Predictors of Nutritional Status, Depression, Internet Addiction, Facebook Addiction, and Tobacco Smoking Among Women With Eating Disorders in Spain

Abstract

Eating disorders (EDs) are a complex group of psychiatric conditions that involve dysfunctional eating patterns, nutritional alterations, and other comorbid psychopathologies. Some women with EDs may develop problematic internet use while they attempt to get information on dieting/weight control or get online support from people with similar problems. They may also drift toward tobacco smoking as a method to regulate their weight or to cope with their weight-related dysphoria. The occurrence of these conditions in EDs may prolong disease course and impede recovery. This study used structural equation modeling to investigate nutritional status (noted by body mass index, BMI), depression psychopathology, internet addiction (depicted by the Internet Addiction Test), Facebook addiction (depicted by the Bergen Facebook Addiction Scale), and smoking among 123 Spanish women diagnosed with EDs (mean age = 27.3 ± 10.6 years). History of hospitalization, marital status, age, and the level of education predicted BMI in certain ED groups. BMI did not predict depression, but it predicted internet addiction, Facebook addiction, and smoking in certain ED groups. Depression did not predict BMI, internet/Facebook addition, or smoking in any ED group. Some sociodemographic and clinical variables had indirect effects on depression, internet addiction, and Facebook addiction while age was the only variable expressing a direct effect on all outcome measures. Age, education, and history of prolonged treatment predicted smoking in certain ED patients. The findings signify that a considerable target for interventional strategies addressing nutritional and addictive problems in EDs would be women with high BMI, history of hospitalization, history of prolonged treatment, who are particularly young, single, and less educated. Replication studies in larger samples, which comprise various subtypes of EDs from both genders, are warranted to define the exact interaction among the addressed variables.

Keywords: Facebook addiction/internet addiction; Spain/Spanish; body mass index/BMI; depression psychopathology; eating disorders; nutritional status; tobacco smoking; women.

Figure 1

Schematic illustration of the model used to test hypotheses of the present study. Hypothesis 1a (H1a): Sociodemographic and clinical characteristics contribute to altered body mass index in patients with EDs. Hypothesis 1b (H1b): Sociodemographic and clinical characteristics contribute to depression in patients with EDs. Hypotheses 1c, d, e (H1c,d,e): Sociodemographic and clinical characteristics contribute to internet addiction, Facebook addiction, and smoking in patients with EDs. Hypothesis 2 (H2): Altered body mass index contributes to depression in patients with EDs. Hypothesis 3 (H3): Depression contributes to altered body mass index in patients with EDs. Hypotheses 4a, b, c (H4a,b,c): Altered body mass index contributes to internet addiction, Facebook addiction, and smoking in patients with EDs. Hypothesis 5a, b, c (H5a,b,c): Depression contributes to internet addiction, Facebook addiction, and smoking in patients with EDs.

Figure 2

Direct effects from structural equation model predicting depression, internet addiction, and Facebook addiction among women with different eating disorders (A), with anorexia nervosa (B), and with other eating disorders (C).