Reciprocal longitudinal relations between weight/shape concern and comorbid pathology among women at very high risk for eating disorder onset

  • Ellen E. Fitzsimmons-CraftEmail author
  • Dawn M. Eichen
  • Andrea E. Kass
  • Mickey Trockel
  • Ross D. Crosby
  • C. Barr Taylor
  • Denise E. Wilfley
Original Article



Understanding how known eating disorder (ED) risk factors change in relating to one another over time may inform efficient intervention targets. We examined short-term (i.e., 1 month) reciprocal longitudinal relations between weight/shape concern and comorbid symptoms (i.e., depressed mood, anxiety) and behaviors (i.e., binge drinking) over the course of 24 months using cross-lagged panel models.


Participants were 185 women aged 18–25 years at very high risk for ED onset, randomized to an online ED preventive intervention or waitlist control. We also tested whether relations differed based on intervention receipt.


Weight/shape concern in 1 month significantly predicted depressed mood the following month; depressed mood in 1 month also predicted weight/shape concern the following month, but the effect size was smaller. Likewise, weight/shape concern in 1 month significantly predicted anxiety the following month, but the reverse was not true. Results showed no temporal relations between weight/shape concern and binge drinking in either direction. Relations between weight/shape concern, and comorbid symptoms and behaviors did not differ based on intervention receipt.


Results support focusing intervention on reducing weight/shape concern over reducing comorbid constructs for efficient short-term change.

Level of evidence

Level I, evidence obtained from a properly designed randomized controlled trial.


Weight/shape concern Comorbidity Eating disorder College-age women 



This research was supported by R01 MH081125, R01 MH100455, T32 HL007456, and F32 HD089586 from the National Institutes of Health and T32 HS00078 from the Agency for Healthcare Research and Quality.

