Korean Clinical Psychology Association

Korean Journal of Clinical Psychology - Vol. 40 , No. 3

[ Original Article ]
Korean Journal of Clinical Psychology - Vol. 40, No. 3, pp.245-257
Abbreviation: KJCP
ISSN: 1229-0335 (Print) 2733-4538 (Online)
Print publication date 30 Aug 2021
Received 28 Apr 2021 Revised 21 Jun 2021 Accepted 06 Jul 2021
DOI: https://doi.org/10.15842/kjcp.2021.40.3.006

신경성 폭식증 고위험 여자대학생의 신경성 폭식증 증상과 우울 증상 간 종단적 상호관계: 자기회귀교차지연 모형을 중심으로
문하솜 ; 이수진 ; 장혜인
성균관대학교 심리학과

Longitudinal Reciprocal Association between Depressive and Bulimic Symptoms among Female College Students with Subclinical Levels of Bulimia Nervosa: A Cross-Lagged Model
Hasom Moon ; Sujin Lee ; Hyein Chang
Department of Psychology, Sungkyunkwan University, Seoul, Korea
Correspondence to : Hyein Chang, Department of Psychology, Sungkyunkwan University, 25-2 Sungkyunkwan-ro, Jongno-gu, Seoul, Korea; E-mail: hichang@skku.edu
This work had been presented at the 9th World Congress of Behavioural & Cognitive Therapies in 2019.


© 2021 Korean Clinical Psychology Association
Funding Information ▼

초록

신경성 폭식증 증상과 우울 증상은 청소년기와 초기성인기에 공병할 위험이 높은 것으로 알려져 있으나, 두 증상의 양방향적 관련성을 조사하려는 시도는 부족하였다. 이에 본 연구에서는 고위험 여자대학생들을 대상으로 신경성 폭식증 증상과 우울 증상이 시간에 따라 서로 예측하는 과정을 종단자료 분석을 통해 검증하고자 하였다. 이때 신경성 폭식증과 우울장애의 중요한 위험요인으로 여겨지는 부정정서와 정서조절곤란을 통제함으로써, 두 증상 간 양방향적 관계를 더 엄격히 분석하였다. 이를 위해 이미 일정 수준 이상의 섭식문제를 경험하고 있는 신경성 폭식증 고위험 여자대학생 117명을 표집 하여 자기보고식 설문지를 이용해 신경성 폭식증 증상과 우울 증상, 부정정서, 정서조절곤란을 6개월 간격으로 총 3회 측정하였다. 자기회귀교차지연 모형 분석 결과, 이전 시점의 우울 증상이 6개월 후 시점의 신경성 폭식증 증상을 유의하게 예측하였으며, 이는 부정정서와 정서조절곤란의 효과를 통제한 후에도 유의하였다. 반면, 이전 시점의 신경성 폭식증 증상은 이후 시점의 우울 증상을 예측하지 못하였다. 본 연구의 결과를 바탕으로 연구의 이론적, 임상적 함의와 한계점을 논하였다.

Abstract

Although bulimic and depressive symptoms are highly comorbid, their reciprocal association remains unclear. The goal of this study was therefore to examine the longitudinal reciprocal relationship between bulimic and depressive symptoms among female college students experiencing subclinical levels of bulimia nervosa. We also incorporated negative affect and emotion dysregulation as common risk factors for both bulimic and depressive symptoms. Participants were 117 female college students who reported relatively high levels of bulimic symptoms during the initial screening. They completed a series of self-report inventories assessing bulimic and depressive symptoms, negative affect, and emotion dysregulation at baseline (T1) and at six-month (T2) and one-year (T3) follow-ups. The results of an autoregressive cross-lagged model indicated that depressive symptoms at T1 and T2 significantly predicted bulimic symptoms at T2 and T3, respectively, controlling for the temporal stability of each symptom, as well as the effects of negative affect and emotion dysregulation. Conversely, bulimic symptoms did not predict future depressive symptoms across time. These findings suggest that depressive symptoms may be a potential target for the early identification and prevention of bulimic symptoms among high-risk females.


Keywords: bulimic symptom, depressive symptom, negative affect, emotion dysregulation
키워드: 신경성 폭식증, 우울장애, 부정정서, 정서조절곤란

Acknowledgments

This work was supported by the Ministry of Education of the Republic of Korea and the National Research Foundation of Korea (NRF-2017S1A5A2A01024881).

