Relationships between psychological stress,coping and disordered eating: A review

Abstract

Objective: Psychological stress and inadequate coping skills have been hypothesized to play important roles in the etiology of disordered eating. This paper reviews the empirical evidence which has emerged regarding the proposed relationships among stress. coping skills and various forms of disordered eating. Method: A search of psychological and medical databases was conducted to identify studies examining life events, and other types of psychological stress and coping strategies, in relation to the onset of disordered eating. Results: Despite methodological limitations such as the use of non-representative samples and retrospective methodologies, evidence of relationships between stress. coping and disordered eating was obtained in the majority of studies reviewed. Discussion: The implications of these findings am discussed and suggestions for future research, including the utilization of longitudinal. prospective studies, am presented.     

Is self-esteem the primary predictor of disordered eating?

This study examined whether self-esteem is the primary predictor of disordered eating. A survey measured levels of self-esteem and a variety of other health behaviors in 196 male and 263 female undergraduate students. We conducted stepwise regressions to determine which of several variables (self-esteem, high stress, poor coping skills, maladaptive perfectionism, gender) best predicted disordered eating. The results indicated that self-esteem was the secondary predictor for bulimia, drive for thinness, and body dissatisfaction. Future research should further investigate how self-esteem interacts with other predictor variables to better determine the relationship between self-esteem and disordered eating.     

The Moderating Effects of Mindfulness on Psychological Distress and Emotional Eating Behaviour

Current evidence and theory suggests that emotional eating resulting from attempts to manage psychological distress, such as anxiety, depression, and stress, is considered to be a major contributor to obesity. Mindfulness has been shown to be related to disordered eating behaviours. Employing a non‐clinical sample of 42 males and 115 females, the present study investigated the contribution of mindfulness as a potential moderator between psychological distress and engagement in emotional eating, while controlling for the effects of gender and general nutrition knowledge. Consistent with predictions, psychological distress was positively associated with engagement in emotional eating, while mindfulness was found to share an inverse relationship. Moreover, after controlling for gender and general nutrition knowledge, the interaction between psychological distress and mindfulness was found to significantly predict the tendency to engage in emotional eating over and above the individual effects of these variables. The findings from the current study add to the current literature supporting the use of mindfulness‐based interventions for treatment of emotional eating practices in individuals experiencing anxiety, stress, and lower levels of depression.     

A multilevel mediation model of stress and coping for women with HIV and their families

Families are influential systems and may be an important context in which to consider the stress and coping process. To date, many studies have focused on modeling the stress and coping process for the individual, isolated from the family. The purpose of this secondary analysis was to investigate a cross-sectional stress and coping model for HIV-positive African-American mothers recruited from HIV service facilities in South Florida (n=214) and their family members (n=294). Avoidance coping was hypothesized to mediate the relationship between stress and psychological distress. In addition, the family average of individual stress was hypothesized to moderate the relationship between avoidance coping and psychological distress. For all constructs, individuals reported on themselves and multilevel modeling techniques were used to account for similarities between members of the same family. The estimated mediation effect was significant. Aggregated family stress significantly moderated the relationship between avoidance coping and psychological distress. This study suggests that individuals exhibit different relationships between avoidance coping and psychological outcomes and that average stress reported by members of a family moderates the relationship between avoidance coping and psychological distress.     

Associations Between Multiple Types of Stress and Disordered Eating Among Girls and Boys in Middle School

Stress is common during adolescence, yet no known studies have linked particular types of stress (performance, relationship, education, financial, and family) with disordered eating among adolescents in middle school. The present study investigated sex differences in types of stress and how multiple types of stress were associated with girls’ and boys’ body dissatisfaction, dieting behaviors, and bulimic symptoms. We found that girls reported higher levels of stress than boys and that different associations between stress and disordered eating existed for girls and boys. We also examined a path model for both sexes such that stress first led to body dissatisfaction, which then led to dieting and finally bulimic symptoms. Our model was supported for girls with performance, relationship, and family stress driving the process. For boys, all five types of stress were associated with body dissatisfaction, which was linked with dieting; however, the relation between dieting and bulimic symptoms was not significant. Future research and therapy should focus on the unique experiences of each sex in order to gain a better understanding of the processes involved in coping with stress and promoting healthy development.     

