Stability and change in patterns of eating disorder symptoms from adolescence to young adulthood.

Using a community adolescent sample, we aimed to (a) empirically derive eating disorder (ED) symptom groups, (b) examine the longitudinal stability of those groups over 10 years, and (c) identify risk factors associated with ED group stability and transition through young adulthood. Young people (N = 2,287) from the Project EAT cohort participated at baseline (1998-1999) and at 10-year follow-up (2008-2009). Participants completed anthropometric measures at baseline and self-report surveys on disordered eating symptoms and risk factors at both time points. Latent transition modeling was used to test the first two aims and multinomial logistic regression was used for the third aim. Three groups emerged and were labeled as: (a) asymptomatic, (b) dieting, (c) disordered eating (e.g., binge eating, compensatory behaviors). Stability of group membership over 10 years was highest for those in the asymptomatic group, while those in the dieting group showed equal likelihood of transitioning to any group. There was a 75% chance that those in the disordered eating group would continue to belong to a symptomatic group 10 years later. We found that these transitions could be predicted by baseline risk factors. For example, adolescents with one standard deviation higher depressive symptoms than their peers had 53% higher odds (OR = 1.53, 95% CI 1.09-2.16) of transitioning from the asymptomatic group to the disordered eating group. Transition among ED groups is relatively common during adolescence and early adulthood. By targeting risk factors such as self-esteem and familial factors in early adolescence, prevention efforts may be improved.

Do symptom-specific stages of change predict eating disorder treatment outcome?

PURPOSE: Interview methods to assess stages of change (SOC) in eating disorders (ED) indicate that SOC are positively correlated with symptom improvement over time. However, interviews require significant time and staff training and global measures of SOC do not capture varying levels of motivation across ED symptoms. This study used a self-report, ED symptom-specific SOC measure to determine prevalence of stages across symptoms and identify if SOC predict treatment outcome. METHODS: Participants [N = 182; age 13-58 years; 92% Caucasian; 96% female; average BMI 21.7 (SD = 5.9); 50% ED not otherwise specified (EDNOS), 30.8% bulimia nervosa (BN), 19.2% anorexia nervosa (AN)] seeking ED treatment at a diverse-milieu multi-disciplinary facility in the United States completed stages of change, behavioral (ED symptom use and frequency) and psychological (ED concerns, anxiety, depression) measures at intake assessment and at 3, 6 and 12 months thereafter. Descriptive summaries were generated using ANOVA or Kruskal-Wallis (continuous) and χ (2) (categorical) tests. Repeated measures linear regression models with autoregressive correlation structure predicted treatment outcome. RESULTS: At intake assessment, 53.3% of AN, 34.0% of BN and 18.1% of EDNOS patients were in Preparation/Action. Readiness to change specific symptoms was highest for binge-eating (57.8%) and vomiting (56.5%). Frequency of fasting and restricting behaviors, and scores on all eating disorder and psychological measures improved over time regardless of SOC at intake assessment. Symptom-specific SOC did not predict reductions in ED symptom frequency. Overall SOC predicted neither improvement in Eating Disorder Examination Questionnaire (EDE-Q) scores nor reduction in depression or trait anxiety; however, higher overall SOC predicted lower state anxiety across follow-up. CONCLUSIONS: Readiness to change ED behaviors varies considerably. Most patients reduced eating disorder behaviors and increased psychological functioning regardless of stages of change, indicating the benefits of treatment and effectiveness of treatment-as-usual for overall psychiatric improvement.

Poor outcome and death among youth, young adults, and midlife adults with eating disorders: an investigation of risk factors by age at assessment.

