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Correlates of Bulimia nervosa: early family mealtime experiences.

Bulimia nervosa, only formally recognized by the American Psychiatric Association in 1980, is a disorder in which an individual rapidly consumes an unusually large amount of food. This "binge" is terminated by vomiting, laxative abuse, abdominal pain, or sleep, and is seen by the individual as abnormal and distressing (American Psychiatric Association, 1980). This condition is also associated with a strong drive to remain or become thin, as well as a preoccupation, even obsession, with food and eating (Boskind-White & White, 1983).

Reports of the prevalence of this disorder vary widely. In a recent epidemiological report, Fairburn and Beglin (1990) analyzed the incidence data on bulimia nervosa from over 50 publications. They found reports of the prevalence of bulimia in adolescent and young adult women to range from 1% to 35%. Fairburn and Beglin believe that these marked discrepancies are due to a number of factors, including nonstandard diagnostic criteria, self-report data, and sampling procedures. They conclude that bulimia nervosa is probably truly present in only 1% of the population of adolescent and young adult women. Other recent reports, however, suggest that the incidence is between 4% and 8% of young women (Heatherton & Baumeister, 1991). Although these percentages are relatively low, they do represent a large number of young women who are suffering from this serious, sometimes life-threatening psychiatric disorder.

Although bulimia nervosa has received a great deal of attention in the lay press and from clinicians and researchers, there is still remarkably little consensus as to the origins of the disorder. Theories span the continuum of causation from those which are primarily biological (Mitchell & Eckert, 1987) to the heavily sociocultural (Irving, 1990). Markedly absent from many of these theoretical explanations is the developmental history of the individuals with this disorder (Attie & Brooks-Gunn, 1989). For most bulimics, the onset of symptoms does not occur until middle to late adolescence. This late onset has tended to focus investigation of etiology on the adolescent stage rather than on possible earlier childhood precursors. The other issue of possibly critical importance in undercovering the origins of this disorder is why food becomes the focus for these young women as opposed to other types of self-destructive behaviors, such as alcohol abuse or sexual acting out. A brief review of the major theories on the origin of this disorder is useful in examining these issues.

Several reports suggest that there may be a genetic risk for anorexia nervosa, but no such data are yet available on bulimia nervosa (Mitchell & Eckert, 1987). Studies of the basic psychobiological factors involved in bulimia nervosa are equally inconclusive (Mitchell & Eckert, 1987). Treatment studies have, however, demonstrated some limited success in the use of psychotropic drugs, particularly antidepressants, in the alleviation of bulimic symptomatology (Mitchell & Eckert, 1987). Reports of family histories of alcoholism and other addictive behaviors and the presence of depressive and anxiety disorders suggest possible biological origins (Strober & Humphrey, 1987). To date, however, relatively little empirical data support a purely biological basis for bulimia.

The physical changes during adolescence were implicated as a causal variable in eating problems in early adolescence in a two-year longitudinal study by Attie and Brooks-Gunn (1989). The rapid onset of weight gain during the pubertal transition period was suggested as a possible "triggering event" for eating problems, particularly for adolescents with negative body images. The authors postulate that early attempts to control the pubertal weight gain by dieting, coupled with poor physical self-image, may lead to the development of seriously disordered eating patterns in later adolescence.

Cognitive-behavioral models have also been espoused. In a comprehensive meta-analysis, Heatherton and Baumeister (1991) suggested that escape theory provides an explanatory model for binge eating. Binge eaters and bulimics tend to set unrealistically high expectations for themselves, experience negative self-awareness and affect, employ cognitive deconstruction, and exhibit impulsive behavior and irrational beliefs. Binge eating, sometimes followed by purging, is engaged in to escape from self-awareness of these aversive factors. Heatherton and Baumeister caution, however, that it has not been clearly demonstrated if binge eating is cause or consequence of this attempted escape.

The pressure to be thin that is pervasive in current society is also frequently implicated as the primary cause of bulimia. Sociocultural theories espouse the view that the cultural expectation generated by the media and society in general--that thinness is equated with attractiveness and beauty--leads many young women to develop dangerous eating patterns to meet this idealized standard (Irving, 1990).

While all of these theories may account for the development of bulimia, none presents a cogent explanation of why food itself becomes the focus of the psychiatric disorder. Biological explanations suggest links to affective disorders and addictive behavior, but not to food specifically. Negative body image caused by pubertal weight gain or cultural influences could also lead to affective or anxiety disorders or self-destructive behaviors. Escape from self-awareness could be facilitated by alcohol or drug abuse or dissociative states. Why food becomes the drug or disorder "of choice" is not fully accounted for by these theories.

