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Articles 1 - 30 of 96
Full-Text Articles in Entire DC Network
Adolescent Externalizing Symptoms And Parent Emotion Socialization: An Examination Of Longitudinal Effects And Differences By Adolescent Sex, Cheston West
Electronic Theses and Dissertations
Adolescence is an important developmental context with several changes in social and emotional functioning. Though adolescents are gaining independence from their caregivers, they still engage in dynamic interactions with their caregivers who remain key figures in their lives. When adolescents express emotions, caregivers engage in various behaviors in response to these expressions, a process known as emotion socialization. This process has mostly been examined as a parent-driven construct in which parent emotion socialization impacts child-level outcomes, namely internalizing symptoms, with limited research on externalizing symptoms. However, available literature demonstrates that child-level characteristics (e.g., externalizing symptoms) are linked to differences in …
Co-Rumination, Psychological Inflexibility, And Internalizing Symptoms In Adolescence, John Parigger
Co-Rumination, Psychological Inflexibility, And Internalizing Symptoms In Adolescence, John Parigger
Electronic Theses and Dissertations
Two risk factors for anxiety and depression in adolescence were examined: co-rumination, which occurs when friends excessively talk about problems; and psychological inflexibility, which occurs when one avoids negative feelings and fails to act on values. I hypothesized that psychological inflexibility would exacerbate the effect of co-rumination on adolescent anxiety and depression. Participants were 167 adolescents (Mage = 14.60 years, SD = 1.3; 65.7% cisgender males) who completed standard measures as part of an online survey. Results indicated no moderation effect, but there were main effects of co-rumination and psychological inflexibility on depression symptoms. Co-rumination may relate to …
Mentalized Affectivity Among Adolescents In Wilderness Therapy: An Initial Exploration, William Holland
Mentalized Affectivity Among Adolescents In Wilderness Therapy: An Initial Exploration, William Holland
Dissertations and Theses
Mentalized affectivity (MA) blends emotion regulation and mentalization in a single construct that underlies psychopathology and is a target of psychotherapeutic intervention as a mechanism of change. Little research has investigated MA’s role in psychopathology and treatment for adolescents. Change in MA has yet to be investigated. Wilderness therapy is a non-traditional treatment model for “hard-to-reach” adolescents; its mechanisms of change have not been robustly researched. This study aims to investigate change in adolescents’ MA capacities over the course of wilderness therapy, in order to explore the role of MA components (Identifying, Processing, Expressing) in adolescent psychopathology; the relation between …
Hormonal Effects On Adhd Symptoms In Adolescents Across The Menstrual Cycle, Ashley G. Eng
Hormonal Effects On Adhd Symptoms In Adolescents Across The Menstrual Cycle, Ashley G. Eng
Theses and Dissertations--Psychology
Background: Females with attention-deficit/hyperactivity disorder (ADHD) become particularly impaired during adolescence, experiencing increased rates of depression and anxiety, as well as important public and personal health outcomes like increased suicide attempts, risky sexual behavior, and substance use. However, female-specific risk factors for ADHD have been vastly understudied despite this increased impairment and comorbidity. One particularly understudied risk factor is the dramatically rising and fluctuating levels of ovarian hormones during late puberty that begin cycling monthly. In adult women, rapid decreases in estrogen levels increase risk for ADHD symptoms across the menstrual cycle, particularly for those with high trait impulsivity. Preliminary …
Examining The Experience And Impact Of Teen-To-Teen Crisis Line Work For Youth Volunteers: A Pilot Study, Taylor Kalgren
Examining The Experience And Impact Of Teen-To-Teen Crisis Line Work For Youth Volunteers: A Pilot Study, Taylor Kalgren
Psychology Theses & Dissertations
For young people, suicide is a leading cause of death. In addition, suicidal thoughts and behaviors begin during adolescence, and rates are high during this developmental period. Crisis lines are one of the oldest suicide prevention strategies used today. Crisis line work is challenging, and therefore, examining the health and safety of these operators is critical. Teen-to-teen (t2t) crisis lines are a unique resource where adolescent volunteers help their similarity aged peers. The goal of this pilot study was to begin to evaluate the impact of t2t crisis lines for youth volunteers. Twenty youth crisis line volunteers (ages 15-20) were …
