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Influence of Stress in the Onset of Eating Disorders: Data From a Two-Stage Epidemiologic Controlled Study

From the Eating Disorders Unit, Department of Psychiatry, "La Fe" University Hospital, School of Medicine, University of Valencia, Spain (L.R., L.L.); Psychiatric Service, Hospital of Sagunto, Spain (L.C.); Vanderbilt University School of Medicine, Nashville, Tennessee (O.B.).

Address correspondence and reprint requests to Luis Rojo, MD, UTCA, Planta 11, Hospital Maternal, H.U. La Fe, Avda de Campanar 21, 46009, Valencia, Spain. E-mail: luis.rojo{at}uv.es

Background: We explore the role of stress in the onset of eating disorders (EDs) in a community sample of adolescents, the mediating role of psychiatric comorbidity and the quantitative evolution of stress in the year preceding the onset of an ED.

Methods: The Life Events and Difficulties Schedule interview was applied to a sample with 32 cases and 32 controls selected from a two-phase epidemiologic study among a representative population of adolescents, followed by a decay model to assess acute and chronic stress in the year preceding the onset of ED. Psychiatric comorbidity was assessed using the SCAN interview.

Results: Cases (46.9%) and 9.4% of controls were found to have associated psychiatric comorbidity (² = 11.74, p = .001). Of cases, 6.3% and none of the controls had at least one severe stressful event (N.S). Of cases, 18.8% and 3.1% of controls had at least one major difficulty (Fisher exact test = 0.05). Of cases, 25% and 3.1% of controls had a provoking stressful agent (Fisher exact test = 0.026). Psychiatric comorbidity partially mediated the relationship between stress and EDs. The Structural Equation Modeling Analysis shows that chronic stress is strongly associated with the onset of EDs, both directly (r² = 0.38) and indirectly, through psychiatric comorbidity (r² = 0.56).

Conclusion: Chronic stress and psychiatric comorbidity are strongly associated with the onset of EDs. Psychiatric comorbidity is a partial mediating factor in the association of stress with eating disorders.

Key Words: eating disorders • anorexia nervosa • stress • life events • chronic stress • comorbidity

Abbreviations: ED = eating disorders; AN = anorexia nervosa; LEDS = Life Events and Difficulties Schedule; BN = bulimia nervosa; BED = binge eating disorder; SCAN = Schedules for Clinical Assessment in Neuropsychiatry; EAT = Eating Attitudes Test; SEM = structural equation modeling; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders; SPSS = Statistical Package for Social Science; AMOS = Analysis of Moment Structures.

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