Eating Disorders and Self Esteem in Adolescents, Teens, and Young Adults

1. Eating Disorders and Self Esteem in Adolescents, Teens, and Young Adults

2. A Comparative Analysis Johnson, F., & Wardle, J. (2005). Dietary restraint, body dissatisfaction, and psychological distress: A prospective analysis. Journal of Abnormal Psychology, 114(1), 119-125. doi:10.1037/0021-843X.114.1.119 Olivardia, R., Pope, H. r., Borowiecki, J., & Cohane, G. H. (2004). Biceps and body image: The relationship between muscularity and self-esteem, depression, and eating disorder symptoms. Psychology of Men &Masculinity, 5(2), 112-120. doi:10.1037/1524-9220.5.2.112

3. Eating Disorders and Self Esteem in Adolescents, Teens, and Young Adults How do self-esteem and eating disorders interact with one another in terms of gender bias, gender difference, and gender predisposition? Is there a correlation between self-esteem and eating disorders and if so, can a symbiotic or cyclical relationship be determined?

4. Introduction Body image, eating disorders, self-esteem, and muscularity are all very significant and pressing issues facing adolescents and young adults. The reasons for the formations of maladaptive behaviors associated with these issues warrant review some of the research literature surrounding them. Hopefully the following will bring to light pertinent and helpful information on the subject in regard to similarities and/or differences between genders as well as what role society/environment and internal perceptions have in influencing the formation of eating disorders in this vulnerable and at risk population.

5. Research Article 1:Dietary Restraint, Body Dissatisfaction, and Psychological Distress: A Prospective Analysis Johnson, F., & Wardle, J. (2005).

6. What are the Authors Research Questions? • Examination of the cross-sectional and longitudinal relationship between dietary restraint and: • Investigation of the relationships between body dissatisfaction and: • Examination of the effects of dietary restraint and body dissatisfaction simultaneously in the same analytic model to compare their predictive power for: • Binge Eating, Emotional Eating, Abnormal Eating Attitudes Toward Eating And Weight • Depression, Stress, Low Self-esteem

7. The Design • Prospective Cohort Design • This is a design which is both cross-sectional and longitudinal

8. Operational Definitions For This Research Study • Cohorts-Group of similar individuals who share certain characteristics • Longitudinal-Following over a period of time to observe variation or change • Cross-sectional-refers to collecting data from cohorts at one particular point in time • Dietary Restraint-intentional efforts to achieve or maintain a desired weight • through reduced caloric intake • Body Dissatisfaction-Extent to which concerns about body shape cause distress and interfere with normal activities.

9. Methods: Participants (Representative Sampling) • Stratified Random Sampling Method • 1,177 Adolescent Females between the Ages of 13-15 Years • Attending 6 Secondary Schools in North West England • 98% of girls present participated representing 84% of the total selected Sample • All female pupils in grades 9 and 10 • Follow up visit was conducted 10-11 months later and 82% of the original population participated (all female pupils in grades 10-11) Stratified Random Sampling

10. Methods: Materials • 8 Total Questionnaires were utilized measuring the following categories. • Dietary Restraint-Dutch Eating Behavior Questionnaire (DEBQ) Shortened Version 5 Items. Internal reliability was 88%. • Body Dissatisfaction-8 Item Body Dissatisfaction Questionnaire (BSQ). Internal reliability was 92% • Abnormal Attitudes to Eating and Weight-25 item version Children’s Eating Attitudes Test (ChEat). Internal reliability was 85%. • Bulimic Symptoms and Emotional Eating-Eating Disorders Inventory (EDI) for binge eating, consisting of 7 items. Internal reliability was 52% • Emotional Eating-Abbreviated version of the DEBQ. Internal reliability was 91%. • Depression-shortened version of the Center for Epidemiological Studies Depression Scale (CES-D). Internal reliability was 85% • Low Self-Esteem-Rosenberg Self-Esteem Scale (RSES). Likert scale format. Internal reliability was 84% • Stress-Cohen’s Perceived Stress Scale (PSS) abbreviated 4 item model. Internal reliability was low at 54%

11. Methods: Materials • BMI: Body Mass Index was used as an index of Body weight adjusted for Height. • BMI=Weight (kg)/Height(m)2 Heights and Weights were taken. • Leicester portable height measure and Tanita 350 portable scales were used.

