RESEARCH PAPER

Disturbed eating behaviours and associated psychographiccharacteristics of college studentsV. M. Quick* & C. Byrd-Bredbenner†

*Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Division of Epidemiology,

Statistics and Prevention Research, Bethesda, MD, USA

†Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ, USA

Keywords

body image, college students, disturbed eating,

psychographic characteristics.

Correspondence

V. M. Quick, Eunice Kennedy Shriver National

Institute of Child Health and Human

Development, National Institutes of Health,

Division of Epidemiology, Statistics and Prevention

Research, 6100 Executive Blvd., Rm 7B13E,

Bethesda, MD, USA.

Tel.: +1 301 435 6936

Fax: +1 301 402 2084

E-mail: gingermquick@gmail.com

How to cite this article

Quick V.M. & Byrd-Bredbenner C. (2013)

Disturbed eating behaviours and associated

psychographic characteristics of college students.

J. Hum. Nutr. Diet.

doi:10.1111/jhn.12060

Abstract

Background: Young adulthood is a stressful transition period that may

increase the risk for disturbed eating, especially for college students. The

present study aimed to explore disturbed eating behaviours and a broad

array of associated psychographic characteristics in a large, diverse sample

of college students.

Methods: College students (n = 2604; 58% white; 63% female) enrolled at

three large, public US universities in 2009 and 2010 were recruited to take

an online survey. The survey included reliable and valid disturbed eating

behaviour and associated psychographic characteristic measures.

Results: Many participants engaged in disturbed eating practices. For exam-

ple, one-quarter of women and one-fifth of men engaged in dietary

restraint. One in seven reported regularly binge eating. One-third used inap-

propriate compensatory behaviours (self-induced vomiting, medicine misuse

and excessive exercise) as a means for controlling weight and/or shape, with

the rate of these behaviours reaching clinically significant levels for 4%, 3%

and 5% of participants, respectively. Examination of psychographic charac-

teristics revealed that one-fifth had moderate levels of depression and anxi-

ety severity and almost half engaged in at least one obsessive–compulsive

disorder type behaviour. Females felt under more pressure to attain the

media physical appearance standard than males.

Conclusions: The findings of the present study suggest that nutrition educa-

tion interventions for college students may be needed to address disturbed

eating behaviours and to provide guidance on how to seek professional

help. The findings also suggest that it may be prudent for healthcare profes-

sionals to routinely screen college students for disturbed eating behaviours

and offer interventions early when treatment is likely to be most effective.

Introduction

Young adults who are college students face many challenges

as they navigate this transitional life stage. This period,

known as ‘emerging adulthood’, is characterised by self-

focus, identity exploration, and major changes in home life

and education/work situations (Arnett, 1997, 1998, 2001).

For most, young adulthood is marked by moving from

their family-of-origin home to independent living, trading

full-time education for full-time work, forming intimate

nonfamily relationships and becoming parents.

These changes are stressful and can impact health-

related behaviours negatively (Bell & Lee, 2006). For

example, emerging adults are at particularly high risk for

weight gain and disturbed eating behaviours (Lewis et al.,

2000; Hoek, 2006). Disturbed eating behaviours are

abnormal practices associated with eating disorders [e.g.

restraint, emotional, disinhibited, binge, and night eating;

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Journal of Human Nutrition and Dietetics ª 2013 The British Dietetic Association Ltd. 1

Journal of Human Nutrition and Dietetics

weight, shape, and eating concerns; strict dieting; and

controlling body weight and shape through inappropriate

compensatory behaviours (i.e. purging)] that, individu-

ally, do not warrant a psychiatric diagnosis of an eating

disorder, such as anorexia nervosa and bulimia nervosa,

which are clinically defined by DSM-IV (American Psy-

chiatric Association, 2000) criteria. Dietary practices,

sociocultural expectations, body image perceptions and

psychological characteristics may all affect the develop-

ment of disturbed eating behaviours (Striegel-Moore,

1997; Stice, 2002).

Dietary practices of young adults often fall short of rec-

ommendations (Dietary Guidelines for Americans, 2010;

National Cancer Institute, 2010). Intakes of many key

nutrients, including folic acid, calcium, potassium, fibre

and iron (for females), are less than recommended (Ervin

et al., 2004; Barley et al., 2010). By contrast to these defi-

cits, they are consuming excessive amounts of calories,

fat, cholesterol, sugar and sodium (Ervin et al., 2004;

Gunn et al., 2010). Young adults’ unbalanced dietary

intakes increase their risk for chronic disease (Higgins

et al., 1988; Dietz, 1998; Flegal et al., 2010). For women,

insufficient folic acid intake increases their risk of giving

birth to children with neural tube defects (McDowell

et al., 2008).

