CHARLES K. COOPER

THOMAS N. WISE, M.D.

LEES. MANN, M.A.

Psychological and cognitivecharacteristics of vegetarians

From the departments of psychiatry and medicine, The Fairfax Hospital and theGeorgetown University School ofMedicine. Reprint requests to Dr. Wise, Department ofPsychiatry, The Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22046.

ABSTRACf: The health beliefs and psychological status of 20vegetarians were assessed with eight different psychometric tests.Although the group demonstrated elevated somatic concerns on theHopkins Symptom Checklist (HSCL-90) and the Illness BehaviorQuestionnaire (IBQ), it did not differ from control populations onother dimensions of psychopathology. The subjects cited healthconcerns as the primary reason for avoiding meat products. Theydisplayed a generally positive attitude toward modern medicine. Theimplications of these findings as compared with those of previoussurveys of vegetarians are discussed.

During the past decade, increasingnumbers of individuals have adoptedvegetarian dietary patterns. Religiousprohibitions, cultural beliefs, healthbenefits, and counterculture attitudeshave been cited as primary reasons forsuch a diet, which departs from theWestern tradition of meat intake. Al­though previous reports have studiedfactors leading to the adoption of veg­etarianism, little objective data areavailable to describe the psychologi­cal orcognitive characteristics of suchpersons.' To our knowledge, this

study is the first to describe the objec­tive psychological characteristics of agroup of vegetarians.

Investigational procedure1\venty subjects were recruited to par­ticipate in this study by means of ad­vertisements placed in local healthfood stores and community news­papers. All of them filled out a ques­tionnaire pertaining to demographiccharacteristics, the rationale for di­etary habits, attitudes about health be­liefs, and the utilization of various

nontraditional health providers.They then completed a battery of

psychometric inventories for the fol­lowing purposes. The HSCL-9()2 as­sesses psychological distress alongnine primary dimensions. The IBQ3measures attitudes that suggest inap­propriate or maladaptive modes of re­sponding to one's state of health. Thespecific dimensions include generalhypochondriasis, disease conviction,psychological vs somatic concerns,affective inhibition, dysphoria, deni­al, and irritability. The Eysenck Per­sonality Inventory (EPI)4 measurespersonality in terms of two indepen­dent dimensions: extroversion-intro­version and neuroticism-stability. TheBuss-Durkee InventoryS evaluateshostility.

1\vo measures of cognitive stylewere utilized. The Rotter Locus ofControl (LOC) scale6 quantifies theperson's concept ofcontrol over his orher fate. It identifies an individual ei­ther as externally located, denotingbelief in little control overone's futureand dependence on surroundingforces, or as internally controlled,with a sense of self-reliance and beingable to influence one's future. The

JUNE 1985' VOL 26· NO 6 521

Vegetarians

Table 1-Characteristlcs of theStudy Group of Vegetarians (N =20)

Seventeen of the group reportedthat friends and family either agreedwith their dietary approach or did notcare. Only two thought that their par­ents disagreed with vegetarianism.and one noted that a friend had com­mented negatively on his choice ofdiet. Use of a visual analogue scale.with 0 denoting "total agreement"that modern medicine is useful and100 meaning "total disagreement."produced an average for the group of29.6 mm (SO, 33.2). Only two re­spondents had seen a nutritionist andone had sought advice from a herbaldoctor. However. eight had tried yogaand six had practiced transcendentalmeditation. Four had utilized acu­puncture, and five had tried a macro­biotic diet in the past. Seventeen werepresently taking vitamins.

Recreational drugs were infre­quently used. Eleven subjects hadtried marijuana, yet only two used itmore than once a week. Seven hadtaken LSD and four phencyclidine,but none had ever used those drugsregularly. Seventeen had used alco­hol. but only seven took more than onedrink per week.

