Hostname: page-component-7c8c6479df-ph5wq Total loading time: 0 Render date: 2024-03-28T12:31:59.331Z Has data issue: false hasContentIssue false

Two-phase survey of eating disorders in gifted dance and non-dance high-school students in Taiwan

Published online by Cambridge University Press:  12 March 2007

MEG MEI-CHIH TSENG
Affiliation:
Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan
DAVID FANG
Affiliation:
Center for Teacher Education, National Taipei College of Nursing, Taipei, Taiwan
MING-BEEN LEE
Affiliation:
Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
WEI-CHU CHIE
Affiliation:
Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
JEN-PEI LIU
Affiliation:
Division of Biometry, Department of Agronomy, National Taiwan University, Taipei, Taiwan
WEI J. CHEN*
Affiliation:
Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei, Taiwan
*
*Address for correspondence: Dr Wei J. Chen, Institute of Epidemiology, College of Public Health, National Taiwan University, 17 Xu-Zhou Road, Taipei 100, Taiwan. (Email: weijen@ha.mc.ntu.edu.tw)

Abstract

Background

Despite a growing body of literature reporting eating disorders (EDs) in non-Western countries in recent years, most of these studies are limited to questionnaire-based surveys or case-series studies. This study aimed to investigate the prevalence and correlates of EDs in Taiwanese high-school students.

Methods

The study subjects consisted of all the female high-school students enrolled in the gifted dance class in 2003 in Taiwan (n=655) and non-dance female students randomly chosen from the same school (n=1251). All the participants were asked to complete self-report questionnaires, including the 26-item Eating Attitudes Test (EAT-26) and the Bulimic Investigatory Test Edinburgh (BITE). All the screen positives and an approximate 10% random sample of the screen negatives were then interviewed using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders Patient Version (SCID-I/P).

Results

The prevalence of individual EDs was much higher in the dance [0·7% for anorexia nervosa (AN), 2·5% for bulimia nervosa (BN) and 4·8% for EDs, not otherwise specified (EDNOS)] than in the non-dance (0·1, 1·0 and 0·7% respectively) students. Multivariate logistic regression analyses revealed that being in the dance class, higher concern about body shape and lower family support were correlates of EDs for all students, whereas lower parental education level was associated with EDs only for non-dance students.

Conclusion

EDs were more prevalent in the weight-concerned subpopulation. Although AN is still rare, BN has emerged as a comparable prevalent disorder in Taiwan, as in Western countries.

