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Coping, daily hassles, and perfectionism: chronicity in binge eating in female university students Mallin, Barbara N. 1993

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COPING, DAILY HASSLES, AND PERFECTIONISM: CHRONICITY IN BINGE EATING IN FEMALE UNIVERSITY STUDENTS by BARBARA NANCY MALLIN B.A., The University of British Columbia, 1989 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in THE FACULTY OF GRADUATE STUDIES (Department of Counselling Psychology)  We accept this thesis as conforming to the required standard  THE UNIVERSITY OF BRITISH COLUMBIA August 1993 © Barbara Nancy Mallin, 1993  In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission.  (Signature)  Department of  Cc: \M-Li v) (  (  The University of British Columbi Vancouver, Canada  Date  DE-6 (2/88)  S 04 1 3 / 63 ---  ,,,9(.1(1010J-7  ii Abstract Binge eating is an eating disorder that is chronic and has a high relapse rate. The literature suggests a need to separately examine variables that maintain the disorder and variables that initiate this disorder. This study examined the relationship between problem-focused coping, emotion-focused coping, daily hassles, self-oriented perfectionism, socially-prescribed perfectionism, and the severity of binge eating. Eighty-one female university students who had been binge eating for over six months completed four questionnaires, consisting of the COPE scale (Carver, Scheier, & Weintraub, 1989), the Medical Education Hassles Scale-R (Wolf, Elston, & Kissling, 1989, 1991), the Multidimensional Perfectionism Scale (Hewitt & Flett, 1989, 1991), and the Binge Scale (Hawkins & Clement, 1980). A simultaneous multiple regression analysis was conducted with binge eating as the criterion variable, and problem-focused coping, emotion-focused coping, daily hassles, selforiented perfectionism, and socially-prescribed perfectionism as the predictors. The regression equation for binge eating reached significance, E(5,75) = 12.76, 12. < .0001, and accounted for 42% of the variance in binge eating. Two variables, daily hassles and socially-prescribed perfectionism, were significantly positively related to binge eating. Daily hassles accounted for 34% of the variance in binge eating, and socially-prescribed perfectionism accounted for 33%. The results indicate that high daily hassles and high socially-prescribed perfectionism are associated with greater binge eating. These findings provide support for examining the role of stress, measured as daily hassles, as a maintenance factor in binge eating. Further support was found for the role of socially-prescribed perfectionism, a personality construct that may contribute to the maintenance of binge eating.  iii Table of Contents Abstract ^ Table of Contents ^  Page ii iii  List of Figures ^  vi  List of Tables ^  vii  Acknowledgment ^  viii  Introduction ^  1  Problems in Defining Eating Disorders ^  1  Introduction to the Problem ^  4  Literature Review ^  9  History of Bulimia and Binge Eating ^  9  Etiology of Bulimia or Binge Eating ^  13  Psychosocial Perspective of Etiology ^  14  Current Research Directions: The Chronicity of Bulimia or Binge Eating ^  15  Theoretical Framework for Stress and Coping ^  16  Binge eating and coping ^  20  Current Research Directions: Binge Eating and the Stress Process ^  20  Daily Hassles ^  24  Perfectionism ^  26  Theoretical Framework for an Addictions Model ^  32  Why Women? ^  39  Sociocultural factors ^  39  Developmental issues ^  40  High-Risk Populations ^  41  Summary ^  43  iv Hypothesis ^  45  Method ^  46  Participants ^  46  Procedure ^  46  Predictor variables ^  51  COPE Scale ^  51  Daily Hassles ^  53  Multidimensional Perfectionism Scale ^  54  Criterion variable ^ Binge scale ^ Data Analysis ^ Results ^ Descriptive Statistics ^ Hypothesis ^  58 58 60 62 62 63  Binge Eating ^  63  Post-hoc Analyses ^  66  Discussion ^  69  Predictors of Binge Eating ^  69  Problem-focused Coping ^  69  Emotion-focused Coping ^  70  Daily Hassles ^  71  Self-oriented Perfectionism ^  73  Socially-prescribed Perfectionism ^  73  Limitations and Delimitations ^  75  Future Research ^  75  Implications for Counsellors ^  78  References ^  80  Appendices ^  92  V  Appendix A. Demographic Information ^  92  Appendix B. Hassles Scale ^  94  Appendix C. COPE Scale ^  95  Appendix D. Multidimensional Perfectionism Scale ^  96  Appendix E. Binge Scale ^  97  Appendix F. Advertisement for Participants ^  98  Appendix G. Letter of Consent for Participants ^  99  Appendix H. Research Results Form ^  100  Appendix I. Verbatim to Telephone Callers ^  101  Appendix J. Analysis of Variance of Participants who have been binge eating greater than 5 years and less than 5 years ^ 102 Appendix K. Multiple Regression Analysis including Other-oriented perfectionism ^  103  Appendix L. Comparison of Means and Standard Deviations of COPE scale from Carver & Scheier (1989) and this study ^ 104 Appendix M. Correlation Matrix of COPE subscales and Binge Scale ^ 105 Appendix N. Multiple Regression without Restraint Coping ^ 106 Appendix 0. MANOVA for Non-Purging and Purging Binge Eaters ^ 107 Appendix P. Analysis of Variance of Participants tested during the summer months and during winter session ^  108  vi  List of Figures Figure 1. Venn Diagram denoting bulimia overlapping with anorexia, and bulimia overlapping with obesity associated with binge eating. (adapted from Russell, 1985) ^  11  vi i  List of Tables Table 1.  Demographic Characteristics of Sample ^  48  Table 2.  Correlations of Predictor Variables ^  64  Table 3.  Multiple Regression Analysis ^  65  viii  Acknowledegment I would like to thank my supervisor, Dr. Bonnie Long, for her continuing guidance, support, and encouragement during the thesis process. I learned a great deal from working with Bonnie. My appreciation also to Dr. Judith Daniluk and Ms. Gwen Chapman for serving on my committee. Special thanks to Marite Askey for helping me to plan and implement the workshops for the participants. Her support was invaluable. Thank you to family and friends who encouraged me during the writing of this thesis. Finally, my appreciation to all of the women who volunteered for this study.  1 Introduction Binge eating has escalated on university campuses during the 1980s (Rolls, Federoff, & Guthrie, 1991). Binge eating can be defined as periods of uncontrolled, excessive eating, where a large amount of food is consumed in a short period of time (Dolan & Ford, 1991). Disturbingly, binge eating is a chronic disorder that has a high relapse rate (Fairburn & Cooper, 1982; Keller, Herzog, Lavori, Bradburn, & Mahoney, 1992). Therefore, there is a need to separately study the factors that maintain the disorder from factors that initiate the disorder. This study focuses on variables that may contribute to the maintenance of binge eating in female university students. During the 1980s the literature on eating disorders has generally focused on binge eating within the context of bulimia or bulimia nervosa. Bulimia can be defined as an episodic pattern of binge eating which involves the rapid consumption of a large quantity of food in a relatively short period of time. It is often followed by self-induced vomiting, laxative abuse, and/or severely restrictive diets in an attempt to undo behavior which would result in weight gain (Connors & Johnson, 1987). Because there is considerable confusion in the literature regarding definitions of eating disorders, it is necessary to first examine the broader term, eating disorder, and then situate binge eating within that. Problems in Defining Eating Disorders Definitions of eating disorders are confusing, partially because there is so much overlap between the disorders. In defining the term "eating disorders", Levine and Smolak (1992) do not distinguish between anorexia nervosa and bulimia nervosa. Instead, Levine and Smolak focus on the "substantial similarities in their psychopathology (i.e., the shared nervosa; Fairburn & Garner, 1988; Garner, Olmstead, & Polivy, 1983a)" (p. 62). In both disorders there is a preoccupation with looks, weight, and self-control of  2 food. Levine and Smolak view eating disorders on a continuum, a viewpoint that is consistent with several other researchers (Polivy & Herman, 1987; Striegel-Moore, Silberstein, & Rodin, 1986). However, many researchers would refute the notion that eating disorders constitute a single continuum, and argue for the heterogeneity of anorexia nervosa and bulimia nervosa (Crowther & Mizes, 1992; Welch, Hall, & Renner, 1990). Although, Crowther and Mizes (1992) suggest that there is some value to regarding eating disorders on a continuum, they question whether a meaningful demarcation exists. The following is the DSM III-R Diagnostic Criteria for Bulimia Nervosa. (a) Recurrent episodes of binge eating (rapid consumption of a large amount of food in a discrete period of time). (b) Feeling of lack of control over eating behavior during the eating binges. (c) The person regularly engages in either self-induced vomiting, use of laxatives or diuretics, strict dieting or fasting, or vigorous exercise in order to prevent weight gain. (d) A minimum average of two binge eating episodes a week for at least three months. (e) Persistent overconcern with body shape and weight. For Levine and Smolak (1992), frequency of binge eating (with or without purging), which meets the DSM-III-R criteria for bulimia nervosa, defines an eating disorder. Thus, binge eating is often studied as "bulimic behavior" (Connors & Johnson, 1987; Johnson & Love, 1985; Pope, Hudson, Yurgelun-Todd, & Hudson, 1984), and bingers are defined as individuals with bulimic symptoms (Steiger, Liquornik, Chapman, & Hussain, 1991). People who binge but do not purge are sometimes called "non-purging bulimics" (McCann, Rossiter, King, & Agras, 1991), "binge-eaters" (Dolan & Ford, 1991; Hawkins & Clement, 1980; Kirkley, Burge, & Ammerman, 1988), or bulimics (Greenburg & Harvey, 1986; Polivy & Herman, 1985). Chronic dieters or "restrained eaters" often become bulimics, non-purging bulimics, or binge eaters (Kirkley et al., 1988; Kirschenbaum & Dykman, 1991; Polivy & Herman, 1985). The term "binge-  3 restricter" is also used for someone who alternates between bingeing and dieting (Johnson & Connors, 1987). Binge eating and bulimia are also called "disinhibited eating" (Kirschenbauam & Dykman, 1991; Polivy, Heatherton, & Herman, 1988). In addition, those who have anorexia nervosa can slip into binge-purge behavior then back to starving and are sometimes called "bulimarexics" (Boskind-White, 1985). Weiss, Katzman, and Wolchik (1985) explain: Unfortunately, the DSM-III criteria were developed after work on this disorder had begun. Therefore, the use of the term "bulimia" has been confusing. For example, bulimia has been used to describe both a symptom (binge eating) and a syndrome. As a symptom, the term bulimia has been used to describe subgroups of patients with anorexia nervosa, and to describe an eating pattern in patients who are overweight or obese. As a syndrome, bulimia has been studied under a variety of different names, which makes interpretation of the literature difficult. (pp. 1-2). Johnson and Connors (1987) suggest that although a wide variety of binge eating and bulimia definitions have been used in the prevelance research, none are without problems. In the 1990s some researchers have argued that binge eating and bulimia should be investigated separately (Spitzer et al., 1991) whereas others suggest that the research to date examining differences between purgers and non-purgers does not support the divison of binge eating from bulimia nervosa (Walters et al., 1993). Thus, it was necessary to draw on research that focused both on binge eating and bulimia because the literature treats the two as interchangeable, and there have not been many published studies on binge eating as a distinct entity. At times I drew on studies of anorexia because anorexics may be binge eating, and certain studies have sociocultural implications that apply to both anorexics and binge eaters.  4 Introduction to the Problem Although the prevalance of eating disorders is unknown, researchers estimate that from 4% to 19% of college-aged women engage in some bingeing and purging behavior (Halmi, Falk, & Schwartz, 1981; Pope et al., 1984; Pyle, Mitchell, & Eckert, 1983). Pyle, Neuman, Halvorson, and Mitchell (1991) explain that studies report different prevalence rates for bulimia because they use different criteria. Moreover, some researchers suggest that the DSMIII-R, with its stringent criteria, underdiagnoses eating disorders compared to diagnoses made by clinicians (Ben-Tovim, 1988; Pyle et al., 1991). Specific high-risk populations include female students at competitive, stressful schools and campuses where dating is emphasized (Striegel-Moore et al., 1986), women in boarding schools and college dorms (Squire, 1983), female medical students (Herzog, Pepose, Norman, & Rigotti, 1985), and women in previously-defined male occupations (Steiner-Adair, 1989). In general, the literature indicates that there is a higher risk of eating disorders in competitive environments. The limited literature on differences in psychopathology between purging and non-purging bulimics (binge eaters) is inconclusive. Grace, Jacobsen, and Fullager (1985) found no differences between purging and nonpurging bulimics using measures of eating attitudes, self-esteem, anxiety, and locus of control. Similarly, Willmuth, Leitenberg, Rosen, and Cado (1988) found no differences between purging and non-purging bulimics on standardized measures of eating attitudes and disorders, body size disortions, desire to be thin, and disturbance on behavioral trait scales of the Eating Disorder Inventory (EDI; Garner, Olmstead, & Polivy, 1983). Walters et al. (1993) found no differences between purging and non-purging bulimics on the variables of locus of control, neuroticism, extraversion, self-esteem, maternal care, and paternal care. However, McCann et al. (1991) found that purging bulimics  5 scored higher than non-purging bulimics on measures of major depression, panic disorder, past anorexia nervosa, and the narcisstic, masochistic, and borderline scales of the Personality Disorders Examination (Loranger, Susman, Oldham, & Russakoff, 1985). In summary, there is little conclusive evidence that binge eaters and bulimics should be studied separately. Research shows binge eating to be a very chronic condition, with high relapse rates. Fairburn and Cooper (1982) studied almost 500 bulimic women, and found the mean duration of the disorder to be 5.2 years. Herzog (1986) found the average duration of symptoms to be longer than 6 years. Pyle et al. (1991) found many similarities between bulimic women who were classified as being in remission, and women who were classified as being actively bulimic. For example, 50% of the remitted bulimic women were binge eating at least once a week. Because of the chronicity of the disorder, Fairburn (1991) suggests that research should focus on maintenance issues. This is not to say that initiating factors of the problem should be ignored, but there is a need to separately investigate factors that could maintain binge eating. Lacey, Coker, and Birtchnell (1986) state that the bulimic cycle is established by a precipitating event within a 6-month period, after which time there are separate underlying factors, usually acting together that maintain the cycle. There is evidence that stress plays a role in binge eating in women (Cattanach & Rodin, 1988; Fremouw & Heyneman, 1984; Hawkins & Clement, 1984; Loro & Orleans, 1981; Shatford & Evans, 1986; Striegel-Moore et al., 1986). Therefore, the stress and coping theoretical framework of Lazarus and Folkman (1984) was used to understand how stress might contribute to the maintenance of binge eating behavior. The model is process-oriented, and is based on the premise that the person and the environment are involved in a reciprocal and dynamic relationship. This framework is useful because of women's experiences of stress in competitive environments. Stressors experienced at university  6 are many, and may involve the first move away from home, competition for marks, the stress of making new friends, trying to achieve a certain "look", and competing in sports. Cattanach and Rodin (1988) suggest that the stress process in bulimia needs to be viewed more comprehensively, and that appraisals and coping processes that may cause a person to be sensitive to potential stressors should be considered. Lazarus and Folkman (1984) distinguish between problem-focused coping strategies and emotion-focused coping strategies. Problem-focused coping strategies involve planful action and/or reinterpretation to manage or alter one's environment without causing distress. Research indicates that problemfocused coping strategies are related to more effective outcomes (Billings & Moos, 1981; Felton & Revenson, 1984; Folkman, Lazarus, Dunkel-Schetter, Delongis, & Gruen, 1986b), although, theoretically, this is not necessarily so. Emotion-focused coping strategies are used to regulate one's emotional response to the environment. Therefore, binge eating can be considered one of the emotion-focused coping strategies -- a form of "escapism" coping. Research on stress has shifted in recent years from an emphasis on major life events, to an emphasis on daily hassles (Kanner, Coyne, Schafer, & Lazarus, 1981). Hassles have been defined as "the irritating, distressing, demands that to some degree characterize everyday transactions with the environment" (Jandorf, Deblinger, Neale, & Stone, 1986, p. 206). Many researchers have found hassles to be better predictors of adaptational outcomes than major life events (DeLongis, Coyne, Dakof, Folkman, & Lazarus, 1982; Kanner et al., 1981). Significant correlations have been made between hassles and health, psychological symptoms, morale, and job performance (DeLongis, Folkman, & Lazarus, 1984; Ivancevich, 1986; Schmidt, Zyzanski, Ellner, Kuman, & Arno, 1985). Thus, experiencing daily hassles may contribute to women's eating disorders.  7 Lazarus and Folkman (1984) posit that in understanding the stress process, the properties of the person are important considerations. These properties are viewed as moderating variables and pre-exist as "antecedent conditions." A moderating variable that has been linked to eating disorders is perfectionism (Bruch, 1978; Dowling, 1988; Steiner-Adair, 1989). Perfectionism is the tendency to set high standards and to evaluate oneself in an overly critical fashion, and has been hypothesized to be related to many psychological problems (Frost, Marten, Lahart, & Rosenblate, 1990). A consistent theme in the literature is that perfectionists are motivated by a fear of failure (Burns, 1980; Frost et al., 1990; Hamachek, 1978), and are disturbed by discrepancies between the real-self and the ideal-self (Frost et al., 1990; Hewitt & Flett, 1991; Horney, 1950; Pacht, 1984). "Performing at or near the ideal-self standard would be viewed by the perfectionist as a responsibility rather than a challenge" (Frost et al., 1990). Until recently, there has been little research on the construct of perfectionism. This is partially because the concept had not been adequately operationalized. However, in the past three years, Hewitt and Flett (1991) and Frost et al. (1990) demonstrated that perfectionism is multidimensional, and they have developed scales to reflect this. Both scales are beginning to be used in the study of eating disorders (R. 0. Frost, personal communication, December 17 1991; P. Hewitt, personal communication, December 17, 1991). Hewitt and Flett (1991) describe three dimensions of perfectionism: (a) self-oriented perfectionism, (b) other-oriented perfectionism, and (c) socially-prescribed perfectionism. Self-oriented perfectionism involves setting exacting and rigid standards for oneself, and harshly evaluating one's own performance. Striving to avoid failure and feeling a discrepancy between the real self and ideal self are features of self-oriented perfectionism. Other-oriented perfectionism involves setting unrealistic standards for  8  significant people in one's life. This behavior is similar to self-oriented perfectionism, only directed outward and is related to interpersonal frustrations such as cynicism and loneliness. Socially-prescribed perfectionism involves the belief or perception that significant others have unrealistic standards for oneself, and that one is constantly being stringently evaluated by significant others. Thus, both self-oriented perfectionism and socially- prescribed perfectionism may contribute to the maintenance of an eating disorder. The purpose of this study was to examine factors that could contribute to the maintenance of binge eating in female university students. Trait-like coping strategies, daily hassles, and perfectionism were expected to predict the severity of binge eating. I hypothesized that a significant linear relationship would exist between some or all of the predictor variables and the criterion variable. Specifically, I hypothesized that problem-focused coping would have a significant negative relationship with severity of binge eating, and emotion-focused coping would have a significant positive relationship with binge eating. In addition, I expected that the frequency of daily hassles would have a significant positive relationship with severity of binge eating. Last, I predicted a significant positive relationship between the perfectionism subscales of self-oriented and socially-prescribed perfectionism and binge eating.  