likeyou_butnot (likeyou_butnot) wrote in ed_ucate,

Sorry it go so messed up. As far as the lecture I went to.... It wasn't anything too, too, amazing. She talked about the preasure that mostly girls (and guys too to be  "buff") have due to the media. She also talked about how communities need to join together to help with this problem. It made me realize that my ed isn't/wasn't?!? about appreaence really. Yes, that is part of it I'm sure, but for me it is/was about having my thing. I am sorry if this is typed majorly poorly. I can't see what I'm doing b/c I don't have my comp and I can't see this one well. Peace out guys!

Subjective self-control and behavioural impulsivity coexist in

anorexia nervosa

G.K.L. Butler*, A.M.J. Montgomery

Department of Psychology, University of Greenwich, Eltham, London SE9 2UG, UK

Received 23 April 2004; received in revised form 5 November 2004; accepted 29 November 2004


Objective: Anorexia nervosa (AN) has been associated with impulse regulation problems. This study investigated

subjective and behavioural impulsivity in women with anorexia nervosa (n=15) and a control group (n=16).

Method: A self-report measure (the impulsiveness, venturesomeness, and empathy questionnaire; I7) and two

behavioural measures (a continuous performance task [CPT]; and a novel risk taking measure [Bets 16]) of

impulsivity were used along with the Beck Depression Inventory (BDI).

Results: The AN group had elevated BDI scores and lower self-reported impulsiveness and venturesomeness

scores, but they also displayed impulsive behaviour on the CPT (more errors of commission with faster reaction


Discussion: The coexistence, in AN, of self-reported self-control and behavioural impulsivity indicates that the

relationship between impulsivity and disordered eating in AN is more complex than previously recognised and

supports the view that self-awareness in AN is low.

D 2004 Elsevier Ltd. All rights reserved.

Keywords: Anorexia; Impulsivity; Self-control; Self-awareness

1471-0153/$ - see front matter D 2004 Elsevier Ltd. All rights reserved.


* Corresponding author. Present address: School of Social Science, Kingston University, Penrhyn Road, Kingston Upon

Thames, Surrey, KT1 2EE, UK. Tel.: +44 20 8547 2000; fax: +44 20 8547 7388.

E-mail address: (G.K.L. Butler).

Eating Behaviors 6 (2005) 221–227

1. Introduction

Casper, Hedeker, and McClough, (1992) proposed that the eating disorders anorexia nervosa (AN)

and bulimia nervosa (BN) may be at opposing ends of an impulsive/control continuum: they reported

lower scores in an AN group for impulsivity and danger seeking and suggested that traits associated

with AN reflect accentuated self-control, caution, and conscientiousness. This view is supported by

Vitousek and Manke (1994), who suggested that BN involves behaviours (compulsiveness, impulsivity,

and affective instability) which are opposite to those of AN (rigidity and constraint).

Empirical studies of impulsivity have used both self-report questionnaires and more objective

behavioural measures (e.g., reaction time tasks), as indices of different aspects of the multi-dimensional

impulsivity construct (Gerbing, Ahadi, & Patton, 1987; Malle & Neubauer, 1991). However,

investigations of impulsivity in disordered eating have mostly used self-report measures. Using the selfreport

I7 questionnaire, Fahy and Eisler (1993) found that women with BN had higher scores on the

impulsivity scales (impulsiveness and venturesomeness) than an AN group. Claes, Vandereycken, and

Vertommen (2002) also found that a restricting AN group had significantly lower I7 impulsiveness scores

than a BN group, but did not differ from controls on either measure. However, using a continuous

performance task (CPT), Seed, Dixon, McCluskey, and Young (2000) found that women with AN

responded to more non-targets (errors of commission; indicating impulsivity) and missed more target

stimuli (errors of omission; indicating inattention) than controls, without any differences in response


Overall, self-report measures of impulsivity indicate that those with restricting AN are more selfcontrolled

than those with BN. However, it is uncertain whether they also differ from controls, or

whether differences are limited to self-report measures, thereby indicating reduced self-awareness in AN

as proposed by Heatherton and Polivy (1992).

The present study assessed impulsivity in women with AN using the I7 questionnaire and two

objective behavioural measures. The behavioural measures were a CPT, which assesses reaction time

and accuracy, and a risk-taking measure (Bets 16). The Bets 16 task does not depend on response speed,

thus avoiding potential difficulties of interpretation caused by psychomotor retardation associated with

the depression that is often exhibited in AN (Bulik, 2002).

