Do Bulimic Behaviors Increase Shame? Toward an Understanding of Transdiagnostic Risk

有大量的证据证明了神经性贪食症（BN）的合并症， 焦虑和抑郁，以及物质滥用等外化障碍。一条重要的路线 研究是超越对并发症的描述，以确定潜在的机制， 这项研究的目的是开始测试参与一种行为的可能性， 一组特定的共病、功能失调的行为增加了羞耻感， 增加的羞耻感会增加其他共病行为的风险。调查的科学依据 这种可能性是，（a）BN、内化和外化障碍之间的共病估计为 高达74.4%（Ulfvebrand et al，2015）;（B）先前关于合并症的研究通常是描述性的， 强调有必要调查解释这一现象的机制;（c）羞耻感与下列因素有关： （4）在最近的纵向研究中，我和我的同事证明， 在小学饮食预示着抑郁，饮酒和吸烟水平的增加 几年后在高中。本提案的研究部分是一项旨在开始测试这一点的研究 想法，使用BN女性的暴食行为作为研究这种并发症模型的切入点。 具体来说，我建议在实验室里测试，在消极情绪下进食是否会增加状态。 与健康对照组相比，BN女性的羞耻感。在一次即兴进食后， 情绪诱导，BN的女性将经历国家羞耻感的增加，这比任何增加都要大。 健康对照组的状态羞耻，这些增加将预测随后的状态增加 焦虑和抑郁以及使用物质的冲动增加。增强状态的演示 对于患有BN的女性来说，在基于痛苦的饮食会议之后的羞耻和transdiagnosis风险是至关重要的一步 在我希望进行的一个研究项目中，使用实验设计和纵向设计。培训 该建议的组成部分包括：（1）实验室设计和执行方面的培训， 实验研究;（2）羞耻感的训练，它与内疚感等相关结构的区别， 羞耻感的反诊断作用、测量羞耻感的方法以及减少羞耻感的可能性;（3） 多层次建模培训：我计划的研究计划将涉及观察嵌套的研究 （4）在研究伦理方面的进一步高级培训，包括第二次 研究生课程的伦理研究与临床人口，出席大学的临床伦理 大型圆桌会议和研究伦理讲座系列;（5）编写研究报告供出版，包括 学习如何有效地应对修改和重新提交的决定;（6）提出原始研究， 领导，国际科学会议;和（7）在指导初级研究生的培训， 本科研究助理，包括那些协助拟议的研究。

There is abundant evidence documenting the comorbidity of bulimia nervosa (BN), internalizing disorders such as anxiety and depression, and externalizing disorders such as substance misuse. One important line of research is to move beyond descriptions of comorbidity to determine underlying mechanisms that may account for it. The intent of the proposed research is to begin to test the possibility that engagement in one behavior in a specified set of comorbid, dysfunctional behaviors increases the experience of shame, and that the increased shame contributes to risk for others of the comorbid behaviors. The scientific basis for investigating this possibility is that (a) estimates of comorbidity between BN, internalizing, and externalizing disorders are as high as 74.4% (Ulfvebrand et al, 2015); (b) prior research on comorbidity has often been descriptive, highlighting the need to investigate mechanisms to explain it; (c) the experience of shame is associated with each of these disorders; and (d) in recent longitudinal work, my colleagues and I demonstrated that binge eating in elementary school predicts increased levels of depression, alcohol use, and tobacco smoking four years later in high school. The research component of this proposal is a study designed to begin to test this idea, using bulimic behaviors by women with BN as an entry point for studying this comorbidity model. Specifically, I propose to test, in the laboratory, whether eating while in a negative mood increases state shame in women with BN as compared to healthy controls. After an ad lib eating session following negative mood induction, women with BN will experience an increase in state shame that is greater than any increase in state shame for the healthy control group and these increases will predict subsequent increases in state anxiety and depression as well as increased urges to use substances. Demonstration of increased state shame and transdiagnostic risk following a distress-based eating session for women with BN is a crucial step in a program of research I hope to conduct, using both experimental and longitudinal designs. The training component of this proposal includes the following: (1) training in the design and execution of laboratory, experimental studies; (2) training in the construct of shame, its distinction from related constructs such as guilt, the role of shame transdiagnostically, methods of measuring shame, and the possibility of reducing shame; (3) training in multilevel modeling: my planned program of research will involve studies of observations nested within people, nested within groups; (4) further advanced training in research ethics, including a second graduate course on ethical research with clinical populations, attendance at the University's clinical ethics grand rounds and research ethics lecture series; (5) preparation of research reports for publication, including learning how to respond effectively to revise and resubmit decisions; (6) presenting original research at leading, international scientific meetings; and (7) training in the mentoring of junior graduate students and undergraduate research assistants, including those assisting with the proposed research.