9 Literature Review The literature reflects much confusion in the use of the terms binge eating and bulimia. Thus, I review research on both binge eating and bulimia, and discuss them interchangeably. Because binge eating is a very chronic disorder that has a high relapse rate, I focus on the issues related to chronicity (maintenance) of the disorder. First, I discuss bulimia and binge eating historically in order to highlight the current state of controversy regarding diagnostic criteria. Second, I outline theories of etiology, and focus on two theories that are important to the present study. Third, I summarize current research directions in the relatively new field of bulimia and binge eating research. Fourth, I outline Lazarus and Folkman's (1984) theoretical framework for stress and coping, because this study focuses on women's experience of stress in a competitive environment as a factor in maintaining binge eating behavior. Fifth, I discuss the shift that has taken place in stress research, and focus on daily hassles as better predictors of adapational outcome. Sixth, I review the literature on perfectionism, because the personality construct of perfectionism is considered an important variable in the coping patterns of women who binge eat. In addition, a social learning model of addictions provides additional insight into the chronicity and high relapse rate of bulimic behavior. Finally, I discuss high-risk populations, specifically female university students. History of Bulimia and Binge Eating Research on bulimia as a distinct diagnostic entity dates back only to 1979 (Gandour, 1984). Research prior to that date, classified binge eating and often purging behavior as subgroups of anorexia nervosa. Systematic investigation of the psychology of bulimia has been hampered by a lack of agreement about the term "bulimia," and much confusion between bulimia and  10  bulimia symptomatology in anorexia nervosa. Often there is overlap between bulimia and anorexia nervosa. Only recently have researchers (Halmi et al., 1981), and the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSMIII), defined bulimia as a syndrome that is independent of anorexia. As outlined by DSM-III and III-R, two factors distinguish bulimics from anorexics who binge: (a) Anorexics do not maintain normal body weight, whereas weight loss is not a necessary component of bulimia; if weight loss does occur in bulimia it never exceeds 25% of the original body weight; and (b) whereas anorexics deny the illness, bulimics are very aware that their behavior is abnormal, and are afraid of being unable to stop voluntarily. Russell (1979) more specifically defined the diagnostic criteria for bulimia as requiring: "self-induced loss of weight with severe inanition, persistent amenorrhea (or an equivalent endocrine disturbance in the male), and a psychopathology characterized by a dread of losing control, eating, and becoming fat." He later redefined the criteria to exclude amenorrhea, which he saw as a transient feature in bulimia, and to include a powerful and intractable urge to overeat. Such a cluster of behaviors he called "bulimia nervosa" to convey its relationship to anorexia nervosa, yet to distinguish the syndrome. Russell further described the link with anorexia nervosa in the abnormal concern both syndromes present with body size and in the pathological fear of fatness. The DSM-III criteria, albeit detailed (Gandour, 1984), did little to clarify whether bulimia should be viewed as a separate disorder from anorexia nervosa, or on a continuum and just a variation of the same syndrome (Dunn & Ondercin, 1981; Russell, 1985; Slade, 1982). The term bulimia describes both a symptom (binge eating) and a syndrome. This has caused some confusion according to Mitchell and Pyle (1982), who found the DSM-III criteria limited  11 in their inclusion of overweight or obese patients who present the eating pattern of bulimia (the syndrome). Russell (1985) developed a Venn diagram with three overlapping circles, to help illustrate the overlap between these eating disorders. The first two circles, that are almost identical, join in approximately one-third of their area with one circle representing anorexia nervosa and the other bulimia. The part shared by the two circles represents the bulimia nervosa syndrome. The larger circle represents obesity, and minimally overlaps the bulimia circle. The intersection with the bulimia circle represents those patients who are obese and present binge eating behavior. The diagram was viewed by Russell (1985) as the beginning of a subclassification of eating disorders.  Figure 1. Venn Diagram denoting bulimia overlapping with anorexia, and bulimia overlapping with obesity associated with binge eating. (adapted from Russell, 1985).  Bulimia  Obesity  Anorexia Nervosa  Bulimia Nervosa  In 1985, the American Psychiatric Association proposed a revised set of diagnostic criteria for bulimia that resembles Russell's (1979) criteria, but  12  which, in Fairburn and Garner's (1986) view, still falls short on three major points. First, in order to eliminate the confusion over the term "bulimia", which is intended to represent both a symptom and a syndrome, Fairburn and Garner proposed to limit the use of the term to denote only epidsodes of overeating and to use the term "bulimia nervosa," identified by Russell (1979), to denote the full syndrome. Second, it was suggested that the necessary diagnostic feature be represented by the characteristic concern about shape and weight, as found for anorexia nervosa. Third, the diagnosis of bulimia nervosa should be made for any patient presenting the core features of recurrent episodes of bulimia (i.e., behavior aimed at controlling body weight), and overconcern about shape and weight. For Fairburn and Garner, the extreme concern over the body was indeed the uniting feature between the two syndromes that had been overlooked in the DSM-III criteria. The revised version, DSM-III-R, has remedied many of these shortcomings, but is still subject to much criticism. All of the above criteria must be met in order for a diagnosis of bulimia nervosa to be made. The disorder has been renamed "bulimia nervosa", keeping it in line with British terminology. However, in actual practice, both terms are still being used interchangeably in the literature, with the term "bulimia" still being used to identify the symptoms and the syndrome. Another revision is the addition of "a persistent overconcern with body shape and weight," as one of the criteria in DSM-III-R, thus recognizing the need to specify abnormal attitudes. Finally, the controversial sharp segregation from anorexia nervosa has been omitted. However, Garner and Garfinkel (1988) feel that the DSM-III-R criteria do not address fundamental theoretical issues regarding the potential overlap between anorexia nervosa and bulimia nervosa. They feel that the similarities between the two disorders are far greater than DSM-III-R and the current literature  13  imply. It seems that the issue of diagnostic criteria for bulimia is still somewhat controversial. Binge eating is a sub-type of a full bulimic syndrome. Women who present with the full bulimic syndrome, and women who binge eat but do not meet the full DSM-III-R criteria for bulimia, are often discussed interchangeably in the literature. Most studies focus on women who self-report or test as binge eaters because obtaining a sample who meet all of the DSM-III-R criteria for bulimia is extremely difficult, and the criteria are controversial. Currently, The Eating Disorders Work Group of the DSM-IV Task Force is recommending that binge eating (non-purging bulimia) be considered for separate inclusion in the DSM-IV (Spitzer et al., 1991). The recommendation also includes that the disorder be named Binge Eating Disorder (BED). This recommendation is met with opposition by some researchers (Walters et al., 1993) who feel that the research to date does not support a division of bulimics and binge eaters.  Etiology of Bulimia or Binge Eating Many theoretical frameworks exist to explain the etiology of bulimia, which by definition includes episodic patterns of binge eating (Connors & Johnson, 1987). No single theory can account for the entire etiology of eating disorders (Johnson & Connors, 1987). For a comprehensive review of theoretical frameworks see Garner & Garfinkel (1985). The psychoanalytic theories include the drive-conflict model (Waller, Kaufman, & Deutsch, 1940), the object-relations model (Aronson, 1986; Sugarman, Quinlan, & Devenis, 1981) derived from Mahler (1972), and self-theory (Bruch, 1973, Selvini-Palazzoli, 1978) derived from Kohut (1971). Psychobiological perspectives of eating disorders are recent in inception and involve cortisol levels (Copeland, 1985; Katherine, 1991). The Family Systems approach to eating disorders has gained the attention of many theorists (Minuchin, Rosman, & Baker, 1978; Schwartz,  14 1988). In this study, I draw on the psychosocial perspectives of Lacey et al. (1986) and Hawkins and Clement (1984) to provide an etiological framework, because the use of binge eating to regulate stress is common to these perspectives and the focus is on maintenance of the disorder. Psychosocial Perspective of Etioloay Lacey et al. (1986) describe the precipitants of bulimia or bulimic behavior (binge eating) as being one or more of the following: (a) a loss experience; (b) sexual conflicts; (c) or change in location or occupation. In addition, they describe underlying factors that maintain the disorder. First, the sociocultural factor that involves the cultural ideal of thinness. Second, the familial factor that can include parental marital conflict, parental attitudes towards food, parental attitudes towards sexuality, and poor relationships with parents. Third are the individual factors, which include doubts concerning femininity, food as a defense strategy, academic striving, and poor peergroup relationships. Lacey et al. suggest that it is the action of certain life events on these underlying factors in an already dieting woman that precipitates the disorder. The authors suggest that these women lack the necessary adult coping skills to deal with these difficulties. Food and its manipulation becomes a means of coping by use of a defense mechanism. Hawkins and Clement (1984) place similar emphasis on a Person X Environment "Fit" when examining bulimia and binge eating. In describing the college lifestyle the authors emphasize major life stresses, daily hassles (interpersonal or academic), and competing priorities as precipating events to bulimia. Stressors such as rejections in romantic relationships or academic difficulties may precipitate overeating. The process is mediated by a faulty cognitive appraisal of the stressor. Thus, the person perceives a loss of control over academic or personal priorities and turns to food as a  15 distracting function. The young woman may then redefine her problem as being the overeating or the overweight appearance. Hawkins and Clement (1984) explain that these normative psychosocial processes become problematic when there are at least one of two predisposing factors (e.g., an elevated set point weight for body fat, and/or focus on body image). These two theories contribute to our understanding of binge eating with regard to life stress. Lacey et al. (1986) view coping skills as central, and Hawkins and Clement (1984) have incorporated the concept of cognitive appraisal. Current Research Directions: The Chronicity of Bulimia or Binae Eating Due to the chronicity of bulimia nervosa, Fairburn (1991) suggests that current research should focus on factors contributing to the maintenance of the disorder, and factors contributing to relapse. Lacey et al. (1986) suggest that the precipating event for bulimia and/or binge eating occurs 6 months before the actual cycle of disordered eating is well established. They state that an event can precipitate a cycle of bulimia or binge eating only when superimposed on a background of underlying factors that represent long and chronic emotional difficulties. After 6 months, it is necessary to look at factors that maintain the disorder. However, there is very little discussion in the literature as to when the maintenance period begins. Johnson and Connor (1987) suggest that the original reason for the onset of bulimic behavior is often obscured by the time the person seeks help. Goldner and Leung (1989) feel that the initiating factors that cause bulimia are not specific and cover a wide range (e.g., low self-esteem, peer pressure, family conflict, abuse, poor judgement, loss, and anxiety). However, even when the initiating factors are resolved, the compulsion to binge and/or purge will generally have become a problem in its own right. "Secondary physical and psychosocial complications (e.g., fatigue, depression,  16  social isolation) will serve to entrench these compulsive behaviors and disable any resources that the individual might normally mount" (Goldner & Leung, 1989, p. 279). In describing therapy for bulimic individuals, Fairburn (1985) states that once binge eating is occuring on a more intermittent basis, the emphasis of treatment should move toward an examination of the factors maintaining the eating problem. He feels that binge eating can become a chronic, maladaptive way of dealing with problems. The bingeing can provide distraction from unpleasant thoughts, short-term relief from dysphoric moods, the occupying of spare time, the induction of sleep, and a release from the monotonies and rigors of extreme dieting. Boskind-White and White (1987) state that bulimia is a learned behavior, which eventually becomes a habit that is difficult to give up. The bingepurge cycle becomes a ritual in the lives of bulimic women, and in moments of stress they turn towards food. Food is readily available and nurturing. In summary, the factors that maintain bulimia or binge eating require separate investigation from the initiating factors. There is a paucity of research on maintenance factors, and it has been predicted that this is where the field will be heading (Fairburn, 1991). Researchers have begun to look at some of the current theoretical models of stress and coping in order to investigate the association between the stress process and bulimia (Cattanach & Rodin, 1988; Shatford & Evans, 1986). Because bulimia or binge eating are chronic disorders, studying the coping processes of women who binge eat may provide insight into the maintenance of the disorder. Theoretical Framework for Stress and Coping In order to examine the functioning of binge eaters during the maintenance period, it is useful to analyze the behavior from a theoretical framework of stress and coping. In the past decade, the concepts of stress and coping have received much attention in the psychological literature. Two  17 of the prominent researchers over the past decade are Folkman and Lazarus (Folkman, 1984; Folkman & Lazarus, 1980, 1985; Lazarus & Folkman, 1984). Lazarus (1966) initiated a transactional model of stress and coping, which was further developed by Lazarus and Folkman (1984). ^This model is processoriented, in that the person and the environment are involved in a dynamic, reciprocal, transactional relationship. Lazarus and Folkman (1984) define stress as the relationship between the person and the environment, taking into account both the characteristics of the person and the nature of the environment. The authors explain that we cannot objectively predict psychological stress as a reaction, without referring to the properties of the person. "Psychological stress, therefore, is a relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well being" (p. 21). In examining the stress and coping process it is important to distinguish between mediating and moderating variables (Baron & Kenny, 1986). It is not uncommon for researchers to use the terms mediator and moderator interchangeably (Baron & Kenny, 1986; Folkman & Lazarus, 1988). Folkman and Lazarus (1988) describe moderating variables as antecedent conditions such as gender, socioeconomic status, or personality traits that interact with other conditions in producing an outcome" (p. 467). By contrast, a mediating variable occurs during the process of the person-environment encounter. Appraisals and coping strategies are examples of mediating variables. It is the individual's evaluation of a situation that will determine whether or not the situation is felt to be stressful. Lazarus and Folkman (1984) call this concept "cognitive appraisal." Cognitive appraisal is the process of categorizing an encounter, with respect to its significance for well-being. It follows that stress does not exist as a separate entity, but  18  is determined by cognitive appraisal and personal resources. Stress is a system of interdependent processes, including apprasial and coping, which mediate the type, frequency, intensity, and duration of psychological and somatic response (DeLongis, Folkman, & Lazarus, 1988). Lazarus and Folkman (1984) define coping as "constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the individual" (p. 141). Coping is viewed as a process and involves continuous appraisals and re-appraisals in the person-environment relationship. A person may rely more heavily, at certain times, on one form of coping (e.g., defensive strategies), and at other times on problem-solving strategies. Lazarus and Folkman (1984) hypothesize that primary coping strategies can be best organized into two categories: (a) problem-focused strategies, and (b) emotion-focused strategies. The function of problem-focused coping is to manage or alter the problem with the environment causing distress. The function of emotion-focused coping is to regulate the emotional response to the problem. There is a dynamic interplay between these two coping strategies, as they influence each other throughout a stressful encounter. Problem-focused and emotion-focused coping strategies have the capacity to both facilitate and impede each other. Lazarus and Folkman's definitions of problem-focused and emotion-focused coping help to avoid the problem of confounding coping with outcome because the emphasis is on the efforts to manage stress, regardless of the outcome (Aldwin & Revenson, 1987). Problem-focused coping strategies include defining the problem, generating alternate solutions, weighing out the pros and cons of the alternate solutions, making a choice, and taking action. Empirical research suggests that problem-focused strategies are related to more effective coping (Billings & Moos, 1981; Felton & Revenson, 1984; Finn, 1985). Problem-focused  19  coping strategies and positive reappraisal have been found to be highly correlated (Folkman & Lazarus, 1985; Folkman et al., 1986b). Studies have also shown that problem-focused forms of coping are more likely to be used when the individual appraises a situation as changeable (Folkman & Lazarus, 1980, 1985; Folkman et al., 1986b). Emotion-focused coping includes strategies such as avoidance, selective attention, wishful thinking, distancing, self-control (keeping feelings to oneself), accepting responsbility (blaming self for problem), escapism (eating, drinking, using drugs) (Folkman & Lazarus, 1988; Lazarus & Folkman, 1984). Emotion-focused coping is used more frequently when the situation has been appraised as unchangeable, and the individual feels that they have very limited or no options which will affect outcome (Folkman et al., 1986b). Research has suggested a mutually reinforcing causal cycle between poor mental health and maladaptive coping strategies (Aldwin & Revenson, 1986, 1987; Felton & Revenson, 1984). Aldwin and Revenson (1987) studied the relationship between coping strategies and psychological symptoms in 291 adults in a longitudinal community survey. The participants completed the revised Ways of Coping Scale (Folkman & Lazarus, 1985) for a self-named stressful episode. The prior mental health history of the participants was known by using a sample from another study. The emotion-focused strategy of escapism was most strongly related to current psychological symptoms. Although this strategy was confounded with prior mental health, it still accounted for 19% of the variance in residualized symptoms. The researchers also found that the participants who were in poorer mental health and under greater stress used less adaptive coping strategies in general. Coping strategies also affected mental health, regardless of prior psychological history, suggesting a reciprocal relationship between psychological status and  20  coping style. In summary, emotion-focused coping strategies appeared to primarily increase emotional distress.  