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Relevance of Social and Self‐standards in Eating Disorders
Abstract
Objective
To compare the importance given to self/other standards by eating disorder (ED) patients and healthy controls.MethodsA total of 392 individuals (240 consecutively referred and 152 healthy controls) took part in this study. All subjects were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria and were female patients. Participants completed the Family Style, Self-Expectations and Emotional related subscales of the Cross-Cultural Questionnaire.ResultsThree domains (namely, family standards, self-achievement and physical appearance) were associated with ED. Family standards scores discriminated for the presence of an ED (area under receiver operating characteristic curve equals 0.89), the main predictors being a higher level of importance of physical appearance (p < .001), family standards (p = .029) and conflicts with parents about physical appearance (p < .001). Higher self-standards, in physical appearance, were more relevant in bulimia nervosa and ED not otherwise specified, whereas higher family standards were more associated with anorexia nervosa.Conclusions
High self-standards and social standards are common features in ED. The parallelism that ED may establish between reaching them and their life success may have a crucial role as a developing and maintaining factor in ED. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.
... This is in line with a previous study investigating aspects of positive functioning, in which patients with AN reported better subjective quality of life when compared with individuals with BN and BED. 4 As for patients with AN, various influencing factors may play a role in self-report measures of PWB. For instance, possible egosyntonic aspects and lack of insight may explain why PWB is not very impaired in out-patients with AN. 33,34 A sense of self-worth, self-competence, personal mastery, and a sense of achievement has been found in patients with AN related to their ability of controlling weight. [34][35][36][37] Other possible explanations for reporting less impairment in PWB may be due to specific personality traits associated with AN that the study was not able to take into account. ...
... For example, the trait of perfectionism gives rise to the need to avoid appearing imperfect and the sense of dependence in terms of relying on the approval of others. 38 Additionally, sociocultural values such as thinness desirability and positive social feedback for being thin may be associated with greater selfreported PWB in women with AN. 4,33 This may be particularly relevant in out-patients with AN with a nonlife-threatening BMI, who may consider their thinness positively as it is associated with success and popularity. 34,37 Our findings showing that impaired levels of PWB were independent from the presence of psychopathology support the notion that the presence of well-being does not simply correspond to the absence of psychological distress. ...
Positive functioning is widely neglected in research on eating disorders (EDs). The aim of this exploratory study was to assess psychological well-being (PWB) in out-patients with ED and in controls.
The authors assessed PWB in 245 out-patients with EDs [105 with bulimia nervosa (BN), 57 with anorexia nervosa (AN), and 83 with binge eating disorder (BED) who met DSM-IV-TR] and 60 controls. They tested whether PWB was associated with eating attitude test (EAT) scores and if such associations differed among ED groups while taking into account confounding variables.
Significant differences between groups in all PWB scales were found. While individuals with BN reported significantly lower scores in all PWB dimensions than healthy controls, patients with BED scored significantly lower than controls in PWB autonomy, environmental mastery, and self-acceptance scales. Patients with AN showed similar scores to controls in all PWB dimensions, except for positive relationships and self-acceptance. In all ED groups, most PWB dimensions resulted significantly and negatively associated with EAT scales, except for AN where oral control was found to positively correlate with a high sense of purpose in life. All results were maintained even after adjusting for possible confounding variables.
Patients with EDs reported an impairment in PWB. The paucity of PWB was not necessarily dependent on the presence of high levels of psychological distress and on the severity of the disorder. Such assessments may therefore yield a more comprehensive evaluation in this clinical population. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2013;).
... maladaptive weight control practices, body dissatisfaction, social isolation and low self-esteem (Gunnard et al., 2011;Krug et al., 2012;McClure, Tanski, Kingsbury, Gerrard, & Sargent, 2010;Neumark-Sztainer, Wall, Story, & Standish, 2012). ...
... Accordingly, previous studies (Hayden-Wade et al., 2005;Neumark-Sztainer, 2009;Neumark-Sztainer et al., 2012) have indicated that family members and friends often provide negative comments about body shape and reinforce pressure to diet and to employ unhealthy weight control methods. Such pressures and teasing in addition to unsuccessful weight loss attempts and a constant control of food intake have been revealed to be associated with body dissatisfaction, low self-esteem, depression and other emotional problems (Adambegan et al., 2012;Gunnard et al., 2011). Follow-up studies with numerous time points will be beneficial in detailing the temporal arrangement of such a teasingemotional-body dissatisfaction-dysfunctional eating cycle. ...
Objective:
This study aimed to examine whether there is an association between individual, social and family influences and dysfunctional eating patterns early in life and the likelihood of developing a subsequent underweight eating disorder (ED) or obesity.
Method:
The total sample comprised 152 individuals (underweight ED, n = 45; obese patients, n = 65; healthy controls; n = 42) from Barcelona, Spain. The Cross-Cultural Questionnaire (CCQ) was used to assess early eating influences as well as individual and family eating patterns and attitudes towards food.
Results:
Even though a few shared eating influences emerged for both groups, unique factors were also observed. Whereas relationship with friends, teasing about eating habits by family members and the mass media were of specific relevance to the underweight ED group, the patient's own physical appearance, body dissatisfaction, teasing about eating habits by friends, teasing about body shape by family members and dysfunctional eating patterns were unique to obesity.
Conclusions:
Overlapping environmental risk factors provide evidence for integral prevention and intervention approaches that simultaneously tackle a range of weight-related problems. The unique factors might be important for targeting high-risk individuals.
... Individuals high in neuroticism tend to experience more unpleasant emotions, anxiety, impulsiveness, and possess poor coping skills, which may lead to engagement in ED behaviours (Cervera et al., 2003;Garrido, Funes, Peñaloza Merlo, & Cupani, 2018;Ghaderi & Scott, 2000;Lilenfeld, Wonderlich, Riso, Crosby, & Mitchell, 2006). Furthermore, low self-esteem has continuously been found to contribute to the development of body dissatisfaction and is a strong predictor of ED attitudes and behaviours (e.g., food restraint and aversion, and a tendency to base one's worthiness on body shape; Alfoukha, Hamdan-Mansour, & Banihani, 2017;Etcoff, Orbach, Scott, & D'Agostino, 2004;Fairburn, Shafran, & Cooper, 1999;Gunnard et al., 2011;Izydorczyk, Sitnik-Warchulska, Lizińczyk, & Lipiarz, 2019;Kuck et al., 2021;Mantilla & Birgegård, 2015;Paterson, McKenzie, & Lindsay, 2011;Rodgers et al., 2020;Tiunova, 2015;Van den Berg et al., 2010). Thus, as FNE shares some characteristics of the facets of neuroticism (e.g., self-consciousness, anxiety, vulnerability; Hazel, Keaten, & Kelly, 2014;Levinson & Rodebaugh, 2011) and low selfesteem, FNE may be further strengthening the potentiality for ED development (Junghans-Rutelonis et al., 2015;Khanam and Mogha, 2012;Kocovski & Endler, 2000;Schmitz et al., 2003). ...
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.
... Im Sport spielt der Wunsch nach Leistungssteigerung durch Gewichtsreduktion eine zentrale Rolle, da oft ein hoher gesellschaftlicher Druck oder Konkurrenzkampf vorherrscht [34]. Eigenschaften wie ein geringes Selbstwertgefühl [7], Perfektionismus [58,60], hohe Selbstansprüche [33], Konkurrenzdenken und/oder Schmerztoleranz [65] werden mit ES in Verbindung gebracht. Ein Grund, der in der Literatur häufig genannt wird, ist das Streben nach einer bestimmten idealen Körperform [8,21,22,72,75], was im Zusammenhang mit Gefühlen wie Unzufriedenheit mit dem eigenen Körper und negativen Stimmungen steht und der Beginn von gestörtem Essverhalten sein kann [8]. ...
Zusammenfassung
Neben einer guten Tanztechnik spielt die Körperform von professionellen Tänzer*innen eine entscheidende Rolle. Im klassischen Tanz gilt eine leptosom-grazile Form mit langen Gliedmaßen bei Frauen als ideal. Dementsprechend ist die Prävalenz von Untergewicht hoch. Dabei ist es nicht ausgeschlossen, dass dieses physische Erscheinungsbild mittels Diäten erreicht wird. Auffällig ist eine höhere Prävalenz von Störungen des Essverhaltens und Essstörungen vor allem bei Tänzerinnen im Vergleich zu nicht tanzenden Vergleichsgruppen. Im Zusammenhang mit dem Untergewicht können hormonelle Störungen, wie Amenorrhoe, Osteoporose oder Leistungseinschränkungen auftreten. Daher ist es wichtig, Tänzer*innen regelmäßig zu untersuchen und präventive Maßnahmen zu ergreifen. Ziel der vorliegenden Übersicht ist die Darstellung der Literatur zu diesem Thema.
... Although much of the perfectionism literature has focused on trait perfectionism, some investigators have examined people's domain-specific standards (e.g., performance standards among figure skaters; Dunn et al. 2011). Researchers have also assessed several domain-specific standards but have aggregated across these domains to yield a general index (e,g., Gunnard et al. 2011). The present study underscores the importance of assessing standards in specific domains, given the present finding that people's standards were only moderately correlated across the two roles. ...
Background
People with major depressive disorder (MDD) and generalized anxiety disorder (GAD) have elevated trait perfectionism. We tested whether they hold perfectionistic standards for specific life roles and examined the extent to which they met their own expectations for, gained satisfaction from, and expended effort in these roles.Methods
Seventy-four women with MDD, GAD, both disorders, or no mental disorders (CTL) described their standards for a socially-and achievement-oriented roles, coded for perfectionism. Using ecological momentary assessment, participants reported the extent to which they met, how much satisfaction they gained from, and how much effort they expended in each role.ResultsAlthough the clinical groups endorsed elevated trait perfectionism, they did not differ from CTLs in their role-specific standards. Compared to CTLs, the clinical groups reported meeting their standards to a lesser extent and receiving less satisfaction from both roles. The two MDD groups reported expending less effort in achievement-oriented, but not socially-oriented, roles than the other two groups.Conclusion
Despite similar standards for socially- and achievement-oriented roles, people with MDD and/or GAD are less likely to meet their standards and gain satisfaction from these roles. Having MDD, independent of GAD, is associated with putting less effort into achievement-oriented roles.
