1
|
Barakat S, McLean SA, Bryant E, Le A, Marks P, Touyz S, Maguire S. Risk factors for eating disorders: findings from a rapid review. J Eat Disord 2023; 11:8. [PMID: 36650572 PMCID: PMC9847054 DOI: 10.1186/s40337-022-00717-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/04/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Risk factors represent a range of complex variables associated with the onset, development, and course of eating disorders. Understanding these risk factors is vital for the refinement of aetiological models, which may inform the development of targeted, evidence-based prevention, early intervention, and treatment programs. This Rapid Review aimed to identify and summarise research studies conducted within the last 12 years, focusing on risk factors associated with eating disorders. METHODS The current review forms part of a series of Rapid Reviews to be published in a special issue in the Journal of Eating Disorders, funded by the Australian Government to inform the development of the National Eating Disorder Research and Translation Strategy 2021-2031. Three databases were searched for studies published between 2009 and 2021, published in English, and comprising high-level evidence studies (meta-analyses, systematic reviews, moderately sized randomised controlled studies, moderately sized controlled-cohort studies, or population studies). Data pertaining to risk factors for eating disorders were synthesised and outlined in the current paper. RESULTS A total of 284 studies were included. The findings were divided into nine main categories: (1) genetics, (2) gastrointestinal microbiota and autoimmune reactions, (3) childhood and early adolescent exposures, (4) personality traits and comorbid mental health conditions, (5) gender, (6) socio-economic status, (7) ethnic minority, (8) body image and social influence, and (9) elite sports. A substantial amount of research exists supporting the role of inherited genetic risk in the development of eating disorders, with biological risk factors, such as the role of gut microbiota in dysregulation of appetite, an area of emerging evidence. Abuse, trauma and childhood obesity are strongly linked to eating disorders, however less conclusive evidence exists regarding developmental factors such as role of in-utero exposure to hormones. Comorbidities between eating disorders and mental health disorders, including personality and mood disorders, have been found to increase the severity of eating disorder symptomatology. Higher education attainment, body image-related factors, and use of appearance-focused social media are also associated with increased risk of eating disorder symptoms. CONCLUSION Eating disorders are associated with multiple risk factors. An extensive amount of research has been conducted in the field; however, further studies are required to assess the causal nature of the risk factors identified in the current review. This will assist in understanding the sequelae of eating disorder development and in turn allow for enhancement of existing interventions and ultimately improved outcomes for individuals.
Collapse
Affiliation(s)
- Sarah Barakat
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia. .,Faculty of Medicine and Health, Charles Perkins Centre (D17), InsideOut Institute, University of Sydney, Level 2, Sydney, NSW, 2006, Australia.
| | - Siân A McLean
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Emma Bryant
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, Australia
| | - Peta Marks
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia
| | | | - Stephen Touyz
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia
| |
Collapse
|
2
|
Brewerton TD. Mechanisms by which adverse childhood experiences, other traumas and PTSD influence the health and well-being of individuals with eating disorders throughout the life span. J Eat Disord 2022; 10:162. [PMID: 36372878 PMCID: PMC9661783 DOI: 10.1186/s40337-022-00696-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/09/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Multiple published sources from around the world have confirmed an association between an array of adverse childhood experiences (ACEs) and other traumatic events with eating disorders (EDs) and related adverse outcomes, including higher morbidity and mortality. METHODS In keeping with this Special Issue's goals, this narrative review focuses on the ACEs pyramid and its purported mechanisms through which child maltreatment and other forms of violence toward human beings influence the health and well-being of individuals who develop EDs throughout the life span. Relevant literature on posttraumatic stress disorder (PTSD) is highlighted when applicable. RESULTS At every level of the pyramid, it is shown that EDs interact with each of these proclaimed escalating mechanisms in a bidirectional manner that contributes to the predisposition, precipitation and perpetuation of EDs and related medical and psychiatric comorbidities, which then predispose to early death. The levels and their interactions that are discussed include the contribution of generational embodiment (genetics) and historical trauma (epigenetics), social conditions and local context, the ACEs and other traumas themselves, the resultant disrupted neurodevelopment, subsequent social, emotional and cognitive impairment, the adoption of health risk behaviors, and the development of disease, disability and social problems, all resulting in premature mortality by means of fatal complications and/or suicide. CONCLUSIONS The implications of these cascading, evolving, and intertwined perspectives have important implications for the assessment and treatment of EDs using trauma-informed care and trauma-focused integrated treatment approaches. This overview offers multiple opportunities at every level for the palliation and prevention of EDs and other associated trauma-related conditions, including PTSD.
