Glenn Waller

Psychometric Properties of the Long and Short Versions of the Young Schema Questionnaire: Core Beliefs Among Bulimic and Comparison Women

Youngs Schema Questionnaire is a potentially valuable clinical and research tool for the investigation of core beliefs and has been well validated. However, at 205 items it is comparatively unwieldy. A briefer, 75-item version has recently been produced by Young, but lacks the psychometric validation that would demonstrate its utility relative to the longer version. The present study aimed to determine whether the long and short versions of the Schema Questionnaire have comparable psychometric properties among a clinical group of bulimics and a comparison group. The two forms had similar levels of internal consistency, and parallel forms reliability and discriminant validity, and their levels of clinical utility were broadly comparable. These findings support the use of the more convenient 75-item version of this questionnaire in clinical and research settings since its psychometric properties are similar to those of the long version. However, these results require replication with other clinical groups.

A Greater role of emotional than physical or sexual abuse in predicting disordered eating attitudes: The role of mediating variables

OBJECTIVE Previous research on the role of trauma in eating psychopathology has generally focused on reported childhood sexual abuse. There has been relatively little research addressing the full range of abusive experiences, and none considering their long-term impact on eating. This study investigated the relationships between four forms of reported childhood abuse (physical abuse, sexual abuse, emotional abuse, neglect) and unhealthy eating attitudes in adult life. Within this relationship, depression, anxiety, and dissociation were considered potential mediators, and age of onset of abuse was considered a potential moderator. METHOD A nonclinical sample of 236 women completed self-report measures of abuse, eating psychopathology, and psychological function. Multiple regression analyses were used to test for associations as well as for mediating and moderating influences. RESULTS When the intercorrelations of the different forms of reported abuse were controlled for, emotional abuse was the only form of childhood trauma that predicted unhealthy adult eating attitudes. That relationship was perfectly mediated by the womens levels of anxiety and dissociation. Age at onset of emotional abuse did not moderate these relationships. DISCUSSION Although these results require extension to a clinical sample, the findings underscore the need to consider a history of emotional trauma as a potentially central factor in any abusive history. Treatment may depend on addressing the psychological consequences of such trauma.

Cognitive content among bulimic women: the role of core beliefs.

OBJECTIVE Most cognitive analyses of bulimic disorders have stressed the role of negative automatic thoughts or dysfunctional assumptions regarding weight, shape, and food. This study considered the role of more general core beliefs in the cognitive content of bulimic disorders. METHODS Fifty bulimic and 50 comparison women completed the Schema Questionnaire (YSQ) and a diary measure of bulimic behaviors. RESULTS The groups could be differentiated using just three of the beliefs: perceived Defectiveness/Shame, Insufficient Self-Control, and Failure to Achieve. This discrimination included differences between bulimic subgroups. At the symptomatic level, the bulimic womens Emotional Inhibition beliefs predicted their severity of binging, whereas their Defectiveness/Shame beliefs predicted severity of vomiting. CONCLUSIONS The findings support a model of bulimic psychopathology where the central cognitions encompass more than beliefs about food, shape, and weight. Clinical implications are considered.

Bulimics' responses to food cravings: is binge-eating a product of hunger or emotional state?

This study examined the roles of hunger, food craving and mood in the binge-eating episodes of bulimic patients, and identified the critical factors involved in the processes surrounding binge-eating episodes that follow cravings. This was a prospective study of the binge-eating behaviour of 15 women with bulimia nervosa. The participants used food intake diaries and Craving Records to self-monitor their nutritional behaviour, hunger levels and affective state. Cravings leading to a binge were associated with higher tension, lower mood and lower hunger than those cravings not leading to a binge. Levels of tension and hunger were the critical discriminating variables. The findings of the study support empirical evidence and models of emotional blocking in binge-eating behaviour and challenge the current cognitive starve-binge models of bulimia. The role of food cravings in the emotional blocking model is discussed in terms of a classically conditioned motivational state. Implications for treatment are addressed.

Social anxiety and coping strategies in the eating disorders.

Studies of social phobia in the eating disorders have demonstrated high comorbidity with both anorexia and bulimia nervosa. This study examined levels of social anxiety across different types of eating disorders, and determined the association of such anxiety with specific forms of emotional regulation. One hundred fourteen females who met DSM-IV criteria for an eating disorder and a comparison group of 50 nonclinical women completed three self-report questionnaires, which measured bulimic behaviours, dissociation, and social anxiety. The clinical groups reported higher levels of social anxiety than the nonclinical group. In both the nonclinical individuals and the bulimia nervosa patients, social anxiety was found to be associated with higher levels of bulimic psychopathology. By contrast, social anxiety in the restrictive anorexic group was linked to higher levels of dissociation. The present findings highlight the clinical importance of addressing social anxiety in eating-disordered individuals, and suggestions are made for the treatment of different forms of emotional regulation in such cases. Implications for future research are also discussed.

