Depression and Eating Disorders
The eating disorder category in the DSM-IV includes Anorexia Nervosa, Bulimia Nervosa, and the Eating Disorder Not Otherwise Specified categories. Peck and Lightsey (2008) note that while the DSM classification symptom is currently the most used system, there has been some debate in the about how to classify people with eating disordered behavior. A viable alternative to the discrete categories used in the DSM is notion of viewing eating disorders along a continuum from having no such behaviors to the severe eating disordered behaviors. In an effort to combine the two methods the self-report Questionnaire for Eating Disorders Diagnosis (QEDD) was developed. The QEDD distinguishes nonsymptomatic individuals (no symptoms) to symptomatic individuals (those that have some symptoms, but do not qualify for a diagnosis to anyone qualifying for an eating disorder diagnosis). Previous research has provided support for this conceptualization by comparing the QEDD with scores on another well-known eating disorders survey, the Eating Disorders Inventory-2 (EDI-2).
Previous research has indicated that two dimensions of personality constructs, perfectionism and self-esteem have relations with eating disorder behaviors. Perfectionism, the need for control and intolerance for mistakes, is typically positively related to eating disordered behavior, whereas self-esteem, the person’s subjective impression of their overall worth, is negatively related to eating disorder behaviors. The current study had two goals: comparing the QEDD continuum placement with scores on the EDI-2. contiumThe hypothesis fir the first goal was that self-esteem decreases and perfectionism increases as and eating disordered behavior increases (measured by the EDI-2 and the continum) increases as placement on an eating disorders. The authors an issue with the EDI-2 perfectionism subscale that does not fully measure perfectionism according to its constructs and therefore added the Multidimensional Perfectionism Scale to the analysis. The Rosenberg Self-Esteem Scale was also used. The second goal was to provide further validation for the QEDD and the continuum.
Two hundred and sixteen female college students completed the survey measures at a Midwestern University. Responders were dived into three groups based on their QEDD profiles (asymptomatic, symptomatic but not disordered, eating disordered). The EDI-2 scales were found to be statistically unreliable and not used in determining if the groups differed on personality characteristics. The findings indicated that the personality variables and the continuum assessment were related in the hypothesized directions. A discriminant function analyses using the personality variables indicated that the asymptomatic group was generally satisfied with their bodies, where as the symptomatic groups were not. Using prior probabilities the discriminant function was able to classify 45.2% of the disordered participants (better than chance), 31.6% of the symptomatic women (not better than chance), and 82.2% of the asymptomatic participants (better than chance). Nearly half of the symptomatic group was classified as eating disordered. The authors concluded that there is evidence that the continuum concept is valid, the QEDD can be useful in diagnosis but needs refining, and that the relation between personality characteristics and eating disorders can provide useful diagnostic information. They also recognize the study’s limitations (sample limitations).
The continuum concept of classifying psychiatric disorders has been proposed for many years. Even the DSM classification scheme recognizes that a psychiatric disorder often represents a normal behavior that has become rigid and dysfunctional. There are so many issues with this study, that it is premature to state that the QEDD is a valid instrument. For instance there was no independent measure of eating disorders used (the EDI-2 bulima scale was dropped and there was no DSM-IV diagnosis). Moreover, the QEDD demonstrated good specificity but poor sensitivity. Certainly people with psychiatric disorders display other issues, but good self-esteem is not a global concept except for people that are severely depressed (we have high self- esteem about some things and lower about others) nor is it stable. This study actually raises some interesting questions regarding eating disorders, but does not answer them.
Peck, L.D. And Lightsey, O.R. (2008). The eating disorders continuum, self-esteem, and perfectionism. Journal of Counseling & Development, 8, 184-192.
The relationship between unipolar depression and having an eating disorder is well-documented in the literature. Green et al. (2009) note that issues in eating disorders that are also common to people that suffer from depression only are: (1.) Social comparison which refers to a process by which people compare themselves with a target to provide them with information concerning the value of their own personal characteristics (e.g., thinness, personal capabilities, etc.). (2.) Body dissatisfaction has been reported to show a unique relationship with depression. This has led some authors to conclude the relationship among eating disorders, depression, and body dissatisfaction is primarily a result of the relationship between depression and body dissatisfaction; however, the authors still consider it an important factor. (3.) Low self-esteem is also a factor identified as being common to eating disorders and unipolar depression.
