Coming to Terms With Risk Factors for Eating Disorders: Application of Risk Terminology and Suggestions for a General Taxonomy.

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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk and maintenance factors for eating pathology: A meta-analytic review.

This meta-analytic review of prospective and experimental studies reveals that several accepted risk factors for eating pathology have not received empirical support (e.g., sexual abuse) or have received contradictory support (e.g., dieting). There was consistent support for less-accepted risk factors (e.g., thin-ideal internalization) as well as emerging evidence for variables that potentiate and mitigate the effects of risk factors (e.g., social support) and factors that predict eating pathology maintenance (e.g., negative affect). In addition, certain multivariate etiologic and maintenance models received preliminary support. However, the predictive power of individual risk and maintenance factors was limited, suggesting it will be important to search for additional risk and maintenance factors, develop more comprehensive multivariate models, and address methodological limitations that attenuate effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Food, mood, and attitude: Reducing risk for eating disorders in college women.

Food, Mood, and Attitude (FMA) is a CD-ROM prevention program developed to decrease risk for eating disorders in college women. Female 1st-year students (N = 240) were randomly assigned to the intervention (FMA) or control group. Equal numbers of students at risk and of low risk for developing an eating disorder were assigned to each condition. Participants in the FMA condition improved on all measures relative to controls. Significant 3-way interactions (Time × Condition × Risk Status) were found on measures of internalization of sociocultural attitudes about thinness, shape concerns, and weight concerns, indicating that at-risk participants in the intervention group improved to a greater extent than did low-risk participants. At follow-up, significantly fewer women in the FMA group reported overeating and excessive exercise relative to controls. (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)     

A Biopsychosocial Model of Disordered Eating and the Pursuit of Muscularity in Adolescent Boys.

This review provides an evaluation of the correlates and/or risk factors associated with disordered eating and the pursuit of muscularity among adolescent boys. One of the main conclusions is that similar factors and processes are associated with both behavioral problems. Several factors found to be consistently associated with disordered eating among boys are also similar to those found with girls. These include body mass index, negative affect, self-esteem, perfectionism, drug use, perceived pressure to lose weight from parents and peers, and participation in sports that focus on leanness. However, as many of the findings have only been verified using cross-sectional designs, prospective studies are now needed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk factors for clinically significant importance of shape and weight in adolescent girls.

The objective of the current study was to conduct a longitudinal study of adolescent girls to determine how temperament, attitudes toward shape and weight, life events, and family factors might contribute to the growth of clinically significant importance of shape and weight, assessed using the Eating Disorder Examination (EDE). Time 1 data were available from 699 female twins (M age = 13.96 years) and 595 parents, and approximately 1.15 years later (Time 2) the twins completed the EDE again (M age = 15.10 years). Twins were treated as singletons in the analyses. Time 1 importance of shape and weight was a significant predictor of Time 2 lifetime disordered eating behaviors. Seven Time 1 variables were significant univariate predictors of Time 2 importance of shape and weight. In multivariate analyses, fathers’ sensitivity to reward was the only significant predictor of growth of Time 2 importance of shape and weight. Some support was found for established risk factors of disordered eating risk, while the multivariate analyses highlight the importance of developing conceptualizations of eating disorder etiology beyond the individual level. (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)     

Thinness and eating expectancies predict subsequent binge-eating and purging behavior among adolescent girls.

One's expectancies for reinforcement from eating or from thinness are thought to represent summaries of one's eating-related learning history and to thus influence the development of binge-eating and purging behavior. In a 3-year longitudinal study, the authors tested this hypothesis and the hypothesis that binge eating also influences subsequent expectancy development. The authors used trajectory analysis to identify groups of middle school girls who followed different trajectories of binge eating, purging, eating expectancies, and thinness expectancies. Initial eating and thinness reinforcement expectancies identified girls whose binge eating and purging increased during middle school, and expectancies differentiated girls who began these problem behaviors from girls who did not. Initial binge-eating scores differentiated among eating expectancy developmental trajectories. The onset of most behaviors can be understood in terms of learned expectancies for reinforcement from these behaviors. The same model can be applied to the risk for eating disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychiatric disorders associated with risk for the development of eating disorders during adolescence and early adulthood.

Longitudinal data were used to investigate whether anxiety, depressive, disruptive, personality, or substance use disorders are associated with risk for the development of eating disorders during adolescence or early adulthood. Psychiatric disorders were assessed among 726 youths from a random community sample during adolescence and early adulthood. Depressive disorders during early adolescence were associated with elevated risk for the onset of eating disorders, dietary restriction, purging behavior, and recurrent weight fluctuations after preexisting eating problems and other psychiatric disorders were controlled statistically. Disruptive and personality disorders were independently associated with elevated risk for specific eating or weight problems. The present findings suggest that depressive disorders during early adolescence may contribute to the development of eating disorders during middle adolescence or early adulthood. (PsycINFO Database Record (c) 2010 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)     

Relapse as a nonlinear dynamic system: Application to patients with alcohol use disorders.