Sociocultural expectations heavily influence body

image perceptions in Western societies (Thompson et al.,

1999) by promoting a degree of thinness attainable by

few (Hesse-Biber et al., 2006). These expectations are

transmitted via media and exchanges with friends and

family. The pressure to avoid obesity and conform to

cultural or familial ‘standards’ for ‘beauty’ (i.e. thinness)

may prompt disturbed eating behaviours directly and/or

cause distorted body image perceptions (Thompson

et al., 1999; Holsten & Cashwell, 2000; Stice & Hoffman,

2004). Body image distortion is an inaccurate interna-

lised representation of one’s weight, shape and appear-

ance that can lead to body dissatisfaction (Thompson

et al., 1999).

The emotional stress of changes associated with emerg-

ing adulthood also increases the risk of psychological dis-

orders (Misra & McKean, 2000; Sacker & Cable, 2010).

The rates of depression, anxiety, and other mental disor-

ders among young people in the USA have risen steadily

over the last seven decades (Twenge et al., 2010). For

example, five to eight times as many college students

meet the criteria for diagnosis of major depression and/or

anxiety disorder compared to those a century ago, even

when controlling for changes in diagnostic criteria and

measures over the years (Twenge et al., 2010). Poor psy-

chological well-being also is common among individuals

with disturbed eating practices (Crow et al., 1996). For

example, as depression and anxiety severity increase, so

do disturbed eating practices, such as dietary restraint

(i.e. restricting one’s food intake) and disinhibited eating

(i.e. losing control over food intake), which can trigger

binge eating (i.e. eating a large amount of food in a rela-

tively short time and feeling out of control) and purging

(e.g. self-induced vomiting, misuse of laxatives, excessive

exercise) (Bulik, 2002). Similar associations have been

reported for individuals with obsessive–compulsive dis-

order (OCD) severity and eating disorders (Wonderlich,

2002).

Dichotomous thinking is another psychological charac-

teristic associated with disturbed eating behaviours.

Dichotomous thinking is a form of cognitive rigidity

where individuals see reality in polarised categories of

‘either-or’ rather than as a continuum of possibilities

(Byrne et al., 2008). That is, they think of food as being

either ‘good’ or ‘bad’. Individuals who set rigid dietary

‘rules’ are more likely to binge eat after any transgression

from these rules (Fairburn et al., 2003). Dichotomous

thinking is also a key factor in cognitive behavioural

models of eating disorders (Byrne et al., 2008).

Nutrition education has the potential to help young

adults develop and maintain healthy, rather than dis-

turbed, eating patterns. The most effective educational

interventions are targeted and tailored to specific audi-

ences (Maibach et al., 1996; Institute of Medicine, 2002;

Bernhardt, 2004). Our understanding of disturbed eating

practices and the many factors associated with these prac-

tices in young adults is limited because previous research

has defined disturbed eating behaviours narrowly,

explored a restricted array of characteristics related to dis-

turbed eating, focused on females and/or clinical groups,

and/or used instruments with modest reliabilities (Kashu-

beck-West et al., 2001; Fairburn & Brownell, 2002;

Ogden, 2003; Reas & Grilo, 2004; Mitchell & Peterson,

2005; Olmsted et al., 2007). The limitations of existing

research thereby hinder the development of nutrition

education interventions designed to help this age group

maintain nondisturbed eating patterns. The high rate and

exorbitant costs of treating those with disturbed eating

practices indicate that a more comprehensive understand-

ing of this audience is needed (Ma et al., 2003; McCor-

mick & Stone, 2007). Thus, the present study aimed to

describe a broad array of disturbed eating practices and

psychographic characteristics linked with disturbed eating

behaviours in a large, diverse sample of free-living young

adults who are college students and to compare differ-

ences between sexes.

Materials and methods

This cross-sectional research study was approved by the

Institutional Review Board at Rutgers University.

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2 Journal of Human Nutrition and Dietetics ª 2013 The British Dietetic Association Ltd.

Disturbed eating among college students V. M. Quick and C. Byrd-Bredbenner

Sample

Young adults, ages 18–26 years, enrolled in college were

recruited via verbal announcements, listservs, web post-

ings and flyers at three large US public universities from

2009 to 2010. In addition, university instructors of large

general education courses (e.g. psychology, health) were

invited to recruit students in their classes. Recruitment

materials indicated that the study involved spending

approximately 30 min completing an online survey and a

chance to win one of 10 cash prizes ($25). Participants

enrolled in courses taught by a participating professor

also were awarded a few bonus points for participation

and/or research participation credits that were required

by the course.

Instrument

The survey instrument had three sections. The first sec-

tion established the participant’s basic demographic char-

acteristics, such as age, sex and race/ethnicity. Self-report

height and weight data were used to calculate body mass

index (BMI; kg m�2).

