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.     

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.     

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.     

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.     

Adolescent nutritional and psychological patterns and risk for the development of an eating disorder

A group of 256 female and 248 male adolescent students were assessed regarding nutritional practices and psychological attitudes associated with the development of eating disorders. While the majority showed adequate nutritional practices, there was a high prevalence of dieting and the consumption of low-calorie foods among the girls. For boys, there was no relationship between a strong desire for thinness and restriction of foods high in calories; boys tended to report that hunger and positive affective states were related to overeating. A risk factor conception of nutritional and psychological precursors to the later development of an eating disorder was discussed.This research was supported in part by a Biomedical Research Support Grant to Dr. Cheryl Perry.     

Psychosocial Correlates of Shape and Weight Concerns in Overweight Pre-Adolescents

Shape and weight concerns among overweight pre-adolescents heighten risk for eating disorders and weight gain. Treatment and prevention efforts require consideration of psychosocial factors that co-occur with these concerns. This study involved 200 overweight pre-adolescents, aged 7–12 years (M age = 9.8; SD = 1.4), presenting for family-based weight control treatment. Hierarchical regression was used to examine the influence of pre-adolescents’ individual characteristics and social experiences, and their parents’ psychological symptoms, on shape and weight concerns as assessed by the Child Eating Disorder Examination. Findings revealed that higher levels of dietary restraint, greater feelings of loneliness, elevated experiences with weight-related teasing, and higher levels of parents’ eating disorder symptoms predicted higher shape and weight concerns among overweight pre-adolescents. Interventions addressing overweight pre-adolescents’ disordered eating behaviors and social functioning, as well as their parents’ disordered eating behaviors and attitudes, may be indicated for those endorsing shape and weight concerns.     

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.     

The Level of Competition as a Factor for the Development of Eating Disorders in Female Collegiate Athletes

Athletes have been identified by some as a population at risk for the development of eating disorders. The role of the level of athletic competition as a factor for disordered eating, however, has not been defined. The present study examined eating attitudes among a sample of NCAA Division 1 female collegiate athletes (N = 38), NCAA Division III athletes (N = 40), and non-athlete controls (N = 31). Participants completed the Eating Attitudes Test (EAT-26), the Eating Disorder Inventory-2 (EDI-2), and a demographic and health questionnaire. Results indicated that athletes at higher levels of competition showed more signs of pathological eating and were at an increased risk for the development of eating disorders. Athletes in sports emphasizing a lean physique and in weight-restricting sports were also more vulnerable than athletes in other types of sports and non-athlete controls.     

The Efficacy of a Universal School-Based Prevention Program for Eating Disorders among German Adolescents: Results from a Randomized-Controlled Trial

Disordered eating is highly prevalent during adolescence and has a detrimental effect on further development. Effective prevention programs are needed to prevent unhealthy developmental trajectories. This study evaluated the efficacy of the POPS-program (POtsdam Prevention at Schools), a universal school-based eating disorder prevention program for adolescents. In a cluster-randomized design, we compared the intervention group receiving the prevention program to a waiting control group. Outcomes included indicators of disordered eating and relevant risk factors for eating disorders (body dissatisfaction, internalization of the thin ideal, perceived media pressure, perfectionism, emotional element of exercise, social comparison, and perceived teasing). Questionnaires were administered at the start of the intervention, 3 and 12 months post intervention. At baseline, 1112 adolescents aged 10 to 16 years participated (49% girls; 51% intervention group). Intention-to-treat analyses with the complete data set and per-protocol analyses as a completer analysis were performed. The intervention group showed a more favorable course compared to the control group regarding all observed risk factors for eating disorders except for perceived teasing. Effect sizes were small but comparable to other primary prevention programs. At 1-year follow-up, a small but significant effect on disordered eating was observed. Results of the per-protocol analyses were mostly confirmed by the intention-to-treat analyses. Results were promising for both genders although girls benefited more regarding disordered eating and internalization of the thin ideal. Further studies are warranted examining successful program elements and whether gender-specific programs are needed.     

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.     

A Prospective Study of Individual Factors in the Development of Weight and Muscle Concerns Among Preadolescent Children

The present study was designed to assess body mass index (BMI), self-esteem, parent and peer relations, negative affect, and perfectionism, as predictors of dieting, food preoccupation, and muscle preoccupation, in 326 preadolescent children (150 girls and 176 boys) aged between 8 and 10 years. Preadolescents were tested twice over a 10-month period. BMI was found to be the main predictor of girls' and boys' dieting, both cross-sectionally and longitudinally. Perfectionism was an important predictor of boys' dieting and muscle preoccupation, while self-esteem, peer relations and negative affect predicted girls' muscle preoccupation. The findings are discussed in relation to past research with both preadolescents and adolescents. Marissa Saling is a registered clinical psychologist. She received her Doctor in Psychology (Clinical) in 2003 from Deakin University, Melbourne Australia. Her major research interests include eating disorders and chronic fatigue syndrome. Lina Ricciardelli is a Senior Lecturer at Deakin University. She received her PhD in 1990 from the University of Adelaide, Australia. Her major research interests include disordered eating, body image concerns and substance abuse among youth. Marita McCabe is a Professor at Deakin University. She received her PhD in 1981 from Macquarie University, Australia. Her major research interests include disordered eating, body image concerns, sexuality and chronic illness across the lifespan.     

