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Exploring differential patterns of situational risk for binge eating and heavy drinking
Abstract
This study was designed to compare risk situations for binge eating vs. heavy drinking among women who struggle with both problems. Participants were 41 women in treatment for an alcohol problem who also self-reported binge eating. Participants completed the Inventory of Binge Eating Situations (IBES; [Baker, J. M. (1998). Binge eating and binge drinking among university women. Unpublished master's thesis, Department of Psychology, Queen's University, Kingston, Ontario, Canada]) and the Inventory of Drinking Situations (IDS-42; [Annis, H. M., Graham, J. M., & Davis, C. S. (1987). Inventory of Drinking Situations (IDS) user's guide. Toronto, Canada: Addiction Research Foundation]) to measure frequency of binge eating and heavy drinking, respectively, in eight categories of situations. A 2 (substance) x8 (situation) repeated measures ANOVA revealed a significant substancexsituation interaction. Further exploration of this interaction indicated that heavy drinking is more likely than binge eating to occur in reward and interpersonal situations involving pleasant emotions, pleasant times with others, social pressure, and conflict with others. In contrast, binge eating and heavy drinking are equally likely to occur in relief situations involving unpleasant emotions, and physical discomfort, as well as in situations involving urges and temptations, and testing control. Implications of findings for the treatment of co-occurring binge eating and heavy drinking in women are discussed.
... Second, the literature on maintenance factors of BE + HD suggests that affect, social context, the presence of food or alcohol, and prolonged dietary restraint (i.e., attempting to restrict dietary intake across the day) might be momentary risk factors for binge eating or heavy drinking episodes. To date, there have been three studies examining the momentary processes that promote binge eating or heavy drinking in comorbid samples [4,10,11]. Pisetsky and colleagues [11] used EMA to examine the temporal association between affect and self-reported alcohol intoxication among women with bulimia nervosa and found that positive affect significantly decreased in the hours prior to alcohol intoxication. Additionally, in two cross-sectional studies that assessed situational factors associated with binge eating and heavy drinking episodes among women with BE + HD [4,10], results found that heavy drinking episodes occurred more often than binge eating episodes in situations with positive emotions or in social situations, and both binge eating and heavy drinking episodes were likely to occur in situations involving behavior-specific temptations (e.g., presence of food or alcohol). ...
... Pisetsky and colleagues [11] used EMA to examine the temporal association between affect and self-reported alcohol intoxication among women with bulimia nervosa and found that positive affect significantly decreased in the hours prior to alcohol intoxication. Additionally, in two cross-sectional studies that assessed situational factors associated with binge eating and heavy drinking episodes among women with BE + HD [4,10], results found that heavy drinking episodes occurred more often than binge eating episodes in situations with positive emotions or in social situations, and both binge eating and heavy drinking episodes were likely to occur in situations involving behavior-specific temptations (e.g., presence of food or alcohol). While these studies highlight some potential internal and external factors to consider for BE + HD, further research using EMA is needed to identify the specific momentary factors that increase risk for binge eating episodes and heavy drinking episodes in BE + HD. ...
... Contrary to our initial hypotheses, affect and social context were not predictive of subsequent binge eating or heavy drinking episodes for individuals with BE + HD. These results were surprising given previous cross-sectional findings that affect was associated with risk for binge eating and heavy drinking in women with BE + HD [10]. We considered a few possible explanations for these results. ...
Purpose
The co-morbidity of binge eating and heavy drinking (BE + HD) is a serious concern due to the high prevalence rates and associated elevated severity. Clarifying the momentary factors that increase risk for binge eating and heavy drinking among BE + HD is important for expanding theoretical models of BE + HD and informing treatment recommendations. The current study used ecological momentary assessment (EMA) to compare the momentary processes maintaining binge eating between BE + HD and individuals with binge eating only (BE-only) and to identify the momentary risk factors for binge eating episodes and heavy drinking episodes among BE + HD.
Methods
Participants (BE + HD: N = 14; BE-only: N = 37) were adults with clinically significant binge eating who completed between 7 and 14 days of EMA prior to treatment.
Results
The presence of food and within-day dietary restraint predicted higher odds of binge eating for both groups. Among BE + HD, the presence of alcohol and dietary restraint increased risk for subsequent binge eating and subsequent heavy drinking, and the absence of food increased risk for subsequent heavy drinking.
Conclusion
These results offer preliminary support for treatment interventions for BE + HD that focus on reducing dietary restraint and teaching strategies for urge management in situations with palatable food or alcohol. Future research should study the maintenance mechanisms of BE + HD with larger, more diverse samples and using study design approaches with more experimenter control (i.e., laboratory experiments).
Level of evidence
Level IV, multiple time series without intervention.
... Second, the literature on maintenance factors of BE + HD suggests that affect, social context, the presence of food or alcohol, and prolonged dietary restraint (i.e., attempting to restrict dietary intake across the day) might be momentary risk factors for binge eating or heavy drinking episodes. To date, there have been three studies examining the momentary processes that promote binge eating or heavy drinking in co-morbid samples [10,11,4]. Pisetsky and colleagues (2016) used EMA to examine the temporal association between affect and self-reported alcohol intoxication among women with bulimia nervosa and found that positive affect signi cantly decreased in the hours prior to alcohol intoxication. Additionally, in two cross-sectional studies that assessed situational factors associated with binge eating and heavy drinking episodes among women with BE + HD [10,4], results found that heavy drinking episodes occurred more often than binge eating episodes in situations with positive emotions or in social situations, and both binge eating and heavy drinking episodes were likely to occur in situations involving behavior-speci c temptations (e.g., presence of food or alcohol). ...
... Pisetsky and colleagues (2016) used EMA to examine the temporal association between affect and self-reported alcohol intoxication among women with bulimia nervosa and found that positive affect signi cantly decreased in the hours prior to alcohol intoxication. Additionally, in two cross-sectional studies that assessed situational factors associated with binge eating and heavy drinking episodes among women with BE + HD [10,4], results found that heavy drinking episodes occurred more often than binge eating episodes in situations with positive emotions or in social situations, and both binge eating and heavy drinking episodes were likely to occur in situations involving behavior-speci c temptations (e.g., presence of food or alcohol). While these studies highlight some potential internal and external factors to consider for BE + HD, further research using EMA is needed to identify the speci c momentary factors that increase risk for binge eating episodes and heavy drinking episodes in BE + HD. ...
... Contrary to our initial hypotheses, affect and social context were not predictive of subsequent binge eating or heavy drinking episodes for individuals with BE+HD. These results were surprising given previous cross-sectional ndings that affect was associated with risk for binge eating and heavy drinking in women with BE+HD (Birch et al., 2007). We considered a few possible explanations for these results. ...
Purpose – The co-morbidity of binge eating and heavy drinking (BE+HD) is a serious concern due to the high prevalence rates and associated elevated severity. Clarifying the momentary factors that increase risk for binge eating and heavy drinking among BE+HD is important for expanding theoretical models of BE+HD and informing treatment recommendations. The current study used ecological momentary assessment (EMA) to compare the momentary processes maintaining binge eating between BE+HD and individuals with binge eating only (BE-only) and to identify the momentary risk factors for binge eating episodes and heavy drinking episodes among BE+HD.
Methods – Participants (BE+HD: N = 14; BE-only: N = 37) were adults with clinically-significant binge eating who completed between 7 – 14 days of EMA prior to treatment.
Results – The presence of food and within-day dietary restraint predicted higher odds of binge eating for both groups. Among BE+HD, the presence of alcohol and dietary restraint increased risk for subsequent binge eating and subsequent heavy drinking, and the absence of food increased risk for subsequent heavy drinking.
Conclusion - These results offer preliminary support for treatment interventions for BE+HD that focus on reducing dietary restraint and teaching strategies for urge management in situations with palatable food or alcohol. Future research should study the maintenance mechanisms of BE+HD with larger, more diverse samples and using study design approaches with more experimenter control (i.e., laboratory experiments).
Level of Evidence: Level IV, multiple time series without intervention
... One explanation concerning the co-occurrence of different forms of FEDs and elevated levels of alcohol use is that they share underlying emotional risk mechanisms, such as elevated reward sensitivity and negative affect dysregulation (Schulte, Grilo, & Gearhardt, 2016;Stewart, Brown, Devoulyte, Theakston, & Larsen, 2006). In the cases of reward-seeking behaviors, individuals seek reinforcing activities, such as using alcohol or binge eating in order to enhance positive emotions, and they perceive these behaviors as highly pleasant (Birch, Stewart, & Brown, 2007;Dawe & Loxton, 2004;Schulte et al., 2016). Related to the 'self-medication' concept, it has been assumed that different forms of FEDs (e.g. ...
... Related to the 'self-medication' concept, it has been assumed that different forms of FEDs (e.g. binge eating disorder) and alcohol consumption occur as a coping response with the aim of mitigating negative affect (Birch et al., 2007;Cook, Wonderlich, & Lavender, 2014;Stewart et al., 2006). Alternatively, the impulsivity facet of negative urgency might also play an important role, which is the tendency to act rashly when experiencing negative affective states. ...
... It was Z. Horváth, et al. Addictive Behaviors 107 (2020) 106431 assumed that alcohol use among adolescents who show higher risk for FEDs would be driven by coping (e.g., drinking to forget about problems) and enhancement motives (e.g., drinking because it is exciting) to a greater extent, which subsequently contribute to more severe forms of alcohol consumption (Anderson et al., 2006;Birch et al., 2007;Luce et al., 2007). Therefore, based on the aforementioned theoretical considerations (i.e., shared, positive and negative affective reinforcement mechanisms which might explain the co-occurrence of different forms of FEDs and elevated levels of alcohol use, and their implications for the motivational background of alcohol use), the present study primarily assessed the mediating role of internal motives (i.e., using alcohol to regulate internal or affective states) between risk for FEDs and alcohol use. ...
Background
A complex and bidirectional association has been assumed between feeding and eating disorders (FEDs) and alcohol consumption. Previous research has demonstrated that alcohol use among individuals with different forms of FEDs is more frequently motivated by two subtypes of internal drinking motives: coping and enhancement motives. Namely, these individuals might use alcohol primarily to regulate internal states, such as to mitigate negative emotions or enhance positive emotions.
Objectives
The present study investigated the mediating role of internal drinking motives on the association between risk for FEDs and alcohol consumption over the effects of relevant covariates, such as depressive symptoms or body mass index (BMI).
Methods
Hungarian data of the European School Survey Project on Alcohol and Other Drugs (ESPAD) from 2015 were used. The final sample included responses from 5457 adolescents (50% males; mean age: 16.62 years). Validated self-report psychometric instruments assessed the level of alcohol use, depressive symptoms and risk for FEDs, and drinking motives.
Results
Risk for FEDs presented a significant positive relationship with internal drinking motives and alcohol use. In the mediation analysis, a significant indirect effect was identified between risk for FEDs and alcohol use via internal drinking motives among females.
Conclusions
Results demonstrated that risk for FEDs was positively associated with internal drinking motives and alcohol use. An indirect effect of risk for FEDs on alcohol consumption via internal drinking motives was discriminated over the impact of depressive symptoms. However, the latter relationship was only found among females which may highlight the gender differences in the relationship between risk for FEDs and alcohol use.
... 15,16 In considering why adolescents repeatedly engage in binge behaviors, it has been argued that they serve a similar function and purpose such as regulating emotions and/or escaping from negative emotions and coping with distress. [17][18][19][20][21] Above all, women who binge eat and drink often report the two behaviors in response to feeling lonely, bored or powerless in relation to their partners or they describe bingeing as a means of escape from fear of failure or feelings of low self-esteem and inadequacy. [22][23][24] Indeed, recent studies showed that binge eating and binge drinking among young people were associated with difficulties in emotion regulation (ER) and in dealing with situations involving negative emotions. ...
