UBC Theses and Dissertations

UBC Theses Logo

UBC Theses and Dissertations

Self-esteem components in eating disordered women : body-image disturbance, body dissatisfaction, and… McLagan, Beverley May 1988

Your browser doesn't seem to have a PDF viewer, please download the PDF to view this item.

Item Metadata

Download

Media
831-UBC_1988_A8 M35.pdf [ 4.02MB ]
Metadata
JSON: 831-1.0056018.json
JSON-LD: 831-1.0056018-ld.json
RDF/XML (Pretty): 831-1.0056018-rdf.xml
RDF/JSON: 831-1.0056018-rdf.json
Turtle: 831-1.0056018-turtle.txt
N-Triples: 831-1.0056018-rdf-ntriples.txt
Original Record: 831-1.0056018-source.json
Full Text
831-1.0056018-fulltext.txt
Citation
831-1.0056018.ris

Full Text

SELF-ESTEEM COMPONENTS IN EATING DISORDERED WOMEN BODY-IMAGE DISTURBANCE, BODY DISSATISFACTION, AND CULTURAL AND INDIVIDUAL BODY SHAPE IDEALS by BEVERLEY MAY MCLAGAN B.A., U n i v e r s i t y of B r i t i s h Columbia, 1985 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS i n THE FACULTY OF GRADUATE STUDIES Department of C o u n s e l l i n g Psychology We accept t h i s t h e s i s as conforming to the req u i r e d standard THE UNIVERSITY OF August, © BEVERLEY MAY BRITISH COLUMBIA 1988 MCLAGAN, 1988 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. Department of C o u n s e l l i n g P s y c h o l o g y The University of British Columbia 1956 Main Mal l Vancouver, Canada V6T 1Y3 Date A u g u s t , 1988 DE-6(3/81) A b s t r a c t T h i s study examined the d i f f e r e n c e s between e a t i n g d i s o r d e r e d and non-eating d i s o r d e r e d women on s e l f - d e f i c i t s , s p e c i f i c a l l y self-esteem, body-image d i s t u r b a n c e , and body d i s s a t i s f a c t i o n . In a d d i t i o n , the ex i s t e n c e of a c u l t u r a l and i n d i v i d u a l i d e a l body shape was i n v e s t i g a t e d . I t was expected that e a t i n g d i s o r d e r e d women, compared to non-eating d i s o r d e r e d women would e x h i b i t lower self-esteem, higher body d i s s a t i s -f a c t i o n and a gr e a t e r degree of body o v e r e s t i m a t i o n (as measured by the w a i s t ) . Furthermore, i t was expected t h a t e a t i n g d i s o r d e r e d women would choose a thinn e r c u l t u r a l and i n d i v i d u a l i d e a l shape than the non-eating d i s o r d e r e d women. The s u b j e c t s were 82 females aged 19 to 40 years. The ea t i n g d i s o r d e r e d group was r e c r u i t e d from a l o c a l support group and su b j e c t s met e i t h e r the DSM-III (1980) c r i t e r i a f o r anorexia nervosa, or R u s s e l l ' s (1979) c r i t e r i a f o r b u l i m i a nervosa. None of these s u b j e c t s were h o s p i t a l i z e d at the time of t e s t i n g . Non-eating d i s o r d e r e d s u b j e c t s were nu r s i n g students r e c r u i t e d from a l o c a l c o l l e g e . The E a t i n g A t t i t u d e s Test was administered to these s u b j e c t s as a s c r e e n i n g device to ensure that no su b j e c t s were in c l u d e d who had a mild e a t i n g d i s o r d e r . A l l s u b j e c t s completed a t e s t package: The E a t i n g A t t i t u d e s Test; The Adult S e l f - P e r c e p t i o n P r o f i l e ; The E a t i n g Disorder Inventory; and a demographic sheet. At a second i n t e r v i e w , s u b j e c t s completed a body-image e s t i m a t i o n procedure (Askevold, 1975), the c u l t u r a l and i n d i v i d u a l i d e a l questions (Perceived Body Image Sc a l e , Manley & LePage, 1986), and were weighed and measured f o r h e i g h t . A one-way m u l t i v a r i a t e a n a l y s i s of v a r i a n c e was computed f o r measures of self-esteem, body d i s s a t i s f a c t i o n and body-image di s t u r b a n c e , examining d i f f e r e n c e s between the two groups. S i g n i f i c a n t d i f f e r e n c e s were found f o r se l f - e s t e e m and body d i s s a t i s f a c t i o n (JD^T .OOI), with body-image d i s t u r b a n c e approaching s i g n i f i c a n c e (£ 4,.06). An i n v e s t i g a t i o n of the means r e v e a l e d that e a t i n g . d i s o r d e r e d women showed l e s s s e l f -worth, more i n e f f e c t i v e n e s s and experienced g r e a t e r body d i s s a t i s f a c t i o n , than d i d non-eating d i s o r d e r e d women. While body-image disturbance was present i n both groups, the e a t i n g d i s o r d e r e d group showed a s l i g h t l y g r e a t e r tendency to o v e r -estimate t h e i r waist area than d i d the non-eating d i s o r d e r e d group. A Chi square a n a l y s i s computed f o r the c u l t u r a l and i n d i v i d u a l i d e a l s r e v e a l e d the e a t i n g d i s o r d e r e d group chose a s i g n i f i c a n t l y t h i n n e r c u l t u r a l i d e a l shape (p_^.05) and i n d i v i d u a l i d e a l shape (p_ ^.001) than the non-eating d i s o r d e r e d group. Both groups chose a very narrow range of acceptable female shapes to represent the c u l t u r a l and i n d i v i d u a l i d e a l body shapes. I m p l i c a t i o n s f o r these r e s u l t s and suggestions f o r f u t u r e r e s e a r c h are d i s c u s s e d . Table of Contents ABSTRACT . . i i LIST OF TABLES ' . v i i LIST OF FIGURES v i i i ACKNOWLEDGEMENTS . i x INTRODUCTION. 1 METHOD 9 Subjects 9 Eating Disordered Group ... 9 Non-Eating Disordered Group... 10 Measures 11 Dependent Measures 12 Adult S e l f - P e r c e p t i o n P r o f i l e 12 Eating Disorder Inventory. 12 Image Marking Method 14 Perceived Body Image Scale 14 Apparatus 16 Procedure 16 Data A n a l y s i s 19 Procedures f o r Handling Missing Values 19 RESULTS 20 Demographic and Weight Related C h a r a c t e r i s t i c s 20 Eating Disordered Group 20 Non-Eating Disordered Group 21 MANOVA An a l y s i s 24 G l o b a l S e l f - w o r t h , I n e f f e c t i v e n e s s , Body D i s s a t i s f a c t i o n and Body-image Disturbance 24 Chi Square A n a l y s i s 29 C u l t u r a l Ideal 29 I n d i v i d u a l Ideal 29 C o r r e l a t i o n M a t r i x 31 DISCUSSION 33 REFERENCES 43 APPENDIX A 52 Review of L i t e r a t u r e 53 Self-Esteem 53 Body-Image 57 C u l t u r a l I d e a l 62 I n d i v i d u a l I d e a l 63 Body D i s s a t i s f a c t i o n 64 Summary 66 APPENDIX B 67 D e s c r i p t i o n of Measures and D i a g n o s t i c C r i t e r i a . . . 68 E a t i n g A t t i t u d e s Test 68 Adul t S e l f - P e r c e p t i o n P r o f i l e . 69 E a t i n g Disorder Inventory 70 Image Marking Method 73 Perceived Body Image Scale 76 S e l e c t i o n C r i t e r i a 79 APPENDIX C 8 2 Purpose of Study L e t t e r . . . . . . . . ' 83 v i APPENDIX D 84 Consent Form 85 E a t i n g A t t i t u d e s T e s t . . . 86 A d u l t S e l f - P e r c e p t i o n P r o f i l e 88 E a t i n g D i s o r d e r I n v e n t o r y 92 Demographic Sheet 94 L i s t of Tables v i i I. I l l n e s s and Treatment C h a r a c t e r i s t i c s of E a t i n g Disordered Group 22 I I . . Demographics of E a t i n g Disordered and Non-Eating Disordered Groups 25 I I I . Weight Related C h a r a c t e r i s t i c s of Ea t i n g Disordered and Non-Eating Disordered Groups 27 IV. D i e t i n g Information f o r E a t i n g Disordered and Non-Eating Disordered Groups 28 V. Means and Standard D e v i a t i o n s f o r Dependent Measures 30 VI. C o r r e l a t i o n M a t r i x f o r Dependent Measures, Age and Weight 32 VII. DSM-III C r i t e r i a f o r Anorexia Nervosa 80 V I I I . R u s s e l l ' s C r i t e r i a f o r Bulimia Nervosa 81 L i s t of Figures Perceived Body Image Scale, Figure Cards Acknowledgements I wish to thank my committee members f o r t h e i r time, i n t e r e s t and support on t h i s t h e s i s . In p a r t i c u l a r , my a p p r e c i a t i o n i s extended to my committee c h a i r p e r s o n , Dr. Sharon Kahn, whose continued encouragement, understanding, and humour have been sources of s t r e n g t h and m o t i v a t i o n through-out the p r o j e c t . My thanks a l s o to Dr. Bonita Long f o r her guidance, knowledge of s t a t i s t i c s , and patience during my computer a n a l y s i s . Thanks to Dr. E l l i o t Goldner f o r h i s suggestions during the e a r l y stages, and f o r t a k i n g the time to attend my defence. In a d d i t i o n , I would l i k e to thank Dr. Ronald Manley f o r h i s f r i e n d s h i p and suggestions f o r the m a t e r i a l s used i n t h i s p r o j e c t . To the women from the support group who u n s e l f i s h l y v o l unteered t h e i r time f o r t h i s p r o j e c t during t h e i r own recovery, I wish to extend my g r a t i t u d e . F i n a l l y , I wish to thank my f a m i l i e s f o r t h e i r b e l i e f and support i n my a b i l i t y to succeed. I n t r o d u c t i o n Schwartz, Thompson, and Johnson (1982) have s t a t e d the cur r e n t c u l t u r a l concerns about d i e t i n g and f i t n e s s have s h i f t e d from hobby a c t i v i t i e s to obsessions. They b e l i e v e d t h i s s h i f t was one f a c t o r i n the i n c r e a s e i n the p u r s u i t of th i n n e s s , and f u r t h e r suggested that t h i s obsession may have a connection with the inc r e a s e i n women s u f f e r i n g from anorexia nervosa and b u l i m i a . Two of the most c o n s i s t e n t c l i n i c a l and re s e a r c h o b s e r v a t i o n s i n e a t i n g d i s o r d e r e d women are the presence of low s e l f - e s t e e m and the obsession with body shape (B a i r d & Si g h t s , 1986; Bruch, 1962). An i n d i v i d u a l ' s s o c i a l world may be the primary e x t e r n a l source of v a l i d a t i o n and esteem. In p a r t i c u l a r , women i n Western c u l t u r e s may d e r i v e esteem from the appearance of t h e i r p h y s i c a l body. Secord and Jourard (1953) i n d i c a t e d that women, more than men, attached more meaning to the r e l a t i o n s h i p between s e l f - e s t e e m and p h y s i c a l appearance. Examining the importance of body-image to an i n d i v i d u a l ' s l e v e l of s e l f - e s t e e m i n a group of male and female c o l l e g e students, they found that the v a l u a t i o n of body-image and the s e l f tended to c o i n c i d e , and that the females were more l i k e l y to show a n x i e t y towards t h e i r b o dies. Secord and Jourard concluded that the body i s an important aspect of one's world and suggested the higher concern by females may be a r e s u l t of the s o c i e t a l focus on the female body. i G o o d s i t t (1985) d e s c r i b e d anorexia nervosa as a d i s o r d e r i n the o r g a n i z a t i o n of the s e l f . Anorexics are d e f i c i e n t i n s e l f - r e g u l a t o r y s t r u c t u r e s which r e s u l t i n f e e l i n g s of i n e f f e c t i v e n e s s or low sel f - e s t e e m , and the f e e l i n g of being out of c o n t r o l . The d i s o r g a n i z a t i o n of the s e l f leaves the anorexic woman f e e l i n g l i k e an empty body that i s e a s i l y i n f l u e n c e d , d i s t o r t e d , and f a t t e n e d . According to s e l f - d e f i c i t theory ( G o o d s i t t , 1985) the i n d i v i d u a l who l a c k s an. organized and cohesive core, seeks a sense of e f f e c t i v e n e s s and s e l f -worth from e x t e r n a l sources. Kohut and Wolf's (1978) s e l f theory s t a t e s s i m i l a r l y that without s u f f i c i e n t p a r e n t a l support and m i r r o r i n g , an i n d i v i d u a l may never i n t e g r a t e e x t e r n a l sources of s e l f - w o r t h i n t o a core s e l f . By f o c u s i n g on e x t e r n a l c o n t i n g e n c i e s such as food and weight, e a t i n g d i s o r d e r e d women, i n p a r t i c u l a r , a t t a c h personal meaning to t h e i r l i v e s . Garner and Bemis (1985) s t a t e d "[the] t y p i c a l p a t i e n t with anorexia nervosa i s h i g h l y s e l f - c r i t i c a l and experiences h e r s e l f as inadequate i n most areas of personal or s o c i a l f u n c t i o n i n g " (p. 128). They found that a n o r e x i c women assume that weight, shape, or thinness i s the dominating f a c t o r i n t h e i r judgment of s e l f - w o r t h . In o b s e r v a t i o n s of 12 anorexic p a t i e n t s (3 male and 9 females) over a 10-year p e r i o d , Bruch (1962) d e s c r i b e d the presence of an o v e r a l l sense of i n e f f e c t i v e n e s s coupled with a body-image 3 d i s t u r b a n c e . Bruch (1973) was the f i r s t to suggest the importance of body-image dis t u r b a n c e i n e a t i n g d i s o r d e r s . She considered the d e n i a l of emaciation i n anorexia nervosa to be a d e l u s i o n a l q u a l i t y of the s e l f - c o n c e p t and body-image. Numerous re s e a r c h e r s have i n v e s t i g a t e d body-image di s t u r b a n c e i n e a t i n g d i s o r d e r e d women, i n d i c a t i n g the presence of hody s i z e o v e r e s t i m a t i o n (Slade & R u s s e l l , 1973; Wingate & C h r i s t i e , 1978; Willmuth, L e i t e n b e r g , Rosen, Fondacaro, & Gross, 1985), however, there i s i n c o n s i s t e n c y i n the degree of ov e r e s t i m a t i o n . Researchers (Garner & G a r f i n k e l , 1982; Klesges, 1983; Slade, 1985) have suggested that these c o n t r a d i c t o r y f i n d i n g s may be due to the d i f f e r e n t concepts of body-image used, measuring devices employed, and s u b j e c t s t e s t e d from study to study. In a d d i t i o n , some re s e a r c h e r s suggested body-image d i s t u r b a n c e i s no more s e r i o u s i n e a t i n g d i s o r d e r e d women than non-eating d i s o r d e r e d women ( B i r t c h n e l l , Lacey, & Harter, 1985; Button, F r a n s e l l a , & Slade, 1977; Garner, G a r f i n k e l , Stancer, & Moldofsky, 1976). I n v e s t i g a t i o n s of body-image dis t u r b a n c e i n non-eating d i s o r d e r e d women a l s o produced s i z e o v e r e s t i m a t i o n , which suggested t h a t the presence of body-image dis t u r b a n c e i s not unique to e a t i n g d i s o r d e r s (Klesges, 1983; Thompson & Thompson, 1986). Furthermore, r e s e a r c h e r s have confirmed that men and women judge t h e i r bodies d i f f e r e n t l y , with men making a whole body judgment and women making a part-to-pa.rt.. j udgment ( C r i s p . & Kalucy, 1974). While most women overestimate t h e i r body s i z e , 4 both e a t i n g d i s o r d e r e d and non-eating d i s o r d e r e d women overestimate t h e i r waist area more than other body regions (Berscheid, Walster, & Bohrnstedt, 1973; B i r t c h n e l l , Lacey, & Harter, 1985; Button, 1986). This p a r t - t o - p a r t judgment may o r i g i n a t e from the media focus on women's body par t s to s e l l the image of an i d e a l woman (e.g., p e r f e c t l e g s , f l a t stomach, slender t h i g h s ) . Given the s o c i e t a l and media focus on female appearance, women have c l e a r l y d e f i n e d images from which to compare t h e i r own bodies ( B e l l , K i r k p a t r i c k , & Rinn, 1986; F a l l o n & Rozin, 1985; Secord & Jourard, 1953). Th e r e f o r e , women may hold two images i n mind simultaneously; t h e i r own body-image and the i d e a l female body-image, with t h i s l a t t e r image f u r t h e r d i v i d e d i n t o two p a r t s , the c u l t u r a l i d e a l and the i n d i v i d u a l i d e a l ( F a l l o n & Rozin, 1985; Guy, Rankin, & N o r v e l l , 1980). The c u l t u r a l i d e a l i s the shape s o c i e t y deems acceptable f o r females, while the i n d i v i d u a l i d e a l may be s i m i l a r t o , or d i f f e r e n t from the c u l t u r a l i d e a l , and rep r e s e n t s the shape the i n d i v i d u a l would l i k e to possess. Researchers have suggested the e x i s t e n c e of a c u l t u r a l standard of thinness f o r women that shows a narrow range of accepta b l e body shapes ( S i l v e r s t e i n , Perdue, Peterson, & K e l l y , 1986; S i l v e r s t e i n , Perdue, Peterson, Vogel, & F a n t i n i , 1986; S i l v e r s t e i n , Peterson, & Perdue, 1986). This c u l t u r a l i d e a l comes from media images that p o r t r a y women as t h i n , f i t , and y o u t h f u l . While women's body shapes f a l l along a continuum of s i z e s , r e s e a r c h e r s have confirmed that most females imagine a d i s t i n c t c u l t u r a l image of the acceptable female shape. Guy, Rankin, and N o r v e l l (1980) asked male and female c o l l e g e students to chose the i d e a l body type f o r t h e i r same sex. The females c i t e d the ectomorph ( l e a n -bodied) body shape as r e p r e s e n t a t i v e of the i d e a l female body type. While s t u d i e s have not i n v e s t i g a t e d the e x i s t e n c e of a c u l t u r a l i d e a l i n e a t i n g d i s o r d e r e d women, re s e a r c h e r s have found t h a t most of these women have a c l e a r l y d e f i n e d personal i d e a l (Freeman, Thomas, Solyom, & Koopman, 1985; Touyz, Beumont, C o l l i n s , & Cowie, 1985). According to the N a t i o n a l E a t i n g D i s o r d e r s Information Centre (1987), heavy, normal weight, and t h i n women a l l d e s i r e an even t h i n n e r body shape than they p r e s e n t l y possess. I n v e s t i g a t o r s confirmed that i n d i v i d u a l i d e a l s v a r i e d between groups of women with e a t i n g d i s o r d e r s , with those s u f f e r i n g from b u l i m i a nervosa d e s i r i n g the s m a l l e s t i d e a l shape (Freeman, Thomas, Solyom, & Koopman, 1985; S t r iegel-Moore, S i l b e r s t e i n , & Rodin, 1986; Touyz, Beumont, C o l l i n s , & Cowie, 1985). F a l l o n and Rozin (1986) examined the pers o n a l i d e a l of females and compared t h i s i d e a l to the personal female i d e a l h e l d by the opposite 6 sex. They found that females d e s i r e d a t h i n n e r body shape than the i d e a l shape they assumed males found a t t r a c t i v e . I f a woman overestimates her body s i z e , and then compares t h i s o v e r e s t i m a t i o n to a t h i n c u l t u r a l i d e a l , the discrepancy between these two images may cause some degree of body disparagment. According to Wooley and Wooley (1985) women make comparisons between t h e i r a c t u a l and i d e a l body-images that r e s u l t i n a discrepancy that i s viewed by most as a cause f o r s e l f - c r i t i c i s m . When body d i s s a t i s f a c t i o n was examined i n r e l a t i o n to s e l f - e s t e e m i n non-eating d i s o r d e r e d women, res e a r c h e r s found a moderate s i g n i f i c a n t c o r r e l a t i o n (Secord & Jourard, 1953). Freeman, Beach, Davis, and Solyom (1985) d i s c u s s e d the importance of body-image d i s s a t i s f a c t i o n as an i n d i c a t o r of r e l a p s e i n women with b u l i m i a nervosa. Subjects both d i s t o r t e d t h e i r body s i z e and h e l d an i d e a l t h i n n e r than the a c t u a l s i z e . The authors concluded that p a t i e n t s with intense body d i s s a t i s f a c t i o n , even a f t e r therapy to c o r r e c t body-image d i s t u r b a n c e , remained at great r i s k f o r r e l a p s e . S e v e r a l questions r e g a r d i n