Risk factors and the prevalence of anorexia nervosa among female students in Serbia
Abstract
Background/Aim. The widespread symptoms of anorexia nervosa (AN) in young women require to draw professional attention to this problem in Serbia. In previous research on AN, insecure attachment styles, perfectionism and concerns about body shape were identified as notable risk factors. The aim of this study was to identify the prevalence of AN among female students and assess the importance of these factors in its development. Methods. The Eating Attitudes Test (EAT-40), the Experiences in Close Relationships Scale (ECR), the Frost Multidimensional Perfectionism Scale (FMPS) and the Body Shape Questionnaire (BSQ) were applied to a sample of 500 randomly selected female students of the University of Belgrade, the mean age of 22.44 years (min 18, max 35). In addition, Body Mass Index (BMI) was also calculated. Results. Although 38 (7.6%) female students displayed symptoms of AN (EAT > 30) and 13 (2.6%) had BMI indicating anorexia nervosa syndrome (BMI ≤ 17.50 kg/m2), only 1 (0.2%) student fulfilled both criteria. The majority of female students (60.4%) had some type of insecure attachment style. There is a significant influence of attachment styles on symptoms of AN: female students with insecure attachment styles have a significantly higher mean score on the EAT compared to those with secure attachment style (F = 7.873; p < 0.01). There was a positive correlation between scores on the EAT and FMPS (r = 0.217; p < 0.01), and scores on the EAT and BSQ (r = 0.388; p < 0.01). Conclusions. The obtained results show the prevalence of AN of 0.2% among female students and indicate the importance of insecure attachment styles, perfectionism and concern about body shape as risk factors. Activities for the prevention of AN in this subpopulation should include internet-based therapy and special counseling services with specific programs focusing on emotion-regulation skills through mindfulness, acceptance and commitment techniques, as well as specific cognitive-behavioral techniques.
References
Prouty AM, Protinsky HO, Canady D. College women: eating behaviors and help-seeking preferences. Adolescence 2002; 37(146): 353−63.
Eisenberg D, Nicklett EJ, Roeder K, Kirz NE. Eating Disorder Symptoms Among College Students: Prevalence, Persistence, Correlates, and Treatment-Seeking. J Am Coll Health 2011; 59(8): 700−7.
Vandereycken W. Dealing with Denial in Anorexia Nervosa. Eat Disord Rev 2006;17(6): 1−4.
Arriaza CA, Mann T. Ethnic differences in eating disorder symptoms among college students: the confounding role of body mass index. J Am Coll Health 2001; 49(6): 309−15.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Text revision. 4th ed. Washing-ton, DC: American Psychiatric Association; 2000.
Kovács-Krizbai T, Szabó P. Prevalence of eating disorders in Romanian, Hungarian and Saxon secondary school students in Transylvania. Psychiatr Hung 2009; 24(2): 124−32.
Karwautz A, Rabe-Hesketh S, Hu X, Zhao J, Sham P, Collier DA, et al. Individual-specific risk factors for anorexia nervosa: a pi-lot study using a discordant sister-pair design. Psychol Med 2001; 31(2): 317−29.
Canetti L, Kanyas K, Lerer B, Latzer Y, Bachar E. Anorexia ner-vosa and parental bonding: the contribution of parent-grandparent relationships to eating disorder psychopathology. J Clin Psychol 2008; 64(6): 703−16.
Zachrisson HD, Skårderud F. Feelings of insecurity: review of at-tachment and eating disorders. Eur Eat Disord Rev 2010; 18(2): 97−106.
Latzer Y, Hochdorf Z, Bachar E, Canetti L. Attachment style and family functioning as discriminating factors in eating disorders. Contemp Fam Ther 2002; 24(4): 581−99.
Ward A, Ramsay R, Turnbull S, Benedettini M, Treasure J. Attach-ment patterns in eating disorders: past in the present. Int J Eat Disord 2000; 28(4): 370−6.
Tereno S, Soares I, Martins C, Celani M, Sampaio D. Attachment styles, memories of parental rearing and therapeutic bond: a study with eating disordered patients, their parents and thera-pists. Eur Eat Disord Rev 2008; 16(1): 49−58.
Troisi A, Massaroni P, Cuzzolaro M. Early separation anxiety and adult attachment style in women with eating disorders. Br J Clin Psychol 2005; 44(Pt 1): 89−97.
Koskina N, Giovazolias T. The effect of attachment insecurity in the development of eating disturbances across gender: the role of body dissatisfaction. J Psychol 2010; 144(5): 449−71.
Suldo SM, Sandberg DA. Relationship Between Attachment Styles and Eating Disorder Symptomatology Among College Women. J Coll Stud Psychother 2000; 15(1): 59−73.