... The sample consisted of 1004 students (395 males and 609 females). The average age of the students was 17.9 (SD ¼0.8; range [16][17][18][19][20][21]. Participants involved in the study were in the last two years of high school and the majority of them were aged 17-18 years (80.8%). ...
... Adolescents experience more frequent and intense emotion than younger individuals, and their capacity to manage or regulate emotions in a socially appropriate and adaptive manner has been recognized as a central risk factor for both binge eating and drinking. 17,18 Our findings tended to confirm that emotional strategies that are response focused, as Expression Suppression in the model suggested by Gross, 30 seem to characterize adolescents who engage in binge behaviors. Consistent with this theory, higher levels of ES were reported by binge eaters and adolescents assuming both binge behaviors, but not by binge drinkers. ...
This cross-sectional study examined binge eating and binge drinking behaviors exploring their association with the strategies of Emotion Regulation, such as Cognitive Reappraisal (CR) and Expression Suppression (ES). The sample consisted of 1004 Italian students (395 males and 609 females) attending high school. The average age of the students was 17.9 years (SD =0.8; range: 16–21). They completed self-report measures assessing binge behaviors and Emotion Regulation strategies. No differences resulted between adolescents assuming binge behaviors and no bingers as regards CR; conversely, adolescents engaging in binge eating and in both binge behaviors reported the highest levels of ES. Furthermore, both Emotion Regulation strategies were significant predictors of binge eating. The present study suggested that binge behaviors were strongly associated with adolescent’s ability to evaluate and manage their emotions, so that adolescents may benefit from more precise and specific prevention and treatment approaches focused on training to use more adaptive and effective strategies to regulate their emotions.
... Recent findings (Stewart et al. 2000, Stewart and Brown 2005, Birch et al. 2007) have suggested that binge eating and drinking -above all in women -may be associated with difficulties in regulating emotions (dysregulation hypothesis) and ...
... Health, Risk & Society 363 that situations involving negative emotional states posed the highest risk for engaging in both behaviours. More specifically, Birch et al. (2007) argue that binge eating amongst women is a relief from psychological distress (e.g., reducing anxiety and desires) and temptation, while binge drinking is more likely to occur in reward situations (e.g., fulfilling needs and desires). Moreover, binge drinking is more likely to occur than binge eating in situation that involve interpersonal interaction, pleasant times with others and social pressure. ...
... Differently, diffused and foreclosed adolescents appear unhappy, dissatisfied with themselves and insecure lacking any sort of basic structure that might afford them a solid basis for making choices and following a consistent life path. Many of these adolescents seem to be more likely at risk for engaging in behaviours as a maladaptive coping mechanism that functions to provide relief from these affective states (Adams et al. 2005, Stewart et al. 2000, Stewart and Brown 2005, Birch et al. 2007, Good et al. 2008. Moreover, diffused and foreclosed adolescents being associated with higher levels of egocentric thought and lower levels of perspective-taking ability may be more prone to engage in binge behaviours. ...
The study aims to examine the relationship between Ego identity status model and Binge Eating Disorder in adolescence. The Extended Objective Measure of Ego-Identity Status- 2 (Bennion & Adams, 1986; Laghi et al., 2008, 2009), the Iowa-Netherlands Comparison Orientation Measure (Gibbons & Buunk, 1999; D'Alessio & Laghi, 2007; Baiocco, D'Alessio & Laghi, 2009), and the Binge Eating Scale (Gormally, Black, Daston & Rardin, 1982; Couyoumdjian, Baiocco & Del Miglio, 2006) have been administered to a sample of students (N = 316). Adolescents were categorized in the more advanced statuses (achievement and moratorium) and the less advanced statuses (diffusion and foreclosure) and in moderate, severe, and no binge eaters according to answers provided in the BES. The survey revealed - by means of univariate and multivariate analysis - that these groups differ in terms of Identity status dimensions. Ideological and Interpersonal domains, and conformism are predictors of BED. The findings of this study emphasize the importance of carefully considering the domains included in future research on identity formation.
... Although both objective binge eating and drinking tend to onset in adolescence or early adulthood and have similar pathways, there are important ways in which they differ (Birch et al., 2007). Objective binge eating characteristic of EDs often occurs in isolation and in states of negative emotion or stress (e.g., Birch et al., 2007;Smyth et al., 2007). ...
... Although both objective binge eating and drinking tend to onset in adolescence or early adulthood and have similar pathways, there are important ways in which they differ (Birch et al., 2007). Objective binge eating characteristic of EDs often occurs in isolation and in states of negative emotion or stress (e.g., Birch et al., 2007;Smyth et al., 2007). However, many emerging adults tend to drink in order to enhance positive mood states, when socializing, or when in a positive mood (Creswell, 2021). ...
Introduction
Objective binge eating and problematic alcohol use often co-occur and are common behaviors in emerging adults. Both behaviors are thought to be driven by affect regulation processes. Objective binge eating often occurs in the context of increasing or acute negative affect, and often occurs in solitude. Alcohol use in emerging adults can also be associated with negative affect regulation. However, in contrast to objective binge eating, a large body of research indicates that there are positively valenced pathways to alcohol use in this age group. Emerging adults often drink socially, to enhance enjoyment, and in the context of positive mood. We propose that one pathway to objective binge eating in this developmental period is through alcohol use itself, such that emerging adults who consume alcohol and who are more likely to act impulsively in the context of positive emotion (i.e., have high levels of positive urgency) may be more likely to binge eat following drinking.
Methods
We collected data using ecological momentary assessment in 106 undergraduates on positive and negative affect, motives for drinking and eating, and alcohol use and objective binge eating, in addition to baseline questionnaires of impulsivity.
Results
There were no significant changes in affect prior to drinking in this sample. Alcohol use at one time point significantly increased odds of objective binge eating at a later time point in the same day. Individual differences in positive urgency, the tendency to act rashly while experiencing positive affect, were also associated with increased odds of objective binge eating that occurred after alcohol use. Individual differences in negative urgency, the tendency to act rashly after experiencing negative affect, did not have a main effect on objective binge episodes, but did interact with alcohol use to increase the odds of objective binge eating following drinking. The vast majority of drinking episodes prior to objective binge eating were social drinking episodes, and participants most commonly endorsed "to have fun" as a reason for drinking.
Discussion
Results suggest that alcohol consumption may increase risk for objective binge eating in emerging adults.
... However, these behaviors also differ for some aspects. For instance, youths consider binge drinking to be more socially acceptable in public than they do binge eating (Birch, Stewart, & Brown, 2007;Wakeford, Kannis-Dymand, & Statham, 2017). Moreover, binge drinking is more likely than binge eating to occur in interpersonal situations involving pleasant emotions, pleasant times with others, and social pressure, whereas binge eating is a relief from psychological distress (Birch et al., 2007). ...
... For instance, youths consider binge drinking to be more socially acceptable in public than they do binge eating (Birch, Stewart, & Brown, 2007;Wakeford, Kannis-Dymand, & Statham, 2017). Moreover, binge drinking is more likely than binge eating to occur in interpersonal situations involving pleasant emotions, pleasant times with others, and social pressure, whereas binge eating is a relief from psychological distress (Birch et al., 2007). ...
Framed from a framework based on the integration of self-determination theory (Ryan & Deci, 2000 ) and Endler and Parker's (1990) conception of coping strategies, the authors analyzed the relationships between peer pressure and binge behaviors (binge eating and binge drinking) in adolescence. Moreover, the authors explored the mediating role of satisfaction/frustration of basic psychological needs and coping strategies in these associations. Participants were 570 high school students (M = 15.75 years, SD = 1.14 years) living in Italy. The study design was cross-sectional and adolescents were administered self-report questionnaires. Path analysis showed significant and positive direct associations of peer pressure with both binge eating and binge drinking. Moreover, findings show that there is an indirect path in which peer pressure is positively associated with need frustration that is related to the use of emotion-oriented coping strategies that, on their turn, are associated with binge eating. Differently, binge drinking seems to be only directly related to peer pressure. The authors put light to the complex nature of the relationships between peer pressure and binge behaviors in adolescence, taking into account the separate contribution of need satisfaction and need frustration, as well as of coping strategies. Finally, practical implications of the study are discussed.
... Beyond the perspective adopted, at the heart of each explanatory model is the assumption that binge behaviours serve some function for the individual and that function influences the persistence, or maintenance, of the behaviour (Ferriter and Ray 2011). Recent findings (Stewart et al. 2000, Stewart and Brown 2005, Birch et al. 2007) have suggested that binge eating and drinking – above all in women – may be associated with difficulties in regulating emotions (dysregulation hypothesis) and ...
... Health, Risk & Societythat situations involving negative emotional states posed the highest risk for engaging in both behaviours. More specifically, Birch et al. (2007) argue that binge eating amongst women is a relief from psychological distress (e.g., reducing anxiety and desires) and temptation, while binge drinking is more likely to occur in reward situations (e.g., fulfilling needs and desires). Moreover, binge drinking is more likely to occur than binge eating in situation that involve interpersonal interaction, pleasant times with others and social pressure. ...
This cross-sectional study examined binge eating and binge drinking behaviours analysing their association with the process of identity formation in adolescence and individual tendency towards conformism. The sample consisted of 1500 Italian students (660 boys and 840 girls) attending high school. The average age of the students was 17.31 years (SD = 1.34; range: 17–19). They completed self-report measures assessing binge behaviours, ego identity status and social conformism. Diffused adolescents were more likely to be engaged in binge eating and binge behaviours than others validating that the achievement of a consolidated ego identity is important for enhancing well-being and preventing problematic outcomes in adolescents. Moreover, adolescents engaging in binge behaviours reported the highest levels of tendency to compare their performances or ideas and opinions with others and to conform with them. The present study suggested that binge behaviours were strongly associated with an adolescent's identity process and have important implications for future empirical investigation and for clinical intervention.
... Examining why adolescents repeatedly engage in binging behaviours, it has been argued that these behaviours are associated with common triggers and they serve a similar function and purposes, such as regulating emotions and/or escaping from them and coping with distress and/or dissatisfaction with life (Birch, Sherry, & Brown, 2007;Stewart & Brown, 2005;Stewart, Samoluk, Conrod, Pihl, & Dongier, 2000). Stewart and Brown (2005) found overlap in the circumstances prompting binge eating and drinking in those women who engaged in both behaviours. ...
... Similar evidence for common triggers for binge eating and binge drinking was found for situations involving pleasant emotional states. Some women reported experiencing positive emotions as a consequence of binge eating and binge drinking describing feeling happy, confident or euphoric (Birch et al., 2007;Stewart & Brown, 2005). So, some adolescents may engage in both behaviours because they have not learned more adaptive strategies to enhance positive affect (emotional rewards) whereas some adolescents may engage in both behaviours because they have not learned more adaptive strategies to relieve negative affect (emotional relief). ...
Evidence of an association between binge eating and binge drinking and of related health consequences have stimulated investigators to examine and explore risk and protective factors plus the reasons why individuals engage in these risky behaviours (Benjamin & Wulfert, 2003; Ferriter & Ray, 2011). This study examined the relationship between binge drinking and eating, time perspective and psychological functioning. A cross-sectional survey of 1350 17-19 year-old adolescents was conducted. Findings suggested that adolescents engaged in both binge eating and binge drinking behaviours reported negative experiences in the past, and they showed a lower future orientation and a greater inclination to fatalism than did the other students Additionally, they were more likely to report lower feelings of satisfaction with life and self-esteem than the others. The pattern of results allows to conclude that time perspective may be a salient dimension when exploring the psychosocial correlates of binge behaviours, particularly within adolescents.
... Elevated rates of co-occurrence of binge eating and binge drinking have led investigators to explore personality traits associated with these behaviors or, more generally, with eating and alcohol use problems (Birch, Stewart, & Brown, 2007;Wolfe & Maisto, 2000). One line of research has identified impulsivity as a personality trait associated with the co-occurrence of eating and drinking problems. ...
