An exploration of how adolescents experience and reason their parents' comments on their weight, shape, and eating

INTRODUCTION

Disordered eating among adolescents is of increasing concern given associated physical and mental health sequelae. Cognitions underlying disordered eating are formed in childhood and adolescence. Parents are a significant presence during this period, so it is critical to understand how they influence their adolescent's eating cognitions and behaviors.

METHODS

Qualitative analysis using interpretative phenomenological analysis (IPA) methodology was employed to consider the lived experiences of 10 Australian adolescents (14-19 years), 60% female, as they engaged with their parents in a range of weight, shape, and eating communications.

RESULTS

Our inductive IPA revealed three key themes representing adolescents' experiences and meaning-making: Parents as Influencers-adolescents acknowledged parents are influencers (objects) within a wider context of community and cultural norms (symbols) and can be protective for peer influence on body image ideals; Expression and Perception-the "what" (weight-talk as an object) and the "how" (objects as independent influences) of gendered parental communication related to health and fitness ideals and illustrated diverse interpretations of both verbal and non-verbal expression; and Fertile Soil and Maturity-the adolescent's characteristics and context influence perceptions of communication, a fear of deviating from norms, and an overarching focus on being "healthy" yet not always knowing what that was. Perception of bidirectional communication also offered valuable insights into potential dangers through family loyalty and in-group permissions.

CONCLUSIONS

Findings highlight implications for the nuanced influence of parental communication and illustrate the pivotal role of parents within the bioecosystem of adolescent development.

Correction: Dahill et al. Associations between Parents' Body Weight/Shape Comments and Disordered Eating Amongst Adolescents over Time-A Longitudinal Study. Nutrients 2023, 15, 1419

There was an error in the original publication [...].

The prevalence and burden of avoidant/restrictive food intake disorder (ARFID) in a general adolescent population

BACKGROUND

Little is known about the prevalence and impairment associated with possible Avoidant/restrictive food intake disorder (ARFID) in community adolescent populations. We aimed to investigate the prevalence, health-related quality of life (HRQoL), and psychological distress associated with possible ARFID in a sample of adolescents from the general population in New South Wales, Australia.

METHODS

A representative sample of 5072 secondary school students aged between 11 and 19 years completed the online EveryBODY survey in 2017. The survey included demographic data, eating behaviours, psychological distress and both physical and psychosocial health-related quality of life.

RESULTS

The prevalence of possible ARFID was 1.98% (95% CI 1.63-2.41) and did not differ significantly across school years 7-12. The weight status of participants with possible ARFID did not differ significantly from those without possible ARFID. When measuring gender identity, the ratio of males to females with possible ARFID was 1:1.7. This was statistically significant, however, the effect size was very small. Psychological distress and HRQoL did not differ significantly between the possible ARFID and non-ARFID group.

CONCLUSIONS

The prevalence of possible ARFID was found to be similar to that of anorexia nervosa and binge eating disorder in the general adolescent population. Adolescents who identify as girls rather than boys may be more likely to develop ARFID, replication with new samples is required to confirm these findings. The impact of ARFID on HRQoL may be minimal in adolescence and become more significant in adulthood, further research using longitudinal design, healthy control groups and/or diagnostic interviews is required.

Development of transdiagnostic clinical risk prediction models for 12-month onset and course of eating disorders among adolescents in the community

OBJECTIVE

To develop and internally validate risk prediction models for adolescent onset and persistence of eating disorders.

METHODS

N = 963 Australian adolescents (11-19 years) in the EveryBODY Study cohort completed online surveys in 2018 and 2019. Models were built to predict 12-month risk of (1) onset, and (2) persistence of a DSM-5 eating disorder.

RESULTS

Onset Model. Of the n = 687 adolescents without an eating disorder at baseline, 16.9% were identified with an eating disorder after 12 months. The prediction model was based on evidence-based risk factors for eating disorder onset available within the dataset (sex, body mass index percentile, strict weight loss dieting, history of bullying, psychological distress, weight/shape concerns). This model showed fair discriminative performance (mean AUC = .75). The most important factors were psychological distress, weight and shape concerns, and female sex. Diagnostic Persistence Model. Of the n = 276 adolescents with an eating disorder at baseline, 74.6% were identified as continuing to meet criteria for an eating disorder after 12 months. The prediction model for diagnostic persistence was based on available evidence-based risk factors for eating disorder persistence (purging, distress, social impairment). This model showed poor discriminative performance (mean AUC = .65). The most important factors were psychological distress and self-induced vomiting for weight control.

DISCUSSION

We found preliminary evidence for the utility of a parsimonious model for 12-month onset of an eating disorder among adolescents in the community. Future research should include additional evidence-based risk factors and validate models beyond the original sample.

PUBLIC SIGNIFICANCE

This study demonstrated the feasibility of developing parsimonious and accurate models for the prediction of future onset of an eating disorder among adolescents. The most important predictors in this model included psychological distress and weight and shape concerns. This study has laid the ground work for future research to build and test more accurate prediction models in diverse samples, prior to translation into a clinical tool for use in real world settings to aid decisions about referral to early intervention.

Associations between Parents' Body Weight/Shape Comments and Disordered Eating Amongst Adolescents over Time-A Longitudinal Study

Parents are key influencers of adolescents' attitudes on weight, shape, and eating, and make more positive than negative comments, with negative comments most impactful. This study examined prospective unique associations of parental positive and negative comments in a community sample of adolescents with paediatric psychosocial quality of life (PED-QoL), Eating Disorder Weight/Shape Cognitions (EDEQ-WS), BMI percentile, and Psychological Distress (K10) scales. Data were from 2056 adolescents from the EveryBODY study cohort. Multiple regressions were conducted for the impacts of parental positive and negative comments on four dependent variables at one year after controlling for their stage of adolescence (early, middle, late). Multiple imputation and bootstrapping were used for handling missing data and violations of normality. Results indicated that positive maternal comments on eating were associated with increased EDCs and better quality of life at one year. Paternal positive weight shape comments were associated with a decrease in psychological distress, but positive eating comments saw a decrease in quality of life. Findings highlight the nuances of parental comments and how these are perceived and interpreted, and could alert health care workers and family practitioners who have weight, shape, and eating conversations to be aware of the potential influence of their communication.

Examination of bidirectional relationships between fear of negative evaluation and weight/shape concerns over 3 years: A longitudinal cohort study of Australian adolescents

OBJECTIVE

Adolescents commonly experience both fear of negative evaluation and weight/shape concerns. However, evidence concerning the prospective associations between these constructs during adolescence is limited. The current study examined the bidirectional relationships between fear of negative evaluation and weight/shape concerns over a 3-year period in adolescents.

METHOD

Australian high school students (n = 2073; 55% girls) completed self-report measures at three timepoints, each 1 year apart.