Based on research using self-report measures, it was predicted that women with AN will report higher

levels of depression (Bulik, 2002) and low levels of impulsiveness and venturesomeness (Claes et al.,

2002). Predicting effects on their preferences for Bets 16 is more problematic, but the findings of Seed et

al. (2000) provide a clear basis for predicting increased errors of omission and commission on the CPT,

without changes in reaction times.

2. Methods

2.1. Participants

Women with a diagnosis of AN, one with atypical AN (ICD-10; World Health Organisation, 1992),

were recruited from an Inpatient Eating Disorder Unit in Southeast England (n=15, mean age=27.9,

S.D.=9.9). Controls were age-matched female psychology undergraduates (n=16, mean age=28.4,

S.D.=8.3), from a university in Southeast England, who were screened for abnormal eating attitudes and

G.K.L. Butler, A.M.J. Montgomery / Eating Behaviors 6 (2005) 221–227 222

behaviours with the Eating Attitudes Test-26 (Garner, Olmsted, Bohr, & Garfinkel, 1982) and the

Bulimic Inventory Test (Henderson & Freeman, 1987). The mean ages of the two groups did not differ

[t(29)=0.13, pN.05].

2.2. Apparatus

The continuous performance task was presented on and data were recorded on a Phoenix NoteBIOS

4.0 multimedia notebook.

2.3. Measures

2.3.1. The Impulsiveness, Venturesomeness, and Empathy questionnaire, or I7

Is a 54-item questionnaire consisting of three scales, impulsiveness, venturesomeness, and empathy

(IVE) (Eysenck, Pearson, Easting, & Allsopp, 1985). Questions require a response of either dYesT or

dNoT. Scores range from 0 to 19 (I & E) or from 0 to 16 (V). High scores reflect higher levels of the trait.

2.3.2. Beck Depression Inventory

The Beck Depression Inventory (BDI) is a 21-item questionnaire (Beck, Ward, Mendelson, Mock, &

Erbaugh, 1961) asking about feelings over the past week. Higher scores reflect greater severity of


2.3.3. The Eating Attitudes Test

The Eating Attitudes Test (EAT-26) (Garner et al., 1982) is a 26-item self-report questionnaire for

detecting previously undiagnosed cases of AN. A cut-off score of 20 successfully discriminated 84% of

AN and control participants (Garner et al., 1982).

2.3.4. The Bulimic Inventory Edinburgh

The Bulimic Inventory Edinburgh (BITE) (Henderson & Freeman, 1987) is a 33-item questionnaire to

assess bulimic behaviours. Scores of 0–10 fall within the normal range. A score of 5 or greater on the

severity scale is considered clinically significant.

2.3.5. Bets 16

This risk-taking measure consists of 16 pairs of two-outcome hypothetical bets presented in pie chart

format, where paired bets have the same expected value (EV). For each pair of bets participants choose

between a guaranteed win (GW, the safe choice), and a long shot (LS, the risky choice). The GWoffers a

larger chance of winning a small amount of money against a less likely win of a moderate amount of

money. The LS offers a 10–30% probability of a proportionately larger win or a more likely win of

nothing (o0). One point is awarded for each LS choice, with high scores indicating greater risk taking.

Bets 16 exhibits good internal consistency (.92), moderate convergent validity, and moderate test–retest

coefficient over 3 weeks (.77) (Montgomery, in preparation).

2.3.6. Continuous Performance Task

This is a DOS-based computer task which presents grey letters (approximately 1 in. in size) one at a

time onto a black background for 200 ms with an inter-stimulus interval of 1.5 s. The AX version was

G.K.L. Butler, A.M.J. Montgomery / Eating Behaviors 6 (2005) 221–227 223

used where, in target trials, participants respond to the letter X, but only if preceded by the letter A. On

other trials, participants should inhibit responses. Reaction times, errors of omission (failure to respond

on a target trial), and errors of commission (responding when the target letters were not presented—nontarget

trial) were recorded. Errors of omission reflect inattention and errors of commission reflect

impulsive behaviour (Conners, 1995).

