Kassandra Gratwick-Sarll

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.

Self-Recognition of Eating-Disordered Behavior in College Women: Further Evidence of Poor Eating Disorders “Mental Health Literacy”?

Self-recognition of eating-disordered behavior was examined among female college students (n = 94) with a high level of bulimic-type eating disorder symptoms. A vignette was presented describing a fictional young woman with bulimia nervosa. Participants were asked whether they might currently have a problem such as the one described, while also completing self-report measures of eating disorder symptoms, general psychological distress, and functional impairment. Less than half (47.9%) of participants believed that they currently had a problem with their eating. In both bivariate and multivariable analysis, the variables most strongly associated with self-recognition were overall levels of eating disorder psychopathology, prior treatment for an eating problem, and the use of self-induced vomiting as a means of controlling weight or shape. No other eating disorder behaviors were independently associated with self-recognition. The findings support the hypothesis that young women with eating disorder symptoms may be unlikely, or at least less likely, to recognize a problem with their eating behavior when that behavior does not entail self-induced vomiting. Health promotion and early intervention programs for eating disorders may need to address the perception that, among young women of normal or above-average body weight, only problems with eating that involve self-induced vomiting are pathological.

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).

Improving Eating Disorders Mental Health Literacy: A Preliminary Evaluation of the "Should I Say Something?" Workshop

A repeated measures, uncontrolled, preliminary evaluation of a single 3-hour workshop—“Should I Say Something?”—aimed at improving eating disorders mental health literacy, was conducted in a sample of 177 university undergraduates. Following participation in the workshop, significant increases in eating disorder recognition and knowledge, and significant decreases in stigmatizing attitudes, were reported by participants. Moreover, 85% of participants reported that they provided assistance to someone whom they suspected had a mental health condition, including an eating disorder, during the 3-month follow-up period. This study provides preliminary evidence that “Should I Say Something?” may be effective in improving the mental health literacy of young people.

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.

Improving eating disorders "mental health literacy" in young people: a preliminary evaluation.

Methods Participants were 177 young men and women recruited from a University campus. Key aspects of ED-MHL, including awareness and understanding of the nature and treatment of eating disorder (ED) behaviour, the importance of early, appropriate help-seeking and barriers to treatment such as poor insight and attitudes likely to be conducive to stigma, were assessed by means of self-report questionnaire before and immediately after the intervention. The intervention comprised a single, three-hour workshop, developed by Hart and colleagues, designed to address a broad range of issues relating to the nature and treatment of EDs.