Girls Growing in Wellness and Balance: Researching Yoga as Prevention in the Schools. Catherine Cook-Cottone, Ph.D. University at Buffalo, SUNY

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1 Girls Growing in Wellness and Balance: Researching Yoga as Prevention in the Schools Catherine Cook-Cottone, Ph.D. University at Buffalo, SUNY

2 Thank You! International Association of Yoga Therapists Kripalu Symposium on Yoga Research Conference Committee

3 Svadhyaya or Self-Study

4 Eating Disorders Anorexia Nervosa Bulimia Nervosa Binge Eating Disorder Image from-

5 Prevalence of Eating Disorders and Rationale for Research Prevalence (DSM-V): AN (.4%-.8%), BN (1-3%), BED (1.6%-3.4%) 90% of individuals diagnosed are female Prevalence for at-risk females (15-29 years-old): 3-10% Subclinical manifestations Current estimates suggest that some form of eating disordered behavior occurs in 30% of girls Cook-Cottone, C.P. (2009). Eating disorders in childhood: Prevention and treatment supports. Childhood Education, 85, Stice et al., 2013.; APA, DSM-V (2013)

6 Dissertation: Body Dissatisfaction Body Dissatisfaction in College Women: Identification of Risk and Protective Factors 13% of the 215 women surveyed showed clinical level Body Dissatisfaction In a hierarchical regression- biggest predictors of BD Physical Self-concept accounting for 45% of the variance (p <.001, positive relationship) Adding Drive for Thinness accounted for 52% of variance (p <.001, negative relationship) Competence and Academic Self-concept did not add to the prediction of BD (Cook-Cottone & Phelps, 2003)

Attuned Representation of Self (ARMS) Cook-Cottone, C.P. (2006). The attuned representation model for the primary prevention of eating disorders: An overview for school psychologists.

7 Attuned Representation of Self (ARMS) Cook-Cottone, C.P. (2006). The attuned representation model for the primary prevention of eating disorders: An overview for school psychologists. Psychology in the Schools, 43, Cook-Cottone, C. P. (2015). Mindfulness and yoga for embodied self-regulation: A primer for mental health professionals. New York, NY: Springer Publishing.

8 Internal Self Physiology, emotions, and cognitions influence a sense of internal integration and attunement. Difficulty with one aspect can affect ones internal experience of well-being: physiological challenges emotional dysregulation, or cognitive distortions Cook-Cottone, 2006, 2015a, 2015b

9 External Self Components the external experience of self can affect attunement. Disruptive external influences can include: ineffective communication patterns within the family, abuse, community pressures, cultural media influences, and gender inequities. Cook-Cottone, 2006, 2015a, 2015b

10 Attunement and Integration As we manage internal and external aspects of self, the quality of attunement can be changed by any one aspect of experience. Cook-Cottone, 2006, 2015

Disordered Self Conflict, struggle, and disorder can manifest in the absence and the consequent seeking of attunement (Cook-Cottone, 2006, 2015). Cook-Cottone, C.P.

11 Disordered Self Conflict, struggle, and disorder can manifest in the absence and the consequent seeking of attunement (Cook-Cottone, 2006, 2015). Cook-Cottone, C.P. (2006). The attuned representation model for the primary prevention of eating disorders: An overview for school psychologists. Psychology in the Schools, 43,

The Attuned Representation of Self Model (ARMS) Illustrates the positive experience of individuals in their bodies by explicating the role of

12 The Attuned Representation of Self Model (ARMS) Illustrates the positive experience of individuals in their bodies by explicating the role of attunement, or the adaptive mutual influence and co- regulation among the internal and external aspects of the experience of self. Cook-Cottone, 2006, 2015a, 2015b

13 Centrifugal and Centripetal Forces Cook-Cottone, C. P. (2015). Incorporating Positive Body Image into the Treatment of Eating Disorders: A Model for Attunement and Mindful Self-Care. Body Image.

14 Why School-based Prevention for Eating Disorders? Access to all kids Weight related behaviors and concerns may emerge as early as 4 th grade Primary prevention programs should begin early, before related concepts solidify. Serwacki, M., & Cook-Cottone, C.P. (2013). Yoga in the schools: A systematic review of the literature. International Journal of Yoga Therapy.

