Why Do Women with Alcohol Problems Binge Eat?

Abstract

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.

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Journal of Health Psychology
http://hpq.sagepub.com/content/11/3/409
The online version of this article can be found at:
DOI: 10.1177/1359105306063313
2006 11: 409J Health Psychol
Sherry H. Stewart, Catrina G. Brown, Kristina Devoulyte, Jennifer Theakston and Sarah E. Larsen
Alcohol Problems
between Binge Eating and Heavy Drinking in Women Receiving Treatment for
Why Do Women with Alcohol Problems Binge Eat? : Exploring Connections
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409
Why Do Women with
Alcohol Problems
Binge Eat?
Exploring Connections
between Binge Eating and
Heavy Drinking in Women
Receiving Treatment for
Alcohol Problems
SHERRY H. STEWART, CATRINA G.
BROWN, & KRISTINA DEVOULYTE
Dalhousie University, Canada
JENNIFER THEAKSTON
University of Waterloo, Canada
SARAH E. LARSEN
St Mary’s University, Canada
Journal of Health Psychology
Copyright © 2006 SAGE Publications
London, Thousand Oaks and New Delhi,
www.sagepublications.com
Vol 11(3) 409–425
DOI: 10.1177/1359105306063313
Abstract
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.
Keywords
■ alcohol problems
■ binge eating
■ co-morbidity
■ motives
■ women
ACKNOWLEDGEMENTS. This research was supported through a
generous grant from the Nova Scotia Health Research Foundation to
the first and second authors. The authors would like to acknowledge
the assistance of Health Services Director Tom Payette (Capital
District Health Authority), Program Managers Paul Helwig (Core),
Colleen Phillips (Detoxification) and Jean McClelland (Matrix), as
well as the service providers at each of these programs for their
assistance in recruiting participants for the study. We would also like to
thank K. Katina Garduno for her assistance in data entry. And of
course, we extend our thanks to the women receiving services at these
programs for their participation in our study.
COMPETING INTERESTS: None declared.
ADDRESS. Correspondence should be directed to:
SHERRY H. STEWART, Department of Psychology, Dalhousie
University, Life Sciences Centre, 1355 Oxford Street, Halifax,
Nova Scotia, B3H 4J1, Canada. [email: sherry.stewart@dal.ca]
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EATING disorders and alcohol problems are
significant health issues facing women today.
Much research attests to the fact that they are
commonly co-occurring problems (see Holder-
ness, Brooks-Gunn, & Warren, 1994; Stewart &
Brown, in press; Wilson, 1993a for reviews).
Although the precise rates of substance use
problems in eating disorder samples have varied
across studies, likely due to factors such as the
manner in which substance problems were
assessed and the particular substance(s) studied,
one consistent finding is elevated rates of
alcohol problems in eating disordered samples
(Wilson, 1993a).
Typically, the greatest association between
alcohol problems and eating disorders has been
found among women with bulimia and women
with the binge eating/purging subtype of
anorexia, with up to 55 percent of women
presenting for treatment of these eating
disorders also displaying alcohol problems
(Wilson, 1993a). High rates of eating disorders,
particularly those involving binge eating, have
likewise been reported among groups of women
with alcohol problems. Approximately 30–40
percent of women with alcohol problems report
a history of eating disorders (Taylor, Peveler,
Hibbert, & Fairburn, 1993)—a substantially
higher rate than the 1–3 percent prevalence
among women in the general population (APA,
1994).
The co-occurrence of eating disorders and
alcohol problems does not appear to be limited
to clinical samples. Community-based studies
also support the co-existence of eating disorders
(particularly those involving binge eating) and
alcohol problems in women (e.g. Kendler et al.,
1991). Such findings rule out the possibility that
the elevated co-occurrence of eating disorders
and alcohol problems among women seeking
treatment are simply an artefact of ‘Berkson’s
bias’ (i.e. the increased tendency for those with
more than one problem to seek treatment; see
Stewart & Brown, in press).
An important limitation of the majority of
studies on the co-prevalence of eating and
alcohol problems in women has been the
tendency to examine the overlap at the diag-
nostic level (e.g. co-morbidity of bulimia
nervosa and alcohol abuse) rather than at the
symptom level (e.g. co-occurrence of binge
eating and heavy drinking). Persons (1986)
argues that research efforts to understand the
nature of the processes underlying psychologi-
cal phenomena such as binge eating and heavy
drinking will be more successful if the phenom-
ena themselves are studied directly than if diag-
nostic categories are studied, and that the
symptoms approach is better suited to the
development of theory. Research on the overlap
of eating and alcohol problems in women would
benefit substantially by extending the focus of
scrutiny from establishing rates of co-occurring
diagnoses, to investigating mechanisms to
account for the overlap of specific features of
these problems such as binge eating and heavy
drinking behaviors.
Theories abound that attempt to explain the
co-occurrence of bulimia and alcohol problems
in women (see Stewart & Brown, in press).
Krahn (1991) proposes three general mechan-
isms for co-prevalence. First, alcohol problems
may cause bulimia (e.g. the disinhibiting effects
of alcohol intoxication may increase the likeli-
hood of a woman succumbing to binge eating;
Polivy & Herman, 1976). Second, bulimia may
cause alcohol problems (e.g. the guilt and nega-
tive emotions that follow binge eating episodes
may prompt self-medication with alcohol;
Wiederman & Pryor, 1996a, 1996b). Finally, both
bulimia and alcohol problems may be different
expressions of the same underlying cause.
Several theories have been advanced to explain
how both eating and alcohol problems in women
may be different expressions of the same under-
lying problem (see review by Stewart & Brown,
in press). Two prominent theories are those
claiming that binge eating and heavy drinking
share similar rewarding properties among those
deprived of the substance in question, and those
claiming that both addictive behaviors share
similar emotional relief functions. Each of these
theories will be reviewed in turn.
Emotional reward
A good deal of research shows that women with
eating disorders show a high propensity toward
excessive use of weight control strategies includ-
ing chronic dieting (see review by Polivy &
Herman, 1985). Mitchell, Hatsukami, Eckert
and Pyle (1985) argue that this dieting behavior
may accentuate their predisposition not only to
binge eating, but also to heavy drinking. Food
deprivation, it is theorized, often leads to desire
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for high calorie, sweet substances including
alcohol (Mitchell et al., 1985). Based on animal
studies (e.g. Rodgers, McClearn, Bennett, &
Herbert, 1963), it has been asserted that this
desire may lead to both binge eating and exces-
sive alcohol use. This latter explanation is
referred to as ‘reciprocal reinforcement’ (see
Bulik et al., 1992; see also Krahn, 1991).