singe eating and coping. It is possible that a mutually reinforcing relationship exists between binge eating and emotion-focused coping strategies. Studies have found that the appraisal of controllability of a perceived threat significantly predicts coping (Folkman & Lazarus, 1980; Folkman et al., 1986b; McCrae, 1984; Stone & Neale, 1984). Bulimic women perceive themselves as not being in control of themselves or their environment, and therefore may appraise a situation as more stressful than non-bulimic women (Cattanach & Rodin, 1988). Consequently, women who binge eat may choose maladaptive coping strategies, such as emotion-focused coping.  Current Research Directions: Binge Eating and the Stress Process Researchers have begun to examine the possibility that inadequate coping skills put some women at high risk for binge eating or bulimia. Preliminary research in this area was conducted by Hawkins and Clement (1984), who organized data into a functional analytic framework of binge eating (i.e. 'pathways-to-bulimia' model). Precipitating events such as major life changes and daily stresses are speculated to lead to faulty cognitive appraisal. The person negatively evaluates the stressor, feels helpless, and then experiences depression. The feelings of helplessness and depression are presumed to precipitate the binge eating episode as a distraction from the stressors and as a means to reduce depression. The immediate consequences for binge eating are assumed to be the positive reinforcement from the taste of the food and the reduction of depression through eating. However, negative cognitions are experienced as the person becomes aware of the amount of food consumed, the consequent effects on weight, and the failure to stay on a diet. These negative cognitions are experienced as feelings of guilt and self-deprecation, which are the antecedents to either a period of fasting or purging to  21 compensate for the previous binge episode. The cycle will then repeat itself when the person is again faced with daily stressors that she appraises in such a way that makes her feel helpless. Fremouw and Heyneman (1984) feel that Hawkins and Clement's (1984) model is consistent with clinical observations of the binge cycle. However, Fremouw and Heyneman (1984) speculate that more in-depth research on each of the potential factors associated with bulimia is needed. A systematic, finely detailed analysis of the immediate antecedents and consequences of a binge episode is needed for a more functional analysis. Some of the suggested variables await empirical demonstration, such as the proposal that increased stress precipitates the binge or that depression is the emotional antecedent to bingeing. (p. 256) Fremouw and Heyneman (1984) collected diary data from nine obese women participating in a weight reduction program at West Virginia University. These researchers felt that a behavioral diary would provide a more valid description of binge eating than a retrospective description of typical patterns. Participants were asked to keep the diaries for 2 1/2 weeks to self-monitor eating episodes and associated information about their cognitions and moods. Diary information included a description of the food consumed; a judgement of whether the episode was a meal, snack, or binge; the time, place, and number of people present during the episode; and a 0 to 7 rating of overall perceived stress just prior to eating. In addition, the diaries contained two separate sections to assess cognitions before and after an eating episode. This information consisted of a rating of perceived hunger (0 to 3 scale) and eight alternative forced-choice rating of mood listing a predominant self-statement. In addition, the subjects rated the valence of their self-statements (how positive or negative the self-statement was on a  22 scale from -5 to +5, with zero being neutral). To clarify analysis of the affective data, the eight mood types that the women recorded were divided into two categories: postive/neutral or negative. The positive/neutral category included only the "happy" and "neutral" ratings, and the negative category consisted of the combined "guilty", "depressed", "frustrated", "bored", "anxious", and "angry" ratings. Chi-square analysis for moods prior to and moods after eating were both significant (i2 < .01). Overall, ratings of mood both prior to and following eating were significantly more negative for binges and significantly more positive/neutral for snacks. The conclusions drawn from this study were that self-defined binge episodes were preceded by negative emotions, the negative emotions may be the product of the significantly higher stress levels reported prior to bingeing, and that negative self-statements follow bingeing. The authors point out that much more research on binge eating behaviors is needed. Some researchers feel that a lack of adequate coping skills renders a bulimic woman less able to deal effectively with stress, and bingeing becomes the chosen maladaptive coping mechanism (Boskind-White & White, 1987; Hawkins & Clement, 1984; Katzman, Wolchik, & Braver, 1984; Loro & Orleans, 1981). Cattanach and Rodin (1988) agree that lack of coping skills is a possibility, but also suggest the possibility that bulimic women do have an adequate repertoire of coping skills, and lack the personal resources to effectively utilize these skills. Streigel-Moore et al. (1986) feel that stress alone is not a risk factor, but stress combined with other risk factors (personality variables and sociocultural variables) may play a role in a woman's likelihood of becoming bulimic. "Research is needed to determine whether bulimic women, compared with other women, encounter a higher level of life stress, subjectively  23 experience stressors as more stressful, or are less skilled at coping with stress" (p. 254). Cattanach and Rodin (1988) feel that clinical experience strongly implicates the role of psychosocial stress in both the etiology and maintenance of bulimia. They state that the empirical literature is confusing and sometimes contradictory, and they suggest that the stress process needs to be viewed more comprehensively in order to have heuristic value in the study of bulimia. Perhaps the nature of the psychosocial stress process in bulimia can be best understood by viewing stress not just as a stimulus/response phenomenon, but by examining the variables that effect stress as well. Cattanach and Rodin (1988) state that mediators in the study of bulimia should include appraisal, control, coping processes, social supports, personality factors, and other intervening variables that may predispose one to be more reactive to potential stressors. Further, it is important to specify whether a particular mediator plays an etiological role, or a maintenance role in the relationship between the stress process and bulimia. It is worth noting that Cattanach and Rodin (1988) have made the common error of confusing mediators and moderators. Social supports, in terms of the social supports that exist for a person would be a moderating variable. However, the actual seeking out of social support would classify it as a mediating variable. Personality factors are antecedent conditions, and therefore should be defined as moderators. Shatford and Evans (1986) studied the coping strategies used by bulimic and non-bulimic women in dealing with environmental stressors. Using LISREL causal modelling analysis, the researchers attempted to sequentially build a causal model of bulimia. This model was an attempt to describe the relationship between environmental stressors, depression, psychological states, and mediators of stress in the manifestation of bulimia. The LISREL  24 analysis uses maximum likelihood procedures to estimate the validity of the measures of the model, and then provides a Chi-square goodness-of-fit test. Environmental stressors were assessed as both life events and daily hassles (Daily Hassles Scale; Kanner et al., 1981). The passive coping strategies used by bulimic women tended to be less effective in reducing stress than the more active coping strategies (problem-focused) used by the non-bulimic group. Environmental stressors were indirectly related to bulimia, with coping strategy as the mediating variable. These researchers conclude that environmental stressors are directly related to stress mediators, which in turn are directly related to bulimia. Psychological variables did not have a direct link to coping or bulimia. However, the model did suggest that psychological variables are indirectly related to bulimia, with coping strategies as the mediators. Cattanach and Rodin (1988) suggested that a weakness of Shatford and Evans (1986) study was that the model did not allow for discrimination between factors that precipitate and factors that maintain bulimia. In the following sections, I apply the stress and coping model of Lazarus and Folkman (1984) to the study of binge eating. More specifically, I examine the environmental stressors of bulimic women, with an emphasis on competitive environments. I also examine the possibility that the chronicity of binge eating can be reinforced by environmental stressors, personal characteristics, and coping strategies. Daily Hassles Women who experience high levels of stress are at a greater risk for binge eating (Abraham & Beumont, 1982; Fremouw & Heyneman, 1984; Strober, 1984; Wolf & Crowther, 1983). In order to study the stress process in women who binge eat, it is necessary to have a measure of the severity or frequency of stressors. Research on stress has shifted over the years from examining  25 major life events (Holmes & Rahe, 1967), to examining relatively minor daily hassles (Kanner et al., 1981). Lazarus and Folkman (1984) emphasize the role of microstressors in their transactional model of stress and coping. Microstressors are defined as the cumulative impact of day-to-day events (hassles) that have personal meaning and significance for the individual, as opposed to major life events. Hassles are defined as irritating, frustrating, and distressing incidents that occur daily in one's transaction with the environment (DeLongis et al., 1982). DeLongis et al. (1984) explain that hassles include diverse experiences such as arguing with a spouse, meal preparation, and having too many things to do. Significant correlations have been found between hassles scores and outcomes such as morale, psychological symptoms, somatic health, performance on the job, and being absent from work (DeLongis et al., 1984; Ivancevich, 1986; Monroe, 1983; Schmidt et al., 1985; Zarski, 1984). Braun (1989) reports that studies that have made direct comparisons have found hassles to be better predictors of adaptational outcomes than life events (DeLongis et al., 1982; Kanner et al., 1981; Monroe, 1983). These studies utilized the Hassles Scale, developed by Kanner et al. (1981). Wolf, Elston, and Kissling (1989) studied the impact of hassles versus major life events with 72 freshmen medical students. The Medical Education Hassles Scale (Wolf et al., 1989) was used, and is a modified version of the Kanner scale. It is considered by the authors to be more appropriate for use with students, because the Kanner scale was designed on a middle-aged population. A Life Events Scale (Hough, Fairbank, & Garcia, 1976) was utilized as well. Students completed the hassles measure for 9 consecutive months, and the life-stress measure at the beginning and the middle of the school year. The results of the study supported the hypothesis that number of hassles reported are related to psychological well-being as measured by the  26 Affects Balance Scale (Derogatis, 1975). The hassles measure was found to be a better predictor of concurrent and subsequent moods, than was the life stress measure. Stress may be a maintenance factor in binge eating, therefore greater daily hassles is expected to be associated with severity of binge eating. Perfectionism In order to understand how women who binge eat experience stress in a competitive environment, it is necessary to examine the personality construct of perfectionism. The literature indicates that bulimia is more than a series of chaotic dietary habits. It is a disorder associated with considerable psychological distress and a variety of maladaptive personality characteristics (Garner & Garfinkel, 1988). Because a review of the literature suggests that the highest rates of eatings disorders are found in competitive environments, perfectionism may be an important variable in the prediction of eating disorders. Individual differences in perfectionism have been discussed in the literature from the Adlerian, psychoanalytic, and Jungian perspectives (Adler, 1956; Horney, 1950, Woodman, 1981). However, it is only recently that there have been attempts to study perfectionism in a systematic and empirical manner (Burns, 1980; Frost et al., 1990; Hewitt & Flett, 1991). These studies come from the cognitive-behavioral school of thought. Perfectionism has been a relevant theme in descriptions of eating disorders (Bruch, 1978; Dowling, 1988; Steiner-Adair, 1989). However, perfectionism and binge eating or bulimia have not been studied systematically. The lack of research may be due to the fact that until recently the Burns Perfectionism Scale (1980) was the only measure of perfectionism available. However, in the past few years, research on perfectionism has escalated, and the construct is now seen as  27 multidimensional. Currently, there are two new measures in use (Multidimensional Perfectionism Scale, MPS; Frost et al., 1990; and the Multidimensional Perfectionism Scale, MPS; Hewitt & Flett, 1991). Hamachek (1978) distinguishes between normal and neurotic perfectionism. Both types of perfectionists are described as wanting approval. However, Hamachek claims that normal perfectionists "feel free to be less precise as the situation permits" (p. 29). Because neurotic perfectionists are overly concerned with mistakes, even minor ones may result in the perception that they have failed. This overconcern for mistakes, according to Hamachek (1978), causes neurotic perfectionists to operate from a fear of failure rather than from a need for achievement. Burns (1980) and Pacht (1984) also discuss the fear of mistakes as being a core feature of the perfectionist's belief system.^Normal perfectionists derive a deep sense of pleasure from their efforts. By contrast, neurotic perfectionists do not feel a sense of pleasure because they never feel that they have achieved well enough to warrant a feeling of pleasure (Hamachek, 1978). There is general agreement in the literature that perfectionists are deeply troubled by what they sense as a discrepancy between their real self and their ideal self (Frost et al., 1990; Hewitt & Flett, 1991; Horney, 1950; Pacht, 1984). Currently, there is evidence that the ideal self functions as as schema in processing information (Hewitt & Genest, 1990). Karen Horney (1950) discussed the problems that can develop from trying to live up to an idealized image. The perfectionist is constantly trying to bridge the gap between the real self and the idealized image (Horney, 1950). "In this event he keeps reiterating the word 'should' with amazing frequency .... and believes that he actually could be perfect if only he were more strict with himself, more controlled, more alert, more circumspect" (p. 98). Horney explains that the idealized image has a static, unattainable quality. It is a  28 fixed idea which the rigid mind worships, with a resulting hindrance to personal growth. It is interesting that the early work of Karen Horney is still applicable today. Her emphasis on the use of the word "should" is consistent with more current cognitive thinking (Beck, Rush, Shaw, & Emery 1979; Burns, 1980; Ellis, 1962). Her description of the perfectionist being strict and controlled is consistent with the problems of eating-disordered women. Pacht (1984) feels that perfectionists live by extremes on a continuum. "They are unable to recognize that there is a middle ground. They are therefore, either God or they are scum" (p. 387). This description fits for bulimic or binge-eating women, who feel worthwhile when they stick rigidly to a diet, feel guilty after a binge, and then attempt to purify themselves by purging or fasting. Pacht (1984) feels that many people in the age range of 20-40 years old are trying to achieve perfection in order to be rewarded with parental love. Similarly Frost et al. (1990) feel that the perfectionist evaluates his or her performance in terms of parental expectations, approval, or disapproval. Failure to meet high standards means a potential loss of parental love and acceptance. Parental approval has implications in the study of eating disorders, because eating disorders have often been described in terms of a young girl or woman trying to live by the agenda of her parents, and having problems with individuation (Boskind-White & White, 1987; Bruch, 1978; Garner & Garfinkel, 1985). Burns (1980) feels that perfectionists are at risk for impaired health, poor self-control, troubled interpersonal relationships, and low-self esteem. It is important to note that eating-disordered women generally suffer from the above-described problems. Burns bases his theory on studies conducted at the University of Pennsylvania Mood Clinic. Burns further speculates that the  29 perfectionist is vulnerable to a number of mood disorders, including depressions, performance anxiety, social anxiety, writer's block, and obsessive-compulsive illness. Hewitt and Dyck (1986) studied the relationsip between stressful life events, perfectionism, and relative depression in a university sample. One hundred and five male and female college students participated in the study. Stressful life events were measured using the Social Readjustment Rating Scale (SRRS; Holmes & Rahe, 1967). Depression was measured using the Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961). Perfectionism was measured using the Burns Perfectionism Scale (BPS; Burns, 1980). The participants completed the BDI and BPS twice (2 months apart) and the SRRS only on the first occasion. Participants scoring above the median on the BPS at Time 1 were categorized as perfectionists. Participants scoring at or below the median were categorized as non-perfectionists. Additional analyses using stepwise multiple regressions were performed. The relationship between BPS scores and BDI scores was analyzed at two separate points in time. This analysis indicated that the variables were not associated at Time 1, r = .14, 12 > .05, but they were