Date: October 10, 2017

Subject: Occupational Therapy

MLA Citations:

Yoshie, Mio, et al. "The eating attitudes, body image, and depression of Japanese female university students." Social Behavior and Personality: An International Journal, vol. 45, no. 6, 2017, p. 943+. Academic OneFile, go.galegroup.com/ps/i.do?p=AONE&sw=w&u=j043905010&v=2.1&id=GALE%7CA500683411&it=r&asid=b9919f8a30ab80cd4a9e0ae08910d1ae. Accessed 10 Oct. 2017.

Assessment:

Eating Disorders in the Realm of Occupational Therapy

        A very important yet often neglected aspect of Occupational Therapy is the treatment of eating disorders. Usually, this profession is focused towards developmental and physical disorders, but eating disorders are also considered very serious cases that involve psychological illness and the need for therapy. According to my research this past week, depression and obsessive thoughts both have a positive correlation with inappropriate eating habits. One might notice that these two things -- depression and obsessive thoughts -- are very common things that are treated by OTRs (Registered Occupational Therapists) or other people in a profession regarding psychology.

        From this information that I gathered, I have come to the conclusion that I need to consider the variety of eating disorders that are encompassed by the realm of mental disorders when examining where I will focus my studies regarding Occupational Therapy.  This knowledge was revealed to me clearly when the study described in my research mentioned that they only used female subjects to study mental disorders. The fact that they only studied females implies that there is an entire other realm of eating disorders that one must research, because society’s expectations for an ideal male and female body are very different. Therefore, eating disorders can affect both sexes differently. It can be drawn from this conclusion that a very significant facet of mental illness is taken up by multiple varieties of eating disorders, and that  they should therefore be a major focus of OTRs. Another significant thing that I have discovered is the definition of “self identity,” as it encompasses the way a person sets himself apart from others and views their life an unique and individual. I realize that this is a crucial aspect to consider when developing a plan of treatment for someone in need of therapy; Their self identity must be protected yet refined, causing them to be a more well rounded and happier person. Therapy can be considered a failure if a person does not feel content with himself, even if their mental illness is treated.

        These findings have inspired my further research because Obsessive Compulsive Disorder (OCD) is a very stigmatized mental illness and therefore a primary interest of my psychology studies, and I now know that obsessive thoughts (a key symptom of OCD) are incorporated heavily into eating disorders. Since it has been previously concluded that eating disorders must be more significantly addressed by OTRs, I know that by going into this field I will be working with people with symptoms very similar to those with OCD. My research has also further directed my course of study because I have realized that there are typically significantly different needs associated with males and females in need of occupational therapy. This means that I will have to understand both styles of treatments. However, differentiation between how males and females are treated may cause some social issues regarding sexism. People will debate whether or not it is fair for males and females to have different courses of treatment, even if those courses are what is ideal to treat their particular condition. Going forward into the next week, I am confident in knowing that I am further backed by information regarding the wide variety of cases and patient symptoms which someone working in the profession of Occupational Therapy may face.

The eating attitudes, body image, and depression of Japanese female university students

Mio Yoshie, Daiki Kato, Miyuki Sadamatsu and Kyoko Watanabe

Social Behavior and Personality: An International Journal. 45.6 (July 2017): p943.

DOI: http://dx.doi.org/10.2224/sbp.5961

Copyright: COPYRIGHT 2017 Scientific Journal Publishers, Ltd.

http://www.sbp-journal.com/

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Abstract:

We examined the interrelationship of eating attitudes, body-checking behavior cognition, and depression among Japanese female university students. The 197 student participants were divided, according to their Eating Attitudes Test (EAT-26) scores, into 3 groups: high (EAT-H), medium (EAT-M), and low (EAT-L). Body-checking behavior and depression scores were compared among the 3 groups, using a 1-way analysis of variance. Results showed that the EAT-L group had the lowest scores for objective verification, body control, and depression. Further, the obsessive thoughts body image score increased as scores on the EAT-26 did, indicating that inappropriate eating attitudes have a strong impact on obsessive thoughts. In addition, the EAT-M group had a higher reassurance-confidence score than that of the EAT-L group, and the EAT-H group had the highest scores for objective verification, obsessive thoughts, body control, and depression. Implications of the findings are discussed and directions for future research proposed.

