Appetite 40 (2003) 47–54 www.elsevier.com/locate/appet Research Report Relationship of gender and symptoms to reported cravings for food: construct validation of state and trait craving questionnaires in Spanish

Antonio Cepeda-Benitoa,*, Mari Carmen Fernandezb, Silvia Morenoc

aTexas A&M University, Department of Psychology, College Station, Texas, TX 77843-4235, USA b Facultad de Psicologia, Universidad de Granada, 18071 Granada, Spain cCentro de Psicologı´a Clı´nica Viania, Sos del Rey Cato´lico #7, 18006 Granada, Spain

Received 1 February 2002; accepted 24 October 2002

Abstract Using confirmatory factor analysis, we cross-validated the factor structures of the Spanish versions of the State and Trait Food Cravings Questionnaires (FCQ-S and FCQ-T; Cepeda-Benito et al., 2000a) in a sample of 304 Spanish college students. Controlling for eating disorder symptoms and food deprivation, scores on the FCQ-T were higher for women than for men, but no sex differences were observed on the FCQ-S. Eating disorder symptomatology was predictive of trait cravings, whereas food deprivation was predictive state cravings. Trait cravings, but not state cravings, were more strongly associated to symptoms of anorexia and than with other psychopathology. We suggest that cravings can be conceptualized as multidimensional motivational states and that our data support the hypothesis that food cravings are strongly associated with symptoms of bulimia nervosa. q 2002 Elsevier Science Ltd. All rights reserved.

Keywords: Craving; Eating disorder symptoms; Measurement

1. Introduction cravings through cue-exposure and response-prevention methods (Bulik et al., 1990, 1998). Cravings are subjective motivational states that, in To date, the predominant model highlighting the role of theory, promote ingestive behaviors. Similarly to the cravings in binge eating and bulimia has been the hypothesized causal relationship between drug cravings starvation/dietary restraint model (Fairburn and Cooper, and compulsive drug use (Tiffany, 1990), the construct of 1989; Heatherton and Polivy, 1992; Vitousek, 1996; food cravings has been important for theories and treatments Cooper, 1997). This model explains the development of a of eating disorders. Food cravings have been blamed for self-fueling cycle of dietary restraint, food craving and binge eating in bulimia, early dropout from weight-loss bingeing in which calorific restriction and homeostatic treatments, over-eating in obese individuals, and the imbalances cause cravings and drive individuals to bingeing prevalence of bulimia nervosa (see review by Cepeda-Be- (Fairburn and Cooper, 1982; Booth et al., 1990; Cepeda-- nito et al. (2000b)). The effectiveness of pharmacotherapy in Benito and Gleaves, 2001). However, in sharp contrast with reducing compulsive or binge eating has been attributed to the hypothesis that calorific deficits trigger food cravings the possibility that -enhancing drugs either block and bingeing, several studies have downplayed the role of or reduce food cravings (Fluoxetine Bulimia Nervosa in the experience of food cravings (Davis et al., Collaborative Study Group, 1992). Moreover, some cogni- 1985; Hill et al., 1991) and the impact of dietary restraint in tive-behavioral interventions for binge eating also target bingeing and purging (Heatherton and Polivy, 1992; Cooper et al., 1993; Lowe et al., 1996, 1998). Moreover, some investigators have indicated that cravings are not necess- * Corresponding author. Tel.: þ1-409-845-8038; fax: þ1-409-845-4727. arily pathological, as suggested by the high incidence of E-mail address: [email protected] (A. Cepeda-Benito). and other food cravings in normal individuals

0195-6663/03/$ - see front matter q 2002 Elsevier Science Ltd. All rights reserved. doi:10.1016/S0195-6663(02)00145-9 48 A. Cepeda-Benito et al. / Appetite 40 (2003) 47–54

