dietary restraint and negative affect as mediators of body dissatisfaction and bulimic behavior in...

Behaviour Research and Therapy 39 (2001) 1317–1328www.elsevier.com/locate/brat

Dietary restraint and negative affect as mediators of bodydissatisfaction and bulimic behavior in adolescent girls and

boys

Lina A. Ricciardelli *, Marita P. McCabeSchool of Psychology, Deakin University, Burwood Highway, Burwood, 3125 Melbourne, Australia

Accepted 26 February 2000

Abstract

Stice’s dual pathway model of dietary restraint and negative affect was examined in both adolescentgirls and boys. Self-report measures assessing body dissatisfaction, dietary restraint, negative affect andbulimic behavior were administered to 267 girls and 199 boys aged between 12 and 16 years. The findingsfor the girls were consistent with Stice’s model, in that they indicated that both dietary restraint and negativeaffect mediated the relationship between body dissatisfaction and bulimic behavior. For the boys whodesired a thinner body size, only negative affect was found to mediate the relationship between bodydissatisfaction and bulimic behavior. On the other hand, for boys who desired a larger body size, bothbody dissatisfaction and dietary restraint were found to exert an independent effect on bulimic behavior.As boys can aspire to two contrasting and seemingly opposite body size ideals, the findings highlight thatthe relationship between body dissatisfaction, dietary restraint, negative affect and bulimic behavior aremore complex in males than in females. Further research using longitudinal designs is needed in order totest the directional and bidirectional nature of the observed interrelationships. 2001 Elsevier ScienceLtd. All rights reserved.

Keywords: Bulimic behavior; Adolescent boys; Adolescent girls; Dietary restraint; Negative affect; Body dissatisfaction

1. Introduction

Recent models which have been designed to explain the development of bulimia nervosa andbulimic behavior have been primarily tested and validated with young adult women and adolescentgirls (Shepherd & Ricciardelli, 1998; Stice, Nemeroff & Shaw, 1996; Stice, Shaw & Nemeroff,

* Corresponding author. Tel.:+61-3-92446866; fax:+61-3-92446858.E-mail address: [email protected] (L.A. Ricciardelli).

0005-7967/01/$ - see front matter 2001 Elsevier Science Ltd. All rights reserved.PII: S0005-7967(00)00097-8

1318 L.A. Ricciardelli, M.P. McCabe / Behaviour Research and Therapy 39 (2001) 1317–1328

1998; Thompson, Coovert, Richards, Johnson & Cattarin, 1995; Varnado, Williamson & Neteme-yer, 1995). This is despite the fact that approximately 10% of individuals who are treated forbulimia nervosa and binge eating disorder are males (Carlat, Camargo & Herzog, 1997; Tanofsky,Wilfley, Spurrell, Welch & Brownell, 1997; Wilson, Nonas & Rosenblum, 1993). In addition,community samples of adolescent and adult males have demonstrated high levels of binge eatingbehavior that are often comparable to that of females (Franco, Tamburrino, Carroll & Bernal,1988; Maude, Wertheim, Paxton, Gibbons & Szmukler, 1993).

Among young women, body dissatisfaction has been consistently found to be one of the mainrisk factors predictive of bulimia nervosa and bulimic eating patterns (Gleaves, Williamson &Barker, 1993; Ricciardelli, Tate & Williams, 1997). Stice (1994) proposed a model that identifiestwo pathways in which body dissatisfaction may lead to the development of bulimic behavior foryoung women and adolescent girls. The first pathway involves dietary restraint. Within this path-way, body dissatisfaction is closely associated with dietary restraint, and in turn, dietary restraintleads to an increase in the likelihood of binge eating and bulimia nervosa (Brody, Walsh & Delvin,1994). The second pathway is via negative affect. Body dissatisfaction is closely associated withnegative affect, and women experiencing negative affect demonstrate higher levels of bulimicbehavior (Beebe, 1994; Shepherd & Ricciardelli, 1998; Stice, 1994; Stice et al., 1998). Bingeingand purging, in turn, are thought to reduce negative affect by providing temporary relief anddistraction from one’s negative emotional state (Beebe, 1994; Stice, 1994). Therefore, the twopathways which were developed by Stice (1994) to explain the development of bulimic behavior,have both received empirical support for young adult women and adolescent girls.

