Professional Documents
Culture Documents
Thinness and Eating Expectancies Predict Subsequent Binge-Eating and Purging Behavior Among Adolescent Girls
Thinness and Eating Expectancies Predict Subsequent Binge-Eating and Purging Behavior Among Adolescent Girls
Jean R. Simmons
Kate Flory
University of Kentucky
Cleveland Clinic
University of Kentucky
Ones expectancies for reinforcement from eating or from thinness are thought to represent summaries
of ones eating-related learning history and to thus influence the development of binge-eating and
purging behavior. In a 3-year longitudinal study, the authors tested this hypothesis and the hypothesis that
binge eating also influences subsequent expectancy development. The authors used trajectory analysis to
identify groups of middle school girls who followed different trajectories of binge eating, purging, eating
expectancies, and thinness expectancies. Initial eating and thinness reinforcement expectancies identified
girls whose binge eating and purging increased during middle school, and expectancies differentiated
girls who began these problem behaviors from girls who did not. Initial binge-eating scores differentiated
among eating expectancy developmental trajectories. The onset of most behaviors can be understood in
terms of learned expectancies for reinforcement from these behaviors. The same model can be applied
to the risk for eating disorders.
Keywords: binge eating, purging, expectancies, risk factors
quodale and Meehl (1953), and Bolles (1972). The theory postulates that one forms expectancies for the consequences of various
behaviors as a result of ones learning history. These expectancies
then influence ones future behavioral choices: One tends to
choose behaviors from which one expects rewards and avoid
behaviors for which one expects punishment. In other words, ones
expectancies for the consequences of a given behavior are a
summary of ones learning history and are thus the cognitive
mechanisms by which prior learning leads to subsequent behavior.
The application of this perspective by researchers has led to useful
examinations of many psychological phenomena, including psychopathology (Alloy & Tabachnik, 1984), affect (Carver &
Scheier, 1990), gambling behavior (Walters & Contri, 1998), and
risk for alcohol abuse (Smith, Goldman, Greenbaum, & Christiansen, 1995).
Expectancy Theory
189
190
Method
Participants
The participants were 394 middle school girls. They were first assessed
in the fall of their 7th-grade year (Time 1), which was their 1st year in a
2-year middle school. A total of 397 girls were approached to participate,
and 3 refused. The participants were followed through the fall of their
9th-grade year (their 1st year of high school). We began with 394 participating 7th graders and were able to locate and test 343 of them (87%) 1
year later (Time 2). At 2 years after the initial testing (Time 3), we were
able to locate 283 of them (83% of the Year 2 sample). As described below,
we used multiple imputation procedures to estimate missing values, which
enabled us to report results from the full sample of 394 girls. The mean age
at study outset was 12.84 years. Participants were predominantly Caucasian (78.7%); 10.5% identified themselves as African American; and the
remaining participants identified themselves as Asian, Hispanic, American
Indian, Arab, or East Indian. They were from diverse economic backgrounds: 26% reported family incomes that were less than $25,000, 50%
reported incomes that were between $25,000 and $50,000, and 24% reported incomes that were greater than $50,000.
Measures
Eating Expectancy Inventory Scale 1 (EEI; Hohlstein et al., 1998). We
used EEI Scale 1: Eating Helps Manage Negative Affect (e.g., when I am
feeling depressed or upset, eating can help me take my mind off my
problems). It has been shown to be internally consistent and associated
with eating disorder symptomatology in several adolescent samples
(MacBrayer et al., 2001; Simmons et al., 2002).
Thinness and Restricting Expectancy Inventory (TREI; Hohlstein et al.,
1998). The TREI is a single scale measure that reflects overgeneralized
expectancies for life improvement from thinness (e.g., I would feel less
stressed, in general, if I were thin). It has also been shown to be internally
consistent and concurrently predictive of eating-disorder symptomatology
in several adolescent samples (MacBrayer et al., 2001; Simmons et al.,
2002).
Bulimia TestRevised (Thelen, Farmer, Wonderlich, & Smith, 1991).
