A prospective test of the dual pathway model of bulimic pathology: mediating effects of dieting and negative affect

“As noted earlier, another vulnerability hypothesis of the etiology of bulimia nervosa comes from Stice’s dual-pathway model of bulimia nervosa, which includes interactions of several vulnerability factors including negative affect, dietary restraint, sociocultural pressure for thinness, and idealization of a thin body…”

“There is considerable evidence that these factors predict future increases in eating pathology (Killen et al., 1994; Patton, 1988; Stice, 2001; Stice & Agras, 1998; Stice, Killen, Hayward, & Taylor, 1998).”

“Additionally, the dual pathway model [66, 67] provides a framework for understanding the mechanisms in which adolescent girls’ social media use can influence their body image.”

“dissatisfaction which in turn increases dieting and eating pathology (Stice, 2001).”

“The 8-item Body Dissatisfaction Scale (Stice, 2001) assesses satisfaction with body parts (e.g., stomach, hips) using response options ranging from 1 (extremely satisfied) to 6 (extremely dissatisfied).”

“Weight-related criticisms or teasing have been found to be significant factors in body dissatisfaction (Catarin & Thompson, 1994; Green & Pritchard, 2003; Stice, 2001).”

“Studies have also identified factors that predict future increases in eating disorder symptoms (e.g., F. Johnson & Wardle, 2005; Neumark-Sztainer et al., 2007; Stice, 2001), but the effects from these studies are difficult to interpret because such analyses do not confirm that participants experienced emergence of cli…”

“In support, body dissatisfaction predicted increases in negative affect (Stice, 2001) and onset of major depression (Stice et al.”

“Satisfaction and Dissatisfaction with Body Parts Scale (Stice 2001) Finally, to evaluate the tripartite influence model facet of body dissatisfaction, this nine-item scale was used to examine dissatisfaction with nine physical appearance features (e.g., height, waist, thighs, stomach, body build) from 1 = extremely sa…”

“…more pressure than men to achieve the idealzed body type, and consequently face more body image threats e.g., social and mass media content glorying the thin ideal and tigmatizing larger bodies) and scrutiny from others in daily life Fredrickson & Roberts, 1997; Thompson & Stice, 2001).”

“It is striking that these two etiological pathways, which have received prospective empirical support previously (e.g., Stice, 2001) were disrupted longitudinally in our women who had a secure relationship with God.”

“Body dissatisfaction is viewed as a primary precursor of disordered eating, though its effects may be indirect, occurring through two distinct, but related pathways—affect regulation and dietary restraint (Stice, 2001).”

“In separate cross-sectional studies, negative affect and dietary restraint were together significantly associated with binge eating (Stice, Akutagawa, Gaggar, & Agras, 2000; Womble et al., 2001) and bulimic symptoms (Stice, 2001).”

“…internalization of the thin-ideal, which theoretically, in turn, should result in decreases in body dissatisfaction, dieting, and eating pathology (Stice, 2001; Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999), given its role as a widely recognised risk factor for these outcomes among females…”

“This might lead to an insufficient understanding of developmental patterns, as the impact of BE at baseline has not been accounted for (Stice, 2001).”

“, & Stice, E. (2004). Risk factors for body dissatisfaction in adolescent boys and girls: A prospective study.”

“Examination of these constructs is warranted, as poor body image has been linked to a number of important outcomes, including negative affect, eating disorder symptoms, and threshold eating disorders (Hrabosky et al., 2009; Stice, 2001; Stice, Mazotti, Wiebel, & Agras, 2000).”

“This is of particular importance because of reliable associations between negative body image and the development of eating disorders (e.g., Neumark-Sztainer, Paxton, Hannan, Haines, & Story, 2006; Stice, 2001; Stice & Shaw, 2002) and lower psychological well-being more generally (e.”

“…scores on dietary restraint scales, relative to those with lower scores, are at increased risk for future onset of binge eating, bulimic pathology, and increases in bulimic symptoms (Field et al., 1999; Johnson & Wardle, 2005; Killen et al., 1996; Neumark-Sztainer et al., 2006; Stice, 2001).”

“Binging is a coping mechanism of either dietary restraint caused by craving for food, or of attachment-related stress and negative feelings or both (Stice, 2001).”

“A high score on eating restraint is considered a risk factor for eating disorders (e.g., Jacobi, Hayward, de Zwaan, Kraemer, & Agras, 2004; Stice, 2001), especially Bulimia Nervosa (BN) (Stice, 1998, 2001; Stice, Killen, Hayward, & Taylor, 1998), and * Corresponding author.”

