Risk Factors for Onset of Eating Disorders: Evidence of Multiple Risk Pathways from an 8-Year Prospective Study
TL;DR: This three-way interaction suggests a body dissatisfaction pathway to eating disorder onset that is amplified by depressive symptoms, as well as a pathway characterized by self-reported dieting among young women who are more satisfied with their bodies.
About: This article is published in Behaviour Research and Therapy.The article was published on 2011-10-01 and is currently open access. It has received 478 citations till now. The article focuses on the topics: Eating disorders & Risk factor.
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TL;DR: To successfully fight this enigmatic illness, understanding of the underlying biological and psychosocial mechanisms has to be enhanced, strategies for prevention and early intervention improved, and treatments targeted through improved understanding of specific disease mechanisms targeted.
488 citations
TL;DR: Results provide support for the theory that pursuit of the thin Ideal and the resulting body dissatisfaction, dieting, and unhealthy weight control behaviors increase risk for binge/purge spectrum eating disorders, but suggest that youth who are inherently lean, rather than purposely pursuing the thin ideal, are at risk for AN.
Abstract: Because no single report has examined risk factors that predict future onset each type of eating disorder and core symptom dimensions that crosscut disorders, we addressed these aims to advance knowledge regarding risk factor specificity. Data from 3 prevention trials that targeted young women with body dissatisfaction (N = 1,272; Mage = 18.5, SD = 4.2) and collected annual diagnostic interview data over 3-year follow-up were combined to identify predictors of subthreshold/threshold anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and purging disorder (PD). Negative affect and functional impairment predicted onset of all eating disorders. Thin-ideal internalization, body dissatisfaction, dieting, overeating, and mental health care predicted onset of subthreshold/threshold BN, BED, and PD; positive thinness expectations, denial of cost of pursuing the thin ideal, and fasting predicted onset of 2 of these 3 disorders. Similar risk factors predicted core eating disorder symptom onset. Low BMI and dieting specifically predicted onset of subthreshold/threshold AN or low BMI. Only a subset of factors showed unique predictive effects in multivariate models, likely due to moderate correlations between the risk factors (M r = .14). Results provide support for the theory that pursuit of the thin ideal and the resulting body dissatisfaction, dieting, and unhealthy weight control behaviors increase risk for binge/purge spectrum eating disorders, but suggest that youth who are inherently lean, rather than purposely pursuing the thin ideal, are at risk for AN. Impaired interpersonal functioning and negative affect are transdiagnostic risk factors, suggesting these factors should be targeted in prevention programs. (PsycINFO Database Record
325 citations
Cites background from "Risk Factors for Onset of Eating Di..."
...tion, dieting, or negative affect did not (Stice et al., 2011)....
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...Additional details can be found in Stice et al. (2008, 2011, 2015)....
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...It has shown internal consistency ( .94), 3-week test–retest reliability (r .90), predictive validity for eating disorder onset, and sensitivity to intervention effects (Stice et al., 2008, 2011)....
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...T hi s ar tic le is in te nd ed so le ly fo r th e pe rs on al us e of th e in di vi du al us er an d is no t to be di ss em in at ed br oa dl y. tion, dieting, or negative affect did not (Stice et al., 2011)....
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...Thinideal internalization, body dissatisfaction, and dieting predicted PD onset over 7-year follow-up, but social pressure to be thin, negative affect, and depressive symptoms did not (Stice et al., 2011)....
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TL;DR: An overview of eating disorders in adolescent and adult athletes including prevalence data, suggested sport- and gender-specific risk factors, and suggestions for long-term follow-up are presented.
Abstract: The prevalence of disordered eating and eating disorders vary from 0-19% in male athletes and 6-45% in female athletes. The objective of this paper is to present an overview of eating disorders in adolescent and adult athletes including: (1) prevalence data; (2) suggested sport- and gender-specific risk factors and (3) importance of early detection, management and prevention of eating disorders. Additionally, this paper presents suggestions for future research which includes: (1) the need for knowledge regarding possible gender-specific risk factors and sport- and gender-specific prevention programmes for eating disorders in sports; (2) suggestions for long-term follow-up for female and male athletes with eating disorders and (3) exploration of a possible male athlete triad.