Social Media Use In Adolescence: Longitudinal Relationships With Social Functioning And Psychopathology, Aidan P. Schmitt
Social Media Use In Adolescence: Longitudinal Relationships With Social Functioning And Psychopathology, Aidan P. Schmitt
Master's Theses and Doctoral Dissertations
Social media use and psychopathology are both prevalent during adolescence; however, the relationship between these two variables is not yet fully understood. Research on these topics is generally myopic in that it focuses on a brief window of time (e.g., cross-sectional studies), a small number of variables (e.g., hours spent per day; depressive symptoms), and uses single reporters and measures (e.g., adolescent report using a questionnaire). Extant literature shows moderate relationships between frequency of social media use and depressive symptoms; however, most studies do not use statistical methods that investigate bidirectionality or parse apart between-person and within-person effects, so effects …
Witnessing Community Violence And Its Consequences: Changes Across Middle School, Sarah Pittman
Witnessing Community Violence And Its Consequences: Changes Across Middle School, Sarah Pittman
Theses and Dissertations
Community violence exposure is prevalent among youth residing in economically marginalized communities that have high rates of violence. Witnessing community violence has been concurrently associated with persistent adverse consequences. However, few studies have applied a developmental psychopathology framework and examined dynamic developmental processes between witnessing community violence and outcomes over time. Moreover, most prior studies have used analyses that assume that associations between witnessing violence and outcomes are the same for all adolescents, which is inconsistent with both developmental theories and theories specific to community violence exposure. The goal of this study was to apply a developmental psychopathological framework to …
An Exploration Of The Relation Between Psychological Functioning And Reactions To Global Climate Change For Late Adolescents In New York City, Emma Routhier
Dissertations and Theses
Climate change poses a potentially unique generational crisis, as it threatens the viability of the very world that the current adolescent generation stands to inherit. While some studies have begun to appreciate the specific experience of adolescents as it pertains to climate change, they attend to young people’s behavior or self-reported feelings. The present study aims to employ psychoanalytic constructs, with attention to the unconscious determinants of psychic life and behavior, in an empirical examination of this topic, and to introduce a level of sensitivity to the vicissitudes of the adolescent period that have not previously been addressed in the …
Moderating Factors In The Relationship Between Bully Victimization And Psychosomatic Symptoms, Tonya Paulson
Moderating Factors In The Relationship Between Bully Victimization And Psychosomatic Symptoms, Tonya Paulson
Theses and Graduate Projects
The purpose of this study was to investigate the relationship between bully victimization and psychosomatic symptoms, and to examine the protective influence of perceived parent and peer support across developmental age groups. Bully victimization frequency, somatic symptom severity, perceived parent support, and perceived peer support were assessed using archival data from 7,304 youth who participated in the 2009-2010 Health Behavior in School-Aged Children (HBSC) U.S. survey, excluding perpetrators of bullying. Bully victimization and somatic symptoms were significantly positively correlated. Older adolescents consistently reported more severe somatic symptoms, but age did not moderate the relationship between bullying and somatic symptoms. Higher …
Co-Rumination, Romantic Relationships, And Depressive Symptom Development In Adolescence, Jessica L. Shankman
Co-Rumination, Romantic Relationships, And Depressive Symptom Development In Adolescence, Jessica L. Shankman
Electronic Theses and Dissertations
The present research aimed to better understand the associations among romantic involvement, co-rumination with friends, and depressive symptom development in a sample of 338 adolescents (ages 14-19 years). Using a multi-method, longitudinal study design, the present study examined whether co-rumination (self-reported and observed) mediated the relationship between romantic involvement and depressive symptoms over time. Next, analyses separately tested whether this process was further moderated by positive friendship quality, whether youth discuss romantic experiences during problem talk with friends, and/or gender. Analyses also tested whether romantic relationship quality among romantically involved youth influenced depressive symptoms over time via co-rumination.
