T, L, & W



Eating Attitudes, Body Shape Perceptions and Mood of Elite Rowers

Peter C. Terry, Andrew M. Lane, and Lucinda Warren

Brunel University, U. K.

Running Head: RISK FACTORS AND MOOD

Date of Submission: 17th December, 1997

Eating Attitudes, Body Shape Perceptions and Mood of Elite Rowers

Abstract

The study assessed the influence of age, gender and weight category upon eating attitudes, body shape perceptions, and mood. Elite rowers (N = 103) participating in the 1996 World Championships or Great Britain National Championships completed the Eating Attitude Test (EAT), the Body Shape Questionnaire (BSQ), and a short form of the Profile of Mood States (POMS-C). Participants were grouped as lightweight (Female: < 59 kg, n = 19; Male: < 72.5 kg, n = 31) or heavyweight (Female: n = 25; Male: n = 28) competitors. Results showed higher EAT scores among the lightweight group, 12.0% of whom reported scores above the threshold associated with eating disorders. Body shape concerns were higher for heavyweights than lightweights and for females than males. The interaction effect was not significant. BSQ scores were negatively correlated with age. Depression, Confusion and Tension scores collectively predicted 37% of the variance in BSQ scores while Depression scores predicted 9% of the variance in EAT scores. The results provide further evidence that the risk of eating disorders among elite rowers is moderated by age, gender and weight category. Further, they suggest that measures of mood may help identify athletes at risk from eating disorders.

Keywords: RISK FACTORS, EATING DISORDERS, PSYCHOLOGICAL STATES

Eating Attitudes, Body Shape Perceptions and Mood of Elite Rowers

The issue of eating disorders among athletes represents a serious potential threat to physical and psychological well-being (see Sundgot-Borgon, 1994a, 1994b; Swoap & Murphy, 1995; Thompson & Sherman, 1993). The exact prevalence of disorders such as bulimia nervosa and anorexia nervosa in sport populations remains unclear. There are at least three reasons for this lack of clarity. First, the secretive nature of eating disorders and the potentially serious repercussions of discovery for an athlete, such as being dropped from the team, may contribute to a general underestimate of their prevalence in sport (Thornton, 1990). Second, prevalence rates depend upon the diagnostic procedures used and these vary greatly from investigation to investigation (Brownell & Rodin, 1992; Swoap & Murphy, 1995). Third, the varying emphasis upon leanness and aesthetics across sports impacts upon the prevalence rate of eating disorders among different athletic populations (Sundgot-Borgen, 1994a).

Despite the absence of definitive prevalence rates, it is generally agreed that eating disorders are a significant threat to health among a large number of sport participants. For example, Burckes-Miller and Black (1988) reported that 39.2% of female athletes and 14.3% of male athletes in their sample of 695 met the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R; American Psychiatric Association, 1987) criteria for bulimia nervosa. The criteria include recurrent episodes of binge eating, regular self-induced vomiting or other pathogenic weight-loss techniques, and persistent overconcern with body shape and weight. Further, 3% of their sample (4.2% of females and 1.6% of males) met the diagnostic criteria for the potentially fatal disorder of anorexia nervosa, which include disturbed body image, body weight 15% below that expected, intense fear of gaining weight, and amenorrhea in females.

Another area of general agreement among researchers is that some sports expose participants to greater risk of eating disorders than others (Dick, 1991). This may arise either because individuals with a predisposition to eating disorders are drawn toward certain sports (c.f., Sacks, 1990) or because the demands of particular sports push athletes towards undesirable weight loss strategies (c.f., Rosen, McKeag, Hough & Curley, 1986). There is substantial evidence that athletes in sports which emphasize leanness are at greater risk of eating disorders than other athletic groups (Borgen & Corbin, 1987; Brookes-Gunn, Burrow, & Warren, 1988; Davis & Cowles, 1989; Sundgot-Borgon, 1994b). Such sports can be separated into three categories; those judged on aesthetic appearance, such as gymnastics, diving and figure skating; those where reduced body weight helps maximize performance, such as distance running and swimming; and those which incorporate weight classifications, such as wrestling, judo, boxing, and rowing. In sports with weight classifications, where failure to "make weight" means exclusion from the contest, participants may face strong temptation, even coercion, to regulate body weight at lower than natural limits. Such a process may lead to negative attitudes towards eating and negative perceptions of body shape which in turn may lead to clinical disorders.