The Bulimia TestRevised is a paper-and-pencil measure. In two independent studies, it had sensitivity, specificity, and negative predictive
values over .90, and positive predictive values over .70 with respect to
DSMIV criteria as diagnosed by interview (Thelen, Mintz, & Vander Wal,
1996; Welch, Thompson, & Hall, 1993). The scale has perhaps most often
been used to measure individual differences in symptom endorsement
along a continuum (e.g., Hohlstein et al., 1998; Simmons et al., 2002). It
has a four-factor structure that includes binge-eating and purging factors
among adolescents (Vincent, McCabe, & Ricciardelli, 1999). We used two
slightly modified scales from the measure to reflect these two criteria. Ten
items reflected binge eating. One example is, I would presently rate
myself a compulsive eater (one who engages in episodes of uncontrolled
eating). Internal consistency for the scale was ! " .88. Eleven items were
chosen to reflect purging behavior (e.g., how often do you intentionally
vomit after eating?). Internal consistency for this scale was ! " .83.
Responses to items were on a 5-point Likert scale and were coded so that
higher scores reflected higher levels of the target behavior. For example,
responses to the vomiting frequency question ranged from less than once
a month or never to two or more times a week.
Results
Participant Attrition Analysis and Treatment of
Missing Data
According to school officials, 12% of students moved from the
school system between Times 1 and 2, and 13% moved between
Times 2 and 3. Our retention rates of 87% and 83% indicated that
we retained almost all students still in the school system (we lost
44 students at Time 3 because of high school administrative
difficulties; those difficulties were unrelated to student characteristics). We compared study dropouts with retained students on
demographic, expectancy, and symptom measures. The two groups
did not differ on any demographic variable, except that dropouts
were more likely to live with only one parent, #2(1, N " 394) "
23.18, p $ .001. The two groups did not differ on binge-eating,
purging, or expectancy scores. We concluded that scores were
missing at random.
We therefore used multiple imputation to estimate missing data.
This procedure is thoroughly described by Allison (2003); it has
been shown to produce relatively unbiased population parameter
estimates. We used SAS Version 9.1 (PROC MI) to conduct the
imputation procedure as described by Allison (2003), and final
parameter estimates were based on 10 imputed data sets.
Procedure
191
N=30
N=302
N=48
N=14
Wave 1
Wave 2
Wave 3
Purging Behavior
50
Purging Scores
40
N=30
N=323
N=37
N=4
30
20
10
0
Wave 1
Wave 2
Wave 3
192
193
Table 1
Means and Standard Deviations of the Groups
TE
Group
EE
SD
BE
SD
P
SD
SD
302
30
48
14
2.97
3.90
3.95
4.53
1.36
1.70
1.71
1.62
1.82
2.34
2.93
3.65
0.96
1.08
1.17
0.92
323
30
37
4
3.02
3.71
4.27
5.62
1.40
1.52
1.70
1.38
1.97
2.27
2.67
2.63
1.05
1.09
1.34
0.87
59
125
85
102
23
13.43
14.06
14.50
16.10
23.17
5.71
6.21
5.60
6.00
11.03
14.71
14.22
16.74
16.29
24.08
5.06
3.65
5.79
5.68
12.16
232
82
36
35
9
13.26
18.94
15.00
16.13
24.78
4.99
8.41
5.31
5.31
8.77
15.15
18.16
15.67
15.87
17.78
4.87
8.85
5.87
4.61
4.68
Note. Means for the expectancy measures are item means and are based on a 17 scale. Means for the symptom
measures are total scores. TE " thinness expectancies; EE " eating expectancies; BE " binge eating; P "
purging.
194
Thinness Expectancies
Expectancy Score
7
6
N=59
N=125
N=85
N=102
N=23
5
4
3
2
1
0
Wave 1
Wave 2
Wave 3
Eating Expectancies
Expectancy Score
6
5
N=232
N=82
N=36
N=35
N=9
4
3
2
1
0
Wave 1
Wave 2
Wave 3
19.05, p $ .001, &2 " .16. Initial binge eating also differentiated
between the eating expectancy increase group and the group with
continually low expectancy endorsement, t(1, 389) " 2.57, p $
.005, rpb " .18. The trajectory group that began at moderate levels
of expectancy endorsement and then declined began with lower
binge-eating scores than did the two groups who maintained stable
high or moderate eating expectancy endorsement, t(1, 389) " 4.62,
p $ .001, rpb " .17. In addition, the three trajectory groups that
began with higher eating expectancy scores were significantly
higher in initial binge eating than were the other two groups, t(1,
389) " 5.11, p $ .001, rpb " .32.
