Neil J. McLean

Elite athletes: effects of the pressure to be thin.

This study represented the first attempt to examine the prevalence of eating disorders in a large sample of both male and female elite athletes compared to a matched control group of non-athletes. The subjects were 263 Australian elite athletes representing a variety of sports, and 263 non-athletes. All subjects were interviewed using the Composite International Diagnostic Interview and completed a number of self-report questionnaires. Both male and female athletes competing in sports that emphasise a lean body shape or a low body weight evidenced a significantly higher prevalence of eating disorders and eating disorder symptoms than other athletes and non-athletes. The results suggest that athletes do, in fact, have a higher prevalence of eating disorders than non-athletes. However, it is not so much being an athlete that places an individual at increased risk for developing an eating disorder; rather it is athletes competing in sports which emphasise the importance of a thin body shape or a low body weight who appear to be particularly vulnerable.

Eating disorders in athletes: A review of the literature

Over the last two decades an increasing amount of research has begun to examine the issue of eating disorders in athletes. While a number of studies in this area have been published, the results have not been able to clarify the nature of the relationship between athletic involvement and eating problems. This review critically evaluates existing studies of eating disorders in athletes, highlighting various methodological limitations. Studies are grouped under three main headings: uncontrolled studies; controlled studies; and studies comparing athletes with different body type requirements. A fourth section of the paper evaluates studies which have addressed the issue of gender differences in eating disorders among athletes. Suggestions are made for guidelines that will improve future research in this area.

Low–moderate prenatal alcohol exposure and risk to child behavioural development: a prospective cohort study

Please cite this paper as: Robinson M, Oddy W, McLean N, Jacoby P, Pennell CE, de Klerk N, Zubrick S, Stanley F, Newnham J. Low–moderate prenatal alcohol exposure and risk to child behavioural development: a prospective cohort study. BJOG 2010;117:1139–1152.

First-time mothers' expectations of parenthood: What happens when optimistic expectations are not matched by later experiences?

Becoming a parent is a major developmental transition of adulthood. Individuals often have optimistic expectations about parenthood, yet this transition also presents a number of challenges. The authors investigated whether new parents have overly optimistic expectations about parenthood and, if they do, how this influences their adjustment to this role. The sample consisted of 71 first-time mothers who completed questionnaires during pregnancy and at 4 months postpartum. The study assessed womens expectations of caring for their infant and the influence parenthood would have on their well-being and their relationships with others. Most womens expectations were matched or exceeded by their parenting experiences. However, where experiences were negative relative to expectations, there was greater depression symptomatology and poorer relationship adjustment.

Coping with the challenges of recovery from stroke: long term perspectives of stroke support group members.

Recovery from stroke poses significant physical and psychological challenge. To develop appropriate psychological support interventions, increased understanding of the challenge and coping behaviours that promote adjustment is critical. This study presents results from a series of focus groups with stroke support group members. The evolution of challenges faced during hospitalization, rehabilitation and into the longer term is described. The active, social and cognitive coping strategies reported as helpful are explored. In the long term, acceptance of life changes, engagement in new roles and activities and the presence of social support appear to be key factors in post-stroke adjustment.

Overconcern with weight and shape is not the same as body dissatisfaction: Evidence from a prospective study of pre-adolescent boys and girls

Overconcern with weight and shape and body dissatisfaction have both emerged as significant predictors of disordered eating. However, it is unclear how these constructs relate to each other, and if each has different antecedents and consequences. This study aimed to identify prospective predictors of each construct and to determine their relative importance in predicting dietary restraint and binge eating. Eight- to 13-year-old boys and girls (N=259) were assessed at baseline and one-year follow-up, using a range of measures that included the Child Eating Disorder Examination. Psychosocial variables predicted overconcern with weight and shape whilst objective weight predicted body dissatisfaction. Body dissatisfaction and weight and shape concern predicted restraint, and weight and shape concern and restraint predicted binge eating. Findings provide support for the theoretical differences between body dissatisfaction and overconcern with weight and shape, and highlight the importance of focusing on specific body image variables.

The onset and course of binge eating in 8- to 13-year-old healthy weight, overweight and obese children

OBJECTIVES This study aimed to (1) determine the prevalence of binge eating and overeating in 8- to 13-year-old children; (2) identify factors that cross-sectionally predict binge eating and overeating; and (3) identify factors that prospectively predict onset of binge eating and overeating. METHODS Participants were 259 boys and girls who were assessed at baseline and one-year follow-up, using a range of semi-structured interviews that included the Child Eating Disorder Examination. RESULTS At baseline, 9% of children reported binge eating and 6% reported overeating. Obese children were most at risk for these behaviours. Dietary restraint and the tendency to use food to regulate emotions were significant in predicting binge eating onset prospectively, and eating concern was significant in predicting binge eating cross-sectionally. CONCLUSION Results provide support for current cognitive-behavioural models of binge eating, and have implications for guiding binge eating prevention and intervention efforts with children.

