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01789 9521

This is to certify that the

thesis entitled

THE ROLE OF SHAME IN BULIMIA NERVOSA
AND THE FEMALE BULIMIC'S PERCEPTIONS OF
INTERPERSONAL NEEDS

presented by
MELISSA FRISCH MCCREERY

has been accepted towards fulfillment
of the requirements for

M. A. PSYCHOLOGY

degree in

 

 

   

Major professor

Bertram Karon

Date October 23, 1991

 

0-7639 MS U is an Afﬁrmative Action/Equal Opportunity Institution

PLACE IN RETURN BOX to remove this checkout from your record.
To AVOID FINES return on or before date due.
MAY BE RECALLED with earlier due date if requested.

 

DATE DUE DATE DUE DATE DUE

AER 0 82008

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6/07 p:lC|RC/DateDue.indd-p.1

 

THE ROLE OF SHAME IN BULIMIA NERVOSA
THE FEMALE BULIMIC‘S PERCEPTION OF INTERPERSONAL NEEDS
By

Melissa Frisch Mchery

A THESIS
Submitmd to
Michigan State University
in partial fulﬁllment of the requirements
for the degree of

MASTER OF ARTS

Department of Psychology
1991

ABSTRACT
THE ROLE OF SHAME IN BULIMIA NERVOSA
AND
THE FEMALE BULIMIC'S PERCEP'I‘IONS OF INTERPERSONAL NEEDS
By

Melissa Frisch McCreery

This study sought corroboration of Kaufman's (1985, 1989) conceptualization of
bulimia as a shame-based disorder in which shame is attached to interpersonal needs.

Twenty bulimic and twenty non-bulimic female undergraduates completed the
Internalized Shame Scale (188) and the "Autonomy" and "Emotional Reliance on Another
Person" scales of the Interpersonal Dependency Inventory (IDI) twice, (1) for themself,
and (2) for their "ideal self." Subjects also completed the 188 for 3 characterizations
presented on audiotape; one was self-reliant. another expressed interpersonal needs. one
had no distinct interpersonal style.

Bulimics were signiﬁcantly more ashamed and more emotionally reliant than non-
bulimics. The groups differed in perceptions of the ideal woman. An ANOVA revealed
signiﬁth differences by group and by characterization in the ratings of shame to the
characterizations. Interpersonal needs were perceived as shameful for both groups;
bulimics rated them as signiﬁcantly more shameful than the non-bulimics. The results
support Kaufman's conceptualization of bulimia and highlight societal conﬂicts which may
exacerbate females' shame over interpersonal needs.

For Scott,
for a lot of reasons
and many many steps.

ACKNOWLEDGMENTS

I would like to thank Dr. Bertram Karon for all of his support and encouragement,
and for the generous loan of ofﬁce space, without which I‘d still be running subjects.
Many thanks also go to Dr. Gershen Kaufman for his careful and methodical attention to
this project. His understanding of shame theories and his meticulous editorial critiques
have added immeasm'ably to the ﬁnal product. Thank you Dr. Raymond Frankmann for
your tireless scrutiny of my statistics. Finally, I send a big thank you to Scott McCreery

for patiently enduring and for offering unceasing support and crisis intervention.

iv

TABLE OF (XJNTENTS

LIST OF TABLES ................................................................................... v
LIST OF FIGURES ................................................................................ vi
INTRODUCTION ................................................................................... 1
Theories of Shame .......................................................................... l

Affect Theory ....................................................................... 2
Psychoanalytic Theories ........................................................... 4

Shame-based Disorders: Differing Views ............................................... 6

Family Shame: Individual and Family Scripts .......................................... 8
Dynamics of Bulimic Development ....................................................... 9
Dysfunctional Communication .................................................... 9

Denial of Needs and Feelings .................................................... ll

Depression and Substance Abuse ............................................... 12

Food, Dieting, and Body Image ................................................. 13

Perfectionism and Cultural Values ................ ' .............................. 14

The Development of Bulimic Symptomology: Synthesizing Shame

Theory and Bulimic Research ............................................................. 16
Bulimics' Perceptions of Their Disorder ................................................ 20
Bulimics' Perceptions of Interpersonal Needs .......................................... 21
Research Objectives and Overview of Design .......................................... 24
Research Objectives and Hypotheses ........................................... 24

Overview of Design ............................................................... 25

METHOD ............................................................................................ 27

V

Subjects ...................................................................................... 27

Measures .................................................................................... 30
Eating Disorders Inventory ....................................................... 32

Interpersonal Dependency Inventory ............................................ 32

Internalimd Shame Scale ......................................................... 32

Taped Vignettes .................................................................... 33

Procedure .................................................................................... 34
RESULTS ............................................................................................ 37
Demographic Information ................................................................. 37
Responses to Screening Measures ....................................................... 38
Responses to Taped Vignettes ............................................................ 39
DISCUSSION ....................................................................................... 45
Demographics ............................................................................... 45

Initial Measmes (measures included in the screening battery) ........................ 45
Responses to Audiotaped Characterizations ............................................. 47
Implications for Theory and Research ................................................... 48
CONCLUSION ..................................................................................... 55
REFERENCES ...................................................................................... 56
APPENDICES ....................................................................................... 60
Appendix A: Taped Vignettes ............................................................ 60
Appendix B: Pilot Testing Questionnaire ............................................... 65
Appendix C: Descriptive Information ................................................... 66
Appendix D: Screening Measures ....................................................... 68
Appendix E: Individual Measures (responses to vignettes) ........................... 79
Appendix F: Consent Forms and Information Forms ................................. 81

LIST OF TABLES

Table 1: Items on the "Bulimia Scale" of the Eating Disorders Inventory ................... 29
Table 2: Bulimic Group -1 scores .............................................................. 31
Table 3: Pilot Study: Subject means ............................................................. 35
Table 4: Summary of group means and standard deviations: Screening responses ........ 43

Table 5: Summary of group means and standard deviations: Responses to
taped vignettes ....................................................................................... 44

LIST OF FIGURES

Figure l: Shame ratings of characterizations by group ......................................... 40
Figure 2: Esteem ratings of characterizations by group ........................................ 42

INTRODUCTION

The etiology of bulimia nervosa has not been clearly determined. but it appears to
be complex and to involve multiple levels of experience-{acme at the level of the
individual, the family, and society. Implicit in each of these levels of analysis is the role of
shame. In fact. shame appears to play a major role in the development of bulimia nervosa.
Unfortunately, little empirical attention has been devomd to examining and deﬁning this
relationship. The present study aims to examine bulimia nervosa in light of Kaufman’s
(1985, 1989) theory of shame and his conceptualization of bulimia as a shame-based
disorder in which shame is directly associamd with interpersonal needs. The literatme on
shametheca'yaswellastheresearchliteramreonthedynamics underlyingbulimiawillﬁrst
be reviewed and an integration of the two ﬁelds of research will be presented, on the
premisemmbuﬁmianervosacanbestbecmcepmalizedasashame-baseddismder

Theories of Shame

Thorough investigation of shame has only recently begun. Theoretical formulations
of shame have varying assumptions and emphasize different motives and concerns. While
phenomenological descriptions of shame are very similar (shame is experienced as acute
feelings of inadequacy, inferiority, and exposure), theories differ in their understanding of
the origins of shame. The two primary conceptions of shame theory originate in Tomkins'
affect theory, and in reformulations and applications of Freudian psychoanalytic theory.

Aﬁecmrm

Tomkins' (1963, 1987) theory of affect conceptualizes the affects as an innate
system. the primary motivational force in human beings, separate from the innate drives.
Affects are understood as a system of ampliﬁers which direct attention to the individual's
needs as indicated by physiological data inputs.

". . . affects are sets of muscular, glandular, and skin receptor responses

located in the face (and also widely distributed throughout the body) that

generate sensory feedback to a system that ﬁnds them either inherently

"acceptable" or "."unacceptable These organized sets of responses are
aﬂggered at subcortical centers where speciﬁc "programs" for each distinct
t ecare stored. programs that are innately endowed and have been

genetically inherited. They are capable, when activated. of simultaneously

capturing such widely distributed structures as the face, the heart, and the

endocrine glands and imposing on them a speciﬁc pattern of correlated

responses. Onedoesnotleamtobeaﬁaidortocryortostartle,an anymore

than one learns to feel pain or to gasp for air" (Tomkins, 1987 p. 1 7).

There are nine innate affects, interest-excitement, enjoyment-joy, Stuprise-startle, distress-
anguish, fear-terror, anger-rage, shame-humiliation, dissmell (the innate smell response to
bad odors), and disgust, (Tomkins, 1987).

While aﬂ'ect is located in subcortical centers in the brain, the primary site of action
of the affect system is the face. Each innate affect is involved with groups of voluntary
muscles which are temporarily taken over by an affect as it emerges, creating a prototypical
facial response for each of the nine affects. The Shame response is characterized by
hanging the head, lowering or averting the eyes, and blushing. According to Tomkins
(1987), what is viewed and understood as facial display of emotion is actually an "inward
feed" of information from the face to conscious awareness. Affect is primarily facial
behavior. As the developing individual becomes aware of these facial responses, he
becomes aware of his affects. Originally, psychological processes do not create affect.
Affect is innately activated by stimulation of speciﬁc receptors or the pattern of stimulation.
The density ofnem‘al ﬁring along with its proﬁle over time determines which affect will be

innately triggered.

Tomkins conceptualizes shame as anauxiliary affect, meaning thatitrequires the
presence of another affect; shame then serves to modulate that original affect. According to
Tomkins (1963, 1987), shame is activamd innately as an inhibitor of continuing interest
and enjoyment. Nathanson (1987) uses the term "prom-shame" to describe the infantile
experience of shame. According to Nathanson, this prom—shame has no meaning. it is
simply an innate reaction to the rapid but partial reduction ofpositive affect. Later, the
infant “learns” to use these innate facial expressions for voluntary expression as well. In
addition, over time, shame becomes associated with input ﬁom interpersonal interactions,
as life experience adds to the original physiological experience of shame.

Kaufman (1985, 1989) has expanded Tomkins' original formulation of shame and
provides a detailed explanation of the processes involved in the creation of a shame-based
identity. While classical Freudians posit libidinal and aggressive drives as the sources of
human motivation, and object relations and interpersonal theorists understand components
of the interpersonal relationship as the primary motivating force, affect theorists view affect
as the fundamental source of human motivation. Aﬁ‘ect is viewed by both Kaufman (1985,
1989) and Tomkins (1963, 1979, 1987) as distinct from drives and also from the need for
relationship. According to Kaufman (1989) it is affect which serves as the primary
motivator.

“It is affect that gives texture to experience, urgency to drives, satisfaction

to relationships, and motivating power to purposes envisioned in the future.

The affect system and the drive system are distinct, interrelated motivators.

They em wer and direct both behavior and personality, but the drives must

borrow eir power from affect. . .” (Kaufman, 1989 p. 61).

Aﬂ‘ect is an ampliﬁer of all experience, including needs, drives, cognition, memory, or
even other affects (Tomkins 1963, 1987). When any of these is ampliﬁed by affect, that
affect can then become attached to the need, drive, cognition, memory or experience.
According to Kaufman (1989) individuals internalize their experience through imagery.
Scenes are internalized images that have become infused with affect. Scenes, imprinted

with affect, are stored in memory and become the foundations of personality (Kaufman,
1989).

When an affect, drive or interpersonal need is followed by shaming, shame scenes
are created. According to Kaufman (1989), if a particular drive, affect, or need becomes
linked with shame, an internalized connection (shame-bind) to that affect, need, or drive
will be established. The creation of shame binds means that recurrences of that affect, nwd
or drive will now spontaneously activate shame by reactivating the entire scene. Because
the shame-bound need, drive, or affect, is now experienced with shame, its expression will
be constricted, fru'ther restricting the expression of self.

Psychological magniﬁcation of scenes occurs when one affect-laden scene becomes
fused with a scene ampliﬁed by the identical affect (Kaufman, 1989; Tomkins, 1979).
Families of scenes are created in this way. Patterns of action, called scripts, are then
created as a means of anticipating or controlling a magniﬁed group of scenes. In the case
of shame-bound scenes, scripts serve the defensive purpose of protecting the individual
from experiencing further shame. As additional shame binds are created, magniﬁcation
takes place and shame increases its power and control over the self.

£11.11.

Another distinct group of shame theories is rooted in psychoanalytic theory. In
these particular theories, both physiological drives and interpersonal needs supercede the
importance of aﬁect as a motivating force. Freud originally posited Shame as a reaction
formation against morally forbidden exhibitionistic impulses, a reaction against forbidden
drives (cimd in Miller, 1985). Not surprisingly, sexual wishes play a primary role in this
understanding. Miller (1985) argues that this view is overly constricted. The linkage of
shame to bodily concerns must be understood in a broadercontext. Shame in adulthood
brings with it the history of childhood shame experiences, some of which are tied to the

body and to bodily functions. However, adulthood and even childhood experiences of
shame are much more generalized than this theoretical formulation allows.

Some psychoanalytic theorists have understood Shame in a broader context, as the
outgrowth of interpersonal experience. Lewis (1987a, 1987c) believes that shame is a state
of self-devaluation which is experienced vicariously as the negative evaluation by an other.
Shane is a “super-ego experience” and shame is the “affective-cognitive signal to the self
that its basic affectional ties are threatened” (Lewis, 1987c p. 114). Shame is originally
caused by a failure of a central attachment bond. It necessarily develops out of relationships
with others. The development of shame requires a relationship between the self and an
other where one cares about the other's evaluation.

Wm'mser's (1981) conceptualization of shame is similar. He believes that a failure
to meet the standards of internalized images results in shame. Wurmser (1981) emphasizes
the power of early or archaic internalized shame over later "realistic" or external shame.
Although our culture often equates shame with sexual exposure, he argues that shame also
involves the broader experience of weakness or failure. To be weak or dirty or defective in
one's own eyes is to be ashamed. In addition, Wurmser believes that shame involves two
modes of exposure. One is embarrassed when one is revealed and also when one is caught
viewing someone else's exhibitionism. Looking and being looked at can both be shameful.
Wurmser (1981) posits that much of severe psychopathology is based on often disguised
shame conﬂicts, and is set up to undo, and at the same time perpetuate, the shame traumas
that have created a profound sense of unloveability.

Morrison (1984, 1987, 1989) has written about shame within a self psychology or
Kohutian framework. Morrison views shame as an affect of central
importance which reﬂects feelings of inferiority, defect, and failtu'e of the self.