12. Methods: Data Analysis (Reliability) • Statistical Analyses • Pearson’s Correlations was used for simple analyses. • Logistic Regression was used to compare the effects of dietary restraint and body dissatisfaction. • Cronbach’s Alpha Coefficient for Internal Reliability on individual Questionnaires.

13. Methods: Variables (Validity) • Dependent Variables • (Responsive or Measured Variables) • Abnormal Eating Attitudes • Bulimia • Emotional Eating • Stress • Low Self-Esteem • Depression • Independent Variables • (Predictor or Manipulated Variables) • Dietary Restraint • Body Dissatisfaction

14. Objectivity • Was the research based on scientific evidence, fact, and results rather than conjecture? • Yes. The authors of this study utilized scientific methods when conducting their study. They relied on these methods throughout and while making their findings and conclusions.

15. Reliability • Were results of the tests used in the study consistent and can they be replicated? • Yes. Multiple statistical analyses were utilized in the compilation of the data. Including inter-data reliability. It is detailed in the study and discrepancies are explained.

16. Validity • Does the research measure what it claims to measure, does the body of work support it? • Yes. This research measures what it purports to measure. The results and findings support the research questions.

17. Representative Sampling • Was an unbiased subset of a statistical population that accurately reflects the members of the entire population used? • Yes-A Random Stratified Sample was utilized for the purpose of this research.

18. Replication • Can this study be reproduced accurately based on the procedures detailed in the methods and design section? • Yes- The research methods were very highly detailed. • The methods included details for procedures, sample selection, drop out rates, participation results, and materials.

19. Research Findings • Dietary restraint appeared to have a positive correlation between the dependent variables ONLY when paired with body dissatisfaction. • When tested alone dietary restraint did NOT have a positively significant correlation with the dependent variables. • Dietary restraint was not found to be a significant predictor of stress, depression or low self-esteem once the effects of body dissatisfaction were taken into account. • Body dissatisfaction presented as the driving force with positive correlations between the dependent variables. • This study did not necessarily agree with all previous research. Particularly those reporting a dual pathway model of bulimic pathology. • The higher level of body dissatisfaction in the more restrained eaters seems to be the primary predictor of their bulimic symptoms.

20. Research Findings • Bulimic symptom indicators/predictors were correlated to body image dissatisfaction rather than dietary restraint. This was on a global/generalized scale rather than based on dissatisfaction with individual body parts. This was both longitudinal and cross sectional. • As is well established, dietary restraint and body dissatisfaction were highly correlated, related, making it possible that either could be primarily responsible for these associations. When both predictors were included in the same analytic model, both body dissatisfaction and dietary restraint were significant cross-sectional and longitudinal predictors of abnormal weight and eating attitudes (Johnson & Wardle, 2005, p. 123)

21. Research Conclusions • This study points out the need for more studies of this nature both within the “normal” population in order to minimize the development of potential eating disorders, and in the “eating disorder” population in order to treat these disorders better. • A further important implication of the results is that restrained eating is not, at least in this sample, a correlate or harbinger of many of the adverse psychological and behavioral outcomes with which it has previously been associated. (Johnson & Wardle, 2005, 124) • More research needs to be done. • Conflict with some prior research which indicated dietary restraint had a greater impact on the development of bulimic symptoms. • Limitations of the study were numerous as it was self-report and non-experimental therefore direct causal relationships cannot be established.

22. Research Article 2:Biceps and Body Image: The Relationship between Muscularity and Self-Esteem, Depression, and Eating Disorder Symptoms Olivardia, R., Pope, H. R., Borowiecki, J., & Cohane, G. H. (2004).

