Self-esteem, irrational beliefs and coping strategies in relation to eating problems in a non-clinical population

Person. indidf. Diff Vol. IO. No. 5, pp. 581-584. Printed in Great Britain. All rights reserved

Self-esteem,

1989

Copyright a

0191-8869189 53.00 + 0.00 1989 Pergamon Press plc

irrational beliefs and coping strategies in relation to eating problems in a non-clinical population ROWENA MAYHEW and ROBERT J. EDELMANN*

Department

of Psychology, (Received

University

of Surrey, Guildford, Surrey GU2 5XH, England

25 April 1988; received for publication

7 July 1988)

Summary-In order to evaluate the relationship between three factors commonly associated with eating disorders, Rosenberg’s Self-Esteem Scale (SES), the Irrational Beliefs Scale (IBS), Coping Index (CI) and Eating Disorders Inventory (EDI) were administered to 49 undergraduate Ss. Higher ED1 scores were related to lower self-estreem, increased irrational beliefs, less frequent use of cognitive and behavioural coping strategies and increased use of avoidance coping. The implications of the results for future research are discussed.

INTRODUCTION The view that eating problems are stress related has been suggested by a number of clinical researchers (e.g. Mitchell and Pyle, 1981). Others have voiced the opinion that problems, for such individuals, are further complicated by their lack of alternative coping mechanisms (Weiss, Katzman and Wolchik, 1985). One possibility is that a familial emphasis on traditional female passivity may inhibit the development of self-management or coping skills (Mixes, 1985). There is, however, a dearth of published studies on the relation between disordered eating patterns and coping strategies. Deficits in coping strategies have also been linked with the presence of reasoning errors in relation to eating disorders (e.g. Mizes. 1985). In this context, Garner and Bemis (1982) describe thinking patterns character&d by superstitious beliefs, perfectionism and overgeneralisation, while Guidano and Liotti (1983) refer to faulty and irrational thinking patterns. While such observations are common in clinical practice and challenging such beliefs is central to cognitive interventions for eating disorders (e.g. Fairburn, 1985; Garner and Bemis, 1985) there has been little attempt to empirically confirm the relation between these thinking styles and disordered eating patterns. Closely related to irrational thinking patterns is the assumption in patients with eating disorders that weight, shape or thinness are the sole or predominant referents for inferring personal value or self-worth (Gamer and Bemis, 1982). As patients strive to attain but never reach their hoped for weight, shape etc. negative beliefs about themselves and perceived ineffectiveness in controlling their behaviour will predominate. The importance of ineffectiveness in relation to eating disorders is recognised by the inclusion of such a dimension in the Eating Disorders Inventory (EDI) (Gamer, Olmstead and Polivy, 1983). In relation to ineffectiveness one of the most consistent observations in the literature on eating disorders is the link with poor self-esteem (e.g. Bruch, 1973; Crisp, 1980). The aim of the present study was thus to assess the relationship between coping styles, irrational beliefs, self-esteem and eating problems in a non-clinical population.

METHOD Subjects

The Ss were 49 female undergraduate students aged 18-33 yr (average age 21 yr). Questionnaires

Four psychological tests were administered. (a) Eating Disorders Inventory (EDI). First developed by Gamer er 01. (1983) this questionnaire consists of 64 items designed to measure attitudinal and behavioural traits relevant to anorexia nervosa and bulimia. The scale reliably differentiates between appropriate clinical and non-clinical populations and was divided by Gamer et al. (1983) into eight theoretically or deductively derived subscales. These subscales are labelled Drive for Thinness, Body Dissatisfaction, Ineffectiveness, Perfectionism, Interpersonal Distrust, Interoceptive Awareness, and Maturity Fears. (b) Se!f-esteem Scale (SES). First developed by Rosenberg (1965) this questionnaire consists of IO items to which respondents indicate on a 4-point scale the extent to which they agree/disagree that the statement applies to them, high scores being indicative of poor self-esteem. The scale has been widely used. (c) frrurional Beliefs Scale (7BS). The IBS (Malouf and Schutte, 1986) consists of 20 items each rated on a scale of I (strongly disagree) to 5 (strongly agree). It has been shown to have adequate reliability and validity. (d) Coping Index (Cl). The CI was first developed by Billings and Moos (1981) as a I9 item scale and later extended to the 32 item scale (Billings and Moos, 1984) used in the present study. Respondents select a recent stressful event and rate their frequency of use of 32 items describing three methods of coping response: active-cognitive, active-behavioural and avoidance. The scale has been widely used by Billings, Moos and their colleagues. Procedure The four questionnaires

*To whom correspondence

were stapled together in random order and subjects took approx. 20min to complete.

should be addressed. 581

_ .