RESULTS

Findings showed a bidirectional relationship, whereby increases in fear of negative evaluation predicted exacerbated weight/shape concerns, and vice versa. Results point towards a vicious maintenance cycle between fear of negative evaluation and weight/shape concerns.

DISCUSSION

Findings from the current study highlight the importance of considering both fear of negative evaluation and weight/shape concerns in the development of health promotion and prevention programs designed to reduce the occurrence and adverse effects of body dissatisfaction or improve general mental health.

PUBLIC SIGNIFICANCE

Many adolescents experience some level of fear of negative evaluation (i.e., worry about being judged by others) and worry about their weight and/or shape. This study examined the prospective relationship between both constructs. Findings showed a bidirectional relationship, whereby higher fear of negative evaluation predicted increased weight/shape concerns, and vice versa. Programs designed to reduce body dissatisfaction might be improved by targeting both fear of negative evaluation and weight/shape concerns.

Associations among relationship status, gender, and sexual attraction in Australian adolescents' eating pathology

OBJECTIVE

Engaging in romantic relationships in adolescence may inadvertently increase participation in appearance culture and the risk for eating pathology. Little research has considered this effect, particularly as it relates to adolescents' gender identity and sexual attraction. Therefore, this study examined the associations among relationship status, gender, and sexual attraction in adolescents' eating pathology.

METHODS

Data from the first wave of the EveryBODY study, a large sample of Australian adolescents aged 11-19 years (n = 3262, M_age  = 15.00, 53.80% girls), were used. Participants reported their relationship status and eating pathology (fasting, purging, binge eating, driven exercise, steroid use, and shape/weight concerns) using an online survey.

RESULTS

Logistic regressions adjusting for age and BMI percentile revealed that romantic relationships were associated with higher adjusted odds (AORs) for reporting clinical frequency/severity threshold of fasting, purging, steroid use, and shape and weight concerns (AORs: 1.34-3.68). Relative to boys, girls had higher adjusted odds of reporting clinical frequency/severity threshold of all eating disorder features (AORs: 1.47-7.40), except for steroid use for muscle gain. Adolescents who reported same-sex attraction, were unsure of their sexual attraction, or did not endorse any sexual attraction had greater adjusted odds of reporting clinical frequency/severity threshold of fasting, purging, and shape and weight concerns (AORs: 1.35-1.83) than those with only other-sex sexual attraction. Interactions among relationship status, gender, and sexual attraction were nonsignificant.

CONCLUSIONS

Romantic experience emerged as a novel correlate for adolescents' eating pathology. Future research should uncover the contextual factors within relationships that may contribute to this association.

PUBLIC SIGNIFICANCE

The initiation of romantic relationships is normative during adolescence. However, adolescents' romantic desirability is often determined by their physical appearance, increasing the risk for eating pathology. Among a large sample of Australian adolescents, romantic involvement was associated with greater likelihood of clinical threshold eating pathology for adolescent boys and girls, regardless of sexual attraction. It is urgent to identify the factors within romantic relationships that are associated with eating pathology.

Burden and preference-based quality of life associated with bullying in children

The objectives of this study are to assess the association between childhood bullying and preference-based health-related quality of life (QoL) in Australian school children and their parents and estimate quality-adjusted life years (QALYs) associated with bullying chronicity. Children aged 8-10 years completed the child health utilities (CHU-9D), while parents completed the Australian quality of life (AQoL-8D). Children were grouped into four categories of bullying involvement (no bullying, victim, perpetrator, or both perpetrator and victim) based on the Revised Olweus Bully/Victim Questionnaire. Parental data were compared across two bullying involvement groups (bullying vs. no bullying). QALYs were calculated for children over two years and comparisons made based on the number of assessments where bullying was reported (baseline, 1- and 2-year follow up). Children who were involved in bullying (victims and/or perpetrators) reported statistically significantly lower mean utility scores compared to children who were not involved in bullying. Parents whose child was involved in bullying had significantly lower mean utility scores compared to parents of children not involved with bullying. There appeared to be a dose-response relationship, with higher QALY losses associated with increasing frequency of reported bullying. Bullying among Australian school children was associated with significantly lower preference-based QoL for themselves and their parents. This study also confirmed the significant burden of disease for bullying among children measured by an incremental decrease in QALY with an increasing chronicity of bullying over time.

Difficulties with emotion regulation and weight/shape concerns as predictors of eating disorder behaviors among adolescents

BACKGROUND

Difficulties with emotion regulation are a proposed key transdiagnostic factor of mental health difficulties, including eating disorders. However, it remains unclear whether difficulties with emotion regulation prospectively predict engagement in eating disorder behaviors. The current study examined whether difficulties with emotion regulation were associated with eating disorder behaviors after 1 year, in addition to weight and shape concerns.

METHOD

A community sample of high school students (n = 3,074; 53.2% girls) completed self-report measures of eating behaviors, weight/shape concerns, and difficulties with emotion regulation at two timepoints, 1 year apart.

RESULTS

Findings indicated that greater difficulties with emotion regulation were uniquely associated with engaging in binge eating, fasting, and purging after 1 year. However, only greater weight and shape concerns, not difficulties with emotion regulation, were uniquely associated with engaging in driven exercise. Limited associations were detected for the frequency of eating disorder behaviors. Additionally, exploratory analyses were conducted to examine potential onset and persistence of eating disorder behaviors. Few gender differences were observed across analyses, with the exception of driven exercise, which was linked to difficulties with emotion regulation only among adolescent boys, but not girls.

CONCLUSIONS

Findings suggest that difficulties with emotion regulation are a distinct factor in the occurrence of some eating disorder behaviors among adolescents. Exploratory findings further suggest that difficulties with emotion regulation appear to be particularly involved in the persistence of these behaviors in adolescents. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Mediating role of moral disengagement in the perpetration of cyberbullying by victims and bystanders

INTRODUCTION

Proliferation of internet use in adolescence has resulted in an increase in cyberbullying. Previous experiences of cyber victimization and cyber bystanding are commonly linked with cyberbullying perpetration, allowing the bullying cycle to persist. Moral disengagement is one factor that may facilitate victims and bystanders to later perpetrate cyberbullying. The process occurs through enlistment of justificatory strategies to enable individuals to perpetrate without feeling remorse. The present study investigates the potential role of moral disengagement in the perpetration of cyberbullying by victims and bystanders.

METHODS

Young people (N = 563, M_age  = 13.52, SD = 1.04) recruited from Australian schools completed a cross-sectional self-report survey comprising of validated measures of moral disengagement, and involvement in cyberbullying across different roles (perpetration, victimization, and bystanding).

RESULTS

Findings indicated that moral disengagement significantly mediated the link between victimization and perpetration, and between bystanding and perpetration. Specifically, victims and bystanders engage in cyber perpetration through enlisting moral disengagement strategies.

