Factors Affecting Self-Image in Patients with a Diagnosis of Eating Disorders on the Basis of a Cluster Analysis

Authors

  • Maciej Wojciech Pilecki Department of Child and Adolescent Psychiatry, Jagiellonian University Medical College, ul. Kopernika 21a, 31-501 Krakow, Poland
  • Kinga Sałapa Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, ul. Św. Łazarza 16, 31-530 Krakow, Poland
  • Barbara Józefik Laboratory of Psychology and Systemic Psychotherapy, Department of Child and Adolescent Psychiatry, Jagiellonian University Medical College, ul. Kopernika 21a, 31-501 Krakow, Poland

DOI:

https://doi.org/10.6000/1929-6029.2013.02.04.3

Keywords:

Anorexia, bulimia, QSIA, DATA MINING, cluster analysis

Abstract

The aim of this study was to assess the relationship between self-image in eating disorders and age, duration and severity of the disorder, comorbidity, depressiveness and self-evaluation of eating problems. The results of the Offer self-image questionnaire for adolescents (QSIA) were compared in four groups: anorexia nervosa restrictive subtype (ANR, n: 47), anorexia nervosa binge/purge subtype (ANBP, n: 16), bulimia nervosa (BUL, n: 34) and eating disorders NOS (EDNOS, n: 19). The control group was age matched female pupils (NOR, n = 76). The Kruskal-Wallis test revealed significant differences between the age of patients from the ANR (16.34, SD 1.58) and BUL (17.56, SD 0.96) groups (p = .008). The self-image of schoolgirls from the NOR group was on most scales significantly better than the self-image of girls from clinical groups. On four scales differences between the (better) self-image in the ANR group and that in the BUL group were observed. Next, a cluster analysis using a generalised k-means algorithm with v-fold cross validation of QSIA questionnaire results was conducted in the group of clinical eating disorders (ANR, ANBP, and BUL). Three clusters were obtained. The first was characterized by very good self-image (above the average for the general population), the second by poor self-image and the third by negative self-image. Severity of depressiveness measured using the Beck Depression Inventory turned out to be the only factor which differentiated the clusters of self-image in eating disorders.

Author Biographies

Maciej Wojciech Pilecki, Department of Child and Adolescent Psychiatry, Jagiellonian University Medical College, ul. Kopernika 21a, 31-501 Krakow, Poland

Department of Child and Adolescent Psychiatry

Kinga Sałapa, Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, ul. Św. Łazarza 16, 31-530 Krakow, Poland

Department of Bioinformatics and Telemedicine

Barbara Józefik, Laboratory of Psychology and Systemic Psychotherapy, Department of Child and Adolescent Psychiatry, Jagiellonian University Medical College, ul. Kopernika 21a, 31-501 Krakow, Poland

Laboratory of Psychology and Systemic Psychotherapy, Department of Child and Adolescent Psychiatry

References

Koenig L, Howard KI, Offer D, Cremerius M. Psychopathology and adolescent self-image. New Dir Ment Health Serv 1984; 22: 57-71. http://dx.doi.org/10.1002/yd.23319842207 DOI: https://doi.org/10.1002/yd.23319842207

Fairburn CG, Cooper Z, Doll HA, Welch SL. Risk factors for anorexia nervosa: three integrated cases – control comparison. Arch Gen Psychiatry 1999; 56: 468-76. http://dx.doi.org/10.1001/archpsyc.56.5.468 DOI: https://doi.org/10.1001/archpsyc.56.5.468

Stice E, Marti CN, Durat S. Risk factors for onset of eating disorders: evidence of multiple risk pathways from an 8-year prospective study. Behav Res Ther 2011; 49: 622-7. http://dx.doi.org/10.1016/j.brat.2011.06.009 DOI: https://doi.org/10.1016/j.brat.2011.06.009

Ghaderi A, Scott B. Prevalence, incidence and prospective risk factors for eating disorders. Acta Psychiatr Scand 2001; 104: 122-30. http://dx.doi.org/10.1034/j.1600-0447.2001.00298.x DOI: https://doi.org/10.1034/j.1600-0447.2001.00298.x

Stice E, Ng J, Shaw H. Risk factors and prodromal eating pathology. J Child Psychol Psychiatry 2010; 51: 518-25. http://dx.doi.org/10.1111/j.1469-7610.2010.02212.x DOI: https://doi.org/10.1111/j.1469-7610.2010.02212.x

Beato-Fernández L, Rodríguez-Cano T, Belmonte-Llario A, Martínez-Delgado C. Risk factors for eating disorders in adolescents. A Spanish community-based longitudinal study. Eur Child Adolesc Psychiatry 2004; 13: 287-94. http://dx.doi.org/10.1007/s00787-004-0407-x DOI: https://doi.org/10.1007/s00787-004-0407-x

APA. Diagnostic and Statistical Manual of Mental Disorders DSM-IV. Washington: APA 1994.

