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The Emotional Eating Scale: The Development of

a Measure to Assess Coping with Negative Affect


by Eating
Bruce Arnow
Justin Kenardy
W. Stewart Agras
(Accepted 19 April 1994)
The development of the Emotional Eating Scale (EES) is described. The factor solution
replicated the scale's construction, revealing Anger/Frustration, Anxiety, and Depres-
sion subscales. All three subscales correlated highly with measures of binge eating,
providing evidence of construct validity. None of the EES subscales correlated signifi-
cantly with general measures of psychopathology. With few exceptions, changes in EES
subscales correlated with treatment-related changes in binge eating. In support of the
measure's discriminant efficiency, when compared with obese binge eaters, subscale
scores of a sample of anxiety-disordered patients were significantly lower. Lack of
correlation between a measure of cognitive restraint and EES subscales suggests that
emotional eating may precipitate binge episodes among the obese independent of the
level of restraint. The 25-item scale is presented in an Appendix (Arnow, B., Kenardy,
J., & Agras, W.S.: International Journal of Eating Disorders, 17, 00-00,1995). 1995 by
John Wiley & Sons, Inc.
As Polivy and Herman (1993) have noted, stress and negative mood are the most fre-
quently cited precipitants of binge eating (e.g., Abraham & Beumont, 1982; Arnow,
Kenardy, & Agras, 1992; Heatherton & Baumeister, 1991; Herman & Polivy, 1975; Ling-
swiler, Crowther, & Stephens, 1989; Ruderman, 1985). Yet our knowledge of the rela-
tionship between negative mood and overeating is limited, particularly among the
obese.
Bruce Arnow, Ph.D., is Assistant Professor of Psychiatry and Chief of the Psychology Service at the Depart-
ment of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California.
Justin Kenardy, Ph.D., is Senior Lecturer in Psychology at the University of Newcastle in New South Wales,
Australia. W. Stewart Agras, M.D., is Professor of Psychiatry and Director of the Behavioral Medicine Program
at the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford,
California. Address reprint requests to Bruce Arnow, Ph.D., Department of Psychiatry, Behavioral Medicine
Program, Stanford University School of Medicine, Stanford, CA 94305-5542.
International Journal of Eating Disorders, Vol. 18, No. 1, 79-90 (1995)
1995 by John Wiley & Sons, Inc. CCC 0276-3478/95/010079-12
80 Arnow, Kenardy, and Agras
There are several reasons for this. First, conceptual models guiding research and
treatment of the obese have often assigned emotional eating a peripheral role. The
internal-external theory of obesity, formulated by Schachter (1968, 1971), proposed that
compared with normals, the obese would demonstrate increased responsiveness to
salient environmental food cues. As the obese were viewed as less responsive to internal
stimuli in general, emotional distress lacked a significant role in this model (Schachter,
Goldman, & Gordon, 1968). Nisbett's set point theory (1972) suggested that the obese
have a higher than average ideal weight; attempting to conform to cultural norms, they
eat less than their body physiologically requires. The consequent deprivation was as-
sumed to have several effects including increased responsiveness to environmental food
cues, as well as heightened emotionality. In this case, however, emotional lability as-
sociated with eating was considered an epiphenomenon rather than a factor worthy of
investigation in its own right.
Restraint theory (Herman & Mack, 1975; Herman & Polivy, 1980; Polivy & Herman,
1985), which incorporated Nisbet's emphasis on the role of dieting, suggests that at-
tempts to maintain one's eating well below the level necessary for satiety occasion a state
of physiological deprivation predisposing the individual to counterregulatory eating
under a variety of circumstances. The restraint model has generated a considerable
amount of research including several laboratory studies of the interaction between neg-
ative mood and restrained eating (e.g.. Cools, Schotte, & McNally, 1992; Herman &
Polivy, 1975; Herman, Polivy, Lank, & Heatherton, 1987; Ruderman, 1985; Steere &
Cooper, 1993), but for a variety of reasons including the secrecy associated with emo-
tional eating and variability in subjects' food preferences (Ganley, 1989) the relevance of
such studies to understanding the eating patterns of the obese is questionable. Further-
more, negative mood, while an important factor in this model, is conceptualized as
secondary to restraint, one of many conditions including alcohol consumption and food
rule violations, under which disinhibition or binge eating might occur.
