Disordered Eating and Associated Risk Factors: Profiling Malaysian University Students with Disordered Eating

  • Yi-Ting Tang School of Social Sciences, Universiti Sains Malaysia, 11800 Gelugor, Penang, Malaysia.
  • Jia Xian Liew School of Social Sciences, Universiti Sains Malaysia, 11800 Gelugor, Penang, Malaysia.
  • Weng-Tink Chooi School of Social Sciences, Universiti Sains Malaysia, 11800 Gelugor, Penang, Malaysia.
Keywords: social appearance anxiety, body dissatisfaction, body mass index, anxiety, binge eating

Abstract

Disordered eating (DE) refers to a range of troubling eating behaviors that are considered early warning signs of an eating disorder. The current literature warned that university students are at high risk for developing DE. This study aimed to investigate DE among Malaysian university students and its associated factors, including body dissatisfaction (BD), body mass index (BMI), general anxiety, and social appearance anxiety (SAA); particularly, establishing a profile of participants who displayed tendencies of DE. University students aged 18–25 in Malaysia completed the Disordered Eating Examination-Questionnaire (EDE-Q), Contour Drawing Rating Scale (CDRS), Beck Anxiety Inventory (BAI) and Social Appearance Anxiety Scale (SAAS). Their weight and height were also collected. 201 participants (female = 169; Mage = 21.3, SD = 1.34) were recruited. 43 participants (21.4%, 43/201) self-reported regular occurrence (≥ 4 occurrences) of binge episodes over the previous 28 days. 41 (95.3%) of the 43 participants reported BD, and 35 (81.3%) of them expressed a desire to be thinner. Additionally, they scored significantly higher on all four subscales and the Global EDE-Q scale as well as the SAAS, compared with those who self-reported less binge eating. Compared with those who self-reported having experienced less binge eating, those who regularly engaged in binge eating appeared to have significantly higher levels of SAA and four aspects of the psychopathology of DE, including weight, shape and eating concern as well as restraint. BD and the drive for thinness appeared to be prevalent amongst them.

Downloads

Download data is not yet available.

References

Aardoom, J. J., Dingemans, A. E., Slof Op't Landt, M. C. T., & van Furth, E. F. (2012). Norms and discriminative validity of the Eating Disorder Examination Questionnaire (EDE-Q). Eating Behaviors, 13(4), 305–309. https://doi.org/10.1016/j.eatbeh.2012.09.002

Ackard, D. M. (2004). Anorexia, bulimia, disordered eating, and obesity. In M. J. Legato & J. P. Bilezikian (Eds.), Principles of gender-specific medicine (pp. 715–728). Elsevier. https://doi.org/10.1016/b978-012440905-7/50337-6

Alhaj, O. A., Fekih-Romdhane, F., Sweidan, D. H., Saif, Z., Khudhair, M. F., Ghazzawi, H., Nadar, M. S., Alhajeri, S. S., Levine, M. P., & Jahrami, H. (2022). The prevalence and risk factors of screen-based disordered eating among university students: A global systematic review, meta-analysis, and meta-regression. Eating and Weight Disorders : EWD. Advance online publication. https://doi.org/10.1007/s40519-022-01452-0

Aparicio-Martinez, P., Perea-Moreno, A.‑J., Martinez-Jimenez, M. P., Redel-Macías, M. D., Pagliari, C., & Vaquero-Abellan, M. (2019). Social media, thin-ideal, body dissatisfaction and disordered eating attitudes: An exploratory analysis. International Journal of Environmental Research and Public Health, 16(21). https://doi.org/10.3390/ijerph16214177

Awad, G. H., Kashubeck-West, S., Bledman, R. A., Coker, A. D., Stinson, R. D., & Mintz, L. B. (2020). The role of enculturation, racial identity, and body mass index in the prediction of body dissatisfaction in African American women. Journal of Black Psychology, 46(1), 3–28. https://doi.org/10.1177/0095798420904273

Badrin, S., Daud, N., & Ismail, S. B. (2018). Body weight perception and weight loss practices among private college students in Kelantan State, Malaysia. Korean Journal of Family Medicine, 39(6), 355–359. https://doi.org/10.4082/kjfm.17.0132