Collapse
Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
| |
Collapse
|
3
|
Familienbeziehungen, interpersonelle Probleme und Symptomausprägung bei Anorexia und Bulimia nervosa – Patientinnen und Schülerinnen im Vergleich. Prax Kinderpsychol Kinderpsychiatr 2022; 71:543-563. [DOI: 10.13109/prkk.2022.71.6.543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
|
4
|
Lie SØ, Bulik CM, Andreassen OA, Rø Ø, Bang L. The association between bullying and eating disorders: A case-control study. Int J Eat Disord 2021; 54:1405-1414. [PMID: 33942329 DOI: 10.1002/eat.23522] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Childhood bullying is associated with a range of adverse mental health outcomes, and here we investigated the association between bullying exposure and eating disorders (EDs). METHOD In this case-control study, we compared bullying history in individuals with EDs with community controls. Participants (n = 890, mean age = 29.50 ± 10.60) completed an online self-report battery assessing bullying history and lifetime history of bulimia nervosa (BN), binge-eating disorder (BED), and anorexia nervosa (binge-eating/purging (AN-BP) or restrictive (AN-R) subtype). Logistic regressions were performed to estimate odds ratios (ORs). RESULTS In the combined ED sample, individuals with a history of any ED were significantly more likely than controls to have experienced bullying victimization during childhood or adolescence (ORs = 1.99-3.30), particularly verbal, indirect, and digital bullying. Bullying prior to ED onset was also significantly more common than bullying within the same time frame for controls (ORs = 1.75-2.16). Further analysis showed that these effects were due to individuals with BN or BED reporting significantly more lifetime (p < .001) and premorbid bullying (p = .002) than controls, while individuals in the other diagnostic subgroups did not differ significantly from controls. DISCUSSION Our results confirm an association between bullying and binge-eating/purging ED subtypes. Prospective studies are needed to establish bullying as a risk factor for EDs.
Collapse
Affiliation(s)
- Selma Ø Lie
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Cynthia M Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ole A Andreassen
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lasse Bang
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
5
|
Moreno-Encinas A, Graell M, Martínez-Huertas JÁ, Faya M, Treasure J, Sepúlveda AR. Adding maintaining factors to developmental models of anorexia nervosa: An empirical examination in adolescents. EUROPEAN EATING DISORDERS REVIEW 2021; 29:548-558. [PMID: 33621386 DOI: 10.1002/erv.2826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/14/2020] [Accepted: 01/20/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE A biopsychosocial approach has been proposed to explain the pathogenesis of anorexia nervosa (AN), despite only a few of the existing etiological models having received empirical support. The aim of this study was to empirically investigate Herpertz-Dahlmann, Seitz, and Konrad (2011, https://doi.org/10.1007/s00406-011-0246-y)'s developmental model and to consider if interpersonal reactions to the illness might serve as maintaining factors following the model proposed by Treasure and Schmidt (2013, https://doi.org/10.1186/2050-2974-1-13) METHOD: One hundred adolescents and their families were participated in the study: 50 diagnosed with AN, paired by age and parents' socio-economic status with 50 adolescents without a pathology. Biological, psychological and familial variables were assessed using ten questionnaires and a blood analysis test. Additionally, structural equation modeling was conducted to assess two hypothetical models. RESULTS The fit of both models was good after the addition of two covariate parameters (e.g., Comparative Fit Index > 0.96 and Tucker-Lewis Index > 0.95). Premorbid traits were linked to body dissatisfaction and to the number of stressful life events; this in turn was linked to AN symptoms. Biological and familial consequences reinforced this pathology. CONCLUSIONS Our findings provide support for both models, suggesting that inter relationships between bio-psycho-familial variables can influence the course of AN during adolescence.
