Eating disorder symptomatology is highly prevalent in adolescence and is regarded one of the most important precursors of clinical eating disorders. The present longitudinal study examined the development of eating disorder symptomatology in adolescents over two years. At Time 1,528 high school students filled out self-report questionnaires (50.5% female; Mage = 15 years). Multivariate latent growth curve modeling and latent class growth analyses were performed to model latent trajectories and to identify latent trajectory classes. Stable trajectories of drive for thinness and body dissatisfaction were found, whereas bulimia and BMI increased over time. Important gender differences pointed to girls experiencing more eating disorder symptoms at each time point. Additionally, more diverse trajectory classes were found in girls than in boys. Finally, classes with the most eating disorder symptoms also experienced the most problems in identity development, internalizing symptoms, and the least effortful control. The present study underscores the importance of identifying vulnerable adolescents that experience greater eating disorder symptomatology, as they also seem to experience the worst psychosocial development.
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Details about all specific models that were tested in this study (which parameters were included and/or constrained), can be requested from the first author.
When conducting the LGC model with BMI, a significant increase can be found in both girls and boys (Interceptgirls = 19.85, Slopegirls = 0.63, Interceptboys = 19.65, Slopeboys = 0.63), mirroring earlier research (Bucchianeri et al. 2013).
Virtually the same latent classes emerged in girls and boys when including BMI instead of adjusted BMI. More information can be requested from the first author.
Abebe, D. S., Lien, L., & von Soest, T. (2012). The development of bulimic symptoms from adolescence to young adulthood in females and males: a population-based longitudinal cohort study. International Journal of Eating Disorders, 45, 737–745. https://doi.org/10.1002/eat.20950.
Allen, K. L., Crosby, R. D., Oddy, W. H., & Byrne, S. M. (2013). Eating disorder symptom trajectories in adolescence: effects of time, participant sex, and early adolescent depressive symptoms. Journal of Eating Disorders, 1, 32 https://doi.org/10.1186/2050-2974-1-32.
Baker, J. H., Thornton, L. M., Lichtenstein, P., & Bulik, C. M. (2012). Pubertal development predicts eating behaviors in adolescence. International Journal of Eating Disorders, 45, 819–826. https://doi.org/10.1002/eat.22022.
Berlin, K. S., Parra, G. R., & Williams, N. A. (2013). An introduction to latent variable mixture modeling (part 2): longitudinal latent class growth analysis and growth mixture models. Journal of Pediatric Psychology, 39, 188–203. https://doi.org/10.1093/jpepsy/jst085.
Bollen, K. A. (1989). Structural equations with latent variables. New York, NY: Wiley.
Bucchianeri, M. M., Arikian, A. J., Hannan, P. J., Eisenberg, M. E., & Neumark-Sztainer, D. (2013). Body dissatisfaction from adolescence to young adulthood: findings from a 10-year longitudinal study. Body Image, 10, 1–7. https://doi.org/10.1016/j.bodyim.2012.09.001.
Cafri, G., Thompson, J. K., Ricciardelli, L., McCabe, M., Smolak, L., & Yesalis, C. (2005). Pursuit of the muscular ideal: physical and psychological consequences and putative risk factors. Clinical Psychology Review, 25, 215–239. https://doi.org/10.1016/j.cpr.2004.09.003.
Cain, A. S., Epler, A. J., Steinley, D., & Sher, K. J. (2010). Stability and change in patterns of concerns related to eating, weight, and shape in young adult women: a latent transition analysis. Journal of Abnormal Psychology, 119, 255–267. https://doi.org/10.1037/a0018117.
Chernyak, Y., & Lowe, M. R. (2008). Drive for thinness is not the same as drive to be thin: on the motivation for dieting in normal weight restrained eaters and bulimic individuals. Appetite, 51, 358–358. https://doi.org/10.1016/j.appet.2008.04.054.
Claes, L., Robinson, M. D., Muehlenkamp, J. J., Vandereycken, W., & Bijttebier, P. (2010). Differentiating bingeing/purging and restrictive eating disorder subtypes: the roles of temperament, effortful control, and cognitive control. Personality and Individual Differences, 48, 166–170. https://doi.org/10.1016/j.paid.2009.09.016.
Claes, L., Vandereycken, W., & Vertommen, H. (2002). Impulsive and compulsive traits in eating disordered patients compared with controls. Personality and Individual Differences, 32, 707–714. https://doi.org/10.1016/S0191-8869(01)00071-X.