A second reason for the relative lack of attention to the relationship between negative
mood and binge eating among the obese is that much of the interest in binge eating
among investigators was concentrated upon bulimics and anorexics (Arnow et al., 1992;
Marcus & Wing, 1987; Marcus, Wing, & Hopkins, 1988). Though Stunkard (1959) first
identified binge eating as a potentially important factor in obesity over 30 years ago, with
few exceptions (e.g., Hudson & Williams, 1981; Leon & Chamberlain, 1973a, 1973b;
Slochower & Kaplan, 1980) references to binge eating among the obese were confined to
the clinical literature (Bruch, 1973; Buchanon, 1973; Crisp, 1967; Kornhaber, 1970; Wol-
man, 1982), until the early 1980s when the prevalence of binge eating among the obese
began to become more systematically documented (Gormally, Black, Daston, & Rardon,
1982; Keefe, Wyshogrod, Weinberger, & Agras, 1984; Loro & Orleans, 1981; Marcus &
Wing, 1987; Marcus, Wing, & Lamparski, 1985; Marcus et al., 1988; Telch, Agras, &
Rossiter, 1988). Noting the lack of attention to emotional eating among the obese, Lowe
and Fisher (1983) speculated that because emotional eating was often described in psy-
choanalytic terms, the scientific community was less inclined to pursue its significance
(p. 147).
Not surprisingly, few self-report instruments exist to assess emotional eating in the
obese. Among those we have, few have a sufficient number of items to enable a detailed
analysis of the potentially distinctive relationships between specific negative mood
states and disinhibited eating. The Three Factor Eating Questionnaire (TFEQ; Stunkard
& Messick, 1985) was originally presented with a scale assessing Disinhibition in addi-
tion to scales measuring Dietary Restraint and Perceived Hunger. However, in a large (N
Emotional Eating 81
= 442) factor analytic investigation of the TFEQ, Ganley (1988) reported that Disinhibi-
tion was best described by two factors, one assessing Weight Lability and the other.
Emotional Eating. But the latter has only six items, and Ganley noted the need for
expansion (p. 645). Furthermore, the true-false format employed in the TFEQ (Stunkard
& Messick, 1985) has several limitations including placing the respondent in a situation
in which neither choice is valid all of the time and enhancing tendencies toward re-
sponding in socially desirable ways (Mason & Bramble, 1978).
The Dutch Eating Behaviour Questionnaire (DEBQ; van Strien, Frijters, Bergers, &
Defares, 1986) has an emotional eating scale in addition to scales assessing restraint and
externality. The DEBQ's 13-item emotional eating scale comprises two factors, one deal-
ing with eating in response to diffuse emotions, and the other assessing eating in the
presence of clearly labeled emotions. While the DEBQ facilitates a more detailed analysis
of emotional eating than the TFEQ (Stunkard & Messick, 1985), it does not permit
distinctions in the relationship between specific mood states (e.g., anger, anxiety, de-
pression) and overeating.
The common practice of referring generically to "negative mood" and its relation to
overeating may reflect an absence of measures to facilitate sufficiently detailed distinc-
tions rather than substantial evidence that all varieties of negative mood precipitate
disinhibited eating in the same way. Indeed, several studies have suggested otherwise.
For example, Steere and Cooper (1993) reported that restrained eaters' consumption
following an anxiety induction procedure was unaffected when levels of perceived hun-
ger were low and was reduced when perceived hunger was high. They concluded that
the assumption that "dietary restrainers as a group experience anxiety as disinhibitory
of eating may not be entirely accurate" (p. 218). In a descriptive study of binge eaters
(Arnow et al., 1992), we reported that subjects described anger/frustration prior to a
binge 42% of the time, but sadness/depression only 16% of the time. And Eldredge,
Agras, and Arnow (in press) found that subjects who reported overeating predomi-
nantly in response to anger and depression gained significantly more weight between
baseline and entry into a treatment program for binge eating and weight loss than did
subjects who reported overeating in response to anxiety. The latter group actually de-
creased in weight while the former two groups both increased.
