Review of the evidence for a sociocultural model of bulimia nervosa and an exploration of the mechanisms of action

Self-competence and self-liking in the prediction of change in bulimic symptoms

OBJECTIVE

To examine the relationship of self-competence and self-liking (two distinct dimensions of self-esteem) to bulimic symptoms.

METHOD

Two separate longitudinal studies were conducted on undergraduate women from two universities (Study 1, N=129; Study 2, N=406). Measures of self-competence, self-liking, and bulimic symptoms were administered on two occasions, separated by several weeks.

RESULTS

Self-competence demonstrated a stronger relationship than self-liking to change in bulimic symptoms over time.

DISCUSSION

These findings have significant theoretic implications for the construct of self-esteem and implications for risk for and treatment of bulimia.

Gender differences in binge-eating: a population-based twin study

OBJECTIVE

To assess whether genetic and environmental effects on liability to binge-eating (BE) are of equal importance for males and females and whether the same genetic risk factors predispose to BE in the two sexes.

METHOD

Questionnaire data on 8045 same sex and opposite sex twins, aged 19-31 years, from a population-based Norwegian registry, was used to estimate the relative contribution of genetic and environmental factors to liability for BE utilizing structural equation modeling.

RESULTS

In the best-fitting model, the magnitude of genetic and environmental effects on BE was the same for males and females. Heritability was 51%. The correlation between genetic risk factors in men and women was estimated to be +0.57.

CONCLUSION

Binge-eating appears to be equally heritable in males and females. Although the majority of the genetic risk factors are shared between the sexes, there may exist gender-specific genetic effects on liability.

Social anxiety and social comparison: differential links with restrictive and bulimic attitudes among nonclinical women

This study investigated the relationship of two social psychological constructs (social anxiety and social comparison) with bulimic and restrictive eating attitudes among nonclinical women. Eighty young women completed a measure of social anxiety (the Fear of Negative Evaluation Scale, FNE), a measure of social comparison (the Iowa-Netherlands Comparison Orientation Measure, INCOM), the Beck Depression Inventory (BDI), and the Eating Disorders Inventory (EDI). The results indicate a differential link between the two different social processes and the nature of eating psychopathology. Specifically, heightened social anxiety predicted drive for thinness, while levels of social comparison predicted bulimic attitudes. The findings support a model where the two social processes are each associated with different patterns of eating pathology.

The relationship between sociocultural pressure to be thin and body dissatisfaction in preadolescent girls

This study investigates the relationships among sociocultural pressures to be thin, internalisation of the thin ideal, social comparison, body mass index, and body dissatisfaction in young girls. One hundred and fifty-three 10-13 year old girls completed measures assessing sociocultural pressure to be thin, media exposure, body dissatisfaction, social comparison, and internalisation of the thin ideal. Although sociocultural factors, as a group, were significantly associated with internalisation of the thin ideal, perceived media pressure was the only sociocultural influence uniquely related to internalisation of the thin ideal. Perceived pressure to be thin delivered by the media was found to be associated with body dissatisfaction via internalisation of the thin ideal. The relationship between internalisation of the thin ideal and body dissatisfaction was also partially influenced by social comparison. Body mass was found to have a direct association with body dissatisfaction. A model incorporating the relationships among media pressure, internalisation of the thin ideal, social comparison, and body dissatisfaction is proposed.

Cognitive behaviour therapy for eating disorders: a "transdiagnostic" theory and treatment