In contrast, several studies conducted with non-clinical samples of males, have not alwaysfound significant relationships between body dissatisfaction, dietary restraint, negative affect andbulimic behavior (Keel, Fulkerson & Leon, 1997; Leon, Fulkerson, Perry & Early-Zald, 1995;Richards, Casper & Larson, 1990). It has been suggested that whereas women use dietary restraintto moderate body dissatisfaction, men may not use dietary restraint in the same way (Carlat &Camargo, 1991). Men who are dissatisfied with their body are less likely to want to lose weight,as dieting would take men away for the “mesomorphic” ideal (Carlat & Camargo, 1991; Rauden-bush & Zellner, 1997). In addition, although similar levels of binge eating have been foundbetween men and women, some studies have shown that boys and men are less likely to feeldepressed after bingeing, and they report less guilt about binge eating (Carlat & Camargo, 1991;Leon et al., 1995; LaPorte, 1997; Snow & Harris, 1989). In fact, binge eating in men is not seenas abnormal or as inappropriate as it is in women, and it may even be socially sanctioned formen (Carlat & Camargo, 1991). Thus, the meaning, function and outcome of binge eating maybe quite different for males and females. It is also not surprising that men require that a largeramount of food be consumed before they label it a “binge” , and men associate mostly gastrointes-tinal outcomes rather than negative emotional responses with their labeled binges (LaPorte, 1997).

Whilst the above discussion would suggest that negative affect may not play an important rolein determining binge eating and other bulimic behavior among males, some studies have foundevidence which links emotional distress to bulimic behavior among males (Fox, Page, Arm-strong & Kirby, 1994; Leal, Weise & Dodd, 1995; Leon, Fulkerson, Perry, Keel & Klump, 1999;Ricciardelli, Williams & Kiernan, 1999; Vincent & McCabe, 2000). The inconsistent findingswith males may be due to the fact that body dissatisfaction among males is fairly equally splitbetween those wanting a larger body size and those wanting to be thinner than their current body

1319L.A. Ricciardelli, M.P. McCabe / Behaviour Research and Therapy 39 (2001) 1317–1328

size (Davis & Cowles, 1991; Drewnowski & Yee, 1987; Furnham & Calnan, 1998; McCabe &Ricciardelli, 2000; Raudenbush & Zellner, 1997). This may lead to different associations betweenbulimic behavior and negative affect in these two groups of males.

The present study was designed to examine Stice’s (1994) model among adolescent males andfemales. Stice’s model identifies dietary restraint and negative affect as two pathways whichmediate the relationship between body dissatisfaction and bulimic behavior. A separate examin-ation of boys who wanted to be thinner versus those who wanted to be bigger than their currentbody size was conducted, as this may explain some of the conflicting findings in previous research.Whilst Stice’s model has been evaluated for adolescent girls and adult women, the model has yetto be examined for males.

2. Method

2.1. Participants

The participants were 267 girls and 199 boys aged between 12 and 16 years. The mean ageof the girls was 13.91 years (SD=0.92). The mean age of the boys was 13.99 years (SD=1.02).The participants were recruited from grades 7 to 10 in two co-educational state schools from themetropolitan area of Melbourne, Australia. All respondents were drawn from middle socioecon-omic groups, and were primarily Anglosaxon (86%) in their cultural backgrounds.

2.2. Materials

2.2.1. Stunkard body figure drawingsThe Stunkard Body Figure drawings (Stunkard, Sorensen & Schulsinger, 1983) were used to

assess whether participants wanted to be thinner than their current body size, whether they wereat their desired body size, or whether they wanted to be bigger than their current body size. Thebody size drawings consisted of nine drawings each of female and male figures, ranging fromvery thin to obese. Respondents were asked to select the drawing that represents their currentfigure and subsequently select the drawing that represents their ideal figure. A discrepancy scoreis calculated by subtracting the ideal figure from the perceived figure. A positive discrepancyscore describes those individuals who want to be thinner than their current body size. A negativediscrepancy score describes those individuals who want to be bigger than their current body size.A discrepancy score of zero describes those individuals who are at their desired body size. Theinstrument has been widely used and validated in research with both men and women (Fallon &Rozin, 1985; Raudenbush & Zellner, 1997; Silberstein, Striegel-Moore, Timko & Rodin, 1988).

2.2.2. Body dissatisfactionBody dissatisfaction was assessed using the Body Dissatisfaction sub-scale (nine items) from

the Eating Disorder Inventory-2 (EDI-2; Garner, 1991). As the Body Dissatisfaction sub-scalewas primarily devised to assess body image concerns among girls, three additional items whichmore specifically addressed body image concerns for boys were included in the scale (Furnham &Calnan, 1998; McCabe & Ricciardelli, 2000; Moore, 1990; Nowak, Spear & Crawford, 1996).


The items addressed dissatisfaction with abdominal/stomach region, chest and size/width of yourshoulders. Each of the 12 items were scored using a six-point likert scale, which required respon-dents to answer whether each item applies “always” , “usually” , “often” , “sometimes” , “ rarely”or “never” (1–6), with higher scores indicating higher levels of body dissatisfaction. Total scoresranged from 12 to 72. Garner (1991) has provided reliability and validity data for the originalnine item sub-scale.

