Top

BMC Public Health

Published in:

Open Access 01-12-2023 | Eating Disorder | Research

Bulimia symptoms and anger and aggression among adolescents

Authors: Roman Koposov, Andrew Stickley, Denis Sukhodolsky, Vladislav Ruchkin

Published in: BMC Public Health | Issue 1/2023

Abstract

Background

Previous research has indicated that anger and aggression may be elevated in adolescents with a bulimia nervosa (BN) diagnosis. However, as yet, little is known about whether bulimia symptoms are linked to anger and aggression in adolescents in the general population. To address this deficit this study aimed to explore the associations between a clinical level of bulimia symptoms (CLBS) and anger, anger rumination and aggression in community-based adolescents, and determine whether gender is important in this context.

Methods

This study was conducted on a representative sample of youth from northwestern Russia (n = 2613, age 13–17 years old, 59.5% female) using self-report scales. A proxy variable for a CLBS was created using the Eating Disorder Diagnostic Scale. Aggression, anger and anger rumination were assessed by the Trait Anger Scale of the State Trait Anger Expression Inventory, the Anger Rumination Scale, and scales created to assess physically and verbally aggressive behavior. Multivariate analysis of covariance was used to examine the associations between the study variables.

Results

A CLBS was more prevalent in girls than in boys (13.4% vs. 3.5%). The association with anger and aggression was stronger in both genders with a CLBS, compared to those adolescents without a CLBS. In the CLBS group, boys as compared to girls scored higher on verbal and physical aggression, anger rumination and social aggression. In both the CLBS and Non-CLBS groups higher anger and aggression scores were associated with increasing age.

Conclusions

Findings suggest that aggression and anger rumination are elevated in adolescents with BN symptoms, and that the associations between anger, aggression and BN symptoms may be stronger in boys. As previous research has indicated that the presence of aggressive behaviors may affect the prognosis of BN and complicate management of the disorder, clinician screening for these behaviors in adolescents with BN symptoms may facilitate the provision of more effective treatment, especially among boys.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: APA; 2013.CrossRef

Hail L, Le Grange D. Bulimia nervosa in adolescents: prevalence and treatment challenges. Adolesc Health Med Ther. 2018;9:11–6. https://doi.org/10.2147/AHMT.S135326.CrossRefPubMedPubMedCentral

Anderson NK, Nicolay OF. Eating disorders in children and adolescents. Semin Orthod. 2016;22(3):234–7. https://doi.org/10.1053/j.sodo.2016.05.010.CrossRef

Davidsen AH, Hoyt WT, Poulsen S, Waaddegaard M, Lau M. Eating disorder severity and functional impairment: moderating effects of illness duration in a clinical sample. Eat Weight Disord. 2017;22:499–507. https://doi.org/10.1007/s40519-016-0319-z.CrossRefPubMed

Ackard DM, Fulkerson JA, Neumark-Sztainer D. Prevalence and utility of DSM-IV eating disorder diagnostic criteria among youth. Int J Eat Disord. 2007;40(5):409–17. https://doi.org/10.1002/eat.20389.CrossRefPubMed

Swanson SA, Crow SJ, Le Grange D, Swendsen J, Merikangas KR. Prevalence and correlates of eating disorders in adolescents: results from the national comorbidity survey replication adolescent supplement. Arch Gen Psychiatry. 2011;68:714–23. https://doi.org/10.1001/archgenpsychiatry.2011.22.CrossRefPubMedPubMedCentral

Flament MF, Buchholz A, Henderson K, Obeid N, Maras D, Schubert N, Paterniti S, Goldfield G. Comparative distribution and validity of DSM-IV and DSM-5 diagnoses of eating disorders in adolescents from the community. Comparative study. Eur Eat Disord Rev. 2015;23(2):100–10. https://doi.org/10.1002/erv.2339.CrossRefPubMed

Hammerle F, Huss M, Ernst V, Bürger A. Thinking dimensional: prevalence of DSM-5 early adolescent full syndrome, partial and subthreshold eating disorders in a cross-sectional survey in german schools. BMJ Open. 2016;6:e010843. https://doi.org/10.1136/bmjopen-2015-010843.CrossRefPubMedPubMedCentral

Micali N, Ploubidis G, De Stavola B, Simonoff E, Treasure J. Frequency and patterns of eating disorder symptoms in early adolescence. J Adolesc Health. 2014;54(5):574–81. https://doi.org/10.1016/j.jadohealth.2013.10.200.CrossRefPubMed

10.

