Eating disorders and anxiety among high school students in Western area of Turkey

Egemen Unal, Resat Aydin, Mehmet Enes Gokler, Alaettin Unsal


Background Eating disorders (ED) are the one of the most common chronic illness among adolescents. The aim of the present study was to investigate eating disorders and it's associations between anxiety among high school students in Sivrihisar in Eskisehir, Turkey.

Methods: This cross-sectional study was carried out in the high school students of center of Sivrihisar between 01 January 2014 and 28 February 2014. The questionnaire prepared according to literature, consisting of 3 parts (socio-demographic characteristics, eating attitude test (EAT-40) and beck anxiety inventory (BAI)). The students completed questionnaire in the presence of a member of the research team. The data collected were self-reported by the students.

Results: Of the study group 64.4% (n=625) were females and 35.6% (n=345) were males. The prevalence of eating disorder was 13.0% (n=126). The mean and standard deviation of students' total score of EAT-40 were 18.80±9.88 (ranged 3 to 95).  The mean and standard deviation of students' total score of BAI were 20.32±12.32 (ranged 0 to 63). The positive weak correlation was found between the total scores of EAT-40 and BAI (r=0.178; p=0.001).

Conclusions: ED is an important health problem for adolescents. On the studies upon epidemiology of ED towards high school students, socio-economic factors should be assessed in more detailed and more comprehensive perspective.



Eating disorder, Anxiety, High school student

Full Text:



Patton G, Selzer R, Coffey C, Carlin J, Wolfe R. Onset of adolescent eating disorders: population based cohort study over 3 years. BMJ. 1999;318 (7186):765-8.

Herpertz-Dahlmann B, Hagenah U, Vloet T, Holtkamp K. (2005) Adolescent eating disorders, Praxis der Kinderpsychologie und Kinderpsychiatrie. 2005;54(4):248-67.

Kaye WH, Bulik CM, Thornton L, Barbarich N, Masters K, Group PFC. Comorbidity of anxiety disorders with anorexia and bulimia nervosa. American Journal of Psychiatry. 2004 (PMID:15569892)

Tanofsky-Kraff M, Goossens L, Eddy KT, Ringham R, Goldschmidt A, Yanovski SZ, Braet C, Marcus MD, Wilfley DE, Olsen C. A multisite investigation of binge eating behaviors in children and adolescents. Journal of consulting and clinical psychology. 2007;75(6):901.

First MB. Diagnostic and statistical manual of mental disorders. DSM IV-4th edition APA:1994.

Fairburn CG, Harrison PJ. (2003) Eating disorders. The Lancet. 2003;361(9355):407-16.

Hudson JI, Hiripi E, Pope HG, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological psychiatry. 2007;61(3):348-58.

Killen JD, Hayward C, Litt I, Hammer LD, Wilson DM, Miner B, Taylor CB, Varady A, Shisslak C. Is puberty a risk factor for eating disorders? American Journal of Diseases of Children. 1992;146(3):323-5.

Murnen SK, Smolak L. Gender and Eating Disorders. The Wiley Handbook of Eating Disorders. 2015;352-66.

Striegel‐Moore RH, Rosselli F, Perrin N, DeBar L, Wilson GT, May A, Kraemer HC. Gender difference in the prevalence of eating disorder symptoms. International Journal of Eating Disorders. 2009;42(5):471-4.

Hoek HW, Van Hoeken D. Review of the prevalence and incidence of eating disorders. International Journal of eating disorders. 2003;34 (4):383-96.

Thogersen-Ntoumani C, Ntoumanis N, Nikitaras N. Unhealthy weight control behaviours in adolescent girls: A process model based on self-determination theory. Psychology and Health. 2010;25(5):535-50.

Ong SH, Wickramaratne P, Tang M, Weissman MM. Early childhood sleep and eating problems as predictors of adolescent and adult mood and anxiety disorders. Journal of affective disorders. 2006;96 (1):1-8.

Levinson CA, Rodebaugh TL. Social anxiety and eating disorder comorbidity: The role of negative social evaluation fears. Eating behaviors. 2012;13 (1):27-35.

Dakanalis A, Carrà G, Calogero R, Zanetti MA, Volpato C, Riva G, Clerici M, Cipresso P. (2016) The Social Appearance Anxiety Scale in Italian adolescent populations: Construct validation and group discrimination in community and clinical eating disorders samples. Child Psychiatry & Human Development. 2016;47(1):133-50.

Hofmann SG, DiBartolo PM. Social anxiety: Clinical, developmental, and social perspectives. Elsevier.

Godart N, Perdereau F, Rein Z, Berthoz S, Wallier J, Jeammet P, Flament M. Comorbidity studies of eating disorders and mood disorders. Critical review of the literature. Journal of affective disorders. 2007;97(1):37-49.

Johnson JG, Cohen P, Kasen S, Brook JS. Eating disorders during adolescence and the risk for physical and mental disorders during early adulthood. Archives of general psychiatry. 2002;59 (6):545-52.

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. Psychological bulletin. 2004;130(1):19

Brendel K. A systematic review and meta-analysis of the effectiveness of child-parent interventions for children and adolescents with anxiety disorders. (2011). Dissertations. Paper 249.

O'Brien KM, Vincent NK.) Psychiatric comorbidity in anorexia and bulimia nervosa: nature, prevalence, and causal relationships. Clinical psychology review. 2003;23(1):57-74.

TÜİK ADNKS Veri Tabanı, Şehir, belde ve köy nüfusları-2011 (Erişim tarihi: 16.03. 2012).

