Risk factors for eating disorders

Pathways by Which Self-Compassion Improves Positive Body Image: A Qualitative Analysis

The current study applied consensual qualitative research-modified to essays written by 51 college women completing an expressive writing intervention over three time points for a total of 153 essays to identify how increases in self-compassion improve body image. A qualitative coding team tracked changes in affect and cognition over three time points. The results demonstrated that college women consistently expressed body acceptance and psychological flexibility. Additionally, the participants expressed important increases in mindfulness as well as decreases in social influences, feelings of separation, negative health behaviors, and attention to media messages. Decreases were found in their expressions of body functionality, love and kindness toward their body, and internal locus of control. These findings suggest pathways through which self-compassion may improve women's body image by increasing mindfulness and decreasing the negative ways of relating to one's body, specifically in the areas of media, clothing, make-up, and negative social interactions.

Eating Disorders and Disturbed Eating Behaviors Underlying Body Weight Differences in Patients Affected by Endometriosis: Preliminary Results from an Italian Cross-Sectional Study

This study aimed to characterize the prevalence of eating disorders (EDs), disturbed eating behaviors (DEBs), and emotional eating attitudes (EEAs) among patients affected by endometriosis in order to understand a potential crosslink between this impacting gynecological disease and a Body Mass Index shift. A total of 30 patients were recruited at an endometriosis outpatient clinic in Bologna and were assessed by using standardized instruments and specific questionnaires for EDs, DEBs, and EEAs. Sociodemographic information and endometriosis clinical features and history information were collected by adopting a specific questionnaire. Retrospective reports of lifetime Body Mass Index (BMI) changes, current BMI, peak pain severity during the last menstrual period, and the average of pain intensity during the last intermenstrual period were used for a correlation with the mean score from eating-behavior scales' assessment. The preliminary results indicate that, although only 3.33% of endometriosis patients are affected by ED, statistically significant differences at the mean scores of DEBs and EEAs assessment scales were found by stratifying patients on the basis of BMI levels at risk for infertility and coronary heart disease and on the basis of moderate/severe pain levels. The enrichment of the sample size and the recruitment of the control group to complete the study enrollment will allow us to investigate more complex and strong correlation findings and to assess the prevalence of EDs among endometriosis patients.

The effects of media and peers on negative body image among Chinese college students: a chained indirect influence model of appearance comparison and internalization of the thin ideal

BACKGROUND

Negative body image is a common psychological phenomenon among Chinese college students meriting investigation. Peers and the media are important factors that negatively influence body image. This study explored the mechanisms of media and peers promoting negative body image among Chinese college students.

METHOD

Data from 407 college students (173 men and 234 women) were collected using the Revised Social and Cultural Attitude Questionnaire of Appearance, Appearance Comparison Scale, Peer Impact Scale, and Negative Body Image Scale.

RESULTS

Correlational analysis results demonstrated that media attention was not significantly correlated with negative body image. All other variables were significantly positively correlated. Path analysis results indicated that the direct effect of media attention on negative body image was not significant, while the direct effect of peer impact was significant. In addition, appearance comparison and internalization of the thin ideal acted as a chained indirect effect between negative body image, media attention, and peer impact.

CONCLUSIONS

The research revealed that focusing on perfect bodies displayed in the media did not produce a negative body image. However, focusing on the media and peer conversations regarding the body caused the participants to compare appearances and internalize ideal body shape standards, leading to negative self-evaluations.

Revisiting the relationship between body dissatisfaction and eating disorder symptoms in Chinese adolescents: the mediating roles of regulatory emotional self-efficacy and depression symptoms

PURPOSE

Even though many studies have investigated the relationship between body dissatisfaction and eating disorder symptoms, the relationship is still far from being clear, especially about what factors that could potentially mediate such relationship. This study aimed to examine the direct pathway in the relationship between body dissatisfaction and eating disorder symptoms, and possible mediation pathways between the two via regulatory emotional self-efficacy and depression symptoms.

METHODS

A sample of 654 adolescents from central China completed questionnaires for a set of study variables. Modeling analysis was conducted that examined the direct pathway between body dissatisfaction and eating disorder symptoms, and the mediating roles of regulatory emotional self-efficacy and depression symptoms between these two constructs. Multi-group modeling analysis was conducted to assess model invariance across gender and age groups.