(Rozin et al., 1991), and the fact that many individuals (Kozlowski et al., 1989). For instance, in the two studies experience cravings as a simple yearning, desire, or longing described in the previous paragraph, Lafay et al. (2001) for specific types of food (Weingarten and Elston, 1990, classified about 20% of their sample as cravers and stated 1991; Rozin et al., 1991; Michener and Rozin, 1994). that ‘subjects were considered to be cravers if they Given the lack of consensus regarding the nature of food experienced a strong urge to eat specific foods at least cravings and their role in maintaining binge eating among once a week during the past 6 months’ (p. 197). In sharp bulimia nervosa patients, the main aim of the study was to contrast, Christensen and Pettijohn (2001) classified as investigate the relationship between eating disorder symp- cravers 91% of their sample after asking participants toms and food cravings. Noting that food cravings are more whether they ‘generally experienced intense desires or prevalent, intense, and troublesome in women than men urges (cravings) to eat specific foods’ (p. 138). (Rozin et al., 1991), we also studied the extent to which sex The present research measured cravings as a continuous differences in food-craving report are a mere reflection of variable using two multi-factorial, and previously validated the higher prevalence of eating-disorder symptomatology in food craving instruments: the Food Craving Questionnaire- women than men, or, conversely, whether sex differences in Trait (FCQ-T) and the Food Craving Questionnaire-State food-craving report continue to emerge even after removing (FCQ-S; Cepeda-Benito et al., 2000a, 2000b). These the influence of eating disorder psychopathology. To date, instruments were created consistent with the theory that sex differences in craving report have attributed to hormonal food cravings can arise from or be expressed as both changes related to menstruation, and sex differences in physiologically and psychologically mediated processes dietary and mood-regulating neurotransmitter deficiencies, (Weingarten and Elston, 1990). To our knowledge the FCQ- cultural influences, and eating-disorder psychopathology T and the FCQ-S are the only available (published) (see reviewes by Benton, 2001; Dye, 2001; Gendall and measures of food cravings that have been psychometrically Joyce, 2001; Gofton and Murcott, 2001; Reid and validated. The English version of the instruments have been Hammersley, 2001). Thus, we predict that both eating validated and crossvalidated using three samples of disorder symptoms and sex will uniquely and substantially American participants (Cepeda-Benito et al., 2000b), contribute to predict food-craving report. Such pattern of whereas the psychometric properties of the Spanish versions results would not only support the hypothesis that food have been validated using a single sample of Spanish cravings are more prevalent among individuals with respondents (Cepeda-Benito et al., 2000a). behavioral symptoms of bulimia, but also the notion that Given that the Spanish version of the FCQ-T did not food-cravings are not necessarily linked to eating disorder include in its original validation two items later added to the psychopathology. final and revised English version of the FCQ-T (37 vs. 39 We want to emphasize that the present study is the first to items), the present study was also conceived as a cross- examine sex differences in craving report while controlling validation of the Spanish FCQ-T and FCQ-S. In particular, for eating disorder psychopathology. Recent studies have we expected to (1) replicate the factor structures of both found greater incidence of food cravings in women than questionnaires, (2) find that the FCQ-T, as a tool intended to men and have reported that patterns of associations between measure a stable construct, would not be affected by a food craving and mood varies as a function of sex. Lafay temporal or incidental variable such as such as length of et al. (2001) found that whereas women associated food time without eating, and (3) show that the FCQ-S, as a cravings with negative mood states, men were more likely to measure of temporal and circumstantial states, would not be report positive mood in connection with food cravings. affected by a categorical (sex) and a relatively stable (eating Lafay et al. (2001) also reported that cravers were more disorder psychopathology) measure. concerned with body weight than noncravers, especially women cravers. Conversely, Christensen and Pettijohn (2001) reported that cravings were more 2. Method strongly associated with negative mood in men than women. Although neither of these studies examined whether sex 2.1. Participants and procedures differences in food craving report were due to differential mood or eating disorder psychopathology, their sex effects The participants were 304 volunteer undergraduate and conflicting results highlight the importance of studying psychology students (75% women) from the Univesidad food cravings in both men and women. de Granada. Granada is a city of over two hundred sixty Controversies regarding the origin and manifestation of thousand people in Southern Spain. Ages ranged from 17 to food cravings are due in part to a lack of scientific consensus 38 with a mean age of 19.1 (SD ¼ 2.8) years. Participants regarding what should be the most adequate definition and were recruited through verbal announcements at the measurement of food cravings (see Cepeda-Benito and beginning of different class periods. They were asked to Gleaves, 2001). Whereas some researchers have defined complete the questionnaires anonymously during their cravings as a mere desires for a specific food or drug, others regular class periods. All administrations were group claim that a craving could be any desire for anything sessions and participants were not compensated for their