Appetite, 1990, 14, 126-128
Commentary Developing Concerns with A Supplement to Tuschl
Dietary
Restraint:
ANDREW J. HILL Department
of Psychiatry,
University
of Leeds, U.K.
Tuschl(l990) suggests several plausible ways in which dietary restraint (or dieting) may predispose an individual to bulimia. However, two further aspects of the relationship may be important in understanding the emergence of bulimia. First, the behavioural pattern of dietary restraint may be established during adolescence, a time of marked psychological, physical and physiological maturation, And second, the pursuit of thinness, proposed as a motivator for dieting, is itself central to the psychopathology of bulimia. As bulimia often starts to present itself during late adolescence, it is reasonable to assume that dieting has been actively engaged in at an even younger age. This is supported by several studies which have found dieting to be almost the normative behaviour of female adolescents. Even girls as young as 12 years old achieve high restraint scores (e.g. Wardle & Beales, 1986). Furthermore, restraint at this age is functional. There is evidence that restrained teenagers tend to restrict their normal meal and snack intake (Wardle & Beales, 1986). In addition, they are susceptible to the action of disinhibitors and overeat in a behavioural test of restraint (Hill et al., 1989). This pattern of conscious restraint over eating, interspersed with episodes of disinhibited eating, is typical of adult dieters and has been argued to predispose them to become bulimic (Polivy & Herman, 1985). Clearly, this pattern may be established early in adolescence. Just how early we do not know, but a desire for thinness and concerns about dieting may be expressed by girls as young as 9 years old (Hill & Rogers, Note 1). It is possible that the diagnosis of bulimia nervosa at the age of 20, for example, may represent the end-point of years of episodic dieting. But not only does dieting during early adolescence produce an undesirable pattern of eating behaviour and may corrupt food intake regulatory mechanisms, it may actually interfere with the normal course of physical development and maturation. Self-imposed caloric restriction by children at a time of high nutritional demand can lead to both short stature and delayed puberty (Pugliese et al., 1983, Russell, 1985). Although dieting lies at the heart of many conceptual approaches to eating disorders, it is not the only risk factor for their development. The crucial question is, why do some dieters go on to be bulimic (or indeed anorexic) and others not? It is clear that the behavioural disturbance which bingeing represents is only part of the clinical picture of bulimia. Another part of the equation is missing. Tuschl offers society’s demands for thinness as the first step in the causal process, fostering dieting and
Address correspondence to: Dr A. J. Hill, Biopsychology Group, Department of Psychiatry, Leeds University, Leeds LS2 9LT, U.K. 0195-6663/90/020126+03 $0300/O
0 1990 Academic Press Limited
A. J. HILL
127
therefore bulimia. In fact, it is the bulimic”s personal embodiment of this drive for thinness, or put another way, “fear of fatness”, which forms a core part of the psychopathology of bulimia. This.persistent overconcern with body shape and weight is not only a diagnostic criterion for bulimia, but accounts for the tactic of vomiting, purging or extended starvation following a binge as a means of avoiding weight gain. So why does the young adolescent dieter follow a calorie restricted lifestyle? There is some evidence that she mirrors parental concerns about dieting. If the mother is highly restrained, then it is likely that her young daughter will also be highly restrained (Hill et al., Note 2). But if adults diet because they are dissatisfied with their weight or size and would like to be slimmer, is the same true of adolescent girls? Significant correlations between weight indices and restraint would seem to indicate that this is so (Wardle & Beales, 1986; Hill et al., 1989). Yet within these subject groups there are girls of various weights expressing high levels of dietary restraint. In other words, there are girls who are concerned with dieting, but who are of average weight for their height and age. How do these girls perceive themselves? Using a strategy based on that of Fallon & Rozin (1985) we have compared the body shape perception of a group who scored highly on a restraint scale with a group of low scorers (Hill & Rogers, Note 1). While the perceived ‘current’ appearance of the low restrained group was largely in accord with their ‘ideal’ shape, there was a significant disparity between the current body image and ideal body image of the restrained group. The restrained girls perceived themselves as slightly heavier than the unrestrained group (an accurate judgement), while their desired ideal shape was leaner. Two features of this result may represent cause for concern. First, this pattern of discrepancy between perceived and desired size is similar to that found in adult bulimic patients (Cooper & Cooper, 1987). Second, these girls were 9 years old. It would appear that our cultural demands for extreme thinness are breeding both a behavioural strategy (dietary restraint) which predisposes the individual to binge, and fostering an unrealistic desire for a thin body shape. It may be the early adoption of both restrained eating and an ultra slim ideal which represents the risk for adult health. The corruption of the biopsychological system proposed by Tuschl may therefore start early in life.