... Moreover, behavior problems correlated with impulsivity, such as shoplifting, gambling, and sexual promiscuity, are also more prevalent among women who binge eat, binge drink, or engage in both behaviors (Benjamin & Wulfert, 2005). For this reason, reviewers have suggested that the co-occurrence of eating and drinking problems could be associated with a unitary "multi-impulsive personality type" (Birch et al., 2007), a category consistent with prior descriptions of multiimpulsive bulimic individuals (Fichter, Quadflieg, & Rief, 1994;Lacey & Evans, 1986) or emotionally dysregulated eating-disordered individuals (Thompson-Brenner & Westen, 2005;Westen & Harden-Fischer, 2001). ...
Elevated rates of comorbidity between binge eating and alcohol use problems have been widely documented. Prior studies have examined specific personality traits associated with the co-occurrence of these problems. The current study explores comprehensive personality factors that are associated with the co-occurrence of binge eating and binge drinking among a diverse sample of 208 college undergraduates. Using the Five Factor Model of personality, the authors assessed both comprehensive personality factors and style of impulse control, a personality style defined by different combinations of neuroticism and conscientiousness. On the basis of responses to a screening instrument, college students were assigned to one of four groups: binge eat, binge drink, binge eat and drink, and non-binge. The binge eat and drink group reported a higher level of neuroticism than did students in the binge drink and non-binge groups. Additionally, the binge eat and drink group was more likely to report an undercontrolled style of impulse control than were other groups. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
... Like binge eating, levels of binge drinking typically peak in young women during their university years (Mushquash et al., 2012;Sherry & Hall, 2009). The specificity of perfectionistic concerns' relationship to binge eating vs. drinking (Birch et al., 2006) is unclear and understudied, despite evidence binge eating and drinking commonly co-occur (Mackinnon et al., 2011). The rationale for testing perfectionistic concerns in relation to binge eating and drinking is that both are bingeing behaviors; if perfectionistic concerns is associated with binge eating but not binge drinking, this provides specificity to our findings. ...
Perfectionism is linked to a range of psychopathology, including binge eating. Our study enhanced understanding of the role maternal perfectionistic concerns play in the maintenance of binge eating in emerging adult daughters. A sample of 73 mother-daughter dyads (mean age = 49.51 years for mothers and 19.89 years for daughters) reported on perfectionistic concerns (composite of doubt about actions and concern over mistakes), binge eating, and binge drinking (composite of frequency, severity, and perceptions). Using actor-partner interdependence modelling, mothers' and daughters' perfectionistic concerns were positively associated with their own binge eating (actor effects). Mothers' perfectionistic concerns were positively associated with daughters' binge eating (partner effect), but not vice versa. Perfectionistic concerns did not show significant actor or partner associations with binge drinking, supporting the specificity of our model. Findings suggest binge eating has characterological and interpersonal antecedents.
... Similar results were obtained in an 8594 sample of boys and girls between 9 and 15 years of age, in which they observed that eating disorders were highly prevalent in this population and that all the types of eating disorders were associated with an early onset and frequency of BD behavior [39]. Recent findings have also suggested that, in women, both binge behaviors may be associated with difficulties of regulating emotions and facing situations involving negative emotional states [40]. In contrast, Sonneville et al. (2013) [41] did not observe that BE predicts more frequent BD in the future, while depressive symptoms and psychological distress were related to future drug use. ...
Adolescence and youth are critical periods in which alcohol consumption is usually initiated, especially in the form of binge drinking. In recent years, it is increasingly common to find adolescents and young people who also present binge behaviors towards unhealthy food with the aim of alleviating their anxiety (emotional eating) and/or because of impulsive personality. Despite the social and health relevance of this issue, it remains scarcely studied and more preventive research needs to be developed. Our meta-analysis study aimed to evaluate the relationship and co-occurrence of both binge behaviors during adolescence and young adulthood to clarify the link between binge drinking and eating. Selective literature search on different online databases was performed. We identified discrete but significant results regarding the direct association between binge drinking and binge eating in correlation coefficients and odds ratio. Future research should focus on the common psychological background and motives behind these problematic behaviors owing to their clinical implications for effective prevention and treatment.
... En relación con este último aspecto, la ansiedad se ha visto fuertemente asociada con la alimentación emocional que se produce usualmente como una respuesta a una emoción negativa o angustia, como podría ser el malestar que se origina tras el conflicto de pareja [4]. Dicho malestar podría mitigarse comiendo en exceso, priorizándose unos alimentos ante otros, o mediante episodios de atracones, tal y como han revelado estudios previos que han considerado diferentes situaciones estresantes (e.g., problemas familiares, presión social, cuarentena durante la pandemia de la COVID-19) [5,6]. Aún más, la gestión de la ansiedad a través de la alimentación emocional ha llegado a verse relacionada con la bulimia nerviosa u obesidad [4]. ...
La alimentación emocional se podría considerar como un mecanismo de regulación emocional en situaciones de elevada intensidad y/o altamente estresantes, como pueden ser los conflictos de pareja. El objetivo de esta investigación fue observar si las variables generadas tras un conflicto interpersonal como la rumia, las emociones negativas y la gestión del conflicto están relacionadas con la alimentación emocional. Asimismo, se realizó un análisis de las diferencias de sexo en las variables de estudio de manera simultánea. El estudio contó con una muestra de 273 participantes (82 hombres, 191 mujeres), cuyas edades oscilaban entre los 18-68 años. Los participantes indicaron mayormente, que los conflictos que habían sufrido con sus parejas habían sido originados por diferencia de opiniones, por problemas de convivencia o por celos, como los conflictos más frecuentes entre estos encuestados. Los resultados del estudio mostraron correlaciones positivas entre la rumia y las emociones negativas con la alimentación emocional, mientras que se observó que estaba negativamente correlacionada con la gestión del conflicto. Teniendo en cuenta las diferencias de sexo, se observó que las mujeres presentaron mayor relación significativa con la rumia, las emociones negativas y la gestión del conflicto, a diferencia de los hombres. La discusión de los resultados de este estudio nos permite confirmar que existe una relación entre los conflictos de pareja y la alimentación emocional, ya que, a mayores conflictos de pareja y menor gestión de los dichos, mayor alimentación emocional.
... The comorbidity between AUD and other disorders, including the addiction to other substances, is well known. In that sense, clinical data show connections between BD and BE, 12,37 and similarities between both BE and BD can be observed. BE implies the ingestion of high amounts of palatable foods (lipids or sugars) in short periods of time 38,39 just as BD implies high consumption of ethanol in a brief time. ...
Animal models of alcohol (ethanol) self-administration are crucial to dissect the neurobiological mechanisms underlying alcohol dependence, yet only a few of these induce pharmacologically relevant levels of alcohol consumption and rarely the alcohol self-administration co-occurs with other addictive behaviours. The present study aims to validate a novel model of voluntary ethanol consumption in male Wistar rats, in which ethanol access follows a binge eating experience. Over 10 sessions, Wistar rats were exposed to binge or control eating (i.e., the ingestion of 11.66 and 0.97 kcal/3 min, respectively, derived from a highly palatable food), immediately followed by two-bottle choice intake tests (2%, 6%, 10% or 14% w/w ethanol vs. water). Rats exposed to binge eating drank significantly more 6% or 10% (w/w) ethanol than control peers, reaching up to 6.3 gEtOH /kg. Rats stimulated with 2%, 6%, 10% or 14% ethanol after binge eating, but not those given those ethanol concentrations after control eating, exhibited significant within-group increases in ethanol drinking. This ethanol consumption was not altered by quinine adulteration (up to 0.1 g/L), and it was blocked by naltrexone (10 mg/kg), administered immediately before binge eating. Blood ethanol levels significantly correlated with ethanol consumption; and the more ethanol consumed, the greater the distance travelled in an open field test conducted after the two-bottle choice test. Altogether, this self-administration model seems a valid and robust alternative with remarkable potential for research on different stages of the alcohol addiction and, particularly, to assess interactions between alcohol consumption and others addictive-like behaviours.
... of substance and process/behavioral addictions, interpersonal relationship distortion, such as controlling, submission, and co-dependence are frequently observed (Najavits, Sonn, Walsh, & Weiss, 2004;Stuart, G. L., Moore, Ramsey, & Kahler, 2003). It is also commonly shared that these two types of addictions are manifestations that replace conflicts and emotional discomfort originated within a psycho-social context (Birch, Stewart, & Brown, 2007;Itabashi et al., 2020). In the same way, relationship addictive behaviors in many cases are not the original psycho-social problems per se, but function to mask or obscure those problems, as in my clinical case which I will illustrate later. ...
This article aimed at building a comprehensive hypothesis on the origin and developmental process of addictive behaviors based on facts obtained from the author’s clinical experience. A woman with a variety of addictive behaviors was introduced as an instance. Not only childhood adversity which contribution already had been proven in the development of addiction, the author also focused on psycho-social obstruction during adolescence, more specifically, that of constructing peer relationships as well as that of renewing the relationship with parents crucial for passing through the second individuation process (Blos, 1967). Furthermore, how the obstruction related to the adversity during early life was discussed. At the end of the article, reference was made to possible benefits in adulthood brought about by intervening with adolescents who are at high risk of addictive behaviors.
... A comparative study (n = 41) in women found that binge eating and heavy alcohol use happen separately in situations that included pleasant events, social pressure and interpersonal interactions. Both binge eating and heavy alcohol use co-occur in events associated with unpleasant emotions, physical discomfort, urging and tempting situations [24]. Caffeine and tobacco use are common in women with EDs because they can be used as an appetite suppressant. ...
Eating disorders (EDs) are negative eating habits that have harmful mental and physical effects. EDs primarily affect young women. Most cases are diagnosed in adolescence. The most common EDs are bulimia nervosa (BN), anorexia nervosa (AN), and binge eating disorder (BED). There is a strong association between EDs and substance use disorder (SUD) in adolescence. Bulimia nervosa and alcohol use disorder (AUD) are the most common co-occurrence. There is a high behavioral association between EDs and AUD. Alcohol consumption could be a primary trigger for binge eating in women with BN. Alcohol can be used as an appetite suppressor and as a compensatory behavior to avoid food.
The objective of this literature review was to explore the relation between EDs and SUD. The results of the study showed SUD is common with EDs. There are many reasons for this association such as shared neurobiological mechanisms, personality features, environmental and genetic factors.
... Indeed, it has been suggested that food and alcohol may represent substances that young people may use to regulate their emotions, and, thus, their drinking and eating behaviors may be seen as a strategy of emotion regulation to influence and alter affective states [72][73][74][75]. Adolescents experience frequent and intense emotions, and their difficulties modulating and regulating emotions in a functional and adaptive way have been considered a predisposing factor for disordered eating and drinking [76][77][78][79]. In line with a previous study [13], the current research supports the argument of emotion dysregulation as a potential risk factor for drunkorexia behavior among adolescents. ...
Purpose
Drunkorexia represents an emerging phenomenon that is still understudied especially among adolescents. The present study aimed to investigate the relation between drunkorexia and psychological characteristics relevant and commonly associated with existing forms of eating disorders.
Methods
The sample was composed of 849 adolescents (513 boys, 334 girls, 2 unknown; range 14–22) who completed a survey composed of Compensatory Eating and Behaviors in Response to Alcohol Consumption Scale and Psychological scales of the Eating Disorders Inventory-3.
Results
Our findings highlighted that drunkorexia was associated with low self-esteem, personal alienation, interoceptive deficits, emotional dysregulation, and asceticism. Hierarchical multiple regression analysis indicated that difficulties with emotion regulation and ascetic tendencies were significant predictors of drunkorexia among adolescents.
Conclusions
Our findings suggest the importance for programs preventing drunkorexia to be focused on training adolescents in using more adaptive strategies to manage emotions and accepting both emotional and physical signals without feeling guilty or threatened.