One symptom of eating disorders that may be
relevant to this mechanism is ‘dietary restraint’
—the tendency to chronically restrict dietary
intake in attempts to control body weight and
shape (Polivy & Herman, 1993). Several
researchers have found a positive relationship
between degree of dietary restraint and self-
reported levels of alcohol consumption (e.g.
Lavik, Clausen, & Pedersen, 1991; Stewart,
Angelopoulos, Baker, & Boland, 2000a; Xinaris
& Boland, 1990). Stewart and Samoluk (1997)
found that, relative to women low in restraint,
restrained eating women were more easily
attracted not only to food cues, but also to
alcohol cues.
However, as increased rates of alcohol prob-
lems have not been observed among women
with the restricting subtype of anorexia (Wilson,
1993a), it is clear that other factors in addition
to dietary restraint must also contribute to the
overlap between eating disorders and alcohol
problems. In contrast to anorexic behavior,
which pivots on deprivation, self-denial and
restraint (Brown, 1993; Orbach, 1986), bulimia
reflects cyclical capitulation to desire. Bulimic
women tend to struggle between regulating,
controlling or disciplining their behaviors and
surrendering to their needs and desires. When
women struggling between ‘discipline and
desire’ surrender to desire or want, binge eating
may occur as a way to satisfy that want and to
gain emotional reward. A similar argument has
been made regarding the cycle between drink-
ing restraint and excessive use of alcohol (e.g.
Collins, George, & Lapp, 1989; Stewart & Cham-
bers, 2000). This suggests the possibility that
heavy drinking may serve a similar function as
binge eating, in allowing a woman to capitulate
to the reward or temptation that is represented
by the forbidden object of desire (food or
alcohol, respectively) (see Francis, Stewart, &
Hounsell, 1997; Israeli & Stewart, 2001 for
reviews of the concept of ‘forbidden foods’ for
chronic dieters). Efforts at self-restraint and
restriction of either food or alcohol (typical of a
dichotomous, all-or-nothing approach) may set
women up to binge on the forbidden substance
through the common mechanism of the cycle of
discipline and capitulation to desire and reward
(see Brown, 2001).
Emotional relief
In addition to the notion that both eating and
alcohol problems may emerge from a common
mechanism of the cycle of restraint and capitu-
lation to reward, both eating and alcohol prob-
lems have been linked in their separate
literatures as ways of coping with negative
emotions (i.e. providing emotional relief). For
example, both eating problems and alcohol
problems among women have been separately
associated with depression (Forth-Finegan,
1991). One possible common mechanism in the
case of concurrent binge eating and heavy
drinking may be that both are efforts at dealing
with depression.
A related psychosocial theory that attempts
to explain the interplay of co-occurring women’s
mental health issues, such as eating and alcohol
problems, incorporates the notion of ‘complex
post-traumatic stress reactions’ following
trauma exposure (Herman, 1992). Women with
histories of sexual violence and childhood
sexual abuse often develop problems with
eating disorders and alcohol in adulthood
(Briere, 1988; Briere & Zaidi, 1989; Herman,
1992). A common contributor to the co-
occurrence of binge eating and heavy drinking
in women may be symptoms of posttraumatic
stress disorder or depression subsequent to
trauma. Women with histories of trauma may
attempt to self-medicate for the resultant
emotional problems with heavy drinking or
binge eating (see Stewart, 1996).
Both binge eating and heavy drinking have
been associated with a state of constriction that
allows for the temporary management of one’s
internal emotional life. The binge eating and
heavy drinking can produce, for instance,
numbing, tension relief, calming and a contain-
ment of difficult emotions. These consequences
might serve a strong relief function for a trau-
matized, anxious or depressed woman. Indeed,
many who seek the escape of constriction, but
who do not easily separate themselves from
difficult feelings or experiences may use alcohol
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or excessive eating to help them achieve this
valued relief (Stewart, 1996; Stewart & Israeli,
2002).
The present study
In the present study, we wished to study further
the possibility that binge eating and heavy
drinking may be so highly co-prevalent because
they reflect common mechanisms involving
emotional regulation: namely that both behav-
iors might involve the provision of emotional
rewards and/or emotional relief.
Filstead, Parrella and Ebbitt (1988) examined
the nature of the intimate connections between
binge eating and substance abuse in 54 indi-
viduals (mainly women) receiving inpatient
concurrent treatment for both substance use
problems (including alcohol problems) and
eating disorders by focusing on whether the two
problem behaviors had similar triggers. Using
questionnaires assessing the situations in which
binge eating and heavy drinking occur, these
authors found some evidence for common trig-
gers. For example, how often a woman drinks
when in unpleasant emotional states signifi-
cantly predicted how often she binge eats when
experiencing unpleasant emotions as well.
Similar evidence for common triggers for binge
eating and heavy drinking was found for situ-
ations involving pleasant emotional states,
testing personal control and interpersonal
conflict. None the less, there were several limi-
tations to the Filstead et al. (1988) results. First,
the authors did not comment on the degree of
relation between conceptually distinct triggers
for each behavior. Our examination of their
results (Flistead et al., 1988, Table 4, p. 138)
suggests the potential for binge eating and
heavy drinking to serve similar functions within
a given individual. For example, frequency of
drinking in situations involving unpleasant
emotions was correlated not only with how
often an individual binge eats in unpleasant
emotions situations, but also how often she
binge eats in situations involving conflict with
others, suggesting the common motivation of
emotional relief may underlie both binge eating
and heavy drinking in these kinds of situations.
Second, their study focused on individuals with
co-existing clinical diagnoses of bulimia and
alcohol abuse/dependence, all of whom were
receiving treatment for both disorders, raising
questions about the degree to which Filstead
et al.’s (1988) results can be generalized. Third,
their sample included both men and women, but
the groups were too small to allow for reliable
gender comparisons. Given the much higher
prevalence of eating problems in women (APA,
1994), it makes sense (at least at the outset) to
restrict this novel area of investigation to
women to reduce variability due to gender.