Several studies have examined familial variables to uncover the origins of bulimia. Although few of those focus upon the role food itself plays in the lives of bulimics, they do shed some light on family patterns that could influence the development of this disorder.

Low levels of cohesion, disorganization, and nonexpressiveness are evident in the families of individuals with eating disorders (Attie & Brooks-Gunn, 1989). Mothers of bulimics are significantly more domineering and controlling of their daughters, while both parents are generally more demanding. These parents tend to stress academics and appearance more than do the parents of nonbulimics, and are more likely to openly compare their children to one another (Sights & Richards, 1984). Families of bulimics tend to espouse high achievement standards, fail to support autonomy, and engender self-doubt in their daughters (Attie & Brooks-Gunn, 1989). Parents of bulimics tend to be more belittling, less helpful and nurturing, and more restricting than parents of nonbulimics (Humphrey, 1986; Strober & Humphrey, 1987). Johnson and Flach (1985) and Ordman and Kirschenbaum (1986) found that bulimic young women report higher familial conflict and low family cohesiveness. Patterns of family dysfunction emerge from their findings.

However, since family dysfunction precedes many psychological disorders, it is not clear why bulimia develops in some women and not in others. Despite the centrality of food in this disorder, very little research has examined family influences as they relate to food.

Some early work on eating disorders by Bruch (1969) suggests that eating is a learned, not an instinctual, behavior. Bruch maintains that stress or distorted interaction during mealtimes can have a lifelong effect on behavior. Recent work by Frank (1991) suggests that family enmeshment in bulimics tends to be unequally focused on issues of eating, hunger, and weight, leading to shame and guilt feelings focused on eating behavior. Marcus and Weiner (1989) espouse a transactional model for anorexia nervosa that has implications for the development of bulimia. They suggest that specific themes are present in families of anorexics. The transactional pattern they propose suggests that a common script played out by family members centers upon the importance of physical appearance. Discussions about weight and weight control, clothing, hair, and other physical attributes are common. Both parents' and children's evaluation of their own and others' appearance and attractiveness is a common topic.

The work of Bruch, Frank, and Marcus and Weiner adds credence to the importance of the messages surrounding food and attractiveness received by children who later develop bulimia. One area that has received scant attention, however, is the actual childhood mealtime experiences of adolescent and young adult bulimics. The purpose of the present study was to investigate whether the presence of such experiences would differentiate bulimics from nonbulimics. Family adaptability and cohesion and depression were also measured because of their frequently reported relationship to bulimic symptomatology. A group of "repeat dieters" was also included in this study. They were conceptualized as a relevant control group because they have many of the weight concerns reported by bulimics (Dykens & Gerrard, 1984), but use dieting to control weight rather than binge/purge behaviors.

METHOD

Subjects

Subjects for this study were undergraduate women enrolled in introductory psychology classes at a large midwestern university. The Bulimic Investigatory Test, Edinburgh (BITE; Henderson & Freeman, 1987) and a background information questionnaire were administered to 663 women to identify probable bulimics, nonbulimics, and repeat dieters. Sixty subjects (9.1% of the original sample of 663) qualified for the bulimic group, 55 women (8.3% of the original sample) for the repeat dieter group, and 368 (55.5%) for the nonbulimic group.

Subjects were classified as bulimic if their BITE total score was 25 or higher (possible range of scores = 0-30). Nonbulimics were defined by BITE total scores of less than 10. Repeat dieters had BITE scores that ranged from 2 to 23, and self-reported having been on three or more weight-loss diets in the past year, rated themselves as at least 3 on a 5-point Likert scale of present weight dissatisfaction, but did not use purging techniques or engage in binge-eating episodes. Mean BITE scores for each group were: nonbulimics, 4.9; repeat dieters, 10.8; and bulimics, 29.8. Subjects who were below the average weight for their height (as calculated by the Metropolitan Height and Weight Table for Women) by 25% or more were excluded from this study as possibly suffering from anorexia nervosa or a combination of bulimia and anorexia (bulimarexia). Of the remaining women, 128 (51 nonbulimics, 26 repeat dieters, and 51 bulimics) agreed to participate in the study.

