The role of gender, affectivity and parenting in the course of disordered eating: A 4-year prospective case-control study among adolescents

Background: Prolonged eating disturbances increase the risk for a full-blown eating disorder and lifelong health impairment. Screening will improve early detection of eating pathology, but the major question still remains: who will benefit from early treatment and who needs little or no intervention. To answer this question, information about the factors that predict the course of disordered eating is valuable. Objectives: To investigate the course of eating disturbance from middle to late adolescence, to test certain individual and parental factors potentially explaining the differences in the course of eating disturbance, and to estimate the predictive power of these factors in terms of the recurrence of eating disturbance and the onset of new presentations of eating pathology after mid-adolescence. Design: A four-year follow-up study with a case-control design. Settings: School health care and community settings in south-western Finland. Participants: Students who had reported eating disturbance at baseline (n = 208, response rate 69%) and a group of non-symptomatic controls (n = 514, response rate 81%) were enrolled and matched by school, grade, and gender. Methods: At baseline assessment, mid-adolescent students (mean age 14.9 years) self-administered the SCOFF eating disorder questionnaire as part of their regular health examination. Background information, including self-reported mood questionnaire RBDI, was obtained from the students' health care records. Four years later, the participants (mean age 19.0 years) responded to the questionnaire by mail. Logistic regression analyses were used to assess the recurrence and onset of eating disturbance and the associated factors. Results: Altogether 52% of girls and 17% of boys who reported eating disorder symptoms in the baseline assessment remained symptomatic at follow-up. Depressiveness - even transient - in mid-adolescence predicted recurrence of eating disturbance in late adolescence. Prolonged dissatisfaction with appearance predicted the onset of eating disturbance in previously symptom-free girls. In general, experience of average parenting was good enough for the girls in terms of recovering from eating disturbance and avoiding the onset of eating problems after mid-adolescence. Conclusions: Adolescent girls who report both eating disturbance and negative affectivity may benefit from extra support. The beneficial role that parents may have in helping these girls must not be forgotten.