CONCLUSIONS

Moral disengagement may, therefore, be one factor that mediates the association between cyber victimization and cyber bystanding, and cyber perpetration. Understanding mechanisms by which victims and bystanders engage in perpetration have implications for supporting victims and bystanders in antibullying strategies to minimize the occurrence of cyber perpetration.

Longitudinal relationship between experience of sexual harassment and 2-year body image and weight outcomes in adolescence: mediation through self-objectification and psychological distress

BACKGROUND

The current study investigated the experience of sexual harassment as a risk factor for weight gain and weight/shape concerns in a community sample of adolescents, with potential mediating factors self-objectification and psychological distress.

METHOD

1034 Australian adolescents (aged 11 to 19 years) from the EveryBODY longitudinal study of disordered eating pathology participated. Data were collected through online surveys annually for 3 years. Participants completed self-report measures of demographics, sexual harassment, psychological distress, self-objectification, weight/shape concerns and BMI percentile.

RESULTS

A parallel mediation model adjusting for baseline scores found no direct effect between baseline experiences of sexual harassment and change in BMI percentile or weight/shape concern after 2 years. Experiences of sexual harassment significantly increased self-objectification scores after 1 year in female adolescents. Subsequently, higher self-objectification significantly increased the risk of greater weight/shape concern after 1 year in female adolescents. However, no significant mediating relationship was found in the relationship between sexual harassment and weight/shape concern or BMI percentile for either gender. Psychological distress was found to be a clear risk factor for weight/shape concern in both genders after 1 year.

CONCLUSIONS

Intervention programmes in schools should focus on developing policies to reduce sexual harassment, self-objectification and distress in adolescents.

LEVEL OF EVIDENCE

Level IV, longitudinal multiple time series without intervention.

Prevalence of muscle dysmorphia in adolescents: findings from the EveryBODY study

BACKGROUND

We sought to provide the first point prevalence estimates of muscle dysmorphia (MD), a form of body dysmorphic disorder characterized by a preoccupation with perceived insufficient muscularity, in adolescents.

METHODS

Data were taken from a survey of 3618 Australian adolescents (11.172-19.76 years; 49.3% girls). Measures captured demographic characteristics, symptoms of MD and eating disorders, psychological distress and functional impairment. Diagnostic criteria for MD developed by Pope et al. (1997, Psychosomatics, 38(6), 548-557) were applied, entailing preoccupation with insufficient muscularity causing significant levels of distress or disability that cannot be better accounted for by an eating disorder.

RESULTS

The point prevalence of MD was 2.2% [95% confidence interval (CI) 1.6-3.0%] among boys and 1.4% (95% CI 0.9-2.0%) among girls. Prevalence was not associated with gender (V = 0.031) or socioeconomic status (SES) (partial η²< 0.001), but was marginally associated with older age (partial η² = 0.001). Boys with MD were more likely than girls with MD to report severe preoccupation with muscularity (V = 0.259) and a weight-lifting regime that interfered with their life (V = 0.286), whereas girls with MD were more likely to report discomfort with body exposure (V = 0.380).

CONCLUSIONS

While future epidemiological research using diagnostic interviews is needed to verify these estimates, the findings suggest that MD is relatively common from early to late adolescence. Gender differences in MD prevalence may be minimal; however, the symptom profile appears to diverge between boys and girls. These findings provide a platform for future, analytical research designed to inform clinical and public health interventions.

The Impact of Teasing and Bullying Victimization on Disordered Eating and Body Image Disturbance Among Adolescents: A Systematic Review

Adolescence is a developmental period in which disordered eating and negative body image are highly prevalent, yet their risk factors are insufficiently understood and targeted. Despite research implicating both teasing and bullying victimization in the development of eating disorders, these strands of research are yet to be integrated. This systematic review hence aimed to identify whether teasing and bullying victimization are associated with greater risk of eating disorders and body image disturbance for adolescents. Systematic searches of PsycINFO and PubMed databases identified 79 papers that included quantitative analyses of the relationship between weight-related or nonspecific teasing or bullying victimization and disordered eating or body image disturbance. Overall, studies indicated that adolescents who are teased or bullied are more likely to experience disordered eating and negative body image compared to nonvictimized adolescents. This was more consistently observed in cross-sectional studies than in longitudinal findings. We identify several methodological limitations of the literature, including the infrequent consideration of potential mediating and moderating variables. Finally, we outline future directions such as temporal sequencing of the complex interrelationships among teasing and bullying, disordered eating, and body image disturbance in adolescents.

‘I Can Construct it in My Own Way’: A Critical Qualitative Examination of Gender Self-Categorisation Processes

Gender self-categorisation is used to communicate a gender group membership in daily life and is recognised across research as an important facet of an individual’s identity. However, understandings of the psychological processes associated with gender self-categorisation have, historically, been restricted by binary, cisgender assumptions. This study qualitatively examined the processes associated with gender self-categorisation in a sample of transgender (binary and nonbinary, n = 15) individuals alongside a negative case analysis of one cisgender woman. Reflexive thematic analysis was used to construct a map of components which interacted to inform participants’ gender self-categorisation. Participants reported that their self-categorisation was reciprocally informed by their internal sense of gendered self, their gendered attributes and by other people’s perceptions. Further, participants’ knowledge and understanding of gender in the world more broadly provided context for this reciprocal process. The process of gender self-categorisation mapped in this study has important implications for researchers regarding theory and methods, for educators and parents regarding how children might be taught about gender and for clinicians regarding how to talk with clients about gender outside of a diagnostic framework.

Methods used to assess insight in individuals with eating disorders: a scoping review

Insight can be impaired in individuals with an eating disorder and the nature of this impairment can vary. Although this topic has been the focus of several studies and reviews, methodologies used to assess insight have received less attention. A scoping review was conducted using a systematic search of articles before January 2021 to elucidate the methodologies used to assess insight in those with an eating disorder, with discussion of strengths and limitations. A total of 3089 studies were screened, and 24 quantitative studies which assessed at least one aspect of insight in individuals with an eating disorder were included in the review. Methods of assessing insight included coding of clinical notes, low scores on measures of self-report symptoms, direct assessment of insight, vignette, and self-report single-item questions. Insight into disordered eating symptoms was most frequently assessed. Most research used samples who were female, white, diagnosed with anorexia nervosa, and were seeking or receiving treatment. In designing future research and interventions, optimal methods used to assess insight should consider the research/clinical question, available resources, and the targeted demographic. Further, descriptions of which aspects of insight are being assessed should be considered in the interpretation of both current and future findings.

