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PubMed1993

The relation among stress, psychological symptoms, and eating disorder symptoms: a prospective analysis.

Prior research has shown that psychopathology and stress are associated with eating disorder symptoms, but the relations among these variables were confounded by concurrent measurement at a single point in time. The present study examined the relations among stress, psychological, and eating disorder symptoms prospectively over 4 months in 143 adolescent girls. In cross-sectional analyses at follow-up, controlling for baseline levels, stress and eating disorder symptoms each predicted changes in the other. Eating disorder symptoms were not predicted by psychological symptoms nor vice versa. Stress was predicted by eating disorder symptoms from the first assessment to follow-up. On balance, the results are somewhat stronger for the argument that eating disorder symptoms are predictive of subsequent psychological stress over short periods of time.

Adolescent↗

PubMed1993

Comorbidity of DSM-III-R eating disorders and personality disorders.

The purpose of this study was to assess the relationship of eating disorders to personality disorders. Two hundred subjects were independently administered the Structured Clinical Interview for DSM-III-R (SCID) and the Personality Disorder Examination (PDE) face-to-face by two experienced clinicians. One hundred forty-six also completed the Personality Diagnostic Questionnaire-Revised (PDQ-R). Rates of personality disorder among patients with and without eating disorders were determined by each of the three instruments. Comorbidity between bulimia nervosa and anorexia nervosa and a conservative estimate of individual Axis II disorders was examined. Eating disorders with and without personality disorders were compared on age at onset and two measures of illness severity. Results indicate that the association, in general, between personality disorders and eating disorders varies by diagnostic method. Bulimia nervosa, however, is associated with borderline personality disorder and anorexia nervosa with avoidant personality disorder. Eating disorders with personality disorders are characterized by chronicity and low levels of functioning compared with eating disorders without personality disorders.

Adolescent↗

PubMed1994

Eating attitudes in urban and suburban adolescents.

We administered the Eating Attitudes Test (EAT), Rosenberg Self-Esteem Scale, and Spielberger Trait Anxiety Inventory to two populations of high school students. The first group, 268 suburban females (mean age 16.2 years), completed their questionnaires in May 1988. The second population, 389 females and 281 males (mean age 16.0 years) in a city school with 92% black of Hispanic students, completed their questionnaires in February 1990 and were also measured for height and weight as part of a health screening. Scores of 21 or higher on the EAT-26 were achieved by 17.5% of the suburban females, 15.0% of the urban females, and 6.0% of the urban males. Significantly more suburban females (63%) considered themselves overweight, compared with both urban females (35%) and males (19%), yet only 14% of suburban females were calculated to be > 10% over ideal body weight, compared with 45% of urban females and 39% of urban males. Contrary to expectations, self-esteem was higher and anxiety lower in the urban students than the suburban students; self-esteem and anxiety were each significantly correlated with higher EAT scores in both populations, but believing oneself overweight was correlated with higher EAT scores in only the suburban students. These data indicate that abnormal eating attitudes are present among both urban and suburban students but with important differences in their manifestations and implications.

Adolescent↗

PubMed1995

Risk factors for eating disorders in Greek- and Anglo-Australian adolescent girls.

Past research indicates ethnicity may be related to eating disorder and related risk factors. The present study examines risk factors for eating disorders in 50 Anglo- and 50 Greek-Australian girls (mean age = 13.5 years). The variables assessed included bulimic tendencies, body dissatisfaction, use of extreme weight loss behaviors (EWLBs), self-esteem, depression and family cohesion and adaptability. Cultural eating patterns were also explored. A stepwise discriminant function analysis to examine whether the two groups could be discriminated on these variables was significant and correctly classified 73.9% of the sample, the chief discriminating variables being Pressure to Eat, EWLBs, and Family Adaptability. Univariate analyses indicated differences between the groups on Pressure to Eat, Family Adaptability, and Mother's Shape. Although the groups were discriminable, a number of variables generally associated with eating disorder did not contribute to the function. These data are discussed in terms of cultural assimilation.

Adolescent↗

PubMed1995

Sociocultural influences on eating attitudes and behaviors, body image, and psychological functioning: a comparison of African-American, Asian-American, and Caucasian college women.

Eating attitudes and behaviors, body image, and psychological functioning were evaluated in 98 female college students: 36 African-Americans, 34 Asian-Americans, and 28 Caucasians. African-Americans had significantly higher body mass index than either Asian-American or Caucasians. In contrast, Caucasians reported greater levels of disordered eating and dieting behaviors and attitudes and greater body dissatisfaction than did Asian-Americans and African-Americans who differed little on these measures. The nature of variability in these eating behaviors and attitudes and body image was also examined within each of the three groups. A generally consistent pattern emerged within each racial group: low self-esteem and high public self-consciousness were associated with greater levels of problematic eating behaviors and attitudes and body dissatisfaction. A history of being teased about weight and size was associated with problematic eating behaviors and attitudes and body dissatisfaction in African-Americans and Caucasians but not in Asian-Americans. The findings suggest that there exist important racial differences on various aspects of eating, dieting, and body image in college women. Contrary to hypothesis, the degree of acculturation and assimilation within the African-American and Asian-American groups was unrelated to variability in these domains.