Collapse
Affiliation(s)
- Alba Moreno-Encinas
- School of Psychology, Autonomous University of Madrid, Biological and Health Psychology Department, Madrid, Spain
| | - Montserrat Graell
- Child and Adolescent Psychiatry and Psychology Department, University Hospital Niño Jesús, CIBERSAM, Madrid, Spain
| | | | - Mar Faya
- Child and Adolescent Psychiatry and Psychology Department, University Hospital Niño Jesús, CIBERSAM, Madrid, Spain
| | - Janet Treasure
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ana Rosa Sepúlveda
- School of Psychology, Autonomous University of Madrid, Biological and Health Psychology Department, Madrid, Spain
| |
Collapse
|
6
|
van Doornik SFW, Ostafin BD, Jonker NC, Glashouwer KA, de Jong PJ. Low satisfaction with normative life domains in adolescents with anorexia nervosa. Clin Psychol Psychother 2021; 28:1266-1274. [PMID: 33608934 PMCID: PMC8596741 DOI: 10.1002/cpp.2574] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Low satisfaction with normative life domains might be an important factor in the persistence of anorexia nervosa (AN). Initial evidence in non-clinical samples showed that lower satisfaction with normative life domains was related to more intense eating disorder symptoms. As a critical next step, the current study examined satisfaction with normative life domains in a clinical sample. Specifically, the present study tested whether adolescents with AN reported lower satisfaction with normative life domains than adolescents without an eating disorder. METHOD Adolescents with AN (n = 69) and adolescents without an eating disorder matched on age, gender and educational level (n = 69) completed the Brief Multidimensional Students' Life Satisfaction Scale to assess satisfaction with five life domains (family, friendships, school, self and living location) and life in general. RESULTS Adolescents with AN reported significantly lower satisfaction with normative life domains than the comparison group. Subsequent analyses showed that this overall group difference was primarily driven by adolescents with AN reporting lower satisfaction with the self, school experience and life in general. CONCLUSIONS Findings supported the hypothesis that adolescents with AN show relatively low satisfaction with meaningful, non-AN-related life domains. This points to the potential relevance of enhancing satisfaction with specific life domains to optimize treatment effectiveness.
Collapse
Affiliation(s)
- Sanne F W van Doornik
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
| | - Brian D Ostafin
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
| | - Nienke C Jonker
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
| | - Klaske A Glashouwer
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands.,Department of Eating Disorders, Accare Child and Adolescent Psychiatry, Groningen, Netherlands
| | - Peter J de Jong
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
| |
Collapse
|
7
|
Shift work, sleep duration, and body image dissatisfaction among female workers in southern Brazil. Arch Womens Ment Health 2019; 22:583-592. [PMID: 30474745 DOI: 10.1007/s00737-018-0927-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 11/08/2018] [Indexed: 10/27/2022]
Abstract
We examined the association between shift work and sleep duration with body image dissatisfaction (BID) among shift-working women in southern Brazil. In this cross-sectional study, data of 505 women shift workers, between 18 and 60 years old, were collected between January and April 2011. BID was assessed using the Stunkard Figure Rating Scale. Information on shift work, sleep duration, and other explanatory variables was collected through a questionnaire. An aggregated exposure variable was created and termed "sleep deprivation," with the exposure category being night-shift workers who slept < 7 h/day. The respective prevalence ratio values were estimated using a Poisson regression. The prevalence of BID among shift-working women was 42.4 (95% CIs = 38.0 to 46.7%), and 199 (93.0%) of these women wished they had a smaller body size. Shift work (PR = 1.40; p = 0.006) and sleep duration (PR = 1.32; p = 0.010) were independently associated with BID. Additionally, workers with sleep deprivation exhibited a higher probability of BID than those without sleep deprivation (PR = 1.31; p = 0.012). These results reveal a situation of vulnerability and the need for strategies and actions directed at shift-working women with the aim of reducing the effects of sleep deprivation on mental health, particularly with regard to body image disorders.
Collapse
|
8
|
Lie SØ, Rø Ø, Bang L. Is bullying and teasing associated with eating disorders? A systematic review and meta-analysis. Int J Eat Disord 2019; 52:497-514. [PMID: 30706957 DOI: 10.1002/eat.23035] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 01/11/2019] [Accepted: 01/11/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Involvement in bullying and teasing has been associated with adverse health outcomes, including eating disorders (EDs). The purpose of this systematic review and meta-analysis was to examine the association between bullying/teasing and EDs. METHOD A systematic search was conducted. We included research articles that examined the association between bullying/teasing (victimization and perpetration) and EDs. Studies were required to compare ED cases with a reference group. We performed a qualitative synthesis of included studies. Additionally, a random-effects meta-analysis of odds ratios were performed to compare rates of bullying/teasing victimization between cases and healthy controls. RESULTS A total of 22 studies were included for review. Compared to healthy controls, those with EDs were significantly more likely to have been bullied and teased. Evidence of this association was particularly strong for bulimia nervosa and binge-eating disorder, but was more mixed for anorexia nervosa. It was unclear whether such victimization was more common in EDs compared to psychiatric controls. The meta-analysis showed that compared to healthy controls, those with EDs were twofold to threefold significantly more likely to have been teased about their appearance and bullied prior to onset of their ED. Few studies examined bullying perpetration. A number of methodological shortcomings of studies were noted. DISCUSSION Being victimized through bullying and teasing is associated with EDs, and may constitute a risk factor. Our review underscores the need for more studies, and highlights gaps in the literature. As many patients have been victims of bullying and teasing, addressing such experiences in treatment may be valuable.