Corning, A. F., & Heibel, H. D. (2016). Re-thinking eating disorder prevention: the case for prioritizing the promotion of healthy identity development. Eating Disorders, 24, 106–113. https://doi.org/10.1080/10640266.2015.1034057.
Croll, J., Neumark-Sztainer, D., Story, M., & Ireland, M. (2002). Prevalence and risk and protective factors related to disordered eating behaviors among adolescents: relationship to gender and ethnicity. Journal of Adolescent Health, 31, 166–175. https://doi.org/10.1016/S1054-139X(02)00368-3.
Dittmar, H., & Howard, S. (2004). Professional hazards? The impact of models’ body size on advertising effectiveness and women’s body-focused anxiety in professions that do and do not emphasize the cultural ideal of thinness. British Journal of Social Psychology, 43, 477–497. https://doi.org/10.1348/0144666042565407.
Duncan, T. E., & Duncan, S. C. (2004). An introduction to latent growth curve modeling. Behavior Therapy, 35, 333–363. https://doi.org/10.1016/S0005-7894(04)80042-X.
Erikson, E. H. (1968). Identity: youth and crisis. New York, NY: Norton.
Evans, D. E., & Rothbart, M. K. (2007). Developing a model for adult temperament. Journal of Research in Personality, 41, 868–888. https://doi.org/10.1016/j.jrp.2006.11.002.
Fairburn, C. G. & Brownell, K. D. (Eds) (2002). Eating disorders and obesity: a comprehensive handbook. 2nd ed. New York, NY: The Guilford Press.
Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41, 509–528. https://doi.org/10.1016/S0005-7967(02)00088-8.
Ferreiro, F., Seoane, G., & Senra, C. (2012). Gender-related risk and protective factors for depressive symptoms and disordered eating in adolescence: a 4-year longitudinal study. Journal of Youth and Adolescence, 41, 607–622. https://doi.org/10.1007/s10964-011-9718-7.
Ferreiro, F., Seoane, G., & Senra, C. (2014). Toward understanding the role of body dissatisfaction in the gender differences in depressive symptoms and disordered eating: a longitudinal study during adolescence. Journal of Adolescence, 37, 73–84. https://doi.org/10.1016/j.adolescence.2013.10.013.
Field, A. E., Camargo, C. A., Taylor, C. B., Berkey, C. S., Frazier, A. L., Gillman, M. W., & Colditz, G. A. (1999). Overweight, weight concerns, and bulimic behaviors among girls and boys. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 754–760. https://doi.org/10.1097/00004583-199906000-00024.
Garner, D. M. (2004). EDI-3 eating disorders inventory-3: professional manual. Odessa, FL: Psychological Assessment Resources.
Goossens, L., Van Malderen, E., Van Durme, K., & Braet, C. (2016). Loss of control eating in adolescents: associations with adaptive and maladaptive emotion regulation strategies. Eating Behaviors, 22, 156–163. https://doi.org/10.1016/j.eatbeh.2016.06.015.
Harter, S. (1999). The construction of the self: a developmental perspective. New York, NY: Guilford Press.
Johnson, W., Hicks, B. M., McGue, M., & Iacono, W. G. (2007). Most of the girls are alright, but some aren’t: personality trajectory groups from ages 14 to 24 and some associations with outcomes. Journal of Personality and Social Psychology, 93, 266–284. https://doi.org/10.1037/0022-35188.8.131.526.
Jung, F., Spahlholz, J., Hilbert, A., Riedel-Heller, S. G., & Luck-Sikorski, C. (2017). Impact of weight-related discrimination, body dissatisfaction and self-stigma on the desire to weigh less. Obesity Facts, 10, 139–151. https://doi.org/10.1159/000468154.
Jung, T., & Wickrama, K. (2008). An introduction to latent class growth analysis and growth mixture modeling. Social and Personality Psychology Compass, 2, 302–317. https://doi.org/10.1111/j.1751-9004.2007.00054.x.
Kansi, J., Wichstrøm, L., & Bergman, L. R. (2005). Eating problems and their risk factors: a 7-year longitudinal study of a population sample of Norwegian adolescent girls. Journal of Youth and Adolescence, 34, 521–531. https://doi.org/10.1007/s10964-005-8935-3.