Time 1 purging scores also differentiated among the five eating
expectancy groups, F(4, 389) " 4.06, p $ .005. The only significant purging contrast was our comparison of the three initially
high expectancy groups with the two initially low expectancy
groups: The former had higher average purging scores, t(1, 389) "
1.87, p $ .05, rpb " .17.
Discussion
This report describes a test of eating disorder expectancy theory,
which involves applying basic learning expectancy theory to the
problem of eating disorders. The theory holds that individuals
differ in their expectancies for reinforcement from thinness and
dieting and from eating because they have been exposed to different learning histories concerning dieting and food. Learned expectancies are a basis for future behavioral choices; expectancies
are thought to be the mechanism by which prior learning influences behavior. Extreme eating and dieting behaviors, that is,
binge eating and purging, are thought to result from extreme
expectancies, themselves the product of extreme learning histories.
The first important finding of this study concerned the different
trajectories of binge eating and of purging among these adolescent
girls. Early adolescent girls binge-eating behavior and their purging behavior can be characterized by four subgroups with different
trajectories of the target behavior across the 2 years of middle
school and the 1st year of high school. By middle school, girls
already differ in their engagement in eating-disorder behaviors.
Most girls were not involved in either target behavior: 72% reported essentially no binge eating or purging across the three
waves of data collection. However, there were also small numbers
of girls reporting binge eating and purging from the beginning of
middle school. It seems clear that risk assessment should begin
prior to middle school. Of particular importance for the present
study, there was a subgroup of girls who reported significant
increases in binge eating or purging during the middle school
years.
Among the highest scoring girls, the average rates of binge
eating or purging (such as through self-induced vomiting) were
two or three times per month. Although other authors refer to these
rates as reflective of partial syndrome disorders (cf. McKnight
Investigators, 2003), our focus is on bulimic behaviors and their
emergence, rather than on diagnosable eating disorders. We emphasize levels of binge eating and purging that are of obvious
concern to parents or health care professionals. The numbers of
girls in the highest scoring binge-eating and purging groups, although low, are consistent with previous literature. We found
3.55% of girls reporting binge eating more than monthly and 1%
of girls reporting purging more than monthly at Time 1. Wonder-
lich et al. (2004) interviewed girls of similar age and found 3.8%
to have binge eaten more than once and 2% to have engaged in
some compensatory behavior. McKnight Investigators (2003) and
Field et al. (1999) described similar findings.
A key test of eating disorder expectancies as putative risk
factors for bulimic symptom development involves their ability to
differentiate between girls who consistently report an absence of
symptoms and those who report increased levels of symptomatic
behavior over time. These tests, for this longitudinal period, provided clear support for the theory. Both eating and thinness expectancies differentiated the group of non-binge eating girls from
the group who began with little binge eating and increased their
binge eating during the study period. In addition, when a group of
girls not engaging in binge eating was identified, both types of
expectancies predicted the rate at which the girls would begin to
binge eat.
Thinness expectancies also differentiated the nonpurging group
from the group that began with little purging behavior and that
increased their purging over time. And, in a group of initially
nonpurging girls, thinness expectancies predicted the rate at which
girls would begin to purge. It thus appears that expectancies
predate and predict subsequent bulimic symptoms as hypothesized.
In this study, we also examined different trajectories of expectancy development during these formative years. For both the
expectancy that eating helps alleviate negative affect and the
expectancy that thinness leads to overgeneralized life improvement, we found five different trajectories of expectancy development. For both types of expectancies, there were three trajectory
groups characterized by relatively consistent endorsement of expectancy items: one group with low scores, one with moderate
scores, and one with relatively higher scores. It is noteworthy that
a substantial proportion of 7th-grade girls, in their 1st year of
middle school, were already endorsing eating and dieting expectancies at nontrivial levels and that their endorsement rates remained consistent across these transition years. Also, for both
types of expectancies, there was one group of girls who reported
significant increases in endorsement and one group who reported
significant decreases in expectancy endorsement over time. In this
sample, 18% of girls fell in trajectory groups marked by eating
expectancy change over time, and over 53% fell in trajectory
groups marked by thinness expectancy change. Thus, these transition years do seem to be ones in which expectancy levels change
for a meaningful portion of adolescent girls.
