Eating Problems and Their Risk Factors: A 7-Year Longitudinal Study of a Population Sample of Norwegian Adolescent Girls

The longitudinal stability of eating problems and their relationships to risk factors were investigated in a representative population sample of 623 Norwegian girls aged 13–14 followed over 7 years (3 time points). Three eating problem symptoms were measured: Restriction, Bulimia-food preoccupation, and Diet, all taken from the12-item Eating Attitudes Test. The aim of the study was to investigate the stability of these eating problem symptoms both as separate components (as opposed to total symptom load) as well as from a syndrome perspective. Over 7 years, dieting behavior showed the highest correlational stability (0.32). Regarding stable eating problem syndromes, at all 3 time points, 1 group of girls with generalized eating problems was found, characterized by simultaneously pronounced bulimic tendencies and dieting. However, we did not establish individual stability across 7 years for this syndrome group. Through development, eating problem symptoms were associated with characteristic risk factors. Similarities and differences between findings regarding eating problems and eating disorders are discussed.     

Gender-related Risk and Protective Factors for Depressive Symptoms and Disordered Eating in Adolescence: A 4-year Longitudinal Study

The interplay between intrapersonal risk (low self-esteem, perfectionism and body dissatisfaction) and interpersonal protection (social support) appears relevant for delineating gender-specific pathways that lead to both depressive and eating psychopathology. The aims of this longitudinal study were to examine gender differences in the levels of depressive symptoms, disordered eating and the co-occurrence of both problems from preadolescence to mid-adolescence and to identify gender-specific risk and protective factors of depressive symptoms and disordered eating. A Spanish community-based sample initially comprising 942 early adolescents (49% females) was assessed at baseline (T1; X _age = 10.8 years) and at 2 and 4-year follow-up (T2 and T3). Gender differences emerged at T2 for disordered eating and at T3 for depressive symptoms and for co-occurring depressive symptoms and disordered eating. Predictors of depressive symptoms were body dissatisfaction, low self-esteem and fear of getting fat, for girls, and body dissatisfaction and low self-esteem, for boys. Predictors of disordered eating were body dissatisfaction, depressive symptoms, BMI and perfectionism, for girls, and low social support and BMI, for boys. In addition, for boys only, social support moderated the effect of body dissatisfaction on depressive symptoms and the effect of depressive symptoms on disordered eating. The hypotheses of the study were partially supported. Clinical implications are derived regarding the components that should be included in programs for preventing depression and eating disorders in both girls and boys.     

Disordered Eating Precursors in Pre- and Early Adolescent Girls and Boys

First- and second-year findings from a study of the development of disordered eating in pre- and early adolescents are presented. Fifth- and sixth-grade girls (n = 80) and boys (n = 85) were assessed on depression, body image, self-esteem, and eating behaviors and attitudes in Year 1 and again one year later. Weight, height, and pubertal development were also evaluated in Year 1 and Year 2. Gender differences existed on all measures in Year 2 and indicated consistently poorer scores for girls compared to boys. For girls, Year 1 Body Mass Index and pubertal development predicted Year 2 disordered eating. For boys, poor body image in Year 1 predicted Year 2 disordered eating. The importance of identifying early risk factors for eating disorders is discussed.     

Mixed-Sex Settings and the Perception of Competence

This study examines the association of self-perceptions with sixth to eighth graders' exposure to mixed-sex and dating contexts. It contrasts two hypotheses: the stress hypothesis, which suggests that the transition to romantic relationships will be associated with declines in self-esteem, especially for girls, and the leisure hypothesis, which suggests that movement into a desired role in an emotionally positive social context will be associated with positive emotions and higher self-esteem. Results indicate that adolescents experience mixed-sex settings positively, and that comfort with the other sex (for girls) and more time spent with the other sex (for boys) are predictive of more positive self-perceptions. Activity diary data suggest that these differences are due to differences in the emotional climate of same- and mixed-sex settings, rather than to the activities adolescents engage in with same- and mixed-sex groups. Dating boys who are less interested in dating experience lower self-esteem. Results are discussed in light of the transitional nature of mixed-sex relationships in early adolescence and the preparatory role played by same-sex friendships.     

