- Email: [email protected]
How many donuts is a “binge”?
Addictive Behaviors, Vol. 24, No. 2, pp. 299–303, 1999 Copyright © 1999 Elsevier Science Ltd Printed in the USA. All rights reserved 0306-4603/99/$–see front matter
Pergamon
PII S0306-4603(98)00052-5
BRIEF REPORT HOW MANY DONUTS IS A “BINGE”? WOMEN WITH BED EAT MORE BUT DO NOT HAVE MORE RESTRICTIVE STANDARDS THAN WEIGHT-MATCHED NON-BED WOMEN CATHERINE G. GREENO,* RENA R. WING,† AND MARSHA D. MARCUS† *Western Psychiatric Institute and Clinic, University of Pittsburgh Medical School; and †Department of Psychiatry, University of Pittsburgh Medical School
Abstract — Theories of disordered eating suggest that binge eating may occur as a response to violations of unrealistically restrictive dietary standards, but there are few direct comparisons of the dietary standards of binge eaters and nonbinge eaters. In this study, we asked obese women with Binge Eating Disorder (BED) and weight- and age-matched women without BED to report the minimum amount of each of eight foods they considered a “binge” and “out of control” to determine whether binge eaters had stricter dietary standards than women without BED. Women with BED did not consider smaller amounts of food a “binge” or “out of control” than did women without BED; however, binge eaters did report that their “typical” and “largest-ever” servings of each of the eight foods were larger than those reported by nonbinge eaters. This suggests that for this group of eating- disordered women, eating behaviors may be a more important intervention target than overly restrictive dietary standards. © 1999 Elsevier Science Ltd
Binge eating is an important problem in obese people. Approximately 30% of obese patients who present for treatment at university centers report serious binge eating problems, and about 8% merit a diagnosis of Binge Eating Disorder (BED; Marcus, 1993). The initiation of binge episodes is poorly understood. A contributing factor to the initiation of binge episodes appears to be the violation of perceived dietary standards. The violation of dietary standards is hypothesized to lead to the abandonment of attempts to control eating (“disinhibition”), which can cause a full-scale binge. This has been articulated in Marlatt’s Abstinence Violation Effect (AVE; Marlatt, 1979), which has been applied to binge eating (Gormally, Black, Daston, & Rardin, 1982; Grilo & Shiffman, 1994) and also in restraint theory (Polivy, Herman, Olmsted, & Jazwinski, 1984). Dietary standards may exist in the form of overly restrictive beliefs about the types of food that are “forbidden” as well as portion sizes (Knight & Boland, 1989). Although the importance of negative and all-or-none thinking about eating is often mentioned in discussions of binge eating, to date no work has directly tested whether the dietary standards of binge eaters are more restrictive than those of nonbinge eaters. In this study, we asked overweight women diagnosed with BED and an age- and weight-matched comparison group of women without BED to report the minimum Preparation of this article was supported in part by NIH Training Grant 539175, and by NIMH Grant 53817. We gratefully acknowledge the assistance of Lisa Burton in the data collection. Requests for reprints should be sent to Catherine Greeno, Western Psychiatric Institute and Clinic, 3811 O’Hara St., Pittsburgh, PA 15213. 299
