Journal of Abnormal Child Psychology

, Volume 42, Issue 5, pp 791–802 | Cite as

Risk Factors for Disordered Eating During Early and Middle Adolescence: A Two Year Longitudinal Study of Mainland Chinese Boys and Girls

  • Todd Jackson
  • Hong ChenEmail author


Even though reliable eating disorder risk factors have been identified among adolescent girls, little is known about predictors of increased vulnerability within specific phases of adolescence or among adolescent boys, particularly in highly populated non-Western contexts. In this study, early and middle adolescent boys (n = 1,271) and girls (n = 1,415) from Chongqing, China completed validated measures of eating disorder pathology and putative risk factors at baseline and 2 years follow-up. Multivariate models for boys of each age group indicated increases in disordered eating at follow-up were predicted by higher initial body mass index, negative affect and body dissatisfaction levels as well as attendant increases in perceived appearance pressure from mass media, body dissatisfaction, negative affect between assessments. High baseline levels of reported appearance pressure from parents and dating partners contributed, respectively, to prediction models of younger and older boys. More distinct constellations of significant predictors emerged in multivariate models of early versus middle adolescent girls. Together, findings indicated body dissatisfaction and negative affect were fairly robust risk factors for exacerbations in disturbances across samples while risk factors such as perceived pressure from desired/prospective dating partners were salient only during particular phases of adolescence.


Disordered eating Risk factors Adolescents China Gender 



This research was supported by funding from the National Natural Science Foundation of China (#31170981 and #31371037), Education Ministry of China, a Chongqing 100 Persons Fellowship, and the BaYu Scholar Program of the Chongqing Government We thank Zhang Tingyan, He Yulan, Chen Nanjing, Gao Xiao, Jiang Xiaxia, Chen Minyan, Pan Chenjing, Yang Tingting, and Zhao Yi for assistance with data collection and three anonymous reviewers for their helpful feedback.


  1. Andersen, A. E., & Holman, J. E. (1997). Males with eating disorders: challenges for treatment and research. Psychopharmacology Bulletin, 33, 391–398.PubMedGoogle Scholar
  2. Arcelus, J., Mitchell, A., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders: a meta- analysis of 36 studies. Archives of General Psychiatry, 68, 724–731.PubMedCrossRefGoogle Scholar
  3. Bearman, S., Presnell, K., Martinez, E., & Stice, E. (2006). The skinny on body dissatisfaction: a longitudinal study of adolescent girls and boys. Journal of Youth and Adolescence, 35, 229–241.CrossRefGoogle Scholar
  4. Bell, B. T., & Dittmar, H. (2011). Does media type matter? The role of identification in adolescent girls’ media consumption and the impact of different thin-ideal media on body image. Sex Roles, 65, 478–490.CrossRefGoogle Scholar
  5. Bramon-Bosch, E., Troop, N. A., & Treasure, J. (2000). Eating disorders in males: a comparison with female patients. European Eating Disorders Review, 8, 321–328.CrossRefGoogle Scholar
  6. Bruning-Brown, J., Winzelberg, A. J., Abascal, L. B., & Barr-Taylor, C. (2004). An evaluation of an internet-delivered eating disorder prevention program for adolescents and their parents. Journal of Adolescent Health, 35, 290–296.PubMedCrossRefGoogle Scholar
  7. Carver, K., Joyner, K., & Udry, J. R. (2003). National estimates of adolescent romantic relationships. In P. Florsheim (Ed.), Adolescent romantic relationships and sexual behavior (pp. 291–299). New York: Cambridge University.Google Scholar
  8. Chan, D. K. S., Ng, T., & Hui, C. M. (2010). Interpersonal relationships in rapidly changing Chinese societies. In M. H. Bond (Ed.), The Oxford handbook of Chinese psychology (pp. 515–532). London: Oxford University.Google Scholar
  9. Chen, H., & Jackson, T. (2008). Prevalence and sociodemographic correlates of eating disorder endorsements among adolescents and young adults from China. European Eating Disorders Review, 16, 375–385.PubMedCrossRefGoogle Scholar