There were three purposes of our study. First,
we wished to examine the prevalence and
characteristics of binge eating behaviors among
a sample of women receiving treatment for an
alcohol problem. Second, we wished to deter-
mine whether we could reliably distinguish
women with alcohol problems who self-identify
with a history of binge eating from those women
with alcohol problems who do not self-identify
as binge-eaters. Such information might be
useful in helping service providers identify those
women with alcohol problems who are at great-
est risk of co-occurring binge eating problems,
and might also tell us something about the
factors associated with co-prevalence that might
be useful in improvements to current treat-
ments. Finally, we wanted to examine whether
there are common underlying motivations for
binge eating and drinking that might help
explain their co-prevalence—specifically, that
binge eating and drinking might represent a
common motivation of capitulation to
emotional reward and/or that both might serve
an emotional relief function (see Filstead et al.,
1988). This latter purpose was achieved through
the use of both quantitative, standardized ques-
tionnaires and qualitative, semi-structured inter-
views with women in the sample who reported
co-occurring binge eating. The use of both types
of methods allowed for examination of the
convergence of findings across methodologies.
Method
Participants
Participants were 58 adult women (aged 18
years or older) with alcohol problems. All were
clients receiving treatment for alcohol problems
at a program within Addictions Prevention and
Treatment Services, Capital District Health
Authority, in the Canadian province of Nova
Scotia. In particular, women were recruited
from a women-specific outpatient treatment
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program (‘Matrix’) in downtown Halifax, and
from two other treatment programs that accept
both women and men clients. The latter two
were outpatient (‘Core’) and inpatient (‘Detox-
ification’) programs, respectively, located at the
Nova Scotia Hospital site in Dartmouth.
Although neither of the latter two programs is
specifically designed to meet the particular
needs of women, the Core program does have a
women’s issues group as part of its treatment
offerings for women clients. All of these
programs operate according to the principles of
harm reduction (Marlatt, 1998). In order to be
eligible for participation in the study, a client
had to be female, currently be in treatment in
one of the above programs at the time of the
study and self-identify with an alcohol problem.
Those with other co-occurring substance use
problems (e.g. cocaine abuse, analgesic depen-
dence) were not excluded. Women had been in
treatment for various lengths of time and were
at various different stages in the treatment
process when they participated.
Materials
We administered five standardized question-
naires to each participant, each of which was
chosen for its excellent psychometric properties.
The first was an author-compiled measure used
to gather demographic information including
age, ethnicity, employment status, education
achieved (see Conrod, Pihl, Stewart, & Dongier,
2000a), referral source (i.e. specific Addiction
Prevention and Treatment Services program)
and frequency of typical alcohol consumption
(Stewart et al., 2000a; Wechsler, Davenport,
Dowdall, Moeykens, & Castillo, 1994).
The next measure was the 10-item Brief
Michigan Alcoholism Screening Test (B-MAST;
Pokorny, Miller, & Kaplan, 1972), which was
included as a validation of women’s self-identifi-
cation as problem drinkers. This measure is a
shortened version of the original 25-item Michi-
gan Alcoholism Screening Test (MAST; Selzer,
1971). The Brief version has been shown to
perform as well as the original in distinguishing
those with a known alcohol use disorder from
those not known to have any alcohol problems
(Pokorny et al., 1972). More recently, a brief
version of the MAST has been shown to possess
good psychometric properties in identifying
alcohol problems in women (Scifres, 2003).
The third measure was the 12-item Binge
Scale (Hawkins & Clement, 1980), which was
used to identify binge-eaters and to assess the
severity of their binge eating behaviour (defined
as ‘periods of excessive eating in a very short
time’) in terms of the frequency, duration and
rate of binge eating. The respondent answers
items in a multiple choice format; higher scores
indicate more severe binge eating behaviour.
The scale has acceptable internal consistency
(Cronbach’s alpha = .68), high test–retest
reliability over one month (r = .88) and a single
factor structure that accounts for 71 percent of
the total variance (Hawkins & Clement, 1980).
It has also been shown to have good construct
validity in terms of positive correlations with
restrained eating and negative correlations with
self-image acceptance, particularly among
women (Hawkins & Clement, 1980).
The fourth measure was the 42-item Inven-
tory of Drinking Situations (Annis, Graham, &
Davis, 1987; Carrigan, Samoluk, & Stewart,
1998). It was used as the measure of typical
heavy drinking situations. On this questionnaire
there are three types of situations as determined
through factor analysis with a previously tested
sample of substance-abusing women (Stewart,
Samoluk, Conrod, Pihl, & Dongier, 2000c): (1)
those where heavy drinking may serve a ‘relief’
function: conflict with others, unpleasant
emotions and physical discomfort; (2) those
where heavy drinking may serve more of a
‘reward’ function: pleasant times with others,
pleasant emotions and social cues to drink; and
(3) those where heavy drinking may be
triggered by sudden ‘temptations’: situations
involving testing personal control over drinking,
and those involving sudden urges and tempta-
tions to drink. These scales have been shown to
possess good internal consistency (Stewart et al.,
2000c). Stewart, Samoluk and MacDonald
(1999) have argued that it is a useful measure for
looking at the underlying motivations for heavy
drinking since motivations can be inferred from
the situations in which the behaviour is occur-
ring (e.g. underlying motivation of emotional
relief can be inferred when heavy drinking
occurs in situations involving unpleasant
emotions, conflict with others or physical
discomfort) and since it does not require the
respondent to have an awareness of the motiva-
tions underlying their drinking behaviour.
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Consistent with the suggestion that drinking
motives can be inferred from scores on this
measure, Stewart et al. (2000c) showed that
scores in the Inventory of Drinking Situations
correlated in theoretically expected ways with
scores on a measure specifically designed to tap
motivations for drinking, in a large sample of
substance-abusing women. In the present study,
women completed this questionnaire in terms of
heavy drinking occasions over the last year
immediately prior to their entry into treatment.
Ratings were made on a 1–4 relative frequency
scale with respect to how often the respondent
drank heavily in that particular situation (1 =
never; 4 = almost always).
The final measure was the Inventory of Binge
Eating Situations (Baker, 1998), which is a
modified version of the 42-item Inventory of
Drinking Situations, and which was used as the
measure of typical binge eating situations (see
100-item version by Filstead et al., 1988). The
majority of Inventory of Drinking Situation
items have no reference to a substance (e.g.
‘When I felt that I had let myself down’). Thus,
only a few items required rewording in construc-
tion of the Inventory of Binge Eating Situations
(e.g. ‘When I suddenly had an urge to drink’ was
changed to ‘When I suddenly had an urge to
eat’; Baker, 1998). Previous psychometric work
on this measure has revealed acceptable to high
Cronbach’s alpha values for the various scales,
thus indicating similarly good internal consist-
ency to the drinking measure from which it was
adapted (Baker, 1998). Moreover, Baker’s
(1998) work included exploratory factor analy-
ses of this new scale that provided evidence of
its structural validity. Participants completed the
measure with respect to past year binge eating
occasions. Women who had not self-identified as
binge-eaters on the Binge Scale were instructed
to skip this measure (see Baker, 1998).