g body-image d i s t u r b a n c e , body d i s s a t i s f a c t i o n and se l f - e s t e e m with regard to women i n g e n e r a l , and e a t i n g d i s o r d e r e d women i n p a r t i c u l a r , remain unanswered. In past s t u d i e s , each v a r i a b l e has been measured independently. For example, s e l f - e s t e e m has been examined i n women with anorexia nervosa and b u l i m i a (Wagner, Halmi, & Maguire, 1987), b u l i m i a only ( B a i r d & S i g h t s , 1986; Dykens & Gerrard, 1986; Grace, Jacobson, & F u l l a g e r , 1985), i n a n o r e x i c , b u l i m i c and non-eating d i s o r d e r e d women (Willmuth, L e i t e n b e r g , Rosen, Fondacaro, & Gross, 1985), and non-eating d i s o r d e r e d males and females ( Thompson & Thompson 1986). In a d d i t i o n , v a r i a b l e s have been combined and examined i n d i f f e r e n t groups. Studies p a i r i n g s e l f - e s t e e m and body-image d i s t u r b a n c e have found a negative c o r r e l a t i o n between the two v a r i a b l e s such that a higher body-image d i s t u r b a n c e was r e l a t e d to a lower s e l f - e s t e e m score i n both e a t i n g " d i s o r d e r e d women (Garner & G a r f i n k e l , 1982) and non-eating d i s o r d e r e d women (Rosen & Ross, 1968; Secord & Jourard, 1953; Thompson & Thompson, 1986). In a d d i t i o n , Garner and G a r f i n k e l (1982) found a negative c o r r e l a t i o n between body-image d i s t u r b a n c e and body d i s s a t i s f a c t i o n i n a group of anorexic women. Other r e s e a r c h e r s have provided evidence f o r t h i s r e l a t i o n s h i p i n anorexic and b u l i m i c women (Freeman, Beach, Davis, & Solyom, 1985; Garner, Rockert, Olmstead, Johnson, & Coscina, 1985). For a more d e t a i l e d review of the l i t e r a t u r e , see Appendix A. The purpose of the present study was to examine the d i f f e r e n c e s between two groups of women ( e a t i n g d i s o r d e r e d and non-eating disordered) on s e l f - d e f i c i t s , s p e c i f i c a l l y s e l f - e s t e e m , body-image d i s t u r b a n c e , and body d i s s a t i s f a c t i o n Given t h a t e a t i n g d i s o r d e r e d women experience f e e l i n g s of ineffectiveness, and seem to re l y on external sources to bolster self-worth as suggested by s e l f - d e f i c i t theory (Goodsitt, 1985), i t was hypothesized that: (1) the eating disordered group would exhibit lower self-esteem or higher ineffectiveness than the non-eating disordered group, (2) the eating disordered group would overestimate their waist measurement to a greater degree than the non-eating disordered group, (3) the eating disordered group would exhibit a higher degree of body d i s s a t i s f a c t i o n than the non-eating disordered group. In addition, both a c u l t u r a l and individual ideal was used in the present study to determine i f women d i f f e r e n t i a t e body shapes for the female sex as a whole (c u l t u r a l ideal) and for themselves (individual i d e a l ) . It was hypothesized that: (4) the eating disordered group would choose a thinner c u l t u r a l ideal than the non-eating disordered group, (5) the eating disordered group would choose a thinner individual ideal than the non-eating disordered group. 9 Method Subjects Eighty-two female s u b j e c t s (41 e a t i n g d i s o r d e r e d and 41 non-eating d i s o r d e r e d ) between the ages of 19 and 40 p a r t i c i p a t e d i n t h i s study. E a t i n g Disordered Group Over a two month p e r i o d , a w r i t t e n statement of the purpose of t h i s study was d i s t r i b u t e d to approximately 60 p o t e n t i a l v o l u n t e e r s r e c r u i t e d from a l o c a l support group f o r e a t i n g d i s o r d e r s (see Appendix C). One a d d i t i o n a l s u b j e c t (a past support group member), r e c r u i t e d from a l o c a l p s y c h i a t r i s t was a l s o given the w r i t t e n statement. Subjects i n t e r e s t e d i n p a r t i c i p a t i n g were asked to contact the experimenter by telephone. Forty s u b j e c t s v o l u n t e e r e d from the support group, r e s u l t i n g i n a t o t a l of 41 v o l u n t e e r s completing the study. None of the s u b j e c t s i n t h i s group were h o s p i t a l i z e d at the time of t e s t i n g . E a t i n g d i s o r d e r e d s u b j e c t s met one of two c r i t e r i a f o r i n c l u s i o n i n t h i s group, (a) DSM-III (American P s y c h i a t r i c A s s o c i a t i o n , 1980) c r i t e r i a f o r anorexia nervosa, or (b) R u s s e l l ' s (1979) c r i t e r i a f o r b u l i m i a nervosa. The DSM-III (American P s y c h i a t r i c A s s o c i a t i o n , 1980) c r i t e r i a f o r anorexia nervosa was modified to r e f l e c t a 20% l o s s of weight r a t h e r than 25% l o s s of o r i g i n a l body weight, w i t h i n the l a s t two years (see Appendix B, Table 7). The weight m o d i f i c a t i o n was used because recent s t u d i e s have i d e n t i f i e d anorexia nervosa 10 cases when weight l o s s d i d not approach 25% of o r i g i n a l body-weight ( D a l l y & Gomez, 1979; G a r f i n k e l , Moldofsky, S< Garner, 1980). T h i s modified c r i t e r i a has been used i n previous s t u d i e s to i n v e s t i g a t e body o v e r e s t i m a t i o n (Freeman, Thomas, Solyom, & Koopman, 1985; Garner, Olmstead, & P o l i v y , 1983; McLaughlin, Karp, & Herzog, 1985). Subjects meeting t h i s c r i t e r i a maintained a low body weight through severe r e d u c t i o n of food i n t a k e , and may have r e s o r t e d to use of purging methods and/or s e l f - i n d u c e d vomiting as a means of preventing a b s o r p t i o n of an e x i s t i n g reduced food i n t a k e . Subjects who met R u s s e l l ' s (1979) c r i t e r i a f o r b u l i m i a nervosa had i n i t i a l l y experienced a p e r i o d of c a l o r i c r e s t r i c t i o n and extreme weight l o s s , f o l l o w e d by an i n c r e a s e d frequency of e a t i n g binges and a r e l i a n c e on food evacuation methods to prevent weight g a i n , or had never experienced an episode of anorexia nervosa i n the past ( f o r R u s s e l l ' s c r i t e r i a see Appendix B, Table 8). Non-Eating Disordered Group Subjects i n the comparison group were female undergraduate n u r s i n g students r e c r u i t e d from a l o c a l c o l l e g e . During a two-week p e r i o d , the r e s e a r c h e r addressed f i v e c l a s s e s of n u r s i n g students (approximately 136 students) r e g a r d i n g t h e i r p o t e n t i a l p a r t i c i p a t i o n i n t h i s study. A 10-minute p r e s e n t a t i o n was conducted to e x p l a i n the study's purpose and to c l a r i f y that these students.were p a r t i c i p a t i n g as a comparison group. 11 Interested students signed up at the end of the presentation and were l a t e r contacted by telephone. Of the non-eating disordered s u b j e c t s , 70 (51%) volunteered to p a r t i c i p a t e . Twenty volunteers (28.6%) withdrew, c i t i n g l a c k of time to complete the study. F i f t y non-eating disordered volunteers completed the t e s t package. Nine of these women (18%) scored above 15 on the Eating A t t i t u d e s Test, an index of anorexic symptomatology, and t h e i r data were thus e l i m i n a t e d . A t o t a l of .41 non-eating disordered volunteers comprised the normal comparison group. Subjects i n t h i s group met the f o l l o w i n g c r i t e r i a ; (a) age 18 years and over, (b) no h i s t o r y of an eating d i s o r d e r , (c) not c u r r e n t l y i n treatment f o r a p s y c h i a t r i c problem, and (d) a score of 15 or below on the Eating A t t i t u d e s Test. Measures The Eating A t t i t u d e s Test (Garner & G a r f i n k e l , 1979) was used as a screening device f o r the non-eating disordered group, to ensure that none of these subjects had a mild eating d i s o r d e r . The Eating A t t i t u d e s Test (EAT) i s a 40-item s e l f - r e p o r t inventory measuring anorexic symptomatology. I t i s a 6-point L i k e r t - t y p e s c a l e with responses ranging from always to never. Responses are summed to produce an o v e r a l l score. Garner and G a r f i n k e l (1979) reported an alpha r e l i a b i l i t y c o e f f i c i e n t f o r the EAT of r = .79 f o r anorexic p a t i e n t s and _r = .94 f o r combined anorexic and c o n t r o l s , i n d i c a t i n g a high degree of i n t e r n a l consistency. 12 The authors suggested a c u t o f f score of 30 i n determining p o t e n t i a l e a t i n g d i s o r d e r e d women. They r e p o r t e d a mean score of 15.6 as an index of normal e a t i n g behaviour. A c o n s e r v a t i v e score of 15 or below was r e q u i r e d f o r i n c l u s i o n i n t h i s study's non-eating d i s o r d e r e d comparison.group. Dependent Measures A d u l t S e l f - P e r c e p t i o n P r o f i l e (ASPP). The ASPP (Messer & Harter, 1986) i s a m u l t i d i m e n s i o n a l measure of s e l f - e s t e e m , c o n s i s t i n g of 50 items d i v i d e d i n t o 11 subscales (4 items each) and a g l o b a l s e l f - w o r t h s c a l e (6 items). Subscale scores are d e r i v e d from averaging s c o r e s . The q u e s t i o n format i s f o r c e d choice on a 4-point s c a l e , with h a l f of the items beginning with a statement r e f l e c t i n g high competency, and the remaining items beginning with a statement r e f l e c t i n g low competency. These a l t e r n a t i v e s are designed to o f f s e t the tendency to give s o c i a l l y d e s i r a b l e responses. In t h i s study, the g l o b a l s e l f - w o r t h subscale was used to measure se l f - e s t e e m . G l o b a l s e l f - w o r t h r e f e r s to one's g l o b a l p e r c e p t i o n of worth, independent of any p a r t i c u l a r domain. I t taps items such as l i k i n g the way one i s l e a d i n g one's l i f e , being pleased with o n e s e l f , and l i k i n g the kind of person one i s . Messer and Harter (1986) reported an i n t e r n a l c o n s i s t e n c y f o r t h i s subscale of r_ = .91 and .87 f o r the two samples used to norm the s c a l e f o r g l o b a l s e l f - w o r t h . E a t i n g Disorder Inventory (EDI). The EDI (Garner & Olmstead, 1984) i s a 64-item s e l f - r e p o r t i n v e n t o r y measuring the p s y c h o l o g i c a l c h a r a c t e r i s t i c s r e l a t e d to anorexia nervosa and b u l i m i a . Responses o f f e r a 6-point L i k e r t - t y p e s c a l e , 13 ranging from always to never. The EDI i s made up of e i g h t sub-scales; three measuring b e h a v i o u r a l and symptomatic p a t t e r n s of anorexia and b u l i m i a , and f i v e measuring p s y c h o l o g i c a l f a c t o r s r e l a t e d to these d i s o r d e r s . Each subscale i s scored independently by summing the responses w i t h i n each sub s c a l e . Although t h i s s c a l e u t i l i z e s a 6-point response format, three of the s i x responses (never, r a r e l y , and sometimes) r e c e i v e a numerical value of zero, with the remaining responses (always, u s u a l l y , and often) r e c e i v i n g scores of three, two, and one, r e s p e c t i v e l y . In the case of n e g a t i v e l y scored items, the reverse s c o r i n g p a t t e r n i s used, with always, u s u a l l y , and o f t e n r e c e i v i n g zero, and never, r a r e l y , and sometimes r e c e i v i n g scores of t hree, two, and one, r e s p e c t i v e l y . For t h i s study, two subscales were used; body d i s s a t i s f a c t i o n and i n e f f e c t i v e n e s s (a measure of s e l f - e s t e e m ) . The i n e f f e c t i v e n e s s subscale c o n s i s t s of 10 items a s s e s s i n g f e e l i n g s of inadequacy, i n s e c u r i t y , worthlessness and the f e e l i n g of not being i n c o n t r o l of one's l i f e , i n c l u d i n g the concept of negative s e l f - e v a l u a t i o n ( s e l f - c o n c e p t ) . The body d i s s a t i s f a c t i o n sub-s c a l e c o n s i s t s of 9 items r e f l e c t i n g a b e l i e f t h a t c e r t a i n body par t s a s s o c i a t e d with the m a t u r a t i o n a l process (e.g., h i p s , thighs and buttocks) are too l a r g e . Garner and Olmstead (1984) re p o r t e d a r e l i a b i l i t y c o e f f i c i e n t of r_ = .93 f o r anorexics and r_ = .88 f o r comparisons f o r the i n e f f e c t i v e n e s s subscale, and r_ = .90 f o r anorexics and x_ - .92 f o r comparisons f o r the body d i s s a t i s f a c t i o n s u b s c a l e . 14 Image Marking Method. The Image Marking Method (Askevold, 19»75) i s a paper and p e n c i l s e l f - r e c o r d i n g measurement of body-image disturbance. Subject's perceived and a c t u a l body s i z e estimations are recorded f o r the widths of three body s i t e s ; shoulder, waist, and h i p s , and a body-image perception index f o r each s i t e i s c a l c u l a t e d by d i v i d i n g the perceived s i z e by the a c t u a l s i z e and m u l t i p l y i n g by 100. For purposes of t h i s study, only the waist measurement was used f o r s i z e overestimation. A r e l i a b i l i t y c o e f f i c i e n t _r .= .60 was reported by Garner and G a r f i n k e l (1982) and r = .72 reported by Slade (1985) f o r combined studies using an equivalent s i z e e s t i m a t i o n technique to the image marking. A T-bar was constructed to a i d i n the a c t u a l s i z e measurement of subject's body regions. Perceived Body Image Scale (PBIS). The PBIS (Manley & LePage, 1986) i s a v i s u a l measure of body-image, c o n s i s t i n g of 11 cards (5"x8") d e p i c t i n g the f r o n t a l and p r o f i l e view of a nude female f i g u r e . The cards range from card 1 - smallest to card 11 - l a r g e s t (see Figure 1). These f i g u r e cards were used to measure the C u l t u r a l and I n d i v i d u a l i d e a l body-images f o r a l l s u b j e c t s , rather than body-image disturbance. Two questions accompanied the f i g u r e cards; (a) which body best represents the most sought a f t e r shape f o r women i n our c u l t u r e today ( c u l t u r a l i d e a l ) , and (b) which body best represents the way you 16 l i k e to look ( i n d i v i d u a l i d e a l ) . The c u l t u r a l i d e a l question measures the standard of thinness presented to women by the media and was constructed and p i l o t e d f o r t h i s study (see Appendix B). The i n d i v i d u a l i d e a l question measures the subject's personal preference f o r body shape, and was an o r i g i n a l question card from the PBIS. I n t e r - r a t e r r e l i a b i l i t y (_r = .88 and .87 f o r two teams of r a t e r s ) and t e s t - r e t e s t r e l i a b i l i t y (jr = .78 and .85 f o r r a t e r s ) was reported f o r the i d e a l question card (Manley & LePage, 1986). Apparatus Subjects were weighed on a Seca personal s c a l e , Model 760 with a weighing capacity to a maximum of 150 kg. (320 l b s . ) . Procedure Subjects were t o l d they were p a r t i c i p a t i n g i n a study of p e r s o n a l i t y v a r i a b l e s and body-image i n women wit h eating d i s o r d e r s . The non-eating disordered volunteers were t o l d they were p a r t i c i p a t i n g as part of a normal comparison group. Subjects signed a consent form, t e s t booklets were handed out and explained, and any questions answered. A second i n t e r v i e w was arranged at the subject's convenience. The t e s t booklet included; (a) consent form, (b) Eating A t t i t u d e s Test, (c) S o c i a l Self-Esteem Inventory, (d) Adult S e l f - P e r c e p t i o n P r o f i l e , (e) A s s e r t i o n Inventory, ( f ) Eating Disorder Inventory, and (g) demographic sheet (see Appendix D f o r questionnaires used i n t h i s study). This study was conducted i n conjunction w i t h the study of a f e l l o w student using the same pool of s u b j e c t s , but examining 17 d i f f e r e n t v a r i a b l e s . T h e r e f o r e , not a l l of the s c a l e s i n the t e s t package were used f o r the present study. At the second i n t e r v i e w , s u b j e c t s were f i r s t asked to complete the Image Marking Method by standing f a c i n g a blank sheet of paper (72"x29") attached to the w a l l , and handed two red marking p e n c i l s (one h e l d i n each hand). The female experimenter gave the f o l l o w i n g i n s t r u c t i o n s , As you look at t h i s sheet of paper, pretend i t i s a m i r r o r , so that you can see y o u r s e l f r e f l e c t e d on the sheet. I w i l l ask you to estimate t h r e e body s i t e s by approaching the paper and marking what you t h i n k are the widths of your shoulders, the narrowest p a r t of your waist, and the widest part of your h i p s . Subjects placed a red 'x' f o r the widths of each body s i t e with the r i g h t s i d e of the body marked by the r i g h t hand marker, and the l e f t s i d e of the body marked by the l e f t hand marker. A f t e r the three s i t e s were recorded by the s u b j e c t , she stood with her back to the paper and a measure of her height was placed on the sheet of paper. Bulky sweaters or j a c k e t s were removed to allow f o r more accurate marking of s u b j e c t ' s a c t u a l s i z e . Using the T-bar to enhance body s i t e accuracy, the three body widths ( a c t u a l widths) were marked on the sheet with a l i n e . The angle was used i n such a manner that the head was placed a g a i n s t the w a l l , with the handle touching the a c t u a l 18 body s i t e . The T - b a r a l l o w e d s u b j e c t s t o p l a c e t h e b a r i n t h e e x a c t b ody p o s i t i o n t h e y had u s e d as a r e f e r e n c e p o i n t , t h u s e n s u r i n g t h a t t h e e x p e r i m e n t e r was m a r k i n g t h e c u r r e n t body s i t e t h a t t h e s u b j e c t had e n v i s i o n e d . N e x t , s u b j e c t s v i e w e d t h e f i g u r e c a r d s ( P B I S ) a r r a n g e d on a f l a t s u r f a c e , f r o m t h e s m a l l e s t s i z e (on t h e l e f t ) t o t h e l a r g e s t s i z e (on t h e r i g h t ) . The e x p e r i m e n t e r e x p l a i n e d t h a t , " t h i s i s t h e same f e m a l e body f r o m s m a l l e s t , i n c r e a s i n g i n s i z e t o t h e l a r g e s t , s h a p e " . Q u e s t i o n s were h a n d e d t o t h e s u b j e c t s s e p a r a t e l y and s u b j e c t s were a s k e d t o p i c k t h e c a r d most a p p r o p r i a t e t o t h e q u e s t i o n . The o r d e r o f t h e q u e s t i o n s was t h e same f o r e a c h s u b j e c t , w i t h t h e c u l t u r a l i d e a l q u e s t i o n shown f i r s t , f o l l o w e d by t h e i n d i v i d u a l i d e a l q u e s t i o n . A f t e r c o m p l e t i n g t h i s t a s k , s u b j e c t s were a s k e d what m e a n i n g t h e y h a d g i v e n t o t h e c u l t u r a l i d e a l q u e s t i o n . F i n a l l y , s u b j e c t s were w e i g h e d by s t a n d i n g b a c k w a r d s on t h e s c a l e . As s e v e r a l o f t h e e a t i n g d i s o r d e r e d s u b j e c t s d i d n o t w i s h t o s e e t h e i r a c t u a l w e i g h t , t h e y a g r e e d t o p a r t i c i p a t e i n t h e s t u d y i f t h i s m e a s u r e c o u l d be k e p t f r o m them. S t a n d i n g b a c k w a r d s on t h e s c a l e e n s u r e d c o n f i d e n t i a l i t y o f t h e i r w e i g h t , and was a d o p t e d t o meet u n i f o r m i t y f o r a l l s u b j e c t s . W e i g h t was r e a d and r e c o r d e d by t h e e x p e r i m e n t e r and a c o n s t a n t o f 3 pounds was s u b t r a c t e d t o o f f s e t any i n c r e a s e i n w e i g h t due t o c l o t h i n g (k = 3 l b s . ) . A l l s u b j e c t s were d e b r i e f e d , and any q u e s t i o n s a n s w e r e d . 