What Triggers Abnormal Eating in Bulimic and Nonbulimic Women?;The Role of Dissociative Experiences,Negative Affect,and Psychopathology

Abstract

Dissociative experiences and abnormal eating were examined in 92 non-eating-disordered women and 61 age-matched bulimic women. In the nonclinical sample of women, dissociative experiences were associated with abnormal eating attitudes and behavior, even after controlling for other forms of psychopathology; furthermore, dissociation mediated the relationships between abnormal eating and sexual abuse, abnormal eating and emotional distress, and abnormal eating and impulsivity Analyses using both bulimic women and occasional binge eaters among the controls showed that a combination of reported negative affect and dissociative experiences preceding a binge was associated with the highest levels of abnormal eating. Finally, in both bulimic women and occasional binge eaters, feelings of panic appeared to decrease as a binge episode progressed, whereas, in bulimic women only, dissociative experiences appeared to increase during binge eating. The implications for the role of dissociation in combination with emotional distress in triggering and reinforcing abnormal eating in women are discussed.

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References

Abraham

S. F

Beumont

P. J. V.

(1982). How patients describe bulimia or binge eating. Psychological Medicine, 12, 625–635.

American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed, revised). Washington DC: APA.

Baron

R. M

Kenny

D. A.

(1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.

Beck

A. T.

(1967). Depression: Clinical, experimental, and theoretical aspects. New York: Harper & Row.

Becker

de Leeuw

(1988). Relations between variants of non-linear principal component analysis. In van Rijckevorsel

J. L. A.

de Leeuw

(Eds.), Component and correspondence analysis: Dimension reduction by functional approximation (pp. 5–17). New York: Wiley.

Bernstein

E. M

Putnam

F. W.

(1986). Development, reliability, and validity of a dissociation scale. Journal of Nervous and Mental Disease, 174, 727–735.

Brown

L. S.

(1985). Women, weight, and power: Feminist theoretical and therapeutic issues. Women and Therapy, 4, 61–71.

Brownell

K. D

Fairburn

C. G.

(Eds.) (1995). Eating disorders and obesity: A comprehensive handbook. New York: Guilford Press.

Carlson

E. B

Putnam

F. W.

(1993). An update on the dissociative experiences scale. Dissociation: Progress in the Dissociative Disorders, 6, 16–27.

10.

Casper

R. C

Lyubomirsky

(1997). Individual psychopathology relative to reports of unwanted sexual experiences as predictor of a bulimic eating pattern. International Journal of Eating Disorders, 21, 229–236.

11.

Comrey

A. L

Lee

H. B.

(1992). A first course in factor analysis. Hillsdale, N.J.: Erlbaum.

12.

Connors

M. E

Johnson

C. L.

(1987). Epidemiology of bulimia and bulimic behaviors. Addictive Behaviors, 12, 165–179.

13.

Davis

Freeman

R. J

Garner

D. M.

(1988). A naturalistic investigation of eating behavior in bulimia nervosa. Journal of Consulting and Clinical Psychology, 56, 273–279.

14.

Demitrack

M. A

Putnam

F. W

Brewerton

T. D

Brandt

H. A.

(1990). Relation of clinical variables to dissociative phenomena in eating disorders. American Journal of Psychiatry, 147, 1184–1188.

15.

Dolan

(1994). Why women? Gender issues and eating disorders: An introduction. In Dolan

Gitzinger

(Eds.), Why women? (pp.1–11). London: The Athlone Press.

16.

Dolan

Gitzinger

(Eds.) (1994). Why women? London: The Athlone Press.

17.

Everill

Waller

Macdonald

(1995a). Dissociation in bulimic and non-eating-disordered women. International Journal of Eating Disorders, 17, 127–134.

18.

Everill

Waller

Macdonald

(1995b). Reported sexual abuse and bulimic symptoms: The mediating role of dissociation. Dissociation: Progress in the Dissociative Disorders, 8, 155–159.

19.

Fallon

Katzman

M. A

Wooley

S. C.

(Eds.) (1994). Feminist perspectives on eating disorders. New York: Guilford Press.

20.

Fisher

Golden

N. H

Katzman

D. K

Kreipe

R. E

Rees

Schebendach

Sigman

Ammerman

Hoberman

(1995). Eating disorders in adolescents: A background paper. Journal of Adolescent Health, 16, 420–437.

21.

Garner

D. M

Garfinkel

P. E.

(1979). The Eating Attitudes Test: An index of the symptoms of anorexia nervosa. Psychosomatic Medicine, 9, 273–279.

22.

Garner

D. M

Olmsted

M. P

Bohr

Garfinkel

P. E.

(1982). The Eating Attitudes Test: Psychometric features and clinical correlates. Psychological Medicine, 12, 871–878.

23.

Gilbert

Thompson

J. K.

(1996). Feminist explanations of the development of eating disorders: Common themes, research findings, and methodological issues. Clinical Psychology: Science & Practice, 3, 183–202.

24.

Gleaves

D. H

Eberenz

K. P.

(1995). Assessing dissociative symptoms in eating disordered patients: Construct validation of two self-report measures. International Journal of Eating Disorders, 18, 99–102.

25.

Goldner

E. M

Cockhill

L. A

Bakan

Birmingham

C. L.

(1991). Dissociative experiences and eating disorders. American Journal of Psychiatry, 148, 1274–1275.

26.