The sport of rowing is not typically associated with eating disorders, and rarely features in authoratitive reviews on the subject (e.g., Sundgot-Borgon, 1994a, 1994b; Swoap & Murphy, 1995; Thompson & Sherman, 1993). In rowing events, participants are dichotomised into lightweight (female: < 59kg; male < 72.5kg) and heavyweight categories. Consequently there is a clear emphasis upon leanness, especially among lightweight rowers whose natural weight is around the borderline between the two categories and who cannot readily move up to the heavyweight category due to height or strength limitations.

To our knowledge, only three published studies have investigated the risk of eating disorders in rowing. Thiel, Gottfried and Hesse (1993) reported that, of 59 male lightweight rowers and 25 male lightweight wrestlers, 31% showed disturbed body image. They concluded that both sports carry a high risk of eating disorders for participants. Sykora, Grilo, Wilfley, and Brownell (1993) assessed eating attitudes, dieting patterns, weight fluctuation and weight loss methods among 162 collegiate rowers. Results showed that females reported more disturbed eating attitudes and maladaptive weight loss strategies such as vomiting, than males. Participants in both weight categories reported disturbed eating attitudes and extreme weight loss strategies.

More recently, Terry and Waite (1996) investigated eating attitudes and body shape perceptions among 124 elite rowers. Of 31 female lightweight rowers, six (19.4%) reported eating attitudes above the threshold associated with eating disorders while five (16.1%) reported abnormal body shape perceptions. Further, four female lightweight rowers (12.9%) made unsolicited confessions that they habitually used vomiting as a weight control strategy. Four male lightweight rowers (12.9%) also reported abnormal eating attitudes, supporting the notion that the risk of eating disorders extends across both genders (c.f., Burckes-Miller & Black, 1988). This tendency was also highlighted by Thiel, et al. (1993) and by Sykora, et al. (1993) who found among male rowers that 12% reported binge eating episodes twice a week or more and 57% reported fasting to lose weight. Such findings suggest that further research is desirable to determine whether the level of risk identified is typical or anomolous of rowing populations generally.

The link between eating disorders and mood disturbance is well established in the clinical literature (DiNicola, Roberts, & Oke, 1989; Hatsukami, Mitchell, & Eckert, 1984; Vandereycken, 1987). Indeed, affective instability and negative mood characteristics are seen as psychological effects of both bulimia nervosa and anorexia nervosa (Thompson & Sherman, 1993). Therefore it is perhaps surprising that the link between mood and abnormal eating attitudes and body shape perceptions has not been investigated empirically among sport populations. Such an investigation is justified not only from a health perspective but also from a performance perspective. It has been shown that the mood of athletes in the period leading up to competition is linked to athletic performance particularly at the elite level (see Terry, 1995 for review). This mood-performance link has been demonstrated in the sport of rowing (Hall & Terry, 1995; Terry, 1993) and therefore further invesigation of the correlates of mood disturbance among rowing populations appears germane.

The first purpose of the present study was to further examine the extent to which abnormal eating attitudes and body shape perceptions are found in the sport of rowing, and to assess the effects of weight category, gender and age. On the basis of existing evidence (Sundgot-Borgon, 1994b; Sykora et al., 1993; Terry & Waite, 1996) it was hypothesized that female lightweights would be most at risk of eating disorders; and that negative eating attitudes and body shape perceptions would be inversely related to age. The second purpose of the present study was to investigate links between eating attitudes, body shape perceptions and mood among elite rowers. Given the close link between eating disorders and mood disorders (American Psychiatric Association, 1987; DiNicola et al., 1989; Hatsukami et al., 1984; Vandereycken, 1987) it was hypothesized that significant relationships would be found between abnormal eating attitudes, disturbed body shape perceptions, and negative mood characteristics (tension, depression, anger, fatigue, confusion). Further, given the consistently documented relationship between depression and eating disorders (Herpertz-Dahlmann, Wewetzer, & Remschmidt, 1995, Kuehnel & Wadden, 1994; Pulos, 1996; Validisseri & Kihlstrom, 1995) it was hypothesized that, of the mood dimensions, depression scores would best predict eating attitudes and body shape perceptions.