... This hypothesis needs further prospective exploration, notably with regard to how PTSD and binge eating evolve over time in sexual assault patients for example. Eating disorders (ED) and obesity share certain biological and environmental risk factors (Bachar et al., 2010;Haines et al., 2010) as well as genetic (Bulik et al., 2003;Root et al., 2010), behavioral (Gunnard et al., 2012;Roemmich et al., 2011) and intermediate neurocognitive phenotypes (Danner et al., 2012;Van den Eynde and Treasure, 2009;Volkow et al., 2011). A controversial theory furthermore postulates that BED and obesity form part of a broad spectrum of eating-related and weight-related disorders (Marcus and Wildes, 2009;Volkow and O'Brien, 2007;Wilson, 2010). ...
... Adolescents are influenced by and fearful of peer exclusion and evaluation, and this likely includes body and image valuations. EDs are associated with higher family standards on physical appearance (Gunnard et al., 2012). Perfectionism, eating and weight concern are observed at higher levels in mothers of people with AN than in comparison groups (Woodside et al., 2002). ...
In this paper, we argue that Anorexia Nervosa (AN) can be explained as arising from a ‘lost sense of emotional self.’ We begin by briefly reviewing evidence accumulated to date supporting the consensus that a complex range of genetic, biological, psychological, and socio-environmental risk and maintenance factors contribute to the development and maintenance of AN. We consider how current interventions seek to tackle these factors in psychotherapy and potential limitations. We then propose our theory that many risk and maintenance factors may be unified by an underpinning explanation of emotional processing difficulties leading to a lost sense of ‘emotional self.’ Further, we discuss how, once established, AN becomes ‘self-perpetuating’ and the ‘lost sense of emotional self’ relentlessly deepens. We outline these arguments in detail, drawing on empirical and neuroscientific data, before discussing the implications of this model for understanding AN and informing clinical intervention. We argue that experiential models of therapy (e.g., emotion-focused therapy; schema therapy) be employed to achieve emergence and integration of an ‘emotional self’ which can be flexibly and adaptively used to direct an individual’s needs and relationships. Furthermore, we assert that this should be a primary goal of therapy for adults with established AN.
... Although we have not been able to find researches regarding IDV and ED, studies analyzing psychopathological traits, much of them co-morbid and/or related with EDs, found that individuals from collectivistic societies reported greater levels of social anxiety [29,30], lower self-esteem [17], maladaptive perfectionism (mainly high parental expectations) and depression symptoms [31]; but also less emotional expression or suppression of emotions in order to keep the group harmony [32,33], than those from individualistic countries. Likewise, some of the characteristics of collectivistic society, such as high levels of parental overprotection, have been found to be directly associated with eating pathology in both Chinese [34,35] and Spanish culture [36] and may influence the manifestation of these disorders. Besides, Katzman and Lee [37] have theorized that women in collectivistic societies which are in a changing cultural environment (i.e. ...
Cultural studies exploring differences in the manifestation of anorexia nervosa (AN) have primarily focus on Western and non-Western cultures. However, no study so far has considered the role that social attitudes (i.e. Collectivist vs. Individualist cultural values) have in the clinical manifestations of eating disorders, including AN patients. With this in mind, the aim of this study is to compare eating and general psychopathology in a large sample of individuals diagnosed with AN from China, Spain, and United Kingdom (UK), in order to study the differences according to belonging to Western or non-Western country, or the country's Individualist Index (IDV). The total sample comprised on 544 adults with a diagnosis of AN recruited from People´s Republic of China (n = 72), UK (n = 117), and Spain (n = 355). Assessment measures included the Eating Disorders Inventory and the Symptom Checklist-90-Revised. Our results show significant differences in most of the eating and psychopathological indices between the three countries. Patients from Western societies (Spain and UK) share more similarities regarding psychopathological expression of AN than the non-Western country (China). While Western countries show higher levels of body dissatisfaction, somatization and overall psychopathology, Chinese patients tend to deny or minimize depression, anxiety and other psychopathological symptoms. Besides, the IDV shows cultural differences in the interpersonal sensitivity scale, being AN patients from UK (the more individualistic society) who presented with higher levels of interpersonal sensitivity (i.e. discomfort during interpersonal interactions and more negative expectations concerning interpersonal behavior). In conclusion, our findings suggest that psychopathological expression of AN is better explained by Western/Eastern influence than by individualist/collectivist values. Although the diagnosis for the eating disorder may be the same, differences in the psychopathology comorbid to the eating disorders may suggest the need for treatments to be modified according to the culture.
... The prevalence of eating disorders (ED) seems to be much higher for specific groups such as models, athletes and dancers (1)(2)(3)(4). The reasons for these higher rates have been focused (among other elements) on personality factors, specifically some traits such as perfectionism, low self-esteem and high self-standards (2,(5)(6)(7). Sociocultural influences encourage the development of both body image disorders and ED through two mechanisms: reinforcement -for example comments, which support the maintenance of an ideal of thinness-and modelling -imitation of observed behaviours- (8). The existence of specific personality traits along with sociocultural influences may explain, to some extent, the high prevalence of ED among high-risk occupations (9). ...
Introduction: Prevalence of eating disorders (ED) and discrepancies between actual weight and weight perception seem much higher in dancers. The aims analysed in 77 dancers were: risk for ED; relationship between eating attitudes and psychological variables; dieting and self-weighing, and body image distortion. Method: Weight- and body image-related variables, dieting, self-reported physical fitness, specific ED-related variables and other psychological variables were assessed. The robust Huber’s model was applied in order to test the influence of the variables analysed on the Eating Attitudes Test (EAT-40) scores. In case of categorical variables, the Chi-square (χ2-test) or the Fisher’s exact test were applied. Results: Higher risk of ED was not obtained. Despite the relationship between EAT-40 and BMI, body appreciation and drive for thinness, scores on EAT-40 and BMI do not suggest higher risk in dancers. Dancers had a similar weight perception than other populations and body dissatisfaction seems not to be worse than the reported in other types of participants. Conclusions: Despite some limitations, our study adds some data in this field of study bearing in mind the use of a cluster of variables previously not taken into account as a whole.
... This corroborates individual studies which report that people with EDs are more aware than HCs of social presentation and comparison (public self-consciousness) and reflect more in private on how they compare with others (private self-consciousness; Cardi et al., 2014;Forbush & Watson, 2006;Ille et al., 2014). People with AN judge themselves by high external standards which they feel that they do not successfully attain (Gunnard et al., 2012;Karwautz et al., 2001aKarwautz et al., ,2001b. This predicts body dissatisfaction and drive for thinness (Buchholz et al., 2007). ...
... Several environmental risk and maintaining factors have commonly been described among ED subtypes, including low self-esteem, high self-standards, negative social evaluation and social and parental pressure; various authors have suggested assessing the association of several risk factors when analysing those associated with AN (Casper & Offer, 1990;Casper, Offer, & Ostrov, 1981;Gunnard et al., 2012). A very important one is self-image, as highlighted by many authors (Bruch, 1974;Iniewicz, 2005;Selvini Palazzoli, 1974). ...
Objective: The aim of the present study was to investigate the prevalence risk for developing anorexia nervosa (AN) in a very wide sample of adolescents aged 15–19 years, obtaining a psychological profile of these at-risk subjects, as assessed by the Italian Offer Self-Image Questionnaire (OSIQ). Method: Data were extracted from ESPAD-Italia®2005 database (European School Survey Project on Alcohol and Other Drugs). The study (17,866 adolescents, 15–19 years old; 47.8% males), also evaluated gender, age, weight, height and Eating Attitude Test-26 (EAT-26). The OSIQ psychometric qualities were evaluated. Multinomial analysis assessed self-image risk of AN association. Results: Adolescents at risk approached 1.4% (2.2% of girls and 0.5% of boys); 19- and 7-year-old females exhibited a higher prevalence. Overall adolescent risk included: impulse control, family relationships and psychopathology. Critical areas in the AN developing showed age and gender differences: body image for younger females, impulse control for the older,
psychopathology for young males and sexual attitudes for the older represented the poorer
adjustment dimensions. Discussion: Results support screening procedures and tailored
school-based prevention.
... Thin-ideal internalization, which occurs at a very early age (Hayes & Tantleff-Dunn, 2010), places women in an ongoing and obsessive self-evaluation of body image, leading to body dissatisfaction and psychological distress (Fitzsimmons-Craft, 2011;Stice, Hayward, Cameron, Killen, & Taylor, 2000;Thompson & Stice, 2001). Gunnard et al. (2012) found that a high self-standard in physical appearance was a principal feature of EDs. Ferreiro, Seoane, and Senra (2011) found that body dissatisfaction was a significant predictor of both depressive symptoms and disordered eating. ...
... However, this prevalence appears to be much higher for specific groups of society, such as models (Smethurst, Wales, & Arcelus, 2010), athletes (Sundgot-Borgen & Torstveit, 2004) and dancers (Herbrich, Pfeiffer, Lehmkuhl, & Schneider, 2011;Ringham et al., 2006). Research investigating the aetiology of eating disorders has identified a strong correlation between these disorders and specific personality factors, such a low self-esteem (Arcelus, Haslam, Farrow, & Meyer, 2013), perfectionism (Penniment & Egan, 2012;Ringham et al., 2006) and high self-standards (Gunnard et al., 2012). The high levels of perfectionism (Nordin-Bates, Cumming, Sharp, & Aways, 2011;Zoletić & Duraković-Belko, 2009) and low self-esteem (Benn & Walters, 2001) found among dancers may explain why they appear to be more prevalent among this group of people. ...
