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Yan Y, Zhang J, Lu N. Adverse childhood experiences and self-esteem among adolescents: The role of social capital and gender. J Adolesc 2024; 96:1539-1554. [PMID: 38867608 DOI: 10.1002/jad.12361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 05/24/2024] [Accepted: 06/03/2024] [Indexed: 06/14/2024]
Abstract
INTRODUCTION Adverse childhood experiences have long-lasting effects on the self-esteem of adolescents. However, the extrinsic mechanism linking them to self-esteem, which is more modifiable, has rarely been examined. Therefore, this study examined the mediating roles of family, school, and peer social capital and the moderating role of gender in the association between adverse childhood experiences and adolescent self-esteem. METHODS This study involved a cross-sectional survey of first- and second-grade students in the only high school in Wusu, Xinjiang Uygur Autonomous Region, China. Data were collected in May 2023. A sample of 2539 students (M = 16.84 years old; 55.65% female) was included. The measurement models of family, school, and peer social capital were constructed using confirmatory factor analysis. The mediating roles of the three types of social capital and the moderating role of gender were examined using mediation analysis and multiple-group analysis, respectively. RESULTS Family, school, and peer social capital significantly mediated the relationship between adverse childhood experiences and adolescent self-esteem, and family social capital played the strongest role. Gender significantly moderated the direct effect of adverse childhood experiences on self-esteem. The direct effect was significant only among girls. CONCLUSIONS This study underscores the protective role of social capital for self-esteem among adolescents in Northwestern China and similar areas with relatively limited social services. Comprehensive interventions promoting social capital, especially family social capital, should be conducted to enhance self-esteem among adolescents.
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Affiliation(s)
- Yuqi Yan
- Center for Studies of Sociological Theory & Method, Renmin University of China, Beijing, China
- Department of Social Work, School of Social Research, Renmin University of China, Beijing, China
| | - Jingyue Zhang
- Department of Sociology, School of Philosophy and Sociology, Jilin University, Changchun, China
| | - Nan Lu
- Center for Studies of Sociological Theory & Method, Renmin University of China, Beijing, China
- Department of Social Work, School of Social Research, Renmin University of China, Beijing, China
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Mitchison D, Wang SB, Wade T, Haynos AF, Bussey K, Trompeter N, Lonergan A, MNeuroPsych JT, Hay P. Development of transdiagnostic clinical risk prediction models for 12-month onset and course of eating disorders among adolescents in the community. Int J Eat Disord 2023; 56:1406-1416. [PMID: 37052452 PMCID: PMC10404110 DOI: 10.1002/eat.23951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/26/2023] [Accepted: 03/26/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVE To develop and internally validate risk prediction models for adolescent onset and persistence of eating disorders. METHODS N = 963 Australian adolescents (11-19 years) in the EveryBODY Study cohort completed online surveys in 2018 and 2019. Models were built to predict 12-month risk of (1) onset, and (2) persistence of a DSM-5 eating disorder. RESULTS Onset Model. Of the n = 687 adolescents without an eating disorder at baseline, 16.9% were identified with an eating disorder after 12 months. The prediction model was based on evidence-based risk factors for eating disorder onset available within the dataset (sex, body mass index percentile, strict weight loss dieting, history of bullying, psychological distress, weight/shape concerns). This model showed fair discriminative performance (mean AUC = .75). The most important factors were psychological distress, weight and shape concerns, and female sex. Diagnostic Persistence Model. Of the n = 276 adolescents with an eating disorder at baseline, 74.6% were identified as continuing to meet criteria for an eating disorder after 12 months. The prediction model for diagnostic persistence was based on available evidence-based risk factors for eating disorder persistence (purging, distress, social impairment). This model showed poor discriminative performance (mean AUC = .65). The most important factors were psychological distress and self-induced vomiting for weight control. DISCUSSION We found preliminary evidence for the utility of a parsimonious model for 12-month onset of an eating disorder among adolescents in the community. Future research should include additional evidence-based risk factors and validate models beyond the original sample. PUBLIC SIGNIFICANCE This study demonstrated the feasibility of developing parsimonious and accurate models for the prediction of future onset of an eating disorder among adolescents. The most important predictors in this model included psychological distress and weight and shape concerns. This study has laid the ground work for future research to build and test more accurate prediction models in diverse samples, prior to translation into a clinical tool for use in real world settings to aid decisions about referral to early intervention.
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Affiliation(s)
- Deborah Mitchison
- Eating Disorder and Body Image Network, Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Shirley B. Wang
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
| | - Tracey Wade
- Flinders Institute for Mental Health and Wellbeing, Flinders University, Adelaide, South Australia, Australia
| | - Ann F. Haynos
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Kay Bussey
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Nora Trompeter
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Alexandra Lonergan
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Jack Tame MNeuroPsych
- Eating Disorder and Body Image Network, Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Phillipa Hay
- Eating Disorder and Body Image Network, Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
- Mental Health Services, South West Sydney Local Health District, Campbelltown, Australia
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Bedrosova M, Kvardova N, Machackova H. Bystanders' Victim Blaming and Minimizing Consequences of Weight-Based Cyberhate Attacks: The Roles of anti-Fat Attitudes, Body-Positive Online Content, and Gender. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:6915-6941. [PMID: 36541163 DOI: 10.1177/08862605221140037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Physical appearance and, specifically, weight are common reasons for cyberhate attacks among adolescents. Using a between-subject experimental design, this study focuses on the bystanders of such attacks on Instagram. We investigate bystanders' assessments in the form of two moral disengagement (MD) mechanisms-victim blaming and minimizing consequences-and we compare the assessments of attacks that are diversified by the victim's weight (i.e., a victim who is plus-size and a victim who is thinner). We also examine the moderating roles of bystanders' prejudice against people who are plus-size in the form of the so-called anti-fat attitudes, their frequency of viewing body-positive online content, and gender. The study's data come from an online survey conducted in 2020 with a representative sample of 658 Czech adolescents, aged 13-18. We tested our hypotheses with structural equation modeling. The results show that the two MD mechanisms work differently. The victim's displayed weight affected the bystanders' tendency to victim blame: adolescents blamed the victim who is plus-size more than the victim who is thinner, but the victim's weight made no difference in minimizing the consequences of the incident. A moderating effect for anti-fat attitudes and gender was found for victim blaming. Bystanders with higher anti-fat attitudes and boys blamed the victim who is plus-size more than the victim who is thinner. On the other hand, there was no effect for the frequency of viewing body-positive online content for either of the MD mechanisms. The results are discussed with regard to the differences between the two mechanisms and the practical implications for educational and prevention programs for youth.