The aim of the current study was to develop a questionnaire that would permit a more
detailed analysis of the relationship between negative mood and disordered eating. We
refer to the instrument as the Emotional Eating Scale (EES).
DESIGN OVERVIEW
The aim of Study 1 was to develop items for the EES and to examine its psychometric
properties, including its internal consistency, test-retest reliability, and its factor struc-
ture. The aim of Study 2, in addition to replicating the study of the psychometric
qualities of the EES, was to assess its construct and criterion validity. Study 3 focused on
the discriminant efficiency of the EES.
Study 1
The goal of Study 1 was to develop the item pool for the EES and to investigate its
psychometric properties.
82 Arnow, Kenardy, and Agras
Item Development
In developing the scale, we employed a Likert-type format to assess the intensity of
the relationship of mood to eating. The five-point scale used was anchored on "no desire
to eat" and "an overwhelming urge to eat," with "a small desire to eat," "a moderate
desire to eat," and "a strong desire to eat" at the intermediate points. In a previous
study (Arnow et al., 1992) of 19 obese binge eating females, we reported that feelings of
anger/frustration, anxiety, and sadness/depression accounted for 95% of the antecedent
moods reported by respondents with approximate proportions of 2:2:1. We used 21
items drawn from actual responses in that study, and added 4 items from the Profile of
Mood States (McNair, Lorr, & Droppleman, 1971) to bring the total number of items to
25 while maintaining the relative proportions found in the original study.
Method
Subjects
The 25-item EES was administered to 47 obese females who had been accepted into a
treatment study targeting both binge eating and weight loss. Each subject met DSM-III-R
criteria for bulimia nervosa with one exception, namely an absence of purging behavior.
Thus during an initial screening interview each subject reported: (1) recurrent episodes
of binge eating in which she perceived herself to consume a large amount of food in a
short period of time, (2) a perceived lack of control or inability to stop eating during the
binge episode, (3) an average of two or more binge episodes per week for the past 6
months, and (4) marked distress associated with binge eating. Subjects were excluded
from study participation during the prescreening for the following reasons: (1) age below
18 or above 65; (2) current or past history of self-induced vomiting, laxative use, or other
purging behavior; (3) current use of antidepressant medication or appetite suppressants;
(4) concurrent treatment for weight loss or binge eating; (5) concurrent DSM-III-R diag-
nosis of unipolar or bipolar affective disorder with significant suicidal ideation, psycho-
sis, drug abuse, or alcoholism. Subjects in this cohort had a mean age of 44.9 (SD = 10.4,
range 23-64). Subjects mean body mass index (BMI), defined as weight in kilograms
divided by the square of the height in meters, was 37.9 (SD = 6.0, range 26.1-51.7).
Procedure
Subjects were administered the questionnaire following their initial diagnostic inter-
view for the study. Questionnaires were readministered 2 weeks later at an appointment
in which subjects were asked to fill out a number of other measures related to their
presenting symptoms.
Results
All items were subjected to a principal components analysis with a varimax rotation.
Using a scree-test and simple structure criteria, three factors were extracted. Mean
squared multiple correlation was 0.67, indicating adequate coverage of variance. An
orthogonal rotation was used since there was very little between-factor correlation with
oblique rotation. The factor structure is presented in Table 1. The first factor had load-
ings from 11 items.^ Examination of these items revealed that this factor contained the
1. One item "Inadequate" was originally viewed as an "anxiety" item but instead factored on the anger/
frustration factor.
Emotional Eating 83
original anger and frustration items. This factor accounted for 19.7% of the variance. The
second factor had loadings for nine items accounting for 12.5% of the variance; this
factor reflected the original anxiety items. The third factor loaded for five items and
accounted for 10.4% of the variance. The loadings on this factor involved the depression
items. Thus the factor solution replicated the construction of the scale.