Keywords: eating attitudes, eating disorders, body-checking behavior, obsessive thoughts, depression, body image.

Full Text:

Body image is defined as an individual's perception of his or her own body (Schilder, 1935). Eating disorders associated with a distorted body image include anorexia nervosa and bulimia nervosa (American Psychiatric Association, 2013), with many researchers having shown that the desire to be slim and the tendency to obsess over one's body image are increasing in both male and female adults^[a] (Juarez, Soto, & Pritchard, 2012; Tylka, Russell, & Neal, 2015). Kimber, Georgiades, Couturier, Jack, and Wahoush (2015) reported that body dissatisfaction is associated with a greater risk of body image distortion when an individual is underweight or overweight. This tendency is also present in Japanese female adolescents; for example, Tazaki (2007) observed an increase in the number of Japanese young women who skip regular meals due to dieting. Tazaki argued that the more negative was female adolescents' view of their body image, the greater was their desire to diet.

Previous researchers have examined the relationship between the desire for thinness and negative body image. Bruch (1962), for example, stated that anorexia nervosa is a serious disorder because people with this diagnosis cannot recognize their body image correctly and, thus, become overly thin^[b]. Mountford, Haase, and Waller (2006) concluded from their study of people diagnosed with an eating disorder that body-checking behavior represents distorted cognition related to eating. Consequently, Mountford et al. developed the Body Checking Cognition Scale to use in their study.

Individuals engage in body-checking behavior to judge their shape or weight (Fairburn, Shafran, & Cooper, 1999; Shafran, Fairburn, Robinson, & Lask, 2004). Examples of this type of behavior are frequently weighing oneself, examining specific body parts in the mirror, checking the fit of clothes, touching hip bones, pinching flesh, and measuring specific body parts, as well as seeking reassurance about one's own shape and comparing it with other people's shapes (Grilo et al., 2005; Shafran et al., 2004). In contrast, objective verification reflects individuals' motivation to accurately consider^[c] their own body image. A negative body image is a significant driver of the desire for thinness among Japanese women in the general public (Nakao & Takakuwa, 2000). Thus, body image cognition may influence eating attitudes, and this relationship is not specific to people diagnosed with an eating disorder. As such, we believed that it was important to explore how eating attitudes are related to the body image of people in nonclinical populations^[d].

Jackson et al. (2014) revealed that there is a negative relationship between body image satisfaction and depression in middle-aged women. In addition, Yoshie, Asai, and Kato (2014) showed that there is a positive relationship between inappropriate eating attitude and mood states, such as anxiety. Naylor, Mountford, and Brown (2011) also found associations among exercise beliefs, obsessive beliefs, and obsessive-compulsive behavior in a group of people diagnosed with an eating disorder^[e]. However, while the data in these studies were sourced from an older generation and clinical groups, the tendency may also be applicable to nonclinical female university students^[f]. Therefore, we proposed the following hypothesis:

Hypothesis 1: The eating attitudes of Japanese female university students will positively influence their body image, body-checking behavior, and mood state.

Body-checking behavior^[g] includes both behavioral (e.g., body control, which involves individuals adjusting the amount of food and exercise to control their weight) and cognitive (e.g., obsessive thoughts) aspects. Previous researchers have found a significantly positive correlation between the risk of developing an eating disorder and obsessive thoughts^[h] (Naylor et al., 2011); therefore, we proposed the following hypothesis:

Hypothesis 2: Among the types of body-checking behavior, Japanese female university students' obsessive thoughts will be the most strongly impacted by their inappropriate eating attitudes.

Furthermore, a significantly positive correlation between eating disorders and depression^[i] has been found in clinical samples (Brechan & Kvalem, 2015; Watson, Egan, Limburg, & Hoiles, 2014; Yoshie et al., 2014). Thus, we believed that inappropriate eating attitudes may be connected with depression among nonclinical samples as well, and we proposed the following hypothesis:

Hypothesis 3: Inappropriate eating attitudes among Japanese female university students will have a negative impact on depression.^[j]

Method

Participants

Participants were 197 Japanese female university students ([M.sub.age] = 19.98 years, SD = 1.38). They were recruited from a psychology class at Kinjo Gakuin University, and the purpose and ethical considerations of the study were explained to them. All students gave written informed consent and participated voluntarily^[k] in the study, with no compensation offered.