Understanding the relapse process is one of the most important issues in addictive behaviors research. To date, most studies have taken a linear approach toward predicting relapse based on risk factors. Nonlinear dynamical systems theory can be used to describe processes that are not adequately modeled using a linear approach. In particular, the authors propose that catastrophe theory, a subset of nonlinear dynamical systems theory, can be used to describe the relapse process in addictive behaviors. Two small prospective studies using 6-month follow-ups of patients with alcohol use disorders (inpatient, n=51; outpatient, n=43) illustrate how cusp catastrophe theory may be used to predict relapse. Results from these preliminary studies indicate that a cusp catastrophe model has more predictive utility than traditional linear models. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Screening for disruptive behavior syndromes in children: The application of latent class analyses and implications for prevention programs.

The predictive accuracy of classifying children at risk for disruptive disorders through latent class analyses (LCA) was evaluated. Child Behavior Checklist/4-18 (T. M. Achenbach, 1991) items, reflecting symptoms of Diagnostic and Statistical Manual of Mental Disorders (4th ed., American Psychiatric Association, 1994) defined disruptive disorders, alone and in combination with other child and familial risk factors, were used to predict children's risk for disruptive disorder. Predictive accuracy reached a positive predictive value of 69%. Children incorrectly classified (false positive and false negative) were compared with correctly classified children (true positive and true negative) on risk factors in the family context to test whether the screening procedure could be improved through a multiple-gating procedure. The differences in familial context factors between these children were limited, and no clear indications were found on how to use familial context factors to improve the screening procedure after the initial classification by LCA. (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)     

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)     

Adolescence-limited versus persistent delinquency: Extending Moffitt's hypothesis into adulthood.

The authors examined how neuropsychological, personality, and environmental risk factors and their interactions were related to trajectories of delinquent behavior from adolescence to adulthood. Four waves of longitudinal data from 698 male participants, ages 12–18 at Time 1 and ages 25–31 at Time 4, were included in the analyses. Using a growth mixture model approach, 4 trajectories were identified: nondelinquents, adolescence-limited delinquents, adolescence-to-adulthood-persistent delinquents, and escalating delinquents. Five risk factors distinguished escalating from persistent delinquents and 5 also distinguished nondelinquents from the 3 delinquency trajectories. Persistent delinquents scored significantly higher than adolescence-limited delinquents on only one risk factor, disinhibition. Overall, few of the factors that are related to childhood-to-adolescence persistence were associated with persistence in delinquency beyond adolescence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality and behavioral vulnerabilities associated with risk status for eating disorders in adolescent girls.

Presents 1st-yr cross-sectional findings from a study of the development of eating disorders. 937 adolescent female 7th–10th graders completed measures that included information on personality, self-concept, eating patterns, and attitudes. A risk status score was calculated on the basis of comprehensive information regarding Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) eating disorders criteria and other weight and attitudinal data. All personality measures showed significant differences according to risk, based on S classification into high, moderate, and mild risk status and comparison groups. Early puberty was not associated with increased risk. The strongest predictor variables for risk were body dissatisfaction, negative emotionality, and lack of interoceptive awareness. The possible diathesis of personality including temperamental factors in the later development of an eating disorder is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Eating Disorder Diagnostic Scale: Additional Evidence of Reliability and Validity.

The authors conducted 4 studies investigating the reliability and validity of the Eating Disorder Diagnostic Scale (HDDS; E. Stice, C. F. Telch, & S. L. Rizvi, 2000), a brief self-report measure for diagnosing anorexia nervosa, bulimia nervosa, and binge eating disorder. Study 1 found that the HDDS showed criterion validity with interview-based diagnoses, convergent validity with risk factors for eating pathology, and internal consistency. Studies 2 and 3 found that the EDDS was sufficiently sensitive to detect the effects of eating disorder prevention programs. Regarding predictive validity, Studies 3 and 4 found that the EDDS predicted response to a prevention program and future onset of eating pathology and depression. Results provide additional evidence of the reliability and validity of this scale and suggest it may be useful in clinical and research applications. (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.     

Body dissatisfaction, ethnic identity, and disordered eating among African American women.

Initial research suggested that only European American women developed eating disorders (Garner, 1993), yet recent studies have shown that African American women do experience them (e.g., Lester & Petrie, 1998b; Mulholland & Mintz, 2001) and also may be negatively affected by similar sociocultural variables. In this study, we examined a sociocultural model of eating disorders for African American women but included the influences of ethnic identity (e.g., Hall, 1995; Helms, 1990). Participants (N = 322) were drawn from 5 different universities. They completed measures representing ethnic identity, societal pressures regarding thinness, internalization of societal beauty ideals, body image concerns, and disordered eating. Structural equation modeling revealed that ethnic identity was inversely, and societal pressures regarding thinness directly, related to internalization of societal beauty ideals. Societal pressures regarding thinness was also related to greater body image concerns. Both internalization of societal beauty ideals and body image concerns were positively associated with disordered eating (R2 = .79). Overall, the final model fit the data well, supporting its generalizability and the importance of ethnic identity in determining risk. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Males and eating disorders: Gender-based therapy for eating disorder recovery.

Mental health professionals may wonder how males with eating disorders differ from females with eating disorders and how best to treat males with eating disorders. The eating disorder literature largely focuses on females. Limited research has examined assessment and treatment of eating disorders in males. This article offers a unique view of eating disorder treatment for males by integrating it with the literature on the psychology of men. Mental health professionals are given practical suggestions to guide eating disorder recovery in males. A case example shows treatment considerations for working with males with disordered eating behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)