A. Cepeda-Benito et al. / Appetite 40 (2003) 47–54 49 contribution. Dividing the number of participants by the These authors also found support for the construct validity class sizes we estimated a participation rate of 90%. of the English versions of the instruments. Eating disorder symptoms were measured with the 2.2. Measures Eating Disorder Inventory-2 or EDI-2 (Garner, 1991). The EDI-2 consists of 64 items that yield eight ‘clinical’ scales and 27 additional items (items 65–91) that generate three The FCQ-T (39 items) and the FCQ-S (15 items) ‘provisional’ scales. Participants rated the extent to which measure the intensity of 9-trait and 5-state dimensions of each item applied to them ‘always’, ‘usually’, ‘often’, food cravings, respectively (Cepeda-Benito et al., 2000a). ‘sometimes’, ‘rarely’, or ‘never’. The three responses The instructions and the items of the instruments ask farthest from the symptomatic direction receive a weight respondents about cravings, urges or desires for one or more of zero. The remaining three responses are assigned a specific types of food. Participants are asked to think of the weight of 1, 2, or 3, with higher numbers indicating more food or foods they usually crave (for the FCQ-T) or the intense pathology. Garner indicated that the 0–3 scoring specific foods they are currently craving while completing system is recommended over a 1–6 scoring system because the questionnaire (for the FCQ-S). Thus, participants were responses in the nonsymptomatic direction should not asked to report cravings for specific foods but the specific aggregate to contribute to a total scale score that measures food cravings to which they referred varied across symptomatology. The eight clinical scales of the EDI-2 individuals. The instructions of the FCQ-T ask participants were named Drive for Thinness, Bulimia, Body Dissatisfac- how frequently each statement ‘would be true for you in tion, Ineffectiveness, Perfectionism, Interpersonal Distrust, general’ using a six point scale that ranges from 1 (‘Never’ Maturity Fears, and Interoceptive Awareness. Subscale or ‘Not Applicable’) to 6 (‘Always’). Always in reference to totals are obtained by adding the weights assigned to their craved foods, the nine scales of the FCQ-T measured: (1) respective items. intentions and plans to consume food; (2) anticipation of The eight clinical scales of the EDI-2 measure dimen- positive reinforcement that may result from eating; (3) sions that are clinically relevant to eating disorders but anticipation of relief from negative states and feelings as a while some scales measure symptoms highly characteristic result of eating; (4) possible lack of control over eating if of eating disorders, other scales tap more general dimen- food is eaten; (5) thoughts or preoccupation with food; (6) sions of psychopathology often found among eating craving as a physiological state; (7) that may be disorder clients. For example, while Drive for Thinness experienced before or during food cravings or eating; (8) assesses dieting concerns, preoccupation with weight, and environmental cues that may trigger food cravings; and (9) fear of weight gain, and Bulimia measures tendencies to guilt that may be experienced as a result of cravings and/or think about and engage in bingeing, the Ineffectiveness giving into them. scale surveys general feelings of distress, including For the FCQ-S, participants were asked to indicate the inadequacy, worthlessness, and lack of control (see Garner, extent to which they agreed with each statement ‘right now, 1991). at this very moment’ using a five point Likert scale that The Spanish version of the EDI-2 (Garner, 1998) was ranged from 1 (‘Strongly Agree’) to 5 (‘Strongly Disagree’). tested with a Spanish national sample of male (N ¼ 4) and Also in reference to craved foods, the five factors or scales female (N ¼ 302) eating disorder patients, at risk male of the FCQ-S measured: (1) an intense desire to eat; (2) (N ¼ 26) and female (N ¼ 251) individuals, and a non- anticipation of positive reinforcement that may result from clinical control sample of male (N ¼ 2057) and female eating; (3) anticipation of relief from negative states and (N ¼ 1751) adolescents. The normative profiles of Spanish, feelings as a result of eating; (4) obsessive preoccupation eating-disorder patients and control participants were highly with food or lack of control over eating; and (5) craving as a similar to the normative profile of their US counterparts. physiological state. Research with both the English and Spanish versions Full-scale and factor-scale totals for both instruments indicates that EDI-2 scores correlate positively and can be calculated by simply adding the corresponding substantially with other measures of eating disorder item scores. In the present sample, the overall alpha for symptoms, and effectively discriminates between eating the FCQ-T was 0.93, and factor-derived scales provided disorder and control populations (Garner, 1991, 1998). In alphas in the 0.68–0.90 range. The overall alpha for the our study, the overall alpha for the EDI-2 was 0.94 and FCQ-S was 0.89 and factor-scale alphas ranged from 0.62 factor-scale alphas ranged from 0.72 to 0.92. to 0.83. Using confirmatory factor analyses (CFA), Cepeda-Benito et al. (2000b) obtained results supporting 2.3. Statistical methods the above structures and the notion that cravings have multidimensional features (Tiffany, 1990; Weingarten and With regards to the factor structure crossvalidation, we Elston, 1990). That is, the analyses yielded excellent fit performed CFA, using LISREL 8, with the generalized least indices for nine and five factor solutions for the FCQ-T squares (GLS) method (for recommendations for GLS, see and FCQ-S, respectively (Cepeda-Benito et al., 2000b). Browne (1982, 1984) and Anderson and Gerbing (1988)), 50 A. Cepeda-Benito et al. / Appetite 40 (2003) 47–54