The second section examined eating behaviours and

the third section investigated psychographic characteris-

tics associated with eating behaviours. The development

of these sections began with an extensive literature search

to identify a comprehensive array of salient eating behav-

iours and associated psychographic characteristics, as well

as existing valid, reliable, brief self-report measures

appropriate for assessing them in young adults. A panel

of experts (n = 9) in nutrition, eating disorder treatment,

psychology and public health reviewed the list of eating

behaviours and psychographic characteristics to ensure

their comprehensiveness and contextual value with regard

to the aims of the study. The panel also assisted with the

selection of existing scales for assessing eating behaviours

and psychographic characteristics. In addition to the

extant scales used in the present study, the experts recom-

mended creating a method for assessing body image

distortion. The final draft was reviewed by the panel of

experts for contextual value of each item in a scale, clar-

ity, fluidity, grammar, relevance to research purpose and

audience, and to establish content validity of the items

assessing each characteristic.

The contents of sections two and three are described

below. All scales in these sections were scored in accor-

dance with standard procedures established by the existing

scale creators (i.e. averaging all items in a scale), unless

otherwise indicated. In addition, higher scores indicate a

greater presence of the eating behaviour or psychographic

characteristics, unless otherwise indicated.

Disturbed eating behaviours

The second section of the survey examined eating behav-

iours using seven scales, four of which were from the

Eating Disorder Examination Questionnaire (EDE-Q), 6th

edition (Fairburn & Beglin, 1994; Mond et al., 2004; Fair-

burn et al., 2008). The EDE-Q Restraint scale measured

attempts to restrict food intake to influence body shape

and weight. The Eating Concerns scale measured preoccu-

pation with and feelings towards eating food. The EDE-Q

Binge Eating Disorder Module assessed frequency of

binge eating (i.e. eating an unusually large amount of

food accompanied by a sense of loss of control) and the

use of inappropriate compensatory behaviours as a means

for controlling shape or weight (Fairburn et al., 2008).

Inappropriate Compensatory Behaviour scale items were

scored from 0 to 6 based on the frequency the participant

engaged in the behaviours. Scoring took clinical signifi-

cance of the frequency of these behaviours into consider-

ation (i.e. self-induced vomiting, medicine misuse and

excessive exercise are considered clinically significant

when performed � 4, � 4, or >20 times in the past

28 days, respectively) (Luce et al., 2008; Lavender et al.,

2010). For self-induced vomiting and medication misuse

items, a score of 0 to 5 indicated zero to five occurrences

of the behaviour and 6 indicated engaging in the behav-

iour six or more times. For excessive exercise, a score of

0 indicated that no excessive exercise occurred; scores

between 1 and 6 equalled excessively exercising for 1–5,6–10, 11–15, 16–20, 21–25 or >25 times in the past

28 days, respectively. This coding was used for inappro-

priate compensatory behaviours because a score of four

indicated clinical significance and is just above the scale

mid-point, which also allowed for assignment of higher

scores reflecting more frequent occurrences (i.e. severity)

of the behaviour.

Emotional Eating and Disinhibited Eating were assessed

with Three Factor Eating Questionnaire-18 scales (Karls-

son et al., 2000). The Emotional Eating scale assessed

how emotions influence the urge to eat and the Disinhib-

ited Eating scale assessed the extent of loss of control over

eating (Karlsson et al., 2000). To lower participant bur-

den, the Disinhibited Eating scale was reduced to the

items with the strongest factor loadings reported

previously (Karlsson et al., 2000).

The Night Eating Questionnaire assessed night eating

syndrome using only items pertaining to individuals who

get up in the middle of the night and have cravings or

urges to eat (Allison et al., 2008). These items represent

the most salient features of night eating syndrome. Partic-

ipants were coded as a night eater if they got up in the

middle of night and ate � 50% of their daily food intake

after suppertime.

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Journal of Human Nutrition and Dietetics ª 2013 The British Dietetic Association Ltd. 3

V. M. Quick and C. Byrd-Bredbenner Disturbed eating among college students

Psychographic characteristics associated with eating

behaviours

The third section of the survey explored psychographic

characteristics associated with eating behaviours. Psycho-

graphic characteristics were grouped into three areas:

body image attributes, psychological characteristics and

sociocultural environment.

Body image attributes

Five scales were used to assess body image attributes. The

Weight Concerns scale from the EDE-Q (Fairburn & Beg-

lin, 1994; Mond et al., 2004; Fairburn et al., 2008) mea-

sured feelings about body weight. The EDE-Q (Fairburn

& Beglin, 1994; Mond et al., 2004; Fairburn et al., 2008)

Shape Concerns scale assessed feelings about body shape

and size.

The Self-Evaluative Salience and Motivational Salience

scales from the Appearance Schema Inventory-Revised

(Cash & Labarge, 1996) assessed the extent to which indi-

viduals define or measure themselves and their self-worth

by their physical appearance, as well as the extent to

which persons attend to their appearance and engage in

appearance management behaviours, respectively. These

two scales were reduced in length to reduce repetition

and participant burden.