Eating disorders in dancers are thought to be common, but the exact rates remain to be clarified. The aim of this study is to systematically compile and analyse the rates of eating disorders in dancers. A literature search, appraisal and meta-analysis were conducted. Thirty-three relevant studies were published between 1966 and 2013 with sufficient data for extraction. Primary data were extracted as raw numbers or confidence intervals. Risk ratios and 95% confidence intervals were calculated for controlled studies. The overall prevalence of eating disorders was 12.0% (16.4% for ballet dancers), 2.0% (4% for ballet dancers) for anorexia, 4.4% (2% for ballet dancers) for bulimia and 9.5% (14.9% for ballet dancers) for eating disorders not otherwise specified (EDNOS). The dancer group had higher mean scores on the EAT-26 and the Eating Disorder Inventory subscales. Dancers, in general, had a higher risk of suffering from eating disorders in general, anorexia nervosa and EDNOS, but no higher risk of suffering from bulimia nervosa. The study concluded that as dancers had a three times higher risk of suffering from eating disorders, particularly anorexia nervosa and EDNOS, specifically designed services for this population should be considered. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.
... In investigations of importance given to self/other standards by with patients eating disorder and healthy controls, three domains were associated with eating disorders, i.e. family standards, self-achievement and physical appearance [Gunnard et al., 2012]. Higher self-standards, in physical appearance, were more relevant in bulimia nervosa. ...
The eating disorders have been reviewed based on state-of-art of contemporary psychology, medicine and nutrition science, with a special emphasis put on different symptoms and forms, origins and testing methods. Among promoting eating disorders, bulimia nervosa, binge eating disorder, night eating disorder, sleep-related eating disorder are among officially approved and investigated. Among disorders resulting from lack of acceptance of own appearance, anorexia nervosa and bigorexia nervosa are the most serious improper ones. Disorders arising from health care include orthorexia nervosa and recently pregorexia. Different origins of eating disorders are considered, divided into three groups: social, psychological and pathological. The desire to possess a slim shapely silhouette and young appearance, usually under pressure of a social group, may result in disorders such as anorexia nervosa, pregorexia, ageorexia, and bigorexia nervosa. On the other hand, the focusing on eating mainly the biological pure food, being a purely psychological and individual problem, may be a source of orthorexia nervosa. Majority of disorders have a psychological background constituting the escape and an answer to everyday life problems difficult to overcome. Recently, pathology is often considered as an additional and important determinant, which may cause or enhance the appearance of binge eating or night eating disorder. The eating disorders, if not subject to proper therapy and advising, can tend to incline and develop. The further research in order to properly recognise the eating disorders, and find their roots, is necessary at a strict cooperation of psychologists, physicians and nutritionists or dietetics.
... Eating disorders (ED) and obesity share some biological and environmental risk factors (Bachar, Gur, Canetti, Berry, & Stein, 2010; Bulik, Sullivan, & Kendler, 2003; Haines, Kleinman, Rifas-Shiman, Field, & Austin, 2010; Root et al., 2011), behaviours (Gunnard et al., 2011; Roemmich, Lambiase, Lobarinas, & Balantekin, 2011) and intermediate neurocognitive phenotypes (Danner, Ouwehand, van Haastert, Hornsveld, & de Ridder, 2012; Van den Eynde & Treasure, 2009; Volkow, Wang, Fowler, Tomasi, & Baler, 2011). A controversial theory postulates that ED and obesity form part of a broad spectrum of eating-related and weight-related disorders (Marcus & Wildes, 2009; Volkow & O'Brien, 2007; Wilson, 2010). ...
The aims of our study were to examine the lifetime prevalence of obesity rate in eating disorders (ED) subtypes and to examine whether there have been temporal changes among the last 10 years and to explore clinical differences between ED with and without lifetime obesity.
Participants were 1383 ED female patients (DSM-IV criteria) consecutively admitted, between 2001 and 2010, to Bellvitge University Hospital. They were assessed by means of the Eating Disorders Inventory-2, the Symptom Checklist-90-Revised, the Bulimic Investigatory Test Edinburgh and the Temperament and Character Inventory-Revised.
The prevalence of lifetime obesity in ED cases was 28.8% (ranging from 5% in anorexia nervosa to 87% in binge-eating disorders). Over the last 10 years, there has been a threefold increase in lifetime obesity in ED patients (p < .001). People with an ED and obesity had higher levels of childhood and family obesity (p < .001), a later age of onset and longer ED duration; and had higher levels of eating, general and personality symptomatology.
Over the last 10 years, the prevalence of obesity associated with disorders characterized by the presence of binge episodes, namely bulimic disorders, is increasing, and this is linked with greater clinical severity and a poorer prognosis.
... Eating disorders (ED) and obesity share some biological and environmental risk factors (Bachar, Gur, Canetti, Berry, & Stein, 2010;Bulik, Sullivan, & Kendler, 2003;Haines, Kleinman, Rifas-Shiman, Field, & Austin, 2010;Root et al., 2011), behaviours (Gunnard et al., 2011;Roemmich, Lambiase, Lobarinas, & Balantekin, 2011) and intermediate neurocognitive phenotypes (Danner, Ouwehand, van Haastert, Hornsveld, & de Ridder, 2012;Van den Eynde & Treasure, 2009;Volkow, Wang, Fowler, Tomasi, & Baler, 2011). ...
This study aims to explore perceptions of eating disorder service strengths and to develop a clearer picture of improvements clinicians would like to see occur in the services they lead. A survey designed by the Royal College of Psychiatrists' Section of Eating Disorders was completed by 83 lead clinicians in both public and private sector services in the UK and Eire. Content analysis was performed, and common themes were identified.
Five main strengths of a service were identified as follows: quality of treatment (n = 36), staff skills (n = 21), continuity of care (n = 15), family involvement (n = 12) and accessibility and availability (n = 11). These themes also arose when clinicians evaluated areas they wished to develop and improve.
Service providers' views were congruent with each other, NICE guidelines and quality standards as proposed by the Royal College. Although clinicians feel that their service fulfils many practice guidelines, there remains areas in which adherence is felt to be lacking.
Anahtar kelimeler anoreksiya nevroza, bulimiya nevroza, tıkınırcasına yeme bozuklukluğu, aile, ailesel etkenler
Öz
Yeme bozuklukları ölüm oranlarının yüksek olması, iyileşmenin zor olması ve tekrar etme riski-nin çok olması nedeniyle son yıllarda oldukça üzerinde durulan bir konudur. Anoreksiya nervoza belirgin biçimde düşük vücut ağırlığına sahip olma, kilo almaktan ya da şişmanlamaktan çok korkma, düşük vücut ağırlığına sahip olunmasına karşın kilo almayı güçleştiren davranışlarda bulunma, vücut ağırlığı ve biçimine ilişkin çarpık algıya sahip olma ile kendini gösteren bir psi-kolojik bozukluk iken, bulimiya nervoza, belli bir sürede ve koşulda aşırı yeme, yemek yeme esnasında kontrol kaybı ve bunlara eşlik eden kilo vermeye yönelik telafi edici davranışlarla kendini gösteren bir psikolojik bozukluktur. Tıkınırcasına yeme bozukluğunda ise yeme davranı-şı üzerinde kontrol sağlayamama hissi ve normalde çoğu insanın yiyebileceğinden çok daha fazlasını tüketme görülmektedir. Yeme bozukluklarının etiyolojisi biyolojik, çevresel, kültürel, kişisel ve ailesel etkileri içeren çok etkenli bir yapıya sahiptir. Yeme bozukluklarının nedenlerini açıklamak için kişisel etkenlerden aile değişkenlerine kadar pek çok fikir önerilse de aile; psiko-lojik, sistemik, ilişkisel süreçler ve bağlanma süreçleri bakımından yeme bozuklukları etiyoloji-sinde önemli bir rol oynamaktadır. Bu derleme makalesinde temel olarak anoreksiya nervoza, bulimiya nervoza ve tıkınırcasına yeme bozukluğunun etiyolojisinde ailenin rolünün incelenmesi amaçlanmıştır.
Abstract
Family factors in the etiology of eating disorders: A current review
Eating disorders is an issue that has recently been accentuated because of high mortality rate, difficulty of its treatment and relapse risk. Anorexia nervosa is a psychological disorder characterized by a markedly low body weight, fear of gaining weight or getting fat, despite of low body weight, engaging behaviors that make it difficult to gain weight, and distorted perception of body weight and form, while bulimia nervosa is a psychological disorder characterized by overeating in a particular period of time and condition, losing control during eating, accompanied by compensatory behaviors towards losing weight. In binge eating disorder, the feeling of not being able to control eating behavior and consuming much more than most people can normally eat is seen. Etiology of eating disorders has a multifactor structure including biological, environmental, cultural , personal and familial factors. Although a lot of opinions from personal factors to family variables have been suggested to explain the reasons of eating disorders, the family plays an important role in the etiology of eating disorders in terms of psychological, systemic, relational and attachment processes. In this review, it was basically aimed to investigate the role of family in the etiology of anorexia nervosa, bulimia nervosa and binge eating disorder.
Other Specified Feeding and Eating Disorders (OSFED) are a newly defined category in DSM-5 Feeding and Eating Disorders (FED) classification that is used in situations in which symptoms characteristic cause clinically significant distress or impairment in social, occupational, or other important areas of functioning, but do not meet the full criteria for any of FED, and the clinician chooses to communicate the precise reason that the presentation does not meet completely the criteria. Subjects belonging to OSFED mimic the clinical characteristics of main disorders (at a low level or a low frequency) so have similar clinical manifestations and complications. They usually show disturbed eating habits and intense fear of gaining weight; some have distorted body image, are seriously concerned about their weight and body shape, and exhibit high level of anxiety or agitation approaching meals. OSFED is sometimes misinterpreted as a “subclinical” or “subthreshold” diagnosis in terms of severity, and frequently they don’t receive clinical attention. They often require the same level of treatment and support as those with major ED, and without treatment, a significant number of individuals may go on to threshold diagnosis at some point during their illness. In this category, body image disturbances are extensive even though they are not so significant as in major FED. Due to its recent definition, studies on body image in OSFED are lacking and we can derive some inconsistent results.
