Effect of a dissonance-based prevention program on risk for eating disorder onset in the context of eating disorder risk factors

Abstract

Test (a) whether a dissonance-based eating disorder prevention program that reduces thin-ideal internalization mitigates the effects of risk factors for eating disorder onset and (b) whether the risk factors moderate the effects of this intervention on risk for eating disorder onset, to place the effects of this intervention within the context of established risk factors. Female adolescents (N=481) with body image concerns were randomized to the dissonance-based program, healthy weight control program, expressive writing control condition, or assessment-only control condition. Denial of costs of pursuing the thin-ideal was the most potent risk factor for eating disorder onset during the 3-year follow-up (OR=5.0). The dissonance program mitigated the effect of this risk factor. For participants who did not deny costs of pursuing the thin-ideal, emotional eating and externalizing symptoms increased risk for eating disorder onset. Negative affect attenuated the effects of each of the active interventions in this trial. Results imply that this brief prevention program offsets the risk conveyed by the most potent risk factor for eating disorder onset in this sample, implicate three vulnerability pathways to eating pathology involving thin-ideal pursuit, emotional eating, and externalizing symptoms, and suggest that negative affect mitigates the effects of eating disorder prevention programs.

Figures

Fig. 1

a Theoretical components of the dual-pathway model of eating pathology, b Moderators of intervention effects

Fig. 2

Decision rules for the classification tree predicting eating disorder onset with baseline risk factors and study condition. The empirically derived cut-points are shown with the sample size and the incidence for eating disorder onset during the study for each branch and node

Fig. 3

Decision rules for the classification tree predicting eating disorder onset with baseline risk factors and study condition entered as the first predictor. Empirically derived cut-points are shown with the sample size and the incidence during the study for each branch and node