Addictive Behaviors, Vol. 16, pp. 497-505, 1991 Printed in the USA. All rights reserved.

0306-4603/91 $3.00 + .OO Copyright Q 1991 Pergamon Press plc

INFLUENCE OF PERSONALITY ATTRIBUTES AND DAILY MOODS ON BULIMIC EATING PATTERNS

WENDY M. REBERT Carraway Methodist Medical Center, Birmingham, Alabama

ANNETTE L. STANTON University of Kansas

RAYMOND M. SCHWARZ Psychological Counseling Center, SUNY-New Paltz

AbSbWt - Relationships among personality attributes, mood states, and eating patterns were ex- amined in a nonclinical sample of females with bulimic symptomatology and binge eaters. Thir- teen subjects in each group completed trait measures of depression, anxiety, hostility, and locus of control. Subsequently, they self-monitored affect and eating patterns over a 20&y period. Greater state depression, anxiety, and hostility all were associated signiticantly with subsequent daily binge eating, and with purging for bulimic subjects. The association of binge occurrence with state anxiety and hostility was significantly greater for bulimics than for binge eaters. Locus of control and trait hostility were important in influencing reactivity of binge eating to daily moods. As trait hostility and externality increased, reactivity of binges to negative mood states also increased.

Burgeoning evidence suggests that bulimia nervosa, a disorder characterized by recurrent binge eating accompanied by a feeling of loss of control, use of extreme methods to pre- vent weight gain, and overconcern with body weight (American Psychiatric Association, 1987), is associated with dysfunctional personality and affective characteristics. These re- lationships emerge in nonclinical as well as clinical populations, as studies employing college student samples have demonstrated, for example, that bulimics report more de- pression (Dykens & Gerrard, 1986; Greenberg, 1986; Katzman & Wolchik, 1984; Pert- schuk, Collins, Kreisberg, & Fager, 1986), anxiety (Dykens dz Gerrard, 1986; Pertschuk et al., 1986). and lower self-esteem (Dykens & Gerrard, 1986; Katzman & Wolchik, 1984) than do control subjects. Bulimics also differ on a number of personality and eat- ing-related variables from those who engage in binge eating but do not meet diagnostic criteria for bulimia nervosa, leading Katzman and Wolchik (1984) to conclude that “bu- limia and binge eating reflect two distinct variants in a spectrum of eating disorders” (p. 427).

The specific role that negative psychological attributes may play in the development and maintenance of bulimic behaviors has generated much discussion (e.g., Hinz & Williamson, 1987; Schlesier-Stropp, 1984; Strober & Katz, 1987). While such attributes may have etiological significance, placing an individual at risk for the development of bulimia nervosa, depression and low self-esteem also are likely consequences of involve- ment in a disordered eating pattern. Whether or not negative personality and affective characteristics directly influence the occurrence of specific bulimic behaviors merits atten- tion. The empirical demonstration that binge eating and purging are reactive to stable in- dividual dispositions or negative affective states would carry both theoretical and clini-

Requests for reprints should be sent to Annette L. Stanton, PhD, Department of Psychology, 426 Fraser Hall, University of Kansas, Lawrence, KS 66045.

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498 WENDY M. REBERT et al.

cal implications for the disorder. Accordingly, the present study was designed to provide a more detailed examination of the relationships among personality attributes, moods, and eating behaviors.

In this study, bulimics and binge eaters self-monitored affect and eating patterns over a 20-day period, allowing the examination of reactivity of disordered eating behaviors to daily mood. Following Johnson and Larson (1982), who found that bulimics evidenced greater mood fluctuation over a 7-day period than normal controls, the first hypothesis was that bulimics would experience more affective variability than would binge eaters. Second, bulimics were expected to binge and purge in response to the experience of state anxiety, depression, and hostility. Third, these relationships were predicted to be more substantial when the corresponding trait scores were elevated.