Developmental Challenges Middle School Achieving a well-balanced sense of self Physical and psychological effects of puberty Challenging peer relationships Objectification (Media) Internalization of

15 Developmental Challenges Middle School Achieving a well-balanced sense of self Physical and psychological effects of puberty Challenging peer relationships Objectification (Media) Internalization of Societal Messages Self-objectification Deterioration of self-concept Loss of Embodiment Loss of Empowerment Piran, N., & Teall, T. (2012). The developmental theory of embodiment. Preventing eating-related and weight-related disorders: Collaborative research, advocacy, and policy change,

16 The Multitiered Problem-Solving Model and Girls Group Tier 3 Tier 2 Girls Group Tier 1 Cook-Cottone, C.P. (2010). Prevention and intervention of eating disorders. In P. McCabe & S. R. Shaw (Eds.). Current topics in pediatrics in the schools. (pp ). Bethesda, MD: NASP Publications. Cook-Cottone, C.P., & Scime, M. (2006). The prevention and treatment of eating disorders: An overview for school psychologists. The Communiqué, 34,

17 Why yoga? Yoga: to yoke or bind; specifically referring to the union of mind, body and spirit (wellness). Physical self-esteem and competence Mind-body awareness and connection Embodied Self-regulation Cook-Cottone, C.P., Beck, M., & Kane, L. (2008). Manualized-group treatment of eating disorders: Attunement in mind, body, and relationship (AMBR). The Journal for Specialists in Group Work, 33,

18 Prevention of EDs is More than Cognitive Stice and colleagues (2015) concluded, the lack of eating disorder onset effects may imply that factors beyond the pursuit of the thin ideal now contribute to eating disorder onset (p. 20). That is, consistent with the function of clinical level eating disorders in patients lives, the path to preventing eating disorders may be more than cognitive.

19 Embodied Practice Cook-Cottone, C. P. (2015). Incorporating Positive Body Image into the Treatment of Eating Disorders: A Model for Attunement and Mindful Self-Care. Body Image.

20 Theoretical Facet Traditional Self- Regulation Embodied Self- Regulation Target of Intervention Emphasis Cognition driven emotional and behavioral regulation Motives, drives, and achievement Mind and body integration within active practice Honoring the process or the journey Endpoint/Outcome Achievement of goals Balanced and sustainable selfmastery Ecological Scope Individual context Attunement within self and among others Cook-Cottone, C. P. (2015). Mindfulness and yoga for embodied self-regulation: A primer for mental health professionals. New York, NY: Springer Publishing.

Cook-Cottone, C. P., Jones, L. A., & Haugli, S. (2010).

21 Our Prevention and Treatment Model Constructivism Mind and Body Integration Integration of culture, the external self, the internal self, and the physical self. Cook-Cottone, C. P., Jones, L. A., & Haugli, S. (2010). Prevention of Eating Disorders among Minority Youth: A Matched-Sample Repeated Measures Study. Eating Disorders, 18,

Yoga and Eating Disorders Cook-Cottone, Beck, & Kane (2008) A modified version of GGWB that integrated attention to symptoms, dialectic behavior therapy, and cognitive behavior therapy.

22 Yoga and Eating Disorders Cook-Cottone, Beck, & Kane (2008) A modified version of GGWB that integrated attention to symptoms, dialectic behavior therapy, and cognitive behavior therapy. That means we integrated Distress tolerance and emotion regulation CBT approach to symptom reduction Photo from:

23 Cook-Cottone et al. (2008) Outcomes Participants: 29 females, Caucasian Mean age = 20 years old Diagnosed with and in treatment for Anorexia Nervosa Bulimia Nervosa Photo from: g/post/yoga-eating-disorders/

24 Cook-Cottone et al. (2008) Outcomes No control (full data for 24 participants) Paired samples t-tests (pre and post) Outcomes Decreased Body Dissatisfaction t (23) = 4.29, p =.000, Cohen s d =.876 Decreased Drive for Thinness t (23) = 2.84, p =.009, Cohen s d =.58 Decrease and no significant change Bulimia t (23) = 1.487

25 Cook-Cottone et al. (2008) Problems with study Small N (underpowered) No controls Not randomized Low dosage No positive outcome measures self-care body appreciation Self-compassion Emotional regulation Photo from:

Klein & Cook-Cottone (2013) The Effects of Yoga on Eating Disorder Symptoms and Correlates (IJYT) Studies on yoga and EDs 14 studies (+) New Study- Brennan & Welton (2015, SYR, Poster)