Collapse
Affiliation(s)
- Selma Øverland Lie
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lasse Bang
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
9
|
Micali N, Martini MG, Thomas JJ, Eddy KT, Kothari R, Russell E, Bulik CM, Treasure J. Lifetime and 12-month prevalence of eating disorders amongst women in mid-life: a population-based study of diagnoses and risk factors. BMC Med 2017; 15:12. [PMID: 28095833 PMCID: PMC5240354 DOI: 10.1186/s12916-016-0766-4] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 11/26/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Eating disorders (EDs) are common amongst women; however, no research has specifically investigated the lifetime/12-month prevalence of eating disorders amongst women in mid-life (i.e., fourth and fifth decade of life) and the relevant longitudinal risk factors. We aimed to investigate the lifetime and 12-month prevalence of EDs and lifetime health service use and to identify childhood, parenting, and personality risk factors. METHODS This is a two-phase prevalence study, nested within an existing longitudinal community-based sample of women in mid-life. A total of 5658 women from the UK Avon Longitudinal Study of Parents and Children (ALSPAC; enrolled 20 years earlier) participated. ED diagnoses were obtained using validated structured interviews. Weighted analyses were carried out accounting for the two-phase methodology to obtain prevalence figures and to carry out risk factor regression analyses. RESULTS By mid-life, 15.3% (95% confidence intervals, 13.5-17.4%) of women had met criteria for a lifetime ED. The 12-month prevalence of EDs was 3.6%. Childhood sexual abuse was prospectively associated with all binge/purge type disorders and an external locus of control was associated with binge-eating disorder. Better maternal care was protective for bulimia nervosa. Childhood life events and interpersonal sensitivity were associated with all EDs. CONCLUSIONS By mid-life a significant proportion of women will experience an ED, and few women accessed healthcare. Active EDs are common in mid-life, both due to new onset and chronic disorders. Increased awareness of the full spectrum of EDs in this stage of life and adequate service provision is important. This is the first study to investigate childhood and personality risk factors for full threshold and sub-threshold EDs and to identify common predictors for full and sub-threshold EDs. Further research should clarify the role of preventable risk factors on both full and sub-threshold EDs.
Collapse
Affiliation(s)
- Nadia Micali
- Eating and Weight Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Institute of Child Health, University College London, London, UK.
| | - Maria G Martini
- Institute of Child Health, University College London, London, UK
| | - Jennifer J Thomas
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Kamryn T Eddy
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Radha Kothari
- Institute of Child Health, University College London, London, UK
| | - Ellie Russell
- Department of Psychological Medicine, Cardiff University, Cardiff, UK
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Janet Treasure
- Eating Disorders Research Unit, Psychological Medicine, Institute of Psychiatry, King's College London, London, UK
| |
Collapse
|
10
|
Krug I, King RM, Youssef GJ, Sorabji A, Wertheim EH, Le Grange D, Hughes EK, Letcher P, Olsson CA. The effect of low parental warmth and low monitoring on disordered eating in mid-adolescence: Findings from the Australian Temperament Project. Appetite 2016; 105:232-41. [PMID: 27212673 DOI: 10.1016/j.appet.2016.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 05/13/2016] [Accepted: 05/15/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate the interactions between low parental warmth and monitoring at age 13-14 years and disordered eating attitudes and behaviours at age 15-16 years. METHOD Data on 1300 (667 females) adolescents and their parents were drawn from The Australian Temperament Project (ATP), a 30 year (15 wave) population based longitudinal study of social-emotional development. Parent participants completed surveys on parenting practices in late childhood, and adolescent participants reported disordered eating using the drive for thinness and bulimia subscales of the Eating Disorder Inventory (EDI) and an additional body dissatisfaction scale. Interaction was examined on the additive scale by estimating super-additive risk; i.e., risk in excess of the sum of individual risks. RESULTS For boys, neither parental warmth or monitoring, nor their interaction, was related to disordered eating. For girls, low parental warmth (alone) was associated with bulimic behaviours. In contrast, exposure to both low monitoring and warmth was associated with ∼3½-fold, ∼4-fold and ∼5-fold increases in the odds of reporting body dissatisfaction, drive for thinness and bulimia, respectively. For body dissatisfaction and drive for thinness, risk associated with joint exposure exceeded the sum of individual risks, suggesting an additive interaction between parenting styles. CONCLUSION Further investment in family-level interventions that focus on promoting parental monitoring behaviour and a warm parent-child relationship remain important strategies for preventing a range of disordered eating behaviours in adolescents.