Greenes

Fava

Cioffi

Herzog

D. B.

(1993). The relationship of depression to dissociation in patients with bulimia nervosa. Journal of Psychiatric Research, 27, 133–137.

27.

Gross

Rosen

J. C

Leitenberg

Willmuth

M. E.

(1986). Validity of the eating attitudes test and the eating disorders inventory in bulimia nervosa. Journal of Consulting and Clinical Psychology, 54, 875–876.

28.

Hawkins

R. C

Clement

P. F.

(1980). Development and construct validation of a self-report measure of binge eating tendencies. Addictive Behaviors, 5, 219–226.

29.

Heatherton

T. F

Baumeister

R. F.

(1991). Binge eating as escape from self-awareness. Psychological Bulletin, 110, 86–108.

30.

Herzog

D. B

Copeland

P. M.

(1985). Eating disorders. New England Journal of Medicine, 313, 295–303.

31.

Janet

(1907). The major symptoms of hysteria. NY: Macmillan.

32.

Johnson

Larson

(1982). Bulimia: An analysis of moods and behavior. Psychosomatic Medicine, 44, 341–351.

33.

Johnson

Lewis

Hagman

(1984). The syndrome of bulimia: Review and synthesis. Psychiatric Clinics of North America, 7, 247–273.

34.

Katz

B. E

Gleaves

D. H.

(1996). Dissociative symptoms among patients with eating disorders: Associated feature or artifact of a comorbid dissociative disorder? Dissociation: Progress in the Dissociative Disorders, 9, 28–36.

35.

Katzman

M. A

Wolchik

S. A.

(1984). Bulimia and binge eating in college women: A comparison of personality and behavioral characteristics. Journal of Consulting and Clinical Psychology, 52, 423–428.

36.

Kent

Waller

Dagnan

(1999). A greater role of emotional than physical or sexual abuse in predicting disordered eating attitudes: The role of mediating variables. International Journal of Eating Disorders, 25, 159–167.

37.

Kihlstrom

J. F

Glisky

M. L

Angiulo

M. J.

(1994). Dissociative tendencies and dissociative disorders. Special Issue: Personality and Psychopathology. Journal of Abnormal Psychology, 103, 117–124.

38.

Koss

M. P.

(1993). Detecting the scope of rape: A review of prevalence research methods. Journal of Interpersonal Violence, 8, 198–222.

39.

Lingswiler

V. M

Crowther

J. H

Stephens

M. A. P.

(1989). Affective and cognitive antecedents to eating episodes in bulimia and binge eating. International Journal of Eating Disorders, 8, 533–539.

40.

Mann

Nolen-Hoeksema

Huang

Burgard

Wright

Hanson

(1997). Are two interventions worse than none? Joint primary and secondary prevention of eating disorders in college females. Health Psychology, 16, 215–225.

41.

McCallum

K. E

Lock

Kulla

Rorty

Wetzel

R. D.

(1992). Dissociative symptoms and disorders in patients with eating disorders. Dissociation: Progress in the Dissociative Disorders, 4, 227–235.

42.

Polivy

Herman

C. P.

(1985). Dieting and binging: A causal analysis. American Psychologist, 40, 193–201.

43.

Polivy

Herman

C. P.

(1993). Etiology of binge eating: Psychological mechanisms. In Fairburn

C.G.

Wilson

G.T.

(Eds.), Binge eating: Nature, assessment and treatment (pp. 173–205). New York: Guilford.

44.

Putnam

F. W.

(1989). Diagnosis and treatment of multiple personality disorder. New York: Guilford Press.

45.

Reto

C. S

Dalenberg

C. J

Coe

M. T.

(1993). Dissociation and physical abuse as predictors of bulimic symptomatology and impulse dysregulation. Eating Disorders: The Journal of Treatment and Prevention, 1, 226–239.

46.

Root

M. P. P

Fallon

Friedrich

W. N.

(1986). Bulimia: A systems approach to treatment. New York: W. W. Norton.

47.

Rosen

E. F

Petty

L. C.

(1994). Dissociative states and disordered eating. American Journal of Clinical Hypnosis, 36, 266–275.

48.

Swirsky

Mitchell

(1996). The binge-purge cycle as a means of dissociation: Somatic trauma and somatic defense in sexual abuse and bulimia. Dissociation: Progress in the Dissociative Disorders, 9, 18–27.

49.

Torem

(1986). Dissociative states presenting as an eating disorder. American Journal of Clinical Hypnosis, 29, 137–142.

50.

Valdiserri

Kihlstrom

J. F.

(1995a). Abnormal eating and dissociative experiences. International Journal of Eating Disorders, 17, 373–380.

51.

Valdiserri

Kihlstrom

J. F.

(1995b). Abnormal eating and dissociative experiences: A further study of college women. International Journal of Eating Disorders, 18, 145–150.

52.

Waller

N. G

Putnam

F. W

Carlson

E. B.

(1996). Types of dissociation and dissociative types: A taxometric analysis of dissociative experiences. Psychological Methods, 1, 300–321.

53.

Williams

R. L

Schaefer

C. A

Shisslak

C. M

Gronwaldt

V H

Comerci

(1986). Eating attitudes and behaviors in adolescent women: Discrimination of normals, dieters, and suspected bulimics using the Eating Attitudes Test and Eating Disorder Inventory. International Journal of Eating Disorders, 5, 879–894.

54.

Worell

(1996). Opening doors to feminist research. Psychology of Women Quarterly, 20, 469–485.