Barker, E. T., & Galambos, N. L. (2007). Body dissatisfaction, living away from parents, and poor social adjustment predict binge eating symptoms in young women making the transition to university. Journal of Youth and Adolescence, 36(7), 904–911. https://doi.org/10.1007/s10964-006-9134-6

Barnes, M., Abhyankar, P., Dimova, E., & Best, C. (2020). Associations between body dissatisfaction and self-reported anxiety and depression in otherwise healthy men: A systematic review and meta-analysis. PloS One, 15(2), e0229268. https://doi.org/10.1371/journal.pone.0229268

Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56(6), 893–897. https://doi.org/10.1037/0022-006X.56.6.893

Brosof, L. C., & Levinson, C. A. (2017). Social appearance anxiety and dietary restraint as mediators between perfectionism and binge eating: A six month three wave longitudinal study. Appetite, 108, 335–342. https://doi.org/10.1016/j.appet.2016.10.015

Chin, Y. S., Appukutty, M., Kagawa, M., Gan, W. Y., Wong, J. E., Poh, B. K., Mohd Shariff, Z., & Mohd Taib, M. N. (2020). Comparison of factors associated with disordered eating between male and female Malaysian university students. Nutrients, 12(2). https://doi.org/10.3390/nu12020318

Deboer, L. B., & Smits, J. A. J. (2013). Anxiety and disordered eating. Cognitive Therapy and Research, 37(5), 887–889. https://doi.org/10.1007/s10608-013-9565-9

Delinsky, S. S., & Wilson, G. T. (2008). Weight gain, dietary restraint, and disordered eating in the freshman year of college. Eating Behaviors, 9(1), 82–90. https://doi.org/10.1016/j.eatbeh.2007.06.001

Edman, J. L., & Yates, A. (2004). Eating attitudes among college students in Malaysia: an ethnic and gender comparison. European Eating Disorders Review, 12(3), 190–196. https://doi.org/10.1002/erv.567

Fairburn, C. G. (2008). Cognitive behavior therapy and eating disorders. The Guilford Press.

Fischetti, F., Latino, F., Cataldi, S., & Greco, G. (2020). Gender differences in body image dissatisfaction: The role of physical education and sport. Journal of Human Sport and Exercise, 15(2). https://doi.org/10.14198/jhse.2020.152.01

Fitzsimmons-Craft, E. E. (2011). Social psychological theories of disordered eating in college women: Review and integration. Clinical Psychology Review, 31(7), 1224–1237. https://doi.org/10.1016/j.cpr.2011.07.011

Fydrich, T., Dowdall, D., & Chambless, D. L. (1992). Reliability and validity of the beck anxiety inventory. Journal of Anxiety Disorders, 6(1), 55–61. https://doi.org/10.1016/0887-6185(92)90026-4

Gerrard, O., Galli, N., Santurri, L., & Franklin, J. (2021). Examining body dissatisfaction in college men through the exploration of appearance anxiety and internalization of the mesomorphic ideal. Journal of American College Health : J of ACH, 69(5), 560–566. https://doi.org/10.1080/07448481.2019.1704412

Gitimu, P. N., Jameson, M. M., Turel, T., Pohle-Krauza, R [Rachel], Mincher, J., Rowlands, Z., & Elias, J. (2016). Appearance issues, depression, and disordered eating among college females. Cogent Psychology, 3(1), 1196512. https://doi.org/10.1080/23311908.2016.1196512

Godart, N. T., Flament, M. F., Curt, F., Perdereau, F., Lang, F., Venisse, J. L., Halfon, O., Bizouard, P., Loas, G., Corcos, M., Jeammet, P [Philippe], & Fermanian, J. (2003). Anxiety disorders in subjects seeking treatment for eating disorders: a DSM-IV controlled study. Psychiatry Research, 117(3), 245–258. https://doi.org/10.1016/S0165-1781(03)00038-6

