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Open Access Research article

Exploring relationships over time between psychological distress, perceived stress, life events and immature defense style on disordered eating pathology

Phillipa Hay12* and Sarah Elizabeth Williams1

Author Affiliations

1 School of Medicine, University of Western Sydney, Sydney, Australia

2 School of Medicine, James Cook University, Townsville, Australia

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BMC Psychology 2013, 1:27  doi:10.1186/2050-7283-1-27

Published: 5 December 2013



Perceived stress, immature defense style, depression and anxiety and negative life events all are known to be associated with eating disorders. The present study aimed to investigate the relationships between these factors and their relative strength of association with eating disorder symptoms over time.


This research was embedded in a longitudinal study of adult women with varying levels of eating disorder symptoms and who were initially recruited from tertiary educational institutions in two Australian states. Four years from initial recruitment, 371 participants completed the Eating Disorder Examination- Questionnaire (EDE-Q) for eating disorder symptoms.

Kessler-10 Psychological Distress Scale (K-10) as a measure of depression and anxiety, a Life Events Checklist as a measure of previous exposure to potentially traumatic events, the Defense Style Questionnaire (DSQ) and the Perceived Stress Scale (PSS) to determine perceived stress. One year later, in year 5, 295 (878.7%) completed follow-up assessments including the EDE-Q. The questionnaires were completed online or returned via reply paid post.


All four independent factors were found to correlate significantly with the global EDE-Q score in cross-sectional analyses (all Spearman rho (rs) >0.18, p < 0.01) and at one year follow-up (all rs > 0.15, all p < 0.05). In multivariate linear regression modeling adjusted for age and year 4 global EDE-Q scores, perceived stress and psychological distress scores were significantly associated with year 5 global EDE-Q scores (p = 0.046 and <0.001 respectively).


Psychological distress, and to a lesser degree perceived stress had the strongest association with eating disorder symptoms over time The findings support further investigation of interventions to reduce distress and perceived stress in adult females with disordered eating.

Psychological distress; Perceived stress; Life events; Defense style; Eating disorders