REFERENCENOTES 1. Hill, A. J. 8~ Rogers, P. J. Unpublished data. 2. Hill, A. J., Weaver, C. & Blundell, J. E. (1990) Dieting concerns of IO-year old girls and their mothers. British Journal of Clinical Psychology (in press).
REFERENCES Cooper, P. J. 8~ Cooper, Z. (1987) The nature of bulimia nervosa. Pediatric Reviews and Communications, 1, 217-237.
Fallon, A. E. & Rozin, P. (1985) Sex differences in perceptions of desirable bodyshape. Journal of Abnormal Psychology, 94, 102-105.
Hill, A. J., Rogers, P. J. & Blundell, J. E. (1989) Dietary restraint in young adolescent girls: a functional analysis. British Journal of Clinical Psychology, 28, 165-176. Pohvy, J. & Herman, C. P. (1985) Dieting and binging: a causal analysis. American Psychologist, 40, 193-201.
128
FROM DIETARY RESTRAINT TO BINGE EATING
Pughese, H. T., Lifschitz, F., Grad, G., Fort, P. & Marks-Katz, M. (1983) Fear of obesity: a cause of short stature and delayed puberty. New England Journal of Medicine, 309, 513-518. Russell, G. F. M. (1985) Premenarchal anorexia nervosa and its sequelae. Journal of Psychiatric Research, 19, 363-369.
Tuschl, R. J. (1990) From dietary restraint to binge eating: Some theoretical considerations. Appetite, 14, 105-109. Wardle, J. & Beales, S. (1986) Restraint, body image and food attitudes in children from 12 to 18 years. Appetite, 7, 209-217.
Commentary Developing Concerns with A Supplement to Tuschl
Dietary
Restraint:
ANDREW J. HILL Department
of Psychiatry,
University
of Leeds, U.K.
Tuschl(l990) suggests several plausible ways in which dietary restraint (or dieting) may predispose an individual to bulimia. However, two further aspects of the relationship may be important in understanding the emergence of bulimia. First, the behavioural pattern of dietary restraint may be established during adolescence, a time of marked psychological, physical and physiological maturation, And second, the pursuit of thinness, proposed as a motivator for dieting, is itself central to the psychopathology of bulimia. As bulimia often starts to present itself during late adolescence, it is reasonable to assume that dieting has been actively engaged in at an even younger age. This is supported by several studies which have found dieting to be almost the normative behaviour of female adolescents. Even girls as young as 12 years old achieve high restraint scores (e.g. Wardle & Beales, 1986). Furthermore, restraint at this age is functional. There is evidence that restrained teenagers tend to restrict their normal meal and snack intake (Wardle & Beales, 1986). In addition, they are susceptible to the action of disinhibitors and overeat in a behavioural test of restraint (Hill et al., 1989). This pattern of conscious restraint over eating, interspersed with episodes of disinhibited eating, is typical of adult dieters and has been argued to predispose them to become bulimic (Polivy & Herman, 1985). Clearly, this pattern may be established early in adolescence. Just how early we do not know, but a desire for thinness and concerns about dieting may be expressed by girls as young as 9 years old (Hill & Rogers, Note 1). It is possible that the diagnosis of bulimia nervosa at the age of 20, for example, may represent the end-point of years of episodic dieting. But not only does dieting during early adolescence produce an undesirable pattern of eating behaviour and may corrupt food intake regulatory mechanisms, it may actually interfere with the normal course of physical development and maturation. Self-imposed caloric restriction by children at a time of high nutritional demand can lead to both short stature and delayed puberty (Pugliese et al., 1983, Russell, 1985). Although dieting lies at the heart of many conceptual approaches to eating disorders, it is not the only risk factor for their development. The crucial question is, why do some dieters go on to be bulimic (or indeed anorexic) and others not? It is clear that the behavioural disturbance which bingeing represents is only part of the clinical picture of bulimia. Another part of the equation is missing. Tuschl offers society’s demands for thinness as the first step in the causal process, fostering dieting and
