BEHAVIORTHERAPY29, 491-503, 1998

The Effects of Caloric Deprivation and Negative Affect on

Binge Eating in Obese Binge-Eating Disordered Women
W. STEWART AGRAS

CHRISTY F. TELCH
Stanford University

Sixty obese women meeting Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV; American Psychiatric Association, 1994) research criteria for binge-eating
disorder were randomly allocated either to a 14-hour period of caloric deprivation or
to no deprivation. These women were then randomized within each deprivation con-
dition to an induced negative or neutral mood before being served a multi-item
buffet. Negative mood, but not caloric deprivation, significantly increased loss of
control over eating. For self-defined binges, negative mood, but not caloric depriva-
tion, significantly increased the occurrence of binge eating. However, for investigator-
defined binges, both deprivation and negative mood increased the occurrence of
binge eating. Caloric deprivation also led participants to eat significantly more
during the buffet, but not over the laboratory day. Fat intake was significantly higher
in both self-defined and investigator-defined binges as compared to overeating epi-
sodes. For those in the negative mood condition, anxiety had significantly declined
by the end of the buffet.

The experimental identification of variables that lead to binge eating is im-

portant to extend both our understanding and the treatment of the eating dis-
orders. In the study reported here, we investigated two factors hypothesized
to influence binge eating, namely, acute caloric deprivation and negative
mood, in women meeting Diagnostic and Statistical Manual of Mental Dis-
orders (DSM-IV; American Psychiatric Association, 1994) research criteria
for binge-eating disorder (BED). Despite the fact that binge eating in the
obese was first described in the literature over 30 years ago (Stunkard, 1959),
the diagnostic criteria for the disorder have only recently been clarified
(American Psychiatric Association). The disorder affects nearly 2%
of the female population (Bruce & Agras, 1992; Spitzer et al., 1992). BED
is often accompanied by overweight. Some 8% of obese women in the com-

This research was supported by grant #MH50271 from the National Institutes of Health.
Correspondence concerning this article should be addressed to W. Stewart Agras, Depart-
ment of Psychiatry, Room 1326, Stanford University School of Medicine, 401 Quarry Road,
Stanford, CA 94305-5542.

491 0005-7894/98/0491-050351.00/0
Copyright 1998 by Associationfor Advancementof BehaviorTherapy
All rights of reproduction in any form reserved.
492 AGRAS & TELCH

munity may have this disorder (Bruce & Agras), and because the disorder
is more frequent as the level of obesity increases (Telch, Agras, & Rossiter,
1988), between 25% and 35% of individuals in weight-loss programs are diag-
nosed as having BED (Marcus, Wing, & Lamparski, 1985; Spitzer et al.,
1992; Telch et al., 1988). Because of the association with overweight and
obesity, such individuals are more likely to have Type II diabetes mellitus,
essential hypertension, hyperlipidemia, and other complications of obesity.
In addition, BED is accompanied by high levels of comorbid psychopathol-
ogy, including major depression, anxiety disorders, and personality disorder
(Marcus et al., 1990; Yanovski, Nelson, Dubbert, & Spitzer, 1993). Hence,
BED is a chronic, prevalent condition associated with many health and
mental health problems.
This study aimed to clarify the role of two factors that may trigger binge
eating. The first of these is a period of caloric deprivation. Self-monitoring
records demonstrate relatively long periods between eating episodes in BED,
similar to bulimia nervosa (Rosen, Leitenberg, Fisher, & Khazam, 1986; Ros-
siter, Agras, Telch, & Bruce, 1992). One of the effective procedures used
in cognitive-behavioral therapy to treat both bulimia nervosa (BN) and BED
(Agras et al., 1992; Fairburn, Jones, & Peveler, 1991; Telch, Agras, Rossiter,
Wilfley, & Kenardy, 1990) is to remedy acute caloric deprivation by estab-
lishing a regular meal schedule and shortening the intervals between eating
episodes. This appears to decrease the frequency of binge eating. Hence, it
might be expected that a long period of caloric deprivation would lead to
binge eating in BED as compared to no deprivation.
In a recent experimental study examining the effect of caloric deprivation
versus no deprivation in participants with BN, BED, and weight matched con-
trols, those in the deprivation groups ate more calories at a multi-item buffet
than those with no caloric deprivation. However, there were no differences
in caloric intake between diagnostic groups, nor was there a difference
between deprivation groups when total calories consumed over the entire lab-
oratory day were analyzed. No differences were found in the frequency of
binge eating following either deprivation period, although few participants
binged in this experiment (Telch & Agras, 1996a). It is possible, however,
that the 6-hour period of deprivation used in this study was not long enough
to provoke binge eating.
A second factor triggering binge eating is thought to be negative mood.
Studies with college women who restrain their eating find that negative
moods, induced by stimuli such as movie clips, lead to overeating (Schotte,
Cools, & McNally, 1990). In addition, self-monitoring studies in patients
with BN and BED have generally shown that negative moods tend to occur
before binge eating (Abraham & Beumont, 1982; Arnow, Kenardy, & Agras,
1992; Davis, Freeman, & Garner, 1988). In a previous laboratory study, how-
ever, neither patients with BED nor weight-matched non-eating disordered
individuals increased their caloric intake at a buffet following induction of
a negative mood (Telch & Agras, 1996b). Negative mood, however, was sig-
 FACTORS INFLUENCING BINGE EATING 493