Three subscales were derived from the factor structure by summing the items that
loaded on the factors. The mean for the Anger/Frustration subscale was 23.96 {SD =
7.94), the mean for Anxiety was 15.19 {SD = 6.51), and for Depression the mean was
12.00 {SD = 4.00). Measures of internal consistency were calculated for the total scale
and each of the factors. Coefficient alpha for the total scale was .81 indicating acceptable
internal consistency. For the Anger/Frustration, Anxiety, and Depression subscales co-
efficient alphas, respectively, were .78, .78 and .72. Corrected item-total correlations
were also calculated for each subscale. Examination of these indicated little support for
the removal of any item from within the subscales (Anger/Frustration .27-. 58, Anxiety
.32-.67, Depression .37-.58). Examination of the 2-week test-retest correlation of the
scale total score indicated adequate temporal stability (r = .79, p < .001).
Study 2
The aim of Study 2 was to assess the construct, discriminant, and criterion validity of
the EES.
Method
Subjects
Subjects were 51 obese females who had been accepted into a treatment study for
binge eating and weight loss. All subjects met the DSM-III-R criteria for bulimia nervosa
Table 1. Rotated factor matrix
Discouraged
Guilty
Irritated
Angry
Furious
Inadequate
Helpless
Resentful
Frustrated
Jealous
Rebellious
Jittery
On edge
Shaky
Nervous
Excited
Uneasy
Worried
Upset
Confused
Lonely
Bored
Sad
Blue
Worn out
Factor I
.67
.65
.62
.60
.59
.57
.55
.53
.47
.41
.31
-.02
.12
-.09
.02
-.02
.13
.30
.31
.27
-.18
-.12
.29
.11
.06
Factor II
.03
.04
.36
-.05
.09
.30
.30
.02
.04
.18
.16
.83
.74
.67
.64
.58
.52
.48
.47
.36
-.04
-.16
.05
.15
.33
Factor III
-.05
-.09
.38
.27
.25
-.06
-.06
.05
-.12
.29
-.32
.08
-.06
.10
-.42
.10
-.41
.15
.20
-.13
.79
.70
.67
.52
.47
84 Arnow, Kenardy, and Agras
with the exception of purging behavior. The inclusion and exclusion criteria were iden-
tical to those in Study 1. Subjects in this cohort had a mean age of 45.1 (SD = 10.6, range
21-65). Mean BMI was 38.9 (SD = 7.1, range 26.6-55.8).
Measures
To assess construct, criterion, and discriminant validity, subjects completed the fol-
lowing measures: (1) The Binge Eating Scale (BES; Gormally et al., 1982), a 16-item
self-report scale designed to assess the extent and severity of binge eating among the
obese; (2) the TFEQ (Stunkard & Messick, 1985), a 51-item instrument measuring cog-
nitive restraint of eating, hunger, and disinhibition; (3) the Beck Depression Inventory
(BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961), a 21-item self-report scale
measuring depression severity; (4) the Rosenberg Self-Esteem Scale (RSE; Rosenberg,
1979), a 10-item self-report scale assessing global self esteem; and (5) the Symptom
Checklist (SCL-90-R Derogatis, Lipman, & Covi, 1973) which was developed to assess
psychiatric symptomatology in outpatients, and includes a number of specific scales
(e.g., hostility, anxiety, somatization) as well as a General Symptom Index. Frequency
of binge eating was measured with a 7-day calendar recall method. Subjects were asked
to recall binge episodes for each day of the past week. This method has been demon-
strated to be reliable (Wilson, 1987).
Results
The items of the EES were again factor analyzed using procedures identical to those
used in the first sample and a similar three-factor structure emerged. The mean EES
subscale scores for this second sample were Anger/Frustration (Factor I), 26.85 {SD =
8.71, range = 5-42, median = 29), Anxiety (Factor II), 16.49 (SD = 7.31, range = 3-31,
median = 16), and Depression (Factor III), 12.96 (SD = 3.62, range = 5-20, median =
13).