“Shame reﬂects decreased self-esteem--a manifestation of the self’s sense of

failure with respect to goals and ideals, its deﬁcits with respect to early
insufﬁcient functions of its selfobjects” (Morrison, 1987 p. 289).

The phenomenological withdrawal experienced with shame is not only from external
objects; it is also a withdrawal from a negative or despairing self awareness. This self-
awareness is meted in internalized “selfobjects” which reﬂect the empathic quality of early
relationships.

Although they differ in conceptions of how this occrn's, both affect tleorists and
psychoanalytic theorists agree that interpersonal factors (real or imagined) are implicit in the
linkage of shame to behavior . Where Kaufman discusses the binding of innate Shame to
interpersonal needs, and the creation of shame binds through the reactions of others, Lewis
WW, and even Monison to an extent, view shame as created and internalized
somewhere within the context of interpersonal relationships.

Shame-based Disorders: Differing Views

Shame theorists have posited preliminary reconceptualizations of psychopathology,
integrating the concept of shame with the development of psychological disorders. The
theories of Kaufman, Wurmser, and Lewis will be brieﬂy discussed. They are notably
different, reﬂecting their disparate understandings of human motivation and development.

According to Kaufman (1989), repeaed association of shame with interpersonal
needs, with hunger or sexual drives, or with other affects may lead to the development of
"shame syndromes" governed by central internalized shame scenes. These shame
syndromes are “constellations of affect, scene, and script” (Kaufman, 1989 p. 153). There
are distinct shame syndromes, shaped by the nature of the scenes and the shame-binds,
which involve characteristic patterns of reproducing shame and further distorting the self.
The scripts or rules that an individual develops over time to predict, control, respond to,
and interpret a set of scenes magniﬁed by affect ftu'ther solidiﬁes the individual's response
to these scenes (Kaufman, 1989; Tomkins, 1979, 1987). While Kaufman (1989) does not
believe all psychopathology to be founded in shame, he argues that shame scenes and

scripts are central to the development of affective, narcissistic, borderline, compulsive,
addictive, and eating disorders.

Wurmser (1981) posits a shame syndrome as well, a continuum of neurotic to
psychotic behavior which includes varying degrees of four major symptoms,
depersonalization, eating disturbances (which include anorexic behavior as well as bulimic
hinges), depression, and delusionally intense feelings of shameful exposure and rejection.
This shame syndrome originates in infantile conﬂicts over the desire fm’ symbiotic
dependency and merging with the other and an intense desire for autonomy, which is
fueled by fears of total rejection in the form of "Shame anxiety". Shame anxiety is deﬁned
as anxiety caused by the imminent danger of unexpeced exposure, rejection, and
humiliation.

Lewis (1987a, 1987c) believes that neurotic symptomology or behavior is
frequently the result of the conscious attempt to maintain and repair lost affectionate bonds.
The failure ofa central attachmentbond results in shame. This shame as well as the painful
experience of losing an attachment because one has not been able to live up to the standards
of an admired internalind image evokes rage, what Lewis calls "shame-rage" or
'hunriliated—fury". Shame-based rage is turned against the self, out of fear of losing the
valued other. Unacknowledged shame is disruptive to behavior and interferes with one's
adaptive capacity. Lewis understands bulimia as a means of directing the rage toward
one's self (cited in Teusch, 1988). Within these shame/rage-based disorders, shame is
commonly unidentiﬁed and the individual may remain in a state of self hatred with no
recognition of the shame component (Lewis, 1987a).

Shame is a powerful affect experienced as exposure before either self or others.
The linkage of shame with interpersonal experience, with drives, and with other affects can
inhibit their expression in an effort to avoid the painful experience of shame. Feelings of
shame can create internalized rage and the personality can be profoundly affected by shame.

Family Shame: Individual and Family Scripts

Shamehasalsobeenexaminedasafamilydynamicordisorder,fromwithina
family systems framework. According to Fossum and Mason (1986), shame is an
intergenerational phenomenon. The sense of shame about shame and the tendency, both at
the level of the individual and the level of culture to deny, cover up or avoid shame leads to
its perpetuation in both individuals and families.

Kaufman (1989) also addresses the role of the family in the development and
maintenance of a shame-based system He posits that families develop family scripts or
rules (analogous to individual scripts). These scripts serve to create identities and life
roles, both for the individual family members and for the family as a whole. Parents bring
their own childhood experiences with shame into their relationships with their offspring.
Children may reactivate their parent's early shame scenes by reminding them of unaccepted
parts of themselves. The reactivation of these scenes leads to shame in the parent who then
is likely to respond by shaming the child. Parents reenact old shame scenes either as they
originally occrnred or else with the parent now playing the part of his or her own parent, in
this way projecting the original shame onto the child. This process can be understood as
both an attempt to avoid experiencing and acknowledging the shame that was elicited, and
as an opportunity to safely express the shame-rage that occm'red with the earlier
humiliations.

Fossum and Mason (1986) have proposed a general outline of the shame-based
family. They posit a set of characteristics and rules characterizing families who are
dominated by shame. According to Fossum and Mason, all family systems fall on a
continuum ranging from respectful to shame—bound behavior. Within a shame-based
family system, the attachment of shame to drives, needs, and other affects is perpetuaed
and dysfunctional coping results. The family script or set of rules revolves around both the

denial of Shame and, through lack of acknowledgment, the perpetuation of shame (Fossum
& Mason, 1986; Kaufman, 1989).

The script of a shame-based family demands rigid control over all behavior and
interaction, perfectionismumore aptly deﬁned as perfect adherence to a very vaguely
deﬁned external image-and the use of blame to cover shame over instarees of lack of
control or imperfect outcome. Other rules include the following: denial of feelings that are
negative or that signal a need for nurturance or need for an other; the use of unreliability,
incompleteness and lack of resolution to avoid facing issues that might arouse shame; a
taboo about talking about behavior that is shameful; and the use of denial ordisqualiﬁcation
to reframe and thus deny any occurrences of shameful or abusive or compulsive behavior
(Fossum & Mason, 1986). The degree to which these rules arefollowed determines a
family's place on the shame continuum.

Dynamics of Bulimic Development

Shane theorists have posited that excessive shame is the basis for the development
of bulimia nervosa. An examination ofthe research on bulimic women and their
development will help clarify theoretical formulations of shame and elucidate its
relationship with bulimia.

D E . l C . .

Much of the research involving the families of bulimics has focused on
communication patterns within the family. Families of bulimics show several
dysfunctional features fairly consistently. Humphrey and her colleagues (1986) compared
the interpersonal behaviors of 16 bulimic families to non-bulimic family controls in a
problem solving role play situation. Researchers were able to blindly differentiate bulimic
families from non-bulimic family controls based on family communication patterns
(Humphrey, Apple, & Kirschenbaum, 1986). Through the use of complex observation-

10

rating systems, they found that parents .of bulimics had a tendency to use "double-bind"
communications which presented contradictory directives. Bulimics' responses to self-
report measures have revealed indirect family communication styles (Johnson & Flach,
1985). Bulimics and their mothers have bath indicated that their families approach conﬂict
indirectly, and that conﬂict tends to be elevated in these families (Artie & Brooks-Guam,
1989; Johnson & Flach, 1985; Strober & Humphrey, 1987). These families have been
described as more disparaging and hostile (Humphrey et al., 1986; Strober & Humphrey,
1987), more walled oﬁ', less cohesive, disengaged and at the same time more enmeshed
(Humphrey et al., 1986; Johnson & Flach, 1985; Strober & Humphrey, 1987), less
helpful or supportive (Humphrey et al., 1986; Johnson & Flach, 1985), less nurturing or :
trusting (Humphrey et al., 1986; Strobcr & Humphrey, 1987), and less expressive
(Johnson & Flach, 1985). The results of these studies clearly support the adherence of
these families to shame scripts.

Bulimic families appear to lack the Skills or ability to communicate honestly and
directly. It can be posited that the parents in these families are suffering ﬁom their own
shame. This shame, and fears of acknowledging it, leads to severely dysfunctional
communication ploys, invoked as a means of protection from painful aﬁect. These
communication tactics may have been learned in their own childhood and would appear to
be a primary method by which shame is perpetuaed intergenerationally. Shame-based
families fail to provide experiences which allow their members to learn and practice
assertive behavior and effective coping skills.

Bulimics certainly appear to be lacking in these areas. Cattanach and Rodin (1988)
reviewed the literattne on the role of psychosocial stress and bulimia. They found that
while the stressors these women report are relatively normative, bulimic women tend to use
passive, and less effective strategies for dealing with stress. They suggest that bingeing
and purging eventually become the primary coping mechanisms for these women when

ll

tley are confronted with stress, as a way of managing feelings, or when the environment
seems chaotic and beyond their control.
D . 1 EH I l E l'

Difficulties in handling the conﬂicting needs of autonomy and dependence have
been discussed in the shame literature as a manifestation of shame-based scripts (Fossum &
Mason, 1986; Kaufman, 1989; Wurmser, 1981). Fossum and Mason (1986) believe that
placing an exaggerated priority on independence coupled with devaluing or denying needs
for mum and help (because neediness is viewed as shameful) leads to the inhibition of
a name self. They argue that individuals or families who overvalue autonomy never learn
tocreatebalancebetweentheneedstobeindividual anddiﬁ'erentiatedandtleneedtobein
relationship with others. When the need to be independent is overly stressed, the
development of the self is stuned because of the continual need to deny manual (but shame-
bound) needs for dependency on and relationship with other human beings.

Bulimic women appear to have great difﬁculty dealing with issues surrounding
autonomy and identity. Bulimics are reported to have an external locus of control and to
display a related sense of personal ineffectiveness (Dickstein, 1985; Johnson & Maddi,
1986). They are described as feeling helpless and somewhat out of control in relation to
their bodily experiences (Johnson & Maddi, 1986). Bulimics have been reported to display
strong needs to conform and gain approval from others and to be very sensitive to rejection
(Boskind—Lodahl, 1976; Garﬁnkel & Garner, 1983).

Bulimic families offer little support for autonomy (Attic & Brooks-Gum, 1989).
Family communication research emphasizes the lack of supportiveness or mum and
failure to encourage self-sufﬁcient, assertive behavior in these families. These dynamics
can certainly be linked with the bulimic’s feelings of ineffectiveness, need for approval,
and overall difﬁculties in coping with stressful situations. Johnson and Flach (1985) report
that bulimic families tend to have high standards of performance, but at tle same time place

12

alow emphasison social andintellectual activitiesthatmightservetofosterthat
achievement. Perfectionism is expeced, while at the same time the family does not support
independent, assertive, or expressive behaviors. In addition, such a double-bind leads to a
no-win shame situation in which the individual is shamed for being dependent and yet is
leftashamedofherinabilitytobeindependentbecauseslelackstheskillsandsupportin
this endeavor.

Winnicott's (1965) conception of the false self is useful in describing this dynamic.
He views the true self is tle spontaneous self that exists in the infant. Ignoring or reacting
inappropriately to the spontaneity of the true self is the equivalent of shaming (Morrison,
1987). According to Winnicott, the false self is an exaggeration of the public face or image
ore extends totleextemal worldinanefforttoprotectthe true self. Ifthe true selfis
sufﬁciently shamed, i.e., if tle caretaker fails to respond appropriately to the needs and
cres of the young child, then the false selfcan become overdeveloped, and can become tle
internalized sense of self, masking the true self (Wmnicott, 1965).

Jones (1985) argues that the bulimric's shame over her need for others is so intense
that she creates an exaggerated false self. The false self, instead of the true self, is
internalind and the submergence of tie true self is posited to lead to the bulimic's feelings
of emptiness, ineﬁectiveness, unrealness and shame (Johnson & Maddi, 1986; Jones,
1985). One can see that shame is cycling or spiraling, leading to adaptations that only
increase and further perpetuate shame.

WW

Over time, recurring feelings of ineffectiveness and shame may result in depressive
symptomology. Reviews of the literature on depression reveal strong evidence that shame
is an important component of affective disorders (I-Ioblitzelle, 1987; Lewis, 1987b).
Increased rates of depression have been widely reported in the families of bulimics and in
bulimics themselves (Hudson, Pope, Jonas, & Yurgelun-Todd, 1983; Striegel-Moore,

l3

Silberstein, & Rodin, 1986; Strober, Salkin, Burroughs, & Morrell, 1982). Hudson and
his colleagues (1983), applying a family history method to a sample of 75 bulimic patients,
found that 53% of tie sample had ﬁrst degree relatives with a major affective disorder.
Alcoholism, another syndrome associated with shame (Fossum & Mason, 1986; Kaufman,
1985, 1989), is also more common within these families (Hudson et al., 1983). An
observational study of bulimic families revealed mothers to be more hostile and depressed
than families of normal controls, while fathers appeared more irritable, impulsive, exhibited
poorerﬁustrationtoleranceandweremorelikelytobealcoholicthanthefathersfromnon-
bulimic families (Strober et al., 1982).

Bulimics have been noted to manifest highly varied mood states, low frustration
tolerance, and impulsive behavior (Johnson & Maddi, 1986). Growing up in a family
characterized by depression or substance abuse may foster some of the personality
characteristics noted in bulimics. Parenting styles may instill, through modeling, inabilities
to regulate negative feelings, lack of ability to delay gratiﬁcation and impulsive behavior,
low frustration tolerance, and low self esteem as well as a tendency towards substance
abuse or depression as a way of coping with uncomfortable emotions and with the
environment. Depressed parents are likely to have modeled, even more intensely, the
passive, and less effective strategies for dealing with stress which bulimrics display
(Boskind—White & White, 1983; Cattanach & Rodin, 1988). A family in which one must
deny needs for nurturance and dependency, and which models the use of an inanimate
object to fulﬁll those needs, is facilitating the development of a bulimic's issues with food.
The same characteristics are reinforwd, to a varying extent, in other shame-based families.
E l D' . l B l I

Women with eating disorders maintain the belief that rigid control over their weight
is necessary for happiness and well-being (Garner & Garﬁnkel, 1980). They display
perceptual disturbances regarding their weight and body shape which may predispose them

14

to dieting behavior. Research indicates that dieting behaviors increase risk for eating
disorders (Dickstein, 1985; Polivy & Herman, 1985; Shisslak, Crago, Neal, & Swain,
1987). Informetion about family attitudes towards food and diet, speciﬁcally, is lacking,
but given the tendency towards high standards of achievement and perfectionistic
expectations within bulimic families, it is likely that increased adherence to cultural ideals of
slimmess is encouraged as well.