nificantly correlated with loss of control over eating and with labeling an
eating episode as a binge.
Consumption of food during a binge is also thought to reduce negative
mood states, hence reinforcing and maintaining binge eating. Both biological
and psychological theories hypothesize that binge eating serves to reduce
negative affect (Christensen, 1993; Heatherton & Baumeister, 1991). In fact,
in a laboratory study of patients with BN, Kaye and his colleagues found that
negative mood was reduced during the course of a binge, with anxiety being
reduced more effectively than depression (Kaye, Gwirtsman, George, Weiss,
& Jimerson, 1986).
The purpose of the present study was to extend our previous research
regarding the influences of caloric deprivation and negative mood on caloric
consumption, loss of control, and binge eating in women with BED. In an
earlier study (Telch & Agras, 1996a), we observed no effect of a 6-hour
period of deprivation, hence we more closely mimicked the patterns of eating-
disordered individuals by extending the deprivation period in the present
study to a minimum of 14 hours. We hypothesized that (a) the longer depriva-
tion period and induced negative mood would both lead to larger increases
in calories consumed at the buffet, and over the laboratory day, compared
with no deprivation and the neutral mood conditions. We also predicted (b)
an interaction between negative mood and caloric deprivation such that this
condition would lead to a significantly larger increase in caloric intake com-
pared with the remaining groups, and (c) to a greater tendency to binge eat
at the buffet compared with the remaining groups. Finally, (d) we expected
negative mood to diminish specifically as a result of binge eating; that is,
negative mood would decrease more for those who binged than for those
who did not.

Method
Participants
Sixty participants who responded to advertisements for women with binge-
eating problems to take part in a laboratory study of eating, and who received
a $150.00 payment for their participation, were enrolled in this study. All par-
ticipants met DSM-IV research criteria for BED. Exclusionary criteria
included: (a) a current physical or medical condition that may affect eating
behavior (e.g., cancer, pregnancy), (b) use of medication known to affect
eating (e.g., appetite suppressants; participants who were stable on an anti-
depressant for more than one month were permitted in the study), (c) current
bulimia nervosa or anorexia nervosa, and (d) current psychiatric symptom-
atology that would preclude study participation (e.g., serious suicidal idea-
tion or psychosis).
The mean age of the participants was 42.7 (SD = 9.9), their body mass
index (BMI) averaged 36.2 (SD = 8.4), and they reported binge eating on
an average of 3.4 (SD = 1.3) days per week. Ninety-three percent of the par-
494 AGRAS & T E L C H

