J Abnorm Child Psychol DOI 10.1007/s10802-015-0026-7
The Specificity of Psychological Factors Associated with Binge Eating in Adolescent Boys and Girls Marie Sehm 1 & Petra Warschburger 1
# Springer Science+Business Media New York 2015
Abstract Low self-esteem, lack of interoceptive awareness, perfectionism, body dissatisfaction, dietary restraint, weight teasing, and internalization of the societal body ideal are known to be associated with binge eating (BE) in adolescents. The purpose of the present cross-sectional study was to investigate whether these attributes are BE-specific and whether different patterns exist for boys and girls. We assessed BE, internalizing symptoms and psychological factors in 1039 adolescents from a community sample by self-report. Using multinomial logistic regression and controlling for measured height and weight, we compared adolescents with BE with individuals from a healthy control group and adolescents reporting internalizing symptoms. Individuals from the BEgroup reported a greater lack of interoceptive awareness and higher body dissatisfaction than individuals from the healthy control group. Additionally, we found a significant interaction between gender and body dissatisfaction. Internalization of the societal body ideal was related to BE when compared to internalizing symptoms. Results suggest, that the lack of interoceptive awareness and body dissatisfaction display substantial associations with BE, and that the latter effect is especially strong in boys. The internalization of societal standards of beauty emerged as a BE-specific factor and this finding emphasizes the role of the societal body ideal in the nature of eating pathology in boys and in girls. Increasing body satisfaction and the acceptance of realistic body ideals might be effective strategies in preventing eating pathology.
* Marie Sehm [email protected] 1
Department of Psychology, University of Potsdam, Karl-Liebknecht-Str. 24-25, 14476 Potsdam, Germany
Keywords Binge eating . Eating pathology . Adolescence . Girls . Boys . Internalizing symptoms
Binge eating (BE) implies the ingestion of a particularly large amount of food while experiencing a feeling of loss of control. Research has shown that approximately 26 % of female and 13 % of male adolescents experience BE at least once within a span of 12 months (Croll, Neumark-Sztainer, Story, and Ireland 2002). Non-clinical levels of BE are associated with risk for full and partial binge eating disorder (Tanofsky-Kraff et al. 2011) and psychosocial problems such as lower selfesteem and higher body dissatisfaction (Goldschmidt, Wall, Loth, Bucchianeri, and Neumark-Sztainer 2014). There is a large body of research underscoring the relevance of these factors for the etiology and persistence of BE (Jacobi et al. 2004a; Stice 2002). Unfortunately very little is known about the specificity of these attributes. Increasing our knowledge about differential and common factors in the general population is important with respect to the development of prevention approaches. An attribute that has constantly been linked to a variety of psychiatric disorders such as depression, anxiety and eating disorders is low self-esteem (Zeigler-Hill 2011). There is evidence that low self-esteem interacts with other factors to predict BE in female and male individuals (Goldschmidt, Wall, Loth, Le Grange, and Neumark-Sztainer 2012; Minnich, Gordon, Holm-Denoma, and Troop-Gordon 2014). Low interoceptive awareness (i.e., the reduced ability to perceive and interpret internal signals) and high perfectionism have both been described as key features of eating disorders by Bruch (1962). There is cross-sectional (Bardone-Cone, Abramson, Vohs, Heatherton, and Joiner 2006; de Zwaan et al. 1994) and longitudinal evidence (Leon, Fulkerson, Perry, and Early-Zald 1995; Mackinnon et al. 2011) for the
J Abnorm Child Psychol
association between perfectionism, interoceptive awareness and BE. However, both of these variables are also related to other psychiatric disorders, such as anxiety disorder and depression (Furman, Waugh, Bhattacharjee, Thompson, and Gotlib 2013; Sassaroli et al. 2008). For the development and persistence of eating disturbances, body- and eating-related variables are of special importance. Two of the most important factors from this field are body dissatisfaction and dieting, which are hypothesized to interact in the etiology of BE. There is broad empirical evidence for this assumption (Goossens, Braet, and Bosmans 2010; Stice, Marti, and Durant 2011). Furthermore, numerous studies demonstrate that higher body dissatisfaction as well as