E E . . l C l l I! l

Bulimic families emphasize perfectionistic standards of behavior and achievement
(Attic & Brooks-Guam, 1989) and bulimics tend to be perfectionists with high expectations
for themselves (Boskind-White and White, 1983; Garﬁnkel & Garner, 1983). In addition,
tlese women display strong needs to conform and to gain approval ﬁom others (Boskind-
Lodahl, 1976; Garﬁnkel & Garner, 1983). It has been posited that lack of support for and
shaming of the true self can drive the true self underground and encomage the development
of the false self which is built around external ideals (Winnicott, 1965). The characteristics
of the false self are related to those qualities one wishes to present to the environment, the
false self is a mask, a public face that one believes is more likely to gain social approval
than the true self. Characteristics of the false self may be reﬂected in the values of the
family and the culture. According to Kaufman (1989), culture plays a signiﬁcant role in the
development of eating disorders. Cultural attitudes towards weight, body, and appearance
can result in shaming on an interpersonal or societal level.

Theorists argue that changes in cultural ideals regarding the female body have led to
increasedbody shameandan increaseineating disorders. Studiesrevealthatovertle last
few decades, the "ideal woman" has become slimmer, even Playboy centerfolds have
become thinner and more angular over the last 20 years. Miss America contestants Show
declining weight as well (Garner, Garﬁnkel, Schwartz, & Thompson, 1980). Silverstein,
Perdue, Peterson, and Kelly (1986) provide convincing evidence that the media promotes

15

and perpetuates standards of thinness for women. As the ideal body becomes thinner and
lighter, statistics reveal that young women are growing heavier, further widening the
"shame gap" between cultural ideals and reaﬁty (Garner et al., 1980).

The accomplishment of thinness has become a highly valued achievement that earns
admiration and respect among women. Male children are given social approval for
academic success and achievement, girls are most rewarded for being slim (literature
reviewed in Steiner-Adair, 1986). That women are expected to seek these ideals for
themselves and to be ashamed of their failure to attain such status is evidenced both by the
volume and tone of the advertisements and testimonials for diets, exercise, and even plastic
surgery designed to "resculpt" a woman's body.

Theorists have also posited that gender roles and expectations are important
variables which must be considered in developing an understanding of bulimia and of the
bulimic's conﬂict regarding autonomy and dependence. Research has found evidence of
increased adherence to and idealization of traditional female gender roles; among bulimics
these are characterized by dependence and passivity (Boskind-White & White, 1986;
Steiger, Fraenkel, & Leichner, 1989; Pettinati, Franks, Wade, & Kogan, 1987). Boskind-
White and White (1986) argue that simply being female increases the conﬂicting messages
one receives regarding autonomy and dependence. The traditional female role encourages
dependence and yet tle new "super woman" idealizes complete autonomy and success.

Steiner-Adair (1986) theorizes that eating disorders are the result of a cultural
overemphasis on autonomy which is unhealthy and unrealistic, and a culture-wide shaming
of females. She argues that females are acculturated to view themselves in relationship
with others and yet are shamed for these values; instead they are taught to value the traits
for which male children are generally socialized, namely, independence and autonomy. In
other words, women are taught to be one thing and then told to be something else. Within

16

a culture which values "male" tendencies, females shame themselves and are continually
shamed by others.

Using clinical interviews and diagnostic measures with a group of 32 adolescents,
Steiner-Adair (1986) was able to almost perfectly differentiate a subgroup of females who
scored in the disordered eating range on the Eating Attitudes Test, an objective self-report
instrument designed to assess a broad range of eating disordered behavior. This subgroup
identiﬁed cultural ideals of autonomy and success in deﬁning a "superwoman" and did not
separate societal ideals ﬁom their own values in describing what they believed tle ideal
woman to be. They appeared to understand needing or interdependence with others as
shameful. Females who were able to recognize the "superwoman" image and the emphasis
on autonomy as a product of culture, but who included the value of interdependence in their
own goals, did not score as eating disordered.

The varied research on cultural dynamics as they relate to bulimia ﬁts well within a
framework of shame. Cultural attitudes can perpetuate shame at several diﬁ'erent levels.
There is some evidence that bulimia is more prevalent among certain cultural groups,
namely women from middle or upper—class families (Shisslak et al., 1987), suggesting that
groups which espouse certain values (high achievement, thinness, perfection and
autonomy) and shame others may be at increased risk. Preliminary evidence indicates that
the strength of one's ties to the “mainstream,” Caucasian American culture is related to
one's risk for developing an eating disorder (Pumariega, 1986), strengthening the evidence
foraculturallinktothisdisorder.

The Development of Bulimic Symptomology:
Synthesizing Shame Theory and Bulimic Research

While it seems evident that bulimia develops within a shameful and shaming
environment, this does not clarify the nature of bulimic symptomology. An adequate

17

explanation has not been provided as to why the bulimic develops the seemingly strange
patterns of bingeing on food and then purging herself of it. Shame theorists have posited
various explanations for the speciﬁc development of these symptoms.

Wurmser's (1981) understanding of bulimic symptomology reﬂects traditional
psychoanalytic theory. He posits that Shame may result in a syndrome in which four
symptoms are manifest to varying degrees. Through such a formulation, tle eating
disordered female, the borderline, and tie psychotic are all viewed within the same realm,
but falling at different points on the four symptom continuums. These four symptoms
include depersonalization or fragmentation of identity, depression, transitory hallucinatory
or disassociative states, and eating distru'bances. While bulimics do not suffer from
hallucinations, they do show, to a varying degree, the remaining three symptoms.
According to Wurmser (1981), bingeing is a reaction to conﬂicts over merging and
individuation (he does not address purging). The wish for merging is expressed through
wishes and actions related to visual exposme. The desire to be stared at (what Wurmser
calls "devouring looks"), or to be exposed; the passive experience of another's
exhibitionism; and staring at others (namely parental nakedness), all are related to wishes to
merge with an other. The wishes are ﬁightening and Wlu'mser argues that eating is used as
a tie to reality in order to counteract these overwhelming fears and wishes for symbiosis.
Wurmser believes looking and eating to be tools for power and destruction. He also argues
that both are highly libidinized, and within this shame syndrome, both looking and eating
become equated with sexual acts. Merging, through witnessing the other's exposure, is
frightening and according to Wurmser, the visual conﬂict is transferred to an oral binge in
an effort to regain power. From Wurmser’s perspective, eating hinges are shameful and
are kept secret because tley lead to strong guilt feelings. This guilt is related to tle
destructiveness of one’s oral impulses, to shame, to disgust with the oral gratiﬁcation
itself, and to tle weakness deemed inherent in the dependency on oral gratiﬁcation. In this

18

way bingeing behavior both guards against and perpetuates shame. While Wurmser's
theory was not directed at bulimia speciﬁcally, his formulation does call attention to key
dynamics: conﬂict sumounding the need for others, the need for control over feelings, and
shame sm'rounding the hunger drive.

Wurmser errs, however, in viewing the eating disturbance in such sexualized
terms. Emotional intimacy, interest, closeness, and nurturance are equated with sexual
seduction, penetration, loss of control, and concomitant anxiety (W urmser, 1981). Shame
originates in the exposure of self and in witnessing tle exposure of the parents. This
conceptualization neglects the multitude of interpersonal experiences to which shame may
become attached. In addition, it fails to adequately address the autonomy-interdependency
conﬂict. By equating dependence or merging with sexual impulses, the wish becomes
shameful because of the incest taboo, not because of difﬁculties with autonomy and
relaednessudifﬁculties which bulimics consistently display. Wurmser's explanation
changes the nature of the conﬂict. While phenomenologically his descriptions of shame
and the hind of shame to eating are powerful and vivid, his view of etiology seems
inaccurate and narrow.

Kaufman (1989) understands the dimensions of autonomy, interdependence,
disgust, and issues related to food and body very differently. According to Kaufman, both
bingeing and purging are, in part, substitutions for more shameful interpersonal needs.
Bingeing on food is a substitute for interpersonal needs which have become bound with
shame. Eating is not an adequate substitute for these needs and the continued need for the
other, combined with the secondary shame associaed with uncontrolled eating, serves to
perpetuate and extend the bingeing behavior. Shame is displaced ﬁom the self onto the act
of bingeing. Purging, however, involves the additional affect of disgust, which, like
shame, is an auxiliary affect, according to Tomkins (1987). Disgust becomes associaed

19

with the hunger drive, perhaps due to family and cultural expectations of perfection,
thinness and control over eating. .

For Kaufman, the concept of affect magniﬁcation (Tomkins, 1963) is central to
understanding the binge-pluge cycle. According to Tomkins (1963), affect magniﬁcation
is a process whereby an individual overwhelms herself with shame, bringing shame to
peak intensity. At this point, the affect is so intensiﬁed that it “erupts” or “explodes” and is
automatically reduced. Kaufman (1989) uses tle descriptive metaphor of cleansing oneself
emotionally by bathing in shame; through the process of total humiliation and spending the
built up shame, the bulimic is puriﬁed or cleansed. Kaufman argues that the process of
ptn'ging not only rids the bulimic of food, but temporarily of Shame as well. Bingeing
increases the build up of shame and then pinging rapidly magniﬁes it. Shame and disgust
peak and then there occurs a "bursting eﬁ’ect" which leaves the bulimic feeling purged,
puriﬁed of shame. The shame, of course, is not eliminaed entirely, and the cycle
eventually begins again. In addition, bulimia itself creates additional shame, leading to
increased isolation, which creates increased needs for interpersonal contact, further
perpetuating the cycle.

Another component in tle etiology of bulimia is the rage which occurs as a result of
shaming. Lewis' (1987a) concept of shame-rage refers to the rage which is evoked when
shameisexperienced. Therageisrootedin boththefeelingofshame andinthepainful
perceived loss of an attachment because one has failed to meet the standards of an admired,
internalized image. She argues that shame-based rage is directed against the self out of fear
of further alienating and losing the relationship with the other. Bingeing and purging arc
self-destructive rageful acts which also serve to enhance the false self, in order to meet
external demands that were at some point imposed by others. Attention to the false self
masks tle rage, while at the same time, it eases shame about the self (Lewis, 1987a).

20

Bulimics’ Perceptions of Their Disorder

While theorists are continually reformulating their understanding of the etiology of
bulimia, there has been little direct investigation into the bulimic's own perception of her
disorder. Preliminary work in this area strikingly supports etiological theories involving
shame, especially as it relates to interpersonal neeeds.

Teusch (1988) interviewed 40 bulimic women in an attempt to understand how they
make sense of their symptoms. Subjects most often chose shame and guilt, over
depression, positive feelings, anxiety, or anger to describe their affective experience of
bulimia. One hundred percent of the sample attributed factors about themselves to the
development of their bulimia. Family factors were mentioned by 50 percent of tle group in
this regard. Parental emphasis on food, weight, and diet was a prominent theme, but
within this context it was the lack of nurturance and connection with their parents that these
women felt was problematic. Approximately one half of tle women felt that their
"interpersonal beliefs" had contributed to the development of bulimia, and 82 percent
mentioned speciﬁc interpersonal experiences when discussing the development of their
eating disorder. When these women discussed their interpersonal beliefs, Teusch reports
that feelings of emotional isolation and disconnection were prevalent, as were negative (or
shaming) interpersonal experiences.

The motives given for bingeing and purging revealed conscious attempts by these
women to satisfy reeds independently of others and to cope with feelings of shame, rage,
and anxiety that result ﬁom the continued repression of wishes and needs and also from
emotional isolation. Needs for nlu'turance and concomitant inabilities to ask for or receive
nurturance were reported.

These ﬁndings are based solely on self-report and certainly require replication in
other forms. Though it did not set out to investigate either shame or bulimics’ perceptions
of interpersonal needs, this study clearly supports their relevance to bulimia nervosa.

21

These bulimic women repored conﬂicts over needs for dependence on others, an inability
to directly express feelings involving nm'turance or nwdiness, a disruption of family
relationships, issues involving food and body, and intense personal shame about the self,
factors which have been repored elsewhere as well. It is important to note that Teusch
(1988) found no relationship between these womens' degree of insightfulness and
treatment history, making less likely the argument that these women had had their
"motivations" explained to them in therapy.

Bulimics’ Perceptions of Interpersonal Needs

While much attention has been paid to differences in the bulimic's relationships
with others, and to issues regarding the bulimic's level of autonomy and dependency,
smprisingly little research has been directed towards the bulimic's understanding of
interpersonal relationships and interpersonal needs. Interestingly, results of bulimia
research parallel Kaufman's conception of bulimia as a shame-based disorder. Kaufman
(1989) theorizes that tle bulimic's compulsion to binge can be understood as a substitute
for interpersonal needs which have become bound by shame through repeated association.
Bingeing on food takes the place of fulﬁlling the need for others, which is perceived by the
bulimic as a cause for shame. Pinging is a futile and symbolic attempt by the bulimic to rid
herself of the shame she feels, both for the bingeing behavior, and as a result of the
unavoidable experience of interpersonal needs.

Kaufman (1989) delineates seven interpersonal needs, the fulﬁllment of which are
necessary for the optimal development of the individual: 1) the need for touching and
holding, 2) the need for identiﬁcation, tle phenomenological experience of merging with
another, 3) tle nwd to be in relationship with another, 4) the mad for afﬁrmation, 5) the
need to mature, 6) the need for power, and 7) the need for differentiation, embracing

separateness and autonomy. The ﬁrst four needs involve an aspect of submission to or

22

dependency on relationship. The need to nurtme others and tle need for power involve
some aspect of control over relationship, and the need for differentiation, encompassing
separateness and autonomy, indicates the nwd to be separate from a relationship.
According to Kaufman, the fulﬁllment of these needs is critical to the healthy development
of the individual. To the extent that any or all of these needs are linked with the experience
of shame, optimal development is inhibited.

The literature on bulimia is consistent with this view in its reports of the difﬁculties
bulimics experience with interpersonal relationships and in deﬁning themselves in relation
to other people. Bulimic women appear to have great difﬁculty dealing with issues
surrounding autonomy and identity. Bulimics suffer from disrupted social relationships
and increased isolation (Johnson & Berndt, 1983). These women reportedly have great
difﬁculty dealing with time spent alone (Cullari & Redmon cied in Cattanach & Rodin,
1988). Bulimics are reported to have an external locus of control and to display a sense of
personal ineffectiveness (Johnson & Maddi, 1986). Bulimics display strong needs to
conform and gain approval from others and tend to be very sensitive to rejection (Boskind-
Lodahl, 1976; Garfinkel & Garner, 1983).