300
C. G. GREENO et al.
amount of each of eight foods required to make an eating episode feel like it was a “binge” or was “out of control.” The eight foods were among those commonly reported to be consumed during binge episodes (Marcus, Wing, & Hopkins, 1988). There is evidence that binge eaters may apply stricter dietary standards to foods they consider “forbidden” (Knight & Boland, 1989). Four of the eight food we studied were selected to represent highly forbidden foods according to the ratings observed by Knight and Boland (1989), and the remaining four foods were selected to represent foods commonly eaten in binge episodes, but that were not highly forbidden. We were especially interested in providing preliminary evidence for whether binge eaters and nonbinge eaters differ primarily in their perceptions of food, or in their behaviors regarding food. We also asked subjects to report the size of their “typical” and “largestever” servings of each of the eight types of food. Thus, in this study we made five predictions, three regarding dietary standards and two regarding self-reported dietary behaviors: (1) Women with BED would show stricter dietary standards by reporting that the minimum amount of food required to make an episode a “binge” was smaller than the minimum amount reported by women without BED; (2) women with BED would show stricter standards by reporting that a smaller amount of food made them feel their eating was “out of control” than would women without BED; (3) women with and without BED would report that smaller amounts of forbidden than not-forbidden foods would constitute episodes that were “binges” and “out of control”; (4) women with BED would report larger “typical” portion sizes that would women without BED; and (5) women with BED would report larger “largest-ever” servings than would women without BED. M E T H O D S
Subjects Subjects were recruited through newspaper advertisements soliciting adult women to participate in a weight-loss program involving behavior modification and pharmacotherapy. Binge eaters (N 5 42) scored $ 27 on the Binge Eating Scale (BES; Gormally et al., 1982) and their binge eating status was confirmed with a clinical interview, the Eating Disorder Examination (EDE; Cooper & Fairburn, 1987). Similarly, nonbinge eaters (N 5 40) scored # 17 on the BES and their nonbinge eating status confirmed with the EDE. The EDE was conducted by trained clinicians who were blind to subjects’ BES score. Details of diagnoses are available (Greeno, Marcus, & Wing, 1995). Subjects’ average age was 39 years and average BMI was 37.75 in both groups studied. Eating standards and behaviors All subjects were tested individually, in a combined interview-questionnaire format. Pilot testing revealed that the task required some explanation for some subjects, but also that reliability of the task was higher when the subjects answered the questions on a questionnaire, rather than in an interview. Therefore, subjects were asked directly about the first food by the experimenter, and the other seven foods were answered in private on a questionnaire. Experimenters were blind to subjects’ binge status. Subjects were given the following instructions: We’re interested in how much food you think is a “binge” and is “out of control.” For example, you can imagine that if you stop eating after one bite of cake it wouldn’t feel like a binge. But if you ate the whole cake, it might feel like a binge.
Binge standards and behaviors
301
So there’s a point where it shifts from “not a binge” to a “binge.” We’re interested in exactly where that point is for different foods. Just because we ask you doesn’t mean that there has to be an answer; there might not be any amount of that particular food that feels like a binge to you. It doesn’t have to be an amount of food that you have ever eaten; for some foods it might be, for other foods it might not.
Following the instructions, the subjects were asked these four questions: (1) How many donuts would you have to eat to feel you had binged? (2) How many donuts would you have to eat to feel out of control? (3) When you eat donuts, how many do you typically eat? and (4) What is the largest number of donuts you have ever eaten? The experimenter probed the subject for the number of donuts that constituted a “binge.” For example, if the subject said four donuts was as binge, the experimenter asked: “What if you stopped at three, would that still feel like a binge?” If the subject adjusted the number, the same probe was repeated, and was also conducted for “out of control.” After the experimenter ensured that the subject understood that she should name the smallest amount food necessary for an episode to be a “binge” or “out of control,” the subject answered the four questions for the remaining seven foods in questionnaire format. Donuts, candy bars, cookies, and ice cream served as “forbidden” foods, and saltine crackers, bread, hot dogs, and pizza served as not- forbidden foods (Knight & Boland, 1989). Test-retest reliability A total of 32 subjects participated in a reliability study by repeating the task twice within 2 days. Subjects were not informed that they would participate twice. Scores were standardized so that they could be combined into one score for each question for each subject. Spearman correlations among the average standardized scores for the two tests were .81 for binge, .70 for out of control, .90 for typical serving, and .88 for largest-ever serving.
R E S U L T S
Table 1 reports raw portion sizes for each group. Calories for each report were calculated using standard calorie count estimates (Netzer, 1991). Table 2 shows the tests of the hypotheses. Estimated calories were averaged to create two calorie amounts for each question for each subject, one for forbidden foods, and one for not- forbidden foods. A 2 (BED) 3 2 (forbidden food) analysis of variance (ANOVA) was calculated for each question, with BED serving as a betweengroup factor, and forbidden food serving as a within-group factor. Binge eaters did not label a smaller amount of food a “binge” or “out of control,” nor did they hold more stringent standards for forbidden than for not-forbidden foods. Indeed, the primary finding is that, contrary to predictions, both groups of women reported that more calories of forbidden food were required to make an episode a “binge” or “out of control.” Women with BED reported larger typical and largest servings than did women without BED. “Typical” and “largest” servings were also larger for “forbidden” than not-forbidden” foods. A significant interaction was found for binge status and forbidden foods for “largest” servings, reflecting the fact that the difference between “largest” and typical” serving was greater for forbidden foods (about 263 Kcal) than for not-forbidden foods (about 125 Kcal).
