Graduate Theses and Dissertations
Iowa State University Capstones, Theses and
Dissertations
2020
Modification of the dual pathway model for binge eating
Modification of the dual pathway model for binge eating
Davelle May Cheng
Iowa State University
Follow this and additional works at: https://lib.dr.iastate.edu/etd
Recommended Citation
Recommended Citation
Cheng, Davelle May, “Modification of the dual pathway model for binge eating” (2020). Graduate Theses
and Dissertations. 17851.
https://lib.dr.iastate.edu/etd/17851
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Modification of the dual pathway model for binge eating
by
Davelle Cheng
A thesis submitted to the graduate faculty
in partial fulfillment of the requirements for the degree of
MASTER OF SCIENCE
Major: Psychology
Program of Study Committee:
Meifen Wei, Major Professor
Kristi Costabile
David Vogel
The student author, whose presentation of the scholarship herein was approved by the program
of study committee, is solely responsible for the content of this thesis. The Graduate College will
ensure this thesis is globally accessible and will not permit alterations after a degree is conferred.
Iowa State University
Ames, Iowa
2020
Copyright © Davelle Cheng, 2020. All rights reserved.
ii
TABLE OF CONTENTS
Page
LIST OF FIGURES
iii
LIST OF TABLES
iv
ABSTRACT
v
CHAPTER 1. INTRODUCTION
1
CHAPTER 2. LITERATURE REVIEW
10
CHAPTER 3. METHODS
30
CHAPTER 4. RESULTS
37
CHAPTER 5. DISCUSSION
50
REFERENCES
60
APPENDIX A: DEMOGRAPHIC INFORMATION
70
APPENDIX B: BODY DISSATISFACTION (PREDICTOR)
72
APPENDIX C: RESTRICTED EATING (MEDIATOR)
73
APPENDIX D: DIFFICULTIES IN EMOTION REGULATION (MEDIATOR)
75
APPENDIX E: SELF-COMPASSION (MODERATOR)
77
APPENDIX F: BINGE EATING (OUTCOME)
79
APPENDIX G: NEGATIVE AFFECT (MEDIATOR)
80
APPENDIX H: INSTITUTIONAL REVIEW BOARD APPROVAL FORM
81
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LIST OF FIGURES
Page
Figure 1. Dual Pathway Model for binge eating.
3
Figure 2. Modified Dual Pathway Model for binge eating.
3
Figure 3. Hypothesized moderation effect of self-compassion on the association 8
between body dissatisfaction and difficulties in emotion regulation.
Figure 4. Regression coefficients for the modified Dual Pathway Model for women,
47
controlling for BMI.
Figure 5. Regression coefficients for the modified Dual Pathway Model for men,
47
controlling for BMI.
Figure 6. Regression coefficients for the Dual Pathway Model for women,
48
controlling for BMI.
Figure 7. Regression coefficients for the Dual Pathway Model for men,
48
controlling for BMI.
Figure 8. The effect of body dissatisfaction on negative affect at lower versus higher
49
levels of self-compassion.
iv
LIST OF TABLES
Page
Table 1. Independent Samples T-Test Results for Women and Men.
38
Table 2. Means, Standard Deviations, and Intercorrelations for Women.
41
Table 3. Means, Standard Deviations, and Intercorrelations for Men.
42
Table 4. Bootstrap Analyses of the Magnitude and Statistical Significance
46
of Indirect Effects.
v
ABSTRACT
The present study tested a modification of the Dual Pathway Model describing the
development of binge eating (Stice, 1994) with difficulties in emotion regulation as a mediator in
the place of negative affect, as well as self-compassion as a moderator. A total of 440
undergraduate students attending a predominately White, Midwestern university completed an
online survey. Due to significantly different mean differences on most variables, results were
examined separately for women (N = 230) and men (N = 205). The moderation of self-
compassion on the association between body dissatisfaction and difficulties in emotion
regulation was tested using PROCESS (Hayes, 2013) and was found to be non-significant. Using
path analysis, direct and indirect effects of body dissatisfaction, restricted eating, difficulties in
emotion regulation, and binge eating were tested. A multiple-group analysis demonstrated
gender differences for these relationships; in particular, the path from body dissatisfaction to
restricted eating was significant for women but not for men. The mediation of body
dissatisfaction to binge eating through restricted eating was not significant for either group.