Body Image Distortion was assessed by comparing actual

self-reported BMI weight category [i.e. underweight

(BMI < 18.5 kg m�2), normal weight (BMI = 18.5–24.9 kg m�2), overweight (BMI > 25 kg m�2), scored 1,

2 and 3, respectively] to perceived current body weight

(i.e. very thin/thin, average, slightly heavy/overweight,

scored 1, 2 and 3, respectively). Perceived current body

weight was assessed by asking participants, ‘How would

you describe your weight?’, with responses ranging from

very thin to overweight. A Body Image Distortion score

was derived by subtracting actual BMI weight category

score from perceived current body weight score. Scores

could range from �2 to 2. Scores close to zero indicate

accurate body image perception. Positive scores indicate

individuals perceive they are heavier than they actually are,

whereas negative values indicate that individuals perceive

they are thinner than they actually are.

Psychological characteristics

Psychological characteristics were assessed with five

scales. The Patient Health Questionnaire-8 measured the

frequency a person experienced each of the DSM-IV cri-

teria for depression (Spitzer et al., 1999; Kroenke et al.,

2001). The Generalized Anxiety Disorder scale assessed

severity of anxiety (e.g. feeling nervous, anxious or on

the edge) (Spitzer et al., 2006). The Florida Obsessive

Compulsive Inventory (Storch et al., 2007) was used to

assesses presence and severity of OCD symptoms. The

OCD score is calculated only for those who had OCD

symptoms.

Self-esteem was measured using items from the Rosen-

berg Self Esteem scale (Rosenberg, 1965) with the highest

factor loadings (Henkel, 1976). In addition, the original

Likert scale was increased from 4 to 5 points to provide a

broader array of answers and to make it more consistent

with other scales used in this study. Higher scores

indicate lower self-esteem.

The Dichotomous Eating subscale from the Dichoto-

mous Thinking in Eating Disorders Scale (Byrne et al.,

2008) assessed the presence of a rigid, ‘black-and-white’

cognitive thinking style. Scores were computed only for

those who reported dieting because this scale is not

applicable to those who do not diet.

Sociocultural environment

Sociocultural environment was evaluated using seven

scales that focused on media and family environments.

Three scales from the Sociocultural Attitudes Towards

Appearance Questionnaire (Thompson et al., 2004) mea-

sured media influences on body image. The Internaliza-

tion-General scale assessed the influence of media (e.g.

television, magazines) on body image. The Pressures-

Media scale measured perceived pressure from the media

on body image. The Information-Media scale evaluated

awareness of societal appearance norms conveyed by the

media. These scales were shortened to reduce repetition

or to better reflect current media used by young adults.

Retained items were those with highest factor loadings

reported by others (Thompson et al., 2004).

Family eating environment was assessed using Child-

hood Family Mealtime Questionnaire scales, which

assessed recollections of family mealtime experiences dur-

ing childhood (Miller et al., 1993). These scales were

reduced in length to improve their relevance to the target

audience. The Mealtime Communication-Based Stress

scale assessed stress felt during mealtimes as a child. The

Mealtime Structure scale assessed family mealtime pres-

sures as a child. The Appearance Weight Control scale

evaluated the importance of weight management as a

child. The Emphasis on Mother’s Weight scale assessed

the attention participants felt was given to their mothers’

weight during childhood.

Statistical analysis

Internal consistency scores (i.e. Cronbach-a) were calcu-

lated for all eating behaviour and psychographic charac-

teristic instruments. Descriptive statistics (e.g. mean, SD,

frequency) were generated for all demographic items,

eating behaviour measures and psychographic characteris-

tic scales by sex. To determine whether males differed

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4 Journal of Human Nutrition and Dietetics ª 2013 The British Dietetic Association Ltd.

Disturbed eating among college students V. M. Quick and C. Byrd-Bredbenner

significantly from females, independent sample t-tests

were conducted on all measures. P < 0.05 was considered

statistically significant. All analyses were conducted using

PASW STATISTICS, version 19.0 (SPSS Inc., Chicago, IL,

USA).

Results

A total of 2730 individuals completed the survey during

2009 and 2010. Participants who were not in the age

range of 18 to 26 years (n = 99), non-students (n = 21)

or those who omitted key demographic information (i.e.

height, weight or sex; n = 6) were eliminated from the

data analysis. Thus, the total sample size was 2604.

The majority of participants were female (63%) and

first- or second-year college students (64%). Participants

also were primarily white (58%) and Asian (21%). Black/

African Americans and Hispanics each represented

approximately 8% of participants with the remaining 5%

being from other racial/ethnic groups. Participant mean

(SD) age was 19.72 (1.53) years and mean (SD) BMI

was in the healthy range [23.34 (4.04) kg m�2; range

13–55 kg m�2], with few participants being underweight

(6%) or obese/morbidly obese (7%). Most participants

were at a healthy weight (68%) and approximately one-

fifth were overweight. Dieting behaviours were reported

by more than one-third (38%) of participants.

Cronbach-a internal consistency scores were computed

for the scales used to measure eating behaviours and psy-

chographic characteristics. Cronbach-a for all measure-

ments were good to excellent (i.e. range = 0.71 to 0.92)

(Table 1), except for the Inappropriate Compensatory

Behaviour scale (a = 0.51).