Bulimic families appear to offer little support for autonomy. Research emphasizes
the lack of supportiveness or nurturance and failure to encourage self sufﬁcient, assertive
behavior in these families (Attic & Brooks-Gama, 1989; Humphrey et al., 1986; Strober &
Humphrey, 1987). Johnson and Flach (1985) argue that bulimic families tend to have high
standards of performance and high expectations of autonomy, but at the same time place a
low emphasis on social and intellectual activities that might serve to foster that achievement.
Perfectionism is expected, while at the same time the family does not support independent,
assertive, or expressive behaviors. Such a double-bind leads to a no-win shame situation

in which the individual is ﬁrst of all shamed for being dependent and then also left feeling

23

ashamed of her inability to be independent because she lacks the skills and support in this
endeavor.

Fossum and Mason (1986) believe that placing an exaggeraed priority on
independence and devaluing or denying needs for nurturance and help (because neediness
is viewed as shameful) lead to the inhibition of a mum full-functioning self. They argue
that individuals or families who overvalue autonomy-«he ability to function successfully
without others-never learn to create a balance between tle need to be individual and
differentiatedandtheneedtobeinrelationship withothers. When theneedtobe
independent is so stressed, development is stunted because of the continual need to deny
manual (but shame-bound) needs for interdependency and relationship with other human
beings. The shame over needing and the resulting denial of needs for others has been
posited to lead to the bulimic's feelings of emptiness, ineffectiveness, and uruealness
(Johnson & Maddi, 1986).

Other researchers have posited that cultural values and expectations must be
considered in developing an understanding of bulimia and of the bulimic's conﬂicts
regarding autonomy and interdependence. Females receive conﬂicting messages about
autonomy and dependence. The traditional female role encourages dependence and yet the
new "super woman" idealizes complete autonomy and success. Research reveals evidence
of increased adherence to traditional female gender roles among bulimics, characterized by
dependence and passivity (Boskind-White & White, 1986; Steiger, Fraenkel, & Leichner,
1989; Pettinati, Franks, Wade, & Kogan, 1987). However, little attention has been
focused on elucidating the perceptions and ideals of tlese individuals.

Steiner-Adair’s (1986) important discovery that women with disordered eating
could be distinguished from a larger group, solely on the basis of their depiction of the
ideal woman, merits further exploration. The eating disordered subgroup emphasized

24

autonomy and success in their conceptualization of the ideal woman and appeared to
perceive needing others or interdependence with others as both shameful and undesirable.
Shame, especially shame related to interpersonal needs, clearly appears to be woven
throughout the bulimic experience. Research consistently supports the shame-based nature
ofbulimia, boththe shamerootedintheindividualandherfamilyandthecultmalshame
which works to enforce societal ideals by shaping the standards of individuals and families.
Shame theory is a valuable addition to our knowledge of the development of bulimia
nervosa and appears to offer a comprehensive and accurate understanding of the dynamics
involved in this disorder. While preliminary conceptualizations of bulimia as a shame-
baseddisorderappeartomake sense, fm'therresearch must seek to clarify anddocument

the relationship between the two.

Research Objectives and Overview of Design

8 I Q! . . I H l

The aim of this study is to investigate ﬁrst, levels of shame among bulimics;
second, females' perceptions of interpersonal needs involving dependency; and third, the
differences between bulimics' and non-bulimics' attributions of shame to these weds.
Feelings of shame are frequently used to describe the bulimic's experience of herself, both
in self-report and observational research, but researchers have not developed methodology
which would allow the differentiation of secondary shame associated with the bulimic
symptomology ﬁom the primary shame which shame theorists postulate as the root cause
of bulimia. This study attempts to separate these components by investigating bulimics’
and non-bulimics’ attributions of shame and self-esteem to non-eating disordered females
who 1) reveal interpersonal needs, 2) are depicted as autonomous and self-reliant, or 3) are
depicted neutrally, not autonomous or interdependent.

25

It is hypothesized that (1) bulimics will attribute more shame and less self-esteem to
an individual who acknowledges the need for others and who displays needs for touching
and holding, for afﬁrmation, for identiﬁcation, and the need to be in relationship with
another than they will attribute to a woman depicted as autonomous or nomeliant on others
or to a woman who is depicted as neither overtly reliant or autonomous. The study will
also examine differences in the way bulimics and non-bulimics make these attributions of
shame and self-esteem. It is hypothesimd that (2) the bulimic group will rate the self-
rcliant woman as signiﬁcantly less ashamed and as having signiﬁcantly more esteem than
will the non-bulimic group; (3) tle individual who is reliant on others will also be rated
diﬁ‘erently by the two groups, with the bulimic group rating this woman signiﬁcantly
higher in shame and signiﬁcantly lower in self-esteem than the non-bulimic group.

Subjects will also be assessed to ascertain their own levels of shame and their own
values regarding interpersonal relationships, with a particular focus on values regarding
autonomy and dependence on others. It is further hypothesized that (4) bulimics will reveal
higher levels of shame than non-bulimics. The ﬁfth hypothesis (5) is that bulimics will be
more dependent than non—bulimics, as evidenced by signiﬁcantly higher scores on the ﬁrst
scale of the Interpersonal Dependency Inventory (IDI), "Emotional Reliance on Another
Person." Finally, (6) bulimics will profess signiﬁcantly higher ideals of autonomy than
will non-bulimics, as measured by the “Autonomy” scale of the IDI.

Q . E l .

Subjects were female undergraduates. The two independent variables in this study
are tle presence or absence of behaviors and attitudes characteristic of bulimia nervosa and
the style of interpersonal relaedness presened to the subject for assessment. Three
characterizations were presened to each subject. One depicted a woman who is
autonomous and nonreliant; one depicted a woman who displays and is accepting of

interpersonal needs for touching and holding, afﬁrmation, identiﬁcation, and the nwd to be

26

in relationship with another; and the third was a control situation which balances autonomy
with interpersonal needs. The dependent variables are the level of shame and level of self-
esteem attribued to the character in each situation. Additional dependent variables are the
level of shame reported by the individual (as manned by tle Internalized Shame Scale)
and real and idealized responses to the "Autonomy" and "Emotional Reliance on Another
Person" subscales of the Interpersonal Dependency Inventory, a measure of interpersonal
style.

METHOD

Subjects

It was important that this study not Simply investigate differences in beliefs and
perceptions between a clinical population (i.e. bulimics identiﬁed by their participation in
some treatment group) and a nonclinical (or “normal”) population. Any signiﬁcant
diﬁerences between groups may reflect the treatment ideology of a given eating disorders
treatment. Additionally, this study sought to avoid examining a restricted sample of
bulimics by using a clinical group or by advertising for “bulimics willing to participate in
psychological research,” thereby restricting the generalizability of any ﬁndings to bulimics
who identify themselves as such for purposes of research. In order to avoid these
limitations, the undergraduate psychology subject pool at a large midwestern university
was used as tle subject source for both “normal” and “bulimic-type” subjects. Although
this method narrowed the generalizeability of the data to college students, the sampling of
bulimic and bulimic-type subjects in this manner more closely approximated a random
sample than would have been achieved had subjects been solicited in more direct manners.

Form hundred and three undergraduate females aged 17-22 years participating in the
subject pool (as an option to earn extra class credit) were screened for eating disorders
using the Eating Disorders Inventory (EDI) and a sampling of questions ﬁom the EDI
symptom checklist. In addition, all participants in the screening compleed the Internalized
Shame Scale (ISS) and two scales from the Interpersonal Dependency Inventory (IDI),
“Emotional Reliance on Another Person” and the “Assertion of Autonomy” scale. Subjects
were asked to complete the IDI scales two times, ﬁom two different perspectives; ﬁrst, as

they perceived themselves, and second, as they would be if they were their “ideal self’.
27

28

Subjects were chosen for further participation in the study based on their responses
to the EDI and the EDI symptom checklist items. All subjects whose responses to tle EDI
symptom checklist items indicated that they either presently met, or had in the past met, the
DSM III-R diagnostic criteria for bulimia nervosa were initially sele and their .1
responses were scored. Of this pool, all whose responses reﬂected a score of 13 or greater
ontheDrive forThinness scaleand20rgreateron the Bulimia scale werecontactedand
asked to rctum for further participation.

The .1 cutoff points were chosen after careful consideration. A raw score of 13
on the Drive for Thinness scale converts to the 90th percentile rank for female college
students (Gamer & Olmstead, 1984) and clearly identiﬁes a group of women abnormally
concerned with dieting, weight and the pursuit of thinness. A raw scone of two on the
Bulimia scale is less conservative, translating only to the 77th percentile rank for female
college students (Garner & Olmstead, 1984). The Bulimia scale consists of seven items
focusing on tendencies towards uncontrollable bingeing and purging (Table 1). The
subject responds to the statements on a Likert type scale of “always,” “usually,”

“often,” “sometimes,” “rarely,” or “never.” In scoring, responses are weighted from zero
to three, with three being the strongest, or most symptomatic, response. The three choices
opposite in direction to the symptomatic response are scored as zero. Because all the items
on the bulimia scale are symptomatic in tle positive or afﬁrmative direction, it is possible
for a subject to respond “sometimes” to all items on the scale and still receive a score of
zero. A scale score of zero, attained through this response pattern, would indicate some
predilection for bingeing behaviors. A scale score of two or greater therefore appears to
indicate self-perceived tendencies towards bingeing and possibly purging. Used in
combination with other screening criteria, it appears to be a reasonable cut-off point.

The inclusion of the EDI scale scores as screening criteria allowed for the inclusion

of subjects who claimed to no longer be bingeing and/or purging at DSM III-R diagnostic

29

 

I eat when I am upset.

1 stuff myself with food.

I have gone on eating hinges where I felt that I could not stop.
I think about bingeing (overeating).

I eat moderately in front of others and stuff myself when they ’re gone.
I have the thought of trying to vomit in order to lose weight.

Ieatordrinkinsecrecy.

30

levels, but who still showed abnormally elevaed tendencies towards this behavior (Garner,
Olmstead, & Polivy, 1983). It also led to the elimination of a sizeable group of subjects
who reported past bulimic behaviors, but who scored well within tle normal range on the
.1 scales (n = 10).

The 23 subjects who met both tle symptom checklist and EDI criteria comprised the
“bulimic-type” group. EDI Bulimia and Drive for Thinness subscale scores are presented
in Table 2. Of the 23 bulimic-type subjects asked to return, two did not wish to continue
their participation and one was not available during the times the experiment was being
conducted. Twenty bulimic-type subjects completed all phases of the experiment and will
be referred to as “the bulimic group.”

The EDI responses of subjects who reported no bingeing or purging behaviors of
any kind and who reported an ideal weight of no more than ﬁve pounds below their present
weight were scored in random order. The ﬁrst 23 such females whose scale scores on both
the Drive for Thinness and the Bulimia scales were zero (the 25th and 50th percentile ranks
for female college Students, respectively (Garner & Olmstead, 1984)), were selected as tle
“non-eating disordered” or “non-bulimic” group. Of these subjects, one scheduled a rettu'n
appointment but later canceled her participation. Two other sets of responses from the non-
bulimic group hadtoheeliminatedduetotechnicalproblems with thetaperecorderusedto
play the taped interviews. As a result, 20 subjects in the non-bulimic group completed all
phases of the experiment.

Measures

Demographic information including age, marital Status, parents’ marital status,
estimated family income, religion, and ethnicity was collected from all subjects at the time

of the initial screening.

31

 

Table2
E l' . G EDIE .
S l D . E 11' E l' .
1 18 10
2 20 10
3 21 5
4 16 13
5 18 14
6 13 4
7 15 3
8 20 4
9 15 8
10 16 3
11 15 4
12 18 15
13 15 12
l4 l7 6
15 16 3
16 20 7
17 15 5
18 14 15
19 17 2
20 17 2
mean = 16.80 mean = 7.25

standard deviation = 2.26

standard deviation = 4.53

32

E . D' l I [EDI]

The EDI is a 64 item self-rating scale designed to assess the psychological
characteristics relevant to anorexia nervosa and bulimia nervosa. Scores on the subscales
of the EDI have been found to be predictive of clinicians’ ratings and diagnoses (Garner, et
al., 1983). The two scales used in this study were “Drive for Thinness,” an indicator of
“concern with dieting, preoccupation with weight, and entrerrchment in the extreme pursuit
of thinness” (Garner, et al., 1983), and “Bulimia,” which “indicates the tendency toward
episodes of uncontrollable overeating (bingeing) and may be followed by the impulse to
engage in self-induced vomiting" (Garner et al., 1983). Further validity and reliability data
are available (Garner et al., 1983). The EDI symptom checklist includes supplementary
questions targeted at assessing the degree and ﬁequency of binge eating and purging
behaviors.
W

The IDI is a self-report measure consisting of statements that tle subject rates on a
four point scale. The scale was devised to measure different aspects of interpersonal
dependency (Hirschenfeld et al., 1977). Scale one, Emotional Reliance on Another Person
. (17 items), and scale three, Assertion of Autonomy (14 items), were administered in this
study. These scales have displayed consistency across normal and psychiatric outpatient
samples. Preliminary validation Studies provide strong evidence of adequate reliability and
stability and the factor-to-Structure scale has stood up to cross validation studies
(Hirschfeld et al., 1977).
W

The ISS consists of 30 items which subjects rate on a ﬁve point scale. It is
designed to measure the level of internalized Shame. The scale has two sub-scales, self-
esteem and inernalized shame. Alpha reliability in a non-clinical college sample was
reported to be .94 for tle shame scale and .88 for the self-esteem scale. Test-retest

33

reliability coefﬁcients at a seven week interval were .84 for the Shame scale and .69 for self
eseem. The six self-esteem items balance the direction in which items are scored to reduce
the possibility of response set bias. Furtler validation data is available (Cook, 1990).
mm

Subjects selected for participation heard three audiotaped vignettes presented as
“portions of interviews with female college students.” In actuality, the “interviews” were
written by the experimenter and recorded by three graduate students. The three
interviewees each present a diﬁ'erent attitude towards interpersonal relationships. One tape
depicts a woman who is autonomous and self-reliant. The woman in the second tape
displays an interpersonal style characterimd by mutual dependence on others and
interpersonal needs as conceptualized by Kaufman (1989), namely, tle need for touching
and holding, the need for identiﬁcation, the need to be in relationship, and the need for
afﬁrmation. The third interview serves as a control; here expressions of autonomy are
balanced by expressions of interpersonal needs. Transcripts of the vigrettes are included
as Appendix A.