2.2.3. Dietary restraintDietary restraint was assessed using the Drive for Thinness sub-scale (seven items), also from

the EDI-2 (Garner, 1991). The Drive for Thinness sub-scale assesses excessive preoccupationswith dieting and weight. It has been found to correlate highly with other scales which assessdietary restraint and to load highly on a general factor identified as dietary restraint (Williamson,Barker, Bertman & Gleaves, 1995). Items were scored using the same format as the Body Dissatis-faction sub-scale, with higher scores indicating a higher level of dietary restraint. Total scoresranged from 7 to 42. Additional validity data and reliability estimates for the sub-scale are pro-vided by Garner (1991).

2.2.4. Negative affectThe short form of the Depression, Anxiety and Stress Scale (DASS, 21 items) was used to

assess negative affect (Lovibond & Lovibond, 1995). Respondents were required to indicate theextent to which they experienced depression, anxiety and stress related symptoms over the pastweek by circling the number on a likert scale ranging from 0 “did not apply at all” to 3 “appliedto me very much or most of the time” . Responses on the 21 items were summed, with higherscores indicating a greater degree of negative emotional symptoms. Total scores ranged from 0to 63. Lovibond and Lovibond (1995) provide data on the scale’s reliability and validity.

2.2.5. Bulimic behaviorThe Bulimia-Test Revised (28 items; BULIT-R; Thelen, Farmer, Wonderlich & Smith, 1991)

was used to assess bulimic symptoms. Thelen et al. (1991), and Thelen, Mintz and Wal (1996)provide extensive reliability and validity data on the BULIT-R for clinical and non-clinical popu-lations. Vincent, McCabe and Ricciardelli (1999) have provided further evidence of the scale’sconstruct validity with adolescent males and females. Items on the BULIT-R are scored on a five-point scale (1–5), with higher ratings indicating higher levels of bulimic symptoms. As theBULIT-R also examines dietary restraint and body dissatisfaction [see Thelen et al. (1991) forits factor structure] a modified BULIT-R score (18 items) was computed which excluded items ondietary restraint and body dissatisfaction (Shepherd & Ricciardelli, 1998). The modified BULIT-Rscore was used in all analyses. Total scores ranged from 18 to 90.

2.3. Procedure

The Deakin University Ethics Committee and the Victorian State Education Departmentapproved the study. Letters outlining the nature of the study were sent to parents and all studentsin grades 7–10 from two state coeducational high schools. A passive parental consent procedurewas used, resulting in a participation rate of 98%. A trained research assistant administered the


test materials using an anonymous survey method. The students completed the questionnairesduring one class period (40 min).

3. Results

3.1. Preliminary analyses

The Stunkard Body Figure drawings were used to divide the boys and girls into those whowanted to be thinner than their current body size, those who were at their desired body size andthose who wanted to be bigger than their current body size. Among the boys, 29.6% (n=59)wanted to be thinner, 16.6% (n=33) were at their desired body size, whilst 53.8% (n=107) wantedto be bigger. Among the girls, 76.8% (n=205) wanted to be thinner, 12.0% (n=32) were at theirdesired body size whilst 11.2% (n=30) desired a bigger body size. Due to the small number ofgirls in two of the groups, only the girls who wanted to be thinner than their desired body sizewere included in further analyses. Similarly, the number of boys who were at their desired bodysize (n=33) were also too few to be examined further using multivariate statistics.

MANOVA was used to examine differences on Body Dissatisfaction, Drive for Thinness, theDASS, and the modified BULIT-R among the three groups: girls who wanted to be thinner, boyswho wanted to be thinner and boys who wanted to be bigger. An overall group difference wasfound [Hotellings’ T2=0.70, F(8, 732)=32.02, p�0.001] and specific univariate group differenceswere found on Body Dissatisfaction [F(2, 368)=92.64, p�0.001], Drive for Thinness [F(2,368)=63.02, p�0.001],and the DASS [F(2, 368)=3.52, p�0.05]. There were no significant differ-ences among the three groups on the BULIT-R. Descriptive data for these analyses are shown inTable 1. Included for each measure is the internal consistency as assessed by Cronbach a. Overallthese reliability coefficients were very high; they ranged from 0.81 to 0.95.

In order to examine further the significant group differences, post hoc tests were conducted

Table 1Summary of descriptive data for girls and boys

Girls who wanted to be Boys who wanted to be Boys who wanted to bethinner (N=205) thinner (N=59) bigger (N=107)

Mean Mean MeanCronbach a Cronbach a Cronbach a

SD SD SD

Body dissatisfaction 0.81 33.19 0.82 27.52 0.82 21.886.91 6.96 7.28

Drive for thinness0.84 22.67 0.87 18.21 0.90 14.31

(dietary restraint)6.19 6.82 6.27

DASS (negative affect) 0.94 25.70 0.93 24.39 0.95 22.749.48 9.50 9.04

Modified BULIT-R 0.86 38.09 0.82 40.38 0.85 41.3911.64 11.22 12.89


using the Tukey procedure. The girls and boys who desired a thinner body size scored significantlyhigher on Body Dissatisfaction and Drive for Thinness than the boys who desired a bigger bodysize (p�0.05). The girls also scored significantly higher than the boys who desired a thinner bodysize on Body Dissatisfaction and Drive for Thinness (p�0.05), but these two groups did not differon the DASS. Lastly, the girls scored significantly higher than the boys who desired a biggerbody size on the DASS (p�0.05).