Table 1 Interfactor correlations or PHI matrix for the FCQ-T

Scales 1 2 3 4 5 6 7 8 9

1. Plans or intentions to eat – 0.35 0.38 0.36 0.67 0.55 0.46 0.42 0.44 2. Anticipation of positive reinforcement from eating – 0.87 0.27 0.44 0.48 0.59 0.40 0.37 3. Anticipation of negative reinforcement from eating – 0.23 0.40 0.52 0.74 0.37 0.38 4. Lack of control over eating – 0.51 0.37 0.43 0.54 0.44 5. Thoughts or preoccupation with food – 0.62 0.60 0.42 0.56 6. Craving as a physiological state or hunger – 0.44 0.36 0.38 7. Emotions experienced before or during food cravings – 0.36 0.41 8. Environmental cues that may trigger food cravings – 0.40 9. Guilt from cravings and/or for giving into them – and specified a nine and a five factor models for the trait and (Cepeda-Benito et al., 2000b): NFI ¼ 0.98; TLI ¼ 0.98; state version of the FCQ, respectively. Model fit was CFI ¼ 0.99; and RMSEA ¼ 0.039. The responses to the evaluated using the Normed-Fit Index (NFI; Bentler and FCQ-S in Spanish also resulted in an excellent fit for the Bonett, 1980), the Tucker-Lewis index (TLI; see Marsh five-factor structure of the instrument: NFI ¼ 0.99; et al., 1988), the Comparative Fit Index (CFI; Bentler, TLI ¼ 0.99; CFI ¼ 0.99; RMSEA ¼ 0.07. Overall, item- 1990), and the Root Mean Square Error of Approximation modification indices were below 5.0 and item-factor (RMSEA; Steiger, 1990). For the NFI, TLI, and CFI values loadings were above 0.60 in both instruments, providing of approximately 0.90 or greater reflect an adequate fit further support for the multidimensional structure of the (Byrne, 1989; Mulaik et al., 1989). The TLI and CFI have food craving questionnaires. been found to be unaffected by sample size (Marsh et al., Inter-factor correlations for the FCQ-T ranged for 0.87– 1988). Browne and Cudeck (1993) suggest that values of the 0.23, with a mean inter-factor correlation of 0.46 RMSEA of 0.05 or less indicate a close fit, values between (SD ¼ 0.14; see Table 1). Inter-factor correlations for the 0.05 and 0.08 indicate adequate fit, whereas values greater FCQ-S ranged for 0.66–0.17, with a mean inter-factor than 0.10 indicate room for improvement in the model. correlation of 0.42 (SD ¼ 0.16; see Table 2). To examine We also analyzed the relative influence of eating disorder the discriminant validity of both multifactor models, we also symptoms, food deprivation and sex on trait and state food examined confidence intervals around the factor corre- cravings we conducted multivariate analysis of covariance lations (þ or 22 standard errors) to see if any contained 1.0 (MANCOVA). That is, we used the total scores from the (Anderson and Gerbing, 1988). Although none of these FCQ-T and FCQ-S as the multivariate dependent variable confidence intervals contained 1.0, which can be interpreted with sex as the independent (group) variable, and the total as support for the discriminant validity of the model, the score from the EDI-2 and food deprivation as the set of high correlations between some factors weakens the overall covariate variables. This analysis was carried out after discriminant validity of the model. assessing that the MANCOVA assumption of homogeneous regression planes was met. That is, neither time by sex nor 3.2. Eating disorder symptoms, food deprivation and gender eating disorder symptoms by sex interacted to predict the set effects on trait and state food cravings of dependent variables (see Stevens, 1992). Univariate analyses on each dependent variable examined the source As expected, eating disorder symptoms uniquely and of the multivariate effects. Univariate analyses also explored exclusively predicted trait cravings, whereas length of the unique contribution of each covariate variable to predict FCQ-T and FCQ-S scores. The alpha level for statistical significance of the univariate effects was adjusted at Table 2 a , 0.025 following the Bonferroni method (0.05/2). Interfactor correlations or PHI matrix for the FCQ-S Correlation analyses examined the degree of association of Scales 1 2 3 4 5 specific eating disorder symptoms (EDI-2 scales) with trait and state cravings (FCQ-T and FCQ-S scales, respectively). 1. An intense desire to – 0.27 0.53 0.51 0.66 eat 2. Anticipation of positive reinforcement – 0.49 0.21 0.17 from eating 3. Results 3. Anticipation of negative reinforcement – 0.48 0.50 from eating 3.1. Factor structure crossvalidation 4. Lack of control over – 0.43 eating The responses to the FCQ-T in Spanish gave an excellent 5. Craving as a physiological – state or hunger fit the nine-factor structure of this instrument in English A. Cepeda-Benito et al. / Appetite 40 (2003) 47–54 51