at Time 2, r = .35, 12 < .001. The authors feel that it is possible that this pattern was affected by academic stressors that were low at the beginning of the academic year (Time 1), and high during the mid-term period (Time 2). The results relevant to the interaction between stress and perfectionism on depression were evaluated with correlational analysis. The interactional hypothesis was supported by significant relationships between stress and depression for perfectionists, but not for non-perfectionists. To further evaluate the hypothesis in question, the data were entered into stepwise multiple regression to predict Time 2 depression. The results suggest that  30  perfectionistic thinking is associated with depression, but does not significantly predict later depression. The authors draw three generalizations from this study. First, perfectionistic thinking is associated with current depression level and predicts severity of the depression. Second, the relationship between stressful life events and depression is significantly elevated among perfectionistic individuals; and third, prior perfectionistic attitudes, alone or in combination with stressful life events, did not significantly predict future depression. The authors do admit that there were problems with the instruments used, and this may account for the weak support for perfectionism as a cognitive vulnerability factor. Because the SRRS is a general measure of stressful life events, it may not have tapped the stressors that are relevant to a population of university students. The present study may have benefited from a more focused measure of stressful events such as academic failure, peer rejection, or other ego involving stressors" (Hewitt & Dyck, p. 141). This study has important implications--the relationship between stressful life events and depression is significantly elevated in perfectionistic individuals. Evaluating this study from Lazarus and Folkman's (1984) model of stress and coping, it would appear that perfectionism was the moderating variable between stress and depression. Also of relevance is the need to utilize a daily hassles scale that will have relevance to female university students. Finally, it seems that the time of administering the instruments (beginning of the term versus mid-term) can make a difference in levels of stress reported by university students. Hewitt and Flett (1991) posit that conceptualizations of perfectionism have been unidimensional, in that they have focused only on self-directed cognitions (e.g., Burns, 1980). Although Hewitt and Flett (1991) agree that  31  self-directed perfectionism is an essential part of the construct, they feel that perfectionism also embodies interpersonal aspects. These interpersonal aspects can cause adjustment difficulties. Hewitt and Flett feel that their contention that perfectionism has personal and social components is consistent with research on the private versus public aspects of the self (Cheek & Briggs; 1982; Greenwald & Breckler, 1985). Moreover, they differentiate between self-oriented perfectionism, other-oriented perfectionism, and socially-prescribed perfectionism. Self-oriented perfectionism involves the setting of high standards for oneself. However, Hewitt and Flett (1991) diverge from previous definitions (e.g., Burns, 1980) by including a motivational component to self-oriented perfectionism. This motivational component means that the perfectionist is striving to attain perfection as well as striving to avoid failure. Selforiented perfectionism has been related to anxiety (Flett, Hewitt, & Dyck, 1989), anorexia nervosa (Cooper, Cooper, & Fairburn, 1985), and subclinical depression (Hewitt & Dyck, 1986). Other-oriented perfectionism involves setting very high and unrealistic standards for significant others, and carefully evaluating the performance of others. This behavior is similar to self-oriented perfectionism, only it is directed to others. Other-oriented perfectionism can lead to blaming, lack of trust, and feelings of hostility towards others (Hewitt & Flett, 1991). Hewitt and Flett (1990a) speculate that other-oriented perfectionism may be distinct from self-oriented perfectionism. Related research shows that individuals have different attributional styles, either characteristically blaming themselves or other for misfortunes (Wollert, Heinrich, Wood, & Werner, 1983). To date, there is no evidence linking other-oriented perfectionism with binge eating.  32 Socially-prescribed perfectionism involves the need to achieve the standards determined by significant others. Hamachek (1978) states that it is generally believed that perfectionism stems from a neurotic desire to please others. The person who adheres to a high degree of socially prescribed perfectionism believes or perceives that significant others are constantly evaluating them. Individuals with high levels of socially prescribed perfectionism place importance on gaining the attention, and avoiding the disapproval of others. Hewitt, Flett, and Blankstein (1991) studied the associations between the three dimensions of perfectionism and neuroticism in a clinical sample (76 psychiatric patients), and in a non-clinical sample (107 university students). The measure of neuroticism used was the Esyenck Personality Questionnaire (Esyenck & Esyenck, 1975). Socially-prescribed perfectionism was found to be associated with increased neuroticism for males and females in both the clinical and student sample. For a population of 58 female university students there was a significant correlation between socially-prescribed perfectionism and neuroticism,^=.47, g<.01. Studies of socially-prescribed perfectionism and eating-disordered women are currently underway at the University of Toronto (P. Hewitt, personal communication, December 17, 1991). Socially-prescribed perfectionism is an important measure for women with any type of eating disorder because these women are hypersensitive about their appearance. Both self-oriented and socially-prescribed perfectionism may contribute to the maintenance of binge eating, whereas other-oriented perfectionism does not appear to be as relevant.  Theoretical Framework for an Addiction Model of Eating Disorders In order to understand the pressures that women may feel from society to be perfect, and to describe how women may get involved in using food to cope  33 and find it difficult to stop, I examine a social learning model of addictions. According to social learning theory, an addictive behavior represents an overlearned, maladaptive habit, which is viewed by the addict as having an adaptive function (Peele, 1985). The addict puts in jeopardy his or her health, personal well-being, and disregards social coventions to continue the behavior (Alexander et al., 1985). In recent years, the social learning model of addiction has broadened to include substances other than narcotics. Peele (1985) describes addiction as becoming involved in a substitute experience offered by the social milieu. The substitute experience is used as a resolution for unsatisfied needs. Peele explains that compulsive gambling, running, and overeating, can be included as examples of addictive behavior in the social learning model. In the social learning theory of addiction, it is necessary to examine the larger societal conditions that encourage addiction, in order to understand the individual (Peele, 1985). "Groups whose values and social structure are disturbed, and who then show pathological extremes in behavior, including addiction, can be thought of as undergoing stress they cannot realistically hope to modify" (Peele, pp. 111-112). Bulimic women are a group whose values and social structure have been disturbed, and are therefore showing pathological extremes in dieting. Schwartz, Thompson, and Johnson (1982) posit that eating disorders have replaced, in our time, conversion hysteria of the past century. These authors make a parallel between "la belle indifference," the total unconcern for limb paralysis displayed by hysterics, and the denial of body emaciation in anorexics. Interestingly, they point out that in Moslem countries, where sexual norms are still at the stage experienced by the Western world during Victorian times, classical conversion hysterias are still prevalent. The sociocultural shift that has occurred in the West has had a predominant  34 influence on the symptomatology that masks an underlying conflict. Schwartz et al. (1982) suggest that those individuals with an innate vulnerability to stress in any culture are the ones who, in our time, develop the idiosyncratic neurosis of this century; namely eating disorders. Similarly, Steiner-Adair (1989) feels that in order to account for the high rate of eating disorders at this particular time in history, and with a particular population (women), we must look at the larger societal context. "One has to look at the sociocultural context in which the behaviors take on their meaning" (p. 152). Emphasizing sociocultural expectations for women as one of the etiological factors of eating disorders, Boskind-White (1985) gives an historical overview of a society in which ambiguous messages are prevalent. Both thin and voluptuous bodies are found to coexist throughout history. One example is the reed-slim figures of models, and the voluptouous Playboy centerfolds of today. The author points to other dichotomies, such as the rich versus poor, with the upwardly mobile women showing slimmer bodies; the value society places on young versus old; the influence young models like Twiggy had on our culture; feminine versus masculine, the "unisex" decade and the androgynous look; dependence versus independence, the frustrating form of liberation experienced by women in the 1970s, and the rise of the superwoman syndrome. Boskind-White posits that eating disorders are the product of an ambiguous society that places unrealistic demands on women. To be slim is to be loved, successful, and fulfilled. Szmukler (1987) suggests that eating disorders show an epidemiological parallel with substance dependence, because the incidence is related to degree of exposure to the agent. In other words, the more people are exposed to dieting in a population, the more eating disorders we could expect to see. Szmukler cites the example of ballet schools, which have a large percentage of the participants dieting, and a high incidence of eating disorders. Boarding  35 schools have also been cited as breeding grounds for eating disorders (Squire, 1983). In conclusion, eating disorders can be viewed from the perspective of Peele's (1985) social learning model of addiction, which implicates the way that society is encourages the addiction. The social learning model is concerned with the determinants of addictive behavior that include situational and environmental events, and beliefs and expectations. Of equal relevance is the examination of the consequences of these behaviors, so as to better understand the reinforcing effects that may be a factor in the continuation of and increased use of an addictive behavior (Marlatt & Gordon, 1986). Becoming involved in an addictive behavior pattern means that there will be limitations on the person's ability to fulfill their needs in a natural manner. There follows a decline in the person's self-efficacy (belief in one's ability to perform behaviors) and social worth, as the ritualized addictive involvement becomes more firmly entrenched (Peele, 1985). There is considerable debate in the eating disorders literature as to whether bulimia, anorexia, or both, fit into an addictions model. The controversy seems to stem from the question of exactly what it is that eatingdisordered women are addicted to. Some researchers feel that bingeing gives women a temporary "high", and therefore bulimics are addicted to abusing food (Boskind-White & White, 1987; Freeman, 1986; Orbach, 1986). According to Orbach (1986) "The binge is the relief, the letting go, the taking in, the attempted meeting of desire" (Orbach, p. 143). Other researchers feel that it is the starvation period in-between the bingeing that gives women a "high", and therefore both bulimic women and anorexic women are considered to be addicted to self-starvation (Slade, 1982; Szmukler, 1987; Vandereycken, 1990).  36  Freeman (1986) states that bulimia is the eating disorder that fits an addiction/dependence model best. "In fact it is the only eating disorder that clearly does so" (Freeman, p. 232 in Miller & Heather, 1986). Freeman feels that the maintaining factors for bulimia are complex, and involve a number of feedback circuits. The binges themselves initially serve to relieve dysphoria, and are therefore reinforcing. As the binges continue, the person feels guilty and ashamed of this behavior, and the level of disatisfaction with self increases. The cycle of starving and bingeing becomes selfperpetuating. Bulimia is often linked theoretically to alcoholism and substance abuse, and is seen by some as sharing common signs or symptoms of addiction (BoskindWhite & White, 1987; Scott 1983). For example, immediate gratification (the "high" state of pleasure or reduction in tension) is a shared characteristic of bulimia and alcoholism. Both bingeing and drinking are often performed when the person feels anxious, lonely, or bored (Marlatt & Gordon, 1986). The preoccupation with food, the loss of control over food intake, and continued problematic eating behavior despite negative consequences are common signs or symptoms of addiction (Filstead, Parella, & Ebbitt, 1988). Planning and secrecy are shared characteristics of alcoholism and binge eating (BoskindWhite & White, 1987; Freeman, 1986). A frequent characteristic of this addictive cycle is that a single violation by binge eaters (or other addicts) of their sporadic resolutions to curtail their behavior often leads to bingeing (Herman & Polivy, 1980; Marlatt & Gordon, 1986). Peele (1985) describes the addictive experience as powerful, gratifying, and ultimately distressing. The binge eater undergoes a similar cycle of emotions to those experienced by drug addicts, in that the guilt and bad feelings that result from immoderation lead to greater excess (Bruch, 1973).  37 Other researchers feel that anorexia is a dependence state, and that in both anorexia and bulimia, the addiction is self-starvation (Slade, 1982; Szmukler, 1987; Vandereycken, 1990). Szmukler (1987) feels that a comparison can be drawn between an anorexic problem and an alcoholic-dependence syndrome. This occurs because in both conditions the person engages in a behavior (dieting or drinking) that is normally indulged in moderation, and the behavior induces a different physiological state. That state is experienced as pleasant or calming, perhaps especially so for someone who is depressed. At some point, the behavior appears to become out of control, and carries destructive consequences. However, this is denied by the person, and offers of help are rejected. The person's life becomes increasingly organized around the need for a drink, in the one instance, or the need to avoid food, in the other. Tolerance develops, as is suggested by the anorexic's need to increasingly lose more pounds. Withdrawal effects are noted in both conditions; when the state of food restriction is interrupted in anorexia nervosa, the anorexic experiences an intense dysphoria with some physiological changes. The anorexic consequently seeks to avoid such occurrences in the future, just as the alcoholic attempts to secure the availability of alcohol at all times, to avoid the emergence of withdrawal symptoms. Similarly, Vandereycken (1990) posits that bulimics may be starvation-dependent rather than food-dependent. The bulimic episode acts as a violation of the dependency on limited food-intake. He feels that it is the "anorexic" hours or days that are connected with mood elevation, and the bulimic attacks are linked with dysphoric mood swings. Anorexia has been described in a way that fits a social learning model of addiction (Orbach, 1986; Slade, 1982; Szmukler, 1987). The disorder is described as having adaptive value to the anorexic, in that the anorexia provides cushioning from having to look at other areas of one's life. This  38 description of the adaptive value of anorexia nervosa could apply to bulimia as well, because there is much overlap between the two disorders, and the underlying dynamics could be similar. The anorexic woman creates for herself a "false self," because the real self has been overwhelmed by seemingly insurmountable problems (Bruch, 1973; Goodsit, 1983; Orbach, 1986; Szmukler, 1987). Orbach (1986) explains that maintaining the new persona of an anorexic is a "full-time occupation" (p. 111). It requires a degree of hypervigilance that is achieved by an increase in the rituals and obsessive routines that take up so much of the anorexic's time. The maintaining of a new persona, obsesssive routines and rituals apply equally to bulimic behavior. ^Because the underlying problems always threaten to surface, the anorexic further succumbs to the insistent demands of her syndrome--the food refusal, the routines and rituals, the exercise, and the thought patterns (Orbach, 1986). Similarly, in discussing the relationship between depression and anorexia, Szmukler (1987) states, "had the eating disorder not supervened, the affective disorder would have run it's own course" (p. 184). This description of anorexia nervosa fits the social learning model of addiction's criterion of becoming involved in a substitute experience, and applies to bulimia as well. Similarities and overlap between anorexia and bulimia are apparent. One of the more obvious limitations of explaining an eating disorder in terms of an addiction model is that the goal of therapy for most addictions (e.g., alcoholism) is abstinence. However, the abstinence target cannot apply to the treatment of bulimia or anorexia because the person has to eat. One of the goals of therapy is to have the bulimic learn to accept a well-balanced eating pattern connected with a normal body weight (Vandereycken, 1990). In summary, it seems that both anorexia and bulimia are viewed as dependence states by different researchers, depending on whether the viewpoint is that food is the addiction and the substance being abused by bingeing, or  39  dieting is the addiction, and food is being abused by withholding it. Perhaps some of the controvery stems from the overlap between anorexia and bulimia, as outlined by Russell (1985), and Garner and Garfinkel (1988). Interestingly, Slade (1982) explains that many anorexics learn to become bulimic. This learning often takes place when anorexics are hospitalized and forced to eat. "Clinical histories indicate that some anorectic patients discover this option for themselves, whereas others acquire it through direct imitation/modelling of other bulimic patients" (Slade, p. 176). Because of the potential overlap and unclear boundaries between anorexia and bulimia, both disorders equally fit to some extent into an addictions model. Substance abuse can be theoretically linked to Lazarus and Folkman's (1984) transactional model of coping. Using food, alcohol, or drugs to cope is the definition of escapism coping, one of the emotion-focused coping strategies. In the following sections, I highlight areas where the social learning model of addictions could play a role in the maintenance of bulimia. Why Women? Sociocultural factors. Fat is a women's problem because less deviation from an "ideal" is considered to be acceptable (Harris, 1983; McCarthy, 1990; Rothblum, 1989). Garfinkel and Garner (1982) explain that shifts of thinking with regard to the ideal feminine form have taken place in 20th century western society. A "look" has evolved that has come to be associated with other positive attributes. The media have capitalized on and promoted this image, and seem to portray the successful and beautiful woman as thin, in other words in control of her weight. Thinness has become associated with self-control and success. McCarthy (1990) supports Garfinkel and Garner's point of view, and feels that a standard has evolved that she calls the "thin ideal."  