Emotional Eating and Eating Disorder Psychopathology

Eating Disorders

ISSN: 1064-0266 (Print) 1532-530X (Online) Journal homepage: http://www.tandfonline.com/loi/uedi20

Emotional Eating and Eating Disorder Psychopathology Marjaana Lindeman, Katariina Stark To cite this article: Marjaana Lindeman, Katariina Stark (2001) Emotional Eating and Eating Disorder Psychopathology, Eating Disorders, 9:3, 251-259, DOI: 10.1080/10640260127552 To link to this article: http://dx.doi.org/10.1080/10640260127552

Published online: 29 Oct 2010.

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Eating Disorders, 9:251–259, 2001 Copyright © 2001 Brunner-Routledge 1064-0266/01 $12.00 + .00

Emotional Eating and Eating Disorder Psychopathology MARJAANA LINDEMAN and KATARIINA STARK

Downloaded by [University of Helsinki] at 00:29 23 October 2015

University of Helsinki, Finland

The study examined to what extent emotional eating, restrained eating, and bulimic tendencies are found together in naturally occurring groups, and whether these groups differ in terms of the psychological characteristics relevant to eating disorders. One hundred twenty-seven normal-weight women filled in The Dutch Eating Behavior Questionnaire, The Eating Attitudes Test, The Eating Disorder Inventory, and five measures of psychological well-being. Cluster analysis revealed three dieter subgroups (Normal Dieters, Emotional Dieters, and Bulimic Dieters) and one nondieter group. The results showed that only some restrained eaters were emotional eaters and that only some emotional eaters had bulimic tendencies. In addition, emotional and bulimic dieters differed from nondieters more strikingly in terms of eating disorder psychopathology and low psychological well-being than normal dieters did. The results suggest that emotional eating is not responsible for overeating only but may, in concert with chronic dieting, also relate to the general psychopathology found to underlie eating disorders.

Emotional eating refers to the tendency to eat in response to negative emotions. While a normal reaction to emotions like anxiety, anger, or depression is loss of appetite, emotional eaters eat more when they are upset (e.g., Bruch, 1973; Polivy, Herman, & McFarlane, 1994; van Strien, 1996; van Strien, Schippers, & Cox, 1995). Traditionally, emotional eating has been linked to overeating, and the majority of research has shown that emotional eating is indeed positively associated with various forms of excessive eating, for example obesity and bulimic tendencies (e.g., Eldredge & Agras, 1996; Grissett & Fitzgibbon, 1996; Lowe & Fisher, 1985; van Strien, 1996; Waller & Osman, 1998). Nonetheless, Herman and Polivy and their colleagues have suggested that emotional eatAddress correspondence to Marjaana Lindeman, PhD, Department of Psychology, Applied Division, P.O. Box 13, 00014 University of Helsinki, Finland. E-mail: Marjaana.Lindeman@ Helsinki.fi 251


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ing is more closely related to dieting (often related to overeating) than to overeating per se (e.g., Herman & Mack, 1975; Herman, Polivy, Pliner, Threlkeld, & Munic, 1978; Polivy, Herman, & Warsh, 1978). In line with this suggestion, their studies have shown, for example, that in contrast to nondieters, experimentally induced anxiety causes restrained eaters to eat more, even if the food is bad-tasting (e.g., cookies containing a lot of baking powder but no sugar, Polivy et al., 1994). However, correlational studies have not confirmed the relationship between emotional and restrained eating. Although a moderate association between these two patterns of eating has been found in one study (van Strien, Frijters, Bergers, & Defares, 1986), the correlations have usually been quite low (van Strien, 1996; van Strien, Frijters, Roosen, Knuiman-Hijl, & Defares, 1985; Waller & Osman, 1998). Accordingly, it has been suggested (e.g., Waller & Osman) that emotional eating may not play any important role in dietary restraint. One possible explanation for these inconsistent findings, and the one that is addressed in this study, is that emotional eating may characterize only some dieter subtypes. The possibility that emotional eating is strongly related to restrained eating among some individuals and unrelated to it among others is hard to detect in variable-centered designs, for example correlational studies. Therefore, in the present study, we utilize a person-oriented approach, namely cluster-analysis (e.g., Hair, Anderson, Tatham, & Black, 1995; Mischel & Shoda, 1995). With a cluster-analysis we can identify to what extent emotional, restrained, and bulimic eating styles combine together in naturally occurring groups, and we can determine the relative proportions of these emerging groups in a sample. This analysis enables us to analyze whether emotional eating is typical to all dieters or to some dieters only, and whether emotional eating occurs only with individuals with overeating tendencies. In this study, overeating tendencies are operationalized as bulimic attitudes among normal-weight individuals. The second aim was to clarify the relationship between emotional eating and the psychopathological features that underlie eating disorders (e.g., a pervasive interpersonal distrust, extreme perfectionism, and a paralyzing sense of ineffectiveness, e.g., Bruch, 1973; Garner, Olmstead, & Polivy, 1983). Although this topic has not received much research attention, some studies have shown that emotional eating is, albeit moderately, positively associated to eating disorder psychopathology (van Strien, 1996; Waller & Matoba, 1999; Waller & Osman, 1998) and low psychological well-being, for example feelings of inadequacy and low self-esteem (van Strien et al., 1995). Because these studies have typically focused on some kind of excessive eating, these associations have been attributed to the psychological etiology of obesity or bulimia. However, if restrained eaters also eat in response to negative emotions (e.g., Herman & Mack, 1975; Polivy et al., 1994), the question arises whether only those restrained-emotional eaters who synchronously engage in excessive eating show signs of eating disorder psychopathology, or whether

