Identity and conformism among Italian adolescents who binge eat and drink

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Identity and conformism among Italianadolescents who binge eat and drinkFiorenzo Laghi a , Francesca Liga a , Emma Baumgartner a &Roberto Baiocco aa Department of Social and Developmental Psychology, Faculty ofMedicine and Psychology, University of Rome, Rome, Italy

Available online: 08 May 2012

To cite this article: Fiorenzo Laghi, Francesca Liga, Emma Baumgartner & Roberto Baiocco (2012):Identity and conformism among Italian adolescents who binge eat and drink, Health, Risk & Society,14:4, 361-376

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Identity and conformism among Italian adolescents who binge

eat and drink

Fiorenzo Laghi*, Francesca Liga, Emma Baumgartner and Roberto Baiocco

Department of Social and Developmental Psychology, Faculty of Medicine and Psychology,University of Rome, Rome, Italy

(Received 9 September 2011; final version received 27 March 2012)

This cross-sectional study examined binge eating and binge drinking behavioursanalysing their association with the process of identity formation in adolescenceand individual tendency towards conformism. The sample consisted of 1500Italian students (660 boys and 840 girls) attending high school. The average age ofthe students was 17.31 years (SD ¼ 1.34; range: 17–19). They completed self-report measures assessing binge behaviours, ego identity status and socialconformism. Diffused adolescents were more likely to be engaged in binge eatingand binge behaviours than others validating that the achievement of aconsolidated ego identity is important for enhancing well-being and preventingproblematic outcomes in adolescents. Moreover, adolescents engaging in bingebehaviours reported the highest levels of tendency to compare their performancesor ideas and opinions with others and to conform with them. The present studysuggested that binge behaviours were strongly associated with an adolescent’sidentity process and have important implications for future empirical investiga-tion and for clinical intervention.

Keywords: risk; Italy; adolescents; binge eating; binge drinking; identity status;conformism

Introduction

Binge eating and binge drinking are significant and often co-occurring mental andphysical health issues facing society today. Despite immediate health consequencesand long-term risk linked to both binge behaviours, youth – especially femaleyouth – continue to both binge eat and binge drink. Although research suggests thata large proportion of students are placing themselves at risk by engaging in bingedrinking, young people do not see this as a significant problem (Crundall 1995, Oeiand Morawska 2004). Previous studies have established that youths tend to operatewith a sense of invulnerability when it comes to risk-taking behaviour (Denscombeand Drucquer 1999). There is typically a greater expression of risk taking andexploration of new behaviours during adolescence, which are part of thedevelopmental processes that contribute to autonomous identity formation andfunctioning. These risk-taking behaviours have been considered to be part of thenormal experimentation with perceived facets of adult life (Bray et al. 2000, Johnston

*Corresponding author. Email: [email protected]

Health, Risk & Society

Vol. 14, No. 4, June 2012, 361–376

ISSN 1369-8575 print/ISSN 1469-8331 online

� 2012 Taylor & Francis

http://dx.doi.org/10.1080/13698575.2012.680952

http://www.tandfonline.com

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et al. 2000), and adolescents often minimise the harm associated with periodicinvolvement in health-threatening activities. It seems that these mistaken perceptionsmay be linked to a developmental phenomenon called adolescent egocentrism, whichis the tendency to think they are unique and so they cannot be vulnerable to healthrisks like the typical average person (Denscombe and Drucquer 1999). It is alsoimportant to note that youths who do not experience negative consequences wouldbe desensitised to expectations of future risk.

However, simply because binge behaviours are considered developmentallynormative or mistakenly perceived as not harmful, it does not mean that they arewithout clinical or public health significance. Researchers have shown that bingingbehaviours frequently co-occur in non-clinical samples of adolescents and that the16–25% of US college-age women engage in binge-eating behaviours and upwards of40% of college students engage in frequent, heavy episodic drinking behaviours(Johnston et al. 2000, Ferriter and Ray 2011). Although there are few studies aboutthe co-occurrence of eating and alcohol use problems, Gadalla and Piran (2007)found a significant association between being at risk for eating disorders and alcoholconsumption in men and women. The precise mechanism underlying the statisticaland temporal associations between eating and drinking binge behaviours remainsunknown, even if eating disorders tend to precede the emergence of problem drinking.