Keel, P. K., Baxter, M. G., Heatherton, T. F., & Joiner, Jr, T. E. (2007). A 20-year longitudinal study of body weight, dieting, and eating disorder symptoms. Journal of Abnormal Psychology, 116, 422–432. https://doi.org/10.1037/0021-843X.116.2.422.
Kerremans, A., Claes, L., & Bijttebier, P. (2010). Disordered eating in adolescent males and females: associations with temperament, emotional and behavioral problems and perceived self-competence. Personality and Individual Differences, 49, 955–960. https://doi.org/10.1016/j.paid.2010.08.003.
Kline, R. B. (2005). Principles and practice of structural equation modeling. 2nd ed. New York, NY: Guilford Press.
Knauss, C., Paxton, S. J., & Alsaker, F. D. (2007). Relationships amongst body dissatisfaction, internalisation of the media body ideal and perceived pressure from media in adolescent girls and boys. Body Image, 4, 353–360. https://doi.org/10.1016/j.bodyim.2007.06.007.
Lawler, M., & Nixon, E. (2011). Body dissatisfaction among adolescent boys and girls: the effects of body mass, peer appearance culture and internalization of appearance ideals. Journal of Youth and Adolescence, 40, 59–71. https://doi.org/10.1007/s10964-009-9500-2.
Lee, H., Lee, D., Guo, G., & Harris, K. M. (2011). Trends in body mass index in adolescence and young adulthood in the United States: 1959–2002. Journal of Adolescent Health, 49, 601–608. https://doi.org/10.1016/j.jadohealth.2011.04.019.
Lehmann, V., Ouwens, M. A., Braeken, J., Danner, U. N., van Elburg, A. A., Bekker, M. H. J., & van Strien, T. (2013). Psychometric properties of the Dutch version of the eating disorder inventory–3. Sage Open, 3, 1–7. https://doi.org/10.1177/2158244013508415.
Lewinsohn, P. M., Seeley, J. R., Moerk, K. C., & Striegel-Moore, R. H. (2002). Gender differences in eating disorder symptoms in young adults. International Journal of Eating Disorders, 32, 426–440. https://doi.org/10.1002/eat.10103.
Little, R. J. (1988). A test of missing completely at random for multivariate data with missing values. Journal of the American Statistical Association, 83, 1198–1202. https://doi.org/10.2307/2290157.
Micali, N., Horton, N., Crosby, R., Swanson, S., Sonneville, K., Solmi, F., & Field, A. (2017). Eating disorder behaviours amongst adolescents: investigating classification, persistence and prospective associations with adverse outcomes using latent class models. European Child and Adolescent Psychiatry, 26, 231–240. https://doi.org/10.1007/s00787-016-0877-7.
Muthén, B. (2003). Statistical and substantive checking in growth mixture modeling: comment on Bauer and Curran (2003). Psychological Methods, 8, 369–377.
Muthén, B. (2004). Latent variable analysis: growth mixture modeling and related techniques for longitudinal data. In D. Kaplan (Ed.), Handbook of quantitative methodology for the social sciences (pp. 345–368). Newbury Park, CA: Sage.
Muthén, B., & Muthén, L. K. (2000). Integrating person-centered and variable-centered analyses: growth mixture modeling with latent trajectory classes. Alcoholism: Clinical and Experimental Research, 24, 882–891. https://doi.org/10.1111/j.1530-0277.2000.tb02070.x.
Muthén, L. K., & Muthén, B. (2012). Mplus: the comprehensive modeling program for applied researchers: user’s guide. Los Angelos, CA: Muthén & Muthén.
Nagin, D. S. (1999). Analyzing developmental trajectories: a semiparametric, group-based approach. Psychological Methods, 4, 139–157. https://doi.org/10.1037/1082-989X.4.2.139.
Nagin, D. S. (2005). Group-based modeling of development. Cambridge, MA: Harvard University Press.
Neumark-Sztainer, D., Paxton, S. J., Hannan, P. J., Haines, J., & Story, M. (2006). Does body satisfaction matter? Five-year longitudinal associations between body satisfaction and health behaviors in adolescent females and males. Journal of Adolescent Health, 39, 244–251. https://doi.org/10.1016/j.jadohealth.2005.12.001.
Neumark-Sztainer, D., Wall, M., Larson, N. I., Eisenberg, M. E., & Loth, K. (2011). Dieting and disordered eating behaviors from adolescence to young adulthood: Findings from a 10-year longitudinal study. Journal of the American Dietetic Association, 111, 1004–1011. https://doi.org/10.1016/j.jada.2011.04.012.