A pilot study was conducted in order to determine whether the tapes reliably present
tle hypothesized values towards relationships and whether raters reliably assess the tapes
as differing along these hypothesized dimensions. Twenty-one undergraduate females
participating in tle Psychology Research Pool served as subjects in the pilot study.
Subjects listened to each tape and then completed a questionnaire consisting of eight items
requiring a “true” or “false” response (see Appendix B). The eight items (completed for
each tape) assess the presence or absence of autonomy and interpersonal needs ,
speciﬁcally, the need for touching and holding, the need for identiﬁcation, the nwd to he in
relationship, and the need for afﬁrmation.

Individual items were scored either one or zero. A total score of eight indicaed tle
deﬁnite presence of the interpersonal needs for relationship, for identiﬁcation, for touching

34

and holding, and for afﬁrmation. A cumulative score of zero indicated the absence of these
needs in that particular vignette. Statistics of the subjects’ ratings of the three tapes are
presented in Table 3.

All subjects raed the tape depicting interpersonal needs with a score of six or above
(86% rated it with the most extreme score of eight). All rating scores of the tape depicting
tle absence of interpersonal needs were two or less (86% of the ratings were either zero or
one). In addition, the majority of subjects (90.5%) rated all vignettes in the order
hypothesized--the tape depicting interpersonal needs received the highest score, followed
by tle control tape, with the tape depicting the absence of interpersonal needs scoring
lowest overall. The two pilot study subjects who did not Show this pattern scored the two
extreme tapes in tle desired direction but gave the control tape an overall score identical to
the tape depicting no interpersonal needs (in neither case was this score zero). Finally, a
repeated measures analysis of variance revealed a signiﬁcant difference in tle ratings
between tapes (F (2, 40) = 216.81, p < .001).

Procedure

Subjects who met the screening criteria for the bulimic or non-bulimic group were
contacted and asked to return fm' the second phase of the experiment. They were informed
that this phase did not involve personal disclosure and were offered additional academic
credit if they chose to return. Individual appointments were scheduled with all subjects
who wished to participate.

The second phase of the experiment was administered by undergraduate research
assistants who followed a detailed script. Upon arrival, subjects were seated at a table and

given the following instructions: '

35

Table 3
2.] l . l .
Tape 1 Tape 2 Tape 3

(Self-Reliant) (Expresses Interpersonal Needs) (Control)
N 21 21 21
Mean 0.667 7.810 4.000
Minimum 0.000 6.000 1.000
Maximum 2.000 8.000 7.000
Standard 0.730 0.512 1.612

Deviation

36

“Today I am going to ask you to listen to several very short tapes.

The tapes contain portions of interviews with female college students.

Please listen carefully to each tape. Try to form an idea of what you think

thewomanyouarelisteningtoislike. Afterlisteningtoatapelwillask

you to respond to a short questionnaire in the way you think the woman you

heard would respond. The answers to the questions are not necessarily in

tle tapes. What we are interested in are your opinions about the woman,

the impressions that are formed ﬁom the short tape you hear of her.”

After answering any questions, the experimenter provided the subject with headphones, a
tape recorder, and one of the audiotaped interviews. The tapes were presented to subjects
in random order.

After listening to each tape, the subject was given a copy of tle Intemalized
Shame Scale (ISS). The instructions to the scale were altered slightly. Instead of
responding in terms of themselves on tle scale, subjects were asked to assess how well
each statement characterimd tle individual on the tape. After ﬁnishing the scale, the
procedure was repeated with the remaining tapes.

At the completion of tle experiment, participants were debriefed. They were
informed that the initial screening had been used to identify women with a variety of
attitudes about their bodies and with different eating habits. Subjects were provided with
referral information related to any concerns tley might have about their own eating or body
issues, but it was reinforced that their selection for participation in the experiment did not

necessarily indicate a problem with their eating habits and attitudes.

RESULTS

Twenty bulimic-type subjects and twenty non-bulimic subjects completed all phases
of the experiment. Due to a problem with the layout of the screening questionnaire, three
subjects omitted the same two questions on the 1131 scales (one from each scale) in which
theywereaskedtorespondastheyrcally are. Themeanofallorherresponsesonthe
particular scale was used as the response score for the missed item. In addition, one
subject omited a total of three items on tle screening measures, one each from tle IDI
scales “Emotional Reliance on Another Person” (answer as you really are), “Emotional
Reliance on Another Person” (answer as you would ideally be), and “Assertion of
Autonomy” (ideal response). Again, all other scale responses were averaged and this mean
response was used in place of the missing value. Finally, one subject missed one item on
the ISS shame scale used to rate the self-reliant vignette. The same averaging procedure

was again used.
Demographic Information

Subject ages ranged from 17-21 years in the bulimic group (mean = 18.95 years)
and 18-22 years in the non-bulimic group (mean = 19.45 years). A one-way analysis of
variance (alpha = .05) showed no Signiﬁcant age difference between groups (F = 1.983
(1, 38), p = 0.167). All forty subjects were unmarried.

Other descriptive information is presenmd in Appendix C. The non—bulimic group
was more ethnically diverse than the bulimic group. All members of the bulimic group
were Caucasian. The bulimic group also reported a higher average family income (bulimic

37

38

mean = $74,500 vs. non-bulimic mean = $60,500)1. Eighty percent of the bulimic group
reported an annual family income of $60,000 or greater. Only 45% of the non-bulimic
group fell within this income range.

Responses to Screening Measures

As hypothesized, the bulimic group rated themselves as higher in shame than did
the non-bulimic group (bulimic mean shame score = 50.700, non-bulimic mean score =
21.750). A one-way analysis of variance showed signiﬁcant differences between groups
on the ISS in the hypothesized direction (F (1, 38) = 44.9962, p < .001).

An analysis of variance indicated signiﬁcant differences in ratings of emotional
reliance on another person between groups (F = 6.421, p = 0.016) and between real and
ideal scenarios (F = 17.615, p < .001). Bulimics raed themselves as more emotionally
reliant on another person than did non-bulimics (mean scores = 47.500 and 37.650
respectively). A two tailed planned comparison (all comparisons conducted were non-
directional) showed this difference to be signiﬁcant (F = 12.382 , p = .001) Idealized
ratings for both groups indicate that tle ideal individual is perceived to be less emotionally
reliant on another person than subjects in either group perceive themselves to be. The non-
eating disordered group’s perception of the ideal was slightly less emotionally reliant on
another than the bulimic group’s perception (means = 35.200 (non-bulimic group) and
37.050 (bulimic group». A planned comparison was conducted and the difference was not
signiﬁcant (F = 0.453, p -- .505).

Finally, it was hypothesized that the bulimic group would profess signiﬁcantly
higher ideals of autonomy than would the non-bulimic group. The bulimic group rated

 

lForcalculatiorlpurposes,incorneswererccordedastlremidpointofeachrange. Incomesreptrtedas
$90,(X)0 or greater were recorded at $95,(X)0.
2Untcssnotcd.alldegtcesortteedominthissectioncanbeassumedtobe(1,38).

39

themselves higher on the assertion of autonomy scale than the non-bulimic group (mean =
28.700 vs. 25.700) and also professed a higher ideal score (bulimic mean - 30.200,
non-bulimic mean = 25.850). An analysis of variance revealed a signiﬁcant difference in
ratings of autonomy between groups (F = 5.090, p = .03). Planned comparisons for both
the real and ideal ratings revealed a slightly signiﬁcant difference between groups on the
ideal but not the real level of autonomy (for the ideal comparison F = 3.943, p = .054).
The analysis of variance showed no signiﬁcant differences across groups in real and ideal
ratings (F = .546, p = 0.465), nor was the interaction signiﬁcant

(F = .365, p = 0.549).

Responses to Taped Vignettes

Figlme 1 presents the mean ratings of shame across the tluee vignettes. The
attributions of shame by both bulimic and non-bulimic groups are in the direction
hypothesized for the vignettes characterized by self reliance and interpersonal needs. The
control characterization (mean = 22.475) was scored very similarly to the self-reliant
characterization (mean = 22.600). Shame scores for the control and self-reliant vignettes
fall at approximately the 25th percentile of the non-clinical female normative sample (Cook,
1990) (higher scores indicate higher levels of shame). The character who expressed
interpersonal needs received an overall mean shame score of 41.000 which falls at the 70th
percentile of the normative non-clinical female sample.

An analysis of variance with ﬁxed effects revealed signiﬁcant differences between
groups in the shame ratings across vignettes (F (1, 38) = 4.501, p < .05). There was a
signiﬁcant difference as well in the level of Shame attributed to each vignette (F (2, 76) =
25.797, p < .001). A planned comparison revealed a signiﬁcant difference between the
bulimic and non-bulimic groups’ ratings of the interpersonal needs vignette (F (1, 38) =
6.502, p = .015) with bulimics rating the character depicted as having signiﬁcantly more

 

“ S
8 0|
IIlllllljllLLllllJllllLLlLllJlLlillllllllllllllJL

&

8

 

Shame Score (group mean)
I: 3 a

’6

Us

 

 

 

O

I I

I
Self Interpersonal Control
Reliant

Characterization

@ Bulimic Group
© Non-bulimic Group

Figure 1
Shane ratings of characterizations by group

41

shame than tle non-bulimics. In addition, planned comparisons were used to examine
differences in tle bulimic group’s ratings of the vignettes. Bulimics rated the interpersonal
need vigneme with signiﬁcantly more shame than tley rated the self-reliant vignette (F (2,
38) = 13.251, p < .001) or the control vignette (F (2, 38) = 38.749, p < .001).

Self-esteem scores across vignettes were analyzed in a similar manner. Figure 2
shows mean differences across vignettes and between groups. Differences between the
interpersonal need vignette and the self-reliant vigrette were in the hypothesized direction.
Both groups perceived the individual with interpersonal needs as having less self-esteem
than the autonomous individual. An analysis of variance did not show signiﬁcant
differences between groups in their rating of self-esteem (alpha = .05). However, the
ratings of esteem across vignettes were signiﬁcantly different (F (2, 76) = 11.822,

p < .001). Planned comparisons revealed signiﬁcant differences in the bulimic group’s
ratings across vignettes. The group depicted the interpersonal need characterization as
having signiﬁcantly less self-esteem than either the self-reliant characterization (F (2, 38) --
4.445, p < .05) or the control characterization (F (2, 38) = 16.433, p < .001). However,
ﬁndings related to tie self-esteem scales must be interpreted with caution since the scale
contains only six items.

It was hypothesized that the bulimic group would rate the self-reliant woman as
signiﬁcantly less ashamed and as having signiﬁcantly more self-eseem than would the
non-bulimic group. The results do not suppm't this hypothesis. Mean shame and esteem
scores for the self-reliant vignette by the non-bulimic group were 20.150 and 18.850,
respectively. The bulimic group mean Shame score was 25.050 and the mean eseem score
was 18.100 for the self-reliant vignette. A summary of group statistics is presented in
Table 4 and Table 5.

42

N
O

 

'6

u
a

 

Esteem Score (group mean)
at or '6 F: 5':
I I I I I I I I I I I I I I I I IJ I I

§

N

IIIIIIIIIIIIII‘III

 

 

 

O

l h
Self Interpersonal Control
Reliant Needs

Characterization

@ Bulimic Group

O Non-bulimic Group
Figlne 2
Esteem ratings of characterizations by group

 

ISS:
Shame (self)

Mean

Standard Deviation
Self Esteem (self)

Mean

Standard Deviation

IDI:
Emotional Reliance on
Another Person (real self)
Mean
Standard Deviation
Emotional Reliance on
Another Person (ideal)
Mean
Standard Deviation
Autonomy (real self)
Mean
Standard Deviation
Autonomy (ideal)
Mean

Standard Deviation

50.70
15.46

14.10
6.17

47.50
8.63

37.05
7.54

28.70
4.85

30.20
6.73

43

21.75
11.55

19.55
3.53

37.65
9.07

35.20
9.70

25.70
6.05

25.85
7.13

Table 5

25.05
20.67

18.10
5.57

46.50
14.62

13.70
4.22

24.65
10.24

19.75
2.97

20.15
17.18

18.85
5.07

35.50
12.59

16.20
4.96

20.30
10.62

19.60
3.58

DISCUSSION

Paradoxically, the most signiﬁcant results of this study are both the distinct
differences between bulimic and non-bulimic group responses and particular similarities
between the two groups’ perceptions and values. Both merit consideration and discussion.
The results will be discussed from two perspectives: first, differences between groups will
be examined in light of the initial hypotheses; and second, an attempt will be made to
integrate these ﬁndings regarding differences and similarities between groups, and to
suggest further areas for exploration and thought.

Demographics

Of the subjects screened 5.7% met the criteria established for inclusion in the
bulimic group. The screening criteria appear to be somewhat conservative as this
prevalence rate falls at the lower end of the prevalence range of 445% frequently cited for
college women (Halmi, Falk. & Schwartz, 1981; Pyle, Halvorson, Neuman, & Mitchell,
1986). The ﬁndings that the bulimic group tended to be more ethnically homogenous
(Caucasian) and atom middle to upper class families are consistent with the literature
(Mitchell & Eckert, 1987; Shisslak, Crago, Neal, & Swain, 1987). There is no indication
that this sample of college-age bulimics differs from similarly aged samples recruited
through other methods.