OBJECTIVE: Eating disorders (EDs) present across a broad age range, yet little is known about the characteristics and outcome of midlife patients compared to younger patients. Among patients seeking ED treatment who were stratified by age at initial assessment (IA), this study aimed to (1) discern sociodemographic and clinical differences, (2) determine outcome rates, and (3) identify predictors of poor outcome including death. METHOD: Participants [219 females (12 years or older, 94.1% Caucasian) who completed outcome assessment and 31 known decedents] were stratified by age at IA (<18 as youth, 18-39 as young adult, and ≥40 years as midlife adult). Analyses of variance and chi-square tests identified group differences; ordered logistic regression with stepwise selection identified factors predicting outcome. RESULTS: Midlife adults were more significantly compromised at follow-up compared to youths and young adults, including psychological and physical quality of life, ineffectiveness, interpersonal concerns, and general psychological maladjustment. Midlife adults had the highest rates of poor outcome or death; good outcome was achieved by only 5.9% of midlife adult compared to 14.0% of young adult and 27.5% of youth patients. Older age at IA, alcohol and/or drug misuse, endocrine concerns, and absence of family ED history predicted poor outcome or death. DISCUSSION: Midlife adults seeking ED treatment have more complex medical and psychological concerns and poorer outcomes than youths and young adults; further exploration is needed to improve treatment outcome. Specialized treatment focusing on quality of life, comorbid medical concerns, interpersonal connection, and emotion regulation is encouraged.

The meaning of (quality of) life in patients with eating disorders: a comparison of generic and disease-specific measures across diagnosis and outcome.

OBJECTIVE: Compare general and disease-specific health-related quality of life (HRQoL) among female patients with an eating disorder (ED). METHOD: Female patients (n = 221; 95.3% Caucasian; 94.0% never married) completed the Medical Outcome Short Form Health Survey (SF-36) and Eating Disorders Quality of Life (EDQoL) as part of a study of treatment outcomes. Multivariate regression models were used to compare HRQoL differences across initial ED diagnosis (85 AN-R, 19 AN-B/P, 27 BN, 90 EDNOS) and ED diagnostic classification at time of outcome assessment (140 no ED, 38 subthreshold ED, 43 full threshold ED). RESULTS: There were no significant differences across ED diagnosis at initial assessment on either of the SF-36 Component Summary scores. However, patients with AN-B/P scored poorer on the work/school EDQoL subscales than other ED diagnoses, and on the psychological EDQoL subscale compared to AN-R and EDNOS. At outcome assessment, comparisons across full threshold, subthreshold and no ED classification indicated that those with no ED reported better HRQoL than those with full threshold ED on the SF-36 Mental Components Summary and three of four EDQoL subscales. Furthermore, those with no ED reported better psychological HRQoL than those with subthreshold ED. DISCUSSION: Disease-specific HRQOL measures are important to use when comparing HRQoL in ED patients across treatment and outcome, and may have the sensitivity to detect meaningful differences by diagnosis more so than generic instruments. EDQoL scores from patients remitted from symptoms approach but do not reach scores for unaffected college females; thus, treatment should continue until quality of life is restored.

Verbal, physical and sexual dating violence among a population-based sample of teens: Does exposure to intimate partner violence in the home account for the association between dating violence and mental health?

BACKGROUND: Teen dating violence (TDV) and exposure to intimate partner violence (eIPV) are associated with poorer mental health; however, few studies investigate verbal TDV or the independent contributions that TDV and eIPV have on mental health. OBJECTIVE: Examine the prevalence of TDV (verbal, physical, sexual, multiple forms) among youth, associations between TDV and mental health, and how eIPV affects these associations. PARTICIPANTS AND SETTING: A school-based sample of 71,635 9th and 11th grade students (51.5% assigned female, 71.9% White) completed the anonymous 2019 Minnesota Student Survey, providing data on mental/emotional/behavioral (MEB) problems and treatment, depression and anxiety symptoms, non-suicidal self-injury, suicidal ideation/attempts, TDV, and eIPV. METHODS: Chi-square tests were used to compare the prevalence of mental health concerns by TDV form; logistic regression models controlled for demographic characteristics and eIPV. Interaction tests identified the multiplicative effects of eIPV and TDV on mental health. RESULTS: TDV was reported by 36.4% of those with vs 13.6% of those without eIPV. Each type of TDV was significantly associated with adverse mental health (p's<0.001), even after adjusting for demographic variables and eIPV. The prevalence of each mental health outcome was significantly increased by eIPV for youth with no TDV (p's<0.001), verbal only (p's<0.001), sexual only (p's<0.05), and multiple forms of TDV (p's<0.001); findings for physical TDV varied. CONCLUSIONS: Education on healthy, consensual dating relationships is critical, alongside regular screening for eIPV and TDV, referring affected youth for treatment. Further research on factors that attenuate the association between TDV and mental health is warranted.

Psychological and behavioral risk profiles as they relate to eating disorder diagnoses and symptomatology among a school-based sample of youth.

OBJECTIVE: Examine substance use, depression, self-esteem, and suicidality by eating disorder (ED) classifications among nonclinical youth. METHOD: A school-based sample of 4,746 youth completed anthropometric measures and Project EAT survey items matched to DSM-IV ED criteria. Logistic regression analyses and general linear models compared three threshold (AN, BN, or BED), two subthreshold (binge-eating and/or compensatory behaviors not meeting ED diagnosis, or body image disturbance without disordered eating) and one asymptomatic ED classifications. RESULTS: Subthreshold and threshold classifications reported lower self-esteem and greater substance use, depression, suicidal ideation/attempts than asymptomatic youth. The BED group had higher depressive mood, and BED and BN had lower self-esteem, than the subthreshold groups. Odds ratios for suicidality were highest among the BN group and lowest among the body image disturbance group. DISCUSSION: Subthreshold and threshold classifications are associated with compromised health, suggesting the importance of addressing the continuum of weight/shape concerns and disordered eating behaviors within prevention and treatment interventions.

Stability of eating disorder diagnostic classifications in adolescents: five-year longitudinal findings from a population-based study.

This study examined the stability of eating disorder (ED) classifications among a population-based sample of male and female adolescents (n = 2,516) who participated in Project EAT-II, a five-year longitudinal study. Cross-tabulations using weighted data identified diagnostic stability across six classifications (Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, Binge Eating and/or Compensatory Behaviors not meeting ED diagnosis, Body Image Disturbance without disordered eating, and Asymptomatic). One-third (32.6%) of adolescents who were asymptomatic at baseline and over half of those who were symptomatic at baseline reported symptoms five years later. All males and 82% of females with a threshold diagnosis at baseline remained symptomatic five years later, but rarely within the same classification. In conclusion, the presence of ED symptoms in adolescence strongly predicts ED symptoms five years later. ED diagnoses and classifications were unstable over time, underscoring the critical need for prevention efforts and periodic assessment and encouraging early detection and intervention among adolescents.

Number of different purging behaviors used among women with eating disorders: psychological, behavioral, self-efficacy and quality of life outcomes.

The objective of this study was to examine differences between a number of different purging behaviors used and outcome measures among eating disorder patients. Among 211 females who received inpatient or partial hospitalization eating disorder treatment, analyses of covariance and cross-tabulations identified associations among a number of different purging behaviors (vomiting, laxative use, diuretic use) used and psychological, behavioral, self-efficacy and quality of life measures at follow-up. Most patients (80.1%) reported purging for weight control. Use of different purging behaviors was significantly associated at follow-up with lower self-esteem, greater depression, higher state and trait anxiety, higher BMI, poorer self-efficacy for normative eating and body image, compromised quality of life, greater dietary restraint, and eating, shape and weight concerns. Furthermore, a higher percentage of those who used purging behaviors met criteria for a subthreshold or threshold eating disorder at follow-up compared to their non-purging peers. Eating disorder patients who use different purging behaviors are more compromised at follow-up than patients who do not purge. Due to the severe medical complications associated with different purging behaviors, future research should address best practices for clinical intervention and prevention.

Personality dimensions in bulimia nervosa, binge eating disorder, and obesity.

OBJECTIVE: The purpose of this investigation was to examine differences in personality dimensions among individuals with bulimia nervosa, binge eating disorder, non-binge eating obesity, and a normal-weight comparison group as well as to determine the extent to which these differences were independent of self-reported depressive symptoms. METHOD: Personality dimensions were assessed using the Multidimensional Personality Questionnaire in 36 patients with bulimia nervosa, 54 patients with binge eating disorder, 30 obese individuals who did not binge eat, and 77 normal-weight comparison participants. RESULTS: Participants with bulimia nervosa reported higher scores on measures of stress reaction and negative emotionality compared to the other 3 groups and lower well-being scores compared to the normal-weight comparison and the obese samples. Patients with binge eating disorder scored lower on well-being and higher on harm avoidance than the normal-weight comparison group. In addition, the bulimia nervosa and binge eating disorder groups scored lower than the normal-weight group on positive emotionality. When personality dimensions were reanalyzed using depression as a covariate, only stress reaction remained higher in the bulimia nervosa group compared to the other 3 groups and harm avoidance remained higher in the binge eating disorder than the normal-weight comparison group. CONCLUSIONS: The higher levels of stress reaction in the bulimia nervosa sample and harm avoidance in the binge eating disorder sample after controlling for depression indicate that these personality dimensions are potentially important in the etiology, maintenance, and treatment of these eating disorders. Although the extent to which observed group differences in well-being, positive emotionality, and negative emotionality reflect personality traits, mood disorders, or both, is unclear, these features clearly warrant further examination in understanding and treating bulimia nervosa and binge eating disorder.

Factors associated with disordered eating among sexually active adolescent males: gender and number of sexual partners.

OBJECTIVE: To examine the prevalence of disordered eating behaviors among sexually active adolescent males by gender and number of sex partners, and examine psychosocial well-being by sex partner factors among boys reporting disordered eating. METHOD: Data were collected from 10,095 9(th) and 12(th) grade Minnesota Student Survey participants who reported sexual intercourse in the past year. RESULTS: The use of any disordered eating behaviors was reported by 39.4% of the sexually active males reporting only female sex partners, 53.4% reporting only male sex partners, and 56.4% reporting both female and male sex partners. Rates of specific disordered eating behaviors were associated with higher numbers of sex partners (male and/or female) and same gender of sex partner, and were highest among those males who reported 3 or more of both genders of sex partners. Among sexually active males reporting disordered eating, poorer emotional well-being and less family connectedness were associated with greater number of partners and with same-sex partners. CONCLUSIONS: Sexually active males, especially those with multiple and/or same-sex partners, may benefit from interventions targeted at reducing disordered eating behaviors. Among sexually active males engaging in disordered eating behaviors, enhancing emotional health and improving family connectedness may be beneficial, especially among those with sex partners of the same gender and/or with multiple sex partners. The identification of specific psychosocial characteristics that are commonly associated with sexually active adolescent males and who exhibit disordered eating behaviors may provide direction toward the development of appropriate early identification, prevention, and treatment efforts.

Disordered eating and body dissatisfaction in adolescents with type 1 diabetes and a population-based comparison sample: comparative prevalence and clinical implications.

OBJECTIVE: To compare the prevalence of disordered eating and body dissatisfaction between adolescents with type 1 diabetes and a population-based sample of youth. SUBJECTS: A clinic-based sample of 143 adolescents (73 male and 70 female) with type 1 diabetes who participated in the Assessing Health and Eating among Adolescents with Diabetes (AHEAD) study was compared with a population-based sample of 4746 youths (2377 male, 2357 female, and 12 missing) who participated in Project Eating Among Teens (Project EAT). METHOD: Participants completed surveys and anthropometric measurements of height and weight. RESULTS: Although some adolescents with type 1 diabetes endorsed unhealthy weight control practices, overall, they reported less weight dissatisfaction and were less likely to use any unhealthy weight control behaviors and more likely to report regular meal consumption than the population-based sample. Females with type 1 diabetes were less likely to report dieting, fasting, or eating very little food to control weight during the past year than their population-based peers. However, males with type 1 diabetes were less likely than their peers to exercise and to consume more fruits and vegetables for healthy weight control. Of medical concern were insulin omission (1.4% males and 10.3% females) and dosage reduction (1.4% males and 7.4% females) as means of weight control among youth with type 1 diabetes. CONCLUSIONS: Despite medical supervision, some adolescents with type 1 diabetes reported unhealthy weight control behaviors and weight concerns, including insulin manipulation. Altering the insulin regimen may cause complications. All adolescents warrant attention for unhealthy behaviors and weight concerns.

Long-term impact of adolescent dating violence on the behavioral and psychological health of male and female youth.

OBJECTIVE: To evaluate the long-term impact of adolescent dating violence (ADV) on behavioral and psychological health. STUDY DESIGN: From a diverse sample of older adolescents who completed Project EAT in 1999 (wave 1) and 2004 (wave 2; mean age 20.4), 23 male and 102 female adolescents reporting ADV were compared with 671 male and 720 female adolescents reporting no ADV. RESULTS: ADV was positively associated with cigarette smoking and suicide attempts for both sexes, binge-eating and suicidal ideation in male adolescents, and smoking marijuana and high depressive symptoms in female adolescents in analyses unadjusted for wave 1 outcomes. In analyses adjusted for wave 1, in female adolescents, ADV was significantly associated with smoking cigarettes, marijuana use, and high depressive symptoms and marginally associated with suicide attempts; in male adolescents, ADV was significantly associated with smoking cigarettes and marginally associated with binge-eating and suicidal ideation. ADV was significantly associated with an overall high-risk profile (presence > or = 3 health outcomes) for both sexes; results remained significant in female adolescents after adjusting for wave 1. CONCLUSIONS: ADV is associated with greater likelihood of problematic health factors and increases nonspecific risk toward behavioral and psychological impairment in youth, particularly female adolescents.

Protective factors and suicide risk in adolescents with a history of sexual abuse.

OBJECTIVE: To test the hypothesis that certain protective factors will reduce the risk of suicide behaviors in youth who are sexually abused. STUDY DESIGN: Survey data come from 83,731 students in the 6th, 9th, and 12th grades in Minnesota. Four childhood sexual abuse groups were created: a) no history of sexual abuse; b) abuse by non-family member; c) abuse by family member; and d) abuse by both. Dependent variables included suicidal ideation and attempts. Four protective factors included: family connectedness, teacher caring, other adult caring, and school safety. Logistic regression was used in detecting differences in suicide behaviors across the 4 childhood sexual abuse categories. RESULTS: Four percent of students reported sexual abuse by a non-family member, 1.3% by a family member, and 1.4% by both. Although youth with a history of childhood sexual abuse were at increased risk for suicide behaviors compared with other youth, when protective factors were accounted for, the predicted probabilities of suicide behaviors for childhood sexual abuse youth were substantially reduced. Family connectedness was the strongest of the 4 protective factors. CONCLUSION: Modifying select protective factors, particularly family connectedness, may reduce suicide risk in adolescents with childhood sexual abuse.

Diabetes Distress Among Persons With Type 1 Diabetes.

Purpose The purpose of this study is to evaluate associations between diabetes distress and a range of psychological health behaviors and concerns among persons with type 1 diabetes for the benefit of enhancing early identification and intervention of at-risk individuals. Methods Persons with type 1 diabetes (n = 268; 57.1% female, 91.0% white, 76.8% <18 years of age, average A1C 8.4%) completed the 2-item Diabetes Distress Screening Scale (DDS2) and a battery of psychometrically sound instruments measuring satisfaction with life, self-esteem, self-efficacy, depression, perfectionism, body image satisfaction, dietary restraint and eating, and shape and weight concerns. Each subscale score was compared within age groups (<18 years vs ≥18 years) between groups (diabetes distress level [low, moderate, high]) using analysis of variance (with Bonferroni correction or the Kruskal-Wallis test if the variables were not normally distributed). Results For both age groups, high diabetes distress was independently associated with greater A1C values, higher depression scores and eating, and shape and weight concerns than those with low or moderate distress. For patients <18 years of age, those with high diabetes distress scored lower on measures of satisfaction with life, self-esteem, and self-efficacy and higher on dietary restraint and several areas of perfectionism than those with low or moderate distress. Conclusions Individuals with type 1 diabetes who have high diabetes distress also report higher A1C values and poorer psychological health concerns. A brief diabetes distress questionnaire can help to identify those who need additional screening, education and support, and treatment for overall health and well-being.

Parent-child connectedness and behavioral and emotional health among adolescents.

BACKGROUND: This study sought to examine teen perceptions of mother-child and father-child connectedness, with focus on valuing parental opinions and perception of parental communication and caring, and associations with behavioral and emotional health. METHODS: A population-based sample of 4746 students in public schools completed the 2001 Project EAT (Eating Among Teens) survey. RESULTS: Overall, the majority of girls and boys reported valuing their parents' opinion when making serious decisions and believing that their parents cared about them. Yet, one fourth of girls and boys felt unable to talk to their mother about problems, and over half of girls and one third of boys felt unable to talk to their father. Valuing friends' opinions over parents' opinions, and perceiving low parental communication and caring were associated with unhealthy weight control, substance use, suicide attempts, body dissatisfaction, depression, and low self-esteem. Of significant concern, compared to their peers who reported feeling that their mother cared quite a bit or very much, youths who reported feeling as though their mother cared very little or not at all about them reported particularly high prevalence rates of unhealthy weight control behaviors (63.49% girls, 25.45% boys); suicide attempts (33.51% girls, 21.28% boys); low self-esteem (47.15% girls, 24.56% boys); and depression (63.52% girls, 33.35% boys). CONCLUSIONS: Adolescents' perceptions of low parental caring, difficulty talking to their parents about problems, and valuing their friends' opinions for serious decisions were significantly associated with compromised behavioral and emotional health. Interventions aimed at improving the parent-child relationship may provide an avenue toward preventing health risk behaviors in youth.

Eating disorders in persons with type 1 diabetes: A focus group investigation of early eating disorder risk.

Through focus groups, we examined the development and maintenance of an eating disorder in 16 females with type 1 diabetes and an eating disorder. The quotes and qualitative data summaries provide rich insights into understanding why those with type 1 diabetes are at increased risk for eating disorders. Content analyses revealed five themes pertinent to the dual diagnosis (feeling different, difficulty with control/coping, body image, feelings, and quality of life) of which four themes were relevant to eating disorder development. Findings support early identification of those at risk and inform interventions to mitigate development of an eating disorder.

Weight control practices and disordered eating behaviors among adolescent females and males with type 1 diabetes: associations with sociodemographics, weight concerns, familial factors, and metabolic outcomes.

OBJECTIVE: This study examines the prevalence of specific weight control practices/disordered eating behaviors and associations with sociodemographic characteristics, BMI and weight perceptions, family functioning, and metabolic control among adolescent females and males with type 1 diabetes. RESEARCH DESIGN AND METHODS: The study population included 70 adolescent females and 73 adolescent males with type 1 diabetes who completed the AHEAD (Assessing Health and Eating among Adolescents with Diabetes) survey. Data on BMI and glycosylated hemoglobin (HbA(1c)) were drawn from medical records. RESULTS: Unhealthy weight control practices were reported by 37.9% of the females and by 15.9% of the males. Among the females, 10.3% reported skipping insulin and 7.4% reported taking less insulin to control their weight. Only one male reported doing either of these behaviors. Weight control/disordered eating behaviors were not associated with age, parental level of education, family structure, or race/ethnicity. Higher levels of weight dissatisfaction tended to be associated with unhealthy weight control/disordered eating; associations with BMI were inconsistent. Family cohesion was negatively associated with disordered eating among females (r = -0.52; P < 0.001) and males (r = -0.41; P < 0.001), but correlations with other measures of family environment (control, independence, and responsibility for diabetes management) were not significant. Correlations between disordered eating and HbA(1c) levels were significant among females (r = 0.33; P < 0.01) and males (r = 0.26; P < 0.05). CONCLUSIONS: Special attention is needed for youth with weight concerns and those from less cohesive families to assist in the development of healthy diabetes management behaviors.

The associations between childhood dance participation and adult disordered eating and related psychopathology.

OBJECTIVE: To examine the relationship between childhood dance participation and adult eating behavior and psychological health. METHODS: A total of 546 undergraduate females at a large Midwestern university completed questionnaires regarding eating behavior and associated features, depression, self-esteem, and body image. RESULTS: Women who participated in childhood dance are more likely to score higher on measures of bulimic behaviors than nondancers. In addition, childhood dancers indicated greater drive for thinness and poorer impulse control compared to nondancers. Furthermore, there was a statistical trend for childhood dancers to report greater perfectionism and a smaller ideal body mass than nondancers. There were no significant differences between dance groups on measures of depression and self-esteem. CONCLUSION: These findings suggest that participating in dance as a child may influence one's eating behavior as an adult, including associated factors such as drive for thinness and impulse control and potentially perfectionism and preferred body size.

Dieting frequency among college females: association with disordered eating, body image, and related psychological problems.

OBJECTIVE: To examine associations between dieting frequency and eating disorder behaviors, body satisfaction, and related factors. METHOD: Females (N=345) whose average age and body mass index (BMI) were 20.58 and 21.79, respectively, were grouped into three categories of lifetime dieting frequency (never, 1-5 times, or 6 or more times) and matched on current BMI across categories. RESULT: Positive associations were found between dieting frequency and eating disorder symptoms and related problems such as body dissatisfaction, current body size perception, depression, exercise preoccupation, and feelings of ineffectiveness and insecurity. Dieting frequency was inversely associated with self-esteem, ideal body size, emotional regulation, and impulse control. DISCUSSION: Independent of current BMI, frequency of dieting behaviors is strongly associated with negative emotions and problematic behaviors. As this study is correlational in nature, future longitudinal studies should ascertain the sequence of onset of these experiences.

Date violence and date rape among adolescents: associations with disordered eating behaviors and psychological health.

OBJECTIVES: The goal of the study was to assess the prevalence of date violence and rape in adolescents, to examine associations between date violence and rape and disordered eating behaviors and psychopathology, and to determine if these associations remain significant after controlling for sociodemographic characteristics and other physical and sexual abuse by an adult. METHOD: A Minnesota school-based sample of 81,247 boys and girls in 9th and 12th grades completed the 1998 Minnesota Student Survey. RESULTS: Overall, approximately 9% of girls and 6% of boys had experienced date violence or rape. Significant differences across race and grade were found. Date violence and rape is associated with higher rates of disordered eating behaviors and suicidal thoughts and attempts, and lower scores on measures of emotional well-being and self-esteem. Over 50% of youth reporting both date violence and rape also reported attempting suicide. Controlling for race and age, adolescents who have experienced both date violence and rape were more likely to use laxatives (OR: girls = 5.76; boys = 28.22), vomit (OR: girls = 4.74; boys = 21.46), use diet pills (OR: girls = 5.08; boys = 16.33), binge eat (OR: girls = 2.15; boys = 5.80), and have suicidal thoughts or attempts (OR: girls = 5.78; boys = 6.66) than their nonabused peers. These odds were weakened but remained significant after controlling for other abuse by an adult. Furthermore, a greater percentage of girls and boys who reported an abusive dating experience also reported repeat victimization (physical or sexual abuse perpetrated by an adult) when compared to their peers without an abusive dating experience. DISCUSSION: Abusive experiences during dating relationships may disrupt normal developmental processes, including the development of a stable self-concept and integrated body image during adolescence. This disruption manifests itself through thoughts, feelings, and behaviors. Further research should explore effects of adverse adolescent dating experiences.