Depressive Thought Content Among Female College Students With Bulimia

Abstract

The author used a rationalistic cognitive approach to identify typical thought content among female college students with bulimia. The study compared overall depression scores on the Beck Depression Inventoy between women with bulimia and women in a control group and examined differences in specific depression items. Results Bulimia is an eating disorder characterized by episodic binge eating and purging. One population that seems particularly vulnerable to the development of bulimia is college women. Estimates of the incidence of bulimia among college women have ranged from 3.9% to 23.0% (Halmi, Falk, & Schwartz, 1981;Katzman, Wolchik, & Braver, 1984;Segal & Figley, 1985). No strong consensus has emerged concerning the etiology of the disorder, but several predisposing factors have been identified, including family dynamics (Root, Fallon, & Friedrich, 1986), values (Boskind-Lodahl & White, 1983, affective patterns (Johnson & Larson, 1982), and cognitive functioning (Garner & Davis, 1986).If counselors are to be successful in treating clients with bulimia, they must employ a comprehensive approach, including cognitive, affective, and behavioral and family issues. In this study I attempted to specify the cognitive component of bulimia and used rationalistic cognitive theory as its theoretical base. Beck (1967) and Ellis (1962) proposed that painful emotions (such as depression) and self-defeating behaviors result largely from disordered thinking. It is possible that specific ways of disordered thinking associated with the development and maintenance of bulimia are exacerbated by the college environment and lead to the epidemic bulimic behavior found at many colleges today.My clinical observations indicate that women with bulimia are often unable to express intense, painful emotions. To cope with these emotions, the bulimic begins a binge to numb herself from feeling. Thus, in this rationalistic cognitive paradigm, a bulimic episode would involve irrational thoughts that lead to painful, unexpressed emotions, which then result in eating behavior that is out of control.Beck (1976) suggested that dysfunctional thoughts are idiosyncratic; clients with the same diagnoses tended to have similar patterns of disordered thinking. If automatic thoughts are indeed idiosyncratic, as Beck theorized, then bulimic women can be expected to manifest similar content of thought.One painful emotion commonly associated with bulimia is depression (Root et al., 1986;Stuckey, 1982). Although a causal relationship between depression and bulimia cannot be proven, depression certainly accompanies bulimia in many cases. The question of whether physiological or psychological factors are responsible for the depression is beyond the scope of this study. The pilot study indicated that college women with bulimia exhibited idiosyncratic depressive thought content on the Beck Depression Inventory (BDI) (Beck, 1978), particularly body image distortion, self-blame, self-dislike, somatic preoccupation, guilt, dissatisfaction, and suicidal ideation...

Eating disorders among adolescents in an unselected French population

“…Our results confirm that eating disorders come into play on a backdrop of depression (Gross & Rosen, 1988;Brouwers, 1988;Killen et al, 1987), and that adolescents with symptoms of eating disorders are more depressive than their peers. In the same way they also have more somatic and sleep difficulties.…”

Eating disorders among adolescents in an unselected French population

“…Our results confirm that eating disorders come into play on a backdrop of depression (Gross & Rosen, 1988;Brouwers, 1988;Killen et al, 1987), and that adolescents with symptoms of eating disorders are more depressive than their peers. In the same way they also have more somatic and sleep difficulties.…”

College Atmosphere and Eating Disorders

“…In addition, factors such as intellectual and academic pressure, which are often assumed to be related to eating disorders (cf. Brouwers, 1988), were strongly related to symptomatology at School A and, surprisingly, only slightly related to symptomatology at School B. In general, much of the School B sample variance in eating disorder symptomatology was not explained by the campus or personal variables investigated in this study.…”

Sampling Inner Experience in Disturbed Affect

“…It could be speculated that bulimics are not easily able to separate their emotions from their cognitions and thus, they find their emotions unduly distressing, which in tum cues them to binge. Casper, Eckert, et al (1980), among others, reported that bulimics do not overeat just to ease hunger sensations, but also to relieve distressing emotions (Elmore & de Castro, 1990), which generally agrees with Brouwers' (1988) observation that bulimics are often unable to express intense, painful emotions, and binge to numb themselves from feeling. Our subjects did not actually have a high frequency of thoughts about food, and it did seem to be the case, especially with Ashley, that the urge to purge was more associated with a "funnel" of thoughts and emotions than with hunger per se.…”

Eating disorders among adolescents in an unselected French population

“…Our results confirm that eating disorders come into play on a backdrop of depression (Gross & Rosen, 1988;Brouwers, 1988;Killen et al, 1987), and that adolescents with symptoms of eating disorders are more depressive than their peers. In the same way they also have more somatic and sleep difficulties.…”

College Atmosphere and Eating Disorders

“…In addition, factors such as intellectual and academic pressure, which are often assumed to be related to eating disorders (cf. Brouwers, 1988), were strongly related to symptomatology at School A and, surprisingly, only slightly related to symptomatology at School B. In general, much of the School B sample variance in eating disorder symptomatology was not explained by the campus or personal variables investigated in this study.…”

Sampling Inner Experience in Disturbed Affect

“…It could be speculated that bulimics are not easily able to separate their emotions from their cognitions and thus, they find their emotions unduly distressing, which in tum cues them to binge. Casper, Eckert, et al (1980), among others, reported that bulimics do not overeat just to ease hunger sensations, but also to relieve distressing emotions (Elmore & de Castro, 1990), which generally agrees with Brouwers' (1988) observation that bulimics are often unable to express intense, painful emotions, and binge to numb themselves from feeling. Our subjects did not actually have a high frequency of thoughts about food, and it did seem to be the case, especially with Ashley, that the urge to purge was more associated with a "funnel" of thoughts and emotions than with hunger per se.…”

Eating disorders among adolescents in an unselected French population

“…Our results confirm that eating disorders come into play on a backdrop of depression (Gross & Rosen, 1988;Brouwers, 1988;Killen et al, 1987), and that adolescents with symptoms of eating disorders are more depressive than their peers. In the same way they also have more somatic and sleep difficulties.…”

College Atmosphere and Eating Disorders

“…In addition, factors such as intellectual and academic pressure, which are often assumed to be related to eating disorders (cf. Brouwers, 1988), were strongly related to symptomatology at School A and, surprisingly, only slightly related to symptomatology at School B. In general, much of the School B sample variance in eating disorder symptomatology was not explained by the campus or personal variables investigated in this study.…”

Sampling Inner Experience in Disturbed Affect

“…It could be speculated that bulimics are not easily able to separate their emotions from their cognitions and thus, they find their emotions unduly distressing, which in tum cues them to binge. Casper, Eckert, et al (1980), among others, reported that bulimics do not overeat just to ease hunger sensations, but also to relieve distressing emotions (Elmore & de Castro, 1990), which generally agrees with Brouwers' (1988) observation that bulimics are often unable to express intense, painful emotions, and binge to numb themselves from feeling. Our subjects did not actually have a high frequency of thoughts about food, and it did seem to be the case, especially with Ashley, that the urge to purge was more associated with a "funnel" of thoughts and emotions than with hunger per se.…”