292 citations
TL;DR: The results imply that these risk factors are present by early adolescence, although eating disorders tend to emerge in late adolescence and early adulthood, which emphasizes the need for efficacious eating disorder prevention programs for early adolescent girls.
Abstract: Eating disorders show a chronic course and result in significant functional impairment, emotional distress, and medical problems.1, 2, 3 A cross-sectional retrospective epidemiological study suggested that approximately 7.5% of young women meet criteria for a DSM-IV-TR4 eating disorder of anorexia nervosa, bulimia nervosa, or binge eating disorder (BED).1 A recent examination of the natural history of DSM-5 eating disorders5 in a community sample of 496 female adolescents who completed annual diagnostic interviews over an 8-year period found that 13% of participants experienced some form of threshold or subthreshold eating disorder by age 20, with the peak age of onset for bulimia nervosa and BED being 17-18 years of age, and 18-20 for purging disorder.6 Retrospective data suggest a median age of onset (with interquartile range) of 18 years (16-22) for anorexia nervosa, 18 years (14-22) for bulimia nervosa, and 21 years (17-32) for BED among community-recruited adults.1
Although the incidence of eating disorders in early adolescence (ages 10-14) is very low,3, 7 extant data suggest that risk factors for symptoms of eating disorders8 and eating disorder syndromes7,9 escalate in early adolescence. Accordingly, the focus of the present report is on the development and predictive power of potential eating disorder risk factors during early adolescence. The first aim of this study was to describe the developmental changes in potential risk factors from age 13 to 21, using data from a 8-year longitudinal study of community female adolescents.6 We focused on young women because they are at much higher risk for onset of eating pathology than young men.1 We examine whether the course of each variable is increasing, decreasing, or stable over this developmental period and, if change is present, whether it is linear or quadratic, as non-linear change might capture critical periods of increases in risk factors. These data should provide direction regarding when to target populations at elevated risk for eating disorders by virtue of possessing these risk factors. Further, if there are qualitatively distinct periods during which different risk factors emerge prior to eating disorder onset, it may be possible to improve the yield of prevention efforts by targeting different risk factors during these distinct developmental periods. It is possible that decreasing these risk factors may reduce future eating disorder onset, though predictive effects cannot establish a causal relation because it is always possible that some third variable explains both the emergence of the risk factor and eating pathology.
Very few studies have examined the course of potential risk factors prior to mid-adolescence. One exception is Bucchianeri, Arikian, Hannan, Eisenberg, and Neumark-Sztainer,10 who followed a cohort of girls recruited during middle school (M age at first assessment = 12.8 years, SD = 0.7) over a 10-year period; data revealed a significant upward linear increase in body dissatisfaction from middle school to high school and to young adulthood. However, body mass index (BMI = kg/m2) scores also increased across all three time points for both male and female participants, and after adjusting for BMI, the linear trend in body dissatisfaction was nonsignificant. No studies, to our knowledge, have investigated the temporal development of several risk factors prior to and during peak period of eating disorder onset (i.e., from early adolescence to young adulthood).