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Affiliation(s)
- Marie Bedrosova
- Interdisciplinary Research Team on Internet and Society, Faculty of Social Studies, Masaryk University, Czech Republic
| | - Nikol Kvardova
- Interdisciplinary Research Team on Internet and Society, Faculty of Social Studies, Masaryk University, Czech Republic
| | - Hana Machackova
- Interdisciplinary Research Team on Internet and Society, Faculty of Social Studies, Masaryk University, Czech Republic
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Williot A, Blackburn MÈ, Auclair J, Brault MC, Carbonneau N, Dion J. A structural equation model of intuitive eating with adolescents. EUROPEAN REVIEW OF APPLIED PSYCHOLOGY 2023. [DOI: 10.1016/j.erap.2022.100816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Trompeter N, Austen E, Bussey K, Reilly EE, Cunningham ML, Mond J, Lonergan A, Tame J, Mitchison D. Examination of bidirectional relationships between fear of negative evaluation and weight/shape concerns over 3 years: A longitudinal cohort study of Australian adolescents. Int J Eat Disord 2023; 56:646-653. [PMID: 36609864 PMCID: PMC10357886 DOI: 10.1002/eat.23881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/13/2022] [Accepted: 12/13/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Adolescents commonly experience both fear of negative evaluation and weight/shape concerns. However, evidence concerning the prospective associations between these constructs during adolescence is limited. The current study examined the bidirectional relationships between fear of negative evaluation and weight/shape concerns over a 3-year period in adolescents. METHOD Australian high school students (n = 2073; 55% girls) completed self-report measures at three timepoints, each 1 year apart. RESULTS Findings showed a bidirectional relationship, whereby increases in fear of negative evaluation predicted exacerbated weight/shape concerns, and vice versa. Results point towards a vicious maintenance cycle between fear of negative evaluation and weight/shape concerns. DISCUSSION Findings from the current study highlight the importance of considering both fear of negative evaluation and weight/shape concerns in the development of health promotion and prevention programs designed to reduce the occurrence and adverse effects of body dissatisfaction or improve general mental health. PUBLIC SIGNIFICANCE Many adolescents experience some level of fear of negative evaluation (i.e., worry about being judged by others) and worry about their weight and/or shape. This study examined the prospective relationship between both constructs. Findings showed a bidirectional relationship, whereby higher fear of negative evaluation predicted increased weight/shape concerns, and vice versa. Programs designed to reduce body dissatisfaction might be improved by targeting both fear of negative evaluation and weight/shape concerns.
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Affiliation(s)
- Nora Trompeter
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
- Department of Psychological Medicine, King's College London, London, UK
| | - Emma Austen
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Kay Bussey
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Erin E Reilly
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
| | | | - Jonathan Mond
- Centre for Rural Health, University of Tasmania, Launceston, Tasmania, Australia
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Alexandra Lonergan
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Jack Tame
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Deborah Mitchison
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
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Roberts SR, Hay P, Bussey K, Trompeter N, Lonergan A, Mitchison D. Associations among relationship status, gender, and sexual attraction in Australian adolescents' eating pathology. Int J Eat Disord 2023; 56:551-561. [PMID: 36420932 DOI: 10.1002/eat.23861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/11/2022] [Accepted: 11/12/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Engaging in romantic relationships in adolescence may inadvertently increase participation in appearance culture and the risk for eating pathology. Little research has considered this effect, particularly as it relates to adolescents' gender identity and sexual attraction. Therefore, this study examined the associations among relationship status, gender, and sexual attraction in adolescents' eating pathology. METHODS Data from the first wave of the EveryBODY study, a large sample of Australian adolescents aged 11-19 years (n = 3262, Mage = 15.00, 53.80% girls), were used. Participants reported their relationship status and eating pathology (fasting, purging, binge eating, driven exercise, steroid use, and shape/weight concerns) using an online survey. RESULTS Logistic regressions adjusting for age and BMI percentile revealed that romantic relationships were associated with higher adjusted odds (AORs) for reporting clinical frequency/severity threshold of fasting, purging, steroid use, and shape and weight concerns (AORs: 1.34-3.68). Relative to boys, girls had higher adjusted odds of reporting clinical frequency/severity threshold of all eating disorder features (AORs: 1.47-7.40), except for steroid use for muscle gain. Adolescents who reported same-sex attraction, were unsure of their sexual attraction, or did not endorse any sexual attraction had greater adjusted odds of reporting clinical frequency/severity threshold of fasting, purging, and shape and weight concerns (AORs: 1.35-1.83) than those with only other-sex sexual attraction. Interactions among relationship status, gender, and sexual attraction were nonsignificant. CONCLUSIONS Romantic experience emerged as a novel correlate for adolescents' eating pathology. Future research should uncover the contextual factors within relationships that may contribute to this association. PUBLIC SIGNIFICANCE The initiation of romantic relationships is normative during adolescence. However, adolescents' romantic desirability is often determined by their physical appearance, increasing the risk for eating pathology. Among a large sample of Australian adolescents, romantic involvement was associated with greater likelihood of clinical threshold eating pathology for adolescent boys and girls, regardless of sexual attraction. It is urgent to identify the factors within romantic relationships that are associated with eating pathology.
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Affiliation(s)
- Savannah R Roberts
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Phillipa Hay
- Eating and Body Image Group, Translational Health Research Institute, School of Medicine, Western Sydney University, Australia
| | - Kay Bussey
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Nora Trompeter
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Alexandra Lonergan
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Deborah Mitchison
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia.,Translational Health Research Institute, School of Medicine, Western Sydney University, Australia
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Clague CA, Prnjak K, Mitchison D. "I don't want them to judge me": Separating out the role of fear of negative evaluation, neuroticism, and low self-esteem in eating disorders. Eat Behav 2023; 49:101708. [PMID: 36868004 DOI: 10.1016/j.eatbeh.2023.101708] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 02/13/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023]
Abstract
Fear of negative evaluation (FNE) is a transdiagnostic risk factor that has an important role in eating disorder (ED) onset and maintenance, as well as other psychopathologies. However, no research has explored whether FNE has associations with probable ED status when accounting for related vulnerabilities, and whether this relationship changes across gender and weight status. The current study sought out to explore how FNE explains probable ED status above and beyond heightened neuroticism and low self-esteem, with gender and BMI serving as potential moderators of this relationship. Participants were 910 university students (85 % females) aged 18-26 years (Mage = 19.90; SDage = 2.06) living in Australia, who completed measures of psychological distress, personality, self-esteem, FNE, and ED status. Logistic regression analysis showed that FNE was associated with probable ED status. This relationship was stronger among individuals with underweight and healthy-weight, whilst an interaction with gender was not significant. These findings shed light on the unique role FNE has in probable ED status across gender, which appears to be more pronounced in those with a lower BMI. Therefore, FNE should be considered as a potential target in ED screening and early intervention alongside other important transdiagnostic risk factors.