Disturbed eating behaviours

As shown in Table 1, mean Eating Concerns and

Restraint scale scores were low, indicating that partici-

pants did not have negative eating concerns and were

infrequently restricting food intake. However, females

scored significantly higher on both these scales than

males.

Specifically, 1.6% of females and 0.2% of males had

clinically significant Eating Concerns scores (i.e. mean

score � 4) that met eating disorder criteria. One-quarter

of women and one-fifth of men reported restricting

their food intake for � 8 h at least once in the past

28 days as a means of controlling their weight or shape.

In addition, almost one-quarter engaged in binge eating

in the past 28 days. Regular occurrences of binge eating

(i.e. � 4 binge eating episodes in the past 28 days) were

reported by approximately one in seven men and

women.

An examination of use of inappropriate compensatory

behaviours as a means for controlling weight and/or

shape indicated that 6% used self-induced vomiting in

the past 28 days, and 4% reporting a frequency that

reached clinically significant levels for meeting eating dis-

order criteria. Similarly, 6% misused medicine and 3%

had a misuse rate sufficiently high to be categorised as

clinically significant for meeting eating disorder criteria.

Excessive exercise was reported by almost one-third of

participants, with 5% reaching a clinically significant level

for meeting eating disorder criteria. Males and females

did not differ in their frequency of self-induced vomiting

or misusing medicine; however, males excessively exer-

cised significantly more than females.

Participants had moderate Emotional and Disinhibited

Eating scale scores. Females scored significantly higher on

the Emotional Eating scale, but there were no sex differ-

ences on the Disinhibited Eating scale.

Almost 2% of participants met the criteria to be classi-

fied as night eaters. Males had significantly higher night

eating scores than females.

Body image attributes

Although Shape Concerns and Weight Concerns scale

scores were low, 15% and 10% of participants had Shape

Concerns and Weight Concerns scores, respectively, that

were � 4 and are considered clinically significant for

meeting eating disorder criteria. Mean Self-Evaluative Sal-

ience and Motivational Salience scale scores were slightly

above the mid-point, indicating that appearance played a

moderate role in participants’ assessment of their self-

worth and that they did invest some resources in their

physical appearance. Compared with males, females had

significantly greater concerns about their shape and

weight, were more likely to base their self-worth on phys-

ical appearance, and placed a greater value on overall

appearance.

A comparison of actual and perceived BMI weight cate-

gory (i.e. Body Image Distortion) indicated that both

males and females perceived their weights somewhat

accurately. However, male participants were significantly

more likely than females to perceive themselves as being

lighter than their actual body weight.

Psychological characteristics

Mean scores indicated depression and anxiety were mild

for almost half of the participants, with females scoring sig-

nificantly higher on both these scales than males. Almost

half of participants (n = 1224) reported OCD-related

symptoms. Of these participants, OCD severity was low,

with no sex differences. Self-esteem mean scores were

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Journal of Human Nutrition and Dietetics ª 2013 The British Dietetic Association Ltd. 5

V. M. Quick and C. Byrd-Bredbenner Disturbed eating among college students

Table 1 Disturbed eating behaviours and associated psychographic characteristics of college students by sex

Measure (possible score range)*

Number of scale

items (Cronbach a)

All participants

(n = 2604),

mean (SD)

Female participants

(n = 1649),

mean (SD)

Male participants

(n = 955),

mean (SD)

Eating behaviours

Eating concerns‡ (0–6) 5 (0.80) 0.72 (1.01) 0.90 (1.11)†a 0.42 (0.72)

Restraint‡ (0–6) 5 (0.83) 1.22 (1.40) 1.36 (1.44)a 0.97 (1.27)

Binge eating‡ (0–6) 1 (n/a) 0.34 (0.86) 0.35 (0.88) 0.31 (0.82)

Inappropriate compensatory behaviours total‡ (0–6) 3 (0.51) 0.39 (0.86) 0.37 (0.86) 0.41 (0.88)

Self-induced vomiting (0–6) 1 (n/a) 0.25 (1.10) 0.28 (1.15) 0.20 (1.00)

Misuse of medicine (0-6) 1 (n/a) 0.24 (1.06) 0.24 (1.07) 0.24 (1.06)

Excessive exercise (0–6) 1 (n/a) 0.67 (1.33) 0.62 (1.25)c 0.76 (1.46)

Emotional eating§ (1–4) 3 (0.84) 2.01 (0.77) 2.17 (0.77)a 1.74 (0.69)

Disinhibited eating§ (1–4) 3 (0.74) 2.17 (0.68) 2.18 (0.68) 2.15 (0.68)

Night-time eating¶ (0–30) 6 (0.76) 2.05 (5.23) 1.82 (4.94)b 2.42 (5.69)

