DOI 10.1037/pas0000749

    View details for PubMedID 31219280

  • The Athletes' Relationships with Training scale (ART): A self-report measure of unhealthy training behaviors associated with eating disorders. The International journal of eating disorders Chapa, D. A., Hagan, K. E., Forbush, K. T., Perko, V. L., Sorokina, D. A., Alasmar, A. Y., Becker, C. B., Sherman, R. T., Thompson, R. A., Farrell, J. G., Stewart, T. M. 2018; 51 (9): 1080?89

    Abstract

    Several studies indicate that eating-disorder (ED) psychopathology is elevated in athletes compared to non-athletes. The assessment of excessive exercise among athletes is a challenge because, compared to non-athletes, athletes are required to train at higher intensities and for longer periods of time. However, individuals participating in competitive sports are still susceptible to unhealthy physical-activity patterns. Most ED assessments were developed and normed in non-athlete samples and, therefore, do not capture the nuances of athletes' training experiences. The purpose of the current study was to develop and validate a clinically useful, self-report measure of unhealthy training behaviors and beliefs in athletes, the Athletes' Relationships with Training Scale (ART).The initial item pool was administered to N?= 267 women collegiate athletes who were participating in an ED prevention program study and N?=?65 women athletes who were in ED treatment.Factor analyses indicated the ART had a four-factor structure. Factorial and construct validity of the ART were demonstrated. ART scores significantly predicted health care utilization and differed between athletes with an ED versus athletes without an ED. For athletes in ED treatment, ART scores significantly decreased from treatment admission to discharge.The ART showed evidence of strong psychometric properties and clinical utility. The ART could be helpful for clinicians and athletic trainers to help gauge whether athletes are engaging in unhealthy training practices that may warrant clinical attention and for tracking clinical outcomes in athletes with EDs who are receiving treatment.

    View details for DOI 10.1002/eat.22960

    View details for PubMedID 30312490

  • A new approach to eating-disorder classification: Using empirical methods to delineate diagnostic dimensions and inform care. The International journal of eating disorders Forbush, K. T., Chen, P. Y., Hagan, K. E., Chapa, D. A., Gould, S. R., Eaton, N. R., Krueger, R. F. 2018; 51 (7): 710?21

    Abstract

    Despite changes to the diagnostic criteria for eating disorders (EDs) in the DSM-5, the current diagnostic system for EDs has limited ability to inform treatment planning and predict outcomes. Our objective was to test the clinical utility of a novel dimensional approach to understanding the structure of ED psychopathology.Participants (N = 243; 82.2% women) were community-recruited adults with a DSM-5 ED assessed at baseline, 6-month, and 1-year follow-up. Hierarchical factor analysis was used to identify a joint hierarchical-dimensional structure of eating, mood, and anxiety symptoms. Exploratory structural equation modeling was used to test the ability of the dimensional model to predict outcomes.At the top of the hierarchy, we identified a broad Internalizing factor that reflected diffuse symptoms of eating, mood, and anxiety disorders. Internalizing branched into three subfactors: distress, fear-avoidance (fears of certain stimuli and behaviors to neutralize fears, including ED behaviors designed to reduce fear of weight gain), and body dissatisfaction, which was nested within distress. The lowest level of the hierarchy was characterized by 15 factors. The hierarchical model predicted 60.1% of the variance in outcomes at 6-month follow-up, whereas all DSM eating, mood, and anxiety disorders combined predicted 35.8% of the variance in outcomes.A dimensional approach to understanding and diagnosing EDs improved the ability to prospectively predict clinical course above-and-beyond the traditional categorical (DSM-based) approach. Our findings have implications for endeavors to improve the prediction of ED prognosis and course, and to develop more effective trans-diagnostic treatments.

