RESEARCH ARTICLE

The Relationship Among Compulsive Buying, Compulsive Internet
Use and Temperament in a Sample of Female Patients with
Eating Disorders

Laurence Claes

1

*, Astrid Müller

2

, Jan Norré

3

, Leen Van Assche

4

, Steve Wonderlich

5,6

& James E. Mitchell

5,6

1

Catholic University of Leuven, Leuven, Belgium

2

Department of Psychosomatic Medicine and Psychotherapy, University of Erlangen

‐Nuremberg, Erlangen, Germany

3

Free University of Brussels, Brussels, Belgium

4

CGG Andante, Berchem, Belgium

5

Neuropsychiatric Research Institute (NRI), University of North Dakota, School of Medicine and Health Sciences, Fargo, ND, USA

6

Department of Clinical Neuroscience, University of North Dakota, School of Medicine and Health Sciences, Fargo, ND, USA

Abstract
The aim of the present study was to investigate the association among compulsive buying (CB), compulsive internet use (CIU) and
reactive/regulative temperament in a sample of 60 female patients with eating disorders. All patients were assessed by means of the
Compulsive Buying Scale, the CIU scale, the Eating Disorder Inventory

—2, the Behavioral Inhibition System/Behavioral Activation

System scales, the Dimensional Assessment of Personality Pathology and the effortful control scale of the Adult Temperament
Questionnaire. The results showed a positive association between CB and CIU, both categorized as impulse control disorders, not
otherwise speci

fied. Both CB and CIU showed significantly positive correlations with emotional lability, excitement seeking and lack of

effortful control (more speci

fically lack of inhibitory and lack of activation control). The implication of these findings for the treatment

of both disorders will be discussed. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.

Keywords
anorexia nervosa; bulimia nervosa; comorbidity; personality

*Correspondence
Laurence Claes, KULeuven, Department of Psychology, Tiensestraat 102, B

‐3000 Leuven, Belgium. Tel: +32‐(0)16‐31.61.33; Fax: +32‐(0)16‐32.59.16.

Email: [e-mail]

Published online 28 June 2011 in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/erv.1136

In the Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition, impulse control disorders (ICD) are classi

fied as

pathological gambling, kleptomania, intermittent explosive disor-
der, pyromania, trichotillomania and ICD not otherwise speci

fied,

which may include compulsive internet use (CIU), compulsive
sexual behaviour, pathological skin picking and compulsive buying
(CB) (Dell

’osso, Altamura, Allen, Marazitti, & Hollander, 2006;

Kuzma & Black, 2005). Fernandez

‐Aranda et al. (2006, 2008)

showed a prevalence of 18% of CB in patients with bulimia nervosa
(BN) and 12% in patients with other eating disorders (ED),
including anorexia nervosa (AN), BN and eating disorder not
otherwise speci

fied (EDNOS). Shapira et al. (2003)reported a

lifetime prevalence between 0% and 5% of problematic
internet use in AN, between 10% and 15% in BN and about
20% in EDNOS. According to Fernandez

‐Aranda et al. (2006,

2008), CB is the most prevalent ICD in patients with ED. Given the
high correlation between CB and excessive internet use (Mueller
et al., ), we decided to investigate the comorbidity between these
conditions and their associations with temperament in a sample of
patients with ED.

Claes, Bijttebier, Mitchell, de Zwaan, and Mueller (2011)

found a positive association between CB and the Eating Disorder
Inventory

—2 drive for thinness and bulimia scales in a sample of

female university students. Similarly, Tao and Liu (2009) found
that female individuals with internet dependence scored signif-
icantly higher on diet behaviour, bulimia and oral control
compared with female individuals without internet dependence.

Additionally, several studies reported a signi

ficant association

between CB and internet use. For example, Lejoyeux, Mathieu,
Embouazza, Huet, and Lequen (2007) reported that individuals with
CB connect for a longer period of time and more often go to online
shopping sites than normal controls. Kukar

‐Kinney, Ridgway, and

Monroe (2009) showed that individuals with higher CB tendencies
prefer shopping and buying online over traditional stores to avoid
social interactions. And

finally, Mueller et al. (in press) found a

positive association between CB and excessive internet use.

Given the association between CB and excessive internet use, it

is possible that similar temperament characteristics underlie both
CB and excessive internet use. Rothbart, Ahadi, and Evans (2000)
de

fine temperament as individual differences in reactivity and self‐

regulation. Reactive temperament can be conceptualized in terms
of two separate neurobiological systems: the Behavioral Inhibition
System (BIS) and the Behavioral Activation System (BAS) (Gray,
1987). The BIS (anxiety and neuroticism) is sensitive to stimuli
that signal conditioned punishment and with the omission or
termination of reward and is involved in behavioural inhibition.

126

Eur. Eat. Disorders Rev. 20 (2012) 126–131 © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.

