Bulimia nervosa and dietary restraint

Patients with bulimia nervosa were compared with non-bulimic restrained and unrestrained eaters on several questionnaire and interview measures related to eating patterns, preoccupation with dieting and food, and general psychopathology. Bulimic subjects did not differ significantly from non-bulimic restrained eaters on measures of fear of weight gain, dietary restraint, and the Eating Disorders Inventory (EDI) subscales of Drive for Thinness and Body Dissatisfaction, although both groups scored significantly higher on these measures than unrestrained eaters. Subjects with bulimia nervosa differed significantly from both restrained and unrestrained eaters on the Eating Habits Checklist, the Beck Depression Inventory, the EDI total score and Interoceptive Awareness, Introversion and Bulimia subscales, the Three Factor Eating Questionnaire (TFEQ), Disinhibition subscale and the Symptom Checklist 90-revised version. These findings show that bulimic patients may be quite similar to their restrained, non-bulimic counterparts on dietary concern and ideals of slenderness and suggest the importance of including a restrained control group in attempts to isolate the variables that differentiate individuals with the clinical eating disorder from their peers who demonstrate normative discontent about body weight and shape.     

Establishing appropriate symptomatic control groups for the eating disorders

Two symptomatic control groups for the eating disorders were defined using high and low scores on the Dietary Restraint and Disinhibition scales of the Three Factor Eating Questionnaire. Clinical subjects diagnosed with anorexia and bulimia nervosa were compared with these symptomatic control groups using measures of body weight, bulimic symptoms, and anorexic symptoms. In comparison to the high-Restraint/low-Disinhibition group, anorexic subjects scored higher on measures of eating disorder symptoms but not on Restraint and Disinhibition. The high-Restraint/high-Disinhibition group differed from bulimia nervosa subjects on measures of eating disorder symptoms but did not differ on Restraint and Disinhibition. The results suggested that a control group defined by high Restraint and low Disinhibition formed an appropriate control group for anorexia nervosa. For bulimia nervosa, the most appropriate control group was defined by high Restraint and high Disinhibition.     

Self-oriented and socially prescribed perfectionism dimensions and their associations with disordered eating

This study examined the relationship between self-oriented and socially prescribed dimensions of perfectionism (using two measures of perfectionism) and disordered eating assessed across multiple time points in a sample of young women. Study participants (n=406) reported on their levels of perfectionism and on their subsequent patterns of dieting and bulimic symptoms. Self-oriented perfectionism was strongly linked to dietary restraint, whether using the theoretically derived perfectionism dimensions from the Multidimensional Perfectionism Scale (MPS) [Hewitt, P.L., & Flett, G.L. (1991a). Perfectionism in the self and social contexts: Conceptualization, assessment, and association with psychopathology. Journal of Personality and Social Psychology, 60, 456-470] or the dimensions derived from the Perfectionism subscale of the Eating Disorder Inventory (EDI) [Garner, D. M., Olmsted, M. P., & Polivy, J. (1983). Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. International Journal of Eating Disorders, 2, 15-34]. A less clear-cut pattern emerged when bulimic symptoms were investigated, with both self-oriented (MPS and EDI) and socially prescribed perfectionism (MPS) being associated with bulimic symptoms. After controlling for negative affect, only a self-oriented dimension of perfectionism predicted unique variance in bulimic symptoms. What constitutes maladaptive perfectionism, concerns about using EDI-Perfectionism dimensions interchangeably with MPS dimensions, and future directions are discussed.     

The presence of bulimia in high school females

The purpose of this study is to show that the appetite disorder bulimia is present in high school females. Previous research has shown the presence of bulimia in college women. The study was conducted using the entire female population of a large suburban, midwestern community high school. The Eating Disorder Inventory was used to identify the presence of bulimia. Data collected were classified for analysis using the bulimia scale as identified by the EDI. Using analysis of variance (ANOVA) these data were compared on each of the seven scales using bulimia diagnosis and age. The correlation was significant (.01) on five of the seven scales. It was concluded that there is a bulimic population at the high school level which includes females, ages 14-18. The percentages of bulimic females in categories of black, white and others were equal. This is significant because bulimia has not previously been recognized as present in the black population. Knowledge of the attitudes of bulimic students will help those professionals who work with adolescents to recognize bulimic behavior. Community referral agencies and individuals who can help the affected and provide support for the family should be identified and utilized.     

