82 International Journal of Child Health and Nutrition, 2018, 7, 82-96
E-ISSN: 1929-4247/18 © 2018 Lifescience Global
Eating Disorders and Depression in Adolescents: The Impact of
Socioeconomic Factors, Family and Peer Relations
Goran Livazović
*
and Iva Mudrinić
Department for Pedagogy, Faculty of Humanities and Social Sciences, University of J. J. Strossmayer in
Osijek, Croatia
Abstract: This paper analyses the relation between socioeconomic characteristics, family and peer relations, depression
and eating disorders with 218 (144 female, 66.1%) participants aged 14-19 from Croatia. The questionnaire
encompassed questions on socioeconomic traits, family and peer relations, depression and anorexia, bulimia, binge
eating and orthorexia. Girls reported most dissatisfaction with the abdominal region (38.5%), thighs (31.2%) and breasts
(16.1%). Boys reported most dissatisfaction with the abdomen (12.4%), chest (10.1%) and legs/calves (7.3%). Gender
was significant for depression (p<.001), anorexia (p<.01), bulimia (p<.001) and binge eating (p<.05), with girls scoring
higher on all scales. Age was significant for depression (p<.05) in younger participants, and orthorexia (p<.05) for older
adolescents. Participants from vocational schools reported significantly higher family life satisfaction (p<.01), while
gymnasium students reported significantly higher depression (p<.000), bulimia (p<.01) and binge eating behaviour
(p<.01). Higher mother’s educational level was significant for anorexia (p<.05) and orthorexia (p<.01). Family relations
correlated negatively with bulimia and binge eating, but positively with orthorexia. Peer relations were not significant for
eating disorders. Eating disorders show positively correlated comorbidity (p<.000), and were significantly correlated to
depression (p<.000). Anorexia is best predicted by bulimia (p<.001), orthorexia (p<.001), depression (p<.01) and
mother’s education (p<.01). Bulimia is strongly predicted by anorexia (p<.001), binge eating (p<.001), depression
(p<.001) and gender (p<.001). Binge eating is strongly predicted by bulimia (p<.001), depression (p<.01) and school type
(p<.05). Orthorexia is strongly predicted by anorexia (p<.001), family relations quality (p<.05), the mother’s education
(p<.05) and school success (p<.05).
Keywords: Eating disorders, adolescents, family, school, peers, depression, anorexia, bulimia, binge eating,
orthorexia.
1. INTRODUCTION
Although body image dissatisfaction and eating
disorders could theoretically develop in any individual,
they tend to be most prevalent among adolescents.
Changes in body composition lead to differences in
appearance and self-image, which can influence
behaviour and increase introspection or self-
consciousness about mostly body-related concerns [1].
Eating disorders are psychiatric illnesses that result in
irregular eating patterns with negative health effects in
individuals, who develop unrealistic personal attitudes
toward or abnormal body perceptions, causing
behaviours that lead to destructive eating patterns with
negative physical and emotional consequences [2].
They are complex, multi-faceted and acutely sensitive
to societal and cultural pressures. As these disorders
generally develop in childhood and adolescence,
particular attention is devoted to developmental
research that considers biological predispositions,
societal coercion, developmental norms, mutability of
behaviours, and the individual’s unique response to his
or her environment [3].
*Address correspondence to this author at the Department for Pedagogy,
Faculty of Humanities and Social Sciences, University of J. J. Strossmayer in
Osijek, Croatia; Tel: +385918940828; E-mail: glivazovic@ffos.hr,
goran_livazovic@yahoo.com
2. THEORETICAL BACKGROUND
The modern ecological perspective emphasises that
a multitude of triggers – biological, psychosocial and
cultural – may concord in a person and sway eating
patterns into the realm of maladaptation at certain
periods in life. Psychoanalytic perspectives on anorexia
and obesity consider hunger an innate drive, and food
an unconscious symbol of desires (e.g. love, hatred,
sexual gratification, pregnancy). The fear of food intake
seen in anorexia was linked with unconscious fears of
oral impregnation, or fears of adulthood and sexuality
[5, 4]. Hilde Bruch’s [5] prolific psychodynamic theory
emphasised that early developmental problems
between mothers and children could result in a
disruption of an individual’s emotional and physiological
experience of food and satiation, as well as affect the
child’s development of autonomy or inner-directedness
with consequential misperceptions of body size and
satiety [5]. The psychodynamic perspective speculated
that anorexic and obese patients alike, experience their
bodies as not being truly their own, but under the
influence of others, while the behaviours associated
with anorexia were means of undoing feelings of
passivity, ineffectiveness and control by outside forces
[3]. The next big factor were the media promoted body
ideals, the lean tubular body physique in the cult of
thinness that rendered eating disorders as adaptive