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David Greenfeld, M.D. is Assistant Clinical Professor of Psychiatry, Yale University School of
Medicine, and Medical Director, Adolescent and Young Adult Treatment Unit, Yale-New
Haven Hospital. L)onald M. Quinlan, W.D. is Professor of Psychiatry and Psychology, Yale
University School of Medicine. Pamela Harding, MA. is Associate in Research, Department
of Psychiatry, Yale University School of Medicine. Elaine Glass, MAW. is Assistant Clinical
Professor of Psychiatry (Social Work), Yale University School of Medicine, Director, Inpatient
Psychiatric Social Work, Yale-New Haven Hospital. Anne Bliss, MAW. is Assistant Clinical
Professor, Department of Medicine (Social Work), Yale University School of Medicine. Ad-
dress reprint requests to David Creenfeld, M.D., Yale New Haven Hospital, 20 York Street,
New Haven, CT 06504.
INTRODUCTION
METHOD
Procedure
The questionnaire employed an adaptation of the one used by Halmi
et al. (1981). The questionnaire was modified for administration in
anonymous form. All the original questions were included; 18 ques-
tions were added at the end to ascertain in detail symptoms and be-
havior mentioned in the DSM 111 diagnosis of anorexia nervosa and
bulimia. The resulting questionnaire (see Appendix I) consisted of 38
questions for all subjects, with three additional questions for female
respondents regarding menstrual function. Each subject was given the
option of extending answers and providing comments at the end of the
questionnaire.
The study was completed with the assistance of school administra-
tion and faculty. All students were instructed to attend one of the two
sessions immediately following the evening meal: one group for 11th
and 12th grade, the second for 9th and 10th grade. The two sessions
were 1 week apart. A school dean addressed each session, explaining
the role of the investigators and assuring the anonymity of the respon-
dent. During the session, school faculty and student monitors assisted
in the data collection. The questionnaires were completed in a large
building used principally for a chapel but also the normal site for large
school meetings. Students were required to spend a minimum amount
Adolescent Eating Behavior 103
of time (20 minutes), after which those wishing to could leave. No sub-
ject took more than 45 minutes; the majority were completed within
20-30 minutes. One limitation of the data was the proximity of stu-
dents to each other, probably restricting the reporting of more unusual
and pathological responses.
RESULTS
The study data revealed a widespread concern with the subject pop-
ulation with weight, body image, dieting, and eating behaviors (Table
1). Although present in both sexes, these concerns were significantly
more marked in female subjects. Large and sigruficant sex differences
occurred on questions regarding concerns about eating disorders: feel-
ing "fat," describing onself as overweight; using diets, crash diets, and
diet pills for weight control; losing 10 lb or more over the previous
year; consulting a physician for a weight related eating problem; and
counting calories one or more times daily. It is particularly interesting
to note that, although 46% of women and 17%of men described them-
selves as overweight, fewer women than men reported weights that
Females Males XZ
* p < .05.
**p < .01.
***p < .001.
104 Greenfeld et al.
weights that placed them more than 10% above the ideal weight for
their height, age, and sex. (p < 0.01)
No subjects met the DSM I11 criteria for anorexia nervosa. The school
health authorities were aware of three female students diagnosed as
suffering from anorexia nervosa who were temporarily out of school
and not included in this subject population and six female students
regarded as "possibly anorectic." In our sample there were 13 female
subjects and 17 male subjects between 75% and 80% of ideal body
weight. Six of the female subjects in the group and none of the male
subjects in this weight range reported that they often "felt fat": x2 (1)
= 9.81 (p < 0.01). There were 44 female subjects (13.5% of females)
who reported secondary amenorrhea associated with weight loss.
Bulimic behaviors were also common in both sexes but were signifi-
cantly more prevalent in female subjects (Table 2). There were 44.6%
of female subjects and 16.4% of male subjects who described more se-
rious binge eating behaviors, e.g., "uncontrollable urges to eat and eat
until they felt physically ill." Smaller percentages of subjects acknowl-
edged self-induced vomiting, laxative abuse, and diuretic abuse. Large
and significant sex differences occurred in all the bulimic symptoms.
Despite the prevalence of bulimic behavior, comparatively few sub-
jects had a pattern of responses suggesting that they met DSM 111 cri-
teria for bulimia (Table 3). Thus, if DSM 111 criteria are applied
rigorously (including at least weekly binge eating), 0.8% of males and
4.0% of females responded in ways that suggested they might meet
Female Male X2
Table 3. Bulimics.
