Disordered eating in adolescent males from a school-based sample

Personality correlates of eating pathology severity and subtypes in The National Comorbidity Survey Adolescent Supplement

OBJECTIVE

We examined how personality traits are associated with eating pathology (EP) across a range of severities and symptom subtypes.

METHOD

The National Comorbidity Survey Adolescent Supplement (N = 10,148) was used to compare personality across severities (i.e., clinical Eating Disorders [EDs], subclinical disordered eating, preclinical weight concerns, or no weight/EP [no W/EP]), subclinical subtypes (i.e., Binge Eating Only, Binge-Purge, Binge-Restrict, Restrict-Purge, or no W/EP), and clinical subtypes (i.e., Anorexia Nervosa [AN]), Bulimia Nervosa [BN], Binge Eating Disorder [BED], internalizing disorders, or no ED or internalizing disorder) of EP.

RESULTS

More severe EP was associated with more extreme personality trait endorsements. Impulsivity-related traits did not consistently distinguish binge eating/purging from restricting subtypes, although behavioral disinhibition differentiated adolescents with BN or BED from AN.

CONCLUSION

Personality traits related to affectivity and impulsivity were more consistently associated with severity rather than subtype of EP.

Gender and help-seeking for an eating disorder: findings from a general population sample

PURPOSE

This study aimed to compare gender differences in eating disorder (ED) features and to examine the role of gender as a predictor of ED help-seeking controlling for other putative determinants, namely weight/shape overvaluation, age, BMI, and impairment in role functioning.

METHODS

Demographic, ED symptoms, and related data were collected during household interviews of individuals aged ≥ 15 years. One hundred and forty-eight participants (164 after data were weighted) with an ED syndrome were identified.

RESULTS

Compared to women, men with an ED were younger and had lower levels of purging and overvaluation. However, men and women with an ED had similar levels of functional impairment, binge eating and strict dieting. In univariate analyses, males in general, but not males with an ED, were significantly less likely than females to seek help for an ED. In multivariate analysis of people with an ED, only BMI was significantly associated with treatment-seeking.

CONCLUSION

Functional health impairment and common ED behaviours were similar for men and women with EDs. Gender may not be a primary reason to be more or less likely to seek help for an ED. Rather, other features, most notably, a higher BMI, appear to be stronger predictors of ED-specific help-seeking.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Increased rates of body dissatisfaction, depressive symptoms, and suicide attempts in Jamaican teens with sickle cell disease

BACKGROUND

This study aims to examine the association of body image and weight perceptions with risk of depression and suicidal attempts in Jamaican adolescents with sickle cell disease (SCD).

METHODS

Adolescents with SCD and a national sample of Jamaican adolescents completed a questionnaire examining body image, weight perceptions, and risk for depression.

RESULTS

Perceived and desired body images were similar for both groups. Adolescents with SCD had higher levels of "negative body satisfaction" (43.9% vs. 33.9%; P = 0.03), risk for depression (28.7% vs. 19.3%; P = 0.01), and attempted suicide (12.4% vs. 6.6%; P = 0.02) than national sample. Risk of depression was higher in those who perceived themselves to be over or underweight, and lower in those with more friends and attending school. Females and those with body image dissatisfaction were more likely to have attempted suicide. Within the SCD adolescents, girls were at greater odds of having mental health issues.

CONCLUSIONS

Jamaican adolescents with SCD have significantly higher rates of negative body satisfaction and depressive symptoms, and nearly twice the rate of attempted suicide, compared with their healthy peers. This underscores the need for healthcare professionals to better explore and discuss healthy weight, body satisfaction, and coping with the demands and uncertainties of having a chronic illness with Jamaican adolescents with SCD, even while promoting body acceptance and good self-esteem. Screening for mood disorders is strongly recommended and gender-specific interventions should be developed. Healthcare professionals need to encourage positive social interactions that improve adolescents' mental health.

Differences between adolescents exhibiting moderate binging and non-binging eating behaviors

Much research has been conducted to study the association between personality and eating disorders using clinical samples. However, less research has been done on personality variables in non-clinical cases of adolescents prone to binge eating. The purpose of this study is to compare a group of 53 adolescents without binge eating with a group of 28 adolescents with moderate binging behaviors and to investigate the relationship between personality traits and eating behaviors. All participants completed BES, STAY, EPQ-R, IVE and EDI-2. The results demonstrated that the group with moderate binging presented higher scores in state and trait anxiety, psychoticism, neuroticism, and impulsivity than the adolescents without binge eating. The second hypothesis of this research was to analyze the relationship between personality characteristics and eating behaviors. In the group of adolescents without binge eating both neuroticism and psychoticism correlated with ED symptomatology. Similarly extraversion, impulsivity and venturesomeness correlated with ED symptomatology. In the group of adolescents with moderate binge eating, there was an association of trait anxiety, extraversion, venturesomeness and empathy with ED symptomatology in university samples. The results of this study represent a new stimulus to thoroughly investigate those aspects of personality that may be predictive of ED symptomatology and to develop preventative strategies. It is our opinion that it is necessary to focus attention not only on clinical or non-clinical samples, but also on adolescents who could be considered at risk.