26 Klein & Cook-Cottone (2013) The Effects of Yoga on Eating Disorder Symptoms and Correlates (IJYT) Studies on yoga and EDs 14 studies (+) New Study- Brennan & Welton (2015, SYR, Poster) Focus Body dissatisfaction Self-objectification Drive for Thinness Body and Emotional Awareness Protective Factors (competence, physical self-concept, emotion regulation) Eating Disorder Symptoms

27 Klein & Cook-Cottone (2013) Yoga appears to be safe for those with EDs High variation across studies Rigor/Quality Participants characteristics Variations of yoga Dosage Photo from

28 Klein & Cook-Cottone (2013) Of the 14 studies, yoga practitioners are less predisposed to EDs and ED risk factors Body dissatisfaction Self-objectification Drive for thinness Poor body awareness Media influence Bulimic behaviors Binge eating Food pre-occupation One study that integrated yoga/pilates found decreased BD and increased weight control behaviors Photo from 2-the-harm/

29 Klein & Cook-Cottone (2013) Of the 14 studies, yoga practitioners have increased protective factors Self-competence Physical and social self-concepts Emotion regulation Overall- yoga intervention preferred over no yoga Dosage may be important (see Cook-Cottone, 2013) one study with low dosage- no effect- RCT The yoga and dissonance groups each met once a week for 45 minutes over a 6-week period (posttest during last group)- compared to dissonance program Image from

30 Girls Growing in Wellness and Balance: Yoga and Life Skills to Empower

Session Structure: Body Action (Yoga) Mind Journaling Discourse or Tutorial Thinking-based activity Mind and Body Integration Visualization/Relaxation Scime, M.

31 Session Structure: Body Action (Yoga) Mind Journaling Discourse or Tutorial Thinking-based activity Mind and Body Integration Visualization/Relaxation Scime, M., Cook-Cottone, C.P., Kane, L., & Watson, T. (2006). Primary prevention of eating disorders: Innovative practices in positive psychology and wellness. Eating Disorders, 14,

32 Curricular Sequence: Grow to Understand

33 Program Emphases Mind and body connection Embodiment of experience and learning Physicality and coping skills Emotional awareness Creation of personal meaning Mindful self-care Effective problem solving Media literacy

14 Session Sequence: Development of Self (Me) Session One Introduction, Group Norms Introduction to Yoga (breathing) Session Two Making Better Choices The Feeling

34 14 Session Sequence: Development of Self (Me) Session One Introduction, Group Norms Introduction to Yoga (breathing) Session Two Making Better Choices The Feeling and Thinking Brain I THINK, I FEEL, I SAY, I DO Session Three Internal Awareness Understanding the Self- internal regulation Beginning Yoga Postures and Breathing

14 Session Sequence: Development of Self (Me) Session Four Self-care Assessment Self-Care Techniques Advanced Yoga Postures Session Five Intuitive Eating Exotic Fruit and Vegetable Tasting Yoga and

35 14 Session Sequence: Development of Self (Me) Session Four Self-care Assessment Self-Care Techniques Advanced Yoga Postures Session Five Intuitive Eating Exotic Fruit and Vegetable Tasting Yoga and Experiencing the Present Moment Session Six Feeling sort Emotional Integration, Good and Bad Feelings? Yoga, Relaxation, and Coping Session Seven Automatic Negative Thoughts ANT eaters Yoga and Competence

36 14 Session Sequence: Me in My World Session Eight Assertiveness Setting Boundaries Yoga Session Nine Strong and Empowered Women Yoga

their own media) Yoga This Moment was Brought to You BY.

37 14 Session Sequence: Me in My World in this Culture Session Ten Sociocultural Pressures This moment was brought to you by Conceptualizing Beauty and Media Project Work (creating their own media) Yoga This Moment was Brought to You BY. Session Eleven- Thirteen Sociocultural Pressures Conceptualizing Beauty and Media Project Work (creating their own media) Yoga

38 14 Session Sequence: Me in My World in this Culture Session Fourteen Review and Project Presentation Circle of Closure

39 Sample Session Content Feeling Awareness and Understanding Judging Feeling To yoga

40 Sample Session Content Thinking Feeling Brain- Problem solving in the palm of your hand Hot soup to Grandma s soup To Yoga

41 Review of Studies and Girls Group (GGWB)

Scime, Cook-Cottone, Kane, & Watson, (2006) First study of GGWB 10 weeks of session N= 45, No controls, 3 groups Paired sample t-tests Change in Drive for Thinness (EDI) Significant for