This paper is concerned with the psychopathological processes that account for the persistence of severe eating disorders. Two separate but interrelated lines of argument are developed. One is that the leading evidence-based theory of the maintenance of eating disorders, the cognitive behavioural theory of bulimia nervosa, should be extended in its focus to embrace four additional maintaining mechanisms. Specifically, we propose that in certain patients one or more of four additional maintaining processes interact with the core eating disorder maintaining mechanisms and that when this occurs it is an obstacle to change. The additional maintaining processes concern the influence of clinical perfectionism, core low self-esteem, mood intolerance and interpersonal difficulties. The second line of argument is that in the case of eating disorders shared, but distinctive, clinical features tend to be maintained by similar psychopathological processes. Accordingly, we suggest that common mechanisms are involved in the persistence of bulimia nervosa, anorexia nervosa and the atypical eating disorders. Together, these two lines of argument lead us to propose a new transdiagnostic theory of the maintenance of the full range of eating disorders, a theory which embraces a broader range of maintaining mechanisms than the current theory concerning bulimia nervosa. In the final sections of the paper we describe a transdiagnostic treatment derived from the new theory, and we consider in principle the broader relevance of transdiagnostic theories of maintenance.

Psychological responses to body shape exposure in patients with bulimia nervosa

One of the unresolved issues regarding research on bulimia nervosa concerns the question as to how patients diagnosed with bulimia nervosa respond to body image exposure. In addition, it remains unclear whether there are differential responses associated with different exposure techniques (e.g. in vivo exposure vs. exposure by visualization). The aim of the present study was to investigate psychological responses to body image exposure. Twenty participants diagnosed with bulimia nervosa (DSM IV) and twenty non-eating disordered individuals were exposed to their body image using a video recording (video confrontation). In addition, they were asked to imagine and describe the appearance of their body (imagery task). Results indicate that self-reported negative emotions increased in response to both, video confrontation and imagery task, in the clinical as well as in the control group. Furthermore, video confrontation led to more pronounced group differences than exposure by visualization (imagery task). Participants diagnosed with bulimia nervosa took less time to describe their waist, hips and bottom compared to non-eating disturbed controls. This last result could be interpreted in terms of avoidance behavior and other mechanisms during body image exposure.

Religiousness and disordered eating: does religiousness modify family risk?

The purpose of this study was to evaluate the role of intrinsic and extrinsic religiousness in modifying family risk on disordered eating among women. We hypothesized that intrinsic religiousness would buffer the impact of family risk whereas extrinsic religiousness would increase the risk. In a survey of 876 college women between the ages of 18 and 29, the results showed that, when intrinsic religiousness was higher, there was no relationship between family risk and disordered eating. When intrinsic religiousness was lower, there was a significant positive relationship between family risk and disordered eating. These findings support the hypothesized buffering effect of intrinsic religiousness. For extrinsic religiousness, there was a stronger relationship between family risk and disordered eating when extrinsic religiousness was higher than when it was lower, supporting the hypothesized enhanced vulnerability effect. Future research should actively explore other moderating variables as well as aspects of religiousness that may contribute to risk and resiliency in disordered eating.

Predictors of vulnerability to reduced body image satisfaction and psychological wellbeing in response to exposure to idealized female media images in adolescent girls

Predictors of change in body satisfaction, depressed mood, anxiety and anger, were examined following exposure to idealized female advertising images in Grades 7 and 10 girls. Stable body dissatisfaction, physical appearance comparison tendency, internalization of thin ideal, self-esteem, depression, identity confusion and body mass index (BMI) were assessed. One week later, participants viewed magazine images, before and after which they completed assessments of state body satisfaction, state depression, state anxiety and state anger. Participants were randomly allocated to view either images of idealized females (experimental condition) or fashion accessories (control condition). For both grades, there was a significant decrease in state body satisfaction and a significant increase in state depression attributable to viewing the female images. In Grade 7 girls in the experimental condition, decrease in state body satisfaction was predicted by stable body dissatisfaction and BMI, while significant predictors of decreases in the measures of negative affect included internalization of the thin-ideal and appearance comparison. In Grade 10 girls, reduction in state body satisfaction and increase in state depression was predicted by internalization of the thin-ideal, appearance comparison and stable body dissatisfaction. These findings indicate the importance of individual differences in short-term reaction to viewing idealized media images.

