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1994
Explicit Memory Bias for Body-Related Stimuli in
Eating Disorders.
Shannon Buckles Sebastian
Louisiana State University and Agricultural & Mechanical College
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O rder N u m b er 9 5 0 8 5 9 9
E x p licit m em ory bias for b o d y -rela ted stim u li in e a tin g disorders
Sebastian, Shannon Buckles, Ph.D.
The Louisiana State University and Agricultural and Mechanical Col., 1994
UMI
300 N.ZeebRd.
Ann Arbor, MI 48106
EXPLICIT MEMORY BIAS FOR BODY-RELATED STIMULI
IN EATING DISORDERS
A Dissertation
Submitted to the Graduate Faculty of the
Louisiana State U niversity and
Agricultural and Mechanical College
in partial fulfillment of the
requirements for the degree of
Doctor of Philosophy
in
The Department of Psychology
by
Shannon Buckles Sebastian
B . A . , Unive r s i t y of North Carolina, 1989
M . A . , Louisiana State University, 1991
August 1994
Table of Contents
List of T a b l e s ........................................... iii
List of F i g u r e s ......................................
Abstract
...............................................
Introduction ...........................................
iv
v
1
M e t h o d .................................................
27
Results
42
D i s c u s s i o n .............................................
65
R e f e r e n c e s .............................................
83
Appendix A:
Body Image Assessment (BIA).............
88
Appendix B:
Eating Attitudes Test
(EAT).............
90
Appendix C:
Bulimia Test
....................
93
Appendix D:
Interview for the Diagnosis of
.............
Eating Disorders (IDED)
(BULIT)
........
99
Appendix E:
Body Shape Questionnaire (BSQ)
Ill
Appendix F:
Beck Depression Inventory (BDI)........... 115
Appendix G:
Visual Analogue Scale
Appendix H:
Subjective Units of Distress Scale
( S U D S ) .................................... 120
Appendix I:
Eysenck Personality Questionnaire
( E P Q ) ................... , .................122
Appendix J:
Shipley Institute of Living Scale
( S I L S ) .................................... 125
Appendix K:
Verbal Stimuli
..........................
128
Appendix L:
Memory Questionnarie ...................
130
Appendix M:
Scoring Guide for Memory
Questionnaire
.........................
132
(VAS)............... 118
V i t a .......................................................134
ii
List of Tables
1.
2.
3.
Mean, Length, Frequency, and Judgment
Rating of Verbal Stimuli by Word T y p e ......
A NOVA and MANOVA Results and Means of
Subject Characteristic Variables by Group . . .
43
ANOVA and MANOVA Results and Means of
Subject Characteristic Variables by Diagnosis .
46
4.
Serial Position Data:
5.
Memory Data:
6.
Memory Intrusions:
Means by Group ...........
49
Means by G r o u p ...................
Means by Group
54
...........
57
Correlation Analyses:
8.
Reaction Time Data (in seconds):
Means by G r o u p ..............................
Pleasantness Ratings:
Across Groups
Means by Group ...........
iii
50
.............
7.
9.
37
59
62
List of Figures
1.
Experimental Design ...............................
23
2.
Explicit Memory Results: Three G r o u p ..............
51
3.
Explicit Memory Results: Five Group
...............
52
4.
Intrusion D a t a ....................................
55
5.
Reaction Time D a t a ...............................
60
6.
Pleasantness Rating D a t a ........................
63
iv
Abstract
This investigation studied the presence of an explicit
memory bias for emotional body related stimuli
diagnosed with an eating disorder.
to
the
recall
of stimuli
Explicit m e m o r y refers
previously presented.
memory tasks are thought to reflect cognitive
mechanisms.
in patients
Explicit
elaboration
Research on depressed patients has found a bias
for recalling negatively valenced information and/or a bias
against
recalling
positively
valenced
information.
This
study sought to extend this type of memory bias research to
eating disorder patients.
Three groups were examined, a group of clinical eating
disordered women (n=30), a group of weight p r e o c c u p i e d non­
eating disordered individuals
(n=30), and a control
without an eating disorder or weight p r e o c c u p a t i o n
group
(n=3 0 ) .
Each group participated in an encoding task w h i c h presented
words of three affective valences
non-emotional
body
related,
(emotional b ody related,
and n e u t r a l ) .
Subje c t s
were
instructed to imagine themselves in a scene involving each
word.
Following the encoding task,
recall
these
words
in
a
free
subjects w ere asked to
recall
format.
There
was
evidence of a memory bias for emotional body related words
in eating disorder patients.
There was no e v i d e n c e for an
explicit memory bias in weight preoccupied
subjects.
The
groups did not differ in the recall of n o n - e m o t i o n a l body
related or neutral words.
v
As
predicted,
eating disorder patients recalled more
emotional body related words than the weight preoccupied or
control
groups.
It
is
possible
that
eating
disorder
patients engage in greater elaboration of emotional stimuli
related
normals.
to
body
shape
and weight than weight preoccupied
Thus, preoccupation with body shape and weight may
not be sufficient to cause an explicit memory bias.
Results
suggest that the influence of depression and neuroticism on
explicit memory bias is minimal.
Introduction
Recently,
the
information
processing
paradigm
been applied to numerous psychological disorders.
has
Much of
this research has stemmed from Gordon Bower's associative
network theory of memory.
model
(Bower,
associated
fashion.
1981)
Bower's
spreading activation
proposed that memory
networks
w hich
interact
in
is composed of
a
hierarchical
In these networks, memories are associated with
one another and with information relevant to the memories.
In addition, each memory network is composed of "primitive
emotion nodes."
corresponding
Therefore,
events
node,
each
that
Bower proposes that each emotion has a
or
unit,
emotion
occurred
in
node
an
in
is
the
memory
linked
individual's
particular emotion was experienced.
to
system.
memories
life
when
of
that
Bower has noted that
when an emotion node is activated, either by physiological
or
symbolic
stimuli,
excitation
radiates
to
nodes
that
control the autonomic response and overt behavior of the
specific emotion.
Also, spreading a ctivation diffuses to
the memory structures that are related to the particular
emotion.
Thus, the a c tivated emotion node will influence
subsequent memories retrieved.
Cognitive Models of Eating Disorders
The application of Bower's spreading activation model
to disorders
development
such as anxiety and depression spurred the
of
cognitive
models
of
eating
disorders.
Cognitive research has employed various methodologies for
investigating
how
knowledge
from
the
experience
of
environmental stimuli is stored in memory and,
also,
cognitive events influence behavior.
empirical
To date,
how
investigations have focused on quantifying attentional and
memory biases.
Cognitive
proposed
scientists
sensory
such
as Anderson
information,
as
well
(1985)
as
have
permanent
information, play a role in cognitive processes in eating
disorders.
Anderson termed information as p e rmanent when
it serves to preserve sensory information as perceptual
images
On
as
the
"perception-based
other
knowledge
hand,
representations."
"meaning-based
knowledge
representations" are formed when conceptual information is
abstracted from perceptual details.
of Bower,
Similar to the ideas
Anderson theorized that "propositional
units"
represent the smallest units of knowledge and are arranged
hierarchically.
Information
bottom-up processing
is
organized
to
m a x imize
in which low-level basic processes
lead to higher-order representations.
On the other hand, Abelson and Black (1986) appealed
that humans use top-down processing to access knowledge.
These
authors
contended
that
information
is
first
processed at a broad level and later refined to reflect a
specific
situation.
Schlundt
and Johnson
(1990)
noted
that the theories of Anderson (1985) and Abel s o n and Black
(1986)
are not necessarily incompatible.
Investigations
of the bottom-up approach have offered conclusions about
perception,
Whereas,
categorization,
studies
examining
and
the
information
top-down
storage.
approach
have
resulted in greater knowledge of schemata and behavioral
scripts.
been
More specifically,
discussed
as
two types of schemata have
relevant
to
eating disordered individuals:
cognitive
processes
in
self-schemata and weight-
related schemata.
Self-Schemata.
emotional
disorders
vulnerable
to
Beck's
suggested
emotional
cognitive
structures,
units
knowledge
of
(19 67)
that
disorders
or
schema.
that
cognitive
model
individuals
who
have
are
dysfunctional
Schemata
represent
of
are
general
complex
concepts.
Schemata serve to select and modify experiences in order
to
determine
relevant
stored
and,
in
attention,
which
aspects
accordingly,
information
are
most
which
information
schema
influence
selective
and retrieval processes.
Schemata
memory.
encoding,
of
Thus,
will
be
most relevant to the psychopathology of eating disorders
are
self-schema.
Self-schema
influence
cognitive
representation of self-perception and behavior.
(197 7)
contended
individual
behavior.
that
attempts
to
self-schema
explain
or
are
formed
understand
Markus
when
the
his/her
As experiences accumulate, self-schemata become
increasingly resistant to
inconsistent
information.
If
contradictory information is encountered frequently, self­
schema gradually change to approximate the new knowledge.
Vitousek
and
Hollon
core psychopathology
represented
in
(1990)
have
proposed
that
of anorexia and bulimia nervosa
organized
cognitive
structures,
the
is
or
schemata, that connect self-perception with beliefs about
weight.
In
hypothesized
eating
to
disorders,
influence
self-schemata
information
are
processing
concerning food and weight,
and serve to maintain eating
disorder
Markus,
(1987)
symptomatology.
Hamill,
and
Sentis
examined the effect of self-schemata on processing
of weight-relevant
information.
Results
indicated that
individuals who identified their self-concept with weight
processed information concerning body shape, body fat, and
food more quickly than individuals whose self-concept did
not
include
empirical
distinct
the
construct
evidence
cognitive
does
of weight.
not
support
structures
in
However,
the
to date
existence
anorexia
or
of
bulimia
nervosa that are related to eating and weight concerns.
Weight-Related S c h e m a t a .
have
defined
weight
Vitousek and Hollon (1990)
related
schemata
as
cognitive
structures that code information about what it means to be
thin or fat,
self
as thin
bulimics
have
rather than schema about the status of the
or
fat.
developed
It
is
likely
extensive
that
anorexics
associative
and
networks
linking the construct of thinness to beauty, intelligence,
and self-control,
for example.
construct
of
personal
weaknesses
combination
history,
fatness
of
is most
or
cultural
Vitousek
and
On
the
likely
o ther hand,
linked
imperfections.
values
Hollon
various
Due
and
idiopathic
have
proposed
meaning of weight will be more elaborated,
and emotional
to
the
to
a
learning
that
the
idiosyncratic,
for eating disordered as c o m p a r e d to n o n ­
eating disordered individuals.
Furthermore, in the context of i nformation p r o c e s s i n g
theories, schemata can include information about bot h the
self and weight.
These knowledge s t ructures
are termed
"weight-related self-schemata," and are a c o m b i n a t i o n of
self-schemata and weight-related schemata.
self-schemata
represent the
anorexia and bulimia nervosa.
criteria
for
evaluating the
Weight-related
specific p s y c h o p a t h o l o g y
of
Weight and shape be c o m e the
self.
Eventually,
beliefs
about weight and shape influence v i r t u a l l y all aspects of
the
patient's
life
including
affect,
cognition,
and
behavior.
Schlundt and Johnson
how
cognitive
events
disorders.
The
processing
stages
(1990) have o f f e r e d a m odel of
influence
model
assumes
occur
environmental context.
behavior
that
within
a
in
all
the
eating
information
biological
and
The context p r o v i d e s a set of cues
that are encoded as physical energy and b e c o m e ava i l a b l e
for
information
processing
through
sensory
channels.
Schlundt
m oving
and Johnson conceive
through
a
series
information processing as
of
stages
information and output of behavior.
between
input
of
The processes that
occur at each stage depend on the output of the previous
stage.
Processing of information flows through the four
stages of perception, interpretation, decision making, and
response
execution.
In
the model,
the
first
processing involves perceptual processing.
stage
of
At this stage,
input from sensory channels is attended to, and biological
and environmental cues are perceived.
of
the
individual
to
process
Since the capacity
information
is
limited,
"selective attention" determines which information in the
environment is perceived.
by
information
Selective attention is guided
stored
"Misidentification
of
in
cues"
may
long
term
occur
if
memory.
information
stored in long term memory is incomplete or incorrect.
addition,
the
emotional
state
of
the
individual
In
may
influence accessibility of information in long term memory
and result in misperception of cues.
The
into
an
second
stage
overall
involves the
interpretation
integration
of
the
of
cues
environment.
Schemata guide logic and conceptualization of information
in
long
retrieval
term
of
memory.
information.
In
turn,
schemata
influence
In this stage of processing,
several types of cognitive errors may occur (e.g., all-or-
nothing
thinking.
catastrophic
thinking,
or
overgeneralization).
In
the
third
stage
of
processing,
the individual
decides how to behave by considering the response options
that are linked to the interpretive schema.
Maladaptive
behavior may result if the individual considers the wrong
set of potential
outcomes,
particular outcomes,
places unrealistic values on
or misjudges the likelihood of the
outcome of a certain response.
Following selection of
a
is
response,
the
chosen
response
series of overt behaviors.
the
individual
must
translated
into
a
Along with performance skills,
utilize
feedback to
assist
in
monitoring and adjusting behavior with experience.
The
behaviors
the
selected
cognitive
schemata
situation
and
and
their
that
selecting
outcomes
were
used
in
the
behaviors.
influence
interpreting
Schemata
the
are
altered depending on how successful or unsuccessful the
performance.
between
Through
behavior
and
this
the
process,
the
environment
is
relationship
continually
modified over time.
Body
Image in Eating Disorders
Schlundt
concept
of
and
Johnson
self-schemata
pertains to body
(1990)
in the
also
discussed
eating disorders
image disturbance.
the
as
it
These authors have
contended that the cognitive theory of body images can be
represented
in
a
hierarchical
fashion.
At
the
lowest
level perception-based knowledge representations integrate
numerous perceptions to form a composite body image.
At
the second level, body image is a meaning-based knowledge
representation.
At this level, facts are associated with
perceptions
body
of
parts.
At
the
highest
level,
information about general appearance becomes part of the
individual's self-schemata.
Schlundt and Johnson acknowledged that we know very
little
body
about
how
these
image perception.
established,
between
they
long
concepts
become
However,
once the b ody
propose
term
associated
hypothetical
memory,
for the
image
is
associations
information
processing,
motivational systems, and environmental stimuli.
model,
with
In this
the environment is depicted as a source of input
information processing system and the target of
output
for
behavior.
system,
perception,
In
the
information
interpretation,
processing
d e c ision making,
and
response programming intervene between stimulus input and
behavior.
The
information
processing
system
interacts
with the motivational components of affect and physiology,
and the
long term memory
network.
Long
assumed to be organized hierarchically.
term memory
is
Self-schemata,
people schemata, object schemata, and action schemata are
interconnected
behavioral
and
consist
information.
In
of
ideas,
summary,
affect,
affective
and
and
physiological states feed into the information processing
system which interacts with memory to influence retrieval
of
related
depressed,
schemata.
For
example,
if
a
person
feels
then the retrieval of schemata with links to
negative affect nodes is likely.
Attentional Biases in Eating Disorders
Few
studies
have
investigated
mood
congruent
attentional processes in the eating disorders.
suggested that eating disorders
bias"
toward
andbody
stimuli
size /
related
shape.
Some have
lead to an "attentional
to
concerns
Attentional
shift
about
eating
is assumed
to
have occurred if there is a change in direction in which
attention is focused so that the person becomes aware of
a particular aspect of the environment.
Investigations of
selective attention have either examined how attention to
stimuli facilitates or inhibits task performance.
Investigations of selective attention in the eating
disorders have hypothesized that overconcern with body
shape
and weight may result in an attentional
body size and weight related stimuli.
bias
for
Garner and Bemis
(1982) have suggested that preoccupation with body size in
the eating disorders is due to increased time focusing on
weight
coupled
Furthermore,
with
excessive
Williamson,
concerns
Barker,
and
about
Norris
thinness.
(in
press)
have contended that attentional bias may mediate fear of
fatness
and
disorders.
body
image
Williamson
disturbance
et
al.
have
in
the
proposed
eating
that
10
attentional biases favoring fatness and thinness stimuli
are
driven
by
overconcern
thinness
fear
about
stimuli
of
body
fatness
size.
because
and
the
Attention
such
stimuli
resulting
is
drawn
to
represent safety.
Whereas, fatness related stimuli represent danger and fear
of
weight
gain.
Eventually,
selective
attention
to
fatness and thinness related environmental cues may result
in
body
size
d isturbance
and
increased
preference
for
thinness.
Two basic techniques have been adopted from cognitive
research of anxiety and depression and used to investigate
attentional biases
in eating disorders:
and dichotic listening tasks.
was
developed
stimulus
Subjects
while
by
words
are
Stroop
are
the Stroop task
The first research paradigm
(1935).
printed
in
In
this
methodology,
different
color
inks.
instructed to state the color of each word
ignoring
investigation,
the
word
itself.
In
his
original
St r o o p found that the latency to name the
color of ink in w h i c h a word was printed was longer when
the word was the name of a different color.
interference
occurred
when
color
Whereas,
no
naming
nonsense
In recent v ariations of the Stroop task,
the words
are
emotional
syllables.
used
tone.
of
specific
affective
valences,
or
The subject is instructed to name the color of ink
in which
each
word
is
printed
and
response
latency
is
11
measured.
color
Studies
naming when
naming
consistently
stimuli
psychopathological
color
have
has
are
related
concerns.
been
found
found
For
by
to
slowing
the
example,
1985) , spider
(Watts,
McKenna,
related words
Sharrock,
&
to
(Mathews &
spider
Trezise,
phobics
1986),
negatively valenced words to depressed subjects
McCann,
of
threatening
words to generalized anxiety disorder patients
MacLeod,
subject's
slowing
presenting
of
and
(Gotlib &
1984).
Only
a
few
studies
have
investigated
processes in eating disorders.
Hemsley,
& de Silva,
1988)
attentional
One such study
(Channon,
found that anorexic
were generally slower than controls
subjects
in color naming all
words; however, the interference effect was greatest with
food related words.
Likewise,
Fairburn,
Cooper,
Cooper,
McKenna, and Anastasiades (1991) and Cooper, Anastasiades,
and Fairburn
(1992)
employed the Stroop m e t h o d o l o g y with
bulimia nervosa patients.
Results indicated that bulimics
were slower than controls in color naming words related to
eating,
shape,
and weight.
failed to find the Stroop
controls.
eating,
Therefore,
shape,
excessively
and
weight
In addition,
Fairburn et al.
interference effect
in
female
normative degrees of concern about
weight
in
preoccupied
females
may
be
impact the information processing system.
who
are
insufficient
not
to
In conclusion, available evidence has suggested that
eating
disordered
individuals
may
information related to eating,
Tovim, Walker,
selectively
shape,
process
and weight.
Ben-
Fok, and Yap (1989) proposed that food and
shape-related anxiety disrupts cognitive processing
results in cognitive and behavioral interference.
and
Various
researchers have hypothesized about the cause of slowing
on
the
Stroop
task.
The
stage
occurs remains to be determined.
at
which
interference
Attentional and response
explanations have been offered; however, neither seems to
provide an adequate account of the process behind Stroop
interference.
interference
retrieval.
meaning
An alternative analysis might suggest that
occurs
at
some
stage
between
encoding
and
It is at this intermediate stage that semantic
is assessed.
However,
in order to successfully
investigate attentional processes in various psychological
disorders, a clear differentiation of stages of proce s s i n g
must occur.
bulimics
Evidence to date suggests that anorexics and
may
not
have
an
attentional
bias,
but
may
be
in investigations
of
distracted by body and food related stimuli.
The second technique utilized
cognitive processes
listening
task.
in eating disorders
Schotte,
McNally,
is the dichotic
and
Turner
(1990)
employed this technique with bulimia nervosa patients.
this
procedure,
passages,
subjects
one to each
are
ear.
presented
Subjects
with
are
two
In
prose
instructed
to
"shadow,"
or repeat aloud,
the passage presented in one
ear (attended channel) and ignore the passage presented in
the other ear (unattended c h a n n e l ) .
task,
During the listening
subjects are asked to detect target words
passage.
channel
in each
Subjects usually detect targets in the attended
without
difficulty,
but
cannot
easily
identify
targets from the unattended passage, unless the words are
especially
salient
(e.g.,
one's
name
or
emotionally
significant words) . Findings have indicated that bulimics
detected target words related to body,
shape,
or weight
more often than neutral words when both were presented in
the unattended channel.