Body dissatisfaction and disordered eating among Portuguese and Spanish adolescents: The role of individual characteristics and internalisation of sociocultural ideals

The aim of this study was to explore the differences in patterns of risk factors for body dissatisfaction and disordered eating attitudes in both female and male adolescents from Portugal and Spain. The sample included 455 adolescents aged 12-16 years (M = 13.28, SD = 0.65) from two urban areas of each country. Body mass index, self-reported self-esteem, perfectionism, internalisation of sociocultural ideals, body dissatisfaction and disordered eating attitudes were assessed. Path analyses provided partial support for a cross-cultural model of body dissatisfaction and disordered eating in Western countries due to the presence of certain differences in the patterns of relationships across sex and country. The findings suggest the importance not only of identifying cultural specificities, even in "neighbouring" countries, but also of developing a global and comprehensive preventive approach that focuses on the influence of the ideal of beauty transmitted by Western societies.

The effect of age on neural processing of pleasant soft touch stimuli

Tactile interactions with our environment stimulate afferent fibers within the skin, which deliver information about sensations of pain, texture, itch and other feelings to the brain as a comprehensive sense of self. These tactile interactions can stimulate brain regions involved in interoception and reward processing. This study examined subjective, behavioral, and neural processing as a function of age during stimulation of A-beta (Aβ) and C tactile (CT) afferents using a soft brush stroke task. 16 adolescents (ages 15–17), 22 young adults (ages 20–28), and 20 mature adults (ages 29–55) underwent a simple continuous performance task while periodically anticipating and experiencing a soft touch to the palm or forearm, during functional magnetic resonance imaging (fMRI). fMRI results showed that adolescents displayed greater bilateral posterior insula activation than young and mature adults across all conditions and stimulus types. Adolescents also demonstrated greater bilateral posterior insula activation than young and mature adults specifically in response to the soft touch condition. Adolescents also exhibited greater activation than mature adults in bilateral inferior frontal gyrus and striatum during the soft touch condition. However, mature adults showed greater striatum activation than adolescents and young adults during anticipation. In the left anterior cingulate cortex, mature adults exhibited greater activation than adolescents and young adults when anticipating the upcoming touch. These results support the hypothesis that adolescents show an exaggerated neural response to pleasant stimulation of afferents, which may have profound effects on how they approach or avoid social and risky situations. In particular, heightened interoceptive reactivity to pleasant stimuli might cause adolescents to seek experiences that are associated with pleasant stimulation.

Eating disorders and their correlates in high school adolescents of Northern Italy

Objective – The study investigated eating disordered behaviours and life-habits correlated in a large sample of Northern Italian adolescents of both sexes. Methods – The study had a cross-sectional design. 2595 students (2,146 responders; mean age 17.2±1.7 years) attending high schools in Savona (Italy) in April and May 2001 were sampled. To assess eating attitudes, the Inventory for the Screening of Eating Disorders (ISED) was self-administered. Inquiries regarding possible risk factors for eating disorders were also made: socio-economic status, body weight, smoking and alcohol drinking habits, illegal drugs use. Results – Females scored significantly higher than males at ISED (13.4±7.7 vs. 7.6±5.8). 28.5% of females had a total ISED score above the cut-off point (18/19). Unhealthy eating behaviours were strongly associated with higher BMI, body image disturbance and illegal drugs use in both sexes; age had significant role only in males. No significant association between disordered eating behaviours and socio-economic status, smoking habit and alcohol consumption were found. Conclusions – Symptoms of eating disorders are quite spread in the Northern Italian female adolescents and associate with illegal drugs use. These data, with not negligible frequency of unhealthy eating behaviours and attitudes in males too, suggest that primary and secondary preventive interventions for teen-agers should be got ready.

Declaration of Interest: 1) the study received the financial support by Regione Liguria and ASL 2 of Savona; 2) the study didn't receive any forms of financing by pharmaceutical company support and any honoraria for consultancies or interventions was received by each author in the last two years; 3) any other involvements that might be considered a conflict of interest in connection with the submitted article. The authors state that if and when the manuscript accepted for publication, they automatically agree to transfer the copyright to the publisher

Do men with eating disorders differ from women in clinics, psychopathology and personality?

OBJECTIVE

To determine if male and female eating disorders differ in clinics, psychopathology and personality traits when compared with a healthy group.

METHODS

Sixty male and 60 female eating disorder individuals (16% anorexia nervosa, 42% bulimia nervosa and 42% eating disorder not otherwise specified), matched for age and diagnostic, were compared with 120 healthy-eating participants (60 male and 60 female participants). All were diagnosed according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Assessment measures included Eating Disorder Inventory--2, Symptom Checklist--Revised and Temperament and Character Inventory--Revised, as well as other clinical and psychopathological indices.

