Risk factors that predict future onset of each DSM–5 eating disorder: Predictive specificity in high-risk adolescent females.

Abstract

Objective Because no single report has examined risk factors that predict future onset each type of eating disorder and core symptom dimensions that crosscut disorders, we addressed these aims to advance knowledge regarding risk factor specificity. Method Data from 3 prevention trials that targeted young women with body dissatisfaction (N=1272; M age 18.5, SD 4.2) and collected annual diagnostic interview data over 3-year follow-up were combined to identify predictors of subthreshold/threshold anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and purging disorder (PD). Results Negative affect and functional impairment predicted onset of all eating disorders. Thin-ideal internalization, body dissatisfaction, dieting, overeating, and mental health care predicted onset of subthreshold/threshold BN, BED, and PD; positive thinness expectations, denial of cost of pursuing the thin ideal, and fasting predicted onset of 2 of these 3 disorders. Similar risk factors predicted core eating disorder symptom onset. Low BMI and dieting specifically predicted onset of subthreshold/threshold AN or low BMI. Only a subset of factors showed unique predictive effects in multivariate models, likely due to moderate correlations between the risk factors (M r = .14). Conclusions Results provide support for the theory that pursuit of the thin ideal and the resulting body dissatisfaction, dieting, and unhealthy weight control behaviors increase risk for binge/purge spectrum eating disorders, but suggest that youth who are inherently lean, rather than purposely pursuing the thin ideal, are at risk for AN. Impaired interpersonal functioning and negative affect are transdiagnostic risk factors, suggesting these factors should be targeted in prevention programs.

An experimental therapeutics test of whether adding dissonance-induction activities improves the effectiveness of a selective obesity and eating disorder prevention program

“…Exclusion criteria were a reported weight and height resulting in BMI <18 or >30 or a current diagnosis of DSM-IV anorexia nervosa, bulimia nervosa, or binge eating disorder. We allowed participants with a BMI of greater than 18 (which corresponds to the 10 th percentile) to enroll because data indicate that a low BMI increases risk for future onset of anorexia nervosa (16), making them ideal candidates for prevention programs designed to dually prevent obesity and eating disorders. Further, there is no evidence of iatrogenic effects of prevention programs dually targeting obesity and eating disorders for low-BMI individuals.…”

Disordered Eating Attitudes and Behaviors in Youth with Overweight and Obesity: Implications for Treatment

“…Studies have found that unhealthy weight control behaviors were endorsed by up to 76% of girls with obesity and 55% of boys with obesity and more extreme weight control behaviors were reported by 18% of girls with obesity and 6% of boys with obesity [20]. In comparison to their non-overweight peers, youth with overweight and obesity are more than twice as likely to endorse the use of unhealthy or extreme weight control behaviors [21], which merits clinical attention due to their association with a variety of adverse physical and psychosocial outcomes [22, 23], including future ED pathology [24]. …”

The relative importance of dissatisfaction, overvaluation and preoccupation with weight and shape for predicting onset of disordered eating behaviors and depressive symptoms over 15 years

“…Despite the centrality of body image disturbances in models of risk and maintenance (e.g., Fairburn, Cooper, & Shafran, 2003; Stice, Gau, Rohde, & Shaw, 2017), and in diagnostic criteria for eating disorders (American Psychiatric Association, 2013), this construct remains relatively loosely conceptualised, with terms often used interchangeably, or captured under umbrella concepts, such as ‘weight and shape concerns’ (e.g., La Mela et al, 2015; Murphy, Dooley, Menton, & Dolphin, 2016). …”