Moreover, bulimics responded with
larger skin conductance changes to words related to their
concerns as compared to neutral words.
Overall, current evidence suggests that anorexia and
b ulimia
nervosa
patients
selectively
attend
to
stimuli
related to body, shape, and weight; however, this does not
necessarily mean that eating disordered subjects further
e laborate on the stimuli in memory.
Although attentional
biases
the
occur
in
eating
disorders,
attention effects rehearsal and,
degree
to
which
in turn, memory must be
investigated in greater detail.
Me m o r y Biases in Eating Disorders
In
addressing
disorders,
First,
does
two
a
the
issue
hypotheses
memory
bias
are
for
of
memory
worthy
body,
of
bias
in
eating
investigation.
shape,
and
weight
related stimuli exist
in eating disordered
individuals?
Second, if an explicit memory bias exists, is it due to an
encoding
bias,
process?
a
retrieval
For example,
bias,
or
attention
to
some
intermediate
a stimulus may not
lead to encoding and elaboration on that stimulus in all
instances.
The stimuli, especially if anxiety producing,
may be subsequently avoided.
In addition,
is encoded, retrieval is not guaranteed.
or contextual)
if a stimulus
Cues (emotional
relevant to the stimulus may be necessary
to evoke the response.
same context examined
In other words,
memories of the
in different moods may change the
affective valence of the memory.
Investigators must focus
on what factors underlie memory biases in eating disorders
including
attentional
biases,
encoding
processes,
or
retrieval strategies.
Based upon empirical
and anxious patients,
patients
related
findings
related to depressed
it is likely that eating disorder
would exhibit a selective memory for information
to
shape
and
weight.
Although
food
and
body
related cognitions are common to all human beings, eating
disordered
specific
individuals may manifest cognitions that are
to
fear of
shape and weight.
of
cognitive
depression
and misperceptions
of body
This "content specificity" hypothesis
biases
(Haaga,
fatness
has
Dyck,
been
supported
& Ernst,
1991).
in
studies
of
15
Clinical observations have demonstrated that eating
disorder
patients
tend
to
recall
positive
or
negative
comments about their weight for lengthy periods of time.
Other
observational
disorders
school
includes
but
data
that
on memory
processes
anorexics
tend
appear to be deficient
about the world.
to
in
do
in general
eating
well
in
knowledge
Also, the obsessive pursuit of thinness
in anorexia and bulimia nervosa may be conceptualized as
a
focused
cognitive
style
effortful
processing
Gwirtsman,
1986).
which
requires
(Strupp,
considerable
Weingartner,
Kaye,
&
Only one published study to date has directly tested
m emory biases in eating disorders.
employed
various
presentation
neutrally
valenced
stimuli
to
Strupp et al.
strategies
anorexic
to
(1986)
disp l a y
subjects.
The
authors concluded that anorexia nervosa patients per f o r m e d
as well
or better than control subjects on m e m o r y tasks
that required cognitive effort, but performed more poorly
than controls on memory tasks that required incidental, or
automatic, learning.
have
examined
stimuli
patients
In
memory
relevant
(e.g.,
four
biases
the
memory
in
eating
concerns
food, body,
examining
disorders,
to
However, no published investigations
eating
using
disordered
or weight related words).
biases
approaches
of
disorders
have
in various
been
ps y c h i a t r i c
utilized:
recall, cued recall, recognition, and wor d completion.
free
In
these testing procedures
recall
as
complete
many
word
words
stems
(in respective order),
as
with
possible
letters
without
to
form
subjects
assistance,
words
from
a
previous task, choose the words previously presented from
a
list,
or
complete
remaining letters of
presented
words
stems
with
the
an unspecified word which may or may
not have been presented in a previous task.
Recognition
has not been an effective recall task in examining memory
biases.
Neither contextual learning nor mood effects are
elicited
using
recognition
cues are present.
when
additional
It is believed that the presentation of
the learned words over-rides the emotional
& Cohen, 1982).
influencing
filter
(Bower
Moreover, recognition differs from recall
in that it eliminates the search through memory and only
requires a judgment call.
Clinical
Implications of Memory Bias
Teasdale
argues
for
(1983) has proposed a cyclical model which
memory
depression.
biases
as
a
maintenance
variable
in
Teasdale has claimed that a depressed state
will result in negative memories becoming more accessible
and, thus, recalled more often.
is
maintained
and,
in
increasingly
accessible.
Teasdale
further
has
turn,
A
predicted
Consequently, depression
negative
vicious
that
memories
cycle
recall
of
are
develops.
negative
events will lead to lowered expectations of coping skills
and negative interpretations of environmental events.
It is likely that similar cognitive processes exist
in persons with eating disorders.
individuals
related
focus
to
on
these
weight
are strengthened.
experiences
negative
may
concerns,
become
memories
increasingly
In this, weight related concerns
In addition, memories of weight related
(e.g., being teased about weight) may lead to
interpretations
related stimuli
coping
related
concerns
accessible at retrieval.
Since eating disordered
skills
in the
may
of
ambiguous
future.
result
body
or
weight
Lowered expectations of
in
binging
and
purging
in
bulimics or increased dietary restraint in anorexics.
Rationale
The
literature using a free recall methodology has
supported
content
specificity
explicit memory bias
an
explanation
for
for negatively valenced stimuli
depression.
However,
examined
eating
in
as
this
phenomenon
disorders.
In
has
the
not
in
been
depression
literature, Bower's associative network theory and Beck's
self-schema
theories
have
been
used
to
explain
the
findings related to cognitive processes in depression, but
no firm conclusions have been drawn.
As noted by Watkins,
Mathews, Williamson, and Fuller (1992) explicit memory may
be due to several processes.
Attentional biases, encoding
processes,
or retrieval
these,
interact with memory processes
may
explicit memory biases.
strategies,
or a combination of
and result
in
The eating disorder patient may have bi a s e d attention
toward
concern
body stimuli)
related
stimuli
(e.g., food,
weight,
or
or such stimuli may be more salient in the
environment of the eating disordered individual.
Greater
allocation of attention to relevant stimuli m a y make such
stimuli more likely to be encoded.
In o rder to test this
hypothesis,
m ust
tested.
the
attentional
processes
be
empirically
Furthermore, concern related stimuli may prevent
eating
disorder
information.
Thus,
patient
from
learning
conflictual
cognitive biases are maintained.
is likely that food,
weight,
It
or body related information
distracts the eating disorder patient and prevents other
information from being encoded.
Past
studies
have
measured
implicit and explicit memory.
defined
as
the
two
types
of
memory:
Implicit m e m o r y has been
presentation
of
stimuli
from
a
task
affecting subsequent behavior even though the task m a y not
be explicitly recalled.
Various researchers have referred
to implicit memory as procedural,
and
data
driven
information
awareness.
declarative,
that
memory.
is
working,
Explicit
directly
Explicit
reference,
memory
semantic,
memory
accessible
has
expectancy,
also
to
involves
conscious
been
termed
and e p i sodic memory.
In
this study, explicit memory for valenced stimuli will be
measured.
Implicit
encoding
and
explicit memory may
strategies.
Encoding
be
influenced
processes
integration and elaboration (Mandler, 1980).
by
involve
Mandler has
suggested that integration is involved in implicit memory,
whereas,
elaboration
Integration
influences
is described
as
an
activates relevant schemata.
explicit
automatic
memory.
process
which
The result is strengthening
of the activated schema which then becomes more readily
accessible to memory.
can
be
activated
Therefore, well integrated schemata
when
only
stimulus are presented.
a
few
components
of
the
This process is illustrative of
implicit memory.
Elaboration
integration.
information
Control
is
elaboration,
schema
in
has
been
and
associative
how
links
associative
explicit memory,
to
follow
processes mandate what particular
processed
the
postulated
it
are
is
processed.
formed
network.
As
to
In
related
evidenced
in
elaboration increases accessibility and
retrievability of the schema.
It
involved
is
possible
in
in a
information
elaborative
hypothesized
disorder patients.
stimuli
that
Watkins et al.
biases
may
in
be
eating
Eating disorder patients may encode
fashion
related
cognitive
processes
that
to
a
results
in
better
psychopathological
recall
of
concern.
(1992) noted that past research has found
20
free recall, as well as cued recall and word recognition,
to be enhanced by semantic encoding conditions.
The
present
encoding
task.
study
will
Experimental
employ
a
self-referencing
paradigms
have
used
self-
referencing tasks which instruct subjects to relate to-beencoded
stimuli
consistently
exhibit
a
to
found
mood
themselves.
that
These
subjects
congruent
are more
memory
information was self-related.
1979).
suggested
Evidence
that
from
eating
bias
have
likely
if
to
encoded
This process is similar to
Beck's concept of "personalization"
Emery,
studies
(Beck,
Rush,
Shaw,
clinical observation
disorder
patients
tend
&
has
to
personalize ambiguous information, especially in relation
to body,
shape,
or weight.
Therefore,
it is likely that
eating disordered individuals will demonstrate a content
specific
self-referent
recall
bias
in
laboratory
investigation.
The emotionality of stimuli has been postulated to
influence memory.
Mogg and Ma r d e n
(1990)
failed to find
enhanced recall of non-emotional rowing related words by
rowing team subjects.
The authors concluded that stimuli
must have emotional relevance as well as content relevance
to
the
concerns
of
the
subject.
Selective
memory
for
concern related stimuli may not occur when words are not
emotionally salient.
In the present study, emotional body
related words and non-emotional body related words will be
21
included as stimuli
in order to control
for the emotion
related to body words.
Problem
The purpose of this study was to investigate explicit
memory
in eating
disorders.
groups of individuals,
This
study
compared
three
a group of females diagnosed with
anorexia nervosa, bulimia nervosa, or eating disorder not
otherwise specified,
eating
All
disordered
subjects
valences
a group of weight p reoccupied n o n ­
individuals,
were
exposed
(emotional
body
to
and
a c omparison
words
of
related,
three
group.
affective
non-emotional
body
related, and n e u t r a l ) . Subjects participated in a task in
which they imagined themselves in a scene w h i c h involved
each word.
Following this encoding task, subjects engaged
in a filler task.
explicit
recall
memory
words
Next, subjects engaged in a free recall
task
in which
which they were
they
were
exposed to
instructed
earl i e r
to
in the
experimental session.
Thus, the design of this study was
a
x
3
(subject
stimuli)
one.
groups)
design.
3
(affective
This design
is
vale n c e
illustrated
of
verbal
in Figure
The predictions of this investigation are presented
below.
Hypothesis
preoccupied
Questionnaire
critical
1:
Eating
normals
score.
variable
in
will
If
be
disordered
and
equated
Body
weight
determining
on
preoc c u p a t i o n
memory
bias,
weight
Shape
is
it
a
is
22
predicted
that
preoccupied
eating
subjects
disordered
will
recall
subjects
and
weight
proportionally
more
emotional body related words in the free recall task than
the
low
weight
preoccupied
group.
However,
if
the
critical determinant of memory bias is not preoccupation
with
weight,
but
condition itself,
will
recall
a variable particular
to
the clinical
it is predicted that clinical subjects
proportionally
more
emotional
body
related
words in the free recall task than the weight preoccupied
group.
This hypothesis is predicted because of previous
findings of explicit memory bias in depression.
Also,
of
memory
if preoccupation with weight is a determinant
bias,
it
is
predicted
that
the
weight
preoccupied group will recall more emotional body related
words than the low weight preoccupied group.
However,
weight preoccupation is not a critical variable,
if
then it
is predicted that the weight preoccupied group will
not
differ from the low weight preoccupied controls on recall
of emotional body related words.
The dependent variable (memory bias) will be d efined
one
of
two ways.
If groups
neutral words recalled,
do
not differ
in
number
of
the raw number of words recalled
will serve as the memory bias score.
However,
if groups
differ significantly on number of neutral words recalled,
a corrected score equal to the difference between number
23
Group
Eating
Disorder
Weight
Preoccupied
Control____
i
I
)
Emotional
Body Related
Non-Emotional
Body Related
Word
Type
Neutral
DV:
Number of correct words recalled on explicit memory
task.
Figure 1
Experimental Design
24
of body words and number of neutral words recal l e d will be
the memory bias score.
Hypothesis
memory bias,
2:
If emotionality of stimuli
enhances
it is predicted that groups will not differ
on number of non-emotional body related or neutral words
r e c alled.
Hypothesis
3:
Words
recorded
which
wer e
not
presented during the encoding task
(intrusions)
categorized according to valence.
It is p r e d i c t e d that
clinical
subjects
and weight
preoccupied
will be
subjects
will
have more body related intrusions than the control group.
Hypothesis
correlations
disorder
4:
will
It
be
is
found
symptomatology
predicted
between
(EAT,
that
significant
measures
BULIT)
of
eating
and
weight
preoccupation (BSQ), and number of emotional b o d y related
words recalled on the explicit memory task.
Hypothesis 5:
It is predicted that the correlation
between measures of eating disorder s y m p t o m a t o l o g y
BULIT)
body
(EAT,
and the number of neutral words and non-emotional
related
words
correctly
recalled
will
not
be
significant.
Hypothesis
6:
Based on the assumptions
of
associative network theory,
severity of e a t i n g
symptomatology
subthreshold
concern-related
will
nodes
cause
in
memory.
In
Bower's
disorder
activation
o rder
to
of
examine
whether the cause of memory bias is n e u r o t i c i s m or eating
25
disorder
symptomatology,
performed.
and
a
series
of
analyses
will
be
Groups will differ significantly on depression
neuroticism
Inventory
and
as
the
Questionnaire.
depression
measured
N-scale
Following
and
by
of
the
the
Eysenck
removal
neuroticism,
it
Beck
of
Depression
Personality
variance
is predicted
due
that
to
group
differences on memory bias will diminish.
It
is
predicted
that
measures
of
eating
disorder
symptomatology (EAT, BULIT) will be positively correlated
with
recall
depression
bias.
or
If
neuroticism
correlation coefficient,
d epression
removal
of
results
then
variance
in
a
due
decreased
it will be concluded
or neuroticism may
play
to
a m e diating
that
role
in
memory bias.
Hypothesis 7:
and
weight
It is predicted that eating disordered
preoccupied
subjects
will
respond
p roportionally faster than control subjects to emotional
body
related
prediction
stimuli
will
be
in
tested
the
encoding
by
recording
task.
the
This
response
latency for subjects to press a key indicating that they
have
imagined
presented
theory
a
word.
which
subthreshold
scene
This
states
involving
prediction
that
activation.
mood
themselves
is
based
congruent
Therefore,
on
and
Bower's
concepts
imagining
the
have
scenes
related to weight preoccupation should be p r o portionally
26
faster.
This
hypothesis
is
not
crucial
to
the
basic
purpose of this investigation.
Hypothesis 8:
It is predicted that clinical subjects
and we i g h t preoccupied subjects will rate emotional body
w ords as more unpleasant than the control group.
Groups
are not predicted to differ on pleasantness rating of nonemotional or neutral words.
Method
Subi ects
Two experimental groups were included in this study.
One experimental group consisted of thirty females with a
primary eating disorder diagnosis:
10
bulimia
nervosa;
specified.
10
Consecutive
eating
10 anorexia nervosa;
disorder
eating
not
disorder
otherwise
cases
were
identified from inpatient and outpatient admissions to the
St.
Clare unit of Our Lady of the Lake Regional Medical
Center and the Psychological Services Center of Louisiana
State University.
were
included
disorder
cases
Patients which agreed to participate
in
the
were
participation
in
participate.
BSQ
study.
Approximately
screened,
and
study.
Of
the
scores
for
the
35
met
those,
eating
40
eating
criteria
30
agreed
for
to
disorder group
ranged from the lowest score of 90 to the highest score of
204.
The eating disorder diagnosis was determined using
a clinical
interview
Disorders) .
(Interview
for Diagnosis of Eating
Individuals in this group met the diagnostic
criteria for anorexia nervosa, bulimia nervosa, or eating
disorder not otherwise specified
(NOS)
as defined by the
Diagnostic and Statistical Manual of Mental Disorders, the
third
revised
Association,
version
(DSM-III-R;
American
Psychiatric
1987).
DSM-III-R
inclusion
criteria
anorexia nervosa are as follows:
27
for
a
diagnosis
of
(a) Refusal to maintain
28
body
weight
height,
even
over
a
minimal
normal
weight
for
age
and
(b) Intense fear of weight gain or becoming fat,
though
underweight,
(c)
which one's body weight,
Disturbance
size,
of shape
in the
way
in
is experienced,
(e) In females, the absence of at least three consecutive
menstrual cycles when otherwise expected to occur.
DSM-III-R
inclusion
criteria
bulimia nervosa are as follows:
binge eating,
behavior
for
a
diagnosis
of
(a) Recurrent episodes of
(b) A feeling of lack of control over eating
during
the
eating
binges.
(c)
The
person
regularly engages in either self-induced vomiting, use of
laxatives
or
diuretics,
strict
dieting
or
fasting,
vigorous exercise in order to prevent weight gain,
or
(d) A
minimum average of two binge eating episodes a w eek for at
least three months,
(e) Persistent overconcern with body
shape and weight.
Eating disorder not otherwise specified,
as derived
from proposed DSM-IV criteria (Wilson & Walsh,
1991), was
defined as disorders of eating that do not meet criteria
for either anorexia nervosa or bulimia nervosa.
criteria
the
for subthreshold anorexia nervosa
following:
(a)
A patient
who
Inclusion
consisted of
displays
all
of
the
usual features of anorexia nervosa but is not amenorrheic.
(b)
All
of
the
criteria
for
anorexia
nervosa
except the abnormally low weight requirement.
criteria
for
subthreshold
bulimia
nervosa
are
met
Inclusion
included
the
following:
distress
(a) Eating binges accompanied by significant
but
without
any
regular
compensatory
behavior
(e.g., vomiting or laxative a b u s e ) . (b) Eating binges with
atypical
pills) .
compensatory
(c)
Eating
twice a week
the
absence
amount
of
person
who
amounts
mechanisms
binges
at
for 3 months,
of
the consumption
the
repeatedly
chews
food.
An
abuse
of
diet
frequency
of
less
than
(d) Compensatory behavior in
food to meet
of
a
(e.g.,
of a sufficiently
criteria
but
eating
for a binge,
does
not
disorder
swallow
large
(e)
A
large
diagnosis
was
supported in staffing by a licensed psychologist, for each
of the clinical subjects.
The weight preoccupied experimental group consisted
of thirty female undergraduate students at Louisiana State
University
who
met
inclusion
participate in the study.
criteria
and
agreed
to
Subjects were included in the
study if they performed above a score of 106 on the Body
Shape
Questionnaire
Fairburn,
1987).
(BSQ;
As
Cooper,
reported
by
Taylor,
Cooper
cutoff score is one standard deviation
mean for clinical groups on the BSQ.
et
(sd=30)
Cooper,
al.,
&
this
below the
The cutoff score of
106 fell at the 85th percentile in the distribution of BSQ
scores
for control subjects
included
in this study.
Of
the 200 subjects which were screened, approximately 50 met
criteria
Of
those
for inclusion
individuals,
in the weight preoccupied group.
30
agreed
to
participate.
BSQ
scores
for the weight preoccupied group ranged from the
lowest score of 107 to the highest score of 202.
200
subjects
screened,
four subjects scored above
the EAT and above 8 8 on the BULIT.
were
interviewed
Of the
wit h
the
30 on
These four subjects
IDED,
and
one
referred for eating disorder treatment.
subject
was
The control
group consisted of thirty undergraduate female students at
Louisiana State Univ e r s i t y who met inclusion criteria and
agreed
to participate
this group,
the
BSQ.
above
the
in the study.
This
score
mean
for
percentile
control
in
subjects
students
criteria
included
in
individuals were required to score below 90 on
is one
control
(Cooper et a l . , 1987) ,
92nd
To be
which
subjects
deviation
completing
(sd=20)
the
BSQ
The cutoff score of 90 fell at the
the
distribution
included
were
standard
in
this
screened,
for inclusion
of
study.
scores
Of
approximately
in the control group.
those individuals agreed to participate.
the control group ranged from the
the highest score of 89.