These particular constructs (i.e., depression, anxiety, hostility) were chosen because the associations between bulimia and trait anxiety and depression are well documented (Dykens & Gerrard, 1986; Katzman & Wolchik, 1984; Pertschuk et al., 1986; Schlesier- Stropp, 1984). Further, several writers have suggested that binge eating is reactive to a variety of affective states, particularly depression (e.g., Johnson, Stuckey, Lewis, & Schwartz, 1982; Leon, Carroll, Chemyk, & Finn, 1985), anxiety (e.g., Abraham & Beu- mont, 1982; Elmore & de Castro, 1990; Ondercin, 1979), and anger (Johnson & Pure, 1986; Loro, 1984). In addition, an assessment of locus of control was included. Bulimics have been shown to hold general expectancies that reinforcements are dependent on exter- nal factors (Katzman & Wolchik, 1984; Weiss & Ebert, 1983), and it was expected that such externality may influence bulimics’ reactivity to mood. Whether or not binge eaters binged subsequent to negative mood and whether these relationships were affected by sta- ble personality characteristics also were evaluated.

METHOD

Subjects Over a three-quarter period, 562 females (M age = 19.5) from undergraduate psychol-

ogy classes completed a questionnaire screening session in exchange for extra course credit. Based on their responses to the Compulsive Eating Scale (CES; Dunn & Onder- tin, 1981), the Eating Problems Questionnaire (EPQ; Johnson et al., 1982), the Eating Disorder Inventory (Garner & Olmsted, 1984), and 10 other questions constructed by the researchers to aid in operationalizing criteria for bulimia nervosa as specified in the Diug- nostic and Statistical Manual for Mental Disorders - Revised (DSM-III-R; American Psychiatric Association, 1987), subjects were assigned to one of four groups: bulimic, binge eater, atypical eater, and normal eater. Two judges classified subjects, achieving 86% reliability. It was clear that any initial disagreements were due to oversight, in that all were resolved when the judges independently restored subjects’ data for which the original classifications differed.

The 20 subjects (3.56%) classified as bulimic were required to report at least two binge episodes (> 1,000 calories) per week which were accompanied by a feeling of lack of control, to engage in self-induced vomiting, and to display an overconcern with body shape and weight, as assessed by the EPQ and author-constructed questions. On the ED1 subscales relevant to eating habits, this group obtained a mean of 14.67 (SD = 4.60) on Drive for Thinness, 10.50 (SD = 5.34) on Bulimia, and 21.45 (SD = 6.40) on Body Dissatisfaction. On the CES, the group mean was 53.24 (SD = 12.00).

Binge eaters (n = 20, 3.56%) were those who reported binge eating without engaging in any purging behaviors. They also were required to obtain a score of 58 or above on

Moods and bulimic behaviors 499

the CES, which reflected the upper quartile of scores obtained by Dunn and Gndercin (1981) and in the present study. The mean CES score was 63.72 (SD = 5.31). It should be noted that CES scores were unavailable for fall quarter subjects due to a clerical error and that the percentage (13.9%) of binge eaters in the other two quarters is probably a more accurate prevalence estimate. ED1 means were 10.05 (SD = 4.38) on Drive for Thinness, 6.80 (SD = 3.30) on Bulimia, and 18.45 (SD = 9.14) on Body Dissatisfaction.

Normal eaters (n = 328, 58.36%) fulfilled no more than one DSM-III-R criterion for bulimia nervosa and did not engage in purging. Further, no history of bulimia nervosa or anorexia nervosa was reported. Atypical eaters (n = 194, 34.51%) met more than one DSM-III-R criterion for bulimia nervosa but not a sufficient number to be classified as bulimic, reported prior but not current bulimic characteristics (see Stanton, Rebert, & Zinn, 1986), reported prior or current symptoms of anorexia nervosa, or reported purging behaviors.

Procedure During the screening sessions, in addition to completing the measures employed for

group classification, subjects were administered a questionnaire battery intended to assess affective and personality attributes, including the following standardized measures: the Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961); the Multiple Affect Adjective Checklist, General Form (MAACL, Zuckerman & Lubin, 1965), which includes subscales for depression, anxiety, and hostility; the State-Trait Anxiety Inventory, Trait Form (STAI, Spielberger, 1966); and the Rotter Intemal-Exter- nal Locus of Control Scale (Rotter, 1966).

Bulimic and binge eater subjects were contacted by phone to participate in the 20&y self-monitoring phase. In each of these groups, 13 subjects completed participation. Nine subjects declined participation, primarily because they had met the maximum extra course credit opportunity, while five dropped out after beginning the study, and their data were not used.

