Previous research suggests that up to 72% of adult women experience body dissatisfaction (Fiske et al., 2014), which research shows is a risk factor for disordered eating behaviors (DEB; Mustapic et al., 2015). Such eating behaviors can include food restriction, binging, purging, preoccupations surrounding food, and others. DEB lead to increased risk for cardiovascular disease (Ginty et al., 2012), which is the leading cause of death for both women and men in the United States (Murphy et al., 2020). In addition to cardiovascular disease, mental health challenges such as depression, generalized anxiety disorder, and suicidal thoughts are also associated with disordered eating behaviors (Eisenberg et al., 2011). When disordered eating behaviors are practiced, they are likely to continue for many years (Eisenberg et al., 2011; Herle et al., 2020). Specifically, one longitudinal study found that adolescents who engaged in disordered eating behaviors had an increased risk to do so into adulthood when surveyed ten years later (Neumark-Sztainer et al., 2011). This poses a particular risk as eating disorder persistence over time is associated with high mortality rates and worse treatment outcomes (Martin et al., 2021). According to the Centers for Disease Control and Prevention (CDC), practicing DEB, including purging specifically, can also lead to esophagitis and “impairment of digestive functioning,” and DEB has been causally linked to obesity and weight gain (Austin et al., 2008). Overall, the health risks that accompany disordered eating behaviors are both extensive and have the potential to be long-lasting.
Religious beliefs have been associated with DEB but the relationship between religiosity and DEB is an area of ongoing research. Currently, there is no conclusive answer as to whether religion contributes to or aids in recovery from DEB. Rather, different facets of religion seem to be associated with DEB in unique ways. In many cases, having healthy religious attitudes, including believing in a forgiving God and internalizing religious beliefs, can help a person reduce DEB (Boisvert & Harrell, 2012; Exline et al., 2015; Richards et al., 2018). Meanwhile, harboring negative attitudes about God, believing in God’s disapproval, and holding religious guilt can exacerbate DEB (Exline et al., 2015; Richards et al., 1997). Religion can either provide positive coping as the individual finds meaning in their circumstances or it can be a negative coping mechanism as the individual struggles and experiences conflict in their relationship with God (Latzer et al., 2015).
Most studies looking at religious beliefs and DEB focus on individuals with clinically diagnosed eating disorders (Richards et al., 1997, 2018). Less work has focused on individuals that exhibit DEB but have not been clinically diagnosed. Despite there being fewer studies on these individuals, studies of non-clinical samples have consistently shown that eating disorder-related pathology often goes undiagnosed and is prominent among women (Eisenberg et al., 2011; Martin et al., 2021; Yu et al., 2018). It is important to look specifically at these women as DEB is a significant indicator of clinical diagnosis (Herle et al., 2020; Latzer et al., 2015; Martin et al., 2021). Understanding the relationship between religiosity and DEB may aid in identifying risk factors for DEB or may allow for the exploration of coping strategies that mitigate the risks of DEB. This study sought to understand if religious forgiveness and religious and spiritual coping are associated with DEB in women who exhibited DEB but have not been clinically diagnosed. We hypothesized that high religious forgiveness would be associated with lower DEB and that higher religious and spiritual coping would be associated with lower DEB.
Methods
For our study, we initially recruited 62 individuals to participate. However, three participants were excluded from the final analysis due to critical missing data, leading to a final sample size of 59. Individuals with clinically diagnosed eating disorders were excluded from the study in order to focus specifically on the effects of DEB in a non-clinical sample. Of the 59 participants, all identified as women aged 21 – 47, 77.97% identified as White non-Hispanic and 88.14% identified as members of the Mormon Church (see Table 1 for full demographics). Participants completed the Brief Multidimensional Measure of Religiousness and Spirituality (BMMRS ) and the Change in Eating Disorder Symptoms scale (CHEDS; α ≥ 0.73; Harris et al., 2008; Hwang & Spangler, 2016; Johnstone et al., 2020; Spangler, 2010). For this study, we totaled scores from the Forgiveness subsection (items 9 – 11) and the Religious and Spiritual Coping (items 17 – 23) subsection of the BMMRS (Fetzer Institute, 2003). Of the Religious and Spiritual Coping subsection, items 17, 18, 19, and 23 were reverse scored using a Likert scale so that a higher overall score in Religious and Spiritual Coping indicates greater positive religious coping. We also calculated the CHEDS total score.
Results
We ran a multivariate regression analysis to determine if the participant’s scores in the (1) Forgiveness and (2) Religious and Spiritual Coping subscales within the BMMRS were predictors of the participant’s CHEDS total scores. The model showed that the subscales statistically significantly predicted CHEDS scores (F(2, 56) = 6.92; p = 0.002), and an interaction between both variables also statistically significantly added to the prediction model (p < 0.002; See Figure 1).
Discussion
A complex relationship exists between religiosity and DEB. Due to the significant relationship found with the interaction of Forgiveness and Religious/Spiritual coping being a significant predictor of DEB, this study suggests that these variables working together may help with DEB prevention. Meanwhile, having low Forgiveness and Religious/Spiritual coping may be risk factors for DEB development. This implies that healthy forgiveness and developing Religious/Spiritual Coping should be considered for future clinical treatment of and prevention of DEB.
This study’s limitations include having a predominantly White sample that were mainly members of the Mormon Church (see Table 1). Eisenberg et al. (2011) showed that among college students, White non-Hispanic and Asian/Asian American students were significantly more likely to show disordered eating behaviors than Black non-Hispanic students. This suggests there may be a lack of generalizability in our study to Black non-Hispanic women.
Future research should study DEB in other races, ethnicities, age groups, or religions to identify potential cultural differences due to the homogenous sample studied (see Table 1). Although our research focused on women, DEB also affects men, so future research should study the impact of religion on DEB for men as well (Eisenberg et al., 2011; Yu et al., 2018). Future researchers should also study the impact of scrupulosity, defined as compulsions to participate in excessive religious rites to address obsessions about sinful thoughts or actions (Abramowitz et al., 2002). Allen et al. (2021) studied members of the Mormon Church and found that scrupulosity is positively correlated with maladaptive perfectionism, anxiety about God, and avoidance of God. Further, Rutter-Eley et al. (2020) found an association between maladaptive perfectionism and eating disorders. Since our findings revealed a correlation between DEB and forgiveness from God, it is possible that forgiveness from God could prove useful in clinical treatments of disorders related to DEB such as maladaptive perfectionism and scrupulosity. This study should also be replicated to determine the generalizability of the results. Despite the demographic limitations to our study, our research still shows an important relationship between religious/spiritual coping and forgiveness, together acting as predictors of DEB severity. This study addressed previously limited research on the specific relevance of these variables as important factors to be utilized in DEB prevention and treatment.