Author contributions statement

HM, a graduate student at Sungkyunkwan University, conducted literature review, analyzed data, and led manuscript preparation. SL, a graduate student at Sungkyunkwan University who is now a graduate student at University of Michigan, Ann Arbor, MI, USA, was responsible for data collection and analysis. HC, an associate professor at Sungkyunkwan University, served as the principal investigator of the research grant and supervised the research process. All authors provided critical feedback, participated in revision of the manuscript, and approved the final submission.


References
1. Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30, 217-237.
2. Allen, K. L., Crosby, R. D., Oddy, W. H., & Byrne, S. M. (2013). Eating disorder symptom trajectories in adolescence: Effects of time, participant sex, and early adolescent depressive symptoms. Journal of Eating Disorders, 1, 1-14.
3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, DC: American Psychiatric Publishing.
4. Bearman, S. K., & Stice, E. (2008). Testing a gender additive model: The role of body image in adolescent depression. Journal of Abnormal Child Psychology, 36, 1251-1263.
5. Bäck, M., Falkenström, F., Gustafsson, S. A., Andersson, G., & Holmqvist, R. (2020). Reduction in depressive symptoms predicts improvement in eating disorder symptoms in interpersonal psychotherapy: Results from a naturalistic study. Journal of Eating Disorders, 8, 1-10.
6. Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck Depression Inventory Manual. San Antonio, TX: The Psychological Corporation.
7. Berg, K. C., Frazier, P., & Sherr, L. (2009). Change in eating disorder attitudes and behavior in college women: Prevalence and predictors. Eating Behaviors, 10, 137-142.
8. Blaney, P. H. (1986). Affect and memory: A review. Psychological Bulletin, 99, 229-246.
9. Boujut, E., & Gana, K. (2014). Relationship between depressive mood and eating disorders in a non-clinical young female sample: A one-year longitudinal analysis of cross-lagged and simultaneous effects. Eating Behaviors, 15, 434-440.
10. Cho, Y. R. (2007). Assessing emotion dysregulation: Psychometric properties of the Korean version of the Difficulties in Emotion Regulation Scale. Korean Journal of Clinical Psychology, 26, 1015-1038.
11. Cooper, Z., & Fairburn, C. G. (2011). The evolution of “enhanced” cognitive behavior therapy for eating disorders: Learning from treatment nonresponse. Cognitive and Behavioral Practice, 18, 394-402.
12. Davis, H. A., Ortiz, A. M. L., & Smith, G. T. (2019). Transactions between early binge eating and personality predict transdiagnostic risk. European Eating Disorders Review, 27, 614-627.
13. Davis, H. A., & Smith, G. T. (2018). An integrative model of risk for high school disordered eating. Journal of Abnormal Psychology, 127, 559-570.
14. Dobmeyer, A. C., & Stein, D. M. (2003). A prospective analysis of eating disorder risk factors: Drive for thinness, depressed mood, maladaptive cognitions, and ineffectiveness. Eating Behaviors, 4, 135-147.
15. Duncan, A. E., Ziobrowski, H. N., & Nicol, G. (2017). The prevalence of past 12‐month and lifetime DSM‐IV eating disorders by BMI category in US men and women. European Eating Disorders Review, 25, 165-171.
16. Enders, C. K., & Bandalos, D. L. (2001). The relative performance of full information maximum likelihood estimation for missing data in structural equation models. Structural Equation Modeling, 8, 430-457.
17. Fairburn, C. G., Marcus, M. D., & Wilson, G. T. (1993). Cognitive behavioral therapy for binge eating and bulimia nervosa: A comprehensive treatment manual. In C. Fairburn, & G. Wilson (Eds.). Binge eating: Nature, Assessment and Treatment (pp. 361-404). New York, NY: Guilford Press.
18. Fernandez-Aranda, F., Poyastro Pinheiro, A., Tozzi, F., La Via, M., Thornton, L. M., Plotnicov, K. H., . . . Bulik, C. M. (2007). Symptom profile of major depressive disorder in women with eating disorders. Australian & New Zealand Journal of Psychiatry, 41, 24-31.
19. Ferreiro, F., Seoane, G., & Senra, C. (2011). A prospective study of risk factors for the development of depression and disordered eating in adolescents. Journal of Clinical Child & Adolescent Psychology, 40, 500-505.