Restricted eating and difficulties in emotion regulation mediated the indirect effect of body
dissatisfaction to binge eating only for women. The mediation of body dissatisfaction to binge
eating through difficulties in emotion regulation was supported for women and men. Post-hoc
analyses supported the moderation effect of self-compassion on the association between body
dissatisfaction and negative affect for women only. Specifically, women with greater in self-
compassion reported lower negative affect in the face of body dissatisfaction. Finally, post-hoc
analyses examining the paths of the original Dual Pathway Model were conducted. Results
showed only the mediation from body dissatisfaction to binge eating through negative affect was
vi
supported, both for women and men. Limitations, contributions, future research directions, and
implications were discussed.
1
CHAPTER 1. INTRODUCTION
Binge eating is the overconsumption of food within a discrete time period that occurs due
to disinhibition (American Psychiatric Association, 2013). This behavior can include eating more
rapidly than what is considered normal, feeling uncomfortably full, eating when not physically
hungry, eating in isolation due to embarrassment, and feeling distressed about it afterward. Binge
eating is a problem on college campuses. Lipson and Sonneville (2017) found in a survey across
twelve college campuses that the prevalence rate for binge eating was 49% in women and 30% in
men. These high rates of binge eating indicate that college students are an at-risk population who
can benefit from early prevention, identification, and intervention for this disordered eating
behavior.
Binge eating is related to low self-esteem, depression, substance abuse, self-harm, and
suicide (Heatherton & Baumeister, 1991). The mental and physical health consequences
associated with binge eating stress the importance of studying risk factors that can be associated
with the development of this disordered eating behavior, as well as protective factors that may
interrupt this trajectory. This study aimed to examine the relationships among body
dissatisfaction, restricted eating, difficulties in emotion regulation, and binge eating, as well as
the protective role of self-compassion.
Modification of Dual Pathway Model for Binge Eating
Body dissatisfaction is a state of awareness of the discrepancies between one’s body and
an internalized ideal. Considering the enormous pressures to look certain ways and the salience
of these messages in our society, body dissatisfaction is a predictor of eating disorders as people
try to control the way their body looks or cope with the painful emotions related to body
dissatisfaction (Stice & Shaw, 2002). Stice (1994) proposed a Dual Pathway Model that explains
2
the relationship between body dissatisfaction and binge eating. The temporal sequencing for risk
factors in this model has been supported in a longitudinal study (Stice & Van Ryzin, 2019). The
original model includes sociocultural influences on body dissatisfaction, however, this study
focused on how body dissatisfaction is related to binge eating. Figure 1 is provided below for
clarification.
The first pathway is through restricted eating, which can result in binge eating through
two mechanisms. The first mechanism is that restricted eating mediates the relationship between
body dissatisfaction and binge eating. Body dissatisfaction may drive individuals to diet, or
restrict their eating, as a method of weight control (Figure 1, path A). Restricted eating may lead
to binge eating through disinhibited eating (Figure 1, path B). This is because some who restrict
their eating may engage in subsequent binge eating due to caloric deprivation. Those who restrict
their eating may also binge eat due to the abstinence-violation effect (Stice, 2001). Essentially,
one who lapses from a commitment such as restricted eating may then uncontrollably engage in
the behavior they were originally trying to prevent (i.e., binge eating). The second mechanism is
through the relationship between restricted eating and negative affect. Once again, individuals
who experience body dissatisfaction may engage in restricted eating to control their weight
(Figure 1, path A). They may then be more at risk to experience negative affect because they can
be in a starvation state or are cognitively controlling their eating instead of listening to their
physiological cues of hunger and satiety (Figure 1, path C). Finally, they may binge eat as a
distraction or for comfort to cope with their experience of negative affect (Figure 1, path E).
The second pathway is through a mediational negative affect regulation pathway. Those
who experience body dissatisfaction may experience negative affect because they are not
measuring up to their ideal body (Figure 1, path D). Experiencing negative affect may result in
3
binge eating because eating may be a distraction from feeling painful emotions and food may be
used as a comfort (Figure 1, path E).