Godart, N. T., Flament, M. F., Lecrubier, Y., & Jeammet, P [P.] (2000). Anxiety disorders in anorexia nervosa and bulimia nervosa: co-morbidity and chronology of appearance. European Psychiatry, 15(1), 38–45. https://doi.org/10.1016/S0924-9338(00)00212-1

Goldschmidt, A. B., Wall, M. M., Loth, K. A., & Neumark-Sztainer, D. (2015). Risk factors for disordered eating in overweight adolescents and young adults. Journal of Pediatric Psychology, 40(10), 1048–1055. https://doi.org/10.1093/jpepsy/jsv053

Goodwin, R. D., Weinberger, A. H., Kim, J. H [June H.], Wu, M., & Galea, S. (2020). Trends in anxiety among adults in the United States, 2008-2018: Rapid increases among young adults. Journal of Psychiatric Research, 130, 441–446. https://doi.org/10.1016/j.jpsychires.2020.08.014

Grogan, S. (2021). Body image: Understanding body dissatisfaction in men, women and children (Fourth edition). Routledge. https://doi.org/10.4324/9781003100041

Hart, T. A., Flora, D. B., Palyo, S. A., Fresco, D. M., Holle, C., & Heimberg, R. G. (2008). Development and examination of the social appearance anxiety scale. Assessment, 15(1), 48–59. https://doi.org/10.1177/1073191107306673

Hewitt, P. L., & Norton, G. R. (1993). The beck anxiety inventory: A psychometric analysis. Psychological Assessment, 5(4), 408–412. https://doi.org/10.1037/1040-3590.5.4.408

Juarascio, A. S., Perone, J., & Timko, C. A. (2011). Moderators of the relationship between body image dissatisfaction and disordered eating. Eating Disorders, 19(4), 346–354. https://doi.org/10.1080/10640266.2011.584811

Kamaria, K., Mohan, V., & Ayiesah, R. (2016). Body image perception, body shape concern and body shape dissatisfaction among undergraduates students. Jurnal Teknologi, 78(6-8), 37–42. http://eprints.bournemouth.ac.uk/34057/

Kaswadi, K. A. B., Malik, A., & Keat, O. B. (2018). Anxiety and academic achievement among undergraduate students. Journal of Management & Science, 16(2). http://mymedr.afpm.org.my/publications/86047

Kaye, W. H., Bulik, C. M., Thornton, L., Barbarich, N., & Masters, K. (2004). Comorbidity of anxiety disorders with anorexia and bulimia nervosa. The American Journal of Psychiatry, 161(12), 2215–2221. https://doi.org/10.1176/appi.ajp.161.12.2215

Keane, S., Clarke, M., McGrath, D., Farrelly, N., & MacHale, S. (2017). Eating disorder examination questionnaire (EDE-Q): Norms for female university students attending a university primary health care service in Ireland. Irish Journal of Psychological Medicine, 34(1), 7–11. https://doi.org/10.1017/ipm.2015.35

Kelly, N. R., Cotter, E. W., & Mazzeo, S. E. (2012). Eating disorder examination questionnaire (EDE-Q): Norms for Black women. Eating Behaviors, 13(4), 429–432. https://doi.org/10.1016/j.eatbeh.2012.09.001

Lavender, J. M., Young, K. P. de, & Anderson, D. A. (2010). Eating disorder examination questionnaire (EDE-Q): Norms for undergraduate men. Eating Behaviors, 11(2), 119–121. https://doi.org/10.1016/j.eatbeh.2009.09.005

Levinson, C. A., & Rodebaugh, T. L. (2015). Negative social evaluative fears produce social anxiety, food intake, and body dissatisfaction: Evidence of similar mechanisms through Different Pathways. Clinical Psychological Science : A Journal of the Association for Psychological Science, 3(5), 744–757. https://doi.org/10.1177/2167702614548891

Levinson, C. A., Rodebaugh, T. L., White, E. K., Menatti, A. R., Weeks, J. W., Iacovino, J. M., & Warren, C. S. (2013). Social appearance anxiety, perfectionism, and fear of negative evaluation: Distinct or shared risk factors for social anxiety and eating disorders? Appetite, 67, 125–133. https://doi.org/10.1016/j.appet.2013.04.002

