Chocolate craving when depressed: a personality marker

We examined links between chocolate craving in people who aredepressed and both personality style and atypical depressivesymptoms, with a web-based questionnaire completed by nearly3000 individuals reporting clinical depression. Chocolate wascraved by half of the respondents (more so by women), judgedas beneficial for depression, anxiety and irritability, and associated specifically with personality facets encompassedby the higher-order construct of neuroticism. The simple questionof depression-associated chocolate craving appeared an efficientdiscriminator of DSM–IV atypical depression symptoms.

INTRODUCTION

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INTRODUCTION

Hyperphagia is commonly reported by depressed patients and isa specific DSM–IV criterion (American Psychiatric Association, 1994)for defining ‘atypical depression’, a depressivesyndrome combining symptom and personality criteria. Our earlierreview (Parker et al, 2002) of atypical depression weightedthe primacy of a personality style of rejection sensitivity,with several symptoms (including food cravings) more reflectingself-consolatory and possibly homoeostatic strategies. In anotherreview (Parker et al, 2006a) we overviewed studies considering mood state effects of chocolate consumption. In this studywe investigate self-reported benefits of chocolate during adepressive episode and examine for any specificity of personalitystyle to such chocolate craving.

METHOD

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METHOD

People accessing – for whatever reason – our mooddisorder consumer information website (http://www.blackdoginstitute.org.au) were invited to participate in an online survey of lifetimetreatments for a depressive episode (and without any referenceto the survey involving questions on chocolate consumption).Participants provided demographic data, reported symptoms andtreatments of depressive episodes, and rated any increase in35 symptoms or coping responses, degree of increased food cravings and importance of chocolate when depressed. All completed thetiered Temperament and Personality questionnaire (Parker et al, 2006b),assessing personality constructs disposing to depression fromhigher-order constructs (e.g. ‘neuroticism’ and ‘extraversion’) to eight lower-order facets. Asparticipants were recruited anonymously, no data validity checkwas possible.

Sample
Analyses were limited to 2692 of the 3486 respondents who were18 years or older, living in Australia, initial survey completers,and reported depressive episodes lasting 2 weeks or longer.Their mean age was 40.0 years (range 18–77) and 70.8%were female; 73.6% had previously received an antidepressantmedication and 78.3% had received counselling or psychotherapy for depressive episodes.

RESULTS

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RESULTS

When depressed, 1465 (54.4%) reported food cravings, with 1210(44.9%) specifically being chocolate cravers (50.7% of thewomen and 30.9% of the men; ${chi}$ ²=88.3, P<0.001). Only 9.5%acknowledged alternative craved foods. Of the chocolate cravergroup, the 736 (60.8%) who rated chocolate’s capacityto improve their depressed mood as moderately to very importantwere more likely to rate it as making them feel significantly(P<0.001) less anxious ( ${chi}$ ²=366.7) and less irritated ( ${chi}$ ²=337.1).

Temperament and Personality questionnaire scores quantifiedthe chocolate cravers group as having significantly (P<0.001)higher mean scores on the irritability (t=6.3), rejection sensitivity(t=5.6), anxious worrying (t=5.5), self-criticism (t=5.2) and self-focused (t=4.5) scales, all derived from the higher-order neuroticism construct. Differences were not evident on scalesoriginating from the higher-order introversion construct, i.e.personal reserve (t=1.8), social avoidance (t=1.1) and perfectionism (t=0.5). This differential finding was confirmed by this group scoring higher on the consolidated tier 2 higher-order neuroticismscale (16.8 v. 15.4, t=6.5, P<0.001) but not on the tier2 introversion scale (12.3 v. 11.8, t=0.8, P=0.075). A logisticregression (entering all eight personality constructs as predictors of chocolate craving status) identified irritability alongwith rejection sensitivity as the only two significant predictors.

Examined against DSM–IV criterion B atypical depressionaccessory symptoms, those identified as chocolate cravers returnedhigher (P<0.01) scores for appetite increase (t=21.8), weight gain (t=18.8), sensitivity to rejection (t=7.3), hypersomnia (t=5.7) and limbs feeling ‘heavy like lead’ (t=5.4).

