DevelopmentalPsychology 1989, Vol.25, No.

I, 70-79

Copyright 1989 by the American Psychoio0cal Association,Inc. 0012-1019/89/$00.75

Development of Eating Problems in Adolescent Girls: A Longitudinal Study

Ilana Attie New York Hospital--Cornell Medieai Center, White Plains, New York J. B r o o k s - G u n n Educational Testing Service, Princeton, New Jersey

Examined the emergence of eating problems in adolescent girls as a function of pubertal growth, body image, personality development, and family relationships. 193 White females and their mothers were seen in middle-school years (M age = 13.93 years) and 2 years later. Results showed that girls who early in adolescence felt most negatively about their bodies were more likely to develop eating problems (on EAT-26) 2 years later. Concurrently, Time I eating problems were associated with body fat, grade, negative body image, and psychopathology,but not family relationships. At Time 2, adolescent body image and internalizing dimensions of psychopathology predicted problem-eating scores, as did maternal body image and depression. Findings are discussed in terms of adolescent patterns of adaptation, developmental psychopathology,and the study's relevance for understanding clinical eating disorders.

A great deal of research and theory has elucidated the psychological, biological, and familial correlates of eating disorders that emerge during adolescence. With few exceptions (cf. Strobcr & Yager, 1985), however, investigators have not brought a developmental perspective to the study of eating problems, such as dieting and binge eating, despite evidence that such problems are widespread among adolescents and may be precursors to the more severe clinical syndromes of anorexia nervosa and bulimia (Leichner, Arnett, Rallo, Srikameswaran, & Vulcano, 1986; Nylander, 1971). The absence of developmentally oriented research in this area is unfortunate, given that eating problems typically have their onset during early to middle adolescence, are strongly gender- and class-related, and are closely tied to the biological and psychosocial changes that occur during the adolescent period. The aim of this prospective study is to examine the emergence of eating problems, that is, weight preoccupation, dieting, and hinging behaviors, from a developmental perspective. A developmental perspective requires that we study the development of eating problems in the context of challenges con-

This research was conducted with the generous support of the W. T. Grant Foundation and the National Institutes of Health. This study was conducted as part ofllana Attie's doctoral dissertation research at Catholic University. She would fike to thank Kathy Katz, David Pellegrini, and Richard Younissfor their support and guidance. We would also like to thank those who generously gave of their time and effort: Linda Ferrington, Debra Friedman, Marion Samelson, and Janine Gargiulo for data collection and coding, James Rosso for data analysis, and Rosemary Deibler and Florence Kelly for manuscript preparation. Don Rock and Michelle Warren provided helpful comments in data analyses and interpretation. The adolescent girls and their mothers who have participated in our research are, of course, to be thanked most of all. Correspondence concerning this article should be addressed to Ilana Attie, New York Hospital-Cornell Medical Center, Westchester Division, 21 Bloomingdale Road, White Plains, New York 10605. 70

fronting individuals during this life phase (Brooks-Gunn, in press; Brooks-Gunn & Petersen, 1983; Gunnar & Collins, 1988; Hamburg, 1980; Lerner & Foch, 1987). These challenges include (a) accomodation to the physical changes of the pubertal period within a cultural milieu that values the propubertal over the mature female body, (b) the loosening of childhood ties to parents and the move toward greater psychological and physical autonomy, and (c) the development of a stable and cohesive personality structure for the regulation of mood, impulse, and self-esteem. In the discussion that follows, we consider eating problems in the light of these adolescent tasks. Evidence of an inverse relationship between social class and weight (Stunkard, D'Aquili, Fox, & Fflion, 1972), together with gender-related pressures to attain a thin body ideal, points to the importance of sociocultural influences in mediating concerns about shape and weight (Garfinkel & Garne~ 1982). From a historical perspective, the preoccupation with weight and thinness, particularly among middle- to upper-middle-class women in Western society, reflects a relatively recent yet growing cultural trend (Attie& Brooks-Gunn, 1987; Bennett & Gurin, 1982). The correlations of weight problems with gender and affluence suggest that sociocultural attitudes about thinness and fatness may be intensified within certain social strata or subcultural groups (Dornbusch et al., 1984; Striegel-Moore, McAvay, & Rodin, 1986). Recent studies suggest that adolescent girls in competitive environments that emphasize weight and appearance experience increased social pressures to meet the thin ideal (Brooks-Gunn, Burrow, & Warren, 1988; BrooksGunn & Warren, 1985a; Garner & Garfinkel, 1980; Hamilton, Brooks-Gunn, & Warren, 1985). As girls mature sexually, they accumulate large quantities of fat in subcutaneous tissue, as indicated by increased skin-fold thickness (Young, Sipin, & Roe, 1968). For the adolescent girls, this "fat spurt" is one of the most dramatic physical changes associated with puberty, adding an average of 11 kg of weight in the form of body fat (Brooks-Gunn & Warren, 1985b; Gross,

