Body-image and eating disturbances prospectively predict increases in depressive symptoms in adolescent girls: A growth curve analysis.

Using data from a longitudinal community study (N?=?231), the authors tested whether body-image and eating disturbances might partially explain the increase in depression observed in adolescent girls. Initial pressure to be thin, thin-ideal internalization, body dissatisfaction, dieting, and bulimic symptoms, but not body mass, predicted subsequent increases in depressive symptoms, as did increases in these risk factors over the study. There was also prospective support for each of the hypothesized mediational relations linking these risk factors to increases in depressive symptoms. Effects remained significant when other established gender-nonspecific risk factors for depression (social support and emotionality) were statistically controlled. Results provide support for the assertion that body-image and eating disturbances, operating above and beyond gender-nonspecific risk factors, contribute to the elevated depression in adolescent girls. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk factors for binge eating onset in adolescent girls: A 2-year prospective investigation.

Because little is known about the predictors of binge eating (a risk factor for obesity), a set of putative risk factors for binge eating was investigated in a longitudinal study of adolescent girls. Results verified that binge eating predicted obesity onset. Elevated dieting, pressure to be thin, modeling of eating disturbances, appearance overvaluation, body dissatisfaction, depressive symptoms, emotional eating, body mass, and low self-esteem and social support predicted binge eating onset with 92% accuracy, Classification tree analysis revealed an interaction between appearance overvaluation, body mass, dieting, and depressive symptoms, suggesting qualitatively different pathways to binge eating and identifying subgroups at extreme risk for this outcome. Results support the assertion that these psychosocial and biological factors increase risk for binge eating. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Body-image and eating disturbances predict onset of depression among female adolescents: A longitudinal study.

This study examined data from a 4-year school-based longitudinal study (n?=?1,124), to test whether the increase in major depression that occurs among girls during adolescence may be partially explained by the body-image and eating disturbances that emerge after puberty. Elevated body dissatisfaction, dietary restraint, and bulimic symptoms at study entry predicted onset of subsequent depression among initially nondepressed youth in bivariate analyses controlling for initial depressive symptoms. Although the unique effect for body dissatisfaction was not significant in the multivariate model, this set of risk factors was able to fairly accurately foretell which girls would go on to develop major depression. Results were consistent with the assertion that the body-image- and eating-related risk factors that emerge after puberty might contribute to the elevated rates of depression for adolescent girls. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prospective Relations Between Bulimic Pathology, Depression, and Substance Abuse: Unpacking Comorbidity in Adolescent Girls.

[Correction Notice: An erratum for this article was reported in Vol 72(4) of Journal of Consulting and Clinical Psychology (see record 2007-16893-001). The findings of Leon, Fulkerson, Perry, Keel, and Klump ("Three to four year prospective evaluation of personality and behavioral risk factors for later disordered eating in adolescent girls and boys," Journal of Youth and Adolescence, 1999, Vol. 28, No. 2, pp. 181-196), cited on page 62, were incorrectly reported. Leon et al. (1999) found that the latent variable of negative affect/attitudes determined at study entrance significantly correlated with final year eating disorder risk score when conducted with the full sample and when removing Time 1 high eating disorder risk subjects. This latent variable consisted of the GBI Depression, MPQ Negative Emotionality, EDI Ineffectiveness, EDI Interoceptive Awareness, and EDI Body Dissatisfaction scales. A subsequent univariate analysis of Time 1 Negative Emotionality scale score on Time 3 eating disorder risk, adjusting for initial eating disorder risk score, showed a nonsignificant effect size (Stice, E. [2002]. Risk and maintenance factors for eating pathology: A meta-analytic review. Psychological Bulletin, 128, 825-848).] To elucidate the processes that contribute to the comorbidity between bulimic pathology, depression, and substance abuse, the authors tested the temporal relations between these disturbances with prospective data from adolescent girls (N = 496). Multivariate analyses indicated that depressive symptoms predicted onset of bulimic pathology but not of substance abuse, bulimic symptoms predicted onset of depression but not of substance abuse, and substance abuse symptoms predicted onset of depression but not of bulimic pathology. Results suggest that the comorbidity arises because certain disorders are risk factors for the other disorders. Findings also provide support for select etiologic theories and further establish the clinical significance of these conditions by showing that they increase risk for onset of other psychiatric disturbances. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Prospective relations between bulimic pathology, depression, and substance abuse: Unpacking comorbidity in adolescent girls": Correction to Stice et al. (2004).