Hypertensive diseases of pregnancy and the development of behavioral problems in childhood and adolescence: the Western Australian Pregnancy Cohort Study.

OBJECTIVE To examine whether maternal gestational hypertension and preeclampsia are associated with behavioral problems in offspring throughout childhood and early adolescence. STUDY DESIGN We conducted a prospective cohort study of 2804 women in the Western Australian Pregnancy Cohort Study and their children observed at age 2, 5, 8, 10, and 14 years. The Child Behavior Checklist (CBCL) was used to measure problem child behavior with continuous z-scores and clinical cutoff points. Control variables included known biomedical, sociodemographic, and psychological factors. RESULTS After adjustment, with general linear model analyses children of women with gestational hypertension were shown to be more likely to have higher CBCL z-scores, indicative of poorer behavior, from 8 years on, with the largest difference seen at 14 years. Children of mothers with preeclampsia were more likely to have lower CBCL z-scores, indicative of pro-social behaviors. The multivariable logistic regression analysis showed that gestational hypertension was predictive of clinically significant CBCL T-scores from age 8 to 14 years. This association was significant for externalizing behavior, such as delinquent and aggressive behavior, and for internalizing behavior at age 14 years. Unexpectedly, preeclampsia reduced internalizing morbidity at ages 5 and 8 years. CONCLUSIONS The opposing effect on child and adolescent behavior of gestational hypertension and preeclampsia warrants further attention.

Smoking cessation in pregnancy and the risk of child behavioural problems: a longitudinal prospective cohort study

Background The aim of this study was to examine the influence of smoking in pregnancy on child and adolescent behavioural development, in comparison with mothers who ceased smoking in the first 18 weeks of pregnancy and with those who never smoked, in a large prospective pregnancy cohort. Methods The Western Australian Pregnancy Cohort (Raine) Study provided comprehensive data from 2900 pregnancies. Smoking was assessed at 18 weeks gestation, and children were followed up at ages 1, 2, 3, 5, 8, 10 and 14 years. The Child Behaviour Checklist (CBCL) was used to measure problem child behaviour with continuous z-scores and clinical cut points at ages 2, 5, 8, 10 and 14 years. Potential confounders included maternal and family sociodemographic characteristics and alcohol exposure. Results After adjusting for confounders, children of light smokers who quit smoking by 18 weeks gestation had significantly lower CBCL total z-scores, indicative of better behaviour, than children of women who never smoked, children of heavy smokers who quit and continuing smokers. Maternal smoking during pregnancy resulted in higher CBCL total, internalising and externalising scores and a higher risk of clinically meaningful behaviour problems in children from ages 2 to 14. Conclusion The maternal decision not to quit smoking, or the inability to quit smoking, during pregnancy appears to be a particularly strong marker for poor behavioural outcomes in children. There is a need for a greater understanding of the psychosocial characteristics associated with the decision and ability to quit smoking in pregnancy.

Avoidance of affect in the eating disorders.

The Distress Tolerance Scale (DTS) (Corstorphine, Mountford, Tomlinson, Waller, & Meyer, 2007) measures the tendency to use cognitive and behavioural strategies to manage the experience of positive and negative affect. This paper aimed to explore the factor structure of the DTS, particularly in relation to avoidance of affect. Participants were 227 female university students (non-clinical sample) and 257 clients seeking treatment for an eating disorder (clinical sample). Confirmatory factor analysis was used to test two previously proposed factor structures of the DTS in the non-clinical sample. Both of these models were found to be a poor fit to the data. Subsequently, nine items measuring avoidance of affect were analysed using exploratory factor analysis in the non-clinical sample. Three factors of avoidance of affect were identified (Behavioural Avoidance of Positive Affect, Behavioural Avoidance of Negative Affect, and Cognitive Avoidance of Affect). Confirmatory factor analysis supported this avoidance of affect model in the clinical sample. Significant correlations were observed between avoidance of affect subscales and eating psychopathology in both samples. Results suggest that the avoidance of positive emotion may be an important factor in eating disorders. It is recommended that future studies broaden their investigation of the role of emotion in eating disorders to include both negative and positive emotion.