In the last 10 years, there has been growing awareness and concern about theincreased prevalence of these behaviours also among young people across much ofEurope (Kuntsche et al. 2004, D’Alessio et al. 2006). The European School SurveyProjection on Alcohol and Other Drugs research (ESPAD) found that 13% of theyoung Italians who participated in the survey engaged in binge drinking. While theItalian sample drank less than their Northern European counterparts – e.g. Irelandbeing in first place at 32% – they drank more than their counterparts living inSouthern countries – e.g. Greece at 11% – and Eastern European – e.g. Romania at11% – countries (Kuntsche et al. 2004, Beccaria and Prina 2010).

These results reflect the typical features of the various drinking cultures:

. The Mediterranean culture: one starts to drink at a young age, the rate ofdrunkenness is low, but the rate of regular consumption of all alcoholic drinksis high.

. The Nordic and Western European culture: episodes of drunkenness begin atan early age and repeated drunkenness is frequent.

. The Eastern culture: despite the high consumption of spirits among adults,young people’s consumption and episodes of drunkenness are halfway downthe European classification.

In relationship to eating behaviours, a study by Favaro et al. (2003) found that theprevalence of lifetime atypical eating disorders was 4.7% and that of binge eatingdisorder (BED) was 0.6% and was a major risk to female adolescents. In recentyears, there has been such strong social emphasis on ‘thin is in’ that it almost seems‘normal’ to have unhealthy weight and body image concerns (Kiang and Harter2006). A review of the literature points to a strong relationship between binge eatingand a dissatisfaction with body image.

Binge eating and drinking underpin health problems in western society as theyare associated with physical, social and psychological problems and unfavourableoutcomes such as heavier service use patterns, progression to other substance, lost

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efficiency, anxious and depressive symptoms, obesity and diabetes (Gruber et al.1996,Grant and Dawson 1997, Correia et al. 2003, Callas et al. 2004, Ferriter and Ray2011). Binge drinking, in particular, is related with three of the main causes of deathamong young people, mainly amongst female adolescents: illness (41%), murders(41%) and accidents (45%) (Beccaria and Prina 2010, Gallimberti et al. 2011).

Evidence of an association between binge eating and binge drinking and ofrelated health consequences have stimulated investigators to examine and explorerisk and protective factors plus the reasons why individuals engage in these riskybehaviours. Identification of risk factors for binge eating would advance ourunderstanding of the aetiology of correlated disorders and aid the identification ofhigh-risk subgroups. An improved understanding of the ways in which individualand social variables are related to binge behaviours can also provide the basis forimproved health programming: modifying existing treatments as well as developingpreventive and early interventions that can help avoid the mergence of more extremeclinical problems.

Binge behaviours and underlying mechanisms

A binge can be defined as a period of uncontrolled or excessive indulgence and hasbeen used to describe consumption of either food (binge eating) or alcohol (bingedrinking). Binge eating consists in eating larger amount of food than normal during ashort period of time (within any two-hour period) with at least one of six additionalsymptoms: eating much more rapidly than normally; eating until feeling uncomfor-tably full; eating large amounts of food when not feeling physically hungry; eatingalone because of being embarrassed by how much one is eating; feeling disgusted withoneself, depressed or guilty after overeating; or experiencing an inability to stopeating (APA 2000). Binge drinking can be defined as the consumption of consecutivealcoholic beverages in a limited period of time on one or more occasions within thepast six months (Courtney and Polich 2009) and specifically of five or more drinks perdrinking episode for men and four or more drinks for women (Wechsler and Nelson2001, Naimi et al. 2003, Ferriter and Ray 2011).

These behaviours are often characterised as addictive to capture the repetitive anduncontainable nature of the behaviour and have many overlapping features(Holderness et al. 1994, Benjamin and Wulfert 2003, Ferriter and Ray 2011) includ-ing the loss of control, cravings, preoccupation, immediate gratification followed bylong-term harm and, by definition, excessive consumption of the substance.

Given the similarities between binge eating and drinking, there are number ofpossible explanations why individuals indulge in both behaviours. The behavioursmay be underpinned by genetic and/or biological factors: their co-occurrence may beemphasised by aspects of family environment, such as dysfunctional familyinteractions; they may reflect dispositional characteristics, such as impulsivity orhigh tolerance of deviance and they may be determined by expectancies individualsthink are related to them. Beyond the perspective adopted, at the heart of eachexplanatory model is the assumption that binge behaviours serve some function forthe individual and that function influences the persistence, or maintenance, of thebehaviour (Ferriter and Ray 2011).