Address correspondence to: Dr A. J. Hill, Biopsychology Group, Department of Psychiatry, Leeds University, Leeds LS2 9LT, U.K. 0195-6663/90/020126+03 $0300/O
0 1990 Academic Press Limited
A. J. HILL
127
therefore bulimia. In fact, it is the bulimic”s personal embodiment of this drive for thinness, or put another way, “fear of fatness”, which forms a core part of the psychopathology of bulimia. This.persistent overconcern with body shape and weight is not only a diagnostic criterion for bulimia, but accounts for the tactic of vomiting, purging or extended starvation following a binge as a means of avoiding weight gain. So why does the young adolescent dieter follow a calorie restricted lifestyle? There is some evidence that she mirrors parental concerns about dieting. If the mother is highly restrained, then it is likely that her young daughter will also be highly restrained (Hill et al., Note 2). But if adults diet because they are dissatisfied with their weight or size and would like to be slimmer, is the same true of adolescent girls? Significant correlations between weight indices and restraint would seem to indicate that this is so (Wardle & Beales, 1986; Hill et al., 1989). Yet within these subject groups there are girls of various weights expressing high levels of dietary restraint. In other words, there are girls who are concerned with dieting, but who are of average weight for their height and age. How do these girls perceive themselves? Using a strategy based on that of Fallon & Rozin (1985) we have compared the body shape perception of a group who scored highly on a restraint scale with a group of low scorers (Hill & Rogers, Note 1). While the perceived ‘current’ appearance of the low restrained group was largely in accord with their ‘ideal’ shape, there was a significant disparity between the current body image and ideal body image of the restrained group. The restrained girls perceived themselves as slightly heavier than the unrestrained group (an accurate judgement), while their desired ideal shape was leaner. Two features of this result may represent cause for concern. First, this pattern of discrepancy between perceived and desired size is similar to that found in adult bulimic patients (Cooper & Cooper, 1987). Second, these girls were 9 years old. It would appear that our cultural demands for extreme thinness are breeding both a behavioural strategy (dietary restraint) which predisposes the individual to binge, and fostering an unrealistic desire for a thin body shape. It may be the early adoption of both restrained eating and an ultra slim ideal which represents the risk for adult health. The corruption of the biopsychological system proposed by Tuschl may therefore start early in life.
REFERENCENOTES 1. Hill, A. J. 8~ Rogers, P. J. Unpublished data. 2. Hill, A. J., Weaver, C. & Blundell, J. E. (1990) Dieting concerns of IO-year old girls and their mothers. British Journal of Clinical Psychology (in press).
REFERENCES Cooper, P. J. 8~ Cooper, Z. (1987) The nature of bulimia nervosa. Pediatric Reviews and Communications, 1, 217-237.
Fallon, A. E. & Rozin, P. (1985) Sex differences in perceptions of desirable bodyshape. Journal of Abnormal Psychology, 94, 102-105.
Hill, A. J., Rogers, P. J. & Blundell, J. E. (1989) Dietary restraint in young adolescent girls: a functional analysis. British Journal of Clinical Psychology, 28, 165-176. Pohvy, J. & Herman, C. P. (1985) Dieting and binging: a causal analysis. American Psychologist, 40, 193-201.
128
FROM DIETARY RESTRAINT TO BINGE EATING
Pughese, H. T., Lifschitz, F., Grad, G., Fort, P. & Marks-Katz, M. (1983) Fear of obesity: a cause of short stature and delayed puberty. New England Journal of Medicine, 309, 513-518. Russell, G. F. M. (1985) Premenarchal anorexia nervosa and its sequelae. Journal of Psychiatric Research, 19, 363-369.
Tuschl, R. J. (1990) From dietary restraint to binge eating: Some theoretical considerations. Appetite, 14, 105-109. Wardle, J. & Beales, S. (1986) Restraint, body image and food attitudes in children from 12 to 18 years. Appetite, 7, 209-217.