Perfectionistic Automatic Thoughts,Trait Perfectionism,and Bulimic Automatic Thoughts in Young Women

The current research examined the associations among perfectionistic automatic thoughts, trait perfectionism, negative automatic thoughts, and bulimic automatic thoughts. A non-clinical sample of 94 undergraduate women completed the Perfectionism Cognitions Inventory, the Multidimensional Perfectionism Scale, the Automatic Thoughts Questionnaire, and the Bulimic Automatic Thoughts Test. Correlational tests revealed that two automatic thoughts measures (perfectionistic automatic thoughts and negative automatic thoughts) and two trait perfectionism measures (self-oriented and socially prescribed perfectionism) were associated significantly with bulimic automatic thoughts with the strongest association being between perfectionistic automatic thoughts and bulimic automatic thoughts. Regression analyses showed that perfectionistic thoughts predicted unique variance in bulimic thoughts beyond variance attributable to trait perfectionism and negative automatic thoughts. The findings are discussed in terms of the need to incorporate an explicit focus on perfectionistic automatic thoughts into treatment interventions and conceptual models of perfectionism and eating disorders.     

Depression in a Cancer Patient Population

The main goal of this study was to examine depression and its components in cancer patients as compared with healthy control subjects and psychiatric inpatients. The participants were 54 cancer patients (28 females with breast cancer, 26 males with prostate cancer), 59 healthy controls (33 females, 26 males), and 75 psychiatric patients (27 females, 48 males). Participants were administered the Beck Depression Inventory (BDI) and the State Trait Personality Inventory (STPI) Depression scales. Cancer patients had higher overall depression scores than did healthy controls as measured by BDI, but the difference was due primarily to the significantly higher scores of the cancer patients on the BDI Somatic–Performance subscale. No differences were found on the BDI Cognitive–Affective subscale. Cancer patients also scored significantly higher than healthy controls on the State-Trait Personality Inventory (STPI) State Depression (S-Dep) scale because of higher Euthymia subscale scores. The psychiatric inpatients scored significantly higher than the other groups on all measures of depression. The findings of this study suggest that cancer patients may be erroneously labeled as depressed because of somatic–performance difficulties they may experience, which are similar to symptoms of depressed individuals. In addition, it is essential to delineate the various components of depression in evaluating cancer patients.     

Factors in the self-deception questionnaire: associations with depression

Disagreement presently exists over whether depressed or nondepressed persons exercise more cognitive distortion on material about the self. A negative correlation between the Self-Deception Questionnaire (SDQ, Sackeim & Gur, 1978, 1979) and the Beck Depression Inventory (BDI, Beck, 1967) has been cited as evidence that it is the nondepressed individuals who exercise more distortion (Sackeim, 1983). This negative correlation was replicated, and the SDQ was factor analyzed to determine which factors might account for the correlation with depression. The three largest factors, identified by content themes of relationships with parents, emotionality, and denial of tabooed activities, correlated reliably with the BDI. Discussion focused on whether these correlations reflect differences in self-deception that are associated with depression or differences in veridical responding between depressed and nondepressed subjects on those items in the SDQ. Suggestions for future research and possible therapeutic implications are also discussed.     

The Depressive Experiences Questionnaire: Validity and Psychological Correlates in a Clinical Samples

This study sought to compare the original and revised scoring systems of the Depressive Experiences Questionnaire (DEQ) and to assess the construct validity of the Dependent and Self-critical subscales of the DEQ in a clinically depressed sample. Subjects were 103 depressed inpatients who completed the DEQ the Beck Depression Inventory (BDI), the Hopelessness Scale, the Automatic Thoughts Questionnaire (ATQ), the Rathus Assertiveness Schedule (RAS), and the Minnesota Multiphasic Personality Inventory (MMPI). The original and revised scoring systems of the DEQ evidenced good concurrent validity for each factor scale, but the revised system did not sufficiently discriminate dependent and self-critical dimensions. Using the original scoring system, self-criticism was significantly and positively related to severity of depression, whereas dependency was not, particularly for males. Factor analysis of the DEQ scales and the other scales used in this study supported the dependent and self-critical dimensions. For men, the correlation of the DEQ with the MMPI scales indicated that self-criticism was associated with psychotic symptoms, hostility/conflict, and a distress/exaggerated response set, whereas dependency did not correlate significantly with any MMPI scales. Females, however, did not exhibit a differential pattern of correlations between either the Dependency or the Self-criticism scales and the MMPI. These findings suggest possible gender differences in the clinical characteristics of male and female dependent and self-critical depressive subtypes.     