Table 3 Correlations between the EDI-2 scales and the FCQ-T scales

Scales D Thin Bulim B Diss Ineffec Perfect I Distr Int Aw Mat Fear

Plans or intentions to eat 0.10 0.39a 0.14 0.12 0.17 0.01 0.22 0.05 Anticipation of positive reinforcement from eating 20.01 0.26 0.04 0.01 0.19 20.09 0.15 0.02 Anticipation of negative reinforcement from eating 0.12 0.26 0.16 0.01 0.12 20.09 0.10 20.05 Lack of control over eating 0.22 0.60b 0.30a 0.23 0.16 20.01 0.29 0.17 Thoughts or preoccupation with food 0.38a 0.59b 0.36a 0.25 0.22 0.04 0.34a 0.15 Craving as a physiological state or hunger 0.04 0.37a 0.11 0.09 0.20 0.01 0.18 0.03 Emotions experienced before or during food cravings 0.35a 0.52b 0.37 0.21 0.24 20.03 0.28 0.17 Environmental cues that may trigger food cravings 0.08 0.51b 0.19 0.10 0.16 20.09 0.18 0.11 Guilt from cravings and/or for giving into them 0.71b 0.38a 0.58b 0.26 0.11 0.08 0.30a 0.14

Note: EDI-2 scales: D Thin, Drive for Thinness; Bulim, Bulimia; B Diss, Body Dissatisfaction; Ineffec, ineffectiveness; Perfec, Perfectionism; I Distr, Interpersonal Distrust; Int Aw, Internal Awareness; Mat Fear, Maturity Fears. a medium sized correlations ¼ r , 0.29. b Large sized correlations ¼ r , 0.49. food deprivation uniquely and exclusively predicted state 4. Additional analyses cravings. EDI-2 scores and food deprivation together strongly predicted the FCQ-T and FCQ-S multivariate Additional analyses were carried out to examine ¼ ¼ variable, Wilk’s Lambda 0.792; F(4,588) 18.20, association patterns between EDI-2 subscales and the p , 0.001. EDI-2 subscales and food deprivation together factor-derived scales of the FCQ-T and the FCQ-S, also predicted univariate FCQ-T scores, F(2,295) ¼ 27.2, respectively. Cohen (1988) characterized r ¼ 0.1 as a p , 0.001, and univariate FCQ-S scores, F(2,295), small, 0.3 as medium, and 0.5 as large effect sizes. p , 0.02. However, examination of the separate contri- Examination of the bivariate correlations indicated that butions of EDI-2 and food deprivation scores revealed the pattern of associations with the FCQ-T were medium to that the EDI-2 measure only predicted FCQ-T scores, high for the EDI-2 scales that measure eating-disorder b ¼ 0.39, t(295) ¼ 7.4, p , 0.001, while food deprivation symptoms, Drive for Thinness, Bulimia, and Body Dis- only predicted FCQ-S scores, b ¼ 0.16, t(295) ¼ 2.9, satisfaction, but small to medium for the scales that measure p , 0.005. more general psychopathology (see Table 3). Moreover, the The results also supported the expectation that women would report greater cravings than men above and beyond only scale of the EDI-2 that specifically measures sex differences in eating disorder symptomatology, and that tendencies to think about and engage in bingeing, Bulimia, such difference would be specific to trait rather than was the measure that was most consistently and substan- situational cravings. After controlling for EDI-2 scores tially associated with the FCQ-T scales (see Table 3). and food deprivation, there was a significant sex difference Conversely, the correlations between FCQ-S scales and on the FCQ-T and FCQ-S multivariate variable, Wilk’s EDI-2 scales were overall small or close to zero, with the Lambda ¼ 0.960; F(2,294) ¼ 6.18, p , 0.001. Univariate exception of a moderate correlation between the Lack of analyses indicated that FCQ-T scores were significantly Control craving scale and the Bulimia scale of the EDI-2 higher for women (M ¼ 110) than for men (M ¼ 98), (see Table 4). These patterns of correlations are congruent F(1,295) ¼ 12.1, p , 0.001, but that there were no sex with the notion that the FCQ-S and the FCQ-T measure state differences for FCQ-S report, F . 1. and trait cravings, respectively.

Table 4 Correlations between the EDI-2 scales and the FCQ-S scales

Scales D Thin Bulim B Diss Ineffec Perfect I Distr Int Aw Mat Fear

An intense desire to eat 20.17 0.10 20.11 20.02 20.02 20.10 0.04 20.02 Anticipation of positive reinforcement from eating 20.07 0.12 20.08 20.03 0.01 20.07 0.01 20.02 Anticipation of negative reinforcement from eating 0.03 0.18 0.01 0.11 0.01 0.06 0.16 0.11 Lack of control over eating 0.15 0.38a 0.13 0.11 0.02 0.03 0.21 0.04 Craving as a physiological state or hunger 20.18 0.10 20.11 0.01 0.07 0.01 0.05 20.02

Note: EDI-2 scale abbreviations are defined in Table 3. Large sized correlations ¼ r , 0.49. a Medium sized correlations ¼ r , 0.29. 52 A. Cepeda-Benito et al. / Appetite 40 (2003) 47–54

