Advertisement

Journal of Youth and Adolescence

, Volume 44, Issue 8, pp 1580–1591 | Cite as

Distinguishing Between Risk Factors for Bulimia Nervosa, Binge Eating Disorder, and Purging Disorder

  • Karina L. Allen
  • Susan M. Byrne
  • Ross D. Crosby
Empirical Research

Abstract

Binge eating disorder and purging disorder have gained recognition as distinct eating disorder diagnoses, but risk factors for these conditions have not yet been established. This study aimed to evaluate a prospective, mediational model of risk for the full range of binge eating and purging eating disorders, with attention to possible diagnostic differences. Specific aims were to determine, first, whether eating, weight and shape concerns at age 14 would mediate the relationship between parent-perceived childhood overweight at age 10 and a binge eating or purging eating disorder between age 15 and 20, and, second, whether this mediational model would differ across bulimia nervosa, binge eating disorder, and purging disorder. Participants (N = 1,160; 51 % female) were drawn from the Western Australian Pregnancy Cohort (Raine) Study, which has followed children from pre-birth to age 20. Eating disorders were assessed via self-report questionnaires when participants were aged 14, 17 and 20. There were 146 participants (82 % female) with a binge eating or purging eating disorder with onset between age 15 and 20 [bulimia nervosa = 81 (86 % female), binge eating disorder = 43 (74 % female), purging disorder = 22 (77 % female)]. Simple mediation analysis with bootstrapping was used to test the hypothesized model of risk, with early adolescent eating, weight and shape concerns positioned as a mediator between parent-perceived childhood overweight and later onset of a binge eating or purging eating disorder. Subsequently, a conditional process model (a moderated mediation model) was specified to determine if model pathways differed significantly by eating disorder diagnosis. In the simple mediation model, there was a significant indirect effect of parent-perceived childhood overweight on risk for a binge eating or purging eating disorder in late adolescence, mediated by eating, weight and shape concerns in early adolescence. In the conditional process model, this significant indirect effect was not moderated by eating disorder group. The results support a prospective model of risk that applies to bulimia nervosa, binge eating disorder and purging disorder. Common prevention approaches may be possible for bulimia nervosa, binge eating disorder and purging disorder.

Keywords

Adolescence Bulimia nervosa Binge eating disorder Purging disorder Risk factors Raine Study 

Notes

Acknowledgments

We are extremely grateful to the Raine Study participants and their families who took part in this study and to the whole Raine Study team for cohort management and data collection. We would also like to acknowledge the National Health and Medical Research Council (NHMRC) of Australia and the Telethon Kids Institute for their long-term support of the Raine Study. The first author is supported by an early career research fellowship from the National Health and Medical Research Council (NHMRC) of Australia. Core funding for the Western Australian Pregnancy Cohort (Raine) Study is provided by the Raine Medical Research Foundation; The University of Western Australia (UWA); the Faculty of Medicine, Dentistry and Health Sciences at UWA; the Telethon Kids Institute; the Women’s and Infant’s Research Foundation; Curtin University; and Edith Cowan University. Funding for the 14-year Raine Study follow-up was provided by the Raine Medical Research Foundation and NHMRC project grants. Funding for the 17-year follow-up was provided by NHMRC programme grant 35314. Funding for the 20-year follow-up was provided by the Canadian Institutes of Health Research and NHMRC project grants.

Author contributions

KA conceived of the study, conducted the statistical analyses and drafted the initial manuscript; RC provided statistical advice, assisted with the interpretation of results, and helped edit the manuscript; SB contributed to the study design and helped edit the manuscript. All authors read and approved the final manuscript.