We also considered the possibility that initial binge-eating and
purging behaviors themselves influenced the subsequent trajectories of expectancy development. As hypothesized, higher initial
binge-eating behavior was associated more with the group whose
eating expectancies started low and increased over time, compared
with the group who endorsed continually low expectancies. In
addition, lower 7th-grade binge-eating scores predicted membership in the group whose eating expectancies declined over time, as
compared with groups who endorsed continually moderate or high
levels of expectancies.
These findings are consistent with the possibility that binge
eating influences subsequent expectancy development. The direction of the effects is noteworthy. The binge eaters tended to grow
in the belief that eating helps alleviate negative affect, and low
levels of binge eating were associated with a decline in that belief.
There was no evidence of a corrective process in which binge
195
196
References
Agras, W. S., & Telch, C. F. (1998). Effects of caloric deprivation and
negative affect on binge eating in obese binge eating disordered women.
Behavior Therapy, 29, 491503.
Allison, P. D. (2003). Missing data techniques for structural equation
modeling. Journal of Abnormal Psychology, 112, 545557.
Alloy, L. B., & Tabachnik, N. (1984). Assessment of covariation by
humans and animals: The joint influence of prior expectations and
current situational information. Psychological Review, 91, 112149.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
Ball, K., & Lee, C. (2002). Psychological stress, coping, and symptoms of
disordered eating in a community sample of young Australian women.
The International Journal of Eating Disorders, 31, 71 81.
Bolles, R. C. (1972). Reinforcement, expectancy, and learning. Psychological Review, 79, 394 409.
Carver, C. S., & Scheier, M. F. (1990). Origins and functions of positive
and negative affect: A control-process view. Psychological Review, 97,
19 35.
Chassin, L., Pitts, S. C., & Prost, J. (2002). Binge drinking trajectories from
adolescence to emerging adulthood in a high-risk sample: Predictors and
substance abuse outcomes. Journal of Consulting and Clinical Psychology, 70, 6778.
Cooley, E., & Toray, T. (2001). Body image and personality predictors of
eating disorder symptoms during the college years. The International
Journal of Eating Disorders, 30, 28 36.
Crowther, J. H., Sanftner, J., Bonifazi, D. Z., & Shepherd, K. L. (2001).
The role of daily hassles in binge eating. International Journal of Eating
Disorders, 29, 449 454.
Darkes, J., & Goldman, M. S. (1993). Expectancy challenge and drinking
reduction: Experimental evidence for a mediational process. Journal of
Consulting and Clinical Psychology, 61, 344 353.
Darlington, R. B. (1990). Regression and linear models. New York:
McGraw-Hill.
Field, A. E., Camargo, C. A., Taylor, C. B., Berkey, C. S., & Colditz, G. A.
(1999). Relation of peer and media influences to the development of
purging behaviors among preadolescent and adolescent girls. Archives of
Pediatric and Adolescent Medicine, 153, 1184 1189.
Fischer, S., Smith, G. T., & Cyders, M. A. (2005). Integrating personality
and environmental risk factors for bulimia nervosa. In F. Columbus
(Ed.), Recent advances in eating disorder research (pp. 85108). New
York: NOVA Science Publishers.
Fister, S. M., & Smith, G. T. (2004). Media effects on expectancies:
Exposure to realistic female images as protective factor. Psychology of
Addictive Behaviors, 18, 394 397.
Flory, K., Lynam, D., Milich, R., Leukefeld, C., & Clayton, R. (2004).
Early adolescent through young adult alcohol and marijuana use trajectories: Early predictors, young adult outcomes, and predictive utility.
Development and Psychopathology, 16, 193213.