Guided by the dual-pathway model of eating pathology11 and prior research with female adolescents,9,12-15 we focused on six potential risk factors: (1) perceived pressure to be thin, (2) thin-ideal internalization, (3) body dissatisfaction, (4) dieting, (5) temperamental negative affectivity (i.e., the tendency to experience negative emotional states), and (6) body mass. The dual-pathway model posits that perceived pressure to be thin from significant others and the media and internalization of the thin beauty ideal produces body dissatisfaction, which in turn promotes unhealthy dieting behaviors that may progress to an eating disorder. Body dissatisfaction may also contribute to negative affect given the importance of appearance in Western culture, which in turn might lead people to binge eat to provide comfort and distraction from negative emotions. According to the affect regulation model,11 people binge eat in an effort to achieve comfort and distraction from their negative emotions. Previous research with adolescents has found that female adolescents in 6-9th grade reporting social pressure to be thin and body image preoccupation showed a higher risk for onset of threshold or subthreshold bulimia nervosa or binge eating disorder over 3-year follow-up,14 high school women reporting weight and shape concerns and negative affectivity showed a higher risk for onset of threshold or subthreshold bulimia nervosa over 4-year follow-up,8 and female adolescents (11-15 years of age) reporting elevated dietary restraint showed elevated risk for onset of threshold or subthreshold bulimia nervosa over 5-year follow-up.16 It is arguably more important to identify youth at elevated risk for any eating disorder because prevention programs should ideally target all eating disorders, rather than just one type of eating disorder, and elevated dietary restraint has been found to increase risk for onset of any eating disorder among young women (16-23 years of age) over 2-year follow-up,12 young women (14-15 years of age) over 3-year follow-up,14 and 16-year-old women over 1-year follow-up.15 In an earlier report examining data used in the present study using classification tree analysis to predict onset of threshold and subthreshold eating disorders over 8-year follow-up,17 a three-way interaction emerged suggesting a body dissatisfaction pathway to eating disorder onset that was amplified by depressive symptoms, as well as a pathway characterized by self-reported dieting among young women who are more satisfied with their bodies. Further, increased adiposity has been theorized to result in both increased social pressure to be thin and body dissatisfaction, which putatively lead to dieting, negative affect, and elevated risk for eating pathology.18 BMI is known to increase during the adolescent developmental period.19 For example, one study found that self-reported BMI among female adolescents in their younger cohort increased from an average of 21.7 at the first assessment (M age = 12.8) to an average of 26.4 at the third assessment (M age = 23.2).10
To identify variables that predict pathological eating behavior in children and early adolescents, Gardner, Stark, Friedman, and Jackson examined the degree to which six variables (weight, teasing, body esteem, body dissatisfaction, depression, perceived body size, ideal body size) predicted elevated scores on an eating disorder survey in 216 female and male children ages 6-14 who were assessed annually for 3 years.20 They examined each predictor at various ages to identify when the factors tended to became significant predictors of elevated eating disorder scores, finding that low body esteem became a significant factor at age 9, depression at age 10, body dissatisfaction and larger perceived body size judgments at age 11, and thinner ideal body sizes at age 12. Using a similar analytic approach, our second aim was to examine whether each of the Aim 1 potential risk factors examined during early adolescence predicted subsequent onset of DSM-5 eating disorders, and whether the predictive effects of these risk factors varied as a function of age. We sought to extend the findings of Gardner and colleagues20 by (a) following a larger cohort of youth, (b) examining a longer period of time, and (c) by predicting onset of DSM-5 eating disorders as determined by diagnostic interview. To address this aim, we examined the degree to which each of the six potential risk factors at ages 13, 14, 15, and 16 significantly predicted the onset of eating disorders in the four year period following each assessment. These data may also advance etiologic models for eating disorders by illuminating the earliest risk factors that predict eating disorder onset.
260 citations
Cites background from "Risk Factors for Onset of Eating Di..."
...disorder symptoms over the past 12-months at each assessment.(17) The EDDI is a semi-structured interview...
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...Sixth, our focus in this paper was on the course and predictive effects of potential risk factors examined individually, to improve understanding of the developmental patterns and predictive magnitude of each specific potential risk factor; we have previously tested for interactions among risk factors to predict future eating disorder onset across the entire 8-year follow-up period.(17) Given the possibility that some omitted third variable or moderational effects explain the prospective effects observed in longitudinal studies, it will be vital to conduct randomized prevention trials that reduce suspected risk factors with active credible alternative comparison conditions to provide an experimental test of the relation between these risk factors and these eating pathologies....
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TL;DR: The findings inform sociocultural theory of body dissatisfaction, suggesting that internalization of the media ideal precedes and predicts appearance comparison and that body image interventions that target internalized of theMedia ideal, and social appearance comparison as well as body dissatisfaction are likely to be effective.
Abstract: Sociocultural theory of body dissatisfaction posits that internalization of the media ideal and appearance comparison are predictors of body dissatisfaction, a key risk factor for eating disorders. However, no data exist regarding the longitudinal relationships between these variables. The aim of this study was to explore longitudinal relationships among internalization of the media-ideal, social appearance comparison, and body dissatisfaction. A sample of 277 Grade 7 school girls (M age = 12.77 years, SD = 0.44) completed measures of internalization of the media ideal, social appearance comparison, and body dissatisfaction at baseline, 8 months, and 14 months. Path analyses indicated that baseline internalization of the media ideal predicted social appearance comparison and body dissatisfaction at 8 months, and social appearance comparison at 8 months predicted body dissatisfaction at 14 months. A reciprocal effect emerged with body dissatisfaction at 8 months predicting internalization of the media ideal at 14 months. The findings inform sociocultural theory of body dissatisfaction, suggesting that internalization of the media ideal precedes and predicts appearance comparison and that body image interventions that target internalization of the media ideal, and social appearance comparison as well as body dissatisfaction are likely to be effective.
234 citations
Cites background from "Risk Factors for Onset of Eating Di..."
...These findings are important given the critical role of body dissatisfaction in the development of eating disorders among older adolescents (Stice et al., 2011)....
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...Clarifying these relationships is critical in terms of understanding the mechanisms leading to increases in body dissatisfaction, one of the major risk factors for disordered eating (Stice et al., 2011)....
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References
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11 Jun 2013
113,134 citations
TL;DR: Results suggest the K-SADS-PL generates reliable and valid child psychiatric diagnoses.
Abstract: Objective To describe the psychometric properties of the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL) interview, which surveys additional disorders not assessed in prior K-SADS, contains improved probes and anchor points, includes diagnosis-specific impairment ratings, generates DSM-III-R and DSM-IV diagnoses, and divides symptoms surveyed into a screening interview and five diagnostic supplements. Method Subjects were 55 psychiatric outpatients and 11 normal controls (aged 7 through 17 years). Both parents and children were used as informants. Concurrent validity of the screen criteria and the K-SADS-PL diagnoses was assessed against standard self-report scales. Interrater ( n = 15) and test-retest ( n = 20) reliability data were also collected (mean retest interval: 18 days; range: 2 to 38 days). Results Rating scale data support the concurrent validity of screens and K-SADS-PL diagnoses. Interrater agreement in scoring screens and diagnoses was high (range: 93% to 100%). Test-retest reliability κ coefficients were in the excellent range for present and/or lifetime diagnoses of major depression, any bipolar, generalized anxiety, conduct, and oppositional defiant disorder (.77 to 1.00) and in the good range for present diagnoses of posttraumatic stress disorder and attention-deficit hyperactivity disorder (.63 to .67). Conclusion Results suggest the K-SADS-PL generates reliable and valid child psychiatric diagnoses. J. Am. Acad. Child Adolesc. Psychiatry , 1997, 36(7): 980–988.
8,742 citations
TL;DR: Eating disorders, although relatively uncommon, represent a public health concern because they are frequently associated with other psychopathology and role impairment, and are frequently under-treated.
4,304 citations
"Risk Factors for Onset of Eating Di..." refers background in this paper
...We focused on females because they are at much higher risk for onset of eating pathology than males (Hudson et al., 2007)....
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TL;DR: A unified framework for recursive partitioning is proposed which embeds tree-structured regression models into a well defined theory of conditional inference procedures and it is shown that the predicted accuracy of trees with early stopping is equivalent to the prediction accuracy of pruned trees with unbiased variable selection.
Abstract: Recursive binary partitioning is a popular tool for regression analysis. Two fundamental problems of exhaustive search procedures usually applied to fit such models have been known for a long time: overfitting and a selection bias towards covariates with many possible splits or missing values. While pruning procedures are able to solve the overfitting problem, the variable selection bias still seriously affects the interpretability of tree-structured regression models. For some special cases unbiased procedures have been suggested, however lacking a common theoretical foundation. We propose a unified framework for recursive partitioning which embeds tree-structured regression models into a well defined theory of conditional inference procedures. Stopping criteria based on multiple test procedures are implemented and it is shown that the predictive performance of the resulting trees is as good as the performance of established exhaustive search procedures. It turns out that the partitions and therefore the...
3,246 citations