RESULTS

Male eating disorder participants reported significant lower laxative abuse (p = 0.020) and significant higher vomiting episodes (p = 0.019) than female eating disorder participants. Differences on drive for thinness, body dissatisfaction and some Symptom Checklist--Revised scales were found across genders in eating disorder participants. Male eating disorder participants scored significantly lower than female participants with eating disorders on harm avoidance, reward dependence and cooperativeness.

CONCLUSIONS

Although eating disorder clinical features were similar across genders, male eating disorder participants had less body image concern and general psychopathology than female eating disorder participants.

A risk model for disordered eating in late elementary school boys

The authors tested the following risk model for disordered eating in late elementary school-age boys: Pubertal status is associated with increases in negative urgency, that is, the tendency to act rashly when distressed; high levels of negative urgency then influence binge eating through psychosocial learning; and binge eating influences purging. A sample of 908 fifth-grade boys completed questionnaire measures of puberty, negative urgency, dieting/thinness and eating expectancies, and eating pathology. Eating disorder symptoms were present in these young boys: 10% reported binge eating and 4.2% reported purging through self-induced vomiting. Each hypothesis in the risk model was supported. Boys this young do in fact engage in the maladaptive behaviors of binge eating and purging; it is crucial to develop explanatory risk models for this group. To this end, it appears that characteristics of boys, including their pubertal status, personalities, and psychosocial learning, help identify boys at risk.

Examination of a sociocultural model of disordered eating among male and female adolescents

OBJECTIVES

The study tests a version of Stice's (1994) sociocultural model of disordered eating that was modified to incorporate social comparisons. Additionally, it examines how self-reported body-mass index and perceived weight status influence associations within the model.

METHOD

Questionnaires were administered in a state secondary school; the sample consisted of 250 female and 257 male adolescents aged 11-16 years.

RESULTS

The results supported the sociocultural model among both male and female adolescents. Perceived pressure to lose weight was directly associated with eating behaviour, as well as indirectly associated through social comparisons, internalization and body dissatisfaction. However, social comparisons were most strongly related to body dissatisfaction among adolescents who perceived themselves as overweight.

CONCLUSIONS

The findings indicate that models of eating disordered behaviour, developed for adolescent girls, are also appropriate for understanding this behaviour among male adolescents. The results suggest that social comparisons represent a useful addition to Stice's (1994) original model and a potentially fruitful target for interventions.

Role of media and peers on body change strategies among adult men: is body size important?

There has been limited previous research that has examined the role of sociocultural influences on body change strategies among adult men. The current study investigated the role of specific types of messages (encouragement, teasing and modelling) from peers and the media on the strategies to change weight among adult men. Differences were evaluated between 526 men aged from 18 to 60 years from three groups (normal weight, overweight and obese) on body image, body change strategies and messages about their body received from peers and the media. Men were primarily drawn from United States, Australia and Europe. Results showed that messages received by men regarding losing weight or increasing muscle size differed according to weight. Body image and media messages were the strongest predictors of losing weight, whereas body image importance and messages from peers were the strongest predictors of increasing muscles. These findings highlight the importance of sociocultural influences on body change strategies among adult males.

Bulimia nervosa symptoms in the multimodal treatment study of children with ADHD

OBJECTIVE

We investigated body image dissatisfaction and bingeing/purging characteristics of bulimia nervosa (BN) in the ongoing prospective follow-up of the Multimodal Treatment Study of Children with attention-deficit/hyperactivity disorder (ADHD).

METHOD

Participants were 337 boys and 95 girls with ADHD and 211 boys and 53 girls forming a local normative comparison group (LNCG), reassessed in midadolescence (mean age, 16.4), 8 years after original recruitment.

RESULTS

Youth with childhood ADHD showed more BN symptoms in midadolescence than did LNCG youth, and girls demonstrated more BN symptoms than did boys, with effect sizes between small and medium. Childhood impulsivity, as opposed to hyperactivity or inattention, best predicted adolescent BN symptoms, particularly for girls. Among youth with ADHD, treatment received during the follow-up period was not associated with BN pathology.

DISCUSSION

Both boys and girls with ADHD may be at risk for BN symptoms in adolescence because of the impulsivity central to both disorders.

The road less traveled: Associations between externalizing behaviors and eating pathology

OBJECTIVE

Few studies have examined associations between externalizing behaviors and eating disorders in either sex. The current study investigated sex differences in associations between internalizing and externalizing symptoms and disordered eating.

METHOD

A sample of 541 men and women completed self-reported measures of disordered eating (e.g., binge eating), internalizing symptoms (e.g., anxiety), and externalizing behaviors (e.g., delinquency). Hierarchical linear modeling was used to examine sex differences in associations between these symptoms and disordered eating.

RESULTS

Internalizing symptoms showed the strongest associations with disordered eating in both sexes. Hyperactivity and aggression were more strongly associated with disordered eating in men, whereas alcohol use was more strongly associated with disordered eating in women.

