Carmel Harrison

Eating‐disordered behavior in adolescent boys: Eating disorder examination questionnaire norms

OBJECTIVE We sought to provide normative data for the Eating Disorder Examination Questionnaire (EDE-Q) for adolescent boys. METHOD The EDE-Q was completed by 531 boys aged 12-18 years recruited from a number of schools in the Australian Capital Territory (ACT) region of Australia. Data for 1,135 female adolescents, recruited as part of the same research project, are provided for comparative purposes. RESULTS Scores on each the EDE-Q subscales and, with the exception of excessive exercise, the prevalence of each of the eating disorder behaviors assessed, were substantially higher among girls than among boys. Still, 6.0% of boys reported regular episodes of objective binge eating, 8.3% reported regular episodes of loss of control eating, 5.3% reported regular excessive exercise and 4.9% reported overvaluation of weight or shape. Eating-disordered behavior was more common among older adolescents than among younger adolescents and this was the case for both boys and girls. Reliability coefficients for the EDE-Q subscales were marginally lower in boys (0.70-0.94) than in girls (0.84-0.97). CONCLUSIONS The EDE-Q appears to be suitable for use in adolescent boys, with the qualification that eating and weight/shape control behaviors that are largely confined to males may not be adequately assessed. The lack of assessment of subjective binge eating episodes may also be problematic. There is a need for research addressing whether and to what extent different features are associated with distress and disability in boys as well as the validity of the EDE-Q assessment of these features when compared with interview assessment.

Disentangling body image: the relative associations of overvaluation, dissatisfaction, and preoccupation with psychological distress and eating disorder behaviors in male and female adolescents

ABSTRACT Objective The distinctiveness and relative clinical significance of overvaluation, dissatisfaction, and preoccupation with body weight/shape remains inconclusive. This study sought to add to the evidence by testing associations between these three body image constructs and indicators of clinical significance. Method Male and female secondary students (N = 1,666) aged 12–18 years completed a survey that included measures of dissatisfaction with, overvaluation of, and preoccupation with weight/shape, psychological distress, eating disorder behaviors, and basic demographic information. Conditional process analysis was employed to test the independent and mediating effects of overvaluation, dissatisfaction, and preoccupation on distress, dietary restraint, and objective binge eating. Results Overvaluation, dissatisfaction, and preoccupation were highly correlated (r = 0.47–0.84). In girls, preoccupation demonstrated the strongest independent and mediating effects on distress, dietary restraint, and binge eating; whereas neither the direct or indirect effects of dissatisfaction on distress and overvaluation on binge eating were significant. Among boys however, the direct and indirect effects of overvaluation, dissatisfaction, and preoccupation on distress and eating disorder behaviors were relatively equal. Discussion Preoccupation with weight/shape may be particularly clinically significant in girls, whereas all constructs of body image disturbance may be equally clinically significant in boys. The findings are consistent with the view that these constructs, while closely related, are distinct.

Sex differences in psychosocial impairment associated with eating disorder features in adolescents: A school-based study

OBJECTIVE To examine sex differences in psychosocial impairment associated with eating disorder features (EDF) in adolescents. METHOD Questionnaires that assessed EDF (extreme dietary restriction, objective binge eating, subjective binge eating, purging, excessive exercise, and weight/shape overvaluation) and psychosocial impairment (general psychological distress and quality of life) were completed by a school-based sample of adolescent males (n = 531) and females (n = 1135) in the Australian Capital Territory region of Australia. RESULTS Each of the EDF assessed was associated with significant impairment in both male and female participants and this was the case for measures of both general psychological distress and quality of life, the only exception being that subjective binge eating was associated with elevated levels of distress in girls but not boys. The occurrence of subjective binge eating was associated with greater impairment in quality of life in girls than in boys. Otherwise, the effects of EDF on psychosocial functioning did not differ by sex. The prevalence of most EDF was higher in girls than in boys, although EDF were not uncommon in boys. DISCUSSION There appear to be few differences between male and female adolescents in terms of psychosocial impairment associated with EDF. The findings support the need for preventive interventions that seek to reduce the adverse impact of EDF in both boys and girls. The logistic and policy challenges inherent in such efforts warrant greater consideration. Further research is needed to elucidate the help-seeking behavior of young men with EDF who experience psychosocial impairment.

Obesity and emotional well-being in adolescents : Roles of body dissatisfaction, loss of control eating, and self-rated health

Weak or inconsistent association between obesity and impairment in emotional well‐being in population‐based samples has led to efforts to identify mediating variables. This study examined the relative importance of body dissatisfaction (BD), loss of control (LOC) eating, and self‐rated health (SRH) in mediating the association between obesity and impairment in emotional well‐being in a school‐based sample of adolescents (boys, n = 437; girls, n = 950).