Psychographic characteristics associated with disturbed eating

Body image attributes

Shape concerns‡ (0–6) 8 (0.91) 2.02 (1.62 2.40 (1.64a 1.38 (1.36)

Weight concerns‡ (0–6) 5 (0.85) 1.66 (1.53) 1.99 (1.61)a 1.09 (1.19)

Self-evaluative salience** (1–5) 8 (0.85) 3.25 (0.75) 3.35 (0.73)a 3.07 (0.74)

Motivational salience** (1–5) 4 (0.71) 3.62 (0.70) 3.69 (0.67)a 3.49 (0.72)

Body image distortion†† (-2–2) 1 (n/a) �0.19 (0.57) �0.09 (0.54)a �0.37 (0.57)

Psychological characteristics

Depression severity‡‡ (0–24) 8 (0.87) 5.78 (4.92) 6.10 (4.98)a 5.21 (4.78)

Anxiety severity§§ (0–21) 7 (0.90) 5.71 (4.89) 6.25 (4.99)a 4.79 (4.57)

Obessive compulsive disorder¶¶ (0–20) 5 (0.91) 5.56 (3.40) 5.70 (3.40) 5.31 (3.40)

Self-esteem*** (1–5) 4 (0.85) 2.29 (0.90) 2.36 (0.89)a 2.16 (0.90)

Dichotomous eating scale††† (1–5) 4 (0.73) 2.88 (0.61) 2.95 (0.59)a 2.72 (0.64)

Sociocultural environment media‡‡‡

Pressures-Media (1–5) 4 (0.88) 3.09 (1.06) 3.39 (1.02)a 2.57 (0.92)

Internalisation-General (1–5) 1 (n/a) 3.01 (1.22) 3.221 (1.19)a 2.65 (1.18)

Information-Media (1–5) 4 (0.87) 2.91 (0.93) 3.05 (0.92)a 2.67 (0.91)

Family§§§

Mealtime communication-based stress (1–5) 5 (0.73) 1.67 (0.63) 1.62 (0.63)a 1.75 (0.64)

Mealtime structure (1–5) 3 (0.81) 3.29 (1.06) 3.20 (1.10)a 3.45 (0.98)

Appearance weight control (1–5) 5 (0.86) 1.98 (0.92) 2.05 (0.97)a 1.87 (0.81)

Emphasis on mother’s weight (1–5) 3 (0.72) 2.01 (0.88) 2.04 (0.91) 1.98 (0.82)

*Higher scores indicate a greater presence of the eating behaviour or psychographic characteristic, except for Self-Esteem, where higher scores

indicate lower self-esteem.†Mean scores for females are significantly different than males as determined by independent sample t-tests: aP � 0.001, bP < 0.01, cP = 0.05.‡Eating Disorders Examination Questionnaire-6th edition, seven-point frequency of past 28 days scales.§Three Factor Eating-Questionnaire, four-point Likert scale (definitely false to definitely true).¶Night Eating Questionnaire, five-point semantic Likert scale (never to always).**Appearance Schema Inventory-Revised, five-point Likert scale (strongly disagree to strongly agree).††Body Image Distortion = Perceived body weight score (i.e. very thin/thin, average, slightly heavy/overweight) minus actual body mass index cate-

gory (i.e. underweight, normal weight, overweight/obese). Means closer to zero indicate body weight is perceived accurately; positive values indi-

cate weight is perceived as heavier than actual; negative values indicate weight is perceived as lower than actual.‡‡Patient Health Questionnaire-8, four-point Likert scale (not at all to almost every day), score ranges from no depressive symptoms to moderately

severe depressive symptoms.§§Generalized Anxiety Disorder-7, four-point Likert scale (not at all to almost every day), score ranges from no/minimal to severe anxiety.¶¶Florida Obsessive Compulsive Inventory, 5-point semantic Likert scale (i.e. no to extreme avoidance); n = 1224 (n = 819 female; n = 405 male)

includes only participants who reported obsessive compulsive type behaviours.

***Rosenberg Self-Esteem, five-point Likert scale (strongly disagree to strongly agree); higher scores indicate lower self-esteem.†††Dichotomous Thinking in Eating Disorders Scale, four-point Likert scale (definitely false to definitely true); n = 979 (n = 700 female; n = 279

male) includes only participants who reported dieting.‡‡‡Sociocultural Attitudes Towards Appearance Questionnaire, five-point Likert scale (strongly disagree to strongly agree).§§§Childhood Family Mealtime Questionnaire, five-point Likert scale (never to always).

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6 Journal of Human Nutrition and Dietetics ª 2013 The British Dietetic Association Ltd.

Disturbed eating among college students V. M. Quick and C. Byrd-Bredbenner

below the score range mid-point, indicating high levels of

self-esteem. Females had significantly lower self-esteem

than males. Dichotomous Thinking mean scores were

significantly higher in female dieters than male dieters.