DISCUSSION

Results indicated several sex similarities in associations between internalizing symptoms and disordered eating, but some important sex differences among externalizing behaviors. Externalizing behaviors may play a significant role in the development of disordered eating uniquely within men and women.

Interpersonal influences on late adolescent girls' and boys' disordered eating

Perceived socio-cultural pressure to be thin has an important impact on disordered eating during early and middle adolescence, but less is known about late adolescence. Most prospective studies included only girls, and less is known about the influence on boys. This study investigated interpersonal influences on changes in late adolescent boys' and girls' symptoms of disordered eating over one year. Participants were a community sample of late adolescents 16-19 years of age (N=199; 49.75% girls), their mothers, and friends. Structural equation modeling revealed that interpersonal pressure to be thin and criticism about appearance predicted increases in disordered eating over time. Late adolescents', mothers' and friends' reports of pressure were associated with disordered eating at Time 1 and Time 2. Further, adolescents' perceptions and friends' reports of pressure to be thin predicted changes in disordered eating over time. Findings underscore the significance of interpersonal relationships for disordered eating during late adolescence in both girls and boys.

Examining body dissatisfaction in young men within a biopsychosocial framework

This study examined biopsychosocial factors related to body dissatisfaction in young men within multivariate and moderator contexts. A female sample was included as a gender comparison. Male (n=111) and female (n=236) undergraduates filled out self-report questionnaires assessing body mass index (BMI), media influence, a history of weight-related teasing, and socially prescribed perfectionism, along with various indices of body dissatisfaction. Perceived pressure from the media was consistently related to body dissatisfaction in men whereas multiple biopsychosocial variables accounted for body dissatisfaction in women. Socially prescribed perfectionism and a history of weight teasing each moderated the relationship between BMI and male body dissatisfaction, identifying men low in body dissatisfaction. Findings indicate that applying a biopsychosocial framework to the study of body dissatisfaction in men is useful and suggest the need for including other factors, such as male peers and sports involvement, in understanding contributors to male body image.

Factors associated with disordered eating among sexually active adolescent males: gender and number of sexual partners

OBJECTIVE

To examine the prevalence of disordered eating behaviors among sexually active adolescent males by gender and number of sex partners, and examine psychosocial well-being by sex partner factors among boys reporting disordered eating.

METHOD

Data were collected from 10,095 9(th) and 12(th) grade Minnesota Student Survey participants who reported sexual intercourse in the past year.

RESULTS

The use of any disordered eating behaviors was reported by 39.4% of the sexually active males reporting only female sex partners, 53.4% reporting only male sex partners, and 56.4% reporting both female and male sex partners. Rates of specific disordered eating behaviors were associated with higher numbers of sex partners (male and/or female) and same gender of sex partner, and were highest among those males who reported 3 or more of both genders of sex partners. Among sexually active males reporting disordered eating, poorer emotional well-being and less family connectedness were associated with greater number of partners and with same-sex partners.

CONCLUSIONS

Sexually active males, especially those with multiple and/or same-sex partners, may benefit from interventions targeted at reducing disordered eating behaviors. Among sexually active males engaging in disordered eating behaviors, enhancing emotional health and improving family connectedness may be beneficial, especially among those with sex partners of the same gender and/or with multiple sex partners. The identification of specific psychosocial characteristics that are commonly associated with sexually active adolescent males and who exhibit disordered eating behaviors may provide direction toward the development of appropriate early identification, prevention, and treatment efforts.

Body image and self-esteem among adolescents undergoing an intervention targeting dietary and physical activity behaviors

PURPOSE

To determine the effect of a one-year intervention targeting physical activity, sedentary, and diet behaviors among adolescents on self-reported body image and self-esteem. Health promotion interventions can lead to awareness of health risk and subsequent adoption of beneficial changes in behavior. However, it is possible that interventions targeting behaviors associated with childhood obesity may also increase the likelihood of unhealthy eating and physical activity obsessions and behaviors.

METHODS

Body image and self-esteem were assessed for adolescents participating in the PACE+ study, a randomized controlled trial of a 1-year behavioral intervention targeting physical activity, sedentary, and dietary behaviors. The Body Dissatisfaction subscale of the Eating Disorder Inventory and Rosenberg Self-Esteem scale were used to assess body image and self-esteem, respectively, and measurements were performed at baseline, and at 6 and 12 months. Demographic characteristics and weight status of participants were also ascertained. Analysis of responses was performed via both between-group and within-group repeated measure analyses.

RESULTS

There were 657 adolescents who completed all measurements. Body image differences were found for age, gender, and weight status at baseline, whereas self-esteem differences were demonstrated for gender, ethnicity, and weight status. There were no intervention effects on body image or self-esteem for either girls or boys. Self-esteem and body satisfaction did not worsen as a result of participating in the PACE+ intervention for either boys or girls whether or not they lost or maintained their weight or gained weight. Girls assigned to the PACE intervention who experienced weight reduction or weight maintenance at either 6 or 12 months reported improvements in body image satisfaction (p = .02) over time compared with subjects who had experienced weight gain during the 12-month study period.

