Confirmatory and exploratory factor analysis of the distress tolerance scale (DTS) in a clinical sample of eating disorder patients Bronwyn C. Raykos a, ⁎, Susan M. Byrne a,b , Hunna Watson a a Centre for Clinical Interventions, Department of Health in Western Australia, 223 James Street, Northbridge, Western Australia 6003, Australia b School of Psychology, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia abstract article info Article history: Received 15 May 2009 Received in revised form 24 June 2009 Accepted 6 July 2009 Keywords: Distress tolerance scale Eating disorder Validation A confirmatory factor analysis of the factor structure of the Distress Tolerance Scale (DTS) created by Corstorphine et al. [Corstorphine, E., Mountford, V., Tomlinson, S., Waller, G., & Meyer, C. (2007). Distress tolerance in the eating disorders. Eating Behaviors, 8, 91–97.] was conducted to assess whether the scale's purported three factors emerged in a clinical sample of patients with a DSM-IV diagnosed eating disorder. The original three-factor model was generally considered to be a poor fit for the data. Subsequent exploratory factor analysis indicated that a better fit emerged using a four-factor structure. Significant associations were observed between behavioral avoidance of positive affect and eating disorder psychopathology. Implications for use of the DTS with eating disorder patients are discussed. Crown Copyright © 2009 Published by Elsevier Ltd. All rights reserved. 1. Introduction Distress tolerance is defined as the ability to endure and accept intense affect so that problem solving can take place (Linehan, 1993). Individuals with low distress tolerance are likely to find intense emotional experiences unbearable and will therefore act quickly to alleviate these emotional experiences (Simons & Gaher, 2005). Indeed, empirical studies support a relationship between poor distress tolerance and engagement in maladaptive mood-modulatory beha- viors such as smoking and other substance misuse (e.g., Brown, Lejuez, Kahler, & Strong, 2002; Daughters, Lejuez, Kahler, Strong, & Brown, 2005). Avoidance of affect is a particularly important feature of poor distress tolerance and it has been proposed that avoidance of affect contributes to a range of psychological problems, including avoidant personality disorder, social anxiety disorder, health anxiety and eating disorders (Butler & Surawy, 2004). In the past decade there has been increasing interest in the role of distress tolerance and its contribution to eating disorder psycho- pathology. Models of the maintenance of eating disorders purport that the ability to tolerate intense affect is diminished in patients with eating disorders (e.g., Cooper, Wells, & Todd, 2004; Fairburn, Cooper, & Shafran, 2003). Moreover, there is clinical and empirical evidence that affective states often precipitate disordered eating behaviors. This is particularly evident in relation to binge eating, which is thought to perform a functional role by comforting and distracting one's self from distressing emotions (e.g., Agras & Telch, 1998; Fahy & Eisler, 1993; McManus & Waller, 1995). Anorexia nervosa (AN) and restrictive behaviors have been associated with alexithymia, a cognitive- attention deficit that involves difficulties in processing, regulating, and communicating affect (Schmidt, Jiwany, & Treasure, 1993) and this association has been found to be independent of comorbid affective disorders (Bydlowski et al., 2005). Despite evidence of an association between affective states and disordered eating behaviors, there is limited empirical evidence that distress tolerance mediates this relationship. This is primarily because measures of distress tolerance for use with eating disorder patients have not been available. Two different self-report measures of distress tolerance (each of which has been named the Distress Tolerance Scale) have recently been developed (Corstorphine, Mountford, Tomlinson, Waller, & Meyer, 2007; Simons & Gaher, 2005). Although both measures were designed to assess the construct of distress tolerance, there are notable differences between these measures. The distress tolerance scale developed by Simons and Gaher (2005) comprises 15 questions pertaining to processes that make up the global construct of distress tolerance, such as perceived ability to tolerate emotional states (e.g., “feeling distressed or upset is unbearable to me”), extent to which attention is absorbed by distressing emotions (e.g., “my feelings of distress are so intense that they completely take over”), subjective appraisal of emotions (e.g., “my feelings of distress or being upset are not acceptable”), and regulation efforts to mitigate distress (e.g., “I'll do anything to stop feeling distressed”). Participants rate responses on a 5-point Likert scale ranging from 1 (“strongly agree”) to 5 (“strongly disagree”). The scale yields a Global score of distress tolerance and Eating Behaviors 10 (2009) 215–219 ⁎ Corresponding author. Tel.: +61 8 9227 4399; fax: +61 8 9328 5911. E-mail address: bronny.raykos@gmail.com (B.C. Raykos). 1471-0153/$ – see front matter. Crown Copyright © 2009 Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.eatbeh.2009.07.001 Contents lists available at ScienceDirect Eating Behaviors