Among many college-age women with high weight and shape concerns, an 8-week, Internet-based cognitive-behavioral intervention can significantly improve weight and shape concerns for up to 2 years and reduce risk for the future eating disorders, at least in some high-risk groups. To our knowledge, this is the first study to show that EDs can be prevented in high-risk groups.
Unhealthful weight regulation methods and body image concerns, which predispose people to clinical and subclinical eating disorders, are common among high school and college students. For instance, 9% of high school senior girls in the United States reported self-induced vomiting or laxative use to control their weight in the past month according to a national study by the Centers for Disease Control and Prevention. The number of school women with body image concerns is even more prevalent. These attitudes and behaviors are associated with low confidence and self-esteem, shame, and other psychological problems. Self-induced vomiting and laxative use can lead to significant physical consequences, including dental erosion, esophageal tears, and other medical problems, and also are risk factors for the development of eating disorders.
In recent years, a number of potentially modifiable risk factors for eating disorders have been identified. Across populations and in longitudinal studies, excessive weight and shape concerns have been consistently associated with the onset of subclinical and clinical level eating disorders. Given their importance as a risk factor, many investigators have attempted to scale back weight and shape concerns. An Internet-based cognitive-behavioral intervention called Student Bodies, is effective in reducing weight and shape concerns. However, all of those previous studies were short-term with small sample sizes
There is evidence that universal prevention programs that target everyone in a sampling frame produce smaller effects than selected interventions that target only those at high risk for eating pathology. Several universal disorder prevention programs are simpler for high-risk participants than for the complete sample. High-risk individuals may be more motivated to engage in prevention programs, which may result in greater benefits. In addition, low-risk individuals may have less room for improvement on the outcomes. Thus, we hypothesized that intervention effects would be larger for selected programs versus universal programs. Because the key distinction between selected and universal programs is that the former are offered to high-risk individuals, we use the term “risk status of participants” to refer to this variable.
Females are at much higher risk for eating pathology than are males. Thus, females might be expected to be more likely to engage in eating disorder prevention programs than males. Younger adolescents might also possess limited insight, given that their abstract reasoning skills are still developing, which may constrain their ability to benefit from interventions. There might also be a floor effect because the rates of eating pathology are low during early adolescence. Thus, we hypothesized that prevention programs would produce larger effects for middle- to late-adolescent participants relative to preadolescent and early-adolescent participants.
Substance abuse prevention programs with an interactive format have been found to produce larger intervention effects than didactic programs. Participants in interactive programs may show greater intervention effects because this format helps them engage in the program content, which facilitates attitudinal and behavioral change. Interactive programs are also more likely to have participants apply the skills taught in the intervention, which should facilitate skill acquisition. Thus, we predicted that interactive programs would be more effective than didactic programs.
Thus, we hypothesized that intervention effects will be significantly larger for programs delivered by dedicated interventionists versus endogenous providers. Researchers have concluded that brief single-session eating disorder prevention interventions, typically one hour in length, are insufficient to produce lasting attitudinal and behavioral change. Multisession interventions may allow participants to reflect on intervention material between sessions, thereby maximizing internalization of program tenants. Multisession interventions also give participants a chance to try new skills and then return to the group for troubleshooting advice. We hypothesize that intervention effects would be stronger for. Intervention content should also influence whether a program produces effects. Interventions that target established risk factors for eating pathology should be more effective than those that focus on nonestablished risk factors.
Many sociocultural factors affect the development of eating disorders. In families, for example, mothers’ and fathers’ own body dissatisfaction and dieting behaviors have been associated with their children’s eating-related attitudes and behaviors. Parental weight-related teasing, negative comments about body shape, pressure to lose weight, and encouragement to diet have also been associated with body dissatisfaction, dieting, disordered eating behaviors, and eating disorders among both females and males. Furthermore, parents who engage in high levels of parental control, expressed emotionality, critical comments, hostility, or emotional overinvolvement and negate their child’s emotional needs are more likely to have children who develop eating disorders.
