Aggressiveness: A Bridge to Eating Disorders Among Teens?

There is a positive link between a propensity to aggression and eating disorders among adolescents, according to results of a study of Italian teens (Acta Psychiatrica Scandinavica 2003;108:183).

Dr. Antonio Preti and colleagues used a series of questionnaires to assess 1,000 male and female adolescents aged 15 to 19, from Conegliano, a town in northern Italy, and from the surrounding region. The team used the Eating Attitudes Test (EAT), the Bulimic Investigatory Test of Edinburgh (BITE) and the Body Attitudes Test (BAT), as measures of abnormal eating attitudes and behaviors, and the Aggression Questionnaire (AQ) as a measure of the propensity to aggression. The AQ is a 29-item self-completed questionnaire that measures attitudes toward aggressiveness and its expression in everyday circumstances. Its four subscales measure the tendency to physical aggression, verbal aggression, anger levels and hostility levels. Body mass index was derived from self-reported data on weight and height, and the socioeconomic status was derived from a measure of crowding at home, based on the number of rooms available per person, excluding kitchens and bathrooms.

Results: more risk among females

Among the 818 adolescents who reported complete data, females scored significantly higher than males in all eating disorders inventories. The girls also had a higher likelihood than males to report scores above the suggested cut-off point for a clinically relevant eating disorder on the EAT, the BAT, and the BITE. Males scored higher than females on the AQ. In both genders, the researchers found no statistically significant links between age, SES, or BMI and AQ scores.

Abnormal eating patterns and aggression

In both genders, adolescents reporting abnormal eating patterns were significantly more likely to score higher on the AQ. Fifteen percent of females and 2.7% of males scored higher on the EAT than the suggested cutoff mark of 30; this compared with 11% reported in an earlier study of 359 young girls in Padua and 5% in a mixed female-male sample of 904 teens in Pavia, both large towns in northern Italy.

According to the authors, it is important to recognize patients’ feelings of hostility and aggressiveness and to balance countertransference. Patients who are hostile and aggressive also strongly tend to neglect a therapist’s advice, leading to poorer compliance with treatment. These patients then are left at higher risk of negative outcomes, such as suicide attempts, sexual promiscuity, and alcohol and substance abuse.

A balanced approach with psychotherapy and drug prescriptions, particularly the SSRIs, might help reduce aggressive behavior, according to the authors. These agents have positive effects on the serotonergic dysfunction involved in aggressive behavior.