Figure 1. Dual Pathway Model for binge eating.
Figure 2. Modified Dual Pathway Model for binge eating.
The first hypothesis in the present study was that restricted eating partially mediates the
relationship between body dissatisfaction and binge eating (Figure 1, paths A and B). More
specifically, it was anticipated that there would be a positive association between body
dissatisfaction and restricted eating (Figure 1, path A), and a positive association between
A
D
C
E
B
Restricted Eating
Body Dissatisfaction
Binge Eating
Negative Affect
A
D
C
E
B
Restricted Eating
Body Dissatisfaction
Binge Eating
Difficulties in
Emotion Regulation
Self-Compassion
F
4
restricted eating and binge eating (Figure 1, path B). The rationale was that those who experience
body dissatisfaction may restrict their eating to control their weight or appearance. However,
food restriction may relate to feelings of hunger and they may turn to binge eating due to caloric
deprivation, over-focusing on food, and loss of control eating after food deprivation (Polivy,
1996; Stice, 2001).
This study attempted to modify Stice’s model by proposing difficulties in emotion
regulation in the place of negative affect to predict binge eating. The modified model is
presented in Figure 2. Negative affect is the experience of negative emotions such as shame and
fear (Watson, Clark, & Tellegen, 1988). This study made the argument that difficulties in
regulating painful emotions in particular can result in binge eating. The rationale for this
modification was that this study sought to explore how the experience of negative affect and its
management were related to binge eating. For example, some who experience body
dissatisfaction may become consumed by their negative emotions and have a difficult time
concentrating on tasks, they may feel out of control, and they may criticize themselves for
having painful emotions. As a result of their difficulties in regulating their emotions, they may
turn to binge eating to distract or comfort themselves.
There is evidence that those who restrict their eating may have difficulty regulating their
emotions. Those who diet can develop an obsession with food (Jones & Rogers, 2003). This
preoccupation can prevent them from focusing on internal states. They may therefore ignore their
experiences of emotions because thoughts of food dominate their minds. Indeed, those who diet
may experience less awareness and understanding of their emotions and lack access to adaptive
emotion regulation strategies (Lavender et al., 2015; Racine & Wildes, 2013). They may then
engage in binge eating after experiencing difficulty in emotion regulation to alleviate themselves
5
from their painful emotions. Thus, the second hypothesis of this study was to support the
modification of the mechanism from body dissatisfaction to restricted eating (Figure 2, path A),
to difficulties in emotion regulation (Figure 2, path C), and to binge eating (Figure 2, path E).
Specifically, there would be a positive relationship between body dissatisfaction and restricted
eating, a positive relationship between restricted eating and difficulties in emotion regulation,
and a positive relationship between difficulties in emotion regulation and binge eating.
Body dissatisfaction can be associated with difficulties in emotion regulation. Those who
experience body dissatisfaction may feel angry at themselves for failing to control how they
look. They may experience this anger as dominating their mind and have trouble focusing on
other things. Supporting this, Sim and Zeman (2005) found in a sample of teenage girls that body
dissatisfaction was associated with symptoms of emotion dysregulation. Furthermore, Whiteside
et al. (2007) found that greater difficulties in emotion regulation predicted binge eating in a large
sample of undergraduates. In particular, difficulties identifying emotions and limited access to
emotion regulation strategies were strong predictors. This provides support that those who have
difficulties in emotion regulation may binge eat in response to painful feelings. Finally, Sim and
Zeman evidenced that the relationship between body dissatisfaction and bulimic symptoms was
partially mediated by emotion dysregulation variables for teenage girls. It is likely that
difficulties in emotion regulation might be a mediator for the link between body dissatisfaction
and binge eating for college students. Thus, the third hypothesis of this study was to support the
modification of the pathway by which difficulties in emotion regulation mediates the relationship
between body dissatisfaction and binge eating (Figure 2, paths D and E). In other words, there
would be a positive relationship between body dissatisfaction and difficulties in emotion
regulation, a positive relationship between difficulties in emotion regulation and binge eating.
