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1 Korean Journal of Clinical Psychology Vol. 37, No. 4, Original Article 2018 Korean Clinical Psychology Association eissn X Impact of Anger Expression and Negative Urgency on Binge Eating Behavior Ji Su Lim Kyung Park Department of Psychotherapy, Graduate School of Professional Therapeutic Technology, Seoul Women s University, Seoul, Korea This study aimed to examine the mediation effects of negative urgency on the relationship of anger-in and anger-out, which are subtypes of anger expression, with binge eating behavior. Participants were 302 early adults aged 18 to 29 years. They were asked to complete on-line questionnaires, including the Korean version of State-Trait Anger Expression Inventory IV (STAXI- K), Revised Bulimia Test (BULIT-R), and UPPS Impulsive Behavior Scale. Data analysis was conducted using correlation analysis and structural equation modeling. Analyses revealed a significant correlation between anger expression and binge eating behavior. Additionally, there was a significant positive correlation among anger-in, binge eating behavior, and negative urgency. The complete mediation effect of negative urgency on the relationship between anger-in and binge eating behavior was significant, and the direct effect of anger expression on binge eating behavior was non-significant. Finally, implication ns and limitations of this study and suggestions for future research were discussed. Keywords: anger expression, binge eating behavior, negative urgency 마른체형이아름다움의기준으로설정되면서다이어트에대한지 속적인관심이존재하는가운데, 많은여성들이섭식절제를비롯한 다양한방법을통하여체중을줄이고자시도하고있다. 특히외모 에대한기준에민감한 10 대후반부터 20 대여성들의 50 70% 정도 가정상 BMI 에속함에도다이어트를고민하고섭식절제를시도한 적이있다고보고되었다 (Kim & Kim, 2008; Kim, Moon, & Wang, 2010). 체중감소시도에동반되는폭식이나하제사용, 무리한운 동등의이상섭식행동은섭식장애의직접적인위험요소가될수있 으며, 섭식장애의유병률은점차증가하고있는추세이다 (Choi, 2002; Quadflieg & Fichter, 2003). 그러나, 임상장면에서환자들은 섭식문제에대한전문적인도움을구하지않는경향이높고, 단일 진단기준에부합하지않으며복합적이고혼합된섭식문제를가지 는미분류형섭식장애 (eating disorder not otherwise specified, Correspondence to Kyung Park, Department of Psychotherapy, Seoul Women s University Graduate School of Professional Therapeutic Technology, 621 Hwarang-ro, Nowon-gu, Seoul, Korea; kyungpark@swu.ac.kr Received Apr 26, 2018; Revised Sep 3, 2018; Accepted Sep 8, 2018 This work was supported by a research grant from Seoul Women s University (2018). This work is based on a master s thesis of the first author submitted to Graduate School, The Seoul Women s University. EDNOS) 에해당하는경우가많다 (Fairburn & Bohn, 2005). 이러한사실은섭식절제, 폭식행동, 구토, 하제복용등과같은섭식장애의개별적하위증상에대한세부적연구의필요성을제시한다. 폭식행동은신경성폭식증과폭식장애뿐만아니라신경성식욕부진증중폭식및제거형의진단기준에포함되는초진단적증상이며비임상집단에서도빈번히보고된다는점에있어임상적중요성을가진다 (American Psychiatric Association [APA], 2013; Bruce & Agras, 1992). 