Herpertz-Dahlmann B. Adolescent eating disorders: definitions, symptomatology, epidemiology and comorbidity. Child Adolesc Psychiatr Clin N Am. 2009;18(1):31–47. https://doi.org/10.1016/j.chc.2008.07.00.CrossRef

11.

Peebles R, Hardy KK, Wilson JL, Lock JD. Are diagnostic criteria for eating disorders markers of medical severity? Pediatrics. 2010;125:1193–201. https://doi.org/10.1542/peds.2008-1777.CrossRef

12.

Campbell K, Peebles R. Eating disorders in children and adolescents: state of the art review. Pediatrics. 2014;134:582–92. https://doi.org/10.1542/peds.2014-0194.CrossRefPubMed

13.

Gorrell S, Murray SB. Eating disorders in males. Child Adolesc Psychiatr Clin N Am. 2019;28:641–51. https://doi.org/10.1016/j.chc.2019.05.012.CrossRef

14.

Mitchison D, Mond J, Bussey K, Griffiths S, Trompeter N, Lonergan A, Pike KM, Murray SB, Hay P. DSM-5 full syndrome, other specified, and unspecified eating disorders in Australian adolescents: prevalence and clinical significance. Psychol Med. 2020;50(6):981–90. https://doi.org/10.1017/S0033291719000898.CrossRefPubMed

15.

Ruchkin V, Isaksson J, Schwab-Stone M, Stickley A. Prevalence and early risk factors for bulimia nervosa symptoms in inner-city youth: gender and ethnicity perspectives. J Eat Disord. 2021;9:136. https://doi.org/10.1186/s40337-021-00479-5.CrossRefPubMedPubMedCentral

16.

Ricciardelli LA, McCabe MP. Dietary restraint and negative affect as mediators of body dissatisfaction and bulimic behavior in adolescent girls and boys. Behav Res Ther. 2001;39(11):1317–28. https://doi.org/10.1016/S0005-7967(00)00097-8.CrossRefPubMed

17.

Kaltiala-Heino R, Rissanen A, Rimpelä M, Rantanen P. Bulimia and impulsive behaviour in middle adolescence. Psychother Psychosom. 2003;72(1):26–33. https://doi.org/10.1159/000067187.CrossRefPubMed

18.

Zaider TI, Johnson JG, Cockell SJ. Psychiatric comorbidity associated with eating disorder symptomatology among adolescents in the community. Int J Eat Disord. 2000;28:58–67. https://doi.org/10.1002/(sici)1098-108x(200007)28:1<58::aid-eat7>3.0.co;2-v.CrossRefPubMed

19.

Crow SJ, Swanson SA, Grange D, Feig EH, Merikangas KR. Suicidal behavior in adolescents and adults with bulimia nervosa. Compr Psychiatry. 2014;55(7):1534–9. https://doi.org/10.1016/j.comppsych.2014.05.021.CrossRefPubMed

20.

Ferriter C, Ray LA. Binge eating and binge drinking: an integrative review. Eat Behav. 2011;12:99–107. https://doi.org/10.1016/j.eatbeh.2011.01.001.CrossRefPubMed

21.

Stickley A, Koyanagi A, Koposov R, McKee M, Murphy A, Ruchkin V. Binge drinking and eating problems in Russian adolescents. Alcohol Clin Exp Res. 2015;39:540–7. https://doi.org/10.1111/acer.12644.CrossRefPubMed

22.

Mohammadi MR, Mostafavi SA, Hooshyari Z, Khaleghi A, Ahmadi N, Molavi P, et al. Prevalence, correlates and comorbidities of feeding and eating disorders in a nationally representative sample of Iranian children and adolescents. Int J Eat Disord. 2020;53:349–61. https://doi.org/10.1002/eat.23197.CrossRefPubMed

23.