  10. Chen, H., & Jackson, T. (2009). Predictors of changes in weight esteem among mainland Chinese adolescents: a longitudinal analysis. Developmental Psychology, 45, 1618–1629.PubMedCrossRefGoogle Scholar
  11. Chen, H., & Jackson, T. (2012). Gender and age group differences in mass media and interpersonal correlates of body dissatisfaction among Chinese adolescents. Sex Roles, 66, 3–20.CrossRefGoogle Scholar
  12. Chen, H., Jackson, T., & Huang, X. (2006). Initial development and validation of the negative physical self scale among Chinese adolescents and young adults. Body Image, 3(4), 401–412.PubMedCrossRefGoogle Scholar
  13. Chen, H., Gao, X., & Jackson, T. (2007). Predictive models for understanding body dissatisfaction among young males and females in China. Behaviour Research & Therapy, 45(6), 1345–1356.CrossRefGoogle Scholar
  14. China Internet Network Information Center (2012). A statistical report of the development of China's internet network. Beijing: AuthorGoogle Scholar
  15. Collins, W. A., Welsh, D. P., & Furman, W. (2009). Adolescent romantic relationships. Annual Review of Psychology, 60, 631–652.PubMedCrossRefGoogle Scholar
  16. Cui, Z., Huxley, R., Wu, Y., & Dibley, M. J. (2010). Temporal trends in overweight and obesity of children and adolescents from nine Provinces in China from 1991–2006. International Journal of Pediatric Obesity, 5, 365–374.PubMedCrossRefGoogle Scholar
  17. Gao, X., Jackson, T., Chen, H., Liu, Y., Wang, R., Qian, M., et al. (2010). There is a long way to go: a nationwide survey of professional training for mental health practitioners in China. Health Policy, 95, 74–81.PubMedCrossRefGoogle Scholar
  18. Gardner, R., Stark, K., Friedman, B., & Jackson, N. (2000). Predictors of eating disorder scores in children ages 6 through 14: a longitudinal study. Journal of Psychosomatic Research, 49, 199–205.PubMedCrossRefGoogle Scholar
  19. Goodwin, R., & Tang, C. (1996). Chinese personal relationships. In M. Bond (Ed.), The handbook of Chinese psychology (pp. 280–294). Hong Kong: Oxford University.Google Scholar
  20. Grabe, S., Ward, M. L., & Hyde, J. (2008). The role of the media in body image concerns among women: a meta-analysis of experimental and correlational studies. Psychological Bulletin, 134, 460–476.PubMedCrossRefGoogle Scholar
  21. Hoek, H. W., & Van Hoeken, D. (2003). Review of the prevalence and incidence of eating disorders. International Journal of Eating Disorders, 34, 383–396Google Scholar
  22. Holsen, I., Jones, D. C., & Birkeland, M. S. (2012). Body image satisfaction among Norwegian adolescents and young adults: a longitudinal study of the influence of interpersonal relationships and BMI. Body Image, 9, 201–208.PubMedCrossRefGoogle Scholar
  23. Hudson, J. I., Hiripi, E., Pope, H. G., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biological Psychiatry, 61, 348–358.PubMedCentralPubMedCrossRefGoogle Scholar
  24. Jackson, T., & Chen, H. (2007). Identifying the eating disorder symptomatic in China: the role of sociocultural factors and culturally defined appearance concerns. Journal of Psychosomatic Research, 62, 241–249.PubMedCrossRefGoogle Scholar
  25. Jackson, T., & Chen, H. (2008a). Predicting changes in eating disorder symptoms among Chinese adolescents: a nine month prospective study. Journal of Psychosomatic Research, 64, 87–95.PubMedCrossRefGoogle Scholar
  26. Jackson, T., & Chen, H. (2008b). Changes in eating disorder symptoms among adolescent girls and boys in China: an 18 month prospective study. Journal of Clinical Child & Adolescent Psychology, 37, 874–885.CrossRefGoogle Scholar
  27. Jackson, T., & Chen, H. (2008c). Sociocultural predictors of physical appearance concerns among adolescent girls and young women from China. Sex Roles, 58, 402–411.CrossRefGoogle Scholar
  28. Jackson, T., & Chen, H. (2008d). Sociocultural influences on body image concerns of young Chinese males. Journal of Adolescent Research, 23, 154–171.CrossRefGoogle Scholar
  29. Jackson, T., & Chen, H. (2010a). Sociocultural experiences of bulimic and non-bulimic adolescents in a school-based sample from China. Journal of Abnormal Child Psychology, 38, 69–76.PubMedCrossRefGoogle Scholar