ADOLESCENT GIRLS' EATING PROBLEMS 1984). Increases in body fat during the pubertal years are associated with desires to be thinner (Dornbusch et al., 1984). Other pubertal changes such as breast development may be associated with efforts to control food intake, particularly in girls from higher social-class backgrounds (Crisp, 1984; Dornbusch et al., 1984). The timing of maturation may also influence the emergence of dieting behavior. Early maturers are at greater risk for eating problems, in part because they are likely to be heavier than their late maturing peers (Brooks-Gunn, 1988; Faust, 1983; Tanner; 1962). The process of integrating changes in physical appearance and bodily feelings requires a reorganization of the adolescent's body image and other self-representations (Blos, 1962). Female body image is intimately bound up with subjective perceptions of weight; prepubeseent girls who perceive themselves as underweight are most satisfied, followed by those who think they are simply average (Simmons & Blyth, 1987; Tobin-Ricbards, Boxer, & Petersen, 1983). Taken together, the findings suggest that dieting emerges as the body develops and is, in part, a function of body image transformations occurring at puberty. The relative or long-term effects of pubertal changes on eating behavior, however, have not been studied systematically. The mother-daughter relationship and maternal bodily concerns have been considered central to the development of a girl's body image and eating attitudes, although little research addresses these issues directly (Orbach, 1986; Wooley & Wooley, 1985). More generally, family relationships may influence the emergence of eating problems in adolescent girls. From the cfinical literature on eating disorders, we derive a picture of families with high standards for achievement, little support for autonomy, and blurred interpersonal boundaries that leave the adolescent girl with doubts about her sense of effectiveness and deficits in her self-esteem (Goldstein, 1981; Katz, 1985; Kog, Vandereycken, & Vertommen, 1985; Minuchin, Rosman, & Baker, 1978). Whether similar family dynamics play a role in the development of less severe forms of problem eating is not known. Personality factors and affective vulnerability may also contribute to the development of eating problems. Characteristics such as perfectionist strivings, feelings of ineffectiveness, depressive symptoms, and self-regulatory deficits (over- and undercontrol of impulse and affect) are seen frequently in patients with eating disorders (Johnson & Maddi, 1986). Little research has examined these personality variables in nonclinical samples to determine what factors or combination of factors may predispose an adolescent to develop eating problems as opposed to other maladaptive behaviors such as depression or delinquency. In this study, we examine the relative impact of pubertal change, personality development, and family relationships on the emergence of eating problems in nonclinieally referred adolescents. Our focus is on connections (or the lack of connections) between normal development and patterns of maladaptive eating behavior (Carlson & Garber, 1986; Rutter, 1986). Girls were followed from middle school to high school to test the proposition that the development of eating problems represents a mode of accommodation to pubertal change. Following the clinical literature, we consider adaptation to pubertal change in the context of other factors, both intrapersonal and environmental, that may increase the likelihood of developing

71

eating problems (Garner, Rockert, Olmsted, Johnson, & Coscina, 1985). The contributions of physical maturation, body image, psychological adjustment, and perceptions of the family environment to the prediction of eating problems were evaluated longitudinally and concurrently. Middle-school girls were chosen for the study because eating problems (i.e., dieting or binge eating patterns) are relatively rare in children below the age of 13 (Crowtber, Post, & Zaynor, 1985; Irwin, 1981). Researchers have been remiss in studying eating problems in middle adolescence, as opposed to collegeage samples, despite evidence that such problems tend to have their onset during this period (Crisp, 1984; Johnson, Lewis, Love, Stuckey, & Lewis, 1984). Furthermore, participants were drawn from adolescents at risk for the development of eating problems with respect to gender and social class; that is, middleto upper-middle-class girls. The following three predictions were tested: (a) Prediction 1. As just reviewed, we expect independent and significant proportions of variance in problem eating (dieting and binge eating) to be accounted for by each of the following sets of variables: physical maturational status indices, psychological factors, and family influences. (b) Prediction 2. Compulsive eaters will manifest a higher degree of perceived ineffectiveness, perfectionism, and negative body image than will noncompulsive eaters, (Garner, Olmsted, & Polivy, 1983). (c) Prediction 3. Compulsive eaters will manifest a higher degree of reported family role dysfunction and maternal concerns with weight and bodily issues than will noncompulsive eaters (Johnson & Maddi, 1986; Kog et al., 1985; Wooley & Wooley, 1985). Method
Subjects

At Time 1, 193 White girls and their mothers were seen. The girls were in Grades 7 (12%), 8 (29%), 9 (32%), and 10 (27%). Twoyearslater (Time 2), they were contacted when they were in Grades 9 (12%), 10 (29%), I 1 (33%), and 12 (26%). The mean age was 13.93 years at Time 1 (SD = 1.13;ran~ = 12to 15) and 16.09 years at Time 2 (SD = 1.02; range = 14 to 17). Participants were drawn from one of several private schools in New York City, where private school attendance is common for middle- to upper-middle-classfamilies. These schoolsare academically oriented and most of their students attend college.Like most studies drawn from suburban school systems (cfBrooks-Gunn, Petersen, & Eichorn, 1985), the girls' parents were well-educated: Three-quarters attended college. Approximately 40% of the mothers worked full time, and 30% part time. Using paternal education and occupation, 95% of the sample was classifiedin the highest two social classes(Hollingshead & Redlich, 1958). One-half of the girls were firstborn. No demographic differences were found as a function of grade in school or school attended.
Procedure

At Time 1, parental consent was obtained and questionnaires were administered to groups of 10 to 25 girls at their schools. A research assistant was availableto answerquestions. Girls were weighedand measured by a nurse on the research staff.Each girl was paid $5. Over 85% of mothers returned the parent questionnaire; the only differencebetween respondents and nonrespondents was that the latter were more likelyto be working, suggestingthat their nonresponse may have been the result of time constraints.