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the combination of emotional and restrained eating per se, irrespective of overeating inclinations, is associated with the pathology. Therefore, after identifying how emotional eating combines with restrained eating and bulimic features among clusters of participants, the difference between the psychological characteristics among these clusters will be analyzed.

METHOD


Participants One hundred twenty-nine female students from the University of Helsinki participated in the study. One participant was excluded due to missing information, and one because of obesity (BMI > 30), leaving a total of 127 participants. The subjects’ ages varied between 20 and 58 (M = 27.4, SD = 7.45), and they represented various fields of study from the faculties of humanities, social sciences, and pedagogical sciences. The mean body mass index of the subjects was 22.04 (SD = 2.85).

Procedure The participants were recruited on three occasions of faculty examinations with the permission of the Faculty of Humanities. The students in the examinations were informed about the study on the blackboard, and volunteer female students were asked to contact the researcher after the examination. Participants filled in the questionnaires after they were finished with their exams and returned them before leaving the premises. After returning the questionnaires the participants were given feedback in the form of a short paper explaining the rationale of the study and some facts about the current increase in eating disorders among women.

Measures Emotional and restrained eating were measured with The Dutch Eating Behavior Questionnaire (van Strien et al., 1986). The two subscales includes a total of 23 five-point items (1 = seldom, 5 = very often), and scores for the two eating styles were obtained by averaging the item endorsements on each subscale. Bulimic tendencies were measured by the Bulimia subscale of the Eating Attitudes Test (EAT-26; Garner & Garfinkel, 1979; Garner, Olmsted, Bohr, & Garfinkel, 1982). The subjects were asked to indicate their agreement or disagreement with the six items using a six-point scale (1 = never, 6 = always). The responses were scored according to the procedure described by Garner and Garfinkel (1979). The psychological features viewed as important in eating disorders were measured using the Eating Disorder Inventory (EDI; Garner, Olmsted, &


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Polivy, 1983) which includes eight subscales (Drive for Thinness, Bulimia, Body Dissatisfaction, Feelings of Ineffectiveness, Perfectionism, Interpersonal Distrust, Interoceptive Awareness, and Maturity Fears). The subjects indicated their responses on a six-point scale (1 = never, 6 = always). Although EDI scores are often transformed into a four-point scale, untransformed scores were used here because they have been shown to be more valid in nonclinical populations (Schoemaker, van Strien, & van der Staak, 1994). Psychological well-being was measured by the following variables. Depression was assessed by the shortened form of the Center of Epidemiological Studies Depression Scale (CESD-10; Andresen & Malmgren, 1994), a selfreport measure containing 10 items concerning the subjects’ moods and depressive symptoms during the previous week (0 = none of the time, 3 = most of the time). Self-esteem was measured by using the 10-item Rosenberg’s Self-esteem questionnaire (Rosenberg, 1979) and by the Appearance SelfEsteem Scale, a six-item self-report measure developed by Pliner, Chaiken, and Flett (1990). Feelings of inadequacy were assessed by The Feelings of Social Inadequacy Scale (Janis & Field, 1959) and body-image vulnerability was measured by the Appearance Schema Inventory (Cash & Labarge, 1996). Responses on the self-esteem, inadequacy, and body-image vulnerability measures were indicated on a five-point scale.