    View details for DOI 10.1002/eat.22891

    View details for PubMedID 30132954

  • New Horizons in Measurement: a Review of Novel and Innovative Approaches to Eating-Disorder Assessment. Current psychiatry reports Forbush, K. T., Gould, S. R., Chapa, D. A., Bohrer, B. K., Hagan, K. E., Clark, K. E., Sorokina, D. A., Perko, V. L. 2017; 19 (10): 76

    Abstract

    Eating disorders are serious mental-health concerns that will affect over 30 million individuals in the USA at some point in their lives. Eating disorders occur across the lifespan, in a variety of ethnicities and races, in both men and women, and across the socioeconomic spectrum. Given the prevalence and severity of eating disorders, it is important that clinicians and researchers have access to appropriate assessment tools to aid in the early identification and treatment referral, differential diagnosis, treatment planning, and progress monitoring, and to ensure valid research findings. In this review, we describe novel and innovative assessment tools that were developed within the past 5 years for utilization in research and/or clinical practice with individuals with eating disorders.We identified six multidimensional assessments for eating disorders, all of which can be administered online (with some also offering paper-and-pencil versions). Strengths of the measures included good internal consistency, test-retest reliability, and convergent validity. However, in part, due to problematic scale construction methods, certain scales had poor discriminant validity and most were developed and validated in mostly female samples. There are promising new eating disorder measures from which to choose; however, many measures continue to be limited by poor discriminant validity and need additional validation prior to incorporation into routine research and clinical practice.

    View details for DOI 10.1007/s11920-017-0826-2

    View details for PubMedID 28891029

  • The association of folate and depression: A meta-analysis. Journal of psychiatric research Bender, A., Hagan, K. E., Kingston, N. 2017; 95: 9?18

    Abstract

    Previous research suggested that folate levels play an important role in the etiology and course of depression. However, the literature has been inconsistent with regard to differences in folate level between individuals with and without depression. The present meta-analysis synthesized the results of previous studies to examine whether individuals with depression had lower levels of folate than individuals without depression.Meta-analytic procedures were conducted in accordance with PRISMA guidelines. Studies evaluating folate levels in individuals with and without depression via red blood cell folate, serum folate, or dietary intake of folate methods were identified via PsycINFO and PubMed. Random-effects meta-analysis was conducted using Hedge's g, and moderation analysis was used for both folate measurement method and population type. Study heterogeneity was assessed with I2 and publication bias was qualitatively assessed via funnel plot and quantitatively assessed with the trim-and-fill method and Begg's adjusted rank test.We found a significant, small effect size, such that individuals with depression had lower folate levels than those without depression, Hedge's g = -0.24 (95% CI = -0.31, -0.16), p < 0.001. Study heterogeneity was high (I2 = 84.88%), and neither folate measurement method nor population accounted for study heterogeneity.Individuals with depression have lower serum levels of folate and dietary folate intake than individuals without depression. Given that previous literature suggested folate supplementation improved the efficacy of traditional antidepressant medications, future research on folate supplementation in depression is warranted and clinicians may wish to consider folate supplementation for patients with depression.

    View details for DOI 10.1016/j.jpsychires.2017.07.019

    View details for PubMedID 28759846

  • Understanding eating disorders within internalizing psychopathology: A novel transdiagnostic, hierarchical-dimensional model. Comprehensive psychiatry Forbush, K. T., Hagan, K. E., Kite, B. A., Chapa, D. A., Bohrer, B. K., Gould, S. R. 2017; 79: 40?52