23. What are the Authors Research Questions? • 1. The importance of muscularity in the overall body image of men. • Men will perceive themselves to be less muscular and fatter than they actually are • Men will prefer an ideal body that is significantly more muscular and less fat than both their actual body and their perceived image • Men will choose a significantly more muscular and less fat perceived female ideal of the male body the ideal body that females actually choose • The muscularity and fat of the men’s chosen ideal body will not differ significantly from what they judge to be the women’s ideal of the male body • The muscularity and fat of the men’s chosen ideal body will be significantly more muscular and less fat than what they judge to be the body of an average man of their age

24. What are the Authors Research Questions? • 2. The association between body dissatisfaction and body image distortion and depression. • Depression will be positively correlated with muscle belittlement and fat exaggeration • EDI Scores, similarly will be positively correlated with muscle belittlement and fat exaggeration • Self-esteem will be negatively correlated with muscle belittlement and body dissatisfaction • 3. What variables predict the use of steroids and other performance enhancing drugs.

25. The Design • Cross-Sectional • Cohort Design

26. Operational Definitions for this Research Study • Muscle Belittlement-Difference between Perceived Muscularity/Actual Muscularity • Fat Exaggeration-Difference between Perceived “Fatness”/Actual “Fatness” • Body Dissatisfaction-Not liking ones body, dissatisfaction with the way one’s body is proportioned, feeling fat, and feeling out of shape.

27. Methods: Participants (Representative Sampling) • Stratified Random Sampling Method • Male and Female Participants • 154 Male • 77 Female • Ethnically Diverse Boston Area University • Classes of Various Disciplines were selected as well as advertising the study

28. Methods: Materials • SMM for measuring body image perceptions “This instrument is hypothesized to be a more valid measure of body image perspectives in men because it tests body image along two axes: thin–fat and non- muscular–muscular.” • In the SMM different indices were included or excluded for Male and Female Participants. • Beck Depression Inventory Short Form (BDI) • Materials • Measurements for Height, Weight, and Body Fat • Body Fat Measured utilizing the Jackson and Pollock Method. • Fat-Free Mass Index (FFMI) • Calculated using the following equation: • FFMI=W x [(100-BF)/100]xH-2+6.1 x (1.8-H). • Where W is weight in Kilograms, BF is percent Body Fat, and H is Height in Meters.

29. Methods: Materials • Eating Disorders Inventory (EDI) • Demographic/Family/Childhood Questionnaire (Male Participants Only) • Confidential Exercise Behavior Survey • Rosenberg Self-Esteem Scale

30. Methods: Data Analysis (Reliability) • Statistical Analyses (Reliability-Were results consistent or reliable?) • T test for paired samples two-tailed for within subject comparison (Male Male). • Independent t tests two-tailed for between subject samples (Male Female). • Pearson’s Correlation Coefficient for correlations between two variables. • Reported all differences with significance of p<.05.

31. Objectivity • Was the research based on scientific evidence, fact, and results rather than conjecture? • Yes. The authors of this study utilized scientific methods when conducting their study. They gathered data and conducted analyses. This was used in their findings and conclusions.

32. Reliability • Were results of the tests used in the study consistent and can they be replicated? • Yes. Multiple statistical analyses were utilized which were specifically selected for the type of study conducted. This included inter-data reliability. It is detailed in the study and discrepancies, anomalies, and discarded data are explained.

33. Validity • Does the research measure what it claims to measure, does the body of work support it? • Yes. This research measures what it sets out to measure. The results and findings support the research questions and hypotheses.

34. Replication • Can this study be reproduced accurately based on the procedures detailed in the methods and design section? • Yes- The research methods were very highly detailed. • The methods included details for procedures, sample selection, participation results, and materials. It also included detailed descriptions of what to exclude and reasoning for why instruments were selected.