6
Self-Compassion as a Moderator
Self-compassion theory refers to a process by which unpleasant emotions are held in
awareness with “kindness, understanding, and a sense of shared humanity,” (Neff, 2003a, p. 92).
The three components of self-compassion are: self-kindness rather than self-judgment, common
humanity rather than isolation, and mindfulness rather than over-identification with one’s
thoughts and feelings. In accordance with evidence that eating disorders are associated with
difficulties in emotion regulation, extant research has found that those with eating disorders
practice less self-compassion compared to non-clinical samples (Ferreira, Pinto-Gouveia, &
Duarte, 2013). Interventions teaching women self-compassion in compassion-focused therapy
have been used to treat anorexia nervosa, bulimia nervosa, binge eating disorder, and eating
disorder not otherwise specified (Goss & Allan, 2010; Kelly & Carter, 2014).
The fourth hypothesis sought to expand on the modified Dual Pathway Model by adding
self-compassion as a moderator. The fourth hypothesis was that self-compassion would moderate
the positive association between body dissatisfaction and difficulties in emotion regulation (see
Figure 2, path F). This positive relationship was hypothesized to be significantly stronger for
those lower in self-compassion than for those higher in self-compassion. Those who are lower in
self-compassion are predicted to have greater difficulties in emotion regulation in response to
body dissatisfaction. Those who are lower in self-compassion may obsess about the flaws in their
body and feel alone in their state of imperfection. Their fixation and isolation may let them feel
angry and ashamed at themselves for feeling that way. They may also become overwhelmed by
their painful emotions and feel out of control.
On the other side, this study predicted that those higher in self-compassion would be
more likely to be protected from experiences of difficulties in emotion regulation in the face of
7
body dissatisfaction. Conceptually, those who are higher in self-compassion may be more likely
to be tolerant of their imperfect bodies and be kinder towards themselves. They may also remind
themselves that most people experience body dissatisfaction and feel less alone in their painful
experiences. They may accept their bodies as they are. These practices may not completely
eliminate, but serve to decrease the experience of overwhelming painful emotions and losing
control over one’s emotions as a result of body dissatisfaction. Empirically, Adams and Leary
(2007) conducted a self-compassion intervention for restricted eaters. They found that the
intervention reduced self-criticism and negative affect. The authors concluded that the
intervention helped participants reduce self-criticism, realize that everyone eats unhealthily, and
not become overwhelmed by their feelings. Therefore, higher self-compassion can be helpful to
decrease difficulties in emotion regulation when people are dissatisfied with their bodies.
Albertson, Neff, and Dill-Shackleford (2015) tested the effects of a self-compassion meditation
intervention. They found that the intervention reduced feelings of body dissatisfaction and body
shame. Thus, higher self-compassion may be related to the decreased experience of painful
emotions related to body dissatisfaction. Taken together, these studies provide support for
conceptual reasons that self-compassion may serve as a protective factor that buffers the
relationship between body dissatisfaction and difficulties in emotion regulation.
8
Figure 3. Hypothesized Moderation Effect of Self-Compassion on the Association Between
Body Dissatisfaction and Difficulties in Emotion Regulation.
The Present Study
This study proposed three mediation hypotheses and one moderation hypothesis. The first
hypothesis was that restricted eating would mediate the relationship between body dissatisfaction
and binge eating (see Figure 1, paths A and B). The second hypothesis was that the relationship
between body dissatisfaction and binge eating would be mediated by restricted eating and then
difficulties in emotion regulation (see Figure 2, paths A, C, and E). The third hypothesis was that
difficulties in emotion regulation would mediate the relationship between body dissatisfaction
and binge eating (Figure 2, paths D and E).
The fourth hypothesis sought to expand on the modified model by supporting self-
compassion as a moderator (Figure 2, path F). The fourth hypothesis was that self-compassion
1
2
3
4
5
Low (1 SD below)
High (1 SD above)
Difficulties in Emotion Regulation
Body Dissatisfaction
Low Self-Compassion
High Self-Compassion
9
would moderate the relationship between body dissatisfaction and difficulties in emotion
regulation.