2.4. Procedure

The AN group was tested individually in a single session (~1 h) at the eating disorder unit. The

control group was tested individually at their university over two sessions lasting 1–1.5 h overall. Their

tasks included the EAT-26 and BITE. The order of task completion was randomised for each participant.

2.5. Statistical analysis

Where assumptions for parametric tests were met group differences were assessed with t-tests;

otherwise, nonparametric Mann–Whitney U-tests were used. Correlations were assessed with Pearson’s

Product Moment Correlation or Spearman’s Rho. Between group differences were assessed using onetailed

tests for self-report measures and the CPT, but two-tailed test were used for correlations and Bets

16 data.

3. Results

3.1. Group characteristics and between group differences

At testing, the time since admission for the clinical group ranged from 1 to 6 weeks and records

revealed that one was taking chlorpromazine and another metazepam. BDI scores were missing for four

of the anorexic inpatient group, but for the remainder the AN group had higher BDI scores (U=13.0,

n=27, pb.001) (see Table 1).

Data from all measures are presented in Table 1. As Table 1 shows, the AN group scored significantly

lower than controls on both I7 impulsiveness [t(29)=2.24, p=.017] and venturesomeness [t(29)=2.58,

p=.008]. However, the groups did not differ on the number of Bets 16 risky bets chosen (U=103, n=31,

pN.05) or on CPT errors of omission (U=111.0, n=31, pN.05). Only 6 of the control group and 11 of the

AN group made CPT errors of commission, but overall the AN group made more CPT errors of

commission (U=57.0, n=31, p=.005) and, despite their elevated BDI scores, their errors of commission

were made with shorter latencies than those of the control group (U=9.5, n=17, pb.001).

Re-analysis of the data omitting the two medicated patients did not alter the pattern of significant

effects or produce any further significant differences.

3.2. Correlational analysis

For the control group CPT hit reaction time correlated negatively with CPT errors of commission

(rs=.53, n=16, p=.037) and CPT errors of commission reaction time (rs=.83, n=16, p=.042). Bets 16

scores correlated positively with venturesomeness (rs=.53, n=16, p=.036) and negatively with CPT

G.K.L. Butler, A.M.J. Montgomery / Eating Behaviors 6 (2005) 221–227 224

errors of commission reaction time (rs=.84, n=16, p=.036) and BDI scores (rs=.62, n=16, p=.01).

For the AN group venturesomeness correlated with CPT errors of commission reaction time (rs=.61,

n=15, p=.046) and Bets16 scores correlated with CPT errors of omission (rs=.54, n=15, p=.038).

4. Discussion

The present study investigated impulsivity in an inpatient group with anorexia nervosa and a control

group. Body mass index (BMI) scores were unavailable for the inpatient group. However, as ICD-10

diagnostic criteria for anorexia nervosa requires that bBody weight is maintained at least 15% below that

expected. . . or body mass index is 17.5 or lessQ (WHO, 1992; p. 177), it is likely that the clinical group

all had lower BMI scores than those of the control group (average BMI 22.75).

The results from the self-report measures in the present study are in general agreement with earlier

studies: those with AN were depressed (cf. Bulik, 2002) and low in impulsiveness and venturesomeness

(Claes et al., 2002; Fahy & Eisler, 1993). However, in the present study these effects were apparent in

comparisons with a control group rather than a BN group. Thus, the present AN group regarded

themselves as less likely than controls to engage in either risk-taking regardless of consequences

(impulsiveness) or sensation seeking where potential risks are considered (venturesomeness). This

contrasts with the findings from the behavioural measures. Although the AN group did not show an

altered preference for risky bets, they did make more CPT errors of commission, and these occurred with

shorter latencies, indicating impulsivity (Connors, 1995). Seed et al. (2000) have reported increased

errors of commission among an AN group, but they also found increased errors of omission and no

Table 1

Mean and standard deviation (S.D.) scores for controls and anorexia nervosa (AN) groups on the BDI, I7 scales (I, V, E), Bets

16, and the CPT

Measure Control group n=16 AN group n=15

Mean S.D. Mean S.D.