The BAS is sensitive to stimuli that signal unconditioned reward
and the relief from punishment and is involved in approach
behaviour (Bijttebier, Beck, Claes, & Vandereycken, 2009; Claes
et al., 2010). Earlier studies on reactive temperament showed that
CB is unrelated to BIS reactivity and positively related to BAS
reactivity (e.g. Claes et al. 2010, 2011); whereas excessive internet
use (Yang, Choe, Baity, Lee, & Cho, 2005), internet addiction
(Tsai et al., 2009) and CIU (van der Aa et al., 2009; Meerkerk,
van den Eijnden, Vermulst, & Garretsen, 2010) are positively
related to BIS reactivity/neuroticism and negatively to extraver-
sion (van der Aa et al., 2009; Landers & Lounsbury, 2006; Petrie &
Gunn, 1998). The relationship between BAS fun seeking
(sensation seeking) and internet dependence is ambiguous. Some
studies found a positive relationship between internet dependence
and BAS fun seeking (Lin & Tsai, 2002), whereas others found a
negative relationship between internet dependence and BAS fun
seeking (e.g. Lavin, Marvin, McLarney, Nola, & Scott, 1999).

Besides reactive temperament (automatic, bottom

–up), self‐

regulation (controlled, top

–down) can also play a role in human

behaviour. Self

‐regulation is often simultaneously used with

terms such as effortful control (Rothbart, 1989), self

‐control

(Baumeister, Heatherton, & Tice, 1994) and conscientiousness
(Bijttebier et al., 2009). Lack of self

‐regulation, effortful control

or self

‐control is associated with impulsive behaviours (Baumeister

et al., 1994). Several studies have found a negative relationship
between CB and self

‐control (e.g. Faber, 2004; Vohs & Faber, 2007;

Claes et al., 2010, 2011) and CIU and self

‐control/conscientiousness

(e.g. van der Aa et al., 2009; Meerkerk et al., 2010).

Reactivity is characterized by automatic processing, whereas

self

‐regulation is characterized by controlled processing. Auto-

matic processing is a fast, parallel, fairly effortless process that
is not limited by short

‐term memory capacity, is not under direct

subject control and performs skilled behaviours. Controlled
processing on the contrary is

‘often slow, generally serial,

effortful, capacity limited, subject regulated and is used to deal
with novel or inconsistent information

’ (Shiffrin & Schneider,

1984).

The goal of the present study was fourfold. (1) To investigate

the prevalence of CB/CIU symptoms in a sample of female
outpatients with ED. Based on the literature, we expected a
prevalence of CB between 12% and 18%, and a prevalence of
internet use between 0% and 5% for patients with restrictive
type of AN (AN

‐R) and between 10% and 20% for patients

with bingeing/purging type of AN (AN

‐BP, BN and EDNOS).

(2) Furthermore, to determine the association between CB/CIU
and bulimic/anorexic symptoms and (3) to determine the
association between CB and CIU. We expected bulimic
symptoms to correlate more strongly with CB and CIU. And

finally, (4) to investigate whether CB and CIU are characterized
by the same temperament pro

file. Based on the literature, we

expected that both CB and CIU would be characterized by low
levels of effortful control, whereas CB would be positively related
to BAS reactivity, and CIU would be positively related to BIS
reactivity/neuroticism and negatively to extraversion. The
relationship between CIU and BAS reactivity (fun seeking and
sensation seeking) is hard to predict as the literature is rather
ambiguous. Investigating the presence of comorbid (impulse
control) symptoms/disorders in patients with ED is important,

given the fact that the presence of impulsive traits/symptoms
increase the risk of poor treatment outcome and a worse long

‐

term prognosis for patients with ED (Claes, Vandereycken, &
Vertommen, 2002).

Method

Participants and procedure

The sample of ED consists of 60 female outpatients with ED. The
patients were diagnosed according to the criteria in the Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition (American
Psychiatric Association, 1994) on the basis of a standardized
clinical interview and the Eating Disorder Inventory

—2 (EDI‐2;

Garner, 1991; Dutch version: van Strien & Ouwens, 2003): 23 (38.3%)
patients were diagnosed as suffering from AN

‐R; 4 (6.7%), AN‐BP; 16

(26.7%), BN; and 17 (28.3%), EDNOS. The age of the sample of ED
ranged from 15 to 57 years with a mean of 27.82 years (SD = 9.76).
Patients with AN

‐R (M = 23.33, SD = 6.87) were significantly younger

than patients with EDNOS (M = 34, SD = 11.68) [F(3, 52) = 4.06,
p < 0.01]. Almost 25% (24.5%) of the patients with ED followed
secondary education, and 75.5% followed tertiary education (34.7%
college; 40.8% university). There were no signi

ficant differences

between the subgroups with ED with respect to educational level
[

χ

(6)

2

= 5.13, ns].

All patients were provided with an envelope holding informed

consent documents and questionnaires via their individual
therapist. Patients who were willing to participate provided written
informed consent and completed the questionnaires individually at
home. The documents were returned to the researcher in a sealed
envelope via their individual therapist, who had no access to
participant responses. The study procedures were approved by the
University Institutional Review Board of the

first author.

Instruments

Compulsive buying was assessed by means of the Compulsive
Buying Scale (CBS) (Faber & O

’Guinn, 1992). The CBS consists

of seven items representing speci

fic behaviours and feelings

associated with CB (

α = 0.72 in the present study). Six items

(e.g.