Mental Health Literacy and Eating-Disordered Behavior: Beliefs of Adolescent Girls Concerning the Treatment of and Treatment-Seeking for Bulimia Nervosa

This research examined the “mental health literacy” of adolescents concerning eating-disordered behavior. A vignette describing a fictional 16-year old female meeting diagnostic criteria for bulimia nervosa was presented to 522 female high school students, followed by a series of questions concerning treatment of and treatment-seeking for the problem described. Results indicated that primary care practitioners, mothers and close female friends were most highly regarded as potential sources of help. Self-help interventions, including the use of vitamins and minerals, were also highly regarded, whereas participants were less positive about the benefits of mental health specialists and ambivalent about the use of anti-depressant medication. Most participants believed that the problem described would be difficult to treat, and that relapse was likely even given appropriate treatment. An additional finding of note was that among participants with a high level of eating disorder symptoms (n=36, 6.9%), recognition of an eating problem was poor. We conclude that beliefs likely to be conducive to low and/or inappropriate treatment-seeking for eating problems may be common among adolescent girls. In addition, the findings suggest that prevention programs for the eating disorders need to target not only at-risk individuals, but also individuals in their immediate social environment.     

The Effects of Gender and Family,Friend, and Media Influences on Eating Behaviors and Body Image During Adolescence

The current study expands upon body image research to examine how gender, self-esteem, social support, teasing, and family, friend, and media pressures relate to body image and eating-related attitudes and behaviors among male and female adolescents (N = 177). Results indicated that adolescents were dissatisfied with their current bodies: males were concerned with increasing their upper body, whereas females wanted to decrease the overall size of their body. Low self-esteem and social support, weight-related teasing, and greater pressures to lose weight were associated with adolescents’ negative body esteem, body image, and eating attitudes. Females displayed more high risk eating behaviors—which were associated with more psychosocial risk factors—than males, whose high risk attitudes and behaviors were only associated with low parental support and greater pressure to be muscular. Reducing adolescents’ perceptions of appearance-related pressure from family and friends may be key for enhancing body image and decreasing links between low self-esteem and negative eating behaviors and weight-related perceptions. Rheanna N. Ata is currently a research assistant at the Weight Control and Diabetes Research Center, Miriam Hospital/Brown University. She is interested in body image and eating disorders and completed this research during her undergraduate studies at the College of the Holy Cross. Alison Bryant Ludden is a developmental psychologist whose research focuses on social relationships and problem behaviors during adolescence, with a special interest in school as a developmental context. She is an assistant professor of psychology at the College of the Holy Cross. Megan M. Lally is currently a graduate student in psychology at Pepperdine University. She completed this research during her undergraduate studies at the College of the Holy Cross.     

The social context of adolescent self-esteem

The global self-esteem of adolescents was examined in relation to two aspects of their daily lives: (a) the perceived quality of their relationships with parents and peers; and (b) their self-evaluation in the areas of school, popularity, and athletics. The quality of relationships with parents made significant contributions to the explained variance in self-esteem of both boys and girls. The quality of peer relationships made a significant additional contribution for girls but not boys. The importance of parent and peer relationships to self-esteem did not vary as a function of age for either sex. Self-evaluation of popularity was related to girls' global self-esteem, while evaluation of school performance was more important for boys.Received her Ph.D. from George Peabody College. Research interests include adolescent stress and coping, and parent-child relationships.Received his M.D. from Medical College of Georgia. Research interests include stress, eating disorders, and pregnancy in adolescents.     

Psychiatric Morbidity Differences in Male and Female Adolescent Inpatients With Alcohol Use Disorders