References

  1. Allen, K. L., Byrne, S. M., Forbes, D., & Oddy, W. H. (2009). Risk factors for full- and partial-syndrome early adolescent eating disorders: a population-based pregnancy cohort study. Journal of the American Academy of Child and Adolescent Psychiatry, 48, 800–809.PubMedCrossRefGoogle Scholar
  2. Allen, K. L., Byrne, S. M., Oddy, W. H., & Crosby, R. D. (2013a). DSM-IV-TR and DSM-5 eating disorders in adolescents: Prevalence, stability, and psychosocial correlates in a population-based sample of male and female adolescents. Journal of Abnormal Psychology, 122, 720–732.PubMedCrossRefGoogle Scholar
  3. Allen, K. L., Byrne, S. M., Oddy, W. H., & Crosby, R. D. (2013b). Early onset binge eating and purging eating disorders: Course and outcome in a population-based study of adolescents. Journal of Abnormal Child Psychology, 41, 1083–1096.PubMedCrossRefGoogle Scholar
  4. Allen, K. L., Byrne, S. M., Oddy, W. H., Schmidt, U., & Crosby, R. D. (2014). Risk factors for binge eating and purging eating disorders: Differences based on age of onset. International Journal of Eating Disorders. doi: 10.1002/eat.22299.
  5. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, 5th edition (DSM-5). Washington, DC.Google Scholar
  6. Begg, S., Vos, T., Barker, B., Stevenson, C., Stanley, L., & Lopez, A. D. (2007). The burden of disease and injury in Australia 2003. Canberra: Australian Institute of Health and Welfaire (AIHW).Google Scholar
  7. Berg, K. C., Stiles-Shields, E. C., Swanson, S. A., Peterson, C. B., Lebow, J., & Le Grange, D. (2012). Diagnostic concordance of the interview and questionnaire versions of the Eating Disorder Examination. International Journal of Eating Disorders, 45, 850–855.PubMedCentralPubMedCrossRefGoogle Scholar
  8. Berkman, N. D., Lohr, K. N., & Bulik, C. M. (2007). Outcomes of eating disorders: A systematic review of the literature. International Journal of Eating Disorders, 40, 293–309.PubMedCrossRefGoogle Scholar
  9. Birch, L. L., & Fisher, J. O. (2000). Mothers’ child-feeding practices influence daughters’ eating and weight. American Journal of Clinical Nutrition, 71, 1054–1061.PubMedCentralPubMedGoogle Scholar
  10. Doolen, J., Alpert, P. T., & Miller, S. K. (2009). Parental disconnect between perceived and actual weight status of children: A metasynthesis of the current research. Journal of the American Academy of Nurse Practitioners, 21, 160–166.PubMedCrossRefGoogle Scholar
  11. Fairburn, C. G., & Beglin, S. J. (1994). Assessment of eating disorders: Interview or self-report questionnaire? International Journal of Eating Disorders, 16, 363–370.PubMedGoogle Scholar
  12. Fairburn, C. G., Cooper, Z., Doll, H. A., Norman, P., & O’Connor, M. E. (2000). The natural course of bulimia nervosa and binge eating disorder in young women. Archives of General Psychiatry, 57, 659–665.PubMedCrossRefGoogle Scholar
  13. Fairburn, C. G., Doll, H. A., Welch, S. L., Hay, P. J., Davies, B. A., & O’Connor, M. E. (1998). Risk factors for binge eating disorder. Archives of General Psychiatry, 55, 425–432.PubMedCrossRefGoogle Scholar
  14. Field, A. E., Camargo, C. A. J., Taylor, C. B., Berkey, C. S., Roberts, S. B., & Colditz, G. A. (2001). Peer, parent and media influences on the development of weight concerns and frequent dieting among preadolescent and adolescent girls and boys. Pediatrics, 107, 54–60.PubMedCrossRefGoogle Scholar
  15. Field, A. E., Javaras, K. M., Aneja, P., Kitos, N., Camargo, C. A., Taylor, C. B., et al. (2008). Family, peer, and media predictors of becoming eating disordered. Archives of Pediatrics and Adolescent Medicine, 162, 574–579.PubMedCrossRefGoogle Scholar
  16. Fink, E. L., Smith, A. R., Gordon, K. H., Holm-Denoma, J. M., & Joiner, T. E, Jr. (2009). Psychological correlates of purging disorder as compared with other eating disorders: An exploratory investigation. International Journal of Eating Disorders, 42, 31–39.PubMedCrossRefGoogle Scholar