restrained eating are cross-sectionally (Andrés and Saldaña 2014) and prospectively (Stice et al. 2011; Stice, Presnell, and Spangler 2002) associated with BE. Another weight-related variable of growing interest is weight and appearance teasing by peers. This factor is of special importance in investigations of adolescent samples (Menzel et al. 2010). In their review, Menzel et al. summarize that teasing is moderately related to body dissatisfaction, restraint eating and bulimic behavior, respectively and that these associations may be stronger in girls. On the other hand, Gardner et al. (2000) found teasing to be related to later eating disorder symptoms only in boys. Internalization of the sociocultural body ideal has been shown to increase the risk of eating disorders in conjunction with other established risk factors (Thompson and Stice 2001). It has been assumed that internalization of the sociocultural body ideal fosters body dissatisfaction and dietary restraint as a result of the discrepancies between one’s ideal and actual bodies, thereby leading to eating pathology (Keel and Forney 2013). There is evidence that this relationship is especially strong in girls (Knauss, Paxton, and Alsaker 2007).
Specificity of Psychological Factors Although there has been extensive research on the relevance of the above-mentioned factors for the development and persistence of eating disorders, studies addressing the specificity of these factors are rare and results are inconsistent. Fairburn et al. (1998) found that negative comments from the family about shape, weight and eating were a major BE-specific factor. The specificity of critical comments about weight and shape has been confirmed (Gonçalves, Machado, Martins, and Machado 2014; Pike et al. 2006). Goldschmidt et al. (2010) found shape and weight overevaluation to be a significant diagnostic specifier for Binge Eating Disorder (BED), but high levels of shape and weight overevaluation were found in a small group of individuals from the psychiatric control group as well. Moreover, it has been observed that patients with BED and Bulimia Nervosa (BN)
exhibit lower self-esteem than patients with anxiety and depressive disorders and healthy individuals (Jacobi et al. 2004b). The concern over mistakes, which is one component of perfectionism, seems to be specifically associated with Anorexia Nervosa and BN in comparison with other psychiatric disorders (Bulik et al. 2003), but the combination of perfectionism, self-esteem and body dissatisfaction prospectively predicted symptoms of BN as well as depression in another study (Vohs et al. 2001). Striegel-Moore et al. (2005) reported that negative affect and perfectionism increase the risk of BED and other psychiatric disorders, whereas childhood obesity and family problems emerged as BED-specific risk factors. A large Australian longitudinal study investigated a substantial number of predictors for eating disorders from different domains in an adolescent sample. Results suggest that child psychological variables predict psychiatric symptoms in general, whereas only female gender and parent-perceived child overweight emerged as specific risk factors for eating disorders (Allen, Byrne, Forbes, and Oddy 2009). Taken together, these studies suggest that experiencing comments and teasing about weight and shape constitutes a specific psychological correlate of BE, whereas the specificity of the other attributes remains less clear.
Aims and Hypotheses The present study aims to investigate the specificity of the above-mentioned psychological correlates of BE in adolescence by comparing boys and girls reporting BE to a healthy control group and adolescents exhibiting internalizing symptoms (depression, anxiety) in a cross-sectional study. Comparing BE with internalizing symptoms allowed us to account for negative affectivity, which is important in investigating variables such as self-esteem (Jacobi et al. 2004a). Based on the studies outlined above, we hypothesize that there are two subgroups of psychological correlates: general attributes (low self-esteem, high perfectionism and low interoceptive awareness) which are associated with BE and internalizing symptoms at the same time, and specific correlates that include body- and eating-related variables (body dissatisfaction, dietary restraint, weight teasing, and internalization of the sociocultural body ideal) which are associated with BE specifically. Because for some variables boys and girls seem to display different patterns of correlates (e.g., body dissatisfaction and teasing experiences), we expect to find interaction effects with gender.