Peer victimization and weight/shape concerns in adolescents: Examining the moderating role of appearance-based rejection sensitivity

Peer victimization has been related to weight/shape concerns in adolescents. However, a dearth of research has examined potential moderators of this association. The present study examined the concurrent and prospective associations between two types of peer victimization, appearance-based and non-appearance-based, and weight/shape concerns among adolescents, and whether these associations were moderated by appearance-based rejection sensitivity. Participants were 897 adolescents, aged 11-19 years (M = 14 years 8 months, SD = 1 year 4 months), who completed a range of self-report measures as part of the EveryBODY study, one year apart. Both forms of victimization were associated with concurrent, but not prospective weight/shape concerns. Additionally, the concurrent association between appearance-related victimization and weight/shape concerns was dependent on appearance-based rejection-sensitivity, with stronger associations at lower levels of appearance-based rejection-sensitivity. These findings support previous research linking peer victimization with concurrent weight/shape concerns in adolescents. However, the impact of peer victimization on increased weight/shape concerns was not observed.

Emotion Dysregulation and Eating Disorder Symptoms: Examining Distinct Associations and Interactions in Adolescents

Emotion dysregulation has been posited as a key transdiagnostic factor of mental health difficulties, including eating disorders. However, how this transdiagnostic factor interacts with the disorder-specific factor of weight and shape concerns remains unclear. The current study examined whether emotion dysregulation is associated with eating disorder behaviors over and above the association between weight and shape concerns and whether these two factors interacted. The current study used data from two samples, a community sample of high school students (n = 2699), and a clinical sample of adolescents receiving outpatient treatment for an eating disorder (n = 149). Participants completed self-report measures on their eating behaviors, weight/shape concerns, and emotion dysregulation. Findings showed that emotion dysregulation had a unique association with engaging in binge eating and purging (community sample only). Weight and shape concerns were found to have a unique association with engaging in binge eating, fasting, purging, and driven exercise (community sample only). Additionally, weight and shape concerns moderated the association between emotion dysregulation and the probability of engaging in binge eating and driven exercise, whereby the strongest association between emotion dysregulation and these behaviors were observed among adolescents with the lowest levels of weight and shape concerns. Regarding the frequency of eating disorder behaviors, emotion dysregulation had a unique association with severity of binge eating and fasting. Weight and shape concerns were uniquely associated with severity of fasting and driven exercise (community sample only). Findings suggest that emotion dysregulation is a distinct factor of eating disorder behaviors among adolescents.

Gender compatibility and drive for muscularity among adolescent boys: Examining the indirect effect of emotion regulation difficulties

The drive for muscularity continues to be a prominent concern among adolescent boys. However, it is unknown how gender compatibility (gender typicality and gender contentedness) relates to this pursuit. The present study sought to examine the link between gender compatibility and drive for muscularity among male adolescents, and whether this is partially accounted for by emotion regulation difficulties. Participants were 903 male adolescents, aged 11-19 years, who completed self-report measures as part of the EveryBODY study. Using path analysis, a proposed mediation model was assessed, testing an indirect pathway of gender compatibility and drive for muscularity through emotion regulation difficulties. Findings showed an indirect pathway between gender compatibility and drive for muscularity through emotion regulation difficulties. That is, boys who were more content with their male gender and believed they were typical of their gender reported fewer emotion regulation difficulties and, in turn, exhibited a lower drive for muscularity. Findings support theoretical perspectives integrating masculinity and muscularity in boys, in that those who feel less compatible with their masculinity could be susceptible to developing a greater drive for muscularity to regulate distress deriving from perceptions of not being sufficiently masculine. This study sets the groundwork for future longitudinal studies.

Emotion dysregulation across the span of eating disorder symptoms: Findings from a community sample of adolescents

OBJECTIVE

Emotion dysregulation is proposed as a key factor within eating disorder pathology. However, less is known about specific emotion regulation difficulties experienced by adolescents with varying levels of eating disorders symptoms. The present study examined the relationship between eating disorder behaviors and specific facets of emotion dysregulation, and differences in emotion dysregulation between eating disorder diagnostic groups.

METHOD

Participants were 2,783 adolescents, 11-19 years (M = 14 years, 9 months, SD = 1 year, 6 months), who completed self-report measures as part of the EveryBODY study. Adolescents were identified as not having eating disorder symptoms (n = 2,122) or meeting diagnostic criteria for symptoms of specific eating disorder, including: anorexia nervosa or atypical anorexia nervosa (n = 57), bulimia nervosa (n = 136), binge-eating disorder (n = 57), other specified feeding or eating disorder characterized by binge eating or purging (n = 381), and unspecified feeding or eating disorder (n = 30).

RESULTS

Binge eating, driven exercise, and fasting were each uniquely associated with emotion dysregulation, whereas purging was not. Similar findings were obtained within specific domains of emotion dysregulation. Findings from diagnostic groups showed a significant main effect of diagnosis on overall emotion dysregulation and most domains of emotion dysregulation. Adolescents with eating disorder symptoms consistently reported higher emotion dysregulation compared to those without these symptoms.

DISCUSSION

Findings indicate that emotion dysregulation is a key factor across eating disorder pathology, and potential treatment target across the spectrum of eating disorder diagnoses in adolescents.

Longitudinal Links of Individual and Collective Morality with Adolescents' Peer Aggression

Adolescents' aggressive behavior has been often linked to biases in morality. However, limited knowledge is available regarding the relative strength of different moral correlates, both at the individual and class-level, in predicting different types of aggressive behavior over time. To address this gap, the present study tested the prospective associations of moral identity and moral disengagement with reactive and proactive aggression in a short-term longitudinal study. The sample consisted of 1158 Italian adolescents (48.7% females; M_age = 13.6 years, SD = 1.1). Participants completed self-report measures of moral identity, moral disengagement, perceived collective moral disengagement in the fall, and reactive and proactive aggression in the fall and in the spring. Multivariate multilevel analysis indicated that, at the individual level, after controlling for the stability of aggressive behavior, T2 (Time 2) reactive aggression was higher for students who reported lower moral identity and higher moral disengagement at T1 (Time 1). For proactive aggression, a significant interaction effect indicated that the negative association between T1 moral identity and T2 aggression was apparent only at high levels of T1 moral disengagement. Moreover, proactive aggression was significantly predicted by higher perceived collective moral disengagement. At the class-level, T1 collective moral disengagement helped explain between-class variability of T2 reactive and proactive aggressive behavior. How these results expand previous research on morality and aggressive behavior and their potential implications for prevention and intervention programs is discussed.

Associations of weight- or shape-related bullying with diverse disordered eating behaviors in adolescents

OBJECTIVE

Little research has investigated variables affecting the relationship between weight- or shape-related bullying (WSB) and specific forms of disordered eating in adolescence. This study aimed to examine the relationship between WSB and eating disorder behaviors in Australian adolescents, and whether this relationship was moderated by body image attitudes.

METHOD

Data were used from the first wave of the EveryBODY study, a survey of body image concerns and eating disorders in a large representative sample of Australian adolescents (N = 573), aged 11-19 years. Participants completed an online survey with measures of WSB frequency, body image attitudes (drives for thinness, leanness, and muscularity), and disordered eating behaviors.