Results supported …
Investigating The Shared And Unique Mechanisms Of The Development Of Comorbid Eating Disorder-Anxiety Symptoms During Adolescence., Leigh Cara Brosof
Investigating The Shared And Unique Mechanisms Of The Development Of Comorbid Eating Disorder-Anxiety Symptoms During Adolescence., Leigh Cara Brosof
Electronic Theses and Dissertations
Introduction: Eating disorders are associated with significant morbidity, psychiatric comorbidity, and impairment. Despite the detrimental outcomes associated with eating disorders, effective treatments for eating disorders are lacking. One factor that has impeded the identification of targets for intervention in eating disorders is the high comorbidity rate with other psychiatric disorders. Comorbidity models can inform treatments by showing which mechanisms are shared in comorbidity and which mechanisms are unique to specific disorders. Anxiety disorders are the most frequently co-occurring disorders with eating disorders, as 85% of individuals with eating disorders have a comorbid anxiety disorder. One mechanistic process in both anxiety …
The Moderating Impact Of Gender And Friendship Quality On The Effects Of Interparental Conflict On Adolescent Internalizing Problems, Jessica Dandan
The Moderating Impact Of Gender And Friendship Quality On The Effects Of Interparental Conflict On Adolescent Internalizing Problems, Jessica Dandan
Theses and Dissertations
In response to escalating concerns about the increasing incidence of adolescent internalizing disorders, several mechanisms have been investigated to understand their etiology. Though genetic predisposition contributes to the risk for psychopathology, its interaction with environmental stressors such as interparental conflict appears to further increase this risk. Girls are more susceptible to stressors and twice as likely as boys to develop internalizing problems. However, friendship quality may buffer some of the adverse effects incurred from exposure to interparental conflict. A recent review of proposed mechanisms through which conflict is associated with youth psychopathology pinpointed the need for further adolescent-focused research including …
Opening A Crack To Let The Light In: An Exploration Of An Online Group Adolescent Compassion Focussed Therapy Intervention, Euan Pb Fraser Tait
Opening A Crack To Let The Light In: An Exploration Of An Online Group Adolescent Compassion Focussed Therapy Intervention, Euan Pb Fraser Tait
Electronic Thesis and Dissertation Repository
The current study’s goal is to expand the adolescent compassion focused therapy (CFT) literature by exploring participant experiences of a novel CFT protocol which was delivered in an online group therapy format. This study is a mixed methods approach using surveys, open-ended questionnaires, and interviews to explore participants’ experience and expression of feelings of inadequacy (FOI) and self-compassion. Thematic analysis findings revealed that participants struggled primarily with FOI relating to evaluative contexts such as school and sports and that these FOI also carried with them implications of self-worth and perfectionism. Through participating in the program, participants were able to de-shame …
Under The Skin Social Stress: Physiological Effects Of Racial Discrimination And Family Communication During Adolescence, Dana Mansfield
Under The Skin Social Stress: Physiological Effects Of Racial Discrimination And Family Communication During Adolescence, Dana Mansfield
College of Science and Health Theses and Dissertations
Adolescence is a formative, developmental period that encompasses increased life stress. For youth of color, these stressors are amplified due to race-related experiences such as racial discrimination. Studies have shown that family communication greatly influences the physiological stress response in childhood development. The purpose of the current study was to examine how interpersonal and institutional discrimination impact the physiological stress response and how supportive family communication may influence the stress response in adolescents from various ethnic and racial groups. A sample of 379 ethnically diverse adolescents participated in this study and completed self-report questionnaires. Cortisol samples were collected in conjunction …
The Cumulative Impact Of Childhood Adversity On Bold Responses To Inhibitory Control During Early Adolescence In The Abcd Study Cohort, Elizabeth Ashley Stinson
The Cumulative Impact Of Childhood Adversity On Bold Responses To Inhibitory Control During Early Adolescence In The Abcd Study Cohort, Elizabeth Ashley Stinson
Theses and Dissertations
Adolescence is characterized by dynamic neurodevelopment, which poses opportunities for risk and resilience. Adverse childhood experiences (ACEs) pose additional risk to the developing brain, where ACEs have been associated with alterations in functional magnetic resonance imaging (fMRI) BOLD signaling in brain regions underlying inhibitory control. Potential resiliency factors, like positive family environment, may attenuate the risk associated with ACEs. Using baseline to 2-year data from the Adolescent Brain Cognitive Development (ABCD) Study, the current study examined how ACEs relate to fMRI BOLD signaling during successful inhibition on the Stop Signal Task (SST) in regions underlying inhibitory control during early adolescence …
Applying Dialectical Behavior Therapy To Latinx Youth Experiencing Deportation Stress: A Critical Literature Review And Culturally Congruent Application, Desiree Curcio