19 Data A n a l y s i s M u l t i v a r i a t e a n a l y s i s of v a r i a n c e (MANOVA) was used t o t e s t f o r any d i f f e r e n c e s between the e a t i n g d i s o r d e r e d and n o n - e a t i n g d i s o r d e r e d groups f o r the f o l l o w i n g dependent measures: g l o b a l s e l f - w o r t h , i n e f f e c t i v e n e s s , body d i s s a t i s -f a c t i o n , and body-image d i s t u r b a n c e . C h i square a n a l y s i s was used t o determine the degree of r e l a t i o n s h i p between the groups and the n o m i n a l l y s c a l e d data ( c u l t u r a l i d e a l and. i n d i v i d u a l i d e a l ) . The c a t e g o r i e s of the f i g u r e c a r d s were c o l l a p s e d i n an e f f o r t t o ensure c e l l f r e q u e n c i e s e q u a l t o , or g r e a t e r than f i v e . P r o cedure f o r H a n d l i n g M i s s i n g Values T e s t b o o k l e t s were checked f o r m i s s i n g data and c l a r i f i e d w i t h s u b j e c t s a t the b e g i n n i n g of the second i n t e r v i e w . The t y p e s of data missed or r e q u i r i n g c l a r i f i c a t i o n p e r t a i n e d t o demographic i n f o r m a t i o n ( e . g . , i f i d e a l weight was 100-104, s u b j e c t s were asked t o chose one number). No m i s s i n g v a l u e s were found i n the a c t u a l i n v e n t o r i e s . 20 R e s u l t s Demographics and Weight Related C h a r a c t e r i s t i c s E a t i n g d i s o r d e r e d group. The age range of the 41 e a t i n g d i s o r d e r e d women i n t h i s group was 19 to 40 years with a mean age of 26.9 (SD = 4.8 y e a r s ) . The m a j o r i t y of these s u b j e c t s (97.6%) were Euro-Canadian, had a c o l l e g e or u n i v e r s i t y education (63.4%), were s i n g l e (65.8%), with the l a r g e s t percentage l i v i n g alone (39.0%). While the occupations of these s u b j e c t s v a r i e d , the m a j o r i t y of them (75.6%) were employed. T h e i r working hours r e v e a l e d that only 39.0% were employed over 30 hours per week. A s i m i l a r percentage (46.3%) were employed f o r fewer than 20 hours per week, but t h i s number i n c l u d e s those s u b j e c t s who were unemployed (24.4%). The average height of e a t i n g d i s o r d e r e d s u b j e c t s was 64.9 inches t a l l (SD = 2.4 inches) and t h e i r average weight was 121.4 pounds (SD = 24.3 pounds). Weight f o r 27 s u b j e c t s (65.9%) was w i t h i n -10% of the standard weight range f o r height, as derived from the M e t r o p o l i t a n L i f e Insurance Company norms (S o c i e t y of A c t u a r i e s , 1959). T h e i r average weight, expressed as a percentage of standard weight, was 99.1% (SD = 3.7%). Weight f o r 10 s u b j e c t s (24.4%) was >10% below the lower l i m i t of the standard weight range. T h e i r average weight, expressed as a percentage of standard weight, was 77.7% (SD = 8.0%). Weight f o r 4 su b j e c t s (9.8%) was ^10% above the upper l i m i t of the standard weight range. T h e i r average weight, expressed as a percentage of standard weight, was 122.8% (SD = 11.4%). 21 The average onset age f o r an e a t i n g d i s o r d e r i n the e a t i n g d i s o r d e r e d group was 16.1 years, and the average d u r a t i o n of i l l n e s s was 10.8 years (SD = 5.0 y e a r s ) . At the time of t e s t i n g , 65.9% of these s u b j e c t s were c u r r e n t l y r e c e i v i n g some form of p s y c h o l o g i c a l treatment f o r t h e i r e a t i n g d i s o r d e r . Over the course of t h e i r i l l n e s s , t h i s group had r e c e i v e d an average of 24.7 months (Sp_ = 31.6 months) of treatment. Only f i v e of the e a t i n g d i s o r d e r e d s u b j e c t s had never sought medical i n t e r v e n t i o n (see Table 1 f o r i l l n e s s and treatment c h a r a c t e r i s t i c s of e a t i n g d i s o r d e r e d group). The average E a t i n g A t t i t u d e s Test (EAT) score f o r these women was 47.2 (SD = 21.9). The personal weight p r e f e r e n c e s , reported as i d e a l weight on the demographic sheet by the e a t i n g d i s o r d e r e d group, ranged from 85 to 145 pounds, with a mean of 111.4 pounds (SD = 13.0 pounds). T h i r t y - t h r e e s u b j e c t s (80.5%) chose a personal weight preference below t h e i r a c t u a l weight, r e q u i r i n g an average weight l o s s of 16.2 pounds (SD = 15.1 pounds). S i x sub j e c t s (14.6%) who chose a personal weight preference above t h e i r a c t u a l weight, r e q u i r e d an average weight gain of 11.2 pounds (SD = 8.3 pounds). Two s u b j e c t s (4.9%) were c u r r e n t l y at t h e i r p e rsonal weight p r e f e r e n c e . Non-eating d i s o r d e r e d group. The age range of the non-e a t i n g d i s o r d e r e d group was 19 to 37 years with a mean age of 25.4 (SD = 5.5 y e a r s ) . The m a j o r i t y of these s u b j e c t s (78%) were Euro-Canadian, had a c o l l e g e education (100%), and were s i n g l e (75.6%). L i v i n g arrangements f o r these s u b j e c t s v a r i e d , Table 1 I l l n e s s and Treatment C h a r a c t e r i s t i c s of  E a t i n g Disordered Group ... ED group (n = 41) M SD Onset age of i l l n e s s ( y r s . ) 16.1 3.8 Duration of i l l n e s s ( y r s . ) 10.8 5.0 Length of treatment (mos. ) 24.7 31.6 C u r r e n t l y i n treatment 2° 65 . 9 Note. ED = e a t i n g d i s o r d e r e d 23 with almost h a l f (41.5%) l i v i n g with t h e i r p a rents. Most of these s u b j e c t s (97.6%) worked fewer than 20 hours per week due to t h e i r school schedule. The average height of these s u b j e c t s was 64.7 inches t a l l (SD = 2.6 inches) and t h e i r average weight was 127.3 pounds (SD = 21.1 pounds). Weight f o r 32 su b j e c t s (78.0%) was w i t h i n -10% of the standard weight range f o r h e i g h t . T h e i r average weight, expressed as a percentage of standard weight, was 98.3% (SD = 4.5%). Weight f o r 3 s u b j e c t s (7.3%) was >10% below the lower l i m i t of the standard weight range. T h e i r average weight, expressed as a percentage of standard weight, was 85.7% (SD = 4.2%). Weight f o r 6 s u b j e c t s (14.6%) was >10% above the upper l i m i t of the standard weight range. T h e i r average weight, expressed as a percentage of standard weight, was 123.8% (SD =10.3%). The average EAT score f o r the non-eating d i s o r d e r e d s u b j e c t s was 8.6 (SD = 3.6). The mean score f o r non-eating d i s o r d e r e d women f o r t h i s i n v e n t o r y i s 15.6 (SD = 9.3) (Garner & G a r f i n k e l , 1979). The personal weight p r e f e r e n c e s , reported as i d e a l weight on the demographic sheet by the non-eating d i s o r d e r e d s u b j e c t s , ranged from 93 to 165 pounds, with a mean of 120.8 pounds (SD = 13.5 pounds). Twenty-seven s u b j e c t s (65.9%) chose a perso n a l weight preference below t h e i r a c t u a l weight, r e q u i r i n g an average weight l o s s of 11.8 pounds (SD = 11.6 pounds). Eleven s u b j e c t s (26.8%) chose a personal weight preference above t h e i r a c t u a l weight, r e q u i r i n g an average weight gain of 4.6 24 pounds (SD = 5.0 pounds). Three s u b j e c t s (7.3%) were c u r r e n t l y at t h e i r personal weight p r e f e r e n c e . In comparing these two groups, a one-way m u l t i v a r i a t e a n a l y s i s of v a r i a n c e (MANOVA) reve a l e d no s i g n i f i c a n t d i f f e r e n c e s , F(3, 78) = 1.11, p_)>.35, f o r age, weight, and h e i g h t . S i m i l a r l y , a Chi square a n a l y s i s f o r m a r i t a l s t a t u s showed no s i g n i f i c a n t d i f f e r e n c e s between the e a t i n g d i s o r d e r e d and non-eating d i s o r d e r e d groups, % 2 (1/ N = 82) = .77, £ > . 3 8 . For f u r t h e r demographic and weight r e l a t e d c h a r a c t e r i s t i c s , and d i e t i n g i n f o r m a t i o n on a l l s u b j e c t s , see Tables 2, 3 and 4, r e s p e c t i v e l y . MANOVA A n a l y s i s G l o b a l s e l f - w o r t h , i n e f f e c t i v e n e s s , body d i s s a t i s f a c t i o n  and body-image d i s t u r b a n c e . G l o b a l s e l f - w o r t h , i n e f f e c t i v e n e s s , body d i s s a t i s f a c t i o n and body-image di s t u r b a n c e were examined by computing a one-way m u l t i v a r i a t e a n a l y s i s of v a r i a n c e (MANOVA). D i f f e r e n c e s were examined between the e a t i n g d i s o r d e r e d and non-e a t i n g d i s o r d e r e d groups. The m u l t i v a r i a t e group e f f e c t was s i g n i f i c a n t , F(4, 77) = 19.9, £ <C001. An examination of the u n i v a r i a t e F_ t e s t s r e v e a l e d s i g n i f i c a n t group e f f e c t s f o r g l o b a l s e l f - w o r t h , F (1, 80) = 72.9, £ <.001; i n e f f e c t i v e n e s s , F ( l , 80) = 51.23, £ <^ .001; body d i s s a t i s f a c t i o n , F(1, 80) = 33.73, £ ^.001, while body-image e s t i m a t i o n approached s i g n i f i c a n c e , F ( l , 80) = 3.63, £ < \ 0 6 . An examination of the mean scores r e v e a l e d that the e a t i n g d i s o r d e r e d group, compared to the non-eating d i s o r d e r e d group, had l e s s g l o b a l s e l f - w o r t h , more i n e f f e c t i v e n e s s , and experienced 25 Table 2 Demographics of E a t i n g Disordered and  Non-Eating Disordered Group ED group NED group (n = 41) (n = 41) Age 2 E t h n i c group: Euro-Canadian Asian-Canadian Indo-Canadian Education: High school C o l l e g e / U n i v e r s i t y Graduate school Occupation: Unemployed Profess i o n a l Worker Student Health r e l a t e d Hours worked per week: ^,20 hours 20 - 30 hours >^30 hours M a r i t a l s t a t u s : S i n g l e M SD M SD .9 4.8 25.4. 5.5 % % 97.6 78.0 2.4 9.8 0.0 12.2 34.1 0.0 63.4 100.0 2.4 0.0 24.4 0.0 12.2 0.0 21.9 0.0 29.3 100.0 12.2 0.0 46.3 97.6 14.6 2.4 39.0 0.0 65.8 75.6 (Table continues) 26 ED group NED group (n . = 41) (n = 41) °A % Married/commonlaw 12.2 21.9 Separated/divorced 21 .9 2.4 L i v i n g arrangements: Alone 39.0 12.2 Husband ( i n c l u d i n g commonlaw & c h i l d r e n ; b o y f r i e n d ) 19.5 36.6 Parents; s i b l i n g s 17.1 41 . 5 Roommates (male & female) 9.8 9.8 C h i l d r e n only 4.9 0.0 Supportive care (group home) 9.8 0.0 Note. ED = e a t i n g d i s o r d e r e d ; NED = non-eating d i s o r d e r e d . 27 Table 3 Weight Related C h a r a c t e r i s t i c s of E a t i n g  Disordered and Non-Eating Disordered Groups ED group NED group (n = 41) (n = 41) M SD M SD Height (inches) 64.9 2.4 64.7 2.6 Current weight ( l b s . ) 121.4 24.3 127.3 21.1 Highest past weight ( l b s . ) . 144.1 27.0 140.7 24.9 Lowest past weight ( l b s . ) 98.2 15.9 118.0 17.2 Id e a l weight ( l b s . ) 111.3 13.0 120.8 13.5 A c t u a l weight as % of standard weight: % Underweight(90% 24.4 7.3 Average weight (%) 77.7 8.0 85.7 4.2 % Normal weight (90 - 110%) 65.9 78.0 Average weight (%) 99.1 3.7 98.3 4.5 % Overweight )l 10% 9.8 14.6 Average weight (%) 122.8 11.4 123.8 10.3 Note. ED = e a t i n g d i s o r d e r e d ; NED = non-eating d i s o r d e r e d 28 Table 4 D i e t i n g Information f o r E a t i n g Disordered and  Non-Eating Disordered Groups ED group NED group (n = 41) (n = 41) C u r r e n t l y on d i e t : Yes % 39.0 H 7.3 No 61.0 92.7 D a i l y c a l o r i e consumption: 0 - 500 c a l o r i e s 7.3 0.0 500 - 1000 c a l o r i e s 19.5 7.3 1000 - 1500 c a l o r i e s 36.6 31.7 over 1500 c a l o r i e s 36.6 61.0 Frequency of weighing behaviour: ( o n c e a month 36.6 46. 3 1 - 2 times a month 22.0 26. 8 1 - 2 times a week 19.5 19.5 once a day 9.8 7.3 )once a day 12.2 0.0 E a t i n g A t t i t u d e s Test s c o r e : M 47 . 2 8.6 SD 21.9 3.6 Note. ED = e a t i n g d i s o r d e r e d ; NED = non-eating d i s o r d e r e d 29 g r e a t e r body d i s s a t i s f a c t i o n . The e a t i n g d i s o r d e r e d g r o u p showed a g r e a t e r d e g r e e o f b o d y - i m a g e d i s t u r b a n c e t h a n t h e n o n -e a t i n g d i s o r d e r e d g r o u p . F o r g r o u p means and s t a n d a r d d e v i a t i o n s on d e p e n d e n t m e a s u r e s , s e e T a b l e 5. C h i S g u a r e A n a l y s i s C u l t u r a l i d e a l . The C h i s q u a r e a n a l y s i s showed t h a t c u l t u r a l i d e a l , as m e a s u r e d by t h e 11 f i g u r e c a r d s ( c o l l a p s e d i n t o t h r e e c a t e g o r i e s ) , was d e p e n d e n t , ^3 ( 2 , N = 82) = 6.17, p_ ^ . 0 5 , on g r o u p m e m b e r s h i p . As c h o i c e s f o r t h e c u l t u r a l i d e a l r a n g e d f r o m f i g u r e 1 t o 5, s u b j e c t ' s c h o i c e s on f i g u r e s 1 and 2 were c o l l a p s e d t o f i g u r e 3 ( c e l l s i z e s were l e s s t h a n 5 ) , r e s u l t i n g i n 3 c a t e g o r i e s f o r a n a l y s i s . C e l l f r e q u e n c i e s r e v e a l e d t h a t 22 e a t i n g d i s o r d e r e d s u b j e c t s c h o s e a t h i n n e r f i g u r e c a r d ( c a r d 3.or l e s s ) f o r t h e c u l t u r a l i d e a l c ompared t o 11 n o n - e a t i n g d i s o r d e r e d s u b j e c t s , w h i l e 23 n o n - e a t i n g d i s o r d e r e d s u b j e c t s c h o s e a l a r g e r f i g u r e c a r d ( c a r d 4) f o r t h e c u l t u r a l i d e a l c ompared t o 15 o f t h e e a t i n g d i s o r d e r e d s u b j e c t s . S i m i l a r l y , 7 n o n - e a t i n g d i s o r d e r e d s u b j e c t s c h o s e t h e l a r g e s t f i g u r e c a r d ( c a r d 5) i n t h e t h r e e c a t e g o r i e s f o r c u l t u r a l i d e a l , c o m pared t o 4 e a t i n g d i s o r d e r e d s u b j e c t s . I n d i v i d u a l i d e a l . The C h i s g u a r e a n a l y s i s showed t h a t i n d i v i d u a l i d e a l , as m e a s u r e d by t h e 11 f i g u r e c a r d s ( c o l l a p s e d i n t o t h r e e c a t e g o r i e s ) was d e p e n d e n t , ( 2 , N = 82) = 21.09, p_ ^ . 0 0 1 , on g r o u p m e m b e r s h i p . S u b j e c t ' s c h o i c e s f o r i n d i v i d u a l i d e a l r a n g e d f r o m f i g u r e 2 t o 6. I n o r d e r t o i n c r e a s e c e l l f r e q u e n c y , s u b j e c t ' s c h o i c e s on f i g u r e 6 were c o l l a p s e d t o f i g u r e 5, and s u b j e c t ' s c h o i c e s on f i g u r e 2 were c o l l a p s e d t o 30 Table 5 Means and Standard D e v i a t i o n s • f o r Dependent Measures ED NED group group (S = 41) (n = 41) V a r i a b l e s M SD M SD Glo b a l s e l f - w o r t h 1.8 0.6 3.1 0.8 I n e f f e c t i v e n e s s 13.2 7.5- 2.9 5.4 Body d i s s a t i s f a c t i o n 18.5 8.0 8.3 7.8 Body-image disturbance 27.8 32.7 16.9 16.6 Note. High score on g l o b a l s e l f - w o r t h i n d i c a t e s more self-esteem; high score on i n e f f e c t i v e n e s s i n d i c a t e s low se l f - e s t e e m ; high score on body d i s s a t i s f a c t i o n i n d i c a t e s d i s p l e a s u r e with body re g i o n s ; p o s i t i v e score on body-image disturbance i n d i c a t e s o v e r e s t i m a t i o n of waist measurement from a c t u a l s i z e . ED = e a t i n g d i s o r d e r e d ; NED = non-eating d i s o r d e r e d . 31 f i g u r e 3. C e l l f r e g u e n c i e s r e v e a l e d that 22 e a t i n g d i s o r d e r e d s u b j e c t s chose a t h i n n e r f i g u r e card (card 3 or l e s s ) f o r the i n d i v i d u a l i d e a l compared to 3 non-eating d i s o r d e r e d s u b j e c t s , while 25 non-eating d i s o r d e r e d s u b j e c t s chose a l a r g e r f i g u r e card (card 4) f o r the i d i v i d u a l i d e a l compared to 14 e a t i n g d i s o r d e r e d s u b j e c t s . L i k e w i s e , 13 non-eating d i s o r d e r e d s u b j e c t s chose the l a r g e s t f i g u r e , card (card 5, 6) f o r i n d i v i d u a l i d e a l compared to 5 e a t i n g d i s o r d e r e d s u b j e c t s . C o r r e l a t i o n Matrix A c o r r e l a t i o n matrix f o r a l l dependent measures", as w e l l as age and weight was used to examine r e l a t i o n s h i p s among these measures. See Table 5. 32 Table 6 C o r r e l a t i o n M a t r i x f o r Dependent Measures,  Age and Weight age idealwt EDI i EDIbd Waist GSW Actualwt 1 2 3 4 5 6 7. age 1 1 .0000 idealwt 2 0. . 1069 1.0000 EDIi 3 0. .0512 -0.5196 1 .0000 EDIbd 4 -0. . 1 152 -0.3130 0.6550 1.0000 Waist 5 0 .0555 -0.3502 0.4259 0.2703 1.0000 GSW -6 -0. . 1133 0.3873 -0.8324 -0.5743 -0.2799 1 . 0000 Actualwt 7 -0. .0089 0.7621 -0.1670 0.0929 -0.0591 0. 1570 1.0000 Note. Idealwt - w e i g h t s u b j e c t wishes to achieve ( i n l b s . ) ; EDIi = Ea t i n g Disorder Inventory, i n e f f e c t i v e n e s s subscale; EDIbd = E a t i n g Disorder Inventory, body d i s s a t i s f a c t i o n s u bscale; Waist = waist measurement of Image Marking Method; GSW = g l o b a l s e l f - w o r t h subscale of Adult S e l f - P e r c e p t i o n P r o f i l e ; Actualwt = c u r r e n t weight of s u b j e c t ( i n l b s . ) . C r i t i c a l r Values. r .05; 82 = .1829. r .01; 82 = .2565. 