In the self-monitoring phase, the 26 subjects completed questionnaires assessing eating behaviors and state depression, anxiety, and hostility twice a day over 20 consecutive days. Standardized scales were the MAACL (Today form - Depression, Anxiety, and Hostility subscales) and the STAI (State form). The eating behaviors measure was con- structed for this study and required subjects to list each daily binge, including time and duration of binge, and number of calories consumed. Accurate calorie counting was dis- cussed with subjects prior to their beginning self-monitoring. Because we were interested in subjects’ perceptions of what constituted a binge, subjects were requested to record this information for each episode that they considered to be a binge. Participants also recorded frequency of self-induced vomiting and number of laxatives and diuretics taken.

Bulimics completed the mood questionnaires at two specific times each day, based on their report in the screening session of the earliest time they ever binged during the day and the time they typically binged each day. Subjects were asked to complete their ques- tionnaires within an hour before each of these times each day to ensure that mood prior to any binge would be recorded. To provide comparability of the two groups’ self-moni- toring times, each compulsive eater subject was yoked to a bulimic so she also completed the measures at her yoked bulimic’s first and usual binge times. Examination of subjects’ records of eating behaviors and moods indicated that this procedure for timing of mood recording was successful, in that only 11% of binges occurred before mood was recorded across both groups. Eating behaviors were recorded after the last binge of the day by

500 WENDY M. REBERT et al.

each subject, and data regarding eating behaviors and moods were mailed in daily. To ensure that concurrent rather than retrospective monitoring was occurring, no late data were accepted. Of 520 (20 days X 26 subjects) potential total data points across subjects, 14 were not completed, yielding 2.6% missing data.

RESULTS

Validity of the group assignment procedure Prior to examining the major hypotheses, it is necessary to comment on the adequacy

of the group assignment procedure. The representativeness of the bulimic sample may be questioned, given the employment of a nonclinical sample and of diagnostic questionnaire rather than interview data. A comparison of our data to the relevant literature suggests that these subjects did indeed display significant bulimic symptomatology. First, it should be noted that the obtained incidence of bulimia nervosa in this study is comparable to rates obtained in other studies of nonclinical populations (e.g., Katzman, Wolchik, & Braver, 1984; Pyle, Halvorson, Neuman, & Mitchell, 1986), suggesting that a small but consistent proportion of college females appears to manifest bulimic behaviors. Second, our sample’s responses on the ED1 scales reflecting weight preoccupation (i.e., Drive for Thinness, Bulimia, Body Dissatisfaction) were similar to or higher than scores of patients seeking treatment and satisfying DSM criteria for bulimia nervosa based on interview data (Hurley, Palmer, & Stretch, 1990; Olmsted & Garner, 1986; Ordman & Kirschenbaum, 1986). However, ED1 scores reflecting ego deficits related to bulimia nervosa were lower in the present bulimic sample than in the patient groups.

With regard to the distinction between the bulimic and binge eater groups, it should be noted that bulimics’ scores on the ED1 Drive for Thinness and Bulimia subscales were significantly higher than the compulsive eaters’ scores, whereas binge eaters’ scores were higher on the CES. Further, bulimics consumed a significantly greater number of calories per binge than did binge eaters, a finding similar to that of Katzman and Wolchik (1984).

Characteristics of eating behaviors across the 20-day period Examination of the data for self-defined binges revealed that although all subjects met

an initial requirement of at least two self-reported l,OOO-calorie binges per week, the sub- stantial majority appeared to define a binge as any food consumed apart from regular meals. Thus, number of estimated’calories per binge varied widely from 75 to 5,200, and substantial intraindividual variability was present, with most subjects reporting binges of both comparatively few calories (< 500) and a great many calories (> 1,000). When self-defined binges were employed, subjects binged every other day (M binges per day = .59), on the average, with number of binges over the 20-day period ranging from 1 to 28. Bulimics did not differ from binge eaters on number of binges or on average number of regular meals (M = 2.05 per day). To ensure that eating was of sufficient magnitude to constitute a binge, only binges of 1,ooO or more calories were counted as a binge occurrence in the major analyses.

Although bulimic subjects met an inclusion requirement of self-induced vomiting at least once per week, one bulimic reported no purging of any kind over the course of the study. Seven reported engaging in self-induced vomiting, with a range of 1 to 34 epi- sodes. Ten subjects took laxatives or diuretics, ranging from 5 to 31 pills over the 20 days.

