Important Risk Factors for Purging in Young Women

This is a guest blog post by Eric Stephen and Jennifer Rose, co-authors of the latest research article on adolescent risk factors for purging in young women published in the Journal of Eating Disorders.

Over the past several years, purging behaviors—such as vomiting and laxative misuse—have received increased scientific attention both as symptoms of eating disorders and also as behaviors that are of clinical interest in their own right. In order to prevent the development of these behaviors, it’s important to understand their development over an individual’s lifetime. As Jacobi argues, the etiology of these purging behaviors involves a dynamic interplay of biological, psychological, interpersonal, and cultural variables that must be studied together.

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However, the ability of most studies to pinpoint risk factors that are linked to the development of eating disorder behaviors has been limited. Existing studies of the etiology of eating disorders in the general population of adolescents have been hampered by inadequate sample sizes and follow-up periods that are not long enough to fully capture the development of these behaviors.

As a result, important risk factors that could be useful for prevention efforts may be overlooked. By using data collected by the National Longitudinal Study of Adolescent Health (Add Health), we had the unique opportunity to examine risk factors for the development of purging behaviors in a nationally representative sample of adolescent women in the United States. The women in this study entered the study at ages 12-18 and were tracked for eight years, with data collected at three separate waves.

In order to be considered a risk factor for the occurrence of purging behaviors, data on this characteristic must be collected prior to occurrence of the behavior, or must be of a nature where one may reasonably infer that, even when collected after the occurrence of purging behaviors, it is not likely to be influenced by the occurrence of these behaviors (e.g., gender, race/ethnicity; Kraemer et al., 1997).

The 19 potential risk factors for the development of purging behaviors examined in our study were chosen to meet these criteria, and included demographic variables, early onset menarche, body image concerns, adverse childhood experiences (for example, death of a parent, childhood physical abuse), coping, and health or mental health problems (for example self esteem and depression). Data on these risk factors were collected at the study’s origin (Wave I), and were used to predict purging at Wave II (one year later) and at Wave III (eight years later). After adjusting for age, race/ethnicity, parental education, and any reported purging behavior at Wave I, we found that purging one year later at Wave II was predicted by parental poverty and low self-esteem, whereas purging eight years later at Wave III was predicted by body mass index and engaging in delinquent behaviors at the study’s origin.

The results of our study provided support for risk factors for purging that have been shown to predict risk of developing eating disorders in previous studies. However, we also found evidence that risk factors for purging behaviors in young women may be more or less important at different follow up periods. That is, some risk factors, such as parental poverty and low self-esteem, appear to be important proximal risk factors for occurrence of purging behaviors, whereas others, such as body mass index and delinquent behaviors, appear to be more important distal risk factors.

In terms of next steps in the prevention of purging behaviors, which are core symptoms of eating disorders and by themselves can lead to serious medical illness, our study identified some apparently robust risk factors that may help to identify young women at risk of engaging in these behaviors. Prevention efforts may be developed that target these critical risk factors at different developmental periods.


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):19-65. [PubMed]

Kraemer HC, Kazdin AE, Offord DR, Kessler RC, Jensen PS, Kupfer DJ. Coming to terms with the terms of risk. Archives of general psychiatry. 1997;54(4):337-43. [PubMed]

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