Level of evidence
Level V, descriptive study.
... There is small to moderate correlation between binge eating and binge drinking (Gadalla & Piran, 2007), and these two bingeing behaviors often co-occur in undergraduates (Rush et al., 2009), making binge drinking a suitable variable to use in testing the specificity of the reformulated PMOBE. Despite this overlap (Gadalla & Piran, 2007), binge eating and binge drinking are not seen as equivalent and do not necessarily have identical antecedents or consequences (Birch, Stewart, & Brown, 2007). For example, whereas concern over mistakes is positively related to binge eating (Cassin & von Ranson, 2005), research suggests concern over mistakes and binge drinking are unrelated (Flett et al., 2008). ...
The perfectionism model of binge eating (PMOBE) is an integrative model explaining why perfectionism is related to binge eating. This study reformulates and tests the PMOBE, with a focus on addressing limitations observed in the perfectionism and binge-eating literature. In the reformulated PMOBE, concern over mistakes is seen as a destructive aspect of perfectionism contributing to a cycle of binge eating via 4 binge-eating maintenance variables: interpersonal discrepancies, low interpersonal esteem, depressive affect, and dietary restraint. This test of the reformulated PMOBE involved 200 undergraduate women studied using a 3-wave longitudinal design. As hypothesized, concern over mistakes appears to represent a vulnerability factor for binge eating. Bootstrapped tests of mediation suggested concern over mistakes contributes to binge eating through binge-eating maintenance variables, and results supported the incremental validity of the reformulated PMOBE beyond perfectionistic strivings and neuroticism. The reformulated PMOBE also predicted binge eating, but not binge drinking, supporting the specificity of this model. The reformulated PMOBE offers a framework for understanding how key contributors to binge eating work together to generate and to maintain binge eating.
... There is small to moderate correlation between binge eating and binge drinking (Gadalla & Piran, 2007), and these two bingeing behaviors often co-occur in undergraduates (Rush et al., 2009), making binge drinking a suitable variable to use in testing the specificity of the reformulated PMOBE. Despite this overlap (Gadalla & Piran, 2007), binge eating and binge drinking are not seen as equivalent and do not necessarily have identical antecedents or consequences (Birch, Stewart, & Brown, 2007). For example, whereas concern over mistakes is positively related to binge eating (Cassin & von Ranson, 2005), research suggests concern over mistakes and binge drinking are unrelated (Flett et al., 2008). ...
The perfectionism model of binge eating (PMOBE) is an integrative model explaining why perfectionism is related to binge eating. This study reformulates and tests the PMOBE, with a focus on addressing limitations observed in the perfectionism and binge-eating literature. In the reformulated PMOBE, concern over mistakes is seen as a destructive aspect of perfectionism contributing to a cycle of binge eating via 4 binge-eating maintenance variables: interpersonal discrepancies, low interpersonal esteem, depressive affect, and dietary restraint. This test of the reformulated PMOBE involved 200 undergraduate women studied using a 3-wave longitudinal design. As hypothesized, concern over mistakes appears to represent a vulnerability factor for binge eating. Bootstrapped tests of mediation suggested concern over mistakes contributes to binge eating through binge-eating maintenance variables, and results supported the incremental validity of the reformulated PMOBE beyond perfectionistic strivings and neuroticism. The reformulated PMOBE also predicted binge eating, but not binge drinking, supporting the specificity of this model. The reformulated PMOBE offers a framework for understanding how key contributors to binge eating work together to generate and to maintain binge eating.
... However, the contexts in which individuals binge drink and binge eat differ. University students, especially, are likely to binge drink in social contexts (Clapp et al., 2003) and women consider binge drinking more socially acceptable than binge eating in public (Birch, Stewart, & Brown, 2007). In considering gender differences, binge eating is known to be associated with anger suppression in women (Milligan & Waller, 2000;Waller et al., 2003), and with state anger in men (Meyer et al., 2005). ...
Objective: Binge eating and alcohol consumption have been associated with attempts to reduce negative affect such as anger. Anger rumination has been associated with maintaining anger. The aim of the current study was to explore the association between anger rumination and binge eating and at-risk alcohol use. Method: Participants were 563 university students aged between 18 and 66years who completed an online survey containing the Anger Rumination Scale (ARS), Eating Disorder Diagnosis Scale (EDDS), Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and Depression, Anxiety, & Stress Scale (DASS-21). Results: The results showed that individuals who endorsed elevated levels of binge eating behaviour had increased levels of anger rumination, specifically angry afterthoughts and angry memories, compared to healthy controls. In contrast, individuals who engaged in at-risk alcohol use without binge eating did not report significantly increased levels of anger rumination. Conclusions: This study highlights anger rumination as a potential factor in maintaining binge eating behaviour and suggests that screening for and addressing anger rumination may be an important component of psychological treatment.
... This suggests an overlap in the pathways, proteins, or genes responsible for eating disorders that occur either sporadically or together with a complex mental disorder, such as PWS. Unpleasant emotions and urges and temptations are major situational risks for binge eating (Birch, Stewart, & Brown, 2007), while restricted access to food and the resulting reduction in stress together decrease situational risks for binge eating and pica in PWS (Ho & Dimitropoulos, 2010). Psychiatric comorbidities, most commonly impulse control disorders, are common among individuals with Binge-Eating Disorder (Fernandez-Aranda et al., 2008) and those with PWS (Bonnot et al., 2016). ...
The etiology of abnormal eating behaviors, including binge-eating disorder, is poorly understood. The neural circuits modulating the activities of the neurotransmitters dopamine and serotonin are proposed to be dysfunctional in individuals suffering from eating disorders. Prader-Willi syndrome is a neurodevelopmental disorder that causes extreme food seeking and binge-eating behaviors together with reduced satiety. One of the genes implicated in Prader-Willi syndrome, Magel2, is highly expressed in the regions of the brain that control appetite. Our objective was to examine behaviors relevant to feeding and the neural circuits controlling feeding in a mouse model of Prader-Willi syndrome that lacks expression of the Magel2 gene. We performed behavioral tests related to dopaminergic function, measuring cocaine-induced hyperlocomotion, binge eating, and saccharin-induced anhedonia in Magel2-deficient mice. Next, we analyzed dopaminergic neurons in various brain regions and compared these findings between genotypes. Finally, we examined biochemical markers in the brain under standard diet, high-fat diet, and withdrawal from a high-fat diet conditions. We identified abnormal behaviors and biomarkers reflecting dopaminergic dysfunction in mice lacking Magel2. Our results provide a biological framework for clinical studies of dopaminergic function in children with Prader-Willi syndrome, and may also provide insight into binge-eating disorders that occur in the general population. (PsycINFO Database Record
... This may be seen at social events or when people are watching TV, etc. If repeated often, this can also lead to increases in body weight [26,27]. ...
Overweight and obese people, and even people simply concerned about their weight, follow weight loss diets. There is a general lack of knowledge on the part of the public regarding the best steps to take in order to lose weight. It is quite common for people to follow practices that may lead to nutritional and health problems. A person who is overweight or obese suffers an abnormal or excessive accumulation of body fat. Obesity is one of the major public health problems. The increase in the incidence of obesity has been favored by a growth in sedentary ways of life. Further, there is a trend toward consuming easy-to-prepare meals. Nutrition education is vital in the prevention of obesity, yet there is a general lack of knowledge in nutrition matters among people. This general lack of information, coupled with incorrect information, leads to the appearance of inadequate food habits and therefore swelling ranks of the overweight and obese. In fact, the consumption of fruits and vegetables by obese people is much lower than that recommended, especially among adolescents, who also tend to restrict the intake of these foods when trying to lose weight. The general public and overweight/obese persons in particular therefore need to be given correct nutritional information. Obesity prevention programs should encourage the acquisition of healthy food habits, including the consumption of fruits and vegetables, and promote physical exercise with the aim of reducing body weight and adiposity to desirable levels.
... Our results showed that two dimensions of sensation seeking were associated to binge eating in male adolescents. Specifically this study found that, the tendency to be easily bored by repetitive and familiar situations or people, is a significant predictor of binge symptoms in males; this finding supports the argument regarding the role that experiencing negative affect have as possible trigger for binging behaviors (Birch, Stewart, & Brown, 2007;Stewart & Brown, 2006). In this case binge episodes could be activated by a feeling of boredom that individuals could perceive about the experiences they are involved in. ...
... Certain particular eating behaviors, especially displays of dietary disinhibition, like binge eating, has been characterized as displaying similar behavioral patterns as other addictive behaviors (Corwin & Grigson, 2009;Pelchat, 2009). Binge eating can be characterized as a pattern of overeating episodes followed by feelings of loss of control, guilt, and attempts to restrict eating to lose weight (Linde et al., 2004), and has been found to be triggered similar high risk situations as that of heavy drinking (Birch, Stewart, & Brown, 2007). Binge eating constitutes a pronounced problem in obese eating behavior (Elfhag & Rössner, 2005), as well as being a significant predictor for weight regain after successful weight loss (McGuire et al., 1999) Binge eating has also been related to a history of weight cycling (Sherwood, Jeffery, & Wing, 1999) which in itself have been found to be associated with unsuccessful weight loss maintenance (Ball et al., 1999;Haus, Hoerr, Mavis, & Robison, 1994;McGuire et al., 1999). ...
... 42 Other studies suggest that adolescents with EDs and/or ED symptoms use alcohol to cope with problems caused by their EDs. 9,31,43 Internalizing behaviors are frequently comorobid with disordered eating and EDs. 32,44 Birch and colleagues 43 report that heavy drinking or binge eating in isolation of each other often occur in situations that involve pleasant emotions, interpersonal interactions, and social pressure, whereas binge eating combined with heavy drinking is more likely to occur in situations that involve unpleasant emotions, physical discomfort or situations involving urges, temptations, and testing control. ...
To examine the relationship of eating disorder (ED) symptoms with the severity of alcohol use among adolescents in treatment for alcohol and other substance use disorders (AOSUDs).
A sample consisted of 177 adolescents who participated in outpatient AOSUD treatment programs in Connecticut. Chi square tests, one-way ANOVAs and Pearson's correlation coefficients were used to describe the prevalence and correlates of any eating disorders, and the related symptoms. Multivariate regression was used to test the associations between ED symptoms and alcohol consumption.
26.4% of the participants had at least one ED symptom, with the highest number of symptoms occurring in females. The number of ED symptoms was associated with increases in the number of times that they became intoxicated in the year before entering treatment, the number of alcohol-related social problems, and the number of alcohol-related physical symptoms after taking into consideration the effects of age and gender.
The prevalence of symptoms of EDs is high in adolescents with AOSUDs, with the number of ED symptoms correlating with increased alcohol consumption. Further studies on the course and treatment of adolescents with AOSUDs and symptoms of EDs are warranted.
... Teorierna om en gemensam etiologi inkluderar bland annat olika personlighetstyper, gemensamma familje-/miljöfaktorer och biologisk sårbarhet. Orsaksfaktorer som leder till missbruk hos en person med BN eller vice versa kan till exempel vara självmedicinering, effekten av minskat matintag (bantning), att det ena beteendet (till exempel missbruk) uppstår som en konsekvens av att försöka upphöra med det andra (till exempel ätstörning) samt traumatiska upplevelser/övergrepp eller exempelvis sociala aspekter av familjemiljön (Birch Stewart, & Brown, 2007; Krahn, 1991; Sinha, & O'Malley, 2000). ...
... A third possible limitation of the present article is its focus on what the two behaviors hold in common in terms of common underlying motivations, to the exclusion of what distinguishes these two behaviors (e.g. specific contexts in which each behavior occurs might differ substantially; see Birch, Stewart, & Brown, 2005). And finally, we failed to have women report on precisely when the heavy drinking and binge eating were at their greatest severity in the quantitative portion of the data collection. ...