302
C. G. GREENO et al.
Table 1. Amounts (and estimated calories) of food eaten Standards Binge Food Donuts Candy bars Cookies Ice cream Saltines Bread Hot dogs Pizza
Behaviors
Out of control
Typical
Largest
BE
NBE
BE
NBE
BE
NBE
BE
NBE
3.63 (727) 2.92 (732) 8.95 (448) 3.76 (563) 13.44 (201) 4.58 (6.89) 3.19 (479) 5.19 (779)
3.65 (730) 3.22 (806) 10.82 (541) 4.27 (641) 14.85 (273) 5.12 (738) 3.68 (521) 5.46 (788)
3.90 (780) 3.29 (823) 9.41 (471) 4.14 (622) 14.85 (307) 5.12 (768) 3.68 (552) 5.46 (820)
4.15 (830) 3.85 (962) 11.90 (595) 4.85 (727) 20.57 (307) 5.72 (859) 3.82 (574) 5.65 (847)
1.95 (390) 1.46 (366) 5.85 (293) 2.41 (362) 6.88 (103) 2.46 (370) 1.78 (267) 3.36 (505)
1.65 (330) 1.22 (306) 4.67 (234) 1.87 (281) 6.40 (96) 2.00 (300) 1.55 (232) 2.87 (431)
4.90 (980) 4.05 (1012) 15.41 (770) 5.82 (874) 15.85 (237) 6.34 (951) 3.51 (527) 6.26 (940)
3.52 (705) 2.87 (718) 11.77 (589) 3.60 (540) 13.50 (202) 4.60 (690) 2.57 (386) 5.17 (776)
BE, binge eaters; NBE, nonbinge eaters.
D I S C U S S I O N
We found that women with BED do not have more restrictive dietary standards than do women in the comparison group. Although the mean number of calories required for an episode to be a “binge” was smaller for women with BED than for weight-matched controls, estimates did not differ for the two groups. Furthermore, cognitive distortions were not exaggerated for forbidden foods; women in both groups reported that binges of forbidden foods had more calories than did binges of not-forbidden foods. It should be remembered that the amounts reported were the smallest portion that would constitute a “binge” for each food. We predicted that women with BED would report that the amount of food needed to make them feel “out of control” would be smaller than the amount of food needed to make them feel that they had “binged.” Theories of disinhibition suggest that binge
Table 2. Mean estimated calories (and SDs) for forbidden and not-forbidden foods
Binge Out of control Typical Largest
Forbidden foods
Not-forbidden foods
BE
NBE
BE
NBE
612 (195) 670 (200) 352 (97) 901 (346)
680 (242) 779 (331) 288 (90) 638 (264)
476 (138) 525 (140) 280 (60) 581 (176)
518 (169) 575 (246) 239 (69) 456 (158)
BE, binge eaters; NBE, nonbinge eaters.
BED status p,
Forbidden foods p,
BS*FF p,
.16
.0001
ns
.12
.0001
.13
.0002
.0001
ns
.0001
.0001
.02
Binge standards and behaviors
303
eaters feel that they have “lost control” after eating a small amount of disallowed food, and that this feeling of loss of control contributes to the abandonment of attempts to restrict eating, thus setting the stage for a full-scale binge. However, we found that the amount of food labeled “out of control” was larger than the amount of food labeled a “binge” for all foods, for women with and without BED. This finding appears to contrast with binge eaters’ tendency to endorse items on self-report questionnaires saying that sometimes after they eat just one cookie, they say to themselves they’ve already “blown it” so why not just eat the whole box. Further work would be required to learn whether or not this finding is truly in opposition to the hypothesis that attempts at control can be disrupted by the belief that even one cookie is too much. Alternately, hypotheses about disinhibition may hold for other groups of people with eating issues, such as restrained eaters or women with other eating disorders. Amounts of food reported to constitute a “binge” ranged from about 500 to 800 calories, except for saltines, where fewer than 300 calories were required. These estimates are close to the average binges reported in other studies. For diagnosis of ED for this study, subjects were required to report at least two episodes a week of at least 1,000 calories. This finding suggests that binge eaters perceive that substantially smaller amounts of food still constitute a “binge.” In sum, we found no evidence for the cognitive distortions that we predicted. These findings suggest that overly restrictive dietary standards do not need to be a focus of intervention, although other cognitive distortions may be appropriate targets for intervention. Furthermore, the very statistically significant differences between women with and without BED in self-reported portions sizes confirms the need for interventions to continue to focus on problem behaviors, even in the absence of perceptual distortions. R E F E R E N C E S Cooper, Z., & Fairburn, C. (1987). The Eating Disorder Examination: A semi-structured interview for the assessment of the specific psychopathology of eating disorders. International Journal of Eating Disorders, 6, 1–8. Gormally, J., Black, S., Daston, S., & Rardin, D. (1982). The assessment of binge eating severity