Shame and guilt: treatment-seeking correlates of eating disorders in college students/

2005·5.8 MB·English

by  Bowden, Helen Frances

SHAMEANDGUILT:TREATMENT-SEEKINGCORRELATESOFEATING
DISORDERSINCOLLEGESTUDENTS
By
HELENFRANCESBOWDEN
ADISSERTATIONPRESENTEDTOTHEGR.ADUATESCHOOL
OFTHEUNIVERSITYOFFLORIDAINPARTIALFULFILLMENT
OFTHEREQUIREMENTSFORTHEDEGREEDOCTOROFPHILOSOPHY
LTslIVERSIfYOFFLORIDA
2005
Copyright2005
by
HelenF.Bowden
Fmoyromwynfhaemairlty.,Twhheoytsaeurgvhetdmasehtohneovraalbuleeorfoldeetmeordmeilnsatwiohno,seinteexgarimtpyl,elsovsee,rvaenddtfoolmloolwdinmgy
characterincountlesspositivewaysandhelpmetoblossombothpersonallyand
professionally.Formybestfriend,whowalkedwithmeandsupportedmethroughoutall
thephasesofourlives,throughjoysandsorrow,andremainedeveratruefriend.Ilove
youall.
ACKNOWI.EDGMENTS
Theprocessofwritingmydissertationhasbeenanincrediblejourney,attimes
arduous,frustrating,andanxiety-producing.Thelightattheendofthistunnelhasbeen
thecomfortingthoughtofactuallyobtainingmydoctorateoneday;andtheguidanceand
supportIreceivedfromfriends,family,mentors,andmyadvisorofmanyyears.Asthis
journeycomestocompletion,Iamthankfulfortheopportunitytoexpressmygratitudeto
thosewhohavemadethisenormousmilestonepossible.
Firstandforemost,IwouldUketothankDr.MartinHeesackerwithasmuch
gratitudeascanbeconveyedinmerewords.Heservedasmyadvisorduringmytenureat
theUniversityofFlorida,andalsoasmymentor,guidingmethroughthemanyhurdles
andobstaclesthatareendemicingraduateschool.Throughoutmyacademiccareer,Dr.
Heesackergavemethepersonalandprofessionalsupportthathelpedtotransformme
fromanaiveandunrefinedundergraduatetoaself-assuredandresourcefulgraduate
student.Hishelpwasindispensableinthewritingofmydissertation,ashisenlightened
andfarsuperiorgraspofstatisticsandSASmadetheanalyzingofmydatapossible.
Withouthiswisdom,experience,andgeneroustimeandeffort,1wouldstillbewading
aroundinrawdata.So,many,manykudosto"TheMan."
Mygratitudealsomustbeconveyedtomyothersupervisorycommitteemembers.
Dr.FranzEpting,Dr.ConnieShehan,andDr.RobertZiller.Igreatlyappreciatetheir
wisdomandinsights,whichhelpedmetoprogresssmoothlythroughgraduateschool.1
iv
wouldalsoliketothankthemforgraciouslyagreeingtoserveonmydissertation
committeeandfortheirhelpfulguidanceonthecraftingofmydissertation.
Myparentshavebeenatouchstonethroughoutmylife,alwayspresenttoprovide
directionandwisdomTheirunconditionalloveandceaselesssupporthavenourishedmy
soulandlaidthefoundationforallthegreatnessinmylifepast,present,andfuture.Iowe
allofthepositiveaspectsofmycharactertothem.TheyinstilledinmesoUdvaluesanda
truecaringforothers.Icannotexpressadequatelymyappreciationforeverythingthat
theyhavedoneforme,northedepthofmyloveforthemboth.Iamtrulyblessedtohave
theminmylife.
Ihaveknownmybestfriend,Kim,eversincewewereinthirdgrade.Weliterally
grewuptogether,sharinginalloftheexuberanceandturbulenceofchildhood,
adolescence,andnow,adulthood.HerfriendshipisthegreatestofmyUfe.Idoubtthat
manypeoplecanfiillyappreciatehowmcrediblypreciousandrareatruefriendreallyis.
Throughthickandthin,Kimalwaysexpressedunconditionallove,support,and
friendship.Shehasbeenmyconfidante,advisor,counselor,soulsister,playmate,partner-
in-crime,advocate,voiceofreason,laughbuddy,andalways,myfriend.IthankKimfor
walkingbesidemeonlife'sjourney.
V
TABLEOFCONTENTS
Eige
ACKNOWLEDGMENTS iv
LISTOFTABLES «
ABSTRACT ^
CHAPTER
1 INTRODUCTION 1