72
Table I

ILANA ATTIE AND J. BROOKS-GUNN Palta, Prineas, Berman, & Hannan, 1982; Stunkard et al., 1986). The preferred measure of body fat, skinfold thickness, was not available in this study because of the reluctance of school administrators to permit this method of assessment at Time 1 and the use of questionnaire data at Time 2. Therefore, weights and heights were used to estimate body fat using the equation of Mellits and Cheek (1970). Although the Mellits and Cheek formula has been criticized in terms of its accuracy, it was used here as a relative, not absolute, measure of body fat (Johnston, Roche, Sehell, & Wettenhall, 1975; Trussel, 1980). Physicalmaturation. Pubertalstatus (i.e., one's level of physical development at a single point in time) was measured by menareheal status, Tanner breast stage, and Tanner pubic hair growth stage. Girls were classified as either premenarcheal or postmenarcheal at Time 1 on the basis of their response to questions asking if they had begun to menstruate. These reports tend to be quite accurate (Bean, Leeper; Wallace, Sherman, & Jagger, 1979; Brooks-Gunn et al., 1987). Although breast and pubic hair development are continuous processes, they have been classified into five stages by Tanner (Marshall & Tanner, 1969; Reynolds & Wines, 1948). Because assessment of Tanner stage by medical personnel was not possible because of the schools' reluctance, mothers were asked to rate their daughters' breast and pubic hair development at Time I using schematic drawings and written explanations of the Tanner ratings. In another study, 120 mothers and adolescent girls (10 to 14 years of age) rated the daughters' development, and these ratings were compared with those of a physician and nurse-practitioner. The correlations (before correcting for attenuation) between mother ratings and physical observation were .80 for breast growth, .79 for pubic hair growth, and .85 for combined breast and pubic hair rating (Brooks-Gunn et al., 1987). The size of these correlations is considered adequate for the purpose of reliability (Cronbaeh, 1984). The girls were classified as early, on-time, or later maturers using Tanner ratings at Time 1 according to the norms established by Duke, Jennings, Dornbusch, and Siegel-Gorelick (1982). Girls in the highest and lowest 20th percentiles for their age were classified as early and late, respectively, whereas those in the middle 60% were classified as on time (see Gargiulo, Attie, Brooks-Gunn, & Warren, 1987).

Sample Characteristics in Middle School (Time 1) and High School (Time 2)

Time I Characteristic Age Physical status Height (in.) Weight (lb.) Menarche (%) Problem eating EAT-26 Family Parent relationship (SIQYA) Family organization (FES) Family relationship (FES) Psychopathology Emotional tone (SIQYA) Psychopathology (S1QYA) Depression (CES-D) Aggression (YBP) Hyperactive-immature (YAP) Delinquency (YBP) Personality Body image (SIQYA) Perfectionism (EDI) Ineffectiveness (EDI) Time 2

M
13.93 63.71 118.53 "72 2.45 4.92 a --" 4.64 2.94 a a a --" 3.83 a a

SD
I. 12 2.84 21.18 .82 .77

M
16.09 64.34 128.32 95* 2.51 4.83 2.65 2.65 4.80 a 21.14 12.06 6.38 7.73 4.01 3.58 2.14

SD
1.02 2.87* 20.15* .69 .83 .52 .29 .80 7.33 5.95 3.53 4.30 .84* 1.13 .89

.81 .84

.83

Note. EAT-26= Eating Attitudes Test-26 (6-point scale; for Time 1, short
form used); SIQYA= Self Image Questionnaire for Adolescents (6-point scale); FES = Family Environment Scale (4-point scale) CES-D= Center for Epidemiological Studies-Depression Scale (4-point scale); Ynp = Youth Behavior Profile (3-point scale); EDI = Eating Disorders Inventory (6-point scale). "Not collected at that time point. * p < .05; difference between Times 1 and2.

Body Image and Perceptions of Pubertal Change

At Time 2, families were contacted by phone, and test materials were mailed to adolescents and their mothers, who were asked to complete and return them separately. Visits were made to the schools to weigh and measure the girls. Each adolescent received $10 for her participation. Two percent of the families could not be traced; 8% refused participation, and 15% did not return the questionnaires. Respondent and nonrespondent differences were tested with regard to Time 1 family characteristics, child age, grade, pubertal status, and psychological functioning (SIQYAscales; Petersen, Sehulenberg, Abramowitz, Offer, & Jarcho, 1984); no differences were found. The body image scale is one of the nine subscales of the Self-Image Questionnaire for Young Adolescents (SlQYA;Petersen et al., 1984). It taps affective and social comparative aspects of body image (e.g., "I am proud of my body") and the items are rated on a 6-point scale. The body image scale has good internal consistency (Brooks-Gunn, Rock, & Warren, 1989; Petersen et al., 1984). Girls were also asked about their perceptions of matumtional timing, that is, being earfier or later in their breast development and being heavier or lighter than their peers (using a 5-point scale; Gargiulo et al., 1987; Petersen & Crockett, 1985; Simmons & Blyth, 1987).

Measures
Measures were chosen to examine the contribution of physical maturational status indices, psychological factors, and family variables to the prediction of eating problems. The means and standard deviations for all scales used at Times 1 and 2 are presented in Table 1. Alpha coefficients for each of the scales described below were .68 or higher.

Personality Dimensions
Self-report measures of psychopathology and personality dimensions were included at both test sessions. At Time 1, three of the SIQYAScales were used: Psychopathology, Emotional Tone, and Impulse Control (Petersen et al., 1984). The Psychopathology scale is a general measure of adolescent psychopathology that taps a broad range of symptoms (e.g., "I am confused most of the time"; "I often feel that I would rather die than go on living"). The Emotional Tone scale asks about various affective states, such as being easily hurt and feeling anxious or lonely (e.g., "l frequently feel sad"). The Impulse Control scale assesses general self-control and affeetive stability (e.g., "I keep an even temper most of the time"). High scores denote high psychopathology, high emotional tone (positive affect), and greater impulse control. Alpha coefficients are

Physical Status Measures Growthparameters. Height and weight data were measured, and selfreport data were collected. At each test session, correlations between actual weights and self-reported weights were .97. The self-report data were used at Time 2 for group comparison purposes, following the research of others (Brooks-Gunn, Warren, Rosso, & Gargiulo, 1987;