RESULTS

The results showed that, in addition to the direct pathway between body dissatisfaction and eating disturbances, regulatory emotional self-efficacy and depression symptoms partially mediated the relationship between these two constructs. Results of multi-group invariance analysis showed that the mediation model was consistent across gender and age groups.

DISCUSSION

These results indicated that management of regulatory emotional self-efficacy and appropriate intervention for depression could potentially buffer against the negative impact of body dissatisfaction on eating disorder symptoms. Finally, some potential clinical implications are discussed, and possible preventions for eating disorder symptoms are suggested.

LEVEL OF EVIDENCE

V, Cross-sectional descriptive study.

Disordered Eating Behaviors and Food Addiction among Nutrition Major College Students

Evidence of whether nutrition students are free from food-related issues or at higher risk for eating disorders is inconsistent. This study aimed to assess disordered eating behaviors and food addiction among nutrition and non-nutrition major college students. Students (n = 967, ages 18–25, female 72.7%, white 74.8%) enrolled at a public university completed online demographic characteristics surveys and validated questionnaires measuring specific disordered eating behaviors. Academic major category differences were compared. Additionally, high risk participants were assessed by weight status and academic year. Overall, 10% of respondents were a high level of concern for developing eating disorders. About 10.3% of respondents met criteria for food addiction. In addition, 4.5% of respondents had co-occurrence of eating disorder risk and food addiction risk out of total respondents. There were no significant differences in level of concern for developing an eating disorder, eating subscales, or food addiction among academic majors. The percentage of high risk participants was lower in the underweight/normal weight group than in the overweight/obese group in health-related non-nutrition major students but not in nutrition students. Early screening, increasing awareness, and promoting healthy eating habits could be potential strategies to help treat and prevent the development of disorders or associated health conditions in nutrition as well as non-nutrition students.

Eating Disorders in the Adolescent Population:

Adolescents become vulnerable to developing eating disorders as they mature. Very little is known about the prevalence, etiology, assessment, treatment, and outcome of eating disorders among adolescents. In general, research on eating disorders continues to be plagued with design flaws. Future studies need to be prospective research based on larger, more diverse samples of adolescents that represent all developmental stages of adolescence. Consistent diagnostic criteria and definitions of treatment interventions and outcomes also need to be employed. In addition, research should address the identification of protective and risk factors that predict who will actually develop an eating disorder.

Eating Disorders

More than 2 million female Americans have a clinically relevant eating disorder. Although the prevalence and seriousness of this problem has gained increasing attention in recent years, relatively little is known about eating disorder prevention. This article addresses a number of issues related to prevention efforts applied to eating disorders. An overview of putative risk factors that have been identified is presented. In particular, the article emphasizes the importance of understanding the psychological and physical developmental processes during adolescence and the sociocultural context in which eating disorders develop. A summary of empirical investigations of the efficacy of eating disorder prevention programs follows, including an illustration of one of the more promising strategies that has been reported to date. The role of counseling psychologists in further refining eating disorder prevention efforts is discussed.

The impact of social support on the risk of eating disorders in women exposed to intimate partner violence

BACKGROUND

Eating disorders (EDs) are often found among women exposed to intimate partner violence (IPV). The role of social support (SS) as a protective factor against ED among IPV-exposed women is not firmly established.

OBJECTIVE

The objective of this study is to determine the distribution of risk of EDs among women exposed to IPV and to examine the impact of SS on risk of ED among IPV-exposed women.

METHODS

Women (aged 18-64 years) exposed to IPV during their lifetimes (defined by the Humiliation-Afraid-Rape-Kick instrument) were recruited from primary care and domestic violence service agencies and surveyed on demographics, mood/anxiety disorders, psychosocial/community factors, and strategies used in response to IPV. The Eating Disorder Screen for Primary Care assessed the risk of ED. A modified Medical Outcomes Study Social Support Survey assessed overall functional support (scale range: 0-32; categorized into quartiles). Ordinal logistic regression examined the risk of ED based on SS, controlling for prespecified demographics (age, race/ethnicity, marital status, near-poverty level), and health-related factors significant in bivariate analyses (risky alcohol use).

RESULTS

Among 302 women with lifetime IPV, 41 (14%) were at high risk, 127 (42%) were at moderate risk, and 134 (44%) were at low risk of an ED. In bivariate analyses, high risk of an ED was significantly more frequent among women with a low SS score (<19, 24%) versus a high SS score (≥30, 12%) (P=0.03). High risk of an ED was significantly associated with risky alcohol use (18%) versus non-risky alcohol use (13%; P=0.008). In multivariable analysis, a 5-unit increase in overall SS was significantly associated with decreased odds of ED risk (P=0.007).