  17. Haines, J., Neumark-Sztainer, D., Hannan, P. J., & Robinson-O’Brien, R. (2008). Child versus parent report of parental influences on children’s weight-related attitudes and behaviors. Journal of Pediatric Psychology, 33, 783–788.PubMedCentralPubMedCrossRefGoogle Scholar
  18. Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis. London: Guilford Press.Google Scholar
  19. Huang, R. C., De Klerk, N. H., Smith, A., Kendall, G. E., Landau, L. I., Mori, T. A., et al. (2011). Lifecourse childhood adiposity trajectories associated with adolescent insulin resistance. Diabetes Care, 34, 1019–1025.PubMedCentralPubMedCrossRefGoogle Scholar
  20. Jacobi, C., Hayward, C., de Zwaan, M., Kraemer, H. C., & Agras, W. S. (2004). Coming to terms with risk factors for eating disorders: Application of risk terminology and suggestions for a general taxonomy. Psychological Bulletin, 130, 19–65.PubMedCrossRefGoogle Scholar
  21. Jimerson, D. C., Wolfe, B. E., Carroll, D. P., & Keel, P. (2010). Psychobiology of purging disorder: Reduction in circulating leptin levels in purging disorder in comparison with controls. International Journal of Eating Disorders, 43, 584–588.PubMedCentralPubMedCrossRefGoogle Scholar
  22. Keel, P. K., Brown, T. A., Holm-Denoma, J., & Bodell, L. P. (2011). Comparison of DSM-IV versus proposed DSM-5 diagnostic criteria for eating disorders: Reduction of eating disorder not otherwise specified and validity. International Journal of Eating Disorders, 44, 553–560.PubMedCrossRefGoogle Scholar
  23. Keel, P. K., Haedt, A., & Edler, C. (2005). Purging disorder: An ominous variant of bulimia nervosa? International Journal of Eating Disorders, 38, 191–199.PubMedCrossRefGoogle Scholar
  24. Keel, P. K., Wolfe, B. E., Liddle, R. A., De Young, K. P., & Jimerson, D. C. (2007). Clinical features and physiological response to a test meal in purging disorder and bulimia nervosa. Archives of General Psychiatry, 64, 1058–1066.PubMedCrossRefGoogle Scholar
  25. Le Grange, D., Lock, J., Loeb, K. L., & Nicholls, D. (2010). Academy for eating disorders position paper: The role of the family in eating disorders. International Journal of Eating Disorders, 43, 1–5.PubMedGoogle Scholar
  26. Li, J., Kendall, G. E., Henderson, S., Downie, J., Landsborough, L., & Oddy, W. H. (2008). Maternal psychosocial wellbeing in pregnancy and breastfeeding duration. Acta Paediatrica, 97, 221–225.PubMedCrossRefGoogle Scholar
  27. Linville, D., Stice, E., Gau, J., & O’Neil, M. (2011). Predictive effects of mother and peer influences on increases in adolescent eating disorder risk factors and symptoms: A 3-year longitudinal study. International Journal of Eating Disorders, 44, 745–751.PubMedCentralPubMedCrossRefGoogle Scholar
  28. MacKinnon, D. P., Lockwood, C. M., & Williams, J. (2004). Confidence limits for the indirect effect: Distribution of the product and resampling methods. Multivariate Behavioral Research, 39, 99–128.PubMedCentralPubMedCrossRefGoogle Scholar
  29. Mond, J. M., Hay, P., Rodgers, B., & Owen, C. (2007). Recurrent binge eating with and without the “undue influence of weight or shape on self-evaluation”: Implications for the diagnosis of binge eating disorder. Behaviour Research and Therapy, 45, 929–938.PubMedCrossRefGoogle Scholar
  30. Monteleone, P., Di Lieto, A., Tortorella, A., Longobardi, N., & Maj, M. (2000). Circulating leptin in patients with anorexia nervosa, bulimia nervosa or binge-eating disorder: Relationship to body weight, eating patterns, psychopathology and endocrine changes. Psychiatry Research, 94, 121–129.PubMedCrossRefGoogle Scholar
  31. Neumark-Sztainer, D., Bauer, K. W., Friend, S., Hannan, P. J., Story, M., & Berge, J. M. (2010). Family weight talk and dieting: How much do they matter for body dissatisfaction and disordered eating behaviors in adolescent girls? Journal of Adolescent Health, 47, 270–276.PubMedCentralPubMedCrossRefGoogle Scholar
  32. Neumark-Sztainer, D., Wall, M., Story, M., & Van den Berg, P. (2008). Accurate parental classification of overweight adolescents’ weight status: Does it matter? Pediatrics, 121, e1495–e1502.PubMedCrossRefGoogle Scholar