Type
Original Article
Copyright
Copyright © Cambridge University Press 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Abraham, S. (1996). Characteristics of eating disorders among young ballet dancers. Psychopathology 29, 223229.CrossRefGoogle ScholarPubMed
APA (2000). Diagnostic and Statistical Manual of Mental Disorders (4th edn, text revision) (DSM IV-TR). American Psychiatric Association: Washington, DC.Google Scholar
Barbara, L., Christine, J. S., Iris, R. & Martin, H. S. (2002). Characteristics of inpatient weight gain in adolescent anorexia nervosa: relation to speed of relapse and re-admission. European Eating Disorders Review 10, 2240.Google Scholar
Cantwell, D. P., Lewinsohn, P. M., Rohde, P. & Seeley, J. R. (1997). Correspondence between adolescent report and parent report of psychiatric diagnostic data. Journal of the American Academy of Child and Adolescent Psychiatry 36, 610619.CrossRefGoogle ScholarPubMed
Chen, C. N., Wong, J., Lee, N., Chan-Ho, M. W., Lau, J. T. & Fung, M. (1993). The Shatin community mental health survey in Hong Kong: II. Major findings. Archives of General Psychiatry 50, 125133.CrossRefGoogle Scholar
Chen, Y. C., Hsu, C. C. & Hsu, S. H. (1980). A preliminary study of the family APGAR index [in Chinese with English abstract]. Acta Pediatrica Sinica 21, 210227.Google Scholar
Chen, Y. H. (1999). Epidemiological Study of Eating Behavior and Psychosocial Correlates Among Adolescents [in Chinese with English abstract]. Unpublished Master's Thesis, Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei, Taiwan.Google Scholar
Cooper, P. J., Tayor, M. J., Cooper, Z. & Fairburn, C. G. (1987). The development and validation of the Body Shape Questionnaire. International Journal of Eating Disorders 6, 485494.3.0.CO;2-O>CrossRefGoogle Scholar
Derogatis, L. R., Lipman, R. S. & Covi, L. (1973). The SCL-90: an outpatient psychiatric rating scale – preliminary report. Psychopharmacology Bulletin 9, 1328.Google ScholarPubMed
Dotti, A., Fioravanti, M., Balotta, M., Tozzi, F., Cannella, C. & Lazzari, R. (2002). Eating behavior of ballet dancers. Eating and Weight Disorders 7, 6067.CrossRefGoogle ScholarPubMed
Dunn, G., Pickles, A., Tansella, M. & Vazquez-Barquero, J. L. (1999). Two-phase epidemiological surveys in psychiatric research. British Journal of Psychiatry 174, 95100.CrossRefGoogle ScholarPubMed
Fairburn, C. & Beglin, S. (1990). Studies of the epidemiology of bulimia nervosa. American Journal of Psychiatry 147, 401408.Google ScholarPubMed
Fairburn, C. G., Cooper, Z., Doll, H. & Welch, S. L. (1999). Risk factors for anorexia nervosa: three integrated case–control comparisons. Archives of General Psychiatry 56, 468476.CrossRefGoogle ScholarPubMed
Fairburn, C. G., Welch, S. L., Doll, H. A. & O'Conner, M. E. (1997). Risk factors for bulimia nervosa: a community-based case–control study. Archives of General Psychiatry 54, 509517.CrossRefGoogle ScholarPubMed
First, M. B., Spitzer, R., Gibbon, M. & Williams, J. B. W. (2002). Structured Clinical Interview for DSM-IV-TR Axis I Disorders. Biometrics Research Department, New York State Psychiatric Institute: New York.Google Scholar
Gard, M. C. & Freeman, C. P. (1996). The dismantling of a myth: a review of eating disorders and socioeconomic status. International Journal of Eating Disorders 20, 112.3.0.CO;2-M>CrossRefGoogle Scholar
Garfinkel, P. E. & Newman, A. (2001). The eating attitudes test: twenty-five years later. Eating and Weight Disorders 6, 124.CrossRefGoogle ScholarPubMed
Garner, D. M. & Garfinkel, P. E. (1978). Sociocultural factors in anorexia nervosa. Lancet 2, 674.CrossRefGoogle ScholarPubMed