33 D i s c u s s i o n The r e s u l t s of the present study supported the hypotheses i n d i c a t i n g that e a t i n g d i s o r d e r e d women showed s i g n i f i c a n t l y lower g l o b a l s e l f - w o r t h , and higher i n e f f e c t i v e n e s s and body d i s s a t i s f a c t i o n , and chose a th i n n e r c u l t u r a l and i n d i v i d u a l i d e a l f i g u r e than d i d non-eating d i s o r d e r e d women. Body-image di s t u r b a n c e (measured as an ov e r e s t i m a t i o n of the w a i s t ) , although g r e a t e r i n e a t i n g d i s o r d e r e d women compared to non-ea t i n g d i s o r d e r e d women, was present i n both groups. In t h i s study, there were s i g n i f i c a n t d i f f e r e n c e s between the two groups on s e l f - e s t e e m measured two d i f f e r e n t ways. Eat i n g d i s o r d e r e d women d i d not f e e l adequate or worthwhile, nor d i d they l i k e the way they were l e a d i n g t h e i r l i v e s . The non-eating d i s o r d e r e d women were s i g n i f i c a n t l y more s a t i s f i e d with t h e i r l i v e s and hel d more p o s i t i v e f e e l i n g s towards themselves. The c u r r e n t f i n d i n g s support other c l i n i c a l o b s e r v a t i o n s and re s e a r c h s t u d i e s on se l f - e s t e e m i n anorexic and b u l i m i c women who f e e l a l a c k of s e l f - w o r t h and a low sense of e f f e c t i v e n e s s (Baird & S i g h t s , 1986; Boskind-White, 1976; Bruch, 1973; Dykens & Gerrard, 1986; Garner & G a r f i n k e l , 1982; Grace, Jacobson, & F u l l a g e r , 1985). The means and standard d e v i a t i o n s of the e a t i n g d i s o r d e r e d s u b j e c t s (M = 13.22, SD = 7.49) and non-eating d i s o r d e r e d s u b j e c t s (M = 2.88, SD = 5.44) were comparable to those of the e a t i n g d i s o r d e r e d s u b j e c t s (M = 13.1, SD = 8.6) and non-eating d i s o r d e r e d s u b j e c t s (M = 2.3, SD = 3.8) i n the norming sample of the i n e f f e c t i v e n e s s subscale of the E a t i n g Disorder Inventory (Garner & Olmstead, 1984). As the Adult S e l f - P e r c e p t i o n P r o f i l e seemed to be a r e l e v a n t s c a l e i n examining s e l f - e s t e e m , but had not been used on an e a t i n g d i s o r d e r e d group, the more widely researched E a t i n g D i s o r d e r Inventory subscale of s e l f - w o r t h was a l s o i n c l u d e d . A h i g h negative c o r r e l a t i o n was found (r_ = -.83, £ 4.01) between the g l o b a l s e l f - w o r t h and i n e f f e c t i v e n e s s subscales of these measures, such t h a t s u b j e c t s s c o r i n g low i n s e l f -worth on the ASPP, a l s o scored high i n i n e f f e c t i v e n e s s on the EDI. The c o r r e l a t i o n would suggest that these two s c a l e s measure aspects of a s i m i l a r c o n s t r u c t of s e l f - w o r t h . The measurement of body-image d i s t u r b a n c e i n d i c a t e d that both e a t i n g d i s o r d e r e d women and non-eating d i s o r d e r e d women viewed t h e i r waist measurement as l a r g e r than i t a c t u a l l y was. While the e a t i n g d i s o r d e r e d women overestimated t h e i r waist r e g i o n more than the non-eating d i s o r d e r e d women, the d i f f e r e n c e between the two groups only approached the s i g n i f i c a n c e l e v e l (£<^.06). Several reasons may e x p l a i n t h i s f i n d i n g . F i r s t , the s i m i l a r i t y i n weight range between the two groups may account f o r the s m a l l e r degree of d i f f e r e n c e i n s i z e o v e r e s t i m a t i o n . Researchers have suggested that there i s a tendency f o r e a t i n g d i s o r d e r e d women who are i n t e r e s t e d i n ' l o s i n g f u r t h e r weight to over-estimate t h e i r body s i z e (Willmuth, L e i t e n b e r g , Rosen, 35 F o n d a c a r o , & G r o s s , 1985 ) . In the p r e s e n t s t u d y , more e a t i n g d i s o r d e r e d women were d i e t i n g and i n g e s t i n g fewer than 1,000 c a l o r i e s per day than were n o n - e a t i n g d i s o r d e r e d women, w h i c h may have c o n t r i b u t e d t o t h e i r o v e r e s t i m a t i n g t h e i r w a i s t s i z e s l i g h t l y more than the n o n - e a t i n g d i s o r d e r e d women. Second , the l a c k o f a d d i t i o n a l r e s e a r c h w h i c h examines the r e l i a b i l i t y and v a l i d i t y o f the measurement d e v i c e used i n t h i s s t u d y l e a v e s the r e s u l t s o f the body- image d i s t u r b a n c e q u e s t i o n a b l e . T h i r d , the l a r g e v a r i a n c e i n the e a t i n g d i s o r d e r e d g roup may be due t o the f a c t t h a t t h e s e s u b j e c t s were a t v a r i o u s s t a g e s o f t h e i r r e c o v e r y a t the t ime o f t e s t i n g . L a s t l y , s u b j e c t s ' comments d u r i n g t e s t i n g i n d i c a t e d t h a t b o t h groups had d i f f i c u l t y p e r c e i v i n g and m e a s u r i n g t h e i r w a i s t a r ea i n t e rms of a s t r a i g h t l i n e , as r e q u i r e d on the image m a r k i n g method. I t appeared t h a t t he se women v i s u a l i z e d t h e i r b o d i e s u s i n g a c o m b i n a t i o n o f p e r c e p t u a l , c o g n i t i v e , a f f e c t i v e and k i n e s t h e t i c s e n s e s , r a t h e r than one s p e c i f i c s e n s e . F u t u r e r e s e a r c h m e a s u r i n g t he se d i f f e r e n t a reas may p rove v a l u a b l e t o the u n d e r s t a n d i n g o f body- image d i s t o r t i o n . . The f i n d i n g s o f t h i s s t u d y add e m p i r i c a l s u p p o r t t o p r e v i o u s s t u d i e s showing s i z e o v e r e s t i m a t i o n o c c u r i n g i n e a t i n g d i s o r d e r e d women as w e l l as n o n - e a t i n g d i s o r d e r e d women. The f a c t t h a t the n o n - e a t i n g d i s o r d e r e d women i n t h i s s t u d y a l s o saw t h e i r b o d i e s as l a r g e r t han they a c t u a l l y were l e n d s f u r t h e r s u p p o r t to H s u ' s (1982) argument t h a t body- image d i s t u r b a n c e i s no t u n i q u e to a n o r e x i a n e r v o s a and b u l i m i a . R a t h e r than a t t emp t s t o i s o l a t e and measure the phenomenon o f d i s t o r t i o n i n e a t i n g 36 d i s o r d e r e d women, more v a l u a b l e i n f o r m a t i o n may r e s u l t from understanding the meaning of t h i s phenomenon i n the l i v e s of these p a r t i c u l a r women. The measurement of body d i s s a t i s f a c t i o n i n d i c a t e d that e a t i n g d i s o r d e r e d women compared to non-eating d i s o r d e r e d women f e l t more d i s s a t i s f i e d with t h e i r bodies. D i f f e r e n c e s between the two groups i n t h i s study showed that e a t i n g d i s o r d e r e d women f e l t s i g n i f i c a n t l y more d i s c o n t e n t e d with those areas of the body a s s o c i a t e d with m a t u r a t i o n a l changes (e.g., h i p s , thighs and buttocks) than non-eating d i s o r d e r e d women. These f i n d i n g s add support to previous s t u d i e s that show e a t i n g d i s o r d e r e d women do not f e e l comfortable or s a t i s f i e d with t h e i r c u r r e n t body shape (Garner & G a r f i n k e l , 1982; Wooley & Wooley, 1985). An examination of the group means and standard d e v i a t i o n s of the body d i s s a t i s f a c t i o n subscale of the Ea t i n g D i s o r d e r Inventory (Garner & Olmstead, 1984) r e v e a l e d s i m i l a r r e s u l t s between the e a t i n g d i s o r d e r e d group (M = 18.49, SD = 8.03) i n the cu r r e n t study and the ea t i n g d i s o r d e r e d norming sample (M = 15.5, SD = 7.8). The c u r r e n t f i n d i n g s confirm previous s t u d i e s that show e a t i n g d i s o r d e r e d women do not f e e l good about t h e i r bodies and that t h i s f e e l i n g of l o a t h i n g c o i n c i d e s with poor s e l f - e s t e e m and body-image dis t u r b a n c e (Garner & G a r f i n k e l , 1982; S t r i e g e l - M o o r e , S i l b e r s t e i n , & Rodin, 1986). Garner and G a r f i n k e l (1982) suggested that body d i s s a t i s f a c t i o n can be subcategorized under se l f - e s t e e m and may be an 37 i n f l u e n t i a l f a c t o r i n the presence of body-image d i s t u r b a n c e . Just as the degree of body-image disturbance may be important i n a s s e s s i n g and understanding the s e v e r i t y of an e a t i n g d i s o r d e r , i t has been suggested that the degree of d i s s a t i s f a c t i o n together with s i z e o v e r e s t i m a t i o n may be v a l u a b l e i n p r e d i c t i n g r e l a p s e i n women with e a t i n g d i s o r d e r s (Freeman, Beach, Davis, & Solyom, 1985). Garner and Bemis (1985) found that the importance of thinness and body shape becomes the c e n t r a l focus f o r a n o r e x i c women. Ther e f o r e , s a t i s f a c t i o n with body shape may be g r e a t l y i n f l u e n c e d by e x t e r n a l s o c i e t a l pressures f o r women to be t h i n and f i t . The present study made a d i s t i n c t i o n between a c u l t u r a l and i n d i v i d u a l i d e a l image f o r females, by asking s u b j e c t s to chose a shape most women d e s i r e d as the i d e a l shape ( c u l t u r a l ) and a shape they p e r s o n a l l y d e s i r e d ( i n d i v i d u a l ) . The c u l t u r a l i d e a l covered a range of p o s s i b l e body shapes from emaciated to overweight. A very narrow range of shapes were chosen by both groups of women, and r e f l e c t e d the angular body shapes observed i n past r e s e a r c h (Garner, G a r f i n k e l , Schwartz, & Thomopson, 1980; Guy, Rankin, & N o r v e l l , 1980). There were s i g n i f i c a n t d i f f e r e n c e s between the ranges chosen by the two groups. The ma j o r i t y of e a t i n g d i s o r d e r e d women (54%) chose a very t h i n female f i g u r e (card 3 or l e s s ) as the shape most women would l i k e to possess ( c u l t u r a l i d e a l ) , compared to most non-eating d i s o r d e r e d women (56%) who chose a heavier female f i g u r e (card 4). 38 Although the non-eating d i s o r d e r e d women chose a heavier body-shape f o r the c u l t u r a l i d e a l , they s t i l l chose an angular female f i g u r e . Comments by the non-eating d i s o r d e r e d women revealed t h e i r c h o i c e s f o r the c u l t u r a l i d e a l f i g u r e were based on the absence o f a p r o t r u d i n g stomach and waist area, but not too t h i n as to r e v e a l the bone s t r u c t u r e of the h i p and t h i g h areas. These remarks i n d i c a t e d that the stomach area of the female body i s an important i n d i c a t o r of the i d e a l female shape, and that c e r t a i n body regions are markers of the i d e a l body shape. Subjects d i d not make s i m i l a r comments about the brea s t area. The e a t i n g d i s o r d e r e d women i n comparison, d i d not vo l u n t e e r any s i m i l a r i n f o r m a t i o n r e g a r d i n g t h e i r own bodies or the female f i g u r e drawings. Measurement of the i n d i v i d u a l i d e a l image rev e a l e d s i g n i f i c a n t d i f f e r e n c e s between the two groups, with the e a t i n g d i s o r d e r e d women (54%) wanting a t h i n n e r body shape (card 3 or l e s s ) than the non-eating d i s o r d e r e d women (61%) (card 4). The ma j o r i t y of the e a t i n g d i s o r d e r e d women wanted t h e i r bodies to look the same as (51%), or thinn e r than (24%) t h e i r already t h i n female c u l t u r a l i d e a l . These r e s u l t s c o i n c i d e with the ma j o r i t y of these s u b j e c t s (80.5%) choosing an i d e a l weight below t h e i r c u r r e n t weight. On the other hand, the non-eating d i s o r d e r e d women wanted t h e i r bodies to look the same as (41%), or s l i g h t l y l a r g e r than (46%) t h e i r s l i g h t l y h e a v i e r c u l t u r a l i d e a l . The m a j o r i t y of these women (65.9%) however, chose a perso n a l weight preference below t h e i r c u r r e n t weight. These 39 f i n d i n g s are i n c o n s i s t e n t with the N a t i o n a l E a t i n g Disorder Information Centre's r e p o r t (1987) that s t a t e d a l l women whether normal weight, heavy or t h i n wished a t h i n n e r body shape than they c u r r e n t l y possessed. The choi c e s made by the ea t i n g d i s o r d e r e d women, however, r e f l e c t e d s i m i l a r f i n d i n g s to past r e s e a r c h that r e v e a l e d s p e c i f i c groups of e a t i n g d i s o r d e r e d women, those with b u l i m i a nervosa, d e s i r e d t h i n n e r shapes than t h e i r a c t u a l s i z e and t h i n n e r shapes than other groups of e a t i n g d i s o r d e r e d women (Freeman, Thomas, Solyom, & Koopman, 9850; M i c k a l i d e & Andersen, 1985; Touyz, Beumont, C o l l i n s , & Cowie, 1985). The t h i n n e r c u l t u r a l and i n d i v i d u a l i d e a l s chosen by the ea t i n g d i s o r d e r e d women compared to the non-eating d i s o r d e r e d women i n t h i s study i n d i c a t e d that they had h e l d d i f f e r e n t standards of a c c e p t a b i l i t y with regard to what was considered a c u l t u r a l l y acceptable female shape, and a p e r s o n a l l y acceptable shape. I t may be worthwhile to explore f u r t h e r the d i f f e r e n c e s between these two groups of women to a s c e r t a i n the meaning that being t h i n holds to women i n gener a l , and to e a t i n g d i s o r d e r e d women i n p a r t i c u l a r . The r e p r e s e n t a t i v e n e s s of t h i s study's sample of e a t i n g d i s o r d e r e d women was compared to past r e s e a r c h on t h i s c l i n i c a l p o p u l a t i o n . The comparison revealed that the e a t i n g d i s o r d e r e d women i n t h i s study were s i m i l a r to those i n other s t u d i e s f o r c h a r a c t e r i s t i c s such as age; e t h n i c group; education l e v e l ; m a r i t a l s t a t u s ; height; c u r r e n t , lowest past, h i g h e s t past, and i d e a l weights; and onset age of i l l n e s s (Johnson, Stuckey, Lewis, 40 & Schwartz, 1982; M i t c h e l l , Hatsukami, Eckert, & Pyle, 1985; Rost, Neuhaus, & F l o r i n , 1982). In a d d i t i o n , i n 1983, the Na t i o n a l A s s o c i a t i o n of Anorexia Nervosa and A s s o c i a t e d D i s o r d e r s (ANAD) surveyed over 1,400 i n d i v i d u a l s s u f f e r i n g from anorexia nervosa and b u l i m i a , r e v e a l i n g s i m i l a r c h a r a c t e r i s t i c s observed i n past r e s e a r c h and i n the c u r r e n t study. The r e s u l t s of t h i s study are important i n p r o v i d i n g i n f o r m a t i o n on a group of n o n - h o s p i t a l i z e d e a t i n g d i s o r d e r e d women. To the extent that more women than men seek p s y c h o l o g i c a l treatment, and s t a t i s t i c s i n d i c a t e the m a j o r i t y of e a t i n g d i s o r d e r e d c l i e n t s are women (90% - 95%), the p o s s i b i l i t y of c o u n s e l l o r s and t h e r a p i s t s d e a l i n g with t h i s group of women and t h e i r concerns i s l i k e l y . Add to t h i s , the cur r e n t l a c k of medical treatment f a c i l i t i e s , s p e c i a l i z e d medical personnel, and an in c r e a s e i n women with e a t i n g d i s o r d e r s seeking medical i n t e r v e n t i o n , the p o s s i b i l i t y i n c r e a s e s . T h e r e f o r e , i t i s important t h a t c o u n s e l l o r s have r e l i a b l e assessment t o o l s and in f o r m a t i o n to measure and t r e a t the problems of self-esteem, body-image d i s t u r b a n c e , and body d i s s a t i s f a c t i o n i n e a t i n g d i s o r d e r s . The measures used i n t h i s study were chosen f o r t h e i r ease i n a d m i n i s t r a t i o n and t h e i r u s e r - f r i e n d l y aspects. Not only would c o u n s e l l o r s be able to use the r e s u l t s of these measures pre- and post-treatment to observe any changes i n c l i e n t a t t i t u d e , but the measures could be used i n therapy s e s s i o n s as c o u n s e l l i n g t o o l s . A l s o , as most c o u n s e l l o r s do not have the use of s o p h i s t i c a t e d body-image d i s t o r t i o n 41 measuring devices, the simpler paper and pencil measurement used in this study may be a useful indicator of the severity of d i s t o r t i o n , as well as a counselling tool to explore this phenomenon more intimately with the c l i e n t . The results of the present study should be viewed in l i g h t of their l i m i t a t i o n s . While results confirmed most of the past research on self-esteem, body-image disturbance and body d i s s a t i s f a c t i o n , a larger sample size for each group would y i e l d more conclusive r e s u l t s . A c r i t i c i s m of using college students in comparison samples was noted ( S t r i e g e l -Moore, S i l b e r s t e i n , & Rodin, 1986). It would appear that college campuses may be a s t r e s s f u l environment which may amplify the c u l t u r a l pressures on women to be th i n . To offset the possible problems a college sample might create, and to gain new information on a di f f e r e n t comparison group, this study o r i g i n a l l y sought the pa r t i c i p a t i o n of fu l l - t i m e c l e r i c a l workers. Out of the two l o c a l corporations comprising approximately 200 female workers, only two volunteers were w i l l i n g to participate. These women explained that their coworkers were reluctant to participate in a study examining their food behaviours. Some of the women who did not volunteer voiced concerns about finding out how problematic their behaviours were, while others openly indicated they had a problem with losing control over food and "pigged out" or "binged" already. These comments lead to the speculation that, many mpre cases of. eating, disorders, exist that remain 42 undiagnosed, and that women in general view themselves as abnormal when considering t h e i r food, weight and bodies. These limitations and the speculations on the near significance of the body-image disturbance results suggest several avenues for future research. The coexistence of self-esteem, body-image disturbance and body d i s s a t i s f a c t i o n requires r e p l i c a t i o n studies in a larger and more extensive population of males and females, with and without eating disorders, to further understand the relationship between these factors and how they impact eating disordered men and women i n pa r t i c u l a r . Researchers have suggested the importance of physical attractiveness to a woman's sense of self-esteem. Studies need to examine whether th i s i s an important factor and whether differences exist between 1eating disordered and non-eating disordered women. Taking into consideration the problems women in this study had perceiving their waist area in a straight l i n e , measurements of body regions may be more accurate i f the subject could mold his or her body shape using a t a i l o r ' s mannequin. These women seemed to imagine their waist in terms of rounded shapes, using a more kinesthetic approach to their waist measurement. F i n a l l y , investigations of the feelings attached to being fat and the d i s s a t i s f a c t i o n attached to the body may provide more useful and diff e r e n t information on the relationship between body-image and self-esteem, p a r t i c u l a r l y for counsellors who focus treatment on the aff e c t i v e aspects of c l i e n t ' s problems. References American P s y c h i a t r i c A s s o c i a t i o n (1980). D i a g n o s t i c and s t a t i s t i c a l manual of mental d i s o r d e r s (3rd ed.). Washington, D.C: Author. Askevold, F. (1975). Measuring body image. P r e l i m i n a r y r e p o r t on a new method. Psychotherapy Psychosomaties, 26, 71-77. B a i r d , P., & S i g h t s , J.R. (1986). Low s e l f - e s t e e m as a treatment i s s u e i n the psychotherapy of anorexia and b u l i m i a . J o u r n a l of Counseling and Development, 64, March, 449-451. B e l l , C , K i r k p a t r i c k , S.W., & Rinn, R.C. (1986). Body image of anorexic, obese and normal females. J o u r n a l of C l i n i c a l Psychology, 42(3), 431-439. Ber s c h e i d , E., Walster, E., & Bohrnstedt, G. (1973, November). The happy american body: A survey r e p o r t . Psychology Today, pp. 119-131. B i r t c h n e l l , S.A., Lacey, J.H., & Harte, A. (1985). Body image d i s t o r t i o n i n b u l i m i a nervosa. B r i t i s h J o u r n a l of P s y c h i a t r y , 147, 408-412. Boskind-White, M. (1976). C i n d e r e l l a ' s s t e p s i s t e r s : A f e m i n i s t p e r s p e c t i v e on anorexia nervosa and b u l i