Typical patterns of disordered eating among Swedish adolescents: associations with emotion dysregulation, depression, and self-esteem

Subclinical patterns of disordered eating behaviors in the daily life of adolescents and young adults from the general population

BACKGROUND

Disordered eating behaviors (DEBs), a risk factor for the development of eating disorders (EDs), are prevalent in young people and different DEBs frequently co-occur. Previous studies on DEB-patterns have largely used traditional retrospective questionnaires to assess DEBs. In addition, most previous studies did not specifically exclude individuals with clinical EDs, which limits current knowledge concerning purely subclinical patterns of DEBs. In the present study, we aimed to explore phenotypes and group sizes of subclinical patterns of DEBs reported in everyday life via smartphone-based ecological momentary assessment (EMA) in adolescents and young adults from the general population without lifetime EDs. In secondary analyses, we further aimed to investigate whether DEB-patterns would be associated with additional previously identified risk factors for ED-development.

METHODS

EMA was conducted in a community sample of 14-21-year-olds from Dresden, Germany, over four days for up to eight times a day and covered engagement in four DEBs: skipping eating, restrained eating, eating large amounts of food, and loss-of-control eating. Data were analyzed from N = 966 individuals without lifetime EDs with an EMA compliance rate of at least 50% (81.9% of the total sample; average compliance: 84.6%). Latent profile analyses were performed to identify subclinical patterns of DEBs, stratified by sex. Associations between symptomatic profiles and ED-risk factors were tested via regression analyses.

RESULTS

Based on theoretical deliberations, statistical indices, interpretability, and parsimony, a three-profile solution, namely no DEBs, high-mixed DEBs, and low-mixed DEBs, was selected for both sexes. Both symptomatic profiles in both sexes were associated with more unfavorable manifestations in additional ED risk factors compared to the no DEBs profile, with the highest number of associations being observed in the female high-mixed profile.

CONCLUSIONS

The present findings suggest that problematic manifestations of DEBs in young people may occur even in the absence of an ED diagnosis and that they are associated with additional risk factors for EDs, warranting increased efforts in targeted prevention, early identification and intervention in order to counteract symptom progression.

The use and misuse of the SCOFF screening measure over two decades: a systematic literature review

PURPOSE

The SCOFF questionnaire was designed as a simple, memorable screening tool to raise suspicion that a person might have an eating disorder. It is over 20 years since the creation of the SCOFF, during which time it has been widely used. Considering this, we wish to review the use of the SCOFF in peer-reviewed scientific journals, and to assess whether it is being used appropriately in the manner in which it was originally devised and tested.

METHODS

The Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) guidelines were followed, and all search strategies and methods were determined before the onset of the study. PubMed and Wiley Online Library were searched using the terms SCOFF and eating. Two reviewers were involved in the reviewing process. Criteria for appropriate use of the SCOFF were formalised with the tool's original authors.

RESULTS

180 articles were included in the final review. 48 articles had used the SCOFF appropriately, 117 articles inappropriately and 15 articles had been mixed in the appropriateness of their use.

CONCLUSION

This systematic review highlights the inappropriate use of the SCOFF in diverse languages and settings. When used correctly the SCOFF has made a significant contribution to the understanding of eating disorders and its simplicity has been applauded and led to widespread use. However in over two-thirds of studies, the use of the SCOFF was inappropriate and the paper highlights how and in what way it was misused, Guidelines for the appropriate use of the SCOFF are stated. Future validation and avenues of research are suggested.

LEVEL OF EVIDENCE

Level I.

Disordered eating in a 10-year perspective from adolescence to young adulthood: Stability, change, and body dissatisfaction as a predictor

INTRODUCTION

Although there are many studies of disordered eating (DE) in adolescence, studies examining the longitudinal stability and change of DE and its longitudinal associations with other factors are still rather scarce. Such studies are important to inform parents and clinicians how stable DE is and to what extent it will go away with increased maturity. Longitudinal studies may also be of help in establishing predictors of long-term problems. The purpose of the present study was to investigate the stability of DE over a 10-year period from early adolescence to young adulthood, and to explore body dissatisfaction as a predictor in a 10-year perspective.

METHODS

Data were taken from a three-wave longitudinal project (SoL) with survey data collected among the students in Grades 7and 8 in a Swedish municipality in 2007 (T1), 1 year later (T2), and in a 10-year follow-up in 2017 (T3). DE was measured by the eight-item version of the Risk Behaviour Related to Eating Disorders (RiBED-8), and a quasi-clinical criterion of six or more critical answers on the RiBED-8 was used to classify DE cases.

