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Eating Disorders and Broken Families: Is there a relationship between them?

Corey Golden

November 24, 2010

 

Introduction

            Eating Disorders

            The cause of about 45,000 American deaths a year and a lifelong battle against unhealthy eating habits, an eating disorder is one of the most difficult psychiatric illnesses to recover from.  Clinical counselor Angela Blier describes how “when you give up drugs and get clean, you never do them again.  With an eating disorder, you have to eat to survive, so there’s always the chance to backslide.”  The two most common eating disorders are Anorexia Nervosa and Bulimia Nervosa, but others exist including Binge eating disorder and EDNOS.  There are many factors that prompt the beginning of an eating disorder: genetics, peers, family, personality type, the existence of other psychological disorders, and the media.  In addition, it has been found that a particularly distressing occurrence may spark an eating disorder.  Any connections found could aid in decreasing the frightening statistics, such as that 3 in every 100 girls will be diagnosed with an eating disorder.  (http://www.empoweringparents.com/Starving-Themselves-to-Death.php#

            Broken Families/Divorce       

            After thorough research, psychologists do not conclude that divorce always has a negative effect on children.  Furthermore, divorce can result in an increase in a child’s maturity and sense of responsibility.  But sadly, some children are unable to successfully cope with stress, which could possibly lead to depression, anger, or an eating disorder.  The probability of these negative results most likely increases with some parent controlled behaviors such as fighting consistently in front of the children or giving a child very little information about the divorce. 

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Question

Researchers have performed many studies in an effort to discover if a relationship exists between people who have developed an eating disorder and whose parents are divorced.  After examining many different studies, it appears that a correlation does exist between eating disorders and broken families, where the chances of developing an eating disorder increases in people who have divorced parents.

Evidence     

            Risk Factors Study

            Shisslak, Crago, McKnight, Estes, Gray, and Parnaby (1998) performed a study to determine the link between weight control behaviors and their risk factors in elementary and middle school girls.  This sample was chosen because it has been said that early signs of eating disorders begin to appear in elementary and middle school aged children.  523 girls ages 9-15 from schools in Santa Clara, California and Tuscon, Arizona participated in the study, in which they were given the McKnight Risk Factor Survey to evaluate the potential risk factors, as well as a Figure Rating Scale to judge the children’s satisfaction with their bodies.  Researchers calculated BMI and asked questions about demographics, such as age, ethnicity, and parent’s marital status.  The dependent variable was the weight control behaviors, which each received a rating based on severity following the McKnight Risk Factor Survey. 

After performing a regression analysis, associations appeared between each of the two age groups and some of the potential risk factors.  For middle school girls, higher weight control behavior scores were connected to factors such as poor body image, separated/divorced parents, and the interaction of separated/divorced parents and pressure from the father to be thin.  For elementary school girls, higher weight control behavior scores were linked with factors such as the interaction of BMI and separated/divorced parents, peer pressure, and self-confidence.  Researchers hypothesized that the relationship between high scores and divorced/separated parents could be due to the atypical sources of stress that the children feel mixed with a high BMI for elementary school girls and a disapproving father for middle school girls. 

            Evaluation

            Overall, this research study was successful in its research design: the sample was large enough, the variables were measured accurately, and the regression analysis proved the conclusions to be true.  However, the study did possess a few weaknesses.  For example, there were significantly less elementary school girls participating in the study as compared to middle school girls.  In addition, the overwhelming majority of participants were white, but each ethnicity was represented.  Both of these limitations could confuse the results of the study and its generalization to all elementary and middle school girls.  Researchers also noted that longitudinal research is necessary to see if the associated factors change over time.            

            Parental and Mass Media Influences Study

            Martinez-Gonzalez, Gual, Lahortiga, Alonso, de Irala-Estevez, and Cervera (2003) executed a study to identify some of the risk factors for eating disorders in girls.  The researchers randomly selected 2,862 females in Navarra, Spain between the ages of 12 and 21 to participate in the study.  In order to determine which girls had eating disorders, participants filled out the Eating Attitudes Test.  A score above a 30 would bring the participant to a psychiatrist, who then diagnosed them using the DSM-IV.  The psychiatrist diagnosed 119 cases of eating disorders: 9 with Anorexia Nervosa, 22 with Bulimia Nervosa, and 88 with an eating disorder not otherwise specified (EDNOS).  The participants were given a questionnaire that rated self-esteem in four different categories: social, emotional, familial, and academic.  Researchers also calculated BMI for each of the girls. 

After analyzing the data with confidence intervals and multivariate logistic models, researchers found that the proportion of girls with eating disorders was significantly higher when their parents were separated, divorced, or widowed as compared to girls with married parents.  A stable family provides powerful support, promoting psychological health to children.  Divorce in a family often results in a major decrease in the self-esteem of the children in the family, and low self-esteem is also a risk factor of eating disorders.  In addition, living with one parent only allows for half the parental influence regarding healthy eating at meal times.  Regularly reading teen magazines, listening to the radio, and eating alone also all correlated with an increased risk of an eating disorder.             

