Eating Disorders 455
Other Psychological Disorders as Risk Factors
Another factor associated with the subsequent development of an
eating disorder is the presence of a psychological disorder in early
adolescence (see Figure 10.4), particularly depression. A longitudi-
nal study of 726 adolescents found that having a depressive disor-
der during early adolescence was associated with a higher risk for
later dietary restriction, purging, recurrent weight fl uctuations, and
the emergence of an eating disorder. This was the case even when
researchers statistically controlled for other disorders or eating prob-
lems before adulthood (Johnson, Cohen, Kotler, et al., 2002).
Social Factors: The Body in Context
Various social factors contribute to eating disorders. One social fac-
tor is the role played by family and friends, who have the potential
to minimize or amplify an individual’s attention to food, weight, and
body, and who can help shape individual’s thoughts, feelings, and
behaviors related to food, weight, and body. Another social factor
is culture, which can contribute to eating disorders by promoting an
ideal body shape; the media, in turn, propagate the cultural ideal. In
this section we discuss these social factors as well as explanations of
why so many more females than males develop eating disorders.
The Role of Family and Peers
As mentioned earlier, eating disorders tend to run in families. However,
researchers have not found it easy to disentangle the infl uences of genes
from those of the family itself for two main reasons:
- Family members provide a model for eating, body image, and appearance
concerns through their own behaviors (Stein, Woolley, Cooper, et al., 2006). For
example, parents who spend a lot of time on their appearance before leaving
the house model that behavior for their children. - Family members affect a child’s concerns through their responses toward the
child’s body shape, weight, and food intake (Stein, Woolley, Senior, et al., 2006;
Tantleff-Dunn, Gokee-LaRose, & Peterson, 2004; Thompson et al., 1999). For
example, if a parent inquires daily about how much food his or her child ate at
lunch or weighs the child daily, the child learns to pay close attention to caloric
intake and daily fl uctuations in weight.
Children whose parents are overly concerned about these matters are morelikely to develop an eating disorder (Strober, 1995). Marya
Hornbacher described her parents’ eating styles:
While my relationship to my parents has always been very com-
plex, there is also the simple fact that both of them used food—
one to excess, one to absence—as a means of communication,
or comfort, or quest. Food was a problem in my family. A big
problem.... My father was a periodic heavy drinker, ate con-
stantly, and was forever obsessing about his weight—he would
diet, berate himself for falling off his diet, call himself a pig. My
mother was a former—or was it closet?—bulimic with strange
eating habits. She’d eat normally for a while, then go on a diet,
pick at her food, push it away, stare at her butt in the mirror.
(1998, pp. 22–23)Hornbacher was a keen observer of her parents’ behaviors,
especially those related to food, weight, and appearance. And
she realized that she modeled her own behavior on theirs.
Children often pay attention to and imitate how
their family members behave; when parents are
concerned about food, weight, and appearance,
they may intentionally or inadvertently pass on
these concerns to their children.David Young-Wolff/Photo Edit10.4 • Psychiatric Disorders and the Risk
of Developing an Eating Disorder The more
psychological disorders an adolescent—particularly a female
adolescent—has, the more likely he or she is to develop an
eating disorder (Johnson, Cohen, Kasen, & Brook, 2002).Figure 10.4g4Percentage developing eating disorder
during middle adolescence or early adulthood 051015202530Number of psychological disorders
during early adolescenceNo disorder 1 disorder 2 disorders 3+disordersFemales
Males