3.2. Dietary restraint and negative affect as mediators of bulimic behavior

In order to provide evidence in support of Stice’s (1994) model, which predicts that dietaryrestraint and negative affect mediate the relationship between body dissatisfaction and bulimicbehavior, three conditions need to be met (Baron & Kenny, 1986). Firstly, it needs to be shownthat the independent variable measuring body dissatisfaction is related to the mediators, dietaryrestraint and negative affect. Secondly, it needs to be shown that the mediators, dietary restraintand negative affect are related to the dependent variable, bulimic behavior. Finally, in order toestablish the mediator relationship, the effect of the independent variable on the dependent variableneeds to be completely (full mediator) or substantially reduced (partial mediator) by controllingfor the mediating variables. These conditions were examined for each group: adolescent girls whodesired a thinner body size, adolescent boys who desired a thinner body size, and adolescent boyswho desired a bigger body size.

3.3. Adolescent girls who wanted a thinner body size

The first two conditions required in order to demonstrate mediational effects were assessedusing Pearson correlation coefficients. Body dissatisfaction correlated significantly with both ofthe designated mediators, dietary restraint (r=0.66, p�0.001) and negative affect (r=0.23,p�0.001). In addition, the mediators, dietary restraint (r=0.33, p�0.001) and negative affect(r=0.33, p�0.001) correlated significantly with the dependent variable, bulimic behavior.

A hierarchical multiple regression analysis was conducted to determine if the mediating vari-ables reduced the effect of body dissatisfaction on bulimic behavior. As shown in Table 2, bodydissatisfaction accounted for 6% of the variance in the BULIT-R scores [F(1, 203)=15.61,p�0.001]. At step 2, the mediators, dietary restraint and negative affect, predicted an additional11% in the BULIT-R scores [F(2, 201)=17.62, p�0.001]. In addition, as can be seen in Table 2,

Table 2Predictors of BULIT-R scores for adolescent girls who wanted a thinner body size (N=205)

Predictors of BULIT-R R2 Change in R2 B b t p

Step 1 0.06 0.06 �0.001Body dissatisfaction 0.33 0.23 3.95 �0.001Step 2 0.17 0.11 �0.001Body dissatisfaction 0.03 0.02 0.32 0.75Dietary restraint 0.39 0.23 3.01 �0.01Negative affect 0.33 0.26 4.37 �0.001


the effect of body dissatisfaction on bulimic behavior was completely reduced and rendered non-significant once the mediators were entered into the multiple regression equation. Therefore, theresults show that dietary restraint and negative affect fully mediated the relationship betweenbody dissatisfaction and bulimic behavior for the adolescent girls.

3.3.1. Adolescent boys who wanted a thinner body sizeThe first two conditions required in order to demonstrate mediational effects were also met for

the boys who desired a thinner body size than their current one. Body dissatisfaction correlatedsignificantly with dietary restraint (r=0.57, p�0.001) and negative affect (r=0.34, p�0.01). Inaddition, dietary restraint and negative affect correlated significantly with bulimic behavior(r=0.43, p�0.001 and r=0.49, p�0.001, respectively).

A hierarchical multiple regression analysis was conducted to examine the effect of the inde-pendent variable on the dependent variable once the mediating variables were entered into theequation. As shown in Table 3, body dissatisfaction accounted for 13% of the variance in theBULIT-R scores [F(1, 57)=8.86, p�0.01]. At step 2, after the entry of the mediators, an additional18% in the BULIT-R scores [F(2, 55)=7.17, p�0.01] was predicted. However, only negativeaffect was a significant unique contributor. In addition, as can be seen in Table 3, the resultssuggest that negative affect fully mediated the relationship between body dissatisfaction and bul-imic behavior; the standardized regression weight for body dissatisfaction was rendered non-significant once the influence of negative affect was entered into the regression equation.

3.3.2. Adolescent boys who wanted a bigger body sizeThe first condition which is required to demonstrate mediational effects was met also for boys

who desired a bigger body size; body dissatisfaction correlated significantly with both dietaryrestraint (r=0.49, p�0.001) and negative affect (r=0.30, p�0.01). However, only one of the pro-posed mediators correlated with bulimic behavior; dietary restraint correlated significantly withbulimic behavior (r=0.46, p�0.001). There was no significant association between negative affectand bulimic behavior (r=0.08, NS).