섭식장애환자들은폭식행동으로인한주관적인불편감을호소하면서도이를지속하는역설적인경험을하게되는데, 그확실한기제는여전히논의중에있다 (McManus & Waller, 1995). 이에본연구는폭식행동에초점을맞추었으며, 특별히신경성식욕부진증의섭식절제형이 10대후반에주로발생하는반면신경성폭식증은 19 23세에주로발병하며, 폭식장애의경우주발병연령대가 20대후반이라고보고되는점을고려하여 20대여성을대상으로진행하였다 (Smink, Van Hoeken, & Hoek, 2012). 연구에따르면, 과도한섭식절제를지속할때그반작용으로폭식행동이촉발된다고하고이는폭식행동의상당부분을설명한다 (Herman, 1978). 그러나, 섭식절제의시도가없더라도좌절, 불안, 분노, 우울등의불쾌한감정이폭식행동을유발할수있다. 회피이 491

2 Lim and Park 론 (Escape theory) 에따르면정서조절에어려움을겪는사람들의경우부정적인정서를더욱오랫동안느끼게되며, 이로부터회피하고자폭식행동을택한다 (Abraham & Beumont, 1982; Heatherton & Baumeister, 1991). 이와관련하여 Lee(2010) 는사람들은모두삶의어느기간에부정정서를경험하게되지만모든이들이폭식행동을보이는것은아니며, 폭식행동의기제를설명함에있어정서조절곤란에주목해야함을제안하였다 (Burton, Stice, Bearman, & Ronde, 2007; Lee, 2007; Lee & Chae, 2009). 정서조절방략은불쾌한정서를줄이고긍정적인정서는더욱경험하고자하는개인의의식적, 무의식적인과정으로, 그결과에따라적응적, 부적응적인조절방략으로구분된다 (Lee & Kwon, 2009; Westen, 1994). 폭식행동을유발하는부적정서중하나인분노를조절하는양식은크게분노-통제, 분노-표출, 분노-억제로구성되는데, 분노-통제 (Anger-Control) 는자신이경험하는분노를지각하고감독하면서도이를그대로표출하지않고상대방의권리및감정을고려하여공격적이지않게언어적으로전달하는등의방식을사용하는것으로적응적인정서조절방식이라고할수있다 (Chon, Han, Lee, & Spielberger, 1997). 반면자신의분노를비난이나욕설등의즉각적인언어적행동, 혹은타인이나동물및사물에신체적해를가하는등의행동으로표현하는분노-표출 (Anger-Out), 타인에게자신의분노를드러내지않고화가난감정을감추며내면에억누르는분노-억제 (Anger-In) 는전반적인신체적, 심리적건강과부적상관을보이는부적응적방략이다 (Martin et al., 1999; Spielberger, Reheiser, & Sydeman, 1995). 선행연구들에따르면, 분노를과도히표출하거나억제하는경향은폭식행동의증가로이어지는반면, 분노-통제는폭식행동과유의한상관을보이지않았다 (Brytek-Matera, 2008; Chong, 2015; Meyer et al., 2005; Milligan & Waller, 2001; Ooh, 2017). 국내연구의경우, Kim과 Ha(2013) 는완벽주의가폭식행동에미치는영향에있어분노-표출의매개효과를검증하였다. Chong(2015) 은분노표현양식이폭식행동에미치는직접적효과를검증하였는데, 분노-억제가폭식행동에유의한영향을미치는것으로나타났다. Self-Control Strength 모델에따르면, 정서조절의곤란은충동조절의어려움을야기하여폭식행동을발생시킨다 (Muraven, Tice, & Baumeister, 1998). 인지와정서조절, 충동조절의과정은한정된자아의자원을기반으로이루어지는데, 부적응적인정서조절방략은더많은인지적에너지를소모하여충동통제력을약화시키고, 이는알코올섭취나폭식행동등을일으키게된다 (Baumeister, Bratslavsky, Muraven, & Tice, 1998; Dick et al., 2010). Boon, Stroebe, Schut 와 Ijntema(2002) 의 한정된용량가설 (Limited Capacity Hypothesis) 역시섭식절제는꾸준한인지적인노력의유지가필요하며, 정서적자극이주의를방해할때폭식행동이나타날수있다고하였다. 실제로섭식장애환자들의경우작업기억용량및집행기능, 인지적유연성등이비임상군보다유의하게저하되어있다는연구결과들이이를간접적으로지지하는것으로보인다 (Hirst et al., 2017; Hofmann, Gschwendner, Friese, Wiers, & Schmitt, 2008; Schmeichel, Volokhov, & Demaree, 2008; Tchanturia et al., 2004). 분노-억제와분노-표출은부적응적인정서조절방략으로, Tice 와 Bratslavsky(2000) 에따르면, 분노억제는해소되지못한분노가재발생 (Backfire) 하게되는정서조절의실패이며, 분노를표출하는것역시자신의감정을환기시키지못하고지속적으로주의를두게하여인지적에너지를소진시키며, 이는앞서설명하였듯충동을조절함에어려움을야기하여폭식행동으로이어질수있다. 충동성의하위요인인부정정서조급성은 부정정서를경험할때충동적으로행동하는경향성 을의미하고, 부정정서와충동성을통합한개념이다 (Haedt-Matt & Keel, 2011). 정서에기반을둔충동성의개념은이전부터이미여러정신장애의설명에서제시되었는데, 예를들어, 경계선성격장애나약물남용, 섭식장애환자군에있어서부정적인정서가선행될때충동적행동이증가한다는것이밝혀졌다 (Heatherton & Baumeister, 1991; Tice, Bratslavsky, & Baumeister, 2001). 