Alcohol use among university females: Relationship to eating disordered behavior

Ad&rive Behaviors, Vol. 14, pp. 181-185, 1989 Printed in the USA. All rights reserved.

0306-4603/89 $3.00 + .OO Copyright e 1989 Pergamon Press plc

BRIEF REPORT ALCOHOL USE AMONG UNIVERSITY FEMALES: RELATIONSHIP TO EATING DISORDERED BEHAVIOR JEAN K. LUNDHOLM University of Wisconsin-Riverfails Abstract - This study examined the relationship between alcohol abuse and disordered eating among university females. Alcohol abuse was assessed using the alcohol abuse scale of the Millon Clinical Multiaxial Inventory, and disordered eating was assessed using the Eating Disorder Inventory. Of the females who reported frequent episodes of uncontrollable overeating, those who frequently used alcohol were generally dissatisfied with themselves, and those who infrequently used alcohol were generally dissatisfied with others. Females who scored high on alcohol abuse differed from those who scored low by reporting behaviors similar to those identified among women who are substance abusers, Results indicate a possible relationship between alcohol use and disordered eating among university females.

Alcohol abuse has frequently been reported among anorexics (Cantwell, Sturzenberg, Burrough, Salkin, & Green, 1977; Crisp & Toms, 1972; Eckert, Goldberg, Halmi, Casper, & Davis, 1982), bulimics (Hatsukami, Eckert, Mitchell, & Pyle, 1984; Hatsukami, Owen, Pyle, & Mitchell, 1982; Leon, Carroll, Chernyk, & Finn, 1985; Mitchell, Hatsukami, Eckert, & Pyle, 1985; Pyle, Mitchell, & Eckert, 1981; Pyle et al., 1983; Walsh, Roose, Glassman, Gladis, & Sadik, 1985) and bulimic anorexics (Beumont, George, & Smart, 1976; Casper, Eckert, Halmi, Goldberg, & Davis, 1980; Crisp, 1968; Garfinkel & Gamer, 1982; Garfinkel, Moldofsky, & Gamer, 1980; Gamer & Garfinkel, 1980; Pyle et al., 1981; Strober, 1981, 1982). This abuse may be an inappropriate means of coping since the alcohol is reportedly used for sedative effects (Garrow et al., 1975), or may be passed down intergenerationally. Substance abuse has been found in first degree relatives of anorexics (Jones, Cheshire, & Moorhouse, 1985), bulimics (Gwirtsman, Roy-Bryne, Yager, & Gemer, 1983; Hudson, Pope, Jonas, & Yurgelun-Todd, 1983; Leon et al., 1985; Pyle et al., 1981; Strober, Salkin, Burroughs, & Morrell, 1982), and bulimic anorexics (Herzog, 1982; Strober, 1981). Since there appears to be a relationship between alcohol abuse and disordered eating among hospitalized patients, the purpose of this study was to determine if this relationship existed among university females. METHOD

Subjects

Subjects were female (n = 135) undergraduates enrolled in introductory psychology classes at Iowa State University during the fall of 1985. Female university students were selected as the target population since eating disordered behaviors are most frequently reported among people in this age group (Boskind-Lodahl & White, 1978; Fairbum & Cooper, 1982; Pyle et al., 1981; Strangler & Printz, 1980). Requests for reprints should be sent to Jean K. Lundholm, Department of Counselor Education, sity of Wisconsin-Riverfalls, Riverfalls, WI 54022. 181

Univer-

182

JEAN

Table 1. Means,

K. LUNDHOLM

standard deviations, and levels of significance of high and low scorers on alcohol abuse High Score on Alcohol Abuse (n = 25)

Subscale IA I MF ID B BD DT P

of scale scores

Low Score on Alcohol Abuse (n = 24)

X

SD

X

SD

P

11.04 7.52 6.12 3.96 5.80 17.44 9.24 8.72

5.40 5.21 5.21 3.93 5.67 8.37 5:36 4.90

3.42 1.38 1.70 1.21 1.79 13.41 6.79 7.21

4.68 2.04 1.76 1.96 3.93 7.64 5.91 4.25

.OOOl .OOOl .0003 .0034 .0062 .0856 .1354 .2556

IA - lnteroceptive Awareness, I - Ineffectiveness, Interpersonal Distrust, B - Bulimia, BD - Body Thinness, P - Perfectionism.