RESULTS

Results indicated that frequency of WSB was positively associated with purging and muscularity-oriented behavior (MOB), but not dietary restriction, binge eating, or compulsive exercise. The relationship between WSB and MOB was moderated by drive for muscularity, such that victimization frequency was positively associated with MOB for those with high, but not low, desire to attain a muscular physique.

DISCUSSION

Findings indicate that WSB is positively associated with purging and MOB but not other eating disorder behaviors, and that drive for muscularity moderates its effect on some behaviors. Understanding these relationships will be important in implementing tailored interventions for adolescents based on screening for victimization experiences and specific body image attitudes.

Differences between Australian adolescents with eating disorder symptoms who are in treatment or not in treatment for an eating disorder

BACKGROUND

Mental health problems frequently occur during adolescence, however, few adolescents seek treatment for these problems, especially for eating disorders. The current study aimed to quantify how adolescents in a clinical sample (ie, those receiving treatment for an eating disorder), differ in terms of psychological factors (eating disorder symptoms and psychological distress), compared to adolescents with eating pathology in a community sample (ie, those not receiving treatment).

METHOD

Data were used from a community sample of adolescents with eating disorder pathology who have not sought treatment (n = 1011) and a clinical sample of adolescents presenting at eating disorder services for treatment (n = 153). Participants reported demographics and completed questionnaires assessing weight/shape concerns, disordered eating and psychological distress.

RESULTS

Adolescents with a lower BMI, more frequent purging and higher weight/shape concerns were more common in the clinical sample, while those engaging in more frequent driven exercise were less common in the clinical sample. The samples did not differ in severity of psychological distress.

CONCLUSIONS

The findings highlight the need for increasing mental health literacy about the role of BMI and driven exercise in eating disorder symptom presentation to increase early detection of these disorders among adolescents.

Seeing yourself clearly: Self-identification of a body image problem in adolescents with an eating disorder

AIM

Many adolescents who meet diagnostic criteria for an eating disorder do not self-identify as having a problem and may consequently be less likely to seek help. Extant research investigating self-identification has been limited to specific populations (ie, girls meeting criteria for bulimic-type eating disorders). This study investigated how self-identification varied across sex, eating disorder diagnoses, and the presence of extreme eating behaviours, and how self-identification was related to help-seeking in adolescents.

METHODS

Participants included 1002 Australian school students (75.5% female, M_age = 15.14 years, SD = 1.40) who met DSM-5 diagnostic criteria for an eating disorder. An online survey assessed self-identification of having a body image problem, as well as sex, eating disorder diagnosis, extreme eating behaviours, help-seeking for a body image problem, and other potential correlates of self-identification (demographics, psychological distress, social function, weight and shape concerns).

RESULTS

Approximately, 2 in 3 adolescents with an eating disorder self-identified as having a body image problem. Girls who met criteria for a major eating disorder diagnosis, and those engaging in extreme eating behaviours, were more likely to self-identify. When adjusting for covariates, only sex remained significantly associated with self-identification. Adolescents who self-identified were 2.71 times more likely to seek help for a body image problem, adjusting for covariates.

CONCLUSIONS

Public health strategies ought to promote awareness regarding the different ways that body image problems might manifest among both girls and boys, as well as the potential gravity of such problems. Awareness among parents, teachers and primary care providers should also be considered.

The distinct role of body image aspects in predicting eating disorder onset in adolescents after one year

Recent research suggests specific body image aspects, namely weight/shape dissatisfaction, overvaluation of weight/shape, weight/shape preoccupation, and fear of weight gain, have distinct roles in eating disorder (ED) onset and maintenance. The aim of this study was to investigate unique associations between these body image aspects and ED onset, distress, and quality of life in a community sample of adolescents prospectively after 1 year. Adolescents (n = 1,327; 51% female; age range 11-19 years) who completed Waves 1 and 2 of the EveryBODY Study and did not meet criteria for an ED at Wave 1 completed measures of ED symptoms, distress, and quality of life impairment. Results showed that 18.2% of participants (70% female) met criteria for an ED at Wave 2. Only weight/shape dissatisfaction was prospectively associated with onset of any ED. No other body image aspect was uniquely associated with greater distress nor lower quality of life in longitudinal analyses. However, all body image aspects were independent correlates of ED diagnosis within Wave 2. These findings suggest that dissatisfaction might operate as a risk factor for ED development in adolescence, whereas overvaluation, preoccupation, and fear of weight gain could be more proximal markers of ED psychopathology. Therefore, these body image phenomena should be assessed as separate constructs as they may play unique roles in ED onset and classification. ED prevention efforts in adolescence may need to target dissatisfaction first, whereas a focus on other aspects of body image may be more important for early intervention programs. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Encouraging Gender Conformity or Sanctioning Nonconformity? Felt Pressure from Parents, Peers, and the Self

Expectations regarding gendered behaviors are understood to emanate from many sources, including parents, peers, and the self but there has been little research directly comparing these three sources of pressure. The present study assessed felt pressure regarding masculine and feminine stereotypic behaviors and compared pressure from parents, peers, and the self and how these sources are associated with self-perceived gender typicality. Participants (N = 275; 53.09% female; grade 7 M = 12.35 years; grade 9 M = 14.3 years; 71% Anglo-Celtic) were recruited from independent schools in Sydney. Felt pressure from the self to engage in masculine behavior was greater than felt pressure from parents or peers. Male adolescents reported higher felt pressure to conform to gender conforming behavior from parents and the self and pressure to avoid gender nonconforming behavior was greatest from peers. Female adolescents reported felt pressure to conform to gender nonconforming behaviors and this pressure was the strongest from the self. Additionally, for both genders, felt pressure from the self was most consistently associated with gender typicality. These findings highlight the importance of self-expectations for gender cognitions relating to both masculine and feminine behaviors.

Help-seeking for body image problems among adolescents with eating disorders: findings from the EveryBODY study

PURPOSE

Little is known regarding correlates of help-seeking for a body image problem in adolescents with an eating disorder. This study provides the first population-based investigation of help-seeking correlates among adolescents with an eating disorder.

METHODS

Australian adolescents (N = 1002, 75.5% female, mean age = 15.14, SD = 1.40) who met operational diagnostic criteria for an eating disorder completed a survey assessing help-seeking, and potential correlates of help-seeking (sex, age, body mass index, socio-economic status, migrant status, sexuality, eating disorder diagnosis, psychological distress, and quality of life).

RESULTS

Only 10.1% of participants reported having sought help. Bivariate analyses revealed that increased likelihood of help-seeking was associated with female sex, sexual minority status, being born outside Australia, older age, having a major eating disorder (compared to having an unspecified or other specified feeding or other eating disorder diagnosis), higher psychological distress, and reduced psychological and social functioning. Older age, being born outside of Australia, and having a major eating disorder were significant independent correlates of help-seeking.