CONCLUSION

Among IPV-exposed women, low SS is associated with an increased risk of ED. SS may protect against ED by reducing anxiety and promoting positive actions, but further study is needed to confirm this.

The journey from opposition to recovery from eating disorders: multidisciplinary model integrating narrative counseling and motivational interviewing in traditional approaches

BACKGROUND

In the world of today's of ever-briefer therapies and interventions, people often seem more interested in outcome than process. This paper focuses on the processes used by a multidisciplinary team in the journey from opposition to change to recovery from eating disorders. The approach outlined is most relevant to those with severe and enduring illness.

METHODS

This paper describes a five-phase journey from eating-disorder disability and back to health as it occurs for patients in a community-based facility. This integrative model uses narrative and motivational interviewing counseling weaved into traditional approaches. It approaches illness from a transdiagnostic orientation, addressing the dynamics and needs demanded by the comorbidities and at the same time responding effectively in a way that reduces the influence of the eating disorder. The treatment described involves a five-phase journey: Preliminary phase (choosing a shelter of understanding); Phase 1: from partial recognition to full acknowledgment; Phase 2: from acknowledgment to clear cognitive stance against the eating disorder; Phase 3: towards clear stance against the "patient" status; Phase 4: towards re-authoring life and regaining self-agency; Phase 5: towards recovery and maintenance.

RESULTS

In a longitudinal study of patients with a severe and debilitating eating disorder treated with this approach. The drop-out rate was less than 10%. This was during the first two months of treatment for those diagnosed with bulimia nervosa, and this was higher than in those diagnosed with anorexia nervosa. At the end of treatment (15 months to 4 years later) 65% of those treated with anorexia nervosa and 81% of those treated with bulimia nervosa were either in a fully recovered state or in much improved. At the four-year follow-up, 68% of those diagnosed with anorexia nervosa and 83% of those diagnosed with bulimia nervosa were categorized as either fully recovered or much improved. All patients who completed the program were gainfully employed.

CONCLUSIONS

The collaborative work, which is the heart of the described model increases the patient's and family's ownership of treatment and outcome and strengthen the therapeutic bond, thus enhances recovery.

Disgust and eating disorder symptomatology in a non-clinical population: the role of trait anxiety and anxiety sensitivity

The present paper reports the results of a study investigating the relationship between a domains-independent measure of disgust (the Disgust Propensity and Sensitivity Scale-Revised) and measures of eating disorder symptomatology in a non-clinical population. Significant correlations between disgust sensitivity and disgust propensity and selected eating disorder symptomatology measures suggested that disgust is significantly correlated with measures of eating disorder symptomatology and is appraised more negatively. However, both measures of disgust propensity and sensitivity failed to predict any significant residual variance in scores on eating symptomatology measures when either trait anxiety or anxiety sensitivity was controlled for. This suggests that while the experience of disgust may be heightened in individuals with eating disorders, it may be linked to other relevant emotions such as anxiety and anxiety sensitivity rather than being an independent risk factor for symptoms.

Two-phase survey of eating disorders in gifted dance and non-dance high-school students in Taiwan

BACKGROUND

Despite a growing body of literature reporting eating disorders (EDs) in non-Western countries in recent years, most of these studies are limited to questionnaire-based surveys or case-series studies. This study aimed to investigate the prevalence and correlates of EDs in Taiwanese high-school students.

METHODS

The study subjects consisted of all the female high-school students enrolled in the gifted dance class in 2003 in Taiwan (n=655) and non-dance female students randomly chosen from the same school (n=1251). All the participants were asked to complete self-report questionnaires, including the 26-item Eating Attitudes Test (EAT-26) and the Bulimic Investigatory Test Edinburgh (BITE). All the screen positives and an approximate 10% random sample of the screen negatives were then interviewed using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders Patient Version (SCID-I/P).

RESULTS

The prevalence of individual EDs was much higher in the dance [0.7% for anorexia nervosa (AN), 2.5% for bulimia nervosa (BN) and 4.8% for EDs, not otherwise specified (EDNOS)] than in the non-dance (0.1, 1.0 and 0.7% respectively) students. Multivariate logistic regression analyses revealed that being in the dance class, higher concern about body shape and lower family support were correlates of EDs for all students, whereas lower parental education level was associated with EDs only for non-dance students.