m i a . In J . H. Williams (Ed.), Psychology of women. Se l e c t e d readings (436-449). New York: W.W. Norton & Company. Bruch, H. (1962). P e r c e p t u a l and conceptual d i s t u r b a n c e s i n anorexia nervosa. Psychosomatic Medicine, 24(2), 187-194. Bruch, H. (1973). E a t i n g d i s o r d e r s : Obesity, anorexia nervosa and the person w i t h i n . New York: B a s i c Books. Button, E.J. (1986). Body s i z e p e r c e p t i o n and response to i n - p a t i e n t treatment i n anorexia nervosa. I n t e r n a t i o n a l  J o u r n a l of E a t i n g D i s o r d e r s , 5_(4), 617-629. Button, E.J., F r a n s e l l a , F., & Slade, P.D. (1977). A r e a p p r a i s a l of body p e r c e p t i o n d i s t u r b a n c e s i n anorexia nervosa. P s y c h o l o g i c a l Medicine, 1_, 235-243. Coopersmith, S. (1967). The antecedents of s e l f - e s t e e m . San F r a n s i s c o : W.H. Freeman. C r i s p , A.H., & Kalucy, R.S. (1974). -Aspects of the p e r p e t u a l d i s o r d e r i n anorexia nervosa. B r i t i s h J o u r n a l of Medical  Psychology, 47, 349-361. D a l l y , P.J., & Gomez, J . (1979). Anorexia nervosa. London: Heinemann. Dykens, E.M., & Gerrard, M. (1986). P s y c h o l o g i c a l p r o f i l e s of purging b u l i m i c s , repeat d i e t e r s , and c o n t r o l s . J o u r n a l of C o n s u l t i n g and C l i n i c a l Psychology, 54(3), 283-288. F a l l o n , A.E., & Rozin, P. (1985). Sex d i f f e r e n c e s i n p e r c e p t i o n s of d e s i r a b l e body shape. J o u r n a l of Abnormal  Psychology, 94(1), 102-105. F i t t s , W.H. (1965). Tennessee s e l f - c o n c e p t s c a l e manual. N a s h v i l l e , Tennessee: Counselor Recordings and T e s t s . Freeman, R.J., Beach, B., Davis, R., & Solyom, L. (1985). The p r e d i c t i o n of relapse i n bulimia nervosa. Journal of P s y c h i a t r i c Research, _19(2,3), 349-353. Freeman, R.J., Thomas, CD., Solyom, L., & Koopman, R.F. (1985). C l i n i c a l and p e r s o n a l i t y c o r r e l a t e s of body s i z e overestimation i n anorexia nervosa and b u l i m i a nervosa. I n t e r n a t i o n a l Journal of Eating Disorders, 4(4), 439-456. G a r f i n k e l , P.E., Moldofsky, H., & Garner, D.M. (1980). The heterogeneity of anorexia nervosa. Archives of General P s y c h i a t r y , 37, 1036-1040. Garner, D.M., & Bemis, K.M. (1985). Cognitive therapy f o r anorexia nervosa. In D.M. Garner & P.E. G a r f i n k e l (Eds.), Handbook of psychotherapy f o r anorexia nervosa and bu l i m i a (pp. 107-146). New York: The G u i l f o r d Press. Garner, D.M. & G a r f i n k e l , P.E. (1979). The e a t i n g a t t i t u d e s t e s t : An index of the symptoms of anorexia nervosa. P s y c h o l o g i c a l Medicine, 9, 273-279. Garner, D.M. & G a r f i n k e l , P.E. (1982). Body image i n anorexia nervosa: Measurement, theory and c l i n i c a l i m p l i c a t i o n s . I n t e r n a t i o n a l Journal of P s y c h i a t r y i n Medicine, 11, 263-285. Garner, D.M., G a r f i n k e l , P.E., Schwartz, D., & Thompson, M. (1980). C u l t u r a l expectations of thinness i n women. Ps y c h o l o g i c a l Reports, 47, 483-491. Garner, D.M., G a r f i n k e l , P.E., Stancer, H.C., & Moldofsky, (1976). Body image disturbance i n anorexia nervosa and o b e s i t y . Psychosomatic Medicine, 38, 327-336. Garner, D.M., & Olmstead, M.P. (1984). Manual f o r eating  d i s o r d e r inventory (EDI). P s y c h o l o g i c a l Assessment Resources, Inc. F l o r d i a , USA. Garner, D.M., Olmstead, M.P., & P o l i v y , J . (1983). Development and v a l i d a t i o n of a multidimensional ea t i n g disorder inventory f o r anorexia nervosa and b u l i m i a . I n t e r n a t i o n a l Journal of Eating Disorders , 2(2), 15-33. Garner, D.M., Rockert, W., Olmstead, M.P., Johnson, C , & Coscina, D.V. (1985). Psychoeducational p r i n c i p l e s i n the treatment of anorexia nervosa and b u l i m i a . In D.M. Garner & P.E. G a r f i n k e l (Eds.), Handbook of  psychotherapy f o r anorexia nervosa and b u l i m i a (pp. 513-573). New York: The G u i l f o r d Press. Gecas, V., & Mortimer, J.T. (1984, J u l y ) . S t a b i l i t y and  change i n the self-concept from adolescence to  adulthood. Paper presented f o r B r i t i s h P s y c h o l o g i c a l S o c i e t y , U n i v e r s i t y C o l l e g e , C a r d i f f , U.K. Go o d s i t t , A. (1985). S e l f psychology and the treatment of anorexia nervosa. In D.M. Garner & P.E. G a r f i n k e l (Eds. Handbook of psychotherapy f o r anorexia nervosa and  b u l i m i a (pp. 55-82). New York: The G u i l f o r d Press. Grace, P.S., Jacobson, R.S., & F u l l a g e r , C.J. (1985). A p i l o t comparison of purging and non-purging b u l i m i c s . J o u r n a l of C l i n i c a l Psychology, 41(2), 173-180. Guy, R.F., Rankin, B.A., & N o r v e l l , M.J. (1980). The r e l a t i o n of sex r o l e s t e r e o t y p i n g to body image. J o u r n a l of Psychology, 105, 167-173. Hsu, L.K.G. (1982). B r i e f communication. Is there a di s t u r b a n c e i n body image i n anorexia nervosa? J o u r n a l of Nervous and Mental Disease, 170(5) , 305-307. Johnson, C.L., Stuckey, M.K., Lewis, L.D., & Schwartz, D.M. (1982). B u l i m i a : A d e s c r i p t i v e survey of 316 cases. I n t e r n a t i o n a l J o u r n a l of E a t i n g D i s o r d e r s , .2(1), 3-16. Klesges, R.C. (1983). An a n a l y s i s of body image d i s t o r t i o n s i n an i n - p a t i e n t p o p u l a t i o n . I n t e r n a t i o n a l J o u r n a l of E a t i n g D i s o r d e r s , 2(2), 35-41. Kohut, H., & Wolf, E.S. (1978). The d i s o r d e r s of the s e l f and t h e i r treatment: An o u t l i n e . I n t e r n a t i o n a l J o u r n a l of Psycho-Analysis, 59, 413-425. McLaughlin, E.F., Karp, S.A., & Herzog, D.B. (1985). Sense of i n e f f e c t i v e n e s s i n women with e a t i n g d i s o r d e r s : A c l i n i c a l study of anorexia nervosa and b u l i m i a . I n t e r n a t i o n a l J o u r n a l of E a t i n g D i s o r d e r s , 4(4), 511-523. Markus, H. (1977). Self-schemata and p r o c e s s i n g i n f o r m a t i o n about the s e l f . J o u r n a l of P e r s o n a l i t y and S o c i a l Psychology, _35(2), 63-78. Manley, R.S., & LePage, T. (1986). Perceived body image s c a l e . Department of Psychology, B.C.'s C h i l d r e n ' s H o s p i t a l , Vancouver, B.C. Messer, B., & Harter, S. (1986). Manual f o r the a d u l t s e l f - p e r c e p t i o n p r o f i l e . U n i v e r s i t y of Denver. M i c k a l i d e , A.D., & Andersen, A.E. (1985). Subgroups of anorexia nervosa and b u l i m i a : V a l i d i t y and u t i l i t y . J o u r n a l of P s y c h i a t r i c Research, 19(2,3), 121-128. M i t c h e l l , J.E., Hatsukami, D., Eckert, E.D., & Pyle, R.L. (1985). C h a r a c t e r i s t i c s of 275 p a t i e n t s with b u l i m i a . American J o u r n a l of P s y c h i a t r y , 142(4), 482-485. N a t i o n a l A s s o c i a t i o n of Anorexia Nervosa and A s s o c i a t e d D i s o r d e r s (1983). N a t i o n a l survey on anorexia nervosa and b u l i m i a . P r e l i m i n a r y r e p o r t . Working Together, p. 1,4. N a t i o n a l E a t i n g Disorder Information Centre. (1987, A p r i l , May). Working toward a more p o s i t i v e body image. B u l l e t i n , pp. 1-3. Orbach, S. (1986). Hunger s t r i k e . The a n o r e c t i c ' s s t r u g g l e as a metaphor of our age. New York: W.W. Norton & Company. R a c i t i , M.C., & Norcross, J.C..(1987). Screening, i n t e r r e l a t i o n s h i p s , and psychometries. I n t e r n a t i o n a l  Journal of Eating Disorders, 6_(4), 579-586. Rosen, G.M., & Ross, A.O. (1968). R e l a t i o n s h i p of body image to s e l f - c o n c e p t . Journal of Consulting and  C l i n i c a l Psychology, 3_2(1), 100. Rosenberg, M. (1979). Conceiving the s e l f . New York: Bas i c Books, Inc. Rost, W., Neuhaus, M., & F l o r i n , I. (1982). Bulimia nervosa: sex r o l e a t t i t u d e , sex r o l e behavior, and sex r o l e r e l a t e d locus of c o n t r o l i n b u l i m a r e x i c women. Journal of Psychosomatic Research, 26, 403-408. R u s s e l l , G. (1979). Bulimia nervosa: An ominous v a r i a n t of anorexia nervosa. P s y c h o l o g i c a l Medicine, 9_, 429-448. Sanford, L.T., & Donovan, M.E. (1984). Women and s e l f - esteem . New York: Penguin Books. S c h i l d e r , P. (1950). The image and appearance of the  human body. New York: I n t e r n a t i o n a l U n i v e r s i t i e s Press. Schwartz, D.M., Thompson, M.G., & Johnson, C.L. (1982). Anorexia nervosa and b u l i m i a : The s o c i o - c u l t u r a l context. I n t e r n a t i o n a l Journal of Eating Disorders, 1(3), 20-36. Secord, P\F., & Jourard, S.M. (1953). The a p p r a i s a l of body-cathexis: Body-cathexis and the s e l f . J o u r n a l of C o n s u l t i n g Psychology, 17(5), 343-347. S i l v e r s t e i n , B., Perdue, L., Peterson, B., & K e l l y , E. (1986). The r o l e of the mass media i n promoting a t h i n standard of b o d i l y a t t r a c t i v e n e s s f o r women. Sex Roles, 14(9,10), 519-532. S i l v e r s t e i n , B. , Perdue, L., Peterson, B., Vogel, L. , S, F a n t i n i , D.A. (1986). P o s s i b l e causes of the t h i n standard of b o d i l y a t t r a c t i v e n e s s f o r women. I n t e r n a t i o n a l J o u r n a l of E a t i n g D i s o r d e r s , 5_(5), 907-916. S i l v e r s t e i n , B., Peterson, B., & Perdue, L. (1986). Some c o r r e l a t e s of the t h i n standard of b o d i l y a t t r a c t i v e n e s s f o r women. I n t e r n a t i o n a l J o u r n a l of E a t i n g D i s o r d e r s , 5(5), 895-905. Slade, P. (1985). A review of body-image s t u d i e s i n anorexia nervosa and b u l i m i a nervosa. J o u r n a l of P s y c h i a t r i c Research, _19(2,3), 255-265. Slade, P.D., & R u s s e l l , G.F. (1973). Awareness of body dimensions i n anorexia nervosa: C r o s s - s e c t i o n a l and l o n g i t u d i n a l s t u d i e s . P s y c h o l o g i c a l Medicine, 3_, 188-199. S o c i e t y of A c t u a r i e s . (1959). B u i l d and blood pressure  study. Chicago, IL: Author. S t r i e g e l - M o o r e , R.H., S i l b e r s t e i n , L.R., & Rodin, J . (1986). Toward an understanding of r i s k f a c t o r s f o r b u l i m i a . American P s y c h o l o g i s t , 4^(3), 246-263. Thompson, J.K., & Thompson, CM. (1986). Body s i z e d i s t o r t i o n and s e l f - e s t e e m i n asymptomatic normal weight males and females. I n t e r n a t i o n a l J o u r n a l of  E a t i n g D i s o r d e r s , 5(6), 1061-1068. Touyz, S.W., Beumont, P.J.V., C o l l i n s , J.K., & Cowie, I. (1985). Body shape p e r c e p t i o n i n b u l i m i a and anorexia nervosa. I n t e r n a t i o n a l J o u r n a l of E a t i n g D i s o r d e r s , 4(3), 259-265. Wagner, S., Halmi, K.A., & Maguire, T.V. (1987). The sense of personal i n e f f e c t i v e n e s s i n p a t i e n t s with e a t i n g d i s o r d e r s : One c o n s t r u c t or s e v e r a l ? I n t e r n a t i o n a l  J o u r n a l of E a t i n g D i s o r d e r s , .6(4), 495-505. Willmuth, M.E., L e i t e n b e r g , H., Rosen, J . C , Fondacaro, K.M., & Gross, J . (1985). Body s i z e d i s t o r t i o n i n b u l i m i a nervosa. I n t e r n a t i o n a l J o u r n a l of E a t i n g D i s o r d e r s , 4(1), 71-78. Wingate, B.A., & C h r i s t i e , M.J. (1978). Ego s t r e n g t h and body image i n anorexia nervosa. J o u r n a l of Psychosomatic  Research, 22, 201-204. Wooley, S.C, & Wooley, W. (1985). I n t e n s i v e o u t p a t i e n t and r e s i d e n t i a l treatment f o r b u l i m i a . In D.M. Garner & P.E. G a r f i n k e l (Eds.), Handbook of psychotherapy f o r  anorexia nervosa and, b u l i m i a (pp. 391-430). New York: The G u i l f o r d Press. 52 APPENDIX A Review o f L i t e r a t u r e Review of L i t e r a t u r e Appendix A reviews the l i t e r a t u r e on f a c t o r s c o n t r i b u t i n g to an i n d i v i d u a l ' s s e l f - d e f i c i t , s p e c i f i c a l l y s e l f - e s t e e m , body-image e s t i m a t i o n , and body d i s s a t i s f a c t i o n . The review examines these f a c t o r s i n two groups of women, those with anorexia nervosa and/or b u l i m i a , and those without e a t i n g d i s o r d e r s . To-date, numerous s t u d i e s have i n v e s t i g a t e d the phenomenon of body-image dis t u r b a n c e i n e a t i n g d i s o r d e r e d women. However, few s t u d i e s have i n v e s t i g a t e d body-image, se l f - e s t e e m , and body d i s s a t i s f a c t i o n i n e a t i n g d i s o r d e r e d women simu l t a n e o u s l y . Self-esteem The development of an i n d i v i d u a l ' s s e l f - c o n c e p t has been ex p l a i n e d by s e v e r a l t h e o r e t i c a l frameworks. In order to understand the la c k of s e l f - e s t e e m i n women with e a t i n g d i s o r d e r s , the development of the s e l f - c o n c e p t i t s e l f must be examined. According to Markus (1977) in f o r m a t i o n about the s e l f i s c a t e g o r i z e d i n t o s t r u c t u r e s that enable an i n d i v i d u a l to process new i n f o r m a t i o n . These self-schemata i n c l u d e c o g n i t i v e r e p r e s e n t a t i o n s from s p e c i f i c events experienced by the i n d i v i d u a l as w e l l as general events i n v o l v i n g the i n d i v i d u a l and ot h e r s . The self-schemata i s co n s t r u c t e d from past i n f o r m a t i o n and i s e s t a b l i s h e d i n the i n d i v i d u a l ' s memory. Once e s t a b l i s h e d , the self-schemata becomes a f i l t e r through which new in f o r m a t i o n i s processed and weighed f o r i t s o v e r a l l importance to the development of the s e l f -concept. Sanford and Donovan (1984) i n d i c a t e d an i n d i v i d u a l forms the s e l f - c o n c e p t through a s e r i e s of images which are important i n the o v e r a l l s t r u c t u r e of h i s or her world. Images of the s e l f - c o n c e p t d eal with v a r i o u s aspects or domains of the s e l f such as i n t e l l i g e n c e , job competence, m o r a l i t y , p h y s i c a l appearance, e t c . , and are g i v e n v a r y i n g degrees of importance to each i n d i v i d u a l . These images o r i g i n a t e w i t h i n the i n d i v i d u a l , the f a m i l y , and the c u l t u r e ; and they vary among c u l t u r e s , f a m i l i e s and i n d i v i d u a l s . Gecas and Mortimer (1984) i n d i c a t e d the s e l f - c o n c e p t was more c l o s e l y r e l a t e d to the i n d i v i d u a l ' s p e r c e p t i o n of other's e v a l u a t i o n s , r a t h e r than the a c t u a l e v a l u a t i o n s of o t h e r s . These r e f l e c t e d a p p r a i s a l s were t h e r e f o r e important i n the development of s e l f - e s t e e m . Kohut and Wolf (1978) r e f e r to the " s e l f o b j e c t " i n p s y c h o a n a l y t i c theory as t h i s important other ( u s u a l l y parent) c o g n i t i v e l y p e r c e i v e d as e x t e r n a l , while simultaneously seen as part of the s e l f . Given a p p r o p r i a t e empathic responses by the s e l f o b j e c t , an i n t e g r a t i o n of the c h i l d ' s and s e l f o b j e c t ' s i d e a l s and values occurs, c r e a t i n g a cohesive core s e l f which r e s u l t s i n high s e l f - e s t e e m . Without t h i s s e l f o b j e c t support, the i n d i v i d u a l w i l l begin to f e e l unworthy and i n e f f e c t i v e . These i n d i v i d u a l s w i l l experience l i f e from a p a s s i v e standpoint, l o o k i n g outward to e x t e r n a l o b j e c t s f o r s e l f - d e f i n i t i o n and reassurance. T h i s e x t e r n a l search f o r s e l f - d e f i n i t i o n and i n t e g r a t i o n i s p a r t i c u l a r l y t rue of women with e a t i n g d i s o r d e r s . B a i r d and S i g h t s (1986) observed the la c k of s e l f - e s t e e m i n 11 female anorexic and b u l i m i c p a t i e n t s d u r i n g a year - l o n g group therapy program. They s t a t e d that t h i s l a c k of s u f f i c i e n t esteem produced a "maladaptive attempt" to enhance esteem through the p u r s u i t of t h i n n e s s . The body seemed to l a c k i n t e g r a t i o n with the s e l f . When t h r e a t s occured to the s e l f , i t was experienced as a l o s s of c o n t r o l over the body which could only be r e c t i f i e d through the obsessive focus back onto the body. The authors noted that while low se l f - e s t e e m i s a component of other p s y c h o l o g i c a l problems, and does not completely e x p l a i n e a t i n g d i s o r d e r s , the need to focus on p h y s i c a l appearance to f e e l good diminished with the enhancement of s e l f - e s t e e m . In c l i n i c a l o b s e r v a t i o n s , Boskind-White (1976) d e s c r i b e d an u n d e r l y i n g problem of low sel f - e s t e e m i n 138 female u n i v e r s i t y students with anorexia or b u l i m i a . Over a two year p e r i o d , the is s u e s of food behaviours and appearance masked the nonexistent sense of s e l f , and were used as a mechanism to b o l s t e r low sel f - e s t e e m . S e l f - p s y c h o l o g y ( G o o d s i t t , 1985) d e s c r i b e d e a t i n g d i s o r d e r s as a d i s r u p t i o n of the s e l f and a defense mechanism to p r o t e c t the s e l f a g a i n s t f u r t h e r d i s r u p t i o n . Anorexics have poor s e l f - r e g u l a t o r y f u n c t i o n s (soothing, esteem r e g u l a t i o n , t e n s i o n and mood r e g u l a t i o n ) and t h e r e f o r e have 56 a sense of being e a s i l y i n f l u e n c e d and dependent on e x t e r n a l sources. The c o n t r o l of p h y s i c a l appearance r e f l e c t s the attempt to please the s e l f o b j e c t (Kohut & Wolfe, 1978), which to the e a t i n g d i s o r d e r e d woman has become the only source of s e l f - v a l i d a t i o n . Garner and G a r f i n k e l (1982) suggested that t h i s attachment of body shape to s e l f - w o r t h was i n agreement with s e l f - e s t e e m c o n s i s t e n c y theory, which s t a t e s that e x p e c t a t i o n s and per c e p t i o n s are determined by the i n d i v i d u a l ' s s e l f - e v a l u a t i o n of no n - p h y s i c a l a t t r i b u t e s . For women with e a t i n g d i s o r d e r s , s e l f - w o r t h becomes attached to body shape such t h a t body f a t becomes the index by which other a t t r i b u t e s are e v a l u a t e d . Research supports the n o t i o n that low s e l f - e s t e e m i n women with e a t i n g d i s o r d e r s i s r e l a t e d to the o v e r v a l u a t i o n of a t t r a c t i v e n e s s and thi n n e s s (Garner & G a r f i n k e l , 1983; Grace, Jacobson, & F u l l a g e r , 1985). Grace et a l . (1985) compared female purging b u l i m i c s (n = 26), non-purging b u l i m i c s (n = 24) and women without e a t i n g d i s o r d e r s (n = 24) on s e v e r a l measures i n c l u d i n g s e l f - e s t e e m . S e l f -esteem was measured using the Coopersmith S e l f Esteem Inventory (1967). A n a l y s i s of covariance produced s i g n i f