Recent findings (Stewart et al. 2000, Stewart and Brown 2005, Birch et al. 2007)have suggested that binge eating and drinking – above all in women – may beassociated with difficulties in regulating emotions (dysregulation hypothesis) and

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that situations involving negative emotional states posed the highest risk forengaging in both behaviours. More specifically, Birch et al. (2007) argue that bingeeating amongst women is a relief from psychological distress (e.g., reducing anxietyand desires) and temptation, while binge drinking is more likely to occur in rewardsituations (e.g., fulfilling needs and desires). Moreover, binge drinking is more likelyto occur than binge eating in situation that involve interpersonal interaction,pleasant times with others and social pressure.

Thus, binge eating and drinking may be so co-prevalent because they serve asimilar function and purpose such as regulating emotions and/or escaping fromemotions and coping with distress. Binge eating and drinking women often reportedtwo behaviours in response to feeling lonely, bored or powerless in relation to theirpartners or they descript bingeing as a means of escape from fear of failure orfeelings of low self-esteem and inadequacy.

Importantly, the relationship between binge eating and binge drinking has beenshown to extend beyond the limits of clinically diagnosed disease to less severe levelsof both disorders (Benjamin and Wulfert 2003). Binge eating and drinking have beenshown to co-occur in samples of high school and college students, and bothbehaviours also run in families.

Binge behaviours and identity resolution

Identity theory focuses on various aspects of identity, and their relationships toadolescent psychological functioning and focuses on individual identity as animportant protective factor against problematic outcomes such as delinquency oraddictive behaviours (Cote and Levine 2002). Researchers have explored the role andthe impact of ego identity (Scales et al. 2000, Schwartz 2005, Palen and Coatsworth2007), ethnic identity (Yasui et al. 2004, Schwartz et al. 2009) and sexual identity orbehaviour (Hughes and Eliason 2002, Baiocco et al. 2010). Researchers indicate apositive association between personal and group identity and an adolescent’spsychological adjustment and well-being: an integrated sense of identity provides asubjective sense of inner unity and continuity over time, and it has beneficial effectson adolescents’ adjustment (Laghi et al. 2011).

Researchers have shown that the relationships of ethnic identity to adaptive andmaladaptive (Yasui et al. 2004) aspects of psychosocial functioning appear to beconsistent across ethnic groups. Lower levels of ethnic identity were found to beassociated with more difficult adjustment: when adolescents have negative attitudesor are uncommitted to their ethnicity, they are also more likely to experiencenegative psychological outcomes, including internalising and externalising problems(Yasui et al. 2004, Schwartz et al. 2009). These findings parallel previous results thatsuggested ethnic identity as a critical component of the self-concept, especially forthe ethnic minorities who may experienced stigmatisation and discrimination thatwould influence their psychological well-being (Yip and Fuligni 2002, Yasui et al.2004, Shelton et al. 2005). So, adolescents belonging to minority ethnic groups aremore likely to adopt binge behaviours as coping strategies. Although they feelsocially integrated, they face negative affects linked to discriminations. Adolescentsfrom ethnic and cultural minority groups often face the task of defining who they areat the ethnic group level as well as at the individual level (Schwartz et al. 2009).

Recent advances in studies on how youths construct personal identities haveshown that lesbian and gay adolescents compared with heterosexual individuals are

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more likely to engage in a wide range of health-risk behaviours, including bingedrinking (Baiocco et al. 2010) and unhealthy weight management practices (Kannet al. 2002). The Minority Stress Model (MSM, Mayer 2003, Meyer et al. 2008) isbased on the premise that many lesbian and gay adolescents are at risk of bingebehaviours because of stress factors, including discriminative experiences induced bya hostile and homophobic culture (Greenwood et al. 2001, Hughes and Eliason2002). Caldwell et al. (1998) have argued that adolescents and young adults whowere lesbian, gay or bisexual were more likely to binge drink than those who wereheterosexual. Furthermore, the percentage (43%) of binge drinkers found in asample of Italian lesbian and gay youths (Baiocco et al. 2010) is higher than the 32%found in the only research ever conducted in the Italian context in a heterosexualsample of university students (D’Alessio et al. 2006), supporting the associationbetween internalised sexual stigma and binge behaviours.