‘Bought myself something in order to make myself feel

better

’) are answered on a five‐point scale ranging from 1 (very

often) to 5 (never). One item,

‘If I have any money left at

the end of the pay period, I just have to spend it

’, is answered on a

five‐point scale ranging from 1 (strongly agree) to 5 (strongly
disagree). Faber and O

’Guinn (1992) developed a scoring system

involving a regression equation with item weighting to determine
the cut

‐off score for CB. Lower scores indicate a higher level of CB.

Faber and O

’Guinn (1992) reported that the CBS correctly

classi

fied 89.9% of a general population sample and 85.3% of a CB

group. With regard to a recent German population

‐based survey, a

cut

‐off score equal to −1.09 or lower indicates the person has CB

(Mueller et al., 2010). The German version of the CBS correctly
classi

fied 91.1% of a clinical CB group (treatment‐seeking patients

who where all interviewed and de

fined as suffering from clinically

signi

ficant CB) (Mueller et al., 2010). In the present study,

the original version of the CBS was translated into Dutch and
retranslated into English by of

ficial translators. We performed a

factor analysis on the seven items of the CBS in the present sample

L. Claes et al.

CB, CIU and temperament in patients with ED

127

Eur. Eat. Disorders Rev. 20 (2012) 126–131 © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.

and found support for a one

‐factor solution, which explained

38.26% of the variance. All items had a loading of less than 0.51 on
this one

‐factor scale. The internal consistency of the one‐factor

scale was equal to 0.72.

Compulsive internet use was assessed by means of the Dutch

Compulsive Internet Use Scale (Meerkerk et al., 2010). This scale
consists of 14 items which have to be answered on a

five‐point

Likert scale ranging from 1 (never) to 5 (very often). The scale
(n = 14;

α = 0.94 in the present) taps into the dimensions loss of

control, preoccupation, withdrawal symptoms, coping and
con

flicts about internet use (e.g. ‘How often do you find it

dif

ficult to stop using the internet?’) (van der Aa et al., 2009).

Meerkerk et al. reasoned that for internet use to be called
compulsive, the behaviour speci

fied in the 14 CIU items should

play an important role in the life of the internet user. This occurs
when the behaviour occurs on average more than

‘sometimes’

which implicates a cut

‐off score of 14 items × 2 (sometimes) >28

(p. 731).

Eating disorder symptoms were assessed by means of the EDI

‐2

(Garner, 1991; Dutch version: van Strien & Ouwens, 2003). The
EDI

‐2 is a 91‐item, six‐point forced‐choice inventory assessing

several behavioural and psychological traits common in BN and
AN. The EDI

‐2 consists of 11 subscale scores, of which two are

used in the present study: drive for thinness (n = 7;

α = 0.91; ‘I’m

terri

fied of gaining weight’) and bulimia (n = 7; α = 0.91; e.g.

‘I stuff myself with food’).

Reactivity temperament was assessed by means of the BIS/BAS

scales (Carver & White, 1994; Dutch version: Beck, Smits, Claes,
Vandereycken, & Bijttebier, 2009). The BIS/BAS scales consist
of 24 items to be rated on a four

‐point scale ranging from 1

(I strongly agree) to 4 (I strongly disagree). The BIS scale assesses
worry concerning potential punishments in the future [n = 7;

α = 0.80 in the present study; e.g. ‘I have very few fears compared
to my friends (reversed)

’]. The BAS scale assesses enthusiasm in

the pursuit of potentially rewarding outcomes (n = 13;

α = 0.78).

The BAS scale has three subscales, being drive (n = 4;

α = 0.74;

e.g.

‘When I want something, I usually go all‐out to get it’), fun

seeking (n = 4;

α = 0.52; e.g. ‘I often act on the spur of the

moment

’) and reward responsiveness (n = 5; α = 0.63; e.g. ‘It

would excite me to win a contest

’). Besides the BIS/BAS scales,

we also administered the affective lability scale (n = 8,

α = 0.86,

e.g.

‘I often have often emotional ups and downs’) and the

stimulus seeking scale (n = 8,

α = 0.78, e.g. ‘I often act at the

spur of the moment, although I know that I will regret it later

’)

of the Dimensional Assessment of Personality Pathology

—

Short Form (DAPP; Livesley & Jackson, 2002; Dutch version:
van Kampen, De Beurs, & Adrea, 2008) to have an additional
measure of BIS reactivity and BAS reactivity. The DAPP affective
lability scale measures the variability of affect (ups and downs)
instead of the presence of negative affect (like the BIS scale),
whereas DAPP stimulus seeking scale contains more forms of
stimulus seeking compared with the BAS fun seeking scale.

Regulative temperament was measured by means of the

19

‐item effortful control scale from the Adult Temperament

Questionnaire

—Short Form (Evans & Rothbart, 2007; Dutch

version: Hartman & Rothbart, 2001). Participants reported on the
extent to which high or low levels of effortful control generally
characterize their interactions with the environment (1 = not at

all applicable; 7 = completely applicable) (n = 19;

α = 0.83).The

effortful control scale has three subscales being, attentional
control [n = 5;

α = 0.65; e.g. ‘It’s often hard for me to alternate

between two different tasks

’ (reversed)], activation control [n = 7;

α = 0.72; e.g. ‘I hardly ever finish things on time’ (reversed)] and
inhibition control (n = 7;

α = 0.67; e.g. ‘It is easy for me to hold

back my laughter in a situation where is not appropriate

’).