Measures

Two preliminary measures were used to screen subjects. A questionnaire assessed personal and family background information and the criteria to identify repeat dieters (Dykens & Gerrard, 1984). The 33-item BITE, designed both as a screening device and as a measure of treatment response for bulimia, was used to identify bulimic subjects. BITE total scores of 20 or above indicate a high probability that a subject fulfills the DSM-III criteria for bulimia. Its Symptom and Severity subscales have interitem reliability of .96 and .62, respectively, and test-retest reliability of .86 for normal and .68 for bulimic subjects (Henderson & Freeman, 1987). The BITE is a valid instrument and has

been shown to differentiate bulimic, subclinical (those who have disordered eating patterns but do not meet the DSM-III criteria for bulimia), and nonbulimic subjects on both subscales (Henderson & Freeman, 1987).

Three dependent measures were employed. The 30-item Family Adaptability and Cohesion Evaluation Scales II (FACES II; Olson, Russell, & Sprenkle, 1982) was used to measure perceived family adaptability and cohesion. Cutoff points are provided for both the adaptability and cohesion subscales, and scores can be plotted on a circumplex model. Separate "ideal" scores for both adaptability and cohesion are also obtained to compare with subjects' "real" adaptability and cohesion scores.

The Childhood Family Mealtime Questionnaire (CFMQ) is a 69-item scale developed by the investigators to assess mealtime experiences up to 13 years of age (see Appendix). This questionnaire was inspired by the literature correlating various eating problems with early food experiences (Bruch, 1973; Powers, 1980; Wright, Fawcett, & Crow, 1980) and was developed through open-ended interviews with bulimic women concerning those experiences. Initially a 37-item measure, the CFMQ was pilot tested and expanded to its present length. The CFMQ has an interitem reliability of .91 (Miller, 1989). All questions are scored on a 5-point Likert scale; examples include: "I felt mealtimes were a warm and sharing time in my family," "I felt pressured to eat meals rapidly," and "I felt one or both of my parents were angry during meals." The Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) was included to measure group differences in state depression.

Procedure

Bulimic, repeat dieter, and nonbulimic groups were identified using BITE scores and background information. Subjects were contacted by telephone and asked to participate. Subjects were not informed that their participation was related to their earlier responses on the screening instruments. The CFMQ, FACES II, and BDI were administered in small groups.

RESULTS

Childhood Family Mealtime Experiences

Data from the CFMQ were analyzed for the nonbulimic, repeat dieter, and bulimic groups using MANOVA and a ONEWAY program from the Statistical Package for the Social Sciences. The MANOVA was conducted to determine if there were significant differences between groups. Post hoc tests were conducted via a ONEWAY ANOVA when significant differences were found.

At least two of the three groups showed significant differences on 36 of the 67 questions used on the CFMQ. Results were in the predicted direction: mean scores for repeat dieters fell between those for nonbulimics and bulimics on the majority of questions. (see Table 1).

A factor analysis was performed on all CFMQ questions; 18 factors were extracted which accounted for 72% of the variance. After setting the eigenvalue at 1.0 and sorting at the .5 level, 7 factors were left which fit the theoretical model and accounted for 50.3% of the variance. The remaining factors did not assist in data reduction. The 7 factors utilized have been labeled Mealtime Communication Based Stress (Questions 32, 56, 43, 5, 6, 55, 64, 24, 9, 54, 8), Mealtime Structure (Questions 50, 58, 61, 48, 51, 57, 66), Appearance-Weight Control (Questions 34, 35, 37, 52, 33, 44), Parental Mealtime Control (Questions 31, 26, 41), Emphasis on Mother's Weight (Questions 23, 18, 65), Present Parental Meal Influence (Questions 59, 67), and Traditional Family (Questions 38, 36, 39).
Table 1

Means, Standard Deviations, and Univariate Fs for Significant
CFMQ questions

Q. Nonbulimics Repeat Dieters Bulimics F

2 2.31(a) 2.46 2.86(b) 4.06(*)
 (1.05) (0.51) (1.11)

3 2.73(a) 2.85 3.20(b) 3.26(*)
 (0.90) (0.93) (1.02)

5 4.43(a) 4.31 3.94(b) 5.37(**)
 (0.64) (0.55) (0.97)

6 4.57(a) 4.62(a) 4.12(b) 3.69(*)
 (0.81) (0.64) (1.19)

7 2.18(a) 2.27 2.61(b) 3.27(*)
 (0.84) (0.83) (0.94)

8 1.35(a) 1.31(a) 2.02(b) 7.83(**)
 (0.69) (0.55) (1.29)

9 1.55(a) 1.54(a) 2.28(b) 10.5(***)
 (0.73) (0.58) (1.12)