40 McCarthy (1990) speculates that a thin standard for women predisposes a culture to a higher rate of failed dieting, depression, and eating disorders among women. The presence or absence of a thin ideal across cultures has not been systematically examined to date (McCarthy, 1990). However, Sobal and Stunkard (1989) reviewed 137 studies in both developed and developing countries of the relationship between socioeconomic status and obesity in men, women, and children. They report that in certain developed countries there is generally more obesity in the lower classes. This was only clearly the case for women, and there were no consistent findings for either men or children. In developing countries, Sobal and Stunkard point out that the relationship is consistent, but in the opposite direction. There is more obesity in the higher social classes in men, women, and children. Sobal and Stunkard describe this ideal of being fat as the reverse of western attitudes both among women, and towards feminine beauty. Developmental issues.^Developmental issues concerning weight are different for women than for men (Bruch, 1973; Striegel-Moore et al., 1986). Genetically, women are programmed to have proportionately higher body fat than men, a sex-difference that increases across the life span, and appears in all races and cultures (Bruch, 1973; Striegel-Moore et al., 1986). As well, heredity and individual differences in metabolic rate determine how calories are used to maintain weight, with women, in general, having a lower metabolic rate than men (Polivy & Herman, 1983; Striegel-Moore et al., 1986). By the end of childhood, two sex differences that affect weight are established. Girls will refer to other people's opinions of their looks in their self-descriptions more than boys, and body image and self-esteem will correlate for girls (with weight a critical factor), but not for boys (Striegel-Moore et al., 1986). The stigma and ostracism towards overweight begins in childhood, with an impact on the self-esteem of a child that may be  41 irreversible (Harris, 1983; Wooley & Wooley, 1979). Early onset obesity is related to binge eating in the adult (Harris, 1983; Polivy & Herman 1984), so the risk of developing a compulsive eating disorder for women starts in childhood and adolescence (Streigel-Moore et al., 1986). By adulthood, body image is firmly planted in young women's minds. Compared to men, women are more self-critical of their body versus the thin ideal, they overestimate their body size especially around the waist and hips, and they link their body image to self-esteem (Ben-Tovim, Walker, Murray, & Chin, 1990; Striegel- Moore et al., 1986). "Middle-aged men and young and middle-aged women see discrepancies between themselves and the thin ideal, but only women deem this important" (McCarthy, 1990, p. 295).  Eigh-Risk Populations The prevalence of bulimia has been studied both in the community and on college campuses. A community-based sample found an incidence rate of 1.9% (Cooper & Fairburn, 1983), whereas studies of college campuses have reported a range of 1.3% to 4% increase (Drewnowski, Yee, & Krahn, 1988; Pyle et al., 1983; Schotte & Stunkard, 1987). DSM III-R reports an incidence of 4.5% in college freshmen. Hart and 011endick (1985) found five times the frequency of bulimia in women enrolled in university, compared to working women. They speculate that the higher incidence may be due to the stresses of academia, the first move away from home, and/or the social pressure of dormitory living. This would be consistent with the transactional model of stress and coping of Lazarus and Folkman (1984). The new environment of the university could function as an environmental stressor for these women. The pressure to succeed in this environment could be appraised as a domain of central importance. Peer pressure and family pressure to succeed academically and socially may be felt by these women. Perfectionist tendencies may pre-exist or develop as moderating variables. If the individual feels that she cannot  42 succeed academically, or accomodate to the new environment, a threat appraisal may be made, and a maladaptive coping strategy such as bingeing may occur. Binge eating may develop as the woman is in a constant, mutually reciprocal relationship with the new environment. Despite the amount of time and energy involved in bingeing and purging, many bulimic women manage to maintain high grades in college (Boskind-White & White, 1987). These women often define themselves as overachievers. However, the drive for academic success usually comes from felt pressure to please others, and from the expectation of "marrying well" (Boskind-White & White, 1987). Lazarus and Folkman's (1984) model of stress and coping would predict that a stressful environment could result in some women with perfectionist tendencies (moderating variable) to choose an emotion-focused coping strategy such as escapism. The choice of coping strategy would depend on how the situation is appraised. Boarding schools have also been cited as breeding grounds for eating disorders, with competitive, stressful schools showing a higher incidence (Squire, 1983). Striegel-Moore et al. (1986) feel that campuses where dating is emphasized put females at higher risk. Using Lazarus and Folkman's (1984) model, it would follow that dating and social position may be appraised as stressful. This may lead to an over-reliance on looks and body image in order to obtain dates, and maladaptive eating practices could be used to manage the situation. One study of female medical students found this population to be at a high risk for bulimia, with an incidence rate of 15% (Herzog et al., 1985). However, the authors warn that these data should be viewed with caution because it is the only published study done on female medical students, and a broader study is warranted. The authors did conclude that the bulimic female medical students showed the same degree of social maladjustment measured by  43 the Social Adjustment Scale Self-Report (Weissman, Prusoff, & Thompson, 1978), as patients seeking therapy for bulimia. Steiner-Adair (1989) speculates that we see a high rate of eating disorders in women in previously defined male occupations. The author explains that the conflict between relational aspects of female identity, and the cultural image of the independent and autonomously achieving female is a major factor in eating disorders today. "The image of the Superwoman is most often associated with a tall thin body, a brief case, and a high level of independent achievement" (p. 57). Peele's (1985) social learning model of addiction can help to explain eating disorders in women who are in previously-defined male occupations. Peele feels that we have to look to changes in the social milieu to better understand the individual. SteinerAdair (1989) explains that in today's society, women have to take on many masculine characteristics in order to succeed in a previously-defined male occupation. At the same time, some of these women give up or have less time for many of their female characteristics that were healthy, such as having close relationships with friends and colleagues. The result is that many women feel satisfied with their work achievements, but lonely and detached in their personal lives. From an addictions model viewpoint, binge eating could be used as a strategy to fulfill unmet needs. Summary The purpose of this study is to examine the relationship between between trait-like coping strategies, experience of daily hassles, and the personality construct of perfectionism, as maintenance factors in binge eating in a population of female university students. There has been much controversy in the past decade regarding the DSM-III and DSM-III-R categorization of bulimia and binge eating, and what has currently emerged is debate over the need for separate inclusion of Binge Eating Disorder (non-purging bulimia) in DSM-IV. Research on bulimia or binge eating indicates that there is a need to  44 separately study factors that initiate the disorder and factors that maintain the disorder. Goldner and Leung (1989) state that resolution of initiating factors of bulimia does not mean resolution of the disorder. The compulsion to binge and/or purge becomes a problem in its own right. Research has suggested that bulimic women may be deficient in coping skills, and there is a need to study the connection between the stress process and bulimia (Cattanach & Rodin, 1988; Shatford & Evans, 1986; Striegel-Moore et al., 1986). The current focus in stress research views daily hassles as more significant than major life events, in terms of predicting adapatational outcome. Daily hassles are defined as chronic, intermittent, stressors, that occur on an on-going basis. Lazarus and Folkman (1984) emphasize the role of microstressors in their cognitive-phenomenological model of stress and coping. Because there is a high rate of eating disorders in the competitive atmosphere of the university environment, perfectionism is an important predictor variable of eating disorders. Hewitt and Flett (1991) distinguish between self-oriented perfectionism, other-oriented perfectionism, and socially-prescribed perfectionism. Perfectionism and bulimia or binge eating has not been systematically studied to date, though perfectionism has been a prevailing theme in clinical descriptions of eating disorders. A social learning model of addictions provides a framework to understand the larger societal conditions that can cause women to turn to the substitute experience of binge eating. Society exerts tremendous pressure on women to be thin, and there is evidence that dieting and bingeing behavior co-occur. Binge eating partially fits into an addictions model, in that food can be used as a resolution for unmet needs.  45 Hypothesis Hypothesis: There is a significant linear relationship either singly or in combination with some or all of the predictor variables; coping strategies (problem-focused and emotion-focused), daily hassles, perfectionism (selforiented and socially-prescribed), and the criterion variable; severity of binge eating. It was expected that problem-focused coping would be significantly negatively associated with binge eating, and emotion-focused coping, daily hassles, self-oriented perfectionism, and socially prescribed perfectionism significantly positively associated with binge eating.  46 Method Participants The participants were 81 female students from the University of British Columbia. Fifty-two percent were full-time students and 48% were part-time students. Age ranged from 17 to 51 years old (M = 26.6,  aa =  7.80). Body  mass index (BMI) was calculated as weight in kilograms divided by height in meters squared (M = 25.3,  aa =  5.9). Seventy percent of the women were  Caucasian, and 52% were single. Fifty-eight percent of the sample were currently dieting. Fifty-two percent of the sample had been bingeing for over four years, and of these women 32.5% had been bingeing between 5 and 10 years. Seventy-one percent reported eating problems in their family of origin. Thirty-four percent of the women had received therapy for eating problems at some point in their life, and 8.6% were currently receiving therapy. Procedure Collection of data took place between July 1992 and March 1993. Advertisements were posted in various locations on campus (see Appendix F), and the strongest response came from postings in the female washrooms and locker rooms. Forty-six respondents had seen the advertisement in a washroom, 20 in a locker room, 8 in a student residence, and 7 at the bus stop. The participants responded by telephone. I explained the study in a consistent manner for each potential participant (see Appendix I), and I met with the women individually at the Stress Lab on campus. Questionnaires were completed and respondents took approximately 45 minutes to complete them. Three respondents preferred to fill out the questionnaires at home and returned them by mail. Of the 107 women who responded, 12 potential participants were screened out of the study because of one of the following reasons: 4 did not have concerns about their eating behavior, 6 were not students, and 2 were  47 interested in a study of irritable bowel syndrome. In addition, information was not used for 14 respondents who completed the questionnaires, and answered "no" to the question "Do you ever binge eat"? A range of demographic information was collected including age, height, weight, ethnicity, participation in competitive sports, current housing situation, relationship status, financial situation, history of therapy, and history of addictions for self and family (see Table 1).  48 Table 1 Demographic. Characteristic of Sample (N=81)  Characteristic  ^  Percent^aa^Md^Range  Age  26.6  7.8  24.0  17 - 51  Body Mass Index (BMI) (n=78)  25.3  5.9  23.9  7.9 - 42.3  Chronicity of Binge Eating six months to one year one to two year two to four years more than five years:  5.0 6.2 38.3 50.5  Ethnic Background Northern-European Southern-European Eastern-European Oriental East-Indian West-Indian Canadian Other Currently Dieting  54.4 3.7 12.3 8.6 2.5 2.5 11.1 4.9 58.0  Current Year of University (n=80) 1 2 3 4 5 6 higher than  10.1 17.5 22.5 20.0 15.0 8.7 1.2  Participation in Competitive Sports 12.7 (table continues)  49  Characteristic^  Percent^aa^M.^Range  Living Arrangement in residence with parents rented accomodation by yourself rented accomodation with roomate with spouse other:  19.8 17.3 14.8 25.9 12.3 9.9  Marital Status married common-law divorced or separated in a relationship single  19,6 6.2 6.2 16.0 52.0  Methods of Financial Supporta parental Support student Loan part-time Work support from Spouse summer-time employment scholarships handicap pension  45.7 32.1 60.5 22.2 16.3 9.6 1.2  Currently in therapy for eating problems 8.6 Previous therapy for eating problems (n=80)  33.7  Duration of therapy (n=28) in months Drinking problem - self (n=78) Drinking problems in family of origin (n=78) Smoking problems - self (j1=80) Smoking problems in family of origin (n=80) Eating problems in family of origin (2=80) Drug problems - self (R=79) Drug problems in family of origin (11=79)  13.35  23.06  14.1 44.9 26.2 61.2 71.2 13.9 17.7 (table continues)  6.5  1-120  50  Characteristic^  Percent^M^.2.12^Md^Range  Other health/behavioral dependencies - self (n=79) (responses were self-generated) Laxatives Exercise Depression ulcers asthmatic inhalers socializing chronic pain low self-esteem  3.8 3.8 2.5 1.3 1.3 1.3 1.3 1.3  Other health/behavioral dependencies in family of origin (n=79) (responses were self-generated) Laxatives Exercise Depression  3.8 2.5 2.5  Note. Different ii's are the result of missing data. aRespondents could choose more than one answer for the financial support section.  51  Predictor variables Coping was measured by the COPE scale (COPE; Carver, Scheier, & Weintraub, 1989). This scale was used as a measure of trait-like coping, or the way a person typically copes. The COPE is based on the theoretical framework of Lazarus and Folkman (1984) that differentiates between problemfocused and emotion-focused coping, and on a behavioral model of selfregulation (Carver & Scheier, 1981, 1983, 1985; Scheier & Carver, 1988). The COPE is a 52-item scale, with 13 subscales, each containing four items. The subscales include: (a) Positive Reinterpretation and Growth; (b) Active Coping; (c) Planning; (d) Seeking of Support for Instrumental Reasons; (e) Suppression of Competing Activities; (f) Religion; (g) Acceptance; (h) Mental Disengagement; (i) Focusing on and Venting of Emotions; (j) Behavioral Disengagement; (k) Denial; (1) Restraint Coping. Response choices include: 1 = "I usually don't do this at all"; 2 = "I usually do this a little bit", 3 = "I usually do this a medium amount"; 4 = "I usually do this a lot". Scoring is assessed by computing each scale total as an unweighted sum of responses to the four items that comprise that scale. Individual scale scores can range from 4 to 16, with high scores indicating frequent use of a coping strategy. Cronbach's alphas have been computed for each subscale, and these values were acceptably high, ranging from .62 to .92 (Carver et al., 1989). The exception has been the Mental Disengagement Scale with a Cronbach's alpha of .45. The authors explain that lower reliability for this scale is not surprising, because this scale is more of a "multiple-act criterion" than the others. Test-retest reliability data came from two samples of university students. One sample of 89 students completed the COPE at an initial session, and again 8 weeks later. An earlier sample of 116 students had completed an  52 almost final version of the scale over an interval of 6 weeks. The correlations for the items in the two groups range from .42 to .89. The authors feel that these self-reports of coping styles as measured by COPE are relatively stable, "although they do not in general appear to be as stable as personality traits" (p. 271). Convergent and discriminant validity was established by comparing the COPE with personality dimensions. Active coping and Planning were positively correlated with measures of optimism, control, self-esteem, and hardiness. The scales of denial and behavioral disengagement were positively correlated with anxiety. Ten scales were used in this study, 5 that assess a problem-focused trait-like coping style (Active Coping, Planning, Positive Reinterpretation and Growth, Suppression of Competing Activities, and Restraint Coping), and 5 that assess an emotion-focused trait-like coping style (Mental Disengagement, Behavioral Disengagment, Focus on and Venting of Emotions, Denial, and Acceptance). The reason for choosing these subscales is that Carver et al. (1989) have found that active coping, planning, positive reinterpretation and growth, suppression of competing activities, and restraint coping positively correlate and indicate a cluster of "adaptive" coping functions. Mental disengagement, behavioral disengagement, focus on and venting of emotions, denial, and acceptance coping positively correlate, and indicate a "maladaptive" cluster of coping strategies. Although the terms "adaptive" and "maladaptive" place a value judgement on the coping strategies, Carver et al. (1989) do not provide a theoretical framework explaining why each coping strategy is considered to be adaptive or maladaptive. Carver et al. (1989) also describe these clusters as problem and emotion-focused, consistent with Lazarus and Folkman (1984). Therefore the clusters of subscales were considered problem-focused and emotion-focused coping. No value judgement is  53 inferred when a coping strategy is described as "problem-focused" or "emotionfocused". The five scale scores were summed, and the scores could range from 20 to 80 for both problem-focused strategies and emotion-focused strategies. In this study the internal consistency was .88 for problem-focused coping and .79 for emotion-focused coping. In this study the problem-focused subscales generally correlated more highly with each other than with emotion-focused subscales. Similarly emotionfocused subscales generally correlated more highly with each other than with problem-focused subscales. The exception was the subscale of restraint coping, which in this study correlated more highly with emotion-focused subscales and very low with problem-focused subscales (see Appendix L). Because binge eating is an impulsive activity and is associated with loss of control, it may be that this specific population scores differently than the general population on the subscale of restraint coping. Daily hassles was measured by a modified version of the Medical Education Hassles Scale-R (Wolf et al., 1989, 1991). The conceptual framework for this instrument comes from the work of Lazarus and Folkman (1984), which emphasizes the cumulative effect of microstressors, and resulted in the development of the Daily Hassles Scale (Kanner et al., 1981). Wolf et al. (1989) designed the Medical Education Hassles Scale to target a medical student population. This scale applies to students in general with only three of the items mentioning "medical school". The scale was modified by this study by deleting the word "medical" from the scale. This scale was deemed more applicable to university students than the Kanner et al. (1981) scale. The Medical Education Hassles Scale-R (Wolf et al., 1991) consists of 101 items in the areas of personal