Anorexia nervosa (AN) is a serious psychiatric disorder characterized by severe restriction of energy intake and dangerously low body weight. Other domains of functioning are affected, including social functioning. Although difficulties within this domain have started to be acknowledged by the literature, some important gaps remain to be filled. Do social difficulties predate the onset of the illness? What difficulties in particular are relevant for the development and maintenance of the illness? The aim of this study is to combine the use of quantitative and qualitative methods to answer these questions. Ninety participants with lifetime AN (88 women and 2 men) completed an online survey assessing memories of involuntary submissiveness within the family, fear of negative evaluation from others, perceived lack of social competence, feelings of social belonging, eating disorder symptoms, and work and social adjustment. Participants also answered three open questions regarding their experience of social relationships before and after the illness onset. The findings provided support for the hypothesized relationships between the study variables. Involuntary submissiveness and fear of negative evaluation predicted eating disorder symptoms and these associations were partially mediated by perceived lack of social competence. Two-thirds of the sample recalled early social difficulties before illness onset and recognized that these had played a role in the development of the illness. A larger proportion of participants stated that the eating disorder had affected their social relationships in a negative way. This study sheds some light on patients’ perspective on the predisposing and maintaining role that social difficulties play in AN and identifies key psychological variables that could be targeted in treatment.
Body dissatisfaction predicts eating disorder symptomatology for some women but not for others. To better understand this disparity, the authors interviewed 7 college women who reported body dissatisfaction and no engagement in eating disorder symptoms. The authors identified 4 factors that may protect body-dissatisfied women from engaging in eating disorder symptoms.
The purpose of the study is to examine the effect of personality style and emotional dysregulation on female adolescents` eating attitude, and the mediating effect of emotional dysregulation on the relationship between personality style and eating attitude. For this research, questionnaires on personality style, emotional dysregulation and eating attitude were administered to 1370 female high school students based in Seoul. Among 1370 questionnaires collected, 1239 were selected and statistically analyzed by frequency analysis, Pearson`s correlation analysis, multiple regression analysis, and stepwise multiple regression analysis using SPSS Win 21.0. The main findings of the study are as follows: First, according to female adolescents` BMI, the level of their eating attitude differed significantly. Second, according to female adolescents` BMI, female adolescents` personality style and emotional dysregulation were found to affect their eating attitude significantly. Third, emotional dysregulation had a mediating effect on the relationship between female adolescents` personality style and eating attitude. To be more specific, for the normal weight group of female adolescents, emotional dysregulation was found to have a partial mediating effect on the relationship between sociotropy and eating attitude, and a full mediating effect on the relationship between autonomy and eating attitude. On the contrary, for the overweight and obese groups of female adolescents, emotional dysregulation was found to have a full mediating effect on the relationship between sociotropy and eating attitude, and a partial mediating effect on the relationship between autonomy and eating attitude. The results of the study show the ways in which personality and emotional traits contribute to female adolescents` eating attitude according to their BMI, and provide useful information for treatment of adolescents` eating disorder in clinical settings.
It has been postulated that immigrant children are at increased risk of mental health problems. This study examined differences in psychopathology between immigrant and non-immigrant adolescents admitted for the first time to a child and adolescent inpatient psychiatry unit. Participants were 234 adolescents (191 non-immigrants and 43 immigrants). There were significant differences between the two groups in relation to certain stressors: parental separation, family breakdown, being under state custody, physical and/or psychological maltreatment and sexual abuse. Differences between the main diagnoses of the two groups were found in relation to schizophrenia and anorexia nervosa. There are differences between immigrants and natives in terms of diagnosis, and these differences are influenced by ethnicity and stressors. Future studies should seek to identify protective factors in order to prevent mental health disorders in the immigrant population.
Although body image disturbance (BID) is considered a core symptom in anorexia nervosa (AN) and bulimia nervosa (BN), little is known about its psychopathological correlates. The present study aimed at analysing the correlation of aspects of BID with psychopathological and temperamental characteristics.
A sample of 1288 patients (538 AN and 750 BN) were assessed through a structured diagnostic interview, the Eating Disorders Inventory and Tridimensional Personality Questionnaire. Cognition of body image distortion, weight checking, fear of weight gain and body dissatisfaction were assessed by specific questions during the interview.
Various aspects of BID formed similar, but not identical, dimensions in AN and BN. In both groups, anticipatory anxiety and interoceptive awareness were significantly and independently associated with body image distortion, whereas ineffectiveness was associated with weight checking.
Body image disturbance is a multidimensional characteristic linked to psychological features, such as anticipatory anxiety, ineffectiveness and interoceptive awareness. These findings have scientific and treatment implications, and should be considered by clinicians in adopting successful treatment strategies. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.
The objective of this article was to the examine lifestyle behaviours in eating disorder (ED) patients and healthy controls. A total of 801 ED patients and 727 healthy controls from five European countries completed the questions related to lifestyle behaviours of the Cross-Cultural Questionnaire (CCQ). For children, the ED sample exhibited more solitary activities (rigorously doing homework [p<0.001] and watching TV [p<0.05] and less socializing with friends [p<0.05]) than the healthy control group and this continued in adulthood. There were minimal differences across ED sub-diagnoses and various cross-cultural differences emerged. Reduced social activities may be an important risk and maintaining factor for ED symptomatology.
Twin studies have suggested that additive genetic factors significantly contribute to liability to bulimia nervosa (BN). However, the diagnostic criteria for BN remain controversial. In this study, an item-factor model was used to examine the BN diagnostic criteria and the genetic and environmental contributions to BN in a population-based twin sample. The validity of the equal environment assumption (EEA) for BN was also tested.
Participants were 1024 female twins (MZ n=614, DZ n=410) from the population-based Mid-Atlantic Twin Registry. BN was assessed using symptom-level (self-report) items consistent with DSM-IV and ICD-10 diagnostic criteria. Items assessing BN were included in an item-factor model. The EEA was measured by items assessing similarity of childhood and adolescent environment, which have demonstrated construct validity. Scores on the EEA factor were used to specify the degree to which twins shared environmental experiences in this model.
The EEA was not violated for BN. Modeling results indicated that the majority of the variance in BN was due to additive genetic factors. There was substantial variability in additive genetic and environmental contributions to specific BN symptoms. Most notably, vomiting was very strongly influenced by additive genetic factors, while other symptoms were much less heritable, including the influence of weight on self-evaluation. These results highlight the importance of assessing eating disorders at the symptom level.
Refinement of eating disorder phenotypes could ultimately lead to improvements in treatment and targeted prevention, by clarifying sources of variation for specific components of symptomatology.
The objective of this study was to examine whether there is an association between individual and family eating patterns during childhood and early adolescence and the likelihood of developing a subsequent eating disorder (ED). A total of 1664 participants took part in the study. The ED cases (n 879) were referred for assessment and treatment to specialized ED units in five different European countries and were compared to a control group of healthy individuals (n 785). Participants completed the Early Eating Environmental Subscale of the Cross-Cultural (Environmental) Questionnaire, a retrospective measure, which has been developed as part of a European multicentre trial in order to detect dimensions associated with ED in different countries. In the control group, also the General Health Questionnaire-28 (GHQ-28), the semi-structured clinical interview (SCID-I) and the Eating Attitudes Test (EAT-26) were used. Five individually Categorical Principal Components Analysis (CatPCA) procedures were adjusted, one for each theoretically expected factor. Logistic regression analyses indicated that the domains with the strongest effects from the CatPCA scores in the total sample were: food used as individualization, and control and rules about food. On the other hand, healthy eating was negatively related to a subsequent ED. When differences between countries were assessed, results indicated that the pattern of associated ED factors did vary between countries. There was very little difference in early eating behaviour on the subtypes of ED. These findings suggest that the fragmentation of meals within the family and an excessive importance given to food by the individual and the family are linked to the later development of an ED.
It is proposed that a cultural ideal of thinness for women causes depression at a higher rate among women than among men. This model accounts for five currently unintegrated trends in the epidemiology of depression. It explains why: (1) twice as many women as men are likely to be depressed; (2) this sex difference emerges at puberty; (3) this sex difference is only found in western countries; (4) there is more depression today; (5) the average age of onset for depression is younger now than in the past. Four parallel trends in eating disorders can also be accounted for by the same factor.
This article presents a theory of how different types of discrepancies between self-state representa- tions are related to different kinds of emotional vulnerabilities. One domain of the self (actual; ideal; ought) and one standpoint on the self (own; significant other) constitute each type of self-state representation. It is proposed that different types of self-discrepancies represent different types of negative psychological situations that are associated with different kinds of discomfort. Discrepan- cies between the actual/own self-state (i.e., the self-concept) and ideal self-stales (i.e., representations of an individual's beliefs about his or her own or a significant other's hopes, wishes, or aspirations for the individual) signify the absence of positive outcomes, which is associated with dejection-related emotions (e.g., disappointment, dissatisfaction, sadness). In contrast, discrepancies between the ac- tual/own self-state and ought self-states (i.e., representations of an individual's beliefs about his or her own or a significant other's beliefs about the individual's duties, responsibilities, or obligations) signify the presence of negative outcomes, which is associated with agitation-related emotions (e.g., fear, threat, restlessness). Differences in both the relative magnitude and the accessibility of individu- als' available types of self-discrepancies are predicted to be related to differences in the kinds of discomfort people are likely to experience. Correlational and experimental evidence supports the predictions of the model. Differences between serf-discrepancy theory and (a) other theories of in- compatible self-beliefs and (b) actual self negativity (e.g., low self-esteem) are discussed.
Research in the past has demonstrated an association between low self-esteem and eating disorders. Recent research on self-esteem has shown, however, that self-esteem is composed of two distinct factors--self-liking and self-competence. The present study examined the relation between these two self-esteem factors and both eating disorders and eating disturbed cognitions. A total of 51 female participants from a high-risk population were clinically interviewed to identify the eating disorder and administered a series of questionnaires that included a measure of self-liking and self-competence. A strong relationship was found between self-liking and eating disorders, but no relationship was found between self-competence and eating disorders.