CONCLUSIONS

Very few adolescents with an eating disorder seek help for a body image problem. Promoting early, appropriate help-seeking among those who are younger and/or those with less well-known disorders may be particularly important.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

Protect me from my selfie: Examining the association between photo-based social media behaviors and self-reported eating disorders in adolescence

OBJECTIVE

This study examined whether social media behaviors were associated with higher odds of meeting criteria for an eating disorder and whether gender moderated these relationships.

METHOD

Australian adolescents (N = 4,209; 53.15% girls) completed the self-report photo investment and manipulation scales. Additional self-report items assessed avoidance of posting selfies and investment in others' selfies. Eating disorders were identified by the Eating Disorder Examination Questionnaire and other self-report measures aligned with diagnostic and statistical manual for mental disorders-5 criteria.

RESULTS

A multinomial logistic regression examining the effect of avoidance of posting selfies, photo investment, photo manipulation, and investment in others' selfies on the likelihood of meeting criteria for an eating disorder, compared to no disorder, was significant (χ² [42] = 1,128.93, p < .001). Greater avoidance was associated with higher odds of meeting criteria for all disorders except clinical/subclinical binge-eating disorder and purging disorder. Increased photo investment was related to greater odds of meeting criteria for all disorders. A similar relationship emerged for photo manipulation, with the exception of clinical/subclinical binge-eating disorder, and unspecified feeding and eating disorder. Investment in others' selfies was associated with higher odds of meeting criteria for all disorders except clinical/subclinical anorexia nervosa and purging disorder. There was a significant interaction between gender and avoidance (χ² [1] = 5.23, p = .025, OR = 1.74), whereby boys were more likely to meet criteria for clinical/subclinical anorexia nervosa in the context of greater avoidance of posting selfies.

DISCUSSION

Appearance-related social media behaviors may be indicative of eating disorder risk. Implications for clinicians and advancements for social media screening tools are discussed.

Combining whole-school and targeted programs for the reduction of bullying victimization: A randomized, effectiveness trial

Despite the extensive evaluation of school-based interventions for bullying, victimization remains a significant problem in schools. Bullying victimization is significantly predicted by contextual (school-related) factors. As a consequence whole-school programs have been commonly used to prevent and reduce bullying victimization. Evidence also points to individual risk factors (such as emotional distress) in predicting victimization, yet programs to prevent bullying victimization by changing these individual risks are far less developed. Few studies have approximated "real-world" implementation conditions in their trials. The current effectiveness trial evaluated the combination of a whole-school program designed to prevent bullying perpetration and victimization together with a targeted intervention for at-risk students, teaching them individual and dyadic strategies to reduce their anxiety and manage victimization, allowing schools some latitude to implement programs as they typically would. Students from Grades 3 and 4 (N = 8,732) across 135 schools were randomly assigned to one of four conditions: combined intervention; whole-school intervention only; individual intervention only; and care as usual. Victimization decreased significantly and similarly across all four conditions at 12 and 24 months following baseline. Similar reductions and failure to discriminate conditions were found on other key constructs: anxiety; bullying perpetration; and depression. Possible reasons for the failure to demonstrate victimization prevention differences and lessons learned from this large, effectiveness trial are considered.

DSM-5 full syndrome, other specified, and unspecified eating disorders in Australian adolescents: prevalence and clinical significance

BACKGROUND

Little information is available on the prevalence of Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 eating disorders in adolescence, and eating disorders remain unique in the DSM for not systematically including a criterion for clinical significance. This study aimed to provide the first prevalence report of the full suite of DSM-5 eating disorders in adolescence, and to examine the impact of applying a criterion for clinical significance.

METHODS

In total, 5191 (participation rate: 70%) Australian adolescents completed a survey measuring 1-month prevalence of eating disorder symptoms for all criterial, 'other specified' and unspecified eating disorders, as well as health-related quality of life and psychological distress.

RESULTS

The point prevalence of any eating disorder was 22.2% (12.8% in boys, 32.9% in girls), and 'other specified' disorders (11.2%) were more common than full criterial disorders (6.2%). Probable bulimia nervosa and binge eating disorder, but not anorexia nervosa (AN), were more likely to be experienced by older adolescents. Most disorders were associated with an increased odds for being at a higher weight. The prevalence of eating disorders was reduced by 40% (to 13.6%) when a criterion for clinical significance was applied.

CONCLUSIONS

Eating disorders, particularly 'other specified' syndromes, are common in adolescence, and are experienced across age, weight, socioeconomic and migrant status. The merit of adding a criterion for clinical significance to the eating disorders, similar to other DSM-5 disorders, warrants consideration. At the least, screening tools should measure distress and impairment associated with eating disorder symptoms in order to capture adolescents in greatest need for intervention.

Prevalence, features and health impacts of eating disorders amongst First-Australian Yiramarang (adolescents) and in comparison with other Australian adolescents

BACKGROUND

This study aimed to support previous research conducted with First-Australians (FA) by establishing the prevalence of eating disorders, and their demographic distribution and burden in adolescent First-Australians compared to other-Australians (OA).

METHODS

Data were used from the baseline survey of the EveryBODY Study, a longitudinal investigation of eating disorders among Australian adolescents. Of the 5068 participants included, 402 (8%) identified as FA, 4586 (90.5%) identified as OA. Diagnosis of eating disorders was based on the Diagnostic and Statistical Manual version 5. Socioeconomic status and measures of impairment were assessed using validated instruments. Body mass index was calculated based on self-reported weight and height. Statistical analyses used data weighted to the distribution of gender in adolescents in New South Wales in the 2016 Australian Census. Chi-square tests were performed to determine prevalence of eating disorders amongst FA and to compare to OA. ANOVA and logistic regression analyses where conducted to examine the moderation effect of sociodemographic status, measures of impairment and FA status on the distribution of eating disorders.

RESULTS

The prevalence rates for eating disorder diagnoses where similar for FA and OA with the exception of Night eating Syndrome (OSFED-NES), which occurred in 7.14% (95%CI 4.81-10.49) of FA vs. 3.72% (95%CI 3.17-4.36) in OA. The greater prevalence of OSFED-NES in FA was largely explained by poorer psychosocial quality of life amongst FA.

CONCLUSION

Eating disorders are common amongst First-Australian adolescents and are associated with poor psychosocial quality of life. These findings are consistent with previous research conducted with First-Australian adults. There is a need to screen for eating disorders amongst First-Australian adolescent girls and boys.

Diabetes and disordered eating behaviours in a community-based sample of Australian adolescents

BACKGROUND

People with diabetes have been shown to be at risk for disordered eating compared to their non-diabetic peers. However, the majority of studies have been conducted in relatively small samples drawn from clinical diabetes settings or registries. Community-based samples are required to better understand disordered eating behaviours in this population. In a large community-based population sample of Australian adolescents, this study aimed to (1) investigate disordered eating behaviours in adolescents reporting a diagnosis of diabetes compared to their non-diabetic peers and (2) test associations between disordered eating behaviours and insulin restriction.