Initial Measures (measures inclumd in the screening battery)

As hypothesized, bulimics indicated signiﬁcantly greater emotional reliance on
another person than did the non-bulimic group. Numerous other studies have also reported

45

46

bulimics’ elevawd levels of actual dependency (see for example, Boskind-White & White,
1986; Pettinati, Franks, Wade, & Kogan, 1987; Steiger, Fraenkel, & Leichner, 1989). It
was further hypothesized that bulimics would profess signiﬁcantly higher ideals of
autonomy than would non-bulimics. This hypothesis was also supported In addition,
both groups devalued emotional reliance on others in their formulations of the ideal
woman, and rated the ideal woman as more autonomous than they felt themselves to be.
Given the cohort sampled, it is possible that such a result reﬂects an age-appropriate
developmental issue. College women are frequently away from home for the ﬁrst time,
testing their own abilities to function independent of their families. However, such a
valuing of autonomy relative to emotional reliance on another person also reflects the values
encouraged by mainstream American culture, in which images of independence, success,
and self-sufﬁciency are frequently idealized

It is interesting that subjects in the more disturbed group (the bulimic group)
attributed a signiﬁcantly higher level of autonomy to their ideal woman than the non-
bulimic subjects. The bulimic subjects also showed a non-signiﬁcant tendency to value
emotional reliance on another person less than the non-bulimic subjects. It is possible that
these ﬁndings are, in part, a reaction to the bulimic subjects’ dissatisfaction with their
signiﬁcantly higher self-perceived levels of dependence. The trend, however, displayed in
both groups, toward devaluation of normal interpersonal needs, rooted in connectedness to
others, merits additional exploration.

It has been a common clinical observation that bulimics suffer from elevated shame.
That the bulimic group scored significantly higher than the non-bulimic group on the
measure of actual shame makes inntitive sense and provides empirical conﬁrmation of
clinical experience. However, a simple difference in the level of shame between the two
groups does not allow for causal inferences. It is not clear whether the shame is solely tied
to the bulimic’s feelings about her disorder (i.e., shame that she binges uncontrollably and

47

then isolates herself so she can secretly purge), or whether the shame is relawd to issues in
addition to the symptoms of bulimia. Perhaps shame in fact precedes those symptoms and
represents a deﬁning characteristic which differentiates bulimics ﬁom non-bulimics. More
speciﬁc information about this important question concerning the etiological role of shame
can be ascertained from examining both groups’ responses to the audiotaped

characterizations.
Responses to Audiotaped Characterizations

It is important to note both the bulimic group’s dramatic differences in attributions
of shame across the vignettes and in comparison to the non-bulimic group. The bulimic
group’s relative perceptions of the vignette depicting interpersonal needs lend empirical
support to Kaufman’s (1989) conception of bulimia as a shame-based disorder, one in
which shame is attached directly to interpersonal needs. Not only did bulimics show
signiﬁcantly higher levels of actual shame, as hypothesized, bulimics also attributed
signiﬁcantly more shame to the characterization of interpersonal needs than did the non-
bulimic group. Furthermore, the bulimic group rated the woman with interpersonal needs
as signiﬁcantly more ashamed than the self-reliant woman. The elevated levels of shame
reporwd by the bulimics do not appear to be merely the result of their feelings about their
eating disorder or their symptoms. This increased personal shame appears to be related
directly to the bulimics’ lack of acceptance of normal interpersonal needs rooted in
connectedness to others. Bulimics appear to perceive the need for others as exceptionally
shameful, even when that need is depicwd in a non-eating disordered, well-functioning
woman.

The results did not support the hypothesis that bulimics would rate the self-reliant
woman as signiﬁcantly less ashamed and as having signiﬁcantly more self-esteem than the

non-bulimic group. In fact, the bulimic group attributed somewhat greater levels of shame

48

to all three characterizations than did the non-bulimic group. Conceivably, the bulimic
subjects displaced a portion of their own shame onto the women in the vignettes they were
rating. Bulimic family research emphasizes that these families display frequent and
unrealistic expectations of perfection (Johnson & Flach, 1985); therefore, the bulimics’
higher ratings of shame across vignettes could reﬂect their more rigid standards and
expectations. While this ﬁnding certainly warrants additional investigation, it does not
diminish the importance of the bulimics’ differing evaluations of the two major vignettes.
Whatever the explanation for their overall elevated shame scores, the bulimic subjects
clearly judged the female who depicted interpersonal needs and the self-reliant female very
differently.

It should be nowd that neither group seemd to differentiate the control from the
self-reliant vignettes, suggesting that the control vignette too closely resembled the self-
reliant characterization. Of course, it may not be possible to create a truly neun'al
depiction--a woman who expresses neither interpersonal needs nor self-reliance. While the
woman in the control depiction tended to avoid discussion of relationships and focused on

“things” or “activities”--the listener nevertheless may have perceived her as self-reliant.
Implications for Theory and Research

Kaufman’s theory of bulimia, which posits the attachment of shame to interpersonal
needs, is strongly supported by the ﬁndings of this study. Bulimics were clearly less
accepting of such nwds and also attributed signiﬁcantly higher levels of shame to women
who acknowledged having interpersonal needs. Although preliminary, these ﬁndings have
important implications for the treatment as well as concepualization of bulimia nervosa.
Research must continue to investigate andilluminate the bulimic’s stance with regard to
interpersonal relationships, including her values and goals; treatment must also confront
and work through the shame which appears to be attached to essential interpersonal nwds.

49

Philosophies of treatment which emphasize strengthening autonomy may lead to the neglect
of areas which are crucial to the bulimic, namely her need for others. Given the high levels
of dependency often observed in bulimic females, an exploration of the equally intense
personal shame which accompanies such needs is likewise crucial.

Kaufman’s conceptualization of bulimia as a shame-based disorder highlights the
two important dynamics of shame and interpersonal needs. However, the theory, as
currently formulated, stops short of explaining, in depth, important sex differences in the
prevalence of bulimia nervosa along with the increasing incidence of this disorder among
women in the latter half of this cennlry. The results of the present study can be interpreted
in light of recent research which links eating disordered behavior to women’s conﬂicts over
autonomy and the need for others.

While current prevalence rates for bulimia nervosa in young women vary from
445%, estimates of the prevalence of disordered eating, binge eating, and distorted body
images among young females are much higher and have risen dramatically in the last thirty
years (Mitchell & Eckert, l987)1. Undoubtably, the current preponderance of disordered
eating, including bulimia nervosa, is tied, in some way, to culture. Explanations of eating
disorders at an individual or intrapsychic level must also account for and incorporate this
component. In discussing societal forees that shape eating disorders, researchers such as
Kaufman criticize the culture (especially the media) for its blatant depiction of the ideal
woman as extremely thin and beautiful. such a dynamic clearly exists and seems to place
much pressure on women to diet and to pay obsessive attention to their bodies. However,
the results of this study suggest the involvement of additional, more subtle and less
superﬁcial social forces in the development of bulimia nervosa, speciﬁcally, the

 

1In a review of the literatrne on eating disorders, Mitchell and Ecker't (1987) found that 26-79% of women
report binge eating (depending on how bingeing is deﬁned). A study of adolescent females ages 12-14 years
revealed that 78% were dissatisﬁed with their current weight and preferred to weigh less, even though 81%
fell within or below ideal weight ranges (Eisele, Hertsgaard, & Light, 1986). In addition, Garner, Olmsted.
Polivy, and Garﬁnkel (1984) have identiﬁed a group of women who display disordered eating but do not
meet DSM III-R diagnostic criteria for an eating disorder.

50

psychological view of women created by society and the psychological conﬂicts which the
culture may differentially cultivate in women and men. Such conﬂicts may exacerbate
females’ shame over interpersonal needs.

Societal norms, structmes, and values shape development differently for females
and males and lead to gender differences in developmental conﬂicts and goals. Research
and theoretical contributions by Gilligan (1982, 1986a, 1986b), Miller (1986), and
Chodorow (197 8) have emphasized the centrality of relationships and connectedness for
women’s development while highlighting the lack of value our society places on these
interpersonal experiences. These theorists argue that developmental models that understand
psychological maturity solely in terms of separation, autonomy, and independence fail to
incorporate women’s developmental experience and ignore a necessary facet of the
development of all human beings, namely the values of care and connecwdness (Gilligan,
1982). In addition, such a bias, both in psychological theories and throughout the broader
society, creates a conﬂict for females between their own values of relationship and
interdependence and societal values of autonomy and independence.

Theories which explain bulimics’ high levels of dependence as “failures at
separation” and “failures in autonomy” have been criticized in this vein Such theories
depict eating disorders as developmental deﬁcits or as the result of some type of failure to
mature, instead of validating the pressures women typically receive not to separate, but to
remain connected to others in a nurturing or interdependent role. Such explanations, in
regard to women, are unfortunately, common.

Gilligan (1982, 1986a) argues that much of the misunderstanding related to
women’s psychological development is the result of overly simplistic, linear formulations
of development which fail to take into account the complexity of the construct of
dependence and its divergent meanings. Males and females are socialimd differently
around dependence, which, though frequently presented as part of a dichotomy opposed by

51

independence, is really a construct with taro polar opposites, isolation and independence
(Gilligan, 1986a). Males and females are traditionally socialized to understand dependence
differently. Men tend to be socialimd into roles which value separation and autonomy
while women’s socialization tends to emphasize values of connectedness, relatedness, and
nut-nuance. Traditionally, the movement out of dependence is encouraged and rewarded
for males, remaining dependent tends to be regarded more positively for females, either as
a caring conmction or as part of their nurturing role. Female rejection of dependence is
more likely to be interpreted and experienced as isolating and negative (Gilligan, 1986a).

A problem inherent in this socialization is the relative value placed on traditional
gender roles. While nm'turance, cooperation, and interrelawdness are integral and
necessary to the culture, society extolls the “virtues” of autonomy and independent
achievement. This creates, for females, what Steiner-Adair (1986) refers to as a
“developmental double-bind” in which women are socialized to be one way and then learn
that society places value on something else.

Steiner-Adair (1986), in her groundbreaking work on nonsymptomatic indicators of
eating disorders in adolescence, was able to differentiate women who repormd disordered
eating solely in terms of their deﬁnition of the ideal woman. Women without disordered
eating understood society’s emphasis on the values of autonomy, separation, and success,
but were able to separate this view from their own values and their personal deﬁnition of
the ideal woman. This personal deﬁnition acknowledged and incorporawd values of
interconnectedness and the importance of relationships with others. The females who
consistently revealed disordered eating deﬁned the ideal woman in ways which reﬂected
superﬁcial societal values. The ideal woman of this group was thin, successful,
autonomous, and “recognized for independent achievement” (Steiner-Adair, 1986, p. 107).
The eating disordered group presented these societal values as their own and did not
acknowledge values of care and connectedness. Steiner-Adair posits that

52

“ . . . It is a vision of autonomy and independence that excludes connection
to others and a reﬂective relationship with oneself. This preliminary study
suggests that a continuum from normal female adolescent devel ment to
the development of eating disorders may exist when thinness normal
dieting become symbolically tied to autonomous career achievement and a
denial of the importance of and need for interpersonal relationships . . . it is
possible that eating disorders emerge at adolescence because it is at this
point in development when females experience themselves to be at a cross-
roads in their lives where they must shift from a relational approach to life to
an autonomous one, a shift that can represent an intolerable loss when
independence is associated with isolation” (Steiner-Adair, 1986, p.107).

 

A similar pattern emerged in the present study. Non-bulimics tended to formulate a
view of the ideal woman that was not overly disparate with their view of themselves. They
were relatively accepting of normal interpersonal needs, while they reﬂected society’s
relative valuation of autonomy and independence. Bulimics, in contrast, manifested a
much more conﬂicmd picnu'e which was strikingly diﬁ'erent from their self depiction. The
bulimic group depicted an ideal woman who seems paradoxically capable of doing it all.
The bulimic ideal is concurrently reliant on others and autonomous, strikingly close to the
“super women” that eating disordered females created in the Steiner-Adair study. It is also
similar to the "super woman" currently depicted in cm culmre, a woman successful at
everything at once: the perfect mother, lover, and business woman. Interestingly,
interpersonal needs presented outside of the “ideal woman” image-yet still presented in a
vignette depicting a healthy, well-functioning female-were rejected and viewed as highly
shameful by the bulimic group. This difference may be indicative of conﬂicwd feelings
about dependence, and of the bulimic’s lack of real integration and understanding of her
ideal conceptualization. The bulimic seems to have “bought” an image of what she is
supposed to be, an image straight from a television commercial. In contrast to the non-
bulimic group, who seems to have formulated an ideal that is realistic and consistent with
personal values and personal reality, the bulimic group’s ideal appears superﬁcial,
undigested, and unclear. When asked to think further about the concepts of interpersonal
needs and self-reliance, apart from‘an ideal image, the bulimics’ answers were more

53

conﬂicted and self-condemning. Their responses suggest an inability to integrate personal
experience and societal values. Their difficulties are understandable in light of the research
highlighting bulimics’ lack of comfort with ambiguity, conﬂict, and confusion.

The results of the present study must be interpreted with caution. Further
replication and conﬁrmation is necessary before deﬁnitive statements can be made about the
role of shame in the development of bulimia nervosa or about bulimics’ perceptions of
interpersonal needs. However, this study does elucidate the importance of attending
further to bulimics’ affect, perceptions, and values as a means of better understanding and
treating their disorder.

Attention to the bulimic, however, is not enough. It is not only bulimic women
who attribute shame to interpersonal needs. Both groups viewed the woman who
expressed interpersonal needs as more ashamed than the self-reliant woman. The
“developmental double-bind” appears to be a reality for all females, differing only by
degree. This conﬂict may be useful in explaining the current prevalence of nonclinical
levels of disordered eating and food obsessions among women. More research is needed
in order to explore both the intensity and effects of such interpersonal shame.

Finally, while there is evidence that particular dynamics in the bulimic’s family
background may give rise to both shame over interpersonal needs and a lack of skill at
integrating ambiguous and conﬂicting messages, it would not be correct to interpret the
bulimic’s conﬂicts solely on an intrapsychic or family level. The present study supports
previous arguments (e.g. Gilligan, 1986b; Steiner-Adair, 1986) that the bulimic is giving
voice to a conﬂict of values inherent in the culture. Further investigation must seek to
replicate and more clearly deﬁne the role of societal values, especially regarding
dependence and interpersonal needs, in the development of bulimia nervosa. A direct
examination of society’s conﬂictual stance regarding values of dependence and

54

connectedness would have broad implications for both genders as well as for psychological
models of development and psychopathology.

55

CONCLUSION

The present study sought to examine the origin and development of bulimia
nervosa. The aim of the snldy was to investigate levels of shame among bulimics, and the
bulimic’s perceptions of interpersonal needs, along with her values regarding
interdependence and autonomy. These areas have received little attention to date. This
study makes clear that bulimics do appear to differ ﬁom non-bulimics in their perceptions
of the need for others and in their conception of the ideal woman. Shame related to
interpersonal needs appears to be a central force in the dynamics underlying bulimia, and
there is evidence that this shame is perpetuated through conﬂicts generated at the cultural
level.