Locus of control, television viewing, and eating disorder symptomatology in young females

The purpose of this study was to assess the effects of locus of control and television watching (number of hours of television watched per week) on eating disorder symptomatology in girls between the ages 10-17 years. A 2 x 2 factorial design was employed in which girls were identified either as (a) being higher or lower viewers of television, and (b) having either an external or internal locus of control. Girls with an external locus of control had significantly greater eating disorder symptomatology than those with an internal locus of control. For girls watching higher amounts of television, those having an external locus of control had significantly greater eating disorder symptomatology than those having an internal locus of control.

Eating disorders in adolescents and young adults

Adolescence and young adulthood mark the convergence of substantial biologic and social change. Individuals differ in their innate capacity to tolerate change. Research suggests that some of the personality characteristics that are fundamental to individuals with eating disorders may render them particularly vulnerable to the impact of a changing body and changing social demands. The fact that eating disorders emerge primarily during adolescence and often run a protracted course can deprive the afflicted individual of the core social, emotional, and biologic developmental processes that normally occur during this time of life.

Integrating the prevention of eating disorders and obesity: feasible or futile?

The rate of obesity in adults and youth has doubled in the past 20 years; during this same period there has been an increase in the prevalence of "dysfunctional eating behaviors," including eating disorders and unhealthy weight loss practices. Despite the fact that obesity, eating disorders, and unhealthy weight loss practices are cultivated in the same cultural context-an increasingly "toxic" environment regarding food and weight-these problems are regarded as distinct, with different origins, courses, and approaches to prevention and treatment. In this article, we present conceptual and practical reasons for adopting an integrated approach to the prevention of the spectrum of problems related to eating and weight (i.e., eating disorders, obesity, and unhealthy weight loss practices), suggest personal, socioenvironmental, and behavioral factors to be included in an integrated approach to prevention, and provide some ideas for developing an integrated program using a media literacy/advocacy approach. We conclude with a discussion of challenges to the development of interventions aimed at the broad spectrum of weight-related problems and suggestions for addressing these challenges.

Psychological stress, coping, and symptoms of disordered eating in a community sample of young Australian women

OBJECTIVE

To investigate the relationships among stress, coping, and symptoms of disordered eating in a community sample of young Australian women.

METHOD

A longitudinal study design was employed. Two mail-out surveys, assessing perceived psychological stress, coping strategies, body weight dissatisfaction, dieting, and disordered eating behaviors, were completed 6 months apart by 415 young women selected from a cohort of the Women's Health Australia Study.

RESULTS

Strong cross-sectional relationships among the study variables were found. Results of longitudinal analyses, however, demonstrated only tenuous relationships among stress, coping, and later symptoms of disordered eating.

DISCUSSION

These results did not support the hypothesis that stress and coping strategies would predict disordered eating over time. Some evidence was found for a modest reverse relationship between stress and disordered eating. Although contrary to generally accepted theoretical models of disordered eating, these findings are consistent with those of the few previous longitudinal studies reported. Theoretical implications are discussed.

The effect of experimental presentation of thin media images on body satisfaction: a meta-analytic review

OBJECTIVE

The effect of experimental manipulations of the thin beauty ideal, as portrayed in the mass media, on female body image was evaluated using meta-analysis.

METHOD

Data from 25 studies (43 effect sizes) were used to examine the main effect of mass media images of the slender ideal, as well as the moderating effects of pre-existing body image problems, the age of the participants, the number of stimulus presentations, and the type of research design.

RESULTS

Body image was significantly more negative after viewing thin media images than after viewing images of either average size models, plus size models, or inanimate objects. This effect was stronger for between-subjects designs, participants less than 19 years of age, and for participants who are vulnerable to activation of a thinness schema.

CONCLUSION

Results support the sociocultural perspective that mass media promulgate a slender ideal that elicits body dissatisfaction. Implications for prevention and research on social comparison processes are considered.

Parent influences in the transmission of eating and weight related values and behaviors

Early adolescent boys (n = 587) and girls (n = 619) and a parent completed questionnaires, that assessed child dieting behaviors, body dissatisfaction and tendency to overeat, child's current and ideal size, mother and father dieting, and encouragement of the child to diet.