Analyses

All analyses were performed by means of

SPSS

17 (

SPSS

Inc.,

Chicago, IL, USA). To calculate the associations among the
interval

‐scaled variables CB, CIU, eating disorder symptoms and

temperament, we made use of the Pearson correlation coef

fi-

cients. To compare AN

‐R and binge/purge subtypes of ED with

respect to CB and CIU, we made use of ANOVAs. And

finally, to

predict CB and CIU scale scores by means of the temperament
variables, we used regression analyses. For all analyses, the critical
p

‐value was p < 0.05.

Results

Prevalence of compulsive buying and compulsive
internet use

With respect to CB symptoms, 10% (n = 6; one AN

‐R and five

binge/purge ED patients) of the 60 patients with ED scored below
the cut

‐off score of the CBS, indicating a lifetime prevalence of

10% of CB in female patients with ED. With respect to CIU
symptoms, 11.7% (n = 7; two AN

‐R and five binge/purge ED

patients) of the 60 patients with ED scored above the cut

‐off score

of the Internet Use Scale, indicating a lifetime prevalence of
11.7% of CB in female patients with ED. Two (3.3%) of the 60
patients with ED scored above the cut

‐off score of both the

CBS and Internet Use Scale, and both patients belonged to the
binge/purge ED group.

Association among compulsive buying,
compulsive internet use and eating disorder
symptoms/diagnoses

As can be seen in Table 1, CB was signi

ficantly related to the drive

for thinness and bulimia, but the correlation between CB and
bulimia was the strongest. CIU was only signi

ficantly related to

the drive for thinness. Finally, we found a strong positive
correlation between CB and CIU (r = 0.47, p < 0.001).

We also compared patients with AN

‐R with patients with

AN

‐BP, BN and EDNOS with respect to CB and CIU scale scores.

The binge/purge ED patients scored signi

ficantly higher on the

CBS compared with AN

‐R [F(1,58) = 6.25, p < 0.01]. We did not

find significant differences between the subtypes of ED with respect
to CIU [F(1,58) = 1.08, ns].

Association among compulsive buying,
compulsive internet use and temperament

We also investigated the association among CB, CIU and reactive
and regulative temperament (Table 2). With respect to reactive
temperament, CB and CIU were not signi

ficantly related with BIS

reactivity, but both showed positive correlations with DAPP
emotional lability. Furthermore, CB and CIU were positively

CB, CIU and temperament in patients with ED

L. Claes et al.

128

Eur. Eat. Disorders Rev. 20 (2012) 126–131 © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.

related to BAS fun seeking (p < 0.08) and BAS drive, respectively,
and both showed positive correlations with DAPP excitement
seeking.

With respect to regulative temperament (effortful control or

self

‐regulation), CB and CIU were both related to a lack of

effortful control, more speci

fically to a lack of inhibitory control

and a lack of activation control. Contrary to CB, CIU was also
signi

ficantly related to a lack of attentional control.

Finally, we performed regression analyses, with the z

‐transformed

temperament scales that showed signi

ficant association with DAPP

emotional lability, DAPP excitement seeking and EC total as
independent variables and CB and CIU as dependent variables
(Table 3). The regression models with interaction terms were not
displayed because they did not reveal signi

ficant results. Overall,

the results showed that neither emotional instability nor
excitement seeking contributed signi

ficantly to CB and CIU after

controlling for the lack of effortful control.

Discussion

In the present study, we investigated the relationship between CB
and CIU, both considered as ICD not otherwise speci

fied, in a

sample of 60 patients with ED. The prevalence of both CB and
CIU was about 10%, which is similar to the

findings of previous

studies that reported prevalence rates of 12% to 18% of CB in
patients with ED (Fernandez

‐Aranda et al., 2008) and between

0% to 20% of problematic internet use in samples of ED (Shapira
et al., 2003). Both CB and CIU were signi

ficantly related to

restrictive eating behaviours, as previously found by Claes et al.
(2011) and Tao and Liu (2009). However, CB was also signif-
icantly related to both bulimic symptoms and the diagnosis of
binge/purge diagnoses of ED (BN and EDNOS) (see e.g. Claes
et al.; Faber, Christenson, de Zwaan, & Mitchell, 1995; Mitchell
et al., 2002; Mueller et al., 2009). This

finding is also in line with

our experience that individuals seeking treatment for CB are binge
eating and purging rather than dieting.

Furthermore, we found a signi

ficant association (r = 0.47)

between CB and CIU, results that are comparable to Mueller et al.
(in press), who reported a correlation of 0.38 between CB and
excessive internet use in a sample of consumers. We can hypoth-
esize that patients with ED often use the internet to buy things
while avoiding interpersonal contacts (Kukar

‐Kinney et al., 2009).

