Influence of Mass Media on Body Image and Eating Disordered Attitudes and Behaviors in Females: A Review of Effects and Processes

This article reviews research on the effects of television and magazines on body image and on disordered eating attitudes and behaviors in females. Evidence from different types of studies in the fields of eating disorders, media psychology, health psychology, and mass communication indicates that mass media are an extremely important source of information and reinforcement in relation to the nature of the thin beauty ideal, its importance, and how to attain it. Although considerable research remains to be done, evidence is accumulating that repeated exposure to media and to both direct and indirect (via media's effects on peers, parents, coaches, physicians, etc.) pressures from media to be thin constitute risk factors for body dissatisfaction, concerns over weight and disordered eating behaviors in adolescent girls and young women. To guide further research, as well as the prevention and treatment of disordered eating, we present a figural summary of media effects that integrates moderating and mediating factors such as internalization of the thin beauty ideal, social comparison, and activation of the thinness schema. We argue that risk factor research, prevention, and treatment will benefit from systematic research designed to clarify how the impact of various mass media is shaped by source and receiver/perceiver factors.     

青少年饮食失调：同伴的表现形式及作用机制

饮食失调在青少年群体中非常普遍, 同伴被认为是一种重要的影响因素。梳理其作用机制, 对青少年饮食失调的预防和干预有重要意义。研究表明, 同伴对青少年饮食失调具有消极影响, 主要表现为感知到的同伴行为、实际的同伴行为、身体不满意的中介作用、以及同伴质量的影响。研究者从直接、间接的角度就同伴对青少年饮食失调的作用机制及影响进行了阐释。未来的研究应深化研究内容, 如增加关于同伴影响的长期效应、同伴属性划分、影响路径作用大小以及同伴与饮食失调的其它社会影响因素间的交互作用等方面的研究。     

A review of eating disorders research in Mexico

The objective of this paper is to summarize research findings on eating disorders and the current state of the field in Mexico. Papers published in indexed journals and graduate dissertations were retrieved, using “eating disorders,” “anorexia nervosa,” “bulimia nervosa,” “body image,” “binge eating,” “restrained eating,” “weight and shape concern,” and “dieting” as keywords. These were combined with the Boolean operator “AND” with “Mexico” and “Latin America.” Findings are presented for epidemiology, the validity of assessment instruments, comorbidity, and risk factors. A national representative survey found a prevalence of 1.8% for bulimia nervosa, and no cases of anorexia nervosa. However, the lack of studies with confirmatory clinical interview and other national or regional representative samples makes it difficult to reach conclusions about the actual prevalence. A number of instruments for the detection of eating disorders and disordered eating have been validated for the Mexican population. The comorbidity of eating disorders in Mexico includes drug and alcohol abuse, obesity, and borderline personality disorder. Risk factors found included body weight and cultural pressure to be thin. Future lines of research should include epidemiological studies with representative samples and diagnosis confirmation, longitudinal studies, and the exploration of protective and risk factors specific to this population.     

The Children of Mothers with Eating Disorders

There is good evidence that children of parents with psychological disorders are themselves at increased risk of disturbances in their development. Although there has been considerable research on a variety of disorders such as depression and alcohol, research on the children of parents with eating disorders has been relatively recent. This paper aims to review the evidence and covers a number of areas, including genetic factors, pregnancy, the perinatal and postpartum period, infancy, and the early years of life, focusing on feeding and mealtimes, general parenting functions, and growth. This is followed by a consideration of psychopathology in the children, parental attitudes to children's weight and shape, and adolescence. What is clear is that although there are numerous case reports and case series, the number of systematic controlled studies is relatively small, and almost nothing has been written about the children of fathers with eating disorders. What is evident from the available evidence is that children of mothers with eating disorders are at increased risk of disturbance, but that the risk depends on a variety of factors, and that difficulties in the children are far from invariable. The paper concludes by summarizing five broad categories of putative mechanisms, based on the evidence to date, by which eating disturbance in parents can influence child development.     

Coming to terms with risk factors for eating disorders: application of risk terminology and suggestions for a general taxonomy

The aims of the present review are to apply a recent risk factor approach (H. C. Kraemer et al., 1997) to putative risk factors for eating disorders, to order these along a timeline, and to deduce general taxonomic questions. Putative risk factors were classified according to risk factor type, outcome (anorexia nervosa, bulimia nervosa, binge-eating disorder, full vs. partial syndromes), and additional factor characteristics (specificity, potency, need for replication). Few of the putative risk factors were reported to precede the onset of the disorder. Many factors were general risk factors; only few differentiated between the 3 eating disorder syndromes. Common risk factors from longitudinal and cross-sectional studies were gender, ethnicity, early childhood eating and gastrointestinal problems, elevated weight and shape concerns, negative self-evaluation, sexual abuse and other adverse experiences, and general psychiatric morbidity. Suggestions are made for the conceptualization of future risk factor studies.     