Sociocultural environment

Pressures-Media, Internalization-General, and Informa-

tion-Media mean scale scores were slightly above the

mid-point, indicating that participants neither agreed,

nor disagreed that they felt pressure to attain the media

‘thin ideal’. However, females scored significantly higher

on all of these scales than males, indicating that they felt

more pressure to attain the media physical appearance

standard, were more aware of societal appearance norms

set by the media, and more frequently compared their

bodies with those in the media.

Participants recalled little mealtime communication-

based stress, importance placed on weight management,

and did not recall much emphasis being placed on their

mothers’ weight. However, most participants reported

sometimes feeling pressure during meals as a child. Males

reported significantly greater mealtime communication-

based stress and mealtime pressure than females. Con-

versely, females had significantly higher Appearance

Weight Control mean scores than males, indicating that

they recalled a greater importance placed on weight

management.

Discussion

The present study indicates that college students engage

in a variety of disturbed eating behaviours, similar to pre-

vious studies (Luce et al., 2008; Lavender et al., 2010).

Restraint, Eating Concerns, and Binge Eating findings are

comparable to normative data for this audience (Luce

et al., 2008; Lavender et al., 2010); however, regular

occurrences of binge eating (i.e. � 4 times in the past

28 days) in women were double the rate previously

reported (Luce et al., 2008). This finding may indicate

that binge eating prevalence is increasing or was

previously under-reported.

The finding that one-third of participants engaged in

inappropriate compensatory behaviours as a means for

controlling weight and/or shape is troubling. Although

the rate of regular occurrences of self-induced vomiting

in males was comparable to normative data for male col-

lege students, medicine misuse by males was three times

higher than previously reported (Lavender et al., 2010).

This higher rate of medicine misuse could reflect the

more inclusive nature of medicines considered in the

present study (i.e. laxatives, diuretics, insulin), an increase

in medicine misuse for weight control purposes, and/or a

greater willingness to report this behaviour in a confiden-

tial online survey.

By contrast to the higher rate of self-induced vomiting

and medicine misuse by young adult college females

versus males reported by others (Neumark-Sztainer et al.,

2002; Luce et al., 2008), these sex differences did not

emerge in the present study. The similarity between the

sexes may be because the sample in the present study

was much more racially/ethnically diverse than previous

studies, and certain racial groups (e.g. Asian women)

have a lower incidence of unhealthy weight control

behaviours (Mintz & Kashubeck, 1999; Regan & Cach-

elin, 2006). In addition, this similarity could indicate that

males are increasing their use of inappropriate compen-

satory behaviours and/or were more willing to reveal this

information.

The significantly higher rates of excessive exercise

reported by men may illustrate the dual nature of the

male body ideal: low body fat and high muscularity (Lav-

ender et al., 2010). Thus, for males, excessive exercise

may be a muscle-gaining behaviour rather than an inap-

propriate compensatory behaviour (McElhone et al.,

1999). Future research should clarify why excessive exer-

cise is used by males to a greater extent than females.

Body image attributes are important to consider

because they can affect eating behaviours (Heinberg,

1996; Hesse-Biber et al., 2006). The present study lends

support to others (Luce et al., 2008; Lavender et al.,

2010) in that females, compared to males, put greater

emphasis on defining their self-worth and value by their

physical appearance (Cash & Labarge, 1996; Thompson

et al., 2004; Karazsia & Crowther, 2008) and had greater

shape and weight concerns (Luce et al., 2008; Lavender

et al., 2010). The more intense feelings of cultural pres-

sures to be thin typically reported by females (Brown &

Dittmar, 2005) may explain their greater weight and

shape concerns.

Anxiety, depression, and OCD findings confirm that

substantial numbers of young adults suffer from these

psychological problems (Horwath & Weissman, 2000;

Robins et al., 2001; Eisenberg et al., 2007; Mulfinger,

2007; Byrne et al., 2008). Fortunately, these problems are

mild for most, although one in five had moderate levels

of depression and anxiety severity and almost half

engaged in at least one OCD behaviour. The finding that

males had higher self-esteem than females reveals that

sex-specific self-esteem differences reported for children

and teens extend into young adulthood (Raevuori et al.,

2007). Women’s self-esteem continues to lag behind men

after transitioning from adolescence to young adulthood

(Block & Robins, 1993).

Although dichotomous thinking is a key factor in cog-

nitive behavioural models of eating disorders (Byrne

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Journal of Human Nutrition and Dietetics ª 2013 The British Dietetic Association Ltd. 7

V. M. Quick and C. Byrd-Bredbenner Disturbed eating among college students

et al., 2008), studies of this characteristic have been lim-

ited to female adults diagnosed with an eating disorder

and non-eating disordered overweight/obese women

(Byrne et al., 2008). As expected, this form of cognitive

rigidity was lower in both male and female participants

than that reported for females with an eating disorder

(Byrne et al., 2008), although it was similar to over-

weight/obese women. Given males’ lower eating concerns,

it was not unexpected that they were less likely to think

of food as being either ‘good’ or ‘bad’ than females.