We explored the hypothesis that atypical depression symptomshave a self-comforting role. Scores on two self-comfortingitems (craving ‘comfort’ foods, and ‘warmingup’ behaviours such as having a hot bath) increased significantly (Table 1) and linearly (F=999.2 and F=119.7 respectively;P<0.001) with increasing number of DSM–IV accessoryatypical depressive symptoms, suggesting that chocolate cravingmight predict atypical depression status. We therefore examinedthe sensitivity, specificity and overall classification rateof chocolate craving predicting numbers of atypical symptoms.Sensitivity was highest (at 76.4%) for those reporting fivesymptoms of atypical depression, but specificity was only 57.7%.The overall classification rates were 49.2% (for a cut-offof one or more symptoms) and 57.7% (for two or more symptoms),65.5% (for three or more symptoms), 65.0% (for four or more symptoms) and 59.2% for all five symptoms. Thus, for threeor more and four or more symptoms, the probe question successfullyallocated two-thirds of all participants.

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Table 1 Mean ratings of ‘self-soothing’ tendencies among those endorsing differing numbers of atypical symptoms when depressed

DISCUSSION

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DISCUSSION

Although our data were derived from a web-based survey, respondentswere required to have experienced depressive episodes lastingat least 2 weeks and requiring treatment. Chocolate cravingwas common (45%) – and more likely in women – anda preferential choice (with only 10% nominating any alternativecraved food). ‘Importance’ ratings indicated that those classed as ‘depressed cravers’ viewed chocolateas settling anxiety and irritability. Our most intriguing findingwas the specificity of the links between chocolate cravingand personality styles. We anticipated that the ‘depressedcravers’ group would score preferentially on the rejectionsensitivity scale in light of the DSM–IV definition of atypical depression. In fact they scored higher on all fivelower-order scales emerging from a higher-order ‘neuroticism’base, but on none of the three personality scales emergingfrom a higher-order ‘introversion’ base. Our logisticregression (entering all eight personality constructs) identifiedonly irritability and rejection sensitivity as significantpredictors of such craving, consistent with these individuals judging chocolate as reducing anxiety and irritability.

In states of emotional dysregulation, individuals may call ona range of perceived settling or soothing coping repertoires.Although depression-related chocolate craving is likely toreflect many factors, we suggest that such cravings may reflectbiological processes with homoeostatic potential to redressemotional dysregulation.

Eysenck (1967) argued for a two-factor (neuroticism v. introversion)model of personality, defining neuroticism in terms of limbicactivation, with high scorers prone to intense autonomic discharges.Limbic structures such as the amygdala regulate emotion, withCanli et al (2001) demonstrating that higher neuroticism scorescorrelated with left temporal and frontal region activationfollowing negative stimulus. Gender differences in brain activation have also been demonstrated, with George et al (1996) examiningself-induced mood induction, and showing (using positron emissiontomographic scanning) that women had differentially increasedblood flow in limbic and paralimbic structures.

We have previously overviewed chocolate’s mood state effects (Parker et al, 2006a), noting its many psychoactive ingredients, including several biogenic stimulant amines, two analoguesof anandamine (producing effects akin to cannabinoid-inducingeuphoria) and interactions with several neurotransmitter systems(e.g. dopamine, serotonin and endorphins). We noted studiessuggesting that carbohydrate craving was more closely linkedto the opioid rather than to the serotonergic system, with endorphinsalleviating dysphoria – although Moller (1992) has arguedthe role of increased serotonergic activity. Thus, chocolatecravings may advance biological mechanisms potentially settlinglimbic cortex-mediated activation.

Atypical depression has been variably interpreted over time (Parker et al, 2002), and its key features (e.g. hyperphagia,hypersomnia) are not restricted to DSM–IV defined atypicaldepression and are quite common in type II bipolar disorder.To the extent that our methodology made our sample more likelyto include those with an atypical depressive disorder (ratherthan atypical features), some observations are worth noting.We have previously argued (Parker et al, 2002) for the primacyof personality style (as against the DSM–IV mandatorycriterion A feature of ‘mood reactivity’ –defined as capacity to be cheered up by positive events), withcurrent analyses arguing the relevance of neuroticism or emotionaldysregulation as capturing the personality domain. Our chocolatecravers group scored higher on all DSM–IV criterion Baccessory features and (most predictably), hyperphagia. Studyanalyses indicated that the simple question of whether chocolateis craved when depressed had high utility in classifying the likelihood of an atypical depressive syndrome.

Results suggest that personality style dictates the cravingfor chocolate in states of emotional dysregulation (i.e. anxiousand irritable, and not only depressed). As individuals withcertain personality styles find such comfort eating beneficial,such behaviours may reflect biological homoeostatic mechanismsoperating to promote soothing of their personality-based capacity to experience emotional dysregulation.

REFERENCES

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