METHODS

Secondary school students (n = 4854; mean (SD) age 14.4 (1.6) years; 47% boys) completed an online survey, including self-reported presence of diabetes, demographics, weight status, substance use, insulin restriction and disordered eating behaviours. Clinically meaningful cut-offs for disordered eating behaviours were generated for analysis.

RESULTS

Disordered eating behaviours, specifically self-induced vomiting (diabetes 19.2%, no diabetes 3.3%; p <  0.001), laxative use (diabetes 15.4%, no diabetes 2.1%; p <  0.001), use of cigarettes (diabetes 26.9%, no diabetes 4.3%; p <  0.001) and other drugs (diabetes 28.9%, no diabetes 4.0%; p <  0.001), cleanse/detox (diabetes 30.8%, no diabetes 10.5%; p <  0.001) and extreme weight loss diets (diabetes 13.5%, no diabetes 4.7%; p <  0.003) were higher in those reporting a diagnosis of diabetes. In addition, 17% of those with diabetes reported frequent insulin restriction (≥ once per week), and insulin restriction was associated with more frequent disordered eating behaviours.

CONCLUSION

There was a high rate of disordered eating behaviours in adolescents with diabetes compared to their peers without diabetes. The findings of this study may have the potential to inform future health promotion, prevention, and early intervention approaches for those with comorbid diabetes and disordered eating behaviours. Future longitudinal studies are required to evaluate disordered eating behaviours in those with diabetes over time in community-based samples.

Defending victims of cyberbullying: The role of self-efficacy and moral disengagement

Cyberbullying is a significant problem worldwide that affects adolescents' social relations, academic achievement, and mental health. As this form of bullying is typically viewed by a large audience it is important to understand the role of observers as they may hold a key for reducing bullying. The aim of this study was to investigate the role of the socio-cognitive factors of defending self-efficacy (i.e., belief in one's capability to defend) and moral disengagement (i.e., justifications for aggressive behavior) associated with general cyber defending behavior and cyber defending response types: constructive and aggressive. Participants were 540 male and female students of diverse racial identity between the ages of 11 and 15 years who completed a questionnaire comprising multiple measures. Regression analyses revealed that at low levels of defending self-efficacy, moral disengagement was unrelated to general cyber defending behavior. However, at high levels of defending self-efficacy, moral disengagement was positively associated with general cyber defending. Further regression analyses revealed that the results for constructive cyber defending were the inverse of those obtained for aggressive defending. Defending self-efficacy was positively associated with constructive defending and negatively associated with aggressive defending. Moral disengagement was negatively associated with constructive defending and positively associated with aggressive defending. These results address the perplexing issue of why moral disengagement has been related to defending in some studies and not in others. As with most measures of defending, the general cyber defending measure confounds constructive and aggressive defending.

Moral Disengagement of Pure Bullies and Bully/Victims: Shared and Distinct Mechanisms

The vast majority of adolescents recognize that bullying is morally wrong, yet bullying remains a problem in secondary schools, indicating young people may disengage from their moral values to engage in bullying. But it is unclear whether the same mechanisms enabling moral disengagement are active for bully/victims (who both bully and are bullied) as for pure bullies (who are not targets of bullying). This study tested the hypotheses that mechanisms of moral disengagement, including blaming the victim and minimizing the impact of bullying, may operate differently in bully/victims compared to pure bullies. From a sample of 1895 students from grades 7-9 (50.6% female; 83.4% from English speaking homes), 1870 provided self-reports on bullying involvement and mechanisms of moral disengagement associated with bullying. Two cut-offs were compared for bullying involvement (as perpetrator and as target of bullying) during the previous school term: a conservative cut-off (every few weeks or more often) and a liberal cut-off (once-or-twice). Using the conservative cut-off, both pure bullies and bully/victims enlisted moral disengagement mechanisms to justify bullying more than did uninvolved students and pure victims, with no significant difference in scores on any of the moral disengagement scales between pure bullies and bully/victims. For the liberal cut-off, bully/victims reported lower overall moral disengagement scores than did pure bullies, and specifically less distortion of consequences, diffusion of responsibility, and euphemistic labeling. This study advances bullying research by extending the role of moral disengagement in bullying episodes beyond pure bullies to victims, both pure victims and bully/victims. Examination of specific moral disengagement mechanisms and the extent of involvement in bullying enabled a more nuanced differentiation between the bullying groups. These results will inform future interventions aimed at reducing the use of moral disengagement mechanisms that sustain bullying and victimization. Targeted interventions are needed to challenge specific moral disengagement mechanisms from the perspectives of pure bullies and bully/victims.

A meta-analysis of the relationship between moral disengagement and bullying roles in youth

Over the last several years, researchers have become increasingly interested in the influence of moral factors on bullying behaviors. This is the first meta-analytic review to exclusively examine the relationship between moral disengagement (MD) and the key bullying roles of bully, victim, defender, and bystander. Forty-seven independent samples examining a total of 43,809 children/adolescents (aged 7-19) were included in this meta-analysis. Results indicated a positive relationship between MD and bullying (r = 0.31; 95% CI [0.27, 0.34]), MD and victimization (r = 0.08; 95% CI [0.05, 0.12]), and a negative relationship between MD and defending (r = -0.11; 95% CI [-0.17, -0.04]). No significant relationship was found for MD and bystanding behavior. Moderators of bullying type (traditional vs. cyberbullying), reporting type (self vs. peer report), age, and gender were included in the analyses. The results are discussed in the context of relevant literature with particular emphasis on the importance of distinguishing between guilty and unconcerned bystanders, and the significant overlap between bullying and victimization in the cyber context.

Shared associations between histories of victimisation among people with eating disorder symptoms and higher weight

BACKGROUND

The success of integrated prevention initiatives for eating disorders and obesity is hampered by a lack of shared risk factor research. Bullying and sexual abuse are potentially potent shared risk factors for the spectrum of eating and weight disorders.

METHODS

A representative sample of N = 3005 South Australian males and females ≥15 years was interviewed about their height, weight, eating disorder symptoms, lifetime experiences of bullying and sexual abuse and mental and physical health-related quality of life.

RESULTS

Participants who were currently obese (25.2%) or underweight (2.7%) or who reported current eating disorder symptoms (32.7%) were between 10% and 27% more likely to have experienced bullying, and obese and eating disordered participants were also 47% and 56% more likely to have experienced sexual abuse, respectively. In regard to specific symptoms, a lifetime history of bullying was associated with increased risk of obesity, extreme dieting, purging and overvaluation of body weight and/or shape, whereas a lifetime history of sexual abuse was associated with increased risk of obesity, binge eating and extreme dieting and decreased risk of underweight. Lifetime histories of bullying and sexual abuse were associated with health-related quality of life impairment; however, lifetime bullying was associated with a greater adverse impact among participants with current eating disorder symptoms.

CONCLUSION

Self-reported bullying and sexual abuse victimisation have shared associations with eating and weight spectrum problems. Differences in the symptoms associated with bullying versus sexual abuse are discussed, as well as the clinical and public health implications.

Me, my selfie, and I: The relationship between editing and posting selfies and body dissatisfaction in men and women

Factors that promote versus protect against body dissatisfaction remain unclear. Social media may be a risk factor, particularly given ubiquitous engagement among young people, and the pervasive use of "selfies." Conversely, self-compassion has received attention as a protective factor against body dissatisfaction. This study examined: (a) the relationships between "manipulation" of selfies posted online, "investment" in others' responses to selfies, and body dissatisfaction; and (b) whether self-compassion moderated the relationships between social media variables and body dissatisfaction. Results from 184 Australian men (n = 89) and women (n = 95) suggested that social media variables photo manipulation and investment were associated with greater body dissatisfaction for both genders. Self-compassion did not moderate these relationships. Findings suggest that manipulation and concern about selfies posted may be risk correlates for body dissatisfaction in men and women. Further research is needed to investigate protective factors against body dissatisfaction in an online environment.

Fear of negative evaluation among eating disorders: Examining the association with weight/shape concerns in adolescence

OBJECTIVE

Fear of negative evaluation has been proposed as a transdiagnostic factor associated with the development of eating disorders and has been shown to relate to disorders of body image, especially those with weight/shape concerns such as eating disorders and muscle dysmorphia. The current study aimed to investigate whether fear of negative evaluation was a transdiagnostic factor of disorders diagnostically characterized by weight/shape concerns. The study examined whether fear of negative evaluation was associated with higher odds for meeting criteria for an eating disorder and/or muscle dysmorphia, especially those disorders diagnostically characterized by weight/shape concerns.

METHOD

Data were used from a subgroup of the first wave of the EveryBODY study, a longitudinal investigation of eating disorders and body image concerns among Australian adolescents (N = 4,030). Participants completed measures on demographics, weight/shape concerns, disordered eating, psychological distress, muscularity concerns, and fear of negative evaluation.

RESULTS

Findings revealed that fear of negative evaluation was associated with higher odds of meeting criteria for any eating disorder but significantly more so for those characterized by weight/shape concerns diagnostically, as well as binge-eating disorder. Similar results were found for muscle dysmorphia.

DISCUSSION

The findings suggest that fear of negative evaluation constitutes a transdiagnostic feature for developing and/or maintaining an eating disorder.

A Systematic Review Summarizing the State of Evidence on Bullying in Childhood Cancer Patients/Survivors [Formula: see text]

BACKGROUND

One in four school-aged children is bullied. However, the risk may be greater for childhood cancer patients/survivors (diagnosed <18 years), because of symptoms of the disease and treatment that may prejudice peers. While the serious consequences of bullying are well documented in the general population, bullying may have even greater impact in children with cancer due to the myriad of challenges associated with treatment and prolonged school absence.

OBJECTIVE

To summarize the state of evidence on bullying in childhood cancer patients/survivors; specifically, the rate and types of bullying experienced and the associated factors.

METHOD

We searched five electronic databases from inception to February 2018 for original research articles reporting on bullying in childhood cancer patients/survivors.

RESULTS

We identified 29 eligible articles, representing 1,078 patients/survivors ( M = 14.35 years). Self-reports from patients/survivors revealed a considerably higher rate of bullying (32.2%) compared with the general population (25%). Our review identified little information on the factors associated with bullying in patients/survivors. However, the bullying described tended to be verbal and was often related to the physical side effects of treatment, indicating that differences in appearance may prejudice peers. It was further suggested that educating the child's classmates about cancer may prevent bullying.

CONCLUSIONS

Our findings confirm that bullying is a significant challenge for many childhood cancer patients/survivors. Additional studies are needed to identify factors that may influence the risk of bullying, which will inform the development of evidence-based interventions and guidelines to prevent bullying in childhood cancer patients/survivors.

Personal agency in children

The aim of this study is to develop a multidimensional measure for assessing children’s personal agency to handle parental conflict through their coping self-efficacy beliefs (Bandura, 1997). Coping self-efficacy beliefs are individuals’ perceived ability to motivate themselves, access cognitive resources, and perform the actions required to take control of stressful situations. This study examines the psychometric properties and validation of the newly created Parental Conflict Coping Self-Efficacy Scale (PCC-SES). The study was based on 663 children, in grades 5 and 7 and their mothers. An exploratory factor analysis and confirmatory factor analysis through structural equation modeling supported the structure of the PCC-SES. The PCC-SES’s structure was facilitated by three global strategies, namely Proactive Behavior (problem solving and seeking social support), Avoiding Maladaptive Cognitions (avoiding preoccupation, avoiding self-blame and distancing) and Avoiding Maladaptive Behavior (avoiding aggression and avoiding overinvolvement).

Associations between the group processes of bullying and adolescent substance use

The adverse impact of bullying and victimization on substance use among youth has received increasing attention. Bullying is a specific type of aggressive behavior that not only involves bullies and victims but also followers, who actively support or reinforce the bully; defenders, who intervene to defend or assist the victim; or outsiders who passively observe or ignore the bullying. Limited research to date has linked these five bullying role behaviors to substance use. The aim of this study was to investigate the relationship between each of the bullying role behaviors and adolescent alcohol and tobacco use. Participants were 1255 (748 female) students (Mage=15.3, age range: 13-17years) in Grades 9 (n=714) and 11 (n=541). Bullying role behaviors, alcohol and tobacco onset and intensity, and alcohol-related harms were assessed. Results revealed an association between pro-bullying behavior (bullying and following) and all substance use variables, and between defender behavior and smoking and alcohol-related harm. No relationship between victimization, or outsider behavior, and substance use was found after controlling for the other bullying roles. The findings highlight the complex relationship between bullying roles, alcohol and tobacco use and alcohol-related harm in adolescents.

The role of individual and collective moral disengagement in peer aggression and bystanding: a multilevel analysis

This study investigates the relationships between individual and collective moral disengagement and aggression-related behaviors (peer aggression, defending, and passive bystanding) among 918 adolescents (55.8% boys; M age = 14.1 years, SD = 1.1). Hierarchical linear modeling showed that, at the individual level, aggressive behavior was significantly explained by both individual moral disengagement and student perceived collective moral disengagement, which was also positively associated with defending. Student perceived collective moral disengagement moderated the link between individual moral disengagement and peer aggression. At the class level, classroom collective moral disengagement explained between-class variability in all the three aggression-related behaviors. These results extend previous research by demonstrating the role of collective moral disengagement at the individual and the class levels and have potential implications for interventions.