Risk factors for onset of eating disorders: Evidence of multiple risk pathways from an 8-year prospective study

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Abstract

Objective

Use classification tree analysis with lagged predictors to determine empirically derived cut-points for identifying adolescent girls at risk for future onset of threshold, subthreshold, and partial eating disorders and test for interactions between risk factors that may implicate qualitatively distinct risk pathways.

Method

Data were drawn from a prospective study of 496 adolescent girls who completed diagnostic interviews and surveys annually for 8 years.

Results

Body dissatisfaction emerged as the most potent predictor; adolescent girls in the upper 24% of body dissatisfaction showed a 4.0-fold increased incidence of eating disorder onset (24% vs. 6%). Among participants in the high body dissatisfaction branch, those in the upper 32% of depressive symptoms showed a 2.9-fold increased incidence of onset (43% vs. 15%). Among participants in the low body dissatisfaction branch, those in the upper 12% of dieting showed a 3.6-fold increased incidence onset (18% vs. 5%).

Conclusion

This three-way interaction suggests a body dissatisfaction pathway to eating disorder onset that is amplified by depressive symptoms, as well as a pathway characterized by self-reported dieting among young women who are more satisfied with their bodies. It may be possible to increase the effectiveness of prevention programs by targeting each of these qualitatively distinct risk groups, rather than only individuals with a single risk factor.

Highlights

► Classification tree analysis identifies distinct pathways for eating disorders. ► We determine cut-points for identifying adolescents at risk for eating disorders. ► Body dissatisfaction pathway to eating disorder onset emerged. ► Risk increased with depressive symptoms. ► Self-reported dieting is primary risk factor for second pathway.

Section snippets

Participants and procedures

Participants were 496 middle school girls (M age = 13.5, SD = 0.7) recruited from four public schools from the Austin Independent School District (n = 409) and four smaller private schools (n = 87) in Austin Texas. The sample was composed of 2% Asian/Pacific Islanders, 7% African Americans, 68% Caucasians, 18% Hispanics, 1% Native Americans, and 4% other/mixed and average parental education was 29% high school graduate or less, 23% some college, 33% college graduate, and 15% graduate degree, which was

Results

With respect to attrition, the percentages of participants missing self-report and diagnostic interview data from were 0% (N = 496), 1% (N = 491), 3% (N = 481), 3% (N = 481), 2% (N = 486), 3% (N = 481), 4% (N = 476), and 6% (N = 466) for each of the eight annual assessments. It should be noted that we were sometimes able to collect data from participants who did not provide data at an earlier assessment. Attrition was not significantly correlated with any of the variables examined herein.

Variables that showed

Discussion

The objective was to use CTA to determine empirically derived cut-points for identifying adolescent girls at risk for future onset of threshold, subthreshold, and partial eating disorders and test for interactions between risk factors suggestive of qualitatively distinct risk pathways, with the hope that this would allow clinicians to identify youth at greatest risk for eating pathology, which can be a challenge because of the low incidence of these conditions, and to design prevention programs

Acknowledgments

The authors of this manuscript have no conflicts of interest, including financial interests relevant to the subject of this manuscript.

Eric Stice was responsible for study design and contributed to data analysis and manuscript writing and revisions. Nathan Marti contributed to data analysis and manuscript writing and revisions. Shelley Durant contributed to manuscript writing and revisions.

This study was supported by a career award (MH01708) and a research grant (MH/DK61957) from the National

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