Procedure
Women seeking treatment for an alcohol use
problem at one of the previously described
programs at Addiction Prevention and Treat-
ment Services were given a brief description of
the study and were extended an invitation to
participate in the research. Recruitment
methods included personal invitations by one of
the experimenters at open groups, written
letters, posters, verbal referrals by service
providers (who were all made aware of the
study at a program staff meeting) and word of
mouth from client to client. The study descrip-
tion stressed that participation was completely
voluntary and that all responses would remain
confidential. It was made clear that their ability
to obtain services for their alcohol problem was
not at all dependent on their participation, and
that the quality of their treatment would in no
way be affected by their decision regarding
participation in the present study. Willing
women first signed an informed consent form
and then completed the questionnaires in a
group setting.
At the end of the questionnaires appeared an
invitation for participation in a second phase of
this research which was extended to all 41
women who self-identified as binge eaters on
the Binge Scale. Of the 28 women who were
eligible and agreed to participate in this second
portion of the study, we were able to contact and
arrange individual interviews with 18. Three of
these 18 women also participated in a focus
group following their participation in the indi-
vidual interviews. The interviews and focus
group focused on these women’s own percep-
tions of whether there was a relation between
their heavy drinking and binge eating, and if so,
what relation(s) they perceived to exist. The
qualitative interviews and focus group were
included in an attempt to enrich the quantitative
data collection by providing a source of infor-
mation with a deeper level of meaning, and by
collecting sources of information that may not
have been considered when the questionnaires
were designed. More detailed results of this
second phase have been reported elsewhere
(Stewart & Brown, in press). In the present
article, we present sample quotes from the quali-
tative data to provide converging evidence to
the conclusions drawn on the basis of the ques-
tionnaire findings.
Results
Demographic characteristics are provided in
Table 1. The participants ranged in age from 19
to 64 with a mean age of 38.5 years. Fifty-three
participants (91%) identified as Caucasian, two
as Caucasian/Native Canadian (3%), one as
African Canadian (2%), one as Hispanic (2%)
and one as Native Canadian (2%). The majority
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(59%) was unemployed, 24 percent were
employed on a full-time basis and 17 percent
worked part-time. The participants’ years of
education ranged from 7–18 years with an
average length of education of 13.1 years.
All women who self-identified as problem
drinkers by appearing for the study met criteria
for probable alcohol use disorder on the alco-
holism screening test (i.e. scores of 6 or above
on the B-MAST; Pokorny et al., 1972); the
average score on this screen was 19.86 with a
range of 6–29. As would be expected in an
alcohol treatment sample, the women were also
quite frequent drinkers. On average, women in
the sample reported drinking on 4.94 occasions
per week, ranging from 1–14 occasions.
On the basis of responses to the Binge Scale
(Hawkins & Clement, 1980), greater than two-
thirds of the sample (41/58 = 71%) self-
identified as ‘binge-eaters’. Attesting to the
significance of this self-identification, 90 percent
(n = 37) of those who identified as binge-eaters
showed characteristics suggesting they were
‘severe’ binge-eaters (Vanderehyden & Boland,
1987). Eighty-five percent of those reporting
binge eating had been binge eating for more
than 3 months; the other 15 percent had been
binge eating for less than 3 months. The Binge
Scale also provided additional information
about binge eating characteristics such as the
frequency of binge eating, experience of loss of
control over eating and emotional reactions
following a binge (see Table 2). With respect to
core features of binge eating (Wilson, 1993b), 83
percent of the self-identified binge-eaters
reported some degree of feeling out of control
during binge eating, and 90 percent reported
feeling depressed afterward (see Table 2).
Substantial proportions of these women had
tried various weight control strategies: 73
percent reported fasting; 49 percent excessive
exercise; 41 percent laxatives; and 22 percent
STEWART ET AL.: BINGE EATING AND HEAVY DRINKING
415
Table 1. Characteristics of women with alcohol problems who binge eat and who do not binge eat
Non-binge-eater Binge-eater t-value
(n = 17) (n = 41) [
2
]
Age (in years) 43.35 36.54 2.76**
(9.33) (8.23)
Education (in years) 13.06 13.10 –0.05
(2.95) (2.70)
Ethnicity Caucasian (n) 15 38 [0.30]
Other (n)23
Employment Unemployed (n) 7 27 [3.02]
Employed (n)1014
Program Women-specific (n) 5 14 [0.12]
Other (n)1227
Weekly drinking frequency 3.91 5.37 –2.29*
(2.12) (2.24)
Alcohol problems 19.71 19.92 –0.11
(6.08) (7.29)
Relief heavy drinking 58.16 68.35 –2.16*
(17.66) (15.84)
Reward heavy drinking 65.34 71.47 –1.19
(17.76) (18.00)
Temptation heavy drinking 57.35 65.32 –1.37
(21.37) (19.61)
Notes: Binge-eaters identified by first item of the Binge Scale (Hawkins & Clement, 1980); Relief, Reward and
Temptation heavy drinking assessed with the 42-item Inventory of Drinking Situations (Annis et al., 1987);
Alcohol problems assessed with the Brief Michigan Alcoholism Screening Test (Pokorny et al., 1972); Weekly
drinking frequency and demographic characteristics assessed with an author-compiled measure (see Conrod et
al., 2000a); ‘Program’ = specific program at Addiction Prevention and Treatment services
*p < .05; **p < .01
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diuretics. The majority (59%) reported having
used at least two of these strategies for control-
ling their body weight.