habits, financial status, health habits, interpersonal relationships, chores, and viewpoints on the outside world. Examples include relating to professors, concerns about contraception, paying  54  bills, and finding study space. Three items that are concerned with weight were deleted (concerns about weight, weight loss, weight gain), because these items could overlap with items on the Binge Scale (Hawkins & Clement, 1980). Two items regarding mistakes were also deleted (making mistakes, making mistakes on exams), because these items could overlap with items on the Multidimensional Perfectionism Scale (Hewitt & Flett, 1991). After deletions, there are 96 items on the Medical Education Hassles Scale-R. Because frequency and intensity correlated highly in the original version of the test, just one score is used in the revised version (T. Wolf, personal communication, March 30, 1992). The revision is reflected in part of the instructions that reads as follows, "Please respond to each item by placing an "X" through the appropriate number to show how much of a hassle (0 = None or not applicable, 1 = somewhat, 2 = Quite a bit, 3 = A great deal) it was for you during the PAST WEEK". Total scales scores range from 0 to 288, with a higher score indicating a greater combined frequency and intensity of stress. The Medical Education Hassles Scale-R has high test-retest reliability. The scale was administered to medical students monthly, for 9 consecutive months (Wolf et al., 1989). Pearson correlations ranged from .62 to .86 for number of items endorsed, .63 to .81 for frequency, and .66 to .85 for intensity on the original version. In the present study, the Medical Education Hassles Scale-R had an internal consistency of .96. Perfectionism was measured by the Multidimensional Perfectionism Scale (MPS; Hewitt & Flett, 1989, 1991) (see Appendix B). The Multidimensional Perfectionism Scale is a 45-item 7-point Likert scale that indicates level of agreement or disagreement. The MPS subscales measure three dimensions of perfectionism. These include self-oriented perfectionism (unrealistic standards and perfectionistic expectations for the self), other-oriented perfectionism (unrealistic standards and perfectionistic motivation for  55 others), and socially-prescribed perfectionism (believing that significant others expect perfection from oneself). There are 15 items for each subscale. Scale scores range from 15 to 105, with higher scores indicating greater perfectionism. The scale is scored by summing the raw scores for each subscale. For the purposes of this study only the self-oriented and sociallyprescribed scales were used as predictor variables, although all three scales were administered. Item-to-subscale total correlations have been computed for each item (Hewitt & Flett, 1991). These correlations range between .51 and .73 for self-oriented items, .45 and .71 for socially-prescribed items, and .43 and .64 for other-oriented items, and Cronbach's alphas were .86, .87, and .82, respectively for the three dimensions. There is some degree of overlap among the three subscales, with intercorrelations ranging between .25 and .40. Although the subscales share some variance, the subscale intercorrelations are low compared to the subscale alpha coefficients. Hewitt and Flett (1991) explain the reasons to expect some degree of shared variance. All of the measures have either an implicit or explicit focus on attaining standards. Further, Hamachek (1978) distinguishes between the normal perfectionist and the neurotic perfectionist. The neurotic perfectionist would be expected to score highly on all levels of the construct (Hewitt & Flett, 1991). Hewitt and Flett conclude that the subscales are relatively distinct, and are not measuring alternate forms of the same dimension. In order to assess test-retest reliability, Hewitt and Flett randomly selected 34 participants from their sample from Study 3. These participants completed the MPS at Time 1, and again three months later at Time 2. The test-retest reliabilities were .88 for self-oriented perfectionism, .85 for other-oriented perfectionism, and .75 for socially-prescribed perfectionism.  56 Hewitt and Flett suggest that the test-retest reliabilities provide evidence that perfectionism is a stable personality trait. To assess validity, Hewitt and Flett (1991) used factor analysis to determine whether the subscales would produce three corresponding factors. A sample of university students and psychiatric patients was used for this study. In the student sample there were no gender differences in mean subscale scores, and in the patient sample men had higher other-oriented perfectionism scores than women. A principal components factor analysis was performed on the item responses, separately for men and women. Because the results were very similar for men and women, the data were collapsed across gender. In the student sample the first factor was made up of the 15 items of the self-oriented subscale, and the loadings ranged between .45 and .61. The second factor consisted of the 15 items of the socially-prescribed scale, and the loadings ranged between .39 and .63. The third factor was comprised of 13 items from the other-oriented scale, with loadings ranging between .38 and .63. The other two items from this subscale had loadings of .24 and .32 on this third factor, but loaded slightly higher on the second factor. The factor structures obtained from the patient sample were similar, with the exception of a few items measuring other-oriented perfectionism. In order to determine whether the factor structures for both samples were similar, the coefficient of congruence (Harman, 1976) was computed. The coefficients of congruence were .94 for the first factor, .93 for the second factor, and .82 for the third factor. The magnitude of these coefficients would indicate that the factor structure is highly similar across two samples (Harman, 1976). To further assess validity, a subset of target students completed the MPS, and had a significant other evaluate the target on the same dimension. Similarly, clinicians provided observer ratings to the psychiatric participants in the study. The correlations between the student targets and  57 the MPS scores were significant on all three subscales. The correlations were =.35 for the self-oriented scale, =.47, for the other-oriented scale, and L=.49, for the socially-prescribed scale. Similar results were obtained with the clinician/patient ratings. Hewitt and Flett (1991) assessed convergent and discriminant validity by assessing dimensions of general psychopathology and narcissism. It has been observed that narcissists expect perfection from themselves and from other people (Emmons, 1987; Raskin & Terry, 1988). They found that narcissism was associated with the self-oriented and other-oriented subscales. Hewitt and Flett (1991) also found that the self-oriented subscale correlated significantly with the 9 subscales of the Symptom Checklist 90-Revised (SCL90; Derogatis, 1983). This indicates that self-oriented perfectionism is broadly related to psychological distress and specific symptoms in college students. Socially-prescribed perfectionism, which is closely linked with psychological problems, correlated moderately with all of the SCL-90 subscales. Socially-prescribed perfectionism correlates significantly with the Fear of Negative Evaluation Scale (Leary, 1983), the Demand for Approval of Others subscale from the Irrational Beliefs Test (Jones, 1968), and internal locus of control as measured by the Locus of Control Scale (Rotter, 1966). Social desirablity as measured by the Marlowe-Crowne Social Desirability Scale (Crowne & Marlowe, 1960) has a small significant negative correlation with socially-prescribed perfectionism, and other-oriented perfectionism. Selforiented perfectionism was not correlated significantly with social desirability. The authors explain that these findings are expected because feeling unable to meet other's expectations, or endorsing unrealistic standards for others makes social interaction less desirable.  58 Other-oriented perfectionism correlated positively with the other-blame measure of The Self and Other Blame Scale (Mittelstaedt, 1989). There was also a positive correlation between other-oriented perfectionism and authoritarianism, as measured by the Authoritarianism Scale (Heaven, 1985), and dominance as measured by the General Population Dominance Scale (Ray, 1981). The MPS correlates with the Burns Perfectionism Scale (BPS; Burns, 1983). The correlations are as follows: ^= .57 for the self-oriented subscale, ^= .40 for the other-oriented subscale,^= .39 for the socially-prescribed subscale. The MPS also correlates positively with the Millon Clinical Multiaxial Inventory (Millon, 1983), which is a measure of personality disorders. Previous research has suggested a link between perfectionism and personality disorders (Broday, 1988; Lohr, Hamberger, & Bonge, 1988). Hewitt and Flett (1991) found that the greatest number of significant correlations was obtained using the socially-prescribed subscale. Socially-prescribed perfectionism correlated positively with borderline personality, schizoid, avoidant, and passive aggressive patterns. In the present study, the internal consistencies were .91 for selforiented perfectionism, .92 for socially-prescribed perfectionism, and .80 for other-oriented perfectionism. Slightly higher shared variance between the subscales was found. The subscale intercorrelations ranged from .44 to .58. Criterion Variable Binge eating was measured using the Binge Scale (Hawkins & Clement, 1980). This is a 9-item forced choice questionnaire, 6 of the item scores range from 0 to 3, two of the item scores range from 0 to 2, and one of the item scores ranges from 0 to 1. The scoring weights were determined subjectively by the authors. Scale scores range from 0 to 23, and higher  59 scores indicate greater eating disordered behavior. A score of less than 10 is considered normal, scores greater than 12 suggest binge eating problems, and scores greater than 15 suggest a full-blown bulimic syndrome (Hawkins & Clement, 1980). The Binge Scale was used as an interval scale, similar to Hawkins and Clement (1984) and Yates and Sambrailo (1985). The Binge Scale contains 10 additional items for clinical information. This scale is extremely popular in the eating disorders literature, and was recently included among the assessment instruments recommend for used in pediatric psychopharmacology research (Psychopharmacology Bulletin, 1985, p. 1011). The Binge Scale has proved to be a very useful measure of the binge eating spectrum in correlational and comparison group studies, using samples mostly drawn from the college population (e.g., Crowther, Lingswiler, & Stephens, 1984; Dolan & Ford, 1991; Katzman et al., 1984; Wolf & Crowther, 1983). This scale is brief and easy to fill out, roughly corresponds to DSMIII criteria, and enables screening of participants along a continuum of severity from subclinical "situational bingeing" (Squire, 1983), to bulimia nervosa (Hawkins, 1989)^The Binge Scale has shown promise for the development of theoretical "risk" models (Hawkins & Clement, 1984; Katzman & Wolchik, 1984; Wolf & Crowther, 1983; Yates & Sambrailo, 1984). When the Binge Scale was originally piloted, the internal consistency (Cronbach's alpha) was .68. Hawkins and Clement (1980) indicate that this score is satisfactory for a pilot instrument. One month test-retest reliability of the Binge Scale total score was .88. A principal components factor analysis with varimax rotation showed that 71% of the variance in item loading was accounted for by one factor that appeared to represent "guilt" and "concern" about binge eating tendencies. A second factor that contributed 16% of the variance were items measuring reported duration and feelings of satiety  60 associated with bingeing. In the present study, the internal consistency was .85.  The Binge Scale has been used in approximately 150 studies to date (R. Hawkins, personal communication, December 17, 1991). The construct validity of the Binge Scale has been adequately established in these studies. This scale correlates .93 with the Bulimia Test (Smith & Thelan, 1984), which suggests that they are measuring the same construct. The scale also has a positive correlation (=.67) with the Restraint Scale (Wardle, 1986), which is a measure of dieting and compensatory overeating. The Binge Scale was modified by adding the question "How long ago did you start to binge eat?" (see Appendix E) in order to examine chronicity of binge eating in a post hoc manner. The instructions to the Binge Scale were modified by providing the following definition of binge eating in the instructions in bold face type "Binge eating involves periods of uncontrolled, excessive eating, where you eat a large amount of food in a short period of time - not a proper meal." This modification was used verbally by Dolan and Ford (1991) in their epidemiological study of cross-cultural binge eating. The purpose of using this definition was to prevent over-reporting, which may happen when participants are allowed to define binge eating subjectively (Connors & Johnson, 1987). Data Analysis An SPSS:X programme was used for data analysis. Means, standard deviations, and pair-wise correlations for the predictor variables and criterion variable were calculated. Missing data for predictor variables, of which there were three instances, were handled by taking a midpoint where no more than 20% of the scale items were missing. No participants had missing data for the scored items on the criterion variable. A simultaneous multiple  61 regression analysis was conducted in order to examine the relationship between the predictor variables and the criterion variable. Simultaneous multiple regression was used because previous research on binge eating provides no theoretical basis for entering one of the predictor variables prior to another predictor variable. Five predictors were entered into the multiple regression: problemfocused coping, emotion-focused coping, daily hassles, self-oriented perfectionism, and socially-prescribed perfectionism. Age was not entered into the regression because there was no correlation between age and the predictors or criterion variable. The ratio of subjects to predictor variables was satisfied according to the rule of thumb set out by Borg and Gall (1989) (i.e., to increase sample size by at least 15 subjects for each predictor variable entered in the multiple regression).  62  Results Descriptive Statistics Means, standard deviations, and pair-wise correlations for the predictor and criterion variables are given in Table 2. The responses on the COPE subscales are very similar to Carver and Scheier's (1989) study of 1030 college students with the exceptions of the subscales of Restraint Coping and Positive Reinterpretation and Growth, which are significantly lower in the present sample (see Appendix L). A 1-test revealed a significant difference on the subscales of restraint coping (t=5.90, a<.01), and the subscale of positive reinterpretation and growth (1=3.93, a<.001) between the college sample in Carver et al. (1989) and this study. However, this finding must be viewed cautiously because of the different sample sizes. The responses on the self-oriented perfectionism subscale (Z1 = 79.10, ziE = 15.00), look similar on visual examination to those obtained by Hewitt and Flett (Study 4, 1991) in a study of 91 students (mean age 25.4 years) at York University (M = 73.40,  aa =  14.90). However, Hewitt and Flett's sample  consisted of both male and female students, and is therefore not directly comparable to the present study. The responses on the socially-prescribed perfectionism subscale (M = 62.12,  aa =  17.28) also look similar by visual  inspection to Hewitt and Fletts sample described above (1 = 53.66,  aa =  14.99). The responses on the Binge Scale (j = 13.07, aa = 5.05) appear slightly lower on visual examination than Yates and Sambrailo's (1984) study of 24 women attending medical or weight control clinics (M = 17.39,  aa =  3.19).  However, Yates and Sambrailo's sample is different than the present study, making it difficult to draw comparisons. The mean score is higher in the present study than Hawkins and Clement's (1980) study of prevelance among a  63  general university population (not pre-screened for eating problems) of 160 females (M = 5.63, SD = 4.37). Problem-focused coping did not correlate with any of the predictors or the criterion variable (see Table 2 ). However, all other predictors correlated significantly with binge eating (all g's <.05). Age did not correlate significantly with the criterion variable. Hypothesis To test the hypothesis a simultaneous multiple regression was conducted. Emotion-focused coping, problem-focused coping, daily hassles, self-oriented perfectionism, and socially-prescribed perfectionism were used as predictor variables. Severity of binge eating was the criterion variable. Binge eating. Table 3 is a summary of findings from the multiple regression analysis predicting Binge eating. The equation predicting Binge eating reached significance, L(5,75) = 12.76, g<.0001. Two variables, daily hassles (L(1,75) = 2.81, g<.006), and socially-prescribed perfectionism (L(1,75) = 2.65, g<.01) were significantly related to Binge eating. Entering the five predictor variables in the regression equation produced an R-squared of .46, with an adjusted R-squared of .42 (see Table 3). Therefore, a moderate amount of variance (42%) in binge eating is accounted for, particularly by hassles and socially-prescribed perfectionism. In summary, the results indicate that high daily hassles and high socially-prescribed perfectionism are associated with greater Binge eating. In addition, an examination of the standardized beta weights reveals that similar amounts of variance in binge eating were accounted for by hassles (.34) and sociallyprescribed perfectionism (.33). These findings provide some support for the hypothesis.  64  Table 2  Correlations of Predictors lincluding Age) and Criterion Variable (N=81)  Measure Variable  ^  Mean^aa^1^2^3^4^5^6^7^8  1 Prob-Cope^50.33^9.49^2 Emot-Cope^46.24^8.59^-.00^3 Hassles^105.61^44.09^-.02 .59 4 Self-Perf^79.10^15.00^.07 .17 .35 5 Social Perf^62.12^17.28^-.14 .38 .59 .58 6.Other Perf.^63.50^11.60^.09 .05^.33 .44^.48 7 Binge^13.07^5.04^-.09 .45 .61^.33 .58^.22^8.Age^26.60^7.80^.27^.04^.04 -.03^.01^.01 -.14  Note. Prob-Cope is problem-focused coping, Emot-cope is emotion-focused coping, Self-Perf is self-oriented perfectionism, Social Perf is sociallyprescribed perfectionism, Other Perf is other-oriented perfectionism, Binge is binge eating. _r .01(80) = .28,^.05(80) =.22 Adjusted r .01(80) = .43,  x. .05(80) = .38 (Shavelson, 1981).  65 Table 3 Multiple Regression Analysis of Predictors of Binge Eating  (N=81)  Source  Beta  Problem-focused coping  -.03  -.37  ns  Emotion-focused coping  .12  1.17  ns  Hassles  .34  2.81  .006  -.002  -.02  ns  .33  2.65  .010  Self-oriented perfectionism Socially prescribed perfectionism  (git = 1,75)  Note. Beta is the standardized regression coefficient. Percentage of variance in Binge eating accounted for by the regression equation ( 2 is .46 (Adjusted .42). Overall E(5,75) = 12.76, p. <.0001.  