CONCLUSION

EDs were more prevalent in the weight-concerned subpopulation. Although AN is still rare, BN has emerged as a comparable prevalent disorder in Taiwan, as in Western countries.

Reduktion von Risikofaktoren für gestörtes Essverhalten:

Zusammenfassung. Eine erhöhte Bedeutsamkeit von Figur und Gewicht sowie Diätverhalten gehören zu den am besten bestätigten und bedeutungsvollsten Risikofaktoren, die bei jungen Frauen zu einem erhöhten Risiko für spätere Essstörungssymptome oder -syndrome führen. Präventive Interventionen sollten daher versuchen, diese Faktoren zu reduzieren, um die Wahrscheinlichkeit der Entwicklung einer Essstörung zu verringern. Die vorliegende Untersuchung beschreibt die Überprüfung der Wirksamkeit eines für den deutschen Sprachraum adaptierten Internet-gestützten Präventionsprogramms (“Student Bodies“) zur Reduktion von Risikofaktoren für gestörtes Essverhalten bzw. Essstörungen. 100 Studentinnen von zwei Universitäten wurden per Zufall entweder einer Interventionsgruppe oder einer Wartekontrollgruppe zugewiesen. Die Dauer der Intervention betrug 8 Wochen. Zum Post-Zeitpunkt konnte die Wirksamkeit des adaptierten Programms im Vergleich zur Kontrollgruppe gut bestätigt werden. Die Effekte waren deutlich höher für eine Subgruppe von Frauen mit erhöhtem Risiko für Essstörungen.

Internal consistency, convergent validity and reliability of a brief questionnaire on disordered eating (DEQ)

Clinical interviews are considered the gold standard for the evaluation of the specific psychopathology associated with eating disorders. However, there are situations in which brief but valid and reliable self-report questionnaires can be helpful. For this reason, we have developed a new questionnaire, called the DEQ (Disordered Eating Questionnaire), brief enough to be used in epidemiological screenings, that evaluates the frequency and intensity of disordered eating attitudes and behaviours within a time frame of three months and addresses face valid questions to the general population. The aim of this study was to evaluate the dimensionality, reliability and convergent validity of this questionnaire. The DEQ was filled in by Italian secondary school girls and boys, together with the Contour Drawing Rating Scale (CDRS) and with the Eating Attitudes Test (EAT-26). The results showed a single component that explain a portion of variance of around 36%. The reliability of the scale is highly satisfactory. The scale is also valid, since scores on the DEQ scale are significantly and highly correlated with body dissatisfaction, measured by the CDRS, with body mass inex (BMI) and with all the subscales of the EAT-26. As expected, there were gender differences, given that DEQ scores were higher in females than in males.

Substance use and weight loss tactics among middle school youth

OBJECTIVE

Diet pills (DP) and vomiting or laxative (VL) use as weight loss tactics are associated with substance use in older adolescent populations. This study examined the association of weight loss tactics and substance use among middle school students.

METHODS

A Youth Risk Behavior Survey was administered to 6,957 middle school students in eastern North Carolina. Multiple logistic regression examined substance use as predictors of DP and VL use.

RESULTS

DP and VL use was reported by 6.0% and 7.1% of students, respectively, with each reported more frequently by females and White students. Regression analysis demonstrated alcohol, cigarette, or marijuana use as predictors for individual race/gender groups whereas steroid use was a predictor for all race/gender groups. We found a clustering effect of alcohol and cigarette use with both DP and VL use.

DISCUSSION

Substance use is associated with weight loss tactics as early as middle school. More research in the areas of clustering of behaviors and age at onset is needed.

Adolescents with eating disorders. Primary care screening, identification, and early intervention

The identification and treatment of eating disorders in adolescents is a challenging and time-consuming commitment. Early identification and treatment requires a multi-disciplinary team of health care professionals and provides an improved prognosis for these complex conditions. Nurses in all levels of practice are in ideal positions to influence early detection through careful screening (identification of risk factors, patient history, and physical exam), close follow-up, and prompt specialty referral with disease progression.

Causes of eating disorders

Anorexia nervosa and bulimia nervosa have emerged as the predominant eating disorders. We review the recent research evidence pertaining to the development of these disorders, including sociocultural factors (e.g., media and peer influences), family factors (e.g., enmeshment and criticism), negative affect, low self-esteem, and body dissatisfaction. Also reviewed are cognitive and biological aspects of eating disorders. Some contributory factors appear to be necessary for the appearance of eating disorders, but none is sufficient. Eating disorders may represent a way of coping with problems of identity and personal control.