Method

Participants

Participants in the study were 103 elite rowers (age 23.9 + 5.0 yrs) competing in either the 1996 World Championships (n = 39) or the 1996 Great Britain National Championships (n = 64). Participants recruited at the World Championships came from Australia, Canada, Great Britain, New Zealand, South Africa, and the U. S. A. Permission to conduct the study was obtained from the organisers of both regattas. Participants were classified as heavyweight men (n = 28), heavyweight women (n = 25), lightweight men (n = 31), or lightweight women (n = 19).

Instruments

Eating Attitudes Test (EAT)

The EAT is a 26-item questionnaire to identify abnormal eating habits and concerns about weight, derived from a 40-item original (Garner & Garfinkel, 1979). To complete the EAT, subjects rate their agreement with statements about weight and food, such as “I am terrified about being overweight” and “I find myself preoccupied with food”. A score of 20 or more distinguishes between individuals who possess normal eating concerns and those who may be prone to eating disorders. Garner and Garfinkel reported an Alpha coefficient (Cronbach, 1951) of .94 to demonstrate internal consistency. A test-retest reliability coefficient for the EAT was not reported by Garner and Garfinkel but has subsequently been identified at .81 for a children's version (Allison, 1995).

Body Shape Questionnaire (BSQ)

This is a 34-item questionnaire to assess self-perceptions of body shape (Garner, 1985; Cooper, Taylor, Cooper, & Fairburn, 1987). To complete the BSQ, subjects respond to questions such as “Have you imagined cutting off fleshy areas of your body?” and “Have you felt so bad about your shape that you have cried?”. A score of 20 or more distinguishes between normal body image perceptions and self-perceptions associated with eating disorders (Garner, 1985). The psychometric integrity of the BSQ was supported by Cooper et al. (1987) to the extent that scores correlated significantly with both the EAT and the Eating Disorder Inventory (EDI: Garner, Olmsted, & Polivy, 1985). The test-retest reliability coefficient, however, has not been reported.

Items of the EAT and BSQ are scored “always” = 3, “very often” = 2, “often” = 1 and “sometimes”, “rarely” or “never” = 0. EAT-26 and BSQ were chosen as appropriate measures because they have been shown to be capable of identifying "at risk" athletes and yet take only a few minutes each to administer. Brevity was judged to be a prime requirement for data collection in an environment involving World and National Championships.

Profile of Mood States-C (POMS-C)

This is a 27-item inventory to assess mood state. The POMS-C (Terry, Keohane, & Lane, 1996; Terry, Lane, Lane & Keohane, submitted for publication) assesses six mood constructs: Tension (five items), Depression (four items), Anger (five items), Fatigue (five items), Vigor (four items), and Confusion (four items). Tension items include, "Panicky" and "Worried"; Depression items include, "Sad" and "Depressed"; Anger items include, "Bad-tempered" and "Furious"; Fatigue items include, "Exhausted" and "Sleepy"; Vigor items include, "Active" and "Energetic"; and Confusion items include, "Mixed-up" and "Muddled".

To complete the POMS-C, participants rate "How are you feeling right now?" on a 5-point scale anchored by 0 ("not at all") to 4 ("extremely"). Validation studies reported internal consistency coefficients for the six subscales ranging from .74 to .91 (see Terry et al., 1996). The factorial validity of the POMS-C was supported using confirmatory factor analysis (see Terry et al., submitted for publication). This shortened version of the POMS was used in preference to the original POMS (McNair, Lorr, & Droppleman, 1971) for two reasons. First, brevity was essential as athletes had to complete three questionnaires. Second, the original POMS, although used frequently in sport and exercise environments, has not been validated with athletic samples.

Procedures

Data were collected by the third author during her attendance at the championships. Participants were provided with packs containing all questionnaires and detailed instructions. The instructions outlined the general nature of the investigation but made no mention of eating disorders. Participants were assured of absolute confidentiality. To minimize the effects of competition on mood responses, questionnaires were returned to the researcher prior to the commencement of the racing programme.