Peer influences on the development of eating disorders can also be broken down into a variety of factors. Peer pressure to conform to cultural ideals has been consistently identified as an important factor associated with the development of disordered eating behaviors, especially among adolescents. In particular, girls may learn attitudes and behaviors from their peers, such as the importance of being thin and dieting behaviors, through modeling, teasing, and conversations about body image and eating. Some studies have solely focused on the perceptions of either the general public or those with eating disorders. Both types of studies have identified a common set of risk factors, with public perceptions and the perceptions of individuals with eating disorders varying slightly. Overall, both populations have a basic understanding of what eating disorders are and characteristics of each eating disorder. However, despite this knowledge, many adults without eating disorders may be unsympathetic to those suffering from eating disorders, believe that having an eating disorder would not be distressing, and report that eating disorders are not difficult to treat.
The studies to date that have focused on identifying public perceptions of the factors associated with the development of eating disorders have surveyed individuals drawn from communities or schools. Typically, these samples have been quite large, numbering over 100 or even several hundred, and have included both females and males. Despite this, one pitfall of the research so far is that it’s often involved relatively small sample sizes, starting from 15 to 36. Only two studies have included samples over 50 individuals.
Similar to public perceptions of causal factors, people with eating disorders also identify individual and sociocultural factors. Individual factors commonly identified among samples of those who were diagnosed with eating disorders include perfectionism, emotional problems or distress, stress, unhappiness with appearance, high expectations of self, and lack of control. Behaviors and attitudes related to body image, such as weight loss activities, body image distortion, and a belief that thinness equals happiness, were also frequently identified as factors that related to the development of their disorders. Hereditary factors and sexual abuse were not indicated.
Eating disorders do not occur uniformly in all cultures at all times. An obsession with slimness—a core feature of eating disorders—is concentrated in cultures in which food is abundant. In cultures of scarcity, the perfect body shape is far more likely to be rotund, suggesting that ideals tend toward what’s difficult to realize . In this sense, then, a culture of caloric abundance may be considered a cause of eating disorders. It is important to note from the outset, however, that this cause is not specific; growing up in a culture of abundance, while perhaps increasing the chances of your developing an eating disorder, does not make it likely that you will develop an eating disorder; after all, most people in even the most affluent of cultures do not develop eating disorders. A culture of abundance should be considered at the most a background cause. Such a culture may value slimness, but whether a specific individual takes this valuation to a pathological extreme depends on additional factors. For instance, there is variation in the extent to which people internalize our culture’s valuation of slimness, and the extent of such internalization predicts body dissatisfaction, drive for thinness, and certain bulimic characteristics. What factors, though, determine the extent to which the worth of thinness is internalized? We must refer to more individual factors
Initially, it had been believed the idealization of slimness, and therefore the consequent tendency toward eating disorders, was concentrated within the upper-SES strata of the culture of abundance, where in any case , abundance is even greater. As our culture becomes increasingly homogenized, with media images of a thin ideal physique now permeating every corner of society, eating disorders have become correspondingly more democratic. Not surprisingly, the media are often blamed for the incidence of eating disorders, on the grounds that media images of idealized physiques motivate or maybe force people to aim to achieve slimness themselves. The more intense this dissatisfaction, the more likely that one will undertake attempts to lose weight.
Like the media, peer influence is often cited as a contributor to eating disorders. Adolescent girls learn certain attitudes and behaviors from their peers, both by example and encouragement and by way of teasing for failure to adhere to peer norms. Adolescent female friendship cliques tend to be homogenous with reference to body-image concerns, suggesting direct peer influence; however, the likelihood remains that cliques don’t influence their members so much as «recruit» them on the idea of shared concerns. It is difficult to weigh the relative importance of peer influence, as opposed, say, to the influence of the media or the family, which teach an equivalent lessons; some evidence suggests that peers and family are more potent influences than the media, whereas other studies find the reverse. Moreover, peer influence, like these other influences, is so broad and pervasive that it need to cause more pathology than actually occurs. analysis reminds us that not all peers are equally concerned about attaining a slim physique, so blanket condemnation of peer influence or pressure is unwarranted.