부정정서조급성은부정적정서가 (negative emotionality), 충동성의다른하위요인을통제한뒤에도폭식행동을설명하였고 (Anestis, Smith, Fink, & Joiner, 2009; Cyders & Coskunpinar, 2010), 폭식행동의빈도뿐아니라심각도, 섭식통제상실감에도영향을주었다 (Anestis, Selby, Fink, & Joiner, 2007; Park & Kwon, 2017). 부정정서조급성이폭식행동을설명하는기존의이론에어떻게통합될수있는지를이해하기위하여경로를탐색하는연구들이진행되었으나, 그결과는비일관적이었다. 몇몇연구의경우부정정서가폭식행동에미치는영향가운데부정정서조급성의조절효과를증명하였고, 이경우부정정서조급성은상대적으로안정적인개인내적변인이며, 어떤사람이부적정서를느끼더라도이에따라충동적으로행동하지않는경향성이있다면폭식행동은증가하지않을것이라고이해할수있다. 그러나, 부정정서조급성의조절효과가유의하지않았다는상반된결과들이존재하고, 앞서연구들의효과크기가미비한수준이었다는한계가있다 (Cyders & Coskunpinar, 2010; Davis-Becher, Peterson, & Fischer, 2014; Karyadi & King, 2011; Pyeon & Lee, 2016). Lavender, Green, Anestis, Tull과 Gratz(2015) 의연구에서부정 492

3 Anger Expression and Binge Eating, NU 정서조급성은부정정서와폭식증상의관계를매개하였고, Lee와 Jang(2017) 의경우도완벽주의가신경성폭식증증상에미치는영향가운데부정정서와부정정서조급성이유의한매개효과를가졌다. 즉, 부정정서를느꼈을때개인의부정정서조급성의수준에따라폭식행동이조절된다는앞선연구결과와는달리, 부정정서가증가하면부정정서조급성도상승하게되어폭식행동을보이게된다는것이다. 분노표현양식과부정정서조급성간의직접적연관성을검증한선행연구는현재까지는시행된바가없어논의의한계가존재한다. 그러나, 분노를적절히조절하지못함이충동성과함께폭식행동에영향을준다는기존의연구결과들을종합해볼때, 분노표현양식과충동성의하위요인인부정정서조급성역시상관관계를가질것을제안해볼수있다 (Fassino, Daga, Pierò, Leombruni, & Rovera, 2001; Krug et al., 2008; Peñas Lledó, Fernández, & Waller, 2004). 또한, 선행연구들을토대로볼때, 분노-억제와분노-표출은인지적에너지의과도한소모를일으키며이는부정정서조급성의매개효과를통하여폭식행동의증가로이어질것임을가정해볼수있다. 따라서, 본연구에서는 20대여성을대상으로분노표현양식과폭식행동, 부정정서조급성의상관관계를밝히고, 분노-억제와분노-표출이폭식행동에영향을미칠때부정정서조급성이매개하는변인으로서유의한효과를가지는지알아보고자하였다 (Figure 1). 방법연구대상본연구는서울여자대학교윤리심의위원회에서 2017년 9월 5일연구윤리심사승인이후 20대여성을대상으로 2017년 9월중순부터 10월중순까지약한달동안인터넷설문형식을통하여자기보고식설문을실시하였다. SNS, 대형온라인커뮤니티를통하여연구대상자를모집하였으며, 응답자들에게연구에대한간략한설명과자발적동의여부를표시하도록하였고, 동의한이들을대상으로설문을진행하였다. 최종적으로 314명이응답을완료하였다. 연구에동의하지않는다고표했거나무응답한문항이있는설문을제외한 302부로분석을실시하였고, 평균나이는 23.33세 (SD = 2.71) 였다. 측정도구한국판상태-특성분노표현척도 (State-Trait Anger Expression Inventory, STAXI-K) 대학생의분노표현양식을측정하기위해 Spielberger, Krasner와 Angercontrol Angerin Angerout Angercontrol Angerin Angerout Negative urgency Negative urgency Figure 1. Research model (upper) and competitive model (lower). Solomon(1988) 이개발한상태 - 특성분노표현척도를 Chon 등 (1997) 이한국판으로개발한것을사용하였다. 이척도는특성분노 (Trait Anger: 평소분노경험에대한개인의기질적인차이 ) 10 문항, 상태분노 (State Anger: 현재경험하는분노의정도 ) 10 문항, 분노 - 표출 (Anger-Out: 분노를타인이나외부사물을향해표현하는것 ) 8 문항, 분노 - 억제 (Anger-In: 분노를경험하지만억제하는것 ) 8 문 항, 분노 - 조절 (Anger-Control: 자신의분노를조절하기위해노력 하는것 ) 8 문항으로총 44 문항으로구성되어있다. Chon 등 (1997) 의연구에서각하위척도의신뢰도계수 (Cronbach s α) 는분노 - 억 제는.67, 분노 - 표출은.67, 분노 - 통제는.79 였다. 본연구에서는분 노표현양식에해당하는 24 문항을자료분석에사용하였고, 내적일 치도계수는전체.65 였으며하위척도의경우분노 - 억제는.81, 분 노 - 표출은.77, 분노 - 통제의경우.81 로나타났다. Binge eating behavior Binge eating behavior 신경성폭식증검사개정판 (The Bulimia Test-Revised, BULIT-R) 여대생의신경성폭식증증상을측정하기위해 Smith 와 Thelen (1984) 이처음개발하고 Thelen, Farmer, Wonderlich 와 Smith(1991) 가개정하였으며, Yoon(1996) 이번안한 BULIT-R 을사용하였다. BULIT-R 은총 36 문항의자기보고식질문지이며폭식을측정하는 493