Questionnaires assessing heavy drinking and binge eating were administered to 58 women with alcohol problems. A sub-sample of
the binge-eaters then participated in qualitative interviews about their perceptions of the connections between their two problems. Seventy-one percent self-identified as binge-eaters with most reporting ‘severe’ binge eating. Binge-eaters were younger, more frequent drinkers and drank more often for emotional relief than non-binge-eaters. Binge
eating and heavy drinking appeared to serve similar functions in a given client (i.e. emotional relief or reward functions). We
discuss implications of the findings for the development of better
treatments for women struggling with both health issues.
... Although the mechanism underlying the statistical and temporal associations between eating and drinking binge behaviors remains unknown, they may be so co-prevalent because they serve a similar function and purpose, such as regulating emotions and/or escaping from them and coping with distress . Recent findings have suggested that in women, both behaviors may be associated difficulties in regulating emotions and in facing situations involving negative emotional states (Birch et al., 2007; Laghi et al., 2009b; Stewart and Brown, 2005; Stewart et al., 2000). ...
Considering the significant negative consequences that are directly related to binge eat and drink behaviors, many studies have explored the reasons why adolescents engage in them. This study examined the differences in the development, maintenance, and co-occurrence of "binge" behaviors associated with adolescent's identity style and the level of commitment. One thousand four hundred Italian adolescents completed self-report measures assessing binge behaviors and identity styles. Overall, results show that diffused adolescents were more likely to be engaged in binge eating and binge drinking behaviors than others, validating the idea that the achievement of a consolidated ego identity is important for enhancing well-being.
... A third possible limitation of the present article is its focus on what the two behaviors hold in common in terms of common underlying motivations, to the exclusion of what distinguishes these two behaviors (e.g. specific contexts in which each behavior occurs might differ substantially; see Birch, Stewart, & Brown, 2005). And finally, we failed to have women report on precisely when the heavy drinking and binge eating were at their greatest severity in the quantitative portion of the data collection. ...
Questionnaires assessing heavy drinking and binge eating were administered to 58 women with alcohol problems. A sub-sample of the binge-eaters then participated in qualitative interviews about their perceptions of the connections between their two problems. Seventy-one percent self-identified as binge-eaters with most reporting 'severe' binge eating. Binge-eaters were younger, more frequent drinkers and drank more often for emotional relief than non-binge-eaters. Binge eating and heavy drinking appeared to serve similar functions in a given client (i.e. emotional relief or reward functions). We discuss implications of the findings for the development of better treatments for women struggling with both health issues.
Objective:
Alcohol use is a substantial problem among college students and has several negative consequences. The current study examined the associations between anhedonia and alcohol use and related problems via impulsive behavior (e.g., negative urgency, sensation seeking). We parsed anhedonia into four specific facets: consummatory, anticipatory, recreational, and social anhedonia.
Participants:
Six hundred and forty college students aged 18-25 were included in the final analysis.
Method:
Data were collected via Amazon Mechanical Turk. Self-report inventories assessing for anhedonia, alcohol use, impulsive behavior, and depressed mood were utilized.
Results:
Recreational consummatory anhedonia was negatively associated with alcohol use and alcohol-related problems through negative urgency. Recreational consummatory anhedonia also had significant negative associations with alcohol consumption via sensation seeking. Further, social anticipatory anhedonia was positively associated with alcohol use and related problems via negative urgency.
Conclusions:
This study highlights important associations between anhedonia, impulsivity, and alcohol use and related problems.
The Nova Scotia College of Social Worker's concern about critiques of mental health and addiction services, and the role of social work within those services, led to the contracting of this study. They requested a research report that could inform and guide their mental health advocacy efforts. This report is a summary of a community consultation with mental health stakeholders and relevant literature.
Prior studies have indicated a high prevalence of comorbidity between problematic levels of eating and drinking. This high co-prevalence has been partly attributed to the disinhibiting effects of alcohol on eating behaviors. Specifically, alcohol consumption has been shown to increase food intake by disinhibiting eating behaviors. Alternately, it is also possible that food and alcohol consumption might become associated through repeated pairings. Through these repeated pairings, food cues and food consumption might elicit alcohol cravings and subsequent alcohol use. Similarly, alcohol cues and alcohol consumption might elicit food cravings and subsequent food intake. Finally, other common factors might explain both eating and drinking behaviors. In particular, the tendency to cope with distress through food and alcohol consumption has been shown to increase the risk for problematic levels of eating and drinking. The current chapter will review evidence supporting and theories underlying these pathways in order to better understand the high co-prevalence of problematic eating and drinking.
Cigarette smoking and obesity are two major public health problems. However, factors related to the underlying risk for being overweight are not well established. Certain demographic, smoking, and psychological factors have been linked to overweight/obese body mass. The current study examined a multivariate risk model, stratified by gender, in order to better explicate the nature of overweight body mass among daily smokers. In a sample of treatment-seeking smokers (n = 395), among males and females, (1) older age, (2) stronger expectancies about the weight/appetite control effects of smoking, (3) greater smoking-based inflexibility/avoidance due to smoking-related sensations, and (4) less problematic alcohol use, were associated with being overweight. Additionally, among males, having a tobacco-related medical problem and higher tolerance for physical discomfort aided in the discriminant function model for classifying smokers as overweight. Together, numerous cognitive-affective vulnerabilities and smoking processes may be targetable and potentially inform weight-related prevention programs among smokers.
A serdulőkori taplalkozasi magatartas szerepe meghatarozo mind a pozitiv bio-pszicho-szocialis fejlődes folyamataban, mind a felnőttkori egeszseges eletmod kialakitasaban. Vizsgalatunk celja a taplalkozaskontrollal osszefuggesbe hozhato egyenszintű, csaladi es transzperszonalis tenyezők vizsgalata. Adatainkat 1977 erdelyi serdulőtől (15–19 evesek) nyertuk, onkitoltős kerdőives modszerrel. Eredmenyeink a taplalkozaskontrollban nemi es eletkori sajatossagokat igazolnak. A taplalkozassal kapcsolatos tudatossagban a kognitiv-kontroll tenyezők mellett kiemelt szerepet jatszanak a csaladi es transzperszonalis tenyezők. A nemzetkozi vizsgalati eredmenyekkel ellentetben mintankban az enhatekonysagnak az etkezes magatartassal kapcsolatos meghatarozo szerepe nem igazolodik. Ezzel ellentetben felertekelődik a szulői banasmod es az elegedettseg a szulői tamogatassal, es bar nemekhez, valamint eletkorhoz kototten, de igazolast nyer a transzperszonalis tenyezők szerepe. Az egyenszintű jolletmutatok szinten osszefuggesb...
To investigate the effects of acute alcohol intoxication on eating-related urges among women with bulimia nervosa (BN).
Participants included women with BN or normal-weight eating disorder NOS with regular binge/purge symptoms (N = 13), and normal-eater control women (N = 17). Tested individually, the women reported on their mood state as well as on urges to binge eat and engage in various compensatory behaviors, prior to consuming alcohol, and again at 60 and 180 min following the consumption of 1.0 ml kg(-1) alcohol.
Both groups reported feeling less clearheaded after drinking, as well as initial subjective mood stimulation followed by subsequent mood lowering. In addition, BN participants reported reductions in their urges to binge eat, exercise compulsively, and restrict food intake following alcohol consumption-the urge to purge was not significantly affected.
Among women with BN, alcohol consumption appeared to reduce select eating-related urges with concomitant reductions in attention or concentration.
Patients presenting for gastric bypass surgery often demonstrate binge eating behaviors. The present study sought to determine whether binge eating triggers are predictive of weight loss outcomes in bariatric surgery patients at 6 months postoperatively in the setting of a university hospital.
A total of 48 patients presenting for gastric bypass surgery at an academic medical center in the Southeastern United States and who had returned for the 6-month follow-up visit were included in the present study. The patients were mostly women (85%), white (71%), and middle-aged (mean age 47 years), with an average weight of 100.9 kg. The patients completed the Inventory of Binge Eating Situations at baseline, and weight loss outcomes were assessed at 6 months. Weight loss success was indexed using 2 methods: the percentage of excess weight lost (continuous variable) and whether the patient was on track with their weight loss as defined by a ≥ 50% excess weight loss (dichotomous variable).
A significant negative correlation (r = -.31, P = .03) was found between the preoperative Inventory of Binge Eating Situations scores and the percentage of excess weight loss at 6 months after gastric bypass surgery. Logistic regression analysis showed that "on track" status at 6 months was predicted by the Inventory of Binge Eating Situations score at baseline (Wald chi-square = 3.97, df = 1, P = .046).
Careful assessment of binge eating situations could serve as a potential predictor of poor weight loss outcomes in patients seeking gastric bypass surgery. These findings support the baseline assessment of binge eating triggers and future research to examine the effectiveness of interventions for coping with binge eating triggers for gastric bypass surgery patients.
We examined the unique contributions of depression, anxiety, and anxiety sensitivity (AS) in predicting frequency of drinking in different high-risk situations among 60 women receiving treatment for alcohol problems. Participants completed the Beck Depression Inventory-II, Beck Anxiety Inventory, Anxiety Sensitivity Index, and Short Form Inventory of Drinking Situations (IDS-42). Together, the negative emotionality variables reliably predicted scores on the IDS-42 negative and temptation drinking situations subscales but did not reliably predict scores on the IDS-42 positive drinking situations subscales. With one exception, only AS contributed unique variance in predicting negative and temptation context drinking. Both AS and depression contributed unique variance in predicting drinking in conflict with others situations. Implications for treating comorbid emotional and alcohol-use disorders in women are discussed.
This study investigated the parameters of eating behavior in subjects meeting the diagnosis of bulimia nervosa (BN). Twenty BN and 24 female comparison (FC) subjects monitored hourly over a number of consecutive days their food intake, mood, hunger, social circumstances, and experiences of unpleasant events. Compared with FC subjects, BN subjects reported more positive moods relative to their typical moods in the hour prior to consuming a meal. Within the BN group, subjects reported more negative moods in the hour prior to a binge episode compared with their moods prior to consuming a snack or meal. The BN subjects were also calorie deprived in the hour prior to a binge episode relative to FC subjects at an equivalent time of the day. These results are discussed within the framework of restraint theory.
This first Canadian edition of Essentials of Abnormal Psychology covers the terrain one might expect of an abnormal psychology textbook. This includes chapters on historical context, approaches to psychopathology, clinical assessment, diagnosis and research methods, anxiety disorders, somatoform and dissociative disorders, mood disorders and suicide, physical disorders and health psychology, eating and sleep disorders, sexual and gender identity disorders, substance-related disorders, personality disorders, schizophrenia and other related disorders, developmental and cognitive disorders, and finally, legal and ethical issues as related to mental health.
Although the book initially may look rather dense (it is not), there are numerous organisational aids to facilitate learning. These include concept checks (answers included) embedded throughout the chapters, multiple-choice quizzes, and a visual "Cole's Notes" summary of the causes, symptoms, and treatments for the different diagnoses. Students should find the accompanying CD with brief clips of therapists interviewing clients with various mental disorders intriguing and thought-provoking. Instructors may appreciate that each clip has an associated question (e.g., "What symptoms of depression are evident?").
Disordered eating and substance use problems are significant and often co-occurring mental and physical health issues facing women today (see Chapter 13 of this book). Some suggest that when these two conditions co-exist, it may reflect a more significant emotional struggle than when either problem occurs alone (Singer et al., 1993). Researchers are beginning to argue that such co-occurrence must be taken into consideration in the development of more helpful treatment strategies for women (Holderness et al., 1994). Current research, including our own (Stewart et al., 2006), has explored, and continues to explore, common triggers and underlying motivations for both issues. Findings on this topic could be helpful to identify at-risk women, and could also clarify some of the factors associated with co-prevalence, which would be useful in improving current treatments.