“These findings are consistent with studies of clinical EDs that have shown depression and negative affect are highly comorbid with EDs (Eisenberg, Hunt, & Speer, 2013; Stice, 2001), and it is possible power was too low in this subgroup to detect a significant finding.”

“Stice and Shaw [46] indicated in their study that, in turn, heightened dissatisfaction with the body increases the risk of various adverse outcomes, for example, eating disorders.”

“Stice (1994, 2001) has proposed that the relation between body dissatisfaction and the development of an eating pathology is mediated via two distinct pathways: dieting and negative affect.”

“With respect to symptom severity differences, Western-based sociocultural theories of ED development (e.g., Pennesi & Wade, 2016; Schaefer & Thompson, 2018; Stice, 2001; Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999; Weissman, 2019) propose that thinideal internalization, which could manifest as desiring weight lo…”

“…(Field et al., 1999; Neumark-Sztainer et al., 2006; Stice & Agras, 1998; Stice, Killen, Hayward, & Taylor, 1998), onset of threshold and subthreshold bulimia nervosa (Killen et al., 1996), and increases in bulimic symptoms (Johnson & Wardle, 2005; Stice, 2001; Wertheim, Koerner, & Paxton, 2001).”

“One limitation of most previous work is a reliance on retrospective questionnaires or laboratory-based designs.(3,4) Although these methods provide valuable information, they raise concerns regarding memory biases and reporting accuracy on questionnaires and questions about real-world generalizability for laboratory s…”

“Weight/body dissatisfaction, in turn, could motivate extreme and unhealthy behaviors in an effort to lose weight, which in turn might increase the risk of developing binge eating and other disturbed eating behaviors [17, 19 ].”

“…was found to be weak, the overall results of this analysis provided support for the dual-pathway model, supporting the model’s hypotheses that pressure to be thin, thin-ideal internalisation, body dissatisfaction, dieting, and negative affect are risk factors for bulimia pathology (Stice, 2001).”

“A small, but growing number of longitudinal studies have examined the importance of various psychological, biological, and social risk factors for predicting the onset of disordered eating (Attie & Brooks-Gunn, 1989; Button, Sonuga-Barke, Davies, & Thompson, 1996; Cattarin & Thompson, 1994; Killen et al., 1996; Phelps…”

“sure to be thin) are instrumental in predicting body dissatisfaction [7, 8].”

“Negative affect reflecting the experience of such emotions as fear, guilt, and sadness, demonstrates relationships with outcomes including health complaints (Pressman et al., 2013), substance abuse (Baker et al., 2004), and eating pathology (Stice, 2001).”

“Satisfaction and Dissatisfaction with Body Parts Scale (Stice 2001) This nine-item scale queries personal dissatisfaction with body parts from 1 =extremely satisfied to 5 =extremely dissatisfied .”

“It is worth noting that the body dissatisfaction is one of the main risk factors for the development of eating disorders (Stice, 2001, 2002; Stice, Marti, & Durant, 2011).”

“Eating induced by negative affect or distress is thought to be a key mechanism for triggering bulimic behavior and eating binges (Stice, 1994, 2001; Stice, Presnell, & Spangler, 2002).”

“High tendencies to experience generalized and body-specific guilt and shame are associated with psychopathology, such as depression, anxiety, disordered eating, eating disorders, and decreased self-esteem (Bessenoff and Snow, 2006; Dickerson and Kemeny, 2004; Gupta et al., 2008; Harder et al., 1992; Stice, 2001; Stuew…”

“Similarly, there are a number of studies that have found measures of current dieting and restrained eating prospectively predict weight gain over time (Klesges et al. 1989, 1992; French et al. 1994; Stice et al. 1999; Stice, 2001).”

“These risk factors have been shown to predict future eating pathology (Field et al., 1999; Killen et al., 1996; Stice, 2001; Wertheim et al., 2001; Wichstrøm, 2000) and, if present, should be concurrently addressed in preventive interventions.”

“In several longitudinal studies support was found for the restrained pathway in samples of female high school students and female college students (Stice, 2001; Stice & Agras, 1998; Stice, Akutagawa, Gaggar, & Agras, 2000; Stice, Pressnell, & Sprangler, 2002; Stice, Shaw, & Nemeroff, 1998).”

“Sociocultural models of eating disorders (e.g., Stice, 2001) maintain that when women and girls internalize the media standards of beauty as their own guide to beauty and attractiveness, they are likely to experience body dissatisfaction and engage in disordered eating to control their weight as…”

“Etiological models of eating disorders, including the dual pathway model of Bulimia Nervosa (BN; Stice, 2001), the cognitive-behavioral model of Anorexia Nervosa (AN; Fairburn, Shafran, & Cooper, 1999) and BN (Fairburn, Marcus, &Wilson, 1993), models of the development of binge eating (Polivy &…”

“In this way, it is proposed that dieting may be undertaken in response to body dissatisfaction, as the former is perceived to lead to weight loss, which would thus help with attaining the media ideal (Stice 2001).”

