Psychosocial Predictors of Disordered Eating in Adolescents with Celiac Disease: Body Image Dissatisfaction, Anxiety, Depression, and Family Eating Environment

Background/Purpose: Research suggests that there is a higher prevalence of disordered eating in adolescents with celiac disease than in those without. However, research on psychosocial vulnerability factors that could serve as targets for assessment and intervention is limited. To address this gap, this study tested to what extent psychosocial factors including the level of body image dissatisfaction, the severity of anxiety symptoms, the severity of depression symptoms, and the quality of the family eating environment predict disordered eating behaviors, attitudes, and feelings in adolescents diagnosed with celiac disease in the U.S.

Methods: A correlational research design with a nonprobability convenience sample of N = 187 was used. All participants were U.S. adolescents, between the ages of 13 and 18 years old, diagnosed with celiac disease. Participants were recruited through community organizations, social media platforms, and one celiac clinic. Data was collected via a one-time, online survey through Qualtrics. Measures included Celiac Dietary Adherence Test, Eating Attitudes Test-26, Appearance and Weight subscales of the Body Esteem Scale for Adolescents and Adults, Depression and Anxiety subscales of the Revised Child Anxiety and Depression Scale-25, and Family Eating Habits survey. Multiple and logistic regression analyses were used to test hypothesis. Most participants identified as cis-gender female (69%) and White (92%), reflecting previous research that demonstrates a higher prevalence of celiac disease in these populations.

Results: Findings partially supported the hypothesis, indicating a higher level of body image dissatisfaction (measured as weight dissatisfaction), greater severity of depression symptoms, and poorer quality of the family eating environment (measured as atmosphere) predicted greater disordered eating behaviors, attitudes, and feelings when measured as 1. dieting; 2. bulimia and food preoccupation; and 3. composite of behaviors, attitudes, and feelings about dieting, bulimia and food preoccupation, and oral control. No differences in disordered eating were found among groups defined by race, body mass index, or co-occurring diet and health related conditions. Post-hoc analysis indicated that transgender males scored significantly higher than cisgender males on disordered eating behaviors, attitudes, and feelings regarding dieting. However, no other gender group differences were significant under Bonferroni cutoff.

Implications: Filling a critical research gap, results provide an enhanced understanding of psychosocial vulnerabilities for disordered eating in adolescents with celiac disease, offering social workers malleable targets for intervention. Currently, there are no standardized psychosocial guidelines for the prevention and management of disordered eating in adolescents with celiac disease, representing a missed opportunity to minimize the risk of disordered eating in this population. Social workers are uniquely positioned to leverage the insights gained from this study to help develop and champion the standardization of psychosocial care for this population, focusing on assessment, treatment, and ultimately prevention of disordered eating. This research highlights the need for multidisciplinary, comprehensive treatment of adolescents with celiac disease that places an equal emphasis on their psychological and physical wellbeing.