Through a brief overview of two key studies, as well as our own recent research, this chapter examines how an understanding of the mechanisms underlying the co-occurrence of disordered eating and substance use problems in women can improve women’s health programming, both in terms of modifying existing treatments and developing preventive measures and early interventions that can help avoid the emergence
of more extreme clinical problems.
For the past 25 years, the frequent co-prevalence of disordered eating and substance use problems among women has been widely documented. Connections between eating problems, particularly bulimic behavior, among women and the harmful use of alcohol and other drugs have now been strongly established (Krahn,
1991; Singer et al., 1993; see also Goldbloom, 1993; Holderness et al., 1994; Sinha & O’Malley, 2000; and Wilson, 1993, for reviews). Several recent studies, including our own (Stewart et al., 2006), have investigated the possibility that binge eating and problematic substance use may be so highly co-prevalent because they reflect a common mechanism or mechanisms involving emotional regulation: namely, providing emotional rewards (e.g., fulfilling needs and desires) and/or emotional relief from psychological distress (e.g., reducing anxiety or depression).
The conceptual foundations of social learning theory (SLT), respondent conditioning, operant conditioning, and observational learning, are empirically-supported approaches to understanding normative human development and the etiology of psychosocial problems. The principles of SLT are completely consistent with the currently popular eco-systems framework within social work practice. A thorough integration of SLT within the eco-systems model will substantially reduce the shortcomings of the latter, namely its lack of a testable theoretical framework, and lack of prescriptive guidelines for social work assessment and intervention.
Drinking restraint is receiving increased attention as a possible risk factor for alcohol abuse. Although in its relative infancy, survey and laboratory research have delineated relationships between retraint and heavy drinking, as well as other drinking-related variables (cyclical drinking, negative consequences). However, a host of conceptual and methodological issues remain to be addressed. This review presents an overview of the research to date, with emphasis on the research conducted by R. L. Collins et al (e.g., 1989, 1991, 1992). Issues concerning the conceptualization of drinking restraint and its measurement, as well as its relationship to the abstinence violation effect are discussed. Although many issues remain to be resolved, drinking restraint offers promise for elucidating processes involved in the move from social drinking to problem drinking. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Psychological traits of 49 female patients with anorexia nervosa (AN) were compared with those of 38 weight-preoccupied (WP) and 137 non-WP females from samples of college and ballet students. WP Ss were selected on the basis of extreme scores on the Drive for Thinness subscale on the Eating Disorder Inventory (EDI). Results indicate that on the Ineffectiveness, Interpersonal Distrust, and lack of Interoceptive Awareness subscales, relatively few of the WP Ss scored above the AN median. Using cluster analysis procedures, the WP Ss were divided into 2 subgroups. Cluster 1 was characterized by elevated scores on all EDI subscales, indicating significant psychopathology. Cluster 2 had elevated scores only on Drive for Thinness, Body Dissatisfaction, and Perfectionism and could be described as normal dieters. These findings were interpreted as indicating that although there are some highly WP females who display psychopathology quite similar to AN, others only superficially resemble patients suffering from serious eating disorders. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The authors seek to clarify, from both an epidemiologic and genetic perspective, the major risk factors for bulimia nervosa and to understand the relationship between narrowly defined bulimia and bulimia-like syndromes.
Personal structured psychiatric interviews were conducted with 2,163 female twins from a population-based register. Psychiatric disorders were assessed using DSM-III-R criteria.
Lifetime prevalence and risk for narrowly defined bulimia were 2.8% and 4.2%, respectively. Including bulimia-like syndromes increased these estimates to 5.7% and 8.0%, respectively. Risk factors for bulimia included 1) birth after 1960, 2) low paternal care, 3) a history of wide weight fluctuation, dieting, or frequent exercise, 4) a slim ideal body image, 5) low self-esteem, 6) an external locus of control, and 7) high levels of neuroticism. Significant comorbidity was found between bulimia and anorexia nervosa, alcoholism, panic disorder, generalized anxiety disorder, phobia, and major depression. Proband-wise concordance for narrowly defined bulimia was 22.9% in monozygotic and 8.7% in dizygotic twins. The best-fitting model indicated that familial aggregation was due solely to genetic factors with a heritability of liability of 55%. A multiple threshold model indicated that narrowly defined bulimia nervosa and bulimia-like syndromes represented different levels of severity on the same continuum of liability.
The liability to fully syndromal bulimia nervosa, which affects around one in 25 women at some point in their lives, is substantially influenced by both epidemiologic and genetic risk factors. The same factors that influence the risk for narrowly defined bulimia also influence the risk for less severe bulimia-like syndromes.
This article proposes that binge eating is motivated by a desire to escape from self-awareness. Binge eaters suffer from high standards and expectations, especially an acute sensitivity to the difficult (perceived) demands of others. When they fall short of these standards, they develop an aversive pattern of high self-awareness, characterized by unflattering views of self and concern over how they are perceived by others. These aversive self-perceptions are accompanied by emotional distress, which often includes anxiety and depression. To escape from this unpleasant state, binge eaters attempt the cognitive response of narrowing attention to the immediate stimulus environment and avoiding broadly meaningful thought. This narrowing of attention disengages normal inhibitions against eating and fosters an uncritical acceptance of irrational beliefs and thoughts. The escape model is capable of integrating much of the available evidence about binge eating.
This study investigated the parameters of eating behavior in subjects meeting the diagnosis of bulimia nervosa (BN). Twenty BN and 24 female comparison (FC) subjects monitored hourly over a number of consecutive days their food intake, mood, hunger, social circumstances, and experiences of unpleasant events. Compared with FC subjects, BN subjects reported more positive moods relative to their typical moods in the hour prior to consuming a meal. Within the BN group, subjects reported more negative moods in the hour prior to a binge episode compared with their moods prior to consuming a snack or meal. The BN subjects were also calorie deprived in the hour prior to a binge episode relative to FC subjects at an equivalent time of the day. These results are discussed within the framework of restraint theory. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
We first establish the association between binge eating and dieting and present sequence data indicating that dieting usually precedes binging, chronologically. We propose that dieting causes binging by promoting the adoption of a cognitively regulated eating style, which is necessary if the physiological defense of body weight is to be overcome. The defense of body weight entails various metabolic adjustments that assist energy conservation, but the behavioral reaction of binge eating is best understood in cognitive, not physiological, terms. By supplanting physiological regulatory controls with cognitive controls, dieting makes the dieter vulnerable to disinhibition and consequent overeating. Implications for therapy are discussed, as are the societal consequences of regarding dieting as a "solution" to the problem of binging.
Depression, anxiety, and obsessionality frequently are present in underweight, malnourished patients with anorexia nervosa. It is less certain if these symptoms persist after recovery. Thus, we assessed these symptoms in anorexic women at three states of illness (underweight, short-term weight restored, and long-term weight restored) in comparison to a group of healthy women.
We used standardized self- and trained rater instruments to assess depression (Hamilton Depression Rating Scale and Beck Depression Inventory), anxiety (Spielberger State-Trait Anxiety Inventory and Hamilton Anxiety Rating Scale), and obsessions and compulsions (Yale-Brown Obsessive Compulsive Scale).
A similar pattern was found for all symptoms. That is; scores for depression, anxiety, and obsessionality were most elevated in the underweight state. These symptoms improved with weight restoration. However, milder but significantly elevated symptoms persisted in long-term weight-restored anorexic women compared to healthy control women.
These data suggest that malnutrition intensifies the severity of depression, anxiety, and obsessionality in anorexia nervosa. However, the fact that mild to moderate symptoms persisted after long-term weight restoration raises the possibility that such behaviors are related to the pathogenesis of this illness.
The comorbidity of eating disorders and substance use and abuse has frequently been reported in the past 15 years. To date, however, no synthesis of this literature exists. Here, 51 studies reporting on these associations are reviewed. Studies of substance use and abuse in eating disordered women are considered, as are studies of eating disorders among women classified as substance abusers. The rates of substance abuse among eating disordered women are also examined. This review indicates that associations are stronger with bulimia, and “bulimic” behaviors, than with anorexia nervosa. Analogously, bulimic anorectics report more substance use and abuse than restricters. The prevalence of drug abuse was not found to differ between the relatives of bulimics and anorectics. Several mechanisms explaining the eating disorder–substance use/abuse link are considered, and suggestions for future research made. © 1994 by John Wiley & Sons, Inc.
Objective
Depression, anxiety, and obsessionality frequently are present in underweight, malnourished patients with anorexia nervosa. It is less certain if these symptoms persist after recovery. Thus, we assessed these symptoms in anorexic women at three states of illness (underweight, short‐term weight restored, and long‐term weight restored) in comparison to a group of healthy women. Method: We used standardized self‐ and trained rater instruments to assess depression (Hamilton Depression Rating Scale and Beck Depression Inventory), anxiety (Spielberger State‐Trait Anxiety Inventory and Hamilton Anxiety Rating Scale), and obsessions and compulsions (Yale‐Brown Obsessive Compulsive Scale). Results: A similar pattern was found for all symptoms. That is, scores for depression, anxiety, and obsessionality were most elevated in the underweight state. These symptoms improved with weight restoration. However, milder but significantly elevated symptoms persisted in long‐term weight‐restored anorexic women compared to healthy control women. Discussion: These data suggest that malnutrition intensifies the severity of depression, anxiety, and obsessionality in anorexia nervosa. However, the fact that mild to moderate symptoms persisted after long‐term weight restoration raises the possibility that such behaviors are related to the pathogenesis of this illness. © 1997 by John Wiley & Sons, Inc. Int J Eat Disord 21: 367–376, 1997.
This article proposes that binge eating is motivated by a desire to escape from self-awareness. Binge eaters suffer from high standards and expectations, especially an acute sensitivity to the difficult (perceived) demands of others. When they fall short of these standards, they develop an aversive pattern of high self-awareness, characterized by unflattering views of self and concern over how they are perceived by others. These aversive self-perceptions are accompanied by emotional distress, which often includes anxiety and depression. To escape from this unpleasant state, binge eaters attempt the cognitive response of narrowing attention to the immediate stimulus environment and avoiding broadly meaningful thought. This narrowing of attention disengages normal inhibitions against eating and fosters an uncritical acceptance of irrational beliefs and thoughts. The escape model is capable of integrating much of the available evidence about binge eating.
Background: Eating disorders and alcohol use disorders (AUDs) commonly co-occur, although the patterns of comorbidity differ by eating disorder subtype. Our aim was to explore the nature of the comorbid relation between AUDs and eating disorders in a large and phenotypically well-characterized group of individuals.
Method: We compared diagnostic and personality profiles of 97 women with lifetime anorexia nervosa only, 282 women with lifetime bulimia nervosa only, and 293 women with a lifetime history of both anorexia nervosa and bulimia nervosa or anorexia nervosa with binge eating (ANBN) (DSM-IV criteria). All individuals were participants in a multicenter study of the genetics of anorexia nervosa and bulimia nervosa. We explored pattern of onset, Axis I and II comorbidity, and personality characteristics of individuals with and without AUDs by eating disorder subtype. Personality characteristics were assessed with the Multidimensional Perfectionism Scale, the Temperament and Character Inventory, and the Barratt Impulsivity Scale.
Results: Alcohol use disorders were significantly more prevalent in women with ANBN and bulimia nervosa than in women with anorexia nervosa (p = .0001). The majority of individuals reported primary onset of the eating disorder, with only one third reporting the onset of the AUD first. After eating disorder subtype was controlled for, AUDs were associated with the presence of major depressive disorder, a range of anxiety disorders, and cluster B personality disorder symptoms. In addition, individuals with AUDs presented with personality profiles marked by impulsivity and perfectionism.
Conclusions: Individuals with eating disorders and AUDs exhibit phenotypic profiles characterized by both anxious, perfectionistic traits and impulsive, dramatic dispositions. These traits mirror the pattern of control and dyscontrol seen in individuals with this comorbid profile and suggest that anxiety modulation may be related to alcohol use in this group.