ADOLESCENT GIRLS' EATING PROBLEMS high (greater than.70). These scales have similar psychometric properties for younger and older adolescents (Brooks-Gunn, Rock, & Warren, 1989). At Time 2, the Emotional Tone and Impulse Control scales were readministered along with the following measures, which were included to provide a more differentiated understanding of psychopathology and personality features possibly associated with eating problems: (a) Ineffectiveness, a subscale of the Eating Disorders Inventory (V.Dl;Garner et al., 1983), assesses feelings of inadequacy, insecurity, worthlessness, and of not being in control of one's life. (h) Perfectionism, another subscale of the EDI, measures excessive personal expectations for superior achievement (items from the EDI are rated on a 6-point scale; Garner et al., 1983). (c) Affective disturbance was assessed by the Center for Epidemiological Studies Depl~ssion Scale modified for children (CESD), a 20-item self-report measure (rated on a 4-point scale). This instrument has demonstrated adequate levels of internal consistency, reliability, concurrent validity, and construct validity for both adolescents and adults (Faulstich, Carey, Ruggiero, Enyart, & Gresham, 1986; Radloff, 1977; Weissman, Orvaschel, & Padian, 1980). (d) Impulse problems were assessed using three measures from the Youth Behavior Profile (Achenbach & Edelbrock, 1981, 1983) in addition to the Impulse Control scale described earlier. Specifically, the Aggression scale taps behaviors indicative of poor ability to modulate mood states as well as interpersonal problems with aggression; the Delinquency scale taps many behaviors typical of "acting out" or conduct-disordered adolescents; and the Immature-Hyperactive scale taps a range of behaviors reflecting difficulty with the self-regulation of behavior as well as social immaturity. (Items are rated on a 3-point scale.)

73

the family as a family unit (Petersen et al., 1984). In addition, in order to investigate the impact of family organization and functioning at the level of the family system, both mothers and daughters filled out six subscales of the Family Environment Scale (F~; Moos, 1974) at Time 2. The ~ measures 10 dimensions of the home environment related to interpersonal relationships among family members, as well as family structure. The Fzs has demonstrated some empirical support for its factor composition and its ability to discriminate among relevant groups, such as clinic and nonclinic families (Billings & Mons, 1982; Mons & Moos, 1976). Mothers and daughters completed the three Relationship scales (Cohesiveness, Expressiveness, and Conflict), the two Organization scales (Organization and Control), and the Independence scale. The true-false format was modified to a 4-point scale ("describes my family" not at all to very much). Results

Prediction 1: Predictors o f Problem Eating Behavior

Independent and significant proportions of variance in problem eating were expected to be accounted for by each of the following sets of variables: physical maturational status indices, psychologieal factors, and family influences. Independent variables were entered either as sets or as individual predictors. To control for "experiment-wise" error, conceptually similar variables were grouped into sets, and their contribution was assessed only if that set reached significance (Cohen & Cohen, 1983). Ordering of variables was based on the hypothesized relevance of various sets to the prediction o f eating problems, taking care to give priority to the more "organismic" characteristics (e.g., physical maturational status, grade) over "environmental" characteristics (e.g., family). For all regression analyses, the outcome of interest, problem eating, was defined by m e a n scores on the EAT-26. In addition, for each regression model, a cluster partitioning o f variance was performed in order to determine the a m o u n t of u n i q u e variance accounted for by a particular variable (or set), controlling for all other variables in the equation. Longitudinal analyses examined the prediction of change in eating behavior from Time 1 to Time 2. The nature o f such change may be understood by examining differences in both m e a n levels and variances o f eating behavior as well as their correlations across time. Although m e a n levels of EAT-26 increased over the 2 years o f study, they did n o t increase significantly (see Table l). Variability in EAT-26 scores was reduced significantly from initial to follow-up testing. The modest correlations between the Time 1 and Time 2 scores on the EAT-26 (r = .44, p < .01) suggested that interindividual change occurred over the 2 years of study; that is, that girls shifted in their relative rank order with respect to their self-reported eating problems. Hierarchical multiple regression models were constructed entering Time 1 EAT-26 first, which had the effect o f Items on the nine-item EAT scale by factor included the following: "I am on a diet much of the time" and "I am preoccupied with the desire to be thinner" (Diet); "I have the impulse to throw up after meals" and "I have gone on eating binges where I feel that I may not be able to stop eating" (Bulimia); and "I take longer than others to eat meals" and "I feel that others pressure me to eat" (Oral Control). In another paper using this 9-item scale (Brooks-Gunn, Rock, & Warren, 1989), the Bulimia factor was renamed Binging.

Eating Problems
The EAT-26is an abbreviated version of the 40-item Eating Attitudes Test (EAT;Garner & Garfinkel, 1979; Garner, Olmsted, Bohr, & Garfinkel, 1982). Three distinct factors have been identified through factor analytic studies. The first factor, labeled Diet, contains items indicative of a pathological avoidance of fattening foods and preoccupation with a thin body shape. Factor 2, labeled Bulimia and Food Preoccupation, reflects items related to thoughts about food as well as bulimic behaviors, including hinging and vomiting. The third factor, Oral Control, taps self-control of eating and perceived social pressure to gain weight. Each item is rated on a 6-point scale ("describes me" not at all to very wel/). The EAT-26has been validated with anorectic patients and has been used to identify eating disturbances in nonclinical adolescent and adult samples (Button & Whitehouse, 1981; Johnson-Sabine, Wood, Mann, & Wakeling, 1985; Thompson & Schwartz, 1982; Williams, Schaefer, Shisslak, Gronwaldt, & Comerci, 1986). At Time 1, adolescents completed a short version of the EAT-26that consists of nine items, three from each factor.' Partial validation for the use of the shorter form of the EAT-26is based on the fact that it is related to weight, maturational timing, and importance of thinness in adolescent girls (Brooks-Gunn & Warren, 1985); it demonstrates measure equivalence over the adolescent period (Brooks-Gunn et al., 1989); and the alpha coefficient is adequate (.76). Moreov~ on the basis of Time 2 data, the correlation between the shorter (nine-item) version and the full EAT-26is .94. Furthermore, the short form at Time 1 was correlated with the entire EAT-26,WhiCh was gi~n 2 years later (Time 2) to both adolescents and their mothers.