Data analysis

Descriptive statistics were calculated for the sample overall, and grouped by gender and weight category. Group comparisons were calculated using a 2 x 2 (gender x weight category) multivariate analysis of variance (MANOVA) plus follow-up univariate analyses (Tabachnick & Fidell, 1996). Pearson correlation analysis was used to assess inter-relationships between age, EAT, and BSQ scores. Hierarchical multiple regression was used to test the extent to which eating attitudes and body shape perceptions could be predicted from mood scores. Given the unique relationship between depression and eating disorders consistently identified by previous researchers (Herpertz-Dahlmann et al., 1995, Kuehnel & Wadden, 1994; Pulos, 1996; Validisseri & Kihlstrom, 1995), Depression scores were entered first into the regression equation. Anger, Confusion, Fatigue, Tension, and Vigor scores were added in stepwise progression as no clear hierachy between these mood constructs and measures of eating disorders was suggested from previous literature. The alpha level for all tests was set at p < .05.

Results

Descriptive statistics for the sample are provided in Table 1. The MANOVA showed significant main effects of weight category [Wilks' lambda (2,98) = .69, p < .001] and of gender [Wilks' lambda (2,98) = .90, p < .01]. The interaction effect was not significant [Wilks' lambda (2,98) = .96, p > .05]. Follow-up univariate analyses showed significant differences between heavyweight and lightweight rowers for reported scores of both the BSQ [F (1,99) = 4.22, p < .05] and the EAT [F (1,99) = 15.16, p < .001]. Lightweights scored higher on the EAT than heavyweights, while heavyweights reported higher scores on the BSQ than lightweights. A significant difference emerged between males and females for BSQ scores [F (1,99) = 10.99, p = .001] but the difference in EAT scores did not quite reach significance [F (1,99) = 3.31, p = .07]. Females reported higher scores than males on both tests.

These results are not entirely consistent with previous investigations of eating attitudes and body shape perceptions among rowers (Sykora et al., 1993; Terry & Waite, 1996). One substantial deviation between the two sets of results is that in the present study heavyweight rowers reported higher scores for body shape concerns than lightweight rowers whereas the opposite was found by Terry and Waite. Also, Sykora et al. reported that weight category had no impact upon the eating attitudes reported by rowers. The hypothesis that rowers in the female lightweight category would be most at risk of eating disorders was partially supported. They reported the highest incidence of disturbed eating attitudes but, while they reported higher scores for body shape concerns than both groups of male rowers, the female heavyweight rowers reported even greater concern.

Among the lightweight category, 6 of 50 rowers (12%) reported EAT scores above the threshold associated with eating disorders. Of these, 4 were females (21% of female-lightweight rowers) and 2 were males (6% of male-lightweight rowers). There was only one heavyweight rower (female) who reported an EAT score above the threshold. For body shape perceptions, 4 of 44 females (9%) but no males scored above the threshold of 20. These prevalence rates are similar to those previously reported for elite rowers (Terry & Waite, 1996) and are consistent with the notion that weight category has a significant moderating influence upon eating attitudes and gender significantly moderates perceptions of body shape.

Over the sample as a whole, there was a significant correlation (r = .48, p < .01) between EAT and BSQ scores, accounting for 23% of the shared variance (see Table 2). When the sub-groups were analysed separately, the relationship between EAT and BSQ scores accounted for 74% of the shared variance among female heavyweights, 44% among female lightweights, 37% among male lightweights, and, 23% among male heavyweights. The greater proportion of variance accounted for among female rowers suggests that EAT and BSQ scores might point to a generalized susceptibility toward eating disorders among women. Among male rowers, heavyweights in particular, body shape perceptions and eating attitudes appear to be relatively independent of one another. Age, as hypothesized, showed a significant inverse relationship with BSQ scores (r = -.27; p < .05) among the sample as a whole, although not among the four subgroups. Counter to the hypothesis, age was not significantly related to EAT scores in the present study.

Multiple regression analysis (see Table 3) showed that Depression scores predicted 24% of the variance in BSQ scores. Confusion and Tension scores collectively explained a further 13% of the variance. The direction of these predictions showed that as scores for Depression, Confusion, and Tension increased BSQ scores also tended to increase. Depression scores further predicted 9% of the variance in EAT scores, also in a positive linear manner. These findings are consistent with the hypothesized relationships, although Anger, Vigor and Fatigue scores were not significant predictors. Given that Depression was the first variable entered into the hierachical regression model, it is not surprising that it proved the best predictor of eating attitudes and body shape perceptions. This finding does demonstrate, however, that the link between depression and risk of eating disorders shown in clinical environments (e.g., Herpertz-Dahlmann et al., 1995, Kuehnel & Wadden, 1994; Pulos, 1996) is also evident in the athletic environment. Further, the regression model showed that other negative mood constructs, in this case confusion and tension, are capable of predicting additional unique variance in eating disorder indicators.