However, in the present study, we did not explicitly ask what
the patients with ED were doing while using the internet. It is
possible that they were visiting pro

‐AN/BN sites, chatting, gaming

or buying, which needs to be addressed in future studies.

Given the high association between CB and CIU, we

investigated whether similar temperament characteristics underlie
both CB and CIU in patients with ED. With respect to reactive

Table 1 Correlations among CB, CIU and eating disorder symptoms (N = 59)

CBS

CIU

EDI

‐DT

EDI

‐B

CBS

†

–

0.47***

0.28*

0.34**

CIU

–

0.29*

0.19

EDI

‐DT

–

0.45**

EDI

‐B

–

CB, compulsive buying; CIU, compulsive internet use; CBS, Compulsive Buying
Scale; EDI

‐DT, Eating Disorder Inventory—2 drive for thinness; EDI‐B, Eating

Disorder Inventory

—2 bulimia.

†

Scores on the CBS were reversed: higher scores on the CBS indicate a higher level
of CB.

*p < 0.05.
**p < 0.01.
***p < 0.001.

Table 2 Correlations among CB, CIU and reactive/regulative temperament

CBS

†

IUS

BIS total

−0.06

0.02

BAS total

0.19

0.07

BAS

‐DR

0.11

0.27*

BAS

‐FS

0.23

−0.02

BAS

‐RR

0.12

−0.09

DAPP affective lability

0.29*

0.33*

DAPP stimulus seeking

0.30*

0.25*

EC total

−0.43**

−0.46**

EC

‐INH

−0.41**

−0.29**

EC

‐ACT

−0.43**

−0.51**

EC

‐ATT

−0.17

−0.31**

CB, compulsive buying; CIU, compulsive internet use; CBS, Compulsive Buying
Scale; IUS, Internet Use Scale; BIS total, total score in the Behavioral Inhibition
Scale; BAS total, total score in the Behavioral Activation Scale; BAS

‐DR, drive scale

of BAS; BAS

‐FS, fun seeking scale of BAS; BAS‐RR, reward responsiveness scale of

BAS; DAPP affective lability scale, affective lability scale in the Dimensional
Assessment of Personality Pathology

—Short Form; DAPP stimulus seeking scale,

stimulus seeking scale in the Dimensional Assessment of Personality Pathology

—

Short Form; EC total, total score in the effortful control scale of the Adult
Temperament Questionnaire (ATQ); EC

‐INH, inhibitory control scale in the

effortful control scale of the ATQ; EC

‐ACT, activation control scale in the effortful

control scale of the ATQ; EC

‐ATT, attentional control scale in the effortful control

scale of the ATQ.

†

Scores on the CBS were reversed: higher scores on the CBS indicate a higher level
of CB.

*p < 0.05.
**p < 0.01.

Table 3 Predictions of CB and CIU based on reactive/regulative temperament

CBS

†

IUS

R

2

= 0.21**

R

2

= 0.24**

β

β

DAPP emotional lability

0.15

0.19

DAPP excitement seeking

0.12

0.02

EC total

−0.32**

−0.39**

CB, compulsive buying; CIU, compulsive internet use; CBS, Compulsive Buying
Scale; IUS, Internet Use Scale; DAPP emotional lability, emotional lability scale in
the Dimensional Assessment of Personality Pathology

—Short Form; DAPP

excitement seeking, excitement seeking scale in the Dimensional Assessment of
Personality Pathology

—Short Form; EC total, total score in the effortful control

scale of the Adult Temperament Questionnaire.

†

Scores on the CBS were reversed: higher scores on the CBS indicate a higher level
of CB.

**p < 0.01.

L. Claes et al.

CB, CIU and temperament in patients with ED

129

Eur. Eat. Disorders Rev. 20 (2012) 126–131 © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.

temperament, we did not

find a significant association between

CB/CIU and BIS. Also, previous studies (e.g. Claes et al., 2010,
2011) did not report a signi

ficant association between CB and

BIS; however, Meerkerk, van den Eijnden, Franken, & Garretsen
(2010) reported a signi

ficant positive association between CIU

and BIS in students. With respect to the BAS scales, CIU was
signi

ficantly related to BAS drive (i.e. the persistent pursuit of

desired goals), whereas CB was almost (p < 0.08) signi

ficantly

positive related to BAS fun seeking (i.e. the willingness to
approach a potentially rewarding event on the spur of the
moment). Furthermore, both CB/CIU were signi

ficantly related

to emotional lability (i.e. mood swings) and excitement seeking.
The latter con

firming the association between CB/CIU and fun

seeking/sensation seeking (e.g. Claes et al., 2011; Lin & Tsai,
2002). This may raise the hypotheses that both CB and CIU can
be considered emotion

‐regulation strategies, to stabilize the mood

swings and to gain more positive/excitement feelings, which
needs to be addressed in future studies.