Björck C, Björk T, Clinton D, Sohlberg S, Norring C. Self-image and treatment drop-out in eating disorders. Psychol Psychother: Theory Res Pract 2008; 81: 95-104. http://dx.doi.org/10.1348/147608307X224547 DOI: https://doi.org/10.1348/147608307X224547

Vaz FJ. Outcome of bulimia nervosa: prognostic indicators. J Psychosom Res 1998; 45: 391-400. http://dx.doi.org/10.1016/S0022-3999(98)00017-8 DOI: https://doi.org/10.1016/S0022-3999(98)00017-8

Birgegård A, Björck C, Norring C, Sohlberg S, Clinton D. Anorexic self-control and bulimic self-hate: differential outcome prediction from initial self-image. Int J Eat Disord 2009; 42: 522-30. http://dx.doi.org/10.1002/eat.20642 DOI: https://doi.org/10.1002/eat.20642

Halvorsen L, Heyerdahl S. Girls with anorexia nervosa as young adults: personality, self-esteem, and life satisfaction. Int J Eat Disord 2006; 39: 285-93. http://dx.doi.org/10.1080/13504620802613504 DOI: https://doi.org/10.1002/eat.20248

Ewert A, Galloway G. Socially desirable responding in an environmental context: development of a domain specific scale. Envir Educ Res 2009; 1: 55-70. http://dx.doi.org/10.1080/13504620802613504 DOI: https://doi.org/10.1080/13504620802613504

Vandereycken W. Denial of illness in anorexia nervosa—a conceptual review: part 1. Diagnostic significance and assessment. Eur Eat Disord Rev 2006; 14: 341-51. http://dx.doi.org/10.1002/erv.721 DOI: https://doi.org/10.1002/erv.721

Pilecki M, Józefik B. Związek depresyjności z obrazem siebie u dziewcząt z różnymi typami zaburzeń odżywiania się. Psychiatr Psychol Klin 2009; 9: 233-41 [in Polish].

Bizeul C, Brun JM, Rigaud D. Depression influences the EDI scores in anorexia nervosa patients. Eur Psychiatry 2003; 18: 119-23. http://dx.doi.org/10.1016/S0924-9338(03)00033-6 DOI: https://doi.org/10.1016/S0924-9338(03)00033-6

Giel KE, Wittorf A, Wolkenstein L, et al. Is impaired set-shifting a feature of “pure” anorexia nervosa? Investigating the role of depression in set-shifting ability in anorexia nervosa and unipolar depression. Psychiatry Res 2012; 200: 538-43. http://dx.doi.org/10.1016/j.psychres.2012.06.004 DOI: https://doi.org/10.1016/j.psychres.2012.06.004

Brockmeyer T, Holtforth MG, Bents H, Kämmerer A, Herzog W, Friedrich HC. The thinner the better: self-esteem and low body weight in anorexia nervosa.. Clin Psychol Psychother 2013; 20(5): 394-400. http://dx.doi.org/10.1002/cpp.1771 DOI: https://doi.org/10.1002/cpp.1771

Webster J, Tiggemann M. The relationship between women's body satisfaction and self-image across the life span: the role of cognitive control. J Genet Psychol 2003; 164: 241-52. http://dx.doi.org/10.1080/00221320309597980 DOI: https://doi.org/10.1080/00221320309597980

Casper RC, Offer D, Ostrov E. The self-image of adolescents with acute anorexia nervosa. J Pediatr 1981; 98: 656-61. http://dx.doi.org/10.1016/S0022-3476(81)80789-5 DOI: https://doi.org/10.1016/S0022-3476(81)80789-5

McCarthy JD, Hoge DR. Analysis of age effects in longitudinal studies of adolescent self-esteem. Dev Psychol 1982; 18: 372-79. http://dx.doi.org/10.1037/0012-1649.18.3.372 DOI: https://doi.org/10.1037/0012-1649.18.3.372

O’Dea JA, Caputi P. Association between socioeconomic status, weight, age and gender, and the body image and weight control practices of 6- to 19-year-old children and adolescents. Health Educ Res 2001; 16: 521-32. http://dx.doi.org/10.1093/her/16.5.521 DOI: https://doi.org/10.1093/her/16.5.521

Offer D, Ostrov E, Howard KI. A manual for the Offer Self-Image Questionnaire for Adolescents. Chicago: Michael Reese Hospital and Medical Center 1982.

Offer D, Ostrov E, Howard KI. The adolelscent: a psychological self-portrait. New York: Basic Books 1981.

Badura-Madej W, Ulasińska R, Wolska M. Kwestionariusz Daniela Offera „Obraz siebie”. Podręcznik – wersja polska (nieopublikowana). Kraków; 1986-1990 (The Offer Self-Image Questionaire for Adolescents. A manual – Polish version, unpublished. Kraków: 1986–1990.) [in Polish].