5. Discussion classification of individuals into ‘cravers’ and ‘noncravers’ according to an arbitrary and ambiguous definition of food How best conceptualize cravings has been and will most cravings. likely continue to be a controversial subject within both the We suggested that cravings are not necessarily patho- drug addiction and eating disorders literature (Cepeda-Be- logical, but that consistent with prior empirical findings nito and Gleaves, 2001; Tiffany and Carter, 1998; women would report higher levels of craving than men Weingarten and Elston, 1990). The present investigation (Weingarten and Elston, 1991; Rozin et al., 1991). Scores provides further support for a multidimensional conceptu- obtained with the FCQ-T supported this prediction after alization of trait and state food cravings, and contributes to a controlling for eating disorder symptoms and degree of food better understanding of the link between eating disorder deprivation. This finding is important in that, to our symptoms and food cravings. On the one hand, the nine and knowledge, this is the first study to show that gender/sex five factor solutions of the FCQ-T and FCQ-S, respectively, differences in craving report remain after removing the were replicated. CFA showed excellent fit indices for the a- variance accounted for by eating disorder psychopathology. priori proposed factor structures and there were various That is, we can assert that variables other than eating sources of evidence for the discriminant validity of the disorder psychopathology play an important role in food models. Most notably, none of confidence intervals around craving differences between men and women. These results the factor correlations (þ or 22 standard errors) contained also lend support to the notion that food cravings are not 1.0 (Anderson and Gerbing, 1988). Moreover, although the necessarily pathological and can be independent of eating correlation between the Positive Reinforcement and Nega- disorder symptoms (Rozin et al., 1991; Michener and Rozin, tive Reinforcement factors of the FCQ-T were very high, 1994). their respective associations with the Drive for Thinness and The results also supported the convergent and discrimi- Body Dissatisfaction scales of the EDI-2 were substantially nat validity of the FCQ-T and the FCQ-S in that the different. That is, Negative Reinforcement but not Positive arrangement of associations between these measures and the Reinforcement cravings were significantly associated with othertraitandstatevariablesinthestudyfollowed Drive for Thinness and Body Dissatisfaction. The results congruent patterns. In particular, the FCQ-S was and the represent a significant contribution to the literature in that FCQ-T was not influenced by an incidental circumstance this is the first study to crossvalidate the factor structures of (food deprivation), whilst the FCQ-T was and the FCQ-S the Spanish versions of the trait and state FCQ. Moreover, was not sensitive to ‘trait’ variables (eating disorder the study is the first to examine the psychometric properties symptoms and sex). of the revised, longer version of the Spanish FCQ-T. Regarding the FCQ-S, it remains to be seen whether this Multivariate analyses supported the notion that eating state measure will be sensitive to other psychological states disorder habits found in bulimic patients contribute to the (e.g. anger, boredom, euphoria) and environmental circum- experience of food cravings (Green, 2001). That is, after stances (e.g. being alone, having readily access to snacks). controlling for food deprivation and sex, eating disorder Thus, further