Finally, with respect to regulative temperament (self

‐regulation

or effortful control), both CB and CIU were characterized by lack
of effortful control, more speci

fically by low levels of inhibitory

control (i.e. the capacity to suppress inappropriate approach
behaviour) and activation control (i.e. the capacity to perform an
action, when there is a strong tendency to avoid it) (Evans &
Rothbart, 2007). However, while taking into account emotional
lability, excitement seeking and lack of effortful control at the
same time (regressions), only lack of effortful control remained
signi

ficantly related to CB/CIU in patients with ED. Brain

dopamine

— which innervates the limbic‐striatal and frontos-

triatal brain circuits

— has often been implicated in impulsive

behaviours, which may re

flect failures of motivational and

cognitive controls (Cools, 2008 for an overview). Several studies
found that striatal dopamine may be associated with cognitive
capacity and executive functioning (Chen et al., 2005; Cropley,
Fujita, Innis, & Nathan, 2006; Guo et al., 2006; Hsieh et al., 2010),
whereas other studies found signi

ficant relationships between

particular frontal brain activity and addiction (e.g. for online

gaming addiction see Ko et al., 2009). Given the important role of
lack of effortful control in both CB and CIU, it raises the question
whether the term

‘compulsive’ needs to be replaced by

‘impulsive’, as both are considered ICD, not otherwise specified
(see also Heemkerk et al., 2010).

Finally, given the association between CB and CIU and given

that both are driven by lack of effortful control or top

–down

control, the treatment of both symptoms could bene

fit from

training in effortful control. Today, several studies have already
shown that effortful or executive or top

–down control can be

trained (e.g. Baumeister & Heatherton, 1996; Baumeister et al.,
1994; Faber & Vohs, 2004; Sitaram et al., 2007). And hopefully, the
increase of effortful control in the domain of CB/CIU can also be
extended to other impulsive behaviours often prevalent in patients
with ED (e.g. bulimic behaviours, gambling, alcohol abuse).

As far as we know, our study is the

first study that investigated

to associations among CB, CIU and temperament in patients with
ED. Besides the strengths of the study, some limitations need to
be addressed. First, the results of our study need to be replicated
in larger samples of patients with ED, including higher numbers
of different subtypes of ED. Secondly, besides assessing the
compulsive use of the internet, also the content [e.g. chatting,
buying, gaming or visiting sites that promote AN/BN (e.g. pro

‐

ANA/MIA sites)] of the internet use needs to be addressed in
more detail. And

finally, the lack of BIS/BAS reactivity and

effortful control could be assessed by means of behavioural or
neuropsychological tasks, besides the use of self

‐report. Also,

including male patients with ED, besides female patients with ED,
could increase the generalizability of our

findings.

However, the primary

finding of our study is that CB and CIU

are highly correlated and both are driven by lack of effortful
control, which can be trained and which seems to make it
possible to treat different ICD at the same time. For clinicians, it
is essential to assess the degree of effortful control while
confronted with patients who show different types of ICD and
to train effortful control to increase the quality of life of these
patients.

REFERENCES

van der Aa, N., Overbeek, G., Engels, R., Scholte, R., Meerkerk, G., &

Van den Eijnden, R. (2009). Daily and compulsive Internet use

and well

‐being in adolescence: A diathesis‐stress model based

on big

five personality traits. Journal of Youth and Adolescence,

38, 765

–776.

American Psychiatric Association. (1994). Diagnostic and statistical

manual of mental disorders

—Revised (3rd edn). Washington, DC:

APA.

Baumeister, R. F., & Heatherton, T. F. (1996). Self

‐regulation failure:

An overview. Psychological Inquiry, 7, 1

–15.

Baumeister, R. F., Heatherton, T. F., & Tice, D. M. (1994). Losing

control: How and why people fail at self

‐regulation. San Diego, CA:

Academic Press.

Beck, I., Smits, D. J. M., Claes, L., Vandereycken, W., & Bijttebier, P.

(2009). Psychometric evaluation of the behavioral inhibition/

behavioral activation system scales and the sensitivity to

punishment and sensitivity to reward questionnaire in a sample

of eating disordered patients. Personality and Individual

Differences, 47, 407

– 412.

Bijttebier, P., Beck, I., Claes, L., & Vandereycken, W. (2009). Gray

’s

Reinforcement Sensitivity Theory as a framework for research on

personality

–psychopathology associations. Clinical Psychology

Review, 29, 421

– 430.

Black, D. W. (2007). A review of compulsive buying disorder. World

Psychiatry, 6, 14

–18.

Carver, C. S., & White, T. L. (1994). Behavioural inhibition,

behavioural activation, and affective responses to impending

reward and punishment: The BIS/BAS scales. Journal of

Personality and Social Psychology, 67, 319

–333.

Chen, P. S., Yang, Y. K., Lee, Y. S., Yeh, T. L., Lee, I. H., Chiu, N. T.,

et al. (2005). Correlation between different memory systems and

striatal dopamine D

2

/D

3

receptor density: A single photon

emission computed tomography study. Psychological Medicine,

35, 197

–204.

Claes, L., Vandereycken, W., & Vertommen, H. (2002).

Impulsive and compulsive traits in eating disordered patients

compared with controls. Personality and Individual Differ-

ences, 32, 707

–714.