Reflections on athletes and eating disorders

ObjectivesThe purposes of this paper were to offer reflections, thoughts, and observations on the burgeoning research regarding eating disorders in athletes over the past 25 years, to comment on the findings and clinical implications of the studies contained in this special issue, and to provide suggestions for future research.ResultsDisordered eating and eating disorders are complex, multidimensional, and multiply determined, and can affect the health and performance of athletes in both genders and most sports. Although coaches and teammates can be significant sources of weight and body image pressure, they can also play a positive role in identification and prevention.ConclusionsFurther research is needed in several areas. These include a broader focus that includes athletes believed to be at less risk, most notably males and non-lean sport athletes, and ironically younger athletes, who may be at greatest risk. We also need more research related to treatment of athletes with eating disorders and especially how we might better motivate them for recovery.     

Young Women at Risk for Eating Disorders: Perceived Family Dysfunction and Parental Psychological Problems

These results of this study are consistent with theories of eating disorders that highlight the role of family factors in the etiology and maintenance of eating disorders. When 27 young women at risk for eating disorders who scored above the clinical cut-off score on the EDI-II were compared with age and SES matched controls, they were found to obtain more dysfunctional scores on the Family Assessment Device and on ratings of perceived maternal and paternal symptomatology on the SCL-90-R.     

Thin-Ideal Internalization: Mounting Evidence for a New Risk Factor for Body-Image Disturbance and Eating Pathology

Body-image disturbance and eating disorders are a significant physical and mental health problem in Western countries. We describe emerging work on one newly identified variable that appears to be a potent risk factor for the development of these problems internalization of societal standards of attractiveness. Work conducted independently in our labs over the past decade has included scale development, correlational studies, prospective risk-factor studies, randomized experiments, and randomized prevention trials. Findings collectively suggest that internalization is a causal risk factor for body-image and eating disturbances, and that it appears to operate in conjunction with other established risk factors for these outcomes, including dieting and negative affect. Future research is needed to examine the specific familial, peer, and media influences that promote internalization and to replicate and extend our prospective and experimental studies.     

Female Adolescents with Eating Disorders,Parental Psychopathological Risk and Family Functioning

Epidemiological studies on adolescents with eating disorders demonstrate a high prevalence of disordered eating behaviors, with a higher prevalence of eating disorders among girls. Several studies have recently demonstrated an association between female adolescents’ eating disorders, parental psychopathological risk, and an impaired family functioning with poor quality of the relationships among family members. On the basis of these premises, we conducted a cross-sectional study initially recruiting 243 families of female adolescents affected by anorexia nervosa (Group A), bulimia nervosa (Group B), and binge eating disorder (Group C) (average age 14–17) to assess their psychological profile (SCL90-R), specific representations of their family functioning (FACES-IV), and the possible effect of adolescents’ psychological profiles and parents’ psychopathological risk on family functioning. Our results indicate that adolescents and parents in Groups A, B, and C show an unequivocal psychopathological profile; in particular, adolescents with anorexia present the most severe psychopathological risk. Further, our results show that adolescents and their parents differ in their perception of their family functioning. More specifically, adolescents with anorexia perceive their family as highly disengaged, poorly interwoven, and rigid, in addition cohesion and communication qualities are perceived as low. Interestingly, parental psychopathological risk predicts adolescents’ specific perception of their family functioning. These findings may guide clinical interventions as they suggest that distinct maternal psychopathological symptoms can be associated with a variety of clinical configurations in their offspring, whereas paternal psychopathological risk may be present in adolescents suffering from all forms of eating disorders.     

Eating Disorders in African American Girls: Implications for Counselors

Given the recent focus on eating disorders in children, it is imperative that counselors consider eating concerns that affect children of all racial and ethnic groups and hence are effective in working with this population. The author discusses risk factors that potentially contribute to eating disorders in African American girls given their unique socialization experiences as racial and ethnic minorities. Also, the author provides strategies for developing effective and culturally responsive counseling interventions to work with this population.     

Les troubles des comportements alimentaires chez des étudiants de première année : une étude prospective multigroupes

There is increasing use of the phrase “campus eating symptoms” to describe regular binge eating (together with frequent exercise, and occasional reliance on vomiting or laxatives), concerns about body image, depressive symptoms, stress, and university adjustment problems among students. Incidence of eating disorders in the early grades of university is increasing, and the period from age 17–19 years (peak of bulimia) which corresponds to the beginning of study at university is critical. Given the stressful environment that is the 1st academic year, it is useful to consider eating disorders risk factors.

