Does the stress generation hypothesis apply to eating disorders?: an examination of stress generation in eating, depressive, and anxiety symptoms

Subjective and objective binge episodes in relation to eating disorder and depressive symptoms among middle-aged women

PURPOSE

Evidence suggests loss of control over eating may be the driving component of binge eating, a transdiagnostic symptom of eating disorders and highly comorbid with depressive symptoms. Prior studies have evaluated eating disorder and depressive symptoms across types of binge episodes among adolescent and young adult samples, yet no studies have focused on middle-aged women who may be particularly vulnerable to both binge eating and depressive symptoms. The goal of this study was to compare eating disorder symptoms and depressive symptoms across different types of binge eating episodes among middle-aged women.

METHODS

Women (N = 347), ages 40-63, completed an online survey about both objective (OBE) and subjective binge episodes (SBE), eating disorder symptoms, and depressive symptoms. Participants were categorized as OBEs only, SBEs only, both OBEs and SBEs, and no binge eating.

RESULTS

Controlling for group differences, results showed middle-aged women who experienced SBEs only reported greater levels of anorexia nervosa attitudes and behaviors compared to all other groups, and greater dietary restraint compared to those who experienced only OBEs and those with no binge eating. Middle-aged women who experienced any type of binge eating reported greater levels of body image concerns and depressive symptoms compared to those who reported no binge eating.

CONCLUSIONS

Findings suggest that loss of control is more clinically relevant in terms of associations with eating disorder and depressive symptoms in middle-aged women.

LEVEL OF EVIDENCE

Level V based on descriptive studies.

Initial development and validation of the Online Appearance-Relevant Peer Conversations Scale

In this research, we present three studies on the development and validation of the Online Appearance-Relevant Peer Conversations Scale (OARPCS), a 12-item measure of (1) physical appearance and (2) life stressors as foci of online peer communications. In Study 1, young Chinese adults (N = 800) completed OARPCS items and measures of body image, Internet use, and general distress. Exploratory factor analyses supported the hypothesized two factor structure and within gender correlation analyses provided construct validity support. Study 2 replicated the EFA-derived OARPCS factor structure and validity further within confirmatory factor analyses of young adults from Chongqing (N = 750) and Macau (N = 994). Study 3 assessed the predictive validity of OARPCS dimensions in relation to prospective changes in cosmetic surgery consideration, eating disturbances and perceived stress over one year (N = 796). Independent of baseline responses on outcomes, baseline physical appearance and life stressor subscale scores, respectively, explained modest, significant variance in women's body image concerns and men's reported stress. Together, results underscored appearance-relevant content in online peer interactions as influences on body image and emotional status and provided psychometric support for a brief self-report measure of these factors.

Bulimic symptoms and interpersonal functioning among college students

Integrating interpersonal theory and the stress generation hypothesis, two studies investigated the association between bulimic symptoms and interpersonal distress and the mechanism underlying this association. In Study 1, 36 pairs of female roommates completed self-report questionnaires in a laboratory while Study 2 recruited 539 undergraduate men and women to participate in a longitudinal online study by completing self-report measures at two time points. Multilevel modeling revealed that targets' bulimic symptoms predicted roommates' intention to continue living with them in Study 1. Greater bulimic symptoms predicted lower intention. In Study 2, bulimic symptoms had a direct and an indirect effect on interpersonal distress, with reassurance-seeking as a mediator in the indirect effect. Findings replicated previous studies showing that bulimic symptoms generate further distress and, in our studies, interpersonal distress specifically. Moreover, reassurance-seeking was a newly identified mechanism underlying this association. These findings provide support for the usefulness of interpersonal theory and the stress generation hypothesis as a framework for understanding bulimic symptomatology. Clinicians may find it useful to target reassurance-seeking behaviors during the treatment of bulimic symptoms in order to improve treatment outcomes.

An examination of the prospective impact of bulimic symptoms and dietary restraint on life hassles and social support

BACKGROUND

The stress generation hypothesis posits that individuals with psychopathology engage in maladaptive behaviors that create stress. Although extensively researched in the depression literature, few studies have investigated whether the stress generation hypothesis applies to eating disorders. This study examined whether bulimic symptoms and dietary restraint predict future life hassles and low social support among undergraduate students.

METHODS

Three hundred seventy-four undergraduate students participated in this two-part prospective study through a secure online system. They completed questionnaires assessing depressive symptoms, bulimic symptoms, dietary restraint, life hassles, and social support.

RESULTS

Regression analyses revealed that baseline bulimic symptoms predicted greater life hassles but not lower social support one month later, after statistically controlling for baseline measures. Baseline dietary restraint did not predict future life hassles or social support.

LIMITATIONS

Limitations include use of self-report measures, suboptimal response rates at the follow-up assessment, and use of a non-clinical sample with primarily White participants.

CONCLUSIONS

These results provide preliminary support for the stress generation hypothesis in relation to bulimic symptoms. Individuals with bulimic symptoms may generate stressors similar to those experiencing depressive symptoms. Our findings suggest that emphasizing stress management in the treatment of individuals with bulimic symptoms could potentially improve treatment outcomes.

Negative life events and symptoms of depression and anxiety: stress causation and/or stress generation

BACKGROUND AND OBJECTIVES

Stressful life events are known to contribute to development of depression; however, it is possible this link is bidirectional. The present study examined whether such stress generation effects are greater than the effects of stressful life events on depression, and whether stress generation is also evident with anxiety.

DESIGN

Participants were two large age cohorts (N = 732 aged 44 years; N = 705 aged 63 years) from the West of Scotland Twenty-07 study.

METHODS

Stressful life events, depression, and anxiety symptoms were measured twice five years apart. Cross-lagged panel analysis examined the mutual influences of stressful life events on depression and on anxiety over time.

RESULTS

Life events predicted later depressive symptomatology (p = .01), but the depression predicting life events relationship was less strong (p = .06), whereas earlier anxiety predicted life events five years later (p = .001). There was evidence of sex differences in the extent to which life events predicted later anxiety.

CONCLUSIONS

This study provides evidence of stress causation for depression and weaker evidence for stress generation. In contrast, there was strong evidence of stress generation for anxiety but weaker evidence for stress causation, and that differed for men and women.

Restraint feeds stress: The relationship between eating disorder symptoms, stress generation, and the interpersonal theory of suicide

Integrating research on stress generation and the interpersonal theory of suicide we examined whether eating disorder symptoms are related to stress generation and whether negative life events (stressors) contribute to feelings of burdensomeness and low belongingness. At two time points (approximately 1month apart), participants (n=186; 75% female) completed questionnaires measuring eating disorder symptoms, negative life events, burdensomeness, and belongingness. Regression analyses indicated that while controlling for depression, anxiety, and baseline frequency of negative events, dietary restraint significantly predicted negative events at follow-up. Dietary restraint indirectly influenced higher levels of perceived burdensomeness and low belongingness through its influence on negative events. Thus, dietary restraint may contribute to stress generation, and in turn exacerbate feelings of burdensomeness and low belongingness, two important constructs of the interpersonal theory of suicide. Greater understanding of these factors could lead to more effective and targeted suicide interventions for individuals who restrict food intake.