4 Lim and Park 28문항과체중조절행동을포함하는 8개문항으로이루어져있다. 문항에제시된폭식의정의로는타당한폭식행동을측정하기어렵다는 Jeon(2011) 의제안에따라, 폭식의정의는 DSM-5(APA, 2013) 를바탕으로수정하였다. 각문항은 5점척도로이루어져있으며, 점수가높을수록신경성폭식증증상이심각함을의미한다. 점수범위는최하 28점부터최고 140점까지나올수있고, 원척도에따르면여대생의경우 82점이상은폭식행동경향성을, 102점이넘으면신경성폭식증진단을고려해야하는것으로알려져있다 (Thelen et al., 1991). 원척도에서신뢰도계수는.97이었다. 본연구에서는폭식행동을측정하는 28문항만을자료분석에사용하였으며, 문항간신뢰도계수는.92였다. 한국판다차원적충동성척도 (UPPS Impulsive Behavior Scale) Whiteside와 Lynam(2001) 이개발하고 Cyders 등 (2007) 이 1개요인을추가하여개정한총 59문항의자기보고형질문지이다. 부정적긴급성을포함하여총다섯가지하위요인으로이루어져있으며, 4 점척도로평정하여점수가높을수록더충동적임을의미한다. 본연구에서는 Lim(2014) 이국내대학생을대상으로타당화한한국판다차원적충동성척도가운데부정정서조급성을측정하는 12 문항을사용하였다. Lim(2014) 의논문에서신뢰도계수는.91이었고, 본논문의신뢰도계수는.90이었다. 자료분석본연구에서는분노표현양식이부정정서조급성을매개로하여폭식행동에영향을줄것이라는가설을가지고 SPSS 22.0 프로그램과 AMOS 20.0 프로그램을사용하여자료를분석하였다. 인구통계학적항목들을살펴보고, 그외각설문형측정도구를통하여얻은값들의최소값, 최대값, 평균과표준편차그리고왜도와첨도를산출하였다. 사용된척도들의신뢰도확인을위하여내적일치도계수를산출하였으며, 측정변인들의관련성을알아보기위하여 Pearson s correlation analysis 를시행하였다. 구조방정식분석이전에첨도및왜도, 정규분포만족여부를확인하였으며, 분노표현양식의각하위요인, 부정정서조급성을각각단일요인을가정하여최대우도법을통한탐색적요인분석을실시한뒤이를토대로동등한부하량을가지는요인묶음꾸러미 (item parceling) 를구성하였다. 각잠재변수에대한묶음꾸러미와요인부하량을 Figure 2로나타내었다. 부정정서조급성이가지는매개효과의유의성판단을위하여 Bootstrap 절차를이용하여간접효과를알아보았으며 (Kim, 2010), 본연구의자료분석에서는부트스트랩표본 5,000개를생성하였고, 간접효과에대한신뢰구간은 95% 로설정하여 Bootstrap ML 방식으로 χ 2 검정을실시하였다. 그러나, χ 2 검정의경우영가설을엄격하게설정하여모형의기각이너무쉽다는단점이있으며 (MacCallum, Browne, & Sugawara, 1996), 표본 e1 e2 AC1 AC e3 e4 AC3 AC Angercontrol e19 e e5 e6 AI1 AI Angerin -.74 Negative urgency Binge eating behavior e7 e8 e9 e10 e11 e12 AI3 AI4 AO1 AO2 AO3 AO Angerout NU1 NU2 NU3 e13 e14 e15.92 BE1 e16.95 BE2 e17 Figure 2. Item parcells and its factor loadings on latent variables

5 Anger Expression and Binge Eating, NU 크기에따라서같은모형이라도기각여부가달라질수있는경우가발생할수있어 (Hong, 2000), 이를보완하기위하여 χ 2 검정에더하여 Tucker-Lewis-Index(TLI) 나 Comparative Fit Index(CFI), Root Mean Square Error of Approximation(RMSEA) 의적합도지수를통해모델의적합도를평가하였다. 선행연구들에따르면일반적으로 TLT 와 CFI의경우.90 이상이나오면모델이적합한것으로판단할수있고, RMSEA의경우는.06 이하의값일때적정한적합도인것으로해석한다 (Bollen & Stine, 1993; Dimitrov, 2006; Hu & Bentler, 1999). 결과기술통계치및상관관계본연구의주요변인폭식행동, 분노표현양식, 부정정서조급성의평균과표준편차를산출한결과는아래의 Table 1과같다. 본연구의종속변인인폭식행동의평균은 60.19(SD = 2.04) 이었다. BULIT- R에서 Thelen 등 (1991) 이제시한신경성폭식증을고려해야하는절단점수인 102점이상을보고한사람은연구응답자들가운데 3.5% 에해당하였다. 독립변인인분노표현양식의전체평균은 52.39(SD = 5.96) 이었고, 각하위요인의경우분노-통제는 (SD = 3.11), 분노-표출은 14.45(SD = 2.35), 분노-억제는 (SD = 4.08) 로분노-통제가가장높은수치를보였다. 마지막으로매개변인인부정정서조급성의경우평균 27.99(SD = 7.35) 이었다. 본연구의주요변인간관계를살펴보기위하여상관관계분석 (Pearson s Correlation Analysis) 을실시하여상관계수를산출하였고, 그결과를 Table 1에제시하였다. 분석결과폭식행동과분노표현양식, 부정정서조급성의모든변인들의 Pearson 상관계수가 p <.01 수준에서유의하였다. 종속변인인폭식행동은분노표현양식의각하위요인및부정정서조급성과유의한상관을보였다. 폭 Table 1. Descriptive Statistics and Correlations among Variables Binge eating behavior - 2. Anger-control -.23** - 3. Anger-out.36** -.46** - 4. Anger-in.30** -.18**.46 ** - 5. Negative urgency.51** -.33 **.49 **.52 ** - Mean Standard deviation Skewness Kurtosis **p <.01. 