Leyfer, O. T., Ruberg, J. L., & Woodruff-Borden, J. (2006). Examination of the utility of the Beck Anxiety Inventory and its factors as a screener for anxiety disorders. Journal of Anxiety Disorders, 20(4), 444–458. https://doi.org/10.1016/j.janxdis.2005.05.004

Loke, S. M. C., Rajikan, R., & Yahya, H. M. (2022). Body image perception and its association with food intake among undergraduate students in Kuala Lumpur, Malaysia. Makara Journal of Health Research, 26(2). https://doi.org/10.7454/msk.v26i2.1354

Mohamad, N. E., Sidik, S. M., Akhtari-Zavare, M., & Gani, N. A. (2021). The prevalence risk of anxiety and its associated factors among university students in Malaysia: A national cross-sectional study. BMC Public Health, 21(1), 438. https://doi.org/10.1186/s12889-021-10440-5

Myers, T. A., & Crowther, J. H. (2009). Social comparison as a predictor of body dissatisfaction: A meta-analytic review. Journal of Abnormal Psychology, 118(4), 683–698. https://doi.org/10.1037/a0016763

Nagata, J. M., Murray, S. B., Flentje, A., Compte, E. J., Schauer, R., Pak, E., Capriotti, M. R., Lubensky, M. E., Lunn, M. R., & Obedin-Maliver, J. (2020). Eating disorder attitudes and disordered eating behaviors as measured by the Eating Disorder Examination Questionnaire (EDE-Q) among cisgender lesbian women. Body Image, 34, 215–220. https://doi.org/10.1016/j.bodyim.2020.06.005

Nuttall, F. Q. (2015). Body mass index: Obesity, BMI, and health: A critical review. Nutrition Today, 50(3), 117–128. https://doi.org/10.1097/NT.0000000000000092

Ostrovsky, N. W., Swencionis, C., Wylie-Rosett, J., & Isasi, C. R. (2013). Social anxiety and disordered overeating: An association among overweight and obese individuals. Eating Behaviors, 14(2), 145–148. https://doi.org/10.1016/j.eatbeh.2013.01.009

Pawijit, Y., Likhitsuwan, W., Ludington, J., & Pisitsungkagarn, K. (2017). Looks can be deceiving: Body image dissatisfaction relates to social anxiety through fear of negative evaluation. International Journal of Adolescent Medicine and Health, 31(4). https://doi.org/10.1515/ijamh-2017-0031

Pidgeon, A., & A. Harker, R. (2013). Body-focused anxiety in women: Associations with internalization of the thin-ideal, dieting frequency, body mass index and media effects. Open Journal of Medical Psychology, 02(04), 17–24. https://doi.org/10.4236/ojmp.2013.24B004

Pingitore, R., Spring, B., & Garfield, D. (1997). Gender differences in body satisfaction. Obesity Research, 5(5), 402–409. https://doi.org/10.1002/j.1550-8528.1997.tb00662.x

Porras-Garcia, B., Ferrer-Garcia, M., Yilmaz, L., Sen, Y. O., Olszewska, A., Ghita, A., Serrano-Troncoso, E., Treasure, J., & Gutiérrez-Maldonado, J. (2020). Body-related attentional bias as mediator of the relationship between body mass index and body dissatisfaction. European Eating Disorders Review, 28(4), 454–464. https://doi.org/10.1002/erv.2730

Pritchard, M., Brasil, K., McDermott, R., & Holdiman, A. (2021). Untangling the associations between generalized anxiety and body dissatisfaction: The mediating effects of social physique anxiety among collegiate men and women. Body Image, 39, 266–275. https://doi.org/10.1016/j.bodyim.2021.10.002

Quick, V. M., & Byrd-Bredbenner, C. (2013). Eating disorders examination questionnaire (EDE-Q): Norms for US college students. Eating and Weight Disorders : EWD, 18(1), 29–35. https://doi.org/10.1007/s40519-013-0015-1