20. Ferreiro, F., Wichstrøm, L., Seoane, G., & Senra, C. (2014). Reciprocal associations between depressive symptoms and disordered eating among adolescent girls and boys: A multiwave, prospective study. Journal of Abnormal Child Psychology, 42, 803-812.
21. Ferriter, C., Eberhart, N. K., & Hammen, C. L. (2010). Depressive symptoms and social functioning in peer relationships as predictors of eating pathology in the transition to adulthood. Journal of Social and Clinical Psychology, 29, 202-227.
22. Friedman, M. A., Wilfley, D. E., Pike, K. M., Striegel‐Moore, R. H., & Rodin, J. (1995). The relationship between weight and psychological functioning among adolescent girls. Obesity Research, 3, 57-62.
23. Gilbert, N., & Meyer, C. (2005). Fear of negative evaluation and the development of eating psychopathology: A longitudinal study among nonclinical women. International Journal of Eating Disorders, 37, 307-312.
24. Godart, N., Radon, L., Curt, F., Duclos, J., Perdereau, F., Lang, F., . . . & Flament, M. F. (2015). Mood disorders in eating disorder patients: prevalence and chronology of ONSET. Journal of Affective Disorders, 185, 115-122.
25. Goldschmidt, A. B., Wall, M., Loth, K. A., Le Grange, D., & Neumark-Sztainer, D. (2012). Which dieters are at risk for the onset of binge eating? A prospective study of adolescents and young adults. Journal of Adolescent Health, 51, 86-92.
26. Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26, 41-54.
27. Heatherton, T. F., & Baumeister, R. F. (1991). Binge eating as escape from self-awareness. Psychological Bulletin, 110, 86-108.
28. Herpertz-Dahlmann, B., Dempfle, A., Konrad, K., Klasen, F., & Ravens-Sieberer, U. (2015). Eating disorder symptoms do not just disappear: the implications of adolescent eating-disordered behaviour for body weight and mental health in young adulthood. European Child & Adolescent Psychiatry, 24, 675-684.
29. Hudson, J. I., Hiripi, E., Pope Jr, H. G., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61, 348-358.
30. Iqbal, N., & Dar, K. A. (2015). Negative affectivity, depression, and anxiety: Does rumination mediate the links? Journal of Affective Disorders, 181, 18-23.
31. Jeon, J. R. (2011). Relation between negative urgency and binge eating (Unpublished master’s thesis). Seoul National University, Seoul, Korea.
32. Johnson, J. G., Cohen, P., Kasen, S., & Brook, J. S. (2002). Eating disorders during adolescence and the risk for physical and mental disorders during early adulthood. Archives of General Psychiatry, 59, 545-552.
33. Keel, P. K., Fulkerson, J. A., & Leon, G. R. (1997). Disordered eating precursors in pre-and early adolescent girls and boys. Journal of Youth and Adolescence, 26, 203-216.
34. Keel, P. K., Mitchell, J. E., Miller, K. B., Davis, T. L., & Crow, S. J. (2000). Social adjustment over 10 years following diagnosis with bulimia nervosa. International Journal of Eating Disorders, 27, 21-28.
35. Keshishian, A. C., Tabri, N., Becker, K. R., Franko, D. L., Herzog, D. B., Thomas, J. J., & Eddy, K. T. (2019). Eating disorder recovery is associated with absence of major depressive disorder and substance use disorders at 22-year longitudinal follow-up. Comprehensive Psychiatry, 90, 49-51.
36. Lawler, M., & Nixon, E. (2011). Body dissatisfaction among adolescent boys and girls: the effects of body mass, peer appearance culture and internalization of appearance ideals. Journal of Youth and Adolescence, 40, 59-71.
37. Lee, H. H., Kim, E. J., & Lee, M. K. (2003). A validation study of Korea Positive and Negative Affect Schedule: The PANAS scales. Korean Journal of Clinical Psychology, 22, 935-946.
38. Lee, S. J., & Chang, H. I. (2017). The influence of maladaptive perfectionism, negative affect, and negative urgency on bulimic symptoms among female college students. Korean Journal of Clinical Psychology, 36, 192-205.
39. Lenz, A. S., Taylor, R., Fleming, M., & Serman, N. (2014). Effectiveness of dialectical behavior therapy for treating eating disorders. Journal of Counseling & Development, 92, 26-35.
40. Levinson, C. A., Zerwas, S., Calebs, B., Forbush, K., Kordy, H., Watson, H., . . . Bulik, C. M. (2017). The core symptoms of bulimia nervosa, anxiety, and depression: A network analysis. Journal of Abnormal Psychology, 126, 340-354.