among obese persons. Addictive Behaviors, 7, 47–55. Greeno, C. G., Marcus, M. D., & Wing, R. R. (1995). Diagnosis of Binge Eating Disorder: Discrepancies between a questionnaire and clinical interview. International Journal of Eating Disorders, 17, 153–160. Grilo, C. M., & Shiffman, S. (1994). Longitudinal investigation of the Abstinence Violation Effect in binge eaters. Journal of Consulting and Clinical Psychology, 62, 611–619. Knight, L. J., & Boland, F. J. (1989). Restrained eating: An experimental disentanglement of the disinhibiting variables of perceived calories and food type. Journal of Abnormal Psychology, 98, 412–420. Marcus, M. D. (1993). Binge eating in obesity. In C. G. Fairburn & G. T. Wilson (Eds.), Binge eating: Nature, assessment, and treatment. New York: Guilford Press. Marcus, M. D., Wing, R. R., & Hopkins, J. (1988). Obese binge eaters: Affect, cognitions, and response to behavioral weight control. Journal of Consulting and Clinical Psychology, 56, 433–439. Marlatt, G. A. (1979). A cognitive-behavioral model of the relapse process. In N. A. Krasnegor (Ed.), Behavioral analysis and treatment of substance abuse. (NIDA Research Monographs 25). Washington, DC: U.S. Department of Health, Education and Welfare. Netzer, C. T. (1991). The complete book of food counts. New York: Dell. Polivy, J., Herman C. P., Olmsted, M. P., & Jazwinski, C. (1984). Restraint and binge eating. In R. C. Hawkins, W. J. Fremouw & P. F. Clement (Eds.), The binge-purge syndrome: Diagnosis, treatment and research. New York: Springer.
Pergamon
PII S0306-4603(98)00052-5
BRIEF REPORT HOW MANY DONUTS IS A “BINGE”? WOMEN WITH BED EAT MORE BUT DO NOT HAVE MORE RESTRICTIVE STANDARDS THAN WEIGHT-MATCHED NON-BED WOMEN CATHERINE G. GREENO,* RENA R. WING,† AND MARSHA D. MARCUS† *Western Psychiatric Institute and Clinic, University of Pittsburgh Medical School; and †Department of Psychiatry, University of Pittsburgh Medical School
Abstract — Theories of disordered eating suggest that binge eating may occur as a response to violations of unrealistically restrictive dietary standards, but there are few direct comparisons of the dietary standards of binge eaters and nonbinge eaters. In this study, we asked obese women with Binge Eating Disorder (BED) and weight- and age-matched women without BED to report the minimum amount of each of eight foods they considered a “binge” and “out of control” to determine whether binge eaters had stricter dietary standards than women without BED. Women with BED did not consider smaller amounts of food a “binge” or “out of control” than did women without BED; however, binge eaters did report that their “typical” and “largest-ever” servings of each of the eight foods were larger than those reported by nonbinge eaters. This suggests that for this group of eating- disordered women, eating behaviors may be a more important intervention target than overly restrictive dietary standards. © 1999 Elsevier Science Ltd
Binge eating is an important problem in obese people. Approximately 30% of obese patients who present for treatment at university centers report serious binge eating problems, and about 8% merit a diagnosis of Binge Eating Disorder (BED; Marcus, 1993). The initiation of binge episodes is poorly understood. A contributing factor to the initiation of binge episodes appears to be the violation of perceived dietary standards. The violation of dietary standards is hypothesized to lead to the abandonment of attempts to control eating (“disinhibition”), which can cause a full-scale binge. This has been articulated in Marlatt’s Abstinence Violation Effect (AVE; Marlatt, 1979), which has been applied to binge eating (Gormally, Black, Daston, & Rardin, 1982; Grilo & Shiffman, 1994) and also in restraint theory (Polivy, Herman, Olmsted, & Jazwinski, 1984). Dietary standards may exist in the form of overly restrictive beliefs about the types of food that are “forbidden” as well as portion sizes (Knight & Boland, 1989). Although the importance of negative and all-or-none thinking about eating is often mentioned in discussions of binge eating, to date no work has directly tested whether the dietary standards of binge eaters are more restrictive than those of nonbinge eaters. In this study, we asked overweight women diagnosed with BED and an age- and weight-matched comparison group of women without BED to report the minimum Preparation of this article was supported in part by NIH Training Grant 539175, and by NIMH Grant 53817. We gratefully acknowledge the assistance of Lisa Burton in the data collection. Requests for reprints should be sent to Catherine Greeno, Western Psychiatric Institute and Clinic, 3811 O’Hara St., Pittsburgh, PA 15213. 299