ticipants had attended college, and 10% were ethnic minorities (2% Black,
8% Hispanic).
Design and Procedures
Three hundred and eight women who responded to advertisements for the
study were screened by means of a brief telephone interview to determine
their initial eligibility. Of these, 195 were excluded. The most frequent rea-
sons for exclusion were not meeting diagnostic criteria (i.e., not binge eating
with sufficient frequency or the use of self-inducing vomiting) or not being
interested in participating. The remaining 113 respondents were invited to a
formal screening interview and informed that the study involved attending
the laboratory on three occasions. At the first screening visit, informed con-
sent was obtained after the procedures had been fully explained. The ratio-
nale given to potential participants for the study was that we were interested
in the effects of hunger and mood on food selection, taste of the food, and
the experience of eating. The Questionnaire on Eating and Weight Patterns
(QEWP), which contains individual items that target the DSM-IV BED diag-
nostic criteria (Spitzer et al., 1992), was then administered, followed by a
semistructured diagnostic interview. This interview first expanded on the
responses to the QEWP, obtaining specific information regarding eating,
dieting, and binge eating. In addition, a comprehensive history of past mental
health problems and present physical problems was elicited, including
specific questions regarding inclusion and exclusion criteria.
Of the 113 potential participants who were scheduled for a screening visit,
19 did not attend the appointment and 28 were excluded either for not
meeting diagnostic criteria for BED, or for meeting one of the exclusion cri-
teria. After determining their eligibility for the study, the 66 remaining par-
ticipants completed the Beck Depression Inventory (Beck, Ward, Mendel-
sohn, Mock, & Erbaugh, 1961), the Three Factor Eating Questionnaire
(Stunkard & Messick, 1985), which assesses hunger, dietary restraint, and
disinhibition of eating, and the Binge Eating Scale (Gormally, Black, Daston,
& Rardin, 1982), which measures the severity of binge eating. Height and
weight measurements were obtained, and participants were instructed to
record all food and beverage intake on study monitoring forms for the 24
hours preceding the experimental day and to refrain from all eating and
drinking (with the exception of water) after the midnight before attending the
laboratory experiment.
The experiment was conducted during the second visit. Six participants
canceled or did not arrive for their laboratory session. Each participant was
scheduled for an individual session that began at 7:45 a.m. Upon arrival, the
research assistant checked each participant's food diary and questioned her
to ensure that nothing had been eaten since midnight. The first variable
manipulated was length of caloric deprivation. Participants were randomly
allocated either to eat nothing prior to a buffet served at 2:30 p.m. (minimum
14 hours deprivation) or to eat a standard breakfast served at 8:00 a.m. and
 FACTORS INFLUENCING BINGE EATING 495

a standard lunch served at noon (2 hours deprivation). Participants in the no-

deprivation condition were told, "You will now be served a modest, low-fat
breakfast. As a reminder, it is required for the study that you eat all of
the food served to you: Breakfast consisted of ¾ cup cereal (Special K,
Cheerios, or Rice Crispies) with skim milk, fruit (melon, apple, orange, or
~,~ banana), decaffeinated tea or coffee, and a bread roll with 1 teaspoon of
margarine. Lunch, given with the same instructions as for breakfast, con-
sisted of a sandwich (turkey, roast beef, or cheese with mayonnaise), fruit
(apple, orange, or melon), small salad (lettuce, tomato with oil and vinegar
dressing), and decaffeinated beverage. The women remained under observa-
tion and were not allowed to eat or drink anything except the experimental
meals and water during the entire experimental day. When they were not
engaged in specific laboratory activities, they were allowed to read, sew, knit,
or watch television.
The second variable manipulated was mood. Within each of the caloric
deprivation conditions, participants were randomly allocated to either a neu-
tral or a negative mood induction. This induction followed the procedure
described by Wright and Mischel (1982), which has been found to evoke var-
ious affective states through the generation of vivid imagery. The tape-
recorded induction (presented at 2:15 p.m.) guided participants through the
generation of vivid negative or neutral imagery. The negative induction con-
tained the instructions, "Bring to mind a past situation or event that resulted
in your experiencing extremely negative feelings. Imagine the situation as
vividly as you can. Picture the events happening to you. See all the details
of the situation. Think the thoughts you actually thought. Feel the same neg-
ative feelings. Let yourself react as if you were actually there." The neutral
induction involved similar instructions except that participants were asked to
bring to mind a neutral event or situation such as running an errand or doing
some routine activity. In both the negative and neutral conditions, participants
imagined scenes and events specific to their own recent experiences. The
women were given 15 minutes to generate the imagery and associated mood.
Following the mood induction, participants were seated at the buffet. The
food items, food arrangement, and instructions at the multi-item buffet were
based on the laboratory procedures described by Kissileff and his colleagues
(Kissileff, Walsh, Kral, & Cassidy, 1986), with the addition of some new
food items (e.g., glazed doughnuts, pizza, M&Ms). The multi-item buffet
contained typical binge and non-binge foods and totaled 22,192 kcal. Partici-
pants were instructed to "feel free to let yourself go and eat as much as you
want, there's no time limit" The caloric and macronutrient composition of
the foods consumed were calculated by weighing the food items comprising
the buffet before and after the eating episode and calculating the number of
calories and percentages of fat, protein, and carbohydrates consumed.
Mood was assessed by the Multiple Affect Adjective Checklist (MAACL;
Zuckerman & Lubin, 1965), administered (a) prior to the taped mood induc-
tion manipulation, (b) immediately following the taped mood induction, and
496 AGRAS & T E L C H