Reports an error in "Prospective Relations Between Bulimic Pathology, Depression, and Substance Abuse: Unpacking Comorbidity in Adolescent Girls" by Eric Stice, Emily M. Burton and Heather Shaw (Journal of Consulting and Clinical Psychology, 2004[Feb], Vol 72[1], 62-71). The findings of Leon, Fulkerson, Perry, Keel, and Klump ("Three to four year prospective evaluation of personality and behavioral risk factors for later disordered eating in adolescent girls and boys," Journal of Youth and Adolescence, 1999, Vol. 28, No. 2, pp. 181-196), cited on page 62, were incorrectly reported. Leon et al. (1999) found that the latent variable of negative affect/attitudes determined at study entrance significantly correlated with final year eating disorder risk score when conducted with the full sample and when removing Time 1 high eating disorder risk subjects. This latent variable consisted of the GBI Depression, MPQ Negative Emotionality, EDI Ineffectiveness, EDI Interoceptive Awareness, and EDI Body Dissatisfaction scales. A subsequent univariate analysis of Time 1 Negative Emotionality scale score on Time 3 eating disorder risk, adjusting for initial eating disorder risk score, showed a nonsignificant effect size (Stice, E. [2002]. Risk and maintenance factors for eating pathology: A meta-analytic review. Psychological Bulletin, 128, 825-848). (The following abstract of the original article appeared in record 2004-10364-006.) To elucidate the processes that contribute to the comorbidity between bulimic pathology, depression, and substance abuse, the authors tested the temporal relations between these disturbances with prospective data from adolescent girls (N = 496). Multivariate analyses indicated that depressive symptoms predicted onset of bulimic pathology but not of substance abuse, bulimic symptoms predicted onset of depression but not of substance abuse, and substance abuse symptoms predicted onset of depression but not of bulimic pathology. Results suggest that the comorbidity arises because certain disorders are risk factors for the other disorders. Findings also provide support for select etiologic theories and further establish the clinical significance of these conditions by showing that they increase risk for onset of other psychiatric disturbances. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk factors for disordered eating during early and middle adolescence: Prospective evidence from mainland Chinese boys and girls.

Despite evidence that sociocultural and psychological factors contribute to disordered eating, researchers have yet to examine the extent to which putative risk factors influence vulnerability for girls versus boys within and across phases of adolescence, particularly in non-Western cultures. In this study, early and middle adolescent samples from China (N = 2,909) completed measures of eating disorder pathology and putative risk factors at baseline and were reassessed 12 months later. Among both younger and older girls, elevations in appearance-focused interactions with friends, negative affect, and body dissatisfaction predicted increases in symptomatology at follow-up. In contrast, there was more discontinuity in risk factors relevant to samples of boys. Although media and friendship influences contributed to later disturbances among early adolescent boys, psychological factors, including body dissatisfaction and negative affect, had stronger effects in the multivariate model for older boys. Implications of finding are discussed in relation to adolescent development and a Chinese cultural context. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Body Image and Eating Disturbances Across Ethnic Groups: More Similarities Than Differences.

Sociocultural models of eating pathology posit that ethnic minority groups should show fewer eating disturbances than Whites. Thus, the authors tested whether there were ethnic differences in eating disorder symptoms and risk factors for eating pathology and whether the relations between risk factors and eating pathology differed across ethnic groups, with data from adolescent and adult females (N = 785). Only 1 of the 14 tests of main effect differences between ethnic groups was significant and none of the 49 tests of whether ethnicity moderated the relations of risk factors to eating pathology were significant. Findings provide little support for the hypothesized ethnic differences in eating disturbances and suggest that ethnic minority groups have reached parity with Whites in this domain. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development of eating problems in adolescent girls: A longitudinal study.

Examined the emergence of eating problems in adolescent girls as a function of pubertal growth, body image, personality development, and family relationships. 193 White females and their mothers were seen in middle-school years (M age?=?13.93 years) and 2 years later. Results showed that girls who early in adolescence felt most negatively about their bodies were more likely to develop eating problems (on EAT-26) 2 years later. Concurrently, Time 1 eating problems were associated with body fat, grade, negative body image, and psychopathology, but not family relationships. At Time 2, adolescent body image and internalizing dimensions of psychopathology predicted problem-eating scores, as did maternal body image and depression. Findings are discussed in terms of adolescent patterns of adaptation, developmental psychopathology, and the study's relevance for understanding clinical eating disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fasting increases risk for onset of binge eating and bulimic pathology: A 5-year prospective study.

Although adolescent girls with elevated dietary restraint scores are at increased risk for future binge eating and bulimic pathology, they do not eat less than those with lower restraint scores. The fact that only a small proportion of individuals with elevated dietary restraint scores develop bulimic pathology suggests that some extreme but rare form of dietary restriction may increase risk for this disturbance. The authors tested the hypothesis that fasting (going without eating for 24 hr for weight control) would be a more potent predictor of binge eating and bulimic pathology onset than dietary restraint scores using data from 496 adolescent girls followed over 5 years. Results confirmed that only 23% of participants with elevated dietary restraint scores reported fasting. Furthermore, fasting generally showed stronger and more consistent predictive relations to future onset of recurrent binge eating and threshold/subthreshold bulimia nervosa over 1- to 5-year follow-up relative to dietary restraint, though the former effects were only significantly stronger than the latter for some comparisons. Results provide preliminary support for the hypothesis that fasting is a stronger risk factor for bulimic pathology than is self-reported dieting. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Friendship clique and peer influences on body image concerns, dietary restraint, extreme weight-loss behaviors, and binge eating in adolescent girls.