Collapse
Affiliation(s)
- Isabel Krug
- Melbourne School of Psychological Sciences, The University of Melbourne, Victorian Australia, 14-20 Blackwood Street, VIC, 3010, Melbourne, Australia.
| | - Ross M King
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - George J Youssef
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia; Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Anisha Sorabji
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Eleanor H Wertheim
- School of Psychology and Public Health, La Trobe University, Plenty Road & Kingsbury Drive, Melbourne, Bundoora, VIC, 3086, Australia
| | - Daniel Le Grange
- Department of Psychiatry and Department of Pediatrics, University of California, San Francisco, 3333 California Street, Box 0503, LH Suite 245, San Francisco, CA, 94143-0503, USA
| | - Elizabeth K Hughes
- Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, 50 Flemington Rd, Parkville, VIC, 3052, Australia; Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital Melbourne, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Primrose Letcher
- Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital Melbourne, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Craig A Olsson
- Melbourne School of Psychological Sciences, The University of Melbourne, Victorian Australia, 14-20 Blackwood Street, VIC, 3010, Melbourne, Australia; Centre for Social and Early Emotional Development, School of Psychology, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia; Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, 50 Flemington Rd, Parkville, VIC, 3052, Australia; Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital Melbourne, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| |
Collapse
|
11
|
Münch AL, Hunger C, Schweitzer J. An investigation of the mediating role of personality and family functioning in the association between attachment styles and eating disorder status. BMC Psychol 2016; 4:36. [PMID: 27405420 PMCID: PMC4942999 DOI: 10.1186/s40359-016-0141-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 07/01/2016] [Indexed: 11/25/2022] Open
Abstract
Background This study examined relationships between attachment style, eating disorders (EDs), personality variables and family functioning. Methods In our study, 253 women (M = 25.72 years, SD = 8.73) were grouped into one of four categories either according to self-reported ED diagnosis or by exceeding cut-offs for a clinical diagnosis on the Eating Disorder Examination Questionnaire (EDE-Q) or Short Evaluation of Eating Disorders (SEED): anorexia nervosa (AN), bulimia nervosa (BN), other eating disorder (O-ED), no eating disorder (Non-ED). The ED group (AN, BN, O-ED) included 106 women (M = 24.74 years, SD = 7.71), and the Non-ED group 147 women (M = 26.42 years, SD = 9.37). Approximately half of the ED group had a comorbid disorder (59.4 %), while the majority of the Non-ED group had no psychological disorder (89.1 %). Results Participants with an ED were significantly more often insecurely attached (Adult Attachment Scale; AAS), emotionally unstable, less extraverted (Big-Five-Test of Personality; B5T) and showed less positive family functioning (Experiences in Personal Social Systems Questionnaire; EXIS.pers). Results showed partial mediation for attachment and EDs through neuroticism, extraversion and family functioning. Discussion The study found further evidence for elevated problems with attachment, personality, and family experiences in individuals with EDs, while suggesting mechanisms that may link these constructs. Implications for research and practice were discussed. Conclusion This study supports findings that acknowledge the mediating role played by personality factors and family functioning in the relationship between attachment and EDs.
Collapse
Affiliation(s)
- Anna Lena Münch
- Department of Psychology, University of Heidelberg, Hauptstraße 47-51, D-69117, Heidelberg, Germany
| | - Christina Hunger
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Bergheimer Straße 20, D-69115, Heidelberg, Germany.
| | - Jochen Schweitzer
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Bergheimer Straße 20, D-69115, Heidelberg, Germany
| |
Collapse
|
12
|
Abstract
The aim of this study is to evaluate the recent literature on carers/parenting interventions for people with eating disorders. Interesting and important new findings are highlighted as well as the implications that this may have for treatment. We have reviewed and critically analysed the recent literature. Close others often play an important role in recognising the early signs of eating disorders and accessing and implementing treatment. Their role in helping with recovery is to give support and hold a united front themselves and with the professional team to avoid those common interpersonal reactions that adversely impact on outcome such as accommodating to the illness and reacting with high expressed emotion (overprotection and hostility). Managing this role is difficult, and coping resources are often strained. Carers ask for and are now getting expert training in skills to manage this role. There is an overlap between carer/parenting interventions and family therapies. The interface with close others is critical both for early recognition and access and implementation of treatment. Interventions which equip families and close others with the skills to manage eating disorder behaviours are showing potential at improving outcomes.
Collapse
|