(c) immediately following the multi-item buffet. Three scale scores were
derived from the MAACL: (a) total affect (with scores from 0 to 63), (b)
anxiety (0 to 21), and (c) depression (0 to 21). A higher score denotes a more
negative affective state. After the buffet, participants rated their degree of loss
of control over eating using a 9-point Likert scale (0 = completely out of
control, 9 = completely in control). They were also asked to classify the
buffet-eating episode as a binge, overeating, a meal, or a snack.
Statistical Analysis
Because BMI was significantly correlated with calories eaten at the buffet
(r = 0.40, p < 0.05) and during the laboratory day (r = 0.30, p < 0.05), an
ANCOVA was used for analyses of calories consumed, controlling for the
baseline value of BMI. No other correlations between the baseline variables
shown in Table 1 and caloric intake were significant, nor were there any sig-
nificant relationships between these variables and loss of control or mood.
Hence, an ANOVA was used for the analysis of loss of control. Mood changes
were analyzed with a repeated measures multivariate analysis followed by
post-hoc testing of significance for the anxiety and depression scales where
appropriate. Percentages were analyzed using the chi-square statistic.

Results
Mood Induction Manipulation Check
Prior to the mood induction, there were no significant differences on the
overall scale of the MAACL among the four experimental groups. A repeated
measures MANOVA (negative mood induction versus neutral mood induc-
tion x pre- versus postinduction), using the scales of the MAACL as depen-
dent variables, showed that following the mood induction, those in the nega-

TABLE 1
BASELINE CHARACTERISTICS OF THE PARTICIPANTS ( N = 60)
AND CORRELATIONS WITH CALORIC INTAKE DURING THE BUFFET

Correlation with
Variable Mean SD caloric intake

Age (Years) 42.7 9.9 -0.14

Body Mass Index 36.2 8.4 0.40*
Binge days per week 3.4 1.3 -0.15
Beck Depression Inventory 14.0 8.3 0.00
Binge Eating Scale 29.7 7.3 0.18
TFEQ-Hunger 10.0 3.0 0.31
TFEQ-Restraint 7.5 4.4 -0.04
TFEQ-Disinhibition 13.5 2.0 0.24

Note. TFEQ = Three Factor Eating Questionnaire.

* p < .05 after Bonferonni correction for multiple correlations.
 FACTORS I N F L U E N C I N G BINGE EATING 497

tive mood condition had demonstrated a significantly greater overall negative

affect (M = 45.3; SD = 9.7) compared to those in the neutral group (M =
26.2; SD = 4.6), F(2, 56) = 42.1, p < 0.001. Both anxiety, F(2, 56) = 11.2,
p < .001, and depression, F(2, 56) = 2.21, p < .001, were also significantly
greater in the negative mood induction group than in the neutral mood group.
Caloric Intake
Prior to the buffet, caloric intake for participants in the no-deprivation con-
dition did not differ significantly between mood induction procedures, with
a mean of 489 (SD = 501) kcal for those in the negative mood condition,
and 484 (SD = 499) kcal for those in the neutral mood condition. Two sep-
arate 2 x 2 ANCOVAs controlling for BMI were conducted (caloric depriva-
tion versus no deprivation × negative versus neutral mood) using the buffet
and total laboratory day calories (breakfast, lunch, and buffet for the no-
deprivation group versus buffet only for the deprivation group) as dependent
variables. There was a main effect of deprivation, F(1, 55) = 4.13, p < .05,
for calories consumed at the buffet, with those in the deprivation condition
consuming more calories (M = 1,895; SD = 891) on average than those in
the no-deprivation condition (M = 1,312; SD = 1,068). There was, however,
no statistically significant difference for total calories consumed over the lab-
oratory day between the deprivation condition (M = 1,895; SD = 891) and
the no-deprivation condition (M = 2,284; SD = 1,098), suggesting that par-
ticipants in the deprivation condition compensated for the breakfast and lunch
that were withheld by consuming more calories at the buffet. Contrary to our
hypotheses, there were no significant main effects on caloric intake for mood,
nor were significant interaction effects observed in either analysis.

