Eating disorder symptom trajectories in adolescence: effects of time, participant sex, and early adolescent depressive symptoms

Abstract

BackgroundAdolescence is a period of developmental risk for eating disorders and eating disorder symptoms. This study aimed to describe the prevalence and trajectory of five core eating disorder behaviours (binge eating, purging, fasting, following strict dietary rules, and hard exercise for weight control) and a continuous index of dietary restraint and eating, weight and shape concerns, in a cohort of male and female adolescents followed from 14 to 20 years. It also aimed to determine the effect of early adolescent depressive symptoms on the prevalence and trajectory of these different eating disorder symptoms. Participants (N = 1,383; 49% male) were drawn from the Western Australian Pregnancy Cohort (Raine) Study, a prospective cohort study that has followed participants from pre-birth to age 20 years. An adapted version of the Eating Disorder Examination-Questionnaire was used to assess eating disorder symptoms at ages 14, 17 and 20 years. The Beck Depression Inventory for Youth was used to assess depressive symptoms at age 14. Longitudinal changes in the prevalence of eating disorder symptoms were tested using generalised estimating equations and linear mixed models.ResultsSymptom trajectories varied according to the eating disorder symptom studied, participant sex, and the presence of depressive symptoms in early adolescence. For males, eating disorder symptoms tended to be stable (for purging, fasting and hard exercise) or decreasing (for binge eating and global symptom scores) from 14 to 17 years, and then stable to 20 years. For females, fasting and global symptom scores increased from age 14 to peak in prevalence at age 17. Rates of binge eating in females were stable from age 14 to age 17 and increased significantly thereafter, whilst rates of purging and hard exercise increased from age 14 to age 17, and then remained elevated through to age 20. Depressive symptoms at age 14 impacted on eating disorder symptom trajectories in females, but not in males.ConclusionsPrevention, screening and intervention initiatives for adolescent eating disorders need to be tailored to gender and age. Purging behaviour appears to be an important target for work with early to middle adolescent females.

Risk factors for binge eating and purging eating disorders: Differences based on age of onset

“…The Raine Study eating disorder assessment items, and diagnostic algorithms for determining DSM‐5 eating disorders, are outlined in detail elsewhere . Briefly, eating disorder symptoms were assessed using 24 self‐report items adapted from the Eating Disorder Examination‐Questionnaire (EDE‐Q) .…”

The role of sensation seeking and motivations for eating in female and male adolescents who binge eat

“…For this reason, many researchers have tried to explore different factors as possible triggers for binge eating (e.g. Allen, Crosby, Oddy, & Byrne, 2013;NeumarkSztainer et al, 2011). Studies on the dispositional characteristics have identified impulsivity trait as consistently associated with binge eating (e.g.…”

Typical patterns of disordered eating among Swedish adolescents: associations with emotion dysregulation, depression, and self-esteem

“…The debate over whether DE should be viewed as dimensional or categorical has raged for years, but both views seem desirable for representing the full spectrum of DE and detecting DE as early as possible [50]. Usually, DE has been studied by first examining a number of DE indicators, such as eating and/or shape concerns, and then relating either individual DE indicators or the total scores of those indicators to different psychosocial problems such as depression or self-esteem (e.g., [2, 40, 43]). A variable-oriented approach, built on the examination of linear relationships and mean differences, provides important knowledge about the relationships between various DE indicators and psychosocial difficulties.…”

“…DE, regardless of the severity, is also correlated with depressive thoughts [9], while depressive symptoms at age 14 appear to increase eating disorder symptoms in Australian girls at age 20 [2]. Furthermore, depressive symptoms, other psychiatric disorders, and suicidality were all found to be associated with DE among American adolescents of both genders [43, 45], while negative affect is a good predictor of DE in young men [25].…”