This study explored friendship variables in relation to body image, dietary restraint, extreme weight-loss behaviors (EWLBs), and binge eating in adolescent girls. From 523 girls, 79 friendship cliques were identified using social network analysis. Participants completed questionnaires that assessed body image concerns, eating, friendship relations, and psychological, family, and media variables. Similarity was greater for within than for between friendship cliques for body image concerns, dietary restraint, and EWLBs, but not for binge eating. Cliques high in body image concerns and dieting manifested these concerns in ways consistent with a high weight/shape-preoccupied subculture. Friendship attitudes contributed significantly to the prediction of individual body image concern and eating behaviors. Use of EWLBs by friends predicted an individual's own level of use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological and Behavioral Risk Factors for Obesity Onset in Adolescent Girls: A Prospective Study.

Because little is known about risk factors for obesity, the authors tested whether certain psychological and behavioral variables predicted future onset of obesity. The authors used data from a prospective study of 496 adolescent girls who completed a baseline assessment at age 11-15 years and 4 annual follow-ups. Self-reported dietary restraint, radical weight-control behaviors, depressive symptoms, and perceived parental obesity--but not high-fat food consumption, binge eating, or exercise frequency-predicted obesity onset. Results provide support for certain etiologic theories of obesity, including the affect regulation model. The fact that self-reported, weight-control behaviors identified girls at risk for obesity implies that high-risk youths are not engaging in effective weight-control methods and suggests the need to promote more effective strategies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relation of early menarche to depression, eating disorders, substance abuse, and comorbid psychopathology among adolescent girls.

This prospective study tested whether early menarche partially accounts for the increases in depression, eating pathology, substance abuse, and comorbid psychopathology that occur among adolescent girls, with structured interview data from a community sample (N?=?496). Early menarche (prior to 11.6 years) was associated with elevated depression, substance abuse, and "any" disorder but did not confer increased risk for anorexia nervosa, bulimia nervosa, or binge eating disorder. Although there was significant comorbidity across all three classes of pathology, early menarche was associated only with comorbid depression and substance abuse. Results provide partial support for the assertion that early menarche is a general risk factor for psychopathology among adolescent girls but suggest that this risk may not apply to certain disorders and that the effects are modest in size. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Prospective Test of the Stress-Buffering Model of Depression in Adolescent Girls: No Support Once Again.

The stress-buffering model posits that social support mitigates the relation between negative life events and onset of depression, but prospective studies have provided little support for this assertion. The authors sought to provide a more sensitive test of this model by addressing certain methodological and statistical limitations of past studies with prospective data from 496 adolescent girls. Deficits in peer support predicted increases in depressive symptoms, and negative life events predicted onset of depressive pathology. However, none of the 14 prospective tests provided support for the stress-buffering model despite sufficient power. Results provide scant support for the stress-buffering model and suggest that it might be time to shift attention to alternative multivariate models concerning these risk factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective test of the negative affect model of substance abuse: Moderating effects of social support.

The authors tested whether dimensions of negative affect--specifically, trait levels of negative emotionality and state levels of depressive symptoms--increased risk for substance abuse onset and whether perceived social support moderated this relation using data from a 5-year prospective study of 496 school-recruited adolescent girls. Initial negative emotionality, but not depressive symptoms, and deficits in parental, but not peer, support predicted future substance abuse onset in a multivariate hazard model. Tests of the interaction between negative affect dimensions and social support suggested that support did not moderate the relation of negative affect to risk for substance abuse onset. Results provide prospective support for the etiological role in the onset of substance abuse of trait-linked negative affect and of parental support. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Eating pathology among adolescent girls with attention-deficit/hyperactivity disorder.

The authors investigated prospectively assessed eating pathology (body image dissatisfaction and bulimia nervosa symptoms) among an ethnically and socioeconomically diverse sample of adolescent girls with attention-deficit/hyperactivity disorder--combined type (ADHD--C; n=93), ADHD--inattentive type (ADHD--I; n=47), and a comparison group (n=88). The sample, initially ages 6-12 years, participated in a 5-year longitudinal study (92% retention rate). After statistical control of relevant covariates, girls with ADHD--C at baseline showed more eating pathology at follow-up than did comparison girls; girls with ADHD--I were intermediate between these two groups. Baseline impulsivity symptoms, as opposed to hyperactivity and inattention, best predicted adolescent eating pathology. With statistical control of ADHD, baseline peer rejection and parent- child relationship problems also predicted adolescent eating pathology. The association between punitive parenting in childhood and pathological eating behaviors in adolescence was stronger for girls with ADHD than for comparison girls. Results are discussed in terms of the expansion of longitudinal research on ADHD to include female-relevant domains of impairment, such as eating pathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dissonance and healthy weight eating disorder prevention programs: Long-term effects from a randomized efficacy trial.