    Abstract

    Several problems with the classification and diagnosis of eating disorders (EDs) have been identified, including proliferation of 'other specified' diagnoses, within-disorder heterogeneity, and frequent diagnostic migration over time. Beyond problems within EDs, past research suggested that EDs fit better in a spectrum of internalizing psychopathology (characterized by mood and anxiety disorders) than in a separate diagnostic class.To develop a transdiagnostic, hierarchical-dimensional model relevant to ED psychopathology that: 1) reduces diagnostic heterogeneity, 2) includes important dimensions of internalizing psychopathology that are often excluded from ED diagnostic models, and 3) predicts clinical impairment.Goldberg's (2006) method and exploratory structural equation modeling were used to identify a hierarchical model of internalizing in community-recruited adults with EDs (N=207).The lowest level of the hierarchy was characterized by 15 factors that defined specific aspects of eating, mood, and anxiety disorders. At the two-factor level, Internalizing bifurcated into Distress (low well-being, body dissatisfaction, suicidality, dysphoria, ill temper, traumatic intrusions) and Fear-Avoidance (claustrophobia, social avoidance, panic symptoms, dietary restricting, excessive exercise, and compulsions). Results showed that the lowest level of the hierarchy predicted 67.7% of the variance in clinical impairment. In contrast, DSM eating, mood, and anxiety disorders combined predicted 10.6% of the variance in impairment secondary to an ED.The current classification model represents an improvement over traditional nosologies for predicting clinically relevant outcomes for EDs.

    View details for DOI 10.1016/j.comppsych.2017.06.009

    View details for PubMedID 28755757

  • Do emotion regulation difficulties when upset influence the association between dietary restraint and weight gain among college students? Appetite Hunt, T. K., Forbush, K. T., Hagan, K. E., Chapa, D. A. 2017; 114: 101?9

    Abstract

    Obesity is a significant public health concern that affects more than one-fifth of adolescents aged 12-19 in the United States. Theoretical models suggest that prolonged dietary restraint leads to binge-eating behaviors, which in turn increases individuals' risk for weight gain or obesity. Results from the literature indicate a potential role for negative urgency (the tendency to act rashly when distressed) as a mediating variable that explains the link between dietary restraint and binge-eating episodes. The current study tested short-term, prospective longitudinal associations among dietary restraint, binge eating, negative urgency, and weight gain among college students - a population at increased risk for the development of overweight and obesity. We hypothesized that dietary restraint and weight gain would be mediated by negative urgency and binge eating, but only among participants with overweight and obesity. College students (N = 227) completed the Eating Pathology Symptoms Inventory, UPPS-P Impulsivity Scale, and self-reported weight and height to calculate body mass index. Results showed that the association between dietary restraint and weight gain was mediated by negative urgency and binge eating, but only among participants with overweight and obesity. Our findings indicated that negative urgency might represent a mechanism that explains why dietary restraint leads to future binge-eating episodes and weight gain among college students with overweight and obesity. Results suggest that future treatment and prevention programs for overweight and obesity may benefit from incorporating strategies to improve emotion regulation as a way to reduce binge eating and to prevent additional weight gain among 'at-risk' populations.

    View details for DOI 10.1016/j.appet.2017.03.029

    View details for PubMedID 28341607

  • Concurrent and prognostic utility of subtyping anorexia nervosa along dietary and negative affect dimensions. Journal of consulting and clinical psychology Forbush, K. T., Hagan, K. E., Salk, R. H., Wildes, J. E. 2017; 85 (3): 228?37

    Abstract

    Bulimia nervosa can be reliably classified into subtypes based on dimensions of dietary restraint and negative affect. Community and clinical studies have shown that dietary-negative affect subtypes have greater test-retest reliability and concurrent and predictive validity compared to subtypes based on the Diagnostic and Statistical Manual of Mental Disorders (DSM). Although dietary-negative affect subtypes have shown utility for characterizing eating disorders that involve binge eating, this framework may have broader implications for understanding restrictive eating disorders.The purpose of this study was to test the concurrent and predictive validity of dietary-negative affect subtypes among patients with anorexia nervosa (AN; N = 194).Latent profile analysis was used to identify subtypes of AN based on dimensions of dietary restraint and negative affect. Chi-square and multivariate analysis of variance were used to characterize baseline differences between identified subtypes. Structural equation modeling was used to test whether dietary-negative affect subtypes would outperform DSM categories in predicting clinically relevant outcomes.Results supported a 2-profile model that replicated dietary-negative affect subtypes: Latent Profile 1 (n = 68) had clinically elevated scores on restraint only; Latent Profile 2 (n = 126) had elevated scores on both restraint and negative affect. Validation analyses showed that membership in the dietary-negative affect profile was associated with greater lifetime psychiatric comorbidity and psychosocial impairment compared to the dietary class. Dietary-negative affect subtypes only outperformed DSM categories in predicting quality-of-life impairment at 1-year follow-up.Findings highlight the clinical utility of subtyping AN based on dietary restraint and negative affect for informing future treatment-matching or personalized medicine strategies. (PsycINFO Database Record