BDI 5.80 5.90 23.20a,** 14.40

Impulsiveness 10.50 4.87 7.07* 3.49

Venturesomeness 8.50 3.74 5.33* 3.04

Empathy 14.19 2.74 15.40 2.61

Bets 16 5.56 5.73 3.73 4.54

Continuous performance test (CPT)

Omission errors 0.28 0.50 1.93 2.50

Commission errors 0.94 1.80 1.63* 3.50

Hit reaction time 432.60 115.60 400.30 65.70

Commission RT 557.20b 112.70 365.80a,** 133.20

BDI=Beck Depression Inventory.

CPT reaction times (RT) are in milliseconds.

a n=11.

b n=6.

* pb0.02.

** pb0.001.

G.K.L. Butler, A.M.J. Montgomery / Eating Behaviors 6 (2005) 221–227 225

changes in latencies, suggesting inattention rather than impulsivity. Indeed, Halperin, Wolf, Greenblatt,

and Young (1991) point out that in the AX version of the CPT, errors of commission might also reflect

inattention, as they could result from a failure to attend to the stimulus which preceded the X stimulus.

However, if the present increase in errors of commission resulted from inattention we should also expect

to see a similar increase in errors of omission, but we did not. It might be argued that the present

increased errors of commission were a consequence of the AN group having faster reaction times.

However, fast inaccurate responding is typically regarded as impulsive behaviour (Kagan, Rosman, Day,

Albert, & Phillips, 1964). The faster responses of the AN group also suggest that, despite their elevated

BDI scores, they were not exhibiting psychomotor retardation.

Unlike the I7 and the CPT scores, the Bets 16 failed to find differences between the groups. This test

has previously detected increased preference for risky bets among frequent ecstasy users (Butler &

Montgomery, 2004), but might be less suitable for detecting increased risk aversion or require a larger

sample. Although the present sample size is small it is comparable to that of Seed et al. (2000) (n=18)

and was clearly sufficient to detect between groups differences on both self-report and behavioural

measures; however, a larger sample might also detect differences on the Bets 16 measure.

The results of the correlational analysis were in accord with previous studies reporting modest or

nonsignificant correlations between different measures of impulsivity (Gerbing et al., 1987). In

agreement with earlier findings (Butler & Montgomery, 2004), I7 venturesomeness scores were

positively correlated with Bets 16 scores, as would be expected if both tasks measure risk taking where

the consequences of behaviour are considered. Two significant correlations in the AN group featured

CPT measures: CPT errors of omission correlated with Bets 16 scores, so those who made more risky

choices were also more inattentive; and CPT errors of commission reaction time correlated with

venturesomeness, perhaps surprisingly indicating that those who were more risk taking were slower to

respond to non-targets.

The reduced impulsiveness and venturesomeness reported by the AN group are in opposition to their

results on the CPT where their responding was fast and inaccurate or impulsive. This apparent conflict

may derive from the nature of self-report measures, which measure how participants view themselves,

whereas objective measures reflect behaviour. Indeed, this apparent lack of insight might contribute to

the relatively poor prognosis in AN and supports the view of Heatherton and Polivy (1992) that

disordered eating is associated with reduced self-awareness. Alternatively, these apparently contradictory

results might simply reflect the multidimensional nature of impulsivity (Gerbing et al., 1987; Malle &

Neubauer, 1991).

Overall the present results indicate that alterations in impulsivity associated with AN are clearly more

complex than suggested by the results of self-report measures alone. Consequently it seems appropriate

to conclude that results from the self-report measure are at odds with the behavioural measures and

probably reflect either a lack of self-awareness, or a desire for self-control that is not evident in such

tests. If so, then it might be more appropriate to think in terms of profiles of impulsivity/self-control in

such groups.

Research into the time-course of AN has indicated that although a small proportion of patients

successfully manage to restrict their eating over protracted periods, for many the hypercontrol

eventually breaks down (Garner, Garner, & Rosen, 1993) and they can move to the binge/purging type

of anorexia and then to BN. This suggests that levels of self-control and impulsivity can change over

time and this might have important implications for treatment strategies. Monitoring of changes to the

impulsivity profile over time might provide a basis for clinical interventions aimed at (a) addressing

G.K.L. Butler, A.M.J. Montgomery / Eating Behaviors 6 (2005) 221–227 226

self-control/impulsivity issues without necessarily having to directly confront eating behaviour, thus

possibly avoiding treatment resistance and (b) interrupting the transition from anorexia to bulimia and

the associated deterioration in prognosis.


GKLB was funded by a PhD bursary from the University of Greenwich, UK.


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