42 Scime, Cook-Cottone, Kane, & Watson, (2006) First study of GGWB 10 weeks of session N= 45, No controls, 3 groups Paired sample t-tests Change in Drive for Thinness (EDI) Significant for group 1, NS for groups 2 and 3 Change in Body Dissatisfaction (EDI) Significant decrease for all 3 groups Change in Media Influence (page 152) Significant decrease in groups 1 and 2, NS group 3

43 GGWB Results- (Scime & Cook-Cottone, 2008) Scime, M. & Cook-Cottone, C. (2008) Studies the impact of girls group over the course of a few years with 5 th grade females Utilized measures of current eating disorder behavior, future intention of eating disorder behavior, perceived stress, and self-concept.

44 GGWB Results- (Scime & Cook-Cottone, 2008) Participants 75 in intervention 63.5% Caucasian 7% African American 8% Asian American 8% Native American 11% Hispanic 55 controls 82% Caucasian 7.5% African American 1.5% Asian American 1.5% Native American 1.5% Hispanic

GGWB Results- (Scime & Cook-Cottone, 2008) Significantly decreased Body Dissatisfaction F (1,133) = 18.58, p <.001, n 2 partial = 0.

45 GGWB Results- (Scime & Cook-Cottone, 2008) Significantly decreased Body Dissatisfaction F (1,133) = 18.58, p <.001, n 2 partial = (medium to large effect) Significantly decreased Bulimia F (1,134) = 6.34, p <.02, n 2 partial = (small to medium effect) Not significant Drive for Thinness

46 GGWB Results- (Scime & Cook-Cottone, 2008) Significantly increased Social Self-Concept F (1,134) = 4.17, p <.05, n 2 partial = 0,03 (small effect) Not significant for Competence Physical Self-Concept Perceived Stress

GGWB Matched-Control (Cook-Cottone, Jones, & Haugli, 2010) Matched-controlled, repeated measure study Both minority and causation participants, pairs matched for BMI Socioeconomic

47 GGWB Matched-Control (Cook-Cottone, Jones, & Haugli, 2010) Matched-controlled, repeated measure study Both minority and causation participants, pairs matched for BMI Socioeconomic status. Age Participants 50 females Mean age 10.2 years 50% Caucasian 50%- 20% Asian American 18% African American 8% Native American 4% Hispanic Photo from

GGWB Matched-Control (Cook-Cottone, Jones, & Haugli, 2010) Significantly decreased body dissatisfaction (F [1,48] = 15.869, p =.

48 GGWB Matched-Control (Cook-Cottone, Jones, & Haugli, 2010) Significantly decreased body dissatisfaction (F [1,48] = , p =.000) Significantly decreased Drive for thinness (F [1,48] = 9.302, p =.004) Significantly decreased Eating disorder behavior (F [1,48] = 5.625, p =.022) with no differences for minority status.

GGWB Matched-Control (Cook-Cottone, Jones, & Haugli, 2010) Physical self-concept significantly increased (F [1,48] = 10.

49 GGWB Matched-Control (Cook-Cottone, Jones, & Haugli, 2010) Physical self-concept significantly increased (F [1,48] = , p =.002) Social self-concept significantly increased (F [1,48] = , p =.002) with no differences for minority status.

50 Personality and Prevention with Yoga (Norman, Sodano, & Cook-Cottone, 2014) An Exploratory Analysis of the Role of Interpersonal Styles in Eating Disorder Prevention Outcomes Participants: th grade females Mean age = % Caucasian, 6% African American, 5% Asian, 1% Hispanic, and 12% other or mixed race

51 Personality and Prevention with Yoga (Norman, Sodano, & Cook-Cottone, 2014) MANOVA- mean score differences for level of treatment, and time. Level of treatment and time F (1, 112) = 3.23, p =.025) Significantly reduced Drive for Thinness F (1, 14) = 8.847, p <.01) Significantly Reduced Body Dissatisfaction F (1, 14) = 5.480, p =.021) Bulimia scale- non-significant reduction

52 Personality and Prevention with Yoga (Norman, Sodano, & Cook-Cottone, 2014) To explore role of interpersonal dispositions on the outcomes of control and program completers Change scores were computed for DT, BD, and BU Scores were correlated with Dominance and Affiliation dimensions of the CAIS (Child and Adolescent Interpersonal Survey)

53 Personality and Prevention with Yoga (Norman, Sodano, & Cook-Cottone, 2014) Controls Change in DT was significantly correlated with lower dominance This relationship was not found in the treatment group Treatment Significant, negative correlation between affiliation and BU change scores Lower affiliation was related you higher BU scores This relation was not found in the control group Recall, BU did not significantly decline for treatment group. Low affiliation may be playing a role in the lack of decline in the BU scores for the intervention group.