Truglia E, Mannucci E, Lassi S, Rotella CM, Faravelli C, Ricca V. Aggressiveness, anger and eating disorders: a review. Psychopathology. 2006;39:55–68. https://doi.org/10.1159/000090594.CrossRefPubMed

24.

Miotto P, Coppi MDe, Frezza M, Petretto DR, Masala C, Preti A. Eating disorders and aggressiveness among adolescents. Acta Psychiatr Scand. 2003;108(3):183–9. https://doi.org/10.1034/j.1600-0447.2003.00121.x.CrossRefPubMed

25.

Miotto P, Pollini B, Restaneo A, Favaretto G, Preti A. Aggressiveness, anger, and hostility in eating disorders. Compr Psychiatry. 2008;49(4):364–73. https://doi.org/10.1016/j.comppsych.2008.01.004.CrossRefPubMed

26.

Thompson KM, Wonderlich SA, Crosby RD, Mitchell JE. The neglected link between eating disturbances and aggressive behavior in girls. J Am Acad Child Adolesc Psychiatry. 1999;38:1277–84. https://doi.org/10.1097/00004583-199910000-00017.CrossRefPubMed

27.

Krug I, Bulik CM, Vall-Llovera ON, Granero R, Agüera Z, Villarejo C, Jiménez-Murcia S, Fernández-Aranda F. Anger expression in eating disorders: clinical, psychopathological and personality correlates. Psychiatry Res. 2008;161:195–05. https://doi.org/10.1016/j.psychres.2007.10.003.CrossRefPubMed

28.

Jhangiani R, Tarry H, Stangor C. Principles of social psychology. 1st international H5P edition. BC campus; 2022.

29.

Fava M, Rappe SM, West J, Herzog DB. Anger attacks in eating disorders. Psychiatry Res. 1995;56:205–12. https://doi.org/10.1016/0165-1781(95)02577-j.CrossRefPubMed

30.

Engel SG, Boseck JJ, Crosby RD, Wonderlich SA, Mitchell JE, Smyth J, Miltenbergerd R, Steiger H. The relationship of momentary anger and impulsivity to bulimic behavior. Behav Res Ther. 2007;45:437–47. https://doi.org/10.1016/j.brat.2006.03.014.CrossRefPubMed

31.

Zeeck A, Stelzer N, Linster HW, Joos A, Hartman AH. Emotion and eating in binge eating disorder and obesity. Eur Eat Disord Rev. 2011;19:426–37. https://doi.org/10.1002/erv.1066.CrossRefPubMed

32.

Smyth JM, Wonderlich SA, Heron KE, Sliwinski MJ, Crosby RD, Mitchell JE, Engel SG. Daily and momentary mood and stress are associated with binge eating and vomiting in bulimia nervosa patients in the natural environment. J Consult Clin Psychol. 2007;75:629–38. https://doi.org/10.1037/0022-006X.75.4.629.CrossRefPubMed

33.

Sukhodolsky DG, Golub A, Cromwell EN. Development and validation of the anger rumination scale. Pers Individ Differ. 2001;31:689–700. https://doi.org/10.1016/S0191-8869(00)00171-9.CrossRef

34.

Selby EA, Anestis MD, Joiner TE. Understanding the relationship between emotional and behavioral dysregulation: emotional cascades. Behav Res Ther. 2008;46(5):593–11. https://doi.org/10.1016/j.brat.2008.02.002.CrossRefPubMed

35.

Wang SB, Borders A. The unique effects of angry and depressive rumination on eating-disorder psychopathology and the mediating role of impulsivity. Eat Behav. 2018;29:41–7. https://doi.org/10.1016/j.eatbeh.2018.02.004.CrossRefPubMed

36.

Wakeford G, Kannis-dymand L, Statham D. Anger rumination, binge eating, and at‐risk alcohol use in a university sample. Aust J Psychol. 2018;70(3):269–76. https://doi.org/10.1111/ajpy.12187.CrossRef

37.