Adolescent girls with body dissatisfaction (N = 481, SD = 1.4) were randomized to a dissonance-based thin-ideal internalization reduction program, healthy weight control program, expressive writing control condition, or assessment-only control condition. Dissonance participants showed significantly greater decreases in thin-ideal internalization, body dissatisfaction, negative affect, eating disorder symptoms, and psychosocial impairment and lower risk for eating pathology onset through 2- to 3-year follow-up than did assessment-only controls. Dissonance participants showed greater decreases in thin-ideal internalization, body dissatisfaction, and psychosocial impairment than did expressive writing controls. Healthy weight participants showed greater decreases in thin-ideal internalization, body dissatisfaction, negative affect, eating disorder symptoms, and psychosocial impairment; less increases in weight; and lower risk for eating pathology and obesity onset through 2- to 3-year follow-up than did assessment-only controls. Healthy weight participants showed greater decreases in thin-ideal internalization and weight than did expressive writing controls. Dissonance participants showed a 60% reduction in risk for eating pathology onset, and healthy weight participants showed a 61% reduction in risk for eating pathology onset and a 55% reduction in risk for obesity onset relative to assessment-only controls through 3-year follow-up, implying that the effects are clinically important and enduring. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk factors for body dissatisfaction in adolescent girls: A longitudinal investigation.

Because few prospective studies have examined predictors of body dissatisfaction--an established risk factor for eating disorders--the authors tested whether a set of sociocultural, biological, interpersonal, and affective factors predicted increases in body dissatisfaction using longitudinal data from adolescent girls (N=496). Elevated adiposity, perceived pressure to be thin, thin-ideal internalization, and social support deficits predicted increases in body dissatisfaction, but early menarche, weight-related teasing, and depression did not. There was evidence of 2 distinct pathways to body dissatisfaction--1 involving pressure to be thin and 1 involving adiposity. Results support the contention that certain sociocultural, biological, and interpersonal factors increase the risk for body dissatisfaction, but suggest that other accepted risk factors are not related to this outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The future of risk factor research in understanding the etiology of eating disorders

This article explores whether particular risk factors are best seen as precursors or as symptoms. Psychological, cultural, family, developmental, and biological risk domains that may be important in the etiology of eating disorders are briefly reviewed. We describe a 4-year prospective study assessing a wide range of risk factors for development of eating disorders in a large school-based sample of adolescents. For subjects who were relatively asymptomatic, a personality or temperamental characteristic of negative affect/esteem measured at study entrance was the only significant predictor of later risk score for both girls and boys. The significant comorbidity demonstrated in a separate group that had high risk for eating disorders suggests that negative affectivity may be a vulnerability factor for overall psychopathology rather than a predisposition specifically for eating disorders. Following subjects through the young-adult years and later may further clarify the range of influences affecting disordered eating. Primary prevention and early intervention programs in the schools are also recommended.     

Prospective Relations Between Social Support and Depression: Differential Direction of Effects for Parent and Peer Support?

The authors tested whether deficits in perceived social support predicted subsequent increases in depression and whether depression predicted subsequent decreases in social support with longitudinal data from adolescent girls (N = 496). Deficits in parental support but not peer support predicted future increases in depressive symptoms and onset of major depression. In contrast, initial depressive symptoms and major depression predicted future decreases in peer support but not parental support. Results are consistent with the theory that support decreases the risk for depression but suggest that this effect may be specific to parental support during early adolescence. Results are also consonant with the claim that depression promotes support erosion but imply that this effect may only occur with peer support during this period. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mothers, daughters, and disordered eating.

Examined features of 77 mothers' attitudes and behavior that relate to disordered eating among their adolescent daughters. Mothers whose daughters reported a level of disordered eating comparable with clinical samples of bulimic patients were compared with mothers whose daughters reported a low level of eating disturbances. As hypothesized, mothers of daughters with disordered eating were more dissatisfied with the general functioning of the family system. Also, mothers whose daughters were eating disordered were themselves more eating disordered and differed in their dieting history compared with mothers of the girls who were not eating disordered. Furthermore, mothers of girls with disordered eating thought their daughters should lose more weight than mothers of girls who were not eating disordered. They also thought that their daughters were less attractive than the girls judged themselves. (PsycINFO Database Record (c) 2010 APA, all rights reserved)