Eight (40%) of the group had

'The normal values for men are 20 10 25. for women. 191024 "

-

-Femele(N=12)

84

27.2 (SO, 4.2)

75

20.3 (SO. 2.18)

Mele(N=8)

26

28 (SO. 3.8)

26

23.2 (SO. 1.73)

--

Mean age. yr

Marital statusSingleMarried

EducationThrough high schoolCollege graduate

Body Mass Index (wVht~)"

avoid cruelty to animals as a reasonand ten (50%) disliked the eating ofanimal flesh. Eight (40%) spoke offear of a world food shortage as a rea­son for their vegetarianism. whileonly three (15%) said that meat tastedbad to them. Two had adopted a vege­tarian diet owing to the influence oftheir spouses. All members of thegroup were native-born Americansand none had adopted vegetarianismfor religious reasons.

They had learned about vegetarian­ism from a variety of sources; friends(40%), family (30%). health foodstores (10%), and from their own in­quiries (50%). Seventeen (85%) of thegroup never ate poultry. 13 (65%) ab­stained from fish, four (20%) did noteat eggs. and only two (10%) did noteat cheese or milk. All of them woreclothes containing wool and could notbe classified as strict vegetarians. whodo not use clothing, footwear, orhousehold furnishings derived fromanimals. All subjects used productscontaining caffeine. All said that theywould eat only in specific restaurantsand were very vigilant about anymeals or packaged foods that mighthave meat by-products in them.

ResultsBeliefs and behaviors. The studygroup consisted of well-educatedyoung adults of normal weight" whohad been vegetarians for an average of9.0 years (SD. 6.0); see Table I. Theycited multiple reasons for havingadopted a vegetarian diet. Thirteen(65%) mentioned health concerns as areason for their dietary preferences.Twelve (60%) noted the desire to

Portable Rod and Frame Test' assessescognitive style in the form of psycho­logical differential. ie. field depen­dency or independency. Specifically.more structured analytic defensessuch as isolation and intellectualiza­tion correlate with the field-indepen­dent person, whereas denial andrepression correlate with the undiffer­entiated field-dependent style. Theselatter two variables. locus of controland field dependency or independen­cy. are not measures of psychopathol­ogy but are indicators of cognitivestyles.•

Eating Attitudes Test (EAT)" mea­sures the kind of eating behaviors andrelated cognitions that are often seenin anorexic women. The Hysteroid­Obsessoid Questionnaire (HOQ)9measures personality traits. based onthe assumption that hysterical and ob­sessional features represent a continu­um. which can be scored. Specifictraits for the hysterical pole of the con­tinuum include attention-seeking andfrequency of mood change. while theobsessoid pole is characterized byconscientiousness and minimal fan­tasy production.

The data were organized and ana­lyzed using summary statistics. two­tailed I tests for group mean compari­sons, and Pearson correlation coeffi­cients. '0 The control groups consistedof samples studied with each instru­ment and whose scores were reportedin the manual for that particular test.

522 PSYCHOSOMATICS

sought psychiatric care in the past. Forseven of them, depression and inter­personal difficulties had prompted re­course to treatment; one person hadtaken a drug overdose. Fifteen sub­jects (75%) believed that they were inthe proper weight range; four thoughtthemselves overweight; and one felttoo thin. Those thinking that they wereoverweight were in fact found to bewithin normal limits. "

Psychometric testing. The scoreson the HSCL-90 reflected the fact thatthe vegetarians reported more symp­tomatology than did a normal controlgroup but less than a group of psychi­atric outpatients 12 (Table 2). Thesescores for the vegetarians documentsome emotional distress but not in arange comparable to that ofa psychiat­ric population. The IBQ scoresshowed that general hypochondriacalconcerns were significantly (P< .02)more marked than for a control groupof family practice patients, but the re­maining dimensions of disease con­viction, psychological vs somatic con­cern, affective inhibition, dysphoria,denial, and irritability were not signif­icantly different. Mean scores for thevegetarians for general hypochondria­sis on the IBQ and on the remainingsix inventories are shown in Table 3.The EPI results showed the studygroup to be more introverted on theExtroversion Scale but not to differfrom a control population in regard toneuroticism. The Hostility Inventoryrevealed the vegetarians to have nomore hostility than a normal controlgroup. On the HOQ the group meanwas approximately midway betweenthe hysteroid and obsessoid poles.Their locus of control did not differsignificantly from that of a normativeadult population, while they were sig­nificantly (P<.O I) more field-inde­pendent and analytic in style on therod and frame test than controls. 13,"

