Clarifying the Role of Impulsivity inBulimia Nervosa

Sarah Fischer,* Gregory T. Smith, and Kristen G. Anderson

Department of Psychology, University of Kentucky, Lexington, Kentucky

Accepted 18 December 2002

Abstract: Objective: With the goal of demonstrating that urgency impulsivity is associatedwith bulimic symptoms, not (lack of) planning impulsivity, the authors conducted twostudies assessing these personality traits and bulimic symptoms in undergraduate women.Method: In study 1 291 women completed urgency and deliberation scales of the NEOPIR and the BULIT-R. In study 2 101 women completed alternative measures tapping thesepersonality constructs and the BULIT-R. Results: In both studies, what is commonly assessedwith impulsivity measures, a lack of planning, was not significantly associated with bulimicsymptoms. However, urgency, the tendency to act rashly when experiencing negativeaffect, was positively correlated with bulimic symptoms. Discussion: The authors suggestthat future researchers assess urgency, not lack of planning, when assessing impulsivity asa risk factor for bulimia nervosa.# 2003 byWiley Periodicals, Inc. Int J Eat Disord 33: 406–411,2003.

Key words: impulsivity; urgency; bulimia; binge eating

INTRODUCTION

Several researchers have attempted to examine the relationship of the personality traitimpulsivity to bulimia nervosa. The results have been mixed. Some researchers havefound a significant relationship between impulsivity and the disorder, whereas othershave found no relationship. The findings may have been unclear because of differentdefinitions of impulsivity used in the literature.

Whiteside and Lynam (2001) found that there are four different variations of impul-sivity assessed with our current personality measures. Two of these traits are mostplausibly related to personality and eating disorder research: urgency and (lack of)premeditation. Urgency implies a predisposition to act in the face of negative emotion.Individuals high in urgency are likely to act rashly to cope with distress. Premeditationhere refers to an individual’s ability to delay action to think about the consequences, inother words the ability to plan. Researchers often use scales that measure lack of

*Correspondence to: Sarah Fischer, Department of Psychology, University of Kentucky, Lexington, KY 40506-0044. E-mail: sffisc0@uky.edu

Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/eat.10165

# 2003 by Wiley Periodicals, Inc.

premeditation to test whether impulsivity is a risk factor for the development of bulimia.However, we hypothesize that urgency, not lack of planning, is related to bulimicsymptoms.

Several findings in the literature support this hypothesis. Bulimia nervosa and bingeeating disorder are often comorbid with depression (Stice, Killen, Hayward, & Taylor,1998; Telch & Stice, 1998). Bulimic women score higher on the Negative Emotionality scaleof the MPQ than typical women, (Pryor & Wiederman, 1996) and on the Neuroticismscale of the NEO-PIR (Tylka & Subich, 1999). Apparently, bulimic women experience agreater incidence of depression and negative emotions than typical women. It is there-fore plausible to hypothesize that acting rashly to cope with this negative affect may bea risk factor for the binge eating and purging characteristic of bulimia nervosa.

Not only are bulimic women more prone to experience negative affect than typicalwomen, but emotional states such as anxiety and depression have been shown to predictbinge episodes (Arnow, Kenardy, & Agras, 1995). Some researchers have suggested thatbinge eating may be used as a way to alleviate negative affect (Heatherton & Baumeister,1991). The results of Hohlstein, Smith, and Atlas (1998) support this. They demonstratedthat expectancies that eating would help manage negative emotional states are positivelyrelated to bulimic symptoms and differentiate bulimics from normal individuals andpsychiatric controls.

Several researchers have found that lack of planning is unrelated to bulimic symptoms(Newton, Freeman, & Munro, 1993). Although bulimic women are more impulsive thananorexic women on these scales, their scores on scales assessing lack of planning arewithin the normative range (Bushnell, Wells, & Oakley Brown, 1996; Fahy & Eisler, 1993).

We tested the hypothesis that urgency impulsivity, not lack of planning, is related tobulimic symptoms in two studies. In study 1, we used an extensively used personalitymeasure, the NEO-PIR (Costa & McCrae, 1992) as a proxy measure to assess theconstructs of interest: deliberation or premeditation and urgency. In study 2, we usedthe measure developed by Whiteside and Lynam (2001) to assess these types of impul-sivity.