54 GGWB Revised Cook-Cottone et al. (20??) A matched-control study of the revised manual, the program: Participant (32 matched pairs by BMI, SES, and Age) In total, data for 64 girls was collected. Parent reports of height and weight were used to calculate BMI. 1Parent surveys reported that 90.6% of girls were Caucasian (N = 58), and 9.4% were identified as other ethnicities (N = 6). The average age of the group was years old (SD =.333).

55 GGWB Revised Cook-Cottone et al. (20??) Significantly decreased Drive for Thinness F (1,62) = 4.264, p =.043 partial =.064. In right direction- not significant Body Dissatisfaction did not have a significant effect for this sample F(1, 62) = 2.188, p =.144, partial =.032, Nor did the Bulimia scale F(1, 62) =.017, p =.896 partial =.000.

56 Mindful Self-Care The MSCS showed a significant increase post-prevention program F (1, 58) = 4.601, p =.036, partial =.073.

57 Yoga Outcomes in Schools Problems Serwacki & Cook-Cottone, 2012 (IJYT) Need for improved methodology Lack of randomization Small sample sizes Limited detail regarding interventions Lack of treatment fidelity measures Lack of attention to dosage

58 Future Directions

59 New Measures Mindful Self-Care Scale (Cook-Cottone, 2015) Embodiment (Piran, 2015) Body Appreciation Scale-2 (Tylka and Wood- Barcalow, 2015) Self-objectification (Tiggemann & Williams, 2012) Intuitive Eating cale-2 (Tylka & Kroon Van Diest,2013) Other Eating Disorder measures (EAT-26; EDE-Q) Self-Compassion (Tylka, Russell, & Neal, 2015) Measures of Self-regulation

60 Dosage Cook-Cottone, 2013, IJYT Dose-response effects key in many fields Exercise Science- lower doses no effects How much Yoga May need at least 2 and up 3X a week for robust effects One hour sessions (up to 90 if mixed techniques) At least 8 weeks Look at home practice (practice outside of intervention)

61 Current Projects Encinitas schools yoga outcomes yoga as religion Fetal Alcohol Spectrum Disorders (GGWB) physiological measures current functioning assessment Self-report Instructor Verbal Content and ED risk Development and psychometrics refinement of the MSCS

62 Self-Care and Self-Regulation

Mindful Self-Care Scale the Mindful Self-Care Scale is a tool for the assessment of the aspects of self-care addressing each area of the ARMS through actionable practices.

63 Mindful Self-Care Scale the Mindful Self-Care Scale is a tool for the assessment of the aspects of self-care addressing each area of the ARMS through actionable practices. Internal physical practices such as hydration, exercise, rest, and sleep. soothing, self-compassion, and spiritual practices External environment, relationships, support Cook-Cottone, 2015

64 Process

65 Contact Information Catherine Cook-Cottone, Ph.D. Associate Professor, University at Buffalo, SUNY Certified and Registered Yoga Instructor Licensed Psychologist Web Pages: Yogis in Service The Yoga Bag

66 References (Books) BOOKS Cook-Cottone, C. P. (2015). Mindfulness and yoga for embodied self-regulation: A primer for mental health professionals. New York, NY: Springer Publishing. Cook-Cottone, C. P., Tribole, & E., Tylka, T. (2013). Healthy eating in schools: Evidenced-based interventions to help kids thrive. Washington, DC: American Psychological Association. Cook-Cottone, C. P., Kane, L., Keddie, E., & Haugli, S. (2013). Girls growing in wellness and balance: Yoga and life skills to empower. Stoddard, WI: Schoolhouse Educational Services, LLC. Cook-Cottone, C. P. (2009). Success at any cost? School-based prevention of high risk, body-change strategies: Eating Disorders, Steroid Abuse, and Excessive Exercise. Buffalo, NY: GSE Publications/SUNY Press.

