Pathways mediating sexual abuse and eating disturbance in children

OBJECTIVE: To examine the relationship between childhood maltreatment and eating disorders in a sample of children. METHOD: Twenty 10-15-year-old female children who were receiving treatment following reported childhood sexual abuse and 20 age-matched controls were compared on a series of measures assessing eating disorder behaviors, body image concerns, substance use, mood, impulsive behavior, and self-concept. RESULTS: Sexually abused children reported higher levels of eating disorder behaviors, impulsive behaviors, and drug abuse than controls. Furthermore, behavioral impulsivity provided the strongest mediational effect between a history of childhood sexual abuse and purging and restrictive dieting behavior. Drug use proved to be a significant secondary mediator of the childhood sexual abuse eating disorder behavior association. DISCUSSION: These data support the hypothesis that childhood sexual abuse is related to disordered eating in children, and extend similar findings that have been previously reported with adults. Behavioral impulsivity and drug use appear to be significant mechanisms that influence eating disorder behavior following childhood sexual abuse.     

Impulsivity as a risk factor for eating disorder behavior: assessment implications with adolescents

OBJECTIVE: The aims of the current study were to determine if impulsivity serves as a risk factor for eating disorder behavior and to examine whether different risk outcomes are obtained depending on the assessment strategy used to measure impulsivity. METHOD: Three independent studies are reported, each of which examined the relationship of impulsivity and eating disorder behavior in a prospective longitudinal design with adolescent subjects recruited from both public and private schools. Individuals displaying eating disorder behavior at initial assessments were not included in the analyses, to ensure that we were testing the role of impulsivity in the onset of eating disorder behavior. RESULTS: Trait impulsivity, measured with traditional personality scales, failed to predict the onset of eating disorder behavior in all three studies. However, when behavioral constructs associated with impulsivity, such as delinquency or substance abuse, were examined, they significantly predicted the onset of eating disorder behavior in most of the analyses conducted. DISCUSSION: These results provide moderate support for the idea that impulsivity serves as a risk factor for the onset of eating disorder behavior. However, this is only true when more objective behavioral measures were utilized.     

A meta-analytic examination of the relationship between child sexual abuse and eating disorders

OBJECTIVE: This study had two goals. The first was to assess the magnitude and consistency of the relationship between child sexual abuse (CSA) and eating disorders (ED). The second was to examine methodological factors contributing to the heterogeneity of this relationship. METHOD: Meta-analysis was used to examine both questions. Fifty-three studies were included in the analysis. RESULTS: A small, significant positive relationship between CSA and ED emerged. The relationship was marked by heterogeneity. Effect sizes were largest when CSA was the grouping variable, the Eating Disorders Inventory (EDI) or the Eating Attitudes Test (EAT) was used as the measure of eating disorders, and nonclinical groups were compared with clinical samples. DISCUSSION: Models of CSA and ED need to more clearly specify what aspects of ED (e.g., body image or binge eating) are most influenced by which types of CSA. These specific relationships then need to be examined empirically.     

Child sexual abuse and later disordered eating: a New Zealand epidemiological study

OBJECTIVE: This community-based study examined how some women who have experienced childhood sexual abuse (CSA) develop an eating disorder (ED), whereas others develop depression and anxiety, and others show no adverse psychological sequelae. METHODS: A two-stage random community sampling strategy was used to select two groups of women: (1) women with CSA prior to age 16 years and (2) a comparison group of women reporting no abuse. Both groups completed the Parental Bonding Instrument (PBI), the Present State Examination, and additional ICD-10 eating disorders questions. Information on the nature and frequency of the CSA was obtained at interview. CSA women with ED (CSA+ED) were compared with CSA women without ED (CSA-noED) and with CSA women with anxiety and/or depression (psychiatric comparison group). RESULTS: Higher rates of EDs in women who have experienced CSA were confirmed in this study. Belonging to a younger age cohort, experiencing menarche at an early age, and high paternal overcontrol on the PBI independently increased the risk of developing an ED in women who had experienced CSA. Low maternal care was specifically associated with the development of anorexia nervosa, whereas early age of menarche differentiated women with bulimia nervosa. Younger age and early age of menarche also differentiated the CSA+ED women from the psychiatric comparison group. DISCUSSION: Early maturation and paternal overcontrol emerged as risk factors for ED development in women with CSA. Although these variables are also risk factors in the general population, women with CSA may be vulnerable to ED development because these risk factors are particular domains of concern that emanate from experiences of CSA.     