    View details for DOI 10.1037/ccp0000164

    View details for PubMedID 28221058

  • Incremental validity of weight suppression in predicting clinical impairment in bulimic syndromes. The International journal of eating disorders Hagan, K. E., Clark, K. E., Forbush, K. T. 2017; 50 (6): 672?78

    Abstract

    Research has shown that weight suppression (WS; the difference between a person's highest and current body weight in pounds) is a robust predictor of weight gain and eating-disorder (ED) symptoms among individuals with bulimic syndromes. Given the important prognostic role that WS plays in ED course and outcome, we hypothesized that WS would represent a clinically useful indicator of impairment for bulimic syndromes. We further posited that WS would demonstrate incremental validity above-and-beyond other proposed indicators in explaining clinical impairment in bulimic syndromes. Participants were community-recruited adults (N?=?101; 80.2% female) with full-threshold (n?=?51) or subthreshold (n?=?50) bulimia nervosa. Other indicators of impairment included body mass index, frequency of inappropriate compensatory behaviors, lifetime history of any internalizing disorder, and multiple purging. Clinical impairment was assessed with the clinical impairment assessment (CIA). Hierarchical linear regression tested whether WS added to the explanation of CIA score variance above-and-beyond other indicators of bulimic-syndrome impairment. WS was significantly associated with clinical impairment (p?=?.011), but did not demonstrate incremental validity over other independent variables in predicting CIA scores. WS explained an additional 1.7% of the variance in CIA scores above-and-beyond other variables and the independent effect of WS on CIA scores represented a medium-sized effect (Cohen's d?=?0.521). Results suggested that WS may be an indicator of ED-related clinical impairment. Inquiring about WS could be an informative component of routine bulimic-syndrome assessment, given that WS explains some of the variance in clinical impairment in bulimic syndromes.

    View details for DOI 10.1002/eat.22673

    View details for PubMedID 28093836

  • Is dietary restraint a unitary or multi-faceted construct? Psychological assessment Hagan, K. E., Forbush, K. T., Chen, P. Y. 2017; 29 (10): 1249?60

    Abstract

    Given that approximately two-thirds of adults are overweight or obese, there is substantial interest in dieting (dietary restraint) to promote weight loss. However, research on the associations between dietary restraint and binge eating is inconsistent. One possible explanation for contradictory findings is that measures of dietary restraint assess heterogeneous constructs. Nonclinical samples of university student (n = 433; 62.6% female) and community-recruited (n = 407; 47.4% female) adults completed self-report measures of dietary restraint. Exploratory structural equation modeling and exploratory and confirmatory factor analyses were used to identify latent dietary restraint factor(s). Structural equation modeling and multiple regression were used to test associations among latent dietary restraint factor(s), body mass index (BMI), eating-disorder risk, binge eating, and psychopathological and personality variables. Three latent dietary restraint factors emerged: (a) Calorie Counting; (b) Preoccupation With Dieting; and (c) Weight-Focused Restraint. The model demonstrated a good fit to the data. Eating-disorder risk was significantly and positively associated with all restraint factors, whereas higher levels of BMI and binge eating were significantly associated with greater Preoccupation with Dieting and Weight-Focused Restraint only. Our findings indicated that dietary restraint is a heterogeneous construct and that measures of restraint assess different aspects of dieting. Our results have important implications for eating and weight disorders treatment, and suggest that weight-loss interventions that do not simultaneously increase negative attitudes toward one's body may be useful for treating weight disorders, without promoting disordered eating. (PsycINFO Database Record

