Eating disorder symptom trajectories in adolescence: effects of time, participant sex, and early adolescent depressive symptoms

Abstract

Background: Adolescence is a period of developmental risk for eating disorders and eating disorder symptoms. This study aimed to describe the prevalence and trajectory of five core eating disorder behaviours (binge eating, purging, fasting, following strict dietary rules, and hard exercise for weight control) and a continuous index of dietary restraint and eating, weight and shape concerns, in a cohort of male and female adolescents followed from 14 to 20 years. It also aimed to determine the effect of early adolescent depressive symptoms on the prevalence and trajectory of these different eating disorder symptoms. Participants (N = 1,383; 49% male) were drawn from the Western Australian Pregnancy Cohort (Raine) Study, a prospective cohort study that has followed participants from pre-birth to age 20 years. An adapted version of the Eating Disorder Examination-Questionnaire was used to assess eating disorder symptoms at ages 14, 17 and 20 years. The Beck Depression Inventory for Youth was used to assess depressive symptoms at age 14. Longitudinal changes in the prevalence of eating disorder symptoms were tested using generalised estimating equations and linear mixed models.

Results: Symptom trajectories varied according to the eating disorder symptom studied, participant sex, and the presence of depressive symptoms in early adolescence. For males, eating disorder symptoms tended to be stable (for purging, fasting and hard exercise) or decreasing (for binge eating and global symptom scores) from 14 to 17 years, and then stable to 20 years. For females, fasting and global symptom scores increased from age 14 to peak in prevalence at age 17. Rates of binge eating in females were stable from age 14 to age 17 and increased significantly thereafter, whilst rates of purging and hard exercise increased from age 14 to age 17, and then remained elevated through to age 20. Depressive symptoms at age 14 impacted on eating disorder symptom trajectories in females, but not in males.

Conclusions: Prevention, screening and intervention initiatives for adolescent eating disorders need to be tailored to gender and age. Purging behaviour appears to be an important target for work with early to middle adolescent females.

Keywords: Adolescence; Binge eating; Dieting; Eating disorders; Exercise; Fasting; Purging; Raine study; Trajectory.

Figure 1

Changes in girls’ global eating disorder symptom scores (mean scores with 95% confidence intervals), by time and 14-year depression status. There are significant main effects of time and 14-year depression status, and a significant interaction effect between time and depression.

Figure 2

Prevalence rates (with 95% confidence intervals) for categorical eating disorder symptoms in girls, by time and 14-year depression status. There are significant main effects of time for binge eating, purging, fasting and driven exercise; significant main effects of 14-year depression group for binge eating, purging and fasting; and significant time x depression interaction effects for binge eating, purging, fasting and attempts to follow strict dietary rules.