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Affiliation(s)
- Caitlin A Clague
- School of Psychology, Western Sydney University, Sydney, Australia.
| | - Katarina Prnjak
- School of Medicine, Translational Health Research Institute, Western Sydney University, Sydney, Australia
| | - Deborah Mitchison
- School of Medicine, Translational Health Research Institute, Western Sydney University, Sydney, Australia
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Blake K, Portingale J, Giles S, Griffiths S, Krug I. Dating app usage and motivations for dating app usage are associated with increased disordered eating. J Eat Disord 2022; 10:186. [PMID: 36443873 PMCID: PMC9706906 DOI: 10.1186/s40337-022-00693-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 10/23/2022] [Indexed: 11/30/2022] Open
Abstract
The centrality of physical appearance in dating app environments may constitute an appearance-related pressure that increases the likelihood of body dissatisfaction (BD) and disordered eating (DE), thus exacerbating the relationship between DE-predictive traits and DE itself. Although dating app use has been linked to BD and DE, prior research has also neglected the role of individuals' dating app use motivations and relevant traits in eating pathology. To address these gaps, the current study investigated whether dating app usage moderated the effects of appearance-based rejection sensitivity, fear of negative evaluation, emotion dysregulation, and perceived social rank on DE. We also examined the unique effects of individuals' dating app use motivations on DE. Participants (N = 690) completed baseline measures of demographic and trait variables including dating app usage. DE was positively associated with female gender, higher body mass index, a history of eating disorder (ED) diagnosis, appearance-based rejection sensitivity, and emotion dysregulation. There was a small, positive association between dating app usage and DE, indicating that dating app users were more likely to report DE symptoms, appearance-based rejection sensitivity, and emotion dysregulation. No investigated predictor was moderated by dating app usage, but four of the six measured motivations for using dating apps (love, self-worth, ease of communication, and thrill of excitement motivations) were associated with DE among the dating app user sample (casual sex and trendiness motivations were not). Given that DE behaviours can lead to EDs, the present findings suggest that lifetime dating app usage may increase socio-cultural appearance pressures that confer risk for DE.
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Affiliation(s)
- K Blake
- Melbourne School of Psychological Sciences, University of Melbourne, Redomond Barry Builiding, Level 7, Room 707, Melbourne, VIC, 3010, Australia.,School of Biological, Earth, and Environmental Sciences, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - J Portingale
- Melbourne School of Psychological Sciences, University of Melbourne, Redomond Barry Builiding, Level 7, Room 707, Melbourne, VIC, 3010, Australia
| | - S Giles
- Melbourne School of Psychological Sciences, University of Melbourne, Redomond Barry Builiding, Level 7, Room 707, Melbourne, VIC, 3010, Australia
| | - S Griffiths
- Melbourne School of Psychological Sciences, University of Melbourne, Redomond Barry Builiding, Level 7, Room 707, Melbourne, VIC, 3010, Australia
| | - I Krug
- Melbourne School of Psychological Sciences, University of Melbourne, Redomond Barry Builiding, Level 7, Room 707, Melbourne, VIC, 3010, Australia.
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Mitchison D, Mond J, Griffiths S, Hay P, Nagata JM, Bussey K, Trompeter N, Lonergan A, Murray SB. Prevalence of muscle dysmorphia in adolescents: findings from the EveryBODY study. Psychol Med 2022; 52:3142-3149. [PMID: 33722325 DOI: 10.1017/s0033291720005206] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND We sought to provide the first point prevalence estimates of muscle dysmorphia (MD), a form of body dysmorphic disorder characterized by a preoccupation with perceived insufficient muscularity, in adolescents. METHODS Data were taken from a survey of 3618 Australian adolescents (11.172-19.76 years; 49.3% girls). Measures captured demographic characteristics, symptoms of MD and eating disorders, psychological distress and functional impairment. Diagnostic criteria for MD developed by Pope et al. (1997, Psychosomatics, 38(6), 548-557) were applied, entailing preoccupation with insufficient muscularity causing significant levels of distress or disability that cannot be better accounted for by an eating disorder. RESULTS The point prevalence of MD was 2.2% [95% confidence interval (CI) 1.6-3.0%] among boys and 1.4% (95% CI 0.9-2.0%) among girls. Prevalence was not associated with gender (V = 0.031) or socioeconomic status (SES) (partial η2< 0.001), but was marginally associated with older age (partial η2 = 0.001). Boys with MD were more likely than girls with MD to report severe preoccupation with muscularity (V = 0.259) and a weight-lifting regime that interfered with their life (V = 0.286), whereas girls with MD were more likely to report discomfort with body exposure (V = 0.380). CONCLUSIONS While future epidemiological research using diagnostic interviews is needed to verify these estimates, the findings suggest that MD is relatively common from early to late adolescence. Gender differences in MD prevalence may be minimal; however, the symptom profile appears to diverge between boys and girls. These findings provide a platform for future, analytical research designed to inform clinical and public health interventions.
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Affiliation(s)
- Deborah Mitchison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Department of Psychology, Centre for Emotional Health, North Ryde, NSW, Australia
| | - Jonathan Mond
- Centre for Rural Health, University of Tasmania, Launceston, TAS, Australia
| | - Scott Griffiths
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Camden and Campbelltown Hospitals, SWSLHD, Camden and Campbelltown, NSW, Australia
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Kay Bussey
- Department of Psychology, Centre for Emotional Health, North Ryde, NSW, Australia
| | - Nora Trompeter
- Department of Psychology, Centre for Emotional Health, North Ryde, NSW, Australia
| | - Alexandra Lonergan
- Department of Psychology, Centre for Emotional Health, North Ryde, NSW, Australia
| | - Stuart B Murray
- Department of Psychiatry & Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
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Exploring associations between positive and negative valanced parental comments about adolescents' bodies and eating and eating problems: a community study. J Eat Disord 2022; 10:43. [PMID: 35331338 PMCID: PMC8953043 DOI: 10.1186/s40337-022-00561-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescence is a time of rapid emotional and physical development when foundational self-concepts (including beliefs about one's weight and shape) are established. Parents are key influencers of adolescent beliefs and behaviours. This study aimed to investigate associations between perceived positive and negative parental comments on weight/shape and eating, with sons' and daughters' psychological distress and eating disorder cognitions (EDCs). METHODS A representative mixed-sex sample of 2204 Australian adolescents (12-19 years) from the EveryBODY Study completed an online survey exploring eating behaviours, psychological wellbeing and experiences of parental comments regarding weight, shape and eating behaviours. RESULTS Correlation analyses revealed that adolescents' reports of perceived positive parental comments on shape/weight were significantly associated with lower psychological distress and EDCs only for daughters. All perceived negative parental comments on shape/weight or eating were associated with greater psychological distress and EDCs for both sons and daughters. In the final model of the regression analysis, only perceived parental negative shape/weight and maternal negative eating comments, adolescent stage and biological sex were significantly associated with EDCs. When known contributors such as BMI percentile and psychological distress were included in the regression model, adolescent stage and perceived negative paternal comments were no longer significantly associated with EDCs. CONCLUSIONS Overall, results show perceived negative comments were associated with poorer adolescent mental health, both their specific EDCs and general distress. Findings highlight the importance of raising awareness of potential negative impacts within family systems of comments around weight/shape and eating in these key formative years. Trial Registration The study was approved by the Macquarie University Human Research Ethics Committee (HREC 5201600312) and the New South Wales Department of Education.
