title: Influence of stress in the onset of eating disorders: data from a two-stage epidemiologic controlled study.
abstract: BACKGROUND
  We explore the role of stress in the onset of eating disorders (EDs) in a community sample of adolescents, the mediating role of psychiatric comorbidity and the quantitative evolution of stress in the year preceding the onset of an ED.
  
  
  METHODS
  The Life Events and Difficulties Schedule interview was applied to a sample with 32 cases and 32 controls selected from a two-phase epidemiologic study among a representative population of adolescents, followed by a decay model to assess acute and chronic stress in the year preceding the onset of ED. Psychiatric comorbidity was assessed using the SCAN interview.
  
  
  RESULTS
  Cases (46.9%) and 9.4% of controls were found to have associated psychiatric comorbidity (chi2 = 11.74, p = .001). Of cases, 6.3% and none of the controls had at least one severe stressful event (N.S). Of cases, 18.8% and 3.1% of controls had at least one major difficulty (Fisher exact test = 0.05). Of cases, 25% and 3.1% of controls had a provoking stressful agent (Fisher exact test = 0.026). Psychiatric comorbidity partially mediated the relationship between stress and EDs. The Structural Equation Modeling Analysis shows that chronic stress is strongly associated with the onset of EDs, both directly (r(2) = 0.38) and indirectly, through psychiatric comorbidity (r2 = 0.56).
  
  
  CONCLUSIONS
  Chronic stress and psychiatric comorbidity are strongly associated with the onset of EDs. Psychiatric comorbidity is a partial mediating factor in the association of stress with eating disorders.
authors.affiliation: Eating Disorders Unit, Department of Psychiatry, La Fe University Hospital, School of Medicine, University of Valencia, Spain. luis.rojo@uv.es
authors.forename: Luis
authors.initials: L
authors.lastname: Rojo
authors.forename: Llanos
authors.initials: L
authors.lastname: Conesa
authors.forename: Ovidio
authors.initials: O
authors.lastname: Bermudez
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Livianos
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002908:Chronic Disease; D015897:Comorbidity; D003625:Data Collection; D001068:Feeding and Eating Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008016:Life Change Events; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D010555:Personality Inventory; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012494:Sampling Studies; D013030:Spain / Q000453:epidemiology; D013315:Stress, Psychological / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D011795:Surveys and Questionnaires