Influence of Stress in the Onset of Eating Disorders: Data From a Two-Stage Epidemiologic Controlled Study

Llanos Conesa · Ovidio B. Bermudez · Lorenzo Livianos

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Eating Disorders and Behaviors Nutrition, Health and Food Behavior Child Nutrition and Feeding Issues

Abstract

Background: We explore the role of stress in the onset of eating disorders (EDs) in a community sample of adolescents, the mediating role of psychiatric comorbidity and the quantitative evolution of stress in the year preceding the onset of an ED. Methods: The Life Events and Difficulties Schedule interview was applied to a sample with 32 cases and 32 controls selected from a two-phase epidemiologic study among a representative population of adolescents, followed by a decay model to assess acute and chronic stress in the year preceding the onset of ED. Psychiatric comorbidity was assessed using the SCAN interview. Results: Cases (46.9%) and 9.4% of controls were found to have associated psychiatric comorbidity (χ2 = 11.74, p = .001). Of cases, 6.3% and none of the controls had at least one severe stressful event (N.S). Of cases, 18.8% and 3.1% of controls had at least one major difficulty (Fisher exact test = 0.05). Of cases, 25% and 3.1% of controls had a provoking stressful agent (Fisher exact test = 0.026). Psychiatric comorbidity partially mediated the relationship between stress and EDs. The Structural Equation Modeling Analysis shows that chronic stress is strongly associated with the onset of EDs, both directly (r2 = 0.38) and indirectly, through psychiatric comorbidity (r2 = 0.56). Conclusion: Chronic stress and psychiatric comorbidity are strongly associated with the onset of EDs. Psychiatric comorbidity is a partial mediating factor in the association of stress with eating disorders. ED = eating disorders; AN = anorexia nervosa; LEDS = Life Events and Difficulties Schedule; BN = bulimia nervosa; BED = binge eating disorder; SCAN = Schedules for Clinical Assessment in Neuropsychiatry; EAT = Eating Attitudes Test; SEM = structural equation modeling; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders; SPSS = Statistical Package for Social Science; AMOS = Analysis of Moment Structures.

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References

1982The Eating Attitudes Test: psychometric features and clinical correlates 1999Onset of adolescent eating disorders: population based cohort study over 3 years 1991The genetic epidemiology of bulimia nervosa 2000Controlled Family Study of Anorexia Nervosa and Bulimia Nervosa: Evidence of Shared Liability and Transmission of Partial Syndromes 1995Bulimia nervosa in a Canadian community sample: prevalence and comparison of subgroups 1990Abnormal eating attitudes in London schoolgirls — a prospective epidemiological study: outcome at twelve month follow-up 2003Psychiatric comorbidity in anorexia and bulimia nervosa: nature, prevalence, and causal relationships 1996EPIDEMIOLOGY OF THE EATING DISORDERS

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