Eating Problems and the Self-Concept: Results Based on a Representative Sample of Norwegian Adolescent Girls

The joint role of self-esteem and unstable self-perceptions for eating problems was investigated in a representative Norwegian population sample of girls in 3 age groups (N = 5287; aged 12–19 years). Three scales from the 12-item Eating Attitudes Test (EAT-12) measured eating problems: Restriction, Bulimia-food preoccupation, and Diet. Girls low on all EAT scales were most often characterized by high self-esteem combined with stable self-perceptions, whereas girls high on all EAT-scales were characterized by having low self-esteem and unstable self-perceptions. Bulimic tendencies and dieting were more common in older groups, whereas high scores on all EAT-scales simultaneously were equally common in all ages. The findings gave initial support to the continuity hypothesis in indicating that the age trends for eating problems, except for restrictive tendencies, followed those of eating disorders and in that the risk factors found for eating problems parallel those reported for eating disorders.     

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.     

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.     

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.     

Three to Four Year Prospective Evaluation of Personality and Behavioral Risk Factors for Later Disordered Eating in Adolescent Girls and Boys

Findings of a 3- to 4-year prospective investigation of personality, temperament, and behavioral factors predictive of the later development of disordered eating in an adolescent population are presented. The sample consisted of 726 girls and 698 boys who entered the study in grades 7–10 in year 1 or in grade 7 in year 2. Predictors of eating disorder risk score were determined separately by gender. For both girls and boys, the latent variable of negative affect/attitudes determined at study entrance was the only significant predictor of final-year risk score. Semistructured diagnostic interviews confirmed an eating disorder diagnosis in 52.8% of 36 female subjects in the high eating disorder symptom group. A substantial history of lifetime and current comorbidity also was noted in this group. The function of negative affect/attitudes as a generalized psychopathology vulnerability factor and as a specific factor increasing risk for disordered eating is discussed.     

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.     

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.     

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.     

The Prospective Associations between Self-Efficacy and Depressive Symptoms from Early to Middle Adolescence: A Cross-Lagged Model

Over the course of adolescence, an increasing number of adolescents experience depression. In order to effectively target depression, identifying risk factors for depressive symptoms is pivotal. Since low levels of self-efficacy were associated with higher levels of depressive symptoms in previous studies, the current study investigated the bidirectional and prospective associations between depressive symptoms and academic, social and emotional self-efficacy from early to mid adolescence in a cross-lagged path model. The sample consisted of 1,341 adolescents (47?% girls) with a mean age of 14 years, SD?=?0.56. Depressive symptoms and self-efficacy levels were assessed every 6 months over a period of 2.5 years. Depressive symptoms predicted subsequent levels of academic and emotional self-efficacy on all time points, and social self-efficacy on one time point. Self-efficacy did not predict subsequent levels of depressive symptoms. There was no evidence of sex differences in the cross-lagged associations between depressive symptoms and self-efficacy levels. Implications of the findings are discussed.     

Gender Differences in Peer and Parental Influences: Body Image Disturbance,Self-Worth,and Psychological Functioning in Preadolescent Children

The connections between body image disturbance and psychological functioning have been well established in samples of older adolescent girls and young women. Little is known, however, about body image in younger children. In particular, little is known about possible gender differences in preadolescent children. The current study explored self-reported body image disturbance and psychological functioning in relation to peer and parental influences in 141 elementary school-aged girls and boys aged 8–11. Results suggest that girls are more concerned about dieting and are more preoccupied with their weight than are boys. Girls also reported a greater drive for thinness and a higher level of family history of eating concerns than did boys. Correlations suggested that girls' experiences of body image concerns (body dissatisfaction, bulimia, and drive for thinness) were related to a number of factors (such as family history of eating concerns, peer influences, teasing, depression, and global self-worth) whereas boys' experiences of body image concerns were related to fewer factors. On the basis of these findings, the assessment and treatment of body image concerns in preadolescent children (especially girls) are of great importance. Implications for intervention and prevention programs are discussed.     