Garner, D. M. & Garfinkel, P. E. (1979). The eating attitudes test: an index of the symptoms of anorexia nervosa. Psychological Medicine 9, 273279.CrossRefGoogle ScholarPubMed
Garner, D. M. & Garfinkel, P. E. (1980). Socio-cultural factors in the development of anorexia nervosa. Psychological Medicine 10, 647656.CrossRefGoogle ScholarPubMed
Garner, D. M., Garfinkel, P. E., Rockert, W. & Olmsted, M. (1987). A prospective study of eating disturbances in the ballet. Psychotherapy and Psychosomatics 48, 170175.CrossRefGoogle ScholarPubMed
Garner, D. M., Olmsted, M. P., Bohr, Y. & Garfinkel, P. E. (1982). The eating attitudes test: psychometric features and clinical correlates. Psychological Medicine 12, 871878.CrossRefGoogle ScholarPubMed
Halmi, K. A., Sunday, S. R., Strober, M., Kaplan, A. S., Woodside, D. B., Fichter, M. M., Treasure, J., Berrettini, W. H. & Kaye, W. H. (2000). Perfectionism in anorexia nervosa: variation by clinical subtype, obsessionality, and pathological eating behavior. American Journal of Psychiatry 157, 17991805.CrossRefGoogle ScholarPubMed
Hamilton, L. H., Brooks-Gunn, J. & Warren, M. P. (1985). Sociocultural influences on eating disorders in professional female ballet dancers. International Journal of Eating Disorders 4, 465477.3.0.CO;2-0>CrossRefGoogle Scholar
Henderson, M. & Freeman, C. P. L. (1987). A self-rating scale for bulimia. The ‘BITE’. British Journal of Psychiatry 150, 1824.CrossRefGoogle ScholarPubMed
Hoek, H. W. & van Hoeken, D. (2003). Review of the prevalence and incidence of eating disorders. International Journal of Eating Disorders 34, 383396.CrossRefGoogle ScholarPubMed
Holderness, C. C., Brooks-Gunn, J. & Warren, M. P. (1994). Eating disorders and substance use: a dancing vs a nondancing population. Medicine and Science in Sports and Exercise 26, 297302.CrossRefGoogle Scholar
Hsu, L. K. G. (1996). Epidemiology of the eating disorders. Psychiatric Clinics of North America 19, 681700.CrossRefGoogle ScholarPubMed
Jacobi, C., Hayward, C., de Zwaan, M., Kraemer, H. C. & Agras, W. S. (2004). Coming to terms with risk factors for eating disorders: application of risk terminology and suggestions for a general taxonomy. Psychological Bulletin 130, 1965.CrossRefGoogle ScholarPubMed
Jennings, P. S., Forbes, D., McDermott, B., Juniper, S. & Hulse, G. (2005). Acculturation and eating disorders in Asian and Caucasian Australian adolescent girls. Psychiatry and Clinical Neurosciences 59, 5661.CrossRefGoogle ScholarPubMed
Johnson-Sabine, E., Wood, K., Patton, G., Mann, A. & Wakeling, A. (1988). Abnormal eating attitudes in schoolgirls – a prospective epidemiological study: factors associated with abnormal response on screening questionnaires. Psychological Medicine 18, 615622.CrossRefGoogle ScholarPubMed
Keel, P. K., Crow, S., Davis, T. L. & Mitchell, J. E. (2002). Assessment of eating disorders: comparison of interview and questionnaire data from a long-term follow-up study of bulimia nervosa. Journal of Psychosomatic Research 53, 10431047.CrossRefGoogle ScholarPubMed
Keel, P. K. & Klump, K. L. (2003). Are eating disorders culture-bound syndromes? Implications for conceptualizing their etiology. Psychological Bulletin 129, 747769.CrossRefGoogle ScholarPubMed
Kendler, K. S., Walters, E. E., Neale, M. C., Kessler, R. C., Heath, A. C. & Eaves, L. J. (1995). The structure of the genetic and environment risk factors for six major psychiatric disorders in women. Phobia, generalized anxiety disorder, panic disorder, bulimia, major depression, and alcoholism. Archives of General Psychiatry 52, 374383.CrossRefGoogle ScholarPubMed
