Short communicationBeyond alcohol and drug addiction. Does the negative trait of low distress tolerance have an association with overeating?☆
Highlights
► The link between low distress tolerance and drug addiction has been established. ► It is unknown if low tolerance is related to overeating, a food addiction factor. ► Low tolerance is linked to disinhibition and emotional and external overeating. ► Improving distress tolerance skills might lead to better weight loss treatment.
Introduction
Excess weight is clearly a serious problem in the U.S. as evidenced by the most recent combined estimate of overweight and obesity in adults at approximately 68% (Flegal, Carroll, Ogden, & Curtain, 2010). This preventable problem places people at higher risk of developing diseases such as type 2 diabetes and coronary artery disease (Kopelman, 2007). Overweight and obesity rates in the U.S. have grown immensely in a very short period of time, suggesting that genetic factors cannot explain these increases (Hill & Peters, 1998). Further, only approximately 20% of individuals are able to lose 10% of their weight through behavioral weight loss programs (e.g., low calorie diet, increased physical activity, and learning self-monitoring, assertiveness, and problem solving skills; Harvey-Berino et al., 2010) and maintain this loss for a minimum of one year (Wing & Phelan, 2005). Therefore, many people are not successful in losing weight and maintaining this loss for an extended period of time.
It is likely that a complex array of factors contribute to the development and maintenance of overweight and obesity. Unhealthy eating is one factor that has been under consideration for quite some time. Two unhealthy eating behaviors include overeating and dietary restraint. Overeating is the overconsumption of calories, which often come from refined foods high in fat and sugar (Corwin and Grigson, 2009, Ifland et al., 2009). Individuals high in restraint are focused on restricting calories as a method to manage their weight (Elfhag & Morey, 2008). Although restraint is linked to overeating (van Strien et al., 2007), there are likely other factors that are associated with overeating given how difficult it is to stop this behavior in order to lose weight or maintain weight loss. For example, snack foods that are high in sugar and fat are readily available, even in businesses that do not focus on selling food (Farley, Baker, Futrell, & Rice, 2009). Further, people have become accustomed to larger portion sizes in restaurants since the 1970s (Young & Nestle, 2002) and laboratory data support higher consumption when larger portion sizes are available (Rolls et al., 2002, Wansink et al., 2006).
In addition to restrained eating and the environmental factors just mentioned, another factor potentially associated with overeating is low distress tolerance, which is defined as one's inability to handle aversive emotional states (Simons & Gaher, 2005) and can be demonstrated by one's behavior during a stressful situation (e.g., less persistence on physical and psychological tasks; Leyro, Zvolensky, & Bernstein, 2010). Distress tolerance has been conceptualized as a “meta-emotion construct” and considered to be a trait rather than state (Simons & Gaher, 2005). According to Simons and Gaher (2005), people with low distress tolerance have the following characteristics. They are aware of the fact that they cannot tolerate feeling upset, and they feel that others are better equipped to cope with negative emotions. As a result, they are embarrassed about their inability to tolerate negative emotions. Given their perceived lack of coping abilities and inability to handle aversive psychological states, they work hard to avoid experiencing negative emotions. If avoidance is not possible, then they use unhealthy ways to try and remove the aversive emotional state. If this unhealthy solution does not work, then it is quite likely that all of their energy will be focused on their emotions and this will impair their functioning.
Distress tolerance has been studied primarily in individuals who are addicted to cigarettes, but it has also been examined in patients receiving residential treatment for substance abuse and dependence (e.g., alcohol, marijuana, crack/cocaine, or heroin). Distress tolerance has been measured most often by assessing persistence on both psychological and physical tasks. Specifically, individuals who terminate addiction treatment early or are unable to remain abstinent from a substance have less persistence on psychological (i.e., mirror tracing and arithmetic) and physical tasks (i.e., breath holding, carbon dioxide inhalation) as compared to individuals who can remain abstinent or complete treatment (Abrantes et al., 2008, Daughters et al., 2005, MacPherson et al., 2008). A self-report measure of distress tolerance has also been developed in order to provide quick and reliable assessment of one's view of the ability to handle aversive emotions (Simons & Gaher, 2005).
In addition to substances such as drugs, low distress tolerance may be relevant to the consumption of food, and in particular, the behavior of overeating. According to Gearhardt, Corbin, and Brownell (2009), there is evidence to support “food addiction”. One of the inherent difficulties surrounding this topic is that people need food to survive (Corwin & Grigson, 2009). Therefore, it has been suggested that some individuals are addicted to refined foods (Corwin and Grigson, 2009, Ifland et al., 2009). Ifland et al. (2009) provide compelling evidence for the “refined food addiction hypothesis” by demonstrating that over the past 40 years in the U.S., there have been parallel increases in refined food consumption and overweight and obesity. Additionally, empirical and observational studies with humans and empirical studies with non-humans (Ifland et al., 2009) have been put forth to support the idea that food addiction is the same as substance dependence as defined in the current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; APA, 2000). Interestingly, criterion 3 of the DSM-IV-TR appears to be consistent with overeating and states that “the substance is often taken in larger amounts or over a longer period than was intended” (APA, 2000). Given the significant link between low distress tolerance and addiction to cigarettes, alcohol, and illegal drugs, it is plausible that low distress tolerance could also be associated with overeating as it manifests in food addiction. Environmental factors can make it easy for individuals with low distress tolerance to overeat when faced negative emotions.