Arseneault L, Moffitt TE, Caspi A, Taylor PJ, Silva PA. Mental disorders and violence in a total birth cohort. Results from the Dunedin Study. Arch Gen Psychiatry. 2000;57:979–86.CrossRefPubMed

38.

Huemer J, Sagar A, Alquero K, Denny K, Shaw RJ, Steiner H. Overt and covert aggression in college women with bulimia nervosa. Z Kinder Jugendpsychiatr Psychother. 2011;39(6):409–15. https://doi.org/10.1024/1422-4917/a000139.CrossRefPubMed

39.

Werner NE, Crick NR. Relational aggression and social-psychological adjustment in a college sample. J Abnorm Psych. 1999;108(4):615–23. https://doi.org/10.1037/0021-843X.108.4.615.CrossRef

40.

Anderson CA, Bushman BJ. Human aggression. Annu Rev Psychol. 2002;53:27–51. https://doi.org/10.1146/annurev.psych.53.100901.135231.CrossRefPubMed

41.

Benítez JL, Justicia F. Bullying: description and analysis of the phenomenon. Electron J Res Educ Psychol. 2006;4(9):1696–2095.

42.

Hadley M. (2003) Relational, indirect, adaptive, or just mean: recent work on aggression in adolescent girls—part I. Stud Gend Sex. 2003;4(4):367 – 94. https://doi.org/10.1080/15240650409349235

43.

Peets K, Kikas E. Aggressive strategies and victimization during adolescence: grade and gender differences, and cross-informant agreement. Aggress Behav. 2006;32(1):68–79. https://doi.org/10.1002/ab.20105.CrossRef

44.

Salmivalli C, Kaukiainen AO. "Female aggression” revisited: variable- and person-centered approaches to studying gender differences in different types of aggression. Aggress Behav. 2004;30(2):158–63. https://doi.org/10.1002/ab.20012.CrossRef

45.

Björkqvist K. Gender differences in aggression. Curr Opin Psychol. 2018;19:39–42. https://doi.org/10.1016/j.copsyc.2017.03.030.CrossRefPubMed

46.

Heilbron N, Prinstein MJ. A review and reconceptualization of social aggression: adaptive and maladaptive correlates. Clin Child Fam Psychol Rev. 2008;11:176–17. https://doi.org/10.1007/s10567-008-0037-9.CrossRefPubMed

47.

Goodman E, Slap GB, Huang B. The public health impact of socioeconomic status on adolescent depression and obesity. Am J Public Health. 2003;93(11):1844–50. https://doi.org/10.2105/ajph.93.11.1844.CrossRefPubMedPubMedCentral

48.

Lemstra M, Bennett NR, Neudorf C, Kunst A, Nannapaneni U, Warren LM, Kershaw T, Scott CR. A meta-analysis of marijuana and alcohol use by socio-economic status in adolescents aged 10–15 years. Can J Public Health. 2008;99(3):172–7. https://doi.org/10.1007/BF03405467.CrossRefPubMedPubMedCentral

49.

Park S, Kim Y. Prevalence, correlates, and associated psychological problems of substance use in Korean adolescents. BMC Public Health. 2016;27(16):79. https://doi.org/10.1186/s12889-016-2731-8.CrossRef

50.

Heebink DM, Sunday SR, Halmi KA. Anorexia nervosa and bulimia nervosa in adolescence: effects of age and menstrual status on psychological variables. J Am Acad Child Adolesc Psychiatry. 1995;34(3):378–82. https://doi.org/10.1097/00004583-199503000-00024.CrossRefPubMed

51.

de Souza Ferreira JE, da Veiga GV. Eating disorder risk behavior in Brazilian adolescents from low socio-economic level. Appetite. 2008;51(2):249–55. https://doi.org/10.1016/j.appet.2008.02.015.CrossRefPubMed

52.

Najjar RH, Jacob E, Evangelista L. Eating behaviors, weight bias, and psychological functioning in multi-ethnic low-income adolescents. J Pediatr Nurs. 2018;38:81–7. https://doi.org/10.1016/j.pedn.2017.11.008.CrossRefPubMed

53.