Analysis of mood state variability To test the hypothesis that bulimics would display more daily variability in mood than

would binge eaters, two types of analyses were performed on both the first and second

Moods and bulimic behaviors 501

set of daily mood measures for the 20 days’ duration. First, the W50 transformation (see Brown & Forsythe, 1974; O’Brien, 1981) was employed to examine subjects’ mood vari- ability across days. Thus, an absolute value of each subject’s mood score around her re- spective median mood score was computed for each of the depression, anxiety, and hostility daily measures. To compare the means of these absolute deviation scores for the bulimics (n = 13) and compulsive eaters (n = 13), f tests were employed. Although all means were in the expected direction, none were significant at p < .05.

The completion of measures twice daily allowed the examination of mood variability within days. Each subject’s first daily mood score was subtracted from her second score on each of the measures, and means were computed on the absolute values of the result- ing deviations. Means for the bulimics and compulsive eaters were compared via t tests. Again, no f values were significant although the means were in the expected direction. Thus, a nonsignificant tendency for bulimics to display greater mood variability across and within days was apparent.

Analysis of the relationship between moods and eating behaviors To analyze the relationship between eating patterns and mood states, correlations were

computed between scores on each daily mood measure and the occurrence of a binge of at least 1,000 calories for each subject. Only the first daily mood measure was employed to ensure that mood was recorded prior to the binge eating episode. Fisher’s r to z trans- formation was calculated for these correlations so the distributions were approximately normal. Analysis of variance was performed on the transformed correlations for each measure to determine whether between-groups differences emerged and to assess whether or not the grand mean differed from zero. These results are shown in Table 1. As the table demonstrates, when subjects reported greater depression, anxiety, or hostility they were more likely to binge later in the day. Although the average significant correlations for the total sample were modest, it should be noted that for some individual subjects the correlations ranged up to .79. In addition, correlations for bulimic subjects all were greater than .30. F values for the group comparisons were significant for anxiety and hostility, indicating that the relations between these moods and binge occurrence were stronger for bulimics than for binge eaters.

The association between daily mood and purging behaviors for the bulimic group (n = 12) also was examined, with purge occurrence defined as self-induced vomiting or laxative or diuretic ingestion. As shown in Table 1, purging was associated with prior daily anxiety, depression, and hostility, with individual correlations ranging up to .72.

Analysis of associations between trait measures and mood-binge correlations To determine the relationship between stable personality attributes and reactivity of

binge eating to fluctuating moods, the correlations between mood state and l,OOO-calorie binge occurrence were correlated with trait measures of depression, anxiety, hostility, and locus of control for each subject. Correlations were not significantly different for the two groups, and thus data for bulimics and compulsive eaters were combined for these analy- ses. Significant correlations are presented in Table 2.

When the associations were examined between trait scores and mood-binge correlations, results revealed that trait hostility and external locus of control were important in influ- encing the relationship between mood and binge eating. Those high on trait hostility were more likely to binge subsequent to hostile and anxious affect than were subjects low on this trait. Further, those who had an external locus of control were more likely to binge

502 WENDY M. REBERT et al

Table 1. Mean correlations between daily eating behaviors and mood states over 20 days for bulimics and binge eaters

Measure

Combined Binge Groups Bulimics Eaters Group

(n = 26) (n = 13) (n = 13) Comparison r r r F

MAACL - Anxiety STAI - Anxiety MAACL - Depression MAACL - Hostility

MAACL - Anxiety STAI - Anxiety MAACL - Depression MAACL - Hostility

Binge-Mood Correlations

.18** .31 .04 5.25*

.18* .32 .02 4.70*

.22*** .33 .lO 3.62

.16* .33 - .Ol 10.37**

Purge-Mood Correlations (n = 12) .14* .19* .24** .26*

Note. Degrees of freedom for the significance tests associated with binge-mood corre- lations are 1, 24 and with purge-mood correlations are 1, 11. *p < .05 **p < .Ol ***p < .005

in response to state anxiety, depression, and hostility. Finally, results for bulimics dem- onstrated no significant relationships between personality attributes and purging reactivity

to mood.