Selected Full Text Dissertations, 2011-
Deportation policies from Immigration and Customs Enforcement (ICE) have harmful effects on the mental health of immigrant families in the US. These effects can be experienced at multiple points such as living in fear of deportation, undergoing ICE raids, becoming detained, or being deported. The children that witness these experiences of deportation within their families are impacted substantially. Some of the psychological effects of having a parent deported or detained can include internalizing and externalizing problems, attention difficulties, emotional and behavioral changes, interpersonal conflict, and feeling like a burden. While the impacts of deportation on youth are highlighted in the …
Cyberbullying Victimization As A Predictor Of Depressive Symptoms Among Selected Adolescents Amidst The Covid-19 Pandemic, Jeyaseelan Maria Michael, Marc Eric Reyes
Cyberbullying Victimization As A Predictor Of Depressive Symptoms Among Selected Adolescents Amidst The Covid-19 Pandemic, Jeyaseelan Maria Michael, Marc Eric Reyes
Makara Human Behavior Studies in Asia
Cyberbullying victimization has become a significant mental health concern, particularly among adolescents at risk of experiencing negative consequences like depression. As the outbreak of the Covid-19 pandemic forced everyone to stay at home and participate in all their educational, recreational, and entertainment activities online, this study investigated the relationship between cyberbullying victimization (CV) and depressive symptoms among 612 college students in Tamilnadu, India. We hypothesized that experiences of cyberbullying victimization would predict depressive symptoms among the participants. Adolescent participants aged 18 to 19 years old from colleges in Tamilnadu completed an online survey composed of the Cybervictimization questionnaire for adolescents …
Identifying Risk Factors For Ptsd Symptom Clusters In Maltreated, Multiracial Youth Using Nonparametric Modeling, Mallory Constantine
Identifying Risk Factors For Ptsd Symptom Clusters In Maltreated, Multiracial Youth Using Nonparametric Modeling, Mallory Constantine
UNLV Theses, Dissertations, Professional Papers, and Capstones
Multiracial youth are one of the most at-risk racial groups for child maltreatment. Multiracial individuals are also more likely to report mental health concerns than other racial or ethnic groups. This study aimed to identify demographic and psychological risk factors that are unique to multiracial, maltreated youth with respect to PTSD symptoms (i.e., re-experiencing, hyperarousal, avoidance) through classification and regression tree (CART) analyses. Participants included 99 multiracial, maltreated youth directly following their placement in an emergency group shelter due to substantiated maltreatment. The first hypothesis was that female gender, English first language, questions related to guilt and self-blame, and depressive …
Resting State Functional Connectivity In The Default Mode Network: Relationships Between Cannabis Use, Gender, And Cognition In Adolescents And Young Adults, Megan Ritchay
Theses and Dissertations
Introduction: Cannabis is the most commonly used illicit substance in the United States, and nearly 1 in 4 young adults are current cannabis users. The psychoactive component of cannabis, THC, is active at cannabinoid receptors, type 1, or CB1 receptors. CB1 receptors play a critical role in neural development, and chronic cannabis use causes desensitization and downregulation of these receptors. Chronic cannabis use is associated with changes in resting state functional connectivity (RSFC) in the default mode network (DMN) in adolescents and young adults, although results are somewhat inconsistent across studies, likely due to differing methodologies. Additionally, cannabis effects appear …
The Relationship Between Neighbourhood-Level And Family-Level Factors And Sleep Problems Among Children And Youth, Katarina Mckenzie
The Relationship Between Neighbourhood-Level And Family-Level Factors And Sleep Problems Among Children And Youth, Katarina Mckenzie
Electronic Thesis and Dissertation Repository
There is little research on the effects of neighbourhood factors on child sleep outcomes. No study to date has investigated the interactive effects of neighbourhood and family socio-economic characteristics (SECs) on child sleep outcomes. This study aimed to fill this gap. Secondary data analyses were completed on two samples (children and youth) from the 2014 Ontario Child Health Study, a cross-sectional, province-wide sample of 10,802 children aged 4 to 17. Multi-level modeling was used to assess the relationship between child- (e.g., age), family- (e.g., negative parenting) and neighbourhood-level factors and their relationship to sleep outcome variables: problems falling asleep, problems …
Exercise, Cognition, And Cannabis Use In Adolescents, Ileana Pacheco-Colón
Exercise, Cognition, And Cannabis Use In Adolescents, Ileana Pacheco-Colón
FIU Electronic Theses and Dissertations
Heavy and/or chronic cannabis use has been associated with neurocognitive impairment and decline, often in domains such as memory and executive functioning. On the other hand, exercise has been linked to positive effects on brain and cognitive health across the lifespan, as well as to better substance use outcomes. Despite this, little is known about the ways in which exercise could help prevent or ameliorate adverse cannabis-related outcomes among adolescents.
