Eating disorders (ED) are nutritional and mental disorders that cause negative disturbances to a person’s eating behaviors (Gaetani
et al., 2016); obsession with body weight, food habits, and eating behavior are common in ED. These illnesses could develop over time and lead to many side effects including malnutrition, osteoporosis, amenorrhea, anxiety, and depression which all may cause Bulimia nervosa, Anorexia nervosa, or Binge eating disorders (BED) unless ED symptoms get diagnosed and treated in the right time (Dorard and Khorramian-Pour, 2016).
In BED, people lose control over their eating and unlike the Bulimia nervosa, there is no purging (misuse of diuretics, laxatives or enemas, self-induced vomiting, excessive physical activity, or fasting) after the periods of BED (Dorard and Khorramian-Pour, 2016); whilst, they often feel ashamed, distressed, or guilty about their eating. In the study by Stunkard et al, it was observed that there were same eating patterns in obese and BED individuals in almost 21% to 51.6% of them (Stunkard, 1959).
In the fifth Diagnosis Statistical Manual of MentalDisorders, BED is defined as a disorder for further investigations which involves EDNOS (Eating Disorder Not Otherwise Specified) (DSM, 2015). BED is the most common eating disorder in the United States with a prevalence of 4% among American people which is 2-6.4% more than the prevalence of Bulimia nervosa. Women are more prevalent to BED than men with a ratio of 3 to 2, respectively. Moreover, the prevalence
of behavioral disorders, as the most common disorders among individuals with BED, is 32-91% (Smink
et al., 2012).
Overweight and obesity are of serious concerns, since they are followed by many critical co-morbidities including diabetes, hypertension, hyperlipidemia, coronary artery diseases, and different types of cancers. Based on recent studies, obesity and the lowest quality of life are followed by various health considerations and costs (Wang
et al., 2013).
Mental trauma and personal disorders are significantly correlated with the intensity of BED. Cluster B personality disorder (dramatic, overly emotional, unpredictable thinking, or behavior which are usually followed by antisocial, borderline, histrionic, and narcissistic personality disorders), predict the presence of BED significantly (Berenbaum
et al., 2008).
Obesity is not necessarily the symptom of BED; in fact, BED can occur in overweight or even normal weight individuals; people with BED are usually embarrassed and expressextreme un-satisfaction with their weights. Gluck et al. conducted a study on obese individuals and reported that stress was the first stimulator for their over-eating; some researches on the biological functions of the brain showed that serotonin, endorphin, and dopamine are the most important factors in BED periods (Gluck, 2006).
Absence of self-confidence, internalizing social standards, preoccupations with food, poor body-images, un-satisfaction with body weight, and depression are in common symptoms of mental pathology of BED. In a study by Fairburn and co-workers, it was observed that major predictable factors of BED among women were painful experiences in their childhood such as sexual or physical abuse, family issues including psychiatric disorders of parents, lack of attention, over restrictions, timidity, or childhood obesity (Fairburn
et al., 1998).
However, there have been no published articles assessing the relation of BED with anxiety, depression, or happiness; thus, this study aimed to investigate this specific correlation.
Materials and Methods
Study population: The present correlation study was conducted in two stages: in the first phase, 200 participants, who referred to the nutrition clinics for losing their weights were randomly selected in Isfahan, Iran in 2010 – 2011. They were asked to fill the binge eating scale (BES) questionnaire so that patients with BED can be identified from the non-BED individuals. In order to motivate the collaboration among individuals and to keep privacy, their names and personal details were not asked, except for their gender and age. The completed questionnaires were then scored according to Gormally scale (Gormally
et al., 1982), individuals with scores of 17 and higher were selected as BED and entered the study. The final sample size consisted of 120 individuals (28 men and 92 women). Finally, participants were asked to fill the following questionnaires: Oxford Happiness, Beck Depression Inventory, and Cattell anxiety scale.
Binge Eating Scale (BES) Questionnaire: A scale was designed by Gormally et al. to assess the severity of BED among obese persons; the scale consisted of 16 items that each of them had three or four sentences. Participants were asked to select the statement that describes them best. The items were classified from zero to three and thus the total score of BES could vary from zero to 46; scores higher than 17 indicated the present of BED (Gormally
et al., 1982).