300
C. G. GREENO et al.
amount of each of eight foods required to make an eating episode feel like it was a “binge” or was “out of control.” The eight foods were among those commonly reported to be consumed during binge episodes (Marcus, Wing, & Hopkins, 1988). There is evidence that binge eaters may apply stricter dietary standards to foods they consider “forbidden” (Knight & Boland, 1989). Four of the eight food we studied were selected to represent highly forbidden foods according to the ratings observed by Knight and Boland (1989), and the remaining four foods were selected to represent foods commonly eaten in binge episodes, but that were not highly forbidden. We were especially interested in providing preliminary evidence for whether binge eaters and nonbinge eaters differ primarily in their perceptions of food, or in their behaviors regarding food. We also asked subjects to report the size of their “typical” and “largestever” servings of each of the eight types of food. Thus, in this study we made five predictions, three regarding dietary standards and two regarding self-reported dietary behaviors: (1) Women with BED would show stricter dietary standards by reporting that the minimum amount of food required to make an episode a “binge” was smaller than the minimum amount reported by women without BED; (2) women with BED would show stricter standards by reporting that a smaller amount of food made them feel their eating was “out of control” than would women without BED; (3) women with and without BED would report that smaller amounts of forbidden than not-forbidden foods would constitute episodes that were “binges” and “out of control”; (4) women with BED would report larger “typical” portion sizes that would women without BED; and (5) women with BED would report larger “largest-ever” servings than would women without BED. M E T H O D S
Subjects Subjects were recruited through newspaper advertisements soliciting adult women to participate in a weight-loss program involving behavior modification and pharmacotherapy. Binge eaters (N 5 42) scored $ 27 on the Binge Eating Scale (BES; Gormally et al., 1982) and their binge eating status was confirmed with a clinical interview, the Eating Disorder Examination (EDE; Cooper & Fairburn, 1987). Similarly, nonbinge eaters (N 5 40) scored # 17 on the BES and their nonbinge eating status confirmed with the EDE. The EDE was conducted by trained clinicians who were blind to subjects’ BES score. Details of diagnoses are available (Greeno, Marcus, & Wing, 1995). Subjects’ average age was 39 years and average BMI was 37.75 in both groups studied. Eating standards and behaviors All subjects were tested individually, in a combined interview-questionnaire format. Pilot testing revealed that the task required some explanation for some subjects, but also that reliability of the task was higher when the subjects answered the questions on a questionnaire, rather than in an interview. Therefore, subjects were asked directly about the first food by the experimenter, and the other seven foods were answered in private on a questionnaire. Experimenters were blind to subjects’ binge status. Subjects were given the following instructions: We’re interested in how much food you think is a “binge” and is “out of control.” For example, you can imagine that if you stop eating after one bite of cake it wouldn’t feel like a binge. But if you ate the whole cake, it might feel like a binge.
Binge standards and behaviors
301
So there’s a point where it shifts from “not a binge” to a “binge.” We’re interested in exactly where that point is for different foods. Just because we ask you doesn’t mean that there has to be an answer; there might not be any amount of that particular food that feels like a binge to you. It doesn’t have to be an amount of food that you have ever eaten; for some foods it might be, for other foods it might not.