MF - Maturity Fears, ID Dissatisfaction, DT - Drive for

Instruments The instrument used to assess disordered eating was the Eating Disorders Inventory (Garner, Olmstead, & Polivy, 1983) which consisted of eight scales: drive for thinness, bulimia, body dissatisfaction, ineffectiveness, perfectionism, interpersonal distrust, interoceptive awareness,-and maturity. Alcohol abuse was assessed using the alcohol abuse scale of the Millon Clinical Multiaxial Inventory (Millon, 1981). Procedure Data were collected by handing the instruments and set of directions to the subjects. Directions were read to the group, and included a discussion of the purpose of the instrument and an explanation of the response format. The order of test administration was systematically varied. RESULTS

Females who scored 13 or above on the alcohol abuse scale (n = 24) were compared to those who scored 6 or below (n = 24). The effect of this measure of alcohol use over the eight scales of disordered eating was examined using a multivariate analysis of variance (MANOVA). The MANOVA revealed an F approximation for the Hotelling-Lawley trace that was significant F(8, 40) = 6.01, p = .OOOl. Univariate tests applied to the mean scale scores indicated that the high scorers on the measure of alcohol use had significantly higher scores on the scales of interoceptive awareness, F(l, 47) = 27.81,~ = .OOOl;ineffectiveness, F(l, 47) = 29.14,~ = .OOOl; maturity fears, F(l, 47) = 15.52, p = .0003; interpersonal distrust, F(1, 47) = 9.50, p = .0034; and bulimia, F(l, 47) = 8.20, p = .0062. There were no significant differences on the scales of perfectionism, body dissatisfaction, or drive for thinness. Means and standard deviations for the eight scales by alcohol use are shown in Table 1. Intercorrelations among all scales for those with both high and low scores on alcohol abuse were examined. The intercorrelation matrix for those who had high scores on alcohol abuse is shown in Table 2, and reveals a cluster which includes the scales of bulimia, body dissatisfaction, drive for thinness, and interpersonal awareness. Females who reported frequent episodes of uncontrollable overeating also reported a dissatisfaction with the size of their body, a preoccupation with diet and

183

Alcohol use among university females

Table 2. Intercorrelation matrix of scale scores of high scorers on alcohol abuse

BD DT IA I MF ID P

B

BD

DT

IA

.48 .54 .39 .41 .48 .ll .29

.79 .64 .36 .ll .27 .26

.64 .37 .23 .33 .27

.43 .21 .3_5 .14

I

MF

ID

.32 .61 .18

.18 -.22

.28

B - Bulimia, BD - Body Dissatisfaction, DT - Drive for Thinness, IA -1nteroceptive Awareness, I - Ineffectiveness, MF Maturity Fears, ID - Interpersonal Distrust, P - Perfectionism.

weight control, and a lack of confidence in recognizing and identifying emotions and sensations of hunger or satiety. The intercorrelation matrix for those who had low scores on alcohol abuse is shown in Table 3, and reveals a cluster which includes the scales of bulimia, interoceptive awareness, and interpersonal distrust. Females who reported frequent episodes of uncontrollable overeating also reported a sense of alienation and lack of close interpersonal relationships, and a lack of confidence in recognizing and identifying emotions and sensations of hunger or satiety. DISCUSSION

Results of this study indicated a fundamental relationship between episodes of uncontrollable overeating which is often followed by an urge to engage in selfinduced vomiting (i.e., bulimia) and the inability to recognize hunger and satiety, which was similar to both groups. Those who reported episodes of bulimia and frequent use of alcohol reported being dissatisfied with themselves, particularly related to body size. Those who reported episodes of bulimia and infrequent use of alcohol reported being dissatisfied with others, particularly related to interpersonal relationships. Females who scored high on alcohol abuse differed from those who scored low by reporting episodes of bulimia; a sense of alienation and lack of close relationships;

