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

Abstract

BackgroundUsing the person-oriented approach, we determined the relationships between four indicators (restraint and eating, shape, and weight concerns) of disordered eating (DE), as measured by the self-reported Eating Disorders Examination Questionnaire (EDE-Q), to identify typical DE patterns. We then related these patterns to clinical EDE-Q cut-off scores and emotion dysregulation, depression, self-esteem, and two categories of DE behaviors (≥2 or ≤1 “yes” responses on the SCOFF questionnaire).MethodTypical patterns of DE were identified in a community sample of 1,265 Swedish adolescents (M age = 16.19, SD = 1.21; age range 13.5–19 years) using a cluster analysis. Separate analyses were performed for girls (n = 689) and boys (n = 576).ResultsThe cluster analysis yielded a six-cluster solution for each gender. Four of the six clusters for girls and five for boys showed scores above the clinical cut-off on at least one of the four DE indicators. For girls, the two clusters that scored above the clinical cut-offs on all four DE indicators reported severe psychological problems, including high scores on emotion dysregulation and depression and low scores on self-esteem. In contrast, for boys, although two clusters reported above the clinical cut-off on all four indicators, only the cluster with exceedingly high scores on shape and weight concerns reported high emotion dysregulation and depression, and extremely low self-esteem. Furthermore, significantly more girls and boys in the most problematic DE clusters reported ≥2 “yes” responses on the SCOFF questionnaire (as opposed to ≤1 response), indicating clear signs of DE and severe psychological difficulties.ConclusionWe suspect that the various problematic DE patterns will require different paths back to a healthy diet. However, more research is needed to determine the developmental trajectories of these DE patterns and ensure more precise clinical cut-off scores, especially for boys. Comprehensive understanding of DE patterns might be of use to healthcare professionals for detecting DE before it develops into an eating disorder.Trial registrationLund, EPN (dnr: 2012/499).

Disordered eating in a Swedish community sample of adolescent girls: subgroups, stability, and associations with body esteem, deliberate self-harm and other difficulties

“…The more pronounced DE clusters (Multiple eating problems including/without purging) were consistently associated with higher levels of psychological difficulties as well as lower levels of body esteem. The results resemble the associations between DE clusters and more severe levels of psychological problems described in the Hansson et al study [ 3 ]. The associations between DE and psychological symptoms such as depression have also been described by Herpertz-Dahlmann et al [ 15 ].…”

“…Although it is difficult to generalize from these results with clinical samples of adult female patients to a community sample of teenage girls, it is interesting to note that the largest cluster in Clinton et al’s [ 18 ] study showed a pattern of “generalized eating disorder”, which combined both anorexic and bulimic symptoms. This suggests the hypothesis that we may find a cluster of generally disordered eating also among young adolescents – which is also consistent with the results from Hansson et al’s [ 3 ] study. On the other hand, the three-cluster solution chosen by Clinton et al [ 18 ] may be questioned, as they do not report any data on the heterogeneity of the clusters that were arrived at.…”

“…We are only aware of one cluster-analytic study of profiles of DE in community samples. Hansson et al [ 3 ] analysed the patterning of four indicators (eating concern, restraint, shape concern, and weight concern) of DE as measured by the Eating Disorders Examination Questionnaire (EDE-Q) to identify typical DE patterns in a community sample of Swedish adolescents aged 13.5–19 years. The analysis resulted in a six-cluster solution for each gender.…”

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“…In general, males had a more positive self-esteem and body image, and a lower risk of eating disorders than females, as suggested by most of the literature, because women tend to have stronger societal influences and pressures (DiPasquale & Petrie, 2013;Escobar-Molina et al, 2015;Gaines & Burnett, 2014;Hansson,Daukantaitė, &Johnsson, 2016;Kong & Harris, 2015;Stewart et al, 2014;Yilmaz,Esenturk, Ulas, &İlhan, 2017). On the other hand, there was no relationship between self-esteem, body image, and eating disorder risk.…”

“…The social construction theory (SCT) posits that social expectations, influences, beliefs, and social norms will affect individuals (Biever, De Las Fuentes, Cashion, & Franklin, 1998). Females tend to have a higher risk of eating disorder, a more negative body image, and a lower self-esteem when compared to males because they might feel more observed, assessed, and monitored due to cultural influences and pressures of society (Budzisz&Nawrocka, 2016;DiPasquale & Petrie, 2013;Escobar-Molina et al, 2015;Gaines & Burnett, 2014;Hansson et al, 2016;Kong & Harris, 2015;Stewart et al, 2014;Yilmaz et al, 2017).…”