RESULTS

Of the girls, 5.8% passed the cutoff for DE at T1, whereas 9.1% did so at T2 and 7.9% at T3. The boys showed markedly lower figures: 0.5% both at T1 and T2, and 1.5% at T3. There was significant individual stability of DE over the 10-year period, with almost 30% of the girls who passed the cutoff for DE at T1 also doing so 10 years later. Body dissatisfaction in early adolescence predicted the incidence of new cases of DE 10 years later, even when controlling for degree of DE in early adolescence. The results also indicate that DE in early adolescence may be a passing phase among adolescents who express relatively high body satisfaction.

CONCLUSIONS

The present results show a complex picture of different individual trajectories of DE, with degree of body satisfaction playing a significant role for the outcome in a 10-year perspective. Body dissatisfaction appears to be a risk factor for the development of new cases of DE, whereas body satisfaction may protect against the continuation of DE into adulthood.

"Good food equals good health": a focus group study of adolescent boys' perceptions of eating and weight

BACKGROUND

Disordered eating refers to unhealthy, sometimes excessive eating including so-called compensatory behaviours such as extreme dieting or voluntary vomiting. Between 24% and 30% of adolescent boys are suggested to engage in disordered eating, making it a significant public health issue. However, current instruments for assessing disordered eating among adolescents have been primarily developed and validated for girls and women, which may make for flawed assessment of boys. The aim of this study is to shed light on adolescent boys' perceptions of eating, weight, and food intake to better understand their perspectives in service of disordered eating research.

METHODS

This exploratory study was conducted from May to November 2022 using focus groups with a total of 39 adolescent boys (aged 12-19 years) who attended 7th to 12th grade in one of four schools in Southern Sweden. In addition, participants completed a form with questions on background demographics and eating habits. The transcripts of the focus group discussions were analysed using thematic analysis.

RESULTS

The quantitative data showed that around one third of the adolescent boys were overweight or obese. They ate at least one meal per day with the family and ate healthy food about five days per week and unhealthy food about three. Analysis of the qualitative data yielded six themes: The intertwined relationship between food and one's health, "Don't worry, food makes you happy," "To be hungry or not. That is the question," Boys DO care about appearances, Dieting and weight gain, and Disordered eating is a tricky matter.

CONCLUSION

Adolescent boys appeared to have a good understanding of food and healthy eating. They also experienced body positivity and seemed to have only minor issues regarding their weight. The primarily pathological perspective used to measure disordered eating among girls seems in need of revision to adhere to boys' thoughts and ideas regarding eating and weight.

Psychological correlates of body dissatisfaction in Swiss youth over a one-year study-period

Introduction

It is well known that young individuals often report pronounced negative perceptions and attitudes towards their own body or intense fear of being not muscular enough. There is much less data available, however, on the role of psychological mechanisms on these perceptions and attitudes, such as emotion regulation difficulties, correlates of alexithymia, and appearance-related rejection sensitivity.

Methods

We therefore set out to assess associations between these psychological mechanisms, and body image as well as muscle dysmorphic symptoms. Our sample was recruited as part of a larger-scale study aiming at assessing correlates of mental health (with a focus on eating disorder symptoms) in German speaking Switzerland. The first wave (T1), starting in April 2021, included 605 participants (80% female, 19.6 ± 2.5 years) who completed the online-questionnaire and were reassessed in a second wave (T2), one year later.

Results

Results indicated that at both waves, emotion regulation difficulties [DERS-SF] and appearance-based rejection sensitivity [ARS-D] were both positively cross-sectionally associated with body dissatisfaction [BSQ-8C] and muscle dysmorphic symptoms [MDDI] at the first assessment time-point and one year later at follow-up assessment. Moreover, alexithymia [TAS-20] was positively cross-sectionally associated with muscle dysmorphic symptoms at both waves. We further observed high absolute and relative level stabilities for all variables involved across the one-year study period.

Discussion/Conclusion

Even though the effects for some associations were rather small, our findings underline the relevance of such mechanisms in the development of body dissatisfaction and to a lesser extent of muscle dysmorphia symptoms over the period of one year. Additional research is necessary to replicate these findings in other youth samples.

Disordered eating through the lens of positive psychology: The role of embodiment, self-esteem and identity coherence

Applying a positive psychology perspective, this study aimed to identify potential intra-individual factors that might protect against the development of disordered eating in a community sample of young women and men (N = 510; 56 % women; M_age = 24.3). Based on existing literature, the study included the general resilience factors of self-esteem and identity coherence as well as two dimensions of positive embodiment (positive body connection and comfort, and agency and functionality). All factors were negatively correlated with disordered eating among women and men. Hierarchical regression analyses indicated that positive embodiment, specifically positive body connection, was a significant predictor of lower degrees of disordered eating symptoms in both women and men, followed by self-esteem. The overall prediction model accounted for 42.6 % in the variation of disordered eating symptoms for women and 23.9 % for men. Prevention and treatment interventions promoting health factors that protect against the development of eating disorders are much needed. The present study informs such efforts by emphasizing the promotion of positive embodiment.