Norton, S., Cosco, T., Doyle, F., Done, J., & Sacker, A. (2013). The hospital anxiety and depression scale: a meta confirmatory factor analysis. Journal of Psychosomatic Research, 74, 74–81. https://doi.org/10.1016/j.jpsychores.2012.10.010.
Nylund, K., Asparoutiov, T., & Muthen, B. (2007). Deciding on the number of classes in latent class analysis and growth mixture modeling: a Monte Carlo simulation study. Structural Equation Modeling, 14, 535–569. https://doi.org/10.1080/10705510701575396.
Nyman-Carlsson, E., Engström, I., Norring, C., & Nevonen, L. (2015). Eating disorder inventory-3, validation in Swedish patients with eating disorders, psychiatric outpatients and a normal control sample. Nordic Journal of Psychiatry, 69, 142–151. https://doi.org/10.3109/08039488.2014.949305.
Polivy, J., & Herman, C. P. (2002). Causes of eating disorders. Annual Review of Psychology, 53, 187–213. https://doi.org/10.1146/annurev.psych.53.100901.135103.
Puccio, F., Fuller-Tyszkiewicz, M., Youssef, G., Mitchell, S., Byrne, M., Allen, N., & Krug, I. (2017). Longitudinal bi-directional effects of disordered eating, depression and anxiety. European Eating Disorders Review, 25, 351–358. https://doi.org/10.1002/erv.2525.
Reinecke, J. (2006). Longitudinal analysis of adolescents’ deviant and delinquent behavior: applications of latent class growth curves and growth mixture models. Methodology: European Journal of Research Methods for the Behavioral and Social Sciences, 2, 100–112. https://doi.org/10.1027/1614-2241.2.3.100.
Ricciardelli, L. A., & McCabe, M. P. (2001). Dietary restraint and negative affect as mediators of body dissatisfaction and bulimic behavior in adolescent girls and boys. Behaviour Research and Therapy, 39, 1317–1328. https://doi.org/10.1016/S0005-7967(00)00097-8.
Roelants, M., & Hauspie, R. (2004). Groeicurven 2-20 jaar, Vlaanderen 2004 [Growth charts 2-20 years, Flanders 2004]. Retrieved 28 Jul 28, 2017 (Vrije Universiteit Brussel).
Rosenthal, D. A., Gurney, R. M., & Moore, S. M. (1981). From trust on intimacy: a new inventory for examining Erikson’s stages of psychosocial development. Journal of Youth and Adolescence, 10, 525–537. https://doi.org/10.1007/BF02087944.
Satorra, A., & Bentler, P. M. (2001). A scaled difference chi-square test statistic for moment structure analysis. Psychometrika, 66, 507–514. https://doi.org/10.1007/BF02296192.
Schafer, J. L., & Graham, J. W. (2002). Missing data: our view of the state of the art. Psychological Methods, 7, 147. https://doi.org/10.1037//1082-989X.7.2.147.
Schito, G., Pelosi, A., Cordori, C., Marchesi, C., & De Panfilis, C. (2018). Affect regulation and effortful control in bingeing/purging eating disorders: a daily diary study. Journal of Psychosomatic Research, 109, 132–133. https://doi.org/10.1016/j.jpsychores.2018.03.137.
Schwartz, S. J., Zamboanga, B. L., Wang, W., & Olthuis, J. V. (2009). Measuring identity from an Eriksonian perspective: two sides of the same coin? Journal of Personality Assessment, 91, 143–154. https://doi.org/10.1080/00223890802634266.
Siervogel, R. M., Demerath, E. W., Schubert, C., Remsberg, K. E., Chumlea, W. C., Sun, S., & Towne, B. (2003). Puberty and body composition. Hormone Research in Paediatrics, 60, 36–45. https://doi.org/10.1159/000071224.
Slane, J. D., Klump, K. L., McGue, M., & Iacono, W. G. (2014). Developmental trajectories of disordered eating from early adolescence to young adulthood: a longitudinal study. International Journal of Eating Disorders, 47, 793–801. https://doi.org/10.1002/eat.22329.
Stice, E. (2002). Risk and maintenance factors for eating pathology: a meta-analytic review. Psychological Bulletin, 128, 825–848. https://doi.org/10.1037/0033-2909.128.5.825.