Killen, J. D., Taylor, C. B., Hayward, C., Wilson, D. M., Haydel, K. F., Hammer, L. D., Simmonds, B., Robinson, T. N., Litt, I. & Varady, A. (1994). Pursuit of thinness and onset of eating disorder symptoms in a community sample of adolescent girls: a three-year prospective analysis. International Journal of Eating Disorders 16, 227238.3.0.CO;2-L>CrossRefGoogle Scholar
Kishi, T. & Elmquist, J. K. (2005). Body weight is regulated by the brain: a link between feeding and emotion. Molecular Psychiatry 10, 132146.CrossRefGoogle Scholar
Klump, K. L., Ringham, R., Marcus, M. D. & Kaye, W. (2001). A family history/family study investigation of eating disorder risk in ballet dancers: evidence of gene–environment combinations? Paper presented at the Annual Meeting of the Eating Disorders Research Society, Albuquerque, NM.Google Scholar
Lai, B. P. Y., Tang, C. S. K. & Tse, W. K. l. (2006). A longitudinal study investigating disordered eating during the transition to motherhood among Chinese women in Hong Kong. International Journal of Eating Disorders 39, 303311.CrossRefGoogle ScholarPubMed
le Grange, D., Tibbs, J. & Noakes, T. D. (1994). Implications of a diagnosis of anorexia nervosa in a ballet school. International Journal of Eating Disorders 15, 369376.CrossRefGoogle Scholar
Lee, M. B., Lee, Y. J., Yen, L. L., Lin, M. H. & Lue, B. H. (1990). Reliability and validity of using a brief psychiatric symptom rating scale in clinical practice. Journal of the Formosan Medical Association 89, 10811087.Google ScholarPubMed
Lee, S. (1993). How abnormal is the desire for slimness? A survey of eating attitudes and behavior among Chinese undergraduates in Hong Kong. Psychological Medicine 23, 437451.CrossRefGoogle ScholarPubMed
Lee, S., Hsu, L. K. & Wing, Y. K. (1992). Bulimia nervosa in Hong Kong Chinese patients. British Journal of Psychiatry 161, 545551.CrossRefGoogle ScholarPubMed
Lee, S. & Hsu, L. K. G. (1993). Fat phobic and non-fat phobic anorexia nervosa: a comparative study of 70 Chinese patients in Hong Kong. Psychological Medicine 23, 9991017.CrossRefGoogle ScholarPubMed
Nakamura, K., Yamamoto, M., Yamazaki, O., Kawashima, Y., Muto, K., Someya, T., Sakurai, K. & Nozoe, S. (2000). Prevalence of anorexia nervosa and bulimia nervosa in a geographically defined area in Japan. International Journal of Eating Disorders 28, 173180.3.0.CO;2-I>CrossRefGoogle Scholar
Nobakht, M. & Dezhkam, M. (2000). An epidemiological study of eating disorders in Iran. International Journal of Eating Disorders 28, 265271.3.0.CO;2-L>CrossRefGoogle ScholarPubMed
Okano, G., Holmes, R. A., Mu, Z., Yang, P., Lin, Z. & Nakai, Y. (2005). Disordered eating in Japanese and Chinese female runners, rhythmic gymnasts and gymnasts. International Journal of Sports Medicine 26, 486491.CrossRefGoogle ScholarPubMed
Patton, G. C., Johnson-Sabine, E., Wood, K., Mann, A. H. & Wakeling, A. (1990). Abnormal eating attitudes in London schoolgirls – a prospective epidemiological study: outcome at twelve month follow-up. Psychological Medicine 20, 383394.CrossRefGoogle ScholarPubMed
Patton, G. C., Selzer, R., Coffey, C., Carlin, J. B. & Wolfe, R. (1999). Onset of adolescent eating disorders: population based cohort study over 3 years. British Medical Journal 318, 765768.CrossRefGoogle ScholarPubMed
Pickles, A. & Dunn, G. (1995). Screening for stratification in two-phase (two-stage) epidemiological surveys. Statistical Methods in Medical Research 4, 7389.CrossRefGoogle ScholarPubMed
Pike, K. M. & Borovoy, A. (2004). The rise of eating disorders in Japan: issues of culture and limitations of the model of ‘westernization’. Culture, Medicine and Psychiatry 28, 493531.CrossRefGoogle ScholarPubMed
