Eating disorders, as a life threatening condition, are serious disturbances in eating and body image. Eating disorders are very common among women (1). Eating disorders are as Heterogeneous multidimensional syndrome and as a result of neurobiology, psychological, social and cultural function (2). For example, eating disorders among women is due to the cultural focus on female thinness (3). From a developmental perspective, researchers have suggested various factors must be considered as integrated and eating disorders should be conceptualized as developmental disorders in the process of self-regulation with deficits in processing capacity and emotional regulation as the initial disturbance (4). In the recent years, eating disorders and problematic eating behaviors and beliefs are increasingly common (5). Anorexia nervosa and bulimia nervosa affect about 0.3% to 1% of women and is more common among aged 15 to 24 years old women (6). Maladaptive eating attitudes are a common problem among teenagers and can be a prelude for eating disorders (5). Research shows that people with emotional disorders such as depression, anxiety, obsessive-compulsive disorder, interpersonal sensitivity and social phobia have a greater risk of developing eating disorders (7-9). Recent researches have focused their attention on role of personality and their structures in creating the eating disorder (10). Conceptual relationship between personality and eating disorders are very complicated .Also people with eating disorders routinely have diagnostic criteria for personality disorders (11). From the perspective of treatment in eating disorders, comorbidity of eating disorders with personality disorders can interfere with the healing process (12). High schools girls are important target to encourage a healthy lifestyle in adolescence population (13). Researches show that the population in this age group has the greatest risk for beginning of eating disorders (14). Psychiatric comorbidity is very common in people with eating disorders. clinical and society studies show between 55% to 98% of individuals with anorexia nervosa and 88% to 97% of people with bulimia nervosa have axis I disorders (15).Studies show that the rate of anxiety disorders in women with anorexia nervosa is higher in compared with control group and beginning of the anxiety disorders is the prelude of anorexia nervosa. Women with bulimia nervosa in clinical and community samples, report one or more of an anxiety disorder (16, 17). One of the issues studied in this research was to investigation of relationship between anxiety variable and disordered eating behaviors.

Mean, standard deviation and internal correlations of variables under study are presented in table 1.

presented in Table 2.

Table 2: Summary of regression analysis model

Table 3: Summary of stepwise regression analysis to predict disordered eating behaviors

As can be seen, anxiety variable with β=0.58 can significantly predict almost %35 of the variance of disordered eating behaviors.  Also, alexitymia variable with β=0.42 can significantly predict almost %22 of the variance of disordered eating behaviors.

 Discussion

The results of this study showed that anxiety variable can significantly predict disordered eating behaviors. These results are consistent with pervious finding (17, 38, 41 & 42). These findings can be interpreted in terms of the following possibilities: 

Eating disorders have high rates of comorbidity with other mental disorders, especially anxiety disorders .There is a diagnostic overlap between eating disorders with anxiety disorders (17). For example, the common symptoms of bulimia and anorexia nervosa may include severe anxiety about food and eating, fear of gaining weight and anxiety about social evaluation (43). For example, the effects of starving and other applied ways for losing weight may be observed in obsessive compulsive behaviors related to food, eating and body checking as an anxiety disorder (44). The researches show people with eating disorders who has anxiety disorders, are more likely to be resistant against symptoms of eating disorders, have lower health, and show a higher rate of mortality in comparison with people without comorbidity disorder in 14–years period follow up (45). For example, it can be said that the social anxiety by inhibiting commitment in people with eating disorders to the treatment process, due to fear of negative evaluation and avoiding from interaction with others may express a part of comorbid unfavorable variance of anxiety disorders with eating disorder in field of treatment (46). The comorbidity of anxiety disorders shows higher severity of disorder and complexity in appearing the eating disorders which may predict independently the poor consequences (47). In the research was done about the relation of eating with emotion over 22 high weight individuals, the results showed that unfavorable emotion have a specific relation with eating disorder and the anxiety was expressed the most reason for disordered eating behavior (48). When the anxiety is applied in experimental situations, it is more likely that the subjects suffer from disordered eating behavior even if the food isn't delicious (41). Although, the special nature of relations between eating disorders and anxiety is not clear, the researchers say that anxiety may be a dangerous factor in making eating disorders, anxiety may be secondary to eating disorders and or both disorders may share some common vulnerable factors (49). For example, recent theories say that the negative initial experiences are the dangerous factor in growing both disorders. In this model, the basic deleterious cognitions lead to deleterious avoided cognitions, these results from application of safe behaviors that includes both disorders (50). Of this view, the child's anxiety may have an etiology role in making eating disorders which their origin is from ultra fear about situations and certain events which finally leads to extra fear about eating, appearance and weight and at last, leads to disordered eating behavior (51).

Also, the results of this study showed alexithymia can significantly predict disordered eating behaviors. These results are consistent with the findings of previous research (52-55). These findings can be interpreted according to following possibilities. Alexithymia have dimensions of emotional disability in describing and identifying emotions and cognitive aspects of thinking has objective and external oriented (56). Research has shown inability to express emotional experiences as a result of non-discrimination and unregulated emotions have related with disordered eating behaviors by the distortion of body image (57). Cognitive constraints on emotion regulation in people with alexithymia are associated with maladaptive behavior such as starvation or substance abuse because of self-regulatory behaviors. Lack of insight and thinking styles (external oriented) of persons with alexithymia interfere with ability of these individuals to benefit of psychotherapeutic interventions. Females with disordered eating behaviors have higher level of alexithymia than women in the control group and may be their emotions transfer to physical feelings and physical appearance (58). Disability in identifying of emotions has related with body dissatisfaction in people with disordered eating behaviors (57). Researches show that the rate of alexithymia in people with eating disorders in a higher level than people who have been improved their eating disorders and symptoms of eating disorders represent internal conflicts and unclear feelings (59). Individuals with high levels of alexithymia have difficulties in identifying and describing their feelings. They are disorganized due to their limitations in adjusting these emotions by uncontrollable feelings; finally they try to adjust themselves by self-incitement maladaptive behaviors like being on a diet. These strategies are as non-conducive efforts which they are applied to organize internal emotions and feelings and integrate the self-defense sense. It is vital to identify alexithymia in persons with eating disorders symptoms as a negative prognostic factor for treatment strategies (55).

 Conclusion

In summary, the present findings suggest that alexithymia and anxiety can significantly predict disordered eating behaviors among high school girls. The findings of this study will expand previous research on the relationship between anxiety and alexithymia with eating disorders in non-clinical sample of females.  A group of girl’s students are at risk for developing eating disorders and primary and secondary prevention programs are required in order to cope with the situation between them.  Using the strategy to provide information to young girls is important as prevention programs. These programs prevent the occurrence of new cases and persons who have this disorder are encouraged to look for the relevant professionals. This study is required replication and experimental confirmations because of its novelty in the Iranian cases. Until then, the findings should be interpreted with caution. Similarly, sample (group of students) and research (correlation) are discussed the limitations of findings generalizability, interpretation and causal attribution and should be considered. Furthermore, the limitations of self-report measures in this study should not be ignored.

 Acknowledgements

The authors would like to acknowledge the generosity of girls students of Tehran-Iran high schools who agreed to participate in this research.