66 Post-hoc Analyses To determine whether the number of years participants had been binge eating was related to the severity of binge eating, an analysis of variance was conducted. A median split was used to form two groups on years of binge eating. The 40 women who had been binge eating for less than five years, Group 1, was contrasted with the 41 women who had been binge eating for more than five years, Group 2. The mean score on the Binge Scale for Group 1 was 12.47, SD = 5.53, and 13.66, SD = 4.50 for Group 2. The analysis of variance revealed that there was not a significant difference in binge eating between the two groups, 1(1,80) = 1.12,p < .29 (see Appendix J). Because other-oriented perfectionism correlated significantly with binge eating (=.22, p<.05), it was added to the hypothesized multiple regression and a post-hoc analysis conducted (see Appendix K). Other-oriented perfectionism did not predict binge eating t(1,74)=-.812, when problem-focused coping, emotion-focused coping, daily hassles, self-oriented perfectionism, and socially prescribed perfectionism were also present in the regression. No further analysis was conducted with this subscale. In order to examine the associations among the COPE subscales and binge eating and to confirm the use of summed scores for problem-focused and emotion-focused strategies, a correlation matrix was computed (see Appendix M). Binge eating was significantly correlated with three of the six emotionfocused subscales. These were mental disengagement (r=.47, p<.001), denial (r=.43, p<.001), and behavioral disengagement (x=.28, p<.01). Binge eating was not significantly correlated with any of the problem-focused subscales. Of note, the restraint subscale (a problem-focused scale) did not correlate with the other problem-focused subscales. Thus, the subscale of restraint coping was removed from the problem-focused scale and a post-hoc analysis conducted reanalyzing the hypothesized relationships (see Appendix N). With  67 the subscale removed, problem-focused coping still did not significantly predict binge eating. Age was also included in this regression because age correlated significantly with problem-focused coping (.L=.27, p<.01). Age significantly related to binge eating in this regression, 1(1,74) = -2.05, p<.04, along with hassles and socially-prescribed perfectionism (see Appendix M). The negative beta weight indicates that younger women had greater binge eating symptoms when the effects of problem-focused coping, emotion-focused coping, hassles, self-oriented perfectionism, and socially-prescribed perfectionism are accounted for. To determine whether there were significant differences between the 48 participants who do not purge after binge eating and the 33 participants who do purge after binge eating, a multivariate analysis of variance was conducted between the two groups (see Appendix 0). The overall MANOVA is significant, E(6,74)=3.66,12<.003. Purging binge eaters scored significantly higher than non-purging binge eaters on the predictor variables of emotion-focused coping  al =  49.88,  128.33,  az =  az =  9.0; and M = 43.72,  45; and M = 105.60,  az =  az =  prescribed perfectionism (M = 67.34,  7.42 respectively), hassles ad =  44.08 respectively), and socially-  Q.  =18.50; and M = 58.52,  az =  15.60  respectively). This post-hoc analysis suggests that purging binge eaters experience more problems in the areas of stress and coping, and sociallyprescribed perfectionism than do non-purging binge eaters. The participants were tested from July 1992 to March 1993. An analysis of variance was conducted to determine whether the 20 participants tested during the summer months (Group 1) reported less hassles than the 61 participants tested during the fall and winter (Group 2)(see Appendix P). The mean score for Group 1 was 90.7  (aa =  38.0), and the mean score for Group 2  was 110.50 (SD = 45.12). The results of the ANOVA were non-significant E(1,79)=3.11,08. This analysis does not suggest that university women who  68 binge eat are less troubled by daily hassles during the summer months. However the difference in sample size between the two groups must be considered in interpreting these results.  69 Discussion The goal of this study was to examine predictors derived from Lazarus and Folkman's (1984) theory of stress and coping, and Hewitt and Flett's (1989, 1991) model of perfectionism that may contribute to the maintenance of binge eating in female university students. In particular, it was expected that women who use problem-focused coping to deal with stress would exhibit less binge eating behavior, whereas the use of emotion-focused coping would predict greater binge eating. Additionally, daily hassles, self-oriented perfectionism, and socially-prescribed perfectionism would be associated with greater binge eating. Some support was found for these expectations. Predictors of Binae Eating The multiple regression results showed that when the predictor variables (problem-focused coping, emotion-focused coping, daily hassles, self-oriented perfectionism, and socially-prescribed perfectionism) were considered together, daily hassles and socially-prescribed perfectionism predicted binge eating. No other predictor variable reached significance. These findings are consistent with the conclusions reached in Striegel-Moore et al.'s (1986) literature review. They suggest that stress combined with other risk factors (personality variables and sociocultural variables) predict the likelihood of bulimia. Moreover, the significant positive relationship between daily hassles and binge eating is consistent with Lazarus and Folkman's (1984) theory that microstressors negatively impact health and well-being. Finally, the finding that socially-prescribed perfectionism predicted binge eating is consistent with theory that posits that striving to meet external standards is associated with disturbances in eating behavior. Problem-focused Copina Unexpectedly, problem-focused coping did not predict binge eating. Cattanach and Rodin (1988) suggest that bulimics have difficulty reducing  70 stress either because they lack adequate coping skills, or because they lack the personal resources that enable them to effectively utilize their resources. The present study would suggest the latter. One could posit that the participants in this study do utilize problem-focused coping skills to deal with stress, but do not use these skills effectively. The participants in this study used problem-focused coping skills as often as Carver and Scheier's (1989) sample of college students, with the exception of the subscales of restraint coping and positive reinterpretation and growth (see Appendix L). Given the finding that the problem-focused subscale of restraint coping correlated with the emotion-focused subscales and was also negatively correlated with binge eating, it may be postulated that the participants act impulsively in their implementation of problem-focused coping strategies, rendering these strategies less effective. Examples of items on the subscale of restraint coping include "I restrain myself from doing anything too quickly", and "I make sure not to make matters worse by acting too soon". Because the participants in the present study scored significantly lower than Carver and Scheier's (1989) sample on the subscale of positive reinterpretation and growth, one can speculate that university women who binge eat are less skilled at making the best of their problems by "growing" from them or viewing problems in a more favorable light. Examples of items from the subscale of positive reinterpretation and growth include "I try to grow as a person as a result of the experience", and "I try to see it in a different light, to make it seem more positive". Further research is needed to determine whether women who binge eat are effective or ineffective in their implementation of problem-focused coping strategies.  Emotion-focused Coping Although emotion-focused coping did not reach significance in the regression equation, the significant positive zero-order correlation between  71  emotion-focused coping and binge eating provides some support for the stress and coping theory of Lazarus and Folkman (1984) which considers eating as an indicator of escapism, one of the emotion-focused coping strategies. Moreover, the high correlation between emotion-focused coping and hassles (t=.59, 12<.001) may be the reason that emotion-focused coping did not reach significance in the regression equation. Further research is needed to determine whether women who binge eat generally rely on emotion-focused coping strategies. Aldwin and Revenson (1987) found that the coping strategy of escapism was most strongly associated with current psychological problems for a community sample of men and women. The Ways of Coping Scale (Folkman & Lazarus, 1985) used by Aldwin and Revinson included eating as an indicator of escapism, one of the emotion-focused coping strategies (Folkman & Lazarus, 1988; Lazarus & Folkman, 1984). The Carver et al. (1989) emotion-focused subscales of mental disengagement ft = .47) and denial ft = .43) used in this study were significantly correlated with binge eating and are conceptually similar to escapism. Given the results of Aldwin and Revinson's study and this study, one could speculate that the use of escapism types of coping may be a maintaining factor in binge eating, and that women may binge eat to alleviate the distress experienced in stressful situations. Coping strategies may be important mediators of the stress process in women who binge eat.  Daily Hassles The finding that daily hassles [perceived irritating, frustrating, and distressing incidents that occur daily in one's transaction with the environment], (DeLongis et al., 1982) were associated with greater binge eating warrants further discussion. Shatford and Evans (1986) studied female undergraduate psychology students and found that Environmental Stressors (defined as life events and daily hassles) were indirectly related to bulimia,  72  with coping acting as the mediating variable. The authors speculate that bulimic women lack effective coping mechanisms and turn to binge eating in response to stress. They found that the majority of women in their study used emotion-focused coping mechanisms, which were ineffective in mediating stress. Although the present study did not test for the mediating effects of coping, it does lend support to the notion that binge eating is associated with daily hassles, which are associated with the greater use of emotion-focused coping. Wolf and Crowther (1983) used the General Life History Questionnaire (Wolf & Crowther, 1981) to study the relationship between stress experienced in the past year and binge eating in female undergraduate university students. The researchers found that stress (measured as amount of stress experienced during the past year) was the only significant demographic/historical predictor of binge eating. It should be noted, however, that stress accounted for only 6.3% of the variance of binge eating. In the present study, daily hassles accounted for 34% of the variance in binge eating, and it may be that the Medical-Education Hassles Scale-R (Wolf et al., 1989, 1991) is a more accurate measure of stress for university students. The high internal consistency of the Medical Education Hassles Scale-R in the present study suggests that this is a useful instrument to assess stress in female university students. Scale items such as "relating to professors", "lack of understanding about school commitments from other family members", "cramming", "being lonely", reflect the stressors female university students experience. The finding that daily hassles predicted binge eating is also important theoretically. Lazarus and Folkman (1984) emphasize the role of microstressors (hassles) as being more strongly related to psychological symptoms than major life events. The present study lends support to an association between microstressors and problematic behavior. Lacey et al. (1986) and Hawkins and Clement (1984) both suggest that women who binge eat  73 lack the necessary coping skills to deal with normative psychosocial events, and the experience of daily hassles has been attributed to failed or ineffective coping (DeLongis, Folkman, & Lazarus, 1988).  Self-oriented Perfectionism Unexpectedly, self-oriented perfectionism did not predict binge eating behavior. However, the positive correlation between self-oriented perfectionism and binge eating (L=.33, 12<.01) suggests that self-oriented perfectionism may be an important personality variable to consider with this population. The moderate correlation between self-oriented perfectionism and socially-prescribed perfectionsim (r=.58, p<.001) may be the reason that selforiented perfectionism did not reach significance in the regression equation. Alternatively, it may be that for women who binge eat, only perfectionism with regard to other people affects binge eating behavior.  Socially-prescribed Perfectionism The finding that socially-prescribed perfectionism significantly predicts binge eating is consistent with Hewitt et al.'s (1992) results. They found a strong association between socially-prescribed perfectionism and obsessivecompulsive behavior. Binge eating has been described as an obsessivecompulsive behavior (Boskind-White & White, 1987; Peele, 1985). Moreover, Hewitt et al. (1991) found a significant association between sociallyprescribed perfectionism and neuroticism in female university students, and significant associations between socially-prescribed perfectionism and borderline personality, schizoid, avoidant, and passive agressive behaviors in a psychiatric population (Hewitt & Flett, 1991). Based on these results, one can speculate that socially-prescribed perfectionism (i.e., the felt need to achieve standards determined by significant others) is associated with many types of problematic personality traits and behaviors, in addition to binge eating.  74 These results also suggest the importance of the family in women who binge eat. The socially-prescribed subscale includes items about family such as "My parents rarely expected me to succeed in all aspects of my life" (reverse scored), and "My family expects me to be perfect". Frost et al. (1990) suggest that the perfectionist evaluates his or her performance in terms of parental expectations, approval, or disapproval. Failure to excel may mean the loss of parental love and acceptance. Pacht (1984) posits that many people in the age range of 20-40 years old try to achieve perfectionism in order to obtain parental love. The dynamics of eating disorders have been described by some authors in terms of women trying to live by the desires of her parents, at the expense of individuation (Boskind-White & White, 1987; Bruch, 1978; Garner & Garfinkel, 1985). Boskind-White and White (1987) point out that bulimic women in college often describe themselves as overacheivers driven to academic success to please others. Furthermore, the associations among binge eating, hassles, and perfectionism provide support for Peele's (1985) social learning model of addictions, which includes overeating as an example of a compulsive behavior. The social learning model posits that situational and environmental events, as well as beliefs and expectations determine addictive behavior. Sociallyprescribed perfectionism subscale items such as "The people around me expect me to succeed at everything I do", and "Success means that I must work even harder to please others" are examples of beliefs and expectations imposed on situational or environmental events. These subscale items suggest a hypersensitivity to one's surroundings, and one could speculate that women who score high on the subscale would be more susceptible to the sociocultural messages that portray the ideal woman. Finally, the results are consistent with Hewitt and Flett's (1991) finding that perfectionism is a multidimensional construct. When the three  75  subscales were considered together, only socially-prescribed perfectionism predicted binge eating, although there were moderate correlations among the subscales (I's range from .44 to .58).  Limitations and Delimitations From a systems perspective, family interactions may play a key role in the maintenance of eating-disordered behavior. Both Lacey et al. (1986) and Schwartz (1988) have emphasized the family environment as a maintenance factor. Although this study did not comprehensively take into account the family environment, the socially-prescribed perfectionism scale includes one item on parental expectations, one item on family expectations, and eight items on the people around me, and the people I am close to", which would account for some difficulties with family. Another limitation of the study is that experiences of sexual abuse were not documented. Miller, McCluskey-Fawcett, and Irving (1993) found that bulimic women had experienced significantly more incidents of sexual abuse than non-bulimic women. There may have been differences in the present study between participants who had suffered sexual abuse, and those who had not. Results of this study are also limited by the correlational design (all assessments were conducted at one point in time), therefore cause and effect cannot be inferred. Moreover, results are generalizable only to women who are attending university. Because binge eating is a secretive activity, it may be that there are personality differences between women who binge eat and agree to participate in research, and women who binge eat but are more secretive about their problem. There may be important personality differences between people who agree to volunteer for research projects, and those who do not. Last, there may be unknown, unmeasured, variables that account for the relationship between hassles, socially-prescribed perfectionism, and binge eating.  76 Future Research Further research is needed to determine whether coping mediates the stress process in women who binge eat. Shatford and Evans (1986) found that the majority of bulimic women in their study used emotion-focused coping strategies more often than problem-focused coping strategies. Cattanach and Rodin (1988) agree that lack of coping skills is a possibility, but also suggest the possibility that bulimic women do have an adequate repertoire of coping skills, but lack the personal resources to effectively utilize these skills. This study may suggest the latter because neither problem-focused coping nor emotion-focused coping predicted binge eating, when hassles and perfectionism were also predictors. Alternatively, it may be that the lack of usage of the problem-focused strategies of restraint coping, and postitive reinterpretion and growth, create problems for these women. The role of cognitive appraisal, an important component of stress and coping theory, needs to be examined more carefully, and future research may determine whether women who binge eat appraise a situation as more stressful, or differently than women who do not binge eat. Possibly, appraisals could be examined by having women keep diaries of their binge eating episodes, and documenting the antecedant events, appraisals, and the self-talk that took place. It may be helpful to use a situation-specific measure of coping as well as a measure of general coping. Future research should also investigate how university women who binge eat score on the Medical Education Hassles Scale-R (Wolf, 1989) in comparison to university women who do not binge eat. It would be helpful to determine whether binge eaters experience more hassles than women who do not binge eat, or if they experience the same amount of hassles but appraise them as more stressful. Future research should also determine which hassles are most central to this population.  77 The extent to which personality constructs, such as perfectionism, play a role in the coping process in women who binge eat warrants further investigation. Future research should determine whether self-oriented perfectionism plays a role in the maintenance of binge eating. Though my study did not find an association, the effects may have been subsumed by the socially-prescribed perfectionism scale. Future research with the socially-prescribed perfectionism subscale could include interviews with these women to determine how this characteristic is developed and is being reinforced. For example, the interviewer could go over the items on the socially-prescribed subscale to determine if this construct is being reinforced by the family, by society, or both. Future research could examine the cognitive appraisal process in women who score high on sociallyprescribed perfectionism. A prospective study could interview adolescents who score high on socially-prescribed perfectionism to see if they later develop eating problems. Future research should include more than one measure of binge eating. Because there is so much overlap in the literature between the terms binge eating and bulimia, and so much confusion regarding definitions, it would be beneficial to have more than one criterion variable. One could choose from the many measures of binge eating or binge eating and dietary restraint available (e.g., the Three Factor Eating Questionnaire; Stunkard & Messik, 1985) and correlate this measure with the Hawkins and Clement's (1984) Binge Scale. Fifty-eight percent of the participants were dieting, and future research should take a more comprehensive dieting history. Perhaps dieting is being used as a coping mechanism to buffer the effects of stress. It may be that there are significant differences between women who are fluctuating between binge eating and dieting, and women who are binge eating and are obese.  