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Disordered eating among Swedish adolescents: associations with emotion dysregulation, depression and self-esteem
Kristianstad University, School of Education and Environment, Avdelningen för Psykologi. Lund university.
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The path to an eating disorder (ED) always leads through a borderland, which, in this thesis, is referred to as disordered eating (DE) (Neumark-Sztainer, Wall, Eisenberg,Story, & Hannan, 2006; Waaddegaard, Thoning, & Petersson, 2003). In this borderland, people tend to make unhealthy eating choices, such as greatly reducing their food intake, self-inducing vomiting, or engaging in binge eating, but not to the extent that they would receive an ED diagnosis. Nevertheless, DE can have a strong negative effect on psychological health. Approximately 15%–52% of all adolescents, depending on the gender and the study’s focus, are found within the borderland between a healthy diet accompanied by psychological well-being and full-blown ED (e.g. Hautala et al., 2011; Herpertz-Dahlmann et al., 2008). While most of these individuals return to a more or less healthy diet after engaging in DE for some time, others continue to engage in DE and also tend to have trouble regulating their emotions, depression, and low self-esteem. For these reasons, DE itself, apart from being a springboard to EDs, is well worth exploring.At the outset of this thesis, an instrument assessing DE among 1265 adolescents (54.5% girls) was validated. This easily administered questionnaire, referred to by the acronym SCOFF (Morgan, Reid, & Lacey, 1999), comprises five questions assessing possible eating disturbances that are all answered using a “yes”/“no” answer format. The results showed that more girls than boys suffered from DE, and that girls also suffered from more severe DE, which is in line with previous research (e.g. Hautala et al., 2008). Additionally, this assessment of the SCOFF gave rise to the question of whether a positive answer on only certain items (instead of the stipulated cut-off of two) is necessary for indicating the possible presence of DE among adolescents, such as the item assessing whether individuals had ever vomited because they felt uncomfortably full.To further explore DE among adolescents, a person-oriented approach to identify specific patterns of DE based on the subscales of the Eating Disorders Examination Questionnaire (EDE-Q) (restraint, eating, weight, and shape concerns) was used. There were six different DE patterns for both boys and girls. The associations of these patterns with emotion dysregulation, depressive symptoms, and self-esteem, which all are related to DE (e.g. Shea & Pritchard, 2007; Svaldi, Griepenstroh, Tuschen- Caffier, & Ehring, 2012), were also assessed. Four of the six girl clusters and five of the six boy clusters showed scores above the cut-off for a clinical ED on at least one of the four indicators. Furthermore, although the “non-problematic” pattern was substantial, including 50% and 76% of girls and boys, respectively, a large portion of adolescents were part of clusters reporting generally high levels of DE. This might partly have to do with my use of an overly permissive cut-off, but nevertheless indicates that a considerable amount of adolescents suffer from DE. Generally, individuals in the DE patterns showed worse emotion regulation, depressive thoughts, and self- esteem than did those in the “non-problematic” patterns. However, some exceptions were found, which emphasizes the utility of analyzing different patterns of DE, not merely severity. Specifically, both girls and boys belonging to the pattern characterized by scores well above the cut-off on shape and weight concerns reported the lowest levels of self-esteem. Moreover, girls and boys in the pattern with scores above the cut-off on restraint showed good emotion regulation skills, few depressive symptoms, and high self-esteem.In Study III, the possible links between adolescents’ and parents’ possible DE and emotion dysregulation were explored, alongside the possible impact of shared family meals on DE. This study further examined whether it is possible to predict DE among adolescents according to their parents’ behaviors. Both DE and emotion dysregulation were found to be more frequent among adolescents than among parents. Furthermore, both adolescents and parents showed weak but significant associations between DE and emotion dysregulation, and showed similarities regarding specific aspects of emotion regulation, although the associations were gender specific. For example, parental emotional strategies were associated with girls’ emotional strategies, impulse control, and emotional goals, but only with boys’ emotional strategies. The only factor that was (weakly) associated with DE and emotion regulation among adolescents was the number of dinners that they shared with the family. Additionally, parental ED was the only predictor of current adolescent DE.In summary, the results of this thesis showed that many adolescents, especially girls, suffer from DE as well as poor emotional regulation, depressive thoughts, and low self-esteem. This is a problem, especially given that existing instruments for evaluating DE do not seem optimal, especially for boys. For instance, answering “yes” to the question of ever having engaged in self-induced vomiting because you have felt too full is probably best followed by a visit to the school nurse. Furthermore, the results indicated the importance of viewing DE not as a singular problem, but as a collection of different problems, even among individuals of the same gender. These differences call for different strategies aimed at helping adolescents achieve a healthier diet. Finally, while the parental influence of DE was significant, more research is required,preferably in a Swedish or Nordic context, where parental responsibility is not as heavily reliant on the mother as in other countries.