식행동과분노표현양식을살펴볼때, 분노-통제는폭식행동과부적상관관계가있었다 (r = -.23, p<.01). 분노-표출과폭식행동은유의한정적상관을보였다 (r =.36, p<.01). 분노-억제의경우역시폭식행동과정적상관관계가있는것으로나타났다 (r =.30, p<.01). 매개변인인부정정서조급성과폭식행동은유의한정적상관관계가있었다 (r =.51, p<.01). 분노표현양식과부정정서조급성의경우분노-통제와는부적상관관계를가지고있었다 (r = -.33, p<.01). 분노-표출 (r =.492, p<.01) 및분노-억제 (r =.521, p<.01) 와는유의한정적상관관계가있는것으로나타났다. 측정모형분석각측정변수들이잠재변수를타당하게측정하고있는지확인하기위하여먼저확인적요인분석을실시하였다. 그결과 χ 2 값은 , df =109로 p <.001 수준에서유의하였으며, TLI=.93, CFI=.95, RMSEA=.07이었다. 측정모형의적합도지수를보았을때모형이적합하다고판단할수있다. 구조모형분석연구모형에서는 Figure 1에나타내었듯분노표현양식이폭식행동에미치는직접적인경로와부정정서조급성의매개를통한경로모두를포함하였다. 전체모형의검증결과모형의적합도는유의한수준이었으나각분노표현양식의하위요인들이폭식행동으로가는직접경로가유의하지않았다. 분노-통제에서폭식행동으로의경로는.08(p =.47), 분노-억제가폭식행동으로가는경로는 -.09(p =.32), 분노-표출이폭식행동으로가는경로는.25(p =.08) 이었다. 이에 Kenny, Kashy와 Bolger(1998) 의선행연구에따라유의미하지않은경로가제거된모형을경쟁모형으로설정하였다. 가설모형은분노표현양식이폭식행동에미치는영향에있어부정정서조급성이완전매개효과를가지는것으로, Figure 1의하단에제시하였다. 두모형가운데보다적합한모델을선정하기위하여 ML Bootstrap을통하여적합도분석을실시하여비교를하였다. 아래의 Table 2에그값을제시하였다. 두모형을비교하기위하여 χ 2 값의차이및 TLI, CFI, RMSEA 적합도지수들을고려하였다. 두모형모두 χ 2 값은 p<.001에서유의하였고, χ 2 을자유도로나눈값역시 1에서 3 사이에위치하여적합한모델로판단할수있다. RMSEA는엄격한기준인.06 이하보다다소높기는하지만.05에서 0.1 정도면비교적적절하다고볼수있다는 Hong(2000) 의연구에따를때적합하다고보인다. TLI 및 495

6 Lim and Park Table 2. Model Fit Indexes and Chi-Square Value of Research Model and Competitive Model Model ML Bootstrap chi-square df p CMI/DF TLI CFI RMSEA Research Model < Competitive Model < **p <.01. ***p <.001. Table 3. Values about Path Coefficients of Model and Standardized Indirect Effects Estimate Standard error beta p-value Anger-control to negative urgency Anger-in to negative urgency <.001*** Anger-out to negative urgency Negative urgency to binge eating <.001*** Standardized indirect effects upper bound Standardized indirect effects lower bound Anger-out Anger-in Anger-control ***p <.001. CFI 지수가모두.9 이상으로적합한모형이라고확인할수있을것으로보인다. 연구모형과경쟁모형의 χ 2 값차이는유의수준.05 수준에서의임계치인 7.81 을넘지못하여유의하지않았다 (df = 3). 따라서적합도지수들을통하여모형의우수성을판단하고자하였다. 두모형의경우 CFI와 RMSEA 값은동일하였으나 TLI 값을비교하였을때에경쟁모형이.93으로연구모형보다더나은값을보였으나경미한차이에그쳤다. 이에두모형의우수성을비교하는것에는어려움이있을것으로생각되나, 보다간명한수정모형을채택하였다. 분노-억제가부정정서조급성으로가는경로계수와부정정서조급성이폭식행동으로가는경로계수는 p<.001 수준에서유의하였다. 분노표출에서부정정서조급성으로가는경로계수는 p<.05 수준에서유의하였다. 간접효과검증분노표현양식이폭식행동에미치는영향에있어서부정정서조급성이완전매개효과를가지는모형이적합한것으로나타났기때문에 Bootstrap 방법을따라무선표집으로 5,000개의표본을원자료 (N=302) 로부터생성하도록하여신뢰구간 95% 에서간접효과가유의한지검증하였다. 매개효과추정치에대한 95% 신뢰구간안에 0이포함되어있지않을경우에만.05 수준에서유의한것으로결론을내렸다. 그결과분노-표출의경우구조모형검증시에는.27의경로계수가 p<.05 수준에서유의하였으나폭식행동에미치는표 Angercontrol Angerin Angerout Figure 3. Path estimates of research (final) model. ***p <.001. 준화된간접효과의상한선 (upper bounds) 과하한선 (lower bounds) 사이에 0 이포함되어있어간접효과는유의하지않은것으로볼 수있다. 분노 - 억제의경우표준화된간접효과의하한선은.12, 상 한선은.34 로 0 을포함하지않고있어간접효과가유의한것으로 볼수있다. 구조모형의경로계수, 간접효과의유의성검증에대한 결과를 Table 3 에제시하였다. 최종적으로유의한경로는분노 - 억제에서부정정서조급성으로 의계수인.40 과부정정서조급성에서폭식행동으로의계수.57 이 었으며 p<.001 수준에서유의하였다. 최종모형의경로계수는 Figure 3 에제시하였다 *** Negative.57*** urgency.27 Binge eating behavior 496

