Sequencing of symptom emergence in anorexia nervosa, bulimia nervosa, binge eating disorder, and purging disorder and relations of prodromal symptoms to future onset of these disorders.

Abstract

The objective of this study was to characterize the temporal sequencing of symptom emergence for anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and purging disorder (PD), as well as to test whether prodromal symptoms increase risk for future onset of each type of eating disorder and compare the predictive effects to those of established risk factors. Data from four prevention trials that targeted highrisk young women with body image concerns (N = 1,952; M age = 19.7, SD = 5.7) and collected annual diagnostic interview data over 3-year follow-up were combined to address these aims. Regarding behavioral symptoms, compensatory weight control behaviors typically emerged first for AN, BN, and PD, whereas binge eating typically emerged first for BED. Regarding cognitive symptoms, for AN, weight/shape overvaluation typically emerged first, whereas for BN, BED, and PD, overvaluation typically emerged simultaneously with feeling fat and fear of weight gain. Binge eating, compensatory behaviors, weight/shape overvaluation, fear of weight gain, and feeling fat predicted BN, BED, and PD onset, whereas weight/shape overvaluation, fear of weight gain, and lower than expected body mass index predicted AN onset. Predictive effects of prodromal symptoms were similar in magnitude to those of established risk factors: Collectively, prodromal symptoms and risk factors predicted onset of specific eating disorders with 67-83% accuracy. Results suggest that compensatory weight control behaviors and cognitive symptoms are likely to emerge before binge eating in the various eating disorders and that offering indicated prevention programs to youth with prodromal symptoms may be an effective way to prevent eating disorders. General Scientific SummaryCompensatory weight control behaviors, overvaluation of weight/shape, feeling fat, and fear of weight gain typically emerge before binge eating for anorexia nervosa, bulimia nervosa, and purging disorder, but binge eating typically emerges first for binge eating disorder. Prodromal symptoms showed somewhat distinct predictive effects for future onset of specific eating disorders that were similar in magnitude to predictive effects of established risk factors. Findings imply it may be useful to offer indicated prevention programs to youth with prodromal symptoms.

Comparing healthy adolescent females with and without parental history of eating pathology on neural responsivity to food and thin models and other potential risk factors.

“…The higher feelings of fatness despite comparable zBMI and higher self-rated emotionality despite no differences in limbic circuitry response to negative mood induction suggest that parental-history-positive youth may perceive themselves more negatively despite no differences on objective measures of these constructs. Theoretically, overvaluation of weight/shape and feeling fat may increase risk for emergence of compensatory weight control behaviors, which appear to be a key gateway symptom to emergence of EDs (Stice et al, 2021).…”

“…Low Body Mass Index (BMI), weight suppression, weight/shape overvaluation, fear of weight gain, negative affect, and psychosocial impairment have predicted onset of anorexia nervosa (AN; Stice et al, 2017;Stice et al, 2020;Stice et al, 2021). Pressure for thinness, pursuit of the thin ideal, weight/shape overvaluation, fear of weight gain, body dissatisfaction, feeling fat, overeating, binge eating, dieting, weight suppression, compensatory behaviors, negative affect, and psychosocial impairment have predicted onset of bulimia nervosa (BN; Killen et al, 1996;Patton et al, 1999;Stice et al, 2011, Stice et al, 2017Stice et al, 2020;Stice et al, 2021). Pursuit of the thin ideal, weight/shape overvaluation, fear of weight gain, body dissatisfaction, feeling fat, dieting, binge eating, negative affect, and psychosocial impairment have predicted onset of binge eating disorder (BED; Stice et al, 2017Stice et al, , 2020.…”

“…Pressure for thinness, pursuit of the thin ideal, body dissatisfaction, parental overweight, dieting, negative affect, and female sex have predicted onset of any ED (Allen et al, 2014; Dakanalis et al, 2017; Jacobi et al, 2011; Rohde et al, 2015). Low Body Mass Index (BMI), weight suppression, weight/shape overvaluation, fear of weight gain, negative affect, and psychosocial impairment have predicted onset of anorexia nervosa (AN; Stice et al, 2017; Stice et al, 2020; Stice et al, 2021). Pressure for thinness, pursuit of the thin ideal, weight/shape overvaluation, fear of weight gain, body dissatisfaction, feeling fat, overeating, binge eating, dieting, weight suppression, compensatory behaviors, negative affect, and psychosocial impairment have predicted onset of bulimia nervosa (BN; Killen et al, 1996; Patton et al, 1999; Stice et al, 2011, Stice et al, 2017; Stice et al, 2020; Stice et al, 2021).…”

“…We did not focus on restricting AN because the risk processes appear somewhat distinct (Stice et al, 2017; Stice et al, 2020). First, as pursuit of the thin ideal has predicted future onset of any ED (Dakanalis et al, 2017; Rohde et al, 2015) and BN, BED, and PD (Stice et al, 2017; Stice et al, 2021), we hypothesized that parental-history-positive youth would show greater reward region response to thin models than parental-history-negative youth. Reward valuation is a key Research Domain Criteria (RDoC) construct from the positive valence system (Lilienfeld, 2014).…”

‘Feeling fat’ amid the COVID-19 pandemic: Examining the role of emotion dysregulation in the body displacement hypothesis

“…‘Feeling fat’ involves fluctuating physical sensations ( Major, Viljoen, & Nel, 2019 ; Powell & Thelen, 1996 ), distinguishing it from general, more stable constructs like body image concerns. ‘Feeling fat’ is associated with subclinical and clinical eating pathology ( Cooper, Deepak, Grocutt, & Bailey, 2007 ; Mehak and Racine, 2019 , Mehak and Racine, 2021 ) and longitudinally predicts ED onset ( Stice, Desjardins, Rohde, & Shaw, 2021 ). Further, ‘feeling fat’ decreases over the course of enhanced cognitive behaviour therapy (CBT-E) and predicts treatment gain maintenance ( Calugi, El Ghoch, Conti, & Dalle Grave, 2018 ).…”