  33. Newnham, J. P., Evans, S. F., Michael, C. A., Stanley, F. J., & Landau, L. I. (1993). Effects of frequent ultrasound during pregnancy: A randomised controlled trial. Lancet, 342, 887–891.PubMedCrossRefGoogle Scholar
  34. Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2012). Prevalence of obesity and trends in body mass index among US children and adolescents, 1999–2010. JAMA, 307, 483–490.PubMedCrossRefGoogle Scholar
  35. Olds, T. S., Tomkinson, G. R., Ferrar, K. E., & Maher, C. A. (2010). Trends in the prevalence of childhood overweight and obesity in Australia between 1985 and 2008. International Journal of Obesity, 34, 57–66.PubMedCrossRefGoogle Scholar
  36. Preacher, K. J., Rucker, D. D., & Hayes, A. F. (2007). Addressing moderated mediation hypotheses: Theory, methods, and prescriptions. Multivariate Behavioral Research, 42, 185–227.CrossRefGoogle Scholar
  37. Ricciardelli, L. A., & McCabe, M. P. (2001). Dietary restraint and negative affect as mediators of body dissatisfaction and bulimic behavior in adolescent girls and boys. Behaviour Research and Therapy, 39, 1317–1328.PubMedCrossRefGoogle Scholar
  38. Roberto, C. A., Grilo, C. M., Masheb, R. M., & White, M. A. (2010). Binge eating, purging, or both: Eating disorder psychopathology findings from an internet community survey. International Journal of Eating Disorders, 43, 724–731.PubMedCentralPubMedCrossRefGoogle Scholar
  39. Stice, E. (2001). A prospective test of the dual-pathway model of bulimic pathology: Mediating effects of dieting and negative affect. Journal of Abnormal Psychology, 110, 124–135.PubMedCrossRefGoogle Scholar
  40. Stice, E., Marti, C. N., & Durant, S. (2011). Risk factors for onset of eating disorders: Evidence of multiple risk pathways from an 8-year prospective study. Behaviour Research and Therapy, 49, 622–627.PubMedCentralPubMedCrossRefGoogle Scholar
  41. Stice, E., Marti, C., & Rohde, P. (2013). Prevalence, incidence, impairment and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women. Journal of Abnormal Psychology, 122, 445–457.PubMedCentralPubMedCrossRefGoogle Scholar
  42. Stice, E., Shaw, H. E., & Marti, C. (2007). A meta-analytic review of eating disorder prevention programs: Encouraging findings. Annual Review of Clinical Psychology, 3, 207–231.PubMedCrossRefGoogle Scholar
  43. Stice, E., Shaw, H. E., & Nemeroff, G. (1998). Dual pathway model of bulimia nervosa: Longitudinal support for dietary restraint and affect-regulation mechanisms. Journal of Social and Clinical Psychology, 17, 129–149.CrossRefGoogle Scholar
  44. Striegel-Moore, R. H., Dohm, F. A., Kraemer, H. C., Schreiber, G. B., Taylor, C. B., & Daniels, S. R. (2007). Risk factors for binge-eating disorders: An exploratory study. International Journal of Eating Disorders, 40, 481–487.PubMedCrossRefGoogle Scholar
  45. Sysko, R., Devlin, M., Walsh, B. T., Zimmerli, E., & Kissileff, H. R. (2007). Satiety and test meal intake among women with binge eating disorder. International Journal of Eating Disorders, 40, 554–561.PubMedCrossRefGoogle Scholar
  46. Wolke, D., Waylen, A., Samara, M., Steer, C., Goodman, R., & Ford, T. (2009). Selective drop-out in longitudinal studies and non-biased prediction of behaviour disorders. British Journal of Psychiatry, 195, 249–256.PubMedCentralPubMedCrossRefGoogle Scholar
  47. Zhao, X., Lynch, J. G., & Chen, Q. (2010). Reconsidering Baron and Kenny: Myths and truths about mediation analysis. Journal of Consumer Research, 37, 197–206.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Karina L. Allen
    • 1
    • 2
  • Susan M. Byrne
    • 1
  • Ross D. Crosby
    • 3
    • 4
  1. 1.School of PsychologyThe University of Western AustraliaCrawleyAustralia
  2. 2.Telethon Kids InstituteThe University of Western AustraliaCrawleyAustralia
  3. 3.Department of Clinical NeuroscienceUniversity of North Dakota School of Medicine and Health SciencesGrand ForksUSA
  4. 4.Department of BiostatisticsNeuropsychiatric Research InstituteSalt Lake CityUSA

Personalised recommendations