RESULTS To analyze what kind of eating pattern subtypes could be found in the present data, a hierarchical cluster analysis on three variables, namely, restrained eating, emotional eating, and bulimic tendencies, was conducted with squared Euclidian distance and the Ward minimum variance clustering algorithm. Because differences in the rating scales and standard deviations may distort the clusters, the three variables were transformed to z-scores as suggested by Hair et al. (1995). The interpretability and simplicity of the clusters, as well as the shape of the vertical icicle diagrams, suggested the four-cluster solution as the best fitting solution. The extent to which these four clusters of participants endorsed emotional, bulimic and restrained eating can be seen in Table 1. Based on these results, the members of these clusters were labeled as nondieters (N = 34), normal dieters (N = 43), emotional dieters (N = 45), and bulimic dieters (N = 5). Nondieters endorsed restrained eating significantly less than normal dieters, t(123) = 10.23, p < .001, emotional dieters, t(123) = 8.98, p < .001, or bulimic dieters, t(123) = 7.62, p < .001. To describe the psychological characteristics of the members of these clusters, an Analysis of Variance (ANOVA) was conducted with the cluster as a between-subjects variable and the variables related to eating disorder psychopathology and well-being as dependent variables. The omnibus ANOVA


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showed that all differences were significant (p < .05 ). The means are set forth in Table 1. In all subsequent specific comparisons, the error rate was controlled by Scheffe’s method. First, emotional dieters were contrasted to nondieters, and then to normal dieters. The results indicated that emotional dieters scored higher than nondieters on maturity fears (p < .05), body dissatisfaction (p < .001), perfectionism (p < .005), ineffectiveness (p < .02), drive for thinness (p < .001), and interpersonal distrust (p < .05). Moreover, emotional dieters had higher body-image vulnerability (p < .001), more feelings of inadequacy (p < .03), lower global self-esteem (p < 02), and lower appearance self-esteem (p < 001) than the nondieters. Emotional dieters’ depression was marginally higher than that of nondieters’ (p < .09). In comparison to normal dieters, emotional dieters scored higher on ineffectiveness (p < .01), depression (p < .05), and feelings of inadequacy (p < .05). Second, normal dieters were contrasted to nondieters. Normal dieters had higher body-dissatisfaction (p < .001) and drive for thinness (p < .001) and lower appearance self-esteem (p < .03) than non-dieters. Other differences in the means were not significant. Finally, bulimic dieters were contrasted to nondieters, normal dieters, and emotional dieters. The comparisons showed that bulimic dieters scored higher than nondieters on interoceptive awareness (p < .001), body dissatisfaction (p < .001), bulimia (p < .001), perfectionism (p < .02), feelings of

TABLE 1. Means and Deviations (in Parentheses) in Eating Patterns, Eating Disorder Psychopathology, and Psychological Well-Being among the Four Groups Nondieters Eating pattern Restrained eating Emotional eating Bulimic tendencies EDI Drive for thinness Body dissatisfaction Bulimia Interoceptive awareness Feelings of ineffectiveness Maturity fears Perfectionism Interpersonal distrust Well-being Depression Feelings of inadequacy Body-image vulnerability Self-esteem Appearance self-esteem

Normal dieters

Emotional dieters

1.58 1.65 0.00

(.40) (.61) (.00)

3.01 1.66 0.02

(.64) (.46) (.15)

2.90 3.19 0.15

(.75) (.63) (.55)

11.47 22.03 10.09 15.76 18.41 17.29 14.15 13.68

(3.88) (9.45) (2.75) (4.59) (5.19) (3.82) (4.41) (3.71)

19.98 31.21 11.98 16.74 18.58 17.81 16.02 16.70

(5.18) (9.33) (3.53) (4.01) (4.94) (4.87) (5.50) (5.44)

20.39 34.65 13.87 18.28 22.85 20.39 18.96 17.17

(5.79) (10.18) (5.45) (5.37) (6.57) (5.79) (6.74) (6.19)

8.09 (3.64) 2.18 (.51) 2.01 (.70) 4.34 (.45) 3.79 (.57)

8.00 (3.27) 2.23 (.51) 2.28 (.69) 4.21 (.52) 3.36 (.60)

10.48 (5.06) 2.57 (.59) 2.67 (.78) 3.94 (.56) 3.17 (.63)

Bulimic dieters 2.65 4.01 4.60

(.92) (.75) (1.94)

18.80 (4.44) 48.20 (5.07) 38.40 (12.36) 27.80 (3.77) 26.00 (7.42) 18.80 (4.44) 23.40 (6.67) 16.00 (7.52) 14.20 2.77 4.08 3.42 2.30

(3.96) (.40) (.33) (.61) (.52)

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ineffectiveness (p < .05), drive for thinness (p < .001), depression (p < .03), and body-image vulnerability (p < .001), and lower on global self-esteem (p < .01) and appearance self-esteem (p < .001). In comparison to normal dieters, bulimic dieters scored higher on interoceptive awareness (p < .001), body dissatisfaction (p < .01), bulimia (p < .001), depression (p < .02), and body-image vulnerability (p < .001), and lower on global self-esteem (p < .02) and appearance self-esteem (p < .01). Finally, in comparison to emotional dieters, bulimic dieters scored higher on interoceptive awareness (p < .001), body dissatisfaction (p < .04), bulimia (p < .001), and body-image vulnerability (p < .001), and lower on appearance self-esteem (p < .03)