Effect of Major Depression on the Self-Image of Adolescent Boys and Girls

We investigated the specific impact of major depressive disorder (MDD) on the self-image of adolescent boys and girls seeking outpatient treatment. We used the Offer Self-Image Questionnaire (OSIQ) to compare 68 adolescents with MDD and 39 adolescents with no diagnosis of psychiatric illness according to the Structural Clinical Interview for DSM-III-R (SCID). Self-image among MDD patients was in general poorer than in the comparison group and was particularly expressed as dissatisfaction with life and an impaired mastery of the environment. Logistic regression analysis showed S2 (Emotional Tone) to be an independent factor associated with MDD (OR 1.15). In girls S2 was also independently associated with MDD (OR 1.14). The effect of MDD on self-image was more negative in girls than in boys and the self-image pattern differed between the sexes.     

A Longitudinal Investigation of the Development of Weight and Muscle Concerns Among Preadolescent Boys

The study examined the impact of body mass index (BMI), negative affect, self-esteem, and sociocultural influences in the development of weight and muscle concerns among preadolescent boys. Body dissatisfaction, importance placed on weight and muscles, weight loss strategies, and strategies to increase muscles were evaluated. Participants were 237 boys aged between 8 and 11 years who were tested at three assessment periods 8 months apart. The main predictor of boys’ body change strategies was their perceived pressures to modify weight and muscles from parents, peers, and the media. The other main predictor of boys’ body change strategies and the sole predictor of body dissatisfaction was BMI. Self-esteem and negative affect were found to be weak and generally nonsignificant predictors of boys’ body image concerns and body change strategies. Additional studies that examine the risk and protective factors associated with boys’ weight and muscle concerns are needed to assist in the development of prevention programs for preadolescent boys.Lina Ricciardelli is an Associate Professor at Deakin University. She received her PhD in 1990 from the University of Adelaide, Australia. Her research interests are body image concerns, disordered eating and substance abuse among youth.Marita McCabe is a Professor at Deakin University. She received her PhD in 1981 from Macquarie University, Australia. Her research interests are in body image across the lifespan, sexuality, and chronic illnessJess Lillis is graduate student at Deakin University, She completed her undergraduate work in 2000 at Deakin University, Her research interests are body image concerns and negative affect among youthResearch Fellow at Deakin University, She received her D Psych in 2000 from Deakin University, Her interests are in disordered eating and depression among 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.     

The impact of puberty and dating on eating problems among middle school girls

Puberty has been related to the onset of a variety of weight concerns and eating problems among middle school girls, including body dissatisfaction, dieting, and eating disorders. At least two models can be used to explain these relationships. The first emphasizes the timing of puberty, arguing that girls who face early puberty are particularly stressed because of the off-time nature of the event. The second focuses on synchronous events. For girls more than boys, puberty is likely to coincide with the change from elementary to middle school and/or beginning to date. Such synchronous events may create greater stress for girls. Seventy-nine girls were tested during the spring of their sixth- and eighth-grade years. Pubertal and dating status, body dissatisfaction, weight management, and eating disordered attitudes (using the Children's EAT:ChEAT) were assessed. The simple timing model (early vs. on time vs. late) was not supported. The simple synchronous model received some support in that girls with synchronous onset of menstruation and dating had higher ChEAT scores as well as greater body dissatisfaction. However, the data indicated that girls for whom puberty was early and coincidental with dating might be at unusual risk. These girls showed the highest levels of body dissatisfaction and the highest ChEAT scores.Ph.D. from Temple University. Research interest is in developmental psychology.Ph.D. from the University of California at Santa BarbaraThese authors have a joint research program in the developmental psychopathology of eating problems.The first wave of data for this report was collected as part of her undergraduate honors thesis.Earlier versions of these data were presented at the 1991 meeting of the Society for Research in Child Development, Seattle, Washington and the 1992 Conference on Human Development, Atlanta, Georgia.     