Females Males
criteria for bulimia. If DSM 111 criteria are modified, maintaining a re-
quirement for at least weekly binging and excluding criterion C (aware-
ness that the eating pattern is abnormal and fear of not being able to
stop eating voluntarily), the number of women whose responses sug-
gested they met DSM 111 criteria for bulimia is doubled (8.4%). If crite-
rion "C" is excluded and only monthly binging is required, the number
of affected females is again nearly doubled (14.1%).
In both sexes atypical eating behaviors generally were more highly
correlated with students' subjective weight opinion than with the ac-
tual degree of under- or overweight (expressed as a percent of ideal
weight for age and height). Correlations with weight opinion were sig-
nificant for a majority of variables in female subjects (Table 4), far more
than would be expected by chance with the number of variables.
DISCUSSION
Percent Percent
Ideal Weight Ideal Weight
Weight Opinion Weight Opinion
REFERENCES
Abraham, S. F., Mira, M.,Beumont, P. J. V., Sowerbutts, T. D., & Llewellyn-Jones, D.
(1983).Eating behaviors among young women. Medical Journal of Australia, 2,225-228.
Button, E. J. & Whitehouse, A. (1981). Subclinical anorexia anorexia. Psychological Medi-
cine, 11, 509-516.
Clarke, M. G. & Palmer, R. L. (1983). Eating attitudes and symptoms in university stu-
dents. British Jouml of Psychiatry, 142, 299-304.
Crowther, J. H., Post, G.,& Zaynor, L. (1985). The prevalence of bulimia and binge
eating in adolescent girls. Znternatiaal Journal of Eating Disorders, 4 , 29-42.
Dwyer, J. T., Feldman, J. J., & Mayer, J. (1%7). Adolescent dieters: W h o are they: Amer-
ican Journal of Clinical Nutrition, 20, 1045-1056.
Fairbum, C. G., & Cooper, P. J. (1983). Epidemiology of bulimia two community studies.
International Journal of Eating Disorders, 2(4), 61-67.
Gamer, D. M.,& Garfinkle, P. E. (1979). The Eating Attitudes Test. Psychological Medi-
cine, 9, 273-279.
Grey, J. J., & Ford, K. (1985). The incidence of bulimia in a college sample. International
Journal of Eating Disorders, 4, 201-210.
Halmi, K. A., Falk, J. R., & schwartz, E. (1981). Binge eating and vomiting: a survey of
a college population. Psychological Medicine, 11,697-706.
Hawkins, R. C., & Clement, P. F. (1980). Development and construction validation of a
self-report measure of binge tendencies. Addicfive Behaviors, 5, 219-226.
Huenemann, R. L., Shapiro, L. R., Hampton, M. C., & Mitchel, B. W. (1966).A longi-
tudinal study of gross body composition and body conformation and their association
with food and activity in a teenage population. American Journal of Clinical Nutrition,
18,325338.
Katzman, M. A., Wolchick, S. A., & Braver, S. L. (1984). The prevalence of frequent
binge eating and bulimia in a nonclinical college sample. International Journal of Eating
Disorders, 3(3), 53-62.
Miller, B. F., & Keane, C. B. (1983). Encyclopedia and dictionary of medicine, nursing, and
allied health, 3rd ed. Philadelphia: W. B. Saunders, Co.
Nevo, S. (1985). Bulimic symptoms: Prevalence and ethnic differences among college
women. International Journal of Eating Disorders, 4(2), 151-168.
Nylander, I (1971). The feeling of being fat and dieting in a school population: An epi-
demiologic investigation. Acta Socio-Medica Scandinavica, I, 17-26.
Pope, H. C., Hudson, J. I., & Yurgelun-Todd, D. (1984).Anorexia nervosa and bulimia
among 300 surburban women shoppers. American Journal of Psychiatry, 242(2), 292-
294.
Pyle, R. L., Mitchell, J. E., Eckert, E. D., Halvorson, P. A., Neuman, P. A., & Goff, G.
M.(1983). The incidence of bulimia in freshmen college students. International Iournal
of Eating Disorders 2(3), 75-65.
Stangler, R. S., & Printz, A. M. (1980). DSM IIk Psychiatric diagnosis in a university
population. American Journal of Psychiahy, 137(8), 937-940.