Forty-two inpatient women with bulimia nervosa and 29 women with anorexia nervosa were surveyed regarding eating behavior, patterns of licit and illicit substance use, and relation between drug use and appetite. Substantial use of licit substances such as laxatives, diuretics, and emetics were reported in women with bulimia nervosa. In addition, alcohol and cigarette use were significantly more common in women with bulimia nervosa than anorexia nervosa. The majority of bulimic subjects reported that smoking decreased appetite, alcohol increased appetite, and laxatives had no effect on appetite. Analysis of temporal patterns of drug intake suggested that binging and purging as well as alcohol, cigarette, and laxative use were considerably more prevalent in the evening hours. We suggest that the high rates of drug use in women with bulimia nervosa may be related to effects of food deprivation associated with the disorder.
There were 158 female undergraduates categorized on the basis of scores on the Binge Scale and the presence or absence of vomiting in five groups: normals (n = 73), mild (n = 23), moderate (n =23), and severe (n = 14) bingers and binge vomiters (n = 18). These groups were examined on measures of eating-disorders, dietary restraint, negative self-image, psychopathology, and social desirability. A discriminant function analysis isolated three variables that predicted group membership: drive for thinness, restraint, and negative self-image. It was clear from the analysis that binge-vomiters were highly similar to severe binge eaters and both differed from moderate binge eaters, who in turn differed from mild binge eaters and normals. The latter two groups were almost identical. The results point to the importance of bingeing rather than vomiting in the etiology and treatment of bulimia.
Chronic food restriction and maintenance of low body weight have long been known to increase the self-administration and motor-activating effects of abused drugs. Using a lateral hypothalamic self-stimulation (LHSS) rate-frequency method, it is shown that chronic food restriction augments the rewarding (i.e., threshold lowering) effect of diverse drugs of abuse. Further, the effect is attributed to increased sensitivity of a neural substrate, rather than a change in drug bioavailability or pharmacokinetics, because it is preserved when drugs are injected directly into the lateral cerebral ventricle (intracerebroventricularly). The food restriction regimen that augments drug reward also increases the induction of c-fos, by intracerebroventricular amphetamine, in limbic forebrain dopamine (DA) terminal areas. The possibility of increased DA receptor function is suggested by findings that rewarding and motor-activating effects of direct DA receptor agonists are augmented by food restriction, and the augmented behavioral effects of amphetamine are reversed by an otherwise subthreshold dose of D-1 antagonist. Initial studies of DA receptor-mediated signal transduction, that are focused on the D-2 receptor, suggest increased functional coupling between receptor and G-protein (i.e., quinpirole-stimulated [35S]GTPγS binding) in dorsal striatum. Unlike behavioral sensitization induced by intermittent stress or psychostimulant treatment, which persist indefinitely following induction, the augmenting effect of food restriction abates within 1 week of restored ad libitum feeding and weight gain. The possible involvement of endocrine hormones and/or ‘feeding-related’ neuropeptides, whose levels change dynamically with depletion and repletion of adipose stores, is therefore under investigation. Initial tests have been limited to acute treatments aimed at attenuating the effects of hypoinsulinemia, hypoleptinemia and elevated corticosterone levels in food-restricted rats. None of these treatments has attenuated the behavioral effect of food restriction. While a melanocortin receptor agonist has been found to enhance drug reward, melanocortin receptors do not seem to mediate the augmenting effect of food restriction. Continuing investigations of endocrine adiposity signals, ‘feeding-related’ neuropeptides and dopaminergic signal transduction may further elucidate the way in which drugs of abuse exploit mechanisms that mediate survival-related behavior, and help explain the high comorbidity of drug abuse and eating disorders.
problem drinkers [persons with identifiable alcohol problems but who have not experienced severe consequences or serious alcohol withdrawal symptoms] often respond well to nonintensive interventions aimed at helping them assert control over their behavior / while considerable progress has been made in developing treatments for problem drinkers, most alcohol treatment programs continue to offer these individuals only traditional intensive treatments / focuses on where the treatment of problem drinkers fits into a public health approach to alcohol problems (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The author presents a comprehensive assessment approach for evaluating eating disorders that includes an overview of the conceptualization and description of these disorders, followed by detailed discussions of specific approaches to interviews, behavioral observations, self-report inventories, self-monitoring, and body image assessment. The assessment of other common problem areas is covered as they relate to eating disorders, and the use of assessment information for treatment plans and evaluation is described in depth. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The authors examined situational and affective risk factors associated with the use of alcohol and other drugs. Five primary substance groups (alcohol, cocaine, marijuana, sedatives-tranquilizers, and heroin-opiates) were compared on situational risk scales from the Inventory of Drinking and Drug Use Situations. Significant differences were found between groups on both level and pattern of situational and affective risk. Positive social experiences and negative affective states were important risk factors for the alcohol and cocaine groups. Positive affective and situational factors were important for the marijuana group. Negative physical states and interpersonal conflict were important risk factors for the heroin-opiate and sedative-tranquilizer groups. Age and gender were also found to be significantly related to level and pattern of situational risk for alcohol and other drug use.
The present study investigated seven antecedents to the binge-purge cycle proposed by Orleans and Barnett (1984), including restraint, stress, mood, thoughts of food, fatigue, hunger, and dichotomous cognitions. For 1 week, 19 bulimics, 15 binge eaters, and 20 normal control subjects recorded detailed information about these antecedent conditions and the types and quantities of food consumed for each eating episode. Results indicated that prior to their binge episodes, bulimics reported significantly greater stress, preoccupation with food, and negative mood than binge eaters reported prior to their binges and normal controls reported prior to all of their eating episodes. Both bulimics and binge eaters reported greater dichotomous cognitions prior to binge episodes than normal controls experienced prior to all of their eating episodes. Comparisons of the antecedents to eating episodes which bulimics and binge eaters regarded as nonbinge episodes with all eating episodes of the control group indicated that although bulimics and binge eaters experienced significantly greater negative moods than normal controls prior to their nonbinge episodes, only bulimics experienced significantly greater dichotomous cognitions prior to these eating episodes. Theoretical and clinical implications of these findings are discussed.
Objective
Depression, anxiety, and obsessionality frequently are present in underweight, malnourished patients with anorexia nervosa. It is less certain if these symptoms persist after recovery. Thus, we assessed these symptoms in anorexic women at three states of illness (underweight, short-term weight restored, and long-term weight restored) in comparison to a group of healthy women. Method: We used standardized self- and trained rater instruments to assess depression (Hamilton Depression Rating Scale and Beck Depression Inventory), anxiety (Spielberger State-Trait Anxiety Inventory and Hamilton Anxiety Rating Scale), and obsessions and compulsions (Yale-Brown Obsessive Compulsive Scale). Results: A similar pattern was found for all symptoms. That is, scores for depression, anxiety, and obsessionality were most elevated in the underweight state. These symptoms improved with weight restoration. However, milder but significantly elevated symptoms persisted in long-term weight-restored anorexic women compared to healthy control women. Discussion: These data suggest that malnutrition intensifies the severity of depression, anxiety, and obsessionality in anorexia nervosa. However, the fact that mild to moderate symptoms persisted after long-term weight restoration raises the possibility that such behaviors are related to the pathogenesis of this illness. © 1997 by John Wiley & Sons, Inc. Int J Eat Disord 21: 367–376, 1997.
Twenty-eight adolescent bulimics were compared to 201 psychiatrically hospitalized non-eating disordered patients. Non-eating disordered patients were found to be reliably more aggressive, delinquent, and under-controlled than patients with bulimia nervosa. Sexual abuse was found to be less prevalent among bulimic adolescents than comparison adolescents. No significant between group differences were achieved on any measure of alcohol/drug abuse. The behavioral profiles of substance abusing bulimics were highly similar to those of non-eating disordered patients. Three months follow-up of bulimic patients found that they were less depressed, had less somatization, and were less overcontrolled; however, they showed no reliable improvements in eating attitudes/behaviours or drug/alcohol use.
Data concerning the longitudinal course of illness and associated problems reported by a series of 275 female patients with bulimia are presented. Eighty-five percent of these patients indicated that they had started binge-eating during a period of voluntary dieting, and the majority indicated that they had perceived pressure from family members and/or friends to lose weight in association with this dieting episode. Although the development of binge-eating usually preceded or coincided with the development of self-induced vomiting behavior, a pattern of habitual self-induced vomiting developed prior to the onset of binge-eating in 44 (18.4%) patients. Most patients reported having experienced several periods of abstinence from bulimic behavior during the course of the illness, with the majority indicating periods of abstinence of at least two weeks in duration, suggesting that the symptoms of bulimia may wax and wane over time. Several problems were reported at high frequencies by this patient group including a history of self-injurious behavior (34.4%) and a history of at least one suicide attempt (18.8%).
The 42-item version of the Inventory of Drinking Situations (IDS-42) assesses relative frequency of drinking behavior across eight categories of drinking situations and was originally developed as a method for identifying high-risk situations in alcoholic samples. This study was designed to examine the psychometric properties of the IDS-42 in a sample of university students in order to assess its suitability as an assessment tool in the non-clinical population. Three hundred and ninety-six students (111 M, 283 F, 2 with missing gender data) completed the IDS-42 and a well established measure of drinking motives, the Drinking Motives Questionnaire (DMQ). Confirmatory factor analysis of the IDS-42 established a hierarchical factor structure with eight lower-order factors and three higher-order factors of negatively-reinforcing situations, positively-reinforcing situations, and temptation situations. The eight lower-order IDS-42 factors demonstrated moderate to high internal consistency and excellent concurrent validity with conceptually-similar DMQ subscale scores. Non-parametric analyses revealed that male students reported a higher drinking frequency overall as compared to female students, particularly in IDS-42 situations involving Social Pressure to Drink, Pleasant Times with Others, Testing Personal Control, and Urges and Temptations. Across the entire sample of university student drinkers, a higher drinking frequency was reported in positively-reinforcing situations as compared to negatively-reinforcing situations and temptation situations, as predicted. Results suggest the IDS-42 possesses good psychometric properties and support its utility as a tool in identifying situation-specific antecedents to drinking among university students.
Sixty obese women meeting Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) research criteria for binge-eating disorder were randomly allocated either to a 14-hour period of caloric deprivation or to no deprivation. These women were then randomized within each deprivation condition to an induced negative or neutral mood before being served a multi-item buffet. Negative mood, but not caloric deprivation, significantly increased loss of control over eating. For self-defined binges, negative mood, but not caloric deprivation, significantly increased the occurrence of binge eating. However, for investigatordefined binges, both deprivation and negative mood increased the occurrence of binge eating. Caloric deprivation also led participants to eat significantly more during the buffet, but not over the laboratory day. Fat intake was significantly higher in both self-defined and investigator-defined binges as compared to overeating episodes. For those in the negative mood condition, anxiety had significantly declined by the end of the buffet.
Purpose:
We investigated the psychometric properties (factor structure, internal consistency reliability, concurrent validity) of the Short Form Inventory of Drinking Situations (IDS-42) in women substance abusers.
Methods:
A sample of 297 substance-abusing women was recruited from the community. The women completed the IDS-42 and the three-factor Drinking Motives Questionnaire (DMQ).
Results:
Confirmatory factor analyses of IDS-42 items suggested a hierarchical structure for the scale. Eight factors (corresponding to Marlatt and Gordon's eight heavy drinking situations) provided the best model fit at the lower-order level, and three factors (i.e., Negatively Reinforcing vs. Positively Reinforcing vs. Temptation Situations) provided the best model fit at the higher-order level. Lower- and higher-order IDS-42 subscales were shown to possess adequate-to-high levels of internal consistency. The eight lower-order IDS-42 factors demonstrated excellent concurrent validity with conceptually similar DMQ subscale scores. Across the entire sample of female substance abusers, a higher frequency of heavy drinking was reported in Positively Reinforcing Situations and Unpleasant Emotions Situations, as compared to other heavy drinking situations.