With regard to ego identity formation, a few studies (Wheeler et al. 2001, Seatonand Beaumont 2008) have begun to pay attention on the influence of a precarioussense of self on the development and maintenance of BED, especially duringadolescence transitions. These studies indicate that adolescents – mostly women –with binge eating disorders reported greater identity confusion and perceived theiridentities were enmeshed with others, showing that binge behaviours involve evadingthe struggle to form and maintain one’s own identity, However, no previous studieshave investigated the link between the co-occurrence of binge eating and drinkingand identity status among adolescents.

Marcia (1980, 1988) has identified four identity types based on two dimensions,exploration and commitment:

. Identity achievement (commitment following exploration)

. Foreclosure (commitment without much prior exploration)

. Moratorium (ongoing exploration with little commitment)

. Diffusion (no commitment and little systematic exploration)

The different types of identity are each related in a unique way to psychologicaladjustment and problematic outcomes: adolescents who experienced less advancedidentity status – foreclosure and diffusion – are more likely to report the mostnegative profile.

Individuals in a diffused status are characterised by a diffuse-avoidant identitystyle and low self-awareness. They avoid dealing with identity issues, so they may bemore inclined to escape distress using food or drink to reduce anxiety and negativeaffect specifically concerning decisions that have a significant impact on theirpersonal identities and life paths (Berzonsky 1990, Wheeler et al. 2001, Seaton andBeaumont 2008, Laghi et al. 2009). Diffuse-avoidant adolescents proceed on asituation-by-situation basis and have no organised or coherent method fornegotiating their way through life, and they reported low levels of commitment(Berzonsky 1993, Berzonsky and Neimeyer 1994) as well as low self-esteem andunstable self-conceptions (Nurmi et al. 1997). These same characteristics arereported by women with eating and drinking disorders. Likewise, foreclosedadolescents engaged in commitment without prior exploration are also associatedwith high levels of problem behaviours (White and Jones 1996, Mitchell 2001,Adams et al. 2005, Dworkin 2005, Good et al. 2008), as addictive behaviours andassumption of substance.

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Binge behaviours and conformism

Researchers (Parra et al. 2007, Ferrier and Ray 2011) have found that binge eating anddrinking behaviours are shared among adolescents in the same peer networks. Thesebehaviours have been associated to a high tendency of adolescents to make socialcomparisons and to adopt a certain course of action sanctioned by their peer group andnot personal preferences. Specifically, binge drinking behaviour – above all amongboys – represents a way of dealing with fears of merging on the one hand and isolationon the other (Bateman 1996, Weitzman et al. 2003). With regard to binge eating, it wasfound that peer groups and friends were a source of social pressure for thinness andconcern for body image, which encouraged adolescents to assume this type of addictivebehaviour. Stice (1994) noted that adolescent females may be especially vulnerable tosociocultural glorification of a slender body image, as adolescence is a time of increasedconcern about appearance. Social values of attractiveness are particularly salient tofemale youths given they are more likely than man to be evaluated primarily in theirappearance. Some adolescent females may be particularly sensitive to cultural andsocial pressure for conforming to a thin ideal and for experimenting with alcohol,resulting in an increased vulnerability for both eating and drinking addictive beha-viours (Kiang and Harter 2006). Thus, binge eaters and binge drinkers were most likelyinfluenced by external demands and group requirements, and they were inclined toengage in addictive behaviours to conform themselves to norms of a group and to facethe intense preoccupation with appearance and social acceptance (Bateman 1996,Schwartz 2001). Lower satisfaction with appearance increased the risk of engaging inbinge behaviours. These data were consistent with a theoretical model in whichadolescents’ friends – above all girls – tended to resemble one another on a wide rangeof dimensions, including physical and social attributes and attractiveness.

Cultural and subcultural factors implicated in binge behaviours included socialpressure applied by media. Studies of media influences suggest that greater exposureto media depicting thinness may be related to more eating disorder symptomatology,including binge eating (Paxton et al. 1999). Likewise, alcohol advertising maymanipulate adolescents’ vulnerability by shaping their attitudes, perceptions andexpectancies about alcohol use, which influence youth decisions to drink.

Aims of this study

The purpose of this study was to examine possible differences in binge behavioursassociated with identity resolution during adolescence and with adolescents’tendency to socially conform themselves. The research examined two hypotheses.In line with the documented association between low level of commitment and anavoidance – diffused way of decision making with binge eating and binge drinkingproblems, our primary hypothesis was that adolescents who engaged in bothbehaviours could be classified as diffused or foreclosed adolescents. Our secondaryhypothesis was that the co-occurrence of binge eating and binge drinking behavioursamong adolescents could be associated with high levels of social conformity,consisting of a general tendency of an individual to compare himself to others.

