Diann M. Ackard

Date violence and date rape among adolescents: associations with disordered eating behaviors and psychological health

OBJECTIVES The goal of the study was to assess the prevalence of date violence and rape in adolescents, to examine associations between date violence and rape and disordered eating behaviors and psychopathology, and to determine if these associations remain significant after controlling for sociodemographic characteristics and other physical and sexual abuse by an adult. METHOD A Minnesota school-based sample of 81,247 boys and girls in 9th and 12th grades completed the 1998 Minnesota Student Survey. RESULTS Overall, approximately 9% of girls and 6% of boys had experienced date violence or rape. Significant differences across race and grade were found. Date violence and rape is associated with higher rates of disordered eating behaviors and suicidal thoughts and attempts, and lower scores on measures of emotional well-being and self-esteem. Over 50% of youth reporting both date violence and rape also reported attempting suicide. Controlling for race and age, adolescents who have experienced both date violence and rape were more likely to use laxatives (OR: girls = 5.76; boys = 28.22), vomit (OR: girls = 4.74; boys = 21.46), use diet pills (OR: girls = 5.08; boys = 16.33), binge eat (OR: girls = 2.15; boys = 5.80), and have suicidal thoughts or attempts (OR: girls = 5.78; boys = 6.66) than their nonabused peers. These odds were weakened but remained significant after controlling for other abuse by an adult. Furthermore, a greater percentage of girls and boys who reported an abusive dating experience also reported repeat victimization (physical or sexual abuse perpetrated by an adult) when compared to their peers without an abusive dating experience. DISCUSSION Abusive experiences during dating relationships may disrupt normal developmental processes, including the development of a stable self-concept and integrated body image during adolescence. This disruption manifests itself through thoughts, feelings, and behaviors. Further research should explore effects of adverse adolescent dating experiences.

Dieting frequency among college females: Association with disordered eating, body image, and related psychological problems

OBJECTIVE To examine associations between dieting frequency and eating disorder behaviors, body satisfaction, and related factors. METHOD Females (N=345) whose average age and body mass index (BMI) were 20.58 and 21.79, respectively, were grouped into three categories of lifetime dieting frequency (never, 1-5 times, or 6 or more times) and matched on current BMI across categories. RESULT Positive associations were found between dieting frequency and eating disorder symptoms and related problems such as body dissatisfaction, current body size perception, depression, exercise preoccupation, and feelings of ineffectiveness and insecurity. Dieting frequency was inversely associated with self-esteem, ideal body size, emotional regulation, and impulse control. DISCUSSION Independent of current BMI, frequency of dieting behaviors is strongly associated with negative emotions and problematic behaviors. As this study is correlational in nature, future longitudinal studies should ascertain the sequence of onset of these experiences.

The Link Between Body Dissatisfaction and Self-Esteem in Adolescents: Similarities Across Gender, Age, Weight Status, Race/Ethnicity, and Socioeconomic Status

PURPOSE The present study examined whether the cross-sectional association between body dissatisfaction and low self-esteem varies across gender, age, body weight status, race/ethnicity, and socioeconomic status (SES). We also examined the association longitudinally. METHODS A school-based survey of eating, weight, and related attitudes was conducted with a diverse sample of adolescents aged 11-18 years (N = 4,746). Height and weight were measured in the schools at Time 1. Participants were resurveyed through mails 5 years later (Time, 2; N = 2,516). RESULTS The relationship between body dissatisfaction and self-esteem was strong and significant in both boys and girls (all p values < .0001), and did not differ significantly between genders (p = .16), or between the middle school and high school cohorts in either boys (p = .79) or girls (p = .80). Among girls, the relationship between body dissatisfaction and self-esteem was strong, but did vary across weight status, race/ethnicity, and SES (all p values = .0001-.03). The relationship was nonsignificant in underweight girls (p = .36), and weaker but still significant among black, Asian, and low SES group girls (all p values < .0001) in comparison to white and high SES group girls. Among boys, the association did not differ significantly across demographic groups (all p values = .18-.79). In longitudinal analyses, the strength of the association did not change significantly as adolescents grew older. CONCLUSIONS Findings indicate that body dissatisfaction and self-esteem are strongly related among nearly all groups of adolescents. This suggests the importance of addressing body image concerns with adolescents of all backgrounds and ages.