Emotional Dysregulation in Children and Adolescents With Psychiatric Disorders. A Narrative Review

Background: Emotional dysregulation (ED) is a transdiagnostic construct defined as the inability to regulate the intensity and quality of emotions (such as, fear, anger, sadness), in order to generate an appropriate emotional response, to handle excitability, mood instability, and emotional overreactivity, and to come down to an emotional baseline. Because ED has not been defined as a clinical entity, and because ED plays a major role in child and adolescent psychopathology, we decided to summarize current knowledge on this topic based on a narrative review of the current literature. Methods: This narrative review is based on a literature search of peer-reviewed journals. We searched the databases ERIC, PsycARTICLES, PsycINFO and PSYNDEX on June 2, 2020 for peer reviewed articles published between 2000 and 2020 in English language for the preschool, school, and adolescent age (2-17 years) using the following search terms: "emotional dysregulation" OR "affect dysregulation," retrieving 943 articles. Results: The results of the literature search are presented in the following sections: the relationship between ED and psychiatric disorders (ADHD, Mood Disorders, Psychological Trauma, Posttraumatic Stress Disorder, Non-suicidal Self-Injury, Eating Disorders, Oppositional Defiant Disorder, Conduct Disorder, Disruptive Disruptive Mood Dysregulation Disorder, Personality Disorders, Substance Use Disorder, Developmental Disorders, Autism Spectrum Disorder, Psychosis and Schizophrenia, and Gaming Disorder), prevention, and treatment of ED. Conclusion: Basic conditions of ED are genetic disposition, the experience of trauma, especially sexual or physical abuse, emotional neglect in childhood or adolescence, and personal stress. ED is a complex construct and a comprehensive concept, aggravating a number of various mental disorders. Differential treatment is mandatory for individual and social functioning.

Nutritional status and eating disorders among medical students from the Cluj-Napoca University centre

Background and aims

The nutritional disorders are modifiable predisposing factors of the current leading causes of morbidity and premature mortality, such as cardiovascular diseases, diabetes and cancers. An early recognition of appropriate interventions could decrease the burden of medical costs and increase the healthy life expectancy. The aims of our study were the description of nutritional status, its associated factors, and the detection of eating disorders among Romanian medical students of the “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca.

Methods

A cross-sectional study was conducted during the 2015–2016 academic year, including medical students from all study years, by an online questionnaire. The statistics, both descriptive and inferential, were calculated using EpiInfo.

Results

A total of 222 students from the University Romanian section were included, with a sex-ratio (men:women) of 0.22. The average body mass index of the medical students included was 21.3±3.3 kg/m2, for females it was 20.7±3 kg/m2 and for males 23.9±3.1 kg/m2. For the nutritional disorders such as overweight, the prevalence among males (30%) had a net predominance (p<0.001) over females (4.4%), while for underweight, it was prevalent only for female students (20.3%). Overweight was associated with low academic performance (odds ratio (OR)=7.2; 95% confidence interval (95% CI): 1–53.94), smoking (OR=2.4; 95% CI: 1–5.76) and binge drinking (OR=3; 95% CI: 1.26–7.25). Eating disorders were reported by 25.7% of the students and were significantly more prevalent in students in the second academic study cycle (47.4%; 95% CI: 34.7–60.3%) and in students with jobs (7%; 95% CI: 2.3–16.1%).

Conclusions

In this survey, two different distribution models of nutritional disorders for both genders were identified, with the predominance of overweight among men. Eating disorders were more prevalent among students in the second study cycle and those with jobs at the same time.

Disordered eating in a Swedish community sample of adolescent girls: subgroups, stability, and associations with body esteem, deliberate self-harm and other difficulties

BACKGROUND

The developmental study of subtypes of disordered eating (DE) during adolescence may be relevant to understand the development of eating disorders. The purpose of the present study was to identify subgroups with different profiles of DE in a community sample of adolescent girls aged 13-15 years, and to study the stability of these profiles and subgroups over a one-year interval in order to find patterns that may need to be addressed in further research and prevention.

METHODS

Cluster analysis according to the LICUR procedure was performed on five aspects of DE, and the structural and individual stability of these clusters was analysed. The clusters were compared with regard to BMI, body esteem, deliberate self-harm, and other kinds of psychological difficulties.

RESULTS

The analysis revealed six clusters (Multiple eating problems including purging, Multiple eating problems without purging, Social eating problems, Weight concerns, Fear of not being able to stop eating, and No eating problems) all of which had structurally stable profiles and five of which showed stability at the individual level. The more pronounced DE clusters (Multiple eating problems including/without purging) were consistently associated with higher levels of psychological difficulties and lower levels of body esteem. Furthermore, girls that reported purging reported engaging in self-harm to a larger extent.

CONCLUSIONS

Subgroups of 13-15 year old girls show stable patterns of disordered eating that are associated with higher rates of psychological impairment and lower body esteem. The subgroup of girls who engage in purging also engage in more deliberate self-harm.