In order to better understand the heightened incidence of bulimia nervosa and other
forms of disordered eating in females, more focused research must be directed at the
women themselves, their perceptions of their disorders, and their values and ideals.
Attempts must be made to place the voices of these women in the context of culture and to
formulate an integrated conceptualization of the dynamics underlying bulimia nervosa, at
individual, family, and societal levels.

55

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56

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APPENDICES

Appendix A

Iauedllisnem

a) Self-reliant characterization: Marla

Interviewer : Okay, we can get started whenever you‘re ready.

Marla : Alright. . . let's see . . . what kind of person am 1? Well, I’ve always been
described as an individualist in my family . . . and I guess that's right. I think that the best
way to get something done is do it yourself. I'm pretty independent minded . . .and I
enjoy being on my own too. I’ve always been like that. . like I remember once when I
wasalittlegirllgotlostinadepartrnentstorebecauselleftmymomtoﬁndthetoy
department. And they asked me when they found me why I hadn’t just asked someone
how togetthere,butitseemedtomeatthetimelike I’djustdoitonmyown . . . andl
guess now it’s important to me to do things at my own pace and the way I want them done.
I mean, ultimately I’m the one I have to please. Right?

Interviewer : So can you tell me how that plays into your relationships?

Marla : Yeah, I think my boyfriend understands that part of me. I think because of that
we‘re really compatible. We're both really busy all the time, and our relationship is the
ideal escape from all that . . . I think he's the perfect boyfriend.

Interviewer : Can you tell me what that means?

Marla : Well, I have someone to enjoy my free time with and to relax with. I mean, we
both have our own ﬁiends and we each have jobs and we have our school stuff, so we
don't like, need each other and we don't hassle each other all the time . . . I can't imagine
being like that, you know, like those women from the ﬁfties, who relied on their husbands
for everything . . . John and I have fun together. But I don’t like, rely on him for stuff, we
can each take care of ourselves. We have a pretty good time together and that's ideal for

me. We understand each other too.

61

Interviewer : So how would your friends describe you?

Marla : They’d describe me as independent too I think. I mean I have a lot of friends, but I
like to spend most of my time by myself. I get my best ideas when I’m by myself . . . . I
like to think things through when I’m alone. I mean, I can talk to my friends, and I do talk
to them, but I don’t like tell them every little thing that I’m doing all the time. Like last
summerI triedoutfcrthe swimteamandldidn’ttell anybodyinmyhouse untilImadethe
ﬁnal cuts. I guess I just didn’t feel like I needed their support or encouragement . . . I just
ﬁgured, hey,ifImakeitImakeit.

Interviewer : Do you think this independence of yours affects how you are in school?
Marla : Probably . . . yeah, like in class, I guess I'm not one of these people who asks a
lot of questions. I mean, I don’t really go to professors a lot for help . . . You know, I like
to go off and try to ﬁgure things out on my own. It’s kind of a challenge. I enjoy it.

b) Interpersonal needs characterization: Audrey

Interviewer : We can get started whenever you're ready.

Audrey : Okay.

Interviewer : I'll just start by asking you the real general question. What kind of a person
do you think that you are and how do you feel that affects how you function in school and
in your relationships?

Audrey : . . . that's a complicated question . . . umm, I'm not sure what you mean by all
that but, well, people are important to me. I‘m not like Suzy cheerleader or anything, but
my friends, you know, having good friends, that is important. I mean I like to be by
myself sometimes, but not all the time.

Interviewer: How would your ﬁiends describe you?

Audrey : Hopefully as a good friend . . . umm . . . I have a small group of people that I
am pretty close with, people I have known since I was little. It‘s almost like we’re family.

62

. . I mean they know everything about me and I know all about them. Like last year, when
my mom was in the hospital. . .I don't know what I would have done without them.
Having people there to comfort me. . . it was horrible. . .I don't know what I would have
done without ﬁiends there to hug me and for me cry on them and to keep me company
through it. ..... My friends are so great. I mean I really . . .I really respect them. And
their opinion means a lot to me. . . .Like my one friend, she graduated last year, and she's
been helping me work on my resume. I‘m graduating this spring and I’ll be looking for a
job and it's great to have someone who knows the ropes, who is showing me how to do it
right. She was the same major as me so she's been through it.

Interviewer : You said that you have a boyfriend?

Audrey : Yeah, Joe . . . We get along so well together. It's so nice having someone I care
about, you know, that much . . . someone I'm close to, who I can rely on and who
depends on me. . . IfI’ve had a long day he makes me dinner and I do the same thing for
him. And sometimes it feels so good just to be held . . . We help each other out, support
each other, give advice. Like I read him the rough drafts of my English papers and he
gives me feedback. Ijust love having someone like him. It's a lot of compromises
though, when you have two people with different goals and schedules and stuff. It's more
work than not having a boyfriend sometimes. But I think it's worth it. I'm really happy.
Interviewer : And what do you think of school? Do you think that the kind of person you
are affects how you are in school?

Audrey : Not really. I do ﬁne in school I like parts of it (pause) . . .I like smaller classes
much better than those huge ones I had my freshman year. It‘s much easier to get
feedback. to ask questions and to make sure I’m understanding. I think school is easier in
the last two years because you get to know people better. I have this professor who I‘ve
been working with, she's great. This woman is exactly what I would like to be like when I

63

ﬁnally get out of here and start working. And she's been giving me advice on classes and
instructors and things like that.

c) Control characterization: Leslie

Interviewer : Okay, let's get started with the general question. What kind of a person do
you think you are and how do you feel that affects how you function in school and in your
relationships?

Leslie : That's a confusing question . . . I guess I think I'm a happy person. I do well in
school. I like what I'm studying. I like writing papers more than I like taking tests . . . I
think it's the challenge of being creative. I'm not sure how what kind of person I am
affects how I do in school . . . I mean I guess you could say I'm responsible. I get my
work done and I turn it in on time, but I'm not a real perfectionist about school. I have a
lot of other interests as well. That's what I enjoy about a big school. You can really get
lost here if you want to, like you can take a class where you never have to speak to the
teacher, or go to a football game and just lose yourself in the crowd . . . or, you know, you
can take advantage of opportunities to meet people and get involved with smaller groups. I
like having a choice. . .I mean, there are plenty of opportunities to make friends here, but
there is a lot of space to be alone if that’s what I really want at the moment.

Interviewer : So what are your friendships like?

Leslie : Well, I have friends that I would call really close and I have friends I know well
enough to do things with . . . you know?

Interviewer : Do you spend a lot of time with your friends, do you rely on them a lot?
Leslie : Well. . . it really depends. During the school year I don't see my friends at home
much. I’m going to parties and stuff on the weekends and hanging out at people's
apartments . . . I'm not sure ifI rely on them . . . I mean for some things, sure. . .like

when my car broke down last week and I had to call my friend to rescue me, or when we

64

take a class together and we study for the ﬁnal . . . but in some things I'm real
independent. I mean, I know a girl who won't go to the mail by herself, and I'm not like
that. I like to do some things alone. .

Interviewer : Are you involved in a relationship right now?

Leslie : mmhuh . . .

Interviewer : Can you tell me a little about that?

Leslie : Oh . . . okay. My boyfriend Kevin and I have been going out for a while now
and things are really good. I‘m really happy. We get along very well. We complement
each other. It’s so great having someone in your life with lots of the same goals and
interests. We both love to go camping in the summer . . . we like the same music, have the
same taste in movies. He's a great support in some ways . . . but there are just some
things males just don't seem to understand, you know? . . But that's okay. I think I’d go
crazy if we were that compatible. My friends and relationships are important to me, but I
needmyown spaceandtimetoo. . .IguessIlikeandIneedtokeep somethingsto

myself.

65

Appendix B

E'II'Q ..

Please rate the following statements as either true or false:

1.

.°°>'9":":5S*’.N

This individual needs relationships with others.

This individual is autonomous.

This individual is dependent on other people.

This individual does not need other people.

This individual displays a need for touching and/or holding.

This individual is independent of other people.

This individual does not show a need for other people's approval.

This individual showed a need to have someone she can identify with or model herself

after.

Scoring:

"True" responses on items 1, 3, 5, 8 are scored one point.
"False" responses on items 2, 4, 6, 7 are scored one pornt.
Higher scores indicate the presence of interpersonal nwds.

 

 

 

Appendix C
D . . I E .
Parents’ Marital Status:
11 _] 1° . G E 1' . G
single 1 0
married 12 14
divorced, single 0 1
divorced, but at least 7 5
one parent has remarried
n = 20 n = 20
Religion:
11 _] 1° . G E 1° . G
Catholic 8 9
Protestant 10 5
Jewish 0 1
Other 0 1
None 2 4
n = 20 n = 20
Regularity of Religious Observation:
_ . . E 1' . 5
Regular 6 2
Occasional 9 9
Rare 2 5
Never/Not applicable 3 4
n = 20 n = 20

67

 

Estimated Family Income:

11 -l l' . G . B l' . G
$10,000-20,000 1 0
$20,000-30,000 l 0
$30,000-40,000 O 0
“0.000-50,000 4 2
$50,000-60,000 5 2
$60,000-70,000 3 5
$70,000-80,000 2 3
$80,000-90,000 1 2
$90,000 or greater 3 6

n = 20 n = 20

Primary Ethnic Identiﬁcation:

H -l l' . G E l' . S
African American 2 0
Hispanic 1 0
Asian 1 0
Caucasian 16 20

 

AppendixD

W

Items 1-14: Demographic Information

Items 15-78: Eating Disorders Inventor-yl

Items 79-83: Eating Disorders Inventory Structured Interview

Items 84—113: Intemaliwd Shame Scale

Items 114-144: Interpersonal Dependency Inventory; Autonomy and Emotional Reliance
on Another Person scales

Items 145-175: Autonomy and Emotional Reliance on Another Person scales (completed
as ideal)

 

l'I‘heseitemsarenotreproducedhere. TheEatingDisordersInventorycanbeobtainedfmmPsychological
Assessment Resources, Inc., 16204 North Florida Avenue, Lutz, FL 33549.

10.
12:
13.
14.

69

 

 

 

 

 

 

 

 

 

 

 

 

 

Age at last birthday __
Marital Status (check one)
single divorced, remarried
' _separated
divorced, single widowed
_cohabitating (living with signiﬁcant other)
Marital status of wwheck one)
_single
married
_divorced, single
_divorced but at least one parent has remarried
widowed
_cohabitating (not married but living together)
Religion (check one)
Catholic Protestant Jewish
Other ( ) No religious afﬁliation
How regular are you in your religious observance?
Attend regularly Never attend
Attend occasionally Does not apply: no
Attend rarely religious afﬁliation
Primary ethnic or racial identiﬁcation (check one)
Black/African-American Asian
__Native American _White/Caucasian
Hispanic
Your family's estimated gross income for last year (check one)
$10,000-20,000 $50,000-$60,000
__$20,000-30,000 ___$60,000-$70,000
__$30,000-$40.000 __$70.000-$80,000
_$40,000-50,000 ___$80,000-$90,000
over $90,000
Number of people in your family
Number of people supported by your parents
Your present weight (in pounds)
Height (specify feet and/or inches)
Highest past weight
How long ago was this? months ago
Lowest past weight '
How long ago was this? months ago

 

What do you consider your ideal weight (in pounds)?

******************

70

Please answer the following questions by ﬁlling in the appropriate blank. Please answer as
honestly as you can Again. W

79. Have you w had an episode of eating an amount of food that others would regard as

unusuallxlarae (a binge) __yes
(IF NO PLEASE SKIP m QUESTION NUMBER 80)

During the W, how often have you typically had an eating binge?
a. I have not binged 1n the last 3 months
b. Monthly-«I usually binge__ time(s) a month.
c. Weekly-J usually binge__ trme(s) a week.
d. Daily-J usually binge time(s) a day.

 

At the worst of times, what was your average number of binges per week?

binges per week.
80. Have you cam tried to vomit after eating in order to get rid of the food eaten
__yes no (IF NO PLEASE GO TO NUMBER 81).

 

During the W how often have you typically induced vomiting?
a. I have not vomited 1n the last 3 months
b. Monthly-J usually vomit time(s) a month.
0. Weekly-J usually vomit __time(s) a week.
d. Daily--I usually vomit time(s) a day.

 

 

At the m of times, what is the average number of vomiting episodes per week?

 

 

vomiting episodes per week.
81. Have you ever taken diet pills?
yes
If you have taken diet pills, during the 133W how often
have you typically taken diuretics?
a. I have not taken diet pills in the last 3 months
b. Monthly-J usually take diet pills__ time(s) a month.
c. Weekly-J usually take diet pills __time(s) a week.

d. Daily-J usually take diet pills time(s) a day.

 

82. Have you ever used laxatives to control your weight or "get rid of food"?
yes no

Dming the W3, how often have you been taking laxatives for weight control?
a. I have not taken laxatives in the last 3 months
b. Monthly-J usually take laxatives _ time(s) a month.
c. Weekly—I usually take laxatives time(s) a week.
d. Daily--I usually take laxatives time(s) a day.

 

71

83. Have you an taken diuretics (water pills) to control your weight?

ves no

If you have taken diuretics, during the W3, how often
have you typically taken diuretics?

a. I have not taken diuretics in the last 3 months.

b. Monthly-J usually take diuretics _ time(s) a month

c. Weekly-J usually take diuretics _ time(s) a week

d. Daily--I usually take diuretics time(s) a day.

*************************

 

72

Below is a list of statements describing feelings or experiences that you may have from
time to time or that are familiar to you because you have had these feelings and experiences
for a long time. Most of these statements describe feelings and experiences that are
generally painful or negative in some way. Some people will seldom or never have had
many of these feelings. Everyone has had some of these feelings at some time, but if you
ﬁnd that these statements describe the way you feel a good deal of the time, it can be
painful just reading them. Try to be as honest as you can in responding.

Read each statement carefully and circle the number to the left of the item that indicates the
frequency with which you ﬁnd yourself feeling or experiencing what is described in the
statement. Use the scale below.

DO NOT OMIT ANY ITEM.

SCALE:

l--NEVER 2--SELDOM 3--SOMETIMES 4--FREQUENTLY 5--ALMOST

ALWAYS

l 2 3 4 5 84. I feel like I am never quite good enough.

1 2 3 4 5 85. I feel somehow left out.