Eating behavior patterns of the female

JUNE 1985' VOL 26' NO 6

Table 2-SCores on the Hopkins Symptom Checklist forthe Yegetarlans, and the Significance of DIfferences

from SCores Reported* for 1Wo Control Groups

'Scores Significantly (P< 02 lor general hypochondnas,s. p< 01 for the rema'nmg ,temsWith an aSlenskJ differenl from lhose of control populallons, as reported In the manualsfor lhe particular tesl

-

(continued)

523

Restorn~~~~~~.(temazepam)€One 30 mg capsule. h.s. -usualadult dosage.One 15 mg capsule. h. s. - recommended initial dosage forelderly and/or debilitated patients.INDICATlONSAND USAGE: Restoril~ (temazepam) is indi­cated for the relief of insomnia associated with complaintsof difficulty in falling-asleep. frequent nocturnal awaken­ings. and/or early morning awakenings. Since insomniais often transient and intermittent. the prolonged admin­istration of Restoril is generally not necessary orrecommended. Restoril has been employed lor sleep main­tenance for up to 35 consecutive nights of drugadministration in sleep laboratory studies.

The possibility that the insomnia may be related to acondition for which there is more specilic treatment shouldbe considered.CONTRAINDICATlONS: Benzodiazepines may cause fetaldamage when administered during pregnancy. An in­creased risk 01 congenital malformations associated withthe use of diazepam and chlordiazepoxide during the lirsttrimester 01 pregnancy has been suggested in several stud­ies. A1so.ingestion 01 therapeulic doses 01 benzodiazepinehypnotics during the last weeks 01 pregnancy has resultedin neonatal CNS depression. Restoril (temazepam) is con­traindicated in pregnant women. Consider a possibility 01pregnancy when instituting therapy or whether patient in­tends to become pregnant.WARNINGS: Patients receiving Restoril (temazepam)should be cautioned about possible combined effects withalcohol and other CNS depressants.PRECAUTIONS: In elderly and/or debilitated patients. it isrecommended that initial dosage be limited to 15 mg. Theusual precautions are indicated lor severely depressed pa­tients or those in whom there is any evidence 01 latent de­pression; it should be recognized that suicidal tendenciesmay be present and protective measures may be necessary.

If Restoril is to be combined with other drugs havingknown hypnotic properties or CNS-depressant effects. dueconsideration should be given to potential additive effects.Informal/on for Pal/ents: Patients receiving Restorilshould be cautioned about possible combined effects withalcohol and other CNS depressants. Patients should becaulioned not to operate machinery or drive amotor vehi­cle. They should be advised 01 the possibility 01 disturbednocturnal sleep for the lirst or second night after discontin­uing the drug.Laboratory Tests: The usual precautions should be ob­served in patients wilh impaired renal or hepatic lunction.Abnormal liver lunction tests as well as blood dyscrasiashave been reported with benzodiazepines.'""",III:Y: Pregnancy Category X. See Contraindica­tions.PedI,Irl~ Use: Safety and effectiveness in children belowthe age 0118 years have not been established.ADVERSE REACTIONS: The most common adverse reac­tions were drowsiness. diuiness and lethargy. Other sideeffects include conlusion, euphoria and relaxed leeling.Less commonly reported were weakness. anorexia and di­arrhea. Rarelyreportedweretremor. ataxia. lack 01 concen­tration. loss 01 equilibrium. lalling and palpitations. Andrarely reported were hallucinations. horizontal nystagmusand paradoxical reactions. including excitement. stimula­tion and hyperactivity.