Discussion

The first purpose of the study was to investigate the prevalence of abnormal eating attitudes and body shape perceptions among elite rowers. Previous research indicated that rowers, particularly females who compete in the lightweight category, are at risk of eating disorders (Terry & Waite, 1996). As hypothesized, the present results were consistent with this proposal to the extent that 21% of female lightweights but only 4% of female heavyweights reported eating attitudes in the "at risk" category. It is proposed that most lightweight rowers would be unable to compete successfully in the heavyweight category due to height and/or strength limitations and therefore may risk being drawn towards pathogenic weight loss strategies to preserve their lightweight status. The prevalence of abnormal eating attitudes and body shape concerns found in the present study strengthens the suggestion that rowing, as with other "leanness" sports (see Sundgot-Borgon, 1993; Weight & Noakes, 1987), shows an association with eating disorders. Future investigations of eating disorders among athletes are encouraged to consider this link.

The present results may reflect a potentially serious threat to the health of lightweight rowers. Sykora et al. (1993) reported that at least one major American university has terminated its lightweight rowing program because of problems with dieting and eating disorders. There would appear to be a strong case for all rowers, but especially those who compete in the female lighweight category, to receive a structured dietary education program. Such programs could be justified on performance grounds alone, as control of weight is clearly a central performance variable in the sport of rowing, but the need for education is especially compelling on health grounds as without systematic guidance there is a possibility that weight loss strategies may become random and pathogenic.

Team coaches and others responsible for the preparation of lightweight rowers should be encouraged to educate themselves and their athletes on safe weight loss strategies. Such strategies appear to best achieve their objectives when they involve realistic weight goals, frequent weight monitoring, detailed nutritional guidance, an increased awareness of the symptoms of eating disorders, and the recruitment of professional help when necessary (Eisenman, Johnson, & Benson, 1990).

The significant although relatively small inverse relationship for BSQ scores with age indicates a slight tendency for abnormal perceptions of body shape to be associated with younger rowers. However, the findings of no significant relationship between EAT scores and age runs counter to the proposal that young athletes are particularly at risk (Drummer, Rosen, Heusner, Roberts, & Counsilman, 1987; Johnson, 1992; Terry & Waite, 1996). In the present study, it appears that gender is a more important moderating variable than age with respect to risk of eating disorders.

The secondary purpose of the present study was to examine relationships among mood states, eating attitudes and body shape perceptions. The substantial relationship evidenced between EAT and BSQ scores and reported Depression supports the notion that negative psychopathological states develop concurrently with negative physical self-perceptions and unhealthy eating attitudes (Herpertz-Dahlmann, et al., 1995; Grubb, Sellers, & Waligroski, 1993; Varnado, Williamson, & Netemeyer, 1995). Further, this finding is consistent with previous research which showed that the process of dieting is associated with negative cognitive states such as depression, confusion, and tension (Butow, Beument, & Touyz, 1993).

The reasons underlying the link between depression and risk of eating disorders among athletic populations is unclear. Some researchers have suggested that eating disorders among athletes may be associated with perfectionistic tendencies (Taub & Benson, 1992; Terry & Waite, 1996). This suggestion may be credible given the tendency for athletes to report higher values of personal perfectionism than the normal population (Terry-Short, Glynn-Owens, Slade, & Dewey, 1995). Problems may develop when perfectionism leads to a belief that optimal performance in sport can only be achieved through very strict control of weight at a level that may be considerably below the athlete’s natural limit. Therefore, the individual may become depressed as a consequence of believing that they cannot attain the standards demanded by their perfectionism. The development of perceived personal inadequacies may cause feelings of hopelessness, worthlessness, and self-blame, all of which are characteristic of depression (Beck, 1976).