10 2.20(a) 2.12(a) 2.67(b) 3.89(*)
 (1.06) (0.86) (0.99)

11 1.57(a) 1.42(a) 2.33(b) 12.9(***)
 (0.81) (0.58) (1.09)

12 2.41(a) 2.42(a) 2.86(b) 4.23(*)
 (0.80) (0.70) (0.96)

14 2.51 2.15(a) 2.84(b) 4.47(*)
 (0.93) (1.01) (1.01)

15 1.55(a) 1.46(a) 2.10(b) 4.87(**)
 (0.92) (0.76) (1.24)

16 1.61(a) 1.81(a) 2.33(b) 6.17(**)
 (0.85) (0.80) (1.34)

24 4.24(a) 4.19(a) 3.57(b) 8.04(***)
 (0.79) (0.49) (1.14)

26 2.47(a) 2.35(a) 2.88(b) 3.07(*)
 (1.03) (0.69) (1.18)

27 3.61(a) 2.65(b) 3.90(a) 5.70(**)
 (1.61) (1.65) (1.48)

28 2.22(a) 2.27(a) 2.80(b) 5.92(**)
 (0.86) (0.78) (1.04)

31 3.43 3.23(a) 3.65(b) 3.60(*)
 (0.58) (0.51) (0.80)

33 1.84(a) 2.19 2.59(b) 7.19(***)
 (0.90) (0.98) (1.08)

34 2.04(a) 2.35(a) 3.35(b) 13.9(***)
 (1.11) (1.20) (1.49)

35 1.82(a) 2.19(a) 3.16(b) 14.2(***)
 (1.09) (1.10) (1.54)

37 1.31(a) 1.54 1.94(b) 5.89(**)
 (0.68) (0.99) (1.10)

41 3.82(a) 3.46(a) 4.16(b) 7.04(***)
 (0.77) (0.91) (0.73)

42 2.67(a) 2.65(a) 3.28(b) 7.38(***)
 (0.89) (0.89) (0.87)

44 1.96(a) 2.50(b) 2.88(b) 10.3(***)
 (0.96) (0.95) (1.13)

45 1.94(a) 2.04(a) 2.55(b) 8.01(***)
 (0.81) (0.60) (0.88)

48 2.53(a) 2.12(a) 3.12(b) 6.57(**)
 (1.10) (0.99) (1.40)

52 2.45(a) 2.77 2.94(b) 4.87(**)
 (0.76) (0.65) (0.90)

53 2.08(a) 2.04(a) 2.73(b) 8.49(***)
 (0.82) (0.60) (1.06)

54 1.94(a) 2.00 2.37(b) 3.62(*)
 (0.81) (0.85) (0.89)

55 1.53(a) 1.58(a) 2.26(b) 11.2(**)
 (0.70) (0.64) (1.02)

56 4.69(a) 4.46 4.31(b) 3.17(*)
 (0.58) (0.81) (0.86)

59 2.51(a) 2.81 3.02(b) 3.42(*)
 (1.05) (0.85) (0.99)

60 1.61(a) 1.73(a) 2.20(b) 7.1(***)
 (0.85) (0.78) (1.00)

65 1.53(a) 1.58 1.96(b) 3.30(*)
 (0.81) (0.70) (1.06)

67 2.33(a) 2.42 2.86(b) 4.52(*)
 (0.89) (0.86) (1.00)

Note. For each question, all values labeled "a" are
significantly different from values labeled "b."

* p |is less than~ .05.
** p |is less than~ .01.
*** p |is less than~ .001.


A stepwise discriminant analysis was conducted on both significant questions and the complete questionnaire to ascertain how accurately the CFMQ could predict group membership. Inclusion of only significant questions correctly predicted 34 (66.7%) of the 51 nonbulimics, 21 (80.8%) of the 26 repeat dieters, and 40 (78.4%) of the 51 bulimics. Twenty-four (92.3%) of the repeat dieters and 47 (92.2%) of the bulimics were correctly classified using the complete questionnaire, with an overall correct prediction of 86.72%. In both of these cases, the repeat dieter and bulimic groups were predicted more accurately than the nonbulimic group, though the percentage correctly classified of this latter group was still greater than would be expected by chance.

A self-extracting discriminant analysis using minimization of Wilks' lambda was also performed, lambda = 0.20, F(2, 125) = 3.39, p |is less than~ .001. Thirty-nine (76.5%) of the nonbulimics, 23 (88.5%) of the repeat dieters, and 44 (86.3%) of the bulimics were correctly classified. An overall discrimination rate of 82.8% was achieved.