Although more research is being conducted in this area, a search through PsycINFO did
not find any published articles related to self-compassion and body dissatisfaction in men. Men
may experience body dissatisfaction differently from women. Women are at risk for body
dissatisfaction due to sociocultural pressures to conform to a thin ideal, which is perpetuated by
the media, peers, and family (Bessenoff, 2006; Thompson & Stice, 2001). Men also experience
pressure to be thin, but also endorse a drive for muscularity (Fernandez & Pritchard, 2012;
Morrison, Morrison, & Hopkins, 2003). Although experiences of body dissatisfaction may be
different between women and men, body dissatisfaction is related to disordered eating behavior
in both groups (Olivardia, Pope, Borowiecki, & Cohane, 2004; Striegel-Moore & Bulik, 2007).
The Dual Pathway Model was originally proposed for women, however, it is also applicable to
men (Mason & Lewis, 2015). Thus, this study sought to provide evidence of the modified
model’s utility to men. For exploration purposes, a post hoc analysis examined whether the
modified model invariantly applied to women and men. The dearth of research on the role of
self-compassion as a protective factor for men indicates an area for further exploration, since
men are also at risk for body dissatisfaction and may benefit from self-compassion interventions.
Thus, this study aimed to explore the applicability of the modified Dual Pathway Model to
women and men.
10
CHAPTER 2: LITERATURE REVIEW
This literature review begins with an overview of binge eating in college students. After
that, a summary of the Dual Pathway Model for binge eating will be provided along with the
present study’s modification. Next, the moderator of self-compassion will be explored. Finally,
this review will conclude with a summary of the present study.
Binge Eating in College Students
Binge eating is an overconsumption of food within a discrete time period that is
characterized by a loss of control (American Psychiatric Association, 2013). Binge eating is
described as eating rapidly, feeling uncomfortably full, eating when not hungry, secretly eating
due to embarrassment, and experiencing painful emotions such as guilt after overeating. Risk
factors for binge eating include body dissatisfaction, perfectionism, low self-esteem, pressure to
be thin, dieting, and impulse control difficulties (Stice, 2002). Binge eating is also associated
with multiple adverse consequences such as decreased academic performance (Hoerr, Bokram,
Lugo, Bivins, & Keast, 2002), low self-esteem, depression, substance abuse, self-harm, and
suicide (Heatherton & Baumeister, 1991).
The median age for the onset of eating disorders ranges from 18-21 years, which is
considered within the traditional college age range (Hudson, Hiripi, Pope, & Kessler, 2007).
Indeed, college students exhibit high levels of binge eating (Lipson & Sonneville, 2017). College
may be stressful time period due to academic pressures, social pressures to look a certain way,
and feelings of ineffectiveness. College represents for many a time of transition to independence,
however, increased pressures and competition can generate painful emotions that may be dealt
with in different ways, including binge eating. Related to this, Striegel-Moore et al. (1989) found
that 15% of women in a freshman college sample showed an onset of binge eating, and
11
disordered eating behaviors increased over time. College students particularly at risk for binge
eating may include athletes due to intense pressures to look a certain way and sorority members
as a result of group influences on appearance and eating behavior (Hoerr et al., 2002). Taken
together, college students represent an at-risk group for binge eating due to the unique pressures
they experience.
Dual Pathway Model for Binge Eating
There exist several theoretical models for the development of binge eating, however, the
Dual Pathway Model is the most widely researched and supported (Holmes, Fuller-Tyszkiewicz,
Skouteris, & Broadbent, 2015; Stice, 1994; Stice, 2001; Stice, Shaw, & Nemeroff, 1998). The
Dual Pathway Model proposes sociocultural influences on body dissatisfaction, which is related
to binge eating through two pathways. The first pathway to binge eating is through dieting,
which may occur through two mechanisms (see Figure 1). Those who are dissatisfied with their
bodies may diet in order to control their weight or shape (Figure 1, path A). The first mechanism
is that eating restriction may result in binge eating or disinhibited eating due to the abstinence-
violation effect (Figure 1, path B). The second mechanism is that dieting (i.e., restricted eating)
may produce negative affect by promoting cognitive control over eating rather than following
physiological cues, changing psychological functioning, or because of failures to reduce weight
(Figure 1, path C). Negative affect is then related to binge eating, which is used as a coping
mechanism (Figure 1, path E). The second pathway from body dissatisfaction to binge eating is a
negative affect regulation pathway (see Figure 1, paths D and E). Body dissatisfaction produces
negative affect due to the disparity between one’s actual and ideal bodies (Figure 1, path D). This
negative affect can then result in binge eating, which is used as a distraction or comfort (Figure
1, path E).