Regis, J. M. O., Ramos-Cerqueira, A. T. A., Lima, M. C. P., & Torres, A. R. (2018). Social anxiety symptoms and body image dissatisfaction in medical students: prevalence and correlates. Jornal Brasileiro De Psiquiatria, 67(2), 65–73. https://doi.org/10.1590/0047-2085000000187

Rodgers, R. F., Salès, P., & Chabrol, H. (2010). Psychological functioning, media pressure and body dissatisfaction among college women. European Review of Applied Psychology, 60(2), 89–95. https://doi.org/10.1016/j.erap.2009.10.001

Rounsefell, K., Gibson, S., McLean, S., Blair, M., Molenaar, A., Brennan, L., Truby, H., & McCaffrey, T. A. (2020). Social media, body image and food choices in healthy young adults: A mixed methods systematic review. Nutrition & Dietetics: The Journal of the Dietitians Association of Australia, 77(1), 19–40. https://doi.org/10.1111/1747-0080.12581

Sai, A., Othman, M. Y., Wan, Zaini, Wan, Fatihah Zaimah, Tan, C. S. Y., Mohamad Norzilan, N. I., Tomojiri, D., & Furusawa, T. (2018). Factors affecting body image perceptions of female college students in urban Malaysia. Obesity Medicine, 11, 13–19. https://doi.org/10.1016/j.obmed.2018.06.004

Sala, M., & Levinson, C. A. (2016). The longitudinal relationship between worry and disordered eating: Is worry a precursor or consequence of disordered eating? Eating Behaviors, 23, 28–32. https://doi.org/10.1016/j.eatbeh.2016.07.012

Sala, M., Shankar Ram, S., Vanzhula, I. A., & Levinson, C. A. (2020). Mindfulness and eating disorder psychopathology: A meta-analysis. The International Journal of Eating Disorders, 53(6), 834–851. https://doi.org/10.1002/eat.23247

Sanderson, T., & Haase, A. M. (2007). Does physical activity influence anxiety after pregnancy? Physical activity as a predictor of trait anxiety and social physique anxiety in postpartum women. Journal of Sport & Exercise Psychology, 29, S200-S201. https://search.ebscohost.com/login.aspx?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=08952779&an=25216463&h=8cnk3kvsnfmhqrmksidaxhxhof8y43c01ma1kwm9c7jdfyepsf5cq8nk8un%2bwibgzhv0n2ymlhijo2q4z0odsa%3d%3d&crl=c

Shagar, P. S., Donovan, C. L., Boddy, J., Tapp, C., Lee, P., & Harris, N. (2021). Body dissatisfaction, weight-related behaviours, and health behaviours: A comparison between Australian and Malaysian in female emerging adults. Behaviour Change, 38(3), 148–163. https://doi.org/10.1017/bec.2021.9

Shagar, P. S., Donovan, C. L., Loxton, N., Boddy, J., & Harris, N. (2019). Is thin in everywhere? A cross-cultural comparison of a subsection of Tripartite Influence Model in Australia and Malaysia. Appetite, 134, 59–68. https://doi.org/10.1016/j.appet.2018.12.025

Smolak, L., & Murnen, S. K. (2008). Drive for leanness: Assessment and relationship to gender, gender role and objectification. Body Image, 5(3), 251–260. https://doi.org/10.1016/j.bodyim.2008.03.004

Soh, N. L., Touyz, S. W., & Surgenor, L. J. (2006). Eating and body image disturbances across cultures: a review. European Eating Disorders Review, 14(1), 54–65. https://doi.org/10.1002/erv.678

Solmi, M., Radua, J., Olivola, M., Croce, E., Soardo, L., Salazar de Pablo, G., Il Shin, J., Kirkbride, J. B., Jones, P., Kim, J. H [Jae Han], Kim, J. Y., Carvalho, A. F., Seeman, M. V., Correll, C. U., & Fusar-Poli, P. (2022). Age at onset of mental disorders worldwide: Large-scale meta-analysis of 192 epidemiological studies. Molecular Psychiatry, 27(1), 281–295. https://doi.org/10.1038/s41380-021-01161-7