BSQ
for
the
200
150
met
Thirty of
BSQ scores for
lowest score of 4 0 to
Groups were matched for age (+/-
three years), and verbal intelligence
(+/- .5 s.d. on the
Shipley Institute of Living S c a l e ) .
Materials
Body
Image
Bennett. Gorecznv.
consists
of
nine
Assessment
& Gleaves.
silhouette
CBIA;
Williamson.
Davis.
1989; Appendix A ) .
The BIA
cards
depicting
a range
of
female body sizes.
Body image disturbance is m e a s u r e d by
placing the cards in front of the subject in ran d o m order.
The subject is then instructed to select the card which
accurately
depicts
his
or
her
Following selection of a card,
on
the
back
of
retrieved and
the
card)
placed
bod y
the card number
is
recorded.
in front
order a second time.
current
of
the
The
subject
size.
(which is
cards
in
are
random
The subject is instructed to select
the card which depicts the "ideal" body size that w o u l d be
most preferred.
The card number is once again recorded.
Current body size
estimates
are
(CBS) and ideal body size (IBS)
calculated
from
normative
data
t-score
w hich
available for women of differing heights and weights.
normative data
is used to determine
image distortion.
the
degree
of
is
The
body
In the present study, the BIA was used
to examine whether weight preoccupied subjects (as defined
by the Body Shape Questionnaire)
suffer
from b ody
image
d isturbance.
Eating Attitudes Test (EAT; Garner & Garfinkel. 1979;
Appendix B) .
and
pencil
including
The EAT is a 40 item multiple choice paper
measure
which
restrictive
assesses
eating
gain, and drive for thinness.
with
structured
interview
anorexic
patterns,
fear
30
is
indicative
was
of
of
weight
This measure in conjunction
used
to
determine
eating disorder diagnosis was appropriate.
least
attitudes
anorexia
if
an
A score of at
nervosa.
Factor
analysis has revealed three factors on the EAT:
bulimia
and
food
restraint.
preoccupation,
Garner
and
and
oral
Garfinkel
and
r=.94
of
for
control
report
reliability and validity for this measure.
coefficient
anorexics
and
or
adequate
A reliability
.79 was reported for clinical
clinical
dieting,
anorexics,
normal
controls.
Concurrent validity between total EAT score and anorexic
versus
normal
subjects was
Rosen,
Leitenberg,
reported to be
and Willmuth
(1986)
.87.
Gross,
reported that the
EAT also discriminates between bulimics and controls.
purposes of the present study,
For
the EAT score was used to
assess restrictive eating behavior.
Bulimia Test
C) .
The
pencil
BULIT
measure
fBULIT; Smith & Thelen.
is a
of
36
item multiple
symptomatology
of
1984; Appendix
choice
bulimia
paper
and
nervosa.
Performance on this measure was used along with structured
clinical
interview
to
determine
eating disorder diagnosis.
appropriateness
of
an
A total score of at least 88
indicates the presence of bulimic behavior. A score of 102
signifies significant bulimic behavior.
of
the
BULIT
has
resulted in
binging,
negative
problems,
preference
food,
Smith,
a
and
weight
1987).
measure
of
6
factors:
vomiting,
feelings about
binging,
menstrual
for
high
fluctuations
calorie,
(Thelen,
In the present study,
the
Factor analysis
severity of
easily
Mann,
ingested
Pruit,
&
the BULIT served as
binging
and
purgative
33
behavior.
The authors report test-retest reliability to
be .87 and concurrent validity as .54.
Interview
(IDED;
for
Williamson.
Appendix D ) .
the
Diagnosis
Davis.
Norris.
of
Eating
&
Van
Disorders
Buren.
1990;
Subjects which scored above 88 on the BULIT
or 3 0 on the EAT were recontacted and interviewed with the
IDED to evaluate for the presence of an eating disorder.
The
IDED
is
information
a
structured
concerning
bulimia nervosa,
interview
diagnosing
type
determining
scales
an
collects
anorexia
nervosa,
and compulsive binge eating.
administration of the interview,
likert
which
which
eating
the therapist completes
assist
disorder
Following
the
clinician
diagnosis.
reliability and concurrent validity
for the
in
Interrater
likert type
scales is adequate.
Body Shape Questionnaire
(BSQ; Cooper et al..
1987;
Appendix E) . The BSQ is a self-report instrument designed
to measure body shape and weight concerns.
Walsh
(1991)
reported
that
individuals
Hadigan and
diagnosed
with
bulimia nervosa scored significantly higher on the BSQ as
compared to controls
In the present
high
weight
study,
(141.6 versus
the
preoccupied
preoccupied individuals.
past
research
using
the
64.6,
BSQ was used
individuals
respectively).
to
from
discriminate
low
weight
Cutoff scores were derived from
BSQ
(Cooper
et
al.,
1987).
Inclusion criterion for the high weight preoccupied group
34
was
a
score
weight
greater
preoccupied
than
106
group
on
the
the
low
of
individuals
who
(BDI;
Beck.
consisted
BSQ,
and
scored below 90 on the BSQ.
Beck
Depression
Inventory
Mendelson. Mock. & Erbauqh 1961; Appen d i x F ) .
a 21
The BDI is
item self-report measure of depression.
validation
on
the
BDI
is
Empirical
extensive.
correlations range from .31 to .68.
Ward.
Item-total
Beck (1972)
reported
Spearman-Brown corrected split-half reliability to be .93.
Test-retest
reliability
is
estimated
to
nonclinical populations (Miller & Seligman,
for patient populations
In the present study,
(May, Urquhart,
be
.75
for
1973) and .49
& Tarran,
1969).
the BDI was used as an indicator of
level of depression.
Visual Analogue
G) .
The
VAS
consists
continuum with
circles
of
(VAS;
a
"no anxiety"
"extreme anxiety"
subject
Scale
Aitken.
five
at one
1969;
point
Appendix
scale
end of the
along
line
at the opposite end of the line.
the
number
(one
through
five)
represents his or her current level of anxiety.
appears
to
have
adequate
a
and
The
which
The VAS
psychometric
properties.
Subjective
Lazarus.
Units
of
Distress
1966; Appendix H ) .
Scale
(SUDS;
On this scale,
subjective mood along a five point scale.
is
at
one
pole
and
"extreme
depressed
Wolpe
&
subjects rate
"Normal mood"
mood"
is
at
the
35
opposite
pole.
This
brief
scale
has
psychometric
validation comparable to scales of greater length (Davies,
Burrows,
& Pyton,
1975;
Zeally & Aitken,
Eysenck Personality Questionnaire
Evsenck.
1963 ;
questionnaire
Appendix
I).
which
measures
extraversion-introversion
the present study,
was
used
The
1969) .
(EPQ;
EPQ
is
a
90
(E), and p s y c h oticism
of trait
anxiety
(N)
and
&
item
n e u r o ticism
the neuroticism scale
as a measure
Eysenck
(N),
(P) .
In
of the EPQ
depression,
which have been shown to be related to the c o n s t r u c t of
neuroticism.
subscales
Measures of internal consistency of the EPQ
is
adequate
(.74-.85;
N=.84).
T est-retest
reliability at one month ranged from .51 to .90, although
most groups scored in the
Shipley
Institute
1942; Appendix J) .
used
.80 to .90 range.
of
Living
Scale
This paper and pencil
as an estimate
of verbal
(SILS;
Pollack.
i n strument was
intelligence.
The
scale
consists of a vocabulary score and an a b s t r a c t i o n
score
which are summed to yield a total score.
The total score
has been found to reliably estimate a full scale Wechsler
Adult
Intelligence
1966).
Pollack
Verbal
Scale
(1942)
Stimuli
(WAIS)
score
(Prado
&
Taub,
presents validity data.
(Appendix K) .
Stimulus
w ords
were
derived from past studies (Markus, Hamill, & Sentis,
1987;
Channon,
three
Hemsley,
categories
of
&
de
stimuli
Silva,
1988) .
(emotional
body
Eac h
of
related,
non-
emotional
words.
body
related,
and
neutral)
Six eating disorder patients
consisted
of
12
and six non-eating
disordered graduate students made qualitative judgments on
each stimulus word as to whet h e r the word was related to
body
(yes or no)
point
scale
positive).
and intensity of emotional response
from
extremely
negative
to
(11
extremely
Both groups rated emotional body related words
as more negative than non-emotional
body related words.
There was no difference between ratings of non-emotional
body and neutral words.
from Dahl's
(1979)
Frequency ratings were obtained
norms.
A N O V A analyses indicated that
words did not differ significantly on length or frequency
(see Table 1).
All words had a unique two, three, or four
letter word stem.
Memory
(explicit)
Questionnaire
me m o r y
(Appendix
questionnaire
purpose of this experiment.
L) .
was
A
free
created
recall
for
the
The questionnaire consisted
of blank spaces in w hich subjects were instructed to list
words
which
screen.
A
were
p r eviously
maximum
complete the task.
of
ten
presented
minutes
on
was
the
computer
permitted
to
A scoring guide for acceptable words
recalled is p r e sented in A p p endix M.
Computer S o f t w a r e . The Micro Experimental Laboratory
(MEL; Schneider,
the verbal
1988;
Butler,
stimuli and the
1988) was used to display
filler tasks.
Butler
(1988)
found that the M E L program accurately records reaction
37
Table 1
Mean Length, Frequency,
Stimuli by Word Type
and Judgment Rating of Verbal
Word Type
_____________ Emotional
Length
5. 25a
(2.01)
Frequency
ED Rating
Non-Emotional
Neutral
F_____ p
6. 17a
(4.39)
6. 50a
(1.73)
.57
30.08a
(55.32)
31.17a
(65.01)
31.67a
(51.77)
-3.17a
(1.14)
+0.42b
(0.71)
+ 0 . 17b
(0.68)
161.48
.0001
Control Rating -3.38a
(1.21)
+ 0 . 50b
(0.75)
0. 00b
41.44
.0001
(0.62)
.02
.99
.57
Note.
F= Test statistic;
Standard deviations appear
below means in parentheses; Superscripts which differ
indicate that the means differ significantly;
ED= Eating
Disorder.
38
times.
The
program
was
run
on
an
IBM
PC
or
compatible
computer.
Procedure
Subject screening consisted of administration of the
BSQ and the IDED.
Weight and height were also measured.
Following review of all
psychologist,
appropriateness
experimental
subject
interview data with a licensed
or
met
control
inclusion
for
inclusion
was
determined.
groups
criteria,
she was
in
the
If
recontacted
a
to
schedule participation in the computer task.
Encoding
emotional
body
Task.
Subjects
were
related,
non-emotional
presented
body related,
neutral verbal stimuli during the encoding task.
were
instructed
that
they would
with
and
Subjects
be participating
in an
imagination task w hich would include the presentation of
the
verbal
stimuli.
Each
word
was
presented
for
a
duration of ten seconds.
During the ten second interval,
subjects
imagine
were
asked
to
themselves
in
a
past,
present, or future scene that involved themselves and the
word.
had
Subjects were instructed to press a key when they
imagined a scene
A fter
the
appeared
subject
on
the
involving themselves and the word.
had
imagined
monitor
the
encouraging
scene,
the
a
message
subject
to
continue thinking about the scene.
The subject rated the
pleasantness
scale
unpleasant)
of
to
the
10
scene
(very
on
a
pleasant).
from
1
Subjects
(very
were
39
presented
with
seven
experimental
task.
experimental
trial
practice
Following
was
trials
prior
the practice
presented
to
the
trials,
one
for each word,
for a
total of 36 experimental trials.
Filler T a s k .
task,
Following completion of the encoding
subjects participated in a six minute filler task.
The filler task was included to separate the presentation
of
the
test.
encoding
In the
(nonword)
of
filler
the verbal
task,
stimuli
groups
from
of numbers
were displayed on the monitor.
the
or
memory
letters
Subjects were
instructed to identify the groups as numbers or letters as
quickly as possible.
Memory
Task.
Following
the
filler
task,
subjects
were asked to complete the explicit memory questionnaire.
The
questionnaire
involved
a free
subjects were instructed as follows:
words
that
you
can
recall
that
earlier in the imagination task.
to make your best guess.
recall
task
"Please list all the
were
presented
responses
You will
in any order you wish."
is
presented
in
to
you
If you are not sure, try
have a m a x i m u m time
limit of 10 minutes to complete the list.
the words
in which
You m a y list
A list of acceptable
Appendix
M.
Following
completion of the memory test, subjects were administered
the
EAT,
BULIT,
random order.
B I A , EPQ,
SUDS,
VAS,
SILS,
and
BDI
in
40
Statistics
Statistical P o w e r .
standard
biases
deviations
in
indicate
from
depression
that
with
Power
studies
via
80%
analysis
a
power
using
examining
recall
memory
the
present
study
1992).
would
in order to
Cohen,
Differences between the eating disorder,
weight
and
control
.40
task
(effect size;
preoccupied,
of
and
cognitive
free
require approximately 2 0 subjects per g roup
find a difference in recall
means
groups
were
analyzed
using
an
alpha level of .05.
Statistical A n a l y s e s . Since groups did not differ on
number of neutral words recalled,
were
used
as
the
dependent
raw me m o r y test scores
variable.
Subject
characteristics were analyzed using m u l t i v a r i a t e analysis
of variance
(ANOVA).
(MANOVA)
and univariate analysis of variance
Post hoc analyses were performed using Fisher's
protected least significant difference
(LSD)
test
(Kirk,
1982) .
Hypotheses
multivariate
1,
2,
analysis
between subjects factor
and
of
3
were
variance
(group).
analyzed
(MANOVA)
with
with
a
one
An interaction between
group and affective valence was predicted.
Pearson
product-moment
analyze hypotheses 4 and 5.
correlations
were
used
to
A significant correlation was
predicted in hypothesis 4 and a n o n s ignificant correlation
was predicted in hypothesis 5.
41
Hypothesis
6
was
investigated
using
a
part i a l
correlation to hold constant the variance accounted for by
neuroticism.
Hypothesis 7 was analyzed using multivariate a n a l y s i s
of variance
subjects
(MANOVA)
factor
for reaction time with one b e t w e e n
(group).
A significant
interaction was
predicted.
Hypothesis
8
was
analyzed
using
a
multivariate
analysis of variance (MANOVA) for pleasantness rating w i t h
one
between
subjects
factor
(group).
A
si g n i f i c a n t
interaction was predicted.
Statistical analyses were performed as
MANOVA
including
3
(anorexia nervosa,
otherwise
(weight
eating
bulimia nervosa,
specified)
preoccupied
disorder
and
and
2
diagnostic
was
A
gr o u p s
eating d i s o r d e r
non-eating
control)
follows:
disorder
not
gro u p s
calculated.
The
group effect and the group x word type i nteraction w e r e
examined.
Group response patterns
were
e x a mined
contrasts.
Contrasts were calculated between
the
using
eating
disorder and non-eating disorder groups, w i t h i n the e a t i n g
disorder group, and within the non-eating disor d e r group.
Contrasts were also calculated between eating d i s o r d e r and
non-eating
disorder
groups
on
number
of
emotional
related words as compared to non-emotional
words and neutral words,
b ody
body
related
and non-emotional body
related
words as compared to neutral words.
Results
Subject Characteristics
Multivariate
analysis
of
variance
(MANOVA),
univariate analysis of variance (ANOVA), and post hoc LSD
test
(alpha=.05)
BULIT,
BSQ,
CBS,
were
used
CBST,
IBS,
to
compare
groups
on
B D I , E P Q - N , V A S , and
EAT,
SUDS.
The results of the MANOVA and ANOVA are presented in Table
2.
Multivariate
differed
analyses
showed
that
for eating disorder measures
group
(EAT,
profiles
BULIT,
BSQ,
CBS, IBS, CBST, IBST) and depression/neuroticism measures
(BDI,
EPQ-N,
VAS,
SUDS).
Univariate analyses
indicated
that the eating disorder group scored significantly higher
than the weight preoccupied and control groups on the EAT
and
BULIT.
The
eating
disorder
group
also
scored
significantly higher than the control group on the SUDS,
a rating
were
group
of
found
subjective
for VAS
differences
distress.
No
or unadjusted
IBS
wer e
found
for
group
differences
scores.
adjusted
However,
IBS
(IBST).
Post hoc tests for IBST indicated that the eating disorder
group scored lower than the weight preoccupied and control
groups.
compared
suggests
Low IBST scores for the eating disorder group as
to
the
that
experiencing
weight
the
greater
preoccupied
eating
and
disorder
dissatisfaction
despite eguivalent height and weight.
control
subjects
with
were
size
The eating disorder
group and the weight preoccupied group scored
42
body
groups
43
Table 2
ANOVA
and
MANOVA
Results
and
Characteristic Variables bv Group
Means
of
Subject
Group
Variable
ANOVA
F
Age
1.36
.26
22 .73a
(7.57)
20.36°
(4.71)
21.23°
(3.96)
Height
.28
.76
64 .40a
(2.30)
64 .80°
(2.34)
64.77°
(2.34)
Weight
1.24
.29
120.77a
(22.25)
127.97°
(16.74)
127.40°
(19.66)
I . Q.
1.61
.21
98.93°
(9.60)
102.17°
(7.46)
98.40°
(9.18)
EAT*
22 .89
.0001
43 .27°
(22.32)
31. 80b
(20.06)
BULIT*
24.89
.0001
92.20°
(25.66)
76.47b
(24.20)
52.47°
(14.27)
BSQ*
95.87
.0001
147.50°
(28.80)
134.30°
(26.33)
6 7 . 67b
(14.04)
CBS*
7.56
.0009
4 .83°b
(2.07)
5.67°
(1.73)
3 .83b
(1.66)
IBS
2.89
.06
2.40°
(1.69)
3.07°
(1.20)
3. 13°
(0.90)
CBST*
8.97
.0003
56.43°
(13.76)
59.63°
(14.50)
4 5 .7 0b
(11.61)
IBST*
4 .31
.02
39.17b
(15.50)
47.13°
(11.60)
47.57°
(9.59)
P
Eating
Disorder
Weight
Preoccuoied
(table con 1d . )
MANOVA
Control
F
12.37° 11.56
(7.65)
44
Table 2 (Con 1d)
Group
Variable
ANOVA
F
P
Eating
Disorder
11.38
0001
EPQ-N*
20.34
.0001
16.83a
(3.97)
14.33a
(4.43)
9 .2 0b
(5.62)
.90
.41
2 .53a
(1.11)
2. 2 3a
(1.01)
2 .20a
(1.06)
3.97
.02
2 .33a
(1.32)
2 .00ab
(1.05)
1. 53b
(0.90)
SUDS*
16.7 3Q
(14.99)
MANOVA
Control
F
BDI*
VAS
19.77a
(12.26)
Weight
Preoccupied
5 .7 0b
(7.66)
5.82
Note. * indicates that groups differed signi f i c a n t l y on
the variable; F= Test Statistic; p= Probability that F is
significantly different from zero;
Superscripts in each
row
which differ
indicate
that
the
means differ
significantly;
Standard
deviations
are
pre s e n t e d
in
parentheses below means;
MANOVA group d i f f e r e n c e s for
eating disorder measures (EAT, BULIT, BSQ, CBS, IBS, CBST,
IBST)and depression/neuroticism measures (BDI,
EPQ-N,
VAS,
SUDS) were
significant
(gc.OOOl);
EAT= Eating
Attitudes Test;
BULIT= Bulimia Test; BSQ= Body Shape
Questionnaire;
CBS= Current Body Size Estimate;
IBS=
Ideal
Body Size Estimate; CBST= Curr e n t Body Size
Estimate T-Score; IBST= Ideal Body Size E s t i m a t e T-Score;
BDI=
Beck
Depression
Inventory;
EPQ-N=
Eysenck
Personality Questionnaire Neuroticism Scale; VAS= Visual
Analogue Scale; SUDS= Subjective Units of D i s tress Scale.
45
significantly
EAT, BULIT,
higher
BSQ,
than
CBST,
BDI,
the
control
and EPQ-N.
indicates the presence of body
group
on
the
High CBST scores
image disturbance
in the
eating disorder and weight preoccupied groups as compared
to
the
control
group.
preoccupied groups
The
eating
disorder
and
weight
scored significantly higher than the
control group on the BDI and EPQ-N.