Internal and external antecedents of binge eating episodes in a group of women with bulimia nervosa

OBJECTIVE This research examined the internal and external factors that predict whether a food craving develops into a binge in bulimia nervosa. METHOD Fifteen bulimic women kept diary records of food cravings over the course of a week, noting their internal state, environmental triggers, and whether the craving developed into a binge. Eighty cravings were examined, of which approximately one half developed into binges. RESULTS At the bivariate level, binge eating resulted from cravings more often if the women were alone, in the morning, and following eating the craved food. These factors interacted, so that binges were more likely if the women avoided a craved food in the morning, but not later in the day. CONCLUSIONS These findings support a model of binge eating for which both internal states (craving, eating the craved food) and external factors (time of day, social circumstances) need to be taken into account. Relevant models of craving are discussed, along with their implications for clinical practice.

Stress, coping, and disturbed eating attitudes in teenage girls

OBJECTIVE This study explored the relationship between stressors and disturbed eating attitudes among adolescent females, assessing the moderating role of coping and the mediating influence of poor self-esteem. METHOD Two hundred eighty-six teenage girls were recruited from local schools, and completed standardized measures of stressors, coping, self-esteem, perfectionism, and disturbed eating attitudes. Regression analyses were used to test for moderating and mediating effects. RESULTS Stressors and emotion-focused coping were found to be associated with low self-esteem, which in turn was strongly associated with disturbed eating attitudes. Stressors were also directly related to disturbed eating attitudes. DISCUSSION The findings provide partial support for existing models of the etiology and maintenance of eating psychopathology, but have wider implications for our understanding of the eating disorders and their treatment.

Core beliefs in anorexic and bulimic women.

There is research evidence to suggest the presence of dysfunctional cognitions in anorexia nervosa and bulimia nervosa that are not related to food, weight, or shape. These maladaptive cognitions have not been addressed by the conventional cognitive behavioral models of etiology or therapy. This study aimed to assess the impact of unhealthy core beliefs on eating disorders and their symptoms. Twenty restricting anorexics, 10 bulimic anorexics, 27 bulimics, and 23 normal controls completed Youngs Schema Questionnaire. Eating behaviors and attitudes were also measured. The results indicate that both anorexic and bulimic women had significantly higher levels of unhealthy core beliefs than comparison women, but the clinical groups only differed on one individual core belief (entitlement). However, there were different patterns of association between core beliefs and eating psychopathology in anorexic and bulimic women. It is suggested that future clinical practice should incorporate core beliefs as a potential element in the assessment and treatment of eating disorders.

Eating disorders and perceived relationships with parents.

Many clinicians have theorized about the role of family dynamics in the development of eating disorders (e.g., Minuchin, Rosman & Baker, 1978; Palazzoli, 1974). On the same theme, in recent years, a major research study has produced unequivocal evidence for the therapeutic value of family therapy, at least with the younger client (Russell, Szmukler, Dare & Eisler, 1987). However, there are still relatively few data on the nature of family interaction patterns in patients with an eating disorder. To date, there have been two reports on the use of the Parental Bonding Instrument (PBI) (Parker, Tupling & Brown, 1979) with this clinical population. The present report is the third and largest such study, contrasting 98 patients with anorexic and bulimic eating disorders and 242 comparison subjects. In line with the two previous studies, eating-disordered patients recalled that both parents were lower in perceived care/warmth and, in line with the second study, they recalled that their fathers (but not their mothers) were more overprotective. The latter finding appears an intriguing one and requires further exploration.

Parental style and vulnerability to depression: The role of core beliefs.

This study considers the potential role of core beliefs (unconditional schema-level representations) in the relationship between recalled parenting in childhood and major depression in adulthood, comparing a group of depressed outpatients (N = 60) with a healthy community sample (N = 67). The depressed group were differentiated by poorer perceived parenting (low care and high overprotection) and by three unhealthy core beliefs (defectiveness/shame, self-sacrifice, and insufficient self-control). Among nonclinical participants, it appears that vulnerability to harm beliefs act as a partial mediator of the relationship between poor paternal care and the development of depressive features. In contrast, a broader set of core beliefs appears to mediate the relationship of maternal bonding and paternal overprotection with depressive symptoms among the depressed group. The findings suggest that clinical work with adults with major depression might need to take account of parental style. Where parents are reported to be uncaring or overprotective, cognitive-behavioral therapy might need to include a schema-focused component.