Skip to main content Accessibility help
×
×
Home

Who is really at risk? Identifying risk factors for subthreshold and full syndrome eating disorders in a high-risk sample

  • C. Jacobi (a1), E. Fittig (a1), S. W. Bryson (a2), D. Wilfley (a3), H. C. Kraemer (a2) and C. Barr Taylor (a2)...

Abstract

Background

Numerous longitudinal studies have identified risk factors for the onset of most eating disorders (EDs). Identifying women at highest risk within a high-risk sample would allow for focusing of preventive resources and also suggests different etiologies.

Method

A longitudinal cohort study over 3 years in a high-risk sample of 236 college-age women randomized to the control group of a prevention trial for EDs. Potential risk factors and interactions between risk factors were assessed using the methods developed previously. Main outcome measures were time to onset of a subthreshold or full ED.

Results

At the 3-year follow-up, 11.2% of participants had developed a full or partial ED. Seven of 88 potential risk factors could be classified as independent risk factors, seven as proxies, and two as overlapping factors. Critical comments about eating from teacher/coach/siblings and a history of depression were the most potent risk factors. The incidence for participants with either or both of these risk factors was 34.8% (16/46) compared to 4.2% (6/144) for participants without these risk factors, with a sensitivity of 0.75 and a specificity of 0.82.

Conclusions

Targeting preventive interventions at women with high weight and shape concerns, a history of critical comments about eating weight and shape, and a history of depression may reduce the risk for EDs.

Copyright

Corresponding author

*Address for correspondence: C. Barr Taylor, M.D., Stanford University Medical Center, Department of Psychiatry and Behavioral Sciences, 401 Quarry Road, Stanford, CA 94305-5722, USA. (Email: btaylor@stanford.edu)