Body Dissatisfaction Among Adolescent Boys and Girls: The Effects of Body Mass,Peer Appearance Culture and Internalization of Appearance Ideals

Body image dissatisfaction is a significant risk factor in the onset of eating pathology and depression. Therefore, understanding predictors of negative body image is an important focus of investigation. This research sought to examine the contributions of body mass, appearance conversations with friends, peer appearance criticism and internalization of appearance ideals to body dissatisfaction among adolescents. The sample was comprised of 239 (54% female) adolescents, with a mean age of 16 years. Self-report questionnaires were completed on body dissatisfaction, peer appearance conversations and criticism, internalization of appearance ideals, height and weight. For girls and boys, body mass, appearance conversations with friends, peer appearance criticism and internalized appearance ideals emerged as significant predictors of body dissatisfaction. Gender moderated the effect of body mass on body dissatisfaction. Internalization mediated the relationship between peer appearance conversations and criticism, and body dissatisfaction. These findings suggest that while body mass exerts a differential risk for body dissatisfaction among boys and girls, internalisation may represent a key psychological process that underpins body dissatisfaction among both boys and girls.     

Media Exposure, Current and Future Body Ideals, and Disordered Eating Among Preadolescent Girls: A Longitudinal Panel Study

Internalization of the thin body ideal is considered by many to account for the relationship between media exposure and disordered eating among girls and young women, but almost all supporting research has employed adolescent and adult samples. Using longitudinal panel survey data collected from 257 preadolescent girls at 2 points in time 1 year apart, we tested relationships between self-reported television and magazine exposure at wave 1 and current (prepubescent) and future (postpubescent) body ideals and disordered eating at wave 2. Controlling age, race, perceived body size, and body ideals and disordered eating measured at wave 1, television viewing at wave 1 predicted increased disordered eating and a thinner postpubescent body ideal at wave 2. In contrast, none of the media variables predicted a thinner prepubescent body ideal at wave 2. These findings suggest that the thin-ideal internalization construct needs refinement to enhance its developmental sensitivity.

Depression as a Moderator of Sociocultural Influences on Eating Disorder Symptoms in Adolescent Females and Males

This study aimed to explore the role of depression as a moderator of sociocultural influences on eating disorder symptoms. A sample of 509 adolescents (56% female) completed self-report questionnaires assessing depression, body dissatisfaction, drive for thinness, bulimic symptoms and sociocultural influences on appearance from family, peers and the media. Both girls and boys displaying high levels of depressive symptoms perceived stronger media and peer influences on appearance. Among girls, eating disorder symptoms were directly affected by sociocultural influences, in particular media influences, as well as by depression. However, depression played only a limited role as a moderator of these relationships. Among boys, sociocultural influences and depression revealed fewer direct effects on eating disorder symptoms. However, depression had a greater moderating effect on these relationships. Future research into the role of depression may increase the understanding of gender differences in body dissatisfaction, drive for thinness and bulimic symptoms.     

Factors Contributing to Gender Differences in Depressive Symptoms: A Test of Three Developmental Models

In a longitudinal study on 115 early adolescents, the impact of major events, relationship stressors, and coping style in interaction with biological changes on depressive outcome in late adolescence were explored. Three developmental models proposed by Nolen-Hoeksema and Girgus (1994, Psychol. Bull. 115: 424–433), which attempt to explain the emergence of gender differences in adolescent depressive symptoms, were tested. Multiple regression analyses conducted to test Model 1 identified two etiological factors associated with gender differences of depression, namely, stress in the adolescent–mother relationship and a more negative body image. Tests of Model 2 revealed etiological factors which correlated with depression in adolescent girls but not adolescent boys. The correlational patterns of avoidant coping and body image emerged as relevant factors for Model 2. Finally, tests of Model 3 searched for factors which were more likely to be observed in adolescent girls than boys and which would put girls at risk should they interact with a third etiological factor. Early maturational timing emerged as a factor for Model 3.     

Variables that discriminate bulimic from nonbulimic adolescent females

The present study identified variables that discriminated bulimic (N=71) from nonbulimic (N=71) adolescent females within a high school setting. A discriminant function analysis identified six variables that significantly differentiated these two groups. These variables included disturbed eating attitudes, negative perceptions of weight and body image, depressive symptomatology, and alcohol use. Post hoct tests indicated that, compared to the nonbulimic girls, the bulimic adolescents were significantly more depressed, viewed themselves as significantly more overweight, used alcohol significantly more frequently, possessed significantly more disturbed eating attitudes, had a significantly greater discrepancy between their current and ideal weight, and felt it was significantly more important to achieve this ideal weight. The implications of these findings for the etiology and early identification of bulimia in adolescence are discussed.Received Ph.D. from Kent State University. Research interest is applied clinical research.Received Ph.D. from University of Vermont. Research interest is behavioral medicine.