Stice, E., Maxfield, J., & Wells, T. (2003). Adverse effects of social pressure to be thin on young women: An experimental investigation of the effects of "fat talk". International Journal of Eating Disorders, 34(1), 108–117. https://doi.org/10.1002/eat.10171

Stice, E., & Shaw, H. E. (2002). Role of body dissatisfaction in the onset and maintenance of eating pathology. Journal of Psychosomatic Research, 53(5), 985–993. https://doi.org/10.1016/S0022-3999(02)00488-9

Striegel-Moore, R. H., & Bulik, C. M. (2007). Risk factors for eating disorders. The American Psychologist, 62(3), 181–198. https://doi.org/10.1037/0003-066X.62.3.181

Swami, V., Frederick, D. A., Aavik, T., Alcalay, L., Allik, J., Anderson, D., Andrianto, S., Arora, A., Brännström, A., Cunningham, J., Danel, D., Doroszewicz, K., Forbes, G. B., Furnham, A., Greven, C. U., Halberstadt, J., Hao, S., Haubner, T., Hwang, C. S., . . . Zivcic-Becirevic, I. (2010). The attractive female body weight and female body dissatisfaction in 26 countries across 10 world regions: Results of the international body project I. Personality & Social Psychology Bulletin, 36(3), 309–325. https://doi.org/10.1177/0146167209359702

Terhoeven, V., Nikendei, C., Bärnighausen, T., Bountogo, M., Friederich, H.‑C., Ouermi, L., Sié, A., & Harling, G. (2020). Eating disorders, body image and media exposure among adolescent girls in rural Burkina Faso. Tropical Medicine & International Health : TM & IH, 25(1), 132–141. https://doi.org/10.1111/tmi.13340

Thompson, A. J., Poyrazli, S., & Miller, E. (2020). Western media and body image dissatisfaction in young women in developing nations. Eurasian Journal of Educational Research. https://eric.ed.gov/?id=ej1284508

Thompson, J. K. (1999). Exacting beauty: Theory, assessment, and treatment of body image disturbance / J. Kevin Thompson … [et al.]. American Psychological Association. https://doi.org/10.1037/10312-000

Thompson, M. A., & Gray, J. J. (1995). Development and validation of a new body-image assessment scale. Journal of Personality Assessment, 64(2), 258–269. https://doi.org/10.1207/s15327752jpa6402_6

Toledano-Toledano, F., La Moral de Rubia, J., Domínguez-Guedea, M. T., Nabors, L. A., Barcelata-Eguiarte, B. E., Rocha-Pérez, E., Luna, D., Leyva-López, A., & Rivera-Rivera, L. (2020). Validity and reliability of the beck anxiety inventory (BAI) for family caregivers of children with cancer. International Journal of Environmental Research and Public Health, 17(21). https://doi.org/10.3390/ijerph17217765

Turel, T., Jameson, M., Gitimu, P., Rowlands, Z., Mincher, J., & Pohle-Krauza, R [Rachael] (2018). Disordered eating: Influence of body image, sociocultural attitudes, appearance anxiety and depression - a focus on college males and a gender comparison. Cogent Psychology, 5(1), 1483062. https://doi.org/10.1080/23311908.2018.1483062

Wardle, J., Haase, A. M., & Steptoe, A. (2006). Body image and weight control in young adults: International comparisons in university students from 22 countries. International Journal of Obesity (2005), 30(4), 644–651. https://doi.org/10.1038/sj.ijo.0803050

Wong, L.‑M., & Say, Y.‑H. (2013). Gender differences in body image perception among northern Malaysian tertiary students. British Journal of Medicine and Medical Research, 3(3), 727–747. https://doi.org/10.9734/bjmmr/2013/3069

Yean, C., Benau, E. M., Dakanalis, A., Hormes, J. M., Perone, J., & Timko, C. A. (2013). The relationship of sex and sexual orientation to self-esteem, body shape satisfaction, and eating disorder symptomatology. Frontiers in Psychology, 4, 887. https://doi.org/10.3389/fpsyg.2013.00887

Published
2023-03-28
Section
Articles