A hierarchical multiple regression analysis was conducted to examine the mediational effect ofdietary restraint and negative affect on bulimic behavior. As shown in Table 4, body dissatisfactionaccounted for 17% of the variance in the BULIT-R scores [F(1, 105)=20.86, p�0.001]. Anadditional 9% of the variance [F(2, 103)=6.88, p�0.01] in the BULIT-R scores was explainedat step 2, after the entry of the hypothesized mediators, dietary restraint and negative affect.

Table 3Predictors of BULIT-R scores for adolescent boys who wanted a thinner body size (N=59)


Step 1 0.13 0.13 �0.01Body dissatisfaction 0.59 0.37 2.99 �0.01Step 2 0.31 0.18 �0.001Body dissatisfaction 0.21 0.13 0.96 0.34Dietary restraint 0.32 0.20 1.37 0.18Negative affect 0.43 0.37 2.95 �0.01


Table 4Predictors of BULIT-R scores for adolescent boys who wanted a bigger body size (N=107)


Step 1 0.17 0.17 �0.001Body dissatisfaction 0.72 0.41 4.57 �0.001Step 2 0.26 0.09 �0.01Body dissatisfaction 0.45 0.26 2.58 �0.01Dietary restraint 0.73 0.36 3.67 �0.001Negative affect �0.11 �0.08 �0.88 0.38

However, for this group of boys, both body dissatisfaction and dietary restraint were found to besignificant and unique predictors of bulimic behavior in the final regression equation. Moreover,as can be seen in Table 4, the results indicate that dietary restraint partially mediated the relation-ship between body dissatisfaction and bulimic behavior, as the standardized regression weight forbody dissatisfaction was reduced from 0.41 in Step 1 to 0.26 in Step 2; a reduction of 36.6%.

4. Discussion

Whilst previous studies have evaluated Stice’s model for adolescent girls and adult women(Shepherd & Ricciardelli, 1998; Stice et al. 1996, 1998), the present study was the first to examinethe model for adolescent males. Moreover, as males have been found to be fairly equally splitbetween those wanting to be thinner versus those wanting to be bigger than their current bodysize (e.g., Raudenbush & Zellner, 1997), the model was examined separately for the two groupsof adolescent males.

The findings for girls were consistent with Stice’s (1994) model. The model proposes thatdietary restraint and negative affect mediate the relationship between body dissatisfaction andbulimic behavior. As expected, the effect of body dissatisfaction on bulimic behavior for girls wasrendered non-significant once dietary restraint and negative affect were entered into the regressionequation. However, the findings differed for the two groups of boys. For boys who desired athinner body size, only negative affect was found to mediate the relationship between body dissat-isfaction and bulimic behavior. On the other hand, for boys who desired a larger body size, dietaryrestraint was found to partially mediate the relationship between body dissatisfaction and bulimicbehavior. However, body dissatisfaction and dietary restraint primarily exerted independent effectson bulimic behavior.

Previous studies which have examined the association between negative affect and bulimicbehavior among males have found mixed results (e.g., Leal et al., 1995; Leon et al., 1995).However, past studies have failed to separately examine the relationship for males who aspire tothe two contrasting body size ideals. As for females, negative affect appears to be a main pathwaywhich links body dissatisfaction and bulimic behavior for males who desire a thinner body size.The findings from the present study are also consistent with past studies which suggest that dietaryrestraint is not used in the same way among males and females (e.g., Carlat & Camargo, 1991).Past research has demonstrated that the main weight loss strategy used by males is exercise (e.g.,


Drewnowski & Yee, 1987; Drewnowski, Kurth & Krahn, 1995). Further research is needed inorder to examine whether exercise for the purpose of losing weight and attaining a thinner bodysize plays any role in the development of bulimic behavior. As excessive exercise has been foundto be closely related to dietary restraint (e.g., Brehm & Steffen, 1998; Yates, 1991), excessiveexercise as a weight loss strategy may trigger the same physiological (e.g., cravings) and cognitive(e.g., disinhibition) mechanisms that are associated with dietary restraint (e.g., Guertin, 1999;Polivy & Herman, 1985). Excessive exercise may also act as a mediator between body dissatis-faction and bulimic behavior for boys, just as dietary restraint does for girls.

The findings for the boys who desired a larger body size were less straightforward. This maybe due to the fact that the meaning of bulimic behavior and, in particular, binge eating, is lessclear cut for males. This may particularly be the case for males who are wanting a larger body.For many of these males, binge eating is less likely to be seen as inappropriate and is also lesslikely to be associated with negative emotional outcomes (e.g., Carlat & Camargo, 1991; LaPorte,1997; Leon et al., 1995). Consistent with this view, negative affect was found to be unrelated tobulimic behavior for boys who sought a larger body size. On the other hand, dietary restraint wasa predictor of bulimic behavior in this group of males. This may indicate that males who wantto achieve the “masculine ideal of lean muscularity” (Leon et al., 1999: 194), use a combinationof both dietary restraint and binge eating. However, as negative affect was not correlated withbulimic behavior, the results suggest that dietary restraint in combination with binge eating maybe a successful technique for increasing body bulk. Further studies and longitudinal research areneeded in order to understand more fully the directional and the bidirectional nature of the relation-ships between body dissatisfaction, dietary restraint, and bulimic behavior in males who desire alarger body size.