Franko, D. L., & Omori, M. (1999). Subclinical eating disorders in adolescent women: A test of the continuity hypothesis and its psychological
correlates. Journal of Adolescence, 22, 389 396.
Gardner, R. M., Stark, K., Friedman, B. N., & Jackson, N. A. (2000).
Predictors of eating disorder scores in children ages 6 through 14: A
longitudinal study. Journal of Psychosomatic Research, 49, 199 205.
Hohlstein, L. A., Smith, G. T., & Atlas, J. G. (1998). An application of
expectancy theory to eating disorders: Development and validation of
measures of eating and dieting expectancies. Psychological Assessment,
10, 49 58.
Jackson, B., Cooper, M. L., Mintz, L., & Albino, A. (2003). Motivations to
eat: Scale development and validation. Journal of Research in Personality, 37, 297318.
Jones, B., Nagin, D. S., & Roeder, K. (2001). A SAS procedure based on
mixture models for estimating developmental trajectories. Sociological
Methods and Research, 29, 374 393.
Killen, J. D., Barr, C. B., Hayward, C., Wilson, D. M., Haydel, K. F.,
Hammer, L. D., et al. (1994). Pursuit of thinness and onset of eating
disorder symptoms in a community sample of adolescent girls: A threeyear prospective analysis. The International Journal of Eating Disorders, 16, 227238.
MacBrayer, E. K., Smith, G. T., McCarthy, D. M., Demos, S., & Simmons,
J. (2001). The role of family of origin food-related experiences in
bulimic symptomatology. The International Journal of Eating Disorders, 30, 149 160.
MacCorquodale, K., & Meehl, P. E. (1953). Preliminary suggestions as to
a formalization of expectancy theory. Psychological Review, 60, 55 63.
McKnight Investigators. (2003). Risk factors for the onset of eating disorders in adolescent girls: Results of the McKnight longitudinal risk
factor study. American Journal of Psychiatry, 160, 248 254.
Nagin, D. S. (2005). Group-based modeling of development. Cambridge,
MA: Harvard University Press.
Rotter, J. B. (1954). Social learning and clinical psychology. Englewood
Cliffs, NJ: Prentice Hall.
Sanftner, J. L., & Crowther, J. H. (1998). Variability in self-esteem, moods,
shame, and guilt in women who binge. International Journal of Eating
Disorders, 23, 391397.
Simmons, J. R., Smith, G. T., & Hill, K. K. (2002). Validation of eating
and dieting expectancy measures in two adolescent samples. The International Journal of Eating Disorders, 31, 461 473.
Smith, G. T., Goldman, M. S., Greenbaum, P. E., & Christiansen, B. A.
(1995). Expectancy for social facilitation from drinking: The divergent
paths of high-expectancy and low-expectancy adolescents. Journal of
Abnormal Psychology, 104, 32 40.
Stice, E. (2001). A prospective test of the dual-pathway model of bulimic
pathology: Mediating effects of dieting and negative affect. Journal of
Abnormal Psychology, 110, 124 135.
Stice, E. (2002). Risk and maintenance factors for eating pathology: A
meta-analytic review. Psychological Bulletin, 128, 825 848.
Stice, E., & Shaw, H. E. (2002). Role of body dissatisfaction in the onset
and maintenance of eating pathology. Journal of Psychosomatic Research, 53, 985993.
Stice, E., & Whitenton, K. (2002). Risk factors for body dissatisfaction in
adolescent girls: A longitudinal investigation. Developmental Psychology, 38, 669 678.
Stice, E., Ziemba, C., Margolis, J., & Flick, P. (1996). The dual pathway
model differentiates bulimics, subclinical bulimics, and controls: Testing
the continuity hypothesis. Behavior Therapy, 27, 531549.
Thelen, M. H., Farmer, J., Wonderlich, S., & Smith, M. (1991). A revision
of the Bulimia Test: The BULITR. Psychological Assessment, 3, 119
124.
Thelen, M. H., Mintz, L. B., & Vander Wal, J. S. (1996). The Bulimia
TestRevised: Validation with DSMIV criteria for bulimia nervosa.
Psychological Assessment, 8, 219 221.
197