No group differences
were found for age, height, weight,
or I.Q..
Within the clinical eating disorder group, there were
10 subjects in each of three diagnostic groups
nervosa,
bulimia
nervosa,
and
eating
(anorexia
disorder
not
otherwise speci f i e d ) . These three subgroups were compared
using MANOVA and ANOVA.
that
the
differed
CBS,
eating
Multivariate analyses indicated
disorder
diagnostic
for eating disorder measures
IBS, CBST,
neurotic-ism
group
(EAT,
profiles
BULIT,
BSQ,
IBST) but did not differ for depression/
measures
(BDI,
EPQ-N,
VAS,
SUDS).
ANOVA
indicated that the bulimia nervosa diagnostic group scored
significantly
higher
than the
anorexia
nervosa
and
the
eating disorder not otherwise specified (NOS) diagnoses on
the BULIT.
age,
IBST,
The three diagnostic groups did not differ on
height,
VAS,
weight,
or SUDS.
significance,
with
I.Q.,
BDI,
ANOVA
for CBS and CBST approached
the
anorexia
EPQ-N,
BSQ,
nervosa
EAT,
and
IBS,
bulimia
nervosa diagnoses scoring higher than the eating d i s order
NOS diagnoses.
These data are summarized in Table 3.
46
Table 3
and
Means
Results
ANOVA
and
MANOVA
Characteristic Variables bv Diaanosis
of
Subiect
Diaanosis
ANOVA
Variable
F
P
Anorexia
Nervosa
Bulimia
Nervosa
Eating
Disorder MANOVA
NOS
F
.34
.72
23 .00a
(8.34)
21.20s
(5.33)
24 .00s
(9.07)
Height
1. 09
.35
65. 2 0a
(2.15)
64.30s
(2.06)
63 .70s
(2.63)
Weight
2.91
.07
112 .40a
(18.12)
133.60s
(26.09)
1 1 6 . 30s
(17.40)
.92
.41
97.30s
(13.02)
97.20s
(7.27)
102 .30s
(7.47)
1.03
.37
49.90s
(24.87)
44.20s
(16.94)
35.70s
(24.22)
.0001
75.60b
(17.06)
119.00s
(16.94)
82 .00b
(22.47)
Age
I .Q.
EAT
BULIT*
18.27
BSQ
.27
.77
150.40s
(33.50)
141.90s
(24.80)
150. 20s
(29.71)
CBS
3.05
.06
5.40s
(1.96)
5.50s
(1.43)
3 .60s
(2.31)
IBS
.23
.80
2 .10s
(1.85)
2.50s
(1.84)
2 .60s
(1.51)
CBST
3 .10
.06
61.20s
(12.28)
59.90s
(6.62)
48 .20s
(17.37)
IBST
.20
.82
37.80s
(19.19)
37.90s
(11.33)
41. 80s
(16.30)
(table con'd.)
3.89
47
Table 3 (Con 1d)
Diaanosis
ANOVA
Variable
F
P
Anorexia
Nervosa
Bulimia
Nervosa
Eating
Disorder :
MANOVA
NOS
F
.15
.86
20.60a
(16.00)
20.70s
(7.65)
18 . 00a
(12.83)
1.20
.32
15.90a
(5.51)
16.20a
(2.94)
18. 40a
(2.80)
VAS
.18
.84
2 .50a
(1.30)
2 .40a
(1.07)
2 .7 0a
(1.06)
SUDS
.46
.64
2.50a
(1.34)
2.00a
(1.25)
2 .50s
(1.43)
BDI
EPQ-N
.73
N o t e . * indicates that groups differed s i g n i f i c a n t l y on
the variable; F= Test Statistic; p= Probability tha t F is
significantly different from zero;
Superscripts in each
row
which
differ
indicate
that
the
means
differ
significantly;
Standard deviations
are
presented
in
parentheses below means;
MANOVA group differ e n c e s for
eating disorder measures (EAT, BULIT, BSQ, CBS, IBS, CBST,
IBST) were significant (pc.0003) ; M A N O V A group differences
for depression/neuroticism measures
(BDI, EPQ-N, VAS,
SUDS) were nonsignificant (p=.66); NOS = Not O t h erwise
Specified;
EAT= Eating Attitudes Test;
BULIT= Bulimia
Test;
BSQ= Body Shape Questionnaire;
CBS= C u r r e n t Body
Size Estimate;
IBS= Ideal Body Size Estimate;
CBST=
Current Body Size Estimate T-Score; IBST= Ideal B o d y Size
Estimate T-Score; BDI= Beck Depression Inventory; EPQ-N=
Eysenck Personality Questionnaire Ne u r o t i c i s m Scale; VAS=
Visual Analogue Scale; SUDS= Subjective Units of Distress
Scale.
48
Analysis of Explicit Memory Data
The
serial
position
effect
memory data of the present study.
did
not
occur
in
the
As can be seen in Table
4, the eating disorder group recalled a higher number of
emotional
body
related
words
across
serial
positions.
Thus, memory data can be examined without c o n s ideration of
serial position.
The number of words correctly recalled was calculated
for each valence and scores were subjected to mult i v a r i a t e
profile
analysis
of
contrasted
recall
diagnostic
groups
eating
disorder
eating
disordered
scores
three
nervosa,
otherwise
groups
(MANOVA).
for
(anorexia
not
control g r o u p s ) .
variance
The
eating
disorder
bulimia
nervosa,
specified), and
(weight
MANOVA
preoccupied
The MANOVA for free recall
two
g roup
non­
and
indicated a
significant main effect for group (F(12,219)=1.99 , g<.03) .
Results of this analysis showed that group recall profiles
differed significantly.
A significant interaction between
group and word type (F (8 ,168) =2 .4 2, £<.02)
indicated that
the recall patterns for groups differed as a function of
word type.
Group means are presented in Table 5 and the
mean recall profiles are illustrated in Figures 2 and 3.
Contrast analyses indicated that the recall pattern
of
the
recall
eating
disorder
pattern
(F(2,84)=7.36,
of
the
pc.001).
groups
was
different
non-eating
disorder
Recall patterns were
from
the
groups
49
Table 4
Serial Position Data:
Means by Group
Group
Serial
Eating
Weight
Position_____________Disorder______ Preoccupied______ Control
Emotional Body Related W o r d s -----(1-3)
13.67 (2.08)
8.67 (3.22)
5.67 (4.51)
(4-6)
21.00 (5.20)
16.67 (9.71)
18.00 (5.29)
(7-9)
19.67 (1.53)
15.33 (5.69)
15.67 (1.16)
(10-12)
21.33 (6.11)
15.00 (7.21)
18.00 (1.73)
Non-Emotional Body Related W o r d s ----(1-3)
7.33 (3.79)
3.67 (3.51)
8.67 (2.08)
(4-6)
15.33 (5.86)
16.67 (3.22)
15.33 (3.22)
(7-9)
15.67 (3.79)
15.67 (3.22)
14.33 (5.03)
(10-12)
19.33 (2.52)
15.33 (2.52)
15.33 (4.51)
------------------------------Neutral Words------------------(1-3)
8.33 (1.53)
14.00 (5.20)
10.00 (2.00)
(4-6)
12.00 (4.36)
13.67 (4.93)
14.67 (2.31)
(7-9)
12.33 (2.89)
11.00 (8.66)
15.00 (6.08)
8.33 (1.53)
12.00 (1.73)
11.00 (4.36)
(10-12)
N o t e . Means are followed by standard deviations in
parentheses.
50
Table 5
Memory Data:
Means by Group
W ord Type
Emotional
Group________________ Body Related
Non-Emotional
Body Related
Neutral
Anorexia Nervosa
8.70 (2.21)° 5.70
(2 .41) b 5.00
(2.67)b
Bulimia Nervosa
7.20 (2 .3 0) a 5.50
(1. 4 3) b 5.30
(2.50)b
Eating Disorder NOS 6 .60 (2.59)a 4.80
(2 .44)b 4 .50 (3.03)b
Weight Preoccupied
(1.18)b 4 .67 (2.02)b
5.70 (2 .22)b 5.47
Control
5.77
(2 .3 0) b 5. 63
(2.58)b 5. 57
(2.65)b
Eating Disorder
7 .50 (2 .4 6) a 5.33
(2.ll)b 4 .93
(2.66)b
Non-Eating Disorder 5.74 (2 .3 7 )b 5.55 (1.98)b 5. 12 (2 .4 3 )b
Note.
Means are followed by standard devia t i o n s in
parentheses; NOS= not otherwise specified; S u p e r scripts
which differ indicate that the means dif f e r significantly.
51
12
1
11
10
9
8
Words
Recalled
ED
7
C
WP
6
5
4
3
2
1
I
.
Emotional
Body
Non-Emotional
Body
Neutral
Word Type
N o t e . WP= Weight Preoccupied; C= Control;
ED= Eating Disorder.
Figure 2
Explicit Memory Results:
Three Group
52
12
H
10
AN
9
8
Words
Recalled
7
6
1
1
BN
1
1
NOS
C
WP
1
1
5
4
3
2
1
Emotional
Body
Non-Emotional
Body
Neutral
Wor d Type
N o t e . WP= Weight Preoccupied; C= Control;
NOS= Eating Disorder Not Otherwise
Specified;
AN= Anorexia Nervosa; BN=
Bulimia Nervosa.
Figure 3
Explicit Memory Results;
Five Group
53
not
different
groups
the
three
(F(4,168)=.80, p=.53)
groups
(weight
F (2,84)=1.11,
words
for
as
eating
compared
Recall
to
diagnostic
nor for non-eating disorder
preoccupied
p = .33).
disorder
and
control
of emotional
non-emotional
body
groups;
body related
related
and
neutral words differed for the eating disorder diagnostic
groups
as
compared
to
the
(F(4,85)=4.52 , p<.002).
non-eating
Recall
of
disorder
groups
non-emotional
body
related words as compared to neutral words did not differ
for the eating disorder diagnostic groups as compared to
the non-eating disorder groups
(F(4,85)=.39, p>=.81).
Analysis of Intrusions
Words
recorded
by
subjects
during
the
free
recall
explicit memory task which were not presented during the
encoding task were categorized according to word type.
MANOVA
with
calculated.
for group
one
between
subjects
factor
(group)
A
was
Results indicated a significant main effect
(F (6,170) =2 .79,
interaction
was
(F(4,172)=3.73,
also
p<.006).
jd< . 01).
The group x word type
statistically
Examination
significant
of
the
means
indicates that the eating disorder group had fewer neutral
intrusions
than
the
non-eating
disorder
groups.
These
data are presented in Table 6 and Figure 4.
Contrast
analyses
indicated
that
the
intrusion
pattern of the eating disorder groups differed from the
intrusion pattern of the non-eating disorder groups
54
Table 6
Memory Intrusions;
Means by Group
Word Type
Emotional
Group_____________ Body Related
Non-Emotional
Body Related_____ Neutral
Anorexia Nervosa
.30 (-67) a
.40 (1.26)a
.70 (1.13)a
Bulimia Nervosa
.10 ( .3 2) a
.20 ( •42)a
.92
(1.25)a
Eating Disorder NOS .20 (.63)°
.60 (.97)a
.99
(1.15)a
Weight Preoccupied
.07 (.25)°
2 .00
(1.82)b
2 .00
(1.84)b
.13 ( •3 5 )a
Control
.10 ( .31) a
.37 (•85)a
Eating Disorder
.20 (.55)a
.40
(.93)a
.87
(1.14)a
Non-Eating Disorder .12 (.38)a
.22
(.59)a
2.00
(1.84)b
N o t e . Means are followed by standard deviations in
parentheses; N0S= not otherwise specified; Superscripts
which differ indicate that the. means differ significantly.
55
2.8
2.6
2.4
to
o
2.2
1.8
1.6
Intrusions 1.4
1.2
1.0
CO
o
0.6
0.4
o
o
0.2
1
1
1
i
AN
NOS
WP
C BN
!------------------
I
Emotional
Body
Non-Emotional
Body
Neutral
Word Type
N o t e . WP= Weight Preoccupied; C= Control;
NOS= Eating Disorder Not Otherwise
Specified; AN= Anorexia Nervosa; BN=
Bulimia Nervosa.
Figure 4
Intrusion Data
56
_£_F(2 ,84) =6 .77 ,
different
p<.002).
for
eating
Intrusion
patterns
were
disorder
diagnostic
not
groups
(F(4,168)=1.24, p = .29), nor for non-eating d i s order groups
(F (2,84)=1.27 ,
p = .28).
Intrusions
of
emotional
related words as compared to non-emotional
and
neutral
words
differed
for
the
body
eating
body
related
disorder
diagnostic groups as compared to the non-eating disorder
groups
(F(4,85)=4.82,
p<.002).
Intrusions
of
non-
emotional body related words as compared to neutral words
differed
for
the
eating
disorder
diagnostic
groups
as
compared to the non-eating disorder groups ( F (4,85)=4.22,
p < .001).
Correlation Analyses
Correlations
BULIT,
BSQ,
BDI,
between
and
subject
EPQ-N
calculated across groups.
and
The EAT,
scores
memory
BULIT,
on
the
EAT,
scores
were
and BDI were
positively correlated with the number of emotional
body
related
were
words
relatively
recalled,
weak.
but
the
Correlations
correlations
between
these
same
variables were not significantly correlated w ith number of
non-emotional
body
related
words.
A
modest
negative
correlation was found between EPQ-N and recall of neutral
words.
These correlations are summarized in T able 7.
To further investigate the contribution of depression
and neuroticism to the positive correlations betw e e n EAT,
BULIT, and BSQ, and number of emotional body related words
57
Table 7
Correlation Analyses:
Across Groups
Word Type
Obj ective
Measures
Emotional
Body
.26*
Non-Emotional
Body
EAT
r
BULIT
r
.25*
BSQ
r
.19
-.04
-.14
BDI
r
.22*
-.11
-. 13
EPQ-N
r
.11
-.10
Neutral
-.03
-.18
-.04
-.0006
-.23*
N o t e . r= Correlation Coefficient; * indicates that the
correlation was significant at p<.05;
EAT= Eating
Attitudes Test;
BULIT= Bulimia Test;
BSQ= Body Shape
Questionnaire;
BDI= Beck Depression Inventory;
EPQ-N=
Eysenck Personality Questionnaire N euroticism Scale.
recalled,
partial
correlations
holding
constant
the
variance due to BDI and EPQ-N were calculated.
Holding
constant
in
lowered
body
related
the
correlations
words
variance
between
and
BULIT
(r=.25,
BSQ
(r=.19,
due
to
change
related
b = . 08;
EPQ-N
EAT
BDI
of
resulted
emotional
(r=.26,
p<.02;
pc.01;
partial
partial
r=.18,
partial r=.05, p=.61).
was
held
significantly
words
to
number
recalled
p = .15),
due
constant,
between
recalled
and
EAT
p=.09),
of
(r=.26,
and
When variance
correlations
number
r=.15,
did
emotional
p<.01;
not
body
partial
r=.23, p><.03) , BULIT (r=.25, p<.02; partial r = .23, p<.03),
and BSQ (r=.19, p=.08; partial r=.15, p=.17).
of
correlations
reflects
group
The pattern
differences
reported
e arlier on memory of emotional body related words.
Thus,
correlation results do not add to information derived from
evaluation of group differences.
Analysis of Reaction Time Data
In order to examine response latency for subjects to
imagine
themselves
d ifferent
valences,
b etween subjects
indicated
no
in
a
factor
a
scene
MANOVA
was
(group).
significant
( F (6,170)=.77, p = .60).
with
main
words
presented
calculated
with
of
one
Results of the MANOVA
effect
for
group
The interaction between group and
word type was also nonsignificant
(F(4,172)=.99,
p=.41).
Table 8 and Figure 5 summarize the mean reaction times for
each group.
59
Table 8
Reaction Time Data
(in seconds):
Means by Group
Word Type
Emotional
Non-Emotional
Anorexia Nervosa
1.82 (1.60)a
2 .09 (1.06)8
1.85
(1.01)8
Bulimia Nervosa
3.08 (2.22)a
2 .71 (1 . 7 2 )8
2 .96 (2 . 1 4 )8
ED NOS
1.87
1.90
WP
(1.90)8
2 .26
(1. 25) 8
2 .14 (1.4 4 )a
2 .15 (1. 4 0) 8
1.95
(1.06)8
Control
2.30
(1. 2 2 )8
2.08
(1.06)8
2 .07
(1.27)8
Eating Disorder
2 .26 (1.57)8
2.23
(1. 2 6) 8
2 .36
(1.51)8
Non-ED
2.22
2 .12 (1.43)8
2 .01
(1. 36) 8
(1.17)a
(1. 4 3 )a
N o t e . Means are followed by standard d e v i a t i o n s in
parentheses; NOS= not otherwise specified; ED= Eating
Disorder;
WP= Weight Preoccupied;
S u p e r s c r i p t s which
differ indicate that the means differ significantly.
60
10.0 j
9.0
8.0
7.0
6.0
Reaction
Time
(seconds)
5.0
4 .0
0.0
(
Emotional
Body
I .
Non-Emotional
Body
I
Neutral
Word Type
N o t e . WP= Weight Preoccupied; C= Control;
N0S= Eating Disorder Not Otherwise
Specified;
AN= Anorexia Nervosa; BN=
Bulimia Nervosa.
Figure 5
Reaction Time Data
61
Analysis of Pleasantness Ratings
After subjects imagined themselves in a scene using
a word,
they rated the pleasantness or unpleasantness of
the scene which they had imagined.
Ratings were analyzed
using MANOVA.
effect was
group
A
significant main
(F(6,170)=5.36,
£<.0001).
The
group
found
x wor d
interaction was also significant
(F(4,172)=3.17,
Profile
the
analysis
indicated
imagery differently.
that
the
related
eating
scenes
disorder groups.
that
type
£=.02).
rated
their
Examination of the means indicates
disorder
as
groups
for
more
group
rated
negative
than
emotional
the
body
non-eating
Overall, scenes imagined with emotional
body words were rated as least pleasant (M=3.38), followed
by
non-emotional
body
word
imagined
involving
neutral
pleasant
(M=7.30).
Group
scenes
words
means
(M=6.48).
were
for
rated
these
Scenes
as
most
ratings
are
summarized in Table 9 and Figure 6.
Contrast analyses indicated that the rating patterns
for the eating disorder groups and the non-eating d i s o r d e r
groups did not differ
(F(2,84)=1.30, £=.28).
The rating
pattern for the eating disorder diagnostic groups did not
differ
(F(4,168)=.65,
differed
for
£<.008).
Ratings
£=.62),
non-eating
of
but
disorder
emotional
the
groups
body
rating
patterns
(F(2 ,84)=5.06,
related
scenes
as
compared to non-emotional body related and neutral scenes
did not differ for the eating disorder diagnostic groups
62
Table 9
Pleasantness Ratings:
Means by Group
Word Type
Emotional
Group________________ Body Related
Non-Emotional
Body Related
Anorexia Nervosa
2 .46 (1. 2 2 )a 6.01 (1.73)b
Bulimia Nervosa
2 .51 (.88)a
ED NOS
6.47
3 .11 (2.33)a 6.21
(1.77)b
(.78)b
6.97
6.73
6.84
Neutral
(1.37)b
( .93)b
(.85)b
Weight Preoccupied 3.01 (1.16)a 6. 34 (1.35)b
7.57 (1.01)b
Control
4.44
(1.76)b 6. 88
(1.59)b
7.49
(1.62)b
Eating Disorder
2 .69 (1.57)b 6.23
(1. 46) c
6.85
(1.04)c
Non-ED
3.73
(1.59)c
7 .53 (1.48)c
(1.66)a 6.61
N o t e . Means are followed by standard deviations in
parentheses;
ED= Eating Disorder; NOS= not otherwise
specified; Superscripts which differ indicate that the
means differ significantly.
63
8.0
7 .5
7.0
6.5
6.0
5.5
5.0
4.5
c
4.0
Rating
3.5
3.0
2.5
NOS
WP
BN
AN
2.0
1.5
1.0
in
o
o
o
Emotional
Body
Non-Emotional
Body
Neutral
Word Type
N o t e . WP= Weight Preoccupied; C= Control;
NOS= Eating Disorder Not O t h e r w i s e
Specified; AN= Anorexia Nervosa; BN=
Bulimia Nervosa.