DISCUSSION The results portrayed four groups of women who differed in the way restrained eating, emotional eating, and bulimic tendencies were associated in their eating patterns. First, there was a group of nondieters who scored low on each of the three eating style measures. The remaining three groups comprised various types of dieters. The smallest dieter group, bulimic dieters, showed the strongest emotional eating and bulimic tendencies. Emotional dieters, in turn, were women who were both restrained and emotional eaters but had no bulimic symptoms. The third dieter group was labeled as normal dieters because this group endorsed restrained eating but showed neither emotional eating tendencies nor bulimic symptoms. These results are in line with the findings that emotional eating is more typical of restrained eaters than of nondieters (Herman et al., 1978; Polivy et al., 1994, 1978), and that emotional eating cooccurs with bulimic behaviors (Eldredge & Agras, 1996; Grissett & Fitzgibbon, 1996; Lowe & Fisher, 1985; van Strien, 1996; Waller & Osman, 1998). However, our results qualify these arguments by showing that only some restrained eaters are emotional eaters and that only some emotional eaters have bulimic tendencies. As a whole, the results highlight the diversity of chronic dieters. This heterogeneity may partly explain why previous findings about the relationship between emotional and restrained eating have been inconsistent (e.g., Polivy et al., 1994; 1978; van Strien, 1996; van Strien et al., 1986). In one sample, the proportion of emotional eaters may be higher, resulting in higher variance in emotional eating, whereas in other samples, their proportion may be smaller, which may deflate the correlations. Naturally occurring dieter subgroups easily remain unnoticed when correlational analyses or experimental groups are used, but they can efficiently be identified with the cluster analysis method. However, compared with other multivariate methods, cluster analysis is more sensitive to sample biases. Therefore, the validity of the present cluster solution should be verified in


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future studies. Nevertheless, the fact that our results for the normal dieters were fully comparable with the following findings reported by Garner and his colleagues gives indirect support for the validity of the solution. According to Garner et al. (1983; see also Garner, Olmsted, Polivy, & Garfinkel, 1984; Olmsted & Garner, 1986), the three EDI subscales, Drive for Thinness, Bulimia, and Body Dissatisfaction, assess eating attitudes that typically exist among normal dieters. The other EDI subscales, in turn, measure the fundamental aspects of the psychopathology of eating disorders. Similarly, in this study, normal dieters scored higher than nondieters only on two EDI scales, Drive for Thinness and Body Dissatisfaction. In contrast, the other two dieter groups, bulimic dieters and emotional dieters, suffered from low psychological well-being and displayed more psychopathological features related to eating disorders. The results indicating the cooccurrence of bulimic tendencies and eating-related psychopathology are in line with previous work (see Szmukler, Dare, & Treasure, 1995 for a review). However, the findings for the emotional dieters were new. Although they showed no bulimic tendencies, emotional dieters displayed more signs of eating disorder psychopathology, lower global and appearance self-esteem, and higher body-image vulnerability and feelings of inadequacy than nondieters did. Moreover, emotional dieters suffered more from feelings of ineffectiveness, depression, and feelings of inadequacy than normal dieters did. As such, the findings do not support the suggestions that the role of emotional eating in dietary restraint is insignificant (e.g., Waller & Osman, 1998), but rather indicate that emotional eating may differentiate those restrained eaters who have a higher risk for eating disordered behavior from other restrained eaters. The question remains, however, why emotional eating differentiates lowrisk individuals from high-risk individuals. One explanation offered for emotional eating is that it results from intense dieting: Dieting may act as a stressor and generate emotional responsiveness and hyperemotionality (Herman & Polivy, 1975; Herman et al., 1978). Because emotional eating was not typical of all dieters but only of a subpopulation, it might be assumed that this tendency precedes (rather than results) from dieting (for the same argument for bingeing, see van Strien, 1996). Another reason offered for emotional eating is that eating may serve as a distraction from one’s worries: Emotional eaters eat more especially under psychological distress (as opposed to physical stress, Polivy et al., 1994). Given that individuals who are at risk to develop eating disorders suffer from depression and severe self-esteem and body-image defects, it may be that they also are more susceptible to various self-image threats, and hence, more inclined to emotional eating. If this is the case, emotional eating might be a consequence of the general psychological vulnerability related to the eating disorder psychopathology.

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