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Trompeter N, Bussey K, K Forbes M, Griffiths S, Mond J, Lonergan A, Mitchison D. Peer victimization and weight/shape concerns in adolescents: Examining the moderating role of appearance-based rejection sensitivity. Body Image 2022; 40:207-212. [PMID: 34999539 DOI: 10.1016/j.bodyim.2021.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 11/21/2021] [Accepted: 12/11/2021] [Indexed: 11/27/2022]
Abstract
Peer victimization has been related to weight/shape concerns in adolescents. However, a dearth of research has examined potential moderators of this association. The present study examined the concurrent and prospective associations between two types of peer victimization, appearance-based and non-appearance-based, and weight/shape concerns among adolescents, and whether these associations were moderated by appearance-based rejection sensitivity. Participants were 897 adolescents, aged 11-19 years (M = 14 years 8 months, SD = 1 year 4 months), who completed a range of self-report measures as part of the EveryBODY study, one year apart. Both forms of victimization were associated with concurrent, but not prospective weight/shape concerns. Additionally, the concurrent association between appearance-related victimization and weight/shape concerns was dependent on appearance-based rejection-sensitivity, with stronger associations at lower levels of appearance-based rejection-sensitivity. These findings support previous research linking peer victimization with concurrent weight/shape concerns in adolescents. However, the impact of peer victimization on increased weight/shape concerns was not observed.
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Affiliation(s)
- Nora Trompeter
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.
| | - Kay Bussey
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Miriam K Forbes
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Scott Griffiths
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Jonathan Mond
- Centre for Rural Health, University of Tasmania, Launceston, Australia; School of Medicine, Western Sydney University, Sydney, Australia
| | - Alexandra Lonergan
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Deborah Mitchison
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia; School of Medicine, Western Sydney University, Sydney, Australia; Translational Health Research Institute, Sydney, Australia
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Trompeter N, Bussey K, Forbes MK, Hay P, Goldstein M, Thornton C, Basten C, Heruc G, Roberts M, Byrne S, Griffiths S, Lonergan A, Mitchison D. Emotion Dysregulation and Eating Disorder Symptoms: Examining Distinct Associations and Interactions in Adolescents. Res Child Adolesc Psychopathol 2022; 50:683-694. [PMID: 35029782 PMCID: PMC9054869 DOI: 10.1007/s10802-022-00898-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2022] [Indexed: 11/30/2022]
Abstract
Emotion dysregulation has been posited as a key transdiagnostic factor of mental health difficulties, including eating disorders. However, how this transdiagnostic factor interacts with the disorder-specific factor of weight and shape concerns remains unclear. The current study examined whether emotion dysregulation is associated with eating disorder behaviors over and above the association between weight and shape concerns and whether these two factors interacted. The current study used data from two samples, a community sample of high school students (n = 2699), and a clinical sample of adolescents receiving outpatient treatment for an eating disorder (n = 149). Participants completed self-report measures on their eating behaviors, weight/shape concerns, and emotion dysregulation. Findings showed that emotion dysregulation had a unique association with engaging in binge eating and purging (community sample only). Weight and shape concerns were found to have a unique association with engaging in binge eating, fasting, purging, and driven exercise (community sample only). Additionally, weight and shape concerns moderated the association between emotion dysregulation and the probability of engaging in binge eating and driven exercise, whereby the strongest association between emotion dysregulation and these behaviors were observed among adolescents with the lowest levels of weight and shape concerns. Regarding the frequency of eating disorder behaviors, emotion dysregulation had a unique association with severity of binge eating and fasting. Weight and shape concerns were uniquely associated with severity of fasting and driven exercise (community sample only). Findings suggest that emotion dysregulation is a distinct factor of eating disorder behaviors among adolescents.
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Affiliation(s)
- Nora Trompeter
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.
| | - Kay Bussey
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Miriam K Forbes
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Phillipa Hay
- School of Medicine, Translational Health Research Institute, Western Sydney University, Camden and Campbelltown Hospital, SWSLHD, Sydney, Campbelltown, Australia
| | - Mandy Goldstein
- School of Medicine, Translational Health Research Institute, Western Sydney University, Camden and Campbelltown Hospital, SWSLHD, Sydney, Campbelltown, Australia
| | | | - Christopher Basten
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Gabriella Heruc
- School of Medicine, Translational Health Research Institute, Western Sydney University, Camden and Campbelltown Hospital, SWSLHD, Sydney, Campbelltown, Australia
| | - Marion Roberts
- School of Population Health, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
| | - Susan Byrne
- School of Psychological Sciences, University of Western Australia, Perth, Australia
| | - Scott Griffiths
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Alexandra Lonergan
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Deborah Mitchison
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.,School of Medicine, Translational Health Research Institute, Western Sydney University, Camden and Campbelltown Hospital, SWSLHD, Sydney, Campbelltown, Australia
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13
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Nobre GC, Valentini NC. Validity evidence of the Brief Fear of Negative Evaluation Scale for children and adolescents adapted for physical activity and sports settings. MOTRIZ: REVISTA DE EDUCACAO FISICA 2022. [DOI: 10.1590/s1980-657420210010321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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14
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Roche C, Trompeter N, Bussey K, Mond J, Cunningham ML, Murray SB, Lonergan A, Mitchison D. Gender compatibility and drive for muscularity among adolescent boys: Examining the indirect effect of emotion regulation difficulties. Body Image 2021; 39:213-220. [PMID: 34500425 DOI: 10.1016/j.bodyim.2021.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 08/24/2021] [Accepted: 08/28/2021] [Indexed: 11/28/2022]
Abstract
The drive for muscularity continues to be a prominent concern among adolescent boys. However, it is unknown how gender compatibility (gender typicality and gender contentedness) relates to this pursuit. The present study sought to examine the link between gender compatibility and drive for muscularity among male adolescents, and whether this is partially accounted for by emotion regulation difficulties. Participants were 903 male adolescents, aged 11-19 years, who completed self-report measures as part of the EveryBODY study. Using path analysis, a proposed mediation model was assessed, testing an indirect pathway of gender compatibility and drive for muscularity through emotion regulation difficulties. Findings showed an indirect pathway between gender compatibility and drive for muscularity through emotion regulation difficulties. That is, boys who were more content with their male gender and believed they were typical of their gender reported fewer emotion regulation difficulties and, in turn, exhibited a lower drive for muscularity. Findings support theoretical perspectives integrating masculinity and muscularity in boys, in that those who feel less compatible with their masculinity could be susceptible to developing a greater drive for muscularity to regulate distress deriving from perceptions of not being sufficiently masculine. This study sets the groundwork for future longitudinal studies.