Table 3. Intercorrelation matrix of scale scores of low scorers on alcohol abuse

IA ID DT I BD MF P

B

IA

ID

DT

I

BD

MF

.87 .55 .49 .34 .07 .17 .19

.70 .37 .47 .Ol .15 -.Ol

.I0 .38 -.27 .09 -.25

- .07 .52 -.16 .47

.18 .42 -.29

-.02 .36

-.31

B - Bulimia, IA -1nteroceptive Awareness, DT - Drive for Thinness, I - Ineffectiveness, MF - Maturity Fears, P - Perfectionism.

ID - Interpersonal Distrust, BD - Body Dissatisfaction,

JEAN K. LUNDHOLM

184

avoidance of psychological maturity; feelings of inadequacy, insecurity and worthlessness; and lack of confidence in recognizing emotions and sensations of hunger and satiety. This constellation of personality factors are similar to those reported to predispose women to substance abuse (Brisman & Siegel, 1984; Goodsitt, 1983). Garner and Olmsted (1984) reported means and percentiles of the eight Eating Disorder Inventory scales of a large group of university females (N = 770). Compared to that group, those who scored high on alcohol abuse had scores on four of the scales which were at or above the 90th percentile and included: bulimia, ineffectiveness, interpersonal distrust, and maturity fears. Thus, those females who reported frequent alcohol abuse had personality features that were more similar to women with substance abuse than to women who were university students. It has been suggested that disordered eating may be a substance-abuse disorder with food either one of many substances, or the only substance abused (Brisman & Siegel, 1984; Wooley & Wooley, 1981). The results of this study support this notion and also that of a relationship between alcohol abuse and disordered eating among university females.

REFERENCES

Beumont, P.J.W., George, G.C.W., & Smart, D.E. (1976). “Dieters” and “vomiters and purgers” in anorexia nervosa. Psychological Medicine, 6, 617-622. Boskind-Lodahl, M., & White, W.C. (1978). The definition and treatment of bulimarexia in college women-A pilot study. Journal of American College Health Association, 27, 84-97. Brisman, J., & Siegel, M. (1984). Bulimia and alcoholism: Two sides of the same coin? Journal of Substance Abuse Treatment, 1, 113-l 18. Cantwell, D.P., Sturzenberg, S., Burrough, J., Salkin, B., & Green, J.K. (1977). Anorexia nervosa: An affective disorder? Archives of General Psychiatry, 34, 1087-1093. Casper, R.C., Eckert, E.D., Halmi, K.A., Goldberg, S., & Davis, J. (1980). Bulimia: It’s incidence and clinical importance in patients with anorexia nervosa. Archives ofGeneral Psychiatry, 37, 10361040. Crisp, A.H. (1968). Primary anorexia nervosa. Gut, 9, 370-372. Crisn. A.H., & Toms. D.A. (1972). Primarv anorexia nervosa or weight _ _phobia in the male. British -Medical Journal, i, 334-338. . Eckert, E.D., Goldberg, S.C., Halmi, K.A., Casper, R.C., & Davis, J.M. (1982). Depression in anorexia nervosa. Psychological Medicine, 12, 115-122. Fairbum, C.G., & Cooper, P.J. (1982). Self-induced vomiting and bulimia nervosa: An undetected problem. British Medical Journal, 284, 1153-1155. Garfinkel. P.E., & Gamer, D.M. (1982). Anorexia nervosa: A multidimensional New York: .perspective. . Brunner/Mazel. Gartlnkel, P.E., Moldofsky, H., & Gamer, D.M. (1980). The heterogeneity of anorexia nervosa. Archives of General

Psychiatry,

37, 1036-1040.

Garner, D.M., & Gartinkel, P.E. (1980). Socio-cultural factors in the development Psychological

Medicine.

of anorexia nervosa.

10. 647-656.