Restoril (temazepam) is a controlled substance inSChedule IV. Caution must be exercised in addiction-proneindividuals or those who might increase dosage.DOSAGE AND ADMINISTRATION: Adults: 30 mg usualdosage before retiring; 15 mg may suffice in some. Elderlyand/ordebilitated: 15 mg recommended initially until indi­vidual response is de1ermined.SUPPLIED: Restoril (temazepam) capsules-15 mg ma­roon and pink. imprinted "RESTORIL 15 mg"; 30 mg.maroon and blue. imprinted "RESTORIL 30 mg". Pack­ages 01100. 500 and ControlPak" packages 0125 capsules(continuous reverse-numbered roll 01 sealed blisters).Sizes and strengths available to Armed Services: Restoril(temazepam) capsules. in bottles 01 500: 15 mg cap­sules NSN/6505-01-116-0481; 30 mg capsulesNSNl6505-01-116-0482. (RE5-Z33115/83)Before prescribing. see package insert for full productinformation. RE5-'85-1

Vegetarians

vegetarians differed significantly(P< .01) from those of an anorexicpopulation.

Analyses of variance were per­formed for subsets of the vegetarianstudy group to ascertain whether therewere significant test differencesbetween persons who completelyavoided fish and poultry and thosewho occasionally ate such food. Nosuch differences were revealed by anydimensions of the HSCL-90, IBQ,EPI, HOQ, or the LOC.

Examination for correlationbetween specific variables showedthat a tendency toward a hysteroidstyle related significantly (r= .53;P<.03), and that the somatizationsubscale of the HSCL-90 correlatedsignificantly (r= .46; P< .03) with thegeneral hypochondriasis dimension ofthe IBQ. An increasing feeling of hos­tility on the Hostility Inventory corre­lated significantly (r=.49; P<.03)with an increasing external locus ofcontrol. No significant correlationwas found between increasing fielddependency and a hysteroid style,between field dependency and locusof control, or between a hysteroidstyle and increasing hostility.

DiscussionThe study group in this report is simi­lar to those in other surveys" of vege­tarianism in the United States, in thatthe subjects were young and well-edu­cated adults. The present group's cit­ing of health concerns as the majorfactor in the choice of vegetarianismaccords with previous surveys in thiscountry. However, in the UnitedKingdom respondents have men­tioned'· avoidance of cruelty to ani­mals as the primary reason for not us­ing animal products. Surveys" in bothcountries reveal emphasis on meta­physical health beliefs as one elementof various counterculture philoso­phies that vegetarians endorse. Al-

526

though our subjects frequently uti­lized meditation practices, they gener­ally manifested a positive attitudetoward modern medicine and rarelyresorted to nontraditional healers. Theminimal use of drugs and alcohol didnot support a finding'S that vegetarianshave been actively involved with thedrug culture and have adopted theirdiet as a reaction to such behavior.

The psychometric findings pointedto the group's concern with physicalstatus and bodily symptoms. The con­firmation that the group as a wholewas markedly field-independent incognitive style is noteworthy. An ana­lytic style is needed if one is to main­tain a vegetarian diet. Subjects fre­quently mentioned the need for vigi­lance, so as to avoid meat products.They did not display a specific charac­terologic style such as hysterical orobsessional. Although as a group theywere found on the EPI to be more in­troverted, their basic similarity to anormal population supports Lester'sconclusion ,. that persons associatedwith food fads or food cults did notdisplay differences on the EPI.

On the whole, the group was moresymptomatic than a normal popula­tion, as reflected by higher scores onHSCL-90, but they were less symp­tomatic than a psychiatric population.The 12 women did not have anorexiceating patterns. Isolated case reports20

in the psychoanalytic literature havenoted vegetarians to display increasedoral aggression. This study does notconfirm that. The correlationsbetween hostility and external locus ofcontrol may reflect the rigors ofavoid­ing meat among a primarily carnivo­rous population.