Sociocultural pressures for women in our society are directed to the attainment of an ultras-lender body. The resulting drive for thinness and negative affect have been assigned a centralrole in models of bulimia nervosa and other related models of disordered eating (e.g., Garner,1991; McCarthy, 1990; Stice, 1994; Striegel-Moore, Silberstein & Rodin, 1986). However, thesemodels were not designed to explain the development of disordered eating patterns for individualswho strive for a large body (O’Sullivan & Tiggemann, 1997; Pope, Katz & Hudson, 1993). Formany men, the effects of disordered eating may manifest themselves in what Pope et al. (1993)term “ reverse anorexia” , which is “characterised by a fear of being too small, and by perceivingoneself as small and weak, even when one is actually large and muscular” (p. 406). Aspects suchas overeating and exercise behaviors for the purposes of increasing weight and building muscleshave not been included in current models of disordered eating. Clearly, further studies are neededin order to understand more fully the development of disordered eating for males who strive toachieve a larger body size. These studies need to clarify whether or not the meaning of bulimicattitudes and behaviors are the same for boys and girls. They also need to examine other variables,such as self-esteem and coping skills, which may further mediate or moderate the relationshipbetween body dissatisfaction and disordered eating among boys (Stice, 1994).

One limitation of the present study was the use of a cross-sectional design, which does notallow temporal and causal relationships to be evaluated. Another limitation of the present studyis that the sample consisted of a community sample of adolescents aged between 12 and 16 years,therefore, the results may not generalize to adults or individuals with bulimia or binge eatingdisorder. The study also relied entirely on self-report data. In order to obtain a more accurate


assessment of eating behaviors for both genders, future studies need to supplement self-reportdata with clinical interviews and observations.

The present study has increased our understanding of the factors related to bulimic behaviorfor males. For boys who wanted to be thinner, the relationships among body dissatisfaction,negative affect and bulimic behavior were very similar to those found among the girls. For boyswho desired a bigger body size, dietary restraint and not negative affect was found to predictbulimic behavior. Further research is required to understand the cognitive and physiological mech-anisms underlying dietary restraint and negative affect for both males and females.

References

Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research:Conceptual, strategic and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.

Beebe, D. W. (1994). Bulimia nervosa and depression: A theoretical and clinical appraisal in the light of the binge-purge cycle. British Journal of Clinical Psychology, 33, 259–276.

Brehm, B. J., & Steffen, J. J. (1998). Relation between obligatory exercise and eating disorders. American Journal ofHealth Behavior, 22, 108–119.

Brody, M. L., Walsh, T., & Delvin, M. J. (1994). Binge eating disorder: Reliability and validity of a new diagnosticcategory. Journal of Consulting and Clinical Psychology, 62, 381–386.

Carlat, D. J., & Camargo, C. A. (1991). Review of bulimia nervosa in males. American Journal of Psychiatry, 148,831–843.

Carlat, D. J., Camargo, C. A., & Herzog, D. B. (1997). Eating disorders in males: A report on 135 patients. AmericanJournal of Psychiatry, 154, 1127–1132.

Davis, C., & Cowles, M. (1991). Body image and exercise: A study of relationships and comparisons between physicallyactive men and women. Sex Roles, 25, 33–44.

Drewnowski, A., Kurth, C. L., & Krahn, D. D. (1995). Effects of body image on dieting, exercise and steroid use inadolescent males. International Journal of Eating Disorders, 17, 381–386.

Drewnowski, A., & Yee, D. K. (1987). Men and body image: Are males satisfied with their weight? PsychosomaticMedicine, 49, 626–634.

Garfinkel, P. E., Lin, E., Goering, P., Spegg, C., Goldbloom, D. S., Kennedy, S., Kaplan, A. S., & Woodside, D. B.(1995). Bulimia nervosa in a Canadian community sample: Prevalence and comparison of subgroups. AmericanJournal of Psychiatry, 152, 1052–1058.

Garner, D. M. (1991). Manual for the Eating Disorders Inventory-2 (EDI-2). Odessa, FL: Psychological AssessmentResources.

Gleaves, D. H., Williamson, D. A., & Barker, S. E. (1993). Confirmatory factor analysis of a multidimensional modelof bulimia nervosa. Journal of Abnormal Psychology, 102, 173–176.