Subtyping binge eating disorder

Cluster-analytic studies of bulimia nervosa and binge eating disorder (BED) have yielded 2 subtypes (pure dietary and mixed dietary-negative affect). The authors aimed to (a) replicate the subtyping with BED, (b) consider alternative approaches to subtyping, and (c) test the stability in individual differences in the subtyping. Cluster analyses of 101 patients revealed a dietary-negative affect subtype (33%) and a pure dietary subtype (67%). The dietary-negative affect subtype was characterized by greater eating-related psychopathology and psychological disturbance. Cluster analysis produced different results from alternative subtyping approaches (by major depression or by binge eating frequency). Cluster-analytic subtyping of data at 2 time points 4 weeks apart for a subset of 73 patients demonstrated significant consistency (kappa = .55). Findings suggest that moderate dieting is characteristic of BED and that affective disturbances occur in a subset of cases that represent a more disturbed variant. The subtypes may represent reasonably stable individual differences.

Body dissatisfaction and binge eating in obese women: the role of restraint and depression

OBJECTIVE

This study examined the association between body dissatisfaction and binge eating, and the mediating role of restraint and depression among obese women.

RESEARCH METHODS AND PROCEDURES

Participants were obese women taking part in a cognitive-behavioral treatment program who completed self-report measures at baseline (n = 89) and post-treatment follow-up (n = 69).

RESULTS

At baseline, body dissatisfaction was strongly correlated with binge eating score. This was partly a direct effect and partly mediated by depression. No mediating effect of restraint was observed. Over the treatment period, a reduction in body dissatisfaction was associated with a reduction in binge-eating score. As in the cross-sectional data, there was evidence for mediation by change in depression with the greatest improvement in binge eating among those who became more restrained and less depressed.

DISCUSSION

These results suggest that it would be valuable to address psychological well-being, and especially body image, as part of the management of binge-eating behavior in obesity.

Dietary restraint and negative affect as mediators of body dissatisfaction and bulimic behavior in adolescent girls and boys

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

Children's body image concerns and eating disturbance: a review of the literature

In recent years a large number of studies have examined body image concerns, and early symptoms of eating disturbance among children. However, to date there has been no synthesis or evaluation of these studies. The purpose of the present article is to review and evaluate the research that has examined body image concerns, and eating attitudes and behaviors among children 6 to 11 years of age. The instruments used to assess body image concerns and eating disturbance in children closely resemble those used with adolescents and adults. Overall, the psychometric data for these instruments are very good and there is sufficient evidence indicating that they can be used reliably and validly. In addition, similar variables to those studied in adolescent and adult samples have been found to be associated with children's body image concerns and early eating disturbance. These include gender, age, body mass index, race, sociocultural pressures, and self-concept. Our understanding of the development of body image concerns and eating disturbance in children is limited, however, by the fact that most of the research in this field has been based on cross-sectional data, and the studies have focused almost exclusively on weight loss cognitions and behaviors.

Subtyping women with bulimia nervosa along dietary and negative affect dimensions: a replication in a treatment-seeking sample

Recent cluster-analysis studies of women with bulimia nervosa (BN) have suggested two subtypes, a pure dietary subtype and a mixed dietary-negative affect. We aimed to replicate the subtyping findings in a clinical study group of 48 adult women with BN. Cluster analyses revealed a dietary-negative affect subtype (56% of cases) and a pure dietary subtype (44% of cases). The dietary-negative affect subtype was characterized by significantly greater eating-related attitudinal psychopathology and associated psychological disturbance. Our findings suggest that severe restraint is a central feature of BN and that affective disturbance, which occurs in roughly half of cases, is associated with greater eating-related attitudinal psychopathology and psychological symptomatology.