Child sexual abuse and later disordered eating: a New Zealand epidemiological study

OBJECTIVE

This community-based study examined how some women who have experienced childhood sexual abuse (CSA) develop an eating disorder (ED), whereas others develop depression and anxiety, and others show no adverse psychological sequelae.

METHODS

A two-stage random community sampling strategy was used to select two groups of women: (1) women with CSA prior to age 16 years and (2) a comparison group of women reporting no abuse. Both groups completed the Parental Bonding Instrument (PBI), the Present State Examination, and additional ICD-10 eating disorders questions. Information on the nature and frequency of the CSA was obtained at interview. CSA women with ED (CSA+ED) were compared with CSA women without ED (CSA-noED) and with CSA women with anxiety and/or depression (psychiatric comparison group).

RESULTS

Higher rates of EDs in women who have experienced CSA were confirmed in this study. Belonging to a younger age cohort, experiencing menarche at an early age, and high paternal overcontrol on the PBI independently increased the risk of developing an ED in women who had experienced CSA. Low maternal care was specifically associated with the development of anorexia nervosa, whereas early age of menarche differentiated women with bulimia nervosa. Younger age and early age of menarche also differentiated the CSA+ED women from the psychiatric comparison group.

DISCUSSION

Early maturation and paternal overcontrol emerged as risk factors for ED development in women with CSA. Although these variables are also risk factors in the general population, women with CSA may be vulnerable to ED development because these risk factors are particular domains of concern that emanate from experiences of CSA.

Predicting children's reported eating disturbances at 8 years of age

OBJECTIVES

To examine differential parental influences on eating attitudes and behaviors of 8-year-old children with a specific focus on gender effects and to assess the specificity of this relationship.

METHOD

One hundred eight infants were monitored from birth and interviewed at age 8 for eating disturbances and negative affect with an adaptation of the McKnight Risk Factor Survey. Parental measures included the Three Factor Eating Questionnaire subscales Disinhibition and Restraint as well as body mass index, assessed at study entry.

RESULTS

No gender differences were found for frequencies of children's self-reported eating disturbances. Higher maternal restraint scores predicted worries about being too fat in girls but not in boys. Higher maternal disinhibition scores also differentially predicted weight control behaviors in their daughters. Negative affect in the child was (weakly) predicted by higher maternal body mass index. No association between paternal predictors of disturbed eating and the child's eating disturbances and negative emotionality was found.

CONCLUSIONS

The impact of maternal eating disorders and disturbances is much stronger than that of fathers and is specifically directed at their daughters. The clinical importance of these disturbances in terms of precursors of adolescent eating disorders has to be determined by monitoring the sample through puberty.

Eating disorders: the brain, bones and exercise

Eating disorders such as anorexia nervosa and bulimia nervosa present a far greater health problem than is generally acknowledged, and their assessment and management is both complex and challenging. They are characterized by excessive concern with the control of body weight and shape, accompanied by grossly inadequate, irregular or chaotic food intake.

Eating disorders

Anorexia nervosa and bulimia nervosa are primarily psychiatric disorders characterized by severe disturbances of eating behaviour. Anorexia nervosa has been well documented in pre-pubertal children. Eating disorders are most prevalent in the Western cultures where food is in abundance and for females attractiveness is equated with thinness. Eating disorders are rare in countries like India. As Western sociocultural ideals become more widespread one may expect to see an increase in number of cases of eating disorders in non-Western societies. Etiological theories suggest a complex interaction among psychological, sociocultural, and biological factors. Patients with anorexia nervosa manifest weight loss, fear of becoming fat, and disturbances in how they experience their body weight and shape. Patients with bulimia nervosa present with recurrent episodes of binge eating and inappropriate methods of weight control such as self-induced vomiting, and abuse of diuretics and laxatives. Major complications of eating disorders include severe fluid and electrolyte disturbances and cardiac arrhythmias. The most common cause of death in anorexia nervosa is suicide. Management requires a team approach in which different professionals work together. Individual and family psychotherapy are effective in patients with anorexia nervosa and cognitive-behavioral therapy is effective in bulimia nervosa. Pharmacotherapy is not universally effective by itself. Patients with eating disorders suffer a chronic course of illness. The pediatrician plays important role in early diagnosis, management of medical complications, and psychological support to the patient and the family.