  30. Jackson, T., & Chen, H. (2010b). Factor structure of the sociocultural attitudes towards appearance scale-3 (SATAQ-3) among adolescent boys in China. Body Image, 7, 349–355.PubMedCrossRefGoogle Scholar
  31. Jackson, T., & Chen, H. (2011). Risk factors for disordered eating during early and middle adolescence: prospective evidence from Mainland Chinese boys and girls. Journal of Abnormal Psychology, 120, 454–464.PubMedCrossRefGoogle Scholar
  32. Jacobi, C., Hayward, C., de Zwaan, M., Kraemer, H. C., & Agras, W. S. (2004). Coming to terms with risk factors for eating disorders: application of risk terminology and suggestions for a general taxonomy. Psychological Bulletin, 130, 19–65.PubMedCrossRefGoogle Scholar
  33. Jones, D. C. (2004). Body image among adolescent girls and boys: a longitudinal study. Developmental Psychology, 40, 823–835.CrossRefGoogle Scholar
  34. Jones, D. C., & Crawford, J. K. (2006). The peer appearance culture during adolescence: gender and body mass variations. Journal of Youth and Adolescence, 35, 257–269.CrossRefGoogle Scholar
  35. Jones, W., & Morgan, J. (2010). Eating disorders in men: a review of the literature. Journal of Public Mental Health, 9, 23–31.CrossRefGoogle Scholar
  36. Jones, D. C., Bain, N., & King, S. (2008). Weight and muscularity concerns as longitudinal predictors of body image among early adolescent boys: a test of the dual pathways model. Body Image, 5, 195–204.PubMedCrossRefGoogle Scholar
  37. Keel, P., Klump, K. L., Leon, G. R., & Fulkerson, J. A. (1998). Disordered eating in adolescent males from a school–based sample. International Journal of Eating Disorders, 23, 125–132.PubMedCrossRefGoogle Scholar
  38. Larson, R. W., & Verma, S. (1999). How children and adolescents spend time across the world: work, play, and developmental opportunities. Psychological Bulletin, 125, 701–736.PubMedCrossRefGoogle Scholar
  39. Lee, S. (1995). Self-starvation in context: towards a culturally sensitive understanding of anorexia nervosa. Social Science & Medicine, 41, 25–36.CrossRefGoogle Scholar
  40. Lee, A. M., & Lee, S. (1996). Disordered eating and its psychosocial correlates among Chinese adolescent female in Hong Kong. International Journal of Eating Disorders, 20, 177–183.PubMedCrossRefGoogle Scholar
  41. Lee, S., & Lee, A. M. (2000). Disordered eating in three communities of China: a comparative study of female high school students in Hong Kong. Shenzhen, and rural Hunan, International Journal of Eating Disorders, 27, 317–327.CrossRefGoogle Scholar
  42. Lee, S., Leung, C. M., Wing, Y. K., Chiu, H. F., & Chen, C. N. (1991). Acne as a risk factor for anorexia nervosa in Chinese. Australasian Psychiatry, 25, 134–137.Google Scholar
  43. Lee, S., Ng, K. L., Kwok, K., & Fung, C. (2010). The changing profile of eating disorders at a tertiary psychiatric clinic in Hong Kong (1987–2007). International Journal of Eating Disorders, 43, 307–314.PubMedCrossRefGoogle Scholar
  44. Leon, G. R., Fulkerson, J. F., Perry, C., & Early-Zald, M. (1995). Prospective analysis of personality and behavioral vulnerabilities and gender influences in the later development of disordered eating. Journal of Abnormal Psychology, 104, 140–149.PubMedCrossRefGoogle Scholar
  45. Lloyd, C. B., Grant, M., & Ritchie, A. (2008). Gender differences in time use among adolescents in developing countries: implications of rising school enrollment rates. Journal of Research on Adolescence, 18, 99–120.CrossRefGoogle Scholar
  46. Machado, P. P., Machado, B. C., Goncalves, S., & Hoek, H. W. (2007). The prevalence of eating disorders not otherwise specified. International Journal of Eating Disorders, 40, 212–217.PubMedCrossRefGoogle Scholar
  47. McCabe, M. P., & Ricciardelli, L. A. (2005). A prospective study of pressures from parents, peers, and the media on extreme weight change behaviors among adolescent boys and girls. Behaviour research and therapy, 43(5), 653–668Google Scholar
  48. McKnight Investigators. (2003). Risk factors for the onset of eating disorders in adolescent girls: results of the McKnight longitudinal risk factor study. American Journal of Psychiatry, 160, 248–254.CrossRefGoogle Scholar