Method Procedure Participants were recruited from a study on developmental risk factors in childhood and adolescence. All participants
J Abnorm Child Psychol
answered self-report questionnaires and their anthropometric data was assessed by trained personnel. Parents answered questionnaires by mail or online and provided informed consent. The study was approved by the ethics committee of the University of Potsdam, Germany and the Ministry for Education in Brandenburg, Germany. Participants A sample of 1039 adolescents from 12 to 19 years of age with a mean age of 14.37, SD=1.56, provided data on the questionnaires of interest. Girls and boys were almost equally represented (49.7 % boys). Participants were allocated to three groups based on their information on BE, internalizing symptoms and general psychopathology. Inclusion and exclusion criteria, as well as descriptive information for the three groups are displayed in Table 1. The mean frequency of BE episodes within the last month in the BE-group was 4.27, SD=5.28, and 28.2 % of individuals from this group experienced BE at least weekly. 64 adolescents reported neither BE nor internalizing symptoms and scored above the cut-off for general psychopathology in the healthy control group, leaving us with 975 participants for our analyses. Measures BE We screened for BE using two diagnostic items assessing overeating and loss of control of the German Eating Disorder Examination-Questionnaire for children (chEDE-Q; Hilbert, Hartmann, and Czaja 2008). Research has shown that the chEDE-Q is a valid and reliable measure of eating disordered
Table 1
behavior and related symptoms in youth (Goossens and Braet 2010). Consistent with other studies screening for BE was considered positive if participants reported at least one episode of overeating with loss of control within the past month (Field et al. 1999; Stice et al. 2002; Tanofsky-Kraff et al. 2011). Internalizing Symptoms We used 14 dichotomous items of the Mannheimer Jugendfragebogen (MJF; Esser 2006) to assess internalizing symptoms. The MJF assesses the presence of the core symptoms of the most prevalent mental disorders in adolescence. Items assessing depression and anxiety include BI am sad or depressed at least once a week for at least 3 h.^ and BI am anxious, worrying a lot about future events.^, respectively. In accordance with the authors of the MJF, screening for internalizing symptoms was considered positive if at least three anxiety items or two depression items were affirmed. General Psychopathology To measure general psychopathology, we used the German self-report version of the Strengths and Difficulties Questionnaire (SDQ; Klasen et al. 2000). The SDQ is a frequently used and valid instrument (Koskelainen, Sourander, and Kaljonen 2000) assessing a variety of positive and negative psychological characteristics on a three-point scale. A total problem score was generated from the four problem scales of the SDQ and individuals who scored below the cut-off of 16 were allocated to the healthy control group. The total scale has demonstrated acceptable internal consistency in other studies (Van Roy, Veenstra, and Clench-Aas 2008) and the alpha coefficient in our sample was 0.74.