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest. The datasets during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional review boards of the coordinating institutions and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Jacobi C, Hayward C, de Zwaan M, Kraemer HC, Agras WS (2004) Coming to terms with risk factors for eating disorders: application of risk terminology and suggestions for a general taxonomy. Psychol Bull 130:19–65. CrossRefPubMedGoogle Scholar
  2. 2.
    Killen JD, Taylor CB, Hayward C, Haydel KF, Wilson DM, Hammer L et al (1996) Weight concerns influence the development of eating disorders: a 4-year prospective study. J Consult Clin Psych 64:936–940. CrossRefGoogle Scholar
  3. 3.
    Killen JD, Taylor CB, Hayward C, Wilson DM, Haydel KF, Hammer LD, et al. (1994). Pursuit of thinness and onset of eating disorder symptoms in a community sample of adolescent girls: a three-year prospective analysis. Int J Eat Disord 16:227–238. doi: 10.1002/1098-108X(199411)16:3<227::AID-EAT2260160303>3.0.CO;2-L CrossRefPubMedGoogle Scholar
  4. 4.
    McKnight I (2003) Risk factors for the onset of eating disorders in adolescent girls: results of the McKnight longitudinal risk factor study. Am J Psychiat 160:248–254. CrossRefGoogle Scholar
  5. 5.
    Stice E (2002) Risk and maintenance factors for eating pathology: a meta-analytic review. Psychol Bull 128:825–848. CrossRefPubMedGoogle Scholar
  6. 6.
    Jacobi C, Fittig E, Bryson SW, Wilfley D, Kraemer HC, Taylor CB (2011) Who is really at risk? Identifying risk factors for subthreshold and full syndrome eating disorders in a high-risk sample. Psychol Med 41:1939–1949. CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Pallister E, Waller G (2008) Anxiety in the eating disorders: Understanding the overlap. Clin Psychol Rev 28:366–386. CrossRefPubMedGoogle Scholar
  8. 8.
    Stice E, Marti CN, Durant S (2011) Risk factors for onset of eating disorders: Evidence of multiple risk pathways from an 8-year prospective study. Behav Res Ther 49:622–627. CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Eisenberg D, Nicklett EJ, Roeder K, Kirz NE (2011) Eating disorder symptoms among college students: prevalence, persistence, correlates, and treatment-seeking. J Am Coll Health 59:700–707. CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Agras WS (2001) The consequences and costs of the eating disorders. Psychiat. Clin N Am 24:371–379. CrossRefGoogle Scholar
  11. 11.
    de la Rie SM, Noordenbos G, van Furth EF (2005) Quality of life and eating disorders. Qual Life Res 14:1511–1522. CrossRefPubMedGoogle Scholar
  12. 12.
    Klump KL, Bulik CM, Kaye WH, Treasure J, Tyson E (2009) Academy for eating disorders position paper: eating disorders are serious mental illnesses. Int J Eat Disord 42:97–103. CrossRefPubMedGoogle Scholar
  13. 13.
    Fulkerson JA, Sherwood NE, Perry CL, Neumark-Sztainer D, Story M (2004) Depressive symptoms and adolescent eating and health behaviors: A multifaceted view in a population-based sample. Prev Med 38:865–875. CrossRefPubMedGoogle Scholar
  14. 14.
    Sonneville KR, Grilo CM, Richmond TK, Thurston IB, Jernigan M, Gianini L, Field AE (2015) Prospective association between overvaluation of weight and binge eating among overweight adolescent girls. J Adolescent Health 56:25–29. CrossRefGoogle Scholar
  15. 15.
    Wilksch SM, Wade TD (2010) Risk factors for clinically significant importance of shape and weight in adolescent girls. J Abnorm Psychol 119:206–215. CrossRefPubMedGoogle Scholar
  16. 16.
    Cash TF (2002) Cognitive-behavioral perspectives on body image. In: Cash TF &, Pruzinsky T(eds) Body image: A handbook of theory, research, and clinical practice. Guilford, New York, pp 38–46Google Scholar
  17. 17.
    Cameron EM, Ferraro FR (2004) Body satisfaction in college women after brief exposure to magazine images. Percept Motor Skill 98:1093–1099. CrossRefGoogle Scholar
  18. 18.
    Fitzsimmons-Craft EE, Bardone-Cone AM (2012) Examining prospective mediation models of body surveillance, trait anxiety, and body dissatisfaction in African American and Caucasian college women. Sex Roles 67:187–200. CrossRefGoogle Scholar
  19. 19.
    Kaye WH, Bulik CM, Thornton L, Barbarich N, Masters K, Price Foundation Collaborative Group (2004). Comorbidity of anxiety disorders with anorexia and bulimia nervosa. Am J Psychiat 161:2215–2221. CrossRefPubMedGoogle Scholar
  20. 20.
    Vickers KS, Patten CA, Bronars C, Lane K, Stevens SR, Croghan IT et al (2004) Binge drinking in female college students: the association of physical activity, weight concern, and depressive symptoms. J Am Coll Health 53:133–140. CrossRefPubMedGoogle Scholar
