Promoting healthy development, healthy behaviors, and well-being across all life stages is a primary overarching Healthy People 2030 goal from the United States (US) Department of Health and Human Services (Healthy People 2030, n.d). These goals suggest that methods for improving quality of life (QOL) remain a priority for reaching 2030 goals. QOL has been operationalized, measured, and applied in interventions from both objective and subjective perspectives. Objective QOL indicators focus on population-based criteria associated with “good” lives such as income level, access to health care, etc. (Campbell, 1976). However, life satisfaction (LS) is frequently used as an subjective indicator of QOL owing to its ability to extend beyond transient affective life experiences and include an evaluative and reflective appraisal of life overall (Diener, 1984; Diener et al., 1999; Shin & Johnson, 1978; Siahpush, Spittal & Singh, 2008). In addition, because research with adults demonstrates that objective and subjective indicators (e.g., physician versus self-ratings of health) are distinct from each other, researchers have suggested that objective and subjective QOL indicators reflect separate, but complementary information (Diener & Suh, 1997). This study focuses on LS, which Diener (1984) defines as the cognitive assessment an individual makes regarding their feelings and attitudes relative to their life at the time.
LS research is receiving increased interest owing to associations with numerous health conditions such as asthma, diabetes, obesity, arthritis, and heart disease (Strine et al., 2008). For example, one study which utilized the Satisfaction with Life Scale (SWLS) found that negative LS was related to anxiety and depression where positive LS has been shown to be significantly related to successful life adaptation (Magallares et al., 2014). However, LS among individuals with EDs remains relatively underexplored, which may be a barrier in providing effective care and preventing relapse (Kitsantas, Gilligan & Kamta, 2003). This is surprising given research suggesting improved QOL is related to better ED treatment outcomes, including motivation to change one-year post treatment (Muñoz et al., 2012), and reductions in ED psychopathology, depression, and anxiety 6-months post treatment (Leung, Joyce & Russell, 2013).
EDs carry high mortality risks (Smink, Van Hoeken & Hoek, 2012) and are more frequently diagnosed in young women than men (Qian et al., 2013). The three most common EDs are anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and Other Specified Feeding or Eating Disorders (OSFED) (Hudson et al., 2007; American Psychological Association, 2013). According the DSM-5 (APA, 2013), AN is characterized by an irrational fear of gaining weight, distorted body image, excessive food restriction, amenorrhea, and weight issues (< 85% of clinically standard weight). BN is characterized by bingeing and purging and typically measured by those who may engage in excessive exercise, vomiting, laxatives, and/or diuretics use. BED has similar binges (large amount of food within any 2 hour period of time), but is not followed by compensatory behavior (APA, 2013). Those with BED also express a loss of control and distress during the binge episodes. Finally, OSFED is a category reserved for those EDs which do not meet the criterion for AN or BN.
To our knowledge, there is little literature exploring the association between LS and EDs in a clinical population. In a Spanish study by Magallares et al. (2014), the relationship between anorexia nervosa (AN), bulimia nervosa (BN), Other Specified Feeding and Eating Disorders (OSFED), and Subjective Well-Being (SWB; includes positive and negative affect as well as LS) was explored. This study found women with EDs reported lower SWB than those in the control group. Kitstankas et al. (2003) found college students diagnosed with EDs reported significantly lower levels of LS as well as higher levels of negative affect than those at-risk (do not meet ED criteria without more in-depth clinical evaluation) for EDs or at normal weight. Other research indicates individuals who have fully recovered from AN have similar LS scores to healthy controls, while those who have poor outcomes at the end of treatment have significantly lower LS (Halvorsen & Heyerdahl, 2006) and QOL.
The current study seeks to improve the extant literature by utilizing the well-validated and widely used Satisfaction with Life Scale (SWLS; Diener et al., 1985) and draws from a clinical population in four different US states allowing geographic diversity. The primary study aim was to understand LS in a clinical population of patients with ED diagnoses. Based on the results by Magallares et al. (2014), we hypothesized that individuals in this population would report lower LS than population-based norms without an ED diagnosis also using the SWLS. Exploratory study aims were to examine subgroup analyses to understand the association between LS and other demographic characteristics such as ED history, insurance coverage, BMI, and income level for the first time. Such analyses are expected to provide treatment providers and researchers descriptive data to help improve treatment outcomes for those with EDs.