西安市初中生进食行为问题和家庭因素的关系研究

【目的】 调查西安市区初中生进食行为的现状,研究进食行为问题与家庭因素的关系,减少与进食障碍相关的进食行为问题对初中学生的危害。 【方法】 采用分层整群抽样方法,抽取西安市区631名初中学生作为调查对象,应用进食态度测试26项(EAT-26)、家庭亲密度和适应性量表Ⅲ(FACESⅢ)进行现场调查。 【结果】 西安市区13.47%的初中学生存在进食行为问题,其中女生占9.19%,多于男生;女生EAT-26总分明显高于男生,主要表现在节食维度;初三年级进食行为问题较严重,EAT-26总分显著高于初二年级,主要表现在口腔控制维度;初中男生家庭适应性与口腔控制维度呈正相关,而初中女生家庭亲密度与暴食维度呈正相关。 【结论】 家庭因素影响初中生的进食行为,对于存在进食行为问题的个体,应适当改变其家庭模式。     

Relationships between perfectionism and specific disordered eating behaviors

OBJECTIVE: Perfectionism has been reported as a specific risk factor for anorexia nervosa and bulimia nervosa, but not binge eating disorder. This study examined whether these differences are due to differential associations between perfectionism and specific eating disorder behaviors. METHOD: Participants (N = 2,482) completed the eating disorders inventory perfectionism scale and a questionnaire assessing eating disorder symptoms. RESULTS: Perfectionism was associated with an array of disordered eating behaviors in women. However, associations were strongest for fasting and purging. Further, the association between binge eating and perfectionism was statistically mediated by fasting. In men, perfectionism was significantly associated only with fasting, and this association was greater than associations with other disordered eating behaviors. CONCLUSION: Results explain why previous studies have reported weak or inconsistent associations between perfectionism and binge eating and may inform etiological models of EDNOS characterized by fasting or purging.     

Influence of sexual orientation and age on disordered eating attitudes and behaviors in women

OBJECTIVE: We evaluated the influence of age on the association between sexual orientation and disordered eating attitudes and behaviors in women. METHOD: Heterosexual (n=47) and homosexual (n=45) women recruited from the community completed self-report questionnaires including the Body Esteem Scale, the Eating Disorders Inventory-2, the Reasons for Exercise Inventory, and the Self Esteem Scale. RESULTS: A multivariate analysis of variance of eating disorder variables revealed a main effect for sexual orientation on drive for thinness and exercise to control weight and a main effect for age on body mass index (BMI) and body dissatisfaction, but it did not reveal a significant interaction between sexual orientation and age. DISCUSSION: Sexual orientation may influence certain types of disordered eating attitudes and behaviors in women such as endorsing an extreme ideal of thinness. However, homosexual and heterosexual women reported more similarities than differences.     

Menarche, puberty, and first sexual activities in eating-disordered patients as compared with a psychiatric and a nonpsychiatric control group

OBJECTIVE: To examine chronology and experience of menarche, puberty, and first sexual activities in eating-disordered patients as compared with a psychiatric and a nonpsychiatric control group. METHOD: We interviewed 150 females, namely 50 patients with anorexia or bulimia nervosa (ED), 50 patients with polysubstance dependence (PSD-CO), and 50 healthy controls (HE-CO) (defined by DSM-IV) on chronology and their experience of menarche, puberty, and first sexual activities adjusted for childhood sexual abuse. RESULTS: ED women were similar to HE-CO in age at menarche and most sexual milestones, but differed significantly from PSD-CO women, who were "early starters." Regarding their experience of menarche, pubertal body changes, and first sexual activities, however, ED women rated these variables significantly more negatively than did either of the comparison groups. These significant differences remained after adjusting for sexual abuse. CONCLUSION: These findings suggest a negative body attitude in ED patients already at pubertal age, namely years before onset of the disorder. Prospective data are needed.     

Registered report: Initial development and validation of the eating disorders safety behavior scale

Anxiety and eating disorders (EDs) often co-occur, prompting calls to explore anxiety-related maintenance processes in ED samples. Safety behaviors, which function to prevent a feared outcome from occurring or to reduce anxiety associated with a feared stimulus, are observed across anxiety disorders and, along with overt avoidance behaviors, are an important target in treatment. Data suggest that individuals with EDs also engage in safety behaviors. However, no existing assessments provide a comprehensive measure of eating-disorder-specific overt avoidance and safety behaviors. The goal of this Stage 1 Registered Report is to develop a comprehensive self-report measure of ED-specific safety behaviors. In Study 1, we will recruit 50 women with EDs to complete the scale and provide feedback on the response scale. Feedback from these participants will be used to refine the measure. In Study 2, we will evaluate the psychometric properties of the measure in a large sample of women with EDs (n dependent on the size of measurement) and a community sample without current or a history of ED symptoms. We will explore the measure factor structure, known-groups validity by comparing scores from women with EDs to healthy controls, internal consistency, and convergent and divergent validity with other psychological instruments.