Ruth H. Striegel-Moore

Risk factors for eating disorders.

The authors review research on risk factors for eating disorders, restricting their focus to studies in which clear precedence of the hypothesized risk factor over onset of the disorder is established. They illustrate how studies of sociocultural risk factors and biological factors have progressed on parallel tracks and propose that major advances in understanding the etiology of eating disorders require a new generation of studies that integrate these domains. They discuss how more sophisticated and novel conceptualizations of risk and causal processes may inform both nosology and intervention efforts.

Epidemiology and Natural Course of Eating Disorders in Young Women From Adolescence to Young Adulthood

OBJECTIVES To describe the epidemiology of eating disorders (ED) in a community sample of adolescent girls; to compare the clinical characteristics of full-syndrome (FS) and partial-syndrome (PS) ED cases; and to provide information about the continuity between adolescent ED and young adult psychopathology. METHOD A randomly selected sample of high school girls were assessed during adolescence (n = 891) and a year later (n = 810), and a stratified subset (n = 538) was assessed during their 24th year. The assessments included the Schedule for Affective Disorders and Schizophrenia for School-Age Children, the Longitudinal Interval Follow-up Evaluation, level of functioning, mental health treatment utilization, history of suicide attempt, and physical symptoms. RESULTS The incidence of ED was less than 2.8% by age 18, and 1.3% for ages 19 through 23. Comorbidity with other psychopathology (89.5%), but especially depression, was very high. FS- and PS-ED groups differed significantly from a no-disorder comparison group on most outcome measures, and more than 70% of the adolescent FS- and PS-ED cases met criteria for an Axis I disorder in young adulthood. CONCLUSIONS FS- and PS-ED are associated with substantial comorbidity, treatment seeking, impaired functioning, and risk for psychopathology in young adulthood.

A prospective study of disordered eating among college students

The prevalence of disordered eating among college students was assessed at the beginning and the end of the freshman year. The study aimed to identify factors related to worsening of disordered eating during the year. Questionnaires were completed by 590 males and 450 females at baseline and 546 males and 403 females at follow-up. At baseline, the prevalence of bulimia nervosa was 3.8% for females and 0.2% for males. The prevalence of disordered eating symptoms was considerably higher. The prevalence of bulimia nervosa at follow-up was virtually unchanged. However, many students experienced an onset of disordered eating during the year. Analyses of changes during the year revealed that worsening of disordered eating among females was associated with increasingly dysphoric feelings about weight, decreased ratings of their attractiveness, high perceived stress, increased weight dissatisfaction, and increased ineffectiveness.

One-year use and cost of inpatient and outpatient services among female and male patients with an eating disorder: Evidence from a national database of health insurance claims

OBJECTIVE This study examined rates and cost of inpatient and outpatient treatment among 1,932 patients with an eating disorder. METHOD One-year (1995) data were available through MarketScan, a national insurance database containing claims for 1,902,041 male patients and 2,005,760 female patients. RESULTS Female patients (n = 1,756, 0.14% of all females) were significantly more likely to have been treated for an eating disorder than male patients (n = 176, 0.016% of all males), and females received more days of treatment than males. Outpatient treatment was the norm, regardless of gender or type of eating disorder. Average number of days (inpatient or outpatient) was less than the minimum recommended by standards of care. Age-adjusted costs for the treatment of anorexia nervosa and bulimia nervosa were comparable to the cost of treatment for schizophrenia. DISCUSSION The utilization data are discussed in terms of barriers to care and treatment guidelines for eating disorders.

Binge eating in an obese community sample

OBJECTIVE The present study sought to examine the validity and utility of diagnostic criteria for binge-eating disorder (BED) by replicating and extending a study reported by de Zwaan and colleagues (International Journal of Eating Disorders, 15, 43-52, 1994). METHOD Four groups of obese individuals were selected from a large community-based sample of men and women: 33 women and 20 men with BED, 79 women and 40 men with subthreshold BED, 21 women and 39 men who reported recurrent overeating, and 80 female and 80 male normal controls. The groups were compared on measures of body image concern, dieting behavior, and associated psychological distress. RESULTS Individuals with BED were distinguishable from overeaters and normal controls on a number of psychological and behavioral variables. Few differences were found between subthreshold and full-syndrome BED, raising questions about the diagnostic validity of the frequency threshold. Men with BED did not differ from women with BED above and beyond the gender-related differences observed across all four groups. DISCUSSION Our findings support the view of BED as a distinct syndrome.