12
The Dual Pathway Model was originated to explain binge eating in girls and women,
however, it has also been used in studies of adolescent boys and men (Mason & Lewis, 2015;
Ricciardelli & McCabe, 2001). Mason and Lewis (2015) found that in a comparison between
men and women, higher BMI was associated with greater body shame in women and dietary
restraint in men. The authors explain that since women are expected to conform to a thin ideal,
having a larger body can produce feelings of shame. On the other hand, there was a relationship
between higher BMI and body shame in men, yet men may restrict their eating for other reasons,
such as becoming healthier or to shape their body to look more athletic. Stice and Van Ryzin
(2019) recently supported the temporal sequencing for risk factors in the Dual Pathway Model.
They found that pressure to be thin and thin-ideal internalization predicted body dissatisfaction,
which in turn predicted restricted eating and negative affect, which in turn predicted binge
eating. The individual components of the Dual Pathway Model are described in more detail
below.
Contributors to body dissatisfaction. Body dissatisfaction is the “negative subjective
evaluation of one’s physical body” (Stice & Shaw, 2002, p. 985). Body dissatisfaction can be
thought of as a state resulting from awareness of the differences between one’s actual body and
an internalized ideal. Body dissatisfaction is a predictor of eating disorders because people may
engage in disordered eating behavior to control the way their bodies look or to cope with painful
emotions associated with body dissatisfaction. Contributors to body dissatisfaction include
sociocultural pressures to be thin from peers, media, and family, internalization of a thin or
muscular ideal, and high adiposity (Blond, 2008; Grabe, Ward, & Hyde, 2008; McCreary &
Sasse, 2001; Stice & Bearman, 2001; Stice & Shaw, 2002). Essentially, messages from others
about how one’s body should look are internalized as one’s own beliefs. Women are expected to
13
conform to a thin ideal, while men endorse thinness and a drive for muscularity (Fernandez &
Pritchard, 2012; Morrison, Morrison, & Hopkins, 2003). Stice and Shaw (2002) noted that
greater adiposity is a risk factor for body dissatisfaction in girls because increased adiposity
creates a deviation from the thin ideal. Higher adiposity is also associated with body
dissatisfaction in boys (Presnell, Beardman, & Stice, 2004). Dissatisfaction with one’s body can
result in painful emotions because one is not measuring up to how they think they should look
and some may cope by engaging in disordered eating behavior.
Several instruments have been created to measure body dissatisfaction as a
unidimensional or multidimensional construct. The present study used the Body-Esteem Scale
for Adolescents and Adults (BESAA; Mendelson, Mendelson, & White, 2001). The BESAA is a
multidimensional scale of body dissatisfaction that has three subscales: appearance, weight, and
attribution. The appearance subscale assesses feelings about one’s overall appearance. The
weight subscale measures satisfaction with one’s weight. The attribution subscale measures how
one assumes others think about their appearance. Males overall have higher body esteem,
supporting statistics that females are more dissatisfied with their bodies (Feingold & Mazzella,
1998).
The Body Parts Satisfaction Scale-Revised (BPSS-R; Petrie, Tripp, & Harvey, 2001) was
considered for the present study. The BPSS-R measures satisfaction with individual body parts
and provides a body dissatisfaction score for the face and body. The BESAA was chosen because
it is a multidimensional measurement of body dissatisfaction. In particular, the satisfaction with
weight component was important for this study due to its relationship with restricted eating
(Stice, 2001). In summary, the BESAA was used to provide a more nuanced measurement of
body dissatisfaction.