i c a n t d i f f e r e n c e s among groups on self-esteem, and f u r t h e r a n a l y s i s with _t t e s t s r e v e a l e d both b u l i m i c groups showed lower s e l f -esteem than the comparison group (jt(74) = 4.59, _p_ </.000) but no s i g n i f i c a n t d i f f e r e n c e s between the two b u l i m i c groups (_t(50) = 15, £ X05). These r e s u l t s confirmed the author's past 57 c l i n i c a l o b servations l i n k i n g b u l i m i a with low sel f - e s t e e m . In 25 female anorexics assessed at a p s y c h i a t r i c u n i t , a p o s i t i v e c o r r e l a t i o n was found between low se l f - e s t e e m , body d i s t o r t i o n and body d i s s a t i s f a c t i o n (Garner & G a r f i n k e l , 1982). Body-image Body-image may be one aspect or image of s e l f - c o n c e p t . S c h i l d e r d e s c r i b e d body-image as, "[the] p i c t u r e of our own body which we form i n our mind, that i s to say the way i n which the body appears to o u r s e l v e s " (quoted i n Bruch, 1973, p.87) The concept of body-image d i s t o r t i o n o r i g i n a t e d from phantom limb phenomenon ( S c h i l d e r , 1950) i n which a l o s t body part continued to be represented i n the v i c t i m ' s consciousness. Wooley and Wooley (1985) equated the experience of l o s t body f a t i n e a t i n g d i s o r d e r e d women to t h i s phantom limb phenomenon, and f u r t h e r suggested concerns over body f a t may be heightened during emotional s t r e s s , i l l n e s s and s t a r v a t i o n . Bruch (1973) suggested that s i z e o v e r e s t i m a t i o n or body-image d i s t o r t i o n was experienced as a negative phantom phenomenon, where a woman denied p h y s i c a l m a t u r a t i o n a l changes, m i s l a b e l l i n g the i n c r e a s e i n br e a s t s and hips as excess f a t . S e v e r a l t h e o r e t i c a l frameworks e x p l a i n i n g body-image d i s t u r b a n c e i n women with e a t i n g d i s o r d e r s are worth mentioning. In c o g n i t i v e theory, body-image di s t u r b a n c e s are seen as d e n i a l mechanisms and m i s i n t e r p r e t a t i o n s of the meaning of 58 f a t which becomes encorporated i n t o the i n d i v i d u a l ' s b e l i e f system. Bruch (1973) d e s c r i b e d i t as, "the c o r r e c t n e s s or e r r o r i n c o g n i t i v e awareness of the b o d i l y s e l f , the accuracy of r e c o g n i z i n g s t i m u l i coming from without or w i t h i n , the sense of c o n t r o l over one's own b o d i l y f u n c t i o n s , the a f f e c t i v e r e a c t i o n s of the body c o n f i g u r a t i o n , and one's r a t i n g of the d e s i r a b i l i t y of one's body by o t h e r s " (p.80). • P a r a l l e l i n g Kohut and Wolf's (1978) s e l f o b j e c t theory, W i n n i c o t t ' s t r a n s i t i o n a l o b j e c t concept ( i n Wooley & Wooley, 1985) s t a t e s t h a t . t h e i n i t i a l s e c u r i t y , s e l f - e s t e e m and w e l l -being i s imparted by mother to c h i l d and l a t e r t r a n s f e r r e d by the c h i l d to an e x t e r n a l t r a n s i t i o n a l o b j e c t ( i . e . , s e c u r i t y b l a n k e t ) . The f i n a l stage i s an i n t e r n a l i z a t i o n of the o b j e c t i n t o the c h i l d ' s mental s t r u c t u r e . I f t h i s l a s t stage i s i n t e r r u p t e d , s t r u c t u r e s remain formed from e x t e r n a l sources. For example, i f the c h i l d ' s mother f e e l s inadequate about her own p h y s i c a l body, the developing c h i l d may not experience her body as a good and h e a l t h y form to have. Instead, the c h i l d may c o n s t r u c t what Orbach (1986) c a l l e d a " f a l s e body" to p r o t e c t her against t h i s unacceptable shape. The f a l s e body i s a defense which can be transformed i n t o a more accept a b l e shape, d e f i n e d by an e x t e r n a l source, which f o r most women today i s the c u l t u r a l standard of t h i n n e s s . T h i s t h i n , angular i d e a l i s then i n t e r n a l i z e d i n t o the c h i l d ' s mental s t r u c t u r e as the valued a t t r i b u t e against which she evaluates her own body shape. Bruch (1973) remarked, "the obsession of the Western world with slimness, the condemnation of any degree of overweight as undesirable and ugly, may w e l l be considered a d i s t o r t i o n of the s o c i a l body concept, but i t dominates present day l i v i n g " (p.88). Bruch (1973) was the f i r s t to suggest the importance of body-image disturbance i n ea t i n g d i s o r d e r s . She considered the d e n i a l of emaciation i n anorexia nervosa to be a d e l u s i o n a l q u a l i t y of the self-concept and body-image. For eating disordered women, the exaggerated importance and d i s t o r t i o n attached to t h e i r bodies has been so widely observed i n c l i n i c a l p r a c t i c e that the medical community has included body-image disturbance as one of the d i a g n o s t i c c r i t e r i a f o r anorexia nervosa (American P s y c h i a t r i c A s s o c i a t i o n , 1980). The experience of body overestimation appears to a f f e c t females more than males. Klesges (1983) studied 223 c o l l e g e students (102 males and 121 females) on a t t i t u d e and behaviour measures of t h e i r e a ting behaviours. Chi square a n a l y s i s on accuracy of subjects' estimations of weight c l a s s showed normal and underweight females reported they weighed more than they a c t u a l l y d i d (M = 5.17 l b s . , SD = 5.57 lbs.and M = 5.7 l b s . , SD = 5.37 l b s . r e s p e c t i v e l y ) , while normal and underweight males a c c u r a t e l y estimated t h e i r xveights (M = -.12 l b s . , SD = 7.37 l b s . , and M = -1.17 l b s . , SD = 6.29 r e s p e c t i v e l y ) . This study confirmed that body overestimation occurred i n women without e a t i n g d i s o r d e r s . 60 Thompson and Thompson (1986) a l s o examined the r e l a t i o n s h i p between se l f - e s t e e m and body d i s t o r t i o n i n 30 normal weight males and females. Using a s o p h i s t i c a t e d a d j u s t a b l e l i g h t beam apparatus, t h e i r f i n d i n g s confirmed that females s i g n i f i c a n t l y overestimated t h e i r bodies, p a r t i c u l a r l y at the waist and t h i g h s , more than males (F_(l, 58)" - 5.54, p_-602). The r e l a t i o n s h i p between s e l f - e s t e e m and body-image d i s t o r t i o n r e v e a l e d that a higher d i s t o r t i o n score was n e g a t i v e l y c o r r e l a t e d with a lower s e l f - e s t e e m score f o r females (r_ = -.40). Numerous s t u d i e s have i n v e s t i g a t e d the d i f f e r e n c e s between women with e a t i n g d i s o r d e r s and women without e a t i n g d i s o r d e r s , using d i f f e r e n t s i z e e s t i m a t i o n d e v i c e s . Although the methodologies have been c r i t i c i z e d f o r t h e i r g e n e r a l i z a b i l i t y (see Appendix B), the m a j o r i t y of s t u d i e s c o n f i r m that both groups of women overestimate t h e i r body shapes, but those with e a t i n g d i s o r d e r s tend to do so to a g r e a t e r degree. Button, F r a n s e l l a , and Slade (1977) argued that i n the cu r r e n t c u l t u r e , "where d i e t i n g and concerns about f i g u r e , s i z e and weight are commonplace, i t would, perhaps, seem s u r p r i s i n g i f a degree of body p e r c e p t i o n d i s t u r b a n c e was not the norm..." (p.236). In t h e i r study of 20 anorexic p a t i e n t s and normal females, body o v e r e s t i m a t i o n occurred to the same degree i n both groups (2% - 23% f o r a n o r e x i c s , 7% - 31% f o r normals). Willmuth, I e i t e n b e r g , Rosen, Fondacaro , and Gross (1985) used 20 b u l i m i a nervosa p a t i e n t s and 20 matched normal females 61 to measure s i z e d i s t o r t i o n (measured by a d j u s t a b l e s i z e -e s t i m a t i o n d e v i c e ) . They a l s o found both groups overestimated t h e i r s i z e , but the b u l i m i a nervosa group d i d so to a s i g n i f i c a n t l y d i f f e r e n t degree (10% - 20% f o r b u l i m i a nervosa, -2% - 9% normals). S i m i l a r l y , B i r t c h n e l l , Lacey, and Harte (1985) examined body-image d i s t o r t i o n i n 50 b u l i m i a nervosa females and 19 matched c o n t r o l s . R e s u l t s , u s i n g a s i m i l a r s i z e - e s t i m a t i o n apparatus as Willmuth et a l . (1985), showed both groups o v e r e s t i m a t i n g t h e i r s i z e s , with no s i g n i f i c a n t d i f f e r e n c e s between groups (M = 29.9% o v e r e s t i m a t i o n by b u l i m i c s , M = 21% o v e r e s t i m a t i o n by c o n t r o l s ) . These three s t u d i e s have a l l used a body-image measuring d e v i c e that has been shown to produce s i m i l a r r e s u l t s as the image marking method (Askevold, 1975) and d e r i v e s a d i s t o r t i o n index using the same mathematical c a l c u l a t i o n as i n the present study. S t a t i s t i c a l i n f o r m a t i o n on body-image d i s t o r t i o n ( N a t i o n a l E a t i n g D i s o r d e r s Information Centre, 1987) i n d i c a t e d that i n the normal p o p u l a t i o n , 90% of a l l women overestimated t h e i r body s i z e by an average of 25%. Forty percent of a l l women overestimated a p a r t i c u l a r body p a r t by as much as 50%. Studies (Button, F r a n s e l l a , & Slade, 1977; Willmuth, L e i t e n b e r g , Rosen, Fondacaro / & Gross, 1985) added the measure of an abdomen p r o f i l e i n i n v e s t i g a t i o n of s i z e o v e r e s t i m a t i o n because a l a r g e number of women with b u l i m i a nervosa complained of abnormally p r o t r u d i n g stomachs. Researchers have suggested that females have clearly-d e f i n e d images of how t h e i r bodies appear to them ( B e l l , K i r k p a t r i c k , & Rinn, 1986; F a l l o n & Rozin, 1985; Secord & Jour a r d , 1953). F a l l o n and Rozin (1985) showed 227 female students a s e r i e s of same-sex f i g u r e drawings and asked them to i d e n t i f y t h e i r c u r r e n t (how I look now) and i d e a l (how I would l i k e to look) shapes. They found the students picked a th i n n e r i d e a l shape than t h e i r c u r r e n t shape. B e l l , K i r k p a t r i c k , and Rinn (1986) conducted a s i m i l a r study using a n o r e x i c (n = 8), obese (n = 8), and normal weight (n = 8) females matched f o r age. Using 8 s i l h o u e t t e f i g u r e drawings, s u b j e c t s chose s i m i l a r c u r r e n t shapes across the three groups, i n d i c a t i n g a body o v e r e s t i m a t i o n on the part of the a n o r e x i c s . However, a l l s u b j e c t s chose f i g u r e s w i t h i n the same l i m i t e d range of shapes f o r t h e i r i d e a l image. These s t u d i e s suggest that the concept of body-image may be broken down i n t o an i n d i v i d u a l ' s p ersonal or i n d i v i d u a l i d e a l and a c u l t u r a l i d e a l , and that these two i d e a l s may d i f f e r i n shape. C u l t u r a l Ideal Sanford and Donovan (1984) i n d i c a t e d two d i s t i n c t female i d e a l s of beauty e x i s t e d which oppose each other, making i t impossible f o r women to o b t a i n the i d e a l s imultaneously. Type A was the curvaceous, bosomy woman and Type B was the 63 adolescent f a s h i o n model. Given the choice however, the most popular i d e a l was Type B. The Western c u l t u r a l i d e a l f o r women's shape has been de c r e a s i n g towards an angular look over the l a s t twenty years, while the a c t u a l rounded shape f o r women's bodies has been i n c r e a s i n g . Garner, G a r f i n k e l , Schwartz, and Thompson (1980) examined Playboy c e n t e r f o l d s and winning contestants of the Miss America Pageant f o r the years 1959 to 1978. For Playboy c e n t e r f o l d models, the percent of average weight f o r age and height decreased s i g n i f i c a n t l y over the time p e r i o d (_r = .22, jo <^.0l). The Miss America Pageant winners were compared to c o n t e s t a n t s , and r e s u l t s showed that o v e r a l l , there was an average weight d e c l i n e each year of 37 pounds. In a d d i t i o n , while the o v e r a l l winners had not weighed l e s s than the average c o n t e s t a n t s , s i n c e 1970 the winners had weighed s i g n i f i c a n t l y l e s s than the con t e s t a n t s (M = 82.5%, SD = 2.2%; M = 84.6%, SD = 1.4% winner and c o n t e s t a n t s , r e s p e c t i v e l y ) . I n d i v i d u a l Ideal M i c k a l i d e and Andersen (1985) s t u d i e d i d e a l f o r f i g u r e and weight i n a group of 165 anorexic and b u l i m i c women (Mean age 22.7 y e a r s ) . R e s u l t s showed v a r i a n c e i n the i d e a l s , with the b u l i m i c anorexic d e s i r i n g the t h i n n e s t i d e a l s of any group. S i l v e r s t e i n , Perdue, Peterson, Vogel, and F a n t i n i (1986) s t u d i e d 526 female undergraduates and found t h a t most heavy 64 women d i d not want to be as t h i n as the t h i n n e r women d i d . S i l v e r s t e i n , Peterson, and Perdue (1986) suggested that s e l f -s a t i s f a c t i o n decreased as personal body s i z e d e v i a t e d from the s o c i a l s t e r e o t y p e . Body D i s s a t i s f a c t i o n Women are c u r r e n t l y s t r i v i n g to o b t a i n a shape that i s c o n s t a n t l y changing each year, making i t impossible to o b t a i n and maintain the c u l t u r a l i d e a l shape. Body d i s s a t i s f a c t i o n or body disparagement i s l i n k e d to t h i s extreme change i n the c u l t u r a l image. St r i e g e l - M o o r e , S i l b e r s t e i n , and Rodin (1986) a l s o suggested t h a t d i s s a t i s f a c t i o n stemmed from the discrepancy between the a c t u a l and c u l t u r a l shape, not only because the c u l t u r a l i d e a l was becoming i n c r e a s i n g l y t h i n n e r , but because most women overestimated t h e i r body shape. Berscheid, Walster, and Bohrnstedt (1973) assumed that appearance was very important f o r women i n a t t r a c t i n g the opposite sex, f e e l i n g feminine and i n c r e a s i n g s e l f - e s t e e m . They surveyed 2 , 0 0 0 males and females to a s c e r t a i n how important body-image was to sel f - e s t e e m . L i k e Secord and Jourard (1953), these authors d e f i n e d body-image as s a t i s f a c t i o n with s p e c i f i c body p a r t s . Responses by p a r t i c i p a n t s i n d i c a t e d t h a t 50% were s a t i s f i e d with t h e i r body p a r t s , although females were l e a s t s a t i s f i e d with the mid-torso area. In comparing s e l f - e s t e e m and body s a t i s f a c t i o n i n the females, the l e v e l of s e l f - e s t e e m was r e l a t e d to f e e l i n g p r e t t y and being s l i m . 65 Willmuth, L e i t e n b e r g , Rosen, Fondacaro, and Gross (1985) examined the r e l a t i o n s h i p between body-image d i s t o r t i o n and body d i s s a t i s f a c t i o n i n 20 b u l i m i a nervosa p a t i e n t s and found a c o r r e l a t i o n between s i z e o v e r e s t i m a t i o n and scores on the body d i s s a t i s f a c t i o n subscale of the E a t i n g Disorder Inventory (r = .39, £ <\01). Garner and G a r f i n k e l (1982) a l s o found a moderate r e l a t i o n s h i p between body-image d i s t o r t i o n and body d i s s a t i s f a c t i o n i n 25 anorexic p a t i e n t s (r_ = -.48, £ 4-007). Freeman, Thomas, Solyom, S, Koopman ( 1985) examined these two v a r i a b l e s i n r e s t r i c t o r a n orexic (n = 17), p r e v i o u s l y a n o r e x i c b u l i m i c s (n = 23), never anorexic b u l i m i c s (n = 24), phobic c o n t r o l s (n = 18) and normal c o n t r o l s (n = 33). Body d i s s a t i s f a c t i o n was measured by c a l c u l a t i n g the discrepancy between estimates of a c t u a l and i d e a l s i z e , u s i n g a video d i s t o r t i o n camera. R e s u l t s showed that while a l l the groups were d i s s a t i s f i e d with t h e i r p e r c e i v e d body s i z e , the two b u l i m i c groups repo r t e d the l a r g e s t d i s s a t i s f a c t i o n (normals M = 8.5, SD = 4.9; p r e v i o u s l y anorexic b u l i m i c s M = 20.8, SD = 12.4; never anorexic b u l i m i c s M = 17.3, SD = 11.1). As Sanford and Donovan (1984) remarked that the s e l f -concept was formulated from s e v e r a l images, Garner and G a r f i n k e l (1982) suggested that body d i s s a t i s f a c t i o n could be subca t e g o r i z e d under the general concept of self-esteem, 66 and may play a major r o l e i n an i n d i v i d u a l ' s s i z e e s t i m a t i o n , e s p e c i a l l y when coupled with c u l t u r a l concerns towards t h i n n e s s . Summary In summary, women with e a t i n g d i s o r d e r s appear to r e l y on e x t e r n a l sources of s e l f - d e f i n i t i o n to f e e l they are worthy i n d i v i d u a l s . The e x t e r n a l source deemed important to women i n Western c u l t u r e seems to be the appearance of a t h i n body. Obsessive focus on o b t a i n i n g the t h i n body may defend these women aga i n s t the f e a r of emptiness or nonexistence, and i n tu r n , may help them d e f i n e themselves and s t r u c t u r e t h e i r d a i l y l i v e s . APPENDIX B D e s c r i p t i o n of Measures and D i a g n o s t i c C r i t e r i a 68 Appendix B D e s c r i p t i o n of Measures and D i a g n o s t i c C r i t e r i a T h i s s e c t i o n more f u l l y d e s c r i b e s the measures used i n t h i s study. In a d d i t i o n , i t i n c l u d e s the d i a g n o s t i c c r i t e r i a and s c r e e n i n g method used to c l a s s i f y s u b j e c t s i n t o e i t h e r the symptomatic group (women with e a t i n g d i s o r d e r s ) or the asymptomatic group (women without e a t i n g d i s o r d e r s ) . E a t i n g A t t i t u d e s Test (EAT). The EAT (Garner & G a r f i n k e l , 1979) was used as a sc r e e n i n g device to c a t e g o r i z e s u b j e c t s i n t o the asymptomatic group. The authors r e p o r t e d an alpha r e l i a b i l i t y c o e f f i c i e n t of .79.for anorexic p a t i e n t s and .94 fo r combined anorexic and c o n t r o l s , i n d i c a t i n g a high degree of i n t e r n a l r e l i a b i l i t y . The EAT was shown to d i s c r i m i n a t e between the comparison and anorexic females, with the t o t a l EAT score s i g n i f i c a n t l y c o r r e l a t e d with the- c r i t e r i o n group i n c l u s i o n (_r = .87, p_<.00l) and there was l i t t l e o v e rlap i n the two group's frequency d i s t r i b u t i o n s . Only 7% of the normal c o n t r o l s scored as hig h as the lowest anorexic p a t i e n t s . R a c i t i and Norcross (1987) found an alpha c o e f f i c i e n t of .86 f o r the EAT. These authors compared the EAT with the Eat i n g Disorder Inventory (Garner & Olmstead, 1984) f o r c l a s s i f i c a t i o n of s u b j e c t s , and found high agreement i n i d e n t i f y i n g approximately 85% of the women as not weight-preoccupied (using a c u t o f f score of 30 on