Classification criteria and descriptives for participants with BE or internalizing symptoms and the healthy control group (n=975)
Inclusion
BE (n=149)
INT (n=147)
HC (n=679)
at least 1 episode of BE within the past 28 days
at least 3 anxiety or 2 depression symptoms 1 or more episodes of BE within the past 28 days
–
Exclusion
Age
Gender*** (% boys) BMI-SDS***
M SD range
14.43 1.43 12.04–18.08
14.24 1.55 12.02–19.45
general psychopathology (SDQ), 1 or more episodes of BE within the past 28 days, 3 or more anxiety symptoms, 2 or more depression symptoms 14.44 1.60 12.01–19.23
M SD range
36.9 0.52 1.01 −2.72–2.80
36.1 0.29 1.11 −2.43–3.77
54.6 0.15 1.00 −3.11–3.18
INT internalizing symptoms, HC healthy control group, SDQ Strengths and Difficulties Questionnaire, BMI-SDS Body Mass Index-Standard Deviation Scores, BE binge eating ***group differences were significant at p
The Specificity of Psychological Factors Associated with Binge Eating in Adolescent Boys and Girls Marie Sehm 1 & Petra Warschburger 1
# Springer Science+Business Media New York 2015
Abstract Low self-esteem, lack of interoceptive awareness, perfectionism, body dissatisfaction, dietary restraint, weight teasing, and internalization of the societal body ideal are known to be associated with binge eating (BE) in adolescents. The purpose of the present cross-sectional study was to investigate whether these attributes are BE-specific and whether different patterns exist for boys and girls. We assessed BE, internalizing symptoms and psychological factors in 1039 adolescents from a community sample by self-report. Using multinomial logistic regression and controlling for measured height and weight, we compared adolescents with BE with individuals from a healthy control group and adolescents reporting internalizing symptoms. Individuals from the BEgroup reported a greater lack of interoceptive awareness and higher body dissatisfaction than individuals from the healthy control group. Additionally, we found a significant interaction between gender and body dissatisfaction. Internalization of the societal body ideal was related to BE when compared to internalizing symptoms. Results suggest, that the lack of interoceptive awareness and body dissatisfaction display substantial associations with BE, and that the latter effect is especially strong in boys. The internalization of societal standards of beauty emerged as a BE-specific factor and this finding emphasizes the role of the societal body ideal in the nature of eating pathology in boys and in girls. Increasing body satisfaction and the acceptance of realistic body ideals might be effective strategies in preventing eating pathology.
* Marie Sehm [email protected] 1
Department of Psychology, University of Potsdam, Karl-Liebknecht-Str. 24-25, 14476 Potsdam, Germany
Keywords Binge eating . Eating pathology . Adolescence . Girls . Boys . Internalizing symptoms
Binge eating (BE) implies the ingestion of a particularly large amount of food while experiencing a feeling of loss of control. Research has shown that approximately 26 % of female and 13 % of male adolescents experience BE at least once within a span of 12 months (Croll, Neumark-Sztainer, Story, and Ireland 2002). Non-clinical levels of BE are associated with risk for full and partial binge eating disorder (Tanofsky-Kraff et al. 2011) and psychosocial problems such as lower selfesteem and higher body dissatisfaction (Goldschmidt, Wall, Loth, Bucchianeri, and Neumark-Sztainer 2014). There is a large body of research underscoring the relevance of these factors for the etiology and persistence of BE (Jacobi et al. 2004a; Stice 2002). Unfortunately very little is known about the specificity of these attributes. Increasing our knowledge about differential and common factors in the general population is important with respect to the development of prevention approaches. An attribute that has constantly been linked to a variety of psychiatric disorders such as depression, anxiety and eating disorders is low self-esteem (Zeigler-Hill 2011). There is evidence that low self-esteem interacts with other factors to predict BE in female and male individuals (Goldschmidt, Wall, Loth, Le Grange, and Neumark-Sztainer 2012; Minnich, Gordon, Holm-Denoma, and Troop-Gordon 2014). Low interoceptive awareness (i.e., the reduced ability to perceive and interpret internal signals) and high perfectionism have both been described as key features of eating disorders by Bruch (1962). There is cross-sectional (Bardone-Cone, Abramson, Vohs, Heatherton, and Joiner 2006; de Zwaan et al. 1994) and longitudinal evidence (Leon, Fulkerson, Perry, and Early-Zald 1995; Mackinnon et al. 2011) for the
J Abnorm Child Psychol