We compared women with alcohol problems
who reported binge eating (n = 41) with women
with alcohol problems who did not binge eat (n
= 17) on the various study measures (i.e. demo-
graphics, personality and drinking behavior)
using a series of independent sample t-tests and
chi-square analyses (see Table 1). Women with
alcohol problems who binge eat were signifi-
cantly younger than women who did not report
binge eating, and those who reported binge
eating also reported drinking more frequently
on a weekly basis than those who did not binge
eat. Although scores on the alcoholism screen-
ing test (B-MAST) did not differ across groups,
binge-eaters scored higher on frequency of
emotional relief heavy drinking on the Inven-
tory of Drinking Situations, but not other
drinking situation scales (i.e. reward or
temptation heavy drinking), relative to non-
binge-eaters. There were no significant group
differences in the type of Addiction Prevention
and Treatment Services program from which
the participants were recruited (women-specific
JOURNAL OF HEALTH PSYCHOLOGY 11(3)
416
Table 2. Binge-eating characteristics of women with alcohol problems who also binge eat (n = 41)
Frequency Percent
Binge-eating frequency a. seldom 4 10
b. once or twice a month 17 41
c. once a week 11 27
d. almost every day 8 20
e. several times each day 1 2
Length of episode a. less than 15 minutes 8 19
b. 15 minutes to 1 hour 13 32
c. 1 to 4 hours 15 37
d. more than 4 hours 5 12
Quantity of food consumed a. enough to fill me 4 10
b. until stomach feels full 11 27
c. until stomach painfully full 9 22
d. until can’t eat anymore 15 36
e. until all the food is gone 2 5
Vomiting afterward a. never 16 39
b. sometimes 16 39
c. usually 7 17
d. always 2 5
Speed of eating a. more slowly than usual 3 7
b. about the same as usual 13 32
c. very rapidly 25 61
Degree of concern a. not bothered at all 6 15
b. bothers me a little bit 7 17
c. moderately concerned 14 34
d. a major concern 14 34
Loss of control a. could control eating if chose 7 17
b. have at least some control 12 29
c. completely out of control 22 54
Self-loathing afterward a. neutral/not too concerned 7 17
b. moderately upset 15 37
c. hate self 19 46
Depressed afterward a. not depressed at all 4 10
b. mildly depressed 12 29
c. moderately depressed 12 29
d. very depressed 13 32
Note: These characteristics are taken from responses to the Binge Scale (Hawkins & Clement, 1980)
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vs other), or in their education level or employ-
ment status.
Motivations for binge eating
We first wished to establish the underlying, core
motivations for binge eating that were con-
tained in our measure of binge eating situations.
Thus, we conducted a factor analysis on the eight
scores from the Inventory of Binge Eating Situ-
ations (i.e. urges and temptations, social cues
to eat, pleasant emotions, pleasant times with
others, testing personal control over eating,
physical discomfort, unpleasant emotions and
conflict with others) to see which were most
closely associated with one another.
1
Another
purpose of this analysis was to explore the simi-
larity of the factor structure for the Inventory of
Binge Eating Situations to three-factor struc-
ture of the equivalent measure for drinking situ-
ations previously established among women
with substance use problems (Stewart et al.,
2000c). The present factor analysis of the Inven-
tory of Binge Eating Situations revealed two
factors (see Table 3). Attesting to the import-
ance of these two factors, they together
accounted for a very large proportion (73.8%)
of the variance in scores on the Inventory of
Binge Eating Situations. The first factor was
characterized by strong contributions from the
following six types of binge eating situations:
urges and temptations; social cues to eat; pleas-
ant times with others; pleasant emotions; testing
personal control over eating; and physical
discomfort. Thus, the first factor was labeled
Reward Binge Eating because it reflected situ-
ations where binge eating could result in the
addition of desired consequences (e.g. enhance-
ment of pleasurable emotions) (see Table 3).
The second factor was characterized by strong
contributions from the following two types of
binge eating situations: conflict with others and
unpleasant emotions. Thus, the second factor
was labeled Relief Binge Eating because it
reflected situations where binge eating could
result in the removal of undesired states (e.g.
relief from negative emotions) (see Table 3).
2
These results were largely as expected based on
previous findings with the measure of heavy
drinking situations on which the Inventory of
Binge Eating Situations was initially based
(Stewart et al., 2000c). The only exception was
that no separate ‘Temptations’ binge eating
factors emerged. Instead, reward and tempta-
tion situations jointly contributed to the first
factor. This suggests that temptation reasons for
binge eating hold much in common with
emotional reward reasons for binge eating, at
least among women with alcohol problems. The
slight differences in factor structure between the
binge eating situation measure and that found
for the heavy drinking situations measures in
previous work (e.g. Carrigan et al., 1998; Stewart
et al., 2000c) argues against redundancy
between the two measures despite the similar
wording of many of their items. It should also be
noted that the two binge eating motivations of
STEWART ET AL.: BINGE EATING AND HEAVY DRINKING
417
Table 3. Results of factor analysis on eight scales from the Inventory of Binge Eating Situations (Baker, 1998):
component loadings following oblique rotation
Factor I—Reward Factor II—Relief Communality
binge eating binge eating
Urges and temptations .897 –.135 .732
Social cues to eat .896 –.121 .737
Pleasant emotions .856 –.067 .695
Pleasant times with others .789 .239 .819
Testing personal control .731 .192 .675
Physical discomfort .632 .191 .526
Unpleasant emotions –.070 .947 .852
Conflict with others .158 .861 .869
Percent variance accounted
For prior to rotation 57.27% 16.53%
Note: Salient loadings (> .600) indicated in bold. Communality refers to the proportion of variance in a given
binge eating situation score (e.g. unpleasant emotions) that is explained by the two factors in combination
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Reward and Relief were significantly inter-
correlated (r = .373, p < .05). Thus, although the
two motivations for binge eating are distinct,
they are also inter-related. This suggests that a
given woman will tend to binge eat primarily for
one of these reasons, but that the more a woman
binge eats for one of these reasons the more she
also tends to binge eat for the other reason as
well.
Relations between motivations
for binge eating and
motivations for heavy drinking:
quantitative findings
Factor scores on the two binge eating motiva-
tion factors from the Inventory of Being Eating
Situations factor analysis were then used as
criterion variables in multiple regression analy-
ses to determine the unique predictors of each
type of binge eating (i.e. reward and relief binge
eating). Demographic variables (age, ethnicity,
employment status, years of education or addic-
tions treatment program) failed to significantly
correlate with either motivation for binge
eating. Thus, demographic variables were
excluded from further analyses. The three scores
from the Inventory of Drinking Situations (i.e.
Reward, Relief and Temptation heavy drinking
situations) were used to predict the two motiva-
tions for binge eating in separate multiple
regression analyses. This allowed us to examine
the relations between motivations for binge
eating and motivations for heavy drinking.
The three motivations for heavy drinking
together significantly predicted Reward binge
eating (F (3, 357) = 6.56, p < .005). Together, the
set of three reasons for heavy drinking predicted
a significant proportion (34.7%) of the variance
in Reward binge eating scores. Of the three
motivations for heavy drinking, Reward heavy
drinking emerged as the only significant inde-
pendent predictor ( = .555, p < .01). This result
suggests that the more that a woman engages in
heavy drinking to enhance positive emotions,
the more she engages in binge eating for similar
reward functions.