Raffi, A. R., Rondini, M., Grandi, S. & Fava, G. A. (2000). Life events and prodromal symptoms in bulimia nervosa. Psychological Medicine 30, 727731.CrossRefGoogle ScholarPubMed
Ravaldi, C., Vannacci, A., Zucchi, T., Mannucci, E., Cabras, P. L., Boldrini, M., Murciano, L., Rotella, C. M. & Ricca, V. (2003). Eating disorders and body image disturbances among ballet dancers, gymnasium users and body builders. Psychopathology 36, 247254.CrossRefGoogle ScholarPubMed
Ringham, R., Klump, K., Kaye, W., Stone, D., Libman, S., Stowe, S. & Marcus, M. (2006). Eating disorder symptomatology among ballet dancers. International Journal of Eating Disorders 39, 503508.CrossRefGoogle ScholarPubMed
Rizvi, S. L., Peterson, C. B., Crow, S. J. & Agras, W. S. (2000). Test–retest reliability of the eating disorder examination. International Journal of Eating Disorders 28, 311316.3.0.CO;2-K>CrossRefGoogle ScholarPubMed
Shisslak, C. M., McKeon, R. T. & Crago, M. (1990). Family dysfunction in normal weight bulimic and bulimic anorexic families. Journal of Clinical Psychology 46, 185189.3.0.CO;2-B>CrossRefGoogle ScholarPubMed
Shrout, P. E. & Newman, S. C. (1989). Design of two-phase prevalence surveys of rare disorders. Biometrics 45, 549555.CrossRefGoogle ScholarPubMed
Smilkstein, G. (1978). The family APGAR: a proposal for a family function test and its use by physicians. Journal of Family Practice 6, 12311239.Google Scholar
StataCorp (2003). Stata Statistical Software: Release 8.0. Stata Corporation, College Station: TX.Google Scholar
Striegel-Moore, R. H. (1997). Risk factors for eating disorders. Annals of the New York Academy of Sciences 817, 98109.CrossRefGoogle ScholarPubMed
Sundgot-Borgen, J. & Torstveit, M. K. (2004). Prevalence of eating disorders in elite athletes is higher than in the general population. Clinical Journal of Sport Medicine 14, 2532.CrossRefGoogle ScholarPubMed
Szmukler, G. I., Eisler, I., Gillies, C. & Hayward, M. E. (1985). The implications of anorexia nervosa in a ballet school. Journal of Psychiatric Research 19, 177181.CrossRefGoogle Scholar
Thomas, J. J., Keel, P. K. & Heatherton, T. F. (2005). Disordered eating attitudes and behaviors in ballet students: examination of environmental and individual risk factors. International Journal of Eating Disorders 38, 263268.CrossRefGoogle ScholarPubMed
Tsai, G. (2000). Eating disorders in the Far East. Eating and Weight Disorders 5, 183197.CrossRefGoogle ScholarPubMed
Tseng, M. C., Lee, M. B., Chen, S. Y., Lee, Y. J., Lin, K. H., Chen, P. R. & Lai, J. S. (2004). Response of Taiwanese obese binge eaters to a hospital-based weight reduction program. Journal of Psychosomatic Research 57, 279285.CrossRefGoogle ScholarPubMed
Tseng, M. C., Lee, M. B. & Lee, Y. J. (1997). Reliability and validity of Chinese version of the Bulimic Investigatory Test [in Chinese with English abstract]. Taiwanese Journal of Psychiatry 11, 141155.Google Scholar
Waller, G., Calam, R. & Slade, P. (1989). Eating disorders and family interaction. British Journal of Clinical Psychology 28, 285286.CrossRefGoogle ScholarPubMed
Webster, J. J. & Palmer, R. L. (2000). The childhood and family background of women with clinical eating disorders: a comparison with women with major depression and women without psychiatric disorder. Psychological Medicine 30, 5360.CrossRefGoogle ScholarPubMed
Yang, H. J., Soong, W. T., Kuo, P. H., Chang, H. L. & Chen, W. J. (2004). Using the CES-D in a two-phase survey for depressive disorders among non-referred adolescents in Taipei: a stratum-specific likelihood ratio analysis. Journal of Affective Disorders 82, 419430.Google Scholar