Media and peer pressure no doubt impinge more powerfully on females than on males, but we should not be too complacent about explaining the huge disproportion of females among eating disorder patients solely in terms of these influences. At the very least, we must consider the possibility that it is not simply that our culture exhorts females to be thin; it may be the case that females are more attentive than are males to such exhortations, for various reasons that are examined below.
Among American women, blacks were thought to be «protected» from eating disorders owing to the reduced pressure on them to be thin. Black men prefer heavier women than do white men, and black women and children have larger ideal physiques. Thus, when black women develop an eating disorder, it is more likely to be binge eating disorder, an eating disorder that does not prominently feature a drive toward thinness Still, recent case reports suggest that the diffusion of the thin ideal has reached the black subculture as well.
Within the past few years, several studies have found that attachment processes are abnormal in eating-disordered populations; insecure attachment is common during this group. Eating disorder patients generally describe a critical family environment, featuring coercive parental control. Adolescents who perceive family communication, parental caring, and parental expectations as low and those who report sexual or physical abuse are at increased risk for developing eating disorders. In contrast, perceived parental encouragement of autonomy is associated with less dieting behavior possibly serving a protective function against eating disorders.
Mothers of girls with eating disorders may well have an influence on their daughters’ pathology. They think that their daughters should lose more weight and describe them as less attractive than do comparison mothers or the women themselves. Mothers of eating disorder patients are more dissatisfied with the general functioning of the family system and are themselves more eating-disordered than are mothers of girls who do not have eating disorders. Direct maternal comments appear to be more powerful influences than is simple modeling of weight and shape concerns, although even modeling does appear to affect elementary schoolchildren’s weight and shape-related attitudes and behaviors. Mothers’ critical comments prospectively predicted eating disorder outcome for their daughters.
Mothers who themselves have an disorder tend to possess a negative influence on their children’s attitudes and behaviors, feeding them irregularly, using food for nonnutritive purposes, and expressing concern about their daughters’ weight as early because the age of two . By 5 years of age, these children exhibit greater negative affect than do the offspring of mothers without eating disorders and are at serious risk for the later development of an eating disorder. In fact, maternal eating disorders produce childhood feeding problems in offspring, and 50% of children of mothers with eating disorders have psychiatric disorders. Most studies of family functioning are, predictably, correlational, making it difficult to determine whether family dysfunction contributes to eating disorders, eating disorders contribute to family dysfunction, or some common factor contributes to both.
Poor interoceptive awareness is typically cited as a key feature of eating disorders, yet the precise nature of the deficits and their relationship to eating pathology remains unclear. Interoceptive awareness includes both acceptance of affective experience and clarity regarding emotional responses. Participants were 50 disorder patients who completed a checkup , clinical interview and symptom self-report measures. Results of regression analyses controlling for BMI and illness duration indicated that non-acceptance, not lack of clarity, was significantly related to dietary restraint. Findings suggest that negative reactions to emotional responses may contribute to the event or maintenance of dietary restraint. Results highlight the necessity to research the experience of arousal in individuals with eating disorders using experimental methods that deconstruct the components of interoceptive awareness, and thus the potential utility of treatments that increase comfort with affective experience for people with more restrictive patterns.
To conduct a regional, follow-up evaluation to assess the implementation and effectiveness of the National Eating Disorders Screening Program , conducted in high schools nationwide within the spring of 2000.Four New England high schools participated during a postscreen evaluation 1 to 2 months after implementation of NEDSP. A 35-item, self-report postscreen survey was administered to students in classrooms with assistance from school health staff and teachers. Data from 592 girls and 435 boys were included within the analysis within the four high schools participating within the program evaluation.
NEDSP helped to spot students in danger and encouraged students to talk to others about their screening score and disorder symptoms. One-quarter of women and one-fifth of boys reported talking with a minimum of one adult about their EAT-26 screening score. Overall, the scholars felt that the program was helpful and would recommend it to their friends. Early detection of eating disorders in adolescents may shorten the interval between onset of symptoms and treatment, which has the potential to scale back the length of illness and morbidity associated with untreated eating disorders.
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