Effect of body image and self‐image on women's sexual behaviors

OBJECTIVES To evaluate the relationship between womens body image, self-image, and sexual behaviors; to determine the effect of body image on personal and sex variables; and to identify factors that contribute to more frequent and greater comfort with sex. METHOD A magazine survey that included items about body image, self-image, and sexual behaviors was completed by 3,627 women. RESULTS Women more satisfied with body image reported more sexual activity, orgasm, and initiating sex, greater comfort undressing in front of their partner, having sex with the lights on, trying new sexual behaviors, and pleasing their partner sexually than those dissatisfied. Positive body image was inversely related to self-consciousness and importance of physical attractiveness, and positively related to relationships with others and overall satisfaction. Body image was predictive only of ones comfort undressing in front of partner and having sex with lights on. Overall satisfaction was predictive of frequency of sex, orgasm, and initiating sex, trying new sexual behaviors, and confidence in giving partner sexual pleasure. DISCUSSION Results indicate that overall self-image and body image are significant predictors of sexual activity. Directions for future research are discussed.

The "family meal": Views of adolescents

Abstract The study objectives were to (1) increase our knowledge about family meal patterns of adolescents, (2) identify factors that adolescents perceive as reasons for not eating meals with their family, and (3) assess adolescents’ perceptions on whether they eat more healthful foods at family meals than in other eating situations. Focus group discussions were conducted with 141 adolescents from 7th and 10th grade health education classes from urban public junior and senior high schools in Minnesota. Twenty-one focus groups were audiotaped, tapes were transcribed verbatim, transcripts were reviewed for emerging themes, and themes were coded using content analysis procedures. For some adolescents, family meals were part of their daily routine, whereas for others, family meals were not the norm. Diversity also existed with regard to the context of family meals, such as activities during meals and settings for meals. Major reasons for not having meals as a family included parent and teen schedules, teen desire for autonomy, dissatisfaction with family relations, and dislike of food served at family meals. Most of the adolescents thought that they would eat more healthful foods if they ate more often with their families. Key factors that appeared to influence whether participation in family meals would lead to a more healthful diet included food availability at meals, rules around mealtimes, and health-related attitudes of family members. There is great diversity in both the quantity and quality of meals in the families of adolescents. Health care providers working with youth and their families should inquire about family meals and encourage the practice of eating with family members, taking into account what is feasible for a particular family.

Alexithymia: Relationship to personality disorders

Previous studies suggested an association of alexithymia with other personality models, as well as with various psychiatric syndromes. However, with regard to current diagnostic systems, the clinical validity of alexithymia remains to be established. In a sample of 182 psychiatric outpatients, the lifetime prevalence of DSM-III-R axis I disorders was determined by Structured Clinical Interview for DSM-III-R (SCID) interviews. In addition, DSM-III-R personality disorders were assessed using the Personality Diagnostic Questionnaire-Revised (PDQ-R). On the Toronto Alexithymia Scale (TAS), 17% of the sample scored in the alexithymic range. A series of stepwise multiple regression analyses were performed, exhibiting no relationship between alexithymia and any of the DSM-III-R axis I lifetime diagnoses. In contrast, schizotypal, dependent, and avoidant personality dimensions, as well as a lack of histrionic features, emerged as significant predictors of alexithymia, which further supports the conceptualization of alexithymia as a personality dimension.