  49. Muise, A., Stein, D., & Arbess, G. (2003). Eating disorders in adolescent boys: a review of the adolescent and adult literature. Journal of Adolescent Health, 33, 427–435.PubMedCrossRefGoogle Scholar
  50. Müller, S., & Stice, E. (2013). Moderators of the intervention effects for a dissonance-based eating disorder prevention program; results from an amalgam of three randomized trials. Behaviour Research & Therapy, 51, 128–133.CrossRefGoogle Scholar
  51. Nelson, E. E., Leibenluft, E., McClure, E. B., & Pine, D. (2005). The social re-orientation of adolescence: a neuroscience perspective on the process and its relation to psychopathology. Psychological Medicine, 35, 163–174.PubMedCrossRefGoogle Scholar
  52. Olds, T., Wake, M., Patton, G., Ridley, K., Waters, E., Williams, J., et al. (2009). How do school-day activity patterns differ with age and gender across adolescence? Journal of Adolescent Health, 44, 64–72.PubMedCrossRefGoogle Scholar
  53. Paxton, S. J., Norris, M., Wertheim, E. H., Durkin, S. J., & Anderson, J. (2005). Body dissatisfaction, dating, and importance of thinness to attractiveness in adolescent girls. Sex Roles, 53, 663–675.CrossRefGoogle Scholar
  54. Paxton, S. J., Eisenberg, M., & Neumark-Sztainer, D. (2006). Prospective predictors of body dissatisfaction in adolescent girls and boys: a five-year longitudinal study. Developmental Psychology, 42, 888–899.PubMedCrossRefGoogle Scholar
  55. Presnell, K., Bearman, S., & Stice, E. (2004). Risk factors for body dissatisfaction in adolescent boys and girls: a prospective study. International Journal of Eating Disorders, 36, 389–401.PubMedCrossRefGoogle Scholar
  56. Rankin, J. L., Lane, D., Gibbons, F., & Gerrard, D. (2004). Adolescent self-consciousness: longitudinal age changes and gender differences in two cohorts. Journal of Research on Adolescence, 14(1), 1–21.CrossRefGoogle Scholar
  57. Rastam, M., Gillberg, C., & Garton, M. (1989). Anorexia nervosa in a Swedish urban region: a population-based study. British Journal of Psychiatry, 155, 642–646.PubMedGoogle Scholar
  58. Ricciardelli, L. A., & McCabe, M. P. (2003). A longitudinal analysis of the role of psychosocial factors in predicting body change strategies among adolescent boys. Sex Roles, 45, 349–360.CrossRefGoogle Scholar
  59. Rose, A. J., & Rudolph, K. D. (2006). A review of sex differences in peer relationship processes: potential trade-offs for the emotional and behavioral development of girls and boys. Psychological Bulletin, 132, 98–131.PubMedCentralPubMedCrossRefGoogle Scholar
  60. Rosenblum, G. D., & Lewis, M. (1999). The relations among body image, physical attractiveness, and body mass in adolescence. Child Development, 70(1), 50–64.PubMedCrossRefGoogle Scholar
  61. Schafer, J. L., & Graham, J. W. (2002). Missing data: our view of the state of the art. Psychological Methods, 7, 147–177.PubMedCrossRefGoogle Scholar
  62. Smetana, J. G., Campione-Barr, N., & Metzger, A. (2006). Adolescent development in interpersonal and societal contexts. Annual Review of Psychology, 57, 255–284.PubMedCrossRefGoogle Scholar
  63. Smink, F. R., van Hoeken, D., & Hoek, H. W. (2012). Epidemiology of eating disorders: incidence, prevalence and mortality rates. Current Psychiatry Reports, 1, 1–9.Google Scholar
  64. Stice, E. (2001). A prospective test of the dual pathway model of bulimic pathology: mediating effects of dieting and negative affect. Journal of Abnormal Psychology, 110, 124–133.PubMedCrossRefGoogle Scholar
  65. Stice, E. (2002). Risk and maintenance factors for eating pathology: a meta-analytic review. Psychological Bulletin, 128, 825–848.PubMedCrossRefGoogle Scholar
  66. Stice, E., & Agras, W. S. (1998). Predicting onset and cessation of bulimic behaviors during adolescence: a longitudinal grouping analysis. Behavior Therapy, 29, 257–276.CrossRefGoogle Scholar
  67. Stice, E., Telch, C. F., & Rizvi, S. L. (2000). Development and validation of the eating disorder diagnostic scale: a brief self-report measure of anorexia, bulimia, and binge-eating disorder. Psychological Assessment, 12, 123–131.PubMedCrossRefGoogle Scholar