References

Hide All
Agras, WS, Bryson, S, Hammer, LD, Kraemer, HC (2007). Childhood risk factors for thin body preoccupation and social pressure to be thin. Journal of the American Academy of Child and Adolescent Psychiatry 46, 171178.
Attie, I, Brooksgunn, J (1989). Development of eating problems in adolescent girls: a longitudinal study. Developmental Psychology 25, 7079.
Bernstein, D, Fink, L (1998). Manual for the Childhood Trauma Questionnaire. The Psychological Corporation: New York.
Bulik, CM, Sullivan, PF, Tozzi, F, Furberg, H, Lichtenstein, P, Pedersen, NL (2006). Prevalence, heritability, and prospective risk factors for anorexia nervosa. Archives of General Psychiatry 63, 305312.
Carver, CS (1997). You want to measure coping but your protocol's too long: consider the Brief COPE. International Journal of Behavioral Medicine 4, 92–100.
Clara, IP, Cox, BJ, Enns, MW, Murray, LT, Torgrudc, LJ (2003). Confirmatory factor analysis of the Multidimensional Scale of Perceived Social Support in clinically distressed and student samples. Journal of Personality Assessment 81, 265270.
Cooper, Z, Fairburn, CG (1987). The Eating Disorder Examination: a semi-structured interview for the assessment of the specific psychopathology of eating disorders. International Journal of Eating Disorders 6, 18.
Drenowski, A, Hopkins, SA, Kessler, RC (1988). The prevalence of bulimia nervosa in the U.S. college student population. American Journal of Public Health 78, 13221325.
Fairburn, CG, Cooper, Z, Doll, HA, Welch, SL (1999). Risk factors for anorexia nervosa: three integrated case-control comparisons. Archives of General Psychiatry 56, 468476.
Fairburn, CG, Doll, HA, Welch, SL, Hay, PJ, Davies, BA, O'Connor, ME (1998). Risk factors for binge eating disorder: a community-based, case-control study. Archives of General Psychiatry 55, 425432.
Fairburn, CG, Welch, SL, Doll, HA, Davies, BA, O'Connor, ME (1997). Risk factors for bulimia nervosa: a community-based case-control study. Archives of General Psychiatry 54 509517.
Field, AE, Austin, SB, Frazier, AL, Gillman, MW, Camargo, CA, Colditz, GA (2002). Smoking, getting drunk, and engaging in bulimic behaviors: in which order are the behaviors adopted? Journal of the American Academy of Child and Adolescent Psychiatry 41, 846853.
Fitzgibbon, ML, Sanchez-Johnsen, LAP, Martinovich, Z (2003). A test of the continuity perspective across bulimic and binge eating pathology. International Journal of Eating Disorders 34, 8397.
Garner, DM, Olmsted, MP (1984). Eating Disorder Inventory Manual. Psychological Assessment Resources, Inc.: Odessa, FL.
Graber, JA, Brooksgunn, J, Paikoff, RL, Warren, MP (1994). Prediction of eating problems: an 8-year study of adolescent girls. Developmental Psychology 30, 823834.
Hayward, C, Killen, JD, Kraemer, HC, Taylor, CB (2000). Predictors of panic attacks in adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 39, 207214.
Hirshfeld-Becker, DR, Micco, JA, Simoes, NA, Henin, A (2008). High risk studies and developmental antecedents of anxiety disorders. American Journal of Medical Genetics. Part C, Seminars in Medical Genetics 148C, 99–117.
Hoek, HW, van Hoeken, D (2003). Review of the prevalence and incidence of eating disorders. International Journal of Eating Disorders 34, 383396.
Hudson, JI, Hiripi, E, Pope, HG Jr., Kessler, RC (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry 61, 348358.
Jacobi, C (2005). Psychosocial risk factors for eating disorders. In Eating Disorders Review(ed. Wonderlich, S. A., Mitchell, J. E., Zwaan, M. de and Steiger, H.), pp. 5985. Radcliffe Publishing Ltd: Oxford, UK.
Jacobi, C (2007). Comparing risk for onset and chronic course of eating disorders: what do we know about the individuals who have enduring eating disorder pathology? In 8th London International Eating Disorders Conference, London, UK.
Jacobi, C, Abascal, L, Taylor, CB (2004 a). Screening for eating disorders and high-risk behavior: caution. International Journal of Eating Disorders 36, 280295.
Jacobi, C, Fittig, E (2010). Psychosocial risk factors for eating disorders. In Oxford Handbook of Eating Disorders(ed. Agras, W. S.), pp. 123135. Oxford University Press: New York.