41. Lim, S. Y., Lee, E. J., Jeong, S. W., Kim, H. C., Jeong, C. H., Jeon, T. Y., … Kim, J. B. (2011). The validation study of Beck Depression Scale 2 in Korean version. Anxiety and Mood, 7, 48-53.
42. Markey, M. A., & Vander Wal, J. S. (2007). The role of emotional intelligence and negative affect in bulimic symptomatology. Comprehensive Psychiatry, 48, 458-464.
43. Marmorstein, N. R., Von Ranson, K. M., Iacono, W. G., & Malone, S. M. (2008). Prospective associations between depressive symptoms and eating disorder symptoms among adolescent girls. International Journal of Eating Disorders, 41, 118-123.
44. McCarthy, M. (1990). The thin ideal, depression and eating disorders in women. Behaviour Research and Therapy, 28, 205-215.
45. McClelland, J., Robinson, L., Potterton, R., Mountford, V., & Schmidt, U. (2020). Symptom trajectories into eating disorders: A systematic review of longitudinal, nonclinical studies in children/adolescents. European Psychiatry, 63, 1-11.
46. McDonald, R. P., & Ho, M. H. R. (2002). Principles and practice in reporting structural equation analyses. Psychological Methods, 7, 64-82.
47. Measelle, J. R., Stice, E., & Hogansen, J. M. (2006). Developmental trajectories of co-occurring depressive, eating, antisocial, and substance abuse problems in female adolescents. Journal of Abnormal Psychology, 115, 524-538.
48. Micali, N., Solmi, F., Horton, N. J., Crosby, R. D., Eddy, K. T., Calzo, J. P., . . . Field, A. E. (2015). Adolescent eating disorders predict psychiatric, high-risk behaviors and weight outcomes in young adulthood. Journal of the American Academy of Child & Adolescent Psychiatry, 54, 652-659.
49. Munn‐Chernoff, M. A., Grant, J. D., Agrawal, A., Koren, R., Glowinski, A. L., Bucholz, K. K., . . . Duncan, A. E. (2015). Are there common familial influences for major depressive disorder and an overeating–binge eating dimension in both European American and African American Female twins? International Journal of Eating Disorders, 48, 375-382.
50. Murphy, R., Straebler, S., Basden, S., Cooper, Z., & Fairburn, C. G. (2012). Interpersonal psychotherapy for eating disorders. Clinical Psychology & Psychotherapy, 19, 150-158.
51. Oltmanns, T. F., & Emery, R. E. (2012). Abnormal psychology (7th ed., pp. 278-299). Boston, Massachusetts: Pearson.
52. Presnell, K., Stice, E., Seidel, A., & Madeley, M. C. (2009). Depression and eating pathology: prospective reciprocal relations in adolescents. Clinical Psychology & Psychotherapy: An International Journal of Theory & Practice, 16, 357-365.
53. Procopio, C. A., Holm‐Denoma, J. M., Gordon, K. H., & Joiner Jr, T. E. (2006). Two–three‐year stability and interrelations of bulimotypic indicators and depressive and anxious symptoms in middle‐aged women. International Journal of Eating Disorders, 39, 312-319.
54. Puccio, F., Fuller‐Tyszkiewicz, M., Ong, D., & Krug, I. (2016). A systematic review and meta‐analysis on the longitudinal relationship between eating pathology and depression. International Journal of Eating Disorders, 49, 439-454.
55. Rawana, J. S., & Morgan, A. S. (2014). Trajectories of depressive symptoms from adolescence to young adulthood: the role of self-esteem and body-related predictors. Journal of Youth and Adolescence, 43, 597-611.
56. Rawana, J. S., Morgan, A. S., Nguyen, H., & Craig, S. G. (2010). The relation between eating-and weight-related disturbances and depression in adolescence: a review. Clinical Child and Family Psychology Review, 13, 213-230.
57. Ryu, H. R., Lyle, R. M., Galer-Unti, R. A., & Black, D. R. (1999). Cross-cultural assessment of eating disorders: Psychometric characteristics of a Korean version of the Eating Disorder Inventory-2 and the Bulimia Test-Revised. Eating Disorders, 7, 109-122.
58. Santos, M., Richards, C. S., & Bleckley, M. K. (2007). Comorbidity between depression and disordered eating in adolescents. Eating Behaviors, 8, 440-449.
59. Schaefer, L. M., Smith, K. E., Anderson, L. M., Cao, L., Crosby, R. D., Engel, S. G., . . . Wonderlich, S. A. (2020). The role of affect in the maintenance of binge-eating disorder: Evidence from an ecological momentary assessment study. Journal of Abnormal Psychology, 129, 387-396.
60. Sloan, E., Hall, K., Moulding, R., Bryce, S., Mildred, H., & Staiger, P. K. (2017). Emotion regulation as a transdiagnostic treatment construct across anxiety, depression, substance, eating and borderline personality disorders: A systematic review. Clinical Psychology Review, 57, 141-163.