Interestingly, Tension scores did not significantly predict EAT scores and only accounted for an additional 5% of the variance in BSQ scores. Such findings support the notion that although depression and tension share the characteristic of a general negative self-schema, they are conceptually independent (Beck & Clark, 1988). Theoretically, depression should show the stronger relationship with eating disorders as depressed individuals tend to focus on internal thoughts such as perceived body image, whereas tense individuals are proposed to focus to a greater extent on external forces such as threatening environmental stimuli (Beck & Clark, 1988). The present results are consistent with this theoretical stance.

The present results also indicate that measures of mood constructs, particularly depression, could be used as a diagnostic tool to predict the potential for eating disorders. Research findings from clinical psychology have previously demonstrated the association between measures of depression and eating disorders (Herpertz-Dahlmann & Remschmidt, 1993; Herpertz-Dahlmann, et al., 1995). In the sport context, athletes may respond candidly to a mood inventory but may conceal the truth when presented with one of the conventional but transparent indices of eating disorders (Thornton, 1990). Extending the rationale for assessing mood in sport, it is known that depression is linked not only with a risk of eating disorders but also with other causes for concern in the sport world, such as poor performance (e.g., Terry & Slade, 1996), injury (Heil, 1993) and overtraining syndrome (Budgett, 1990). In situations where mood profiling is used as a monitor of the general well-being of athletes (c.f., Terry, 1995), it is recommended that in those cases where depression symptoms are reported this constitutes sufficient reason for at least a follow-up interview to identify the sources of these feelings.

Given the reliance on self-report data in the present study, the findings should be interpreted with a degree of caution. The procedure for data collection attempted to minimize response distortion by allowing participants to complete the questionnaires and return them anonymously to the research team with no possibility of access to their responses by their coach, teammates, or team officials. While this procedure guaranteed confidentiality, the honesty of responses is not known. Notwithstanding this cautionary note, the present study has reinforced the notion that elite athletes are at risk of eating disorders. The personal cost to athletes of succumbing to unhealthy weight loss strategies can be measured not only in the substantial medical risks, but also in the threats to psychological wellbeing in the form of depression, anxiety, or burnout. Future research should continue to investigate the link between measures of mood and eating disorders among elite athletic populations.

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Author Note

Peter C. Terry, Andrew M. Lane, and Lucinda Warren, Department of Sport Sciences.

Correspondence concerning the article should be addressed to Prof. Peter C. Terry Ph.D., Department of Sport Sciences, Brunel University, Borough Road, Isleworth, Middx. TW7 5DU, UK. Electronic mail may be sent via the Internet to Peter.Terry@Brunel.ac.uk

Table 1

Means and Standard Deviations (in brackets) of Scores on Body Shape Questionnaire (BSQ) and Eating Attitudes Test (EAT) among Elite Rowers.

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Group N BSQ EAT

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All subjects 103 4.66 (9.29) 6.64 (6.35)

Male 59 2.02 (6.48) 5.92 (5.25)

Female 44 8.21 (11.21) 7.61 (7.53)

Heavyweight 53 6.51 (11.84) 4.55 (4.87)

Lightweight 50 2.70 (4.82) 8.86 (7.00)

Female-lightweight 19 5.05 (5.93) 10.74 (8.38)

Male-lightweight 31 2.86 (8.74) 7.71 (5.85)

Female-heavyweight 25 10.60 (13.60) 5.24 (5.95)

Male-heavyweight 28 1.26 (3.34) 3.93 (3.65)

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Table 2

Correlation Analysis among EAT Scores, BSQ Scores and Age.

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Group N EAT x BSQ EAT x Age BSQ x Age

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All subjects 103 .48** .02 -.27*

Female-lightweight 19 .66** -.14 .07

Male-lightweight 31 .61** -.18 -.18

Female-heavyweight 25 .86** -.15 -.23

Male-heavyweight 28 .48** -.12 -.20

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* p < .05

** p < .01

Table 3

Multiple Regression to Predict Body Shape Questionnaire (BSQ) and Eating Attitudes Test (EAT) Scores from Mood Scores.

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Source F Multiple R Adjusted R2

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BSQ:

Depression 31.20* .50 .24

Confusion 24.24* .58 .32

Tension 19.71* .62 .37

EAT:

Depression 10.29* .31 .09

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* p < .001

Note. Multiple R and Adjusted R2 are cumulative.

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