Figure 6
Pleasantness Rating Data
as
compared
(F(4,85)=1.86,
to
the
p = .13),
non-eating
disorder
groups
and ratings of non-emotional body
related scenes as compared to neutral words did not differ
for the eating disorder diagnostic groups as compared to
the non-eating disorder groups
(F(4,85)=2.01, p=.10).
Discussion
This
investigation
evaluated
the
presence
of
an
explicit memory bias for emotional body related stimuli in
eating disordered and weight preoccupied subjects.
The
eating
had
disordered
equivalent
(BSQ).
weight
and
scores
The
on
eating
preoccupied
symptomatology,
weight
a measure
disorder
group
but
of
an
were
differences
eating
in
of weight
group
reported
preoccupation
compared
more
eating
Therefore,
disorder
psychopathology
groups
as
equivalent
depression and neuroticism.
features
preoccupied
on
to
the
disorder
measures
of
clinical
were
the
between
primary
the
eating
disordered and weight preoccupied subjects.
An explicit memory bias
stimuli
was
found
in the
for emotional body related
eating disorder
subjects.
As
predicted, an explicit memory bias was evidenced only for
body related words associated with negative emotionality.
No
explicit
related
memory
or
neutral
emotionality
explicit
bias
of
words.
stimuli
memory bias
pathological
existed
may
for non-emotional
The
play
for stimuli
concerns,
i.e.,
body
data
a
suggest
mediating
related to
related
body
that
role
in
a person's
stimuli
for
eating disorder subjects.
Comparisons of eating disorder diagnostic groups to
non-eating
groups
disordered
showed
that
the
weight
recall
65
preoccupied
patterns
for
and
the
control
eating
disordered groups differed
from the recall patterns
the non-eating disordered groups.
for
Recall patterns within
the eating disorder groups and the non-eating disordered
groups did not differ.
related
words
neutral
words
as
A greater number of emotional body
compared
was
disordered groups.
to
recalled
non-emotional
by
each
of
body
the
and
eating
None of the groups differed on recall
of non-emotional body related words as compared to neutral
words.
These findings indicate that the eating disordered
groups
had a bias
related material,
for greater recall
of emotional
body
but not other types of words.
Weight Preoccupation and Memory Bias
Mean
disorder
recall
symptom
patterns
severity
indicated
increased,
that
memory
emotional body related words increased.
as
eating
bias
for
For example, the
anorexia nervosa patients, who are generally considered to
be most disturbed, had a higher recall for emotional body
related
words
than
the
bulimia
nervosa
patients.
The
bulimia nervosa patients, who might be regarded as having
the second greatest disturbance,
recalled more emotional
body related words than the eating disorder not otherwise
specified patients.
The increasing memory bias found in
eating disordered patients suggests that this recall bias
may be symptomatic of extensively developed associative
networks related to body concerns in anorexia and bulimia
nervosa patients.
67
Weight preoccupied non-eating disordered subjects did
not
show
evidence
emotional
body
for
related
an
explicit
words.
memory
These
data
bias
argue
for
that
preoccupation with weight may not be the critical variable
in determining memory bias.
to
the
clinical
importance.
Instead a variable particular
condition
itself
may
be
of
greater
It is recommended that future investigations
examine the relationship between particular aspects of the
clinical condition and memory bias.
The
present
preoccupied women
study
included
(BSQ M=134.30)
a
group
of
weight
and a group of controls
with average levels of weight preoccupation (BSQ M = 6 7 . 6 7 ) .
Baker
weight
(1993)
preoccupation
p reoccupied
bias.
compared women with extremely low levels of
women
(BSQ
M=45.00)
(BSQ M=128.00)
in
and
a
highly
study
of
weight
recall
In contrast to the findings of the present study,
Baker found a memory bias for negative body related words
in h igh weight preoccupied women as compared to extremely
low weight preoccupied women.
The present study did not
find an explicit memory bias for emotional body related
words
in
high
women
with
an
weight
average
preoccupied
level
of
women
weight
as
compared
to
preoccupation.
Differences in the findings of the two studies is likely
due to the definition of the control groups.
The control
group of the present study included a group of women who
had an average level of weight preoccupation as compared
to
Baker's
group
of
low weight
preoccupied women.
The
data from both studies taken together suggest that women
with
a low level
memory
bias
disordered
of weight
for
women
body
with
preoccupation do not have
related
average
material.
or high
a
Non-eating
levels
of weight
preoccupation have a moderate memory bias for body related
words.
Whereas,
women
with
a
high
level
of
weight
preoccupation who also have an eating disorder demonstrate
an even stronger memory bias for body related information.
Therefore, despite the finding that the weight preoccupied
group in the present study did not show a memory bias for
body
related
preoccupation
related
words,
plays
it
no
information.
cannot
role
in
be
concluded
memory
An alternative
bias
weight
for
explanation,
body
given
the findings of Baker (1993) , is that weight preoccupation
may be one of several psychopathological variables which
determine
the
memory
bias
observed
in
this
study
for
eating disorder subjects.
Following the finding of an explicit memory bias in
eating
disordered
analyses
between
subjects,
measures
results
of
of
eating
symptomatology and weight preoccupation,
correlation
disorder
and memory bias
indicated a positive relationship between eating disorder
symptomatology, weight preoccupation, and memory bias for
emotional
body related words across groups.
Since the
eating disorder group scored high on measures of eating
disorder symptomatology
(EAT, BULIT)
and also recalled a
greater number of emotional body related words than nonemotional
body-related
and
neutral
words,
it
is
not
surprising that the memory bias for emotional body related
words
was
eating
positively
disorder
correlated
with
symptomatology.
the
measures
Therefore,
of
these
correlational findings are entirely consistent with data
pertaining
related
to
group
stimuli
and,
differences
thus,
do
in
not
the
recall
clarify
of
body
information
obtained from group effects.
Memory Intrusions
In accordance with the theories of Bower
Mandler
(1980),
individuals
have
(1981)
and
the present investigation predicted that
concerned
with
body
shape
and
weight
extensively developed memory associations
related words and,
thus,
would
for body
would have more memory cues to
assist in retrieval of such words during the free recall
memory
test.
Also,
it
was
predicted
that
elaborated
associated networks for body related material would result
in body related intrusions
related information.
(or errors)
Although eating disordered subjects
demonstrated an explicit memory bias
related words,
in recalling body
for emotional body
the eating disorder group did not have a
greater number of body related intrusions relative to the
control group.
This finding suggests that the memory bias
found in this study was not due to a simple response bias
70
for
emotional
eating
body
disordered
frequently
on the
related
subjects
free
material.
did
recall
not
In
just
task with
related words than other word types.
other
words,
"guess"
more
emotional
body
Therefore,
it can be
argued that the explicit memory bias occurred due to the
strategies used in processing of information and not due
to a response bias.
In
addition,
the
eating
disorder
group
had
fewer
intrusions for neutral words than the non-eating disorder
groups.
According
to
Beck's
theory,
intrusions
of
a
particular type indicate the type of schema which has been
activated.
For example,
if subjects had a high number of
emotional body related intrusions, then the emotional body
related schema was activated.
Data from the present study
do not support predictions from Beck's theory.
The eating
disorder group did not have a high number of body related
intrusions, but had fewer neutral intrusions than the n o n ­
eating disorder groups.
for
neutral
eating
information
disorder
subjects.
information
The data suggest that the schema
One
is
subjects
was
less
than
interpretation
more
easily
in
highly
elaborated
non-eating
might
elicited
be
that
in
in
d i s order
neutral
non-eating
disordered persons than in eating disordered individuals.
71
Depression and N euroticism as Mediating Variables for
Memory Bias
It is important to note that the explicit memory bias
found in the present study diminished when variance due to
d epression was held constant.
One interpretation might be
that the explicit me m o r y bias was due to depression in the
eating disorder group.
However, the eating disorder group
did not differ from weight preoccupied group on measures
of depression, neuroticism, and subjective distress (BDI,
EPQ-N,
and
SUDS;
see
Table
3),
and
no memory
bias
was
found in the weight preoccupied group.
Thus, the data are
not
that
supportive
m emory
bias
depression
of
the
found
or
in
found
disorder
the
neuroticism
since an equivalent
was
interpretation
in the
study
eating
explicit
was
disorder
weight
preoccupied group.
binge
to
group
preoccupied
groups
The
eating
differed
on the
degree of clinical eating disorder symptomatology
emaciation,
due
level of depression and neuroticism
in the we i g h t
and
present
the
eating,
purgative
behavior)
(e.g.,
in
the
eating disorder group. Thus, the explicit memory bias was
most likely determined by some features of clinical eating
disorder symptomatology.
This variable may not have been
adequately measured in the present investigation.
Response Time to Imagine Scenes
In
the
encoding
task,
groups
did
not
differ
in
response latency to imagine a scene involving themselves
72
and
the
presented
word.
The
hypothesized
presence
of
response latency differences was not considered crucial to
the
purpose
of
this
study.
Since
groups
did
not
significantly differ on encoding time for each word type,
the
free recall
words
memory bias
evidenced
by
for
eating
emotional
disorder
body
related
subjects
can
be
interpreted as due to a biased retrieval strategy rather
than a difference in processing time at encoding.
Ratings of Word Pleasantness
The eating disorder and weight preoccupied subjects
rated
their
imagery
significantly
more
control group.
of
emotional
unpleasant
body
than
the
related
words
ratings
of
as
the
The eating d i s order group did not differ
from the weight preoccupied group in pleasantness ratings
of emotional body related scenes.
Groups did not differ
on pleasantness ratings of non-emotional body imagery or
neutral
found
imagery.
in
In general,
the
present
the
study
is
explicit
me m o r y bias
reflected
in
the
pleasantness ratings of the three types of imagery.
The
eating disorder group demonstrated an explicit me m o r y bias
for
emotional
body
related
imagery
and
also
rated
emotional body related imagery as less pleasant than the
non-eating disordered group.
body
related scenes
body
related
groups
and
did not
as
All groups rated emotional
less p l e a s a n t than non-emotional
neutral
demonstrate
scenes.
an
On
explicit
the
o ther
memory
hand,
bias
for
73
non-emotional body
these scenes were
related scenes or neutral
rated as more pleasant than emotional
body related scenes by all groups.
imagery
as
scenes and
evoking
more
Thus, experiencing the
negative
emotionality
was
insufficient by itself to produce memory bias in the non­
eating disordered groups.
pathological
concerns
The emotional salience of one's
influences
the
perception
of
pleasantness for imagery related to that concern, however.
Future Research Considerations
Attentional bias was not investigated in the present
study.
Clinical
observation
suggests
that
eating
disordered individuals may automatically shift attention
toward
body
attentional
size,
related
shift
fear of
example,
stimuli.
may
fatness,
Some have
increase
and body
suggested
preoccupation
that
with
body
image disturbance.
For
the Stroop interference effect for body related
stimuli has been demonstrated in eating disorder patients
(Cooper, Anastasiades, & Fairburn, 1992; Fairburn, Cooper,
Cooper, Anastasiades, & McKenna,
Fok,
& Yap,
However,
the
1989;
stage
Channon,
of
1991; Ben-Tovim, Walker,
Hemsley,
information
& de Silva,
processing
interference occurs has yet to be determined.
the
similarities
evidenced
between
at
1988).
which
Considering
eating
disorder
subjects and depressed subjects on explicit me m o r y tasks,
it is likely that eating disordered subjects may not have
an attentional bias but may be distracted by body related
74
stimuli.
It
cognitive
may
be
that
elaboration
distraction
(rehearsal)
coupled
results
recall of emotional body related stimuli.
that
future
investigations
in
with
increased
It is suggested
empirically
test
this
hypothesis.
The present
memory
bias.
Implicit
recollection
conscious
investigation did not examine
of
stimuli
awareness
previous task.
memory
has
been
previously
of
recalling
implicit
defined
presented
the
without
stimuli
Presented material becomes
as
from
"primed"
a
and
becomes more readily recalled in tests of implicit memory.
Implicit
memory
process.
is
Whereas,
processing.
of
although
implicit
processes
which
nervosa
Kaye,
and
disorder
perform
tasks
and
"effortful"
reviewed
concluded
memory
simultaneously,
are
that
parallel
separation
occur with
poorly
involving
1986).
cognitive
activation
subsequently,
more
psychopathology
& Gwirtsman,
priming
memory
can
"automatic"
of
the proper
Past research has demonstrated that anorexia
memory
investigate
an
recently
explicit
interact
patients
implicit
eating
implicit
be
requires
(1990)
and explicit memory
methodology.
to
explicit memory
Roediger
investigations
implicit
considered
of
than
stimuli
(Strupp,
controls
on
unrelated
to
Weingartner,
Future research could further
processes
concern
in
eating
related
disorders
schemata
testing for implicit memory biases.
by
and,
If an
75
implicit memory bias for body related stimuli was found in
eating disordered patients,
those findings would suggest
that the processing of this information may be relatively
automatic
and
non-effortful.
These
results
would
correspond to clinical observations of thought processes
in eating disorder patients.
Theoretical Implications
Results of the present study can be interpreted using
Beck's
Beck
(1967)
cognitive
proposed
that
model
of
individuals
emotional
have
disorders.
general
units
of
knowledge, or "schema," that determine which aspects of a
situation are most important and which information will be
stored
in memory.
Mor e
specifically,
individuals
have
self-schema which represent self-perception and influence
behavior.
schema
Vitousek and Hollon (1990) suggested that self­
and
development
weight-related
and
psychopathology.
schema
maintenance
In
the
are
of
present
central
eating
study,
to
disorder
the
eating
disorder group demonstrated an explicit memory bias
emotional
body
self-referenced
related
words
encoding
following
task.
encoding
According
the
to
for
via
a
Beck's
theory, this finding suggests that persons with an eating
disorder have activated w e i ght-related self-schema which
facilitates encoding,
processing,
referenced body related material.
and retrieval of self­
According to Bower's (1981) associative network model
of
memory,
fashion.
memories
are
associated
in
an
hierarchical
Thus, memories similar to one another in meaning
are more closely linked than memories of unrelated events.
Bower's spreading activation model
of memory postulates
that the memory network is composed of emotion nodes that
are
linked
to
memories
particular emotion.
of
events
which
elicited
When an emotion node
that
is activated,
the activation radiates to memories which are linked
the emotion.
to
The finding of a memory bias for emotional
body related words and not non-emotional body related or
neutral
which
words
is
activated
in
support
an
of
emotion
Bower's
node
theory.
and
the
Words
memories
associated with the node were more readily recalled than
words which failed to activate an emotion node ( e.g., nonemotional body and neutral w o r d s ) .
Furthermore,
proposes
process
other
that
Mandler's
explicit
memory
(1980)
model
involves
in which the presented word
information
in
memory.
is
Words
an
of
memory
e laboration
asso c i a t e d
with
w hich
more
are
extensively elaborated are more readily retrieved due to
increased
associations
which
serve
as
retrieval
cues.
Beck's theory would suggest that body related schema are
stronger and more extensively developed in eating disorder
patients and,
theories
of
thus,
Beck
are more easily activated.
and
Bower
suggest
that
Both the
information
77
related to the specific psychopathology of the individual
is strengthened in the cognitive system and, thus, is more
readily accessible for conscious recall.
Results of the present study are in support of Beck's
(1967;
1972)
notion
of
disorders.
Beck
specific
concerns
to
content
proposed
specificity
that
depressive
related to
the
in
neurotic
schemata
clinical
are
nature
of
depression (e.g., negative thoughts about the self, world,
and
future).
An
interpretation of the present
findings
according to Beck's theory is that the schemata of eating
disordered individuals are specific to the concerns of an
eating disorder population
shape
and
weight,
and
(e.g.,
fear
of
overconcern with body
fatness).
Thus,
Beck's
theory not only describes the memory system of depressed
individuals,
but also can be successfully applied to the
memory
for
bias
content
specific
material
evidenced
in
eating disorder patients.
Beck's
theory
would
predict
that
emotional
body
related material w ould be more easily activated in eating
disordered
persons
individuals.
support
this
The
than
data
of
in
the
interpretation.
that emotional
body related
easily activated
non-eating
present
Present
disordered
study
findings
does
not
suggest
information may not be more
in eating disordered persons,
but when
activated, emotional body related information is subjected
to elaboration.
The primary
finding of explicit memory
78
bias in eating disordered subjects can be interpreted as
due to the operation of elaborative processes.
Mandler's (1980) framework defines explicit memory as
information
awareness.
that
is
directly
the
primary
processes.
to
conscious
Encoding of stimuli may be influenced by the
process of elaboration.
is
accessible
Mandler suggests that elaboration
process
Elaboration
involved
in
explicit
is conceptualized
as
memory
a control
process which determines how information forms associative
links
in
memory.
A
more
elaborated
increased associations in memory.
word
develops
Extensive associations
(which increase when stimuli is self-referenced) result in
the
formation
of
more
retrieval
information accessibility.
cues
which
increase
Encoding tasks which encourage
self-referencing (e.g., imagination of oneself in a scene)
result in increased elaboration and d epth of processing
which improve retrieval in explicit memory,,
The finding in this study of an explicit memory bias
for
emotional
body
related
words
in
eating
disorder
subjects suggests that the processing of these words may
have
involved
disorders
elaboration.
elaborated
on
If
individuals
emotional
body
these words would form more associations
with
eating
related
words,
in memory than
non-emotional body related and neutral w ord types.
This
interpretation suggests that emotional body related words
79
received more extensive cognitive processing than words of
other valences and, thus, were more readily retrieved.
Conclusions
The
findings
of
the
present
investigation
suggest
that eating disordered individuals have an explicit memory
bias
for emotional body related words.
when
asked to
eating
recall
disordered
information
individuals
In other words,
from a previous
recalled
task,
self-referenced
emotional body related information at a hig h e r rate than
two
other
groups.
demonstrate
words.
an
Since
preoccupied
explicit
the
preoccupied
memory
eating
group
preoccupation,
explicit
Weight
were
bias
equated
is
preoccupation with weight
of
preoccupation
eating
play
likely
alone.
role
of
this
finding
conceptually
indicate
driven
and
to
explicit
related
the weight
of
a
itself
Results
not
weight
neuroticism,
variable
rather than
suggest
s y m ptomatology
in
emotional body related words.
and
and
due
did
body
degree
condition
disorder
a
on
anxiety,
particular to the clinical
severity
for
disorder group
depression,
memory
bias
normals
and
memory
that
weight
bias
for
Theoretical interpretations
that
that
this
the
memory
bias
bias
relies
may
upon
be
the
process of elaboration.
Explicit memory
bias
may
result
in ma i n t e n a n c e
or
worsening of symptomatology in eating d i s o r d e r patients.
Since
the
process
of
elaboration
in
e x p licit
memory
80
renders emotional body related memories more accessible,
retrieval
of
these
vicious
cycle
may
related
material
develop
leads
related schemata.
of
body
memories
becomes
in
to
easier.
Thus,
encoding
of
body
strengthening
of
body
which
the
a
The result is increased acces s i b i l i t y
related material
to
retrieval
and,
subsequent,
worsening of eating disorder symptomatology.
Explicit memory bias in eating disorder p a t ients may
influence
the
development
and
maintenance
of
cognitive
variables pertinent to eating disordered psychopathology.
The
process
of
elaboration
can
effectively
acco u n t
for
possible reasons why persons with eating disorders exhibit
a memory bias for emotional body related subject matter.
Implementation of cognitive modification strategies in the
treatment
eating
disorder
cognitive elaboration.
information
would
subsequently,
Recent
be
body
evidence
in
patients
may
serve
to
Therefore, emotional bod y related
less
likely
to
related
concerns
support
of
be
r e trieved
would
cognitive
al.
bulimia
(1991)
found
cognitive-behavioral
nervosa
to be
superior
interpersonal
therapy.
to behavior
Cognitive
therapy
for
F a i rburn
therapy
therapy
approaches
and,
diminish.
treatment of eating disorders appears promising.
et
modify
to
for
and
eating
disorder treatment could become increasingly eff e c t i v e if
modified according to current and future research findings
concerning memory processes in eating disorders.