STUDY 1

We administered two Impulsivity scales and a measure of bulimic symptoms toa sample of college women. Both of the personality measures used in the study wereconstructed to assess impulsivity, but one reflects urgency, and the other reflectslack of planning. We hypothesized that scores on the urgency-impulsivity facet of theNEO-PIR will be positively associated with bulimic symptoms, and lack of planningwill not.

Method

ParticipantsParticipants consisted of 291 undergraduate women enrolled in a large, Midwestern

university. They received a portion of class credit for their participation in the study.In this sample, 88% were European American, 6% African-American, 2% HispanicAmerican, and <1% Asian American.

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MeasuresBULIT-R. To assess presence of bulimic symptoms, we administered the BULIT-R

(Thelen, Farmer, Wonderlich, & Smith, 1991). This test incorporates DSM-III-R criteriafor bulimia nervosa and has also been validated for use with individuals diagnosed withbulimia nervosa using DSM-IV criteria (Thelen, Mintz, Vander, & Jillon, 1996).

NEO-PIR. To assess urgency, we administered the Impulsivity facet of the Neuroticismdomain of the NEO-PIR (Costa & McCrae, 1992). In a factor analysis of impulsivity scalesconducted by Whiteside and Lynam (2001), this facet loaded most highly onto itemsmeasuring urgency or rash action in the face of negative affect. On inspection of thespecific items in the scale, we found two items that referred specifically to feelings of lossof control while eating and overeating. These items were removed from the scale for thepurposes of this study to avoid criterion contamination.

To assess (lack of) planning or premeditation, we administered the Deliberation facetof the NEO-PIR Conscientiousness domain. Whiteside and Lynam (2001) found thatthis facet, in the negative direction, loaded most highly onto items measuring lack ofplanning.

ProcedureStudents completed all questionnaires in a group administration format.

RESULTS

Sample Characteristics

In this sample, 6.9% of the women reported that they had been experiencing bingeeating episodes for the past 1 to 3 years, whereas 11.7% reported that they had beenexperiencing binge eating episodes for the last 3 years or more. And, 5.2% of the womenreported that after binge eating, they attempted to lose weight by exercising, vomiting, orusing laxatives ‘‘a lot of the time,’’ whereas 2.7% indicated that they used these methodsafter binge eating ‘‘all of the time.’’ Women in this sample reported that in the last3 months, 6.2% had experienced a binge at least once per week, 2.4% at least twice perweek, and 2.4% more than twice per week. Finally, 2.4% of the sample reported that theyinduced vomiting two to three times per month, 1.0% of the sample reported inducingvomiting at least once per week, and 0.7% of the sample reported inducing vomiting atleast twice per week.

Test of Hypotheses

Our hypothesis was that urgency, not lack of planning, is associated with bulimicsymptoms. This hypothesis was confirmed. Although Impulsivity (i.e., urgency) andDeliberation (i.e., planning) were significantly correlated (r ¼ �0.52, p < 0.01), theydiffered in their relationships to bulimic symptoms. Impulsivity was positively asso-ciated with scores on the BULIT-R (r ¼ 0.29, p < 0.01), but Deliberation was not (r ¼ 0.06,p < 0.31). In addition, the correlation of urgency/impulsivity with scores on the BULIT-Rwas significantly higher than the association between deliberation and scores on theBULIT-R (t ¼ 4.81, p < 0.01).

408 Fischer et al.

DISCUSSION

Our hypothesis that the tendency to act rashly to relieve negative affect, rather thanlack of planning, is associated with bulimic symptoms was confirmed. To evaluate therobustness of this finding, we conducted a second study. In study 2, we replicated thedesign of study 1, substituting Whiteside and Lynam’s scale (2001) for the NEO-PIR.Although Whiteside and Lynam’s (2001) scale is new and less widely used, it wasdesigned specifically to assess urgency and lack of planning.

STUDY 2

Method

ParticipantsParticipants consisted of 101 women enrolled in introductory psychology classes at the

University of Kentucky. In this sample, 88% were identified as European American,7% were identified as African-American, and 5% were identified as belonging to otherethnic groups. Participants received course credit for their participation in the study.