78  Implications for Counsellors I hypothesized that problem-focused coping, emotion-focused coping, daily hassles, self-oriented perfectionism, and socially-prescribed perfectionism would be associated with greater binge eating. The results provide some support for the hypotheses. These findings have implications for counsellors who provide individual or group counselling for university women who binge eat. Specifically, it is important that the counsellor considers varibles that may be maintaining binge eating. The results of this study suggest that stress (e.g., daily hassles) and coping are important issues to consider with female university students who binge eat, and that the Medical-Education Hassles Scale-R (Wolf et al., 1989) is a useful measure of stress for this population. This assessment tool could be used by the counsellor in an individual or group setting, and the counsellor and client could generate discussion around scale items that were given a high rating. It may be important that the counsellor examine whether the client is using binge eating to cope with stress. It could be beneficial for the client to keep a diary and identify cues that lead to binge eating. The high correlation between daily hassles and emotion-focused coping, and the significant association between purging binge eaters and greater use of emotion-focused coping (see Appendix 0) lends to the suggestion that the counsellor help the client develop problem-focused coping strategies to manage stress. Previous research has found problem-focused coping to be related to more effective outcomes. Problem-focused techniques, if used effectively, may give the client a sense of empowerment over her situation. If the client is using problem-focused coping techniques but not getting results, the counsellor could have the client describe the situation to attempt to figure out why the client is not effective in using these techniques. An  79 individualized stress-management programme could be determined to meet the needs of each client. The results of this study suggest that the socially-prescribed subscale of the Multidimensional Perfectionism Scale (Hewitt & Flett, 1989, 1991) may be a relevant assessment tool for university women who binge eat. This subscale may be useful in generating discussion about meeting perceived expectations of other people. The counsellor can find out who the significant people are in the client's life. It may be any combination of family of origin, friends, boyfriends, or husbands. It would also be helpful for the counsellor to discuss the role of sociocultural expectations to determine if the client is having problems in this area. For example, the counsellor could ask the client who her role models are, to ascertain whether the woman is trying to look like a media figure who has the perfect figure ascribed by society. Perfectionism and pleasing others should constitute part of the discussion between counsellor and client, with the counsellor asking the client to discuss the payoffs and the price of trying to appear perfect in the eyes of others. The counsellor could help the client discover what her own values are, and how to realize them. Also, because a high score on the socially-prescribed subscale implies a placating type of person, these women may need help with assertiveness training. One could speculate that this type of client may be prone to pleasing the counsellor, and the counsellor could point this out to the client if it appears to be happening. 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Bealth Psychology, 3, 243-251.  ^  92 Appendix A: Demographic Information  Please answer the following questions as they are important for research purposes. Age: ^years^Height: ^cm.^Weight: ^ kg. What is your predominant ethnic background? (circle no more than two): a. Northern-European b. Southern-European (Mediterranean) c. Eastern-European d. Oriental e. East-Indian f. West-Indian g. Other Are you currently dieting? yes ^no Target weight if currently dieting ^ kg. Current year of university or college (please circle one) 1^2^3^4^5^6^7^other (please specify) Full-time student^Part-time student (please circle one) Academic area of interest Do you currently participate in any competitive sports? yes ^ no If yes, please specify which sports  Living arrangement: Please circle one: a.  in residence  b.  with parents  c.  rented accomodation by yourself  d.  rented accomodation with a roommate  e. Other (please specify). ^ Marital status: Married Divorced/separated Currently single  Common-law relationship Currently in a relationship Other Please turn the page  93  - 2 How are you curently supporting yourself? Please check as many as apply to you. a.  Parental support ^  b.  Student loan  c.  Part-time work ^  d.  Support from spouse ^  e. Other (please specify) ^ Are you currently receiving counselling for eating problems? yes no Have you ever received counselling for eating problems? yes^no If yes, how long ago?  months  How long were you in therapy? ^ months Family patterns often influence our experience of stress and eating behavior. Have you or anyone in your immediate family ever experienced concern over any of the following areas? (Please circle)  Yourself^Family member(s) Which members? 1.Drinking problems^yes  no^yes^no  2.Smoking problems^yes  no^yes^no  3.Eating problems^yes  no^yes^no  (please specify the type of eating problem)  4.Drug dependency ^yes^no^yes^no ^ (please specify, e.g., tranquilizers, marajuana) 5.0ther health/behavioral dependencies yes^no^yes^no (please specify) Do you have any other comments which would help us to understand your eating concerns, which we have not addressed? (Please use the back of this page if you wish to make additional comments).  94  APPENDIX B: The Medical Education Hassles Scale-R (sample items)  Directions: Hassles are the irritating, frustrating, or distressing experiences that take place in one's everyday life. They can make you feel upset or angry. Listed on the following pages are a number of ways in which a person can feel hassled. Please respond to each item by placing an "X" through the appropriate number to show how much of a hassle (0 = None or not applicable, 1 = somewhat, 2 = Quite a bit, 3 = A great deal) it was for you during the PAST WEEK. Answer Key 0 1 2 3 0 0 0 0 0  1 1 1 1 1  2 2 2 2 2  3 3 3 3 3  1. 2. 3. 4. 5.  = = = =  None or not applicable Somewhat Quite a bit A great deal  finding a place to study condition of the streets relating to professors concern about accidents not enough money for entertainment and recreation  95  Appendix C: The COPE Scale (sample items) INSTRUCTIONS: We are interested in how people respond when they confront difficult or stressful events in their lives. There are lots of ways to deal with stress. This questionnaire asks you to indicate what you generally do and feel, when you experience stressful events. Obviously, diffent events bring out somewhat different responses, but think about what you usually do when you are under a lot of stress. Then respond to each of the following items by filling in the blank with the appropriate number from the resonse choices listed below. Please try to respond separately in your mind to each item. Please answer every item, and remember there are no "right" or "wrong" answers. Indicate what YOU usually do when YOU experience a stressful event. ,  1 2 3 4  = = = =  I I I I  usually usually usually usually  don't, do do this a do this a do this a  this at all little bit medium amount lot  1.  I try to grow as a person as a result of the experience.  2.  I turn to work or other substitute activities to take my mind off things.  3.  I get upset and let my emotions out.  4.  I concentrate my efforts on doing something about it.  5.  I say to myself "this isn't real".  6.  I admit to myself that I can't deal with it, and quit trying.  7.  I restrain myself from doing anything too quickly.  8.  I get used to the idea that it happened.  9.  I keep myself from getting distracted by other thoughts and activities.  10.  I daydream about things other than this.  96  Appendix D: The Multidimensional Perfectionism Scale (sample items) Listed below are a number of statements concerning personal characteristics and traits. Read each item and decide whether you agree or disagree and to what extent. If you strongly agree, circle 7; if you strongly disagree, circle 1; if you feel somewhere in between, circle any one of the numbers betwen 1 and 7. If you feel neutral or undecided the midpoint is 4. 1. When I am working on something, I cannot relax until it is perfect. 5. I find it difficult to meet other's expectations of me. 10. It doesn't matter when someone close to me does not do their best.  97 Appendix E: The Binge Scale (sample items) INSTRUCTIONS: This questionniare is designed to gather information about binge eating. Binge eating involves periods of uncontrolled, excessive eating, where you eat a large amount of food in a short period of time - Mai-a proper meal. If you respond no to the first item "Do you ever binge eat?" please answer only items 11, 14, and 15. If you respond yea to Item 1, please answer all questions. For each item, circle only one answer unless otherwise specified. This questionnaire is confidential. Do not put your name on it but please make sure the number on the questionnaire is the same as the number on the other materials. 1.  Do you ever binge eat? ^yes^no  2.  How a. b. c. d.  often do you binge eat? seldom once or twice a month once a week almost every day  3. How long ago did you start to binge eat? a. less than 6 months ago b. 6 months to 1 year ago c^1 - 2 years ago d 2 - 4 years ago e other, estimate how long ago ^ 4. What a. b. c. d.  is the average length of a binge eating episode? less than 15 minutes 15 minutes to one hour one hour to four hours more than four hours: estimate how long: ^  5. Which of the following statements best applies to your binge eating? a. I eat until I have had enough to satisfy me. b. I eat until my stomach feels full. c. I eat until my stomach is painfully full. d. I eat until I can't eat anymore. 6. Do you ever vomit after a binge? a. never b. sometimes c. usually d. always  98  Appendix F: Advertisement for Participants DO YOU TURN TO FOOD IN TIMES OF STRESS? ARE YOU STRUGGLING WITH DIETS? ARE YOU CONCERNED WITH ABOUT YOUR EATING BEHAVIOR?  I am a Master's student in the Department of Counselling Psychology conducting a study about Eating Concerns of female university students. My supervisor is Dr. Bonnie Long. We are examining your experience of stress, coping strategies, and the way you feel about yourself, as areas that may lead to eating concerns in female university students.  Participation in the study is strictly confidential, and would require approximately 45 minutes of your time to fill out questionnaires. All participants will have the opportunity to participate in a free Body Image Workshop. Participants will also have access to the completed study.  If you are concerned about your eating habits and are interested in participating in this study, or if you would like more information, please call Barbara Mallin at the Stress Research Laboratory at 822-9199, or call or write to Dr. Bonnie Long at 822-4756, Department of Counselling Psychology, 5780 Toronto Road, University of British Columbia, Vancouver, B.C., V6T 1L2.  99  Appendix G: Introductory Letter to Participants EATING CONCERNS OF FEMALE UNIVERSITY STUDENTS Dear Participant: Thank you for being willing to participate in this study. The following research is being carried out by myself and my supervisor, Dr. Bonnie Long, in the Department of Counselling Psychology at the University of British Columbia. The purpose of this project is to examine factors that contribute to ongoing eating concerns in female university students. It is felt that stress, coping styles, and the way you feel about yourself may play a role in on-going eating concerns. If you feel you have some concerns about your eating habits, we are interested in your information. It is hoped that the information gained through this research will enable counsellors to better understand the needs of women who are struggling with eating conerns.. It is also hoped that such information will help in designing counselling services and workshops for these women. We are asking you to voluntarily participate in this research by completing the attached questionnaire package. Your participation in this study is completely voluntary and will in no way affect your eligibiity to participate in any other programs sponsored by U.B.C. All information is strictly confidential. To ensure confidentiality, we ask that you do not write your name anywhere on the enclosed questionnaires. The questionnaires will take approximately 45 minutes to complete. There are no right or wrong answers, only choices that seem to fit for you. You are completely free to choose not to answer specific questions or to refuse to return the questionnaires. However, because the quality of the research depends on the questionnaires being fully completed, we urge you to answer all questions. IF YOU DO COMPLETE THE QUESTIONNAIRES AND RETURN THEM TO ME THIS WILL INDICATE THAT YOU HAVE CONSENTED TO PARTICIPATE IN THE STUDY. We hope that you will find answering these questionnaires to be interesting, and the results of this study will be beneficial both to you and to others. If you would like a copy of the research results and/or the opportunity to attend a free Body Image Workshop, please indicate your interest on the instruction sheet at the back of the questionnaire package. If you have any questions about the study, please do not hesitate to call me at 822-9199 (Stress Research Laboratory), or Dr. Bonnie Long at 8224756. Thanking you. Sincerely,  Barbara Mallin Graduate Student Counselling Psychology Department University of British Columbia  100  Appendix H: Research Results Form If you are interested in receiving a copy of the research abstract summarizing the findings, please fill out the information below and detach it from the rest of the questionnaire package. Name: ^ Street: City: Postal Code: Telephone Number Would you like a list of self-help references related to the topic of binge eating? Please indicate if you would like a list mailed to the above address. Yes^  No  Would you like a counselling refererral in your area to discuss your feelings about your eating problems? Please indicate if you would like a referral sent to the above address. Yes^  No  Would you like to participate in a free Body Image Workshop, which will be held upon completion of our study? Please indicate if you would like us to contact you at the above address. Yes^  No  101 APPENDIX I: VERBATIM TO TELEPHONE CALLERS  - Thanks for calling. I'm Barbara Mallin, a Master's student in the Counselling Psychology Department, and this study is part of my thesis. My supervisor is Dr. Bonnie Long, and you are welcome to contact her at 8224756..  - What we're doing is examining factors that could contribute to eating problems in female university students. We're looking at stress, coping strategies, and personality variables.  - Are you a student? - Do you feel that you have some concerns about your eating habits? - If you'd like to participate in the project, it involves answering 4 questionnaires, and would take approximately 45 minutes of your time. All of the information is confidential, and your name will not be on any of the forms. There is one optional place for your name to appear, and that is a form enquiring if you would the research results when they are available, and if you would like a copy of resources available for women with eating problems.  - I could meet with you at ... at 2150 Western Parkway. .  ^  102 Appendix J  Analysis of Variance of Participants who have been Binge Eating < five years (n = 40) and Participants who have been Binge Eating > five years (n - 41)  Source of Variation  ^  Main Effects (duration of binge eating)  Sum of ^Mean^E^Sig Squares^Square^of f.  28.37  1  28.37  Residual  2007.20  79  25.40  Total  2035.56  80  25.45  1.12  .29  103  Appendix K  Multiple Regression Analysis Predicting Binge Eating (with the inclusion of the subscale of other-oriented perfectionism) ^(N=81)  Source  Beta (dE = 1,74)  12<  Problem-focused coping  -.02  -.24  ns  Emotion-focused coping  .10  .96  ns  Hassles  .36  2.90  .005  Self-oriented perfectionism  .01  .13  ns  Socially prescribed perfectionism  .36  2.77  .007  -.08  -.81  ns  Other-oriented perfectionism  Note. beta is the standardized regression coefficient. Percentage of variance in Binge eating accounted for by the regression equation (0 is .46 (Adjusted .42). Overall E(6,74) = 10.70, p <.0001.  104 Appendix L  Comparison of Means and Standard Deviations of COPE Scales in Carver and Scheier (1989) and this Study  COPE Scale^Carver & Scheier (j = 1,030)^  (a =  81)  M  SD  M  SD  Active coping  11.89  2.26  10.58  2.64  Planning  12.58  2.66  11.78  3.00  9.92  2.42  8.70  2.31  Restraint copinga  10.28  2.53  8.57  2.73  Positive reinterp. and growthb  12.40  2.42  10.71  2.85  Acceptance  11.84  2.56  11.16  2.81  Focusing on and venting of emotions  10.17  3.08  11.41  3.52  Denial  6.07  2.37  6.01  2.36  Behavioral disengagement  6.11  2.07  7.24  2.79  Mental disengagement  9.66  2.46  10.39  2.85  Suppression of competing activities  aA 1-test revealed a significant difference (I=5.90,a<.01) on the subscale of restraint coping, andb on the subscale of positive reinterpretation and growth (1=3.93, ja<.001).  105 Appendix M Correlation Matrix of COPE subscales and Binge Scale (N=81)  Act Act  Plan  Supp  Res  Pos  Acc  Ven  Den  Bd  Md^Binge  -  Plan  .75  -  Supp  .48  .49  Res  .02  -.03  .06  -  Pos  .69  .59  .49  .12  -  Acc  .37  .37  .23  .13  .35  Ven  .12  .24  .28  -.14  -.01  .31  Den  -.30  -.14  -.11  .11  -.27  -.07  -.13  Bd  -.36  -.38  -.10  .12  -.30  .07  .01  .50  -  Md  -.20  -.01  -.12  .10  -.20  .23  .13  .54  .37  Binge  -.08  .06  .01  -.19  .11  .07  .14  .43  .28  -  -  .47^-  Problem-focused subscales: Act is active coping, Plan is planning, Supp is suppression of competing activities, Res is restraint, Pos is positive reinterpretation and growth. Emotion-focused subscales: Acc is acceptance, Ven is focusing on and venting of emotions, Den is denial, Bd is behavioral disengagement, Md is mental disengagement. Binge is Binge Eating Scale. _r .01(80) =.28;^.05(80) = .22 Adjusted / .01(80) = .43;^.05(80) = .38 (Shavelson, 1981)  106 Appendix N Multiple Regression Analysis Predicting Binge Eating (with the subscale of restraint coping removed) (N=81)  Source^  Beta  ^ (df = 1,74)  7:2<  Problem-focused coping^  .06^.632^ns  Emotion-focused coping^  .13^1.24^ns  Hassles^  .37^2.83^.006  Self-oriented perfectionism^-.003^-.32^ns Socially prescribed perfectionism^.36^2.94^.005 Age^  -.18^-2.05^.044  Note. beta is the standardized regression coefficient. Percentage of variance in Binge eating accounted for by the regression equation (3, 2 ) is .48 (Adjusted .45). Overall E(6,74) = 11.75, p <.0001.  107  Appendix 0 Multivariate and Univariate F-Tests for Non-Purging (N=48) and Purging Binge Eaters (N=33)  fit  Multivariate^(6,74)  E  Ea<  3.66  .003  Problem-focused coping  <1  .587  Emotion-focused coping  11.32  .001  Hassles  17.93  .001  <1  .494  5.40  .023  <1  .842  Univariate^(1,79)  Self-oriented perfectionism Socially-prescribed perfectionism Other-oriented perfectionism  ^  108  Appendix P  Analysis of Variance in Daily Hassles between participants tested in the summer months (July and August. 1992, N=20). and participants tested during the winter session (September 1992 to March 1993. N=61)  Source of Variation ^Sum of^DI^Mean^Sig Squares^Square^of E Main Effects (duration of binge eating)  5899.91  1  5899.91  Residual  149585.45  79  1893.49  Total  155485.36  80  3.12  .08  

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