Body Image Concerns in Young Girls: The Role of Peers and Media Prior to Adolescence

Peer and media influences have been identified as important conveyors of socio-cultural ideals in adolescent and preadolescent samples. This study aims to explore peer and media influences in the body image concerns and dieting awareness of younger girls, aged 5–8 years. A sample of 128 girls was recruited from the first 4 years of formal schooling. Individual interviews were conducted to assess the aspects of body image, as well as dieting awareness by means of a brief scenario. A number of sources of peer and media influence were examined. It was found that by 6 years of age, a large number of girls desired a thinner ideal figure. Both peer and media influences emerged as significant predictors of body image and dieting awareness. Specifically, girls’ perceptions of their peers’ body dissatisfaction predicted their own level of body dissatisfaction and dieting awareness. Watching music television shows and reading appearance-focused magazines predicted dieting awareness. In particular, girls who looked at magazines aimed at adult women had greater dissatisfaction with their appearance. Thus, the present study highlights that girls aged 5–8 years of age are already living in an appearance culture in which both peers and the media influence body image and dieting awareness.Hayley Dohnt, B. Psych. (Hons.), is completing her Ph.D. in Clinical Psychology at Flinders University. Her major research interests are in the area of child psychology and the development of body image.Marika Tiggemann’s Professor of Psychology at Flinders University. Her major research interest is in media influences on body image. She is Associate Editor for the journal Body Image.     

Identifying Trajectories of Adolescents’ Depressive Phenomena: An Examination of Early Risk Factors

Few studies have examined risk factors of childhood and early adolescent depressive symptomatology trajectories. This study examined self-report depressive symptomatology across a 6-year time period from 2nd to 8th grade to identify latent groups of individuals with similar patterns of depressive phenomena in a sample of 951 children (440 girls, 511 boys). Analyses, using semiparametric group modeling (SGM), identified 5 trajectory groups for girls and boys: low depressed stables, low depressed risers, mildly depressed stables, moderately depressed changers, and moderately depressed risers. Individual risk factors, with the exception of shy/withdrawn behavior, were significantly different across trajectory group membership for boys and girls, as was low-income status for boys. Boys in the low depressed and mildly depressed stable trajectory groups had significantly higher levels of antisocial behavior, attention problems, and lower social competency compared to girls in similar groups. These results suggest that universal prevention programs implemented in early elementary school that target selected risk factors may be helpful in reducing future adolescent mental health problems, specifically depressive symptomatology.     

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.     

Stability and Changes in Problem Behavior During Adolescence: Latent Growth Analysis

The aim of this study was to examine growth trajectories of externalizing and internalizing problems during adolescence. In addition, we also examined factors that might account for individual differences in the level of problem behavior and in the rate of change: Adolescent gender and the quality of the relationships with parents and peers. The sample consisted of 212 adolescents (mean age 13.4 years at the initial assessment) who were assessed at 3 measurement waves with approximately 1-year intervals. The results showed substantial absolute and relative stability in both types of problem behavior, but also significant individual differences in both initial levels of problem behavior and in the rate of change across the 3 measurement occasions. Adolescent gender and the quality of the parent–adolescent relationship predicted the initial level of both externalizing and internalizing problems. The protective effect of the positive quality of the relationship with peers was found for internalizing but not for externalizing problems. No differences appeared between boys and girls in the effect of the quality of interpersonal relations on the level and on the rate of change in problem behavior, suggesting that the etiology of problem behavior might be similar for boys and girls in spite of gender differences in the prevalence of problem behaviors.     

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.     