61. Smink, F. R., Van Hoeken, D., Oldehinkel, A. J., & Hoek, H. W. (2014). Prevalence and severity of DSM‐5 eating disorders in a community cohort of adolescents. International Journal of Eating Disorders, 47, 610-619.
62. Smith, K. E., Mason, T. B., Crosby, R. D., Cao, L., Leonard, R. C., Wetterneck, C. T., . . . Moessner, M. (2019). A comparative network analysis of eating disorder psychopathology and co-occurring depression and anxiety symptoms before and after treatment. Psychological Medicine, 49, 314-324.
63. Smith, M. C., & Thelen, M. H. (1984). Development and validation of a test for bulimia. Journal of Consulting and Clinical Psychology, 52, 863-872.
64. Stice, E. (2002). Risk and maintenance factors for eating pathology: A meta-analytic review. Psychological Bulletin, 128, 825-848.
65. Stice, E. (2016). Interactive and mediational etiologic models of eating disorder onset: Evidence from prospective studies. Annual Review of Clinical Psychology, 12, 359-381.
66. Stice, E., Burton, E. M., & Shaw, H. (2004). Prospective relations between bulimic pathology, depression, and substance abuse: unpacking comorbidity in adolescent girls. Journal of Consulting and Clinical Psychology, 72, 62-71.
67. Stice, E., Gau, J. M., Rohde, P., & Shaw, H. (2017). Risk factors that predict future onset of each DSM–5 eating disorder: Predictive specificity in high-risk adolescent females. Journal of Abnormal Psychology, 126, 38-51.
68. Stice, E., Hayward, C., Cameron, R. P., Killen, J. D., & Taylor, C. B. (2000). Body-image and eating disturbances predict onset of depression among female adolescents: A longitudinal study. Journal of Abnormal Psychology, 109, 438-444.
69. Stice, E., Marti, C. N., & Rohde, P. (2013). Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women. Journal of Abnormal Psychology, 122, 445-457.
70. Stice, E., Shaw, H., & Nemeroff, C. (1998). Dual pathway model of bulimia nervosa: Longitudinal support for dietary restraint and affect-regulation mechanisms. Journal of Social and Clinical Psychology, 17, 129-149.
71. Sung, H. M., Kim, J. B., Park, Y. N., Bai, D. S., Lee, S. H., & Ahn, H. N. (2008). A study on the reliability and the validity of Korean Version of the Beck Depression Inventory-II. Journal of the Korean Society of Biological Therapies in Psychiatry, 14, 201-212.
72. Swanson, S. A., Crow, S. J., Le Grange, D., Swendsen, J., & Merikangas, K. R. (2011). Prevalence and correlates of eating disorders in adolescents: Results from the national comorbidity survey replication adolescent supplement. Archives of General Psychiatry, 68, 714-723.
73. Thelen, M. H., Farmer, J., Wonderlich, S., & Smith, M. (1991). A revision of the Bulimia Test: The BULIT—R. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 3, 119-124.
74. Tiggemann, M. (2005). Body dissatisfaction and adolescent self-esteem: Prospective findings. Body Image, 2, 129-135.
75. Verschueren, M., Claes, L., Palmeroni, N., Bogaerts, A., Gandhi, A., Moons, P., & Luyckx, K. (2020). Eating disorder symptomatology in adolescent boys and girls: Identifying distinct developmental trajectory classes. Journal of Youth and Adolescence, 49, 410-426.
76. Voderholzer, U., Hessler-Kaufmann, J. B., Lustig, L., & Läge, D. (2019). Comparing severity and qualitative facets of depression between eating disorders and depressive disorders: Analysis of routine data. Journal of Affective Disorders, 257, 758-764.
77. Wade, T. D., Bergin, J. L., Tiggemann, M., Bulik, C. M., & Fairburn, C. G. (2006). Prevalence and long-term course of lifetime eating disorders in an adult Australian twin cohort. Australian & New Zealand Journal of Psychiatry, 40, 121-128.
78. Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54, 1063-1070.
79. Wonderlich, S. A., Peterson, C. B., Crosby, R. D., Smith, T. L., Klein, M. H., Mitchell, J. E., & Crow, S. J. (2014). A randomized controlled comparison of integrative cognitive-affective therapy and cognitive-behavioral therapy-enhanced for bulimia nervosa. Psychological Medicine, 44, 543-553.
80. Yoon, H. Y. (1996). The relationships among binge eating behavior, depressive symptoms, and attributional style (Unpublished master’s thesis). The Catholic University of Korea, Seoul, Korea.