Family Factors

Two ANOVAs were executed on the FACES II measure. An ANOVA on the two subcategories, adaptability and cohesion, yielded no significant differences between any of the three groups. A second ANOVA was performed to investigate cohesion and adaptability differences between subjects' real and ideal families. No significant group differences were found.

Depression

An ANOVA was conducted on Beck Depression Inventory scores. The bulimic group had the highest mean score (13.5), followed by the repeat dieter group (6.77), and the nonbulimic group (4.71). Both the nonbulimic and repeat dieter groups differed significantly from the bulimic group F(2, 125) = 23.6, p |is less than~ .0005.

DISCUSSION

The CFMQ appears to be a promising measure for the investigation of some of the precursors of bulimia nervosa. The questions clearly discriminate the bulimic from nonbulimic population, and provide some insight into why dysfunctional eating patterns and acute concern over physical appearance may emerge in certain individuals. Although no significant differences were found on family adaptability and cohesion, several other factors suggest important familial influence on the development of this disorder.

Women with bulimia reported more negative early mealtime and food-related experiences than did women who were nonbulimic or repeat dieters. The core features that distinguished the reported childhood experience of women with bulimia from that of other subjects were: high levels of stress and conflict during meals, the use of food as a tool for punishment or manipulation, and an emphasis on dieting and weight. Additionally, for women with bulimia, mealtime was more likely to be the only time the family spent together.

As reported by women classified as bulimic, conversations held during family meals were often conflictual. Interpersonal grievances and hostilities were frequently raised, parents tended to dominate or control the conversation, and children were stifled in their attempts to express opinions. This stressful, controlling posture extended to the act of eating itself. Women with bulimia reported that their families paid a great deal of attention to eating habits. They felt pressured to eat meals rapidly, to "clean their plates," and to finish dinner at the same time as other family members. This is consistent with previous descriptions of the general communication patterns of families of women with bulimia. Humphrey (1986) notes that, in these families, parents often take a controlling and restricting posture in their interactions with daughters, and Root (1986) has noted that family members are often ineffectual problem solvers and poor stress resolvers. These data also confirm the findings of Attie and Brooks-Gunn (1989) indicating maternal dominance and control. The current findings suggest that perhaps because of the pervasive stress and conflict surrounding mealtime, women with bulimia reported greater relief when fathers were absent at meals.

A second feature distinguishing the family mealtimes of bulimic women was the use of food as an instrument of reward or punishment. Among the families of bulimics, food was more likely to be included as an important part of a celebration, or to be offered as a treat when the child was hurt or upset. In addition, mothers would feel hurt if the child did not like what had been prepared. The effect of this early experience was long-lasting, and women with bulimia reported that they would still feel stressed or guilty if they refused food offered by a family member. This supports the supposition that food becomes symbolic of, and to some extent replaces, caring and affection in the families of persons with bulimia (Bruch, 1973; Powers, 1980).

The final feature distinguishing the early mealtime or food-related experiences of bulimic women was the great importance of weight, physical appearance, and attractiveness in the family. Among these families, beauty was closely associated with weight, and family members discussed each other's weight openly. In keeping with this, bulimic women received more encouragement from family members to diet than did nonbulimic women. This is consistent with the fact that women at high risk for bulimia report experiencing greater pressure to be thin from their families than do women at low risk for bulimia (Irving, 1990). This external pressure may be transformed into self-imposed pressure. Indeed, in addition to reporting greater appearance-related pressure emanating from their families, bulimic women in the present study reported that they thought and worried about their weight when they were younger more than did nonbulimics or repeat dieters.

These results are consistent with theoretical approaches that emphasize the importance of early family experience in the later development of psychopathology. The themes presented by Marcus and Weiner (1989) come through clearly in these recollections of childhood food-related experiences with parents. These findings suggest that the emergence of bulimia may be due in part to attractiveness-focused themes and negative mealtime and food-related experiences during childhood.

CONCLUSION

Although support for the study's main hypothesis was found, the results should not be viewed as conclusive. The findings are limited by the relatively liberal screening method used. Paper-and-pencil measures of bulimia are inferior to, and certainly no substitute for, a thorough diagnostic interview (Fairburn & Beglin, 1990). A study conducted with a clinical population would be useful in confirming these results. The study is also limited by the retrospective nature of the questions on the CFMQ. Such questions are subject to fallibility of recall. In addition, it is possible that the memories of bulimics may be influenced or distorted by their disorder.

