While our study measured the broader construct of disordered eating rather than diagnosed eating disorders, prevalence was relatively high among this population. Although the preponderance of DE literature has utilized college-aged, Caucasian women, our results support research that suggests race is not a protective factor against DE (Franko, Becker, Thomas, & Herzog, 2007
; Taylor, Caldwell, Baser, Faison, & Jackson, 2007
). We also found that younger age or lower levels of education conferred no additional risk for DE. Our prevalence of DE, depressive symptoms and PTSD among this help-seeking sample were all similar to those of other studies of African American women. Few studies of these disorders among African Caribbean women have been conducted.
We observed a positive relationship between all of the key exposure variables and DE among women in the full sample. Women reporting a history of abuse by their partner experienced significantly higher risk for DE than non-abused women, and women with physical abuse or sexual and physical abuse were more likely to experience DE than those with emotional abuse alone. Previous research demonstrated a similar role for sexual violence experiences on disordered eating (Jacobi, Hayward, de Zwaan, Kraemer, & Agras, 2004
; Wonderlich et al., 2001
), but our study was unique in its inclusion of physical, sexual, and emotional partner violence. DE has often been associated with a desire to exert personal control; this need may be enhanced in an abusive relationship in which personal control may be impeded. DE may also be used to deal with chronic and acute stress (Pecoraro, Reyes, Gomez, Bhargava, & Dallman, 2004
; Timmerman, 2001
), clearly present in abusive relationships (J. C. Campbell et al., 2002
; J. C. Campbell, 2002
). Recent studies of African American women also reported associations between trauma, stress and (binge) eating disorder (Harrington, Crowther, Payne Henrickson, & Mickelson, 2006
; Harrington, Crowther, & Shipherd, 2010
Women with depressive symptoms and PTSD were at elevated risk for DE in our study. These women may be using DE to cope with their depression (Adams, Katz, Beauchamp, Cohen, & Zavis, 1993
), but a further analysis involving more measures of coping strategies would be required. PTSD symptoms conferred elevated risk for DE, and these findings corroborate previous research showing PTSD to co-occur with eating disorders. PTSD does not co-occur as often as other anxiety disorders (Godart, Flament, Perdereau, & Jeammet, 2002
), but this may be attributed, in part, to the lack of routine assessment for PTSD in these studies (Godart et al., 2002
). Additional research with better measures of DE and full rather than screening measures of PTSD are needed to further examine these relationships.
Considering depressive symptoms, PTSD, severity of physical and sexual violence, and severe risk for lethality from violence among women experiencing abuse, only depressive symptoms remained an independent risk factor DE. The relationship between risk for lethality and DE was fully mediated by the presence of depressive symptoms. It stands to reason that depression is the most important driver of DE, given that women in serious danger in an IPV relationship often become depressed and this in turn influences DE. Even so, given the direct association of IPV with DE in the full sample analysis, a relationship of IPV and DE remains that is not explained by increased depressive symptomatology from potential lethality. Again, additional research especially prospective studies with more precise measures of DE are needed, particularly measures of anorexia nervosa, binge eating and bulimia and analyses by ethnicity of patterns of disordered eating.
A noteworthy strength of this study is its focus on African American and African-Caribbean women of varying ages and educational backgrounds. Most studies on DE have focused on predominantly Caucasian and college samples of women. Our study contributes to the literature on factors associated with ED and DE in a non-college sample and within an understudied minority group.
This study also employed the ACASI method to collect data. Computerized methods have been shown to increase the likelihood of reporting of sensitive topics such as abuse over disclosing to an interviewer (Trautman, McCarthy, Miller, Campbell, & Kelen, 2007
). It also automated the screening of participants and the random selection of controls, maximized participant confidentiality, facilitated administration for low-literacy participants, and enabled immediate identification and follow-up with participants who disclosed possible suicidality or who were at severe risk on the Danger Assessment.
The study, however, has limitations as well. First, the measure of DE used in the study relies on a single item and thus may not capture the range of behaviors associated with DE. Another limitation is related to the wide confidence intervals noted for some of the variables. This may be attributed to low prevalence of DE in a sample of this size, particularly among the non-abused control group. Unfortunately, statistical methods to correct for wide confidence intervals are not available for multilevel modeling at this time. Because the sample was recruited through medical settings, the findings may not reflect the experiences of general and diverse populations of women. In addition, the etiology of DE is complex and may stem from several aspects of a woman’s life, including cultural influences and past experiences. Some of these factors may have been present among the women in our study, but because these potentially causative factors were not included in the parent study, they could not be controlled for in this analysis. Finally, the cross-sectional design prevents us from making causal inferences of the study findings. However, our measures were such that women reported DE in the past year, while abuse measures encompassed past two-year and lifetime partner abuse. Despite these limitations, however, this study’s findings add to the relatively small empirical research base on the effect of IPV, depressive symptomatology and PTSD on disordered eating behavior.