Rogers, Penny; (1997) Antecedents and precipitants of binge-eating: The role of dissociation and childhood psychological maltreatment. Doctoral thesis (D.Clin.Psy.), UCL (University College London).

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Abstract

The present study examines links between dissociation, psychological maltreatment and binge-eating. The study took place in an outpatient setting and subjects were recruited from a psychology service. Forty-five women participated in the study, having been identified as having at least one bingeing episode per fortnight, with their binge-eating episodes meeting all other DSM-IV criteria. The study consists of two inter-linked parts, the first part examines possible antecedents of binge-eating and the second part examines precipitants of binge- eating episodes. Participants completed five questionnaires, two measures of dissociation (Dissociative Experiences Scale, DES, Bernstein and Putnam, 1986; Perceptual Alteration Scale, PAS, Sanders 1986), a measure of childhood psychological maltreatment (Child Abuse and Trauma Scale, CAT, Sanders and Giolas, 1991), a measure of anxiety and depression (Hospital Anxiety and Depression Scale, HAD, Zigmond and Snaith, 1983), and an eating behaviour questionnaire (Three Factor Eating Questionnaire, TFEQ, Stunkard and Messick, 1985). Clinical information was also collected, in addition to completed food diaries. The first part of the study found an association between one dissociation scale (DES) and childhood psychological maltreatment, but this was not found with the second dissociation scale (PAS). The TFEQ did not correlate significantly with maltreatment or any other variable, except for a negative correlation between disinhibition and anxiety. There was therefore no evidence found to support the predicted hypothesis that dissociation plays a mediating role between binge-eating and childhood psychological maltreatment. There was some indication that general psychopathology, as indicated by the HAD scale in this study, was associated with dissociation but not with maltreatment. The results are not consistent with previous research, as some studies have suggested a relationship between sexual abuse and binge-eating, whereas others argue that the relationship is stronger between sexual abuse and depression or general psychopathology. This may be due to methodological and design differences, including the way binge-eating was defined and measured, and the way in which childhood trauma was measured. The second part of the study found an association between the type of precipitant of binge-eating episodes and trauma, those subjects with a history of maltreatment were more likely to binge-eat in response to negative affect (i.e. emotional eating) than those without such a history. An association was not observed between dissociation and precipitants of binge-eating, which was unexpected in view of the association between maltreatment and dissociation. Difficulties were experienced in collecting data for the second part of the study, and also in the use of the data. Therefore, caution is drawn at the use of these results but they do lend some support to the view that binge-eaters are not a homogenous group and that different groups of binge-eaters may have different etiological explanations for their eating disorders. The results of the study highlights the need in clinical practice for a thorough assessment of a person's eating behaviour that considers wider developmental aspects, in addition to maintaining factors, in order that their binge-eating can be reduced without the concurrent development of new symptoms. This approach is well embedded in recent cognitive-behavioural models of eating disorders which take a multi-factorial view of eating disorders.

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