Private high school students are at risk for bulimic pathology

The objective of this study was to assess whether private high school students constitute a group that is at high risk for eating pathology. Female and male public and private high school students (N = 465) were compared on self-reported eating disordered attitudes and behaviors. Private high school students reported elevated eating disordered attitudes and behaviors when compared with students from public schools. The results were somewhat stronger for females than males. The findings suggest that private high school students are a group at high risk for eating pathology. The identification of such high risk groups may facilitate etiologic studies and aid in the implementation of targeted prevention programs.

Similarities in body image in sisters: the role of sociocultural internalization and social comparison

The sociocultural theory of body image disturbance states that Western women experience pressure from sources such as parents, peers, and the media to maintain thinness. Social comparison theory emphasises the role of comparing one's appearance to others. Body image disturbance; awareness and Internalization of sociocultural messages regarding thinness; and sibling social comparisons were examined in 41 closest-in-age sisters through self-report questionnaires. Sisters showed similar levels of body image disturbance and sociocultural awareness and internalization. Sibling comparisons were negative for younger sisters but neutral or positive for older sisters. Sociocultural internalization predicted body dissatisfaction in both sisters, and body size distortion in younger sisters. Negative sibling comparisons during teenage years predicted body size distortion and body dissatisfaction in younger sisters, and preference for thinness in older sisters.

"I would rather be size 10 than have straight A's": a focus group study of adolescent girls' wish to be thinner

The study aimed to investigate the body concerns of adolescent girls, together with the underlying motivations for the wish to be thinner. Focus group methodology was employed in order to access participants' experience in their own language. Altogether 67 girls of Year 11 (aged approximately 16 years) took part in five groups. Audiotaped and transcribed discussions were systematically coded for themes and rated on frequency, extensiveness, intensity, specificity and level of agreement. As expected, sociocultural influences, in particular the media, were reported as exerting the strongest pressures to be thin. More importantly, however, the girls displayed an unexpected sophistication in their conceptualization of the role of both media effects and body image in the construction of their self-image. Contrary to assumptions made in quantitative research, despite clearly articulating a desire to be thinner, the girls also described how this did not necessarily mean they were dissatisfied with their bodies. The findings suggest that the girls' meta-awareness and sophisticated understanding of the media and other pressures, may serve to moderate against these forces which would otherwise seem overwhelming.

Body image and body change methods in adolescent boys. Role of parents, friends and the media

OBJECTIVE

This study examines sociocultural influences affecting both body image and body change methods in adolescent boys.

METHODS

Twenty boys in grade 7 (aged 12-13) and twenty boys in grade 9 (aged 14-15) were individually interviewed. The influence of parents, siblings, friends and the media on both body image and body change methods was evaluated.

RESULTS

For approximately a third of the boys, parents, siblings, friends and the media were perceived to have at least some influence over boys' feelings about their bodies and body change methods. In particular, feedback from mothers and female friends were viewed as having a positive impact on boys' body image whereas feed-back from fathers and male friends was viewed as more important in influencing body change methods. The media was also viewed as contributing to boys' body satisfaction but it was seen to encourage greater exercise to alter body size and shape.

CONCLUSION

The differences and similarities between the sociocultural messages received by males and females are discussed. The implication of these findings in fostering better health among adolescent males are explored.

Hispanic and Anglo college women's risk factors for substance use and eating disorders

This study investigated the role of temperament style (Novelty Seeking and Harm Avoidance) of Hispanic American and Anglo college women in moderating and mediating the relationship between family addiction/family functioning and offspring problem behaviors. The sample was comprised of 67 Hispanic American and 770 Anglo undergraduate women. Findings of this study indicate that the processes of risk that lead to substance use and eating disorders follow different routes for Hispanic American and Anglo women. Novelty Seeking and Harm Avoidance were found to be important factors in both moderating and mediating the effects of parental drinking and family dysfunction for both Hispanic and Anglo college women.