7 Anger Expression and Binge Eating, NU 논의본연구는 20대여성을대상으로하여분노표현양식이폭식행동에미치는영향에부정정서조급성의매개효과를검증하였다. 분노표현양식과폭식행동의관계를알아보고, 그가운데부정정서조급성의매개효과를검증하기위해서한국판상태-특성분노표현척도, 신경성폭식증검사개정판, 한국판다차원적충동성척도를사용하였다. 연구결과, 분노표현양식중분노-억제가부정정서조급성을매개하여폭식행동에영향을미쳤음을확인할수있었다. 본연구결과에대한논의는다음과같다. 주요변인간의상관분석결과, 분노표현양식의하위요인가운데분노-통제 (Anger-Control) 는폭식행동과부적상관을, 분노-표출과분노-억제는폭식행동과정적상관을보였다. 이는선행연구들의결과들과일치하며, 부적응적인분노표현양식이폭식행동과부적상관을가질것이라는본연구가설을지지하는결과이다 (Chong, 2015; Hae, 2017; Kim & Ha, 2013; Meyer et al., 2005; Milligan & Waller, 2000; Peñas Lledó et al., 2004). 전체모형검증결과분노표현양식의각하위요인들과폭식행동의직접적관계는유의하지않았으며, 최종모형의경로계수를볼때분노-억제만이부정정서조급성을매개로하여폭식행동에유의한영향을미쳤다. 이는분노-표출과분노-억제의직접효과를보인선행연구들과불일치하고있는데, 부정적인분노조절방식이충동통제의곤란을유발함으로써폭식행동으로이어질것이라는본연구의가설을지지하는결과이다. 앞서언급했듯, Baumeister 등 (1998) 은스스로를조절하는개인의자아능력이제한된용량이있으며인지와정서조절, 충동성조절의과정이한정된자아의자원을기반으로이루어지는것임을제안하였다. Tice와 Bratslavsky (2000) 는정서를조절하는것은자신의정서상태에지속적인주의를기울이며그에적합한인지적자원의양을결정하고집행하는과정으로, 부적응적정서조절방략의경우해결되지못한부정적인정서가보다길게지속되고, 이에더욱오랜시간주의를두어야하기때문에더욱많은인지적에너지를된다고하였다. 이러한연구들을바탕으로할때, 분노를적절히조절하지못하는것은보다많은인지적소모를일으키고, 이는정서에기반하여충동적으로행동하는경향을높여폭식행동을증가시키게된다고볼수있다. 한편, 본연구의모형검증결과분노-억제가폭식행동에미치는영향가운데부정정서조급성의매개효과가유의하였으며, 이는부정정서조급성이매개변인으로서기능할것이라는본연구의가설을지지하는결과이다. Davis-Becker 등 (2014) 은강렬한부정정서는목표지향적인행동에집중하는것을방해하고적응적결정을 내리지못하도록하며, 부정정서조급성이높은개인들은이러한상황에서보다즉각적이고충동적인스트레스감소행동을하게된다고볼수있기때문에부정정서조급성의조절효과를제안하였다. 그러나, 연구결과분노가폭식행동에미치는영향가운데부정정서조급성의조절효과는유의하지않았고, 부정정서조급성의조절효과가유의했던논문들의경우에도그효과크기는미미했다는한계점이있었다 (Cyders & Coskunpinar, 2010; Karyadi & King, 2011; Pyeon & Lee, 2016). 이에 Lavender 등 (2015) 은부정정서가부정정서조급성의내재된선행변인임이연구를통하여검증하였고, 임상장면에서환자들을보았을때부정정서를강렬히느끼는순간충동적으로행동하는경향성이증가하게됨을관찰할수있었음을근거로부정정서조급성의매개효과를제안한바있으며, 간접효과가유의함을보였다. 본연구의결과, 부정정서조급성의매개효과가유의하였고, 이는부정정서조급성이부정정서수준을조절해줄수있는변인이라기보다, 부정정서수준에따라증가하게되는매개변인으로서의성격을가질것이라는점을시사한다 (Lavender et al., 2015; Lee & Jang, 2017). 마지막으로, 분노- 억제와함께부적응적인분노표현양식으로분류되는분노-표출의경우본논문에서는폭식행동에직접적및간접적영향을미치지않았다. 이는폭식행동의증가에있어서분노- 억제뿐만아니라분노-표출이정적인영향을가질것이라는본연구의가설과는상반되는결과이다. 그러나, 기존선행연구들에서도폭식행동에대하여분노-표출과분노-억제의효과가동시에모두유의했던경우는드물고, 대부분분노-표출이나분노-억제중한요인만이폭식행동을예측하고있어그결과가혼재되어있는상황이다 (Hae, 2017; Kim & Ha, 2013; Peñas Lledó et al., 2004). Polivy(1998) 는과도한섭식절제와마찬가지로부적정서를과도히억제하는것이폭식행동과같은충동적인결과로이어질수있다고주장하였다. 사람들은사회적환경을고려하여정서를지나치게억제하는경향이있는데, 이는정서적해소, 즉 카타르시스 를경험을막는다는것이다 (Heatherton, Herman, & Polivy, 1991; Polivy & Herman, 1985). 이러한주장에따르면분노를표출하는것은보다즉각적인해소와쾌감의경험이될수있고, 반대로분노를억제하는것은부적정서의지속과그에따른인지적억제의노력을요하게된다고볼수있다. 이경우, 분노-표출은정서의해소를의미하기에추가적정서조절의노력을필요로하지않기에부정정서조급성및폭식행동에유의한영향을미치지않았을것이라고생각해볼수있겠다. 그러나, 분노를표출하는것역시자신의정서상태에대한관찰이필요하고, 더욱이무분별한정서표출은부정적인결과로이어질수있다는반론도제기되고있어, 이러한해석을 497