Mindfulness Moderates the Relationship Between Disordered Eating Cognitions and Disordered Eating Behaviors in a Non-Clinical College Sample

Psychological flexibility and mindfulness are two related, but distinct, regulation processes that have been shown to be at the core of psychological wellbeing. The current study investigated whether these two processes independently moderated the association between disordered eating cognitions and psychological distress as well as the relation between disordered eating cognitions and disordered eating behaviors. Non-clinical, ethnically diverse college undergraduates completed a web-based survey. Of 278 participants (nfemale = 208; nmale = 70) aged 18–24 years old, disordered eating cognitions, mindfulness, and psychological flexibility were related to psychological distress after controlling for gender, ethnicity, and body mass index. Disordered eating cognitions and mindfulness accounted for unique variance in disordered eating behaviors. Finally, mindfulness was found to moderate the association between disordered eating cognitions and disordered eating behaviors.     

Assessing the Role of Body Image Coping Strategies as Mediators or Moderators of the Links Between Self-Objectification, Body Shame, and Well-Being

We examined self-objectification in relation to well-being, and the potential moderating versus mediating role of body image coping strategies (appearance fixing, avoidance, positive rational acceptance). Undergraduate women from southern Ontario, Canada (Sample 1, n?=?104; Sample 2, n?=?314) completed measures of depression, disordered eating attitudes, subjective well-being, and body-image coping. Self-objectification was related to greater depression, disordered eating attitudes, and lower subjective well-being. A two-stage mediation model was supported: Body shame and body image coping strategies (appearance fixing and avoidance) partially mediated the associations between self-objectification and outcomes; appearance fixing and avoidance partially mediated the associations between body shame and outcomes. Body image coping strategies did not moderate any of the relations between body shame and outcomes.     

Generalization and Behavior Covariation of Aggression in Children Receiving Stress Inoculation Therapy

Many behaviorally disordered children exhibit aggressive behaviors which often interfere with acquiring prosocial and academic skills. A stress inoculation program was implemented with four behaviorally disordered children to determine whether aggressive behaviors would decrease and generalize to a day school setting. Specific coping behaviors were also recorded to determine whether they increased as a function of this intervention. A multiple baseline design across children was employed with concurrent data collected in the generalization setting. Three of the four children exhibited decreases in aggression and increases in coping behaviors which generalized to the day school. Results are discussed in terms of enhancing generalization and treatment gains with behaviorally disordered youth.     

Stress and coping in mothers caring for a child with severe learning difficulties: A test of Lazarus' transactional model of coping

The literature on psychological stress among women consistently points to the adverse effects of child rearing on mothers, particularly those caring for children with physical or mental handicaps. Early studies of the effects on family functioning of caring for a child with severe learning difficulties adopted a pathological approach in which it was assumed that psychological distress was inevitable among family members, particularly mothers. Recent research has emphasised that many families cope with and adapt to the stress they experience, and seeks to discover how they do so. The paper reports on a study of 166 mothers caring for a child with severe learning difficulties. The aim of the study was to investigate both the factors associated with maternal stress and those which might mediate or buffer the effects of stress. The study used the Folkman and Lazarus' (1979) transactional model of stress. Stress is the condition that results when person/environment transactions lead the individual to perceive a discrepancy between the demands of a situation and his/her resources or ability to cope with those demands. The nature and type of coping generated by a person will be determined by the coping resources in the person's environment. The model identifies five categories of coping resource: utilitarian resources, health/morale, social networks, general and specific beliefs, and problem solving skills. In our study, the five coping resources were represented by the mother's social class and appraisal of her financial worries, physical health, social support, acceptance of and adjustment to the child, and assessment of coping skills. Stress was measured by the Malaise Inventory (Rutter, 1970). Four of the five coping resources were found to be significant contributors in a hierarchical regression analysis of stress scores, contributing additional variance beyond that of behavioural and other child characteristics. Altogether, 55% of the variance in stress scores was explained.     