Methods

Sample

The sample consisted of 1500 students (660 boys and 840 girls). The average age ofthe students was 17.31 years (SD ¼ 1.34; range: 17–19). We were able to select

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schools in both rural and urban areas that were considered by school authorities toenrol students from a full range of socioeconomic backgrounds. We conducted thisstudy in 12 schools, four each from the North, Centre and South of Italy, half fromthe cities and half from surrounding rural villages. Two additional schools declined toparticipate in the study. Although data regarding the cultural origin of the partici-pants were not available, we estimate 98% were from the majority Italian culture.High schools in Italy are divided into distinct educational and occupational fields andinclude five grade levels. In terms of type of high school, 27% of students wereenrolled in science-focused schools, 27% were in technical-industrial arts schools,23% were in liberal arts-focused schools and 23% were in teacher-training schools.

Procedures

Participation was preceded by an informed-consent procedure that required activeconsent from both students and parents. The questionnaires were administered in theclassroom during a normal class and took approximately 40 minutes to complete.Instructions stated that the questionnaires were voluntary and that responses wereanonymous and confidential. This survey was reviewed and approved by the EthicsCommission of the Department of Developmental and Social Psychology ofSapienza, University of Rome.

Measures

Binge Eating Scale (BES)

To measure the severity of binge eating, the BES was applied (Gormally et al. 1982).The BES consists of 16 items, eight describing the behavioural manifestations of bingeeating and eight describing feelings and cognitions associated with binge eating. Eachitem has three or four weighted statements, and the respondent is directed to chooseone. The BES is scored by adding the individual values for the 16 items resulting in apossible range of scores from 0 to 46 (Gormally et al. 1982, Timmerman 1999). BEStranslation has been validated by the NetWorking Team Group of the Italian Societyfor Eating Behavior Disorders (Dalle Grave et al. 2009). The BES has good test–retestreliability (r ¼ 0.87, p 5 0.001) and moderate associations with binge eating severityas measured by food records (r ¼ 0.20–0.40, p 5 0.05; Timmerman 1999). While theBES is typically used in obese or clinical BED populations, the questionnaire has alsobeen used in normal-weight samples (Dalle Grave et al. 2010) to categoriseparticipants into binge eating and non-binge eating groups. Based on other studiesin Italian context (Ricca et al. 2000, Dalle Grave et al. 2009, 2010, Mannucci et al.2010), we chose to use the total score to create a continuous measure of binge eatingtendencies. Greeno et al. 1995, Freitas et al. 2006 and Lo Coco et al. 2011 used a scoreof 18 and above as their indicator of BED. We adopt the same threshold to avoidfalse-negative results and to ensure higher test sensitivity. In this study, constructvalidity of the scale was estimated by factor analysis Kaiser’s criterion (eigenvalue 41), followed by an oblimin rotation, showed two different factors with eigenvaluesgreater than 1 (4.00,1.60) that explained 35.01% of variance: Factor 1 (25.01%variance) was loaded by all the items describing the behavioural manifestations ofbinge eating and Factor 2 (10.0% variance) was loaded by all the items describingfeelings and cognitions associated with binge eating. Internal consistency for the BESin the current investigation was satisfactory (a ¼ 0.84).

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Alcohol use

Participant’s drinking behaviour was assessed using questions about frequency andquantity of drinking:

. Frequency of alcohol consumption (never, less than twice per year, three/fourtimes a year, once a month, at least once a week and three/four times a week).

. Average number of drinks consumed per occasion in the last month (only onedrink; two drinks; three drinks; four drinks and five or more drinks).

We also included a specific question focusing on binge drinking:

. ‘Considering all types of alcoholic beverage, did you have 5 or more drinks (4 ifyou are female) on one single occasion during the past month? How manytimes in the last month?’

Respondents were categorised as ‘binge drinkers’ (1–8 binge drinking episodes in amonth), as reported in other studies (Vik et al. 2000, Rush et al. 2009, Baiocco et al.2010).