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Affiliation(s)
- Claudia Roche
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Nora Trompeter
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.
| | - Kay Bussey
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Jonathan Mond
- Centre for Rural Health, University of Tasmania, Launceston, Australia
| | | | - Stuart B Murray
- Department of Psychiatry & Behavioral Sciences, University of Southern California, Los Angeles, CA, United States
| | - Alexandra Lonergan
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Deborah Mitchison
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia; Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
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15
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Trompeter N, Bussey K, Forbes MK, Mond J, Hay P, Cunningham ML, Mitchison D. Emotion dysregulation across the span of eating disorder symptoms: Findings from a community sample of adolescents. Int J Eat Disord 2021; 54:1946-1955. [PMID: 34558725 DOI: 10.1002/eat.23609] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Emotion dysregulation is proposed as a key factor within eating disorder pathology. However, less is known about specific emotion regulation difficulties experienced by adolescents with varying levels of eating disorders symptoms. The present study examined the relationship between eating disorder behaviors and specific facets of emotion dysregulation, and differences in emotion dysregulation between eating disorder diagnostic groups. METHOD Participants were 2,783 adolescents, 11-19 years (M = 14 years, 9 months, SD = 1 year, 6 months), who completed self-report measures as part of the EveryBODY study. Adolescents were identified as not having eating disorder symptoms (n = 2,122) or meeting diagnostic criteria for symptoms of specific eating disorder, including: anorexia nervosa or atypical anorexia nervosa (n = 57), bulimia nervosa (n = 136), binge-eating disorder (n = 57), other specified feeding or eating disorder characterized by binge eating or purging (n = 381), and unspecified feeding or eating disorder (n = 30). RESULTS Binge eating, driven exercise, and fasting were each uniquely associated with emotion dysregulation, whereas purging was not. Similar findings were obtained within specific domains of emotion dysregulation. Findings from diagnostic groups showed a significant main effect of diagnosis on overall emotion dysregulation and most domains of emotion dysregulation. Adolescents with eating disorder symptoms consistently reported higher emotion dysregulation compared to those without these symptoms. DISCUSSION Findings indicate that emotion dysregulation is a key factor across eating disorder pathology, and potential treatment target across the spectrum of eating disorder diagnoses in adolescents.
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Affiliation(s)
- Nora Trompeter
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Kay Bussey
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Miriam K Forbes
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Jonathan Mond
- Centre for Rural Health, University of Tasmania, Launceston, Tasmania, Australia.,Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia.,Camden and Campbelltown Hospital, South Western Sydney Local Health District, Campbelltown, New South Wales, Australia
| | | | - Deborah Mitchison
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia.,Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
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16
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Aouad P, Hay P, Soh N, Touyz S, Mannan H, Mitchison D. Chew and spit (CHSP) in a large adolescent sample: prevalence, impact on health-related quality of life, and relation to other disordered eating features. Eat Disord 2021; 29:509-522. [PMID: 31770086 DOI: 10.1080/10640266.2019.1695449] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A recent general population study of Chew and Spit (CHSP) behavior in adults found a 0.4% prevalence, predominantly in females. The current study explores this further by examining the same phenomenon in secondary-school aged adolescents. This study also explores the relationship between CHSP and other demographic and eating disorder (ED) features in 5111 adolescents (11-to-19 years of age) from 13 schools in New South Wales, Australia. Participants completed measures of ED symptoms and behaviors and change to impairment with two components: psychological distress (K-10) and health related quality of life (HRQoL; PedsQL). CHSP was found to have a 12.2% (95% CI 0.114, 0.132]) point-prevalence rate. Participants who indicated engaging in CHSP reported significantly higher levels of psychological distress (K-10) and lower HRQoL scores (PedsQL) compared to those that did not report CHSP. There was a dose-response relationship between CHSP frequency, psychological distress and HRQoL physical scores but not for HRQoL emotional and HRQoL social scores. Participants who reported regular CHSP were more likely to be female, younger, and to engage in compensatory behaviors such as purging. The high frequency of CHSP behavior in adolescents with disordered eating could suggest that CHSP should be considered in routine ED screening practices. Future studies may examine how to treat CHSP or investigate more focused treatment approaches, in order to target the behavior of CHSP more directly.
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Affiliation(s)
- Phillip Aouad
- School of Psychology, University of Sydney, Sydney, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, Australia
| | - Nerissa Soh
- Honorary Associate, University of Sydney Northern Clinical School, Sydney, Australia
| | - Stephen Touyz
- School of Psychology, University of Sydney, Sydney, Australia
| | - Haider Mannan
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, Australia
| | - Deborah Mitchison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, Australia.,Department of Psychology, Macquarie University, Sydney, Australia
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17
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Day S, Bussey K, Trompeter N, Hay P, Lonergan A, Mitchison D. Associations of weight- or shape-related bullying with diverse disordered eating behaviors in adolescents. Int J Eat Disord 2021; 54:1641-1651. [PMID: 34181288 DOI: 10.1002/eat.23573] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Little research has investigated variables affecting the relationship between weight- or shape-related bullying (WSB) and specific forms of disordered eating in adolescence. This study aimed to examine the relationship between WSB and eating disorder behaviors in Australian adolescents, and whether this relationship was moderated by body image attitudes. METHOD Data were used from the first wave of the EveryBODY study, a survey of body image concerns and eating disorders in a large representative sample of Australian adolescents (N = 573), aged 11-19 years. Participants completed an online survey with measures of WSB frequency, body image attitudes (drives for thinness, leanness, and muscularity), and disordered eating behaviors. RESULTS Results indicated that frequency of WSB was positively associated with purging and muscularity-oriented behavior (MOB), but not dietary restriction, binge eating, or compulsive exercise. The relationship between WSB and MOB was moderated by drive for muscularity, such that victimization frequency was positively associated with MOB for those with high, but not low, desire to attain a muscular physique. DISCUSSION Findings indicate that WSB is positively associated with purging and MOB but not other eating disorder behaviors, and that drive for muscularity moderates its effect on some behaviors. Understanding these relationships will be important in implementing tailored interventions for adolescents based on screening for victimization experiences and specific body image attitudes.
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Affiliation(s)
- Sinead Day
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Kay Bussey
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, New South Wales, Australia
| | - Nora Trompeter
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, New South Wales, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Blacktown Clinical School, Western Sydney University, Penrith, New South Wales, Australia
| | - Alexandra Lonergan
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, New South Wales, Australia
| | - Deborah Mitchison
- Translational Health Research Institute, School of Medicine, Blacktown Clinical School, Western Sydney University, Penrith, New South Wales, Australia
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Trompeter N, Bussey K, Forbes MK, Mond J, Hay P, Basten C, Goldstein M, Thornton C, Heruc G, Byrne S, Griffiths S, Lonergan A, Touyz S, Mitchison D. Differences between Australian adolescents with eating disorder symptoms who are in treatment or not in treatment for an eating disorder. Early Interv Psychiatry 2021; 15:882-888. [PMID: 32881352 DOI: 10.1111/eip.13027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/23/2020] [Accepted: 08/02/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Mental health problems frequently occur during adolescence, however, few adolescents seek treatment for these problems, especially for eating disorders. The current study aimed to quantify how adolescents in a clinical sample (ie, those receiving treatment for an eating disorder), differ in terms of psychological factors (eating disorder symptoms and psychological distress), compared to adolescents with eating pathology in a community sample (ie, those not receiving treatment). METHOD Data were used from a community sample of adolescents with eating disorder pathology who have not sought treatment (n = 1011) and a clinical sample of adolescents presenting at eating disorder services for treatment (n = 153). Participants reported demographics and completed questionnaires assessing weight/shape concerns, disordered eating and psychological distress. RESULTS Adolescents with a lower BMI, more frequent purging and higher weight/shape concerns were more common in the clinical sample, while those engaging in more frequent driven exercise were less common in the clinical sample. The samples did not differ in severity of psychological distress. CONCLUSIONS The findings highlight the need for increasing mental health literacy about the role of BMI and driven exercise in eating disorder symptom presentation to increase early detection of these disorders among adolescents.