35. Research Findings • Men chose a perceived female ideal of the male body significantly MORE muscular and LEANER than the ideal male body which women actually chose. • Men chose an ideal body for themselves that was slightly fatter and more muscular than that which they perceived as women’s ideal male body. This did not support the research hypothesis. • Men perceived themselves to be slightly fatter than their actual body fat measurement. They perceived themselves to be slightly MORE muscular than their measured muscularity. • Men chose an ideal body with a mean of around 25 pounds more muscle than their measured muscularity and around 8 pounds less body fat than their measured body fat. • .

36. Research Findings • Subscales of the EDI Index were NOT positively correlated with fat exaggeration. • Twenty Seven Percent of men in the sample reported use of PESs. • Self-esteem was significantly negatively correlated with many variables of body dissatisfaction. • Self-esteem was positively correlated with perceived FFMI. • Men’s chosen ideal body was significantly more muscular and less fat than what they judged to be the body of an average slave their own age. • Muscle belittlement was positively correlated with depression. • Fat exaggeration was NOT positively correlated with depression. • Subscales of the EDI Index were positively correlated with muscle belittlement.

37. Research Conclusions • This research indicates concern for public health in the form of increase in cosmetic surgery, use of PESs, orthopedic disorders, and increase in male eating disorders. • More research studies of this type are needed to continue to asses the situation. Particularly as reporting these types of feelings and concerns with your body as a heterosexual male are considered by many to be “gay” or “feminine”. • This research supports that contemporary American men display substantial body dissatisfaction and that this dissatisfaction is closely associated with depression, measures of eating pathology, use of PESs, and low self-esteem. (Olivardia et. al., 2004) • Most of the research in the current study supported previous research.

38. Research Perspectives • Based on a comprehensive review of the above research studies conclusions have been drawn that the authors share a theoretical perspective of cognitive behavioral theory. Cognitive behavioral theory is a cognitive learning theory in which individuals form positive or negative self-concepts that directly affect the behaviors they exhibit. In cognitive behavioral theory these self-concepts can also be affected by the individual’s external environment, reactions to, and perceptions of. In this model dysfunctional beliefs lead to dysfunctional behavior.

39. Research Perspective • In each of these studies the primary focus is on how the research participant’s self-concepts are influenced by both their own perceptions (self), their social environment, which results in maladaptive behavior or the potential for. This is indicated by the use of control with either dietary restraint or PESs. This fits almost perfectly with the tenants of cognitive behavioral theory. Furthermore, the basis of many previous research studies, which these research studies are modeled after use Restraint Theory as a model. This theory is a Cognitive Learning Theory. Examples of this can be found in both the research questions and in the results: This study examines the importance of muscularity in the overall body image of men. (Olivardiaet. Al., 2004, p. 112) and Body dissatisfaction remained a significant predictor of all three outcomes in these analyses. (Johnson & Wardle, 2005, p. 124). Likewise, in the literature it is clearly indicated and supported by the authors, that many of the more successful treatments and those which this research would enhance are based in cognitive learning theory.

40. Take Home Message • Having reviewed and compared these two studies though they may differ in the type am convinced that there is indeed a definite parallel between male and female eating disorders in adolescents and young adults. In particular the mirroring of societal/peer pressure and the correlation between body dissatisfaction and muscle belittlement/binge eating. • While similarities exist the two studies also raise some questions regarding the nature of the disorders as well. • The most significant is the difference in the gender roles and perceptions. T • The preoccupation of muscle mass in males and thinness in females.

41. Take Home Message • The second is the emotional element involved and difference in gender. • More research needs to be conducted regarding both research subjects. • In doing so current populations with eating or dysmorphic disorders, treated populations, and “normal” population need to be represented for comparison. • Additionally the cross-sectional longitudinal design would seem to hold more reliability and validity than cross-sectional alone. • Implications for treatments and assessment need to be followed up with based on this research. This is something that is touched on in both of the studies and which would be interesting to further.