The Depressive Experiences Questionnaire: validity and psychological correlates in a clinical sample

This study sought to compare the original and revised scoring systems of the Depressive Experiences Questionnaire (DEQ) and to assess the construct validity of the Dependent and Self-Critical subscales of the DEQ in a clinically depressed sample. Subjects were 103 depressed inpatients who completed the DEQ, the Beck Depression Inventory (BDI), the Hopelessness Scale, the Automatic Thoughts Questionnaire (ATQ), the Rathus Assertiveness Schedule (RAS), and the Minnesota Multiphasic Personality Inventory (MMPI). The original and revised scoring systems of the DEQ evidenced good concurrent validity for each factor scale, but the revised system did not sufficiently discriminate dependent and self-critical dimensions. Using the original scoring system, self-criticism was significantly and positively related to severity of depression, whereas dependency was not, particularly for males. Factor analysis of the DEQ scales and the other scales used in this study supported the dependent and self-critical dimensions. For men, the correlation of the DEQ with the MMPI scales indicated that self-criticism was associated with psychotic symptoms, hostility/conflict, and a distress/exaggerated response set, whereas dependency did not correlate significantly with any MMPI scales. Females, however, did not exhibit a differential pattern of correlations between either the Dependency or the Self-Criticism scales and the MMPI. These findings suggest possible gender differences in the clinical characteristics of male and female dependent and self-critical depressive subtypes.     

Perfectionism and Deficits in Cognitive Emotion Regulation

The current study investigated the general hypothesis that perfectionists have deficits in cognitive emotion regulation. A sample of 100 students completed the Perfectionism Cognitions Inventory, the Multidimensional Perfectionism Scale, the Cognitive Emotion Regulation Questionnaire (CERQ), and a measure of depression. Correlational analyses revealed that frequent thoughts involving perfectionism were associated with maladaptive cognitive emotion regulation tendencies, including catastrophization, self-blame, rumination, and lack of positive reappraisal. Socially prescribed perfectionism was associated with the maladaptive cognitive emotion regulation strategies of self-blame, catastrophization, and rumination, and it was correlated negatively with the adaptive cognitive emotion regulation strategies of putting into perspective and positive reappraisal. Trait self-oriented perfectionism was linked with self-blame. As expected, higher levels of depression were associated with perfectionism cognitions, socially prescribed perfectionism and deficits in cognitive emotion regulation. Our findings suggest the need for interventions designed to bolster the cognitive coping skills of at-risk perfectionists. This research was supported by a major research grant from the Social Sciences and Humanities Research Council (SSHRC) of Canada. Gordon Flett was also supported by a Canada Research Chair in Personality and Health.     

Gender differences in depression in college students

Although there is much evidence indicating that females report more depressive symptoms on the Beck Depression Inventory (BDI) relative to males, virtually no research has examined or reported gender differences on several other measures tapping negative affect—namely, the Expanded Attributional Styles Questionnaire (EASQ) and the Selves Questionnaire. Our first study examined gender differences on both the BDI and EASQ, and found that females reported more depressive symptoms and a more maladaptive attributional style than males. In our second study, the data revealed that, again, females were found to have a more maladaptive attributional style than males. In addition, on the Selves Questionnaire, there was a significant discrepancy between actual and ideal self for females, but not for males. When delineating most frequently used ideal categories, the data revealed that females were more likely than males to report greater strivings for ideal attributes relevant to interpersonal relationships and body image/attractiveness, whereas males reported more ideal strivings for intelligence. These data suggest some content areas in which females and males differ with regard to “traits” to which they aspire, and which may produce dejection and negative affect if not attained.     