MeasuresUPPS Impulsive Behavior Scale. The UPPS Impulsive Behavior Scale (Whiteside &

Lynam, 2001) was specifically developed to assess different constructs that have beentitled ‘‘impulsivity.’’ The scales representing Urgency and Premeditation were used inthis study. The former contains items that assess an individual’s tendency to act rashlywhen feeling distress. Internal consistency reliability in the current sample was 0.90. ThePremeditation scale contains items that assess an individual’s tendency to think aheadbefore action. In the current study, internal consistency reliability was 0.89.

The BULIT-R was used to assess bulimic symptoms.

ProcedureQuestionnaires were administered in a group format.

RESULTS

Sample Characteristics

In this sample, 8.9% of the women reported that they had been experiencing bingeeating episodes for the past 1 to 3 years, whereas 9.9% reported that they had beenexperiencing binge eating episodes for the last 3 years or more. In this sample, 3.0%reported that after binge eating, they attempted to lose weight by exercising, vomiting, orusing laxatives ‘‘a lot of the time,’’ whereas 6.9% indicated that they used these methodsafter binge eating ‘‘all of the time.’’ Women in this sample reported that in the last 3months, 6.9% had experienced a binge at least once per week, 6.9% at least twice perweek, and 5.9% more than twice per week. In addition, 2.0% of the sample reported thatthey induced vomiting two to three times per month, 1.0% of the sample reportedinducing vomiting at least once per week, and 2.0% of the sample reported inducingvomiting at least twice per week.

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Test of Hypotheses

To test our hypothesis that urgency, not premeditation, was positively related tobulimic symptoms, we calculated the correlation of these two traits with scores on theBULIT-R.

Our hypothesis was confirmed. Urgency was significantly and positively related tobulimic symptoms (r ¼ 0.45, p < 0.001), whereas premeditation was not significantlyrelated to bulimic symptoms (r ¼ �0.19, p > 0.05). The association between urgency andbulimic symptoms was significantly higher than the association between premeditationand bulimic symptoms (t ¼ 4.00, p < 0.01). As was the case with the NEO PIR scales, thetwo impulsivity measures were negatively correlated (r ¼ �0.51, p < 0.01).

DISCUSSION

Researchers have previously examined the trait of impulsivity and how it is related tosymptoms of bulimia nervosa. There have been mixed findings regarding the relation-ship of this trait to bulimic symptoms. We suggest that because of the relationship ofnegative affectivity to bulimic symptoms, impulsivity in how one copes with distressmay be a more useful trait to examine in bulimic women. We conducted two differentstudies to test this hypothesis. In study 1, we used proxy measures of urgency andpremeditation to assess these traits and found that urgency was positively associatedwith bulimic symptoms, whereas (lack of) planning was not. In study 2, we useda personality measure specifically designed to assess these constructs. In study 2 asin study 1, urgency, or the tendency to act rashly in the face of negative affect,was positively correlated with bulimic symptoms, whereas deliberation, or lack ofplanning, was unrelated to bulimic symptoms.

These two personality measures were negatively correlated in both studies, indicatingthat they share common variance. Our findings indicate that the variability they do notshare (i.e., what distinguishes urgency from lack of planning) seems to be the importantvariability for explaining bulimic symptom levels.

Although several of the women in the sample reported bulimic symptoms, a limitationof this study is that it was not conducted with a clinical sample. However, college womenare a high-risk group for eating disorders, and several women in the sample reportedsymptoms such as binge eating, vomiting, excessive exercise, and feeling out of controlwhen eating. A further limitation of the study is that the data are cross-sectional. Wecannot make the claim that urgency is a factor that leads to the development of bulimicsymptoms; future research will be needed to address this issue.

In sum, we found that urgency, the tendency to act rashly to cope with negative affect,was significantly associated with bulimic symptoms in two separate samples, using twomeasures of the construct. However, (lack of) premeditation was not. We suggest thatin future research regarding personality risk factors for the development of bulimianervosa, researchers examine the role of urgency, rather than lack of planning.

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