1 2 3 4 5 86. Ithinkthatpeoplelookdownonme.

l 2 3 4 5 87. Allinall,Iaminclinedtofeelthatlamasuccess.

l 2 3 4 5 88. I scold myself and put myself down.

1 2 3 4 5 89. I feel insecure about others opinions of me.

1 2 3 4 5 90. Compared to other people, I feel like I somehow never
measure up.

1 2 3 4 5 91. I see myselfas being very small and insigniﬁcant.

l 2 3 4 5 92. IfeelIhave muchtobeproudof.

1 2 3 4 5 93. I feel intensely inadequate and full of self doubt.

I 2 3 4 5 94. IfeelasifIamsomehowdefectiveasaperson,likethereis
something basically wrong with me.

1 2 3 4 5 95. When I compare myselfto others I am just not as important.

1 2 3 4 5 96. I have an overpowering fear that my faults will be revealed
in front of others.

1 2 3 4 5 97. I feel I have a number of good qualities.

1 2 3 4 5 98. I see myself striving for perfection only to continually fall
short.

1 2 3 4 5 99.1thinkothersareabletoseemydefects.

l 2 3 4 5 100. Icould beat myselfover theheadwithaclub whenImake
a mistake.

SCALE:

73

l--NEVER 2--SELDOM 3--SOMETIMES 4--FREQUENTLY 5--ALMOST

l
l
1

HHHH
NNNN

2
2
2

3
3
3

uuuu

A
UI

buhhh

UIUIUIUI

101.
102.
103.

104.

105.
106.

107.
108.

109.

110.
111.
112.
113.

ALWAYS
On the whole, I am satisﬁed with myself.
I would like to shrink away when I make a mistake.
I replay painful events over and over in my mind until I
am overwhelmed.
IfeeIIamapersonofworth atleastonanequalplane
with others.
At times I feel like I will break into a thousand pieces.
I feel as if I have lost control over my body functions and
my feelings.
Sometimes I feel no bigger than a pea.
At times I feel so exposed that I wish the earth would open
up and swallow me.
I have this painful gap within me that I have not been
able to ﬁll.
I feel empty and unfulﬁlled.
I take a positive attitude toward myself.
My lonliness is more like emptiness.
I always feel like there is something missing.

For the following statements, please circle the number to the left of the item that indicates
how characteristic the statement is OF YOU.

l--VERY CHARACTERISTIC OF ME
2--QUITE CHARACTERISTIC OF ME
3--SOMEWHAT CHARACTERISTIC OF ME
4--NOT CHARACTERISTIC OF ME

HHHH

NNNN

03030303

55343

114. I prefer to be by myself.

115. I do my best work when I know it will be appreciated.

116. I can't stand being fussed over when I am sick.

117. I believe people could do a lot more for me if they

wanted to.

118. As a child, pleasing my parents was very important to
me.

119. I don't need other people to make me feel good.

74

l--VERY CHARACTERISTIC OF ME
2--QUITE CHARACTERISTIC OF ME
3--SOMEWHAT CHARACTERISTIC OF ME
4--NOT CHARACTERISTIC OF ME

1 2 3 4 120. Disapproval by someone I care about is very painful
to me.

1 2 3 4 121. I'm the only person I want to please.

1 2 3 4 122. The idea of losing a close friend is terrifying to me.

1 2 3 4 123. I rely only on‘ myself.

1 2 3 4 124. I would be completely lost if I didn't have someone
special.

I 2 3 4 125. I get upset when someone discovers a mistake I've
made

I 2 3 4 126. I hate it when people offer me sympathy.

1 2 3 4 127. I easily get discouraged when I don't get what I nwd
from others.

1 2 3 4 128. I don't need much from people.

1 2 3 4 129. I must have one person who is very special to me.

1 2 3 4 130. When I am sick, I prefer that my friends leave me
alone. '

l 2 3 4 131. I'm never happier than when people say I've done a
good job.

1 2 3 4 132. I am willing to disregard other people's feelings in
order to accomplish something that's important to me.

1 2 3 4 133. I need to have one person who puts me above all
others.

1 2 3 4 134. I tend to imagine the worst if a loved one doesn't
arrive when expected

1 2 3 4 135. I don't need anyone.

1 2 3 4 136. I tend to expect too much from others.

1 2 3 4 137. I tend to be a loner.

1 2 3 4 138. When I meet new people, I'm afraid that I won't do the

right thing.
1 2 3 4 139. Even if most people turned against me, Icould still go
on if someone I love stood by me.

75

l--VERY CHARACTERISTIC OF ME
2--QUITE CHARACTERISTIC OF ME
3--SOMEWHAT CHARACTERISTIC OF ME
4--NOT CHARACTERISTIC OF ME

1 2 3 4 140. What people think of me doesn't affect how I feel.

1 2 3 4 141. I think that most people don't realize how easily they
can hm't me.

1 2 3 4 142. I have always had a terrible fear that I will lose the
love and support of people I desperately need.

1 2 3 4 143. I would feel helpless if deserted by someone I love.

1 2 3 4 144. What other people say doesn't bother me.

****#******************

Now respond to the following statements. You have seen the statements before, but THIS
TIME PLEASE RESPOND AS IF YOU WERE EXACTLY AS YOU WISH. In other
words, answer as the ”ideal you" or "perfect you" would respond.

l--VERY CHARACTERISTIC OF ME
2--QUITE CHARACTERISTIC OF ME
3--SOMEWHAT CHARACTERISTIC OF ME
4--NOT CHARACTERISTIC OF ME

1 2 3 4 145. I prefer to be by myself.

1 2 3 4 146. I do my best work when I know it will be appreciated.

1 2 3 4 147. I can't stand being fussed over when I am sick.

1 2 3 4 148. I believe people could do a lot more for me if they
wanted to.

l 2 3 4 149. As a child, pleasing my parents was very important to
me.

I 2 3 4 150. I don't need other people to make me feel good.

1 2 3 4 151. Disapproval by someone I care about is very painful
to me.

1 2 3 4 152. I'm the only person I want to please.

1 2 3 4 153. The idea of losing a close friend is terrifying to me.

1 2 3 4 154. I rely only on myself.

1 2 3 4 155. I would be completely lost if I didn't have someone
special.

I 2 3 4 156. I get upset when someone discovers a mistake I've

made

76

l--VERY CHARACTERISTIC OF ME
2--QUITE CHARACTERISTIC OF ME
3--SOMEWHAT CHARACTERISTIC OF ME
4--NOT CHARACTERISTIC OF ME

1234 157.
1234 158.

1234 159.

1234160.

1234 161.

1234 162.

1234 163.

1234164.

1234 165.

1234 170.

1234 171.
1234 172.

1234173

1234174
1234175

1 2 3 4 166.
1 2 3 4 167.
l 2 3 4 168.
l 2 3 4 169.

I hate it when people offer me sympathy.

I easily get discouraged when I don't get what I need
from others.

I don't need much from people.

I must have one person who is very special to me.
When I am sick, I prefer that my friends leave me
alone.

I'm never happier than when people say I've done a
good job.

I am willing to disregard other people's feelings in
order to accomplish something that's important to me.
I need to have one person who puts me above all
others.

I tend to imagine the worst if a loved one doesn't
arrive when expected

I don't need anyone.

I tend to expect too much from others.

I tend to be a loner.

When I meet new people, I'm afraid that I won't do the
right thing.

Even if most people turned against me, I could still go
on if someone I love stood by me.

What people think of me doesn't affect how I feel.

I think that most people don't realize how easily they

can hurt me.

I have always had a terrible fear that I will lose the
love and support of people I desperately need.

I would feel helpless if deserted by someone I love.
What other people say doesn't bother me.

THANK YOU FOR YOUR PARTICIPATION

77

Appendix E

I l. .1 I“ l . 1
NAME OF THE WOMAN YOU HEARD INTERVIEWED:

 

The following statements or items ask for your opinion. There are no right responses. We
are interested in your ideas of what the person you have just heard is like. Please respond
to the items as you feel the woman you just heard would respond. Circle the number to the
left of the item which indicates the frequency with which you believe the person
experiences the described feeling.

Pleasecompletealltheitemsinthem'derprovided. DONOTOMITANYITEM.

EXAMPLE:

For instance, the ﬁrst statement is "I feel like I am never quite good enough." Is it your
0 ' 'on that the subject of the tape feels this way (1)"never" , (2 "seldom ',

( )"sometimes", (4)"frequently", or (5)"almost always"?

ﬁg‘lilll’llzim 2-SELDOM 3-SOMETIMES 4-FREQUENTLY S-ALMOST
ALWAYS

l 2 3 4 5 1. I feel like I am never quite good enough.

1 2 3 4 5 2. I feel somehow left out.

1 2 3 4 5 3. Ithinkthatpeoplelookdownonme.

l 2 3 4 5 4. Allinall,Iaminc1inedtofeelthatIamasuccess.

l 2 3 4 5 5. I scold myself and put myself down.

1 2 3 4 5 6. I feel insecure about others opinions of me.

1 2 3 4 5 7. Compared to other people, I feel like I somehow never measure up.

1 2 3 4 5 8. I see myself as being very small and insigniﬁcant.

l 2 3 4 5 9. IfeelIhave muchtobeproudof.

l 2 3 4 5 10. I feel intensely inadequate and full of self doubt.

I 2 3 4 5 11. IfeelasifIamsomehowdefectiveasaperson,likethereis

something basically wrong with me.

1 2 3 4 5 12. When I compare myself to others I am just not as important.

78

Again, Please respond to the items as you feel the woman you just heard would

respond.

SCALE:

l--NEVER 2--SELDOM 3--SOMETIMES 4--FREQUENTLY 5--ALMOST

1234513

1234514.
1234515.
1234516.
1234517.

234518.

1234521.
1234522.
1234523.

1234526.
1234527.
1234528
1234529.
1234530.

ALWAYS
I have an overpowering fear that my faults will be revealed in
front of others.
I feel I have a number of good qualities.
I see myself striving for perfection only to continually fall short.
I think others are able to see my defects.
I could beat myself over the head with a club when I make a

mistake.

On the whole, I am satisﬁed with myself.

. I would like to shrink away when I make a mistake.

. I replay painful events over and over in my mind until I am

overwhelmed.
I feel I am a person of worth at least on an equal plane with others.
At times I feel like I will break into a thousand pieces.
I feel as if I have lost control over my body functions and my
feelings.

. Sometimes I feel no bigger than a pea.

. At times I feel so exposed that I wish the earth would open up and

swallow me.
Ihavethispainfulgapwithinrnethatlhavenotbeenabletoﬁll.
I feel empty and unfulﬁlled.

. I take a positive attitude toward myself.

My loneliness is more like emptiness.

I always feel like there is something missing.

79

Appendix F
W
Consent Form 1 (Screening)
Michigan State University
Department of Psychology

DEPARTMENTAL RESEARCH CONSENT FORM

1. I have freely consented to take part in a scientiﬁc study being conducted by Melissa
Frisch McCreery under the supervision of Dr. Gershen Kaufman and Dr. Bert Karon.

This research will require that I respond to some statements and answer some questions
about myself and about my feelings and experiences

Participation in this experiment usually takes approximately one horn: I understand that
I may be asked to return at a later time to participate in an additional one hour experiment
for additional research credit.

2. the study has been explained to me and I understand the explanation that has been given
and what my participation will involve.

3. I understand that I am ﬂee to discontinue my participation in the study at any time
without penalty.

4. Iunderstandthattheresultsofthe studywillbetreatedin strictconﬁdenceandthatl
will remain anonymous. Within these restrictions, results of the study will be made
available to me at my request.

5. I understand that my participation in the study does not guarantee any beneﬁcial results
to me.

6. I understand that, at my request, I can receive additional explanation of the study after
my paru'cipation is complem

Signed:

 

Please printname

Date

80

Information Sheet I (Screening)

Thank you for your participation. The purpose of this study was to examine differences in
a variety of variables--age, family background, interests and concerns, eating habits, and
religion. Your responses will be kept strictly conﬁdential and will not be associated with
your name in any way.

It is possible that you will be called and asked to return for additional participation at a later
time. You are not required to continue your articipation if you do not desire. If you are
called back and choose to participate you ' earn additional credit for your time.

If on have any questions about your participation in this study or would like more

' ormation, you may contact myself or Dr. Gershen Kaufman at the numbers provided
below.

Melissa Frisch McCreery

Dr. Gershen Kaufman

81

Consent Form II (Vignettes)
Michigan State University
Department of Psychology
DEPARTMENTAL RESEARCH CONSENT FORM

1. I have freely consenwd to take part in a scientiﬁc study being conducwd by Melissa
Frisch McCreery under the supervision of Dr. Gershen Kaufman and Dr. Bert Karon.

This research will require that I respond to some statements and answer some questions
about myself and about my feelings and experiences. I will also be listening to audio tapes
of interviews and giving my opinions about what I think the person I heard is like.

Participation in this experiment usually takes approximately one hour.

2. The study has been explained to me and I understand the explanation that has been
given and what my participation will involve.

3. I understand that I am free to discontinue my participation in the study at any time
without penalty.

4. Iunderstandtlrattlreresultsofthe studywillbetreatedinstrictconﬁdenceandthatl
will remain anonymous. Within these restrictions, results of the study will be made
available to me at my request.

5. I understand that my participation in the study does not guarantee any beneﬁcial results
to me. ‘

6. I understand that, at my request, I can receive additional explanation of the study after
my participation is complewd

Signed:

Please print name

 

Date

82

Informational Form H (Vignettes)

Thank you for your participation. The experiment you have just completed was a two part
study investigating females' perceptions of interpersonal relationships, especially the
aspects of autonomy and dependency. The purpose of this study is to investigate whether
or not females' eating habits and feelings about their bodies are related to their feelings and
perceptions about autonomy and needing other people.

Participants for this stud were selected to represent a broad range of eating behaviors.
Participation in this s does not mean that your eating behaviors are disordered. If you
are concerned about your eating behaviors and attitudes towards food and your body, there
are resources available on campus. A partial list is included with this form.

If you have any further questions about this study or would like to talk about issues that it
has raised, you may contact myself or Dr. Gershen Kaufman at the numbers indicated
below.

Thank you again for your participation.

Melissa Frisch McCreery

Dr. Gershen Kaufman

HICHIGRN STATE UNIV. LIBRARIES
IN1111111111111111111111IIIIIMII
31293017899521