Method

Our study is longitudinal. At the beginning, the participants consisted of 1110 freshmen. Data regarding adjustment to university, gender, body image, BMI, transactional variables (perceived stress and coping) and eating disorders (EAT-26) were collected. At T2 (end of academic year), 556 students were recruited to reassess their eating behaviours. The aim of the study was to test gender invariance of a theoretical eating disorders model including all these variables and eating disorders measured a year apart from a mixed population integrating the university for the first times. This model assumes that these variables exert direct effects on eating disorders as measured in time one who in turn will affect the stability of these troubles a year later. Although very little research include boys in the study of eating disorders, the results of our multi-group analysis support the idea of the existence of sex differences in eating disorder predictors: the only common predictor of eating disorders among girls and boys was the use emotion-focused coping. Among boys, the best predictors of eating disorders were problem-focused coping, and seeking social support. Among girls, our results revealed that body mass index, body image, and academic adjustment and stress were the predictors of eating disorders. Finally, we found a temporal stability of eating disorders. This study showed that personal and contextual aspects have a direct impact on students’ eating behaviour. However, among boys, neither body image nor perceived stress affect the eating behaviour but how they cope with stress. The gender gap in the explanation of eating disorders suggest to not exclude the male population in this type of study and to treat the data separately.     

An Examination of the Connections Between Eating Disorder Symptoms,Perceived Burdensomeness,Thwarted Belongingness,and Suicide Risk Among Undergraduate Students

Suicide attempts and premature mortality due to suicide are elevated in people with eating disorders. Informed by the interpersonal theory of suicide, two studies examined the role of perceived burdensomeness and thwarted belongingness in explaining the association between eating disorder symptoms and suicide risk. Results indicated that various eating disorder symptoms had an indirect effect on suicide risk through perceived burdensomeness and thwarted belongingness. Targeting perceived burdensomeness and thwarted belongingness may be useful for decreasing suicide risk among undergraduates with eating disorder symptoms.     

Assessment and Diagnosis of Eating Disorders: A Guide for Professional Counselors

Despite the prevalence of and risk associated with disordered eating, there are few guidelines for counselors on how to conduct an eating disorder assessment. Given the importance of the clinical interview, the purpose of this article is to provide recommendations for the assessment and diagnosis of eating disorders that (a) specifically focus on assessment in the context of a clinical interview and (b) can be used by counselors whether or not they specialize in eating disorder treatment.     

Preliminary Data on Risk Factors and Disordered Eating in Male College Students

The present study investigated four (anger, depression, anxiety, impulsivity) potential risk factors for the development of eating disorders in 79 male college students. All participants completed the Setting Conditions for Anorexia Nervosa Scale (SCANS), to determine if they were at-risk for the development of an eating disorder. The hypothesis, that males who are at-risk for the development of an eating disorder would show a higher occurrence of the potential risk factors, was partially supported. Those who scored high on the Dissatisfaction subscale of the SCANS had high positive correlations with all four risk factors. The SCANS Perfectionism subscale showed no such relationships with any of the risk factoes.     

Belastungen in der Kindheit und in der Jugend Essgestörter

Depending on definition and sample, a minority of varying size of women with eating disorders report to be victims of sexual and/or physical abuse. These stressful experiences are risk factors for mental disorders in general and not specifically for eating disorders. Parental high expectations and pre-morbid negative self-evaluation seem to be specific risk factors for anorexia nervosa and bulimia nervosa. Probably, patients with bulimia nervosa suffered more childhood adversity than those with restrictive anorexia nervosa. Patients with a history of sexual and/or physical abuse may be more severely ill and more difficult to treat than other patients with eating disorders. Careful questioning about childhood adversity seems advisable. In therapy, maintaining factors—like problems of self-esteem—are more important than predisposing or precipitating factors. For prevention, it is recommended to provide for the safety of children when treating their parents with mental illness—particularly substance use disorders—and to avoid parental high expectations.     

Heavenly Bodies: Religious Issues in Cognitive Behavioral Treatment of Eating Disorders

Minimal attention has been given to the role that religion may play in the development, maintenance, and treatment of eating disorders. Many religions espouse specific doctrines about the nature and purpose of the body as well as prescribe particular body grooming and eating practices. These doctrines and practices influence individuals' schemas and experiences of the body and eating, which can either contribute to or provide protection from eating disorders. This paper describes pathways through which religious beliefs and practices may impact risk for and maintenance of eating disorders. Methods for integrating religious concepts, practices, and resources into standard cognitive-behavioral treatment for eating disorders are discussed, including interventions that address purported religiously oriented contributory and protective factors. Treatment of a religious client with an eating disorder is described to illustrate the incorporation of religiously oriented interventions in practice.     