67 References (Research Articles) Cook-Cottone, C. P., Olka E. K., Guyker, W., & Talebkhah, K., (manuscript in preparation). Yoga-based prevention of eating disorders: A matchedcontrol comparison of pre-adolescent females Cook-Cottone, C. P. (in press). Embodied Self-regulation and Mindful Self-care in the prevention of eating disorders. Eating Disorders: The Journal of prevention and intervention. Cook-Cottone, C. P. (2015). Incorporating Positive Body Image into the Treatment of Eating Disorders: A Model for Attunement and Mindful Self-Care. Body Image. Norman, K., Sadano, S., & Cook-Cottone, C. P. (2014). An Exploratory Analysis of the Role of Interpersonal Styles in Eating Disorder Prevention Outcomes. Journal for Specialists in Group Work. Cook-Cottone, C. P. (2013). Dosage as a critical variable in yoga research. International Journal of Yoga Therapy, 23,

68 References (Research Articles) Klein, J., & Cook-Cottone, C. P. (2013). A systematic review of yoga for the treatment of eating disorders. International Journal of Yoga Therapy, 23, Serwacki, M., & Cook-Cottone, C. P. (2012). Yoga in the schools: A systematic review of the literature. International Journal of Yoga Therapy, 22, Cook-Cottone, C. P., Jones, L. A., & Haugli, S. (2010). Prevention of Eating Disorders among Minority Youth: A Matched-Sample Repeated Measures Study. Eating Disorders, 18, Cook-Cottone, C. P., Casey, C., Feeley, T. & Boran, J. (2009). A metaanalytic review of the prevention of childhood obesity in the schools. Psychology in the Schools, 46, Scime, M., & Cook-Cottone, C. P. (2008). Primary prevention of eating disorders: A constructivist integration of mind and body strategies. International Journal of Eating Disorders, 41,

69 References (Research Articles) Cook-Cottone, C. P., Beck, M., & Kane, L. (2008). Manualized-group treatment of eating disorders: Attunement in mind, body, and relationship (AMBR). The Journal for Specialists in Group Work, 33, Scime, M., Cook-Cottone, C. P., Kane, L., & Watson, T. (2006). Primary prevention of eating disorders: Innovative practices in positive psychology and wellness. Eating Disorders, 14, Cook-Cottone, C. P. (2006). The attuned representation model for the primary prevention of eating disorders: An overview for school psychologists. Psychology in the Schools, 43, Serwacki, M., & Cook-Cottone, C. (2012). Yoga in the schools: a systematic review of the literature. International journal of yoga therapy, 22(1),

70 Other References Piran, N., & Teall, T. (2012). The developmental theory of embodiment. Preventing eatingrelated and weight-related disorders: Collaborative research, advocacy, and policy change, Piran, N. (2015). New possibilities in the prevention of eating disorders: The introduction of positive body image measures. Body image. Smink, F. R., van Hoeken, D., & Hoek, H. W. (2012). Epidemiology of eating disorders: incidence, prevalence and mortality rates. Current psychiatry reports, 14(4), Stice, E., Marti, C. N., & Rohde, P. (2013). Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women. Journal of Abnormal Psychology, 122(2), 445. Tiggemann, M., & Williams, E. (2012). The role of self-objectification in disordered eating, depressed mood, and sexual functioning among women a comprehensive test of objectification theory. Psychology of Women Quarterly, 36(1), Tylka, T. L., & Kroon Van Diest, A. M. (2013). The Intuitive Eating Scale 2: Item refinement and psychometric evaluation with college women and men. Journal of counseling psychology, 60(1), 137. Tylka, T. L., Russell, H. L., & Neal, A. A. (2015). Self-compassion as a moderator of thinness-related pressures' associations with thin-ideal internalization and disordered eating. Eating behaviors, 17, Tylka, T. L., & Wood-Barcalow, N. L. (2015). The Body Appreciation Scale-2: Item refinement and psychometric evaluation. Body image, 12,

Eating Disorders. Abnormal Psychology PSYCH Eating Disorders: An Overview. DSM-IV: Anorexia Nervosa

Eating Disorders. Abnormal Psychology PSYCH Eating Disorders: An Overview. DSM-IV: Anorexia Nervosa Abnormal Psychology PSYCH 40111 Eating Disorders Eating Disorders: An Overview Two Major Types of DSM-IV Eating Disorders Anorexia nervosa and bulimia nervosa Severe disruptions in eating behavior Extreme