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Risk Factors for Full- and Partial-Syndrome Early Adolescent Eating Disorders: A Population-Based Pregnancy Cohort Study

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Abstract

Objective

To identify prospective predictors of eating disorders in a population-based sample of 14-year-old boys and girls, using previously collected antenatal, biomedical, familial, demographic, and psychosocial data.

Method

Participants (N = 1,597) were drawn from the Western Australian Pregnancy Cohort (Raine) Study. Data were collected during pregnancy, at birth, and when children were aged 1, 2, 5, 8, 10, and 14 years. An adapted version of the Eating Disorder Examination Questionnaire was used to assess eating disorder symptoms at age 14 years. Logistic regression was used to identify prospective predictors of eating disorder caseness, relative to general control and psychiatric control groups.

Results

At age 14 years, 6% of the sample met full or partial criteria for a DSM-IV eating disorder. Being female and being perceived as overweight by one's parent were the strongest predictors of eating disorder caseness in the final multivariate models, relative to both control groups. Maternal body mass index, social problems, low social-related self-efficacy, and neurocognitive difficulties were also predictive of eating disorder caseness relative to the general control group only.

Conclusions

The results suggest that parent's perceptions of their child's weight are more powerful than objective child body weight in predicting the development of eating disorders. Parent-perceived child overweight was also a specific risk factor for eating disorders, whereas elevated maternal weight and childhood psychosocial difficulties seem to be associated with increased risk for psychiatric disturbance more generally. These results have implications for the prevention of eating disorders, particularly in light of recent increases in the prevalence of childhood obesity.

Section snippets

Participants

Details of the Raine Study have been published previously.33 In brief, Raine Study families were recruited from the antenatal booking clinics at King Edward Memorial Hospital for women (KEMH), the only public maternity hospital in western Australia, between May 1989 and November 1991.33 Women with sufficient proficiency in English to understand the implications of participation, an expectation to deliver their baby at KEMH, and an intention to remain in western Australia were invited to take

Preliminary Analyses

The process for classifying eating disorder cases is outlined in Figure 1. Eating disorder cases included individuals who met self-report criteria for DSM-IV AN or BN, or an EDNOS for which proposed diagnostic criteria exist (BED and “EDNOS purging type”). Criteria for EDNOS purging type were taken from Keel et al.43 and were identical to those for BN with the exception that objective binge eating was not present. Thus, the EDNOS purging group included the participants who reported self-induced

Discussion

This study aimed to identify prospective predictors of eating disorders in a population-based control sample of early adolescents, using previously collected longitudinal data. The participants were drawn from the Western Australian Pregnancy Cohort (Raine) Study, and 6% met full or partial criteria for a DSM-IV eating disorder. A further 3% were found to be at risk for developing an eating disorder. These percentages are comparable to those found in previous studies,2, 7 including studies

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  • Cited by (0)

    This research was conducted at the Telethon Institute for Child Health Research, Center for Child Health Research, University of Western Australia, and was funded by an Australian Rotary Health Research Fund Grant for Projects in Mental Illness. The Western Australian Pregnancy Cohort (Raine) Study is funded by the Raine Medical Research Foundation, the National Health and Medical Research Council of Australia, the Telstra Foundation, the Western Australian Health Promotion Foundation, the Australian Arthritis Foundation, The Asthma Foundation of Western Australia, and Glaxo Wellcome.

    Supplemental digital content for this article can be found online only. See text for specific links.

    The authors thank all of the families who took part in this study and the whole Raine Study team, which includes data collectors, cohort managers, data managers, clerical staff research scientists, and volunteers. The authors also thank Peter Jacoby for statistical advice.

    This article is the subject of an editorial by Dr. David B. Herzog in this issue.

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