A MEDIATIONAL MODEL RELATING SOCIOTROPY, AMBIVALENCE OVER EMOTIONAL EXPRESSION, AND DISORDERED EATING

Two factors that have been found to predict eating disorders are sociotropy or dependent personality style and ambivalence over emotional expression, but there has been little consideration of the relationship between them and how this relationship may contribute to an understanding of eating disorders. A mediational model is proposed in which high sociotropy leads to greater ambivalence over expressing emotions, which in turn increases vulnerability to eating disorders. Consistent with predictions, among 115 college women, a high level of sociotropy was associated with a high level of ambivalence over emotional expression, which in turn was associated with increased disordered eating. Furthermore, ambivalence over emotional expression significantly mediated the effect of sociotropy on disordered eating, even when controlling for depression level. Findings are considered within a developmental framework, and treatment implications are discussed.     

A HISTORICAL OVERVIEW OF THE PSYCHODYNAMIC CONTRIBUTIONS TO THE UNDERSTANDING OF EATING DISORDERS

The objective of this paper is to give an historical overview of the development of psychodynamic theories and to acknowledge their contribution to the understanding of the aetiology of these complex disorders. Relevant psychodynamic and psychoanalytic papers on the historical development of eating disorders were identified through a search of (1) Medline and PsychoInfo, (2) the library of the London Institute of Psychoanalysis, (3) Psychoanalytic Electronic Publishing (PEP), and (4) a number of textbooks on eating disorders.

The search revealed a dearth of psychoanalytic historical perspectives about the aetiology of eating disorders in general. Overall most psychoanalytic publications were based on single case studies and concerned primarily with anorexia nervosa. No single model was identified, but a number of psychoanalytic ideas remain consistent throughout. Several psychoanalysts and contemporary psychodynamically‐informed authors refer to, apply and have further developed a number of these original ideas. This overview highlights the unique contributions of psychodynamic concepts towards a better understanding of the aetiology of eating disorders and how much they have influenced and informed modern thinking on the meaning of these complex conditions. A range of psychodynamic views has emerged and gradually evolved from concentrating solely on intra‐psychic factors to a more comprehensive multi‐modal model. This tendency has become a fertile ground for cross‐fertilization which, along with the bio‐social counterparts, remains the fundamental pillars on which modern understanding of eating disorders still rests.     

Are Eating Disorders and Related Symptoms Risk Factors for Suicidal Thoughts and Behaviors? A Meta‐analysis

This meta‐analysis addressed whether eating disorders (EDs) are risk factors (i.e., longitudinal predictors) for suicidal thoughts and behaviors. We identified 2,611 longitudinal studies published through August 1, 2017. Inclusion required studies include at least one longitudinal analysis predicting suicide ideation, attempt, or death using an ED diagnosis and/or symptom. Fourteen studies (42 prediction cases) met criteria. Results indicated that clinically diagnosed EDs and disordered eating symptoms were significant but weak predictors of suicide attempts but not death. Effects remained weak when moderators were considered. By reviewing the methodological limitations of previous research, these results highlight avenues for future research.     

Binge eating proneness emerges during puberty in female rats: a longitudinal study

Puberty is a critical risk period for binge eating and eating disorders characterized by binge eating. Previous research focused almost entirely on psychosocial risk factors during puberty to the relative exclusion of biological influences. The current study addressed this gap by examining the emergence of binge eating during puberty in a rat model. We predicted that there would be minimal differences in binge eating proneness during pre-early puberty, but significant differences would emerge during puberty. Two independent samples of female Sprague-Dawley rats (n = 30 and n = 36) were followed longitudinally across pre-early puberty, mid-late puberty, and adulthood. Binge eating proneness was defined using the binge eating resistant (BER)/binge eating prone (BEP) model of binge eating that identifies BER and BEP rats in adulthood. Across two samples of rats, binge eating proneness emerged during puberty. Mixed linear models showed little difference in palatable food intake between BER and BEP rats during pre-early puberty, but significant group differences emerged during mid-late puberty and adulthood. Group differences could not be accounted for by changes in nonpalatable food intake or body weight. Similar to patterns in humans, individual differences in binge eating emerge during puberty in female rats. These findings provide strong confirming evidence for the importance of biological risk factors in developmental trajectories of binge eating risk across adolescence.