“This scale possesses internal consistency (α=.95), 3-week test-retest reliability (r=.83), and predicted binge eating onset (Spangler and Stice 2001; Stice et al. 2002).”

“First, although it was not the main focus of this research, we drew on the dual pathway model of bulimic symptoms (e.g., Stice, 2001 ) and proposed that dietary restraint and depression would both directly predict bulimic symptomatology, and body dissatisfaction was proposed to be a direct predictor of dietary restrai…”

“These relationships are consistent with theoretical models of the development of body dissatisfaction and disordered eating (Ricciardelli & McCabe, 2001; Stice, 2001) and previous empirical studies (e.g., Jones et al., 2004; Stice, 2002).”

“69), and predictive validity (Buss & Plomin, 1984; Stice, 2001).”

“In support of this theory, depressive symptoms and negative affect have been found to predict future increases in bulimic symptoms (3-4), as well as onset of binge eating (5), bulimic pathology (6-8), and general eating pathology (9).”

“Stice and colleagues have shown that dietary restraint prospectively predicts the onset of binge eating (Stice & Agras, 1998; Stice, Killen, Hayward, & Taylor, 1998b), as well as the growth of these symptoms (Stice, 2001) after 1–2 years.”

“Second, family members and friends, who comment directly and indirectly about weight, dieting, food choices, clothing styles, and appearance, send the message that girls and women should not be satisfied with their bodies or how they look, but rather strive to diet and lose weight (Stice, 2001).”

“…of body image dissatisfaction (Gross, 2003; Johnson, 2006; Stice &Whitenton, 2002; Zody, 2005), bulimia nervosa (Joiner, Heatherton, & Keel, 1997; Stice & Agras, 1998) and increases in dieting among normal weight women (Cattarin & Thompson, 1994; Stice, Mazotti, Weibel, & Agras, 2000; Stice, 2001).”

“Subtyping studies suggest that 30% to 40% of people who seek treatment for clinical binge eating fit a “dietary depressive” subtype whose binge eating is typified by greater negative affect and more depressed mood (Grilo, 2004; Grilo, Masheb, & Berman, 2001; Grilo, Masheb, & Wilson, 2001; Stice, 2001; Stice & Agras, 1…”

“According to the sociocultural model of disordered eating (Stice, 1994, 2001), perceptions of pressure to have a thin body from various social agents (e.g. media, parents, peers, partners) (e.g. Hesse-Biber et al., 2006) promote an internalization of stereotypical beliefs surrounding the ‘thin…”

“Negative affect is one of the other main individual variables that have been found to be associated with both body dissatisfaction and disordered eating in adolescent girls (Stice, 2001).”

“Body dissatisfaction has previously been linked with increased dieting and bulimic symptoms (Stice, 2001), underscoring the risks in the combination of substance use and abuse problems with body dissatisfaction.”

“Research in this area highlights the individual’s avoidant and escapist behaviour (Stice, 2001) which provide short-term positive effects such as not feeling out of control; these are then reinforced and maintained.”

“Several longitudinal studies have shown high levels of thin-ideal internalization predict subsequent increases in body dissatisfaction among adolescent girls (Bradford & Petrie, 2008; Chen, Gao, & Jackson, 2007; Stice, 2001a; Stice, Presnell, & Bearman, 2001; Stice & Whitenton, 2002).”

“The significant association between bulimic symptoms and syndromes and substance disorders (for a review, see Gadalla & Piran, 2007) led researchers to posit a shared nonspecific risk factor for externalizing problems and bulimic pathology (Stice, 2001).”

“This model, which has received support with adolescents (Grilo, 2004; Stice, 2001) and adults (Grilo, Masheb, & Wilson, 2001), highlights the importance of negative affect.”

“Future studies should also examine how familial and peer social networks interact with media messages to reinforce these sociocultural ideals of physical attractiveness (Thompson & Stice, 2001).”

“For example, perceived appearance pressure from media and close interpersonal networks is central to sociocultural models (e.g. Shroff & Thompson, 2006; Stice, 2001; Van den Berg et al., 2002).”

“Weight concerns related to self-perceptions, for example, internalization of the ‘‘thin ideal’’, may impact eating behaviors and dieting [36].”

“Since we know that negative body image and dissatisfaction are associated with unhealthy eating behaviors such as dieting and bulimic eating behaviors (e.g., Stice 2001), it is essential to test whether playing with these different-sized dolls has a direct impact on eating behavior.”