To assess construct validity, all subjects in the second sample filled out a measure
assessing the severity of binge eating (BES) and the 7-day recall of binge days. Theo-
retically, higher levels of emotional eating should correlate with greater severity of binge
eating. Significant correlations were found between the EES subscales and both the BES
and the 7-day recall of days on which binge eating reportedly occurred (see Table 2).
Thus there is good evidence of construct validity.
Discriminant validity was assessed through measurement of attitudes toward eating
(TFEQ), psychological adjustment (BDI, SCL-90-R), and self-esteem (RSE). In support of
the discriminant validity of the EES, none of the measures of psychological adjustment
(BDI, SCL-90-R, RSE) were significantly related to the EES. Furthermore, no association
was found between the EES subscales and the Cognitive Restraint Factor of the TFEQ.
Significant correlations were found between the EES Anger/Frustration and Depression
subscales and the TFEQ Disinhibition scale. However this finding is expected given that
six of the items in the Disinhibition scale have been shown to be related to emotional
eating (Ganley, 1988).
Criterion-related validity was assessed by examining the relationship between
changes in the EES subscales and response to treatment aimed at reducing binge eating.
The changes in scores on the EES subscales were compared to changes in binge eating
measures pre and posttreatment (see Agras et al., in press, for an outline of treatment).
Changes in the subscales all correlate significantly with changes in the BES (Anger/
Frustration r = .47, Anxiety r = .37, and Depression r = .44). Changes in the Anger/
Frustration subscale (r = .46) and Anxiety subscale (r = .37) also correlate significantly
Emotional Eating 85
Table 2. Correlation coefficients for Emotional Eating Scale subscales
with validity measures
Gormally BES
7-day recall of binge days
TFEQ Cognitive Restraint
TFEQ Disinhibition
SCL-90-R GSI
Beck Depression
Rosenburg Self-Esteem
EES-I
(Anger/Frustration)
.65***
.46***
-. 10
.29*
.24
.15
.22
EES-II
(Anxiety)
.50***
.44**
-. 09
.05
.18
.01
.15
EES-III
(Depression)
.46***
.44**
.06
.29*
.17
-. 01
.15
Note. BES = Binge Eating Scale; TFEQ = Three Factor Eating Questionnaire;
SCL-90-R = Symptom Checklist; GSI = General Symptom Index.
*p < .05.
**p < .01.
***p < .001.
with changes in 7-day recall of binge days, however change in the Depression subscale
does not (r = .23). Regarding magnitude of change, the EES Anger/Frustration subscale
was significantly lower following treatment [f(49) = 5.21, p < .001], but neither the
Anxiety nor the Depression subscales changed significantly. Qverall, however, the re-
sults support the criterion-related validity of the EES.
Study 3
The aim of Study 3 was to assess the discriminant efficiency of the EES by adminis-
tering it to a group of subjects diagnosed with an anxiety disorder.
Method
Subjects
Subjects were 18 women and 8 men who were patients in two separate fee-for-service
groups at the Stanford University Behavioral Medicine Clinic aimed at providing relief
from anxiety disorders. All subjects met DSM-III-R criteria for either panic disorder with
agoraphobia, social phobia, simple phobia, or agoraphobia without history of panic
disorder. Subjects were also screened for the presence of eating disorders (see below).
Interestingly, of the 26 subjects 2 males and 6 females had current eating disorders and
were excluded leaving a sample of 18. Mean age of the remaining participants was 37.65
(SD = 7.74, range 26-58).
Procedure
All participants were asked whether they would be willing to complete a question-
naire regarding their eating habits that was part of an ongoing research project at
Stanford University. None of the subjects refused. They were also given a 9-item screen
assessing for the presence of an eating disorder. The questions asked included whether
the subject considers his or her eating pattern to be abnormal, whether he or she binge
eats, whether there is a sense of loss of control during such episodes, how frequently
such episodes take place, and whether there is a history of, or current purging.