42. Take Home Message • The similarities between perception of body image and dissatisfaction with self and the correlations that were associated with this in both the male and female studies were interesting. • A post facto comparison study of these and analysis of some sort would be interesting and beneficial as well, especially in regard to treatment and diagnosis. • There are limitations to both studies. • These are self-answer instruments. • They are both correlational studies and not a casual or experimental design. • Another limitation is the sample populations. Neither include data from current or recovering eating disorder populations.

43. References Johnson, F., & Wardle, J. (2005). Dietary restraint, body dissatisfaction, and psychological distress: A prospective analysis. Journal of Abnormal Psychology, 114(1), 119-125. doi:10.1037/0021-843X.114.1.119 Olivardia, R., Pope, H. r., Borowiecki, J., & Cohane, G. H. (2004). Biceps and body image: The relationship between muscularity and self-esteem, depression, and eating disorder symptoms. Psychology of Men &Masculinity, 5(2), 112-120. doi:10.1037/1524-9220.5.2.112

44. Evaluation Rubric for Research Presentation Total Assignment = 100 pts (=23% of course grade) 10 pts -- Your research question/ appropriate selection of articles and presentation length--total presentation should be no shorter than 20 and no longer than 40 slides 45 pts -- Summary of each study; please include for each study the following. a. Purpose of Study--what are the study's research questions? (6 pts) b. Design --First, answer this question: is this study experimental?, quasi-experimental?, or correlational? Experimental=are there randomly assigned groups that were treated differently?, Quasi-Experimental--are there groups that naturally occurred--e.g., smokers vs. non-smokers--that were treated differently by the researcher?, Correlational--a group is described and the results show differences among the group members?  Second, IF the study has a developmental focus, analyze the developmental design: cross-sectional, longitudinal, or sequential. (6 pts)c. Methods--include participants, materials/instruments, data collection techniques, and data analysis techniques. After summarizing the methods, analyze what the researchers did in terms of the criteria of 1) objectivity, 2) reliability, 3) validity, 4) representative sampling, and 5) replication. (21 pts)

45. Evaluation Rubric for Research Presentation d. Findings--look for information indicating significant differences--connect the findings back to the research hypotheses. The findings should be contained in the Results section of the paper (6 pts)e. Conclusions--summary of authors' interpretations from Discussion section (6 pts) 15 pts--Theoretical Perspective--what are the researchers' (probably implicit) perspectives on human development?--defend your decisions for each study with reasons (from the purpose, design, data collection and analysis, results, and interpretation); you should 1) identify (2 pts), 2) explain (5 pts), and 3) defend (8 pts) whether the perspective of each study is organismic, cognitive-developmental, cognitive-learning, behavioral, psychodynamic, contextual, or humanistic.  If possible to determine the specific theory being tested by the study, further analyze the origins of the developmental approach being used.  Be sure to defend your point of view.15 pts -- Take Home Message--having read these two studies (notice this is a comparative analysis), what do you now believe? (=conclusions, 5 pts) What other questions do you have? (=future research questions, 5 pts) What can you not know for sure? (=limitations, 5 pts) 15 pts -- Communicative Effectiveness

46. Evaluation Rubric for Research Presentation a. Presence of a brief introduction and conclusion (2 pts)b. Does paper flow? (please use headings) (3 pts)c. Are words misspelled or used incorrectly, are subject-verb agreements correct? (4 pts)d. Correct use of in-text citation (e.g., refer to studies by the authors' last names and year of publication)--please note that the only proper way to refer to a study in formal writing is by the last names of the authors and the year of publication. No article titles should appear in the narrative. (3 pts)e. Style of references (3 pts)For both d. and e. please follow the APA Manual of Style, 6th ed. An APA tutorial is available under the Cunningham Memorial Library's home page (see online tutorials).Please post your presentation as an attachment (with document in Power Point or Word or rtf, preferably) under the Research Presentations Forum of the Discussion Board by the due date listed in the Calendar (under Tools).