Identity status

The Extended Objective Measure of Ego Identity Status-Version 2 (EOM-EIS-II,Adams et al. 1989) was used to measure ego identity status. The EOM-EIS-IIcontains 64 items presented on a six-point Likert scale anchored by 1 (strongly agree)to 6 (strongly disagree). The instrument assesses the degree of identity achievement,moratorium, foreclosure and diffusion, and the individual is classified within fourinterpersonal domains (friendships, dating, gender roles and recreation) and fourideological domains (politics, religion, occupation and lifestyle). Because the EOM-EIS-II is a questionnaire not developed and validated in Italian context, theadaptation is based on a rational translation procedure: two Italian researchersindependently translated the original version in order to make the items as clear andconcise as possible. The two different translations were subsequently compared withthe purpose of obtaining a unanimously accepted version. The agreed version wasthen translated back into English by one bilingual American/Italian translator withno knowledge of the original version. The Italian version was translated back intoEnglish and compared to the original one in order to guarantee syntactic andtechnical matching and conceptual equivalence. The Italian version of the instrumentshows good reliability coefficients and a factorial structure congruent with theoperative definition of the construct (Laghi 2008, Laghi et al. 2009). Convergentvalidity indicated moderate associations with identity styles as measured by IdentityStyle Inventory-3 (r ¼ 0.18–0.52, p 5 0.05).

A factor analysis using maximum likelihood extraction and varimax rotation wasused to analyse data. The analysis of scree plot and eigenvalues greater than 1.0(2.48, 1.80, 1.01) suggested that three factors should be extracted, which explainedthe 66.16% of post-rotational variance: one for achievement (30.95 variance), onefor foreclosure (22.53% variance) and one for diffusion and moratorium statuses,which were found to share some variance (12.68% variance). In the present study,internal reliability of the EOMEIS-2 ranged from 0.80 to 0.88. We assigned identitystatuses to participants with the standardisation technique suggested by Adams et al.

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(1989) and used in other studies concerning identity development and alcoholconsumption (Bishop et al. 2005). The students with a score of one standarddeviation above the mean of an identity status were classified with that status. Whenrespondents scored one deviation above the mean on two (or more) identity statuses,we assigned them to the lower of the two (or more) identity statuses. This procedurewas based on a rank ordering of the statuses from the most to the least mature:achieved, moratorium, foreclosed and diffused.

Applying the same procedures, participants were classified into separate identitystatuses for each identity domain. In common with most studies employing EOMEIS-2, 1300 adolescents (87% of the participants) fell into one of the ‘-pure-’ statuses(achievement, foreclosure, moratorium and diffusion). Participants with scores abovethe mean on two (or three) identity statuses (N ¼ 50; 3%) are assigned to the lower ofthe two (or three) identity status and participants with scores falling less than onestandard deviation above the mean on all four measures (N ¼ 150; 10%) are scoredas the low-profile moratorium. As these adolescents seem to waver between differentoptions, they resemble the moratorium status. According to Adams (1999) andSolomontos-Kountouri et al. (2008), ‘pure’ moratorium and low-profile moratoriumwere treated as a single moratorium status. Moratorium status had the highestpercentage of participants as a result of the inclusion of low-profile participants.

Social conformism

Adolescents were invited to indicate the extent to which they compared themselveswith others on a 5-point Likert-type scale of Iowa–Netherlands ComparisonOrientation Measure (INCOM, Gibbons and Buunk 1999). It composed of 11-itemself-report measure of a general tendency for an individual to compare themselves withothers. High scores represent a greater tendency to make social comparisons. TheINCOM has two subscales: ability and opinions. The Ability dimension (six items)concerns comparison regarding performance, while the Opinion dimension (five items)describes comparison regarding others’ thoughts or opinions. The INCOM has beenshown to have good psychometric properties (e.g., Gibbons and Buunk 1999). TheItalian version of the instrument shows good reliability coefficients and a factorialstructure congruent with the operative definition of the construct. Convergent anddivergent validity estimates indicated that scores were not related to age and type ofschool, whereas they were related to different measures of positive and negativefunctioning, as measured by SCL-90 Revised and Rosemberg Self-Esteem (r ¼ 7 0.18to 70.52, p 5 0.05; Laghi et al. 2007, Laghi et al. 2011). In this study, constructvalidity of INCOM estimated by factor analysis Kaiser’s criterion (Eigenvalue 4 1),followed by an oblimin rotation, showed two different factors with eigenvalues greaterthan 1 (3.19, 1.54) that explained 43.09% of variance: Factor 1 (29% variance) wasloaded by all the items of Ability dimension and Factor 2 (14% variance) was loadedby all the items of Opinion dimension. Alpha reliability indices in the present samplewere 0.86, 0.84 and 0.85 for Ability, Opinion and Total score, respectively.