8 Lim and Park 위해서는보다추가적인증명이필요할것으로생각된다 (Tice & Bratslavsky, 2000). 한편, 상태-특성분노표현척도를한국판으로개정하는과정가운데에서분노-억제와분노-표출이지속적으로유의한상관관계를가지고있었고, 이두하위요인이완벽히독립적이지않고서로방향이다른변인임이꾸준히제기되어왔다 (Chon, 1991; Chon et al., 1997; Chon, Kim, & Ryu 2000; Chon, Kim, & Lee, 2010; Han et al., 1997). 이와관련하여 DePaulo, Blank, Swaim과 Hairfield(1992) 는정서적으로표출하거나정서를억제하려는두가지시도가과제수행에있어흡사한영향을미친다고하였다. 또한, Tice와 Bratslavsky(2000) 는분노를쏟아내기위해서개인은지속적으로자신의내적정서에주의를두어야하기때문에분노표출은정서조절을적게하는것 (under-regulation) 이아니라반추나억제와같은정서조절실패 (mis-regulation) 로설명할수있다고제안한바있다. 즉, 분노를억제하거나표출하는두방식은독립적이지않으며분노조절의어려움을반영하는하나의요인일수있고, 이러한변인간구분의모호함으로인하여연구결과간불일치가생겼을수있다. 혹은분노-억제와분노-표출이충동성과각각상이한관계를가지고있기때문일가능성을고려해볼수있겠는데, 선행연구에따르면충동성은분노-표출과유의한연관을보였으며분노-억제와는그렇지않았다. Peñas Lledó 등 (2004) 의연구에서여성의경우분노-표현은폭식행동, 외부를향한충동성과정적인상관을보였으나분노-억제는이와달리충동성과상관을보이지않았다. 분노- 표출의경우부정적인정서에기반하여충동적으로행동하는성향과밀접한특성을공유하고있기때문에본연구에서유의한매개효과를보이지않았을수있겠다. 그러나, 분노표현양식과부정정서조급성의관계를직접적으로검증한선행연구가전무한실정으로분노-억제와분노-표출이충동성의세부하위요인들과어떠한연관성을가지는가에대하여추후연구가필요할것이다. 본연구의논의와결론을바탕으로한의의는다음과같다. 첫째, 국내선행연구들의연구대상연령대가대부분후기청소년과초기성인기에국한되어있는반면, 신경성폭식증, 폭식장애의발병연령을고려하여 20대여성을대상으로연구를진행하였다. 그결과, 10대후반에서 20대초반을대상으로진행된선행연구들과마찬가지로분노표현양식, 부정정서조급성은폭식행동에유의한영향을미치고있음을알수있었다. 둘째, 기존의폭식행동에관한연구들은우울, 불안, 분노등의부정정서를중심으로이루어져왔으며, 최근에는정서조절의중요성에초점이제시되고있다. 그러나분노를표현하고조절하는방식인분노표현양식과폭식행동의관계를확인한연구들은부족한 실정이다. 분노를표현하는방식이폭식행동에유의한영향을미친다는해외선행연구가존재함에도불구하고국내에서는분노표현양식이폭식행동에미치는직접적영향에대하여검증한연구는거의없으며대다수가분노표현양식을매개혹은조절변인으로상정하고있다. 그러나한국인들과미국인들의분노경험및분노표현양식에있어서차이가존재한다는연구결과 (Chon, Lee et al., 2010) 을보았을때한국인들의분노표현양식이폭식행동에미치는영향을확인해볼필요성이있으며, 본연구에서는이를한국인 20 대여대생들을대상으로검증했다는것에의의가있다. 셋째, 분노표현양식이폭식행동에미치는영향에있어부정정서조급성의매개효과를확인하였다. 선행연구들이폭식행동에있어서부적응적인분노표현양식과충동성이함께영향을미칠것임을제안하고있음에도이를직접적으로검증을하였던연구는부족하였다. 또한 Whiteside와 Lynam(2001) 이제시한다차원적충동성의하위요인가운데폭식행동에특별히영향을미치는것으로밝혀진부정정서조급성과분노표현양식간의관계에대한연구는아직실시되지않은실정이었다. 부정정서가운데에서도분노와충동성은보다밀접한연관성을맺고있는것으로시사되었던바, 본연구에서는분노를표현하는방식에따라충동성의하위요인인부정정서조급성이증가할수있으며, 이로인하여폭식행동이일어나게될수있음을밝혔다. 특히, 분노를과도히억제하는것은사회적상황에서의이점으로작용할수도있으나부정적인정서에더욱주의를두며이를지속시킬수있다. 따라서, 분노를적절히표현할수있는능력의함양이폭식행동의치료에서다루어져야할것으로, 미술치료, 사이코드라마와같은매체를통하여분노를해소하도록도울수있다 (Kim, 2010; Park & Hong, 2008). 또한, 분노의감정이일어난상황이나분노를표현하는태도에관한신념을재평가하는인지치료적접근도효과적인것으로알려져있다. 넷째, 부정정서조급성이부정정서가폭식행동에미치는영향을조절해줄수있는성격특성이라는관점에서시행되었던선행연구들과달리본연구에서는부정정서조급성의매개효과가유의하였다. 이는치료적접근에있어서부정정서조급성을촉발및증가시키는선행요인이될수있는정서조절능력함양과동시에각개인의자기- 통제능력이중요한지점일수있음을시사한다. Self-Control Strength 모델을제안하였던 Baumeister, Vohs 와 Tice(2007) 는개인이훈련을통해서자기 -통제능력을향상시키는것이가능하다고주장하였다. 각개인마다차이가있는한정된자아통제자원이용량이정서조절이나충동통제를꾸준히연습하는과정을통해서증진될수있다는것이다. 폭식행동의치료에있어서도분노를포함한부정적정서의조절및표현을연습할수있도록하는치료 498