Through three separate studies, the current dissertation examines interrelations among exercise, cognition, and cannabis use in children and adolescents in an effort to determine whether exercise can prevent or ameliorate …
Effects Of Adolescent Motivation And Personality On Adherence And Success In A Voluntary Residential Bootcamp Program, Lydia Sigurdson
Effects Of Adolescent Motivation And Personality On Adherence And Success In A Voluntary Residential Bootcamp Program, Lydia Sigurdson
Master's Theses
The Youth ChalleNGe Program is a voluntary program for adolescents who have dropped out of high school and is intended to address various needs of at-risk youth. As a result, individuals are motivated to enroll for an array of reasons. Though prior research on the Youth ChalleNGe Program has sought to identify individual factors that determine program outcomes, no study has considered motivation for enrollment as a predictor of program success. Further, personality traits related to goal setting and self-regulation may impact the relationship between motivation and program outcome. Archival data was gathered from 710 participants in the Youth ChalleNGe …
Coparenting Among Families Of Treatment-Seeking Adolescents: Associations With Coping Behaviors And Psychological Adjustment, Andrew Joseph Flannery
Coparenting Among Families Of Treatment-Seeking Adolescents: Associations With Coping Behaviors And Psychological Adjustment, Andrew Joseph Flannery
Graduate Research Theses & Dissertations
In recent decades, the family literature has demonstrated that the influences of coparenting spread through the entire family system and also uniquely affect child and adolescent psychosocial outcomes. For example, extant evidence shows that coparenting influences the connection between marital conflict and adolescent psychosocial outcomes. However, the period of adolescence is underscored by novel stressors, as teenagers experience biological, psychological, social, and cognitive transformations. Moreover, the median age of onset for mood, anxiety, substance use, and impulse-control disorders is before 25 years of age and most frequently during adolescence. Additionally, the manner in which adolescents cope with stressors may buffer …
Co-Constructing Stigma: Treating Trauma In Adolescence, Isabelle Sanderson
Co-Constructing Stigma: Treating Trauma In Adolescence, Isabelle Sanderson
Graduate School of Professional Psychology: Doctoral Papers and Masters Projects
Public stigma and self-stigma are major factors that impede the seeking of mental health treatment as well as the development of an effective therapeutic alliance. This paper explores the co-creation of stigma dynamics from an intersubjective systems theory lens suggesting these dynamics may play a role for adolescent clients who have experienced significant trauma. Specifically, the potential overlooking and/or misdiagnosis of trauma-related experiences and symptoms often occurring with adolescents diagnosed with ADHD may be contributing to a co-constructed dynamic between the therapist and client to avoid an exploration of trauma that would be experienced as more stigmatizing, more threatening, and …
Developmental Predictors Of Adolescent Mental Health Stigma And A Cluster Randomized Controlled Trial Of "Ending The Silence" In New York City, Joseph S. Deluca
Developmental Predictors Of Adolescent Mental Health Stigma And A Cluster Randomized Controlled Trial Of "Ending The Silence" In New York City, Joseph S. Deluca
Dissertations, Theses, and Capstone Projects
This study explored predictors of mental health stigma among adolescents and the effectiveness of a school-based mental health stigma reduction and health promotion program, “Ending the Silence” (ETS), developed by the National Alliance on Mental Illness. Youth mental health service use is impacted by many factors, but concern about stigma and low mental health knowledge have been consistently identified as leading barriers to help-seeking. Beyond education and contact program components, existing research on how to design a successful adolescent stigma reduction intervention has been inconclusive. A diverse sample of 206 high school students in New York City participated in the …
Considering Culture And Context: A Mixed-Methods Approach To Examining Adolescent Engagement And Parent Satisfaction In Urban Out-Of-School-Time Programs, Jacqueline Oluwakemi Moses
Considering Culture And Context: A Mixed-Methods Approach To Examining Adolescent Engagement And Parent Satisfaction In Urban Out-Of-School-Time Programs, Jacqueline Oluwakemi Moses
FIU Electronic Theses and Dissertations
