EATING DISTURBANCE AS A MANIFESTATION OF THE STRESS PROCESS: A REVIEW OF THE LITERATURE DERRICK A. BENNETT 1 *, MSc AND CARY L. COOPER 2 , PhD, FRSM 1 University of Aberdeen, Aberdeen, Scotland 2 University of Manchester Institute of Science and Technology, Manchester, UK SUMMARY This article reviews the current literature on `disturbed eating patterns', particularly anorexia nervosa (AN) and bulimia nervosa (BN) and the relationship between these two eating disorders and life stress, coping styles, social support and personality factors. The article sets out to describe how these psychosocial factors interact and the possible role they play in eating disturbance. Three possible models of the stress process and its relationship to disordered eating behaviour are proposed. Copyright # 1999 John Wiley & Sons, Ltd. KEY WORDS Ð life events; coping styles; social support; personality; eating disturbance This article sets out to review the current empirical evidence on the relationship between psychosocial factors and anorexia nervosa (AN), bulimia nervosa (BN) and the partial syndromes of these two clinical eating disorders. Both these eating disorders predominantly aect females (aged 16±35 years old) but there is growing evidence to suggest that there is a rise in males presenting with similar symptoms. 1,2 Button 3 noted that in the early 1990s the prevalence of these eating disorders was anorexia nervosa 0.5 percent, bulimia nervosa 1±2 percent, and of the partial syndromes of these two eating disorders about 3 percent. To encompass these terms, of which the AN and BN are clinical and the partial syndromes may or may not meet the clinical criteria, the phrase `eating disturbed' will be used. Binge eating disorder and obesity have not been included in this de®nition of `eating disturb- ance' as they have less overlap in their predisposing criteria than AN and BN. This article will review the current literature on `eating disturbance' and propose three possible `working models' for the stress process that may adequately describe the relationship between stress, coping, social support, personality and disturbed eating patterns. LIFE STRESS AND EATING DISTURBANCE It has been suggested by Andersen 4 that there are two stages by which a clinical eating disorder evolves from what may be considered as `culturally normal' eating behaviours to diagnosable psycho- pathological states. These stages which Andersen proposed are illustrated in the following schematic diagram. According to Andersen's sequence of stages, it can be noted that anorexia nervosa and bulimia nervosa follow similar pathways, with bulimia being one step further along the continuum than anorexia at both stages described above. The evolution from the predisposing stage to the de®ning and maintaining stage of these two clinical eating disorders is interceded by so-called `pre- cipitating factors'. However, it is unclear what these precipitating factors are, and whether they are similar for anorexia and bulimia or the partial syndromes of these two eating disorders. One such precipitating factor is stress and the role it can play in the progression from predisposition stage to de®ning and maintaining stage in `eating disordered or disturbed' behavior via the various mechanisms. Recent empirical evidence, while acknowledging the role of stress, has failed to CCC 0748±8386/99/030167±16$17.50 Copyright # 1999 John Wiley & Sons, Ltd. STRESS MEDICINE Stress Med. 15, 167±182 (1999) *Correspondence to: Derrick A. Bennett, University of Aberdeen, Aberdeen, Scotland.