Depression and cognitive style: comparisons between measures

Several instruments have been developed recently to measure cognitive styles associated with depression. At least four of them appear to have an underlying similarity. Each appears to reflect a tendency for respondents to infer a general lack of self-worth (or a continued likelihood of bad events) on the basis of a single discrete failure. The present research was a comparative test of one of these scales against the other three in terms of associations with Beck Depression Inventory (BDI) scores. Though all instruments were significantly correlated with BDI, partial correlations revealed that our generalization scale was a more robust predictor of BDI than were (a) a measure of characterological self-blame, (b) a measure of cognitive bias, and (c) a measure of attributional style.     

A study of temperament and personality in anorexia and bulimia nervosa

Although temperament and personality traits could influence the development and course of eating disorders, only a few studies examined the similarities and differences in personality between anorexia and bulimia nervosa. We compared 72 patients with DSM-IV eating disorders and 30 healthy controls. Dimensions of personality and personality disorders were evaluated with the Eysenck's EPQ, Cloninger's TCI, and the SCID-II questionnaires. The rates of impulsivity and clinical features were evaluated using specific rating scales. A comorbid personality disorder was found in 61.8% of patients with eating disorder. Avoidant personality disorder appeared was relatively common in anorexia nervosa restricting type; borderline personality disorder was most frequent in bulimia nervosa and the binge eating-purging type of anorexia nervosa. From a dimensional perspective, anorexic patients presented high scores in the dimension of persistence. Higher harm avoidance and impulsivity was found in bulimic patients. The overall eating disorders group presented high scores in neuroticism and low scores in self-directedness. Eating disorder patients have heterogeneous features of temperament and personality traits. Cluster C personality disorders seem more common in anorexia nervosa restricting type and impulsive personality features are associated with bulimic symptoms. Impulsivity seems to be a key aspect of temperament of bulimic patients, whereas anorexic symptoms are linked to persistent temperament traits.     

Choosing Assessment Instruments for Bulimia Practice and Outcome Research

Six commonly used instruments for assessment of eating disorders were analyzed. Effect size results from Erford et al.'s (2013) meta‐analysis for the treatment of bulimia nervosa were used to compare each scale's ability to measure treatment outcomes for bulimia nervosa. Effect size comparisons indicated higher overall effect sizes using the Eating Disorder Inventory and Eating Attitudes Test in assessing bulimia and the Eating Disorder Examination and the Body Shape Questionnaire in assessing body dissatisfaction.     

Genetic and environmental influences on interpersonal cognitions and associations with depressive symptoms in 8-year-old twins

Less is known about depression in children than in adults. This study integrates fields by combining cognitive and interpersonal research investigating childhood depression symptoms through the use of a genetic framework. Three research questions are addressed. First, what are the associations among interpersonal cognitions, anxiety, and depression? Second, what are the relative magnitudes of genetic and environmental influences on interpersonal cognitions? Third, to what extent do genetic and environmental influences explain associations between interpersonal cognitions and depression? Three hundred pairs of 8-year-old twins reported on symptoms of depression and anxiety by completing the Children's Depression Inventory and the Screen for Childhood Anxiety-Related Emotional Disorders. The authors examined interpersonal cognitions with the Children's Expectation of Social Behaviors and the Perceptions of Peers and Self Questionnaires. Interpersonal cognitions were more strongly correlated with depression (mean r = .35) than with anxiety (mean r = .13). Genetic influence on interpersonal cognitions was small (M = 3%), and associations between interpersonal cognitions and depression were mainly explained by environmental influences. These latter findings may result from interpersonal cognitions in young children, reflecting life experiences as opposed to trait-like cognitive biases.     

Body-image disturbances in bulimia nervosa: influences of actual body size

This study evaluated body-image distortion and ideal body-size preferences in 423 nonbulimic women and 108 bulimics. Analyses of covariance were utilized to compare the bulimic and nonbulimic groups on measures of current and ideal body size. Weight was used as a covariate to evaluate the influence of actual body size on perception of current body size and selection of ideal body size. Bulimics chose current body sizes that were significantly larger than those picked by nonbulimics regardless of actual body size. Bulimics also chose thinner ideal body sizes than did nonbulimics, regardless of actual body size. These results suggest that body-image distortion and extreme preference for thinness are a fundamental characteristic of bulimia nervosa. These results were discussed in terms of how perception of a large body size and preference for a very thin body size might interact to produce a high degree of dissatisfaction and overconcern with body size in bulimia nervosa.     