The relationship between eating disorders and substance use: moving beyond co-prevalence research

The frequent comorbidity of eating disorders and substance use has been demonstrated consistently by research. Less is known about the basis of this relationship. A review of the literature indicates that the hypotheses proposed to clarify the etiological relationship between eating disorders and substance use have not been supported sufficiently or consistently by empirical evidence. General criticisms include: a lack of well developed models, a reliance on co-prevalence data, and a lack of integration of knowledge from eating disorder and substance use research. It is suggested that an understanding of the etiological relationship between eating disorders and substance use will be arrived at only after fundamental inquiries into the functional relationship between eating disorders symptomatology and substance use patterns have been conducted. A behavioral assessment approach is offered as a means of evaluating the functional relationship between eating disorder symptomatology and substance use.

Female athletes and eating problems: a meta-analysis

OBJECTIVE

The relationship between athletic participation and eating problems is examined using meta-analysis. Both the risk and protective elements of athletic participation are considered.

METHOD

Data from 34 studies were used to examine the overall relationship between athletic participation and eating problems. Relationships for specific sports, elite athletes, and various age groups are also examined.

RESULTS

Athletes appeared to be somewhat more at risk for eating problems than nonathletes. This was especially true of dancers. Significant effects did not emerge for gymnasts. Elite athletes, especially those in sports emphasizing thinness, were at risk. Nonelite athletes, especially in high school, had reduced risk of eating problems compared to controls. Body dissatisfaction was lower in athletes.

CONCLUSION

There appear to be circumstances under which sports participation by women constitutes a risk factor for certain elements of eating problems. In other situations, athletic participation may be protective against eating problems.

Negative affect moderates the relation between dieting and binge eating

OBJECTIVE

Although laboratory experiments suggest that negative affect inductions potentiate the relation between dieting and disinhibited eating, little research has tested whether this finding generalizes to binge eating in the natural environment. Thus, we assessed whether negative affect moderated the relation between dieting and binge eating in a passive-observational study.

METHOD

This aim was addressed with longitudinal data from a community sample of adolescents (N = 631).

RESULTS

For females, dieting and negative affect predicted binge eating in cross-sectional and prospective analyses, but negative affect potentiated the relation between dieting and binge eating only in the cross-sectional analyses. Similar, but attenuated results were found for males.

DISCUSSION

Findings converge with those from laboratory studies in suggesting that negative affect moderates the relation between dieting and binge eating, but also imply that dieting and negative affect constitute independent risk factors for binge eating. The lack of prospective effects may suggest that the interactive relations have a short time lag or are difficult to detect prospectively.

Factor structure of the Eating Attitudes Test (EAT) in a Turkish university sample

OBJECTIVE

The primary purpose of this study was to compare the factor structure of the Eating Attitudes Test (EAT) in a sample of Turkish university students with both that of the original Canadian study and that of a Turkish study conducted ten years earlier.

METHOD

The EAT 40 was administered to a sample of 270 female undergraduates at the Bogazici and Marmara universities in Istanbul, Turkey.

RESULTS

The factor structure produced more closely resembled the original than did that of the study conducted ten years ago. Of particular note was the presence of a bulimia factor which had not emerged in the previous Turkish study, together with a new factor labelled "Ambivalence about Eating".

DISCUSSION

Comparison of the two Turkish studies highlights the emergence of a bulimia factor not present ten years ago. This reflects clinical experience. Moreover the new Ambivalence about Eating factor is discussed in terms of the transitional nature of Turkish society and the role of a culture clash between traditional and westernized attitudes towards food. It is therefore predicted that the prevalence of eating disorders in Turkish culture will dramatically increase in the foreseeable future.

Body dissatisfaction, bulimia, and depression among women: the mediating role of drive for thinness

OBJECTIVE

Past research has called into question the apparent relationship between body dissatisfaction and bulimia among women once effects of depression are statistically controlled. We further investigated interrelations among body dissatisfaction, depression, and bulimia, as well as considered individual differences in drive for thinness, within two samples of young adult women.

METHOD

The first sample included women diagnosed with anorexia nervosa (n = 91) or bulimia nervosa (n = 142), whereas the second sample included college student women (N = 228). Respondents completed self-report measures of bulimia, drive for thinness, negative affect, and body dissatisfaction.