Maternal and Family Variables

At Time 2, mothers completed the EAT-26 Scale, the Body Image Scale (modified from SIQYA), and the CES-D, as ~ b e d earlier. At Time I and Time 2, the adolescents completed the Family Relationships Scale of the SIQYA,which taps the child's perceptions of each parent and of the parent-child relationship as opposed to the functioning of

74

ILANA ATTIE AND J. BROOKS-GUNN Table 4 Hierarchical Regressions OfEAT-26 Scores on Independent Variables: Time 2 Concurrent Analyses

Table 2 Hierarchical Regressions of EAT-26 Scores on Independent Variables: Longitudinal Analyses Step/independent variable 1 Time 1 EAT-26 2 Grade 3 Actual timing Body fat 4 Body image 5 Psychopathology 6 Family relationships
* p < . 0 5 . ** p < . 0 0 1 .

R .44 .44 .47 .48 .49 .50

A R2 .19 .00 .02 .02 .00 .01

FAR2(F)
32.55** 0.09 1.98 3.79* 0.25 0.33

/3
.436 .024 .154 .098 -.166 -.045 -.058

Step/independent variable 1 Grade 2 Perceived timing Actual timing Body fat 3 Body image 4 Perfectionism CES-D Ineffectiven~ 5 Delinquency Hyperactivity Aggression 6 Family relationships

R .11 .18 .42 .49 .52 .52

AR2 .01 .02 .15 .06 .03 .00

AR2 (F) 1.35 0.85 19.71"* 2.73* 1.39 0.04 .108 -.009 .100 .124 -.393 .039 .224 .192 -.037 -.209 - . 100 -.024

Note. EAT-26= Eating Attitudes Test-26 (Time 1, short form used).

equating subjects on this measure at Time 1. This analysis of covariance approach enabled us to predict change in EAT-26 (i.e., more or less disturbed eating over the 2-year period of study; Cohen & Cohen, 1983). The simple correlation between the initial EAT-26 score and a difference score, computed between Time 2 EAT-26 and initial EAT-26 scores was negative, indicating that change in eating behavior over time typically occurred among girls who initially scored low on the EAT-26scale. Following the covariate, Time 1 predictor variables were entered in the following order. (a) grade, to adjust for possible cohort differences, (b) physical maturation set (i.e., maturational timing and body fat), 2 (c) body image, (d) psychopathology, and (e) family relationships (the last two were hypothesized to have independent relations to problem eating and were entered separately). As shown in Table 2, initial EAT-26 status accounted for 19% of the variance in Time 2 EAT-26. Once initial eating scores were taken into account, only Time 1 body image significantly and negatively predicted gain in eating problems. Psychopathology, family relationships, and physical maturation did not contribute further to the prediction of EAT-26 scores over the 2 years of study. The relatively weak longitudinal relations between Time 1 predictor variables and Time 2 eating problems may have been related to the effect of prior EAT-26 on the prediction of present EAT-26. Perhaps the physical and psychological differences that relate to Time 2 EAT-26were already "captured" by the Time 1

Note. EAT-26= E a t i n g Attitudes Test-26. *p < .05. **p < .01.

Table 3 Hierarchical Regressions of F~ T-26 Scores on Independent Variables: Time I Concurrent Analyses Step/independent variable I Grade 2 Perceived timing Actual timing Body fat 3 Body ima~ 4 Psychopathology 5 Family relationships R .18 .37 .56 .63 .64 AR2 .04 .10 .18 .08 .01 AR2 (F) 4.70" 5.29** 36.38*** 17.01"** 2.97 fl .181 -.181 - . 125 .261 -.432 -.313 -.122

EAT-26 measure. To explore this possibility, several concurrent regressions were performed. Time 1 concurrent regression analyses were similar to those run longitudinally, with the variables entered as follows: (a) grade, (b) physical maturation set (i.e., perceived timing of pubertal development, actual timing, and body fat), (c) body image, (d) psychopathology and (e) family relationships. Results indicated that every set contributed independent and significant proportions of variance to the (concurrent) prediction o f EAT-26 scores (see Table 3). The significant grade effect reflects an increase in self-reported eating problems from Grade 7 to Grade 10. Adjusting for grade, the set o f physical maturational factors (specifically, high body fat) explained a significant proportion of variance (10%) in Time 1 ~T-26 scores, as did negative body image (18%) and psychopathology (8%). The next variable, family relationships (by adolescent self-report), approached significance (p < .10) when entered in the final step. In summary, concurrent analyses at Time 1 point to the power o f the proposed model in accounting for problem eating behavior at initial testing, when girls were in the pubertal period. Concurrent relationships at Time 2 were examined to see if similar factors were associated with problem eating behavior when the adolescents were older. Conceptually, the model used was the same as the two previous ones, although several measures of psychopathology were included at Time 2. The general psychopathology scale was replaced by two sets, psychopathology-internal (perfectionism, ineffectiveness, and depression) and psychopathology-external (delinquency, hyperactivity, and aggression). Independent variables were entered in the order shown in Table 4. The regression of Time 2 EAT-26 on the sets 2 In separate regressions, Tanner staging (breast and pubic hair growth combined) was entered in the Physical Maturation set. This variable did not enter the equation after Body Fat was taken into account. In comparisons of the three maturational timing groups, no mean differences in EAT scores were found at Time 1 or Time 2 (although the early maturers had somewhat higher EAT scores at Time I than the ontime and late maturers; p < .08).