14
Restricted eating. Restricted eating, or dieting, can be a consequence of body
dissatisfaction because this behavior is engaged in with the intention of controlling one’s shape
or weight. Those who restrict their eating believe that doing so will prevent weight gain or
promote weight loss. Unfortunately, dieting may paradoxically be associated with binge eating
and weight gain (French & Jeffrey, 1994; Tiggeman, 2004). In a longitudinal study of the
relationship between dieting and binge eating in a group of adolescents and young adults,
Goldschmidt et al. (2011) found that dieters were more 2-3 times more likely to binge eat, and
depression and low self-esteem increased this risk. Dieting is thought to contribute to binge
eating due to starvation from caloric restriction and the abstinence-violation effect. First, those
who starve themselves may binge eat to make up for caloric deprivation. Biologically, the body
seeks to return to a non-starvation state. Second, breaking a diet can result in binge eating due to
the abstinence-violation effect (AVE). Marlatt and Gordon (1985) proposed the AVE as a model
of relapse in cigarette smokers. The two components of the AVE are a causal attribution for the
lapse and an affective reaction to the attribution. Empirically, Grilo and Shiffman (1994) found
that the repetition of an eating binge was related to greater internal, global, and uncontrollable
causal attributions along with feelings of guilt. In other words, those who break a diet may
criticize themselves, think rigidly, and feel overwhelmed with negative affect. As a result, they
may then be more likely to binge eat.
The Restraint Scale (RS; Herman & Mack, 1975), the cognitive restraint subscale of the
Three Factor Eating Questionnaire (TFEQ; Stunkard & Messick, 1985), and the restrained eating
subscale of the Dutch Eating Behavior Questionnaire (DEBQ; van Strien, Frijters, Bergers, &
Defares, 1986) are extensively used to measure restricted eating. However, there exist
differences in the extent to which self-reports predict actual caloric restriction. For example,
15
Laessle, Tuschl, Kotthaus, and Pirke (1989) found that while all three measure motivation for
restraint, the TFEQ and the DEBQ may be more applicable to assess risk for actual caloric
restriction. Furthermore, the TFEQ and DEBQ may be more likely to assess actual and current
dieting (Allison, Kalinsky, & Gorman, 1992; Lowe, 2003).
The present study used the cognitive restraint subscale of the Three Factor Eating
Questionnaire (TFEQ; Stunkard & Messick, 1985). This subscale was developed as a
unidimensional measure of restricted eating (Stunkard & Messick, 1985). However, since its
inception, the factor structure of this subscale has been disputed. For instance, some analyses
have presented a two-factor structure composed of flexible and rigid control (Shearin, Russ,
Hull, Clarkin, and Smith, 1994; Westenhoefer, 1991). Other studies have found a three-factor
structure consisting of emotional/cognitive concern for dieting, calorie knowledge, and
behavioral dieting control (Ricciardelli & Williams, 1997). Despite the debate about the factor
structure of the TFEQ, in a comparison among four measures of dietary restraint (DEBQ, TFEQ,
the Revised Restraint Scale, and the Current Dieting Questionnaire), Williamson et al. (2004)
found that changes only in TFEQ scores predicted caloric restriction. Furthermore, Zambrowicz
et al. (2019) found a negative correlation (r = -.60) between TFEQ restraint scores and actual
caloric intake, providing the justification for the use of this measure.
Negative affect. Negative affect is a state of distress that can include anger, guilt, and
fear (Watson, Clark, & Tellegen, 1988). Negative affect can be a consequence of body
dissatisfaction because of one’s emotional response to the disparity between one’s own body and
an internalized ideal. That is, those whose bodies don’t “measure up” may experience painful
emotions as a consequence. Negative affect is hypothesized to be a predictor of binge eating
because binge eating is used as a distraction or comfort to cope (Hawkins & Clement, 1984).
16
Indeed, Deaver, Miltenberger, Smyth, Meidinger, and Crosby (2003) found that negative affect
preceded binge eating in a group of college students, which decreased during binge eating
episodes.
The negative affect regulation model has received support from cross-sectional and
laboratory studies. In contrast, a meta-analysis on ecological momentary assessments concluded
that while negative affect indeed precedes binge eating, it may actually increase after binge
eating periods (Haedt-Matt & Keel, 2011). A limitation of ecological momentary assessments is
that it does not accurately assess negative affect during binge eating, therefore it does not assess
the negative affect regulation model during binge eating periods. However, binge eating may
result in subsequent experiences of negative affect (e.g., depression, anger, and shame) because
of one’s self-criticism of their lack of control over their eating. Although evidence is mixed
whether binge eating decreases negative affect during and after binges, negative affect is
supported as a predictor of this behavior.