Association between puberty and disordered eating, body image, and other psychological variables

OBJECTIVE To examine associations between puberty and disordered eating, body image, and other psychological variables. METHOD Females were grouped into three categories of age at puberty onset (Study 1; N = 267) as well as three categories of self-perception of prepubertal weight (Study 2; N = 222). Participants in both studies were matched on current body mass index (BMI) across categories. RESULTS Females who perceived themselves to be overweight prior to puberty scored significantly higher on measures of disordered eating, body dissatisfaction, asceticism, drive for thinness, impulse regulation, interoceptive awareness, and perfectionism. They also perceived their current body figure to be larger when compared with those who believed they were average or underweight prior to puberty. Age at puberty onset was not significantly associated with disordered eating, body dissatisfaction, depression, or self-esteem. However, females who entered puberty at an earlier age scored higher on measures of asceticism, drive for thinness, impulse regulation, and social insecurity. They also chose a more slender ideal body figure than those who entered at an older age. DISCUSSION Females who believe they are overweight prior to puberty may be at risk for the development of disordered eating, body image dissatisfaction, and related problems. Age at puberty onset is not a consistent risk factor of pathological eating.

Casual sex and psychological health among young adults: Is having "friends with benefits" emotionally damaging?

CONTEXT Speculation in public discourse suggests that sexual encounters outside a committed romantic relationship may be emotionally damaging for young people, and federal abstinence education policy has required teaching that sexual activity outside of a marital relationship is likely to have harmful psychological consequences. METHODS In 2003-2004, a diverse sample of 1,311 sexually active young adults (mean age, 20.5) participating in a longitudinal study in Minnesota completed a survey including measures of sexual behavior and psychological wellbeing. Chi-square tests were used to compare the prevalence of recent casual partnerships by selected demographic and personal categories. General linear modeling was then used to compare mean levels of each psychological wellbeing measure between those reporting recent casual partners and those reporting committed partners; partner type was measured both dichotomously and categorically. RESULTS One-fifth of participants reported that their most recent sex partner was a casual partner (i.e., casual acquaintance or close but nonexclusive partner). Casual partnerships were more common among men than among women (29% vs. 14%), and the proportions of male and female respondents reporting a recent casual partner differed by race or ethnicity. Scores of psychological well-being were generally consistent across sex partner categories, and no significant associations between partner type and well-being were found in adjusted analyses. CONCLUSIONS Young adults who engage in casual sexual encounters do not appear to be at greater risk for harmful psychological outcomes than sexually active young adults in more committed relationships.

Alexithymia, obesity, and binge eating disorder

Eighty-three obese subjects with binge eating disorder (BED) were compared with 99 obese subjects not meeting criteria for BED on the Toronto Alexithymia Scale (TAS). Overall, the subjects in our sample were not significantly alexithymic, the mean global TAS score being 62.8 (SD = 10.2) which is comparable with the values found in non-patient control samples. Furthermore, the mean TAS scores did not differ between obese subjects with and without BED. However, we found a slightly higher prevalence of alexithymia (TAS total score 74 and above) in BED subjects compared with non-BED subjects (24.1% and 11.1%, respectively). A series of stepwise multiple regression analyses were run, exhibiting a significant relationship between the TAS and educational level and the Eating Disorder Inventory (EDI) subscales Interpersonal Distrust and Ineffectiveness. Age, body mass index, measures of depression, and eating pathology did not predict TAS scores.

Family mealtime while growing up: associations with symptoms of bulimia nervosa.

The purpose of this study was to examine associations between bulimia nervosa and family meals. Female college students ( N = 560) completed surveys assessing eating disorder pathology, family meal frequency, and family environment. Results indicate that dinner was the meal most frequently shared with family members. The frequency of eating dinner together as a family was inversely associated with scores on two measures of bulimia, and these associations remained statistically significant after controlling for other familial factors. Familial variables associated with bulimic symptoms included low cohesion and independence, and high achievement orientation. While results indicate that bulimic behaviors are inversely associated with the frequency of a family dinner, these relationships need to be explored within the context of broader family dynamics. Individuals working in primary and secondary prevention settings should evaluate family meal patterns and dynamics in families with a member with an eating disorder.