The aim of this pilot study was to examine which unique factors (genetic and environmental) increase the risk for developing anorexia nervosa by using a case-control design of discordant sister pairs.
Forty-five sister-pairs, one of whom had anorexia nervosa and the other did not, were recruited. Both sisters completed the Oxford Risk Factor Interview for Eating Disorders and measures for eating disorder traits, and sib-pair differences. Blood or cheek cell samples were taken for genetic analysis. Statistical power of the genetic analysis of discordant same-sex siblings was calculated using a specially written program, DISCORD.
The sisters with anorexia nervosa differed from their healthy sisters in terms of personal vulnerability traits and exposure to high parental expectations and sexual abuse. Factors within the dieting risk domain did not differ. However, there was evidence of poor feeding in childhood. No difference in the distribution of genotypes or alleles of the DRD4, COMT, the 5HT2A and 5HT2C receptor genes was detected. These results are preliminary because our calculations indicate that there is insufficient power to detect the expected effect on risk with this sample size.
A combination of intrinsic and extrinsic factors increases the risk of developing anorexia nervosa. It would, therefore, be informative to undertake a larger study to examine in more detail the unique genetic and environmental factors that are associated with various forms of eating disorders.
Nonshared environmental influences are experiences that are unique to siblings reared in the same family. We review studies highlighting the importance of nonshared factors for the development of eating disorders and suggest areas for future research.
Findings from behavioral genetic studies of eating disorders as well as methodological issues are reviewed.
Twin studies suggest that approximately 17%-46% of the variance in both anorexia nervosa (AN) and bulimia nervosa (BN) can be accounted for by nonshared environmental factors. Studies directly examining these influences are scarce, although initial data indicate that differential paternal relationships, body weight teasing, peer group experiences, and life events may account for the development of eating pathology in one sibling versus another.
Additional research is needed to identify specific nonshared environmental influences on eating disorders such as differential parental and sibling treatment, disparate peer group characteristics, and differential experience of life events such as physical and sexual abuse.
The authors retrospectively examined a spectrum of childhood traits that reflect obsessive-compulsive personality in adult women with eating disorders and assessed the predictive value of the traits for the development of eating disorders.
In a case-control design, 44 women with anorexia nervosa, 28 women with bulimia nervosa, and 28 healthy female comparison subjects were assessed with an interview instrument that asked them to recall whether they had experienced various types of childhood behavior suggesting traits associated with obsessive-compulsive personality. The subjects also completed a self-report inventory of obsessive-compulsive disorder (OCD) symptoms.
Childhood obsessive-compulsive personality traits showed a high predictive value for development of eating disorders, with the estimated odds ratio for eating disorders increasing by a factor of 6.9 for every additional trait present. Subjects with eating disorders who reported perfectionism and rigidity in childhood had significantly higher rates of obsessive-compulsive personality disorder and OCD comorbidity later in life, compared with eating disorder subjects who did not report those traits.
Childhood traits reflecting obsessive-compulsive personality appear to be important risk factors for the development of eating disorders and may represent markers of a broader phenotype for a specific subgroup of patients with anorexia nervosa.
The aims of the present review are to apply a recent risk factor approach (H. C. Kraemer et al., 1997) to putative risk factors for eating disorders, to order these along a timeline, and to deduce general taxonomic questions. Putative risk factors were classified according to risk factor type, outcome (anorexia nervosa, bulimia nervosa, binge-eating disorder, full vs. partial syndromes), and additional factor characteristics (specificity, potency, need for replication). Few of the putative risk factors were reported to precede the onset of the disorder. Many factors were general risk factors; only few differentiated between the 3 eating disorder syndromes. Common risk factors from longitudinal and cross-sectional studies were gender, ethnicity, early childhood eating and gastrointestinal problems, elevated weight and shape concerns, negative self-evaluation, sexual abuse and other adverse experiences, and general psychiatric morbidity. Suggestions are made for the conceptualization of future risk factor studies.
The aim of this study was to determine if there are differences in cognitive flexibility in anorexia nervosa and bulimia nervosa. Fifty-three patients with an eating disorder (34 with anorexia nervosa and 19 with bulimia nervosa) and 35 healthy controls participated in the study. A battery of neuropsychological tests for cognitive flexibility was used, including Trail Making B, the Brixton Test, Verbal Fluency, the Haptic Illusion Test, a cognitive shifting task (CatBat) and a picture set test. Using exploratory factor analysis, four factors were obtained: 1: Simple Alternation; 2: Mental Flexibility; 3: Perseveration; and 4: Perceptual Shift. Patients with anorexia nervosa had abnormal scores on Factors 1 and 4. Patients with bulimia nervosa showed a different pattern, with significant impairments in Factors 2 and 4. These findings suggest that differential neuropsychological disturbance in the domain of mental flexibility/rigidity may underlie the spectrum of eating disorders.
To examine whether there is an association between individual and family eating patterns during childhood and the likelihood of developing an eating disorder (ED) later in life. The sample comprised 261 eating disorder patients [33.5% [N=88] anorexia nervosa (AN), 47.2% [N=123] with bulimia nervosa (BN) and 19.3% [N=50] with Eating Disorders Not Otherwise Specified (EDNOS)] and 160 healthy controls from the Province of Catalonia, Spain, who were matched for age and education. All patients were consecutively admitted to our Psychiatry Department and were diagnosed according to DSM-IV criteria. Participants completed the Early Eating Environmental Subscale of the Cross-Cultural (Environmental) Questionnaire (CCQ), a retrospective measure of childhood eating attitudes and behaviours. In the control group, also the General Health Questionnaire-28 (GHQ-28) was used. During childhood and early adolescence, the following main factors were identified to be linked to eating disorders: eating excessive sweets and snacks and consuming food specially prepared for the respondent. Conversely, regular breakfast consumption was negatively associated with an eating disorder. Compared to healthy controls, eating disorder patients report unfavourable eating patterns early in life, which in conjunction with an excessive importance given to food by the individual and the family may increase the likelihood for developing a subsequent eating disorder.
Background
Many risk factors have been implicated for eating disorders, although little is known about those for binge eating disorder.Methods
A community-based, case-control design was used to compare 52 women with binge eating disorder, 104 without an eating disorder, 102 with other psychiatric disorders, and 102 with bulimia nervosa.Results
The main risk factors identified from the comparison of subjects with binge eating disorder with healthy control subjects were certain adverse childhood experiences, parental depression, vulnerability to obesity, and repeated exposure to negative comments about shape, weight, and eating. Compared with the subjects with other psychiatric disorders, those with binge eating disorder reported more childhood obesity and more exposure to negative comments about shape, weight, and eating. Certain childhood traits and pronounced vulnerability to obesity distinguished the subjects with bulimia nervosa from those with binge eating disorder.Conclusions
Binge eating disorder appears to be associated with exposure to risk factors for psychiatric disorder and for obesity. When compared with the wide range of risk factors for bulimia nervosa, the risk factors for binge eating disorder are weaker and more circumscribed. Premorbid perfectionism, negative self-evaluation, and vulnerability to obesity appear especially to characterize those in whom bulimia nervosa subsequently develops.
Background:
Many apparently disparate risk factors have been implicated as causes of eating disorders. This study was designed to test the hypothesis that 2 broad classes of risk factors exist for bulimia nervosa: those that increase the risk for development of a psychiatric disorder in general and those that increase the risk of dieting. It was predicted that the latter are especially common among persons with bulimia nervosa.Methods:
A case-control design was used involving 2 integrated comparisons. First, 102 subjects with bulimia nervosa were compared with 204 healthy control subjects without an eating disorder. Second, the same 102 subjects with bulimia nervosa were compared with 102 subjects with other psychiatric disorders. To reduce sampling bias, the subjects were recruited directly from the community. A broad range of putative risk factors was assessed. The subjects with bulimia nervosa and the healthy control subjects differed in their rates of exposure to most of the putative risk factors. Far fewer differences were evident between the subjects with bulimia nervosa and the control subjects with other psychiatric disorders, although exposure to factors that were likely to increase the risk of dieting and to negative self-evaluation and certain parental problems (including alcohol use disorder) were substantially more common among those with bulimia nervosa. The findings support the hypothesis that bulimia nervosa is the result of exposure to general risk factors for psychiatric disorder and risk factors for dieting. An unexpected finding was the particularly high rates of premorbid negative self-evaluation and certain parental problems among those with bulimia nervosa.Results:
The subjects with bulimia nervosa and the healthy control subjects differed in their rates of exposure to most of the putative risk factors. Far fewer differences were evident between the subjectswith bulimia nervosa and the control subjects with other psychiatric disorders, although exposure to factors that were likely to increase the risk of dieting and to negative self-evaluation and certain parental problems (including alcohol use disorder) were substantially more common among those with bulimia nervosa.Conclusions:
The findings support the hypothesis that bulimia nervosa is the result of exposure to general risk factors for psychiatric disorder and risk factors for dieting. An unexpected finding was the particularly high rates of premorbid negative self-evaluation and certain parental problems among those with bulimia nervosa.
Animal analogues of anorexia nervosa suggest that submissive behaviour and social defeat may be implicated in the onset of wasting diseases. Data from human sufferers of anorexia nervosa and bulimia nervosa are also consistent with the presence of submissive behaviours and perceived low social rank (e.g. low self-esteem, helplessness, and feelings of shame). A total of 101 patients with eating disorders completed the Submissive Behaviour Scale and the Social Comparison Rating Scale, and their responses were compared with 101 age- and sex-matched student controls. Patients with eating disorders reported significantly higher levels of submissive behaviour and a more unfavourable social comparison than did student controls. Furthermore, levels of submissive behaviour and unfavourable social comparison were significantly related to severity of eating disorder symptoms, even after taking account of depressive symptoms and other psychopathology. These preliminary results suggest that ranking theory may have some application to eating disorders. Further research is required to determine whether rank plays a specific role in eating disorders (beyond the increased rates of depression which also occur in eating disorders) and, if so, what is its precise role.
In this study comparing 41 eating disorder patients and 34 female controls, the video distortion technique was used to test the accuracy of body size estimation and to assess the ideal body image. No difference was found in the estimation of actual body sizes, although the accuracy of estimation was quite variable in both bulimics and anorexics. With regard to the ideal body image, significant differences were found: All bulimics and 92.6% of the controls wished to be thinner versus 42.9% of the anorexics (23.8% wished to be larger). Looking at subjective body experience, as measured with a selfreport questionnaire (Body Attitudes Test), body dissatisfaction appeared to be negatively correlated with the ideal body image but not with the estimation of actual body sizes. © 1994 by John Wiley & Sons, Inc.
Objective
To describe the development, test-retest reliability, internal consistency, and convergent validity of the McKnight Risk Factor Survey-III (MRFS-III). The MRFS-III was designed to assess a number of potential risk and protective factors for the development of disordered eating in preadolescent and adolescent girls.Method
Several versions of the MRFS were pilot tested before the MRFS-III was administered to a sample of 651 4th through 12th- grade girls to establish its psychometric properties.ResultsMost of the test-retest reliability coefficients of individual items on the MRFS-III were r >.40. Alpha coefficients for each risk and protective factor domain on the MRFS-III were also computed. The majority of these coefficients were r >.60. High convergent validity coefficients were obtained for specific items on the MRFS-III and measures of self-esteem (Rosenberg Self-Esteem Scale) and weight concerns (Weight Concerns Scale).Conclusions
The test-retest reliability, internal consistency, and convergent validity of the MRFS-III suggest that it is a useful new instrument to assess potential risk and protective factors for the development of disordered eating in preadolescent and adolescent girls. © 1999 by John Wiley & Sons, Inc. Int J Eat Disord 25: 195–214, 1999.
The present research provided a simultaneous, broad-based examination of how different types of dysfunctional cognitions may relate to several domains of psychological maladjustment, namely, depression, anxiety, Type A, and bulimia. Consistent evidence was obtained across two studies for the communality of certain types of dysfunctional cognitions. In particular, excessive concerns regarding performance evaluation were found to characterize several of these maladjustment domains. Strong empirical support was also obtained in both studies for the specificity of other types of dysfunctional cognitions. Exclusive to the depression domain, for example, were dysfunctional cognitions pertaining to failure and loss. Anxiety was marked by a specific focus on interpersonal evaluative concerns, whereas higher levels of Type A were specifically associated with self-oriented perfectionism. Finally, bulimia was characterized by content-specificity in terms of dysfunctional cognitions concerning weight-control and appearance. Additional evidence for the important role of content-specific dysfunctional cognitions was obtained in a series of longitudinal analyses reported in study 2. Using very stringent predictive criteria, it was found that the hypothesized content-specific dysfunctional cognitions for three of the four domains (i.e. depression, anxiety, and Type A) were significant predictors of future maladjustment in these domains, even after taking into account initial levels of maladjustment. These results were then discussed in terms of the links between various types of dysfunctional cognitions and the manifestation of both common and specific features of depression, anxiety, Type A, and bulimia.
This study compared maladaptive core beliefs of eating-disordered groups (full and subthreshold syndrome) and healthy controls and investigated the association between eating disorder symptoms and core beliefs. Participants were compared on self-report measures of core beliefs (YSQ) and eating disorder psychopathology (BITE). Anorexia nervosa (AN; both subtypes) and bulimia nervosa (BN) patients had significantly more core beliefs than healthy controls. Binge eating disorder (BED) patients had intermediate scores between AN and BN on the one hand and healthy controls on the other hand. No correlation was found between core beliefs and frequency of binge eating. Frequency of vomiting, laxative misuse and fasting was positively associated with all domains of core beliefs. Patients with eating disorders have some core beliefs which are not directly related to eating, weight or shape. Frequency of purging and fasting behaviors is associated with more severe maladaptive core beliefs. Our data demonstrate the importance of identifying purging and fasting as significant clinical markers.
Examines the motivation for achievement as a psychological factor that shapes economic development. Refuting arguments based on race, climate, or population growth, the book instead argues for cultural customs and motivations - especially the motivation for achievement - as the major catalysts of economic growth. Considering the Protestant Reformation, the rise of capitalism, parents' influences on sons, and folklore and children's stories as shaping cultural motivations for achievement, the book hypothesizes that a high level of achievement motivation precedes economic growth. This is supported through qualitative analysis of the achievement motive, as well as of other psychological factors - including entrepreneurial behavior and characteristics, and available sources of achievement in past and present highly achieving societies. It is the achievement motive - and not merely the profit motive or the desire for material gain - that has advanced societies economically. Consequently, individuals are not merely products of their environment, as many social scientists have asserted, but also creators of the environment, as they manipulate it in various ways in the search for achievement. Finally, a plan is hypothesized to accelerate economic growth in developing countries, by encouraging and supplementing their achievement motives through mobilizing the greater achievement resources of developed countries. The conclusion is not just that motivations shape economic progress, but that current influences on future people's motivations and values will determine economic growth in the long run. Thus, it is most beneficial for a society to concentrate its resources on creating an environment conducive to entrepreneurship and a strong ideological base for achievement. (CJC)
To explore the psychometric properties of the Cross-Cultural Questionnaire (CCQ), a new self-report tool for assessing factors of risk and maintenance for eating disorders (ED).
Data was collected during a multi-centre case-control study. The sample included 854 ED patients and 784 healthy participants from the UK, Spain, Austria, Slovenia and Italy. Exploratory factor analyses examined the factor structure of each section of the CCQ, and Cronbach's alpha coefficients valued the internal consistency of each derived scale score. Logistic regression and receiver operating characteristic (ROC) curve procedure assessed the screening accuracy and predictive validity of the empirical factors.
Based on a total of 127 items, nine dimensions emerged, with satisfactory internal consistency and high congruence between countries. CCQ scores demonstrated satisfactory accuracy for discriminating between ED cases and controls (area under the ROC curve = 0.88). Most of the items achieved discriminative accuracy.
This study offers preliminary evidence that the CCQ, available in five languages, is a useful and valid tool to assess factors of risk and maintenance for EDs.
The aim of the present study was to analyze social and body self-esteem in adolescents with eating disorders and to assess the psychometric properties of the SEED (Self-esteem in Eating Disorders), a self-report questionnaire designed specifically to evaluate these variables. The SEED was used to compare social and body self-esteem in 170 eating disorder adolescent patients, 115 with anorexia nervosa (mean age 15.6), 55 with bulimia nervosa (mean age 16.2) and 359 schoolgirls from the general population (mean age 14.9) The SEED demonstrated good internal consistency (Cronbach alpha for eating disordered patients= .94 and for general population= .87). One week test-retest reliability was also adequate both in eating disorder patients (r= .77) and in girls from the general population (r= .86). Factor analysis yielded two factors which explained the 59% of the variance. The difference between the mean scores of the girls from the general population and the anorexic patients on one hand and the bulimics on the other was statistically significant (p<.001). There were no statistically significant differences between anorexic and bulimic patients. The differences between both anorexic and bulimic patients and girls of the comparison group in the two factors obtained in the factor analysis were highly significant (p<.001). A cut-off point of 15 gave a sensitivity of 75.9% and a specificity of 86.6% in the classification of subjects as eating disorder patients or not. The SEED showed adequate internal and test-retest reliabilities. Eating disorder adolescent patients have lower social and body self-esteem than adolescents from the general population
The aim of this study was to determine links between attitudes toward emotional expression and levels of eating psychopathology among young women.
Eighty-nine young female volunteers completed the Attitudes Toward Emotional Expression scale (AEE) and the Eating Disorders Examination Questionnaire (EDEQ).
There were positive significant associations between AEE subscales and EDEQ scores. In particular, those women who scored high on the EDEQ eating, shape, and weight subscales believe that to display emotion is a sign of weakness. Although those participants with high EDEQ weight concern scores were also likely to believe that they should keep their emotions under control and that others might be rejecting or damaged should they themselves display their emotions.
These findings require replication with a clinical sample, however, they suggest that challenging these attitudes is potentially a useful step in facilitating acceptance of emotion and the development of adaptive emotion regulation strategies in those women with high levels of eating psychopathology.
Implicit and explicit self-esteem were compared in a group of female participants with bulimia nervosa or binge eating disorder (n=20) and a healthy control group (n=20). Lower explicit and a less positive implicit self-esteem bias in the clinical group was predicted. Participants completed a self-esteem implicit association test and two explicit self-esteem measures. The eating disordered group had lower explicit self-esteem, but a more positive implicit self-esteem bias than controls. The results are discussed in relation to the idea that discrepancies between implicit and explicit self-esteem reflect fragile self-esteem and are related to high levels of perfectionism, which is associated with eating disorders.
The purpose of this paper was to review the existing literature regarding the contribution of parental influences to the sociocultural pressures on body image disturbance and disordered eating so as to highlight principal findings so that parents can be given practical information and identify areas that require further research.
Relevant articles were located through Pubmed, Sciencedirect and PsychInfo, as well as the screening of bibliographies.
The available data suggest that parents are strong communicators of sociocultural pressures. Parental influences via verbal messages and active encouragement have been shown to have more impact on offspring's body concerns and eating behaviours than modelling effects. Both mothers and fathers are important sources of influence for their offspring.
Considering the role of parents could help improve public health management. Futher exploration of the way adolescents and young adults interpret and perceive parental attitudes and of potential protective factors is necessary.
To compare patterns of temperament and character and the prevalence of Obsessive-Compulsive Personality Disorder (OCPD) and OCPD traits in parents of children with OCD and parents of healthy controls.
TCI and SCID-II were administered to 63 parents of 32 children with OCD and 63 parents of age- and sex-matched controls with no psychiatric diagnosis. Interviewers were not blind to proband status. Personality dimension scores and frequencies of OCPD criteria in both groups were compared after excluding parents with a diagnosis of OCD. Relationships between TCI dimensions and OCPD symptoms in parents and the clinical characteristics of OCD children were also studied.
Parents of OCD children presented significantly higher scores in harm avoidance and lower scores in self-directedness, cooperativeness and reward dependence than parents of healthy children. A higher incidence of OCPD was found in parents of probands (p<0.02). Hoarding, perfectionism and preoccupation with details were significantly more frequent in parents of OCD children. Counting, ordering and cleaning compulsions in OCD children predicted elevated odds of perfectionism and rigidity in their parents.
The existence of the dimensional personality profile associated with OCD in parents of children with OCD and the higher number of OCPD criteria in these parents in comparison to parents of healthy children highlight the importance of the role of personality factors in familial OCD.
The goals of the study were to compare anger expressions in individuals with eating disorders and healthy controls, and to explore the relation among eating disorder symptoms, comorbid psychopathology, personality traits, and impulsive behaviours. Participants comprised 135 eating disorder patients consecutively admitted to our unit and 103 healthy controls. Assessment measures included the Eating Disorders Inventory 2 (EDI-2), Bulimic Investigatory Test Edinburgh (BITE), Symptom Checklist-Revised (SCL-90-R), Social Avoidance Distress Scale (SAD), Temperament and Character Inventory-Revised (TCI-R), State-Trait Anger Expression Inventory 2 (STAXI-2), and other clinical and psychopathological indices. In the control group also the General Health Questionnaire-28 (GHQ-28) was also used. Women with eating disorders obtained significantly higher mean scores than controls on all STAXI-2 scales except for Anger Control. When various purging methods were assessed independently, the frequency of laxative use was associated with anger suppression. Eating disorder symptoms and specific personality traits were positively associated with different forms of anger expression. Finally, patients with higher scores on anger suppression were more likely to report self-harming behaviors. Eating disorder patients may have inadequate anger expression and deficits in coping with anger and frustration. Furthermore, different purging methods may be related to different facets of anger.
SYNOPSIS
This study reports the factor structure of the symptoms comprising the General Health Questionnaire when it is completed in a primary care setting. A shorter, 28-item GHQ is proposed consisting of 4 subscales: somatic symptoms, anxiety and insomnia, social dysfunction and severe depression. Preliminary data concerning the validity of these scales are presented, and the performance of the whole 28-item questionnaire as a screening test is evaluated. The factor structure of the symptomatology is found to be very similar for 3 independent sets of data.
In this study comparing 41 eating disorder patients and 34 female controls, the video distortion technique was used to test the accuracy of body size estimation and to assess the ideal body image. No difference was found in the estimation of actual body sizes, although the accuracy of estimation was quite variable in both bulimics and anorexics. With regard to the ideal body image, significant differences were found: All bulimics and 92.6% of the controls wished to be thinner versus 42.9% of the anorexics (23.8% wished to be larger). Looking at subjective body experience, as measured with a self-report questionnaire (Body Attitudes Test), body dissatisfaction appeared to be negatively correlated with the ideal body image but not with the estimation of actual body sizes.
Over the last several decades, the self-concept has been implicated as a important determinant of eating disorders (ED). Although considerable progress has been made, questions remain unanswered about the properties of self-concept that distinguish women with an ED from other populations, and mechanisms that link the self-concept to the disordered behaviors. Markus's self-schema model is presented as a theoretical approach to explore the role of the self-concept in ED. To show how the schema model can be integrated with existing work on the self-concept in ED, a framework is proposed that addresses the number, content, and accessibility of the self-schemas. More specifically, it is posited that a limited collection of positive self-schemas available in memory, in combination with a chronically and inflexibly accessible body-weight self-schema, lead to the disordered behaviors associated with anorexia nervosa and bulimia nervosa.
Many apparently disparate risk factors have been implicated as causes of eating disorders. This study was designed to test the hypothesis that 2 broad classes of risk factors exist for bulimia nervosa: those that increase the risk for development of a psychiatric disorder in general and those that increase the risk of dieting. It was predicted that the latter are especially common among persons with bulimia nervosa.
A case-control design was used involving 2 integrated comparisons. First, 102 subjects with bulimia nervosa were compared with 204 healthy control subjects without an eating disorder. Second, the same 102 subjects with bulimia nervosa were compared with 102 subjects with other psychiatric disorders. To reduce sampling bias, the subjects were recruited directly from the community. A broad range of putative risk factors was assessed.
The subjects with bulimia nervosa and the healthy control subjects differed in their rates of exposure to most of the putative risk factors. Far fewer differences were evident between the subjects with bulimia nervosa and the control subjects with other psychiatric disorders, although exposure to factors that were likely to increase the risk of dieting and to negative self-evaluation and certain parental problems (including alcohol use disorder) were substantially more common among those with bulimia nervosa.
The findings support the hypothesis that bulimia nervosa is the result of exposure to general risk factors for psychiatric disorder and risk factors for dieting. An unexpected finding was the particularly high rates of premorbid negative self-evaluation and certain parental problems among those with bulimia nervosa.
Although body-image disturbance is among the diagnostic criteria for anorexia nervosa and bulimia nervosa, the nature and extent of this disturbance have not been precisely identified. This is the purpose of this first meta-analysis of extant research on body image and eating disorders.
Using contemporary techniques, the meta-analysis systematically examined 66 studies (from 1974 to 1993) of perceptual and attitudinal parameters of body image among anorexics and bulimics relative to control groups.
Attitudinal body dissatisfaction, both questionnaire and self-ideal discrepancy measures, produced substantially larger effect sizes than did perceptual size-estimation inaccuracy. Body dissatisfaction measures, whether global or weight/shape related, differentiated bulimic and anorexic groups (with bulimics having more dissatisfaction), whereas perceptual distortion indices did not. Somewhat larger effects occurred with whole-body than with body-part size-estimation assessments. Size distortion among patients with eating disorders appears unlikely to reflect a more generalized sensory/perceptual deficit.
Scientific, conceptual, and clinical implications of these findings are delineated.
Many risk factors have been implicated for eating disorders, although little is known about those for binge eating disorder.
A community-based, case-control design was used to compare 52 women with binge eating disorder, 104 without an eating disorder, 102 with other psychiatric disorders, and 102 with bulimia nervosa.
The main risk factors identified from the comparison of subjects with binge eating disorder with healthy control subjects were certain adverse childhood experiences, parental depression, vulnerability to obesity, and repeated exposure to negative comments about shape, weight, and eating. Compared with the subjects with other psychiatric disorders, those with binge eating disorder reported more childhood obesity and more exposure to negative comments about shape, weight, and eating. Certain childhood traits and pronounced vulnerability to obesity distinguished the subjects with bulimia nervosa from those with binge eating disorder.
Binge eating disorder appears to be associated with exposure to risk factors for psychiatric disorder and for obesity. When compared with the wide range of risk factors for bulimia nervosa, the risk factors for binge eating disorder are weaker and more circumscribed. Pre-morbid perfectionism, negative self-evaluation, and vulnerability to obesity appear especially to characterize those in whom bulimia nervosa subsequently develops.
To describe the development, test-retest reliability, internal consistency, and convergent validity of the McKnight Risk Factor Survey-III (MRFS-III). The MRFS-III was designed to assess a number of potential risk and protective factors for the development of disordered eating in preadolescent and adolescent girls.
Several versions of the MRFS were pilot tested before the MRFS-III was administered to a sample of 651 4th through 12th- grade girls to establish its psychometric properties.
Most of the test-retest reliability coefficients of individual items on the MRFS-III were r > .40. Alpha coefficients for each risk and protective factor domain on the MRFS-III were also computed. The majority of these coefficients were r > .60. High convergent validity coefficients were obtained for specific items on the MRFS-III and measures of self-esteem (Rosenberg Self-Esteem Scale) and weight concerns (Weight Concerns Scale).
The test-retest reliability, internal consistency, and convergent validity of the MRFS-III suggest that it is a useful new instrument to assess potential risk and protective factors for the development of disordered eating in preadolescent and adolescent girls.
Many risk factors have been implicated in the development of anorexia nervosa. Little is known about their relative contributions, nor in most cases is it clear whether they are specific to anorexia nervosa or risk factors for all eating disorders or for psychiatric disorder in general.
We used a case-control design involving the comparison of 67 female subjects with a history of anorexia nervosa with 204 healthy control subjects, 102 subjects with other psychiatric disorders, and 102 subjects with bulimia nervosa. A broad range of risk factors was assessed by interview.
The subjects with anorexia nervosa and the healthy controls differed in their exposure to most of the putative risk factors. There was no greater exposure to factors that increased the likelihood of dieting, once the influence of other classes of risk factors had been taken into account. Premorbid perfectionism and negative self-evaluation were especially common and more so than among the general psychiatric controls. Parental obesity and an early menarche, together with parental psychiatric disorder, distinguished those with bulimia nervosa from those with anorexia nervosa.
There appears to be a broad range of risk factors for anorexia nervosa and bulimia nervosa, some of which are shared with other psychiatric disorders. Factors that increase the likelihood of dieting seem to have more important influence as risk factors for bulimia nervosa than anorexia nervosa. Perfectionism and negative self-evaluation appear to be particularly common and characteristic antecedents of both eating disorders.
The purpose of the present study was to assess body perception in eating disorders and its meaning in therapy. A total of 44 patients, 25 bulimia nervosa and 19 anorexia nervosa, admitted at a specialized in-patient treatment center participated in the present study. Body size estimation procedures (video-distortion and image-marking techniques) and self-report questionnaires were used for the assessment. No significant differences were found in actual body size estimation between the two eating disorder groups, either before or after therapy. It emerged after therapy that the outcome was not related to body size estimation. These findings suggest that there is no evidence for a serious impairment of body perception (size estimation) in eating-disordered patients, but rather for a disturbance in the emotional aspect of body image, as expressed in negative body attitudes. Body size perception does not appear to be a predictor of treatment outcome in eating disorders.