Subthreshold binge eating disorder

OBJECTIVE To examine the clinical features of subthreshold binge eating disorder (BED). METHOD Participants were recruited directly from the community as part of an ongoing study of risk factors for BED. Forty-four women with subthreshold BED were compared with 44 women with BED and 44 healthy controls on demographic characteristics, body mass index (BMI), eating disorder symptomatology, and psychiatric distress. Diagnoses were established using the Eating Disorder Examination (EDE). Participants completed the EDE-Questionnaire, the Brief Symptom Inventory, and were measured and weighed. RESULTS Adjusting for significant group differences in BMI, the two eating disorder groups did not differ significantly on measures of weight and shape concern, restraint, psychiatric distress, and history of seeking treatment for an eating or weight problem. DISCUSSION Given the importance of diagnostic status for access to treatment, further evaluation of the severity criterion specified for BED is needed.

Eating disorder symptoms in a cohort of 11 to 16‐year‐old black and white girls: The NHLBI growth and health study

OBJECTIVE This study sought to provide reference data for the Eating Disorder Inventory (EDI) with use of young adolescent black and white girls. Moreover, the study examined the relationship between race, age, socioeconomic status, and adiposity and each of the eight EDI scales. METHOD To achieve these aims, data were used that had been collected in Years 3, 5, and 7 as part of the National Heart, Lung, and Blood Institute Growth and Health Study, a longitudinal cohort study of risk factors for obesity in black and white girls. For the present report, data were available from 2,228 girls in Year 3, 2,056 girls in Year 5, and 1,902 girls in Year 7. RESULTS EDI scores were found to vary by race, age, socioeonomic status, and body weight of respondents. Black girls scored different from white girls on all EDI subscales. Scores on all but two subscales (Body Dissatisfaction, Drive for Thinness) decreased significantly with increasing age. Significant inverse associations were found between maximum parental education and all EDI subscales except Body Dissatisfaction and Perfectionism. Elevated body weight was associated significantly with Body Dissatisfaction, Drive for Thinness, Bulimia, Interoceptive Awareness, and Ineffectiveness. DISCUSSION Our results illustrate the importance of taking into consideration the potentially confounding role of demographic characteristics and body weight when comparing different race or ethnic groups on the EDI.

Eating disturbance and body image: A comparison of a community sample of adult black and white women

OBJECTIVE This study examined racial differences in eating disorder symptomatology in a community-based sample of middle-aged adult Black and White women and investigated predictors of body image dissatisfaction in these two different racial groups, since most research has focused on young adult White women. METHOD Subjects (538 Black and White women) completed the Eating Disorder Inventory and measures of social pressures about thinness and negative attitudes about overweight. RESULTS Black and White women reported comparable levels of eating disturbance. However, after controlling for degree of overweight, White women had significantly greater rates of body dissatisfaction than Black women. Nonetheless, both racial groups reported considerable body image dissatisfaction and similar factors were found to predict body dissatisfaction for Black and White women. DISCUSSION Our data and other recent data indicate that eating disturbance occurs across a much broader age, race, and socioeconomic distribution than previously suspected. Research implications are discussed.

Etiology of Eating Disorders in Women

Eating disorders have been studied extensively over the past several decades, yet research of their etiology has lagged behind treatment outcome research. This article reviews the challenges inherent in this research. It illustrates the epidemiologic designs that have been used to test risk factor hypotheses and describes the major studies designed to answer the question of what causes eating disorders. It points to significant gaps in knowledge, chief among them the absence of representative data on prevalence and correlates of eating disorders, and the lack of data regarding eating disorders in ethnic minority populations.

DISORDERED EATING, ACCULTURATION, AND TREATMENT‐SEEKING IN A COMMUNITY SAMPLE OF HISPANIC, ASIAN, BLACK, AND WHITE WOMEN

The purpose of this study was to examine disordered eating, acculturation, and treatment-seeking in a community sample of Hispanic, Asian, Black, and White women. Participants were 118 women with disordered eating (49 Hispanic, 21 Asian, 23 Black, and 25 White) and 118 healthy controls. Interviews were conducted to assess eating and weight-related behaviors, psychiatric symptoms, acculturation, and health care usage. Results indicated that the four ethnic groups were equally likely to present behavioral symptoms of bulimia, anorexia, or a binge-eating disorder. Hispanics were the most likely to use diuretics, and Black women were the most likely to use laxatives. Despite psychological distress among the eating disorder group, only a small percentage had received treatment during the past year; the eating disorder group was more likely than the controls to report that they had been denied treatment. More acculturated individuals were more likely to suffer from eating problems, and among the eating disorder group, less acculturated individuals were less likely to have received treatment.