Claes, L., Bijttebier, P., Van den Eynde, F., Mitchell, J., de Zwaan, M.,

& Mueller, A. (2010). Emotional reactivity and self

‐regulation in

relation to compulsive buying. Personality and Individual Differences,

49, 526

–530.

Claes, L., Bijttebier, P., Mitchell, J., de Zwaan, M., & Mueller, A.

(2011). The relationship between compulsive buying, eating

disorder symptoms, and temperament in a sample of female

students. Comprehensive Psychiatry, 52, 50

–55.

Cools, R. (2008). Role of dopamine in the motivational and

cognitive control of behavior. The Neuroscientist, 14, 381

–395.

Cropley, V. L., Fujita, M., Innis, R. B., & Nathan, P. J. (2006).

Molecular imaging of the dopaminergic system and its

association with human cognitive function. Biological Psychiatry,

59, 898

– 907.

Dell

’osso, B., Altamura, A. C., Allen, A., Marazitti, D., Hollander, E.

(2006). Epidemiologic and clinical updates on impulse control

disorders: A critical review. European Archives of Psychiatry and

Clinical Neuroscience, 256, 464

– 475.

Evans, D. E., & Rothbart, M. K. (2007). Developing a model

for adult temperament. Journal of Research in Personality,

41, 868

– 888.

Faber, R. J. (2004). Self

‐control and compulsive buying. In T. Kasser,

& A. D. Kanner. (Eds.), Psychology and consumer culture: The

CB, CIU and temperament in patients with ED

L. Claes et al.

130

Eur. Eat. Disorders Rev. 20 (2012) 126–131 © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.

struggle for a good life in a materialistic world. Washington, DC:

American Psychological Association, pp. 169

–187.

Faber, R. J., & O

’Guinn, T. C. (1992). A clinical screener for

compulsive buying. Journal of Consumer Research, 19, 459

–469.

Faber, R. J., & Vohs, K. D. (2004). To buy or not to buy? Self

‐

Control and self

‐regulatory failure in purchase behavior. In

R. F. Baumeister, & K. D. Vohs. (Eds.), Handbook of self

‐regulation:

Research, theory and applications. New York: Guilford, pp. 509

–524.

Faber, R. J., Christenson, G. A., de Zwaan, M., & Mitchell, J. (1995). Two

forms of compulsive consumption. Comorbidity of compulsive

buying and binge eating. Journal of Consumer Research, 22, 296

–304.

Fernandez

‐Aranda, F., Jimenez‐Murcia, S., Alvarez, E., Granero, R.,

Vallejo, J., & Bulik, C. M. (2006). Impulse control disorders in

eating disorders: Clinical and therapeutic implications. Compre-

hensive Psychiatry, 47, 482

– 488.

Fernandez

‐Aranda, F., Pinheiro,A. P.,Thornton,L. M.,Berrettini,W. H.,

Crow, S., Fichter, M. M., et al. (2008). Impulse control disorders in

women with eating disorders. Psychiatry Research, 157, 147

–157.

Garner, D. M. (1991). Eating Disorder Inventory

—2: Professional

manual. Odessa, FL: Psychological Assessment Resources.

Gray, J. A. (1987). The psychology of fear and stress. Cambridge:

Cambridge University Press.

Guo, J. F., Yang, Y. K., Chiu, N. T., Yeh, T. L., Chen, P. S., Lee, I. H.,

et al. (2006). The correlation between striatal dopamine D

2

/D

3

receptor availability and verbal intelligence quotient in healthy

volunteers. Psychological Medicine, 36, 547

–554.

Hartman, C. A., & Rothbart, M. K. (2001). Dutch version of the Adult

Temperament Questionnaire

—Short Form. The Netherlands,

Groningen: Faculteit der Medische Wetenschappen.

Hsieh, P. C., Yeh, T. L., Lee, I. H., Huang, H. C., Chen, P. S., Yang, Y. K.,

et al. (2010). Correlation between errors on the Wisconsin Card

Sorting Test and the availability of striatal dopamine transporters in

healthy volunteers. Journal of Psychiatry & Neuroscience, 35, 90

–94.

van Kampen, D., De Beurs, E., & Adrea, H. (2008). A short form of

the Dimensional Assessment of Personality Pathology

—Basic

Questionnaire (DAPP

‐BQ): The DAPP‐SF. Psychiatry Research,

160, 115

–128.

Ko, C. H., Liu, G. C., Hsiao, S., Yen, J. Y., Yang, M. J., Lin, W. C.,

et al. (2009). Brain activities associated with gaming urge

of online gaming addiction. Journal of Psychiatric Research, 43,

739

–747.

Kukar

‐Kinney, M., Ridgway, N. M., & Monroe, K. B. (2009). The

relationship between consumers

’ tendencies to buy compulsively

and their motivations to shop and buy on the internet. Journal of

Retailing, 85, 298

–307.

Kuzma, J. M., & Black, D. W. (2005). Disorders characterized by

poor impulse control. Annals of Clinical Psychiatry, 17, 219

–226.

Landers, R. N., & Lounsbury, J. W. (2006). An investigation of Big

Five and narrow personality traits in relation to Internet usage.