Loss of Control Over Eating

A 2 × 2 ANOVA (caloric deprivation versus no deprivation × negative
versus neutral mood) was conducted on ratings of loss of control over eating
at the buffet. There was a significant main effect of mood on loss of control,

TABLE 2
CALORIC INTAKE AT THE BUFFET AND FOR THE LABORATORY DAY,
WITH THE MEAL TYPE AT THE BUFFET BY EXPERIMENTAL GROUP

Did
Experimental Buffet Lab Day Over- Not
Group kcal kcal Binge eat MealSnack Eat
No depriv/neutral 907 + 717 1,876 + 758 1 (1)a 6 1 7 0
Depriv/neutral 2,081 + 887 2,081 + 887 3 (4) 10 2 0 0
No depriv/negative 1,716 + 1,223 2,693 + 1,251 9 (4) 4 0 1 1
Depriv/negative 1,708 + 885 1,708 + 885 5 (8) 6 3 0 1
a Numbers within parentheses denote binge episodes defined by the investigators. All other
eating episodes are self-defined.
498 AGRAS & TELCH

F(1, 55) = 14.8, p < 0.001, indicating that those in the negative mood con-
dition reported a greater sense of loss of control at the buffet than those in
the neutral mood condition. There was no statistically significant effect for
caloric deprivation on loss of control, nor was there a significant interaction.
Binge Eating
Fourteen participants (47%) in the negative mood condition classified their
buffet eating episode as a binge compared with 4 (13%) in the neutral mood
condition. When the number of eating episodes (buffet), classified by the par-
ticipants as binges, overeating, meals, and snacks, was compared between
the negative and neutral mood groups, there was a significant difference
between groups, 22 (1) = 11.4, p < 0.01, with those in the negative mood con-
dition reporting more binges and fewer snacks than those in the neutral mood
condition. In addition, the numbers of binges were not significantly different
between the two deprivation conditions; 8 binge episodes (27%) were reported
for the deprivation condition, and 10 binge episodes (33%) were reported for
the no-deprivation condition.
The mean amount of food consumed in a self-defined binge was 2,079
kcal (SD = 1,012). The mean number of calories consumed in overeating epi-
sodes (i.e., eating a large amount of food with no loss of control) was 1,743
kcal (SD = 959) and was not significantly different from that consumed in
binges, as would be expected. However, the percentages of fat and protein,
but not carbohydrate, differed significantly between binge and overeating epi-
sodes. Binges averaged 40% fat compared with 36% for overeating episodes,
F(1, 42) = 3.93, p < .05, and 9% protein compared with 14% for overeating
episodes, F(1, 42) = 5.04, p < .03.
Because binge eating was self-defined for the above analyses, a secondary
analysis of investigator-defined binges was also performed. For these anal-
yses, a binge was defined as consuming more than 1,500 kcal (i.e., about the
size of two meals), with a score of below 3 (a median split) on the loss of
control scale (i.e., feeling much out of control). This definition removed 3
of the 18 participants with a self-defined binge who scored 4 or 5 on the loss
of control question, and 3 participants who scored high in loss of control but
ate less than 1,500 kcal at the buffet. Five participants with a loss of control
score of 3 who ate more than 1,500 kcal at the buffet were added to the
investigator-defined binge category. These participants had classified the buffet
episode as overeating. The average caloric content of a binge by this definition
was 2,240 (SD = 481) kcal (range: 1,545 to 3,493). Twelve (40%) partici-
pants in the negative mood condition binged compared with 5 (17%) par-
ticipants in the neutral mood condition, 2 ~ (1) = 4.0, p < .04. Unlike the
analysis of self-defined binges, 12 (40%) participants in the deprivation con-
dition binged compared with 5 (17%) in the no-deprivation condition, 22 (1) =
4.02, p < .04. In addition, fat content was significantly higher for episodes
of binge eating (40% fat) than episodes of overeating (37% fat), but there was
no difference in protein consumption or total calories consumed.
 FACTORS INFLUENCING BINGE EATING 499

To ascertain whether a more stable depressed mood was associated with

binge eating, the BDI scores for those who binged and those who did not
binge at the buffet were compared separately for self-defined and investigator-
defined binges. There was no difference in these scores for either analysis.