association between perfectionism, interoceptive awareness and BE. However, both of these variables are also related to other psychiatric disorders, such as anxiety disorder and depression (Furman, Waugh, Bhattacharjee, Thompson, and Gotlib 2013; Sassaroli et al. 2008). For the development and persistence of eating disturbances, body- and eating-related variables are of special importance. Two of the most important factors from this field are body dissatisfaction and dieting, which are hypothesized to interact in the etiology of BE. There is broad empirical evidence for this assumption (Goossens, Braet, and Bosmans 2010; Stice, Marti, and Durant 2011). Furthermore, numerous studies demonstrate that higher body dissatisfaction as well as restrained eating are cross-sectionally (Andrés and Saldaña 2014) and prospectively (Stice et al. 2011; Stice, Presnell, and Spangler 2002) associated with BE. Another weight-related variable of growing interest is weight and appearance teasing by peers. This factor is of special importance in investigations of adolescent samples (Menzel et al. 2010). In their review, Menzel et al. summarize that teasing is moderately related to body dissatisfaction, restraint eating and bulimic behavior, respectively and that these associations may be stronger in girls. On the other hand, Gardner et al. (2000) found teasing to be related to later eating disorder symptoms only in boys. Internalization of the sociocultural body ideal has been shown to increase the risk of eating disorders in conjunction with other established risk factors (Thompson and Stice 2001). It has been assumed that internalization of the sociocultural body ideal fosters body dissatisfaction and dietary restraint as a result of the discrepancies between one’s ideal and actual bodies, thereby leading to eating pathology (Keel and Forney 2013). There is evidence that this relationship is especially strong in girls (Knauss, Paxton, and Alsaker 2007).
Specificity of Psychological Factors Although there has been extensive research on the relevance of the above-mentioned factors for the development and persistence of eating disorders, studies addressing the specificity of these factors are rare and results are inconsistent. Fairburn et al. (1998) found that negative comments from the family about shape, weight and eating were a major BE-specific factor. The specificity of critical comments about weight and shape has been confirmed (Gonçalves, Machado, Martins, and Machado 2014; Pike et al. 2006). Goldschmidt et al. (2010) found shape and weight overevaluation to be a significant diagnostic specifier for Binge Eating Disorder (BED), but high levels of shape and weight overevaluation were found in a small group of individuals from the psychiatric control group as well. Moreover, it has been observed that patients with BED and Bulimia Nervosa (BN)
exhibit lower self-esteem than patients with anxiety and depressive disorders and healthy individuals (Jacobi et al. 2004b). The concern over mistakes, which is one component of perfectionism, seems to be specifically associated with Anorexia Nervosa and BN in comparison with other psychiatric disorders (Bulik et al. 2003), but the combination of perfectionism, self-esteem and body dissatisfaction prospectively predicted symptoms of BN as well as depression in another study (Vohs et al. 2001). Striegel-Moore et al. (2005) reported that negative affect and perfectionism increase the risk of BED and other psychiatric disorders, whereas childhood obesity and family problems emerged as BED-specific risk factors. A large Australian longitudinal study investigated a substantial number of predictors for eating disorders from different domains in an adolescent sample. Results suggest that child psychological variables predict psychiatric symptoms in general, whereas only female gender and parent-perceived child overweight emerged as specific risk factors for eating disorders (Allen, Byrne, Forbes, and Oddy 2009). Taken together, these studies suggest that experiencing comments and teasing about weight and shape constitutes a specific psychological correlate of BE, whereas the specificity of the other attributes remains less clear.
Aims and Hypotheses The present study aims to investigate the specificity of the above-mentioned psychological correlates of BE in adolescence by comparing boys and girls reporting BE to a healthy control group and adolescents exhibiting internalizing symptoms (depression, anxiety) in a cross-sectional study. Comparing BE with internalizing symptoms allowed us to account for negative affectivity, which is important in investigating variables such as self-esteem (Jacobi et al. 2004a). Based on the studies outlined above, we hypothesize that there are two subgroups of psychological correlates: general attributes (low self-esteem, high perfectionism and low interoceptive awareness) which are associated with BE and internalizing symptoms at the same time, and specific correlates that include body- and eating-related variables (body dissatisfaction, dietary restraint, weight teasing, and internalization of the sociocultural body ideal) which are associated with BE specifically. Because for some variables boys and girls seem to display different patterns of correlates (e.g., body dissatisfaction and teasing experiences), we expect to find interaction effects with gender.