Gamer, D.M., & Olmstead, M.P. (1984). Manual for eating disorders inventory (EDZ). Odessa, FL: Psychological Assessment Resources. Garner, D.M., Olmstead, M.P., & Polivy, J. (1983). Development and validation of a multidimensional eating disorder inventory for anorexia and bulimia. Znternationa/ Journal of Eating Disorders, 2, 15-34.

Garrow, J.S., Crisp, A.H., Jordan, H.A., Meyer, J.E., Russell, G.F.M., Silverstone, T., Stunkard, A.J., & Van Itallie, T.B. (1975). Pathology of eating, group report. In T. Silverstone (Ed.), Dahlem konferenzen, Life Sciences Research Report 2, Berlin. Goodsitt, A. (1983). Self-regulatory disorders in eating disorders. International Journal ofEating Disorders,

2, 51-61.

Gwirtsman, H.E., Roy-Bryne, P., Yager, J., & Gemer, R.H. (1983). Neuroendocrine abnormalities in bulimia. American Journal of Psychiatry, 140, 559-563. Hatsukami, D., Owen, P., Pyle, R., & Mitchell, J. (1982). Similarities and differences on the MMPI between women with bulimia and women with alcohol or drug abuse problems. Addictive Behaviors, 7, 435-439.

185

Alcohol use among university females

Hatsukami, D., Eckert, E., Mitchell, J.E., & Pyle, R. (1984). Affective disorder and substance abuse in women with bulimia. Psychological Medicine, 14, 701-704. Herzog, D.B. (1982). Bulimia in the adolescent. American Journal of Diseases ofchildren, 136,985-989. Hudson, J.I., Pope, H.G., Jonas, J.M., & Yurgelun-Todd, D. (1983). Family history study of anorexia nervosa and bulimia. British Journal ofPsychiatry, 142, 133-138. Jones, D.A., Cheshire, N., & Moorhouse, H. (1985). Anorexia nervosa, bulimia and alcoholismassociation of eating disorder and alcohol. Journal of Psychiatric Research, 19(2/3), 377-380. Leon, G.R., Carroll, K., Chemyk, B., Jz Finn, S. (1985). Binge eating and associated habit patterns within college students and identified bulimic populations. International Journal of Eating Disorders, 4, 43-57.

Millon, T. (1981). MiNon clinical nudfiuxiul inventory manual (3rd ed.). Minneapolis, MN: National Computer Systems. Mitchell, J.E., Hatsukami, D., Eckert, E.D., & Pyle, R.L. (1985). Characteristics of 275 patients with bulimia. American Journal of Psychiurry, 142(4), 482-485. Pyle, R.L., Mitchell, J.E., & Eckert, E.D. (1981). Bulimia: A report of 34 cases. Journal ofC/inical Psychiatry,

42, 60-64.

Pyle, R.L., Mitchell, J.E., Eckert, E.D., Halvorson, P.A., Neuman, P.A., & Goff, G.M. (1983). The incidence of bulimia in freshmen college students. International Journal of Eating Disorders, 2, 75-85.

Strangler,

R.S., & Printz, A.M. (1980). D.S.M. III: Psychiatric

American

Journal

of Psychiatry,

diagnosis in a university population.

137, 937-940.

Strober, M. (1981). The relationship of personality characteristics to body image disturbances in juvenile anorexia nervosa: A multivariate analysis. Psychosomatic Medicine, 43(4), 323-330. Strober, M. (1982). Focus of control psychopathology, and weight gain in juvenile anorexia nervosa. Journal of Abnormal Child Psychology, 10, 97-106. Strober, M., Salkin, B., Burroughs, J., & Morrell, W. (1982). Validity of the bulimia-restrictor distinction in anorexia nervosa. The Journal of Nervous and Mental Disease, 170(6), 345-351. Walsh, B.T., Roose, S.P., Glassman, A.H., Gladis, M., & Sadik, C. (1985). Bulimia and depression. Psychosomutic

Medicine,

47(2), 123-131.

Wooley, S.C., & Wooley, O.W. (1981). Overeating as substance abuse. Advances 41-67.

in

SubstanceAbuse, 2,