Garner DM, Garfinkel PE. The Eating Attitudes Test: An index of the symptoms of anorexia nervosa. Psychological medicine. 1979;9(2):273-9.

Erol N, Savasir I. Eating attitude test: An index of anorexia nervosa symptoms. Turkish Journal of Psychology. 1989;23:132-6.

Beck AT, Steer RA, Carbin MG. (1988) Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical psychology review. 1988;8(1):77-100.

Ulusoy M, Sahin N, Erkmen H. Turkish version of the Beck Anxiety Inventory: psychometric properties. Journal of cognitive psychotherapy. 1998;12(2):163-72.

Tolonen H, Kuulasmaa K, Laatikainen T, Wolf H. Recommendation for indicators, international collaboration, protocol and manual of operations for chronic disease risk factor surveys. Project EHRM, European Health Risk Monitoring Project www-publications from the EHRM Project Helsinki, Finland: National Public Health Institute. 2002.

Garrouste-Orgeas M, Troché G, Azoulay E, Caubel A, de Lassence A, Cheval C, Montesino L, Thuong M, Vincent F, Cohen Y. Body mass index. Intensive care medicine. 2004;30(3):437-43.

Tozun M, Unsal A, Ayranci U, Arslan G. (2010) Prevalence of disordered eating and its impact on quality of life among a group of college students in a province of west Turkey. Salud publica de Mexico. 2010;52(3):190-8.

Berkman ND. Center RI-UoNCE-bP (2006) Management of eating disorders. Agency for Healthcare Research and Quality Rockville, Md.

le Grange D, Louw J, Russell B, Nel T, Silkstone C. Eating attitudes and behaviours in South African adolescents and young adults. Transcultural psychiatry. 2006;43(3):401-7.

Morandé G, Celada J, Casas JJ. (1999) Prevalence of eating disorders in a Spanish school-age population. Journal of Adolescent Health. 1999;24 (3):212-9.

Kirkcaldy B, Siefen G, Kandel I, Merrick J. A review on eating disorders and adolescence. Minerva pediatrica. 2007;59(3):239-48

Vander Wal JS, Thomas N. Predictors of body image dissatisfaction and disturbed eating attitudes and behaviors in African American and Hispanic girls. Eating Behaviors. 2004;5(4):291-301.

Rojo L, Livianos L, Conesa L, García A, Domínguez A, Rodrigo G, Sanjuán L, Vila M. Epidemiology and risk factors of eating disorders: A two‐stage epidemiologic study in a Spanish population aged 12–18 years. International Journal of Eating Disorders. 2003;34(3):281-91.

Kamışlı AGS, Karatay AGG, Terzioğlu F, Kublay G. Sigara Ve Ruh Sağlığı. (Tobacco&Mental Health). 978-975-590-247-0

Krug I, Treasure J, Anderluh M, Bellodi L, Cellini E, Di Bernardo M, Granero R, Karwautz A, Nacmias B, Penelo E. (2008) Present and lifetime comorbidity of tobacco, alcohol and drug use in eating disorders: A European multicenter study. Drug and alcohol dependence. 2008;97(1):169-79.

Beary MD, Lacey JH, Merry J. Alcoholism and eating disorders in women of fertile age. British journal of addiction. 1986;81(5):685-9.

Grilo CM, Sinha R, O Malley SS. Eating disorders and alcohol use disorders. Alcohol Research and Health. 2002;26(2):151-7.

PTSD / Trauma and Eating Disorders - Eating Disorder Hope. http:// www.eatingdisorderhope. com/ treatment-for-eating-disorders/ co-occurring-dual-diagnosis/ trauma-ptsd. Access date 24.04.2016.

Horesh N, Apter A, Lepkifker E, Ratzoni G, Weizmann R, Tyano S. Life events and severe anorexia nervosa in adolescence. Acta psychiatrica Scandinavica. 1995;91(1):5-9.

Brewerton TD. (2007) Eating disorders, trauma, and comorbidity: Focus on PTSD. Eating Disorders. 2007;15(4):285-304.

Plata-Salamán CR. Anorexia during acute and chronic disease. Nutrition. 1996;12(2):69-78.

Fairburn CG, Doll HA, Welch SL, Hay PJ, Davies BA, O'Connor ME. Risk factors for binge eating disorder: a community-based, case-control study. Archives of general psychiatry. 1998;55(5):425-32.

Thompson J. Body image, eating disorders, and obesity: An integrative guide for assessment and treatment. American psychological association. 2001.

Forman-Hoffman V. High prevalence of abnormal eating and weight control practices among US high-school students. Eating behaviors. 2004;5(4):325-

Zaider TI, Johnson JG, Cockell SJ. Psychiatric comorbidity associated with eating disorder symptomatology among adolescents in the community. International Journal of Eating Disorders. 2000;28(1):58-67.

Milos G, Spindler A, Schnyder U. Psychiatric comorbidity and Eating Disorder Inventory (EDI) profiles in eating disorder patients. Canadian Journal of psychiatry. 2004;49(3):179-84.

Gadalla T, Piran N. Eating disorders and substance abuse in Canadian men and women: A national study. Eating Disorders. 2007;15(3):189-203.

Sansone RA, Sansone LA. Eating disorders and psychiatric co-morbidity: prevalence and treatment modifications. Clinical manual of eating disorders. 2007:79-112.

Sischo L, Taylor J, Yancey Martin P. Carrying the weight of self-derogation? Disordered eating practices as social deviance in young adults. Deviant Behavior. 2006;27(1):1-30.