Guertin, T. L. (1999). Eating behavior of bulimics, self-identified binge eaters, and non-eating-disordered individuals:What differentiates these populations? Clinical Psychology Review, 19, 1–23.

Fallon, A. E., & Rozin, P. (1985). Sex differences in perceptions of desirable body shape. Journal of Abnormal Psy-chology, 94, 102–105.

Fox, K., Page, A., Armstrong, N., & Kirby, B. (1994). Dietary restraint and self-perceptions in early adolescence.Personality and Individual Differences, 17, 87–96.

Franco, K. S. N., Tamburrino, M. B., Carroll, B. T., & Bernal, G. A. A. (1988). Eating attitudes in college males.International Journal of Eating Disorders, 7, 285–288.

Furnham, A., & Calnan, A. (1998). Eating disturbance, self-esteem, reasons for exercising and body weight dissatis-faction in adolescent males. European Eating Disorders Review, 6, 58–72.

Hay, P. (1998). The epidemiology of eating disorder behaviors: An Australian community-based survey. InternationalJournal of Eating Disorders, 23, 371–382.


Keel, P. K., Fulkerson, J. A., & Leon, G. R. (1997). Disordered eating precursors in pre- and early adolescent girlsand boys. Journal of Youth and Adolescence, 26, 203–216.

Killen, J. D., Taylor, C. B., Hayward, C., Wilson, D. M., Haydel, K. F., Hammer, L. D., Simmonds, B., Robinson, T.N., Litt, I., Varady, A., & Kraema, H. (1994). Pursuit of thinness and onset of eating disorder symptoms in acommunity sample of adolescent girls: A three-year prospective analysis. International Journal of Eating Disorders,16, 227–238.

Koenig, L. J., & Wasserman, E. L. (1995). Body image and dieting failure in college men and women: Examininglinks between depression and eating problems. Sex Roles, 32, 225–249.

LaPorte, D. L. (1997). Gender differences in perceptions ad consequences of an eating binge. Sex Roles, 36, 479–489.Leal, L., Weise, S. M., & Dodd, D. K. (1995). The relationship between gender, symptoms of bulimia, and tolerance

for stress. Addictive Behaviors, 20, 105–109.Leon, G. R., Fulkerson, J. A., Perry, C. L., & Early-Zald, M. B. (1995). Prospective analysis of personality and

behavioral vulnerabilities and gender influences in the later development of disordered eating. Journal of AbnormalPsychology, 104, 140–149.

Leon, G. R., Fulkerson, J. A., Perry, C. L., Keel, P. K., & Klump, K. L. (1999). Three to four year prospectiveevaluation of personality and behavioral risk factors for later disordered eating in adolescent girls and boys. Journalof Youth and Adolescence, 28, 181–196.

Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the DepressionAnxiety Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33,335–343.

Maude, D., Wertheim, E. H., Paxton, S., Gibbons, K., & Szmukler, G. (1993). Body dissatisfaction, weight loss behav-iours, and bulimic tendencies in Australian adolescents with an estimate of female data representativeness. AustralianPsychologist, 28, 128–132.

McCabe, M.P., & Ricciardelli, L.A. (2000). Body image and body change techniques among young adolescent boys.European Eating Disorders Review (in press).

McCarthy, M. (1990). The thin ideal, depression and eating disorders in women. Behaviour Research and Therapy,28, 205–215.

Moore, D. C. (1990). Body image and eating behavior in adolescent boys. American Journal of Diseases of Children,144, 475–479.

Mueller, C., Field, T., Yando, R., Harding, J., Gonzalez, K. P., & Bendell, D. (1995). Under eating and over eatingconcerns among adolescents. Journal of Child Psychology and Psychiatry, 36, 1019.

Nowak, M., Spear, R., & Crawford, D. (1996). Gender differences in adolescent weight and shape-related beliefs andbehaviors. Journal of Pediatrics and Child Health, 32, 148–152.

O’Sullivan, G. A., & Tiggemann, M. (1997). Body dissatisfaction and body image distortion in men who train withweights. Journal of Gender, Culture, and Health, 2, 321–329.

Polivy, J., & Herman, C. P. (1985). Dieting and binging: A causal analysis. American Psychologist, 40, 193–201.Pope, H. G. Jr., Katz, D. L., & Hudson, J. I. (1993). Anorexia nervosa and “ reverse anorexia” among 108 male

bodybuilders. Comprehensive Psychiatry, 34, 131–147.Raudenbush, B., & Zellner, D. A. (1997). Nobody’s satisfied: Effects of abnormal behaviors and actual perceived

weight status on body image satisfaction in males and females. Journal of Social and Clinical Psychology, 16,95–110.

Ricciardelli, L. A., Tate, D., & Williams, R. J. (1997). Body dissatisfaction as a mediator of the relationship betweendietary restraint and bulimic eating patterns. Appetite, 29, 43–54.