Health Consequences of Organizational Injustice: Tests of Main and Interactive Effects

I report the results of two studies that explored relationships between employees' justice perceptions and their psychological well-being. In both studies, the main and interactive effects of distributive justice and procedural justice accounted for significant, unique variance in employees' psychological distress. Consistent with predictions derived from a framework that integrates stress and coping theory with justice theory, relationships between procedural justice and psychological distress were stronger when distributive justice was lower. I discuss theoretical implications for the organizational justice literature and identify the studies' limitations and practical implications.     

中国背景下情绪智力与心理健康关系的元分析

本研究使用元分析的方法探讨了情绪智力与心理健康的关系（包括心理健康症状学指标、感知到的压力、应对方式、社会适应及主观幸福感）,共纳入104篇文献,151个独立样本和75754名被试。结果发现,个体情绪智力与积极应对、社会适应以及主观幸福感呈现显著正相关,与心理健康症状学指标、感知到的压力以及消极应对呈现显著负相关。此外,情绪智力与心理健康的关系受到出版年代、被试年龄、情绪智力理论模型和测量工具的调节作用。结论表明,情绪智力与积极心理健康变量的联系强于与消极心理健康变量的联系,且存在较长时期的稳定性。     

Eating Disorder Prevalence and Symptoms for Track and Field Athletes and Nonathletes

This study explored coaches’ responses to stress, the perceived effects of stress, and the coping strategies coaches employed. Transcribed interviews with 12 world class coaches, based in the UK, were inductively content analyzed. A range of themes emerged describing coaches’ responses to stressors and the effects of stress. Specifically, coaches discussed psychological reactions, and suggested that their negative responses to stress could be projected onto their athletes. While structuring and planning was reported as a coping strategy, coaches described a limited use of psychological skills and tended to avoid stressors that provoked strain responses in efforts to manage stress. Results suggest that coaches should be aware of how they respond to stressors and the influence their responses might have on their athletes. Sport psychologists should help coaches to identify and develop the psychological skills and strategies required to cope with the demands of world class coaching.     

应对研究的成果、问题与解决办法

应激和应对问题 ,由于同人的心理适应和健康密切相关 ,目前在国外已经成为心理学所有领域中研究最多的一个重要课题。然而 ,该课题的研究 ,特别是关于应对方式及其效果评价的研究 ,存在着较突出的问题。通过对国内 4种最主要的有关学术期刊的检索发现 ,同国外相比 ,国内的应激和应对的研究在数量和质量上均有较明显的差距。文章结合国内外有关研究的现状 ,分析、说明了在应对研究中存在的 5个主要问题 :(1)忽略防御机制的有效评估和在心理适应中的作用 ;(2 )应对方式的评定方法不当 ;(3)在对于应激的影响和应对后果的估价中存在着片面性和策略上的错误 ;(4)应对研究的设计同关于应激和应对的“过程”理论不一致 ;(5 )应对研究同临床实践之间存在着较明显的脱节。作者探讨并提出了对于这些问题的可能的解决办法。     

The Relationship of Religious and General Coping to Psychological Adjustment and Distress in Urban Adolescents

The present study explored the relationships among stress, general and religious coping, and mental health in a sample of urban adolescents. The participants included 587 9th- through 12th-grade students attending two Catholic high schools in the New York City area. They completed a set of self-report measures assessing perceived stress, religious coping, general coping, clinical symptomology, positive and negative affect, and life satisfaction. Correlation and regression analyses were used to describe relationships among variables. Perceived stress, negative religious coping, and avoidant coping were significantly associated with indicators of psychological distress. Conversely, positive religious coping and active/engagement coping were significantly associated with indicators of psychological adjustment. Negative religious coping also was found to moderate the relationship between perceived stress and positive affect. Finally, partial correlational analyses revealed significant relationships between religious coping and mental health indicators, even after controlling for the contributions of general coping. Implications of the findings for research and clinical practice with adolescent populations are considered.     