Holland LA, Bodell LP, Keel PK. Psychological factors predict eating disorder onset and maintenance at 10-year follow-up. Eur Eat Disord Rev 2013; 21(5): 405−10.
Jacobs MJ, Roesch S, Wonderlich SA, Crosby R, Thornton L, Wilfley DE, et al. Anorexia nervosa trios: behavioral profiles of indi-viduals with anorexia nervosa and their parents. Psychol Med 2009; 39(3): 451−61.
Castro J, Gila A, Gual P, Lahortiga F, Saura B, Toro J. Perfection-ism dimensions in children and adolescents with anorexia ner-vosa. J Adolesc Health 2004; 35(5): 392−8.
Steele AL, O'Shea A, Murdock A, Wade TD. Perfectionism and its relation to overevaluation of weight and shape and depres-sion in an eating disorder sample. Int J Eat Disord 2011; 44(5): 459−64.
Watson HJ, Raykos BC, Street H, Fursland A, Nathan PR. Media-tors between perfectionism and eating disorder psychopathol-ogy: shape and weight overvaluation and conditional goal-setting. Int J Eat Disord 2011; 44(2): 142−9.
McLaren L, Gauvin L, White D. The role of perfectionism and excessive commitment to exercise in explaining dietary re-straint: replication and extension. Int J Eat Disord 2001; 29(3): 307−13.
Harper L. The Impact of Macronutrient Intake on Body Image among Female College Undergraduate Students [dissertation]. Menomonie, WI: The Graduate School, University of Wiscon-sin-Stout; 2009.
Ha T, Marsh H, Halse C. Taking a closer look at adolescent girls with anorexia nervosa : How different are they to non-clinical adolescent girls in terms of self-concept and body im-age? In: Jeffery PL. editors. NZARE AARE: 2003 : Educational research, risks and dilemmas : Joint conference of the 2003 New Zealand Association for Research in Education. Bris-bane: Australian Association for Research in Education Con-ference 2003; pp. 1−12.
Keel PK, Baxter MG, Heatherton TF, Joiner TE. A 20-year longi-tudinal study of body weight, dieting, and eating disorder symptoms. J Abnorm Psychol 2007; 116(2): 422–32.
Costa LC, Vasconcelos FA, Peres KG. Influence of biological, so-cial and psychological factors on abnormal eating attitudes among female university students in Brazil. J Health Popul Nutr 2010; 28(2): 173−81.
Mintz LB, Betz NE. Prevalence and correlates of eating disor-dered behaviors among undergraduate women. J Couns Psy-chol 1988; 35(4): 463−71.
Akdemir A, Inandi T, Akbas D, Kahilogullari AK, Eren M, Canpolat BI. Validity and Reliability of a Turkish Version of the Body Shape Questionnaire Among Female High School Students: Preliminary Examination. Eur Eat Disord Rev 2011; 20(1): 114−5.
Caradas AA, Lambert EV, Charlton KE. An ethnic comparison of eating attitudes and associated body image concerns in adolescent South African schoolgirls. J Hum Nutr Diet 2001; 14(2): 111−20.
Lowery SE, Kurpius SR, Befort C, Blanks EH, Sollenberger S, Nicpon MF, et al. Body Image, Self-Esteem, and Health-Related Behaviors Among Male and Female First Year College Students. J Coll Stud Dev 2005; 46(6): 612−23.
Batinic B, Lazarevic J, Vukosavljevic-Gvozden T. Perfectionism and body shape concerns in female students with dysfunctional eating attitudes and behaviour. Eur Psichiatr 2013; 28(Suppl 1): 1.
Garner DM, Garfinkel PE. The Eating Attitudes Test: an index of the symptoms of anorexia nervosa. Psychol Med 1979; 9(2): 273−9.
Brennan KA, Clark CL, Shaver PR. Self-report measurement of adult attachment: An integrative overview. In: Simpson JA, Rholes WS, editors. Attachment theory and close relationships. New York: The Guilford Press; 1998. p. 46−76.
Frost RO, Marten P, Lahart C, Rosenblate R. The dimensions of perfectionism. Cogn Ther Res 1990; 14(5): 449−68.
Cooper PJ, Taylor MJ, Cooper Z, Fairbum CG. The development and validation of the body shape questionnaire. Int J Eat Dis-ord 1987; 6(4): 485−94.
Allen JG. Traumatic relationships and serious mental disorders. New York: Wiley and Sons; 2001.
Cunha AI, Relvas AP, Soares I. Anorexia nervosa and family re-lationships: Perceived family functioning, coping strategies, be-liefs, and attachment to parents and peers. Int J Clin Health Psychol 2009; 9: 229−40.