Note. EAT-26= Eating Attitudes Test-26 (Time 1, short form used). *p < .05. **p < .01. ***p < .001.

ADOLESCENT GIRLS' EATING PROBLEMS of Time 2 predictors resulted in a significant effect for body image (accounting for 15% of the variance in overall eating problem scores) and for psychopathology-internal (accounted for by the significant positive association with depression and nearly significant positive association with ineffectiveness). The psychopathology-external set and the adolescents' ratings of the family relationships scale did not contribute further to the prediction of eating problems. Regressions that were run replacing the family relationships scale with adolescents' scores on the systems and relationships dimensions of the FES yielded similar, nonsignificant results. Predictors of eating problems change from middle to later adolescence. Whereas pubertal factors, in terms of maturational status, explained a significant proportion of unique variance in EAT-26scores at Time 1, this effect dropped out 2 years later. Psychological dimensions (i.e., body image and psychopathology) were associated with compulsive eating at both time periods, whereas family relationships were not. Table 5

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Unique VariancePartitioning ofAdolescent EA7"-26 Scores by Maternal Variables

Independent variable MateTnalEAT-26 Maternal body ima~
Maternal CF.S-D

AR2 .02 .00

.00

F 2.78 .00
.51

0 .148 .003
--.068

Family systems Family relationships

.09

5.55*

-.075 -.284

Note. EAT-26= E a t i n g Attitudes Test-26. CES-D = Center for EpidemiologicalStudies-Depressionscale. For the full model:R ffi.32; R" =. 10.
* p < .05.

Prediction 2: Compulsive Versus Noncompulsive Eaters

Three of the variables used previously in Time 2 concurrent regression analyses were selected for more intensive study on the basis of their theoretical relevance to the development of eating problems (Garfinkel & Garner, 1982). They were body image, ineffectiveness, and perfectionism. Two-group discriminant analyses were performed to establish which combination of these variables was maximally predictive of differences between "compulsive" and "noncompulsive" eaters. Compulsive eaters were defined according to a cutoffat the 85th percentile of scores on the EAT-26inventory (M = 3.34) at Time 2. Mean scores were 2.31 (SD = 0.50) for the girls scoring below the 85th percentile and 3.68 (SD = 0.38), above the 85th percentile. According to Garner et al.'s (1982) coding system for the EAT-26 (which weights the most extreme points on a 6-point scale), all subjects in the compulsive group scored above 20, the cutoff" used by Garner to distinguish disturbed from normal eaters. Scores on the Time 2 ineffectiveness, perfectionism, and body image scales were entered simultaneously (forced entry method) into a discriminant function analysis. Because the spssx discriminant program does not allow for pairwise deletion of missing values (Norusis, 1985), only the 173 girls with a complete set were included (150 in the noncompulsive group and 23 in the compulsive group). The three independent variables produced a function that was statistically significant, x2(3, N = 173) = 25.55, p < .001, with a .72 probability of correct classification. Noncompulsive eaters exhibited a more positive body image (the structure loading was .94) and lower self-reported ineffectiveness (-.83) than compulsive eaters; the groups did not differ in terms of their perfectionist strivings. An examination of group centroids revealed that the high compulsive eaters could be distinguished from low compulsive eaters on the basis of their negative body image and feelings of ineffectiven&o$.

Prediction 3: Maternal Predictors of Daughters' Eating

It was hypothesized that compulsive eaters would manifest a greater degree of reported family role dysfunction and maternal

concerns with weight and bodily issues than would noncompulsive eaters. Mothers' self-reports were used to predict their daughters' eating behavior in two sets of analyses: (a) regression analyses using mothers' eating attitudes, depression scores, and perceptions of the family to predict (concurrently) dimensions of daughters' eating behavior at Time 2, and Co) discriminant function analyses to determine which of a number of family environmental factors best discriminate compulsive from noncompulsive eaters. Daughters' Time 2 EAT-26 scores were regressed hierarchically on the following variables: (a) matern~ EAT-26, (b) maternal body image, (c) maternal depression (CESD), and (d) maternal family set (i.e., mothers' ratings of family relationships and family systems on the FES). Because no causal model was hypothesized with respect to the maternal predictors, regression analyses were designed to partition unique variance proportions. In these regressions, the five variables were entered simultaneously, and then the full model was reduced by each variable (or set) in turn. At each step, the variance uniquely attributable to that variable was calculated as the diffference in R 2 between the full model and the reduced model. Only the maternal family set accounted for a significant proportion of variance (9%) once all of the other factors were controlled (see Table 5). Mothers' EAT-26 scores approached significance (p < . 10) as a predictor of danghters' EAT-26scores. Given the significant association of family dimensions with eating patterns, discriminant analyses were conducted to determine which components of family relationships (cohesion, expression, and conflict) and systems (organization and control) best distinguished high from low compulsive eaters (defined, as they were previously, by a cutoff at the 85th percentile). Complete data were available for 128 mothers: 111 were in the noncompulsive group and 17 were in the compulsive group. Mothers' ratings of the three FES relationship dimensions and the two systems dimensions were submitted to a discriminant function analysis. The resulting function reached significance, x2(5, N = 128) = 11.41, p < .05, with a .72 probability of correct classification. Three variables had discriminant loadings above .30; in descending order of magnitude, they were cohesion (. 71), organization (.66), and expression (.59). Neither conflict nor control contributed substantially further to group discrimination. An examination of group centroids revealed that high compulsive eaters may be distinguished from low compulsive eaters on the basis of their lower levels of family cohesion, organization, and expressiveness, as reported by their mothers.