  21. 21.
    Khaylis A, Trockel M, Taylor CB (2009) Binge drinking in women at risk for developing eating disorders. Int J Eat Disord 42:409–414. CrossRefPubMedGoogle Scholar
  22. 22.
    Courtney KE, Polich J (2009) Binge drinking in young adults: Data, definitions, and determinants. Psychol Bull 135:142–156. CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Wechsler H, Nelson TF (2008). What we have learned from the. Harvard School of Public Health College Alcohol Study: Focusing attention on college student alcohol consumption and the environmental conditions that promote it. J Stud Alcohol Drugs 69:481–490. CrossRefPubMedGoogle Scholar
  24. 24.
    Colautti LA, Fuller-Tyszkiewicz M, Skouteris H, McCabe M, Blackburn S, Wyett E (2011) Accounting for fluctuations in body dissatisfaction. Body Image 8:315–321. CrossRefPubMedGoogle Scholar
  25. 25.
    Melnyk SE, Cash TF, Janda LH (2004) Body image ups and downs: prediction of intra-individual level and variability of women’s daily body image experiences. Body Image 1:225–235. CrossRefPubMedGoogle Scholar
  26. 26.
    Rieger E, Van Buren DJ, Bishop M, Tanofsky-Kraff M, Welch R, Wilfley DE (2010) An eating disorder-specific model of interpersonal psychotherapy (IPT-ED): causal pathways and treatment implications. Clin Psychol Rev 30:400–410. CrossRefPubMedGoogle Scholar
  27. 27.
    Grilo CM, Masheb RM, Wilson GT (2006) Rapid response to treatment for binge eating disorder. J Consult Clin Psych 74:602–613. CrossRefGoogle Scholar
  28. 28.
    McFarlane T, Olmsted MP, Trottier K (2008) Timing and prediction of relapse in a transdiagnostic eating disorder sample. Int J Eat Disord 41:587–593. CrossRefPubMedGoogle Scholar
  29. 29.
    Taylor CB, Kass AE, Trockel M, Cunning D, Weisman H, Bailey J et al (2016) Reducing eating disorder onset in a very high risk sample with significant comorbid depression: results of a randomized controlled trial. J Consult Clin Psych 84:402–414. CrossRefGoogle Scholar
  30. 30.
    Tiggemann M (2004) Body image across the adult life span: stability and change. Body Image 1:29–41. CrossRefPubMedGoogle Scholar
  31. 31.
    Nelson MC, Story M, Larson NI, Neumark-Sztainer D, Lytle LA (2008) Emerging adulthood and college-aged youth: an overlooked age for weight-related behavior change. Obesity 16:2205–2211. CrossRefPubMedGoogle Scholar
  32. 32.
    Jacobi C, Abascal L, Taylor CB (2004) Screening for eating disorders and high-risk behavior: Caution. Int J Eat Disord 36:280–295. CrossRefPubMedGoogle Scholar
  33. 33.
    Taylor CB, Bryson S, Luce KH, Cunning D, Doyle AC, Abascal LB et al (2006) Prevention of eating disorders in at-risk college-age women. Arch Gen Psychiat 63:881–888. CrossRefPubMedGoogle Scholar
  34. 34.
    American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. ​American Psychiatric Association, Washington DCGoogle Scholar
  35. 35.
    Maisto SA, Sobell LC, Cooper AM, Sobell MB (1982) Comparison of two techniques to obtain retrospective reports of drinking behavior from alcohol abusers. Addict Behav 7:33–38. CrossRefPubMedGoogle Scholar
  36. 36.
    Eddy KT, Dorer DJ, Franko DL, Tahilani K, Thompson-Brenner H, Herzog DB (2008) Diagnostic crossover in anorexia nervosa and bulimia nervosa: Implications for DSM-V. Am J Psychiat 165:245–250. CrossRefPubMedGoogle Scholar
  37. 37.
    Franko DL, Keshaviah A, Eddy KT, Krishna M, Davis MC, Keel PK, Herzog DB (2013) A longitudinal investigation of mortality in anorexia nervosa and bulimia nervosa. Am J Psychiat 170:917–925. CrossRefPubMedGoogle Scholar
  38. 38.
    Herzog DB, Dorer DJ, Keel PK, Selwyn SE, Ekeblad ER, Flores AT et al (1999) Recovery and relapse in anorexia and bulimia nervosa: a 7.5-year follow-up study. J Am Acad Child Psy 38:829–837. CrossRefGoogle Scholar
  39. 39.
    Kouros CD, Morris MC, Garber J (2016) Within-person changes in individual symptoms of depression predict subsequent depressive episodes in adolescents: a prospective study. J Abnorm Child Psych 44:483–494. CrossRefGoogle Scholar
  40. 40.
    Wilks CR, Korslund KE, Harned MS, Linehan MM (2016) Dialectical behavior therapy and domains of functioning over two years. Behav Res Ther 77:162–169. CrossRefPubMedGoogle Scholar
  41. 41.
    Fairburn CG, Cooper Z (1993) The Eating Disorder Examination. In: Fairburn CG &, Wilson GT (eds) Binge eating: Nature, assessment, and treatment, 12th edn. Guilford, New York, pp 317–360Google Scholar
  42. 42.