Implications of accuracy, sensitivity, and variability of body size estimations to disordered eating

The current study was conducted to investigate the relationships between body size estimations and disordered eating symptomatology. The method of constant stimuli was used to derive three measures of self-perceived body size in 93 women: (1) accuracy of body size estimations (body image distortion); (2) sensitivity in discriminating body size within blocks of trials (body image sensitivity); and (3) variability in making body size estimations between blocks of trials (body image variability). Participants also completed measures of disordered eating. Although body image distortion correlated with dietary restraint and eating concern, body image variability accounted for additional variance in these variables, as well as variance in binge eating. The relationships involving body image variability were found to be mediated by body dissatisfaction and internalization of the thin ideal. Together, these results are consistent with the proposition that body image variability is a significant factor in disordered eating.     

Thinking Fat and Feeling Blue: Eating Behaviors, Ruminative Coping, and Depressive Symptoms in College Women

Restrained and binge eating are related to depressive symptomatology in women; we examined the role of ruminative coping in this association. Sample participants (N?=?329) were female college students in the Midwestern U.S. who completed a health behaviors survey. Multiple regression models examining the pathway between eating (restrained and bingeing, respectively) and depressive symptoms were tested; ruminative coping was examined as the mediator in all models. Models in which dysregulated eating predicted depressive symptoms explained more variance than those testing the reverse pathway. Ruminative coping fully mediated the association between restrained eating and depressive symptoms and partially mediated the association between binge eating and depressive symptoms. Findings suggest ruminative coping is a mechanism linking disordered eating and depressive symptoms.     

Motivations to eat: Scale development and validation

Objective: To validate a measure of psychological motivations to eat based on a four-category model of motivations for alcohol use (Cooper, 1994). Motivations specified by this model are: to cope with negative affect, to be social, to comply with others’ expectations, and to enhance pleasure.Method: In Study 1, 40 respondents were queried in an open-ended format about their reasons for eating; responses were content-coded to determine if they fit into the four theorized categories. In Study 2, an item pool was generated based on responses from Study 1, and random halves of a sample of 812 college students were used to test and then validate the hypothesized factor structure.Results: As expected, the final inventory yielded the four theorized categories. The factor structure was generally invariant across gender, and the resulting Motivations to Eat subscales uniquely predicted restrictive eating, bingeing, and purging.Discussion: Prior eating research has focused mainly on coping and compliance motivations. The present study identified four distinct motivations to eat that potentially are important for understanding healthy and disordered eating.     

The relationship of appraisal and coping to chronic illness adjustment

There is evidence that adaptation to chronic illness may be affected by psychological factors, especially how patients appraise and cope with the stress of their illness. The purpose of the present study was to examine the relationship of stress appraisal and coping responses to multiple behavioral indices of illness adjustment among patients with diverse chronic medical conditions. One hundred and one patients admitted to a multidisciplinary medicine/psychiatry unit completed measures of functional impairment, depression, symptom severity, and the Ways of Coping Checklist--Revised. Hierarchical regression analyses indicated that emotion-focused coping was positively related to poor psychosocial adjustment and depression after controlling for physician rated disease severity. Appraising chronic illness as holding one back predicted greater emotion-focused coping responses and poorer adjustment to illness. The use of problem-focused coping strategies was generally unrelated to illness adjustment. These findings suggest the presence of an emotion-focused coping triad consisting of wishful thinking, self blame, and avoidance, all of which appear to be maladaptive strategies when coping with chronic medical conditions. Implications for coping skills training and the need for longitudinal research is discussed.     

Perceptions and metaperceptions of same-sex social interactions in college women with disordered eating patterns

This study compared perceptions and metaperceptions after a social interaction between a woman with disordered eating (subclinical bulimia nervosa) and a female interaction partner. Hypotheses were: women with disordered eating would have more negative metaperceptions of social interactions than women without disordered eating, and women with disordered eating would show a greater discrepancy between metaperceptions and perceptions than women without disordered eating. All participants completed questionnaires about their perceptions and metaperceptions post-interaction. Results showed women with disordered eating thought that they had made a negative impression; findings addressing the relationships among social desirability, loneliness, social support utilization, and fear of negative evaluation are also discussed.