Abstract

Although various factors associated with eating disorders have been studied, no comprehensive source of research findings was identified in this review. The purpose of this study was to identify and synthesize research findings of factors associated with eating disorders in women published from 1992-2008. These findings may be useful to nurses, other professionals, families, and the public to facilitate the prevention, recognition, treatment, and rehabilitation of women with eating disorders.

The factors most closely associated with eating disorders identified through this review were depression, sexual abuse, substance abuse, anxiety disorders, early pubertal onset and the personality traits of perfectionism and impulsivity. No factor was identified as causal, but sexual abuse and anxiety disorders most commonly preceded the eating disorder. Findings varied among eating disorder subtypes, with sexual abuse and substance abuse more common with bulimic symptomology, while depression and anxiety disorders were commonly associated with both anorexia and bulimia nervosa. Perfectionism was most common in anorexics; in one study, it was identified independent of stress and persisted after recovery.

Limitations noted in the research reviewed included using self-report questionnaires, some small samples, exclusion of some eating disorder subtypes, and a predominant use of cross-sectional and clinical samples. Recommendations for further research included using large epidemiological samples containing multiple subtypes and males, as well as longitudinal studies and methods to determine causal relationships among eating disorders and the associated factors identified. Implications for nursing education, practice, and policy development focused on improving screening during physical examinations and interviews, posing questions to facilitate disclosure, addressing emotions elicited, and suggestions for routine monitoring of patients in clinical settings.

Eating disorders are described as habits that are harmful to an individual and may result in death (The Alliance for Eating Disorder Awareness, 2005), escalating to extremes when a person experiences severe disturbances in eating behavior [National Institute of Mental Health (NIMH), 2008]. These extremes can include severely restricted intake or overeating, with anorexia and bulimia nervosa being the most commonly addressed eating disorders. Characteristics of anorexia nervosa include a relentless pursuit of thinness, an unwillingness to maintain a normal or healthy weight with intense fear of gaining weight, body image distortion and amenorrhea. Bulimia nervosa is characterized by a lack of control over eating with recurrent episodes of binge eating followed by compensatory behavior such as vomiting, use of laxatives or diuretics, fasting, or excessive exercise. A third classification known as “eating disorder not otherwise specified,” includes behaviors similar to anorexia and bulimia, with some variation. Although significant research has been conducted regarding eating disorders, the exact cause--biological, behavioral, or social--remains to be determined. However, these disorders frequently coexist with other psychiatric disorders (NIMH).

Eating disorders affect several million people between the ages of 12 and 35, most commonly women (American Psychiatric Association, 2005). The Renfrew Center Foundation for Eating Disorders (RCFED) estimated that one in five women experience disordered eating (2002). Anorexia nervosa alone has a mortality rate 12 times higher than that of all other causes of death combined for females age 15-24. Women with eating disorders may also experience long-term effects if left untreated. These include sterility, cardiac disorders, osteoporosis, seizures, and anemia (RCFED), as well as heart and kidney problems, which can lead to death (NIMH, 2008).

With increasing prevalence, eating disorders have gained national attention. One of the Healthy People 2010 objectives formulated by the United States Department of Health and Human Services (2005) is to reduce the proportion of adolescents who engage in disordered eating behaviors to control their weight.

Problem

Studies have been conducted in which various factors that may be associated with eating disorders were examined. Associated factors examined included depression, anxiety, sexual abuse, substance abuse, perfectionism and early pubertal onset. However, each study identified a limited number of factors, with no comprehensive integration of the findings identified in any of the research reviewed for this study.

Purpose

The purpose of this integrated research review (IRR) was to identify and synthesize factors associated with eating disorders based on findings from current research. This information may be useful to persons across a variety of settings and disciplines to help prevent eating disorders, identify them early, and implement effective treatment and rehabilitation. Indications for research, professional education, and practice are addressed.

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