The English, Portuguese and Italian versions of the mentioned scale are more reliable, sensitive, and specific. Dezhkam et al. examined the psychometric properties of Persian version of BES that showed a test-retest reliability of 0.71, split half of 0.67, Cronbach's alpha coefficient of 0.85, sensitivity of 84.6%, and specificity of 80.8% using a cut point of 17% (Dezhkam M
et al., 2009).
Oxford Happiness Questionnaire: Various methods have been applied to measure happiness, including Oxford Happiness Questionnaire as one of the best methods developed by Argyle and Lou. There are 29 items in the final form of Oxford happiness Questionnaire; Argyle et al. conducted an Alpha coefficient of 0.90 with 347 participants while Farnham and Bronig used an Alpha of 0.87 with 101 patients (Argyle M and Lu L, 1990). The questionnaire includes 29 groups of statements expressing different states of depression to exaltation. The statements of each group are scored from zero to three, and the sum of all scores indicates the range of every person's happiness. The reliability and validity of this questionnaire were investigated based on the Cronbach's alpha of 0.93 and split-half reliability of 0.92. In addition, the test-retest reliability of the questionnaire was 0.79 after three weeks (Alipoor and Noorbala, 1999).
Beck Depression Inventory (BDI): The BDI (Beck
et al., 1988) is suitable for individuals of 13 years or older with at least pre-school education. This questionnaire is a 21-item depression scale that assesses the emotional, behavioral, and somatic symptoms rated from low to high levels. Researchers have indicated the high validity and reliability of the test (Kumar and Robson, 1984).
Cattell Anxiety Scale Questionnaire (ASQ): The ASQ consists of 40 items with three options, it was prepared by Cattell in 1963 (RB, 1963). Based on extensive researches, this is probably the most effective tool provided as a short questionnaire which can be used for ages of 14-15 years and older in most cultures. Sararoudi reported reliability of the test by calculating the Cronbach's alpha of 0.80; the Cronbach's alpha and split-half methods that have been used to measure the reliability of the scale, were estimated at 0.65 and 0.51, respectively; moreover, the validity of the test was 0.61(Sararoudi
et al., 2011).
Data analysis: Stepwise regression analysis and correlation coefficient were used to examine the relationship between binge eating disorder and depression, happiness and anxiety among individuals. Results were considered significant at P < 0.05.
Results
The findings show that BED, as a dependent variable had a significant linear relationship with depression, happiness, and anxiety, while no significant relationship was observed between BED and predictor variable of age. The highest and lowest correlations belonged to a positive correlation of BED with either of depression (r = 0.51) or anxiety (r = 0.24). A negative correlation was also found between BED and happiness (r = -0.27).
The stepwise regression analysis (
Table 1) showed that the model entered depression score in Step 1, and depression could explain 25% of the variance (R
2 = 0.25).
Table 2 illustrates the significant “F” in the analysis of variance table along with the amounts of “t”. The regression equation for the model are as follows:
BED =15.65 + 0.39 (Depression).
According to the results presented in
Table 3, all the four predictor variables showed a significant correlation with binge eating disorder among females diagnosed with BED who were candidates for weight loss. The highest significant positive correlation was perceived between depression and BED (r = 0.49) while the least significant positive correlation was observed between age and BED in females (r = 0.19); a negative correlation was also found between happiness and BED (r = -0.22).
The results in
Table 3 indicated a significant correlation among three predictor variables of depression, happiness, and anxiety with binge eating disorder in males with BED. There was a highest significant positive correlation (r = 0.54) between depression and BED. The least significant positive correlation at the level of 0.05 (r = 0.36) was shown between anxiety and BED in males; moreover, a significant negative correlation at the level of 0.01 (r = -0.45) was found between happiness and BED.
Comparing males with females, results indicated that depression, happiness, and anxiety had a significant positive correlation with BED in both groups; however, this relationship was higher in males than females in all three variables.
As it is clear from the results of
Table 4, Fisher's Z values that were obtained from the correlation difference between depression and BED in males and females were -0.50, -1.15, and -0.62 for depression, happiness, and anxiety, respectively, which were less than the Z score at the level of 0.05 (Z = 1.96). As a result, no significant differences were observed for depression, anxiety, and happiness among males and females with BED.