CONCLUSIONS

Adverse effects on body satisfaction and self-esteem were not observed among adolescents undergoing this behavioral intervention. These results suggest that a behavioral intervention directed at improving physical activity and diet habits may be safely undertaken by adolescents, including those who are overweight and at risk for overweight, without adverse psychological consequences. Inclusion of specific elements in the intervention that directly addressed body image and self-esteem issues may have reduced the risk for negative psychological effects.

Cue reactivity in male restrained eaters: the role of negative cognitions as predictors of food intake

OBJECTIVE

While restrained eating is one of the most well-established risk factors of eating disorders in females, its role for eating disturbances in males remains largely unclear. The present study investigates eating behaviour in response to food cues and negative cognitions in male restrained eaters.

METHODS

Twenty-four restrained eaters and 21 unrestrained eaters volunteered in a cue reactivity experiment consisting of two exposure trials with and without response prevention. Food and macronutrient intake were monitored, and negative cognitions were assessed using a self-report cognition inventory.

RESULTS

Male restrained eaters consumed a larger amount of food, specifically carbohydrates, than unrestrained eaters. This greater food intake was predicted by negative cognitions about self-esteem and occurred in restrained eaters who had reported binge eating episodes in the diagnostic interview.

DISCUSSION

Results suggest marked cue reactivity in male restrained eaters with an increased risk of overeating in those who experience low situational self-esteem and who are binge eaters.

Psychological status and weight-related distress in overweight or at-risk-for-overweight children

OBJECTIVE

To associate psychological status, weight-related distress, and weight status during childhood in overweight or at-risk-for-overweight children.

RESEARCH METHODS AND PROCEDURES

We associated self-report of depression, trait anxiety, and weight-related distress (body size dissatisfaction and weight-related peer teasing after controlling for the effects of weight) in 164 children (black 35%; age 11.9 +/- 2.5 years; girls 51%) who were overweight or at-high-risk-for-overweight and were not seeking weight loss.

RESULTS

Overall, heavier children reported more psychological and weight-related distress. Black children reported more anxiety and body size dissatisfaction than white children, despite equivalent weights. However, psychological distress was not significantly associated with weight in white children. Girls reported more weight-related distress than boys. Depression was associated with weight-related teasing in all predictive models, except in the model using only black subjects. Trait anxiety was associated with report of peer teasing when using all subjects. Depression was also significantly associated with children's report of body size dissatisfaction in models using all subjects, only girls, or white subjects, but not in analyses using only boys or black subjects. For boys peer teasing was associated with body size dissatisfaction. In models including only black children, depression and trait anxiety were not significantly associated with either report of peer teasing or body size dissatisfaction.

DISCUSSION

Regardless of race or sex, increasing weight is associated with emotional and weight-related distress in children. However, associations of psychological status, weight, and weight-related distress differ for girls and boys, and for black and white children.

Psychological and physical correlates of disordered eating in male and female Turkish college students

The aim of this study was to examine the relationship between disordered eating and three psychological variables (obsessive and depressive symptoms, self-esteem) and body mass index (BMI) in a sample of male and female college students in Turkey. Maudsley Obsessive-Compulsive Inventory (MOCI), Beck Depression Inventory (BDI), Rosenberg Self Esteem Scale (RSES), Eating Attitude Test (EAT), and Bulimic Investigatory Test, Edinburgh (BITE) scales were administered to 408 college students (279 women; 129 men). By multiple regression analysis, the scales of MOCI, BDI, RSES and BMI were used as potential predictors of EAT and BITE scores for each gender. Obsessionality and BMI were the strongest predictors of bulimic and anorexic symptoms in women. In men, while the strongest predictors of bulimic symptoms were the depressive and obsessive symptoms, the best predictor of anorexic symptoms was obsession scores. There were significant differences and some similarities between male and female Turkish college students.

Self-reported weight perceptions, dieting behavior, and breakfast eating among high school adolescents