The sociocultural environment can be a powerful influ-

encer of eating behaviours and body image (Heinberg,

1996; Worobey, 2002). Consistent with the literature

(Ogden & Mundray, 1996; Holmstrom, 2004), men felt

less pressure from the media environment to live up to

an unrealistic, media-defined body type. This may be

because media targets women and bombards them with

messages to be thin. For example, magazines targeted to

men have one-tenth as many advertisements focusing on

body weight and dieting as women’s magazines (Malkin

et al., 1999; Andersen, 2002). Although published

research with males could not be located, family eating

environment findings are similar to those reported for

undergraduate females (Worobey, 2002). The findings of

the present study suggest that both males and females

recollect childhood mealtime experiences as being not

especially stressful.

The congruence of many findings with previous research

is important given that participants were much more

racially/ethnically diverse (i.e. reflective of the proportion

of white versus non-white young adult population in the

USA) (Erkolahti et al., 2003) than the vast majority of

studies exploring similar constructs. Accordingly, the find-

ings suggest that the eating behaviours and related psycho-

graphic characteristics studied may not be bound by race/

ethnicity but perhaps reflect this newly-recognised devel-

opmental stage of emerging adulthood (Arnett, 2001).

The value of a study must be balanced by its strengths

and weaknesses. To date, the present study comprises the

most comprehensive assessment of disturbed eating

behaviours and associated psychographic characteristics in

young adults. In addition, the findings obtained in the

present study help to overcome many of the limitations

of previous studies that investigated disturbed eating

practices and associated psychographic characteristics in

this age group (Kashubeck-West et al., 2001; Fairburn &

Brownell, 2002; Ogden, 2003; Reas & Grilo, 2004; Mitch-

ell & Peterson, 2005; Olmsted et al., 2007). First, the

present study defined disturbed eating behaviours broadly

and explored a wide array of salient associated psycho-

graphic characteristics. Second, the sample was large and

included racially/ethnically diverse, free-living male and

female young adults. Third, instrument selection was

guided by a panel of experts and resulted in a survey

comprised of valid, reliable, audience-appropriate scales.

The care taken to reduce the length of many of the scales

used resulted in scales having good reliability, comparable

to their original full length scales. These shortened scales

can help future researchers reliably measure study attri-

butes with lower participant burden. In addition, the

present study demonstrated the utility of some of these

scales with new audiences (e.g. no previously published

studies could be located that used the Dichotomous

Thinking or Childhood Family Mealtime Questionnaire

with men). Online administration of the survey instru-

ment also can be considered a study strength. This

administration method made it easy, convenient and con-

fidential for young adults to participate and yielded valu-

able data and, perhaps, more accurate responses to

sensitive questions.

Despite the many strengths of the present study, it is

important to take into account its limitations. The

cross-sectional nature of the present study limits the

assignment of temporality to the findings; however, these

findings are very useful for hypothesis generating research

and provide the basis for more prospective designs.

Another limitation was the use of a convenience sample

recruited from only three universities; therefore, results

may not be generalisable to the young adult population

as a whole and to all racial/ethnic groups.

Future studies should aim to examine disturbed eating

behaviour risk and associated psychographic characteris-

tics in a large sample of youth who are followed over

time (prospectively) to determine how disturbed eating

behaviours are initiated in the years leading up to young

adulthood. A better understanding of the factors that

promote and impede disturbed eating behaviours can

inform the development of much needed interventions

that help this age group develop health-protective eating

behaviours that will benefit them throughout adulthood.

Conclusions

The present study reveals that many college students

engage in disturbed eating practices, and the rates for

binge eating in females and inappropriate compensatory

behaviours in males may be higher than previously

assumed. Thus, these findings suggest that nutrition edu-

cation interventions for college student audiences should

address disturbed eating behaviours and provide guidance

on how to seek professional help for them. The findings

of the present study also suggest that it may be prudent

for healthcare professionals to routinely screen college

students for disturbed eating behaviours and intervene

early when treatment is likely to be most effective

(DeSocio et al., 2007). In the long term, screenings and

ª 2013 The Authors

8 Journal of Human Nutrition and Dietetics ª 2013 The British Dietetic Association Ltd.

Disturbed eating among college students V. M. Quick and C. Byrd-Bredbenner

interventions could decrease the rate and/or severity of

disturbed eating behaviours and reduce associated medi-

cal complications, ultimately increasing the quality of life

for college students.

Acknowledgments

Virginia Quick conducted this study when at Rutgers

University.

Conflicts of interest, sources of funding andauthorship

The authors declare that there are no conflicts of interest.

This study was supported by a Kappa Omicron Nu

Research Fellowship.

VQ implemented the study, analysed the data and wrote

the manuscript. CB-B helped with the interpretation of

the data, as well as the writing and reviewing of the

manuscript. All authors critically reviewed the manu-

script and approved the final version submitted for

publication.

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