Computers in Human Behavior, 22, 283

–293.

Lavin, M., Marvin, K., McLarney, A., Nola, V., & Scott, L. (1999).

Sensation seeking and collegiate vulnerability to internet

dependence. Cyberpsychology & Behavior, 2, 425

– 430.

Lejoyeux, M., Mathieu, K., Embouazza, H., Huet, F., & Lequen, V.

(2007). Prevalence of compulsive buying among customers of a

Parisian general store. Comprehensive Psychiatry, 48, 42

– 46.

Lin, S. S. J., & Tsai, C.

‐C. (2002). Sensation seeking and Internet

dependence of Taiwanese high school adolescents. Computers in

Human Behavior, 18, 411

– 425.

Livesley, W. J., & Jackson, D. N. (2002). Manual for the Dimensional

Assessment of Personality Pathology

— Basic Questionnaire

(DAPP

‐BQ). Sigma Press, Port Huron.

Meerkerk, G. J., van den Eijnden, R. J. J. M., Vermulst, A. A., &

Garretsen, H. F. L. (2010). The compulsive Internet use scale

(CIUS). Computers in Human Behavior, 26, 729

–735.

Meerkerk, G. J., van den Eijnden, R. J. J. M., Franken, I. H. A., &

Garretsen, H. F. L. (2010). Is compulsive internet use related

to sensitivity to reward and punishment, and impulsivity?

Computers in Human Behavior, 26, 729

–735.

Mitchell, J. E., Redlin, J., Wonderlich, S., Crosby, R., Faber, R.,

Miltenerger, R., et al. (2002). The relationship between

compulsive buying and eating disorders. The International

Journal of Eating Disorders, 32, 107

–111.

Mueller, A., Muehlhans, B., Silbermann, A., Mueller, U., Mertens, C.,

Horbach, T., et al. (2009). Compulsive buying and psychiat-

ric comorbidity. Psychotherapie, Psychosomatik, Medizinische

Psychologie, 59, 291

– 299.

Mueller, A., Mitchell, J. E., Crosby, R. D., Gefeller, O., Faber, R. J.,

Martin, A., et al. (2010). Estimated prevalence of compulsive

buying in Germany and its association with sociodemographic

characteristics and depressive symptoms. Psychiatry Research,

180, 137

–142.

Mueller, A., Mitchell, J. E., Peterson, L. A., Faber, R. J., Steffen, K. J.,

Crosby, R. D., et al. (in press). Depression, materialism, and

excessive Internet use in relation to compulsive buying.

Comprehensive Psychiatry.

Petrie, H., & Gunn, D. (1998). Internet

“addiction”: The effects of

sex, age, depression and introversion. Paper presented at the

British Psychological Society London Conference, 15 December

1998, London, UK.

Rothbart, M. K. (1989). Temperament and development. In G. A.

Kohnstamm, J. E. Bates, & M. K. Rothbart. (Eds.), Temperament

in childhood. Oxford: John Wiley, pp. 187

–247.

Rothbart, M. K., Ahadi, S. A., & Evans, D. E. (2000). Temperament

and personality: Origins and outcomes. Journal of Personality and

Social Psychology, 78, 122

–135.

Shapira, N. A., Lessig, M. C., Goldsmith, T. D., Szabo, S. T., Lazoritz, M.,

Gold, M. S., et al. (2003). Problematic internet use: Proposed

classi

fication and diagnostic criteria. Depression and Anxiety,

17, 207

–216.

Shiffrin, R. M., & Schneider, W. (1984). Automatic and controlled

processing revisited. Psychological Review, 91, 269

–276.

Sitaram, R., Caria, A., Veit, R., Gaber, T., Rota, G., Kuebler, A., et al.

(2007). fMRI brain

–computer interface: A tool for neuroscien-

ti

fic research and treatment. Computational Intelligence and

Neuroscience, 2007, 10 pages.

van Strien, T., & Ouwens, M. (2003). Validation of the Dutch EDI

‐2

in one clinical and two nonclinical populations. European

Journal of Psychological Assessment, 19, 66

– 84.

Tao, Z. L., & Liu, Y. (2009). Is there a relationship between internet

dependence and eating disorders? A comparison study of

internet dependents and non

‐internet dependents. Eating and

Weight Disorders, 14, 77

–83.

Tsai, H. F., Cheng, S. H., Jeh, T. L., Shih, C.

‐C., Chen, K. C., Yang,

Y. C., et al. (2009). The risk factors of internet addiction

—A

survey of university freshmen. Psychiatry Research, 167, 294

–299.

Vohs, K. D., & Faber, R. J. (2007). Spent Resources: Self

‐regulatory

resource availability affects impulsive buying. Journal of

Consumer Research, 33, 537

–547.

Yang, C. K., Choe, B. M., Baity, M., Lee, J. H., & Cho, J. S. (2005).

SCL

‐90‐R and 16PF profiles of senior high school students

with excessive internet use. Canadian Journal of Psychiatry,

50, 407

– 414.

L. Claes et al.

CB, CIU and temperament in patients with ED

131

Eur. Eat. Disorders Rev. 20 (2012) 126–131 © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.