            Evaluation

            The research design for this study was very successful in its large sample group, randomization to gather the sample, and lack of bias.  The sample group used was selected completely randomly, increasing the validity of the study.  The group was also the largest sample size in a study that used clinical criteria to diagnose eating disorders.  The researchers also implemented the Spanish version of the Eating Attitudes Test, so there was no room for a language barrier as a confounding variable.  The purpose of the study was very clear: to identify the risk factors of eating disorders in order to take preventative measures and intervene instead of relying solely on treatments.  One major downfall of the study was the lack of differentiation between the risk factors for each separate eating disorder (Anorexia Nervosa, Bulimia Nervosa, and EDNOS).  Another weakness was the length of the follow-up study, which only lasted for 18 months. 

            Childhood Adversities Study

            Johnson, Cohen, Kasen, and Brook (2002) designed a prospective longitudinal study to determine if a relationship exists between childhood adversities and eating disorders.  The researchers collected a sample of 782 mothers and their children, interviewing them during the child’s early, teenage, and adult years.  The sample was taken from 976 randomly selected families from New York.  Interviews occurred with the mothers in 1975, 1983, 1985-1986, and 1991-1993, and with the child in 1983, 1985-1986, and 1991-1993.  Both the mothers and children were given the Diagnostic Interview Schedule for Children to assess signs of an eating disorder, and eating disorders were formally diagnosed through the use of the DSM-IV.  The researchers also evaluated parental psychiatric symptoms and maladaptive parental behavior using tests such as the Disorganizing Poverty Interview.  The Disorganizing Poverty Interview simultaneously measured other childhood adversities, such as parental separation/divorce, low family income, or being raised by a single parent.  In addition, childhood maltreatment data was collected through a registry.

            Through the use of contingency tables and regression analysis, the researchers determined whether the association between childhood adversities and eating disorders was statistically significant after controlling for the confounding variables.  The researchers found that occurrences such as sexual abuse during childhood, poverty, and low paternal communication all were associated with a high risk for eating disorders.  They also found that the father-child relationship appeared to be more important than the mother-child relationship in the development of eating disorders.  Children who lacked love and empathy from their fathers were at an elevated risk for eating disorders.  Especially in cases where children live with only their mother after divorce occurs, the lack of relationship with their father could play a major role in the future development of an eating disorder.

            Evaluation

            Being the first research study that wasn’t a cross-sectional case-control study, the design provided a better basis for assessing risks and making inferences since risk factors should be measured before the development of an eating disorder.  The researchers used interview methods made to prevent bias and result in the most accurate measurements possible.  For example, the Disorganizing Poverty Interview has been proved reliable and valid through many different studies.  In addition, the children and mothers were interviewed separately to prevent bias, and the interviewer was blind to the responses from members of the same family.  The study was large enough, yet the sample was mostly Catholic (54%) and white (91%).  This could cause problems in generalizing the results to the population.  On the other hand, the study did have an equal amount of male and female children (397:385).  It also used statistics to account for confounding variables, such as the child’s age and simultaneously occurring adversities.  One other limitation of the study was that it did not identify the risk factors for each specific eating disorder.

Conclusion

            What We Now Know and Future Studies

            As shown through the evidence provided in these studies, the association between people who have developed an eating disorder and whose parents are divorced is strongly supported through research on the risk factors of eating disorders.  Though future studies could focus on the specific types of eating disorders and which ones are linked to parental marital statuses, the overall idea is that a correlation does exist.  Through the study on elementary and middle school girls, we learned that the increased stress on the child with divorced parents combined with factors such as a high BMI or a high-pressure father could cause the increase in the chance of developing an eating disorder.  The parental and mass media study illustrated how the possible low self-esteem in a child of divorce, as well as the lack of one parent’s enforcement of healthy eating habits in single parent homes, can act as risk factors for eating disorders.  Lastly, the childhood adversities study showed how the lack of a father-daughter relationship after a divorce could lead to a child developing an eating disorder.  In order to prevent nearly 45,000 American deaths a year and a lifelong battle against unhealthy eating habits, researchers should study children of divorce and try to help these children work through the negative after-effects.      

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

Jarashow, S.  The Perfection-Thinness Syndrome. (2000).  Union of American

Hebrew Congregations.  Retrieved from Novella, S.  The Lancet retracts Andrew Wakefield’s article.  (2010).  Science-Based Medicine.  Retrieved from http://www.sciencebasedmedicine.org/?p=3716

 

Johnson, J., Cohen, P., Kasen, S., & Brook, J.  (2002).  Childhood adversities associated

with risk for eating disorders or weight problems during adolescence or early adulthood.  Am J Psychiatry, 159(3), 394-400.   

 

 Karuppaswamy, N., & Myers-Walls, J.  Effect of Divorce on Children: What Makes a

Difference. (2010).  Provider-Parent Partnerships.  Retrieved from

http://www.extension.purdue.edu/providerparent/Family-Child%20Relationships/EffectDivorce.htm

 

Martinez-Gonzalez, M., Gual, P., Lahortiga, F., Alonso, Y., de Irala-Estevez, J., &

Cervera, S. (2003).  Parental factors, mass media influences, and the onset of eating disorders in a prospective population-based cohort.  Evid Based Nurs, 6(4), 120. 

 

 

 

Shisslak, C., Crago, M., McKnight, K., Estes, L., Gray, N., & Parnaby, O. (1998).

Potential risk factors associated with weight control behaviors in elementary and middle school girls.  J Psychosom Res, 44(3-4), 301-13. 

 

Wilkins, E.  Starving to Death: Does My Child Have an Eating Disorder? (2010). 

Empowering Parents.  Retrieved from

http://www.empoweringparents.com/Starving-Themselves-to-Death.php#

 

 

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