Results

Binge group membership

On the basis of their responses to the binge screening measure, adolescents wereassigned to one of four binge behaviour groups: binge drinking only (binge drink;

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N ¼ 347), binge eating only (binge eat; N ¼ 231), both behaviours (binge eat anddrink; N ¼ 212) and neither binge behaviour (no binge; N ¼ 710). In a series ofchi-square tests, we examined whether there were significant differences among thefour binge behaviour groups with respect to age, gender and type of school. Theonly significant difference was found for gender [w2 ¼ (3) ¼ 31.3, p 5 0.001].Females were more likely to be classified as binge eaters (25% of females vs. 20%of males), and binge drinkers and eaters (17.5% of females vs. 10% of males),while males were more likely to be classified as binge drinkers (16% of males vs.13% of females).

Identity status and binge group classification

Using the procedure previously explained, the identity classifications were as follows:372 adolescents (25%) were classified as identity achieved, 549 (37%) were classifiedas moratoriums, 314 individuals (21%) were classified as foreclosed and 265adolescents (18%) were classified as diffused. Frequencies for the four groups werecompared on gender and binge group membership. Identity groups did not differaccording to gender [w2 ¼ (3) ¼ 1.1, p ¼ ns], whereas there were differencesregarding binge group membership [w2 ¼ (9) ¼ 78.54, p 5 0.001].

Achieved (58% of no binge vs. 7% of binge drinkers and eaters, 21% of bingeeaters and 14% of binge drinkers) and moratorium adolescents (51% of no binge vs.12% of binge drinkers and eaters, 19% of binge eaters and 18% of binge drinkers)were more likely to be classified as no binge than other binge groups. Foreclosed (12%of no binge vs.43% of binge drinkers and eaters, 28% of binge eaters, 17.5% of bingedrinkers) and diffused adolescents (17% of no binge vs. 31% of binge drinkers andeaters, 29% of binge eaters, 24% of binge drinkers) were more likely to be binge eatersand binge eaters and drinkers than achieved and moratorium adolescents.

Social conformism and binge group classification

We conducted the analysis of variance (ANOVA) on the dimensions of INCOM.The analysis revealed a significant effect for Opinion dimension (F(3,1496) ¼ 88.56;p 5 0.001) and Ability dimension (F(3,1496) ¼ 99.57; p 5 0.001). Results from theunivariate tests and post-hoc test (Tukey test; p 5 0.001) revealed that binge eat anddrink group had significantly higher mean levels of Opinion than the binge eat groupand binge drink group that did not differ significantly from either. Binge eat anddrink group had significantly higher mean levels of Ability than the binge eat group,binge drink group and no binge that differ significantly from either (Table 1).

Table 1. Differences between binge groups on the INCOM subscales.

Iowa–Netherlands comparison

No bingegroup Binge drink Binge eat

Binge drinkand eat

orientation measure M SD M SD M SD M SD

Opinion 12.05a 4.17 14.09b 4.45 14.83b 4.56 17.20c 4.33Ability 11.36a 3.92 13.18b 3.78 14.42b 3.89 16.18c 4.53

Note: Post-hoc Tukey test (p 5 0.001). Different letters indicate mean differences between groups.

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Discussion

Most adolescents reported only occasional involvement in health-threateningbehaviours, which suggested that they thought of a risk taking as an occasionalexperimentation rather than problem behaviour per se. Binge behaviours could beviewed as a signal of inadequate coping with developmental tasks, and they mayserve as a way of coping with the transition that is ultimately ineffective and,therefore, may increase difficulties. The results of the present study confirmed thatadolescents who binge eat and drink reported differences in the identity resolution.Adolescents who achieved an integrated identity or a moratorium status reported noaddictive behaviours in contrast to diffused and foreclosed adolescents. As in earlierstudies (Scales et al. 2000, Palen and Coatsworth 2007), the achievement of aconsolidated ego identity, defined as a sense of personal sameness and psychosocialcontinuity, may be important for enhancing well-being and preventing problematicoutcomes in adolescents. It may be plausible that the more self-explorationadolescents engage the more prepared they are to undertake tasks in a self-directedway and to be satisfied of owns choices without necessarily need to look to otherforms of reassurance and emotional support like food or drinking. Differently,diffused and foreclosed adolescents appear unhappy, dissatisfied with themselves andinsecure lacking any sort of basic structure that might afford them a solid basis formaking choices and following a consistent life path. Many of these adolescents seemto be more likely at risk for engaging in behaviours as a maladaptive copingmechanism that functions to provide relief from these affective states (Adams et al.2005, Stewart et al. 2000, Stewart and Brown 2005, Birch et al. 2007, Good et al.2008). Moreover, diffused and foreclosed adolescents being associated with higherlevels of egocentric thought and lower levels of perspective-taking ability may bemore prone to engage in binge behaviours.