The Positive and Negative Affect Schedule (PANAS; Watson, Clark, & Tellegen, 1988)
is a measure of positive (e.g., “excited,” “proud”) and negative (e.g., “upset,” “scared”) mood
states. The present study used the negative affect scale. Negative affect was positively associated
with depression and anxiety (Crawford & Henry, 2004), and binge eating (Deaver et al., 2003).
Binge eating. As mentioned earlier, binge eating is a common behavior in college
students (Lipson & Sonneville, 2017). The transition to college may be a stressful experience for
some students because they are away from home for the first time and are independently
responsible for their lives and success. College also represents a place where there are high
academic pressures as well as pressures from peers to look and act in certain ways. Together, all
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of these new experiences may be overwhelming, and the negative affective consequences may be
dealt with through binge eating.
The present study used the Eating Disorder Diagnostic Scale (EDDS; Stice, Telch, &
Rizvi, 2000). The EDDS was designed to diagnose binge eating disorder, however, this study
used it to indicate greater binge eating. As with many other disordered eating measures, the
EDDS uses a variety of response formats, particularly dichotomous and frequency.
The Binge Eating Scale (BES; Gormally, Black, Daston, & Rardin, 1982) was considered
for use in the present study. Construct validity for the BES was evidenced through factor analysis
of cognitive factors related to dieting in a sample of overweight and obese adults. The validity of
the BES was questioned by comparing its scores to scores on the Eating Disorder Examination
(EDE; Cooper & Fairburn, 1987), the “gold standard” for diagnosing eating disorders (Greeno,
Marcus, & Wing, 1995). About half of the sample identified as binge eaters by the BES were not
identified by the EDE, leading the authors to hypothesize that the BES does not measure all
constructs that determine binge eating. With this information, the present study used the EDDS
because its construct validity was demonstrated by highly correlating with EDE scores.
Modification of Dual Pathway Model
While the Dual Pathway Model has been empirically supported, it remains to be
determined how the specific experience of negative affect is related to binge eating. In particular,
not all people who experience negative affect in relation to body dissatisfaction engage in binge
eating. The present study proposed that rather than solely the experience of negative affect,
difficulties in emotion regulation predicts binge eating. In addition, the present study sought to
examine self-compassion as a protective factor against binge eating. Therefore, the present study
aimed to modify the Dual Pathway Model (see Figure 2).
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The first hypothesis of the present study was that restricted eating partially mediates the
relationship between body dissatisfaction and binge eating (Figure 2, paths A and B), supporting
findings reported by Stice and Shaw (2002). The predictor of restricted eating may only partially
mediate this relationship because fasting, or induction of a starvation state, may better explain
the association between caloric restraint and binge eating (Stice, Davis, Miller, & Marti, 2008).
However, the aim of the present study was to study a more common eating behavior in a sample
of college students. With this rationale, restricted eating was used for the first mediation
hypothesis.
The present study proposed that instead of solely negative affect, difficulties in emotion
regulation would be a predictor of binge eating. Gratz and Roemer (2004) conceptualized
difficulties in emotion regulation to comprehensively describe emotion dysregulation and
developed the Difficulties in Emotion Regulation Scale (DERS) to capture this construct. These
two authors proposed that there are six dimensions for DERS: non-acceptance of emotional
responses, difficulty engaging in goal-directed behavior, impulse control difficulties, lack of
emotional awareness, limited access to emotion regulation strategies, and lack of emotional
clarity. Non-acceptance of emotional responses refers to having negative secondary emotional
responses or not accepting one’s primary emotional responses. Difficulty engaging in goal-
directed behavior is having trouble concentrating on and completing tasks when experiencing
negative emotions. Impulse control difficulties represent difficulties in controlling behavior
when experiencing negative emotions. Lack of emotional awareness is the lack of attention to
and lack of recognition of one’s negative emotions. Limited access to emotion regulation
strategies refers to the belief that there is not much one can do to regulate their negative