Ricciardelli, L. A., Williams, R. J., & Kiernan, M. J. (1999). Bulimic symptoms in adolescent girls and boys. Inter-national Journal of Eating Disorders, 26, 217–221.

Richards, M. H., Casper, R. C., & Larson, R. (1990). Weight and eating concerns among pre-and young adolescentboys and girls. Journal of Adolescent Health Care, 11, 203–209.

Shepherd, H., & Ricciardelli, L. A. (1998). Test of Stice’s dual pathway model: Dietary restraint and negative affectas mediators of bulimic behavior. Behaviour Research and Therapy, 36, 345–352.

Silberstein, L., Striegel-Moore, R. H., Timko, C., & Rodin, J. (1988). Behavioral and psychological implications ofbody dissatisfaction: Do men and women differ? Sex Roles, 19, 219–233.


Snow, J., & Harris, M. B. (1989). Disordered eating in South-Eastern Pueblo Indians and Hispanics. Journal of Ado-lescence, 12, 329–336.

Stice, E. (1994). Review of the evidence for a sociocultural model of bulimia nervosa and an exploration of themechanisms of action. Clinical Psychology Review, 16, 633–661.

Stice, E., Nemeroff, C., & Shaw, H. (1996). Test of the dual pathway model of bulimia nervosa: Evidence of dietaryrestraint and affect regulation mechanisms. Journal of Social and Clinical Psychology, 15, 340–363.

Stice, E., Shaw, H., & Nemeroff, C. (1998). Dual pathway model of bulimia nervosa: Longitudinal support for dietaryrestraint and affect-regulation mechanisms. Journal of Social and Clinical Psychology, 17, 129–149.

Striegel-Moore, R. H., Silberstein, L. R., & Rodin, J. (1986). Toward an understanding of risk factors for bulimia.American Psychologist, 41, 246–263.

Stunkard, A. J., Sorensen, T., & Schulsinger, F. (1983). Use of the Danish adoption register for the study of obesityand thinness. In S. S. Kety, L. P. Rowland, R. L. Sidman, & S. W. Matthysse, Genetics of Neurological andPsychiatric Disorders (pp. 115–120). New York: Raven Press.

Tanofsky, M. B., Wilfley, D. E., Spurrell, E. B., Welch, R., & Brownell, K. D. (1997). Comparison of men and womenwith binge eating disorder. International Journal of Eating Disorders, 21, 49–54.

Thelen, M. H., Farmer, J., Wonderlich, S., & Smith, M. (1991). A revision of the Bulimia Test: The BULIT-R. Journalof Consulting and Clinical Psychology, 3, 119–124.

Thelen, M. H., Mintz, L. B., & Wal, J. S. V. (1996). The Bulimia Test-Revised: Validation with DSM-IV criteria forBulimia Nervosa. Psychological Assessment, 8, 219–221.

Thompson, J. K., Coovert, M. D., Richards, K. J., Johnson, S., & Cattarin, J. (1995). Development of body image,eating disturbance and general psychological functioning in female adolescents: Covariance structure modeling andlongitudinal investigations. International Journal of Eating Disorders, 18, 221–236.

Tiggemann, M. (1994). Gender differences in the interrelationships between weight dissatisfaction, restraint, and self-esteem. Sex Roles, 30, 319–330.

Van Strien, T. (1996). On the relationship between dieting and “obese” and bulimic eating patterns. InternationalJournal of Eating Disorders, 8, 455–463.

Varnado, P. J., Williamson, D. A., & Netemeyer, R. (1995). Confirmatory factor analysis of eating disorder symptomin college women. Journal of Psychopathology and Behavioral Assessment, 17, 60–79.

Vincent, M.A., & McCabe, M.P. (2000). Gender differences in the role of the biodevelopmental and psychologicalfactors in the expression of body dissatisfaction and disordered eating. (in press).

Vincent, M. A., McCabe, M. P., & Ricciardelli, L. A. (1999). Factorial validity for the Bulimia Test-Revised in ado-lescent boys and girls. Behaviour Research and Therapy, 37, 1129–1140.

Wertheim, E. H., Paxton, S. J., Maude, D., Szmukler, G. I., Gibbons, K., & Hiller, L. (1992). Psychosocial predictorsof weight loss behaviours and binge eating in adolescent girls and boys. International Journal of Eating Disorders,12, 151–160.

Williamson, D. A., Barker, S. E., Bertman, L. J., & Gleaves, D. H. (1995). Body image, body dysphoria, and dietaryrestraint: Factor structure in nonclincal subjects. Behavior Research and Therapy, 33, 85–93.

Wilson, T., Nonas, C., & Rosenblum, G. (1993). Association of binge eating disorder and psychiatric comorbidity inobese subjects. American Journal of Psychiatry, 150, 1472–1479.

Yates, A. (1991). Compulsive Exercise and the Eating Disorders. New York: Brunner/Mazel.

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