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Affiliation(s)
- Nora Trompeter
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Kay Bussey
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Miriam K Forbes
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Jonathan Mond
- Centre for Rural Health, University of Tasmania, Launceston, Australia.,School of Medicine, Western Sydney University, Sydney, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia.,Camden and Campbelltown Hospital, SWSLHD, Campbelltown, Australia
| | - Christopher Basten
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Mandy Goldstein
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.,Mandy Goldstein Psychology, Private Practice, Sydney, Australia
| | - Christopher Thornton
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.,The Redleaf Practice, Private Practice, Sydney, Australia
| | - Gabriella Heruc
- School of Medicine, Western Sydney University, Sydney, Australia.,Appetite for Change, Private Practice, Sydney, Australia
| | - Susan Byrne
- School of Psychological Sciences, University of Western Australia, Perth, Australia.,The Swan Centre, Private Practice, Perth, Australia
| | - Scott Griffiths
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Alexandra Lonergan
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Stephen Touyz
- School of Psychology and Inside Out Institute, University of Sydney, Sydney, Australia
| | - Deborah Mitchison
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.,Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
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Fatt SJ, Mond J, Bussey K, Griffiths S, Murray SB, Lonergan A, Hay P, Pike K, Trompeter N, Mitchison D. Seeing yourself clearly: Self-identification of a body image problem in adolescents with an eating disorder. Early Interv Psychiatry 2021; 15:577-584. [PMID: 32426938 DOI: 10.1111/eip.12987] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/15/2020] [Accepted: 04/28/2020] [Indexed: 12/15/2022]
Abstract
AIM Many adolescents who meet diagnostic criteria for an eating disorder do not self-identify as having a problem and may consequently be less likely to seek help. Extant research investigating self-identification has been limited to specific populations (ie, girls meeting criteria for bulimic-type eating disorders). This study investigated how self-identification varied across sex, eating disorder diagnoses, and the presence of extreme eating behaviours, and how self-identification was related to help-seeking in adolescents. METHODS Participants included 1002 Australian school students (75.5% female, Mage = 15.14 years, SD = 1.40) who met DSM-5 diagnostic criteria for an eating disorder. An online survey assessed self-identification of having a body image problem, as well as sex, eating disorder diagnosis, extreme eating behaviours, help-seeking for a body image problem, and other potential correlates of self-identification (demographics, psychological distress, social function, weight and shape concerns). RESULTS Approximately, 2 in 3 adolescents with an eating disorder self-identified as having a body image problem. Girls who met criteria for a major eating disorder diagnosis, and those engaging in extreme eating behaviours, were more likely to self-identify. When adjusting for covariates, only sex remained significantly associated with self-identification. Adolescents who self-identified were 2.71 times more likely to seek help for a body image problem, adjusting for covariates. CONCLUSIONS Public health strategies ought to promote awareness regarding the different ways that body image problems might manifest among both girls and boys, as well as the potential gravity of such problems. Awareness among parents, teachers and primary care providers should also be considered.
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Affiliation(s)
- Scott J Fatt
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Jonathan Mond
- Centre for Rural Health, University of Tasmania, Launceston, Tasmania, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Kay Bussey
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Scott Griffiths
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Stuart B Murray
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
| | - Alexandra Lonergan
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Kathleen Pike
- Department of Psychiatry, Columbia University, New York, New York, USA
| | - Nora Trompeter
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Deborah Mitchison
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
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20
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Fatt SJ, Mond J, Bussey K, Griffiths S, Murray SB, Lonergan A, Hay P, Trompeter N, Mitchison D. Help-seeking for body image problems among adolescents with eating disorders: findings from the EveryBODY study. Eat Weight Disord 2020; 25:1267-1275. [PMID: 31376110 DOI: 10.1007/s40519-019-00759-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 07/23/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Little is known regarding correlates of help-seeking for a body image problem in adolescents with an eating disorder. This study provides the first population-based investigation of help-seeking correlates among adolescents with an eating disorder. METHODS Australian adolescents (N = 1002, 75.5% female, mean age = 15.14, SD = 1.40) who met operational diagnostic criteria for an eating disorder completed a survey assessing help-seeking, and potential correlates of help-seeking (sex, age, body mass index, socio-economic status, migrant status, sexuality, eating disorder diagnosis, psychological distress, and quality of life). RESULTS Only 10.1% of participants reported having sought help. Bivariate analyses revealed that increased likelihood of help-seeking was associated with female sex, sexual minority status, being born outside Australia, older age, having a major eating disorder (compared to having an unspecified or other specified feeding or other eating disorder diagnosis), higher psychological distress, and reduced psychological and social functioning. Older age, being born outside of Australia, and having a major eating disorder were significant independent correlates of help-seeking. CONCLUSIONS Very few adolescents with an eating disorder seek help for a body image problem. Promoting early, appropriate help-seeking among those who are younger and/or those with less well-known disorders may be particularly important. LEVEL OF EVIDENCE Level III, case-control analytic study.
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Affiliation(s)
- Scott J Fatt
- Department of Psychology, Centre for Emotional Health, Macquarie University, Balaclava Road, North Ryde, Sydney, NSW, 2109, Australia.
- Human Behaviour Lab, Department of Psychiatry, UNSW, Sydney, Australia.
| | - Jonathan Mond
- Centre for Rural Health, University of Tasmania, Launceston, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Kay Bussey
- Department of Psychology, Centre for Emotional Health, Macquarie University, Balaclava Road, North Ryde, Sydney, NSW, 2109, Australia
| | - Scott Griffiths
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Stuart B Murray
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Alexandra Lonergan
- Department of Psychology, Centre for Emotional Health, Macquarie University, Balaclava Road, North Ryde, Sydney, NSW, 2109, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
| | - Nora Trompeter
- Department of Psychology, Centre for Emotional Health, Macquarie University, Balaclava Road, North Ryde, Sydney, NSW, 2109, Australia
| | - Deborah Mitchison
- Department of Psychology, Centre for Emotional Health, Macquarie University, Balaclava Road, North Ryde, Sydney, NSW, 2109, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
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21
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Lonergan AR, Bussey K, Fardouly J, Griffiths S, Murray SB, Hay P, Mond J, Trompeter N, Mitchison D. Protect me from my selfie: Examining the association between photo-based social media behaviors and self-reported eating disorders in adolescence. Int J Eat Disord 2020; 53:485-496. [PMID: 32259344 DOI: 10.1002/eat.23256] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 02/18/2020] [Accepted: 02/21/2020] [Indexed: 01/27/2023]
Abstract
OBJECTIVE This study examined whether social media behaviors were associated with higher odds of meeting criteria for an eating disorder and whether gender moderated these relationships. METHOD Australian adolescents (N = 4,209; 53.15% girls) completed the self-report photo investment and manipulation scales. Additional self-report items assessed avoidance of posting selfies and investment in others' selfies. Eating disorders were identified by the Eating Disorder Examination Questionnaire and other self-report measures aligned with diagnostic and statistical manual for mental disorders-5 criteria. RESULTS A multinomial logistic regression examining the effect of avoidance of posting selfies, photo investment, photo manipulation, and investment in others' selfies on the likelihood of meeting criteria for an eating disorder, compared to no disorder, was significant (χ2 [42] = 1,128.93, p < .001). Greater avoidance was associated with higher odds of meeting criteria for all disorders except clinical/subclinical binge-eating disorder and purging disorder. Increased photo investment was related to greater odds of meeting criteria for all disorders. A similar relationship emerged for photo manipulation, with the exception of clinical/subclinical binge-eating disorder, and unspecified feeding and eating disorder. Investment in others' selfies was associated with higher odds of meeting criteria for all disorders except clinical/subclinical anorexia nervosa and purging disorder. There was a significant interaction between gender and avoidance (χ2 [1] = 5.23, p = .025, OR = 1.74), whereby boys were more likely to meet criteria for clinical/subclinical anorexia nervosa in the context of greater avoidance of posting selfies. DISCUSSION Appearance-related social media behaviors may be indicative of eating disorder risk. Implications for clinicians and advancements for social media screening tools are discussed.