Prevalence of personality disorders among bulimics,nonbulimic binge eaters,and normal controls

We examined the comorbidity of bulimia and personality pathology among college women. Subjects included women (n=23) meeting DSM-III-R criteria for bulimia nervosa (bulimics), women (n=23) who reported binge eating but did not fulfill the criteria for bulimia nervosa (binge eaters), and women (n=23) who did not binge eat (normals). The subjects completed an assessment battery consisting of the Personality Disorders Examination and the SCID as well as the Beck Depression Inventory, the Rosenberg Self-Esteem Index, and measures of impulsivity and self-defeating tendencies. Fourteen of 23 bulimics (61%) met criterion for a personality disorder using DSM-III-R Axis II criteria. In comparison, 3 of 23 (13%) binge eaters and 1 of 23 (4%) normal subjects received an Axis II diagnosis. Borderline and self-defeating diagnoses were the predominant personality disorders in 96% of the bulimics exhibiting clinically significant personality pathology. Bulimics also exhibited significantly more depression, impulsivity, and self-defeating behavior and lower self-esteem than binge eaters and normals. The findings are discussed within a conceptual framework that posits an interaction between personality pathology and restrained eating.     

FEMINIST IDENTITY, GENDER TRAITS, AND SYMPTOMS OF DISTURBED EATING AMONG COLLEGE WOMEN

This study explored relationships among feminist identity, gender traits, and symptoms of disturbed eating. Seventy-one college women completed the following: weight-related questions, Feminist Identity Development Scale, Personal Attributes Questionnaire, Figure Rating Scale, and Eating Disorders Inventory. Identification with feminist values negatively correlated with body dissatisfaction, bulimic symptoms, and feelings of ineffectiveness. Identification with stereotypical masculine traits was inversely related to perfectionist tendencies and feelings of ineffectiveness, but was unrelated to body concerns. These results suggest factors promoting body dissatisfaction and disturbed eating may have less impact on college women identifying with feminist values, such as commitment to nonsexist roles and personal empowerment.     

Derivation and implications of MMPI cluster groups in clinically depressed inpatient females.

The purpose of this study was to subclassify clinically depressed patients based on a cluster-analytic examination of the MMPI. Subjects were 79 female inpatients with major depression. A cluster analysis of the MMPI validity and clinical scales resulted in three clusters labeled psychotic (287 MMPI profile), hostile (24 MMPI profile), and histrionic (32 MMPI profile) depression. The psychotic group exhibited the greatest depression as measured by the Beck Depression Inventory (BDI). The psychotic and hostile groups, however, did not differ on other associated aspects of depression, such as negative cognitions, nonassertiveness, or personality style. The hostile group reported the fewest physical difficulties and the most excessive alcohol use. The groups, however, did not differ on other aspects of depression history or presentation such as family history of depression or previous hospitalizations. A repeated measures ANOVA for the three cluster groups on the BDI at admission, discharge, and 6 months after discharge indicated that all groups showed improvement at discharge but that only the hostile depressive group continued to show improvement at the 6-month follow-up.     

Perfectionism Cognitions, Rumination, and Psychological Distress

The current study examined the extent to which dimensions of perfectionism are associated with a ruminative response orientation and the experience of cognitive intrusions in response to stressful events. Our main goal was to test the hypothesis that individuals characterized by frequent automatic thoughts involving perfectionistic themes would also be characterized by a ruminative response orientation when distressed and they would report intrusive thoughts and images following the experience of a stressful event. A sample of 65 students completed several measures, including the Perfectionism Cognitions Inventory, the Multidimensional Perfectionism Scale, the Response Styles Questionnaire, the Impact of Events Scale, and indices of depression and anxiety. Correlational analyses confirmed that high scores on the Perfectionism Cognitions Inventory were correlated with a ruminative response orientation and the reported experience of intrusive thoughts and images following the experience of a stressful event. High levels of perfectionism cognitions, socially prescribed perfectionism, and rumination were also correlated with measures of depression and anxiety representingthe tripartite model. The results support the view that there is a salient cognitive aspect to perfectionism and the experience of frequent perfectionistic cognitions and related forms of rumination contribute to levels of psychological distress.