This study explored the relationships among weight perceptions, dieting behavior, and breakfast eating in 4597 public high school adolescents using the Centers for Disease Control and Prevention Youth Risk Behavior Survey. Adjusted multiple logistic regression models were constructed separately for race and gender groups via SUDAAN (Survey Data Analysis). Adjusted odds ratios [ORs] and 95% confidence intervals were calculated to determine the strength of relationships. Approximately 42% of the sample reported not eating breakfast within the past 5 days, while 41% were trying to lose weight, and 37% were dieting to lose weight. Excessive dietary practices (eg, fasting, taking diet pills or laxatives, and vomiting to lose weight) were reported by approximately 25% of the sample. When compared to those eating breakfast within the past 5 days, all race and gender groups that did not report eating breakfast were significantly more likely to report fasting to lose weight (ORs = 1.70-2.97). In addition, all race/gender groups, with the exception of black females, were significantly more likely to perceive themselves as overweight (ORs = 1.44-1.61) and trying to lose weight (ORs = 1.40-1.72). Among males, not eating breakfast was significantly associated with taking diet pills to lose weight (ORs = 2.31-2.40), eating fewer calories to lose weight (ORs = 1.38-1.49), and inversely associated with trying to gain weight (ORs = 0.71-0.74). Results suggest that these adolescents may be skipping breakfast as part of a patterned lifestyle of unhealthy weight management and that efforts to encourage youth to eat breakfast will likely not ameliorate all dietary challenges that appear beyond the scope of increased breakfast offerings.

The Skinny on Body Dissatisfaction: A Longitudinal Study of Adolescent Girls and Boys

The present study tested whether theoretically derived risk factors predicted increases in body dissatisfaction and whether gender moderated these relations with data from a longitudinal study of 428 adolescent girls and boys because few prospective studies have examined these aims, despite evidence that body dissatisfaction increases risk for various psychiatric disturbances. Body dissatisfaction showed significant increases for girls and significant decreases for boys during early adolescence. For both genders parental support deficits, negative affectivity, and self-reported dietary restraint, but not Ideal body internalization, body mass index, and eating pathology, showed significant relations to future increases in body dissatisfaction; peer support deficits showed a marginal relation to this outcome. Gender did not moderate these relations, despite adequate power to detect interactive effects.

Gender differences regarding psychopathological, family and social characteristics in adolescents with abnormal eating behavior

OBJECTIVE

(1) To identify gender differences regarding psychopathological, family and social characteristics in adolescents with abnormal eating behavior; (2) to study risk factors for this abnormal eating in boys and girls.

METHOD

Adolescents participating in this community-based longitudinal study completed, at the age of 13 (t(1)) and 15 years (t(2)), a semi-structured interview and the validated Spanish versions of several self-reported questionnaires measuring eating and general psychopathology. A control group of 150 pupils and 159 adolescents with abnormal eating behavior were selected.

RESULTS

Girls with abnormal eating showed significantly more psychiatric morbidity and boys more social difficulties. Body dissatisfaction and psychiatric morbidity predicted abnormal eating at t(2) only in girls.

DISCUSSION

The findings contribute to the debate on gender differences in abnormal eating behavior etiology.

Eating Disorders in South African Males: A Review of the Clinical Presentation of Hospitalised Patients

South African literature on males with eating disorders is scarce. The existence of these disorders in South Africa males requires documentation; hence the current study was undertaken. Specifically, the research attempted to identify features that were present in males in a South African hospital setting which specialises in the treatment of eating disorders. This research was then compared to contemporary international literature. The patient sample ( n = 17) constituted all males who were admitted into the Eating Disorders Unit of the Tara, H. Morass Centre, during the period 1993 to 2002. The data were collected from a record review and was descriptive in nature. The majority of the sample (76%) was diagnosed with anorexia nervosa. The sample was predominantly located in the upper socio-economic classes. The Eating Disorder Inventory (EDI) scores displayed an overall deterioration at discharge. Further, body mass index (BMI) increased insufficiently at discharge. This was in contrast to the findings in the relevant literature and may be the result of a shorter hospital admission. High exercise activity was observed and was important diagnostically. Few definitive co-morbid diagnoses were made, except for significant relational difficulties. This was contrary to the findings in the international literature, which strongly indicates mood and obsessive compulsive disorders. While broad generalisations based on this sample are limited, the findings do serve as a departure point for increasing awareness of the disorder in the male population.

Dietary Restraint, Body Dissatisfaction, and Psychological Distress: A Prospective Analysis

This study uses prospective data from a survey of 1,177 adolescent girls to examine whether emotional eating, binge eating, abnormal attitudes to eating and weight, low self-esteem, stress, and depression are associated with dietary restraint or body dissatisfaction. In analyses that included both restraint and body dissatisfaction as independent predictors, restraint was associated only with more negative attitudes to eating, whereas body dissatisfaction was significantly associated with all the adverse outcomes. These results cast doubt on the proposition that restrained eating is a primary cause of bulimic symptoms, emotional eating, and psychological distress seen in individuals who are trying to control their weight, and rather suggest that body dissatisfaction is the key factor.

Validity of the Eating Attitudes Test: a study of Mexican eating disorders patients

OBJECTIVE

To evaluate the psychometric properties of the Mexican version of the Eating Attitudes Test (EAT-40) in clinical and control populations in Mexico City.

METHOD

276 female patients with eating disorders [52 with anorexia nervosa (AN), 102 with bulimia nervosa (BN) and 122 with eating disorders not otherwise specified (EDNOS)] and a comparison group of 280 normal control female subjects completed the EAT.