Acculturation↗

PubMed2002

A meta-analytic examination of the relationship between child sexual abuse and eating disorders.

OBJECTIVE: This study had two goals. The first was to assess the magnitude and consistency of the relationship between child sexual abuse (CSA) and eating disorders (ED). The second was to examine methodological factors contributing to the heterogeneity of this relationship. METHOD: Meta-analysis was used to examine both questions. Fifty-three studies were included in the analysis. RESULTS: A small, significant positive relationship between CSA and ED emerged. The relationship was marked by heterogeneity. Effect sizes were largest when CSA was the grouping variable, the Eating Disorders Inventory (EDI) or the Eating Attitudes Test (EAT) was used as the measure of eating disorders, and nonclinical groups were compared with clinical samples. DISCUSSION: Models of CSA and ED need to more clearly specify what aspects of ED (e.g., body image or binge eating) are most influenced by which types of CSA. These specific relationships then need to be examined empirically.

Adolescent↗

PubMed2002

Homosexuality as a specific risk factor for eating disorders in men.

OBJECTIVE: The current study examined whether homosexuality is a specific risk factor for disordered eating in men. METHOD: Men (64 heterosexual and 58 homosexual) completed the Beck Depression Inventory (BDI), the Rosenberg Self-Esteem Scale (RSE), the Masculinity and Femininity scales of the Bem Sex-Role Inventory (BSRI), the Bulimia Test-Revised (BULIT-R), the Eating Attitudes Test (EAT-26), and the Body Shape Questionnaire (BSQ). RESULTS: Homosexual men had more pathological scores on the BDI, RSE, BULIT-R, EAT-26, and BSQ. Additionally, homosexual men reported greater discomfort with sexual orientation. After controlling for differences in depression, self-esteem, and comfort with sexual orientation, sexual orientation continued to account for significant variance in BULIT-R, EAT-26, and BSQ scores. DISCUSSION: Future research may benefit from exploring aspects of homosexuality that may contribute specifically to risk for disordered eating in men.

Adolescent↗

PubMed2002

The relationship between compulsive buying and eating disorders.

OBJECTIVE: Compulsive buying has received increased research attention in the last decade. The disorder has high rates of comorbidity for other disorders, including eating disorders. This study explored the possible relationship between compulsive buying and eating disorders. METHOD: Twenty women who scored in the pathological range on a measure of compulsive buying and 20 controls were recruited via the media. Various measures of psychopathology and eating disorder symptoms were administered to both groups. RESULT: Compulsive buyers were significantly more likely to have a higher lifetime history of substance abuse or dependence. No differences existed between normal controls and compulsive buyers in prevalence of current or lifetime eating disorders, nor were there differences in scores of eating-related psychopathology. DISCUSSION: This work failed to demonstrate an increased risk for eating disorder in compulsive buyers, although a higher rate of substance dependence or abuse and higher scores on pathological personality dimension scales were seen.

Aged↗

PubMed2002

The effects of psychoeducation on disturbed eating attitudes and behavior in young women with type 1 diabetes mellitus.

OBJECTIVE: This study aimed to evaluate the effect of a six-session psychoeducation (PE) program on young women with type 1 diabetes mellitus (DM) and disordered eating attitudes and behavior. METHOD: Two hundred twelve young women attending a pediatric diabetes clinic were screened for signs of eating disturbance. Of these women, 130 passed the screening and were invited to participate in the intervention phase of the study. Eighty-five subjects were randomized to the PE or treatment-as-usual group. Assessments were conducted before and after treatment and at 6-month follow-up. RESULTS: Intention-to-treat group by time multivariate analyses of variance (MANOVAs) indicated significant reductions following PE treatment on the Restraint and Eating Concern subscales of the Eating Disorder Examination (EDE) and on the Drive for Thinness and Body Dissatisfaction subscales of the Eating Disorder Inventory (EDI), but no improvement in frequency of purging by insulin omission or hemoglobin A1c levels. DISCUSSION: The PE group was associated with reductions in eating disturbance, but not with improved metabolic control.

Adolescent↗

PubMed2003

Comparing clinical and research treatments for eating disorders.