Results
To compare the responses of the anxiety disorder group to binge eaters, scores of the
latter group of subjects from Studies 1 and 2 were combined. Means for the three sub-
86 Arnow, Kenardy, and Agras
scales were significantly higher in the combined sample of binge eaters. For the EES
Anger/Frustration subscale, the mean for the anxiety disorder group was 5.1 (SD = 4.3)
and for the binge eaters 25.4 (SD = 8.4) [t(lU) = -10.00, p < .001]. For the EES Anxiety
subscale, the mean for the anxiety disorder group was 4.0 (SD = 4.2) and for the binge
eaters 15.9 (SD = 6.9) [t(114) = -7.02, p < .001]. For the EES Depression subscale, the
mean for the anxiety disorder group was 5.2 (SD = 3.6) and for the binge eaters 12.5 (SD
= 3.8 [t(114) = -7.57 p < .001]. Thus the results provide support for the discriminant
efficiency of the EES.
SUMMARY AND DISCUSSION
The EES was designed to facilitate investigation of the relationships between specific
negative emotional states and overeating. Preliminary results indicate that it is internally
consistent, and that it demonstrates adequate temporal stability. Its three separate sub-
scales, Anger/Frustration, Anxiety, and Depression, were confirmed in the factor solu-
tion. All of the subscales correlated significantly with 1 week recall of days on which
binge eating occurred and with the BES (Gormally et al., 1982). The evidence therefore
suggests that higher levels of binge eating are associated with the desire to eat when
experiencing negative affect.
The EES subscales were unrelated to measures of general psychopathology and self-
esteem, including the BDI (Beck et al., 1961), the SCL-90-R (Derogatis et al., 1973), and
the RSE (Rosenberg, 1979). While this supports the discriminant validity of the EES,
suggesting that the subscale scores are not attributable to correlation with a more general
psychopathology factor, the absence of correlation between the EES Depression subscale
and the BDI warrants comment. The lack of relationship between these two measures is
probably due to the different kinds of questions each asks. The BDI asks about one's
current mood. It is a measure of the intensity of depression (Beck et al., 1961). The EES
Depression subscale asks specifically about one's desire to eat when one feels depressed.
The association between the EES Anger/Frustration and Depression subscales and the
Disinhibition scale of the TFEQ (Stunkard & Messick, 1985) is not surprising given
Ganley's finding (1988) that emotional eating is a component of the Disinhibition factor.
More surprising is the lack of association between the EES Anxiety subscale and the
TFEQ Disinhibition scale. While this finding is puzzling, it may be partly accounted for
by the fact that the Disinhibition scale, as Ganley (1988) noted, comprises two factors,
one involving weight fluctuation and the other emotional eating. As Eldredge et al. (in
press) reported, in a study of 86 obese binge eaters between baseline and the beginning
of a diet, those whose EES scores reflected overeating primarily when depressed or
angry gained significantly more weight than those who overate in response to anxiety.
The latter group lost a marginal amount of weight. It is possible that overeating in
response to anxiety is less unbridled and therefore associated with less weight fluctua-
tion than eating in response to either anger or depression.
For the most part, treatment-associated changes in binge eating were associated with
changes in the EES subscales. Changes in all three subscales correlated significantly with
changes in the BES (Gormally et al., 1982), and changes in 7-day recall of binge eating
correlated significantly with changes in the Anger/Frustration and Anxiety subscales.
However, the correlation between the 7-day recall measure and the Depression subscale
failed to reach significance. In addition, though the EES Anger/Frustration subscale was
significantly lower following treatment, the Anxiety and Depression subscales were not.