More specifically, regarding diffused adolescents, procrastination, delay and self-centred action may negatively affect the formation of personal commitments and theability to effectively regulate and control actions in relation to life goals, leadingadolescents to react to situational demands by assuming behavioural or verbal acts(e.g. binge eating and binge drinking) as temporary accommodations rather thanlong-term stable revisions in their self-structure or sense of identity. How they actand respond depends more on where they are and who they are with than who theyare. Furthermore, diffused adolescents tend to unrealistic optimism and use cognitivestrategies focused on emotions; they are more concerned to alleviate the negativefeeling than trying to analyse the risks of dangerous activities. The maladaptivecognitive and social characteristics of adolescents in a diffuse status combined withtheir desire for peer approval may help explain why this group could engage inbinging behaviours more frequently than others.

Finally, it is important to note that in the twenty-first century, adolescentsencounter a world of fairly rapid, social, political, technological and economicchanges, so the values of foreclosure is diminished, and the importance of identityachievement is enhanced. Within a world of changing contextual demands andexpectations, identity achievement provides a basis for adaptive, self-regulatedcoping and decision making.

Regarding the second hypothesis, results reinforced the idea that adolescents whoassume addictive behaviours such as binge eating and drinking expressed a generaltendency to conform to others reporting high extent to which they comparethemselves with others regarding both performance and others’ thoughts or

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opinions. Youths often indicated that they drink for fun, to be happy, to gainconfidence, to be cool and simply for something to do. It seems that this particularform of behaviour is likely influenced by environmental and sociocultural factorsthat may shape an individual’s expectations for how a particular behaviour mayoffer relief from negative emotional states. This finding is in line with previousresearches suggesting that one of the most and potent factor associated toadolescents’ engagement in health-risk behaviours is the extent to which adolescents’peer engage in similar behaviours (Prinstein et al. 2011). Adolescents are highlysensitive to peer pressure and general social forces.

Finally, results of the present study confirmed that eating and drinkingbehaviours may perform in the service of reducing negative affective and facingpsychological distress during adolescence, and they could represent a means tointegrate themselves in a peer network. Excessive food or alcohol assumption shouldbe viewed as a signal of inadequate coping with developmental task.

There are a number of limitations to our study. First, all of the informationconcerning experiences and behaviours of participants was obtained through self-report measures. Second, the cross-sectional design of the research did not permit aninvestigation of directionality in the relationships we examined restricting the casualinferences that might be drawn from the results. A goal for future research could beto investigate the direction of developmental processes such as those examined here,in terms of cause and effect, as well as prove the potential long-term effects of theprocess of identity formation and the implications of an integrated sense of self forpsychosocial outcomes in adolescents. Moreover, it would be interesting to deeplyinvestigate relationships between variables considered in the present study to betterunderstand if the tendency to conform to others is a characteristic of adolescentswho take on addictive behaviours or is a feature more linked to diffused identity.

Despite these limitations, the present study suggests the possibility that bingebehaviours may be strongly associated with an adolescent’s identity process hasimportant implications for future empirical investigation and also for clinicalintervention. To our knowledge, this is the first study to investigate the associationsbetween binge eating and binge drinking co-occurring behaviours and the differentidentity status adolescents experienced. Our results have provided, in support ofprevious findings, valuables additional information regarding the strong associationbetween identity resolution and adolescent well-being. The goal of future healthprogrammes would be to decrease the individual’s motivation to escape from thetask of constructing and reconstructing an individualised sense of identity. This canbe accomplished by helping the individual to develop more adaptive ways of copingwith negative affect linked to identity resolution during adolescence. Additionally,training in cognitive behavioural and social skills could be useful in helpingadolescents avoid binge behaviours in order to receive approval by peer and beintegrated in a group. Furthermore, considering the co-occurrence between eatingdisorders and problem drinking, an integrated treatment programme focusingsimultaneous treatment on both of these interrelated behaviours from the outsetwould be most preferable.

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