Following the instructions, the subjects were asked these four questions: (1) How many donuts would you have to eat to feel you had binged? (2) How many donuts would you have to eat to feel out of control? (3) When you eat donuts, how many do you typically eat? and (4) What is the largest number of donuts you have ever eaten? The experimenter probed the subject for the number of donuts that constituted a “binge.” For example, if the subject said four donuts was as binge, the experimenter asked: “What if you stopped at three, would that still feel like a binge?” If the subject adjusted the number, the same probe was repeated, and was also conducted for “out of control.” After the experimenter ensured that the subject understood that she should name the smallest amount food necessary for an episode to be a “binge” or “out of control,” the subject answered the four questions for the remaining seven foods in questionnaire format. Donuts, candy bars, cookies, and ice cream served as “forbidden” foods, and saltine crackers, bread, hot dogs, and pizza served as not- forbidden foods (Knight & Boland, 1989). Test-retest reliability A total of 32 subjects participated in a reliability study by repeating the task twice within 2 days. Subjects were not informed that they would participate twice. Scores were standardized so that they could be combined into one score for each question for each subject. Spearman correlations among the average standardized scores for the two tests were .81 for binge, .70 for out of control, .90 for typical serving, and .88 for largest-ever serving.
R E S U L T S
Table 1 reports raw portion sizes for each group. Calories for each report were calculated using standard calorie count estimates (Netzer, 1991). Table 2 shows the tests of the hypotheses. Estimated calories were averaged to create two calorie amounts for each question for each subject, one for forbidden foods, and one for not- forbidden foods. A 2 (BED) 3 2 (forbidden food) analysis of variance (ANOVA) was calculated for each question, with BED serving as a betweengroup factor, and forbidden food serving as a within-group factor. Binge eaters did not label a smaller amount of food a “binge” or “out of control,” nor did they hold more stringent standards for forbidden than for not-forbidden foods. Indeed, the primary finding is that, contrary to predictions, both groups of women reported that more calories of forbidden food were required to make an episode a “binge” or “out of control.” Women with BED reported larger typical and largest servings than did women without BED. “Typical” and “largest” servings were also larger for “forbidden” than not-forbidden” foods. A significant interaction was found for binge status and forbidden foods for “largest” servings, reflecting the fact that the difference between “largest” and typical” serving was greater for forbidden foods (about 263 Kcal) than for not-forbidden foods (about 125 Kcal).
302
C. G. GREENO et al.
Table 1. Amounts (and estimated calories) of food eaten Standards Binge Food Donuts Candy bars Cookies Ice cream Saltines Bread Hot dogs Pizza
Behaviors
Out of control
Typical
Largest
BE
NBE
BE
NBE
BE
NBE
BE
NBE
3.63 (727) 2.92 (732) 8.95 (448) 3.76 (563) 13.44 (201) 4.58 (6.89) 3.19 (479) 5.19 (779)
3.65 (730) 3.22 (806) 10.82 (541) 4.27 (641) 14.85 (273) 5.12 (738) 3.68 (521) 5.46 (788)
3.90 (780) 3.29 (823) 9.41 (471) 4.14 (622) 14.85 (307) 5.12 (768) 3.68 (552) 5.46 (820)
4.15 (830) 3.85 (962) 11.90 (595) 4.85 (727) 20.57 (307) 5.72 (859) 3.82 (574) 5.65 (847)
1.95 (390) 1.46 (366) 5.85 (293) 2.41 (362) 6.88 (103) 2.46 (370) 1.78 (267) 3.36 (505)
1.65 (330) 1.22 (306) 4.67 (234) 1.87 (281) 6.40 (96) 2.00 (300) 1.55 (232) 2.87 (431)
4.90 (980) 4.05 (1012) 15.41 (770) 5.82 (874) 15.85 (237) 6.34 (951) 3.51 (527) 6.26 (940)
3.52 (705) 2.87 (718) 11.77 (589) 3.60 (540) 13.50 (202) 4.60 (690) 2.57 (386) 5.17 (776)
BE, binge eaters; NBE, nonbinge eaters.