We investigated the predictive utility of three dimensions of body esteem in explaining self-esteem in samples of eating-disordered (ED) and nonclinical women.
Participants comprised 74 ED women and 103 female university students. All women completed questionnaires measuring body esteem and self-esteem and all provided information on height and weight. We ran hierarchical multiple regression analyses with self-esteem as the outcome variable and participant status (clinical or non), body mass index (BMI), body esteem, and interaction terms as predictors.
The main finding was a Body Esteem x Participant Status interaction involving the attribution dimension of body esteem. Specifically, among ED women, the higher their body esteem attribution (i.e., the more they endorsed items such as "I think my appearance would help me get dates"), the higher their self-esteem; whereas this relationship was not found among the students.
Our results contribute to an emerging profile of ED patients as highly socially sensitive.
Eating disorders are prevalent and complicated disorders which are difficult to treat. Unicausal and main effects models are not likely to do justice to the complexity of psychopathology encountered, as one considers etiology and pathogenesis. Risk and protection can arise out of several domains: biological, psychological and social. Risk and protective factors aggregate in specific developmental phases and interact to produce adverse outcomes. Temperamental factors, eating dysregulation, attachment, deficient self regulation and sociocultural ideals of health and beauty all contribute to pathogenesis. Applying the insights of developmental psychopathology to these disorders has considerable potential to lead to early and preventive interventions. Reviewing the current literature from this perspective and updating a similar discussion from 8 years ago, we witness a continued accumulation of quality empirical data. Compared to previous reviews, the field's attention has shifted to psychosocial/cultural domains relevant to eating, away from biological risk. In the aggregate, these data make possible the increasing differentiation of eating disorders from other psychopathology, and the specific pathways in which anorexia and bulimia may develop. Understanding of risk and vulnerability still outweighs our knowledge of protective factors and resilience. While an ideal study would be longitudinal, such studies are still extremely difficult to conduct and costly, thus, forcing us to further our understanding from lagged designs, cross-sectional data and case control studies. While these have many limitations, they do seem to produce an increasingly coherent account of the development of these disorders and prepare us for more targeted and longitudinal study of high risk populations.
To assess the role of neuroticism and low self-esteem as risk factors for eating disorders (ED).
A representative sample of girls 12-21 years old from Navarre, Spain. Girls free from any ED in 1997 were followed up for 18 months and reevaluated using DSM-IV criteria. Multivariable logistic models were used to examine associations between neuroticism (Eysenck Inventory) or low self-esteem (36-item scale) and incident ED.
Higher levels of neurotic personality increased the risk of ED (adjusted odds ratio [OR] for the highest quartile, 3.3; 95% Cl; 1.6-4.8). High levels of self-esteem were protective (OR, 0.32; 95% CI, 0.16-0.66). Neuroticism was a more powerful predictor than low self-esteem.
Our results provide prospective evidence supporting the role of neuroticism and low self-esteem as major determinants of ED.
This paper is concerned with the psychopathological processes that account for the persistence of severe eating disorders. Two separate but interrelated lines of argument are developed. One is that the leading evidence-based theory of the maintenance of eating disorders, the cognitive behavioural theory of bulimia nervosa, should be extended in its focus to embrace four additional maintaining mechanisms. Specifically, we propose that in certain patients one or more of four additional maintaining processes interact with the core eating disorder maintaining mechanisms and that when this occurs it is an obstacle to change. The additional maintaining processes concern the influence of clinical perfectionism, core low self-esteem, mood intolerance and interpersonal difficulties. The second line of argument is that in the case of eating disorders shared, but distinctive, clinical features tend to be maintained by similar psychopathological processes. Accordingly, we suggest that common mechanisms are involved in the persistence of bulimia nervosa, anorexia nervosa and the atypical eating disorders. Together, these two lines of argument lead us to propose a new transdiagnostic theory of the maintenance of the full range of eating disorders, a theory which embraces a broader range of maintaining mechanisms than the current theory concerning bulimia nervosa. In the final sections of the paper we describe a transdiagnostic treatment derived from the new theory, and we consider in principle the broader relevance of transdiagnostic theories of maintenance.
A previous study found that self-reported body dissatisfaction, depression, and peer pressure to maintain a thin body shape were significant predictors of bulimic behavior in college women, but that family functioning was not a significant predictor [Eat. Behav. 2 (2001) 323]. The current study examined whether perfectionism, low self-esteem, and a more specific family variable--perceived pressure from the family to be thin--predicted any additional variance in eating-disordered behavior after significant variables from the previous study had been taken into account. As in the previous study, self-reported body dissatisfaction, depression, and peer pressure to maintain a thin body shape were significant predictors of bulimic behavior. Perceived weight-related pressure from the family was also a significant predictor. In contrast, high parental expectations were found to predict lower levels of bulimic behavior and to moderate the effects of peer influence on bulimic behavior. The variables found in this study to be related to bulimic behavior may be useful targets for clinical intervention for women with disturbed eating patterns.
This article summarizes the relationship between body image and obesity among adults. It begins with an overview of the etiology of body image dissatisfaction among obese persons. This section will discuss the prevalence and nature of body image dissatisfaction, and its relationship to symptoms of psychopathology. The article then focuses on the assessment of body image and provides an overview of the commonly used psychometric measures. It next turns to the role of psychotherapeutic interventions to treat body image dissatisfaction as a component of comprehensive weight reduction programs. The article concludes by proposing several areas for future study.
The 28-item version of the General Health Questionnaire (GHQ-28) developed by Goldberg and Hillier in 1979 is constructed on the basis of a principal components analysis of the GHQ-60. When used on a Spanish population, a translation of the GHQ-28 developed for an English population may lead to worse predictive values.
We used our Spanish sample to replicate the entire process of construction of the GHQ-28 administered in a primary-care setting.
Two shorter versions were proposed: one with six scales and 30 items, and the other with four scales and 28 items.
The resulting GHQ-28 was a successful adaptation for use on the Spanish sample. When compared with the original version, only 21 items were the same. Moreover, contrary to the English version, which groups sleep problems and anxiety in the same scale, a scale with items related exclusively to 'Sleep disturbances' was found.
While cognitive formulations of eating disorders emphasise the role of dysfunctional assumptions regarding eating, weight and shape (EWS), less is known about the role of dysfunctional assumptions that are unrelated to EWS and those linking beliefs about EWS with negative beliefs about the self or the world. The present study aimed to develop a brief measure of dysfunctional assumptions in the eating disorders and to validate it clinically. Given that cognitive-behavioural therapy frequently involves the testing of patients' assumptions with the help of behavioural experiments, the measure was designed specifically to assess assumptions that can be addressed using such techniques.
The sample consisted of 79 women with DSM-IV eating disorder diagnoses. Each participant completed the measure of testable assumptions in the eating disorders (TAQ-ED), the Eating Disorders Inventory (EDI) and the Brief Fear of Negative Evaluation scale (Brief FNE).
The TAQ-ED was made up of three scales, each of which had acceptable psychometric properties. High scores on the eating attitudes/behaviours scales of the EDI and on the Brief FNE were broadly associated with dysfunctional assumptions about the world and one's body. In contrast, high scores on ego-dysfunction scales of the EDI were associated with dysfunctional assumptions about feelings.
Different aspects of eating disorder pathology appear to be linked to different types of dysfunctional assumptions in the eating disorders. The clinical value of the proposed new measure of dysfunctional assumptions is discussed, and ideas are provided for behavioural experiments testing such assumptions.
Thin body preoccupation and social pressure to be thin (TBPSP) in adolescence are risk factors for the development of full and partial bulimia nervosa and binge eating disorder. This study examined precursors of these potent risk factors.
A prospective study followed 134 children from birth to 11.0 years and their parents. Recruitment began in January 1990 and ended in March 1991. The study was completed in December 2002.
Two moderators identified different groups at risk for the development of TBPSP. A father with high body dissatisfaction characterized the largest group in which TBPSP was elevated for girls who were concerned about and attempted to modify their weight and for children with fathers who had a high drive for thinness. A child at risk for overweight characterized the second smaller group. Parental behaviors such as overcontrol of their child's eating, together with later pressure from parents and peers to be thin, were related to higher levels of TBPSP.
Different pathways lead to the development of eating disorder psychopathology. These results suggest that prevention programs for eating disorders should begin in early childhood, possibly involving parental education and behavior change, and that different prevention programs may be required for different pathways.
This study examined whether elevations on four variables (drive for thinness, depressed mood, maladaptive cognitions, and ineffectiveness) were related to increased severity of eating disorder symptoms over a 4-year prospective interval in a sample of female undergraduates (N=80). Results indicated that initial scores on the four variables were related to severity of anorexic and bulimic symptoms 4 years later. Examination of each variable individually indicated that anorexia and bulimia may have different risk pathways, and that initial maladaptive cognitions and drive for thinness scores were more related to later eating disorder symptoms than were depressed mood or ineffectiveness.
To investigate the differential profile of early family life events associated with lifetime anorexia nervosa (AN), bulimia nervosa (BN), and major depression (MD).
Only data from the monozygotic twins (n = 622) were examined from a community sample of female twins who had participated in three waves of data collection. Eating disorder and MD diagnoses were ascertained from the Eating Disorder Examination at Wave 3 and interview at Wave 2 respectively. Early family events were ascertained from self-report measures at Waves 1 and 3. Two case control designs were used, including a comparison of women: (1) who had lifetime AN, BN, MD, and controls, and (2) twin pairs discordant for either AN, BN, or MD (where the unaffected cotwin formed the control group).
Across the two types of designs, compared to controls, both AN and BN were associated with more comments from the family about weight and shape when growing up. AN was uniquely associated with higher levels of paternal protection while BN was associated with higher levels of parental expectations.
While some overlap among early life events was indicated, especially related to parental conflict and criticism, there was evidence to support some degree of nonoverlap among life events associated with AN, BN, and MD.