Since
no
explicit
published
memory
opportunities
biases
exist
suggested
that
mechanisms
and
studies
in
for
to
eating
future
future
examined
disorders,
research
examine
memory
processes
implicit
The
presence
bias
the
cognitive
suggest
have
many
investigations.
disorder patients.
would
date
of an
It
is
attentional
in
eating
implicit memory
processes
of
eating
disorder patients are automatic
(do not require effortful
pr o c e s s i n g ) .
should
Investigations
further
examine
encoding processes as well as retrieval strategies.
Past
research has found evidence for encoding biases in eating
disorder patients.
on
the
Stroop
Interference for body related stimuli
task
(e.g.,
dichotic listening tasks
reported
in
bulimia
Cooper
et
al.,
(Schotte et al.,
nervosa
1992)
1990)
patients.
and
on
has been
Evidence
for
retrieval biases include the finding of an explicit memory
bias
for emotional
b ody
related
study as well as similar
women by Baker
stimuli
findings
in the present
in weight preoccupied
(199 3).
Clinical observations indicate that obsessive thought
processes
Thus,
it
are
common
in
is recommended
eating
that
possible mediating factors,
of
illness,
age
there
be
individuals.
further
study
of
such as obsessional thought,
which may enhance elaboration.
length
disordered
of
exacerbations and remissions
Clinical variables such as
onset,
and
symptomatic
should also be examined as
factors which
influence memory bias.
Following
further
empirical study, explicit memory tests may po t e n t i a l l y be
useful as assessment and treatment outcome measures.
This
type of research may serve to improve clinical treatments
for the eating disorders.
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Selective
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Self-schemas for body weight and the p r o c e s s i n g of
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Development
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Negative thinking in depression.
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Color naming of phobia related words.
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Appendix A
Body Image Assessment
88
(BIA)
89
B o d v size s il h o u e t t e f o r B o d y I m a g e A s s e s s m e n t.
Appendix B
Eating Attitudes Test
90
(EAT)
D.M. Garner and P.E. Carflnke.
"EAT"
Plea«« circle Che response which best applies to each of the numbered
statements.
Please answer each question carefully.
Thank you.
■
►.
■
PH
•<
0
»
O
►
.
U
G
>
1
C
■*
K
-h
V *> «
W. 0S u
O w
u
2 3
1.
Like eating with other people.
2
3
2.
Prepare foods for others but do not
•at what I cook.
0 1 2
3
3.
Become anxious prior to eating.
0 1
2
3
4.
Am terrified about being overvelght.
0 1
2
3
j.
Avoid eating when I am hungry.
0 1 2
3
6.
Find myself preoccupied with food.
0 1 2
3
7.
Have gone on eating binges when I feel
thsc I may not be able to stop.
0 1
2
3
8.
Cut my food into small pieces.
0 1 2
3
9.
Aware of the calorie content of foods
that I eat.
0
3
10.
Particularly avoid foods with a .high
carbohydrate content (e.g. bread, potatoes,
rice, etc.)
11.
Feel bloated after meals.
12.
Feel that others would prefer If I ace
more.
13.
Vomit after I have eaten.
14.
Feel extremely guilty after eating.
15.
Am preoccupied with a desire to be thinner.
16.
Exercise strenuously to b u m off calories.
17.
Weigh myself several time a day.
18.
Like my clothes to fit tightly.
0 1
1 2
Always
92
(JU
UA4
O
►n
u
>V
0
1 2
3
0
1 2
0
C
u
u
'**
O
(
D
«J
f
i
«
H
U
t
e>
MO
•-*
a
u
3
c*c
w
>
Xi)
4
5
U
19.
Enjoy eating meat.
3
20.
Wake up early in the morning.
1 2
3
21.
Eat the same foods day after day.
0
1 2
3
22.
Think about burning up calories when I
exercise.
0
1 2
3
23.
Have regular menstrual periods.
0
1 2
3
24.
Other people think I an too thin.
0
1 2
3
25.
Am preoccupied by the thought of having
fat on my body.
0
1 2
3
26.
Take longer than others to eat my meals.
0
1 2
3
27.
Enjoy eating at restaurants.
0
1 2 3
28.
Take laxatives.
0
1 2 3
29.
Avoid foods with sugar in them.
0
1 2 3
30.
Eat diet foods.
0
1 2 3
31.
Feel that food controls my life.
0
1 2 3
32.
Display self control around food.
0
1 2 3
33.
Feel that others pressure me to' eat.
0
1 2 3
34.
Give too much time and thought to food.
0
1 2 3
35.
Suffer from constipation.
0
1 2 3
36.
Feel uncomfortable after eating sweets.
0
1 2 3
37.
Engage in dieting behavior.
0
1 2 3
38.
Tike my stomach to be empty.
0
1 2 3
39.
Enjoy trying new rich foods.
0
1 2 3
40.
Have the Impulse to vomit after meals.
Appendix C
Bulimia Test (BULIT)
93
94
Ham tJ
Vote:
BOUT
huM V i each qaupturn on th e £oZLcming pages bg checking ike. appic pu'at z namhen
unde/L tosh question. PZexse nespand t o cn r-i / f r m as ktmtsXZu os pnr.Aj'htt .
nsmesrnen, alL o£ A t injonmation you pnovidz
be. be.pt s tn ic ttg co n fid en tial
7.
Vo uou even, to t uncontnoiJr.ti u to th e p a in t o i stu ffin g goons e lf (i~ z ., ac
on eating him t i l T
1. once, a mondi on. Less
2.
2-J tim e s t m onth
3.
once an sales, a. wees
4. 3 ~ i times a wees
5. once a dag on none
2.
I
os satis ile x w th mu eating paxtznns.
7. oases
2. n e x tia l
3.
disonnet a l i t t l e
4.
tilAtrnrrrf
5.
disonnet strxnglg
J.
'rf**-*
£E2ZJj*JZ
''
*** - *
1
*‘"~T*
1. pnaztLcxiLg evens tic s . I esc*
2. vc/ur ^teqsisCly
1. often
4.
4.
sometimes
5.
stidca an neves.
ttfev.:.*? you. pnxsenttg coil. uounself c. "iinat eattn.*?
7. yes, akscixGlg
2. get
3.
4.
5.
5.
uts, pnessHg
uts, pets s i tig
no, pwhczig not
I pnefen to tat:
1.
I.
3.
a t hme. a le rt
a t hast, iaith atkens
in cl pvcliz ntstcunamt
4. a t t fniznd’ s house
5. doesn't muter.
6.
Vo you {uel you have c e n tra l oven th e amount of food. you cermet*
1. mast on a il of Xhe tim e
Z. a. lo t of tkz tim e
3. oezesicm ilg
4. ncnsJLu
5. ntven
95
7.
I u s t Ic a e tiv e s on s u p p o s itc n iz s to
1.
Z.
I.
3.
o n e s ofi XSiCcs a. u k s Jl
4.
5.
l - l tin ts a m onth
ones a. month an le s s
I t a t u n til. I je s t to o tin z d ta c o n tin u e .
1.
Z.
5.
4.
5.
9.
h e lp e a n tn a l m w e ig h t.
ones, a day- on mono.
3-<S tin ts a. w e s t
a t I t a i t ottos a day
5-o tia ts a w e s t
ones on ta lc s a wzsh
l - l tin ts a m onth
ones i month on le s s
[ onn z v tn )
How o jtin da you p ns^en to tin g ia s ensam, m ilh . s h e e ts , on p u s d irx s
a b in q il
7
always
1. jn u u s n tly
3. som ttim ts
4. seldom on n tv e n
5. I d o n 't b in g e
disc,
.
1C.
How m er. one you c rr e s e n ts e e o u t jow. ic ts r g
1.
I d o n 't binge
Z.
bothie s m t & l i t t l e
3. modseets esnsser.
4 . n lio n to n csnn
5. pnozobly th<"
r
^
iX jc
•
U cst pzceis I fenrrv
a t on s ittin g .
1.
Z.
4.
w ith o u t a d o u b t
v tn y p ro b a b ly
p n e ieb iy
pos s ib le
5.
no
3.
1Z.
i j dhey knew "o x mudz jeez 7 ear rs
To you a m t a t t c th e p o in t e j je e r in g s ic s ?
7. u tey {n e o v s n tly
Z.
3.
4.
5.
12.
-» ~ t «
w o rs ts !
jn u u t r t iy
{ a ir ly o jtz n
o c c a s io n a lly
n e a tly on neves.
I aa cJjnnuL to t a t a n y th in g
7 . always
Z. almost always
3. ^iLcutrXlu
4.
5.
s c m itic ts
seldom on neves.
jo n je a n t h a t T wor.'i be a b le tc s te p .
I d o n 't lik e . m id 4 ' n ^ te a I e a t to o n tic h .
1. a lu x u ji
I.
(fie q u e n tiv
3. som etim es
4. Ap frirm on nevef1
5.
I d o n 't e a t to o ntudi
How o {te n do you in tz n tia n a L L j v o m it a ^ tc s e a tin g ?
1. I on. mans. times a. uiesh
I.
ones a. week
3. l - l tim es a. m onth
4. ones. a. month
5. Lsss th a n ones, a m onth on. neves
Which o { th e $oiLouicng d e scsib e s yous o'e e iin g s
I.
I d o n 't blnae e a t
Z. I ie s L O .K .'
3. I ie s L m iidLu u p s e t w ith musetf,
4. I fatsi. q u ite u p s e t w ith mysei.^
5. I have m yseti
a ^ ts /1 binge e a ti/ic
I e a t a. t a t o( iocd. u h en I ’ m n o t even .h im g n v .
1. uesu ^n zouentty
I . in e a u e rtL y
3. ocsasianaLLu
4. sometimes
5. Ap f rirtm OH ntVV I
Hu
I.
Z.
3.
4.
5.
e a tin g p a ttz s rs one d if£ e s e n t -n c r e a tin g
always
a lm o s t always
insquentLg
sometimes
Acfrirm on. neVOS
I have ts ie d to Lone w e ie h t bu {a s tin a
1. n o t in th e p a a t yeas
Z. ones in th.e p a s t yeas
I. Z-3 tim es in th e p a s t yeas
4. 4-1 tim es in th e p a s t yeas
5. mans then 5 tin e s in th e p a s t yeas
p a ttz s n s o f m a t pec.
on. g o in g on nc~— h " d ie ts .
I {e sL Aaa on. b lu e a ^ te s e a tin g mane th a n I *d. pla n ne d tz e a t.
1. always
1. alm ost always
3. in s a u s rtlg
4.
5.
sometimes
Ae ld e r., neves, on. n o t aqopLicshLe
97
21.
tufien engaged in an e a tin g hinge., T te n d to
canbohudnatei (AusueXi and ita n c h e * 1. .
e a t bood* th a t au. h ig h -in
1.
2.
nf.im u*
ntrmkt. allO at]*
3. bK eguentty
4. *ometiate*
5. At f d n n, on. I d o n 't: h in g e
21.
Coorpaned to m o *t peapf.e, m a b iL L b j to e s n tx a L m
to bej
1. g re a te r. th a n o th e r * ' t t h i l f H r
I,
about the. *ame
3. l£ M
4. mcb. I t * *
5 . I hone a b s a in te L u no c o n te n t
21.
One ob itour. b e a t {> u s n d i MiHHmfy u ig c e it* t h a t you b a th e a t a t a new
r e * ta a r a r t b a b b it th a t n ig h t. JU though y o u 'd p ia rn e d on to tin g *o m e t)u
L ia h t a. home., you go ahead, and e a t o a t, to tin g q u ite a L o t ana M eeting
unarm bontnbLu {u L L . How m a id you b ee t a b o u t y o u u e tb on th e .U de har.x
1. b in e , q ta d I'd t r ie d th a t new n z A ts u n a n t
2. a
re g n e tb u i th a t I'd eaten ao trunk
3. icm tw h a t d iw a rp a in te d in tmueLb
4. u p it t w ith rrauetb
5 . *j^r-r!y diAQUtarsji w ith mu*eib
24.
I ’’vr’ i f ' 1 p n e *e n tL r la b e l. m u e tb - "c o m p u ls iv e e ater.” , (one -aha engage* .
tp i& o d e i o ( u n c o n tro lle d e a tin n i.
* ze ia
-
:.
4.
5.
e a tin g behe.-UX-* A P Pr*>
1*
yes, p n rc a z lr
yea, pot i i k i u
no, p m babLu n o t
25.
M hct i t th e m oot 'w e ig h t y o u 'v e ever. L o s t in
1. over. 2D pound*
2.
12-20 poundi
J . | -, *J pound*
4. 4-7 poundi
5. t f At than 4 pound*
one e a rth ?
2k.
I{ I e a t to o munk a t n ig h t I { t e l d s x rz **e d th e n e x t s a v in g .
1. f/HTTWA
2.
S.
4.
5.
27.
y ie q iix n tty
iO O ttiO LL
ki t le a an never.
I d o n 't e a t to o n tio k a t n ig h t
Vo you b e iie v e th a t i t i t e a *ie n {on you to
1. ' u e * , i t 4* no p rr b le a a t dLL boa .■at.
2. ye*, it ? * e a s ie r
3. ye*, i t 4* a. Lit t l e ea sie r.
4. about th e *a r.e
5. no, i t 4* Le** easy
v o m it th a n i t i *
[o n n o *.
98
11.
I {udL th a t iood c a n tn o is my L l^ e .
/. nhnrrtrA
1.
5.
4.
5.
29.
I ie e i depressed ir • m z d ia ttiy a ^ t o i T e a t to o m th .
7. alw ays
Z.
3.
4.
5.
50.
a lm o st alw ays
fn e g u e n tty
sometim es
I P/rlrrm OA. rtXVeA
{n equentLy
Sometimes
Ae/rlnm o il neVZIL
I d o n ' t t a t to o much
How o^ten do you vom it a^tzn. eatlna in ondzn. to Lose weight;
7. Less th a n ones, a m onth on. n tv e k
Z. cm o t a month
3. 2-5 tim e s a m onth
4.
5.
ones, a week
I on mans, tin e s a. week.
57.
Wftex consuming a txvine, q u a n tity o { fo o d , a t w h a t note, o^ speed do uou
u s u a lly eat?
I. botx. .ra p id ly th a n m a tt p e o p le have, m en. eaten in th e ir L ive s
I.
a L o t mans. n a p id iij th a n m o s t p zn p is.
3. a L i t t l e mans. A n p i d l y th a n m o .it p z n p is .
4 . aaout the. sane A n t s, at most pzopss.
5. mens s h rw ly th a n m ost p e o p le ( oa n o t s p p tic a b L z l
11.
W hat is the. m ast w e ig h t sv^ x
T. oven. 10 pounds
Z.
11-10 pounds
3. l - l 7 pounds
4 . 4-7 pounds
5 . Less th a n 4 pounds
53.
M u la s t m enstuscL p e n ia d was>
7. w ith in th e p a s t m onth . .
Z.
eves, g a in e d in one. m onth 7
w ith in
th e . p a s t Z. m onths
th e . p a s t 4 m onths
w ith in th e p a s t 6 m onths
n o t w ith in th e . p a s t 6 m onths
3. w ith in
4.
5.
54.
jt.
I use d iiin e tla s (lartivt. p iL L s I t s h e lp o a n tn o L mu w e ig h t:
'7. o n o t a day oil mans.
Z . 3-e t in t s a. w e st
3. ones, on f a i r z a. week
4 . 2-3 tin e s a m onth
5 . onex.a. month on Less [ on n tv e n i
How da you th in k youn a p p e tite , camponcs w ith th a t o ^ mast pe cp ie uou hnoxt
7. mono tin e s Langes, th a n m o st
Z. m cA Langen
3. a U ttte Langen.
4 . a b o u t th e same
5. smalLzn. th a n m ost
Appendix D
Interview for the Diagnosis of Eating Disorders
99
(IDED)
INTERVIEW FOR DIAGNOSIS OF E ATING D I S O RDERS
(IDED)
D A T E ________________
NAME
j____________________________________A G E _______
D A T E O F B I R T H _____________ W E I G H T ________
RACE.
H E I G H T _______
A D D R E S S ___________________________________________________ __
TELEPHONE
R E F E R R E D B Y _____________________
I.
G eneral
Assessment
1.
What tyoes o f p r o b l e m s do you
h a v e w i t h e a t i n g or w e i g h t re lated m a t t e r s ?
H o w long has th i s b e e n a p r o b l e m ?
2.
What
2.
Were you o v e r u e i a h t
4.
Wer e y o u / a r e
(Descr i b e .)
5.
What has been t h e c o u r s e of yo u r e a t i n g p r o b l e m s ?
the b eha vio r began, i ncr e a s e s , d e c r e a s e s , c h a n g e s
has been your
you
and
His t o r y
highest
as
and low e s t
a child?
overueignt
as an
Y
weight?
N
When7
(Describe.)
adolescent'-
Y
N
(H o w
in e a t i n g
101
6.
H ave you had a n y m e d i c a l / d e n t a l p r o b l e m s ?
(Check for
dizziness, LBP, HBP, t oo t h e r o s i o n , t h y r o i d problems,
di abetes. )
7.
Do you avoi d e a t i n g
certain
foods?
Y
N
(Describe.)
What emotion al r e a c t i o n o c c u r s w h e n y o u eat these
"f orbidden" f o o d s ?
(Foods w h i c h a r e a v o i d e d or pur g e d du e
a belief that th e foods will l ea d to r a p i d and s i g n i f i c a n t
uei ght gai n . )
8.
II.
1.
H o w many m e m b e r s
a re
there
in y o u r
household'5
Do they k n o w abo u t y ou r e a t i n g
If yes, hou do the y r e a c t / f e e l
problems?
a bo u t your
W ou l d
treatment?
they p a r t i c i p a t e
in your
to
Y
N
eat i n g
disorder'5
Anorexia N e r v o s a
Do you c u r r e n t l y go p e r i o d s
(starvation) to c o n t r o l your
of t i m e
weight?
w i t h o u t eat i n g
Y
N
(If Y, d e s c r i b e . )
102
Whe n die, you
first
begin
to
lo s e
Are there any f a c t o r s / s i t u a t i o n s w h i c h s e e m
d e c r e a s e p e r i o d s of r e s t r i c t i v e e a t i n g ?
2.
Do
Y
3.
you feel that your
N
fDesc r i b e . )
What emotional
3 lbs. "
weight
your
uei gli t/r est ric t
to
eating?
increase
or
is n o r m a l ?
reaction
would
you
have
if y o u
reaction
would
you
have
if
lost
5 lbs."'
10 lbs."
What
emo tional
you g a i n e d
? lbs."'
Z
lbs.''
10 lbs."
-I.
Do you wish to be t h i n n e r t h a n y o u a r e n o w ?
Y
e l f Y, asl. w h a t b o d y a r e a s s h o u l d b e t h i n n e r . )
What
is your
Do you
thinI
goal
or
N
weight?
worry
a lot
about
y ou r
weight
and
body
sire?
103
Do you often feel
V
N
(Describe.)
"fat"
Do you weigh y o u r s e l f
5.
Wh e n was your
last
often?
menstrual
H a v e you e x p e r i e n c e d
t hr e e mo nt h s ?
Y
N
III.
when
you g a i n
Y
N
only
a
few p o u n d s ?
How often?
cycle?
menstrual i r r e g u l a r i t i e s
(D esc r i b e . )
within
the.last
B u i ;mia Ner v o s a
Do you ever b i n g e (rapid c o n s u m p t i o n of l a r g e a m o u n t s of food
in a d i s c r e t e p e r i o d of time'')
Uhat is t he d a i l y c o u r s e of
your binge e a t i n g ?
( D e s c r i b e all c o v e r t an d o v e r t e v e n t s
to, d uring, a n d after a binge.)
that usu a l l y occu r p r i o r
Do you ever feel as t h o u g h y o u h a v e o v e r e a t e n
small p o r t i o n s of c e r t a i n f a t t e n i n g f o o d s ?