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Affiliation(s)
- Alexandra R Lonergan
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Kay Bussey
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Jasmine Fardouly
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Scott Griffiths
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Stuart B Murray
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
| | - Jonathan Mond
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia.,Centre for Rural Health, University of Tasmania, Launceston, Australia
| | - Nora Trompeter
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Deborah Mitchison
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.,Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
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Arditte Hall KA, Coleman K, Timpano KR. Associations Between Social Anxiety and Affective and Empathic Forecasts: A Replication and Extension in a Mechanical Turk Sample. Behav Ther 2020; 51:365-374. [PMID: 32402253 DOI: 10.1016/j.beth.2019.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 05/30/2019] [Accepted: 06/04/2019] [Indexed: 11/18/2022]
Abstract
People often overestimate the intensity and duration of their future emotions, referred to as an impact bias. Impact biases have been documented in predictions people make about their own emotions, as well as the others' emotions (i.e., affective and empathic forecasting, respectively). Recent studies have shown that negative impact biases may be stronger, and positive impact biases may be attenuated, in individuals with symptoms of social anxiety. The current study sought to replicate and extend these findings in a Mechanical Turk (MTurk) sample. MTurk is a particularly interesting online platform for such research because of the unusually high prevalence of social anxiety among MTurk users. Within a computer-based survey, 93 MTurk users read vignettes in which a second-person narrator elicited either disgust, anger, or happiness from another person. After each vignette, participants predicted how the narrator (i.e., affective forecasts) and the other person (i.e., empathic forecasts) would feel. Overall, results confirmed the existence of associations between social anxiety symptoms and negative affective and empathic forecasting biases, though no significant relations were found between social anxiety symptoms and positive forecasting biases. Negative affective and empathic forecasting biases were significantly correlated. Age and gender were also examined as potential predictors and moderators of hypothesized effects. Though younger age and female gender were associated with specific forecast ratings, controlling for these variables did not alter the associations between social anxiety and affective or empathic forecasts and no moderation effects were found. Overall, results provide additional support for the relevance of impact biases to social anxiety and suggest that they may be useful targets of intervention.
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Affiliation(s)
- Kimberly A Arditte Hall
- VA National Center for PTSD; VA Boston Healthcare System; Boston University School of Medicine.
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Mitchison D, Mond J, Bussey K, Griffiths S, Trompeter N, Lonergan A, Pike KM, Murray SB, Hay P. DSM-5 full syndrome, other specified, and unspecified eating disorders in Australian adolescents: prevalence and clinical significance. Psychol Med 2020; 50:981-990. [PMID: 31043181 DOI: 10.1017/s0033291719000898] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Little information is available on the prevalence of Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 eating disorders in adolescence, and eating disorders remain unique in the DSM for not systematically including a criterion for clinical significance. This study aimed to provide the first prevalence report of the full suite of DSM-5 eating disorders in adolescence, and to examine the impact of applying a criterion for clinical significance. METHODS In total, 5191 (participation rate: 70%) Australian adolescents completed a survey measuring 1-month prevalence of eating disorder symptoms for all criterial, 'other specified' and unspecified eating disorders, as well as health-related quality of life and psychological distress. RESULTS The point prevalence of any eating disorder was 22.2% (12.8% in boys, 32.9% in girls), and 'other specified' disorders (11.2%) were more common than full criterial disorders (6.2%). Probable bulimia nervosa and binge eating disorder, but not anorexia nervosa (AN), were more likely to be experienced by older adolescents. Most disorders were associated with an increased odds for being at a higher weight. The prevalence of eating disorders was reduced by 40% (to 13.6%) when a criterion for clinical significance was applied. CONCLUSIONS Eating disorders, particularly 'other specified' syndromes, are common in adolescence, and are experienced across age, weight, socioeconomic and migrant status. The merit of adding a criterion for clinical significance to the eating disorders, similar to other DSM-5 disorders, warrants consideration. At the least, screening tools should measure distress and impairment associated with eating disorder symptoms in order to capture adolescents in greatest need for intervention.
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Affiliation(s)
- Deborah Mitchison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Jonathan Mond
- Centre for Rural Health, University of Tasmania, Launceston, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Kay Bussey
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Scott Griffiths
- School for Psychological Sciences, University of Melbourne, Sydney, Australia
| | - Nora Trompeter
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Alexandra Lonergan
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Kathleen M Pike
- Departments of Psychiatry and Epidemiology, Columbia University, New York, USA
| | - Stuart B Murray
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
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Burt A, Mitchison D, Dale E, Bussey K, Trompeter N, Lonergan A, Hay P. Prevalence, features and health impacts of eating disorders amongst First-Australian Yiramarang (adolescents) and in comparison with other Australian adolescents. J Eat Disord 2020; 8:10. [PMID: 32190326 PMCID: PMC7066723 DOI: 10.1186/s40337-020-0286-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 02/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to support previous research conducted with First-Australians (FA) by establishing the prevalence of eating disorders, and their demographic distribution and burden in adolescent First-Australians compared to other-Australians (OA). METHODS Data were used from the baseline survey of the EveryBODY Study, a longitudinal investigation of eating disorders among Australian adolescents. Of the 5068 participants included, 402 (8%) identified as FA, 4586 (90.5%) identified as OA. Diagnosis of eating disorders was based on the Diagnostic and Statistical Manual version 5. Socioeconomic status and measures of impairment were assessed using validated instruments. Body mass index was calculated based on self-reported weight and height. Statistical analyses used data weighted to the distribution of gender in adolescents in New South Wales in the 2016 Australian Census. Chi-square tests were performed to determine prevalence of eating disorders amongst FA and to compare to OA. ANOVA and logistic regression analyses where conducted to examine the moderation effect of sociodemographic status, measures of impairment and FA status on the distribution of eating disorders. RESULTS The prevalence rates for eating disorder diagnoses where similar for FA and OA with the exception of Night eating Syndrome (OSFED-NES), which occurred in 7.14% (95%CI 4.81-10.49) of FA vs. 3.72% (95%CI 3.17-4.36) in OA. The greater prevalence of OSFED-NES in FA was largely explained by poorer psychosocial quality of life amongst FA. CONCLUSION Eating disorders are common amongst First-Australian adolescents and are associated with poor psychosocial quality of life. These findings are consistent with previous research conducted with First-Australian adults. There is a need to screen for eating disorders amongst First-Australian adolescent girls and boys.