To our knowledge, no studies have focused on determining whether low distress tolerance, as conceptualized by Simons and Gaher (2005), is associated with overeating in a non-eating disorder patient sample, but a study conducted by Anestis, Selby, Fink, and Joiner (2007) focused on the relationship between distress tolerance and bulimia nervosa. Anestis et al. (2007) found a significant inverse relationship between distress tolerance and scores on the Bulimia subscale of the Eating Disorder Inventory, which measured “the degree to which individuals experience a loss of control while eating large quantities of food and then subsequently purge” (Anestis et al., 2007). This finding demonstrates that individuals with low distress tolerance can struggle with binge eating and purging behavior. Binge eating involves consuming a tremendous amount of food in a short period of time and is characterized by feelings of being out of control (APA, 2000). Although it is likely that most binge eaters would endorse overeating, it is not as likely that most individuals who report overeating would meet diagnostic criteria for binge eating (Stice, Telch, & Rizvi, 2000). Examining the relationship between overeating and low distress tolerance is a worthy area of study given the strong rate of relapse from dieting and the relative lack of understanding of the phenomenon. Therefore, in this study we aimed to determine whether low distress tolerance was significantly related to overeating in a sample of individuals not seeking treatment for an eating disorder. We hypothesized that emotional and external eating as measured by the Dutch Eating Behavior Questionnaire (DEBQ; van Strien, Frijters, Bergers, & Defares, 1986) and disinhibition as measured by the Three-Factor Eating Questionnaire (TFEQ; Stunkard & Messick, 1985) would be negatively associated with distress tolerance.
Section snippets
Participants
After receiving approval to conduct the study from the Human Subjects Institutional Review Board at the university of the first author, participants were recruited via a Psychology Department subject pool. Two hundred and thirty-three students participated in the study. Data from eight participants were excluded from analysis. Six participants had missing data which did not allow the opportunity to score one of the questionnaires administered during this study. One participant could not be
Results
The demographic characteristics of the final sample of 225 participants are displayed in Table 1. The participants’ ages ranged from 18 to 50, with a median age of 19. The sample had slightly more females than males. The participants were primarily Caucasian (82.3%), and 62.7% were in the normal weight BMI category (WHO Consultation on Obesity, 2000).
Table 2 displays the results of the linear regression models involving distress tolerance and the overeating variables. The results indicate that
Discussion
The goal of this study was to investigate whether there was a significant relationship between low distress tolerance and overeating. As expected, we found the lower the distress tolerance, the higher the scores on the emotional eating, external eating, and disinhibition scales. These findings suggest that individuals with low distress tolerance may use excessive food consumption to remove an aversive emotional state. It is also quite possible that excessive food consumption leads to low
References (33)
- et al.
Thoughts for food. Brain mechanisms and peripheral energy balance
Neuron
(2006) - et al.
The role of negative affect in risk for early lapse among low distress tolerance smokers
Addictive Behaviors
(2008) - et al.
Symposium overview. Food addiction. Fact or fiction?
Journal of Nutrition
(2009) - et al.
Personality traits and eating behavior in the obese. Poor self-control in emotional and external eating but personality assets in restrained eating
Eating Behaviors
(2008) - et al.
Preliminary validation of the Yale food addiction scale
Appetite
(2009) - et al.
Internet delivered behavioral obesity treatment
Preventive Medicine
(2010) - et al.
Refined food addiction. A classic substance use disorder
Medical Hypotheses
(2009) - et al.
Distress tolerance and pre-smoking treatment attrition. Examination of moderating relationships
Addictive Behaviors
(2008) - et al.
Portion size of food affects energy intake in normal-weight and overweight men and women
American Journal of Clinical Nutrition
(2002) - et al.
The three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger
Journal of Psychosomatic Research
(1985)
On the relationship between emotional and external eating behavior
Addictive Behaviors
Ice cream illusions. Bowls, spoons, and self-served portion sizes
American Journal of Preventive Medicine
Association of body mass with dietary restraint and disinhibition
Appetite
Long-term weight loss maintenance
American Journal of Clinical Nutrition
Diagnostic and statistical manual of mental disorders
The multifaceted role of distress tolerance in dysregulated eating behaviors
International Journal of Eating Disorders
Cited by (25)
Ability to tolerate distress moderates the indirect relationship between emotion regulation difficulties and loss-of-control over eating via affective lability
2021, Eating BehaviorsCitation Excerpt :The role of poor distress tolerance in LOCE as an isolated construct is currently under-represented, although low distress tolerance is implicated in problematic eating behavior. For example, emotional eating is associated with low distress tolerance (Kozak & Fought, 2011), as are bulimic symptoms including binge eating (Anestis et al., 2007; Corstorphine et al., 2007). Moreover, among gay and bisexual women LOCE is correlated with low distress tolerance both within and outside the context of binge eating (Bayer, 2014).
Registered Dietitian Nutritionists in Substance Use Disorder Treatment Centers
2018, Journal of the Academy of Nutrition and DieteticsBehavioural patterns in Mediterranean-style drinking: Generation Y preferences in alcoholic beverage consumption
2018, Journal of Behavioral and Experimental EconomicsAre overeating and food addiction related to distress tolerance? An examination of residents with obesity from a U.S. metropolitan area
2017, Obesity Research and Clinical PracticeCitation Excerpt :More recently, DT work has also been extended to eating behaviour. A study by Kozak and Fought [21] provided some initial support for a modified version of the Individual Difference Model [22], which proposes to explain how individual differences lead to a high vulnerability to stress-induced overeating. In the modified model, low DT is the high vulnerability component that leads to stress-induced overeating.
- ☆
We would like to thank the following individuals for assisting with data collection and data entry: Rachel Bocknek, Kimberly Bonk, Gerta Dume, Cody Kearse, Christine Nguyen, Jenna Steiner, and Baku Turdumambetova. We appreciate the comments given by Todd Shackelford, PhD on the revised version.