The three motivations for heavy drinking
together also significantly predicted Relief
binge eating (F (3, 37) = 6.67, p < .005). Together,
the set of three reasons for heavy drinking
predicted a significant proportion (35.1%) of
the variance in Relief binge eating scores. Of the
three motivations for heavy drinking, Relief
heavy drinking emerged as the only significant
independent predictor ( = .697, p < .001). This
finding suggests that the more a woman engages
in heavy drinking to cope with negative
emotions, the more she engages in binge eating
for similar reasons of emotional relief.
Relations between motivations
for binge eating and
motivations for heavy drinking:
qualitative findings
3
Women’s narratives provided us with an in-
depth look into their binge eating and heavy
drinking and the relations of these two behav-
iors. The women’s descriptions of the situations
in which they engage in problematic eating and
drinking, as well as the emotional antecedents
and the outcomes they hope to gain, largely
echoed the results from the quantitative data in
that two major reasons underlying both behav-
iors emerged in the narratives: relief from nega-
tive emotions, or enhancement of positive
emotions. For example, one of our participants
to whom we will refer as ‘Charlotte’ commented
that both binge eating and heavy drinking serve
as a ‘. . . way to create a feeling or take away a
feeling’.
Many women acknowledged quite straight-
forwardly that they binge eat and drink heavily
for the same reasons. We organize this review of
the qualitative findings according to the two
categories of common reasons for these behav-
iors that emerged in the interviews (see Stewart
& Brown, in press, for more detail): emotional
relief and emotional reward.
Emotional relief
Both binge eating and heavy drinking were
often referred to in the interviews and focus
group as a means of escape from painful or
difficult emotions, such as depression, anxiety,
shame, guilt and anger. For example, one of our
participants, ‘Chelsea’, had the following to say
about her drinking: ‘I drank to kill the pain and
hurt . . . and to hide from the world.’ ‘Chelsea’
similarly acknowledged that ‘[j]ust feeling really
bad about yourself . . .’ would motivate her
binge eating. ‘If I am feeling really low,
depressed, then I will turn to food.’
Common triggers for both included issues
with relationships, fear of intimacy, fear of
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failure, feelings of low self-esteem and inade-
quacy, feeling hurt by others or conflict with
others. For example, one of our participants,
‘Isabelle’, noted the following common
antecedent for both binge eating and heavy
drinking:
It was usually when somebody else did some-
thing to me, if somebody hurt me. That was
usually how I coped with it, was either . . .
eating, drinking . . . Whatever it was I did was
all how I reacted to being hurt.
In addition, the respondents reported heavy
drinking and binge eating in response to feeling
lonely, bored or powerless (in relation to their
male partners). Women repeatedly described
using heavy drinking and binge eating to ‘shut
down’, to dissociate, to numb themselves and to
relieve tension. For example, according to
‘Taylor’:
the binge eating is sedating, like the alcohol. I
numb out while I am doing it . . . [Binge eating
and heavy drinking] do the same thing . . .
They release the pressure. I feel like a volcano
is building up, and I can’t handle it, and I don’t
know what to do. By bingeing, by drinking
excessively . . . it’s like letting some steam
escape, or letting you know some . . . a little
bit of lava out . . . so it doesn’t explode. It’s a
release. It really is a release.
The qualitative data thus provided a substan-
tially enriched picture, from the women’s own
perspectives, of how both binge eating and
heavy drinking were forms of emotional retreat
and served emotional relief functions.
Emotional reward
Some women reported experiencing positive
emotions as a consequence of binge eating and
heavy drinking. For example, women described
feeling happy, confident or euphoric when binge
eating or heavy drinking. Some women
mentioned enjoying the sugar rush from binge
eating ‘junk food’ and likened this to the
intoxication or high they desired from heavy
drinking.
For example, one of the women interviewed,
‘Claire’ described both binge eating and heavy
drinking as follows: ‘I find [binge eating and
heavy drinking] gives me comfort and warmth.
It makes me feel fulfilled.’ ‘Charlotte’ had the
following to say about her heavy drinking: ‘It
was to create feelings of happiness and joy that
I couldn’t find within myself . . . When I first
start experiencing the high from drinking, it
feels just great.’ ‘Charlotte’ similarly saw binge
eating as serving emotional reward functions as
illustrated in the following quote: ‘food excites
me because I had so little of it growing up, being
deprived of it for so many years’.
Again, the qualitative data provided a sub-
stantially enriched picture, from the women’s
own voices, of how both binge eating and heavy
drinking served emotional reward functions in
meeting their needs for emotional enhancement
and capitulating to their desires and tempta-
tions.
Discussion
Our study reveals critical information about
why women with alcohol problems binge eat.
Previous research using the diagnostic
categories approach (Persons, 1986) has shown
a substantial overlap between alcohol use
disorders and bulimia nervosa (see review by
Wilson, 1993a). For example,Taylor et al. (1993)
found that women receiving treatment for
alcohol problems were more likely to experi-
ence bulimia than women in the general popu-
lation. In our study, we adopted an approach
alternative to the diagnostic categories
approach—namely we investigated the specific
psychological phenomena (Persons, 1986) of
binge eating and heavy drinking which are
arguably behaviors at the core of bulimia and
alcohol use disorders, respectively (Wilson,
1993a). In our sample of 58 women receiving
treatment for alcohol problems, rates of binge
eating were very high: 71 percent of these
women acknowledged a history of binge eating
on the self-report Binge Scale (Hawkins &
Clement, 1980). This rate of binge eating is
approximately double the rate of 36 percent
observed in the general population of white
women between 14 and 40 years old across a
large number of prevalence studies using self-
report questionnaires (see review by Fairburn &
Beglin, 1990). Moreover, using Vanderehyden
and Boland’s (1987) scheme for categorizing
scores on the Binge Scale, the very large major-
ity (90%) of our participants who acknowledged
binge eating could be classified as ‘severe’ binge
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eaters. These alarming statistics suggest that
women in treatment for alcohol problems at
community-based service agencies for alcohol
problems are at very high risk for displaying co-
existent and severe problems with binge eating.