D I S C U S S I O N
We found that women with BED do not have more restrictive dietary standards than do women in the comparison group. Although the mean number of calories required for an episode to be a “binge” was smaller for women with BED than for weight-matched controls, estimates did not differ for the two groups. Furthermore, cognitive distortions were not exaggerated for forbidden foods; women in both groups reported that binges of forbidden foods had more calories than did binges of not-forbidden foods. It should be remembered that the amounts reported were the smallest portion that would constitute a “binge” for each food. We predicted that women with BED would report that the amount of food needed to make them feel “out of control” would be smaller than the amount of food needed to make them feel that they had “binged.” Theories of disinhibition suggest that binge
Table 2. Mean estimated calories (and SDs) for forbidden and not-forbidden foods
Binge Out of control Typical Largest
Forbidden foods
Not-forbidden foods
BE
NBE
BE
NBE
612 (195) 670 (200) 352 (97) 901 (346)
680 (242) 779 (331) 288 (90) 638 (264)
476 (138) 525 (140) 280 (60) 581 (176)
518 (169) 575 (246) 239 (69) 456 (158)
BE, binge eaters; NBE, nonbinge eaters.
BED status p,
Forbidden foods p,
BS*FF p,
.16
.0001
ns
.12
.0001
.13
.0002
.0001
ns
.0001
.0001
.02
Binge standards and behaviors
303
eaters feel that they have “lost control” after eating a small amount of disallowed food, and that this feeling of loss of control contributes to the abandonment of attempts to restrict eating, thus setting the stage for a full-scale binge. However, we found that the amount of food labeled “out of control” was larger than the amount of food labeled a “binge” for all foods, for women with and without BED. This finding appears to contrast with binge eaters’ tendency to endorse items on self-report questionnaires saying that sometimes after they eat just one cookie, they say to themselves they’ve already “blown it” so why not just eat the whole box. Further work would be required to learn whether or not this finding is truly in opposition to the hypothesis that attempts at control can be disrupted by the belief that even one cookie is too much. Alternately, hypotheses about disinhibition may hold for other groups of people with eating issues, such as restrained eaters or women with other eating disorders. Amounts of food reported to constitute a “binge” ranged from about 500 to 800 calories, except for saltines, where fewer than 300 calories were required. These estimates are close to the average binges reported in other studies. For diagnosis of ED for this study, subjects were required to report at least two episodes a week of at least 1,000 calories. This finding suggests that binge eaters perceive that substantially smaller amounts of food still constitute a “binge.” In sum, we found no evidence for the cognitive distortions that we predicted. These findings suggest that overly restrictive dietary standards do not need to be a focus of intervention, although other cognitive distortions may be appropriate targets for intervention. Furthermore, the very statistically significant differences between women with and without BED in self-reported portions sizes confirms the need for interventions to continue to focus on problem behaviors, even in the absence of perceptual distortions. R E F E R E N C E S Cooper, Z., & Fairburn, C. (1987). The Eating Disorder Examination: A semi-structured interview for the assessment of the specific psychopathology of eating disorders. International Journal of Eating Disorders, 6, 1–8. Gormally, J., Black, S., Daston, S., & Rardin, D. (1982). The assessment of binge eating severity among obese persons. Addictive Behaviors, 7, 47–55. Greeno, C. G., Marcus, M. D., & Wing, R. R. (1995). Diagnosis of Binge Eating Disorder: Discrepancies between a questionnaire and clinical interview. International Journal of Eating Disorders, 17, 153–160. Grilo, C. M., & Shiffman, S. (1994). Longitudinal investigation of the Abstinence Violation Effect in binge eaters. Journal of Consulting and Clinical Psychology, 62, 611–619. Knight, L. J., & Boland, F. J. (1989). Restrained eating: An experimental disentanglement of the disinhibiting variables of perceived calories and food type. Journal of Abnormal Psychology, 98, 412–420. Marcus, M. D. (1993). Binge eating in obesity. In C. G. Fairburn & G. T. Wilson (Eds.), Binge eating: Nature, assessment, and treatment. New York: Guilford Press. Marcus, M. D., Wing, R. R., & Hopkins, J. (1988). Obese binge eaters: Affect, cognitions, and response to behavioral weight control. Journal of Consulting and Clinical Psychology, 56, 433–439. Marlatt, G. A. (1979). A cognitive-behavioral model of the relapse process. In N. A. Krasnegor (Ed.), Behavioral analysis and treatment of substance abuse. (NIDA Research Monographs 25). Washington, DC: U.S. Department of Health, Education and Welfare. Netzer, C. T. (1991). The complete book of food counts. New York: Dell. Polivy, J., Herman C. P., Olmsted, M. P., & Jazwinski, C. (1984). Restraint and binge eating. In R. C. Hawkins, W. J. Fremouw & P. F. Clement (Eds.), The binge-purge syndrome: Diagnosis, treatment and research. New York: Springer.