  68. Stice, E., Marti, C. N., Shaw, H., & Jaconis, M. (2009). An 8-year longitudinal study of the natural history of threshold, subthreshold, and partial eating disorders from a community sample of adolescents. Journal of Abnormal Psychology, 118, 587–597.PubMedCentralPubMedCrossRefGoogle Scholar
  69. Stice, E., Rohde, P., Durant, S., & Shaw, H. (2012a). A preliminary trial of a prototype internet dissonance-based eating disorder prevention program for young women with body image concerns. Journal of Consulting and Clinical Psychology, 80, 907–916.PubMedCentralPubMedCrossRefGoogle Scholar
  70. Stice, E., South, K., & Shaw, H. (2012b). Future directions in etiologic, prevention, and treatment research for eating disorders. Journal Clinical Child & Adolescent Psychology, 41, 845–855.CrossRefGoogle Scholar
  71. Striegel-Moore, R. H., & Bulik, C. M. (2007). Risk factors for eating disorders. American Psychologist, 62, 181–198.PubMedCrossRefGoogle Scholar
  72. Striegel-Moore, R. H., Silberstein, L. R., & Rodin, J. (1993). The social self in bulimia nervosa: public self-consciousness, social anxiety, and perceived fraudulence. Journal of Abnormal Psychology, 102, 297–303.PubMedCrossRefGoogle Scholar
  73. Thomas, J. J., Vartanian, L. R., & Brownell, K. D. (2009). The relationship between eating disorder not otherwise specified (EDNOS) and officially recognized eating disorders: meta-analysis and implications for DSM. Psychological Bulletin, 135, 407–433.PubMedCentralPubMedCrossRefGoogle Scholar
  74. Thompson, J. K., Heinberg, L. J., Altabe, M., & Tantleff-Dunn, S. (1999). Exacting beauty: Theory, assessment, and treatment of body image disturbance. Washington: American Psychological Association.CrossRefGoogle Scholar
  75. Wade, T., Byrne, S., & Bryant-Waugh, R. (2008). The eating disorder examination: norms and construct validity with young and middle adolescent girls. International Journal of Eating Disorders, 41, 551–558.PubMedCrossRefGoogle Scholar
  76. Wade, T. D., Wilksch, S. M., & Lee, C. (2012). A longitudinal investigation of the impact of disordered eating on young women’s quality of life. Health Psychology, 31, 352–359.PubMedCrossRefGoogle Scholar
  77. Wang, Y., & Fong, V. L. (2009). Little emperors and the 4: 2: 1 generation: China’s singletons. Journal of the American Academy of Child & Adolescent Psychiatry, 48, 1137–1139.CrossRefGoogle Scholar
  78. Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: the PANAS scales. Journal of Personality & Social Psychology, 54, 1063–1070.CrossRefGoogle Scholar
  79. Wertheim, E. H., Koerner, J., & Paxton, S. J. (2001). Longitudinal predictors of restrictive eating and bulimic tendencies in three different age groups of adolescent girls. Journal of Youth and Adolescence, 30, 69–81.CrossRefGoogle Scholar
  80. Wertheim, E. H., Paxton, S. J., & Blaney, S. (2009). Body image in girls. In L. Smolak & J. K. Thomspon (Eds.), Body image, eating disorders, and obesity in youth: assessment, prevention, and treatment (pp. 47–76). Washington: American Psychological Association.CrossRefGoogle Scholar
  81. Wichstrøm, L. (2000). Psychological and behavioral factors unpredictive of disordered eating: a prospective study of the general adolescent population in Norway. International Journal of Eating Disorders, 28, 33–42.PubMedCrossRefGoogle Scholar
  82. Wilksch, S., & Wade, T. D. (2009). Reduction of shape and weight concern in young adolescents: a 30-month controlled evaluation of a media literacy program. Journal of the American Academy of Child & Adolescent Psychiatry, 48, 652–661.CrossRefGoogle Scholar
  83. World Health Organization. (2000). The Asia-Pacific perspective: redefining obesity and its treatment. Sydney: Health Communications Australia.Google Scholar
  84. Xie, B., Chou, C. P., Spruijt-Metz, D., Reynolds, K., Clark, F., Palmer, P., et al. (2006). Weight perception and weight-related sociocultural and behavioral factors in Chinese adolescents. Preventive Medicine, 42, 229–234.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Key Laboratory of Cognition and PersonalitySouthwest UniversityChongqingChina

Personalised recommendations