9 Anger Expression and Binge Eating, NU 적개입및충동조절의꾸준한연습을돕는프로그램이도움이될수있겠다. Masicampo와 Baumeister(2007) 는이와관련하여자기-통제능력향상을위한개입으로마음챙김 (Mindfulness) 이효과적임을제안하였다. 환경과자신의상태를인식하고끊임없이이를변화시키는자기- 통제와조절의과정은, 개인이자신의내적및외적상태에대하여알아차리고상위인지적통찰과통합적인기능을증진시키는마음챙김과밀접한연관성을가진다. 연구결과에따르면마음챙김연습은자기- 통제능력의향상에유의한영향을미쳤으며, 자기- 통제연습을하는것역시마음챙김의증가로이어졌다. 마음챙김연습은폭식행동및분노표현양식에도유의한효과를보이는것으로알려져있는데, Lee와 Kim(2015) 에따르면마음챙김명상은인지행동치료와약물치료를받고있는섭식장애환자들의폭식행동및분노-표출수준을유의하게감소시켜 CBT 및약물치료에추가적인효과를가지고있었다. 분노-억제및부정정서조급성이폭식행동의증가에유의한영향을미친다는본연구결과로비추어볼때에마음챙김개입은분노를알아차리고조절하는것에긍정적인영향을주며, 자아-통제능력의향상을동시에도와주어폭식행동치료에보다효과적으로사용될수있을것으로보인다. 본연구의한계점및추후연구에대한제언은다음과같다. 첫째, 본연구는비임상집단을대상으로하여분노표현양식과부정정서조급성이폭식행동에미치는영향을살펴보았다. 그러나실제섭식장애진단을받은임상집단과는질적으로차이가있을수있다. 따라서추후연구에서는비임상집단및각섭식장애의하위집단을각각나누어본연구의모형을재검증하여임상집단과비임상집단간의차이가있는지살펴보는것이필요할것이다. 둘째, 본연구의대상은섭식장애환자의 90% 이상이여성이라는선행연구들을바탕으로 20대여성에한정되어있다. 그러나, 근래에는남성및중년여성들에게도섭식장애발병비율이증가하고있다 (Choi, 2002; Kim, Lim, Hwang, & Kim, 2018). 따라서추후연구에서는 20대여성이외에 10대후반이나 20대남성, 그리고중년여성에대하여본연구의모델이적용되는지에대하여알아볼필요가있을것이다. 이를통하여폭식행동에서의성별및연령대에따른차이점이있는지검증할수있을것이다. 셋째, 본연구는인터넷을통하여자발적으로설문에응한사람들을대상으로하는연구였기때문에일반화에어려움이있을수있으며, 응답자들이상대적으로설문에우호적으로대답하였을가능성이있다. 연구과정가운데설문을진행함에있어몇몇응답자들로부터폭식과과식의차이점이무엇인지에대한문의를받은 바, 일반인들을대상으로하는연구에서폭식에대한정의를응답 자들이이해하기어려울수있어폭식행동에대한설명이충분히 설문에제시되어있어야할것으로보인다. 또한앞서언급하였듯 Spielberger 등 (1995) 이개발한 STAXI 척도의분노 - 표현및분노 - 억제간의상관이높아연구의결과해석에어려움이있었던바, 추 후연구를진행할시이에대한고려가필요할것이다. 이에관하여 본연구는설문방식으로진행하였기때문에응답자들의실제분 노경험및표현에대하여생태학적타당도가낮으며해석에모호 함이있었던점을보완하기위하여실험연구나 EMA 등의연구방 법을이용한검증이필요할것이다. 넷째, 본연구에서는폭식행동만을종속변인으로설정하여연 구를진행하였으나추후연구에서는폭식행동이외에도분노표현 양식및부정정서조급성과하제및지사제사용이나구토행동등 보다다양한이상섭식행동들에대한세부적인연구가필요할것 으로보인다. References Abraham, S. F., & Beumont, P. J. V. (1982). How patients describe bulimia or binge eating. Psychological Medicine, 12, American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association. Anestis, M. D., Selby, E. A., Fink, E. L., & Joiner, T. E. (2007). The multifaceted role of distress tolerance in dysregulated eating behaviors. International Journal of Eating Disorders, 40, Anestis, M. D., Smith, A. R., Fink, E. L., & Joiner, T. E. (2009). Dysregulated eating and distress: Examining the specific role of negative urgency in a clinical sample. Cognitive Therapy and Research, 33, Baumeister, R. F., Bratslavsky, E., Muraven, M., & Tice, D. M. (1998). Ego depletion: Is the active self a limited resource? Journal of Personality and Social Psychology, 74, Baumeister, R. F., Vohs, K. D., & Tice, D. M. (2007). The strength model of self-control. Current Directions in Psychological Science, 16, Bollen, K. A., & Stine, R. A. (1993). Bootstrapping goodness-of-fit measures in structural equation models. Sage Focus Editions, 154, 111. Boon, B., Stroebe, W., Schut, H., & Ijntema, R. (2002). Ironic processes in the eating behaviour of restrained eaters. British journal of health psychology, 7(1), Bruce, B., & Agras, W. S. (1992). Binge eating in females: A population based investigation. International Journal of Eating Disorders, 12,

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