Measures

Eating Attitudes Test. We used the Japanese version of the Eating Attitudes Test (EAT-26; Mukai, Crago, & Shisslak, 1994), which is a 26-item inventory used to diagnose eating disorders and measure eating attitudes. Each item is rated on a 6-point Likert scale ranging from 1 (never) to 6 (always), and the scale consists of one factor. The Cronbach's reliability was .85^[l] in this study.

Body Image Cognition Scale. Yoshie (2014) adapted the Body Image Cognition Scale (BICS) from the Body Checking Cognitions Scale (BCCS; Mountford et al., 2006), the latter of which consists of four subscales: objective verification, reassurance, safety beliefs, and body control. Although both the BICS and BCCS are used to measure body-checking behavior cognition and have the same basic factor structure, Yoshie added and revised some BCCS items in the process of adapting the BICS to take into account Japanese culture^[m]. Thus, the Japanese BICS comprises 22 items divided across four subscales: objective verification (five items), obsessive thoughts (six items), reassurance-confidence (four items), and body control (seven items). Each item is rated on a 5-point Likert scale ranging from 1 (disagree) to 5 (agree). Cronbach's [alpha] for each BICS subscale was acceptable in this study: objective verification ([alpha] = .75), obsessive thoughts ([alpha] = .64), reassurance-confidence ([alpha] = .79), and body control ([alpha] = .79).

Center for Epidemiologic Studies Depression Scale. The Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977), which was adapted into Japanese by Shima, Shikano, Kitamura, and Asai (1985), is used to measure depression.^[n] Both versions are standardized 20-item inventories, with each item being rated on a 4-point Likert scale ranging from 0 (disagree) to 3 (agree). The sum of the scores is treated as the overall depression score. The original and Japanese CES-D are standardized inventories with established reliability and validity ([alpha] = .84-.90; Radloff, 1977).

Procedure

Participants were divided into three groups based on their EAT-26 score. The group at high risk of developing an eating disorder or having inappropriate eating attitudes (EAT-H; n = 14) scored over 3 points, the medium-risk group (EAT-M; n = 78) scored between 2 and 3 points, and the low-risk group (EAT-L; n = 105) scored under 2 points^[o][p]. BICS and CES-D scores were then compared among these three groups using one-way analyses of variance.

Results

The EAT-26 score was treated as an independent variable, and BICS and CES-D scores were treated as dependent variables. There were significant differences found for all subscales of the BICS: objective verification, F(2, 194) = 18.19,p < .01, [[eta].sup.2] = .16; obsessive thoughts, F(2, 194) = 30.05, p < .01, [[eta].sup.2] = .24; reassurance-confidence, F(2, 194) = 3.28, p < .05, p2 = .03; and body control, F(2, 194) = 23.33, p < .01, [[eta].sup.2] = .19. Multiple comparisons showed that the mean score for the EAT-M group was higher than that for the EAT-L group (p < .05) in relation to objective verification, reassurance-confidence, and body control. In addition, the EAT-H group scored higher than did the EAT-L group (p < .05) for objective verification and body control. Regarding obsessive thoughts, the EAT-H group gained the highest score, followed by the EAT-M group and then the EAT-L group (p < .05). There were also significant differences in depression scores, F(2, 194) = 5.31,p < .01, [[eta].sup.2] = .05, such that the EAT-M and EAT-H groups had higher scores than the EAT-L group did (p < .05)^[q]. The interrelationship of eating attitudes, body image cognition, and depression is shown in Table 1.