Jacobi, C, Hayward, C, de Zwaan, M, Kraemer, HC, Agras, WS (2004 b). Coming to terms with risk factors for eating disorders: application of risk terminology and suggestions for a general taxonomy. Psychological Bulletin 130, 1965.
Johnson, JG, McCutcheon, S (1980). Assessing life stress in older children and adolescents: preliminary findings with the Life Events Checklist. In Stress and Anxiety(ed. Sarason, I. and Spielberger, C.), pp. 115125. Hemisphere Publishing Corporation: Washington, DC.
Killen, JD, Hayward, C, Wilson, DM, Taylor, CB, Hammer, LD, Litt, I, Simmonds, B, Haydel, F (1994 a). Factors associated with eating disorder symptoms in a community sample of 6th and 7th grade girls. International Journal of Eating Disorders 15, 357367.
Killen, JD, Taylor, CB, Hayward, C, Haydel, KF, Wilson, DM, Hammer, L, Kraemer, H, Blair-Greiner, A, Strachowski, D (1996). Weight concerns influence the development of eating disorders: a 4-year prospective study. Journal of Consulting and Clinical Psychology 64, 936940.
Killen, JD, Taylor, CB, Hayward, C, Wilson, DM, Haydel, KF, Hammer, LD, Simmonds, B, Robinson, TN, Litt, I, Varady, A, Kraemer, H (1994 b). Pursuit of thinness and onset of eating disorder symptoms in a community sample of adolescent girls: a 3-year prospective analysis. International Journal of Eating Disorders 16, 227238.
Kraemer, HC, Blasey, CM (2004). Centering in regression analyses: a strategy to prevent errors in statistical inference. International Journal of Methods in Psychiatric Research 13, 141151.
Kraemer, HC, Kazdin, AE, Offord, DR, Kessler, RC, Jensen, PS, Kupfer, DJ (1997). Coming to terms with the terms of risk. Archives of General Psychiatry 54, 337343.
Kraemer, HC, Kazdin, AE, Offord, DR, Kessler, RC, Jensen, PS, Kupfer, DJ (1999). Measuring the potency of risk factors for clinical or policy significance. Psychological Methods 4, 257271.
Kraemer, HC, Lowe, KK, Kupfer, DJ (2005). To Your Health: How to Understand What Research Tells Us About Risk. Oxford University Press: New York.
Kraemer, HC, Morgan, GA, Leech, NL, Gliner, JA, Vaske, JJ, Harmon, RJ (2003). Measures of clinical significance. Journal of the American Academy of Child and Adolescent Psychiatry 42, 15241529.
Kraemer, HC, Stice, E, Kazdin, A, Offord, D, Kupfer, D (2001). How do risk factors work together? Mediators, moderators, and independent, overlapping, and proxy risk factors. American Journal of Psychiatry 158, 848856.
Leon, GR, Fulkerson, JA, Perry, CL, Early-Zald, MB (1995). Prospective analysis of personality and behavioral vulnerabilities and gender influences in the later development of disordered eating. Journal of Abnormal Psychology 104, 140149.
Leon, GR, Fulkerson, JA, Perry, CL, Keel, PK, Klump, KL (1999). Three to four year prospective evaluation of personality and behavioral risk factors for later disordered eating in adolescent girls and boys. Journal of Youth and Adolescence 28, 181196.
Luce, KH, Crowther, JH (1999). The reliability of the Eating Disorder Examination – Self-Report Questionnaire Version (EDE-Q). International Journal of Eating Disorders 25, 349351.
Measelle, JR, Slice, E, Hogansen, JM (2006). Developmental trajectories of co-occurring depressive, eating, antisocial and substance abuse problems in female adolescents. Journal of Abnormal Psychology 115, 524538.
Mitchell, JE, Myers, TC, Glass, JB (2002). Pharmacotherapy and medical complications of eating disorders in children and adolescents. Child and Adolescent Psychiatric Clinics of North America 11, 365385.
Moorhead, DJ, Stashwick, CK, Reinherz, HZ, Giaconia, RM, Streigel-Moore, RM, Paradis, AD (2003). Child and adolescent predictors for eating disorders in a community population of young adult women. International Journal of Eating Disorders 33, 19.
Neumark-Sztainer, D, Wall, MM, Haines, JI, Story, MT, Sherwood, NE, van den Berg, PA (2007). Shared risk and protective factors for overweight and disordered eating in adolescents. American Journal of Preventive Medicine 33, 359369.
Orme, JG, Reis, J, Herz, EJ (1986). Factorial and discriminant validity of the Center for Epidemiological Studies Depression (CES-D) scale. Journal of Clinical Psychology 42, 2833.