RESULTS

At the univariate level, all of the above constructs were significantly related to body dissatisfaction. In multiple regression analyses using depression and bulimia as predictors of body dissatisfaction, both were uniquely related to body dissatisfaction. These findings were similar to the results of previous research. However, when drive for thinness was added to the regression equations, drive for thinness was a unique predictor of body dissatisfaction whereas bulimia was not (neither was depression among college women).

DISCUSSION

Bulimia, depression, and body dissatisfaction may be the results of incorporation of cultural standards regarding thinness, hence the apparent relationships among these variables. The role of drive for thinness in the pathogenesis of depression and body dissatisfaction among women needs to be investigated further.

Pleasure, pursuit of health or negotiation of identity? Personality correlates of food choice motives among young and middle-aged women

The clustering of four food choice motives (health, weight concern, pleasure and ideological reasons) and the relationship between personality and the food choice motives were analysed among young and middle-aged women in two studies. The personality variables included personal strivings, magical beliefs about food, awareness and internalization of thinness pressures, appearance and weight dissatisfaction, depression, self-esteem and symptoms of eating disorders. Study 1 was done with 171 young and middle-aged women. In Study 2, with data provided by 118 senior high-school girls, one cluster of girls who did not regard any of the food choice motives as important was found, otherwise the food choice clusters were fairly similar in both studies. They were labelled as health fosterers, gourmets, ideological eaters, health dieters and distressed dieters. Only the second dieter group, distressed dieters, showed low psychological well-being and symptoms of disordered eating. The results also indicated that ideological food choice motives (i.e. expression of one's identity via food) were best predicted by vegetarianism, magical beliefs about food and health, and personal strivings for ecological welfare and for understanding self and the world.

Gender and ethnic differences in the relationship between body esteem and self-esteem

Gender and ethnic differences in the relationship between body esteem and self-esteem were examined to assess the degree to which these variables change in relation to each other over time. Difference scores (between Time 1 and Time 2, 1 week apart) were obtained using the Self-Esteem Scale (M. Rosenberg, 1979) and the Body Esteem Scale (S. L. Franzoi & S. A. Shields, 1984) for 163 White women, 140 White men, 55 Black women, and 37 Black men. The results indicated that the correlation of the difference scores was stronger for the group of White women than for the other 3 groups, suggesting that changes in self-esteem parallel changes in body esteem more for White women than for White men, Black men, and Black women. The findings are discussed in relation to the prevalence of bulimia nervosa among White women.

Features of eating disorders in patients with irritable bowel syndrome

The relationship between characteristics of irritable bowel syndrome (IBS) and eating disorders (ED) was investigated in a clinical sample of 43 female and 17 male IBS patients who completed the Eating Disorder Inventory (EDI). A diagnosis of IBS was generally unrelated to the Body Dissatisfaction, Perfectionism, and Ineffectiveness subscales of the EDI, but symptom severity was correlated with Perfectionism and Ineffectiveness. Severe bouts of vomiting were significantly associated with desires for lower body weight and reported binge-purge behaviors and cognitions measured by the Bulimia subscale of the EDI. Results suggest the need for a more comprehensive understanding of both types of illness as well as a possible framework for future empirical work.

Test of Stice's dual pathway model: dietary restraint and negative affect as mediators of bulimic behavior

The present study was designed to test whether dietary restraint and negative affect mediate the relationship between body dissatisfaction and bulimic behavior. Four hundred and twelve female students completed questionnaires which measured body dissatisfaction, restrained eating, negative affect and bulimic behavior. The results indicated that dietary restraint and negative affect partially mediated the relationship between body dissatisfaction and bulimic behaviors. The findings are discussed in light of previous research which suggests that restraint needs to be viewed as a multidimensional construct. Longitudinal studies are now needed to investigate the causal and possible bidirectional nature of the interrelationships in the model tested here.