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Associations among alexithymia, disordered eating, and depressive symptoms in treatment-seeking adolescent military dependents at risk for adult binge-eating disorder and obesity

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Abstract

Purpose

Evidence suggests that difficulties identifying and describing one’s feelings, core components of alexithymia, are associated with attitudinal and behavioral symptoms of disordered eating; depressive symptoms also may underlie these associations. Specifically, research indicates that alexithymia is positively related to depressive symptoms, which in turn may promote both disordered-eating attitudes and certain disinhibited-eating behaviors (e.g., emotional eating). Findings also suggest that military-dependent youth with high weight may exhibit elevated depressive symptoms and disordered eating. As such, understanding associations among alexithymia, depressive symptoms, and disordered eating is particularly relevant for this vulnerable population.

Methods

We examined 149 adolescent military dependents (14.4 ± 1.6y; 55.0% female; 20.0% non-Hispanic Black; BMIz: 1.9 ± 0.4) at high risk for binge-eating disorder and obesity in adulthood. Participants completed questionnaires assessing two components of alexithymia (difficulty identifying feelings [DIF] and difficulty describing feelings [DDF]), depressive symptoms, emotional eating, and trait anxiety; disordered-eating attitudes were assessed via semi-structured interview.

Results

A series of regression-based models examined indirect relationships of DIF and DDF with disordered-eating attitudes and emotional eating through depressive symptoms. Bootstrapped 95% confidence intervals revealed a significant indirect path from each of the alexithymia components to disordered-eating attitudes via depressive symptoms; indirect paths to emotional eating were non-significant.

Conclusion

Results support the salience of depressive symptoms in the relationship between alexithymia and disordered-eating attitudes. Future research should utilize prospective designs and explore direct and indirect associations of alexithymia with other disordered-eating behaviors.

Level of evidence

Level III, evidence obtained from a well-designed cohort study.

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D. Klein, B. Ford, and C. Ford are Commissioned Officers in the United States (U.S.) Air Force or Navy. The opinions and assertions expressed herein are those of the authors and are not to be construed as reflecting the views of USU, the U.S. Air Force, the U.S. Navy, or the U.S. Department of Defense.

Funding

Funding for this study was provided by NIDDK 1R01DK104115 to M. Tanofsky-Kraff and the Defense Health Agency, MED 83-10180 to M. Haigney. J. A. Yanovski is supported by the Intramural Research Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, ZIA-HD-00641. The funding sources had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.

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Authors and Affiliations

  1. Military Cardiovascular Outcomes Research (MiCOR) Program, Uniformed Services University of the Health Sciences (USU) and the Metis Foundation, Bethesda, MD, USA

    Alexander Rice, Jason M. Lavender, Lisa M. Shank, M. K. Higgins Neyland, Bethelhem Markos, Hannah Repke, Hannah Haynes, Julia Gallagher-Teske, Mark Haigney & Marian Tanofsky-Kraff

  2. The Metis Foundation, San Antonio, TX, USA

    Alexander Rice, Jason M. Lavender, Lisa M. Shank, M. K. Higgins Neyland, Bethelhem Markos, Hannah Repke, Hannah Haynes & Julia Gallagher-Teske

  3. Department of Medicine, USU, Bethesda, MD, USA

    Jason M. Lavender, Lisa M. Shank, M. K. Higgins Neyland, Mark Haigney & Marian Tanofsky-Kraff

  4. Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS, 10 Center Drive, Bethesda, MD, USA

    Lisa M. Shank, Hannah Haynes, Natasha A. Schvey, Jack A. Yanovski & Marian Tanofsky-Kraff

  5. Department of Medical and Clinical Psychology, USU, Bethesda, MD, USA

    Lisa M. Shank, Natasha A. Schvey, Tracy Sbrocco & Marian Tanofsky-Kraff

  6. Washington University School of Medicine, St. Louis, MO, USA

    Denise E. Wilfley

  7. Department of Family Medicine, USU, Bethesda, MD, USA

    Brian Ford & David A. Klein

  8. Department of Family Medicine, Fort Belvoir Community Hospital, Fort Belvoir, VA, USA

    Caitlin B. Ford

  9. Department of Family Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Sarah Jorgensen & Jeffrey Quinlan

Authors
  1. Alexander Rice
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  2. Jason M. Lavender
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  3. Lisa M. Shank
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  4. M. K. Higgins Neyland
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  5. Bethelhem Markos
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  6. Hannah Repke
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  7. Hannah Haynes
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  8. Julia Gallagher-Teske
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  9. Natasha A. Schvey
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  10. Tracy Sbrocco
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  11. Denise E. Wilfley
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  12. Brian Ford
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  13. Caitlin B. Ford
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  14. Sarah Jorgensen
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  15. Jack A. Yanovski
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  16. Mark Haigney
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  17. David A. Klein
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  18. Jeffrey Quinlan
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  19. Marian Tanofsky-Kraff
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Contributions

All authors variously contributed to the study conception, design, data collection, and/or material preparation. A. Rice performed data analyses and wrote the first draft of the manuscript. All authors commented on previous versions of the manuscript, and read and approved the final manuscript.

Corresponding author

Correspondence to Jason M. Lavender.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

Approval was provided by the Uniformed Services University of the Health Sciences Institutional Review Board and the Fort Belvoir Community Hospital Research Office.

Consent to participate

Informed consent and assent were obtained from parents/guardians and study participants, respectively.

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Rice, A., Lavender, J.M., Shank, L.M. et al. Associations among alexithymia, disordered eating, and depressive symptoms in treatment-seeking adolescent military dependents at risk for adult binge-eating disorder and obesity. Eat Weight Disord 27, 3083–3093 (2022). https://doi.org/10.1007/s40519-022-01429-z

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  • DOI: https://doi.org/10.1007/s40519-022-01429-z

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