Also consistent with the previous literature
that restraint and discipline around food, eating,
body weight and shape, contributes to binge
eating (Polivy & Herman, 1985), we found very
high rates of reports of involvement in restric-
tive/disciplined activities around controlling the
body. For example, 73 percent of those acknowl-
edging binge eating in our study reported fasting
as compared to 29 percent in the general popu-
lation of women; 41 percent reported use of
laxatives as compared to 6 percent in the
general population; and 61 percent reported
vomiting as compared to 8 percent in the
general population (Fairburn & Beglin, 1990).
In fact, the majority of our self-identified binge-
eaters (59%) reported having used at least two
of these strategies for controlling body weight.
We did find that women with alcohol prob-
lems who binge eat do differ from those who do
not binge eat in a few ways. Specifically, the
binge-eaters were found to be younger, gener-
ally more frequent drinkers and in particular
drink more often for emotional relief purposes.
We can only speculate about why these particu-
lar characteristics discriminate binge-eaters
from non-binge-eaters.
With respect to age, it could be that younger
women have not had as much life experience to
allow them to develop more adaptive ways of
coping, making the younger women more
susceptible to using binge eating as a coping
strategy. Younger women may also have more
severe issues that they have to cope with (e.g.
dealing with young children; uncertainty about
life goals and pressure to make those choices) in
addition to fewer skills to deal with these issues
in comparison to the older women. Alterna-
tively, since this is not a study that follows the
same women over time, it could be that these
same young women will show the same high
rates of binge eating when they are older. This
could be true if the younger women today are
more susceptible than today’s older women to
cultural messages regarding the importance of
control of body weight/shape—messages which
have been identified as contributing to bulimia
(Polivy & Herman, 1993).
The nature of relations of binge eating with
the patterns of alcohol use was informative. The
finding that women who binge eat drink more
frequently and drink for relief purposes more
often is consistent with the idea that the co-
existence of binge eating with alcohol problems
represents a more severe clinical picture than
alcohol problems alone (Singer, Nutter, White,
& Song, 1993). In fact, emotional relief drinking
has been argued to reflect a more problematic
motivation for drinking than reward or tempta-
tion drinking patterns (e.g. Annis et al., 1987).
Inconsistent with this argument, however,
binge-eaters and non-binge-eaters did not differ
in terms of alcohol problems on the B-MAST
(Pokorny et al., 1972).
4
We also observed relationships between
reasons for binge eating and reasons for heavy
drinking among those women with alcohol
problems that binge eat, suggesting underlying
common mechanisms for these behaviors.
According to results obtained with standardized
questionnaires, those women who frequently
binge eat for emotional relief purposes (e.g.
when experiencing unpleasant emotions or
interpersonal conflict) also tend to engage in
frequent heavy drinking for similar reasons of
emotional relief. Those who binge eat frequently
for reasons of capitulating to desire and
emotional reward (e.g. when experiencing urges
and temptations to eat, social cues to eat or
pleasurable emotions) also tend to engage in
frequent heavy drinking for similar reasons
pertaining to pursuing emotional rewards. These
results suggest possible common mechanisms
involving emotional self-regulation (e.g. control
of negative emotions; capitulation to desire and
temptation) for binge eating and heavy drinking
among separate groups of women with co-
occurring problems involving alcohol and binge
eating. These results are very similar to those
obtained by Filstead et al. (1988) among in-
patients receiving simultaneous treatment for
an eating and substance use disorder providing
evidence that these relations extend to those
women with alcohol problems whose eating
difficulties may not fit traditional diagnostic
categories. Our study also improves on the
previous research by Filstead et al. (1988) in
that: we focused on the relations between core
underlying motivations for binge eating and
heavy drinking (i.e. reward and relief) rather
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than examining relations between binge eating
and heavy drinking in eight separate situations;
we focused on motivations for the heavy use of
alcohol in particular (reducing the confusion
involved in examining motivations for use of
different substances within a single study); and
we limited our investigation to women.
5
The findings from the quantitative portion of
our study regarding the potential common moti-
vations for engaging in binge eating and heavy
drinking are subject to the criticism that the
findings may be secondary to ‘common method
variance’—particularly since the Inventory of
Binge Eating Situations (our measure of binge
eating motivations) was modeled closely after
the 42-item Inventory of Drinking Situations
(our measure of heavy drinking motivations).
However, we have independent data from the
qualitative interviews and focus groups that
further attest to the common motivations that
women themselves see for the two behaviors.
Specifically, the qualitative data also revealed
two main reasons for engaging in either behav-
ior (namely, emotional reward and emotional
relief) and many women directly acknowledged
their perceptions that the two behaviors were
serving similar functions for them. Thus, the
qualitative data supported, and substantially
enriched, the quantitative findings that binge
eating and heavy drinking were associated with
similar triggers and served similar purposes for
many women.
Several potential limitations to our study
should be acknowledged. First, we used a ques-
tionnaire to establish whether or not women
were binge eating; this methodology has been
criticized for over-estimating the prevalence of
binge eating (Fairburn & Beglin, 1990; Wilson,
1993b). An advantage of our choice of method
for assessing binge eating was that it left the
decision of what qualified as a binge to the client
herself, thus taking women’s own experience
and perspective into account. And, although we
allowed for the inclusion of women whose binge
eating was not of clinical severity, the very large
majority (90%) of self-identified binge eaters
reported severe levels of binge eating behavior
(Vanderehyden & Boland, 1987). Moreover, the
alternative perspective to over-reporting must
be considered as well. Some women in the
sample may have chosen to not self-identify as
binge-eaters, believing that relative to their
severe problem with alcohol, their eating diffi-
culties are not important enough to warrant
reporting.
A second possible limitation pertains to the
potential for some sort of recruitment bias since
participation in either portion of the study
(quantitative or qualitative) was not mandatory.
Because the study pertains to the relation of
eating and alcohol problems, it is possible that
more women with eating problems agreed to
take part in the first portion than women without
eating problems. We attempted to minimize this
possibility by making it clear in our recruitment
methods that we were interested in the perspec-
tives of all women receiving treatment for
alcohol problems regardless of whether or not
they have any eating problems. It is also possible
that the women who participated in the quali-
tative interviews and focus group differed from
the other women reporting binge eating in some
important way(s). We attempted to minimize
this latter possibility by ensuring that the invita-
tion to participate in the second portion of the
study was inclusive of all women reporting binge
eating (regardless of motivations or severity)
and we made very active efforts to contact all
women who indicated willingness to schedule
them for an interview.