^

EDI Drive for thinness Bulimia Body dissatisfaction Inefiecliveness Perfectionism Interpersonal distrust lntroceptive awareness Maturity fears SES IBS cc EC AC

0.73”’ 0.42’** 0.80”* 0.71*** 0.51*** 0.52”’ 0.54*** 0.22 -0.61”’ 0.47.** -0.24. -0.34.. 0.38.. 27.8 IS.9

0.19 0.23 0.18 0.21 0.13 -0.04 -0.08 0.15 -0.13 -0.09 0.10 1.6 2.3

- ... - _ ._ - -. - .- - .. _. -.

w

.

i

.a

xales:

0.14 o&4*** 0.58”’ 0.20 -0.70*** 0.33.’ -0.04 -0.26’ 0.54*** 2.6 3.9

-

5

amona

-

Y

-

-

_

-1

-

c

Beliefs Scale; CC: Cognitive

0.44*** 0.3 I l 0.20 0.22 0.28’ -0.41’ 0.33’. -0.25’ -0.29. 0.23 9.9 8.2

-

4

I. Intercorrelations

Scale; IBS: Irrational

-

3

Table

-

2

0.31’ 0.45*** 0.37.’ 0.33.. 0.41*** 0.18 -0.08 -0.40” 0.37.. -0.12 -0.23 0.20 4.6 5.1

lf < 0.05; l*p < 0.01; l**p < 0.001. EDI: Eating Disorders Inventory; SES: Self-Esteem

6. 7. 8. 9. IO. II. 12. 13. 14. x SD

5.

I. 2. 3. 4.

I

_.

=.

Coping;

_

-I,.

_

“,

-

_ -

8

devialions

.

.

.

Coping;

0.40** -0.50*** 0.42”. -0.14 -0.31. 0.44.’ 2.8 3.3

BC: Behavioural

0.35.. 0.11 -0.36** 0.16 -0.14 -0.13 0.24’ 2.1 2.5

0.05 0.2 I -0.08 -0.18 0.21 -0.15 -0.07 -0.03 4.1 3.6

-

7

-

-

6

wale means and standard 9

AC:

-0.18 0.10 -0.13 -0.24. 0.07 LO 1.4

-

-

IO

Avoidance

-0.30 0.01 0.14 -0.47*** 28.6 5.4

-

Coping.

-0.28’ - 0.28, 0.37.’ 59.4 10.8

-

0.56*** -0.18 15.7 5.2

I2

-

II

__ -

-0.12 19.5 5.x

-

-

-

-_

13

5.2 3.9

14

NOTES AND

583

COMMUNICATlOSS

SHORTER

Table 2. Comparison of means for hqh and low EDI scoring grOUpS

SES IB BC cc AC

Hiah EDI

Low EDI

I

P

25.1 63.2 17.6 14.8 6.6

30.9 56.3 21.0 16.4 3.4

3.8 2.5 2.1 I.1 2.3

0.001 0.05 0.05 oY5

SES: Self-Esteem

Scale. IB: Irrational Beliefs Scale; BC: Behavioural Coping; CC: Cognitive Coping;

AC: Avoidance Coping.

RESULTS

Means, standard deviations, and intercorrelations between variables are presented in Table 1. Significant negative correlations between the ED1 and the SES, cognitive coping and behavioural coping subscales of the CI as well as positive correlations with the IBS and avoidance coping subscale of the CI were obtained. There was variation in this pattern of results in relation to subscales of the EDI, closest correspondence being obtained by the Body Dissatisfaction, Ineffectiveness and Introceptive Awareness subscales. In order to investigate the results further subjects were subdivided about the mean ED1 score into high scoring (N = 22) and low scoring (N = 27) groups and r-tests computed with other variables used in the study. Differences between low and high scoring groups are presented in Table 2 and reflect the relationship between eating problems, low self-esteem. irrational beliefs, less frequent use of behavioural coping and enhanced avoidance coping suggested by the correlational data.