Adolescents of color living in poverty are at elevated risk for mental health problems with limited access to quality care, and 21% of youth in poverty are diagnosed with mental health disorders that, left untreated, lead to significant long-term consequences. Positive future orientation – optimistic expectations for graduation, gainful employment, and healthy relationships – among vulnerable adolescents has been identified as a unique protective factor associated with positive mental health trajectories. Out-of-school-time (OST) programs in neighborhood settings can promote positive future orientation and maximize benefits for adolescents, but we know little about cultural and contextual influences on youth enrollment and …
Rejection Sensitivity And Social Support As Predictors Of Peer Victimization Among Youth With Psychiatric Illness, Katherine C. Hyde
Rejection Sensitivity And Social Support As Predictors Of Peer Victimization Among Youth With Psychiatric Illness, Katherine C. Hyde
Graduate Theses and Dissertations
In this study, I examined whether rejection sensitivity and perceptions of social support predicted concurrent peer victimization in a sample of adolescents with psychiatric illness. Participants included 43 adolescents, aged 12-18 with diverse psychiatric diagnoses, who were recruited from a summer residential treatment program. Participants completed measures of peer victimization, perceptions of social support, and rejection sensitivity. Participants also completed the global victimization item in the Revised Olweus Bully/Victim Questionnaire, which allowed for comparison of rates of peer victimization across studies (Solberg & Olweus, 2003). Results replicate and extend previous research that indicates adolescents with psychiatric illness experience high rates …
An Integrated Analysis Of The Mechanisms By Which Parents Facilitate The Development Of Emotion Regulation In Young Adolescents, Andrew Fox
Clinical Psychology Dissertations
Effective emotion regulation strategies are associated with adaptive outcomes in youth. While previous research has established parental socialization of emotion regulation as an important predictor of adaptive outcomes, the mechanisms by which parents contribute to young adolescents’ emotion regulation outcomes is poorly understood. The current study examined pathways between parenting style, parental socialization of emotion regulation practices, and adolescent negative affectivity to emotion regulation outcomes in adolescents cross-sectionally and prospectively over the course of a year. Participants were 150 young adolescents ages to 10 to 14 (Mage = 13.03, SDage = .90; 51.33% female) and their parent/legal …
Dietary Intake And Executive Function In Youth And Emerging Adulthood: Environmental Correlates And Developmental Considerations, Amy Michelle Egbert
Dietary Intake And Executive Function In Youth And Emerging Adulthood: Environmental Correlates And Developmental Considerations, Amy Michelle Egbert
Dissertations
Obesity is a major public health concern impacting one in five young people in the U.S., and research suggests that consumption of high calorie, low nutrient foods may play a role in weight gain. Executive function (EF) has emerged as a factor that may play a role in dietary intake across youth development. Although biopsychosocial models of obesity emphasize the importance of identifying individual and environmental influences that may be associated with poor dietary intake, empirical research in this area is lacking. Therefore, the current set of studies seeks to 1) systematically review the literature on the association between EF …
Eating Expectancies Moderate The Relationship Between Negative Affect And Repetitive Negative Thought In Adolescents And Emerging Adulthood In Relation To Binge Eating Symptoms, Dylan M. Hurst, Leigh C. Brosof M.S., Cheri A. Levinson Ph.D
Eating Expectancies Moderate The Relationship Between Negative Affect And Repetitive Negative Thought In Adolescents And Emerging Adulthood In Relation To Binge Eating Symptoms, Dylan M. Hurst, Leigh C. Brosof M.S., Cheri A. Levinson Ph.D
Undergraduate Arts and Research Showcase
Objective: Adolescence and young adulthood are critical time periods for the development of an eating disorder (Dakanalis et al., 2017). Eating expectancies that eating helps manage negative affect (EE; learned associations that eating manages negative emotions), negative affect (NA; negative emotions, such as sadness, guilt, and fear), and repetitive negative thinking (RNT; recurrent intrusive negative thoughts about past or future events) are all predictive of eating disorder behaviors, such as binge eating (Bruce et al., 2009, Berg et al., 2017, McEvoy et al., 2019). However, it is less clear how these risk factors may impact one another to influence the …