The Effect of Eating on Mood

To ascertain mood changes following the buffet, the MAACL scores before
and after the buffet for those in the negative mood condition were compared
using a multivariate analysis. This analysis revealed that participants in the
negative mood condition reported a significant decrease on the overall neg-
ative affect score of the MAACL, F(2, 56) = 42.1, p < .0001, following the
buffet.
This experiment did not include a condition in which participants did
not have access to food following the mood induction procedure; hence, it
is not possible to ascertain the effects of eating on mood, separate from the
passage of time. However, two further analyses are of interest. First, change
in mood from post-induction to post-buffet was compared for participants in
the negative mood condition who did or did not classify their eating episode
as a binge. There were no differences between these two groups in total
MAACL score, anxiety, or depression over the course of the buffet. Hence,
it appears that eating (or passage of time), not specifically binge eating, is
related to mood change.
A second multivariate analysis compared negative affect scores derived
from the MAACL between the neutral and negative mood groups from pre-
to post-buffet. There was a significant interaction between mood and time,
F(2, 56) -- 12.7, p < .001, indicating a differential effect on mood between
the neutral and negative groups, with mood in the negative group declining
while mood in the neutral group remained stable. In a post-hoc analysis, how-
ever, the MAACL score for depression remained significantly higher for the
negative induction group post-buffet (M = 13.7; SD = 4.8) compared with
the neutral group (M = 9.3; SD = 3.4), F(1, 58) = 4.07, p < 0.001. There
was no difference in anxiety scores between groups post-buffet, indicating
that anxiety had declined to a comparable level with the neutral group.

Discussion
This study suggests that different factors may trigger self-defined and objec-
tively defined binge-eating episodes in overweight females with BED. For
self-defined binges, negative mood more frequently led to binge eating than
did a neutral mood, whereas self-defined binge eating occurred equally fre-
quently for the two levels of caloric deprivation. On the other hand, when
binge episodes were more objectively defined, requiring both a large amount
of food eaten and a high score on the loss of control scale, both caloric depri-
vation and negative mood led to binge eating. This finding is in accord with
the observation that caloric deprivation, but not negative mood, was associ-
500 AGRAS & TELCH

ated with significantly increased caloric intake at the buffet. Negative mood,
but not deprivation, significantly increased loss of control over eating, per-
haps explaining the mechanism underlying the triggering of binge eating by
a negative mood. That is, in the presence of negative mood, the threshold
for losing control over eating may be lowered. Binge eaters may also be more
likely to classify an eating episode as a binge when in a negative mood, even
if the amount of food consumed is not large.
We initially predicted an interaction between caloric deprivation and nega-
tive mood, such that this group would consume a larger amount of calories
than other groups, both at the buffet and over the laboratory day. This did
not occur, despite the fact that the power to detect an interaction was suffi-
cient to detect a relatively small effect size of 0.30. As noted above, negative
mood did not lead to increased caloric intake either at the buffet or over the
laboratory day as a whole; hence, it would be unlikely that negative mood
would interact with deprivation to produce increased caloric consumption.
The power to detect a difference in binge eating between groups was too
small to test the hypothesis that binge eating would be greatest in the group
exposed to prolonged deprivation and a negative mood. We had also expected
the longer period of deprivation to lead to increased caloric consumption over
the laboratory day. However, consistent with the use of a shorter period of
deprivation in a previous study (Telch & Agras, 1996a), no such effect was
observed. This strengthens our conclusion from that study, that binge eaters
demonstrate normal compensation in response to an experimentally induced
caloric deficit.
These findings raise further difficulties concerning the clinical definition
of a binge. Whereas most individuals who reported binge eating at the buffet
also rated a high degree of loss of control on a separate questionnaire post-
buffet, a few did not. In addition, some individuals who reported binge eating
consumed less than a large amount of food. It appears then, as confirmed
in a more detailed study of these participants' definition of a binge (Telch,
Pratt, & Niego, in press), that three factors are used variably by women with
BED to define a binge: loss of control over eating; eating a large amount of
food; and eating in response to negative affect. At times the definition will
incorporate only one of these elements, but at other times the same individual
will use more than one element to define a binge. Whether these different
definitions carry different diagnostic or therapeutic implications continues to
be unclear at present.
These results suggest that negative mood is an important variable in trig-
gering binge eating in women with BED, experimentally confirming descrip-
tive studies in which patients with BED and BN rate negative mood as an
important trigger of binge eating (Abraham & Beumont, 1982; Bruce &
Agras, 1992). Moreover, there was no difference in baseline depression
scores, as measured by the BDI, for those who binged or did not binge at
the buffet, suggesting that it is acute negative affect rather than a stable nega-
tive mood that leads to binge eating. These findings also extend previous
 FACTORS INFLUENCING BINGE EATING 501