Y
w h e n you eat
N
( D es cri be. )
Wh e n
binge?
did you
first
begin
to h a v e p r o b l e m s
with
Are
the
Do
Y
the r e any f actors whic h a p p e a r
fre q u e n c y of b i n g e e a t i n g ?
increase
or
yo u
after
vomit7
Y
meals
N
or
aft er
H o w oft e n
a binge?
per
Y
laxatives?
Y N
How
often, what
type7
Do
yo u use
diuretics7
Y N
How
ofte n, what
type7
appetite
Do
you o ft e n
Do
y'-u pnrj.irjp in v i a o r o u s
When
did
Are
the
you
go
suppressants7
in strict d i e t s ?
first
begin
H o w of t e n d o e s
Y
N
Y
N H o w often, t y p e 7
exercise7
H o w often,
Y N
type7
Ho w often, t y p e ?
to p u r g e ?
t he r e an y fact ors whi c h
f req uen cy of p u r g i n g ?
appear
the b i n g e e a t i n g
N
day/ueek?
yo u use
you use
Y
N
Do
Do
decrease
yo u feel out of c ontrol prio r t o or d u r i n g a b i n g e 7
N
( D esc rib e.)
Do you feel h u n g r y p r i o r to a b i n g e 7
Do yo u p u r g e
Do
to
to
occur?
i n c r e a s e or d e c r e a s e
105
Ho w
long
have
How often
does
y o u b ee n
binging
the b i n g e —p u r g e
at
least
cycle
t w i c e per
week?
occur?
IV.
Compulsive
Overeating
1.
If you binge ,
2.
Do you b i n g e
3.
What
4.
Do you o f t e n
(Descr i be . }
5.
Ha v e yo u h a d f r e q u e n t w e i g h t f l u c t u a t i o n s g r e a t e r than
ten p o u n d s in th e pa s t few y e a r s ?
Y
N
(Describe.)
6.
Do you c o n s i d e r your e a t i n g t o b e a b n o r m a l ?
Y
N
Do you feel that yo u h a v e c o n t r o l o v e r yo u r e a t i n g ?
emotions
what
t y p e s of
alo ne,
or
food
in s e c r e t ?
typically precede
attempt
do you
to di e t
Y
N
typically
eat?
(Describe.)
a binge?
in o r d e r
to
lose w e i g h t ?
Y
N
Ho w do you fool
(D g s >:r i b e . )
Are
during
you s a t i s f i e d
If no,
what
with
is you r
and
your
goal
after
a binge
current
weight?
epi
weight?
107
Rating
I.
An o r e M a N e r v o s a
1.
Refusal
to m a i n t a i n
Scale
appropriate
1
A :c ep t s Prefer'
n or m a I
/.
ut .
b e 1ou
norma 1
ut .
Inter'se
fear
1 2
Mo
Minimal
Pr.
Px
Body
)
Never
4.
Prefers
107.
bel o w
no r m a l
ut .
of
Pr e fer s
157
bel ow
normal
ut.
weight
2
Minima!
Fe a r
3
After
eating
meals
the
IDED
weight
for h e i g h t
6
5
P r e fers
207.
bel ow
norma1
wt .
Prefers
257.
bel ow
nor m a 1
wt.
7
Prefers
> 257.
bel ow
nor m a 1
wt .
gain
4
5
Moderate S t rong
Fear
Fe a r
image d i s t u r b a n c e :
2
Occasionally
when
"stuffed"
for
Feels
4
After
eat i ng
smal 1
amounts
of food
6
Intense
Fear
7
Morbid
Fear
"fat'
5
6
Most
A lm o s t
of t he all of
time
tim e
7
A1 1
of the
t ime
Amenorrhea
1
2
3
4
5
Ver y
Slight M i s s e d
Mi s s e d
Missed
Regular Irreg2 cycles 3 cycles 4 cycles
u l a r i t y last
6 last
6
last
6
mos.
mos.
mos -
6
7
Missed
Missed
5 cycles 6 cycles
last
6
last
6
mos.
mos.
108
Bu li m i a N e r v o s a
1.
Re cur r e n t
1
2
Neve r
binges
binge
eating
episodes
3
I nfr equ ent I n f r e q u e n t
and small
but la r g e
Fe eli ng
A1ways
in
co ntrol
of
los s of
4
Frequent
and
large
control
Rare
Occa1 os ?
si on a 1
of
loss
control of
contro1
5
Frequent
including
binges
a nd
Forbidden
food s
during
Frequent
loss of
contr ol
binge
5
Usual 1y
out o f
control
S
Very
frequent
u/ o n l y
large
binges
eating
6
Al m o s t
always
out of
con t r ol
7
Nev er
in
cont r o 1
Purgative behavior
2
P c 'g cs
1-2/
year
4.
3
4
F u r c:!’‘
Pur qec
1 time/ 1-3
2 mos.
t i mes /
mo.
F r e q u e n c y of
Rarely
occurs
Occ urs
a few
t i mes/
year
binge
5
Fur nes
1-2
times/
we e k
6
IT QP r
3-6
times/
week
7
Very
f req u e n t
w/
blnges
for bi d .
foods
7
Dnrnpc
i or m
times/
day
eating
4
5
6
7
1-4
5-8
2-3
4-6
Occurs
t i m e s / ti m e s / t i m e s / t i m e s / d a i l y
month
month
week
week
or a l m o s t
dai 1 y
109
5.
Overconcern
I
Z
No
Min ima l
ovei—
concern
concern
with
body
shape
and
sice
3
4
5
Some
Moderate Preocpreoc—
degree
cupi e d
c u p a t i o n of p r e most
occupa—
of t h e
t i on
ti m e
6
Preoccupi ed
almost
all of
the
t im e
7
Preoc­
cupied
al 1 of
t he
t im e
Compulsive Overeating
I.
Recurrent
Never
Bing es
binge
Infrequent
and small
Consumption
bi nge
1
1
No
binges
2
Prefers
to eat
with
fr ien ds
or fami ly
Frequent
and
1 ar g e
high-calorie,
4
2
Inconspicuous
episodes
Infrequent
but larg e
of
No
Min ima l
binges Overeat
of normal
foods
3.
eating
Moderate
Overeat
of normal
foods
eating
Bi n g e s
on
normal
foo d s
during
3
Overeats
with
friends
or
family
4
Binges
with
few
people
8
5
Frequent
Very
i n c 1 u d i n g fr e q u e n t
binges +
u/ o n l y
f o r b i d d e n 1 ar ge
foo ds
bi n g e s
food
7
Ve r y
fr e q u e n t
w/
binges +
forbi d.
foods
easily
ingested
d uri n g
5
Bi n g e s
on
normal
and
hi — cal
fo o d s
Overeats
Binges
exc 1 usi vel y at meal s
on h i — cal
an d b i n g e s
foods
onl y
hi — c al
foods
8
a binge
5
Binges
at h o m e
alone
with
others
in h o u s e
6
7
Rarely Binges
b i n g e s o n l y when
with
alone
anyone
else
present
R ep eat ed
e ff o r t s
;
^
Never
Diets
Diets
1-2
2 —1
times/
year
t i mes/
year
diets
N e g a t i v e affect
1
2
No
Seldom
over eats
b i nge s
1
Non e
Frequent
prior
o v e r-
eats
d ue to
affect
weiaht
2
Minima1
u t.
flu; .
4
Die ts
5-6
t i mes/
year
6
Diets
al mo s t
every
we e k
5
Diets
every
month
7
Di et 5
al 1
o f the
t i me
to bing e
3
4
S o m e t i m e s Often
due to
-- affect
E.
at d ieting
n
P ew
1-9
lb .
flu c .
5
Freq.
B inge
Binge
eats
ea t s
due to
d u e to
extreme
moderate
affect - affe ct
f1u c t u a t l o n s
4
Few
10
lb.
flue.
greater
5
Many
10
lb.
flue.
6
Few
10-20
lb.
flue.
than
6
Usually
Bing e
eats
due to
mild
- affect
7
Almost
always
binge
ea t s
du e t o
- affect
10 lbs.
7
Many
10-20
lb.
f luc .
Absence of p u r g a t i v e b e h a v i o r s
1
2
3
P u r g e s Purges P u r g e s
d a ily
weekly m o n t h l y
9.
1
No
Px
R e a liz ati on
that
4
Pu rge s
Infrequently
5
Purges
1— 2/
year
eat ing p a t t e r n
6
7
Diets
Non e
occasionally
is a b n o r m a l / o u t
of c o n t r o l
6
4
5
Fre­
Fre­
Extremely
Mi ni m a 1 D c c a Fre­
quent
que nt
f re que nt
Px
si onal
quent
m o d e r a t e intense
and
mild
mi l d
feeli ngs feeli ngs feeli ngs feelings i n t e n s e
Appendix E
Body Shape Questionnaire
111
(BSQ)
112
We
would
likcr
to
know
how
you
h a v e be en feeling a bou t your
a p p e a r a n c e o v e r the P A S T F O U R W E E K S .
Please
rend ea c h q u e s t i o n
and c i r c l e
the a p p r o p r i a t e
n u m b e r to
the right.
Please answ er
all the q u e s t i o n s .
OVER
THE
PAST
t.
Has f e e li n g
brood about
2.
FOUR
WEEKS;
Never
1
2
H a v e y o u b e e n so w o r r i e d a b o u t
your s hap e that you have b e e n
f e e l i n g th at y o u o u g h t to d i e t 0
L
2
3.
H a v e y o u t h o u g h t th at y o u r
t h i g h s , h i ps, o r b o t t o m a r e
too L a r g e for t h e rest of y o u 1
1
2
I.
Have you be e n a f r a i d that you
m i g h t b e c o m e fat (cr f a t t e r ) ?
I
2
5.
Have you w o r r i e d about y o u r
flesh not b ei n g firm enough'7
1
2
6 .
H a s f e e l i n g f u l l ( e.g.. a f t e r
e a t i n g a L a r g e n ea l i m a d e you
f e e L fa:'.’
1
2
7.
Ha-, e y o u fe lt so ba d a b o u t
shape that you h a ve cri ed?
I
2
I
2
Has b e i n g -lth t h i n w o m e n m a d e
yo u fee l s e l f - c o n s c i o u s a b o u t
you r s h a p e 7
1
2
10.
Have you wo r r i e d about your
t hig h s s p r e a d i n g out w h en
sitting down?
L
2
11.
Has e a t i n g e v e n a small a m o u n t
of f o o d m a d e y o u feel fat ?
L
2
12.
H a v e yo u n o t i c e d the s h a p e of
o t h e r w o m e n a n d feLt that y o u r
o wn s ha pe c o m p a r e d u n f a v o r a b l y 0
1
2
L3.
Has t hin k in g a b o u t your s h ap e
i
2
i n t e r f e r e d w i t h y o u r a b i l i t y to
c o n c e n t r a t e (e.g.. while w a t c h i n g
TV, r e a d i n g ,
l i s t e n i n g to c o n v e r s a t i o n s ) 7
3
u
«
••r-*i; v. " i df*H
tje c a u s e
y .
b o r e d made you
y o u r shape?
Rarely
.our
I iesn
jour
r •;n r :n e
m
gn t
woLC.e
Sometimes
Often
Very
Often
Always
113
Page
Seve r
Rarely
Some-
Often
times
Very
2
Alwav
Often
I
4,
15.
H a s b e i n g n a k e d , s u c h as
t a k i n g a b a t h, m a d e you
f e e l fa t?
when
H a ve you a v o i d e d we ar in g
c l o t h e s w h i c h m a k e you
p a r t i c u l a r l y a w a r e o f the
of y o u r b o d y ?
1
2
3
4
5
6
1
2
3
4
5
6
shape
16.
H a ve you i m a g i n e d cutt ing off
f l e s h y a reas of yo u r body?
i
2
3
4
5 ‘
6
17.
Has eating sweets,
e th e r high c al ori e
y o u fe el fat.?
1
2
3
4
5
6
18.
H a v e y o u no t g o n e o u t to s o c i a l
1
o c c a s i o n s (e.g., par t i e s ) b e c a u s e
y o u h a v e fel t b a d a b o u t y o u r s h a p e ?
2
3
4
5
6
19.
H a v e yo u f e l t
and rou nded?
1
2
3
4
5
6
20.
H a v e you
body ?
I
2
3
4
5
6
21
Has
you
I
2
3
4
5
6
•• a \
felt
excessively
ashamed
worry about
diet'’
<*
f f» ; *
your shape
been empty
cakes, o r
f ood m a d e
your
of
your
shape
h a p r : e «- »
w h e n your
( e . g . . in
large
made
i hcu t
1
s t o m a c h ha s
the m o r n i n g ) ' ’
23.
H a v e y o u t h o u g h t t hat you a r e
the s h a p e y o u a r e b e c a u s e yo u
l a c k sel f - c o n t r o l ?
1
2
3
4
5
6
24.
H a ve you w o r r i e d about o t h e r
p e o p l e s e e i n g r o l l s of f l e s h
a r o u n d y o u r w a i s t or s t o m a c h ?
I
2
3
4
5
6
25.
H a v e y o u f elt t h a t it
fa ir that o t h e r w o m e n
t h i nn e r than you?
1
2
3
4
5
6
26.
Hav e you v o m i t e d
feel thinner"’
1
2
3
4
5
6
is n o t
ar e
in o r d e r
to
114
Page
Never
27.
W h e n in c o m p a n y h a v e y o u
w o r r i e d a b o u t t a k i n g u p to o
ouch room (e.g., sittin g on
sofa or bus sea t)?
Rare iY
Sometimes
Often
Very
Often
3
Always
1
2
3
4
5
6
1
2
3
4
5
6
1
2
3
4
'.5
6
2
3
4
5
6
a
28.
Have you w o r r i e d about
flesh bei ng d i m p l y ?
29.
Has see i n g y o u r ref le ct io n
(e.g.,
in a m i r r o r o r s h o p
w i n d o w ) m a d e y o u feel bad
about your s h a p e 7
30.
Ha ve you
p i n c h e d a r e as of
b o d y to s e e h o w m u c h fat
is t h e r e ?
31.
Have you
a v oided situations
1
w h e r e p e o p l e c o u l d see y o u r b o d y
(e.g., c o m m u n a l c h a n g i n g rooms or
swimming pools)?
2
3
4
5
6
32.
Have you
taken laxatives
o r d e r to f e e l t h i n n e r 7
2
J
t
5
6
33.
Have you
been particularly
1
s e l f - c o n s c i o u s a b o ut y o ur s hape
w h e n in t h e c o m p a n y of e t h e r p e o p l e ?
2
3
4
5
6
3 4 . Has
you
your
your
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- o r r y ab cut your shape made
fee.I y o u o u g h t to e x e r c i s e 0
1
1
1
5
Appendix F
Beck Depression Inventory
115
(BDI)
116
BECK INVENTORY
NAME: ___________________ CLIENT t: _____________ _
DATE:
ADMINISTRATIONt:
On this questionnaire are groups of statements. Plaaae read each group of stacemencn
carefully. Then pick, out the one statement in each group which bene describes the way you
have been feeling the PAST UEEK. D?CLtJDtWG TQDATI Circle the number beside the statement
you picked. If several statements in the same group seem to apply equally well to you,
circle each one. Be sure to read all the statements in each group before making your choice
1.
2.
3.
0
1
2
3
I
I
I
I
do not feel sad.
feel sad.
am sad all the time and I can't snap out of
am so sad or unhappy that I can't stand It.
it.
0 I am qoc particularly discouraged about the future.
1 I feel discouraged about the future.
2 I feel I have nothing to look forward to.
3 I feel that the future Is hopeless and thatthings cannot Improve.
0
1
2
3
I do not feel like a failure.
I feel I have failed more than Che averageperson.
As I look back on my life, all 1 can see is a lot of
I feel T am a complete failure as a person.
faLlure.
1 get as much satisfaction out of things a* £ used to.
1 I don't enjoy things the way I used to.
2 I dou't get real satisfaction out of anything anymore.
3 I am dissatisfied or bored with everything.
0
5.
0 I don't feel particularly guilty.
1 I feel guilty a good part of the elms.
2 I feel quire guilty most of the time.
3 I feel guilty all of the time.
6.
0
1
2
}
1 don't feel I am being punished.
I feel I may be punished.
1 expect tc be punished.
I feel I am ceing punished.
7.
0
1
2
3
1 don't feel disappointed In myself.
I am disappointed in myself.
I am disgusted with myself.
I hate myself.
8.
0
1
2
3
I don't feel I am worse chan anybody else.
I am critical of myself for my weaknesses
or mistakes.
I blame myself all the rime for my faults.
I blame myself for everything bad that happens.
9.
0 1 don't have any thoughts of killingmyself.
1 I have thoughts of killing myself, but I would not carry chem out.
2 I would like to kill myself.
3 I would kill m y B e l f if I had the chance.
10.
0
1
2
3
I don't cry anymore than usual.
I cry more than I used to.
I cry all the time now.
I used to be able to cry, now I can't cry
even chough I wane to.
CONTINUED ON BACK OF PACE
r
117
11.
12.
13.
0
Iam uo more Irritated nov than I ever am.
1 Iget annoyed or irritated more easily than I used to.
2 I feel irritated aJ1 the time now.
3 I don't gee irritated at all by the things that used to Irritate me.
0
1
2
3
0
1
2
3
I have oot lost interest in other people.
I am lees interested in other people chan I uaed to be.
Ihave lost moat of try interest in ocher people.
Ihave lost all of my interest in other people.
1make decisions about as well aj I ever could.
Iput off making decisions more than I used to.
I have greater difficulty in making decisions than before.
Ican't make decisions at a 11 anymore.
14.
0
1
2
3
1don't feel I look any worse than I used to.
Iam worried chat I am looking old or unattractive.
I feel that there are permanent changes in oy appearance that make me look uoactract:
Ibelieve chat I look ugly.
15.
0
1
2
3
1can work about as well aa before.
It takes an extra effort to get started at doing something.
Ihave co push myself very hard to do anything.
Ican't do any work at all.
16.
0
I.can sleep aa well as usual.
1 Idon't sleep as well a«! X used co.
2 I wake up 1-2 hours earlier than usual and find it hardco gee back,cc sleep.
3 I wake up several hours earlier than X used co and cannot gee backco sleep.
17.
0
1
2
3I
18.
0
1
2
j
My appetite Is no worse chan usual.
My appetite is not as good as it used to be.
My appecite Is much worse now.
I ;iave r.c appetite ac all anymore.
19.
0
1
2
3
I haven't lost much weight. If any lately.
Ihave lost more chau 5 pounds.
Ihave lose more chan 10 pounds.
Ihave lost more chon 15 pounds.
1don't get more tired chan usual.
Iget tired more easily chan I uaed to.
Igee clred from doing almost .anything.
am coo clred
Co do anything.
X ampurposely crying to lose
weight by eacing
Leas.
No
_
Yes _____
20.
0 I am no
more worried abouc my health than usual.
1 I am worried abouc physical problems such as aches and pains; or upset stomach;
or constipation.
2
Iam very worried abouc physical problems and it's hard to chink ofmuch
else.
3
Iam so worried abouc my physical problems, chat I cannocthinkaboucanything else.
21.
0
1
2
3
1 have not uotlced any recent change in my interest in sex.
Iam less interested in sex than I used co be.
Iam much less interested in sex now.
I have lost inceresc in sex completely.
Appendix G
Visual Analogue Scale
118
(VAS)
119
Subject #
Please rate your present anxiety or discomfort
scale below by circling the appropriate number.
No
Anxiety
Minor
Anxiety
Moderate
Anxiety
High
Anxiety
on
the
Extreme
Anxiety
! ----------- 2 ------------ 3 ------------ 4 ------------- 5
Appendix H
Subjective Units of Distress Scale
120
(SUDS)
121
Subject #
On the scale below, please indicate how sad or depressed
you are feeling right now, by circling the appropriate
number.
Normal
Mood
Slightly
Depressed
Moderately
Depressed
Very
Depressed
Extremely
Depressed
1 ----------- 2 ------------ 3 ------------ 4 ------------- 5
Appendix I
Eysenck Personality Questionnaire
122
(EPQ)
123
I N £ VEH Y QUES T/ON, M A R K JUST ONE BOX
1.
D o y o u h j v c m a n y d i f f e r e n t hobbies?
2.
D o y o u st op i o t h i n k th ing s over bef ore doing a n y t h i n g 7
.