Associations Between Smoking and Extreme Dieting Among Adolescents

This study examined the association between cigarette smoking and dieting behaviors and trends in that association among US adolescents in grades 9–12 between 1999 and 2007. Youth Risk Behavior Survey datasets were analyzed using the multivariable logistic regression method. The sample size of each survey year ranged from 13,554 to 15,273 with girls representing 49–51% of the sample (N = 71,854). About 62% of the entire study participants were whites and 14% were blacks. Prevalence estimates of current smoking and corresponding 95% confidence intervals were computed across four comparison groups formed by gender and body weight. Extreme dieting was an independent predictor of smoking. Extreme dieters showed a higher variability of smoking behavior than their peers. The magnitude of the association between smoking and extreme dieting became smaller in recent years among adolescents but remained unchanged among non-overweight girls over that same time period. When adolescent smoking behavior is examined, the intensity of dieting behavior should be considered within its association with other co-occurring unhealthy behaviors.     

Suicidal ideation in adolescence: Depression,substance use,and other risk factors

The interrelationships of depression and suicide with adolescent drug use, delinquency, eating disorders, and the risk factors for these different problems were investigated among 597 9th and 11th graders in an urban high school. There is a strong association of drug use with suicidal ideation among girls, and a stronger relationship with attempts among girls and boys. Suicidal youths are ill-adjusted and display a lack of attachment and commitment to family and school. Causal models indicate that poor interpersonal interactions with parents, absence of peer interactions, and life events lead to depression, which in turn leads to suicidal ideation. Depressive symptoms are the strongest predictors of suicidal ideation. Among females, depression predicts drug involvement, and in turn, drug use increases suicidal ideation. Drug use is only one class of problem behaviors that constitutes a risk factor for suicidal behavior in adolescence. Delinquency and eating disorders also have direct effects on suicidal ideation beyond those of depressive affect. As for drug involvement, these problem behaviors are more predictive of suicidal behavior among girls than boys. Similarity and specificity of the predictors for problem behaviors within and between the sexes are discussed. Although young women use drugs to handle feelings of depression, drug use appears ineffective in the long run in relieving these depressive feelings. Understanding the dynamics of suicidal ideation in adolescence has important public health implications, since ideation is a strong predictor of attempts, especially among females.Revised version of a presentation at the Workshop on Adolescent Depression, Princeton, NJ, June 3, 1987.Work on this research has been partially supported by Research Grants DA00064, DA01097, DA03196, and DA02867, and by Research Scientist Award DA00081 from the National Institute on Drug Abuse; and awards from the John D. and Catherine MacArthur Foundation and the Research Foundation for Mental Hygiene, New York State Psychiatric Institute. Partial support for computer costs was provided by Mental Health Clinical Research Center Grant MH30906-07 from NIMH to the New York State Psychiatric Institute.Received Ph.D. in Sociology from Columbia University. Research interests include adolescent psychosocial development, epidemiology and risk factors for drug use, and interpersonal networks.Work on this research was carried out while a Research Associate at the School of Public Health, Columbia University. Received Ph.D. in Sociology from Columbia University. Research interests include personal networks and social support systems in chronic illness, societal factors in mental health, psychosocial consequences of drug use and abuse, panel mortality, and survey methodology.Received M.P.H. from Columbia University. Research interests include reliability and child psychiatry.     

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.     

A Prospective Study of Mexican American Adolescents’ Academic Success: Considering Family and Individual Factors

Mexican American youth are at greater risk of school failure than their peers. To identify factors that may contribute to academic success in this population, this study examined the prospective relationships from 5th grade to 7th grade of family (i.e., human capital [a parent with at least a high school education], residential stability, academically and occupationally positive family role models, and family structure) and individual characteristics (i.e., externalizing symptoms, bilingualism, gender, and immigrant status) to the academic performance of 749 Mexican American early adolescents (average age = 10.4 years and 48.7% were girls in 5th grade) from economically and culturally diverse families as these youth made the transition to junior high school. Results indicated that while controlling for prior academic performance, human capital and positive family role models assessed when adolescents were in 5th grade positively related to academic performance in 7th grade. Further, being a girl also was related to greater 7th grade academic success, whereas externalizing symptoms were negatively related to 7th grade academic performance. No other variables in the model were significantly and prospectively related to 7th grade academic performance. Implications for future research and interventions are discussed.     

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.