2 LITERATUREREVIEW 8
EatingDisorders 9
AnorexiaNervosa 9
Onsetandprevalence 9
Typesofanorexia 9
Psychologicalcharacteristics 10
Familycharacteristics 11
Diagnosticcriteria 12
Warningsigns 13
Healthhazards 13
Treatment 14
Treatmentchallenges 17
BulimiaNervosa 17
Onsetandprevalence 17
Typesofbulimia 18
Psychologicalcharacteristics 18
Familycharacteristics 20
Diagnosticcriteria 20
Warningsigns 21
Healthhazards 21
Treatment 22
Treatmentchallenges 23
TheScopeoftheProblem 24
ResearchonTreatment-SeekingBehavior 31
TangneyandDearing'sShameandGuiltTheory 46
vi
KeyConcepts ^"
CreationandValidationoftheTOSCA-3andSGSS 51
TheRelationshipbetweenShameandGuiltandEatingDisorders 52
Hypotheses
AdditionalResearchQuestions 55
3 METHODOLOGY 57
Participants
Procedures
Instruments 599
SUencingtheSelfScale(STSS) 599
StateShameandGuiltScale(SGSS) 60
TheTestofSelf-ConsciousAffect-3(TOSCA-3) 61
QuestionnaireforEatingDisordersDiagnosis(Q-EDD) 633
TheEatingAttitudesTest-26(EAT-26) 66
TheKnowledgeofEatingDisordersScale(KEDS) 67
Analyses 67
HypothesisTests 67
AnalysesofAdditionalResearchQuestions 69
4 RESULTS 72
DemographicandOrderofPresentationEffects 72
HypothesisTests 77
AnalysisofAdditionalResearchQuestions 79
5 DISCUSSION 866
ResearchQuestions 922
LimitationsandSuggestionsforFutureResearch 977
Strengths 999
ImplicationsforPsychotherapy 101
APPENDIX
A INFORMEDCONSENT 1044
B INSTRUCTIONS 1055
C EATINGATTITUDESrEST-26,SELECTEDITEMS 1066
D QUESTIONNAIREFOREATINGDISORDERSDIAGNOSIS,SELECTED
ITEMS 1077
E SILENCINGTHESELFSCALE,SELECTEDITEMS 1088
F TESTOFSELF-CONSCIOUSAFFECT-3,SELECTEDITEMS 1099
vii
G STATESHAMEANDGUILTSCALE,SELECTEDITEMS
H KNOWLEDGEOFEATINGDISORDERSSCALE
BODYIMAGESCALE
I
DEMOGRAPHICQUESTIONNAIRE
J
LISTOFREFERENCES
BIOGRAPHICALSKETCH
viii
LISTOFTABLES
Table Eage
4-1 Minimumandmaximumvalues,means,andstandarddeviationsoftheprimary
dependentvariables
4-2 lintercorrelationsamongtheprimarydependentvariables 834
4-3 QuestionnaireforEatingDisordersDiagnosesresults 85
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AbstractofDissertationPresentedtotheGraduateSchool
oftheUniversityofFloridainPartialFulfillmentofthe
RequirementsfortheDegreeofDoctorofPhilosophy
SHAMEANDGUILT:TREATMENT-SEEKINGCORRELATESOF
EATINGDISORDERSINCOLLEGESTUDENTS
By
HelenFrancesBowden
May2005
Chair: MartinHeesacker
MajorDepartment: Psychology
Thepurposeofthisstudyistoexaminefactorsrelatedtoeating-disordered
individuals'decisiontoseekornotseektreatment.Twoofthefactorsthatareexamined
includeJunePriceTangneyandRondaDearing'sconceptsofshameandguilt.Although
shameandguiltareoftenusedinterchangeablywhendescribingeating-disordered
individuals,accordingtoTangneyandDearing,shameandguiltaredistinctself-
consciousemotionsthatleadtodifferentoutcomes.Intheirmodel,shameleadsto
avoidanceanddefensiveness,whereasguiltleadstotheacceptanceofresponsibilityand
thedesiretotakeaction.Therefore,participantswithhigherGuiltscoresarepredictedto
evidencegreatertreatment-seekingbehavior,whereasthosewithhigherShamescoresare
predictedtoengageinlesstreatment-seekingbehavior.Inaddition,asmostoutreach
programsoncollegecampusesfocusoneducatingstudentsaboutthesymptomsand
healthhazardsofeatingdisordersandwheretofindtreatment,thisdissertationexamines
whetherthesetwofactorsareactuallyrelatedtotreatment-seekingbehavior.Also,though
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