the EAT). They i d e n t i f i e d the E a t i n g D i s o r d e r Inventory as more c o n s e r v a t i v e than the EAT i n c l a s s i f y i n g women as weight-preoccupied. In the present study, a c u t o f f score of 15 on the EAT was 69 used to c l a s s i f y s u b j e c t s as not weight-preoccupied. T h i s more c o n s e r v a t i v e score r e f l e c t s the mean score of normal s u b j e c t s reported on the EAT s c a l e (M = 15.6). A d u l t S e l f - P e r c e p t i o n P r o f i l e (ASPP). The ASPP (Messer & Harter, 1986) was developed as a mu l t i d i m e n s i o n a l instrument to measure a d u l t s e l f - c o n c e p t ( s e l f - e s t e e m ) . This s c a l e was d i v i d e d i n t o 11 domains (4 items each) and one domain (6 items each) that was independent of the r e s t . The domains i n c l u d e d : (a) s o c i a b i l i t y , (b) job competence, (c) nurturance ( c a r i n g f o r o t h e r s ) , (d) a t h l e t i c a b i l i t i e s , (e) p h y s i c a l appearance, ( f ) adeguate p r o v i d e r , (g) m o r a l i t y , (h) household management, ( i ) intimate r e l a t i o n s h i p s , ( j ) i n t e l l i g e n c e , (k) sense of humor, and (1) g l o b a l s e l f -worth. For purposes of t h i s study, the subscale of g l o b a l s e l f - w o r t h was used which r e f l e c t s an e v a l u a t i v e component of one's worth or esteem. The authors had devised the g l o b a l s e l f - w o r t h subscale as an i n d i c a t o r of an o v e r a l l sense of competency. U n l i k e other s e l f - e s t e e m measures that use a summation score to d e r i v e s e l f - w o r t h (Coopersmith, 1967; F i t t s , 1965; Rosenberg, 1979), the g l o b a l s e l f - w o r t h subscale of the ASPP was devised to stand independently of other domains in c l u d e d i n t h i s measure. The ASPP was o r i g i n a l l y normed on two samples. Sample A c o n s i s t e d of 141 parents (male and female) with an age range of 30 to 50 years, who were upper middle c l a s s 70 f a m i l i e s , 100% having completed high s c h o o l , with the m a j o r i t y having completed c o l l e g e . N i n e t y - f i v e percent of t h i s group were Caucasian. This sample was d i v i d e d i n t o four groups: (a) f u l l - t i m e homemakers/mothers (n = 42), (b) part-time working women/mothers (n = 26), (c) f u l l - t i m e working mothers (n = 29), and (d) f u l l - t i m e working f a t h e r s (n = 44). Sample B c o n s i s t e d of 215 mothers with a mean age of 26, and a l l having c h i l d r e n under three years of age. Subjects were from both middle and lower c l a s s e s , over 90% were married, 90% had completed h i g h s c h o o l , 50% had attended c o l l e g e , and 95% were Caucasian. T h i s sample was d i v i d e d i n t o two groups: (a) working mothers, and (b) homemakers. * Messer and Harter (1986) reported i n t e r n a l c o n s i s t e n c y (based on Cronbach's alpha) acceptable f o r a l l 12 domains with g l o b a l s e l f - w o r t h producing .91 and .87 f o r both sample A and B r e s p e c t i v e l y . E a t i n g Disorder Inventory (EDI). The EDI (Garner & Olmstead, 1984) was devised because e x i s t i n g p e r s o n a l i t y measures di d not adequately address the c o g n i t i v e and b e h a v i o u r a l c h a r a c t e r i s t i c s observed c l i n i c a l l y i n anorexia nervosa. In a d d i t i o n , the measurement of p s y c h o l o g i c a l t r a i t s was important f o r the d e l i n e a t i o n and treatment of anorexia nervosa and b u l i m i a . O r i g i n a l l y , 11 c o n s t r u c t s were designed to measure the p s y c h o l o g i c a l and b e h a v i o u r a l components of anorexia nervosa and b u l i m i a , however, only 71 the f o l l o w i n g 8 subscales met the r e l i a b i l i t y and v a l i d i t y requirements set by the authors, to be inc l u d e d i n the s c a l e : (a) d r i v e f o r t h i n n e s s , (b) b u l i m i a , (c) body d i s s a t i s f a c t i o n , (d) i n e f f e c t i v e n e s s , (e) p e r f e c t i o n i s m , ( f ) i n t e r p e r s o n a l d i s t r u s t , (g) i n t e r o c e p t i v e awareness, and (h) maturity f e a r s . T h i s study used two s u b s c a l e s : (a) body d i s s a t i s f a c t i o n and (b) i n e f f e c t i v e n e s s . Body d i s s a t i s f a c t i o n r e f e r r e d to the f e e l i n g that body pa r t s a s s o c i a t e d with m a t u r a t i o n a l changes ( i e : h i p s , buttocks, t h i g h s ) were too l a r g e . I n e f f e c t i v e n e s s r e f e r r e d to an negative e v a l u a t i v e component of s e l f - w o r t h . The s c a l e was normed on a c r i t e r i o n group of three subsamples of female anorexia nervosa p a t i e n t s (N = 113). Half of the t o t a l group were r e s t r i c t o r a norexics (n = 48) while the other h a l f e x h i b i t e d b u l i m i c symptoms (n = 65). The mean age f o r the combined subgroups was 21.8 years. The comparison group comprised three independent subsamples of female u n i v e r s i t y students (N = 577). The mean age of the combined group was 19.9 years. Garner and Olmstead (1984) repor t e d r e l i a b i l i t y f o r a l l subscales r e g u i r e d a Cronbach's alpha s et above .80 f o r the anorexic samples. The i n t e r n a l c o n s i s t e n c y f o r the i n e f f e c t i v e n e s s subscale was .93 f o r anorexics and .88 f o r comparisons. For body d i s s a t i s f a c t i o n , r e l i a b i l i t y was reported at .90 f o r anorexics and .92 f o r comparisons. 72 The authors reported evidence of c r i t e r i o n - r e l a t e d , convergent, d i s c r i m i n a n t and construct v a l i d i t y . C r i t e r i o n -r e l a t e d v a l i d i t y was e s t a b l i s h e d by comparing the EDI reports of anorexic p a t i e n t s (n = 49) to the c l i n i c a l judgments of two c l i n i c i a n s f a m i l i a r w i t h these p a t i e n t s . C l i n i c i a n s were asked to "rate the relevancy of each of these t r a i t s or c h a r a c t e r i s i t c s f o r t h i s p a t i e n t compared to other anorexics that you have t r e a t e d " (p. 6). C o r r e l a t i o n s between the p a t i e n t reports and c l i n i c i a n r a t i n g s were s i g n i f i c a n t at the £^..001 l e v e l f o r a l l subscales (.68 f o r i n e f f e c t i v e n e s s and .44 f o r body d i s s a t i s f a c t i o n ) . Convergent and d i s c r i m i n a n t v a l i d i t y were determined f o r the anorexia nervosa p a t i e n t s , since s e v e r a l of the EDI subscales overlapped the constructs of e x i s t i n g p s y c h o l o g i c a l t e s t s . Using an alpha l e v e l of £<\001 f o r c o r r e l a t i o n s , the body d i s s a t i s f a c t i o n and bul i m i a subscales were s i g n i f i c a n t l y r e l a t e d to percent of average weight. Body d i s s a t i s f a c t i o n was most r e l a t e d to d i s s a t i s f a c t i o n with maturational areas which were h i g h l y s e n s i t i z e d f o r the majority of eating disordered p a t i e n t s ( i e : b r e a s t s , buttocks, hips and abdomen). The i n e f f e c t i v e n e s s subscale was r e l a t e d to low self-esteem, depression, and e x t e r n a l locus of c o n t r o l . R a c i t i and Norcross (1987) reported a t o t a l EDI r e l i a b i l i t y c o e f f i c i e n t (Cronbach's alpha) of .93 f o r a female c o l l e g e sample (n = 283). I n e f f e c t i v e n e s s and body d i s s a t i s f a c t i o n showed .90 and .92 r e s p e c t i v e l y . These authors reported t h a t , "the EDI appears to be an i n t e r n a l l y c o n s i s t e n t , m u l t i d i m e n s i o n a l instrument with a r e l a t i v e l y s t a b l e f a c t o r s t r u c t u r e that accounts f o r a h i g h percentage of the t o t a l v a r i a n c e " (p. 585). The authors concluded the EDI was a v a l u a b l e s c a l e f o r r e s e a r c h i n e a t i n g d i s o r d e r s . . Image Marking Method. Askevold's (1975) Image Marking Method was used i n t h i s study to measure body-image d i s t u r b a n c e . Measurements were taken at three body s i t e s : (a) widest p a r t of the shoulders, (b) narrowest part of the waist, and (c) widest p a r t of the h i p s . These measurements were recorded on a blank sheet of paper (72"x29") taped to the w a l l . The s u b j e c t ' s p e r c e i v e d body widths were compared to the s u b j e c t ' s a c t u a l body widths (recorded by the experimenter) and a body-image p e r c e p t i o n index was d e r i v e d by c a l c u l a t i n g : p e r c e i v e d s i z e X 100 a c t u a l s i z e R e s u l t s above 100 i n d i c a t e d an o v e r e s t i m a t i o n , while r e s u l t s below 100 i n d i c a t e d underestimation of body widths. Askevold t e s t e d t h i s method on a symptomatic group of anorexic and obese females (n = 22), and an asymptomatic group of female p h y s i o t h e r a p i s t s (n = 20). His r e s u l t s showed that both groups overestimated the widths of t h e i r body s i t e s by an average of 5 centimeters, with the anorexic s u b j e c t s i n d i c a t i n g a markedly gr e a t e r o v e r e s t i m a t i o n than the comparison group. Using t h i s technique, other r e s e a r c h e r s have been able to d i f f e r e n t i a t e between an o r e x i c p a t i e n t s and comparison groups (Slade, 1985; Wingate & C h r i s t i e , 1978). Although s u b j e c t s i n each of the s t u d i e s overestimated t h e i r s i z e , the anorexic groups d i d so to a s i g n i f i c a n t l y g r e a t e r degree. Garner and G a r f i n k e l (1982) recorded a r e l i a b i l i t y c o e f f i c i e n t of .60 using the image marking method. Slade (1985) reviewed the use of d i s t o r t i o n measuring devices and found the image marking-procedure and s i z e - e s t i m a t i o n procedure (movable c a l p i e r technigue) obtained s i m i l a r r e s u l t s i n o v e r e s t i m a t i o n . In combining s t u d i e s on o v e r e s t i m a t i o n and image marking, Slade i n v e s t i g a t e d the i n t e r n a l c o n s i s t e n c y of s i z e - e s t i m a t i o n techniques. Three s t u d i e s i n v o l v e d anorexic s u b j e c t s , with an average c o r r e l a t i o n of .72. A l l four s t u d i e s i n v o l v e d normal s u b j e c t s with an average c o r r e l a t i o n between measures of .63. Slade s t a t e d these s t u d i e s suggested a reasonable l e v e l of i n t e r n a l c o n s i s t e n c y f o r the anorexic and normal s u b j e c t s using e i t h e r the s i z e - e s t i m a t i o n or image marking techniques. One c r i t i c i s m of the image marking method i s i t ' s r e p o r t e d l a c k of use i n subsequent i n v e s t i g a t i o n s of body-image d i s t u r b a n c e . While f u r t h e r s t u d i e s using t h i s method may have produced s i m i l a r r e s u l t s i n s i z e e s t i m a t i o n , r e s e a r c h e r s have i n s t e a d , chosen to design and use more s o p h i s t i c a t e d d i s t o r t i o n measurement devices r a t h e r than attempting r e p l i c a t i o n u s ing the o r i g i n a l marking method. T h i s l a c k of r e p l i c a t i o n has produced a problem i n making g e n e r a l i z a t i o n s or comparisons between s t u d i e s r e g a r d i n g the r e l i a b i l i t y of body-image measurement devices (Slade, 1985). For example, the image marking method (Askevold, 1975; Wingate & C h r i s t i e , 1978), the a d j u s t a b l e l i g h t beam apparatus (Thompson & Thompson, 1986), and the video camera with d i s t o r t i o n lenses (Freeman, Beach, Davis, & Solyom, 1985; Touyz, Beumont, C o l l i n s , & Cowie, 1985) use d i f f e r e n t i n d i c e s and measurement of body d i s t o r t i o n and r e q u i r e d i f f e r e n t s u b j e c t p a r t i c i p a t i o n . These d i f f e r e n t methods make comparisons between techniques q u e s t i o n n a b l e . In a d d i t i o n , the a d j u s t a b l e l i g h t beams and video cameras are expensive, h i g h l y s o p h i s t i c a t e d and only a v a i l a b l e i n c l i n i c a l l a b o r a t o r i e s , making them u n s u i t a b l e f o r use by c o u n s e l l o r s and t h e r a p i s t s i n o u t p a t i e n t s e t t i n g s . The use of a r e l i a b l e a l t e r n a t i v e method of measuring body-image d i s t u r b a n c e i s p a r t i c u l a r l y of i n t e r e s t to non-medical p r o f e s s i o n a l s due to the l a c k of medical s p e c i a l i s t s t r e a t i n g e a t i n g d i s o r d e r e d women. As more of these women seek non-medical i n t e r v e n t i o n , c o u n s e l l o r s and t h e r a p i s t s w i l l r e q u i r e access to methods e a s i l y administered to provide a mu l t i d i m e n s i o n a l treatment program. While reported r e l i a b i l i t y of the image marking method appears moderate, and i t s use i n resea r c h has been l i m i t e d , i t i s a simple and inexpensive method of body-image d i s t u r b a n c e measurement. I f past f i n d i n g s on body o v e r e s t i m a t i o n were 76 confirmed using t h i s method, i t would suggest t h i s technique may be a r e l i a b l e a l t e r n a t i v e to the more t e c h n o l o g i c a l machines c u r r e n t l y used i n r e s e a r c h . Askevold (1975) mentioned the use of an angle to help make an accurate measurement of each body s i t e . For the present study, a T-bar (9.88" at the head x 20.5" i n length) was c o n s t r u c t e d to record s u b j e c t ' s a c t u a l body s i t e s . In a h o r i z o n t a l p o s i t i o n , the handle of the bar was placed a g a i n s t the s u b j e c t ' s s i d e at each body s i t e , and the head was placed a g a i n s t the, sheet of paper. In t h i s p o s i t i o n , the experimenter could r e c o r d the a c t u a l body s i t e s chosen by the s u b j e c t s themselves, r a t h e r than making a s u b j e c t i v e measurement of each s i t e . For example, what the experimenter t h i n k s i s the narrowest part of the s u b j e c t ' s waist may not c o i n c i d e with the s u b j e c t ' s i n t e r n a l image of the same r e g i o n . P e r c e i v e d Body Image Scale (PBIS). The PBIS (Manley & LePage, 1986) i s a c o g n i t i v e , a f f e c t i v e and p e r c e p t u a l measure of body-image. The drawings from t h i s s c a l e were -used i n the c u r r e n t study to measure a c u l t u r a l and i n d i v i d u a l i d e a l female shape f o r each s u b j e c t , r a t h e r than measuring body-image d i s t o r t i o n . T h i s s c a l e i n c l u d e s four q u e s t i o n cards, three measuring body-image e s t i m a t i o n s and one i n d i c a t i n g a p e r s o n a l preference or i d e a l body-image. The p e r s o n a l i d e a l q u e s t i o n card was used i n t h i s study to measure personal or i n d i v i d u a l i d e a l (which body best represents the way you would l i k e to l o o k ? ) . To measure the c u l t u r a l i d e a l , the experimenter designed and i n c l u d e d an a d d i t i o n a l card (which 77 body best represents the most sought a f t e r shape f o r women i n our c u l t u r e today?). T h i s card was then p i l o t e d on f i v e women, ranging i n age from 16 - 71 years, using the female f i g u r e cards of t h i s s c a l e . Each woman was asked the meaning she gave to the question, and a l l i n d i c a t e d t h e i r c h o i c e was based on a media image of "someone l i k e the models i n the magazines". This checking procedure was a l s o adopted f o r a l l s u b j e c t s i n the study to ensure they understood the question's i n t e n t i o n . S e v e r a l s u b j e c t s commented duri n g the study t h a t t h e i r choice f o r the c u l t u r a l i d e a l was based on the look of t h i n n e s s , the presence of p r o t r u d i n g bones, or the absence of a rounded tummy. When questioned f u r t h e r , these comments were made based on the images presented i n magazines, by f a s h i o n models and on t e l e v i s i o n . T h e r e f o r e , the i n t e n t i o n of measuring a c u l t u r a l image presented by media was accomplished. In a d d i t i o n , when t h i s card was handed to s u b j e c t s , the usual q u e s t i o n they asked was whether the experimenter wanted a perso n a l o p i n i o n or the o p i n i o n of women i n g e n e r a l , which i n d i c a t e d the two may be very separate. The f i g u r e cards of the PBIS were produced by a medical a r t i s t who began with a s k e l e t a l frame which became the f i r s t card ( s m a l l e s t s i z e ) . An acetate paper was pl a c e d over t h i s drawing and a g r i d was drawn on the acetate such that the v e r t i c a l l i n e was placed down the middle of the drawn f i g u r e and two h o r i z o n t a l l i n e s were drawn; (a) across the shoulder and i l i a c c r e s t , and (b) across the mid-torso both i n t e r -s e c t i n g the v e r t i c a l l i n e . G r i d p o i n t s were drawn on the 78 h o r i z o n t a l l i n e s i n equal increments from the v e r t i c a l l i n e . Card 2 was created (one f i g u r e s i z e l a r g e r ) on the acetate paper by drawing a female body using - one increment from the m i d - v e r t i c a l l i n e as the body o u t l i n e . A l l subsequent cards were created i n the same manner, i n c r e a s i n g i n equal increments u n t i l card 11 depicted the l a r g e s t s i z e . The PBIS was o r i g i n a l l y administered to a c l i n i c a l and c o n t r o l group between the ages of 13 and 31 years to measure body-image disturbance. The c l i n i c a l group (n =40) was comprised of i n - p a t i e n t s and out-patients seeking treatment f o r anorexia nervosa or b u l i m i a at a l o c a l h o s p i t a l or p r i v a t e c l i n i c . The comparison group "(n = 24) were volunteers from a l o c a l high school and s t a f f at a l o c a l h o s p i t a l . The authors found t h i s s c a l e produced s i g n i f i c a n t d i f f e r e n c e s between the eating disordered group and the comparison group on the Ideal question, although no s i g n i f i c a n c e was found w i t h i n the eating disordered group ( c o n t r o l s M = 4.3, anorexic M = 3.4, and b u l i m i c s M = 3.3). I n t e r r a t e r r e l i a b i l i t y (.88 and .87 f o r two teams of r a t e r s ) and t e s t - r e t e s t r e l i a b i l i t y (.78 and .85 f o r r a t e r s ) f o r I d e a l question were found to be s i g n i f i c a n t at the p_ 001 l e v e l . T e s t - r e t e s t r e l i a b i l i t y was conducted on 14 eating disordered p a t i e n t s who were tested over 56.5 days during h o s p i t a l i z a t i o n (authors caution that weights f l u c t u a t e d during the t e s t i n g which could a f f e c t the c o e f f i c i e n t ) . For the Ideal card, the t e s t - r e t e s t r e l i a b i l i t y was .68, p_ ^.007. 79 S e l e c t i o n C r i t e r i a Subjects f o r the e a t i n g d i s o r d e r e d group were s e l e c t e d a c c o r d i n g to t h e i r symptoms, using e i t h e r the DSM-III C r i t e r i a f o r Anorexia Nervosa (American P s y c h i a t r i c A s s o c i a t i o n , 1980) or R u s s e l l ' s (1979) c r i t e r i a f o r Bulimia Nervosa. For s e l e c t i o n c r i t e r i a on both, see Tables 7 and 8 r e s p e c t i v e l y . 