The prevalence of eating disorders such as anorexia nervosa, bulimia, as well as subclinical eating and body image problems, increases substantially during the transition from high school to college. While an estimated 1% to 3% of the general U.S. population meet formal diagnostic criteria for an eating disorder (Hudson, Hirpi, Pope, & Kessler, 2007), a 7-10% prevalence has been reported for college students (Raghavan & Gates, 2007). In addition to formal DSM-IVTR (American Psychiatric Association, 2000) clinical syndromes, surveys indicate that 12-20% of college women report disturbed weight control behaviors and/or eating attitudes (Nelson, Gortmaker, Subramanian, Cheung, & Wechsler, 2007; Sira & Pawlak, 2010). Other research has found weight control and body image problems among college students that include some, but not all, of the criteria for a DSMIVTR eating disorder. Many of these college women qualify for a DSM-IV diagnosis of Eating Disorder--Not Otherwise Specified.
While distorted body image is a key diagnostic criterion for anorexia nervosa (American Psychiatric Association, 2000), other patterns of disordered eating are often accompanied by excessive concern about physical appearance. Body image, while including multiple dimensions such as self-monitoring and depersonalization (Cuzzolaro, Vetrone, Marano, & Garfinkel, 2006), can be defined as the subjective concept of one's physical appearance based on self-observation and the reactions of others (Lobera & Rios, 2011).
Eating disorders are disproportionately found among women. Epidemiological studies have found that males account for only 5-10% of anorexia nervosa cases (Lucas, Beard, O'Fallon, Kurland, 1991) and 1015% of those with bulimia (Carlat & Carmago, 1991; Garfinkel, Linn, & Goering, 1991). In college samples, 10% of males reported clinically significant patterns of disordered eating (Nelson, Hughes, Katz, & Searight, 1999; Sira & Pawlak, 2010). While body image distress has been consistently associated with eating problems in women, relatively little is known about this association in males (Pope, Gruber, Mangweth, Bureau, DeCol, Jouvent, & Hudson, 2000). Typically females will view themselves as overweight, while males view themselves as underweight and are less distressed about excess weight.
Within the college population, there is evidence that subgroups such as athletes and dancers have a higher prevalence of eating disordered attitudes and behaviors. This pattern is particularly likely in sports such as distance running and wrestling where leanness is related to enhanced performance (Sherman & Thompson, 2001) and ballet (Ravaldi, Vannacci, Bolognesi, Mancini, Faravelli, & Ricca, 2006) and gymnastics in which both appearance and size are important (Garner, Rosen, & Barry, 1998). Among college athletes, prevalence rates for disordered eating have varied from 7.1 % overall with higher rates for female athletes ranging from 25% to 32% of female collegiate athletes exhibiting "pathogenic weight control behaviors" (Rosen, McKeag, Hough, & Curley, 1986). While both college student and athlete status are independently associated with greater eating disorder symptomatology, the fact that the majority of student athletes do not exhibit disordered eating or body image distress suggests that other factors are involved (Sherman & Thompson, 2001).
In his classic study, Minuchin (Minuchin, Rosman, & Baker, 1978) found that enmeshment, a family pattern in which individual autonomy and differences are suppressed with a concomitant blurring of parent-child relationship boundaries, characterized families with an anorexic adolescent. Other studies have suggested that a high degree of criticism--particularly focusing on the adolescent's weight--as well as coercive parental control are associated with eating problems and body image distress (Haworth-Hoeppner, 2000). …