Pike, KM, Hilbert, A, Wilfley, DE, Fairburn, CG, Dohm, FA, Walsh, BT, Striegel-Moore, RH (2007). Toward an understanding of risk factors for anorexia nervosa: a case-control study. Psychological Medicine 10, 111.
Plutchik, R, van Praag, HM (1987). Interconvertability of five self-report measures of depression. Psychiatry Research 22, 243256.
Rosen, JC, Vara, L, Wendt, S, Leitenberg, H (1990). Validity studies of the Eating Disorder Examination. International Journal of Eating Disorders 9, 519528.
Safer, DL, Telch, CF, Agras, WS (2001). Dialectical behavior therapy for bulimia nervosa. American Journal of Psychiatry 158, 632634.
Scher, CD, Stein, MB, Asmundson, GJG, McCreary, DR, Forde, DR (2001). The Childhood Trauma Questionnaire in a community sample: psychometric properties and normative data. Journal of Trauma and Stress 14, 843857.
Spoor, ST, Stice, E, Burton, E, Bohon, C (2007). Relations of bulimic symptom frequency and intensity to psychosocial impairment and health care utilization: results from a community-recruited sample. International Journal of Eating Disorders 40, 505514.
Stice, E, Killen, JD, Hayward, C, Taylor, CB (1998). Support for the continuity hypothesis of bulimic pathology. Journal of Consulting and Clinical Psychology 66, 784790.
Striegel-Moore, RH, Bulik, CM (2007). Risk factors for eating disorders. American Psychologist 62, 181198.
Striegel-Moore, RH, Dohm, FA, Kraemer, HC, Taylor, CB, Daniels, S, Crawford, PB, Schreiber, GB (2003). Eating disorders in white and black women. American Journal of Psychiatry 160, 13261331.
Strober, M, Freeman, R, Bower, S, Rigali, J (1996). Binge eating in anorexia nervosa predicts later onset of substance abuse disorder: a 10-year prospective, longitudinal follow-up of 95 adolescents. Journal of Youth and Adolescence 25, 519532.
Stunkard, AJ, Sorenson, T, Schulsinger, F (1983). Use of the Danish adoption register for the study of obesity and thinness. In The Genetics of Neurological and Psychiatric Disorders(ed. Kety, S. S., Rowland, L. P., Sidman, S. W. and Mathysee, S. W.), pp. 115120. Raven Press: New York.
Taylor, CB, Altman, TM, Shisslak, C, Bryson, S, Estes, LS, Gray, N, McKnight, KM, Kraemer, H, Killen, JD (1998). Factors associated with weight concerns in adolescents. International Journal of Eating Disorders 24, 3142.
Taylor, CB, Bryson, S, Luce, KH, Cunning, D, Doyle, AC, Abascal, LB, Rockwell, R, Dev, P, Winzelberg, AJ, Wilfley, DE (2006). Prevention of eating disorders in at-risk college-age women. Archives of General Psychiatry 63, 881888.
Taylor, CB, Bryson, SW, Altman, TM, Abascal, L, Celio, A, Cunning, D, Killen, JD, Shisslak, CM, Crago, M, Ranger-Moore, J, Cook, P, Ruble, A, Olmsted, ME, Kraemer, HC, Smolak, L (2003). Risk factors for the onset of eating disorders in adolescent girls: results of the McKnight longitudinal risk factor study. American Journal of Psychiatry 160, 248254.
Wade, T, Treloar, S, Martin, NG (2008). Shared and unique risk factors between lifetime purging and objective binge eating: a twin study. Australian and New Zealand Journal of Psychiatry 42, A26–A26.
Wechsler, H, Lee, JE, Kuo, MC, Lee, H (2000). College binge drinking in the 1990s: a continuing problem. Results of the Harvard School of Public Health 1999 College Alcohol Study. Journal of American College Health 48, 199210.
Weissman, MM, Bothwell, S (1976). Assessment of social adjustment by patient self-report. Archives of General Psychiatry 33, 11111115.
Wilfley, DE, Bishop, ME, Wilson, TG, Agras, WS (2007). Classification of eating disorders: toward DSM-V. International Journal of Eating Disorders 40, 123129.
Wilson, TG, Sysko, R (2009). Frequency of binge eating episodes in bulimia nervosa and binge eating disorder: Diagnostic considerations. International Journal of Eating Disorders 42, 603610.
Wonderlich, SA, Connolly, KM, Stice, E (2004). Impulsivity as a risk factor for eating disorder behavior: assessment implications with adolescents. International Journal of Eating Disorders 36, 172182.
Zimet, GD, Powell, SS, Farley, GK, Werkman, S, Berkoff, KA (1990). Psychometric characteristics of the Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment 55, 610617.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed