Social influences in the development of anorexia nervosa. A case study.

This paper is an overview of theory and research findings on social influences on the development of eating disorders. Included are feminist theories of socialisation, theories of autonomy and modelling within the family context self-esteem, perfectionism, and temperament as well as the displacement hypothesis. This overview is followed by a case study. An 18-year-old female patient and her history are described from various angles of incidence to determine how far components of these findings may have contributed to her development of anorexia nervosa (AN). Vulnerability, precipitating, and perpetuating factors are discussed. It is shown that the patient demonstrated relatively high levels of risk factors known to play a part in the etiology of AN.

A comparison of three questionnaires (EAT-12, EDI, and EDE-Q) for assessment of eating problems in healthy female adolescents.

On the basis of the restraint theory and the continuum hypothesis of eating disorders, the objective of this paper was twofold. First, subjects who, on the basis of items from the Eating Disorder Examination Questionnaire (EDE-Q) which are generated from DSM-III-R diagnostic criteria, fulfilled the diagnostic criteria for anorexia nervosa (AN) and bulimia nervosa (BN) were identified. Second, differences in scale scores between a case group and a non-case group were tested, and case group distribution of the two self-report questionnaires Eating Attitudes Test (EAT-12) and Eating Disorder Inventory (EDI) was compared as a means for investigating the sensitivity of the instruments in detecting eating disorder cases. In a classroom setting 224 8th-grade female students from 5 schools in western Norway completed the questionnaires. The responses to the questionnaires were analysed by case group and instrument/subscales by using the t test, Cohen's d-values, eta squared statistic, point biserial correlation, and two-way ANOVA. No BN cases and 10 AN cases were identified. AN cases scored significantly higher on all measures of eating problems than normal subjects and differed most from non-cases on the "dieting" dimension. Clinical implications are discussed in the light of screening.

Prevalence and dimensionality in adolescent eating problems.

Prevalence of three eating problem dimensions (body concerns, dieting, and loss of control over eating) was studied in a Norwegian sample consisting of 4129 normal adolescents aged 12-16. The existence of eating problem dimensionality had been demonstrated in an earlier study of the same sample, and is in line with the reasoning presented in both restraint theory and the continuum hypothesis for eating disorders. Body concern was the most dominant dimension in both genders in the present study, whereas loss of control over eating was the least dominant for girls. For boys, both the dieting and the loss of control over eating dimension showed a low dominance. Older girls reported significantly more eating problems than younger girls, but this difference was not found for boys. The results are discussed and taken to support restraint theory and the continuum hypothesis. It is concluded that the study gives support to the view of the relationship between the three dimensions as cumulative and developmental, and that longitudinal research should be conducted to examine how these eating problems are related to later eating disorders.

Multidimensionality in adolescent eating problems. A two-phase measurement study.

The aims of this study were, firstly, to examine the factor structure of single items from several self-report methods used to measure eating disorder symptoms, and secondly, in search for a short assessment instrument to reduce the number of items within each factor. Factor analyses were employed to identify and confirm the constructs measured by a total of sixty items drawn from these assessment methods. In phase one, 508 secondary school pupils were recruited as subjects, and principal factor analysis identified three factors; body concern, dieting, and loss of control over eating. Twenty-nine items were retained, and in phase two subjected to a second data collection among 4129 secondary school pupils. Confirmatory factor analysis was employed to cross-validate the factor structure from phase one. The three-factor structure was confirmed satisfactorily for boys, but not for girls aged 12-14 years. For girls aged 14-16 years, it was confirmed when a number of items were omitted. The findings are discussed in relation to restraint theory and the continuum hypothesis.

The dimensionality of the 12-item version of the Eating Attitudes Test. Confirmatory factor analyses.

The assumed three-dimensional structure of the 12-item version of the Eating Attitudes Test was examined by confirmatory factor analysis in a non-clinical sample of 224 female and 261 male adolescents in grade 8 aged 14-15 years. Alternative models were examined. Data did neither support a three-dimensional structure, nor a one-dimensional structure using twelve items. Three dimensions were supported when one and three items were omitted from the girls' and boys' analyses, respectively. A second order factor structure was supported in both genders. Conceptual and psychometric issues are discussed. A discussion of the measurement domain of the eating problem construct in non-clinicals is warranted.

A generalizability study of the Eating Attitudes Test (EAT-12) in non-clinical adolescents.

One of the most frequently used measures of eating and weight problems is the Eating Attitudes Test (EAT). The paper discusses conceptual heterogeneity in the EAT in the light of eating disorder continuum theory. Psychometric qualities of the Norwegian 12-item version of the EAT was based on a sample of 224 female and 261 male adolescents aged 14-15 years. Generalizability theory enabled us to study the impact of multiple sources of measurement errors of the EAT-12. The analyses suggest that acceptable generalizability is achieved by the present design on applying 4 items within 3 categories of the EAT. Alternative designs are suggested, and the utility of G-theory is discussed. The results also provide evidence of a gender difference in the structure of the universe score variance. Non-clinical adolescents' ways of organizing information about food and eating are discussed in the light of gender differences.