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 distin-
guishes 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. Thus, we cannot rule out the possi-
bility that the high prevalence of binge eating
observed might be secondary to reduced alcohol
consumption during treatment (i.e. ‘symptom
substitution’). Indeed, the fact that 15 percent of
the 41 binge-eaters reported, on the Binge Scale,
that they had been binge eating for less than 3
months is consistent with the possibility of
symptom substitution for at least some women.
In fact, several of the interviews contained infor-
mation that was consistent with the possibility of
symptom substitution, as we describe elsewhere
(Stewart & Brown, in press).
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Despite these potential limitations, our results
raise the possibility of distinct groups of women
with co-existing binge eating and heavy drink-
ing who vary according to the specific emotional
self-regulation function these behaviors are
serving. Our findings suggest that there are
some women who both binge eat and drink
heavily in order to achieve emotional relief. Our
findings further suggest that there are also
women who both binge eat and drink heavily
primarily due to desires to achieve emotional
rewards. Separate harm reduction programs
should be developed to meet the needs of each
type of woman (see Conrod et al., 2000b). And,
given the overlap of these distinct motivations
for binge eating and heavy drinking (Stewart
et al., 2000b), we need to recognize that some
women may benefit from both of these kinds of
programs.
Current programs for treating alcohol prob-
lems in the Canadian province of Nova Scotia
do not explicitly recognize the high rates of
binge eating among their women clients.
Beyond a single session on healthy diet, even
women-focused treatments like Matrix do not
include specific programming around this co-
existing mental health issue. This is at least
partly due to the fact that addictions counselors
rarely receive training in the treatment of eating
disorders, and to the separation of addictions
and mental health services in this province.
Although the high rates and severity of binge
eating observed in the present sample of women
receiving treatment for alcohol problems in
these programs are disturbing, the finding of
common motivational mechanisms underlying
binge eating and heavy drinking is encouraging
from a treatment perspective. It suggests that
current harm reduction approaches being used
for alcohol problems might be fairly readily
adapted to include focus on co-existing binge
eating which is serving a similar motivational
function.
Treatment for alcohol problems at Addiction
Prevention and Treatment Services in the
Capital District Health Authority is based on a
harm reduction model (Marlatt, 1998) as
opposed to the traditional all-or-nothing absti-
nence-based methods of treatment. Solutions to
bingeing, whether the binges involve food or
alcohol, that focus on abstinence fail to address
the basic emotional regulation functions that
these behaviors are serving. In harm reduction
approaches for alcohol problems, like Relapse
Prevention, high-risk situations for relapse to
heavy drinking are identified and the individual
is assisted in developing more helpful strategies
for dealing with these situations (Marlatt, 1998).
This type of approach might be readily adapted
to focus on both binge eating and heavy drink-
ing according to the emotional self-regulation
functions these behaviors are serving. For
example, for those women where binge eating
and heavy drinking involves capitulation to
temptation and reward, harm reduction treat-
ment could focus on problem solving skills to
prevent impulsive responding in response to
temptations and triggers for reward, develop-
ment of healthier methods of recognizing,
accepting and meeting emotional needs and
helping the woman overcome the discipline/
desire cycle. Programming for emotional relief
bingers could focus on helping these women to
develop healthier methods of managing
unpleasant emotions. Given the high rates of
post-traumatic stress disorder secondary to
trauma in women with alcohol problems who
drink for emotional relief (Stewart, Conrod,
Samoluk, Pihl, & Dongier, 2000c), the latter type
of harm reduction treatment may need to focus
on recovery from trauma and treatment of
post-traumatic stress disorder if future research
more firmly establishes this potential link with
relief binge eating as well. It would be import-
ant once such harm reduction treatments are
developed that their relative efficacy to treat-
ment-as-usual for alcohol problems be assessed
(see Conrod et al., 2000b).
Notes
1. The method of factor analysis used in this study
was principal components analysis. Since prior
research suggests inter-correlations between
binge-eating situation subscales (Baker, 1998;
Filstead et al., 1988), we chose oblique rotation
(‘direct oblimin’) to allow for inter-correlations
between the factors extracted. We determined the
number of factors to extract based on the number
of eigenvalues greater than 1.00.
2. In interpreting the meaning of the factors, we
defined salient loadings as those greater than or
equal to 0.600. There were several reasons to
consider this two-factor solution a good structure
for explaining the underlying, core components of
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binge eating motivations in our sample of women
with alcohol problems. First, each of the binge
eating situations loaded on at least one of the
factors identified and none loaded on more than
one factor. Second, each factor showed loadings
from more than one binge eating situation. Finally,
a substantial proportion of the variance in each of
the eight binge eating situations was explained by
the two factors.
3. To maintain women’s confidentiality, we have used
pseudonyms, chosen by the interviewed women
themselves, to identify quotes from specific partici-
pants.
4. It would be useful in future research to employ a
measure more sensitive to gradations of severity of
alcohol problems than the B-MAST, which was
actually developed as a screen for alcohol prob-
lems, rather than as an index of alcohol problem
severity (Pokorny et al., 1972).
5. Our methodology also improves on that used by
Filstead et al. (1988) in that we used a smaller
number of binge eating and heavy drinking situ-
ation scales in our analyses with a similarly large
number of participants making our results more
likely to be replicated in future.
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Author biographies
SHERRY H. STEWART, PhD is Killam
Professor in the Departments of Psychiatry
and Psychology at Dalhousie University, and
holds a prestigious Investigator Award from
the Canadian Institutes of Health Research.
She is well known for her research on the
co-occurrence of addictive and mental health
disorders.
CATRINA G. BROWN, PhD is Associate
Professor in the School of Social Work at
Dalhousie University, and her research
interests are in eating disorders, addictions and
depression in women. She currently holds
funding from the Nova Scotia Health Research
Foundation and the Social Sciences and
Humanities Research Council of Canada.
KRISTINA DEVOULYTE was involved in the
quantitative portion of this study as part of a
comprehensive requirement for her graduate
studies. She is completing her doctoral degree
in clinical psychology at Dalhousie University
and is currently a pre-doctoral intern at the
Queen Elizabeth II Health Sciences Centre in
Halifax, Nova Scotia.
JENNIFER THEAKSTON was the research
assistant for the quantitative portion of this
study and was involved in administering the
questionnaires to the women participants. She
is currently completing her graduate studies in
industrial/organizational psychology at the
University of Waterloo.
SARAH E. LARSEN was the research assistant
for the qualitative portion of this study and was
involved in conducting the qualitative
interviews with the sub-sample of binge-eaters.
She continues to work with Drs Brown and
Stewart on research pertaining to mental health
and addictive disorder co-morbidity in women.
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