76 Discussion

ILANA ATrlE AND J. BROOKS-GUNN velopmental changes in the manifestations of both as well as of their increased prevalence in gifts during early to middle adolescence. The gender-related differences in expressions of adolescent psychopathology in the form of depression and eating disorders and the emergence and possible coexistence of these disturbances following the pubertal transition are important areas for future research (Attie & Brooks-Gunn, in press). Ineffectiveness and perfectionism, the other internalizing measures, did not contribute to the prediction of EAT-26 scores at Time 2. This is a surprising finding, given that impairments in autonomous functioning and perfectionist strivings are considered to be major ego deficits that predispose the adolescent to develop clinical eating disorders (Bruch, 1973; Garner et al., 1983). In the present study, ineffectiveness was moderately correlated with depression (r = .50, p < .01) and may not have accounted for additional variance once depression entered the regression equation. Results of discriminant analyses support this interpretation. Ineffectiveness loaded quite highly on a function that successfuUy discriminated high from low compulsive eaters (Garner et al., 1983). Longitudinal analyses focused on the prediction of change in eating behavior, showing that only body image predicted longterm change, that is, a change in a gifts relative standing with respect to her peers. Those girls who early in adolescence or perhaps preadolescence felt most negatively about their bodies were significantly more likely to develop eating problems beyond what would be expected on the basis of their earlier EAT-26 scores; this effect held once variability in physical maturation, psychopathology, and family relationships was taken into account. Given this finding, it may be important to examine the meaning of body image and the mechanisms by which it may mediate changes in eating behavior among young adolescent girls. The absence of longitudinal effects for physical maturation, psychopathology, and family factors on EAT-26 scores implies that the factors associated with eating problems in later adolescence are relatively independent of those that initiate them. Perhaps at puberty, a pattern of eating behavior is set in motion, with the subsequent trajectory being defined, in part, by pubertal transformations in body image. High levels of body dissatisfaction during the pubertal l~riod may predispose the adolescent to develop eating problems during middle and later adolescence. Repeated and often unsuccessful dieting efforts and associated fluctuations in weight may disrupt what otherwise would be a relatively cohesive and continuous experience of the postpubertal body. This instability may create an ongoing vulnerability to body image disturbance that would reinforce an affect-behavior sequence manifested in recurrent efforts to control weight. Daughters' perceptions of family relationships were not associated with self-reported eating problems, once other variables in the model were taken into account. Maternal ratings of the family milieu, however, predicted eating problems: Girls who report high levels of eating problems live in families marked by relatively less cohesion, organization, and expressiveness, according to reports by their mothers and similar to clinical findings (Goldstein, 198 I; Johnson & Maddi, 1986). The discrepancy between findings using mother and daughter ratings of the FES suggests differences in their perceptions of the family's func-

This study may be the first to examine prospectively the emergence of eating problems in normal adolescents. Taking a developmental approach, the impact of the pubertal transition was examined relative to other aspects of the female adolescent experience. The findings suggest that eating problems emerge in response to physical changes of the pubertal period. Although psychosocial influences also play a role, it is not until middle to late adolescence that personality variables explain more of the variance in compulsive eating than do physical factors. The concurrent and longitudinal findings suggest that body shape becomes a primary focus and that efforts to control weight intensify during the middle-school years. These are precisely the years during which most adolescent girls are completing their pubertal development. When variability that is due to grade in school (as well as other model variables) was controlled for, physical maturation factors explained the largest proportion of variance in initial problem eating. Body fat, an index of maturational status, was positively associated with eating problems, whereas perceived and actual maturational timing were not. It is significant that this association emerged in a sample of norreal weight, not obese, girls. Thus, the rapid accumulation of body fat that is part of the female experience of puberty may function as a triggering event, insofar as it elicits the first of perhaps many attempted weight-loss diets. Closely tied to physical maturation changes is the subjective experience of body image. Girls who felt most negatively about their bodies had higher EAT-26 scores, controlling for both indices of developmental timing (i.e., physical maturational status and grade in school). What about psychopathology and family relationships, the two dimensions most frequently associated with eating disturbances in clinical samples? Whereas family relationships, viewed from the adolescent's perspective, made a marginal contribution to the concurrent prediction of EAT-26scores at Time l, psychopathology explained a significant proportion of unique variance in problem eating behavior. At the 2-year follow-up, the more developmental influences (i.e., grade in school and physical maturational status) no longer accounted for compulsive eating patterns. The persistence of such patterns may be explained by other factors. One strong influence was body image, which continued to predict eating behavior in an inverse fashion. Of all the other variables in the model, psychopathology accounted for the greatest share of variance in EAT-26scores at Time 2. Eating behavior was associated with tendencies toward affective and behavioral overcontrol (specifically depressive syrnptomatology) as opposed to undercontrol (specifically delinquency and aggression). Whether the association of depressive symptoms with problem eating was also present at Time 1 is not known, because the global measure of psychopathology used at initial testing did not tap distinct symptom clusters or personality styles. It may be noted, however, that when a measure of depressed mood and anxiety (i.e., the Emotional Tone scale) was included as part of a psychopathology set at Time 1, it failed to add significantly to the prediction of eating problems, suggesting, albeit speculatively, that disturbed eating and depressive symptoms may not be associated in early adolescence~ The association between depressive affect and eating problems at Time 2 may be a reflection of de-