DISCUSSION

Although there was a tendency for bulimics to display greater mood variability than binge eaters across and within the 20-day monitoring period, the differences were nonsig- nificant. As suggested by the Johnson and Larson (1982) study, however, it is likely that affective variability is greater for bulimics than for normal eaters. For bulimics, greater state depression, anxiety, and hostility all were associated with subsequent daily binge eating and purging. Although average correlations were modest for bulimics and binge eaters combined, they were larger for the bulimic group alone and some were quite sub- stantial for individuals, leading us to examine which subjects’ eating behaviors were par- ticularly reactive to moods.

The relationship between particular personality attributes and reactivity to mood states was not as specific as was originally hypothesized; subjects receiving high scores on a particular trait measure did not binge or purge exclusively in response to the correspond- ing affective state. Rather, trait hostility and locus of control, but not trait depression and anxiety, emerged as the important attributes influencing binge reactivity to mood. Those

Table 2. Significant correlations of trait measures with correlations between daily binge eating and mood for the combined groups (n = 26)

Trait Measure

MAACL Anxiety Correlated with Binge

STAI-S Correlated with Binge

MAACL Depression Correlated with Binge

MAACL Hostility Correlated with Binge

MAACL hostility

Locus of control

.48* .53* - .52*

.52* - .54* .62*

*p < .05

Moods and bulimic behavioti 503

who were more hostile were more likely to binge subsequent to hostile and anxious affect, and externality predicted binge eating in response to depression, anxiety, and hostility.

Writings on both the etiology (e.g., Striegel-Moore, Silberstein, & Rodin, 1986) and treatment (e.g., Weiss, Katzman, & Wolchik, 1985) of bulimia nervosa point to the po- tentially important role of the bulimic’s inability to regulate negative feelings. Consistent with these models, this study suggests that many bulimics engage in dysfunctional eating behaviors in response to the experience of negative affect. Perhaps the experience of neg- ative emotion serves to disinhibit restrained eating (Davis, Freeman, & Garner, 1988; Ru- derman, 1985). High trait hostility and external locus of control assessed at the beginning of treatment might help to identify those at risk for such disinhibition in response to distress. A treatment model such as that developed by Weiss et al. (1985) appears prom- ising in its focus on the development of alternative coping strategies for managing such emotions.

Several suggestions can be generated from this study for methodological refinement and future investigation. First, research in this area requires an adequate assessment of daily binge eating and purging. The present results and those from other self-monitoring studies (Crowther, Lingswiler, & Stephens, 1984; Ortega, Waranch, Maldonado, & Hubbard, 1987; Rosen, Leitenberg, Fisher, & Khazam, 1986) suggest that bulimics are likely to self-define a binge as any food consumed apart from regular meals, a finding that is not surprising in the context of theory on dietary restraint (Polivy & Herman, 1985; Ruder- man, 1986). This suggests that over and above the instruction to “count each binge,” the researcher should either define for the subjects a minimum calorie criterion or require that subjects record foods or calories consumed. As Davis et al. (1988) found in a naturalistic study of eating behaviors in treatment-referred bulimics, subjects in the present study re- ported fewer binge-eating and purging episodes during self-monitoring than was expected given initial reports. This may have resulted from subjects’ reluctance to report these be- haviors on a daily basis, an actual decrease in the behaviors attendant upon self-monitor- ing or an initial overestimation of binge and purge episodes, possibilities which require further examination.

A second measurement issue which deserves attention is the mood-recording procedure. Requiring mood recording prior to the bulimic’s reported first and usual binges appeared successful in ensuring that moods were reported prior to eating episodes. Johnson and Larson’s (1982) novel “pager method” may also be useful, providing that the times binges occur are also recorded. The assessment of triggers for negative affect and the bulimic’s perceived coping ability is also advisable in future studies.

Although bulimics in this study met DSM-III-R criteria by questionnaire report, their eating patterns may not have been as severe as those of bulimics seeking treatment. It is possible that many subjects in our sample represented incipient or comparatively mild cases of bulimia and that bulimics in treatment evidence more habitual disordered eating behaviors. Further, given that some subjects declined to participate in the self-monitoring phase of this study, the generalizability of results to the population of bulimics requires investigation. Examination of the developmental course of binge reactivity to mood, diet- ing practices, and other variables may contribute to more informed treatment and preven- tion efforts.

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