80 Table 7 DSM-III C r i t e r i a f o r Anorexia Nervosa (a) Intense fear of becoming obese, which does not diminish as weight l o s s progresses. (b) Disturbance of body image, e.g. cl a i m i n g to " f e e l " f a t even when emaciated. (c) *Weight l o s s of at l e a s t 25% of o r i g i n a l body weight or, i f under 18 years of age, weight l o s s from o r i g i n a l body weight plus projected, weight gain expected from growth charts may be combined to make the 25%. (d) Refusal to maintain body weight over a minimal normal weight f o r age and height. (e) No known p h y s i c a l i l l n e s s that would account f o r the weight l o s s . * A m o d i f i c a t i o n of 20% weight l o s s was used. 81 Table 8 R u s s e l l ' s (1979) C r i t e r i a f o r Bulimia Nervosa (a) A powerful and i n t r a c t i b l e urge to overeat r e s u l t i n g i n episodes of o v e r e a t i n g . (b) Avoidance of " f a t t e n i n g " e f f e c t s of food by inducing vomiting or abusing p u r g a t i v e s or both. (c) A morbid f e a r of becoming f a t . 8 2 APPENDIX C P u r p o s e o f S t u d y L e t t e r APPENDIX D Test B o o k l e t Package Consent form E a t i n g A t t i t u d e s T e s t A d u l t S e l f - P e r c e p t i o n P r o f i l e E a t i n g D i s o r d e r I n v e n t o r y Demographic sheet 86 EATING ATTITUDES TEST Please place an "X" under the column which applies best to each of the numbered statements. Most of the questions direct ly relate to food or eating, although other types of questions have been included. There are NO right or wrong answers so try very hard to be completely honest in your answers. Results are completely confidential. Please answer each question carefully. a tu CO ft me CO o •iH >> C 4-> r H u CO >, CD CD CD CD 5 u 4-1 6 U > CD l « o rt) CD < > O CO PS 85 1. Like eating with other people. 2. Prepare foods for others but do not eat what I cook. 3. Become anxious prior to eating. 4. Am terr i f i ed about being overweight. 5. Avoid eating when I am hungry. 6. Find myself preoccupied with food. 7. Have gone on eating binges where I feel that I may not be able to stop. 8. Cut my food into small pieces. 9. Aware of the calorie content of foods that I eat. 10. Particularly avoid foods with a high carbohydrate content (e.g. bread, potatoes, r i ce , e tc . ) . 1-1. Feel bloated after meals. 12. Feel that others would prefer i f I ate more. 13. Vomit after I have eaten. 14. Feel extremely guilty after eating. 15. Am preoccupied with a desire to be thin. 16. Exercise strenuously to burn off calories. 17. Weight myself several times a day. 18. Like my clothes to f i t t ight ly . 19. Enjoy eating meats. 20. Wake up early in the morning. 21. Eat the same foods day after day. 22. Think about burning up calories when I exercise. 23. Have regular menstrual periods. 24. Other people think that I am too thin. 25. Am preoccupied with the thought of having fat on my body. 26. Take longer than others to eat my meals. 27. Enjoy eating at restaurants. 28. Take laxatives. 29. Avoid foods with sugar in them. 30. Eat diet foods. 31. Feel that food controls my l i f e . 32. Display self-control around food. 33. F«e l that others pressure me to eat. 34. Give too much time and thought to food. 35. Suffer from constipation. 36. Feel uncomfortable after eating 37. Engage, in dieting behaviour. 38. Like my stomach to be empty. 39. Enjoy trying new rich foods. 40. Have the impulse to vomit after CO +J CD B 10 o • H >, c +J ta >, CD 01 s u 4-> S rH CM o < > o CO sweets. meals. WHAT I AM LIKE T h e s e are s ta tements w h i c h a l l o w p e o p l e to d e s c r i b e t h e m s e l v e s . T h e r e are n o r ight o r w r o n g answers s ince p e o p l e d i f fer m a r k e d l y . P lease read the ent i re s e n t e n c e a c r o s s . First d e c i d e w h i c h o n e of the two parts o f e a c h s ta tement best describes you; then go to that s ide of the s t a t e m e n t a n d c h e c k w h e t h e r that is just sort of t rue for y o u or really true for v o u . Y o u wil l just c h e c k O N E of the f o u r boxes for e a c h s t a t e m e n t . R e a l l y Sor t o f T r u e T r u e for M e for M e ( ) ( ) S o m e adu l ts l ike the w a y they are l e a d i n g their l ives B U T O t h e r adu l ts d o n ' t l ike the w a y they are l e a d i n g their l ives. Sort of R e a l l y T r u e T r u e for M e for M e ( ) ( ) ( } ( ) S o m e adu l ts fee l that they are e n j o y a b l e to be w i th ( ) ( ) S o m e a d u l t s are no t sa t i s f i ed w i th the w a y they d o their work ( ) ( ) S o m e adu l ts see c a r i n g o r nur tu r ing o thers as a c o n t r i -b u t i o n to the fu tu re B U T O t h e r adu l ts o f t e n q u e s t i o n ( ) ( } w h e t h e r they are e n j o y a b l e to b e wi th . B U T O t h e r a d u l t s are sa t is f ied the ( ) ( ) w a y they d o their w o r k . B U T O t h e r adu l ts d o no t ga in a ( ) ( ) sense of c o n t r i b u t i o n to the fu tu re t h r o u g h nur tu r ing o thers . ( ) ( ) In g a m e s a n d spor ts s o m e a d u l t s u s u a l l y w a t c h ins tead o f p l a y B U T O t h e r adu l ts u s u a l l y p l a y rather than just w a t c h . ( ) ( ) ( ) ( ) S o m e adu l ts are h a p p y w i th the w a y they l o o k ( ) ( ) S o m e adu l ts fee l they are no t a d e q u a t e l y s u p p o r t i n g t h e m -selves a n d t h o s e w h o are i m p o r t a n t to t h e m ( ) ( ) S o m e a d u l t s l ive u p to their o w n m o r a l s t a n d a r d s B U T O t h e r adu l ts are no t h a p p y w i th the w a y they look . B U T O t h e r adu l ts feel they are p r o v i d i n g a d e q u a t e s u p p o r t for t h e m s e l v e s a n d o thers B U T O t h e r adu l ts h a v e t r o u b l e l iv ing u p to their m o r a l s t a n d a r d s . ( ) ( ) ( ) ( ) ( ) ( ) 10. ( ) ( ) S o m e adu l ts are ve ry h a p p y b e i n g the w a y they are ( ) ( ) S o m e adu l ts are not ve ry o r g a n i z e d in c o m p l e t i n g h o u s e h o l d tasks B U T O t h e r adu l ts w o u l d l ike ( ) to b e d i f fe rent . B U T O t h e r adu l ts are o r g a n i z e d in c o m p l e t i n g h o u s e h o l d tasks. ( ) ( ) ( ) 11 . ( ) ( ) S o m e a d u l t s h a v e the ab i l i ty to d e v e l o p i n t i m a t e r e l a t i o n s h i p s B U T O t h e r adu l ts d o no t f i n d it e a s y to d e v e l o p in t ima te re la t ionsh ips . ( ) ( ) •J2. ( ) ( ) W h e n s o m e adu l ts d o n ' t u n d e r s t a n d s o m e t h i n g , it m a k e s t h e m fee l s t u p i d B U T O t h e r adu l ts d o n ' t n e c e s s a r i l y fee l s t u p i d w h e n they d o n ' t u n d e r s t a n d . ( ) 13. 14. ( ) ( ) S o m e adu l ts c a n rea l ly l a u g h at t h e m s e l v e s ( ) ( ) S o m e adu l ts feel u n c o m f o r t a b l e w h e n they have to m e e t new p e o p l e B U T O t h e r adul ts have a hard t ime ( ) l a u g h i n g at t h e m s e l v e s B U T O t h e r adu l ts l ike to m e e t new p e o p l e . ( ) ( ) ( ) IS. ( ) ( ) S o m e adul ts feel they are very g o o d at their w o r k B U T O t h e r adul ts wor ry a b o u t ( ) ( ) w h e t h e r they c a n d o their work Metier and Harter. Adult Self-Perception Profile. Univenitv.of Denver. 1984 (R) - 2 - 8 9 16. (. ) ( •) Some adults do not enjoy fostering the growth of others BUT Other adults enjov fostering ( ) ' ( ). the growth of others 17. ( ) ( ) Some adults sometimes question whether they are a worthwhile person BUT Other adults feel that they are a worthwhile person ( ) ( ) 18. ( ) ( ) Some adults think thev could BUT Other adults are afraid they ( ) ( ) do well at just about any new physical activity they haven't tried before might not do well at physical activities riiey haven t ever tried. 19. ( ) ( ) Some adults think that they are not very attractive or good looking BUT Other adults think that thev are attractke or good looking ( ) ( ) 20. ( . ) . ( ) Some adults are satisfied with how thev provide for the important people in their lives BUT Other adults are dissatisfied with how thev provide for these people-( ) ( ) 21. 22. ( ) ( ) ( ) Some adults would like to be a BUT Other adults think that they better person morally are quite moral ( ) Some adults can keep their household running smoothly BUT Other adults have trouble keeping their household running smoothly ( ) ( ) ( ) ( ) 23. ( ) ( ) Some adults find it hard to BUT Other adults do not have establish intimate relationships difficulty establishing intimate relationships. ( ) ( ) 24. ( ) ( ) Some adults feel that they are intelligent BUT Other adults question whether ( ) ( ) they are very intelligent. 2S- ( ) ( ) Some adults are disappointed 8UT Other adults are quite pleased ( ) ( ) with themselves with themselves. 26. ( ) ( ) Some adults find it hard to act BUT Other adults find it very easy ( ) ( ) in a joking or kidding manner with friends or colleagues to joke or kid around with friends and colleagues. 27. ( ) ( ) Some adults feel at ease with other people 28. ( ) ( ) Some adults are not very productive in their work BUT Other adults are quite shy. ( ) BUT Other adults are very ( ) productive in their work. ( ) ( ) 29. ( ) ( ) Some adults feel they are good at nurturing others BUT Other adults are not very ( ) nurturant. ( ) 30. ( ) ( ) Some adults do not feel that they are very good when it comes to sports BUT Other adults feel they do ( ) ( ) very well at all kinds of sports. 31. ( ) ( ) Some adults like their physical BUT Other adults do not like their ( ) ( ) appearance the way it is physical appearance 32. ( ) ( ) Some adults feel they cannot provide for the material necessities of life BUT Other adults feel thev do ( ) adequately provide for the material necessities of life. ( ) - 3 - 90 33. ( ) ( ) Some adults are dissatisfied with themselves BUT Other adults are satisfied with themselves. ( ) ( ) 34. ( ) ( ) Some adults usually do what thev know is morally right BUT Other adults often don't do what thev know is morally right. ( ) ( ) 35. ( )„ ( ) Some adults are not very efficient in managing activities at home BUT Other adults are efficient in managing activities at home. ( ) ( ) 36. ( ) ( ) Some people seek out close relationships BUT Other persons shy away from ( ) ( ) close relationships. 37. ( ) ( ) Some adults do not feel that they are very intellectually capable BUT Other adults feel that they are ( ) ( ) intellectually capable. 38. ( ) ( ) Some adults feel they have a good sense of humor 39. ( ) ( ) Some adults are not very sociable BUT Other adults wish their sense ( ) of humor was better BUT Other adults are sociable. ( ) ( ) ( ) 40. ( ) ( ) Some adults are proud of their work BUT Other adults are not very ( ) ( ) proud of what they do 41. ( ) ( ) Some adults like the kind of person they are BUT Other adults would like to ( ) ( ) be someone else 42. ( ) ( ) Some adults do not enjoy nurturing others BUT Other adults enjoy being ( ) ( ) nurturant. 43. ( ) ( ) Some adults feel they are better than others their age at sports BUT Other adults don't feel thev ( ) ( ) can play as well. 44. ( ) ( ) Some adults are unsatisfied with something about their face or hair BUT Other adults like their face and hair the way they are. ( ) ( ) 4S. ( ) ( ) Some adults feel that they provide adequately for the needs of those who are important to them BUT Other jdults feel thev do not provide adequatelv for these needs. ( ) ( ) 46. ( ) ( ) Some adults often question the morality of their behavior 47. ( ) ( ) Some adults use their time efficiently at household activities BUT Other adults feel that their behavior is usually moral. BUT Other adults do not use their time efficiently ( ) ( ) ( ) ( ) 48. ( ) ( ) Some adults in close relationships have a hard time communicating openly BUT Other adults in close relationships feel that it is easy to communicate openly ( ) ( ) 49. ( ) ( ) Some adults feel like they are just as smart as other adults SO. ( ) ( ) Some adults feel that they are often too serious about their life BUT Other adults wonder if they are as smart. BUT Other adults are able to find humor in their life. ( ) ( ) ( ) ( ) _ 4 -When you have completed the "What I Am Like" form, please f i l l out this "Importance Rating" form which asks about the importance of various areas in your l i f e . For each area, choose how important this statement is to your sense of self-worth. Place an "X" under the column which best applies to you. Lastly, on the lines below, l i s t the 3 statements which are most important and the 2 or 3 statements which are least important to you. Very Pretty Only sort of Not very How important is i t to you? Important Important Important Important 1. To be sociable/at ease with others. 2. To be good at your work, (how did you define '-'ork: job homemaking) 3- To care for others. k. To be good at physiral activit ies. 5- To be good looking. 6. To be an adequate provider. 7. To be moral. 8. To be good at household management. 9. To have intimate relationships. 10. To be intelligent. 11. To have a sense of humor. On the lines below l i s t the 3 areas from above which are most important to you and l i s t the 2 or 3 areas which are least important to you: Most Important Least Important 92 EDI This i s a scale which measures a v a r i e t y of attitudes, f e e l i n g s , and behaviours. Some of the items r e l a t e to food and eating. Others ask you about your f e e l i n g s about yourself. There are no ri g h t or wrong answers, so tr y very hard to be completely honest i n your answers. Results are completely c o n f i d e n t i a l . Read each question and place an "X" under the column which applies best to you. Please answer each question very c a r e f u l l y . CO >» cd S cd 3 co a CD +J CH O CO cu S cu 6 o CO cu i-i cd PS U cu > cu 12 1. I eat sweets and carbohydrates without f e e l i n g nervous. 2. I think that my stomach i s too big. 3. I wish that I could return to the security of childhood. 4. I eat when I. am upset. 5. I s t u f f myself with food. 6. I wish that I could be younger. 7. I think about d i e t i n g . 8. I get frightened when my fe e l i n g s are too strong. 9. I think that my thighs are too large. 10. I f e e l i n e f f e c t i v e as a person. 11. I f e e l extremely g u i l t y a f t e r overeating. 12. I think that my stomach i s j u s t the right s i z e . 13. Only outstanding performance i s good enough i n my family. 14. The happiest time i n l i f e i s when you are a c h i l d . 15. I am open about my f e e l i n g s . 16. I am t e r r i f i e d of gaining weight. 17. I tr u s t others. 18. I f e e l alone in the world. 19. I f e e l s a t i s f i e d with the shape of my body. 20. I f e e l generally i n control of things i n my l i f e . 21. I get cofused about what emotion I am f e e l i n g . 22. I would rather be an adult than a c h i l d . 23. I can communicate with others e a s i l y . 24. I wish I were someone else. 25. I exaggerate or magnify the importance of weight. 26. I can c l e a r l y i d e n t i f y what emotion I am f e e l i n g . 27. I f e e l inadequate. 28. I have gone on eating binges where I have f e l t that I could not stop. 29. As a c h i l d , I t r i e d very hard to avoid disappointing my parents and teachers. 30. I have close r e l a t i o n s h i p s . 31. I l i k e the shape of my buttocks. 32. I am preoccupied with the desire to be thinner. 33. I don't know what i s going on inside of me. 34. I have trouble expressing my emotions to others. 35. The demands of adulthood are too great. 36. I hate being less than best at things. 37. I f e e l secure about myself. 93 CO V >> s CO r - l • H >> r - l a • M r - l cd ca 01 0> CD CD 3 3 +-> e U > co 4-1 o cd OJ < 53 O co « 53 38. I think about binging (over-eating). 39. I feel happy that I am not a child anymore. 40. I get confused as to whether or not I am hungry. 41.. I have a low opinion of myself. 42. I feel that I can achieve my standards. 43. My parents have expected excellence of me. 44. I worry that my feelings w i l l get out of control. 45. I think that my hips are too big. 46. I eat moderately in front of others and stuff myself when they are gone. 47. I feel bloated after eating a normal meal. 48. I feel that people are happiest when they are children. 49. If I gain a pound, I worry that I w i l l keep gaining. 50. I feel that I am a worthwhile person. 51. When I am upset, I don't know i f I am sad, frightened, or angry. 52. I feel that I must do things perfectly, or not do them at a l l . 53. I have the thought of trying to vomit in order to lose weight. 54. I need to keep people at a certain distance (feel uncomfortable i f someone tries to get too close). 55. I think that my thighs are just the right size. 56. I feel empty inside (emotionally). 57. I can talk about personal thoughts or feelings. 58. The best years of your l i f e are when you become an adult. 59. I think that my buttocks are too large. 60. I have feelings that I can't quite identify. 61. I eat or drink in secrecy. 62. I think that my hips are just the right size. 63. I have extremely high goals. 64. When I am upset, I worry that I wi l l start eating. Adapted and reproduced by special permission of the Publisher, Psychological Assessment Resources, Inc., 16102 North Florida Avenue, Lutz, Florida, 33549, from the Eating Disorder Inventory, by D. Garner, M.P. OLmstead, J . Polivy, Copyright, 1984. Further reproduction is prohibited without permission from PAR, Inc. 94 BACKGROUND INFORMATION 1. Age ' 2. Occupation 3. How many hours per week do you work? (Check one) Less than 20 hrs/wk. ( ) 20-30 hrs/wk. ( ) Over 30 hrs/wk. ( ) 4. Highest l e v e l of education achieved? (Check one) Grade school ( ) C o l l e g e / U n i v e r s i t y ( ) High school ( ) Graduate school ( ) 5. L i v i n g arrangements: Single ( ) Separated/Divorced ( ) Married ( ) Widowed ( ) 6. Who e lse l i v e s in your household with you? (State t h e i r r e l a t i o n s h i p to you) Highest past weight (excluding pregnancy)? How long ago? (years or months) How long d id you stay at t h i s weight? (years or months) 8. Lowest past adult weight? How long ago? (years or months) How long d id you stay at t h i s weight? (years or months) 9. What do you consider your i d e a l weight? 10. Age at which weight problems began ( i f any)? 11. How often do you weight yourse l f? (Check one) Less than once a month ( ) Once a day ( ) Once or twice a month ( ) More than once a day ( ) Once or twice a week ( ) 12. Are you current ly on a d ie t to lose weight? yes ( ) no ( ) Approximately how many c a l o r i e s do you eat da i ly? (Check one) 0-500 ca lor i e s ( ) 500-1000 ( ) 1000-1500 ( ) 1500 & over ( ) 13. Have you ever been prev ious ly diagnosed as having an eat ing disorder? yes ( ) no ( ) I f yes, how long ago? (years or months) Did you receive treatment? yes ( ) no ( ) I f yes, for how long? (years or months) 14. Are you current ly in therapy for any problems? yes ( ) no ( ) 

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
http://iiif.library.ubc.ca/presentation/dsp.831.1-0056018/manifest

Comment

Related Items