Badura-Madej W, Bomba J, Hagman H, Klenberg L, Ulasińska R. Self-image of adolescents and adolescent depression. Comparative study of Finnish and Polish adolescents. 10 Sympozjum Sekcji Naukowej Psychiatrii Dzieci i Młodzieży Polskiego Towarzystwa Psychiatrycznego. Współczesne dzieciństwo i adolescencja. Materiały Konferencyjne. 1988; Kraków [in Polish].

Garner DM, Garfinkel PE. The Eating Attitudes Test: an index of the symptoms of anorexia nervosa. Psychol Med 1979; 9: 273-9. http://dx.doi.org/10.1017/S0033291700030762 DOI: https://doi.org/10.1017/S0033291700030762

Włodarczyk-Bisaga K, Dolan B, McCluskey S, Lacey H. Disordered eating behaviour and attitudes towards weight and shape in Polish women. Eur Eat Disord Rev 1995; 3: 205-16. http://dx.doi.org/10.1002/erv.2400030403 DOI: https://doi.org/10.1002/erv.2400030403

Włodarczyk-Bisaga K, Dolan B. A two-stage epidemiological study of abnormal eating attitudes and their prospective risk factors in Polish schoolgirls. Psychol Med 1996; 26: 1021-32. http://dx.doi.org/10.1017/S0033291700035340 DOI: https://doi.org/10.1017/S0033291700035340

Beck T, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961; 4: 561-71. http://dx.doi.org/10.1001/archpsyc.1961.01710120031004 DOI: https://doi.org/10.1001/archpsyc.1961.01710120031004

Parnowski T, Jernajczyk W. Inwentarz Depresji Becka w ocenie nastroju osób zdrowych i chorych na choroby afektywne. Psychiatr Pol 1977; 11: 417-21 [in Polish].

Pilecki M. Rozpowszechnienie zaburzeń odżywiania się w populacji uczennic klas pierwszych krakowskich szkół ponadpodstawowych. Nieopublikowna praca doktorska. Kraków: Uniwersytet Jagielloński, Collegium Medicum; 1999. (Prevalence of eating disorders in the population of Kraków high school first grade school girls. Unpublished doctoral thesis. Kraków: Jagiellonian University 1999) [in Polish].

Cooper Z, Fairburn CG. The eating disorder examination: a semi structured interview for the assessment of the specific psychopathology of eating disorders. Int J Eat Disord 1987; 6: 1-8. http://dx.doi.org/10.1002/1098-108X(198701)6:1<1::AID-EAT2260060102>3.0.CO;2-9 DOI: https://doi.org/10.1002/1098-108X(198701)6:1<1::AID-EAT2260060102>3.0.CO;2-9

Salapa K, Kalinowska B, Jadczyk T, Roterman I. Measurement of hydrophobicity distribution in proteins — non-redundant protein data bank. Bio-Algorithms Med-System, 2012; 8: 327-38. DOI: https://doi.org/10.2478/bams-2012-0023

Salapa K, Kalinowska B, Jadczyk T, Roterman I. Measurement of hydrophobicity distribution in proteins – complete redundant protein data bank. Bio-Algorithms Med-System, 2012; 8: 195-206. DOI: https://doi.org/10.2478/bams-2012-0018

Mintz L, O’Halloran S, The Eating Attitudes Test: Validation with DSM-IV eating disorder criteria. J Per Assess 2000; 3: 489-503. http://dx.doi.org/10.1207/S15327752JPA7403_11 DOI: https://doi.org/10.1207/S15327752JPA7403_11

Cramer P. Protecting the self: defense mechanisms in action. New York: Guilford Press 2006; 384.

Peat C, Mitchell JE, Hoek HW, Wonderlich SA. Validity and utility of subtyping anorexia nervosa. Int J Eat Disord 2009; 42: 590-4. http://dx.doi.org/10.1002/eat.20717 DOI: https://doi.org/10.1002/eat.20717

Fairburn CG, Cooper Z. Eating disorders, DSM–5 and clinical reality. Br J Psychiatry 2011; 198: 8-10. http://dx.doi.org/10.1192/bjp.bp.110.083881 DOI: https://doi.org/10.1192/bjp.bp.110.083881

Wildes JE, Marcus MD. Alternative methods of classifying eating disorders: Models incorporating comorbid psychopathology and associated features. Clin Psychol Rev 2013; 33: 383-94. http://dx.doi.org/10.1016/j.cpr.2013.01.006 DOI: https://doi.org/10.1016/j.cpr.2013.01.006

Bravender T, Bryant-Waugh R, Herzog D, et al. Classification of eating disturbance in children and adolescents: proposed changes for the DSM-V. Eur Eat Disord Rev 2010; 18: 79-89. http://dx.doi.org/10.1002/erv.994 DOI: https://doi.org/10.1002/erv.994

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Published

2013-10-31

How to Cite

Pilecki, M. W., Sałapa, K., & Józefik, B. (2013). Factors Affecting Self-Image in Patients with a Diagnosis of Eating Disorders on the Basis of a Cluster Analysis. International Journal of Statistics in Medical Research, 2(4), 263–274. https://doi.org/10.6000/1929-6029.2013.02.04.3

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General Articles