Ooes y o u r m o o d o f t e n go u p and do w n ?
A.
Have y o u ever t a k e n the praise f o r something y o u k n e w som eon e else had r e a ll y d o n e 7
5.
Ar e y o u a t a lk a t iv e p e r s o n ? ....................................
6.
W o u ld being in debt w o r r y you?
7.
D o y o u ever feel “ ju st m i s e r a b l e ' ' f o r no reason?
8.
.
.
.
yesQ
3.
9.
0
y e s
.
. . .
YESO
.
..............................
Q
y e s
.........................
..............................................
Were y o u ever gr eed y b y h e l p in g yo u r s e lf to m or e th a n y o u r share o f a n y t h i n g 7
D o y o u l o c k u p y o u r hou se c a r e f u l l y at night ? .................................................................
.
D
y e s
.
.
NO □
"0 0
y e s
Q
y e s
Q
NO0
NO □
NO 0
0
NO
W o u l d it u p s e t y o u a l o t to see a c h i ld or an an im a l s u f f e r 7
y e s
Q
NO 0
YES0
A r e y o u r a t h e r l i v e l y ? ...........................................................................
11.
................................................................
! 2.
D o y o u o f t e n w o r r y a b o u t things y o u should no t base do n e or s a i d 7
13
I f y o u say y o u w i ll d o som e Using, d o y o u always keep y o u r p r o m is e n o m a t t e r h o w in c o n v e n i e n t
. I m i g h t b e ? ........................................................
YES □
14.
Can y o u u s u a ll y let y o u r s e l f go and enjoy > our sell j i a li v e ly p a r t y ?
y e s
15.
Are y o u an i r r i t a b l e pe rs on?
.
.
16.
Have y o u ever b la m e d so m eo ne f o r do in g so m et hin g ; vu * n e *
17.
D o y o u e n / o y m e e t i n g n e w pe op le?
’p
{_%•* v o >j
' i f * r <rsur a n r f pla ns are a good
Ar e > o u r feelings easily h u r t ?
.
.
<
as re i
. . . .
. . . .
A r e al l y o u r h i b i u goo d an d desirable ones?
.
21.
D c y o u t e n d to keep in th e b a c k g r o u n d on social
.
.
occasions'*
.
.
Do v o u o f t e n feel “ f e d - u p " 7
N O 0
NO0
NO |
yesD
YESj
NO 0
yes n
NO0
"O'0
YES □
"0 0
D
YES Q
N O 0
YfSD
N O 0
YES □
W o u l d y o u ta ke drugs w h i c h m a y have strange or dan ge ro us effects?
73
D
0
NO0
y e s
H
70.
22.
n o 0
y e s
10.
19.
"oQ
"<>□
YES □
yes0
.
N O 0
y e s
D
N O 0
N O 0
24
Have y o u ever t a k e n a n y t h i n g (even a p m or C u i i o n j m a t be lo ng ed to \
25.
D o yo u l i k e go in g o u t a l o t?
26.
D o y o u e m o y h u r t i n g p e o p le y o u love?
.
YES □
NO □
27.
A r e y o u c l ten t r o u b l e d a b o u t feelings o f g u i l t '
YES □
NO 0
28.
D o y o u s o m e t im e s u l k a b o u t things y o u k n o w n o t h i n g a bo ut ?
YES □
NO 0
29 .
D o y o u p r e f e r r e a d i n g t o m e e t in g people?
YES 0
NO0
.
.
.
YES 0
.
.
.........................
NO 0
.30.
D o y o u ha ve en em ie s w h o w a n t to ha r m y o u 7
YES 0
NO0
31.
W o u l d y o u call y o u r s e l f a ne rv ou s per son*
YES 0
NO 0
32.
D o y o u ha ve m a n y f r i e n d s ? .........................
YES 0
NO0
33
D o y o u e n i o y p r a c t ic a l jo kes th at can sometimes r e a ll y h u r t peop le?
YES0 N O 0
.
.
.
.
34.
A r e y o u a w o r r i e r ? ....................................................................................................
Y E S 0 NO 0
35.
As a c h i l d d i d y o u d o as y o u were t o ld i m m e d ia te l y and w i t h o u t g r u m b l i n g ?
YES 0
N O 0
36.
W o u l d y o u cal l y o u r s e l f h a p p y - g o - l u c k y ? .
YES 0
N O 0
37.-
D o g o o d m a n n e r s and cleanliness m a tt e r m u c h to y o u ?
38.
D o y o u w o r r y a b o u t a w f u l things t h a t m ig h t h a p p e n 7
.
.
................................
YES 0
N O 0
YES 0
NO0
39.
Have y o u ever b r o k e n or lo s t s om et hi ng b e l on gi ng to so m e o n e else?
YES0
N O 0
40.
D o y o u u s u a l l y Lake the i n it ia t iv e in mak ing n e w friends ?
YES 0
NO 0
41.
W o u l d y o u call y o u r s e l f tense or “ h i g h l y - s t r u n g " 7 .
YES0
N O 0
42.
Ar e y o u m o s t l y q u i e t w h e n y o u are w i t h ot her p e o p l e 7
Y E S 0
n o 0
43.
D o y o u t h i n k m ar ri ag e is ol d -f a sh io n e d and sho uld be do n e a w a y w i t h 7
Y E S 0
N O 0
44.
D o y o u s o m e t im e s boast a l i t t l e 7
45.
Ca n y o u eas ily get some li fe i n t o a rather d u l l p a r t y ?
.
.
.
.
.
■
.
.
.
.
.
....................................................
. YES 0
N O 0
. YES 0
N O 0 j
GO RI GH T ON TO THE N E XT PAGE.
I
124
46
Do peo ple w h o d r iv e c a r e f u l l y a n n o y y o u 7
47
Do y o u w o r r y a b o u t y ° u f hea lth ?
48 .
Have y o u ever u i d a n y t h i n g bad or n a i l y a b o u t ar. r on e 7
.
.
.
.
•
YES0
N O 0
YES0
<K) { 3
vesQ
49.
Do y o u I'ke i d l i n g jo k es and f u n n y stories l o y o u r f r i e n d s ’
ves
Q
nO
50'
D o mo st things taste the same to yo u?
yes
0
n o
G
51.
As a c h i ld d i d y o u ever t a lk back to yo ur p a r e n t s ’ .
0
.
.
.
.
.
..........................................................
.
54.
D o y o u s uf fe r f r o m s l e e p l e s s n e s s ? .........................
55.
D o y o u al wa ys wash b e f o r e a meal?
..........................
7ESQ
n o
.
y e s q
n o n
. . .
.........................
.
..........................
no
YES 0
NO Q
>
YES □
□ 1
o
2
D o y o u li ke m i x i n g w i t h people?
D o e i it w o r r y y o u i f y o u k n o w th ere are m is t a ke s m y o u r w o r k 7
■
□
52.
53.
56.
Do y o u n e a rl y al w ay s have a “ re ad y a n s w e r " w h e n p e o p le talk t o y o u ?
57.
D o y o u like f o ar riv e at a p p o i n t m e n t s in p l e n t y of ti m e ?
.
.
.
.
..........................
O
YES □
NO U
YES 0
NO 0
58.
Have y o u o f t e n f e lt listless and t ir e d for no r e a s o n '
YES 0
NO 0
59
Have y o u ever c h e a te d at a garne?
YES0
NO 0
60 .
D o y o u like d o i n g th ing s in w h ic h y o u have to act a u i c k i y 5
YES 0
NO 0
61.
1; (or w j . i y o u r m o t h e r a goo d w o r r u n ?
YES 0
NO 0
62 .
Do yo u o f t e n feel li fe is ve ry du ll ?
63
Have y o u ever t a k e n adva ntag e o f s o m e o n e '
.
.
0
.
.
.
.
.
U S0
no
YES 0
NO 0
0
64
Dc y o u o f t r n ta k e o n m o r e act i»ities than v o u h a . r t -m ■ f - - ’
N .'.r
- .0 0
65.
Are there sevr ral p e o p le w h o keep t ry .n g to a*m :) v m u !
. [ 1 0
NO 0
66.
Do y o u w o r r y j ! o t a b o u t y o u r l o o k s ’
Y E .S 0
N O 0
67 .
Do y o u t h i n k p e o p le spend t o o m u c h tim e s af eg ua rd in g their f u t u r e w i t h savings an d in s u r a n c e s ’
YES0
N O 0
68 .
Have y o u ever w i s h e d t h a t y o u we re d e a d ’
YES [01
NO [ ]
69
W o u ld v o u do d ge p a y m g taxes if y o u were s u r * ■
v f i n
n o
.
YES 0
N O 0
■
VF.5 0
N O 0
•
, c r ,uiri neve* be f o u n d o u t ’
Have y o u ever in s is te d o n hav ing y o u r o w n w a y 7
74.
When y o u ca tc h a t r a i n d o y o u o f t e n arrive at tnc >asi m i n u t e ?
75.
D o y o u s u f fe r f r o m " n e r v e s * 1?
76.
D o y o u r f r i e n d s h i p s b r e a k u p easily w i t h o u t it bei ng y o u r f a u h ?
.
D o y o u o f t e n feel l o n e l y ? .........................
78.
D o y o u al w a y s p r a c t ic e w h a t y o u preach ?
79 .
D o y o u s o m e t im e s li k e teasing animals?
.
..............................................
.
.
.
.
.
.
.
........................................................................
..........................
........................................
.
.................................
................................................................
.
................................
YES 0
N O 0
.
YES 0
N O 0
.
YES0
N O 0
■
YES 0
N O 0
.
YES 0 ]
N O 0
.
. . .
..........................
.
.
.
>*
.........................
77 .
. . .
.
.
. . .
0
O
2
73.
......................................
□
o
2
D o y o u w o r r y t o o lo n g a f t e r an emb ar ra ssin g e x p e r i e n c e ’
□
D o y o u t r y n o t t o be r u d e to p e o p l e 7 .
72.
□
ua.". , OJ ge; a p a n , g w i n g ’
>
. ‘J.
71 .
0 i
80 .
Are y o u easily h u r t w h e n p e o pl e f i n d f a u lt w i t h y o u o r th e w o r k y o u do?
YES 0
N O 0
81 .
Have y o u ever b e e n late f o r i n a p p o i n t m e n t or w o r k 7
YES0
N O 0
YES 0
N O 0
. . .
.
.
.............................................
D o ot h e r p e o p le t h i n k o f y o u as be in g very li v e ly ?
87.
D o peop le tell y o u
88.
Ar e y o u t o u c h y a b o u t som e things?
89.
Arc y o u a l w j y j w i l l i n g t o a d m i t it w h en y o u have m ad e a m is ta ke ?
90.
W ou ld y o u feel v e r y s o r r y f o r an a n im a l c a u g h t m
YES0
l o t o f lies?
.
.
u">
Uj
a
.................................................................................................
.
..............................................
.........................
t rap ?
.
.
.
.
.
.
.
N O 0
o
z
86.
■
□
Are y o u s o m e t im e s b u b b l i n g over w i t h en er gy and s o m e t im e s v e r y s l u g g i s h ? ..............................................
D o y o u s o m e t im e s p u t o f f u n t i l t o m o r r o w w h a t y o u o u g h t t o d o t o d a y ? ....................................................
□
84.
85.
o
2
W o u ld y o u li k e o t h e r p e o p le to be af ra id o f y o u 7
□
Do y o u li k e p l e n t y o f b u s t le and e x c i t e m e n t a r o u n d y o u ’
83.
□
82.
YES0
N O 0
Y“
0
N O 0
YES
0
■
Y ES 0 !
.
YES
0J
NO
0
NO 0
N O 0
PLEASE CHECK TO SEE T H A T YOU H A V E A N SWE R ED ALL THE QUESTIONS
Appendix J
Shipley Institute of Living Scale
125
(SILS)
126
SH IPLEY IN S T m /T E O F LIVING SCALE
Administration Form
W alter C. Shipley, P h .D .
WfDSj
. Sex:
. U iu a J O c c u p a tio n : .
.
M
F
Age
Today'sDetc_
■P«fT 1
•
Ic a tru c rto rw : lo tae test b e lo w , th e f i a t w o rn in each line a
Lhin i_ u th e f i m
w o r d . I f y o u d o n t k n o w . ju c u . B< t u r t io c ircle
p r im e d in c a p ita l le u e n . O p p o s ite it i r e fo u r o th e r w o rd *. C ircle
th e onr ^ord in each lin e th a t tn e a m the ta m e U u n ( u th e f i m
(h e o n e w o r d w h ic h m e iA J th e jam* thirtf, o r m o u n e a rly the
w o rd .
EXAM PLE:
red
LARG E
•
( I)
(Z)
(3)
(<)
(5)
(6)
(7)
TALK
P E R M IT
PARDON
COUCH
REMEMBER
TU M BLE
H ID E O U S
(5) C O R D J A L
(9) E V ID E N T
"
(10)
(II)
(12)
(II)
(14)
(15)
(16)
(17)
IM P O S T O R
M E R IT
F A S C IN A T E
IN D IC A T E
IG N O R A N T
F O R T IF V
RENOW N
NARRATE
(IS ) M A S S IV E
MCI H IL A R IT Y
(20)
(21)
(22)
(22)
(24)
(25)
(21?)
(27)
(2S)
(29)
(30)
(31)
(32)
(33)
(34)
(35)
(36)
(37)
(38)
S M IR C H E D
SQUANDER
C A P T IO N
F A C IL IT A T E
JO C O SE
A P P R IS E
RUE
D E N IZ E N
D IV E S T
AM ULET
IN E X O R A B L E
SERRATED
USSOM
M O L L IF Y
P L A G IA R IZ E
O R IF IC E
Q U ER U LO U S
P A R IA H
ABET
(3.9) T E M E R IT Y
(40) P R IS T IN E
s ile n t
draw
allo w
eat
sew
forgive
ptn
rw im
d rin k
pound
eraser
recall
dress
lilted
lilv e ry
sw ift
green
con d u c to r
deserve
welcome
defy
red
submerge
length
yield
brigh t
Laugnter
stolen
tease
d ru m
help
hum orous
reduce
eat
senator
dispossess
chum
u n tid y
dried
m o ld y
m itigate
app rop riate
brush
m aniacal
outcast
waken
fashness
vain
muddy
obvious
officer
distrust
fix
exate
sharp
strengthen
head
buy
large
speed
pointed
beiittie
ballast
fum
p tliry
strrw
lament
inhabitant
intrude
speak
cut
d irid e
sofa
cum ber
fa ll
young
leafy
skeptical
b oo k
fig h t
stir
s ig nify
un in fo rm e d
vent
fame
associate
speedy
grace
.c c i:;
cut
heading
r tn p
fe rv id
in fo rm
dom in a te
fish
ra lly
d in g o
orphan
iDToUuie
aosched
loose
direa
rig id
a im e d
supple
p e rta in
imend
bole
cunoai
pnen
ensue
tinudJty
sound
revoke
b u ild in g
de v o u t
le n til
in cite
denre
f im
T a rn over (his sheet and co ntin u e w iih P in II when instructe d to do so.
wUfMtn«f*
sleep
drive
td l
f la i l
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_________________ Put II
__________
l a i t r a a l o a x : C o m p le te th e f o llo w in g b y f illin g in e ith e r a
n u m b e r o r a le tte r f o r each d u b ( ______ ). D o th e it e m i to o r d e r.
b u t d o o l spend to o m u c h tim e o n a n y o n e ite m .
EXAM PLE;
•
(!)
(3 ) A B
BC
(4 ) Z Y X
t h o n lo n g
CD
W
(.1) 1 2 3 1 1
v
oh
2 .1 4 J 2
(9 ) A
ica pe
he
3 4 5 4 3
cape
-at tar
* t i p is
—
-------------------------
; 3 7 -----------------------
32657
sp ud up
(1 « ) S c o tla n d
;3r,;
2 *57 3
b o th to
ia n d s c ic e
suy —
(16) t t m t i n
t i v ra w
( IS ) 5124
S2
154
(19) la g leg
pen p in
(2 0 ) tw o w
fo u r r
*6
ro g u e —_
:c
—
-----------
fee t ip e nd
p U o k __
13 ___
b ig bog
one o
—
h ip ___ _ _ _ ____
n i o o n b a r ro d
73
—
s c a p e g o a t ----------------
sn ore 17635
(1 7 ) n r p itc h th r o w
—
______________________
(1 5 ) su rg e o n 123456?
rib n d
/ ___
----- — -- ------
p in t in
73265
(13) fcnn m
n
4 3 6 ________
D ____
(1 0 ) (a t :o ( b ir d d ra b
(121 57325
;w
mood
7. 3 V C X
mu t a
d o w n ________
U ___
e
(7 ) escape
(11 )
E
D ___
(6) N E y s w
( B)
D
I 2 3 a 5 ___
(2 ) w h ite b la c k
-
A B C
r o b ----------------------
th re e ___
S u m m a ry S c o re i
V; R i w ______ r
A: Ri w ______
C Q : ______ AQ ______ Lsi IQ ______
T ______
To ta l: Raw ___
. meals
Appendix K
Verbal Stimuli
128
129
Verbal Stimuli
Stimuli___________ Length___________ Frequency
large
5
(43)
heavy
5
(38)
plump
5
(1)
chubby
6
(1)
obese
5
(1)
Emotion
pudgy
5
(1)
overweight
10
(3)
blubber
7
(1)
cellulite
9
(1)
fat
3
(47)
figure
6
(202)
weight
6
(22)
NonEmotion
Neutral
fair
complexion
build
stature
physique
shoulder
brunette
knee
finger
elbow
ankle
shin
4
10
5
7
8
8
8
4
6
5
5
4
(113)
(21)
(211)
(2)
(1)
(20)
(1)
(1)
(1)
(1)
(1)
(1)
post
pear
powder
boulder
nutmeg
purchase
brown
cruise
shampoo
wardrobe
chronicle
storeroom
4
4
6
7
6
8
5
6
7
8
9
9
(84)
(8)
(28)
(H)
(4)
(47)
(17 6)
(2)
(2)
(8)
(5)
(1)
Appendix L
Memory Questionnaire
130
131
Subject # _________
Memory Questionnaire
In the spaces provided below, please write all of the
words that you can recall from the imagination task.
If
you are not sure, try to make your best guess.
You will
have ten minutes to complete the list.
You may list the
words in any order you wish.
1.
15.
2„
16.
3.
17.
4.
18 .
5.
19.
20.
21.
8.
22.
9.
23 .
10,
24,
11,
25.
12
26.
13 ,
27.
14 .
28.
Appendix M
Scoring Guide for Memory Questionnaire
132
133
Verbal Stimuli: Accentable Responses
Responses
Emotion
NonEmotion
Neutral
large
heavy
plump
chubby
obese, obesity
pudgy
overweight
blubber
cellulite
fat
figure
weight, weighed,
weighing
fair
complexion
build
stature
physique
shoulder, shoulders
brunette, brunettes
knee, knees
finger, fingers
elbow, elbows
ankle, ankles
shin, shins
post, posts
pear, pears
powder, powdered, powdering
boulder, boulders
nutmeg
purchase, purchased, purchasing
brown
cruise, cruised, cruising
shampoo, shampooing, shampooed
wardrobe, wardrobes
chronicle, chronicled
storeroom, storerooms
Vita
Shannon Buckles Sebastian was born on July 15, 1967, in
Lexington,
School
Kentucky.
of Lexington,
She graduated from Henry Clay High
Kentucky
in
1985.
She
received
a
Bachelor of Arts degree with highest honors in Psychology
in 1989
Hill.
from the University of North Carolina at Chapel
She received a Master of Arts degree
in Clinical
Psychology in 1991 from Louisiana State University.
is
currently
degree
in
University,
a
candidate
Clinical
for
the
Psychology
Baton Rouge,
Doctor
from
Louisiana.
134
of
She
Philosophy
Louisiana
State
DOCTORAL EXAMINATION AND DISSERTATION REPORT
Candidate:
Major Field:
Shannon Buckles Sebastian
Psychology
Title of Dissertation:
Explicit Memory Bias for Body^Related Stimuli
in Eating Disorders
Approved:
ilvJU
Major Professor and Chairman
EXAMINING COMMITTEE:
c .
Date of Examination:
5/12/93
< a L