OBJECTIVE: This study evaluated whether there is a gap between research and practice in the treatment of eating disorders. METHOD: Psychologists in clinical practice (N = 126) were surveyed regarding their treatment of a recent client with an eating disorder and a content analysis of published treatment outcome studies for eating disorders (N = 76) was conducted. RESULTS: The treatment of eating disorders in clinical and research settings was found to differ significantly on several variables, including the types of therapeutic issues addressed and the frequency of comorbidity seen in clients. Logistic regression analyses found that the frequency with which psychologists read journal articles about eating disorders was significantly related to whether their clients received empirically validated treatment. DISCUSSION: Psychologists in clinical practice are not using empirically validated treatments not only because of a lack of training but also because such treatments provide little guidance for dealing with the issues and comorbid problems that their clients with eating disorders often have.

Adolescent↗

PubMed2001

Pathways mediating sexual abuse and eating disturbance in children.

OBJECTIVE: To examine the relationship between childhood maltreatment and eating disorders in a sample of children. METHOD: Twenty 10-15-year-old female children who were receiving treatment following reported childhood sexual abuse and 20 age-matched controls were compared on a series of measures assessing eating disorder behaviors, body image concerns, substance use, mood, impulsive behavior, and self-concept. RESULTS: Sexually abused children reported higher levels of eating disorder behaviors, impulsive behaviors, and drug abuse than controls. Furthermore, behavioral impulsivity provided the strongest mediational effect between a history of childhood sexual abuse and purging and restrictive dieting behavior. Drug use proved to be a significant secondary mediator of the childhood sexual abuse eating disorder behavior association. DISCUSSION: These data support the hypothesis that childhood sexual abuse is related to disordered eating in children, and extend similar findings that have been previously reported with adults. Behavioral impulsivity and drug use appear to be significant mechanisms that influence eating disorder behavior following childhood sexual abuse.

Adolescent↗

PubMed2003

Season of birth and disordered eating in female college students.

OBJECTIVE: Earlier studies have suggested relationships between season of birth and eating disorders. These studies have found that women with anorexia nervosa (AN) and bulimia nervosa (BN) are more likely to be born in the first 6 months rather than in the last 6 months of the year. The current study examines relationships between season of birth and general disordered eating in female college students. METHOD: Subjects included 155 female twin and triplet participants from the Michigan Twin Study. Disordered eating was assessed with subscales from the Minnesota Eating Disorders Inventory (M-EDI) and the Eating Disorders Examination Questionnaire (EDEQ). Both a two-group comparison and a three-group comparison of M-EDI and EDEQ scores were conducted. The two-group comparison comprised subjects born between January and June and subjects born between July and December. The three-group comparison comprised subjects born between January and April, between May and August, and between September and December. RESULTS: No significant differences in M-EDI or EDEQ scores were observed in any of the group comparisons. DISCUSSION: The lack of significant differences across birth periods suggests that season of birth effects may not generalize to general disordered eating characteristics in nonclinical samples.

Adolescent↗

PubMed2001

Sexual orientation and eating psychopathology: the role of masculinity and femininity.

OBJECTIVE: Previous research suggests that eating disorders are related to homosexuality in men, although links with female sexual orientation are less clear. Appearance factors have generally been implicated in this relationship. However, previous studies have failed to consider the role of femininity, even though evidence suggests that this is a more critical factor than sexual preference. The aim of this study was to consider the relationship between gender-role orientation and eating psychopathology in nonclinical men and women of different sexual orientations. METHOD: One hundred university students (40 homosexual; 60 heterosexual) completed the Bem Sex Role Inventory and the Eating Attitudes Test. RESULTS: For the group as a whole, there were links between femininity and high levels of eating psychopathology, whereas masculinity was associated with relatively healthy eating-related attitudes and behaviors. When considering the role of sexual orientation, these links were specific to homosexual men and women. CONCLUSIONS: In relation to homosexual men and women, the results support a model where femininity might be seen as a specific risk factor for eating disorders, whereas masculinity is likely to be a protective factor. Methodological and conceptual implications are discussed.

Adolescent↗

PubMed2001

Reducing risk factors for eating disorders: targeting at-risk women with a computerized psychoeducational program.

OBJECTIVE: This controlled study evaluated whether an 8-week program offered over the Internet would significantly decrease body image dissatisfaction, disordered eating patterns, and preoccupation with shape/weight among women at high risk for developing an eating disorder. METHOD: Fifty-six college women were recruited on the basis of elevated scores (> or =110) on the Body Shape Questionnaire (BSQ). Psychological functioning, as measured by the Eating Disorder Inventory Drive for Thinness (EDI-DT) subscale, Eating Disorder Examination-Questionnaire (EDE-Q), and the BSQ, was assessed at baseline, posttreatment, and at 10-week follow-up. RESULTS: All participants improved over time on most measures, although effect sizes suggest that the program did impact the intervention group. DISCUSSION: Findings suggest that technological interventions may be helpful for reducing disordered eating patterns and cognitions among high-risk women. Future research is needed to assess whether such programs are effective over time for prevention of and reduction in eating disorder symptomatology.