Stice, E., & Shaw, H. E. (2002). Role of body dissatisfaction in the onset and maintenance of eating pathology: a synthesis of research findings. Journal of Psychosomatic Research, 53, 985–993. https://doi.org/10.1016/S0022-3999(02)00488-9.
Striegel-Moore, R., Franko, D.L., Cash, T.F., & Pruzinsky, T. (2002). Body image issues among girls and women. In T.F. Cash & P.T. (Eds), Body image: a handbook of theory, research and clinical practice (pp. 189–191). New York, NY: The Guilford Press.
Swanson, S. A., Horton, N. J., Crosby, R. D., Micali, N., Sonneville, K. R., Eddy, K., & Field, A. E. (2014). A latent class analysis to empirically describe eating disorders through developmental stages. International Journal of Eating Disorders, 47, 762–772. https://doi.org/10.1002/eat.22308.
Thompson, J. K., & Stice, E. (2001). Thin-ideal internalization: mounting evidence for a new risk factor for body-image disturbance and eating pathology. Current Directions in Psychological Science, 10, 181–183. https://doi.org/10.1111/1467-8721.00144.
Tiggemann, M. (2004). Body image across the adult life span: Stability and change. Body Image, 1, 29–41. https://doi.org/10.1016/S1740-1445(03)00002-0.
Van Winckel, M., & Van Mil, E. (2001). Wanneer is dik te dik? In C. Braet & M. A. J. M. Van Winckel (Eds), Behandelingsstrategieën bij kinderen met overgewicht (pp. 11–26). Bohn Stafleu Van Loghum: Houten/Diegem.
Vandereycken, W. (2006). Denial of illness in anorexia nervosa—a conceptual review: part 2 Different forms and meanings. European Eating Disorders Review, 14, 352–368. https://doi.org/10.1002/erv.722.
Vartanian, L. R., Hayward, L. E., Smyth, J. M., Paxton, S. J., & Touyz, S. W. (2018). Risk and resiliency factors related to body dissatisfaction and disordered eating: the identity disruption model. International Journal of Eating Disorders, 51, 322–330. https://doi.org/10.1002/eat.22835.
Verschueren, M., Luyckx, K., Kaufman, E. A., Vansteenkiste, M., Moons, P., Sleuwaegen, E., & Claes, L. (2017). Identity processes and statuses in patients with and without eating disorders. European Eating Disorders Review, 25, 26–35. https://doi.org/10.1002/erv.2487.
Verstuyf, J., Van Petegem, S., Vansteenkiste, M., Soenens, B., & Boone, L. (2014). The body perfect ideal and eating regulation goals: investigating the role of adolescents’ identity styles. Journal of Youth and Adolescence, 43, 284–297. https://doi.org/10.1007/s10964-013-9949-x.
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. https://doi.org/10.1023/A:1005224921891.
Williamson, D. A., Anderson, D. A., Jackman, L. P., & Jackson, S. R. (1995). Assessment of eating disordered thoughts, feelings, and behaviors. In D. B. Allison (Ed.), Handbook of assessment methods for eating behaviors and weight-related problems (pp. 347–386). London: Sage.
Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361–370.
Margaux Verschueren has a Ph.D. Fellowship of the Research Foundation-Flanders. The authors thank the high school students for participating in the study.
Margaux Verschueren has a Ph.D. fellowship of the Research Foundation—Flanders (1125918N).
M.V. conceived of the study, participated in its design and coordination, performed the statistical analyses, and drafted the manuscript; L.C. collected the data of the present study, conceived of the study, participated in its design and coordination and drafted the manuscript; N.P. participated in the design of the manuscript and helped drafting it; A.B. participated in the design of the manuscript and helped drafting it; A.G. collected the data of the present study; P.M. participated in the design of the manuscript and helped drafting it; K.L. conceived of the study, participated in its design and coordination, performed the statistical analyses, and drafted the manuscript. All authors read and approved the final manuscript.
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The datasets generated and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.
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The study was approved by the ethical committee of the Faculty of Psychology and Educational Sciences, University of Leuven.
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Verschueren, M., Claes, L., Palmeroni, N. et al. Eating Disorder Symptomatology in Adolescent Boys and Girls: Identifying Distinct Developmental Trajectory Classes. J Youth Adolescence 49, 410–426 (2020). https://doi.org/10.1007/s10964-019-01174-0
- Eating disorder symptomatology
- Internalizing symptoms
- Effortful control