    Berg KC, Peterson CB, Frazier P, Crow SJ (2012) Psychometric evaluation of the Eating Disorder Examination and Eating Disorder Examination-Questionnaire: a systematic review of the literature. Int J Eat Disord 45:428–438. CrossRefPubMedGoogle Scholar
  43. 43.
    Beck AT, Steer RA, Brown GK (1996) Manual for the Beck Depression Inventory-II. Psychological Corporation, San AntonioGoogle Scholar
  44. 44.
    Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Erlbaum, HillsdaleGoogle Scholar
  45. 45.
    Wonderlich JA, Lavender JM, Wonderlich SA, Peterson CB, Crow SJ, Engel SG et al (2015) Examining convergence of retrospective and ecological momentary assessment measures of negative affect and eating disorder behaviors. Int J Eat Disord 48:305–311. CrossRefPubMedGoogle Scholar
  46. 46.
    Spielberger CD, Gorsuch RL, Lushene RE (1970) STAI manual for the State-Trait Anxiety Inventory. Consulting Psychologists Press, Palo AltoGoogle Scholar
  47. 47.
    Verkuil B, Brosschot JF, Thayer JF (2007) Capturing worry in daily life: Are trait questionnaires sufficient? Behav Res Ther 45:1835–1844. CrossRefPubMedGoogle Scholar
  48. 48.
    Wechsler H, Nelson TF (2001) Binge drinking and the American college student: What’s five drinks? Psychol Addict Behav 15:287–291. CrossRefPubMedGoogle Scholar
  49. 49.
    Leigh BC (2000) Using daily reports to measure drinking and drinking patterns. J Subst Abuse 12:51–65. CrossRefPubMedGoogle Scholar
  50. 50.
    Curran PJ (2000). A latent curve framework for the study of developmental trajectories in adolescent substance use. In: Rose JS, Chassin L, Presson CC, Sherman SJ (eds) Multivariate applications in substance use research: new methods for new questions, Erlbaum, Mahway, pp 1–4Google Scholar
  51. 51.
    Muthén LK, Muthén BO (2012) Mplus user’s guide, 7th edn. Muthén & Muthén, Los AngelesGoogle Scholar
  52. 52.
    Browne MW, Cudeck R (1993). Alternative ways of assessing model fit. In: Bollen KA, Long JS (eds) Testing structural equation models, Sage, Newbury Park, pp 136–192Google Scholar
  53. 53.
    Hu LT, Bentler PM (1999) Cutoff criteria for fit indexes on covariance structure analysis: Conventional criteria versus new alternatives. Struct Equation Model 6:1–55. CrossRefGoogle Scholar
  54. 54.
    Kline RB (2005) Principles and practice of structural equation modeling, 2nd edn. Guilford, New YorkGoogle Scholar
  55. 55.
    MacCallum RC, Browne MW, Cai L (2006) Testing differences between nested covariance structure models: Power analysis and null hypotheses. Psychol Methods 11:19–35. CrossRefPubMedGoogle Scholar
  56. 56.
    Patalay P, Sharpe H, Wolpert M (2015) Internalising symptoms and body dissatisfaction: Untangling temporal precedence using cross-lagged models in two cohorts. J Child Psychol Psyc 56:1223–1230. CrossRefGoogle Scholar
  57. 57.
    Baumeister R (1991) Escaping the self: alcoholism, spirituality, masochism, and other flights from the burden of selfhood. Basic Books, New YorkGoogle Scholar
  58. 58.
    Pisetsky EM, Crosby RD, Cao L, Fitzsimmons-Craft EE, Mitchell JE, Engel SG et al (2016) An examination of affect prior to and following episodes of getting drunk in women with bulimia nervosa. Psychiat Res 240:202–208. CrossRefGoogle Scholar
  59. 59.
    Barry AE, Piazza-Gardner AK (2012) Drunkorexia: Understanding the co-occurrence of alcohol consumption and eating/exercise weight management behaviors. J Am Coll Health 60:236–243. CrossRefPubMedGoogle Scholar
  60. 60.
    Eisenberg MH, Fitz CC (2014) “Drunkorexia”: Exploring the who and why of a disturbing trend in college students’ eating and drinking behaviors. J Am Coll Health 62:570–577. CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2017

Authors and Affiliations

  • Ellen E. Fitzsimmons-Craft
    • 1
    Email author
  • Dawn M. Eichen
    • 2
  • Andrea E. Kass
    • 3
  • Mickey Trockel
    • 4
  • Ross D. Crosby
    • 5
    • 6
  • C. Barr Taylor
    • 4
    • 7
  • Denise E. Wilfley
    • 1
  1. 1.Department of PsychiatryWashington University School of MedicineSt. LouisUSA
  2. 2.Department of PediatricsUniversity of CaliforniaSan DiegoUSA
  3. 3.Department of Psychiatry and Behavioral NeuroscienceThe University of ChicagoChicagoUSA
  4. 4.Department of Psychiatry and Behavioral SciencesStanford University School of MedicineStanfordUSA
  5. 5.Neuropsychiatric Research InstituteFargoUSA
  6. 6.Department of Psychiatry and Behavioral ScienceUniversity of North Dakota School of Medicine & Health SciencesFargoUSA
  7. 7.Center for m2HealthPalo Alto UniversityPalo AltoUSA

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