Adult↗

PubMed2001

Alcohol abuse and dysfunctional eating in adolescent girls: the influence of individual differences in sensitivity to reward and punishment.

OBJECTIVE: An unusually high comorbidity of eating disorders and alcohol abuse has been found in clinical and community samples of young women. This paper proposes that individual differences in sensitivity to reward and punishment may influence the propensity of young women to engage in dysfunctional eating and drinking behaviour. METHOD: The Drive for Thinness scale, the Alcohol Use Disorders Identification Test and the BIS/BAS scales were administered to 232 high school girls. RESULTS: Heightened sensitivity to reward was the better predictor of alcohol misuse while heightened sensitivity to both reward and punishment was predictive of dysfunctional eating. When categorised by group, alcohol abusing, dysfunctional eating, and comorbid girls reported greater sensitivity to reward than non-disordered girls. Girls with dysfunctional eating with and without comorbid alcohol abuse reported greater sensitivity to punishment than alcohol abusing only girls. DISCUSSION: These findings suggest that girls who abuse alcohol and have dysfunctional eating may share a vulnerability to heightened sensitivity to reward, yet be differentiated by sensitivity to punishment.

Adolescent↗

PubMed2001

Postnatal depression, eating, exercise, and vomiting before and during pregnancy.

OBJECTIVE: To examine the postnatal distress and the eating, exercise, and weight losing behavior of women before and during pregnancy. METHOD: The subjects were healthy women who had given birth to a singleton healthy baby in the week before the study. They were drawn from two consecutive series of mothers of babies whose birth weights were either < or =2,500 g or >2,500 g. A total of 181 women were interviewed using a standardized interview modified for pregnancy and related behaviors. They also completed the Edinburgh Postnatal Distress Questionnaire. RESULTS: Regression analysis produced a final model containing variables that made a unique contribution to predicting the level of distress of women in the week following childbirth. The model accounted for 25% of the variance and included four variables that were associated with greater distress: fear of weight gain before and during pregnancy, being distracted by thoughts of food during pregnancy, being afraid of gaining more weight than the pregnancy would explain, and vomiting more frequently during the first 3-4 months of pregnancy. A fifth variable accounted for less distress, that is, participating in low-intensity exercise for reasons of shape and weight during months 3-4 of pregnancy. Other variables associated with distress only in the preliminary analysis were maternal age, binge eating, and vomiting before pregnancy. The most distressed mothers were suffering from an eating disorder at the time of pregnancy. The binge and/or purge type of eating disorder was associated with more distress than a food restriction type. DISCUSSION: Postnatal distress is associated with body weight and shape concerns, with disordered eating before and during pregnancy, and with vomiting during pregnancy. The protective role of low-intensity exercise during early pregnancy needs to be explored. Women with eating disorders should be considered at risk for postnatal problems.

Adult↗

PubMed2002

Psychological stress, coping, and symptoms of disordered eating in a community sample of young Australian women.

OBJECTIVE: To investigate the relationships among stress, coping, and symptoms of disordered eating in a community sample of young Australian women. METHOD: A longitudinal study design was employed. Two mail-out surveys, assessing perceived psychological stress, coping strategies, body weight dissatisfaction, dieting, and disordered eating behaviors, were completed 6 months apart by 415 young women selected from a cohort of the Women's Health Australia Study. RESULTS: Strong cross-sectional relationships among the study variables were found. Results of longitudinal analyses, however, demonstrated only tenuous relationships among stress, coping, and later symptoms of disordered eating. DISCUSSION: These results did not support the hypothesis that stress and coping strategies would predict disordered eating over time. Some evidence was found for a modest reverse relationship between stress and disordered eating. Although contrary to generally accepted theoretical models of disordered eating, these findings are consistent with those of the few previous longitudinal studies reported. Theoretical implications are discussed.

Adaptation, Psychological↗

PubMed2004

Effects of negative mood induction and impulsivity on self-perceived emotional eating.

OBJECTIVE: The current study investigates the influence of negative mood induction and impulsivity on self-perceptions with respect to emotional eating. Negative affect as well as high impulsivity was expected to increase levels of self-perceived emotional eating. METHOD: College students who were high versus low in impulsivity were assigned randomly to either a negative (failure on a quiz) or a neutral mood induction. Their levels of self-perceived emotional eating were measured after and before mood induction. RESULTS: Negative affect appeared to enhance the level of self-perceived emotional eating significantly (p < .01). There was no statistically significant effect of impulsivity. The interaction effect of affect and impulsivity approached significance (p = .08), indicating that highly impulsive subjects compared with subjects low in impulsivity were more strongly influenced by negative affect in self-perceived emotional eating. DISCUSSION: Negative affect substantially influences self-perceptions in terms of emotional eating, which is relevant for both prevention and treatment.

Adolescent↗