Longitudinal studies of family transactional patterns, particularly surrounding food and physical appearance, are needed to determine the validity of these preliminary findings. These data also suggest a greater role of the father than has been reported in past studies. Because of the powerful influence the father can have on the development of the daughter's self-esteem and self-concept, this area is ripe for investigation. Finally, more detailed analyses of the effects of familial environment on the development of this disorder, and the unique role food plays in these families, are needed to more fully understand the etiology of bulimia nervosa.

Appendix

Childhood Family Mealtime Questionnaire

Instructions: Think back to family mealtimes during your childhood (up to the age of 13). Please answer these questions according to how you felt at that time (response scale: 1 = never; 2 = rarely; 3 = sometimes; 4 = usually; 5 = always).

1. My whole family ate dinner together.

2. My father was served first at mealtimes.

3. Meals were the one time my family was together.

4. Our family was required to eat together.

5. I liked to eat dinner with my family.

6. In my family, everyone could speak their views at dinner time.

7. Dinner was a time for my family to bring out their grievances against each other.

8. It was a relief when my father was not at dinner.

9. Because of stress during meals, I liked or wished to eat alone.

10. Food seemed to be more important in my family than in most others I have seen.

11. I felt pressured to eat meals rapidly.

12. I enjoyed eating meals alone.

13. During my childhood, my family ate dinner at a regular time.

14. At dinner, one or both of my parents dominated the conversation.

15. Everyone in my family was expected to finish dinner at the same time.

16. I enjoyed eating meals without my father.

17. During dinner, we sat at the same place.

18. My mother dieted when I was young.

19. When I was young, I took vitamins.

20. My mother worried about my eating a balanced diet.

21. During mealtimes, one or both of my parents praised me for achievements.

22. I enjoyed eating meals without my mother.

23. My mother worried about her weight when I was young.

24. I felt able to speak my mind during mealtimes.

25. Someone in my family had allergies which interrupted meals.

26. During meals, you could tell who was in control in my family.

27. My father sat at the head of the table.

28. There was attention focused on one or more persons' eating habits during mealtimes.

29. The T.V. was on during mealtimes.

30. During mealtimes, I felt comfortable contradicting my father's opinion.

31. We ate foods my father liked.

32. I felt mealtimes were a warm and sharing time in my family.

33. In my family, we talked about our own or each other's weight.

34. I remember thinking about my weight when I was young.

35. I remember worrying about my weight when I was young.

36. I saw one of my mother's main roles as that of a cook.

37. When I was young, I was encouraged to diet.

38. I saw my mother's main role as that of a homemaker.

39. In my family, mealtimes were set by my father's schedule.

40. In my family, mealtimes were set by my mother's schedule.

41. When my family wanted to celebrate, food was a part of the celebration.

42. My mother would be hurt if we did not like the food she prepared.

43. I looked forward to mealtimes.

44. In my family, we thought of beauty as depending a lot on weight.

45. I felt one or both of my parents were angry during meals.

46. One or both of my parents brought up the cost of food at mealtimes.

47. My mother got up to get things during dinner.

48. At home, I had to clean my plate (i.e., eat all the food on it).

49. When I was no longer a baby, my mother still dished up food on my plate.

50. My family was conscious of wasting food.

51. My parents made me eat foods I did not like.

52. In my family, we thought and/or talked about physical appearance.

53. When I was hurt or upset, my mother would offer me food as a special treat.

54. There was yelling during dinner.

55. I remember feeling nervous during dinner.

56. My family talked during dinner.

57. Table manners were important to my parents.

58. During meals, I was told not to waste food.

59. Presently, when I am at home, my parents influence what I eat.

60. Presently, if I refuse food offered to me by a member of my family, I will feel stressed and/or guilty.

61. If I did not like what we were having for dinner, I had to eat it anyway.

62. Dinner was the only time I spent with my father.

63. My father cooked dinner.

64. Dinner times were silent in my family.

65. My father commented about my mother's weight when I was young.

66. Table manners were brought up at dinner.

67. Presenting, when I am at home, my parents influence the way I eat.

68. I was breast-fed as a baby.

69. As a baby, I was fed on demand (not on a set schedule).

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Debra A. F. Miller, Ph.D., and Lori M. Irving, M.A., Department of Psychology, University of Kansas.
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Author:Miller, Debra A.F.; McCluskey-Fawcett, Kathleen; Irving, Lori M.
Publication:Adolescence
Date:Sep 22, 1993
Words:5378
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