RESULTS

The EAT had an adequate level of internal consistency in the clinical sample (Cronbach's alpha=0.90). Total score was significantly correlated with criterion group membership (r=0.77, p< or =0.0001), suggesting a high level of concurrent validity. There was a small overlap in the frequency distribution of the 2 groups (eating disorders and control) and only 6% of the normal controls scored as high as lowest anorexic and bulimic patients. The factorial analysis yielded five factors accounting for 46.6% of total variance: 1) Dietary restraint, 2) Bulimia, 3) Drive of thinness, 4) Food preoccupation and 5) Perceived social pressure.

CONCLUSIONS

This study provides evidence that the Mexican version of the EAT is an economical, reliable and potentially useful instrument for research in this field.

Population at risk for eating disorders in a Spanish region

OBJECTIVE

To estimate the prevalence of adolescent population at risk for eating disorders (EDs), to examine gender differences and their association with non-psychotic mental disorders.

METHODS

Cross-sectional study using an anonymous, self-reported questionnaire in the classroom and measurement of weight and height in a representative sample of 4334 teenagers of both sexes. A definition of population at risk for EDs has been established, that differentiates those with dieting criteria and those with binge-purge eating behaviour criteria. This definition includes a combination of weight, behaviour, Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria, and Eating Disorder Inventory (EDI) results. The General Health Questionnaire-28 (GHQ-28) was used to assess non-psychotic mental disorders.

RESULTS

The prevalence of population at risk for EDs was 2.2% (95% CI: 1.6-2.8) for men and 15.3% (95% CI: 13.8-16.9) for women. The prevalence rate of combining both ED risk and mental disorder was 0.8% (95% CI: 0.4-1.2) for men and 9.9% (95% CI: 8.6-11.2) for women. Non-psychotic mental disorders were more prevalent in the population at risk for EDs than in the rest of the population.

CONCLUSIONS

A considerable proportion of adolescent females have eating problems and non-psychotic mental disorders. Their male counterparts also suffer from these disorders, however, a different pattern is followed.

Body image dissatisfaction among males across the lifespan: a review of past literature

OBJECTIVE

Most past research has focused on body dissatisfaction among females. This paper provides a review and evaluation of studies that have examined body dissatisfaction among males. Body dissatisfaction in males has been associated with poor psychological adjustment, eating disorders, steroid use, exercise dependence, as well as other health behaviors. It is therefore important to understand the level of body dissatisfaction, as well as the factors that are related to this construct.

METHOD

The review is divided into three sections: body dissatisfaction among children, adolescents and adults. Within each section, levels of body dissatisfaction are examined, as well as the research that relates to sociocultural influences on body dissatisfaction. Difficulties in drawing valid conclusions from the data due to methodological problems are highlighted.

RESULTS

From the current data, it would appear that there are strong similarities in the levels of body dissatisfaction of male and female children, with most children demonstrating high levels of body satisfaction. During adolescence, boys are about equally divided between wanting to lose weight and increasing weight, but there are few studies that have examined a desire for increased muscle size. In adulthood, men evidence a stronger desire to lose weight as they get older.

CONCLUSION

Overall, past studies have primarily focused on questions that are relevant to females, and there is a need to conduct studies that evaluate areas of body dissatisfaction that have greater relevance for males. This will then allow a better understanding of the relationship between body dissatisfaction and psychological and behavioral problems experienced by males at all stages of the lifespan.

Depressive symptoms and adolescent eating and health behaviors: a multifaceted view in a population-based sample

BACKGROUND

Previous research has shown significant associations between depression and substance use and eating disordered behaviors. However, no research to date has described associations between depressive symptoms and nutritional intake or physical activity among adolescents in a nonclinical, population-based sample.

METHODS

Classroom surveys were completed by 4,734 ethnically diverse, middle- and high school students. Based on their depressive symptom scores, males and females were categorized with low-, moderate-, or high-depressive symptom status. Linear models were used to examine eating and health behavior variables by depressive symptom groups.

RESULTS

Depressive symptoms were positively associated with health-compromising attitudes such as perceived barriers to healthy eating and weight concerns, and health-compromising behaviors such as unhealthy weight-control behaviors and substance use, including caffeine. Depressive symptoms were negatively associated with health-promoting behaviors such as eating breakfast, lunch, and dinner. However, most associations between depressive symptoms and dietary micronutrients were not statistically significant. Health-promoting moderate-to-vigorous physical activity was negatively associated with depressive symptoms among males.

CONCLUSIONS

Adolescents who report depressive symptoms are at risk for other health-compromising attitudes and behaviors and are also less likely to engage in health-promoting behaviors. Depressive symptoms may be an underlying trait in the expression of health behaviors among adolescents.

Body image, strategies to change muscles and weight, and puberty: do they impact on positive and negative affect among adolescent boys and girls?