Method Procedure Participants were recruited from a study on developmental risk factors in childhood and adolescence. All participants
J Abnorm Child Psychol
answered self-report questionnaires and their anthropometric data was assessed by trained personnel. Parents answered questionnaires by mail or online and provided informed consent. The study was approved by the ethics committee of the University of Potsdam, Germany and the Ministry for Education in Brandenburg, Germany. Participants A sample of 1039 adolescents from 12 to 19 years of age with a mean age of 14.37, SD=1.56, provided data on the questionnaires of interest. Girls and boys were almost equally represented (49.7 % boys). Participants were allocated to three groups based on their information on BE, internalizing symptoms and general psychopathology. Inclusion and exclusion criteria, as well as descriptive information for the three groups are displayed in Table 1. The mean frequency of BE episodes within the last month in the BE-group was 4.27, SD=5.28, and 28.2 % of individuals from this group experienced BE at least weekly. 64 adolescents reported neither BE nor internalizing symptoms and scored above the cut-off for general psychopathology in the healthy control group, leaving us with 975 participants for our analyses. Measures BE We screened for BE using two diagnostic items assessing overeating and loss of control of the German Eating Disorder Examination-Questionnaire for children (chEDE-Q; Hilbert, Hartmann, and Czaja 2008). Research has shown that the chEDE-Q is a valid and reliable measure of eating disordered
Table 1
behavior and related symptoms in youth (Goossens and Braet 2010). Consistent with other studies screening for BE was considered positive if participants reported at least one episode of overeating with loss of control within the past month (Field et al. 1999; Stice et al. 2002; Tanofsky-Kraff et al. 2011). Internalizing Symptoms We used 14 dichotomous items of the Mannheimer Jugendfragebogen (MJF; Esser 2006) to assess internalizing symptoms. The MJF assesses the presence of the core symptoms of the most prevalent mental disorders in adolescence. Items assessing depression and anxiety include BI am sad or depressed at least once a week for at least 3 h.^ and BI am anxious, worrying a lot about future events.^, respectively. In accordance with the authors of the MJF, screening for internalizing symptoms was considered positive if at least three anxiety items or two depression items were affirmed. General Psychopathology To measure general psychopathology, we used the German self-report version of the Strengths and Difficulties Questionnaire (SDQ; Klasen et al. 2000). The SDQ is a frequently used and valid instrument (Koskelainen, Sourander, and Kaljonen 2000) assessing a variety of positive and negative psychological characteristics on a three-point scale. A total problem score was generated from the four problem scales of the SDQ and individuals who scored below the cut-off of 16 were allocated to the healthy control group. The total scale has demonstrated acceptable internal consistency in other studies (Van Roy, Veenstra, and Clench-Aas 2008) and the alpha coefficient in our sample was 0.74.
Classification criteria and descriptives for participants with BE or internalizing symptoms and the healthy control group (n=975)
Inclusion
BE (n=149)
INT (n=147)
HC (n=679)
at least 1 episode of BE within the past 28 days
at least 3 anxiety or 2 depression symptoms 1 or more episodes of BE within the past 28 days
–
Exclusion
Age
Gender*** (% boys) BMI-SDS***
M SD range
14.43 1.43 12.04–18.08
14.24 1.55 12.02–19.45
general psychopathology (SDQ), 1 or more episodes of BE within the past 28 days, 3 or more anxiety symptoms, 2 or more depression symptoms 14.44 1.60 12.01–19.23
M SD range
36.9 0.52 1.01 −2.72–2.80
36.1 0.29 1.11 −2.43–3.77
54.6 0.15 1.00 −3.11–3.18
INT internalizing symptoms, HC healthy control group, SDQ Strengths and Difficulties Questionnaire, BMI-SDS Body Mass Index-Standard Deviation Scores, BE binge eating ***group differences were significant at p