investigations should examine whether the symptoms were predictive of higher trait cravings. Although FCQ-S is sensitive to food craving changes in reaction to we predicted an overall substantial association between trait food cues, emotional states, and other relevant stimuli. For cravings and the EDI-2, we also expected that this example, at the basic level researchers could manipulate association would be particularly high with the scales of mood and test the hypothesis that food cravings are elicited the EDI-2 that measure eating disorder symptoms in general by affective states (Buffenstein et al., 1995; Cepeda-Benito and bulimia nervosa symptoms in particular. Confirming and Tiffany, 1996). At the applied level, researchers could our expectations, the scales Drive for Thinness, Bulimia, test whether interventions, such as cue-exposure/response- and Body Dissatisfaction were moderately-to-strongly prevention strategies, effectively reduce craving reactivity associated with trait cravings, whereas scales that measure (Bulik et al, 1990; Federoff et al., 1997), and whether such less specific symptoms of eating disorders (Ineffectiveness, changes in craving reactivity translate into better treatment Perfectionism, Interpersonal Distrust, Maturity Fears, and outcomes (e.g. reduced bingeing in bulimic patients). Interoceptive Awareness) were weakly associated with trait Although the study was conducted with a highly relevant cravings. Moreover, Bulimia, a scale that assesses binge- sample (most participants were young, female college eating tendencies was the measure most consistently students), future studies should investigate the extent to associated with the FCQ-T. That is, the results are consistent which the factor structures of FCQ-T and FCQ-S replicate with previous research liking cravings to symptoms of with eating disorder patients. Moreover, the hypothesis that bulimia (van der Ster Wallin et al., 1994), and to life-time dietary restraint leads to cravings, and cravings lead to prevalence of bulimia nervosa (Gendall et al., 1997). bingeing needs to be investigated directly with bulimia However, the present study is the first to establish and nervosa patients. The present investigation shows that there association between food cravings and symptoms of bulimia is a clear relationship between eating disorder symptoms using a continuous measure of food cravings of known and food cravings, but future research should also study the reliability and validity, rather than a using a dichotomous processes by which such relationship comes about. Finally, A. Cepeda-Benito et al. / Appetite 40 (2003) 47–54 53 because the results are congruent with the notion that food Cepeda-Benito, A., & Tiffany, S. T. (1996). The use of a dual-task cravings are associated with eating disorder symptoms but procedure for the assessment of cognitive effort associated with are not necessarily pathological, future investigations cigarette craving. Psychopharmacology, 127, 155–163. Cepeda-Benito, A., Gleaves, D. H., Fernandez, M. C., Vila, J., & Reynoso, should aim to delucidate whether we should distinguish J. (2000a). The development and validation of Spanish versions of the between healthy and unhealthy food cravings. state and trait food cravings questionnaires. Behaviour Research and Therapy, 38, 1125–1138. Cepeda-Benito, A., Gleaves, D. H., Williams, T. L., & Erath, S. T. (2000b). The development and validation of the state and trait food cravings Acknowledgements questionnaires. Behavior Therapy, 31, 151–173. Christensen, L., & Pettijohn, L. (2001). 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