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Affiliation(s)
- Adam Burt
- 1School of Medicine, Western Sydney University, Sydney, Campbelltown Australia
| | - Deborah Mitchison
- 2Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Sydney, Campbelltown Australia.,3Centre for Emotional Health, Department of Psychology, Macquarie University, North Ryde, New South Wales Australia
| | - Elizabeth Dale
- 4Ngarruwan Ngadju First Peoples Health and Wellbeing Research Centre, Australian Health Services Research Institute and Illawarra Health and Medical Research Institute, School of Psychology, University of Wollongong, Wollongong, New South Wales Australia
| | - Kay Bussey
- 5Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Nora Trompeter
- 5Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Alexandra Lonergan
- 5Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Phillipa Hay
- 2Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Sydney, Campbelltown Australia.,6Campbelltown Hospital, SWSLHD, Sydney, Campbelltown Australia
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Pursey KM, Hay P, Bussey K, Trompeter N, Lonergan A, Pike KM, Mond J, Mitchison D. Diabetes and disordered eating behaviours in a community-based sample of Australian adolescents. J Eat Disord 2020; 8:5. [PMID: 32128205 PMCID: PMC7047351 DOI: 10.1186/s40337-020-0282-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 01/30/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND People with diabetes have been shown to be at risk for disordered eating compared to their non-diabetic peers. However, the majority of studies have been conducted in relatively small samples drawn from clinical diabetes settings or registries. Community-based samples are required to better understand disordered eating behaviours in this population. In a large community-based population sample of Australian adolescents, this study aimed to (1) investigate disordered eating behaviours in adolescents reporting a diagnosis of diabetes compared to their non-diabetic peers and (2) test associations between disordered eating behaviours and insulin restriction. METHODS Secondary school students (n = 4854; mean (SD) age 14.4 (1.6) years; 47% boys) completed an online survey, including self-reported presence of diabetes, demographics, weight status, substance use, insulin restriction and disordered eating behaviours. Clinically meaningful cut-offs for disordered eating behaviours were generated for analysis. RESULTS Disordered eating behaviours, specifically self-induced vomiting (diabetes 19.2%, no diabetes 3.3%; p < 0.001), laxative use (diabetes 15.4%, no diabetes 2.1%; p < 0.001), use of cigarettes (diabetes 26.9%, no diabetes 4.3%; p < 0.001) and other drugs (diabetes 28.9%, no diabetes 4.0%; p < 0.001), cleanse/detox (diabetes 30.8%, no diabetes 10.5%; p < 0.001) and extreme weight loss diets (diabetes 13.5%, no diabetes 4.7%; p < 0.003) were higher in those reporting a diagnosis of diabetes. In addition, 17% of those with diabetes reported frequent insulin restriction (≥ once per week), and insulin restriction was associated with more frequent disordered eating behaviours. CONCLUSION There was a high rate of disordered eating behaviours in adolescents with diabetes compared to their peers without diabetes. The findings of this study may have the potential to inform future health promotion, prevention, and early intervention approaches for those with comorbid diabetes and disordered eating behaviours. Future longitudinal studies are required to evaluate disordered eating behaviours in those with diabetes over time in community-based samples.
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Affiliation(s)
- Kirrilly M Pursey
- 1Faculty of Health and Medicine, University of Newcastle, Callaghan, 2308 NSW Australia
| | - Phillipa Hay
- 2Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW Australia.,Campbelltown and Camden Hospitals, Campbelltown, NSW Australia
| | - Kay Bussey
- 4Department of Psychology and Centre for Emotional Health, Macquarie University, Sydney, NSW Australia
| | - Nora Trompeter
- 4Department of Psychology and Centre for Emotional Health, Macquarie University, Sydney, NSW Australia
| | - Alexandra Lonergan
- 4Department of Psychology and Centre for Emotional Health, Macquarie University, Sydney, NSW Australia
| | - Kathleen M Pike
- 5Departments of Psychiatry and Epidemiology, Columbia University Irving Medical Center, New York, NY USA
| | - Jonathon Mond
- 6Centre for Rural Health, University of Tasmania, Launceston, Australia.,7School of Medicine, Western Sydney University, Campbelltown, Australia
| | - Deborah Mitchison
- 2Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW Australia.,8Department of Psychology, Macquarie University, Sydney, NSW Australia
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Trompeter N, Bussey K, Hay P, Griffiths S, Murray SB, Mond J, Lonergan A, Pike KM, Mitchison D. Fear of negative evaluation among eating disorders: Examining the association with weight/shape concerns in adolescence. Int J Eat Disord 2019; 52:261-269. [PMID: 30663786 DOI: 10.1002/eat.23018] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/17/2018] [Accepted: 12/21/2018] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Fear of negative evaluation has been proposed as a transdiagnostic factor associated with the development of eating disorders and has been shown to relate to disorders of body image, especially those with weight/shape concerns such as eating disorders and muscle dysmorphia. The current study aimed to investigate whether fear of negative evaluation was a transdiagnostic factor of disorders diagnostically characterized by weight/shape concerns. The study examined whether fear of negative evaluation was associated with higher odds for meeting criteria for an eating disorder and/or muscle dysmorphia, especially those disorders diagnostically characterized by weight/shape concerns. METHOD Data were used from a subgroup of the first wave of the EveryBODY study, a longitudinal investigation of eating disorders and body image concerns among Australian adolescents (N = 4,030). Participants completed measures on demographics, weight/shape concerns, disordered eating, psychological distress, muscularity concerns, and fear of negative evaluation. RESULTS Findings revealed that fear of negative evaluation was associated with higher odds of meeting criteria for any eating disorder but significantly more so for those characterized by weight/shape concerns diagnostically, as well as binge-eating disorder. Similar results were found for muscle dysmorphia. DISCUSSION The findings suggest that fear of negative evaluation constitutes a transdiagnostic feature for developing and/or maintaining an eating disorder.
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Affiliation(s)
- Nora Trompeter
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Kay Bussey
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
| | - Scott Griffiths
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Stuart B Murray
- Department of Psychiatry, University of California San Francisco, San Francisco, California
| | - Jonathan Mond
- Centre for Rural Health, University of Tasmania, Launceston, Australia.,School of Medicine, Western Sydney University, Sydney, Australia
| | - Alexandra Lonergan
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | | | - Deborah Mitchison
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.,School of Medicine, Western Sydney University, Sydney, Australia
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