The purpose of this study was to examine the impact of strategies to both decrease weight and increase muscle tone on negative (depression, anxiety) and positive affect among adolescent males and females. The respondents were 1185 adolescents (587 males, 598 females) who were enrolled in grades 7 and 9 (mean age for males=13.22 years; mean age for females=13.21 years). Respondents completed the Body Image and Body Change Inventory that assessed body image satisfaction, body image importance, body change strategies to decrease weight, body change strategies to increase muscle tone, and food supplements. Respondents also completed the Pubertal Development Scale, the depression and anxiety scales of the Depression Anxiety and Stress Scale, and the positive affect items from the Positive and Negative Affect Scale. Structural equation modelling was used to determine how body satisfaction and importance, body change strategies, and puberty impacted on depression, anxiety, and positive affect. The results demonstrated that for both boys and girls, there was a strong association between body change strategies and negative affect. For boys, body dissatisfaction did not predict negative affect, although this was a strong predictor for girls. Body change strategies did not strongly predict positive affect for either boys or girls, although body image satisfaction was a strong predictor for both genders. The implications of these findings for obtaining a better understanding of the role of pubertal development, body image, and body change strategies in predicting positive and negative affect among adolescent males and females are discussed.

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.

The spectrum of eating disorders: prevalence in an area of Northeast Italy

This study aims at exploring the prevalence of eating disorders in a sample of adolescents living in a community in Northeast Italy. It takes into account age and gender differences in a mixed male-female sample of 1000 school-aged adolescents corresponding to 10% of the young population aged 15-19 years of the district. The study was based on self-reported questionnaires, including the Eating Attitudes Test (EAT), the Bulimic Investigatory Test of Edinburgh (BITE), and the Body Attitudes Test (BAT). The cases at risk were identified on the basis of the suggested validated cutoff for a clinically relevant syndrome. Females scored higher than males at all ages, body mass index levels, and socio-economic status levels. We found 100 females (15.8%) and 8 males (2.8%) scoring higher than the suggested cutoff for caseness on the EAT (cutoff=30); 26 females (4.1%) and 1 male (0.3%) scoring higher than the suggested cutoff for caseness on the BITE (cutoff=20); 287 females (45.5%) and 24 males (8.6%) scoring higher than the suggested cutoff for caseness on the BAT (cutoff=36). We did not find any gradient between age and socioeconomic status and the scores on the eating disorder inventories. BAT scores predicted with sharp precision the presence of an abnormal psychometric pattern on the EAT and the BITE. The prevalence of psychometric patterns that indicate an eating disorder seems in our adolescent sample higher than those reported in previous similar studies carried out in the North of Italy. The use of self-report inventories is a limitation in drawing definitive conclusions on the rates of eating disorder in this area; however, bodily dissatisfaction seems to be psychologically linked to abnormal eating patterns.

Higher drive for thinness in adolescent males with insulin-dependent diabetes mellitus compared with healthy controls

Eating behaviour in adolescent males with insulin-dependent diabetes mellitus (IDDM) living in central Sweden was compared with that of healthy age-matched male controls using the Eating Disorder Inventory for Children and an interview. The patients were heavier than controls (p = 0.004) and had higher Drive for Thinness scores (p = 0.002). None was diagnosed as having a current eating disorder.

CONCLUSION

The results of the study may indicate an increased risk of future eating disorders in males with IDDM.

Child and adolescent predictors for eating disorders in a community population of young adult women

OBJECTIVE

This study investigated early predictors for developing eating disorders by young adulthood in a community sample of women participating in a 22-year longitudinal study.

METHOD

Twenty-one women were identified at age 27 with lifetime full or partial eating disorders. These women were compared with 47 women with no history of eating disorders on predictive factors from three broad domains.

RESULTS

The women with eating disorders had more serious health problems before age 5 and mother-reported anxiety-depression at age 9. At 15, mothers described them as having more behavior problems. Before age 15, families of the eating disorder group had more histories of depression, eating problems and changes in family financial circumstances.

DISCUSSION

This study identifies early predictors distinguishing girls who develop eating disorders. Findings point to the need for continued research in the area of early health to comprehensively examine the biologic, behavioral, and environmental risks for eating disorders.

Substance use and weight loss tactics among middle school youth

OBJECTIVE

Diet pills (DP) and vomiting or laxative (VL) use as weight loss tactics are associated with substance use in older adolescent populations. This study examined the association of weight loss tactics and substance use among middle school students.

METHODS

A Youth Risk Behavior Survey was administered to 6,957 middle school students in eastern North Carolina. Multiple logistic regression examined substance use as predictors of DP and VL use.

RESULTS

DP and VL use was reported by 6.0% and 7.1% of students, respectively, with each reported more frequently by females and White students. Regression analysis demonstrated alcohol, cigarette, or marijuana use as predictors for individual race/gender groups whereas steroid use was a predictor for all race/gender groups. We found a clustering effect of alcohol and cigarette use with both DP and VL use.

DISCUSSION

Substance use is associated with weight loss tactics as early as middle school. More research in the areas of clustering of behaviors and age at onset is needed.