Correlates of binge eating with and without overvaluation of weight or shape: further evidence from a general population sample of women

The objective of this work was to further examine the status of the overvaluation of weight/shape in binge-eating disorder (BED) by examining correlates of probable BED with and without overvaluation. Subgroups of women – probable BED with overvaluation (n = 37), probable BED without overvaluation (n = 78), obese individuals who reported no binge eating (‘obese controls’) (n = 194), and normal-weight individuals who reported no binge eating (‘healthy controls’) (n = 573) – recruited from a general population sample, were compared on measures of eating disorder psychopathology, general psychological distress, and psychosocial functioning. Women with probable BED with overvaluation reported significantly higher levels of eating disorder psychopathology and general psychological distress, and significantly poorer psychosocial functioning, than those with probable BED without overvaluation. No significant differences on any outcome measures were found between women with probable BED without overvaluation and obese controls. The findings provide additional evidence for the role of overvaluation in indicating disorder severity among individuals with BED and variants of this disorder. Moreover, it highlights the need for further consideration of the status of overvaluation in relation to BED diagnostic criteria.

Adolescents' perception of the severity of binge eating disorder: a population-based study

Abstract Background: Binge eating disorder (BED) is relatively common in young people and is associated with marked impairment in physical and mental health. Aims: We examined perceptions of the severity of BED in a population-based sample of adolescents. Methods: Male (n = 531) and female (n = 1135) adolescents recruited from 12 Australian schools completed a survey that featured a vignette of a fictional female school student suffering from BED followed by a series of questions addressing perceptions of severity. Results: Approximately half of participants agreed or strongly agreed that BED is a serious problem (male: 52.0%; female: 63.2%) requiring professional treatment (male: 48.2%; female: 54.5%). Approximately one-third of boys (30.7%) believed that BED is primarily a problem of “lack of will power/self-control”, whereas one in five girls (19.3%) held this view. Less than half of participants (male: 42.7%; female: 44.1%) believed that someone with BED would be deserving of sympathy. Conclusion: The findings suggest that many adolescents, boys in particular, do not consider BED to be a serious mental health problem and believe that individuals with BED lack will-power and/or are undeserving of sympathy. Awareness and understanding of BED may need to be addressed in school-based mental health promotion programs.

Poor self-recognition of disordered eating among girls with bulimic-type eating disorders: cause for concern?

Bulimic‐type eating disorders are common among young women and associated with high levels of distress and disability and low uptake of mental health care. We examined self‐recognition of disordered eating and factors associated with this among female adolescents with bulimic‐type eating disorders (n = 139) recruited from a large, population‐based sample.

Loss of control eating with and without the undue influence of weight or shape on self-evaluation: evidence from an adolescent population

BackgroundThe overvaluation of weight and/or shape (“overvaluation”), a diagnostic criterion for anorexia nervosa and bulimia nervosa, is increasingly supported for inclusion in the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5) criteria of binge eating disorder (BED). However, current evidence has been largely confined to adult populations. The current study aims to examine the status of overvaluation among adolescents with loss of control (LOC) eating recruited from a large, population-based sample.MethodSubgroups of female adolescents LOC eating with overvaluation (n = 30); LOC eating without overvaluation (n = 58); obese no LOC eating (“obese control”) (n = 36); and “normal-weight control” (normal-weight, no LOC eating) (n = 439) – recruited from secondary schools within the Australian Capital Territory (ACT) were compared on measures of eating disorder psychopathology, general psychological distress and quality of life.ResultsParticipants in the LOC eating with overvaluation subgroup reported significantly higher levels of eating disorder psychopathology than all other groups, while levels did not differ between participants in the LOC eating without overvaluation and obese control subgroups. On measures of distress and quality of life there were no significant differences between LOC eating with and without overvaluation subgroups. Both reported significantly greater distress and quality of life impairment than normal-weight controls. LOC eating with overvaluation participants had significantly higher levels of distress and quality of life impairment than obese controls, whereas scores on these measures did not differ between LOC eating without overvaluation and obese control subgroups.ConclusionThe results suggest that the presence of overvaluation among adolescents with LOC eating indicates a more severe disorder in terms of eating disorder psychopathology, however may not indicate distress and disability as clearly as it does among adults with BED.

Indicators of clinical significance among women in the community with binge-eating disorder symptoms: Delineating the roles of binge frequency, body mass index, and overvaluation

OBJECTIVE This study aimed to investigate the relative contributions of binge eating, body image disturbance, and body mass index (BMI) to distress and disability in binge-eating disorder (BED). METHOD A community sample of 174 women with BED-type symptomatology provided demographic, weight, and height information, and completed measures of overvaluation of weight/shape and binge eating, general psychological distress and impairment in role functioning. Correlation and regression analyses examined the associations between predictors (binge eating, overvaluation, BMI), and outcomes (distress, functional impairment). RESULTS Binge eating and overvaluation were moderately to strongly correlated with distress and functional impairment, whereas BMI was not correlated with distress and only weakly correlated with functional impairment. Regression analysis indicated that both overvaluation and binge eating were strong and unique predictors of both distress and impairment, the contribution of overvaluation to variance in functional impairment being particularly strong, whereas BMI did not uniquely predict functional impairment or distress. DISCUSSION The findings support the inclusion of overvaluation as a diagnostic criterion or specifier in BED and the need to focus on body image disturbance in treatment and public health efforts in order to reduce the individual and community health burden of this condition.