Objective: To examine gender differences in demography, cooccurrence of Diagnostic Statistical Manual (third edition, revised; DSM-III-R) axis I disorders and axis II personality disorders, and self-reported psychological distress in adolescent psychiatric inpatients with alcohol use disorders. Method: A consecutive series of 61 adolescent inpatients (36 boys and 25 girls) with either alcohol abuse or dependence were reliably assessed with structured diagnostic interviews for DSM-III-R Axis I and Axis II personality disorders. Results: Boys and girls did not differ in age, ethnicity, socioeconomic status, global functioning, age at first psychiatric contact, or number of hospitalizations. Girls were more likely to meet criteria for oppositional defiant disorder, eating disorders, and additional drug use disorders. Girls were also more likely than boys to meet criteria for at least one personality disorder and borderline personality Contrary to gender patterns in the general population, the proportion of girls and boys with affective disorders and conduct disorders did not differ significantly. Conclusions: Relatively few gender differences were found in adolescent inpatient alcohol abusers even where they would be expected, based on non substance-abuse general population gender patterns. When observed, gender differences were in the direction of greater psychiatric disturbance among girls. Some of the gender patterns observed among alcohol abusing adolescents are at odds with gender differences observed in non substance-abuse samples.     

Variants of Callous-Unemotional Conduct Problems in a Community Sample of Adolescents

Callous-unemotional traits are believed to be a childhood precursor to psychopathy, and among youth with conduct problems they designate those showing a particularly severe, stable, and aggressive pattern of antisocial behavior. Youth with callous-unemotional traits are a heterogeneous population and, analogous to adults with psychopathy, research suggests that lower anxious primary and high-anxious secondary variants exist. Using a community sample of 2,306 Greek-Cypriot adolescents (M age = 16 years; 49.7 % female), the first aim of the study was to examine whether variants of callous-unemotional traits could be identified using latent profile analysis of scores on measures of callous-unemotional traits, conduct problems, and anxiety. Additional aims of the study were to compare the identified clusters on external measures theorized to distinguish them (i.e., self-esteem, narcissism, impulsivity, sensation seeking and proactive/reactive aggression) and social factors relevant to adolescent development. Results indicated that, in addition to low risk (i.e., low scores on callous-unemotional traits, conduct problems, and anxiety) and anxious (i.e., high scores on anxiety, low scores on callous-unemotional traits and conduct problems) subgroups, two groups of youth scoring high on callous-unemotional traits and conduct problems were identified. High-anxious secondary callous-unemotional variants were distinguished by lower self-esteem in combination with greater narcissism, aggression, and markedly higher conduct problems, whereas lower anxious primary variants showed higher self-esteem. Secondary callous-unemotional variants also reported greater susceptibility to peer pressure and popularity striving than primary variants. Both variants exhibited poorer outcomes relative to low risk and anxious youth, although anxious youth reported lower self-esteem and higher impulsivity and reactive aggression scores in comparison with low risk youth. Findings integrate two lines of inquiry focused on subtyping children and adults with psychopathic traits and antisocial behaviors. They also support the utility of subtyping callous-unemotional traits based on conduct problems and anxiety levels and provide information on common and distinct risk factors associated with primary and secondary callous-unemotional variants in a community sample of adolescent boys and girls.     

A prospective follow-up of children with anorexia nervosa

We report on a prospective follow-up (mean 3.1 years) of 22 children with anorexia nervosa (mean age at onset—12.1). Adequate information was obtained for 18 children. The specific outcome was good in 10 (55.5%), intermediate in 5 (27.8%), and poor in 3 (16.7%); none had died. No prognostic factors were identified. The findings are compared with those from the long term follow-up of a previous cohort of children with anorexia nervosa, and confirm the unsatisfactory prognosis for this age group.Major research interest concerns the etiology and treatment of eating disorders in children and adolescents.Has been with the Eating Disorders Research Team since 1992. His major interest is research methodologyHas been with the eating disorders Research Team since 1989. Her major interests are in obsessional-compulsive problems and eating disorders in children.Major research interests include eating disorders in children and adolescents, cystic fibrosis, the effects of transplantation in children and adherence to treatment. Chief Editor ofClinical Child Psychology and Psychiatry. Has been collaborating with the Eating Disorders Research Team since 1985.     

Maternal Child-Rearing Attitudes and Role Satisfaction and Children's Temperament as Antecedents of Adolescent Depressive Tendencies: Follow-up Study of 6- to 15-Year-Olds

Development of depressive tendencies was assessed over a 9-year period in a random sample of 389 Finnish children. Predictors of maternal role satisfaction and hostile child-rearing attitudes, assessed when the children were ages 6 and 9 years, respectively, and a temperament predictor of perceived child difficultness, assessed when the children were age 6 years, were measured using questionnaires designed for this study. Depressive tendencies were assessed by a self-report at age 15 (modification of Beck's Depression Inventory). Using structural equation modeling, we tested a hypothesized model comprising direct as well as mediated effects between the childhood predictor variables and adolescent depressive tendencies. The results indicated support for a similar mediational model in girls and boys. Low maternal role satisfaction and maternal perceptions of child difficultness, measured when children were age 6 years, predicted hostile maternal child-rearing attitudes measured when children were age 9 years, which in turn had a significant direct effect on depressive tendencies among these children during adolescence. The only other direct effect was found solely in girls: Low maternal role satisfaction predicted adolescent depressive tendencies. These results underline the close interplay of child temperament and mothering factors in the development of depressive tendencies in girls and boys.     

Self-esteem and self-presentation among the young as a function of age and gender

This study investigated the effect of self-esteem on the tendency to convey a false impression to others by hiding one's feelings behind a facade. Utilizing a sample of youth (ages 8–19), a multiple regression analysis revealed that the lower the self-esteem, the greater the tendency to present a false front. In addition, other aspects of the self-concept, including vulnerability to criticism, self-consciousness, and the tendency to fantasize affect the tendency to present a false front. Furthermore, the nature of the self-esteem/ fabrication relationship is a joint function of age and gender. As age increases, the direct effect of self-esteem on fabrication loses statistical significance, but this loss occurs differently for boys and girls. For boys, the direct effect is significant in pre-adolescence (8–11), but not in early or late adolescence (12–14 and 15–19). For girls, the direct effect is significant in pre- and early adolescence (8–11 and 12–14), but not in late adolescence (15–19). Reasons for the differing patterns for boys and girls are discussed.This study was supported by NIMH Grant No. 5 R01 MH 27747-06, awarded to Morris Rosenberg. The data were analyzed using the facilities of the Computer Science Center, University of Maryland, College Park.Received his Ph.D. in sociology at the University of Wisconsin, Madison. Current major interest is the process of self-presentation.     

Body image satisfaction,dieting beliefs,and weight loss behaviors in adolescent girls and boys

Body image and weight loss beliefs and behaviors were assessed in 341 female and 221 male high school students. Estimates of body dissatisfaction varied depending on the measurement strategy used. Despite having similar weight distributions around the expected norm, girls were significantly more dissatisfied with their bodies than boys. Body Mass Index was positively related to body dissatisfaction in girls and boys, while higher exercise levels were related to higher body satisfaction in boys. Nearly two-thirds of girls and boys believed being thinner would have an impact on their lives, but the majority of girls believed this would be positive while the majority of boys believed this would be negative. Thirteen percent of female subjects reported using one or more extreme weight loss behavior at least weekly. Beliefs regarding the effectiveness of different weight loss measures were assessed. Weight loss behaviors in this Australian sample appear similar to comparable U.S. samples.Received Ph.D. from University of Tasmania. Main research interest in body image, weight loss behaviors, and eating disorders.Received Ph.D. from University of Connecticut. Main research interest in body image, eating disorders and weight loss behaviors.Dietitian degree from Melbourne University, Melbourne. Main research interest in eating practices and clinical outcome.M.D. from University of Melbourne, D.P.M. from U.K. FRC Psych. Main research interests in eating disorders.B.B.Sc.(Hons.) received from La Trobe University, Melbourne, B.A. received from University of Minnesota, Duluth. Main research interest in attitudes and attributions.B.A. Received from University of Minnesota, Duluth. Main research interest in adolescence and eating disorders.     

A Biopsychosocial Model of Body Image Concerns and Disordered Eating in Early Adolescent Girls

Body image and eating concerns are prevalent among early adolescent girls, and associated with biological, psychological and sociocultural risk factors. To date, explorations of biopsychosocial models of body image concerns and disordered eating in early adolescent girls are lacking. A sample of 488 early adolescent girls, mean age = 12.35 years (SD = 0.53), completed a questionnaire assessing depressive symptoms, self-esteem, body mass index (BMI), sociocultural appearance pressures, thin-ideal internalization, appearance comparison, body image concerns and disordered eating. Structural equation modelling was conducted to test a hypothetical model in which internalization and comparison were mediators of the effect of both negative affect and sociocultural influences on body image concerns and disordered eating. In addition, the model proposed that BMI would impact body image concerns. Although the initial model was a poor fit to the data, the fit was improved after the addition of a direct pathway between negative affect and bulimic symptoms. The final model explained a large to moderate proportion of the variance in body image and eating concerns. This study supports the role of negative affect in biopsychosocial models of the development of body image concerns and disordered eating in early adolescent girls. Interventions including strategies to address negative affect as well as sociocultural appearance pressures may help decrease the risk for body image concerns and disordered eating among this age group.     

Outcome,psychosocial functioning,and prognostic factors in adolescent anorexia nervosa as determined by prospective follow-up assessment

The aim of this prospective longitudinal study was to examine outcome, psychosocial functioning, and prognostic factors in adolescent anorexia nervosa. Thirty-four (88%) out of a consecutive series of 39 inpatients were reinvestigated three and seven years after discharge. The patients and 34 controls matched for age, sex, and occupational status were interviewed using structured interviews on their Diagnostic Statistical Manual, third edition, revised (DSM-III-R) eating disorder diagnoses, specific eating disorder psychopathology, comorbid psychiatric disorders, and psychosocial functioning. At the seven-year follow-up 15 patients (44%) still fulfilled DSM-III-R criteria for some form of eating disorder diagnosis, 21 (62%) for some other psychiatric diagnosis. Patients with a poor outcome showed significantly more problems in most areas of psychosocial functioning than the good-outcome group, but even recovered anorectic patients had more psychosexual difficulties than healthy controls. From a large range of potential prognostic factors, only low body weight at intake and low minimum weight during course of illness proved to be of predictive value.Received M.D. from Rheinische Friedrich-Wilhelms University, Bonn. Major research interests are childhood and adolescent eating disorders including links to affective disorders.Received M.D. from Philipps University. His current interests include follow-up studies of adolescent eating disorders.Received M.D. from Philipps University. His interests are body image disturbances in eating disorders and research in neurophysiology and neuropsychology.Received M.D. from Friedrich-Alexander University, Erlangen, Germany, and Ph.D. from Rupprecht-Karls University, Tübingen. Current research interests are eating disorders, affective disorders, and early onset schizophrenia.     

Correlates of loneliness in midadolescence

The present study was designed to assess the relationship between adolescent loneliness and the following factors commonly associated with adult loneliness: attributional style, self-esteem, social anxiety, and social skills. Subjects were 186 ninth-grade students (107 males and 79 females) who were asked to complete seven different paper-and-pencil measures. Data were analyzed by calculating separate stepwise multiple regression equations for the total sample, males and females. Three significant predictors were found for the total sample: student social skills rating scale, self-esteem, and the perception of stability in interpersonal situations (attributional style). A different pattern of predictors emerged for males and females. Loneliness could be predicted for males from three variables: low self-esteem, the perception of uncontrollability in noninterpersonal situations, and self-perceptions of poor social skills. The best multiple predictors of loneliness for the females were self-perceptions of poor social skills, high social anxiety, and stable attributions for interpersonal situations.This study is based on a master's thesis submitted by the first author to Wake Forest University, May 1986. A portion of this paper was presented at the annual meeting of the Society for Research in Child Development, Baltimore, Maryland, April 1987.Received Ph.D from West Virginia University. Current interests include social competence and social skills of adolescents and the adjustment of sexually abused children and adolescents.Received Ph.D from University of Illinois. Currently studying the friendships and peer relations of children and adolescents.Received Ph.D from Johns Hopkins University. Currently studying loneliness and close relationships.     

Gender Differences Among Adolescents in Family,and Peer Influences on Body Dissatisfaction,Weight Loss,and Binge Eating Behaviors

The present study examined perceived family and peer influences on body dissatisfaction, weight loss, and binge eating behaviors in adolescents. Three hundred and six girls aged 11 to 17 years (M = 13.66, SD = 1.12) and 297 boys aged 11 to 18 years (M = 13.89, SD = 1.13) completed a questionnaire that examined the direct influence and quality of family and peer relationships on body dissatisfaction and disordered eating. Direct influences of family and peers, rather than the quality of these relationships, predicted body dissatisfaction and disordered eating in adolescent boys and girls. Interesting differences were found between girls and boys in the nature of the influences and in the way they were expressed. In particular, parental and peer discussion and encouragement of weight loss predicted disordered eating behaviors in girls, while maternal and peer encouragement predicted binge eating and weight loss behaviors in boys. Fathers played a salient role in the expression of more severe forms of eating problems, while siblings played a small yet significant role in cognitive restraint among girls. The findings highlight gender differences in the importance of significant others in the expression of body dissatisfaction and disordered eating in adolescence.     

Adolescent Self-Esteem and Gender: Exploring Relations to Sexual Harassment, Body Image, Media Influence, and Emotional Expression

Self-esteem plays a central role in mental health, yet not enough is known about how youth evaluate themselves as they move across adolescence. This study used a cross-sectional design to examine age and gender patterns in self-esteem and to explore how contemporary social influences relate to adolescent self-esteem. Self-reported influences on self-esteem involving the media, sexual harassment, body image, family and peer relationships, and emotional expression were evaluated with 93 boys and 116 girls in Grades 5, 8, and 12. Girls reported lower self-esteem than boys in early adolescence, and late adolescent boys reported lower self-esteem than younger boys. The predictors as a set accounted for a significant portion of the variance in self-esteem, while the best predictor of self-esteem varied by age and gender. Large gender differences were present for emotional expression, with boys becoming more restrictive across adolescence. Girls reported more negative body image and media influence scores than did boys in late childhood and early adolescence. Body image appeared to mediate the relationships between certain predictors and self-esteem for girls, while gender and grade appeared to moderate the relationship between media influence and self-esteem for girls and boys.     

Ethnic and American Identity as Predictors of Self-Esteem Among African American,Latino, and White Adolescents

In order to examine ethnic and American identity as predictors of self-esteem among adolescents, we surveyed 669 American-born high school students (372 Latinos, 232 African Americans, and 65 Whites). Participants completed measures of self-esteem, ethnic identity, American identity, attitudes toward other groups, and demographic variables. Multiple regression analyses of self-esteem were carried out separately for each ethnic group, using ethnic and American identity, other-group attitudes, gender, age, socioeconomic status, and grade point average as predictors. Results indicated that for all groups ethnic identity was a significant predictor of self-esteem. For the White students only, American identity was a strong predictor of self-esteem and was highly correlated with ethnic identity. Other predictors varied across ethnic groups. Although ethnic identity was a significant predictor of self-esteem, it accounted for a relatively small proportion of the variance, suggesting the importance of other influences on self-esteem.     

The Contribution of Emotion Regulation to Body Dissatisfaction and Disordered Eating in Early Adolescent Girls

To understand whether difficulties in emotional functioning distinguish between body dissatisfaction and disordered eating, a set of emotion regulation (i.e., negative emotion, emotional awareness, coping), demographic (i.e., age), and physical (i.e., BMI (Body Mass Index)) factors were assessed in 234 early adolescent girls, grades six to eight. Compared to younger girls, older girls had higher BMI and reported increased body dissatisfaction. Age, BMI, and negative affect predicted body dissatisfaction, whereas BMI, body dissatisfaction, and lack of emotional awareness predicted disordered eating. Further, girls who reported high levels of disordered eating reported experiencing increased levels of negative affect, greater difficulties with emotional awareness, and more difficulty coping constructively with negative emotion than girls who reported low levels of disordered eating. Results support the contention that body dissatisfaction, combined with difficulties in emotional awareness are related to disordered eating.Leslie Sim is an assistant professor at the Mayo Medical School, a Senior Associate at the Mayo Clinic, and Clinical Director of the Mayo Inpatient Eating Disorders Program. She received her Ph.D. from University of Maine in Developmental and Clinical Psychology. Her research interests include eating disorders, self-injurious behavior, and emotion regulation skills in children and adolescents.Janice Zeman is an associate professor at the College of William and Mary. She received her Ph.D. from Vanderbilt University in Developmental and Clinical Psychology. Her research interests include children's and adolescents' emotion regulation skills particularly as they relate to maladaptive functioning with other research interests in parental and peer socialization of emotion.