ADOLESCENT GIRLS' EATING PROBLEMS tioning or in their willingness to report them. Not only is denial a salient feature of adolescents with eating disorders (Fairbum, 1984), so is the tendency for family members to avoid conflict (Minuchin et al., 1978). Limitations of this study include the following. First, as with the vast majority of studies in this area, this investigation focused on a sample of White gifts from upper-middle-class families. Although epidemiological studies suggest that these individuals are at greatest risk for the development of eating problems, the present findings cannot be generalized to lowerclass White or to minority adolescents. Second, the inclusion of younger girls would have enabled a more precise delineation of pubertal effects, especially with regard to the impact of the early pubertal changes. Third, the findings only refer to problem eating and may not be relevant for groups with frank eating disorders. Despite these limitations, the findings suggest several conclusions and possible directions. Problem eating seems to develop during early to middle adolescence, and these early patterns influence later eating behavior. Body image, or more likely the pubertal transformation in body image, is a significant predictor of compulsive eating problems during the adolescent years. As Crisp (1984) noted, puberty itself is a risk factor for eating problems in females. While providing empirical support for Crisp's theoretical perspective, this study also highlights other factors that place the adolescent at risk for the development of eating problems, including poor body image, an impaired sense of effectiveness, and tendencies toward atfective constriction or overcontrol. Vulnerable girls tend to come from relatively less cohesive and supportive families according to reports by their mothers. Whether young women with eating problems are at increased risk for the development of an eating disorder cannot he determined without further longitudinal follow-up. Nevertheless, in a number of ways, the data from this study lend support to a continuum of weight-related concerns. In the spirit of speculation, the continuum may be thought of in developmental terms, beginning on one end with dieting as a response to the physical and psychological changes of puberty, to the persistent patterns of compulsive eating associated with personality eharaeteristics that reflect the failure to resolve salient developmental tasks (i.e., modulation and expression of mood and impulse, integration of a changing body image, and enhanced autonomy), to the more serious eating pathology and psychosoeial impairment seen in adolescent patients with eating disorders. Perhaps most important, these data suggest that in order to understand the etiology of eating problems, it is necessary to follow a younger sample of preadolescent and adolescent girls through the period of greatest risk--middle through late adolescence. References Aehenbach, T. M., & Edelbroek, C. S. ( 1981). YouthSelf-Reportfor Ages 11-18. Unpublished manuscript. Burlington: University of Vermont, Department of Psychiatry. Aehenbaeh, T. M., & Edelbroek, C. S. (1983). Manual for the Child Behavior Checklist and Revised Child Behavior Profile. Burlington, V'I2.Queen City Printers. Attie, I., & Brooks-Gunn, J. (1987). Weight-related concexnsin women: A response to or a cause of stress? In R. C. Barnett, L. Biener; &

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Weissman, M. M., Orvaschel, H., & Padian, N. (1980). Children's symptom and social functioning serf-report scales: Comparison of mothers' and children's reports. Journal of Nervous and Mental Disease, 168, 736-740. Williams, R. L., Schaefer, C. A., Shisslak, C. M., Gronwaldt, V. H., & Comerci, G. D. (1986). Eating attitudes and behaviors in adolescent women: Discrimination of normals, dieters, and suspected bulimics using the Eating Attitudes Test and Eating Disorder Inventory. International Journal of Eating Disorders, 5(5), 879-894. Wooley,S. C., & Wooley,O. W. (1985). Intensive outpatient and residential treatment for bulimia. In D. M. Garner & P. E. Garfinkel (Eds.), Handbook of psychotherapyfor anorexia nervosa and bulimia (pp. 391-430). New York:Guilford Press. Young C. M., Sipin, S. S., & Roe, D. A. (1968). Density and skinfold measurements: Body composition of pre-adolescent girls. Journal of American Dietetic Association, 53, 25-31.

Received December 29, 1987 Revision received July 13, 1988 Accepted July 19, 1988

Calls for Nominations for JCCP, Educational

JPSP: Attitudes, and JPSP: Interpersonal

The Publications and Communications Board has opened nominations for the editorships of the Journal o f Consulting and Clinical Psychology, the Journal o f Educational Psychology, and the Attitudes and Social Cognition section and the Interpersonal Relations and Group Processes section of the Journal o f Personality and Social Psychology for the years 1991-1996. Alan Kazdin, Robert Calfee, Steven Sherman, and Harry Reis, respectively, are the incumbent editors. Candidates must be members of APA and should be available to start receiving manuscripts in early 1990 to prepare for issues published in 1991. Please note that the P&C Board encourages more participation by members of underrepresented groups in the publication process and would particularly welcome such nominees. To nominate candidates, prepare a statement of one page or less in support of each candidate. For Consulting and Clinical, submit nominations to Martha Storandt, Department of Psychology, Washington University, St. Louis, Missouri 63130. Other members of the search committee are Bernadette Gray-Little, Frederick Kanfer, and Hans Strupp. For Educational, submit nominations to Richard Mayer, Department of Psychology, University of California, Santa Barbara, California 93106. ~ e r members of the search committee are Robert Glaser, Jill Larkin, Sigmund Tobias, and Noreen Webb. For JPSP: Attitudes, submit nominations to Don Fogs, Department of Psychology, University of Texas, Austin, Texas 78712. Other members of the search committee are Marilyn Brewer, David Hamilton, Melvin Manis, and Richard Petty. For JPSP: Interpersonal, submit nominations to Frances Degen Horowitz, Department of Human Development and Family Life, University of Kansas, Lawrence, Kansas 66045. Other members of the search committee are Kay K. Deaux, Phoebe C. Ellsworth, and Roberr M. Krauss. First review of nominations will begin February 15, 1989.