The prevention of eating disturbances: the impact of a self-esteem enhancement programme

Abstract

Eating disorders are complex, multidimensional disorders characterised by clinically significant disturbances in body image and eating behaviours. There is a small but growing body of literature establishing efficacious interventions, however, there is much progress yet to be made. The present study developed and evaluated the effectiveness of a school based eating disturbance prevention programme designed to enhance self-esteem. Self-esteem has been identified as both a risk and protective factor, able to address a number of risk factor domains and attaining some success in the prevention literature. The Straight Talking About Self-esteem and Resilience (STARS) programme was developed for this study using Harter’s (1986, 1987) model of the determinants of self-worth. This model has been theoretically, empirically and phenomenologically validated and provides a framework in which strategies can be developed to enhance self-esteem. Two hundred and thirty-seven Year seven students (M = 12.7 years, SD = 0.42) from five independent schools in Perth, Western Australia, were randomised into control and intervention groups. Comprehensive self-report impact and process data was collected from the student, teacher and parent cohort at baseline, post-test and 8-month follow-up.The thesis is comprised of four studies. Study 1 examined the psychometric properties of the Self- Perception Profile for Children (S-PPC, Harter, 1985), the self-esteem measure used in this study and derived from Harter’s (1986, 1987) model. Study 2 evaluated the STARS programme comparing intervention and control groups on a number of outcome variables including measures of self-esteem, body image and eating disturbance. Study 3 assessed the social validity of the STARS programme. Study 4 examined the relationship between risk factors and eating disturbances over a 12- month period.The S-PPC was established as reliable and valid to use for research purposes with Australian children aged 11 to 14 years. There were no significant intervention effects with the STARS programme for either the whole sample or an at-risk sample. However, participants reported finding the programme both enjoyable and useful. Regression analysis indicated that focussing prevention efforts on teasing about body size/shape in the home environment would be an important addition to a prevention programme. Furthermore, prevention programmes may benefit from reflecting risk factors as they become developmentally more salient and therefore be ongoing throughout the period of risk. An explanation for the lack of intervention effects for the STARS programme is explored and further refinement of the programme is discussed. The implications of these data for preventing eating disturbances using a self-esteem universal school-based intervention are examined.