work in which female obese binge eaters who labeled their eating as a binge
reported significantly higher negative affect than those who did not, indepen-
dent of the amount eaten (Telch & Agras, 1996b).
From a therapeutic viewpoint, these findings suggest that procedures
aimed at enhancing patients' ability to regulate negative affect adaptively may
be an important addition to the treatment of BED. Equipped with more adap-
tive affect-regulation strategies, such women should reduce both self-defined
and more objectively defined binges, because negative mood led to both types
of binges significantly more often than did the neutral mood condition.
The macronutrient content of binges, measured objectively in this study,
consisted of significantly higher fat intake and a lower protein intake (the
latter only in self-defined binges) than the content of overeating episodes.
This replicates findings from previous studies of women diagnosed as having
BN or BED (Kissileff et al., 1986; Yanovski, Leet, & Yanovski, 1992). It is
possible that such differential intake occurs as a result of loss of control over
eating combined with exposure to an array of palatable foods. Food choices
may become disrupted under such circumstances. In addition, fat content
may be a marker for increased consumption of simple carbohydrates (sweet
fat foods). Increased consumption of simple carbohydrates would lead to
insulin release, an increase in the ratio of tryptophan to other large neutral
amino acids, and, therefore, an increase in serotonin secretion, which, in
turn, leads to satiety and, probably, enhanced mood.
A further finding of interest was the alleviation of anxiety over the course
of the buffet, whereas depression declined but was still significantly higher
than the level reported in the neutral mood condition post-buffet. This finding
replicates that of a laboratory study reported by Kaye and his colleagues
(1986). This finding does not confirm the hypothesis that dysphoric mood
states in general are alleviated by binge eating. One explanation for this
finding is that for women with BED, who presumably lack adaptive affect-
regulation skills, the experience of negative affect can be anxiety provoking
because they fear the possibility of being emotionally overwhelmed. Once
the negative affect is blocked or reduced to a tolerable level by eating, anxiety
would disappear, although other negative emotional states such as depression
would persist at the lowered levels. Negative mood did not appear to be
reduced specifically by a binge, because the reductions in mood were not sig-
nificantly different for those who binged and those who did not. This suggests
that either eating, as distinct from binge eating, or the passage of time is
responsible for the diminution in negative mood. Distinguishing between
these two hypotheses will require further experimental work.
Some cautions in the interpretation of these data are warranted. Laboratory
studies cannot exactly reproduce the complex events leading to binge eating
in the natural environment. In this study, the buffet was served in the early
afternoon. It is possible that serving the buffet later in the day, at a time more
typical for binges to occur, would have led to different results. An alternative
to a between-groups design would have been a within-participants design in
502 AGRAS & TELCH

which each participant was entered into each of the four experimental con-
ditions. This design was discarded for the present experiment because we
felt that the carry-over effects from one condition to another would have been
substantial, and that the dropout rate would have been high from a study
requiring 4 full days of a person's time.
The results reported here are applicable only to a female obese binge-
eating population. Hence, it would be of interest to compare the effects of
these two variables in triggering the binge eating of both men and women
with BED. Further experimental work in elucidating the influence of negative
mood and caloric deprivation in BN is also necessary, because patients with
BN demonstrate greater dietary restraint than patients with BED. In addition,
an experimental investigation comparing the effects of passage of time,
eating, and binge eating in reducing negative mood will be important,
because it would test a hypothesis central to both psychological and biolog-
ical theories of binge eating.

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RECEIVED: September 23, 1997

ACCEPTED: May 6, 1998