Place, publisher, year, edition, pages
Lund: Faculty of Social Sciences , 2017. , 126 p.
Keyword [en]
Disordered eating, emotion dysregulation, depression, self-esteem, SCOFF, parental associations
National Category
Psychology
Identifiers
URN: urn:nbn:se:hkr:diva-16878ISBN: 978-91-7753-327-6 (print)OAI: oai:DiVA.org:hkr-16878DiVA: diva2:1110050
Opponent
Supervisors
Available from: 2017-06-15 Created: 2017-06-15 Last updated: 2017-07-13Bibliographically approved
List of papers
1. SCOFF in a general adolescent population
Open this publication in new window or tab >>SCOFF in a general adolescent population
2015 (English)In: Journal of Eating Disorders, ISSN 2050-2974Article in journal (Refereed) Published
Abstract [en]

Background

Although Disordered Eating Behaviors (DEB) is an ill-defined concept, multiple studies have examined prevalence of DEB and its relations to other variables in various populations. DEB have been shown to predict more serious eating disorders which in turn can lead to death. Mostly girls seem to suffer from DEB, but the question has been raised whether this, at least, partially is due to the methods used for screening. The SCOFF-questionnaire has been suggested as a quick and easily administered tool to assess DEB. However, the psychometric results regarding SCOFF suggest some inconsistencies, and more research is needed in various countries and age samples.

Method

To validate SCOFF, a total of 1265 Swedish adolescents (51.6 % girls) completed self-report questionnaires using the Eating Disorder Examination Questionnaire (EDE-Q) as a reference standard.

Results

The factor analyses show inconclusive results as to whether SCOFF should be regarded as a comprehensive scale; furthermore, the results indicate a correlation between SCOFF and the EDE-Q in both girl and boy samples. Girls scored significantly higher on SCOFF and also had a higher total score, indicating more severe problems than boys.

Conclusions

The results raised questions as to whether the SCOFF might be interpreted and responded to in different ways by girls and boys, risking overlooking boys’ DEB and also whether one “yes” answer, instead of the stipulated two, could be sufficient when using SCOFF for screening purposes. In sum, the results challenge the use of SCOFF in a general adolescent population.

Keyword
Subclinical, disordered eating behaviors, SCOFF
National Category
Psychology
Identifiers
urn:nbn:se:hkr:diva-15207 (URN)10.1186/s40337-015-0087-6 (DOI)26677411 (PubMedID)
Available from: 2016-01-19 Created: 2016-01-19 Last updated: 2017-06-15Bibliographically approved
2. Disordered eating and emotion dysregulation among adolescents and their parents
Open this publication in new window or tab >>Disordered eating and emotion dysregulation among adolescents and their parents
2017 (English)In: BMC Psychology, E-ISSN 2050-7283, Vol. 5, no 1Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Research on the relationships between adolescent and parental disordered eating (DE) and emotion dysregulation is scarce. Thus, the aim of this study was to explore whether mothers' and fathers' own DE, as measured by SCOFF questionnaire, and emotion dysregulation, as measured by the difficulties in emotion regulation scale (DERS), were associated with their daughters' or sons' DE and emotion dysregulation. Furthermore, the importance of shared family meals and possible parent-related predictors of adolescent DE were explored.

METHOD: The total sample comprised 1,265 adolescents (M age  = 16.19, SD = 1.21; age range 13.5-19 years, 54.5% female) whose parents had received a self-report questionnaire via mail. Of these, 235 adolescents (18.6% of the total sample) whose parents completed the questionnaire were used in the analyses. Parents' responses were matched and compared with those of their child.

RESULTS: Adolescent girls showed greater levels of DE overall than did their parents. Furthermore, DE was associated with emotion dysregulation among both adolescents and parents. Adolescent and parental emotion dysregulation was associated, although there were gender differences in the specifics of this relationship. The frequency of shared dinner meals was the only variable that was associated to DE and emotion dysregulation among adolescents, while parental eating disorder was the only variable that enhanced the probability of adolescent DE.

CONCLUSION: The present study contributes to the literature by demonstrating that there are significant associations between parents and their adolescent children in terms of DE, emotion dysregulation, and shared family meals. Future studies should break down these relationships among mothers, fathers, girls, and boys to further clarify the specific associational, and possibly predictive, directions.

Keyword
Adolescents, Disordered eating, Emotion dysregulation, Parents, Shared meals
National Category
Psychology
Identifiers
urn:nbn:se:hkr:diva-16643 (URN)10.1186/s40359-017-0180-5 (DOI)28376909 (PubMedID)
Available from: 2017-04-26 Created: 2017-04-26 Last updated: 2017-06-15Bibliographically approved
3. Typical patterns of disordered eating among Swedish adolescents: associations with emotion dysregulation, depression, and self-esteem
Open this publication in new window or tab >>Typical patterns of disordered eating among Swedish adolescents: associations with emotion dysregulation, depression, and self-esteem
2016 (English)In: International Journal of Eating Disorders, ISSN 0276-3478, E-ISSN 1098-108X, Vol. 4, 28Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Using 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).

METHOD: Typical patterns of DE were identified in a community sample of 1,265 Swedish adolescents (Mage  = 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).

RESULTS: The 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.

CONCLUSION: We 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 REGISTRATION: Lund, EPN (dnr: 2012/499).

National Category
Psychology Medical and Health Sciences
Identifiers
urn:nbn:se:hkr:diva-16261 (URN)10.1186/s40337-016-0122-2 (DOI)000395714500001 ()27822375 (PubMedID)
Available from: 2016-11-25 Created: 2016-11-25 Last updated: 2017-08-14Bibliographically approved

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