DISCUSSION

Due to the small sample used in the present study and the relatively narrow range of ED1 scores any interpretation of the results must of necessity be treated with caution. The highly significant intercorrelations between variables and significant differences between low and high ED1 groups do however suggest an important avenue for future research. It is obviously important to ascertain the extent to which these variables might be predictive of eating problems. There have been many attempts to describe the personality characteristics of anorectics (e.g. Dally and Gomez, 1979) and bulimics (e.g. Allerdissen, Florin and Rost, 1981) but it is not always clear whether the described characteristics are after the onset of difficulties or are premorbid. The importance of this issue is illustrated by the findings from two recent studies. Feldman and Eysenck (1986) report that bulimics score significantly higher than- anorexics on an Addiction Scale derived from the Eysenck Personality Ouestionnaire (EPG; Evsenck and Evsenck, 1975). while de Silva and Evsenck (1987) reoort elevated Addiction Scores for anorexics when compared to normais. As the authors suggest, it is possible that some anorexics, those with relatively high Addiction Scale Scores, are potentially bulimic, although longitudinal and follow-up studies are required to resolve this issue. With this exception, there has been little attempt to examine “personality” deficits which may lead to the development of eating disorders. Thus while one may wish to ascertain the extent to which those characteristics investigated in the present study are similarly related in a clinical sample a more appropriate strategy would be to follow through a non-clinical sample to ascertain the extent to which irrational beliefs, poor coping abilities and low self-esteem are predictive of later pathological conditions. The development of high self-expectations (and hence poor self-esteem) and perceived ineffectiveness (and hence poor coping abilities) as typical irrational beliefs may well be central to the development of later eating disorders (Mizes, 1985). Such individuals may be especially vulnerable to stressful life events (Lacey and Birtchnell, 1986). Within the context of such a stress-coping framework, disordered eating may be perceived, in the absence of appropriate coping skills and the presence of irrational beliefs, as adaptive for the individual concerned. Whether such characteristics are indeed predictive of eating disorders can only be ascertained by longitudinal assessment. It is possible that teaching vulnerable individuals adaptive stress-coping strategies and cognitive restructuring could be part of a preventative therapeutic package.

REFERENCES

Allerdissen S. F., Florin I. and Rost W. (1981) Psychological characteristics of women with bulima nervosa (bulimarexia). Behar. Anal. Modi/. 4, 3 14-3 17. Billings A. G. and Moos R. H. (1981) The role of coping responses and social resources in attenuating the impact of stressful life events. J. Behuo. Med. 4, 139-157. Billings A. G. and Moos R. H. (1984) Coping, stress, and social resources among adults with unipolar depression. J. Person. sot. Psychol. 46, 877-891. Bruch H. (1973) Euting Disorders: Obesity, Anorexiu Nervosa und the Person Wirhin. Basic Books, New York. Bruch H. (1982) Anorexia nervosa: Therapy and theory. Am. J. Psychiar. 139, 1531-1538. Crisp A. H. (1980) Anorexia Neruosa: Let Me Be. Academic Press. New York. de .%a, P. and Eysenck S. (1987) Personality and addictiveness in anorexic and bulimic patients. Person. indicid. D@ 8, 749-75 I. Dally P. J. and Gomez J. (1979) Anorexia Nercosu. William Heineman, London. Eysenck H. J. and Eysenck S. B. G. (1975) Manual of the Eysenck Personulity Incentory. Hodder & Stoughton, London. Fairburn C. G. (1985) Cognitive-behavioral treatment for bulimia In Hundbook ojPsychorherupyfir Anorexia Nerrosu and Bulimiu (Edited by Gamer D. M. and Gartinkel P. E.). Guildford Press, New York. Feldman J. and Eysenck S. (1986) Addictive personality traits in bulimic patients. Person. indiuid. Dtf. 7, 923-926. Garner D. M. and Bemis K. M. (1982) A cognitive-behavioral approach to anorexia nervosa. Cogn. rher. Res. 6, 123-150.

584

NOT!3

AND

SHORTER

COMMUNlCATlONS

Garner D. M. and Bemis K. M. (1985) Cognitive therapy for anorexia nervosa. In Handbook of Psychotherapy for Anorexia Nerrosa and Bulimia (Edited by Garner D. M. and Garfinkel P. E.). Guildford Press, New York. Garner D. M., Olmstead M. P. and Polivy J. (1983) Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. Inr. J. Ear. Dir. 2, 15-34. Guidano V. F. and Liotti G. (1983) Cognitive Processes and Emotional Disorders: A Slructural Approach IO Ps,vchorherap.s. Guildford Press, New York. Lacey J. H. and Birtchnell S. A. (1986) Abnormal eating behaviour. In The Psychosomaric Approach: Conremporary Practice of Whole-Person Care (Edited by Christie M. J. and Mellett P. G.). Wiley, New York. Malouf J. M. and Schutte N. S. (1986) , Develooment and validation of a measure of irrational belief. J. consult. clin. Psvchol. 54, 860-862. Mitchell J. E. and Pyle R. L. (1981) The bulimic syndrome in normal weight individuals: A review. fnr. J. Eat. Dis. 1,6l-73. Mizes J. S. (1985) Bulimia: A review of its svmntomatologv and treatment. Ado. Behar. Ther. 7, 91-142. Rosenberg M. (1965) Society and the Adolescen; Se!f Image. Princeton University Press. Weiss L., Katzman M. and Wolchik A. (1985) Treating Bulimia. A Psvchoeducational Approach. Pergamon Press, Oxford.