    View details for DOI 10.1037/pas0000429

    View details for PubMedID 27991825

  • Characterizing severe and enduring anorexia nervosa: An empirical approach. The International journal of eating disorders Wildes, J. E., Forbush, K. T., Hagan, K. E., Marcus, M. D., Attia, E., Gianini, L. M., Wu, W. 2017; 50 (4): 389?97

    Abstract

    Targeted approaches for the treatment of severe and enduring anorexia nervosa (SE-AN) have been recommended, but there is no consensus definition of SE-AN to inform research and clinical practice. This study aimed to take initial steps toward developing an empirically based definition of SE-AN by characterizing associations among putative indicators of severity and chronicity in eating disorders. Patients with AN (N?=?355) completed interviews and questionnaires at treatment admission and discharge; height and weight were assessed to calculate body mass index (BMI). Structural equation mixture modeling was used to test whether associations among potential indicators of SE-AN (illness duration, treatment history, BMI, binge eating, purging, quality-of-life) formed distinct subgroups, a single group with one or more dimensions, or a combination of subgroups and dimensions. A three-factor (dimensional), two-profile (categorical) mixture model provided the best fit to the data. Factor 1 included eating disorder behaviors; Factor 2 comprised quality-of-life domains; Factor 3 was characterized by illness duration, number of hospitalizations, and admission BMI. Profiles differed on eating disorder behaviors and quality-of-life, but not on indicators of chronicity or BMI. Factor scores, but not profile membership, predicted outcome at discharge from treatment. Data suggest that patients with AN can be classified on the basis of eating disorder behaviors and quality-of-life, but there was no evidence for a chronic subgroup of AN. Rather, indices of chronicity varied dimensionally within each class. Given that current definitions of SE-AN rely on illness duration, these findings have implications for research and clinical practice.

    View details for DOI 10.1002/eat.22651

    View details for PubMedID 27991694

    View details for PubMedCentralID PMC5386793

  • Voluntary emotion regulation in anorexia nervosa: A preliminary emotion-modulated startle investigation. Journal of psychiatric research Racine, S. E., Forbush, K. T., Wildes, J. E., Hagan, K. E., Pollack, L. O., May, C. 2016; 77: 1?7

    Abstract

    Emotion regulation difficulties are implicated in the development and maintenance of anorexia nervosa (AN). However, research has been limited by an almost exclusive reliance on self-report. This study is the first to use the emotion-modulated startle paradigm (EMSP) to investigate emotional reactivity and voluntary emotion regulation in individuals with AN. Twenty women with AN viewed negative, positive, neutral, and food images and were asked to enhance, suppress, or maintain their emotional responses mid-way through picture presentation. Startle eyeblink magnitudes in response to startle probes administered prior, and subsequent, to regulation instructions indexed emotional reactivity and regulation, respectively. On emotional reactivity trials, startle magnitudes were greater for negative, positive, and food images, compared to neutral images. Participants had difficulty suppressing startle responses to negative and food images, as indicated by non-significant suppress-maintain comparisons. In contrast, startle responses to enhance and suppress cues during presentation of pleasant images were comparable and significantly lower than maintain cues. Findings converge with self-report data to suggest that patients with AN have difficulties with voluntary emotion regulation. The EMSP may be a promising trans-diagnostic method for examining emotion regulation difficulties that underlie risk for eating disorders and other psychiatric conditions.

    View details for DOI 10.1016/j.jpsychires.2016.02.014

    View details for PubMedID 26945729

    View details for PubMedCentralID PMC4826846

  • Specificity of parental bonding and rumination in depressive and anxious emotional distress PERSONALITY AND INDIVIDUAL DIFFERENCES Williams, C. L., Harfmann, E. J., Ingram, R. E., Hagan, K. E., Kramer, N. M. 2015; 79: 157?61

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