In considering this pattern of results it is important to note that one third of the subjects
Emotional Eating 87
in the treatment study received cognitive-behavioral therapy (CBT) for weight loss only
based on the LEARN Program for Weight Control (Brownell, 1985), two thirds received
CBT for binge eating followed by weight loss therapy, and one third received desi-
pramine in addition to CBT for binge eating followed by weight loss treatment (Agras et
al., in press). Emotional eating was not the primary target in any of these therapies. In
a prior study of the efficacy of desipramine in the treatment of nonpurging binge eaters
(McCann & Agras, 1990), the authors noted that the mechanism of action appeared to be
appetite suppression which facilitated increased restraint rather than changes in levels
of depression or in subjects' ability to manage depression. And the weight loss treat-
ment, based on the LEARN manual (Brownell, 1985), emphasized alterations in diet,
exercise, and eating habits rather than emotional eating. The manual used in the CBT for
binge eating conditions was used in a prior study (Telch, Agras, Rossiter, Wilfley, &
Kenardy, 1990) and was based largely on CBT for bulimia nervosa. While some attention
was paid to tracking mood changes and other precipitants to binge episodes, the major
emphasis is on altering patterns of restraint that presumably underlie binge eating
disorder, including encouragement to eat three meals daily, and avoiding "forbidden
foods" (see Telch et al., 1990 for a description of the manual). It is therefore not sur-
prising that these therapies failed to demonstrate a broader impact upon the urge to eat
during negative emotional states. On the other hand, the significant change in the
Anger/Frustration subscale might have been due to the fact that CBT intervention to
normalize one's eating pattern and avoid forbidden foods probably reduces the sense of
failure and inadequacy that seems to characterize binge eaters' relationships with food.
Among the items on that subscale that might have been affected by such intervention
include "Guilty," "Discouraged," "Inadequate," "Helpless," "Frustrated," and "Rebel-
lious."
Perhaps the most interesting finding is the strong relationship between all EES sub-
scales and the 7-day recall of days on which binge eating occurred, combined with an
absence of correlation between the EES and the Cognitive Restraint subscale of the
TFEQ. This provides some indirect support for a suggestion in our earlier report (Arnow
et al., 1992) that negative mood may precipitate binge eating in obese patients regardless
of levels of restraint. This is relevant not only to our attempts to understand binge eating
disorder, but also to treatment since current cognitive-behavioral approaches assume
the presence of restraint in these patients, and spend considerable therapeutic effort
attempting to attenuate it. Recent evidence from other studies as well suggests that
restraint may not be as critical a variable among obese binge eaters as was initially
reported. For instance, Wilson, Nonas, and Rosenblum (1993) reported that only 8.7%
of a cohort of binge eaters seeking obesity treatment reported having been on a "strict
diet" prior to beginning binge eating. And while an earlier investigation (Marcus et al.,
1985) found that compared with obese nonbingers, self-reports of obese binge eaters
indicated significantly higher levels of restraint, a more recent investigation using the
Eating Disorders Examination (Cooper & Fairburn, 1987), a structured clinical interview,
found that the Restraint subscale scores of obese bingers were significantly lower than
those of normal weight bulimia nervosa subjects (Marcus, Smith, Santelli, & Kaye, 1992).
The EES was developed in a clinical population and its applicability to nonclinical
populations is unknown. In addition, as it was intended to permit more differentiated
study of the phenomenon of emotional eating, the meaning of a total score is unclear
and may obscure the specific relationships the measure was designed to illuminate.
Thus results should be reported by specific subscale.
This research was supported in part by grant MH38637 from the NIH.
Arnow, Kenardy, and Agras
APPENDIX 1
Emotional Eating Scale
We all respond to different emotions in different ways. Some types of feelings lead
people to experience an urge to eat. Please indicate the extent to which the following
feelings lead you to feel an urge to eat by checking the appropriate box.
Resentful
Discouraged
Shaky
Worn Out
Inadequate
Excited
Rebellious
Blue
Jittery
Sad
Uneasy
Irritated
Jealous
Worried
Frustrated
Lonely
Furious
On edge
Confused
Nervous
Angry
GuUty
Bored
Helpless
Upset
No Desire
to Eat
A Small
Desire to Eat
A Moderate
Desire to Eat
A Strong
Urge to Eat
An
Overwhelming
Urge to Eat
Emotional Eating 89
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