Distress tolerance in the eating disorders

Eat Behav. 2007 Jan;8(1):91-7. doi: 10.1016/j.eatbeh.2006.02.003. Epub 2006 Mar 6.


Objective: It is commonly noted that patients with eating disorders have difficulties in regulating emotional states. This construct is similar to the concept of distress tolerance, which has been identified as a problem in patients with impulsive disorders. However, the elements that make up distress tolerance are not clearly delineated, making it difficult to target treatment in relevant cases. This study aimed to develop a measure of distress tolerance, and to validate it clinically with the eating disorders.

Method: The sample consisted of 72 women with DSM-IV eating disorder diagnoses, and 62 women with no history of eating disorders. Each completed a newly developed measure of distress tolerance (the Distress Tolerance Scale; DTS) and the Eating Disorders Inventory.

Results: The DTS was made up of three scales, each with acceptable psychometric properties. Two of those scales differentiated the groups--the clinical women showed higher levels of 'Avoidance of affect', while the non-clinical women had higher scores in the 'Accept and manage' scale. Avoidance of affect was positively associated with unhealthy eating attitudes.

Conclusions: It is important to examine both maladaptive and adaptive means of coping with affect in the eating disorders. Treatment strategies for modification of distress tolerance should address both the reduction of avoidance and the development of emotional management skills. Further research is needed to determine whether these findings are relevant to the presence of other impulsive behaviours in the eating disorders.

MeSH terms

  • Adaptation, Psychological*
  • Adolescent
  • Adult
  • Anorexia Nervosa / psychology
  • Avoidance Learning
  • Bulimia / psychology
  • Bulimia Nervosa / psychology
  • Defense Mechanisms
  • Emotions*
  • Feeding and Eating Disorders / diagnosis
  • Feeding and Eating Disorders / psychology*
  • Female
  • Humans
  • Personality Inventory / statistics & numerical data
  • Psychometrics / statistics & numerical data
  • Reference Values
  • Reproducibility of Results
  • Risk Factors
  • Stress, Psychological / complications*
  • Thinness / psychology