Since the three psychological factors may be largely explained by the relationship between eating disorders and depression addressing these constructs should important emphasis in treating comorbid eating disorders and depression or a unique relationship may exist for depression and eating disorders after controlling for these. Green et al. (2009) investigated the relationship between eating disorder behaviors and depression after controlling for the maladaptive constructs mentioned above. They predicted negligible unique variance in eating disorder behaviors would be explained by depression after controlling for them.
Two hundred and eight undergraduate students (127 women and 81 men) completed a battery of questionnaires at a large Midwestern university (Eating Disorder Examination-Questionnaire, Rosenberg Self-Esteem Scale, Body Shape Questionnaire- Shortened Version, Social Comparison Rating Scale, and the Beck Depression Inventory-II) as part of a larger study.
A hierarchical regression analysis was conducted to examine depression as a predictor of eating disorders after controlling for the above factors. Results indicated that after for controlling for the factors depression alone still significantly contributed to eating disorder behaviors (one percent of the variance).
This study found that a very small significant unique contribution to depressive behaviors in eating disorders after control for the common factors of social comparison, self-esteem, and body-dissatisfaction. However, there is a difference between a practical finding and a statistically significant finding. In essence, what the study determines is that the three aforementioned concepts most likely contribute to a very substantial amount to the depression observed in eating disorders despite the finding of a statistically significant unique depressive contribution in eating disorders which may not reflect a clinically significant finding. This has some very practical treatment implications for eating disorders. The study does suffer from several limitations such as not using clinical subjects, using mostly Caucasian subjects, and a reliance on surveys or self-report data. Nonetheless, this study does provide very useful and interesting information regarding the relationship of the depression eating disorders.
Green, M.A., Scott, N.A., Cross, S.E., Yu-Hsin Liao, K., Hallengren, J.J., Davids, C.M., Carter, L.P., Kugler, D.W., Read, K.E., & Jepson, A.J. (2009). Eating disorder behaviors and depression: A minimal relationship beyond social comparisons, self- esteem, and body dissatisfaction. Journal of Clinical Psychology, 65, 989-999.
Proposed Title: The Contribution of Family Functioning Depressive Symptoms to Eating Disorder Behaviors
There have been several theories regarding the etiology of eating disorders that focus on the contribution of the family system to the disorder. There have been several studies that indicate that low self-esteem, social comparisons, a drive for control and perfectionism are related both to the depressive symptoms in eating disorders and to the expression of eating disordered behavior itself. However, there is a paucity of research that examines how these depressed of characteristics of people with eating disorders are expressed in different ethnic groups such as African-Americans, Hispanics, Asians, those with different religious beliefs, etc. Previous research has identified that several depressive — type behaviors such as low self-esteem, dissatisfaction with one’s body or physical appearance, and the tendency to make downward social comparisons are related to the symptoms of an eating disorder and not to a separate depressive disorder in those people that display a high propensity towards eating disorder type behaviors. However, again the previous research has tended to focus on Caucasian college students and may not generalize to more diverse populations. Moreover, in spite of the wealth of literature concerning how dysfunctional family systems contribute to eating disordered behavior, these factors have not been identified or investigated in the light of the individual’s particular family dynamics. The current study would attempt to replicate findings from previous studies on a more diverse group of participants, those with different family dynamics, as well as those formally diagnosed with eating disorders as it would be useful to investigate how these variables interact in subjects that have diverse backgrounds.
Reference one: Peck, L.D. And Lightsey, O.R. (2008). The eating disorders continuum, self-esteem, and perfectionism. Journal of Counseling & Development, 8, 184-192. This article begins by discussing the advantages of conceptualizing eating disorders on a continuum as opposed to the traditional categorical method used in the DSM — IV diagnostic system. The relationship of and a drive for perfectionism found…