Karriker-Jaffe KJ, Foshee VA, Ennett ST, Suchindran C. The development of aggression during adolescence: sex differences in trajectories of physical and social aggression among youth in rural areas. J Abnorm Child Psychol. 2008;36:1227–36. https://doi.org/10.1007/s10802-008-9245-5.CrossRefPubMedPubMedCentral

54.

Letourneau NL, Duffett-Leger L, Levac L, Watson B, Young-Morris C. Socioeconomic status and child development: a meta-analysis. J Emot Behav Disord. 2011;21:211–24. https://doi.org/10.1177/1063426611421.CrossRef

55.

le Grange D, Loeb KL, Van Orman S, Jellar CC. Bulimia nervosa in adolescents: a disorder in evolution? Arch Pediatr Adolesc Med. 2004;158:478–82. https://doi.org/10.1001/archpedi.158.5.478.CrossRefPubMed

56.

Stice E, Telch CF, Rizvi SL. Development and validation of the Eating Disorder Diagnostic Scale: a brief self-report measure of anorexia, bulimia, and binge-eating disorder. Psychol Assess. 2000;12:123–31. https://doi.org/10.1037/1040-3590.12.2.123.CrossRefPubMed

57.

Larsen A, Lilja M, Sturidsson K, Blatny M, Hrdlicka M, Stickley A, Ruchkin V. Bulimia symptoms in Czech youth: prevalence and association with internalizing problems. Eat Weight Disord. 2020;25:1543–52. https://doi.org/10.1007/s40519-019-00790-w.CrossRefPubMed

58.

Koposov RA, Stickley A, Ruchkin V. Bulimia symptoms in Russian youth: prevalence and association with internalizing problems. Front Psychiatry. 2022. https://doi.org/10.3389/fpsyt.2021.797388.CrossRefPubMedPubMedCentral

59.

Spielberger CD. Manual for the state-trait anger expression inventory. Odessa, FL: Psychological Assessment Resources; 1988.

60.

Eckhardt C, Kassinove H, Tsytsarev SV, Sukhodolsky DA. Russian version of the state-trait anger expression inventory: preliminary data. J Pers Assess. 1995;64(3):440–55. https://doi.org/10.1207/s15327752jpa6403_4.CrossRefPubMed

61.

Isaksson J, Sukhodolsky DG, Koposov R, Stickley A, Ruchkin V. The role of gender in the associations among posttraumatic stress symptoms, anger, and aggression in Russian adolescents. J Trauma Stress. 2020;33:552–63. https://doi.org/10.1002/jts.22502.CrossRefPubMed

62.

Ruchkin V, Schwab-Stone M, Vermeiren R. Social and Health Assessment (SAHA): Psychometric Development Summary. New Haven, CT: Yale University; 2004.

63.

Fischer S, Le Grange D. Comorbidity and high-risk behaviors in treatment-seeking adolescents with bulimia nervosa. Int J Eat Disord. 2007;40:751–3. https://doi.org/10.1002/eat.20442.CrossRefPubMed

64.

Stice E, Marti N, Shaw H, Jaconis M. An 8-year longitudinal study of the natural history of threshold, subthreshold, and partial eating disorders from a community sample of adolescents. J Abnorm Psychol. 2009;118:587–97. https://doi.org/10.1037/a0016481.CrossRefPubMedPubMedCentral

65.

Connolly AM, Rieger E, Caterson. Binge eating tendencies and anger coping: investigating the confound of trait neuroticism in a non-clinical sample. Eur Eat Disord Rev. 2007;15(6):479–86. https://doi.org/10.1002/erv.765.CrossRefPubMed

66.

Card NA, Stucky BD, Sawalani GM, Little TD. Direct and indirect aggression during childhood and adolescence: a meta-analytic review of gender differences, intercorrelations, and relations to maladjustment. Child Dev. 2008;79:1185–229.CrossRefPubMed

67.

Smith KE, Mason TB, Lavender JM. (2018). Rumination and eating disorder psychopathology: a meta-analysis. Clin Psychol Rev. 2018;61:9–23. https://doi.org/10.1016/j.cpr.2018.03.004

68.