Discussion

In this study, we examined if the eating attitudes of Japanese female university students influence their body image, body-checking behavior, and mood state. Our results supported Hypothesis 1^[r], showing that the EAT-L group had the lowest scores among the three groups for the objective verification and body control factors of the BICS, and also for depression. Thus, the EAT-L group can be said to be at low risk of developing an eating disorder and can maintain healthy eating behavior. Sugiyama, Kiire, Imai, and Kumano (2014) suggested that people with healthy eating attitudes have high body satisfaction and, therefore, low levels of body checking. In relation to this, our EAT-L group was able to maintain a balance between food intake and exercise without excessively worrying about their weight or body image, which aligns with Fairburn's (1997) assertion that people with, compared to those without, an eating disorder have a more idealized weight and body image.^[s]

Mitsui (2005) found that depressive tendencies were present in people with medium and high levels of risk for developing eating disorders, which aligns with our finding that depression levels were higher in the EAT-H and EAT-M groups than in the EAT-L group. These results supported Hypothesis 3^[t], indicating that inappropriate eating attitudes facilitate depression in both clinical and nonclinical samples. In addition, Shima et al. (1985) stated that there is a risk of developing depressive disorders among people who score over 16 points on the CES-D. Both the EAT-H and EAT-M groups had this result. Mitsui (2005) stated that an individual's lack of basic trust can cause strong anxiety and depression, causing their self-identity--that is, the sense a person is different from other^[u]s--to be radically threatened; this can result in disordered eating. Further, as Mitsui observed, female university students with high EAT-26 scores have difficulty with controlling their feelings, which is associated with loss of control over one's eating behaviors.^[v]

Scores for obsessive thoughts, another BICS factor, increased according to the participants' EAT-26 results. The effect size of the analysis was the largest in relation to obsessive thoughts, and inappropriate eating attitudes had a stronger impact on this factor than on any other BICS factor. This result supports Hypothesis 2^[w]. Halmi et al. (2000) discussed the relationships among anorexia nervosa, perfectionism, and obsessionality and stated that participants with tendencies toward developing an eating disorder have general obsessive tendencies, which extend to body-checking behavior. In addition, Yoshie et al. (2014) showed that participants with high EAT-26 scores exhibit high levels of trait anxiety, which is the tendency to feel anxious and is part of an individual's personality^[x]. As Yoshie et al. revealed, people with inappropriate eating attitudes have a tendency to easily feel anxious, which facilitates obsessive thoughts and behavior. These results supported Hypothesis 2.

Finally, scores for the fourth BICS factor, reassurance-confidence^[y], were higher in the EAT-M group than in the EAT-L group, the latter of whom did not have tendencies toward developing an eating disorder and could be considered to be healthy. Alternatively, the EAT-L group could be interpreted as being careless about their eating attitudes or body image, rarely requiring reassurance about the shape of their body and how closely it matches their ideal body image, and not seeking confidence through body checking. In contrast, the EAT-M group showed a moderate level of interest in their body image and, consequently, their eating behavior.^[z] On the basis of these results, the EAT-L group had little motivation to body check and monitor their eating behavior, owing to indifference, whereas the EAT-M group cared about their body image in daily life, and the body-checking habit brought them reassurance and confidence. Cooley, Toray, Valdez, and Tee (2007) established that there is a positive relationship between inappropriate eating behavior and reassurance seeking. Their results support our findings and also indicate that future researchers should investigate how reassurance seeking through body-checking behavior, which in moderate amounts can be positive^[aa], is suppressed in the EAT-L group.

In conclusion, we have provided evidence that eating disorder tendencies are positively correlated with a greater risk of excessive body-checking behavior, depression, and obsessive behavior. In addition, while the focus in previous studies has been on people diagnosed with eating disorders (Halmi et al., 2000; Mountford et al., 2006), we explored the behavior of nonclinical participants^[ab] without eating disorders, such as those in the EAT-L group. However, although they did not have inappropriate eating attitudes, the carelessness of the EAT-L group about their eating behavior may be a factor in their suppressing the reassurance or confidence that can be sought through body-checking behavior.

There are some limitations in this study. First, our sample included only female participants^[ac]. Previous researchers have shown that the symptoms of eating disorders differ between men and women (Raevuori, Keski-Rahkonen, & Hoek, 2014); therefore, we recommend collecting the data of male participants and comparing the results with ours.^[ad] Second, we employed the EAT-26 scale only to measure eating attitudes. However, other scales have been developed to assess eating disorder tendencies; for instance, the Eating Disorder Inventory (Garner, Olmsted, & Polivy, 1983) is a measure of an eating disorder tendency that includes multiple factors, such as drive for thinness and body dissatisfaction. Future researchers could use other scales to provide more detailed and useful information regarding the relationships among eating attitudes, body-checking behavior, and depression.^[ae]