Implications:
Results support the IDS-42's good psychometric properties and demonstrate its utility as a tool in identifying situation-specific antecedents to heavy drinking among women substance abusers.
Assessed the effects of alcohol on the eating behavior of normally restrained and unrestrained eaters. The icecream consumption of 55 female college students was measured in a taste rating context following their consumption of alcohol or placebo, the label of which was systematically manipulated. In the absence of a disinhibitory label, alcohol served as a mood elevator (with consumption decreasing for restrained eaters and increasing for unrestrained eaters), replicating the authors' 1976 findings. Alcohol disinhibited the consumption of normally restrained eaters only when supplemented by a disinhibitory label. Results are interpreted as support for a cognitive/pharmacological interaction model of alcohol intoxication. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The concept of changes in emotional arousal during the binge-purge cycle plays a principal role in bulimia theory. Female bulimic patients (n = 29) retrospectively rated the intensity of several emotions during their binge-purge cycle. When collapsed into positive versus negative emotion categories, both categories showed significant changes in emotions over the course of the binge-purge episode. Negative emotion increased after a binge and decreased during the purge. Positive emotion decreased after binging and increased during and after purging.
Initial interest in the relationship between eating disorders, which occur primarily in women, and substance abuse, which is much more frequent in men than women, stemmed from the observations of Crisp (1968) who noted that chronic anorexics who developed bulimic behavior often abused alcohol. More recently, cross-sectional studies of women with eating disorders have documented prevalences of alcohol and other substance abuse in these women that are much higher than those reported in the general female population. Conversely, women with substance abuse disorders report eating-disordered behavior more often than the general population. This article first presents a definition of eating disorders and then addresses (1) the rate of coprevalence of eating disorders and substance abuse; (2) the mechanism of the coprevalence of these disorders; (3) the clinical similarities of these disorders; and (4) future directions.
Six adult male research volunteers, in two groups of three subjects each, lived in a residential laboratory for 13 days. All contact with the experimenter was through a networked computer system and subjects' behaviors, including food intake, were continuously recorded. During the first part of the day, subjects remained in continuously recorded. During the first part of the day, subjects remained in their private rooms doing planned work activities, and during the remainder of the day, they were allowed to socialize. Two cigarettes containing active marijuana (2.3% delta 9 THC) or placebo were smoked during both the private work period and the period of access to social activities. Smoked active marijuana significantly increased total daily caloric intake by 40%. Increased food intake was evident during both private and social periods. The increase in caloric intake was due to an increased consumption of snack foods as a consequence of an increase in the number of snacking occasions. There was no significant change in caloric consumption during meals. The principal increase within the category of snack foods was in the intake of sweet solid items, e.g., candy bars, compared to sweet fluid, e.g., soda, or savory solid items, e.g., potato chips. Increases in body weight during periods of active marijuana smoking were greater than predicted by caloric intake alone.
Self-reports of high-risk events, situations and experiences associated with substance abuse and binge-eating behaviors were examined in a sample of hospitalized patients being treated for both problems. The question being posed in the present study is: Are the high-risk situations for heavy drinking and binge eating similar or different? Results suggest some similarities in the intensity of specific high-risk situations as represented by questionnaire subscale scores, for both of the problem behaviors, but they point to interesting differences as well. The hierarchical importance of the high-risk situations for the two behaviors were markedly different.
The authors present data on 275 patients who met DSM-III criteria for bulimia. The mean age of the patients was 24.8 years, and the average duration of illness was approximately 7 years. These patients reported a variety of abnormal eating-related behaviors: binge eating (100%), self-induced vomiting (88.1%), laxative abuse (60.6%), diuretic abuse (33.1%), and chewing and spitting out food (64.5%). Over one-third reported a history of problems with alcohol or other drugs and most indicated substantial social impairment.
The authors report an abbreviated version of the Michigan Alcoholism Screening Test (MAST). They hypothesized, on the basis of previously published data, that scores based on ten of the questions of the MAST would be as effective in discriminating between alcoholics and nonalcoholics as scores based on all 25 questions. The responses of 60 alcoholic and 62 nonalcoholic psychiatric patients supported their hypothesis.
The Michigan Alcoholism Screening Test (MAST), devised to provide a consistent, quantifiable, structured interview instrument to detect alcoholism, consists of 25 questions that can be rapidly administered. Five groups were given the MAST: hospitalized alcoholics, a control group, persons convicted of drunk driving, persons convicted of drunk and disorderly behavior, and drivers whose licenses were under review. The validity of the MAST was assessed by searching the records of legal, social, and medical agencies and reviewing the subjects' driving and criminal records. The MAST responses of 15 subjects who were found to be alcoholic in the record search were analyzed to determine where the screening failures had occurred. Recommendations are made for reducing the number of such "falsė negatives."
The present study investigated the topography of binge eating by comparing characteristics of eating episodes recorded by individuals who engage in binge eating (n = 29) with those who do not (n = 27), and characteristics of binge and non-binge episodes recorded by individuals who binge eat. For 2 weeks, subjects continuously recorded the type and quantity of food eaten during each eating episode, time and place of consumption, number of persons present, mood while eating, and whether the food eaten was part of a meal or snack. Results indicated binge eaters experienced negative moods during a significantly greater proportion of their eating episodes than non-binge eaters. Within the group of binge eaters, negative moods were experienced during a significantly greater proportion of binge episodes than non-binge episodes. Furthermore, binge episodes occurred significantly more often than non-binge episodes from 6:00 to 12:00 p.m. and significantly less often at appropriate places. Clinical implications of these findings are discussed.
Bulimia is an eating disorder purported to comprise binge eating episodes with subsequent depressive moods and self-deprecating thoughts. This study reports the development and preliminary construct validation of a Binge Scale intended to provide more descriptive, quantifiable information about the behavioral and attitudinal parameters of bulimia. Over two-thirds of the females and nearly one-half of the males in the samples reported binge eating occurences. The severity of binge eating was associated with degree of dieting concern (“restraint”) and inversely related to self-image acceptance, particularly among females. Maintaining body weight below “set point” through restrained eating efforts may increase the susceptibility to periodic binge episodes.
SYNOPSIS
Thirty-two patients who complained of episodes of ravenous overeating which they felt unable to control (bulimia) were asked to describe their behaviour and symptoms. There was considerable variation both between and within individuals, but a number of factors were defined which appeared to be common to all with the complaint. It is difficult to set up strict criteria for the recognition of bulimia, and those that have recently been proposed are criticized in the light of our present findings.
An innovative sampling method was used to compare normal-weight bulimic patients to normal controls on four dimensions: (1) overall moods, (2) extent of mood fluctuating, (3) degree of social isolation, and (4) extent of food-related behavior. In addition, a sequence analysis was conducted to explore the impact of binging and purging episodes on various affective states among the bulimics. Results indicated that the bulimics experienced significantly more dysphoric and fluctuating moods than normal controls and that they spent much more time alone and in food-related behavior than the control group. The discussion presents a hypothetical integration regarding the etiology and maintenance of the bulimic behavior based on the results of the data and post-trial interviews with the bulimic patients.
A detailed comparison was made of two methods for assessing the features of eating disorders. An investigator-based interview was compared with a self-report questionnaire based directly on that interview. A number of important discrepancies emerged. Although the two measures performed similarly with respect to the assessment of unambiguous behavioral features such as self-induced vomiting and dieting, the self-report questionnaire generated higher scores than the interview when assessing more complex features such as binge eating and concerns about shape. Both methods underestimated body weight.
The comorbidity of eating disorders and substance use and abuse has frequently been reported in the past 15 years. To date, however, no synthesis of this literature exists. Here, 51 studies reporting on these associations are reviewed. Studies of substance use and abuse in eating disordered women are considered, as are studies of eating disorders among women classified as substance abusers. The rates of substance abuse among eating disordered women are also examined. This review indicates that associations are stronger with bulimia, and "bulimic" behaviors, than with anorexia nervosa. Analogously, bulimic anorectics report more substance use and abuse than restricters. The prevalence of drug abuse was not found to differ between the relatives of bulimics and anorectics. Several mechanisms explaining the eating disorder-substance use/abuse link are considered, and suggestions for future research made.
In the evolving clinical and research literature on the eating disorders anorexia nervosa and bulimia nervosa, evidence of an association with alcohol misuse has emerged among the psychiatric comorbidities. This review examines both theoretical models of and empirical evidence for this association, as well as considering the implications for treatment.
This study investigated two issues: the level of weight and shape concerns, and the self-reported tendency to eat in response to negative emotions among obese individuals with binge eating disorder (BED), eating disorder not otherwise specified (EDNOS), and no eating disorder (CONTROL).
On the basis of demographic and diagnostic surveys, 156 participants in a weight loss program were categorized on two dimensions, eating disorder category and weight (BED vs. EDNOS vs. CONTROL/low vs. high body mass index), yielding a 2 x 3 experimental design.
Individuals with BED reported a greater tendency to eat in response to negative mood states than CONTROL subjects and low weight EDNOS subjects, but not high weight EDNOS subjects. Weight did not influence self-reported weight and shape concerns. Individuals with BED expressed greater concern for weight and shape than non-eating disordered CONTROLs.
The findings suggest that overconcern with weight and shape be further investigated as a diagnostic feature of BED and that emotional eating is associated with BED but not obesity per se.
The comorbidity of DSM-III-R axis I and axis II disorders presents conceptual and nosological challenges to psychiatry. In a consecutive series of 164 psychiatric outpatients and 36 healthy controls in Milan, Italy, psychopathology was measured by structured interviews for DSM-III-R disorders and temperament was measured by the Tridimensional Personality Questionnaire (TPQ). Low reward dependence (RD) distinguished cluster A personality disorders and no axis I disorders. High novelty seeking (NS) characterized cluster B personality disorders and patients with eating disorders, alcohol abuse, or substance abuse. High harm avoidance (HA) characterized all cluster C personality disorders and patients with mood or anxiety disorders. The temperament dimensions were nearly independent of one another, but patients often had multiple DSM-III-R diagnoses. The joint relations of these disorders to multiple temperament dimensions accounted for their characteristic patterns of comorbidity. These findings support the hypothesis that interactions among temperament dimensions during development influence comorbidity between axis I and axis II disorders.
The results of past research suggest that bulimics are more likely than anorexics to engage in substance use, and that binge eating and/or purging may be an indicator of increased likelihood of substance use. We further investigated substance use among women with eating disorders.
We compared women with anorexia nervosa (n = 134) to women with bulimia nervosa (n = 320) with regard to history of substance use and investigated potential relationships between eating disorder symptom presentation and substance use.
Even after controlling for age and eating disorder symptom severity, women with bulimia nervosa were more likely than those with anorexia nervosa to have used alcohol, amphetamines, barbituates, marijuana, tranquilizers, and cocaine. Independent of diagnostic category, severity of caloric restriction was predictive of amphetamine use, severity of binge eating was predictive of tranquilizer use, and severity of purging was predictive of alcohol, cocaine, and cigarette use.
Results are discussed in relation to the results of past research and with an emphasis on the importance of considering eating disorder symptom presentation in addition to formal eating disorder diagnosis.
The present study was designed to examine the factorial nature of the Three Factor Eating Questionnaire-Restraint Scale (TFEQ-R) and to compare the relationship of both the Restraint Scale (RS) and TFEQ-R to current dieting, history of dieting, disinhibition, self-esteem and restrained drinking in 144 females. A principal component analysis identified three interpretable factors: Emotional/Cognitive Concern for Dieting, Calorie Knowledge, Behavioral Dieting Control. Only Emotional/Cognitive Concern for Dieting equated with RS as both measures correlated with self-esteem and restrained drinking. Results are discussed in light of other proposed models of dietary restraint and in relation to two recent factors which have been identified in the drinking literature, Cognitive Emotional Control and Cognitive Behavioral Control.