Gerevich J, Bácskai E, Czobor P. The generalizability of the Buss–Perry Aggression Questionnaire. Int J Methods Psychiatr Res. 2007;16(3):124–36. https://doi.org/10.1002/mpr.221.CrossRefPubMedPubMedCentral

69.

Breithaupt L, Rallis B, Mehlenbeck R, Kleiman E. Rumination and self-control interact to predict bulimic symptomatology in college students. Eat Behav. 2016;22:1–4. https://doi.org/10.1016/j.eatbeh.2016.03.011.CrossRefPubMed

70.

Lee KS, Vaillancourt T. Longitudinal associations among bullying by peers, disordered eating behavior, and symptoms of depression during adolescence. JAMA Psychiatry. 2018;75(6):605–12. https://doi.org/10.1001/jamapsychiatry.2018.0284.CrossRefPubMedPubMedCentral

71.

Gonçalves S, Machado BC, Martins C, Hoek HW, Machado PPP. Retrospective correlates for bulimia nervosa: a matched case–control study. Eur Eat Disorder Rev. 2016;24(3):197–205. https://doi.org/10.1002/erv.2434.CrossRef

72.

Reijntjes A, Kamphuis JH, Prinzie P, Telch MJ. Peer victimization and internalizing problems in children: a meta-analysis of longitudinal studies. Child Abuse Negl. 2010;34(4):244–52. https://doi.org/10.1016/j.chiabu.2009.07.009.CrossRefPubMed

73.

Jacobi C, Hayward C, de Zwaan M, Kraemer HC, Agras WS. Coming to terms with risk factors for eating disorders: application of risk terminology and suggestions for a general taxonomy. Psycho Bull. 2004;130(1):19–65. https://doi.org/10.1037/0033-2909.130.1.19.CrossRef

74.

Duarte C, Pinto-Gouveia J, Rodrigues T. Being bullied and feeling ashamed: implications for eating psychopathology and depression in adolescent girls. J Adolesc. 2015;44:259–68. https://doi.org/10.1016/j.adolescence.2015.08.005.CrossRefPubMed

75.

Woodside BD, Staab R. Management of psychiatric comorbidity in anorexia nervosa and bulimia nervosa. CNS Drugs. 2006;20(8):655–63. https://doi.org/10.2165/00023210-200620080-00004.CrossRefPubMed

76.

Belokrylov I, Bryukhin A, Lineva T, Okonishnikova E. Dynamics of aggressive manifestations in eating disorders. Eur Psychiatry. 2021;64(S1):354–S354. https://doi.org/10.1192/j.eurpsy.2021.949.CrossRef

77.

Zalar B, Weber U, Sernec K. Aggression and impulsivity with impulsive behaviours in patients with purgative anorexia and bulimia nervosa. Psychiatr Danub. 2011;20(1):27–33.

78.

Boerhout C, Swart M, Van Busschbach JT, Hoek HW. Effect of aggression regulation on eating disorder pathology: RCT of a brief body and Movement oriented intervention. Eur Eat Disord Rev. 2016;24(2):114–21. https://doi.org/10.1002/erv.2429.CrossRefPubMed

Title: Bulimia symptoms and anger and aggression among adolescents
Authors: Roman Koposov
Andrew Stickley
Denis Sukhodolsky
Vladislav Ruchkin
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: Eating Disorder
Bulimia
Eating Disorder
Published in: BMC Public Health / Issue 1/2023
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-023-15664-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Bulimia symptoms and anger and aggression among adolescents

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2023

Spatial distribution and associated factors of severe malnutrition among under-five children in Ethiopia: further analysis of 2019 mini EDHS

Usage and health perception of cannabidiol-containing products among the population in Germany: a descriptive study conducted in 2020 and 2021

An exploratory qualitative study of the psychological effects of HIV diagnosis; the need for early involvement of mental health professionals to improve linkage to care

Oral health literacy, knowledge and perceptions in a socially and culturally diverse population: a mixed methods study

Trajectories of spherical equivalent refraction from grades 1 to 4 in Chinese children

Effect of physical activity promotion program on adherence to physical exercise among patients with type II diabetes in North Shoa Zone Amhara region: a quasi-experimental study