One explanation for the above find­ings is that vegetarians are acutelyaware of physical health and bodilymessages. They actively cope withthese concerns by adopting what theyperceive to be the most healthy diet. A

PSYCHOSOMATICS

vegetarian diet appropriately supple­mented with vitamins has beenshown" to be advantageous in reduc­ing coronary artery disease and lower­ing serum cholesterol. Our study didnot apply depth psychology to ascer-

REFERENCES1. Position paper on the vegetarian approach to

eating. J Am Diet Assoc 77:61-69. 19802 Derogalis LR, Rickels K. Uhlenhoth J. el al

The Hopkins Symptom Checklist, in Pichol P,Oliver-Martin R (eds): Psychological Mea­surements in Psychopharmacology. Basel,Karger, 1981. pp 79-HO.

3 Pilowsky I. Spence NO: Manual lor the "'nessBehavior Questionnaire. Adelaide, Australia,University of Adelaide, 1981

4. Eysenck HJ, Eysenck SB: Manual for the fy­senck Personality Inventory. San Diego, Edu­cational and Industrial Testing Service, 1968

5. Buss AH, Durkee A: An inventory for assess­ing different kinds of hostility. J Consult Psy­choI21343-349,1957.

6. Letcourt HM: Locus of Control. New York,John Wiley, 1977

7. Witkin HA, Goodenough DR Cogmtive Styles

aunder Dictionary& Encyclopedia of LaboratoryMedicine and Technologedited by Jame L. Bennington.Philadelphia, WB. aunders,19 ,1,700 pp $45.00 (softcover).

Rehabilitation Psychology:A Comprehensive Thxtbookby David W Krueger, Rockville.Md., Aspen y terns Corp., 19 .406 pp, $31.

Pathological Play in Borderlineand Narcissistic Personalitiesby Irving leingart, Jamaica, N. Y.,SP Medical dentific Books,1983. 139 pp. $24.95.

The Denial of Streedited by Shlomo Breznitz. NewYork, International Univer itiePre . 19 , 16 pp, $25.

JUNE 1985· VOL 26· NO 6

tain why vegetarian beliefs and prac­tices had been adopted. However, itdoes suggest that vegetarians as agroup show minimal deviations fromnormal controls on psychometric test­ing. Previous reports indicating such

New York, Internalional Universities Press,1981

8 Garner OM, Garfinkel PE: The Eating AttitudesTest: An index ot symptoms of anorexia ner­vosa Psychol Med 9:273-279, 1979

9. Hope K, Caine TM: The Hysteroid-ObsessoidQuestionnaire: A new validation. BrJ Soc ClinPsychoI7210-215,1968

10 Colton T: Statistics In Medicine. Boston, LittleBrown, 1974

11 Thomas AE, McKay DA, Cutlip, MD: A nomo­graph for assessing body weight. Am J ClinNUIr 29:302-302, 1976

12 Derogatis L, Lipman RS. Covi L Symptomchecklist 90 Psychopharmacol BuI/9:13-27,1973

13. Harvey JM: Locus ot control shift in adminis·trators. Percept Mot Skills 33:980-982.1971

14. Vaught G: Correlations between scores for aportable RFT and a stationary RFT. Percept

New books received

Psychiatry: Specially BoardReview, ed 3by Namir F. Damlouji. John P.Feighner. and Marc A. chuckit,

ew Hyde Park, . Medical )(-amination Publi hing, 1983. 246pp, $26.50 (paperback).

Visualization: The se ofImagery in the HealthProfe ionsb ITol R. Korn and Karen John­on, Homewood, III. Dow Jones­

Irwin, 19 3,219 pp, 29.50.

The Handbook of ClinicalP ycbology: Theor ,Research, and Practiceby C. ugene Walker,Homewood, III. Dow Jone -Irwin,19 3, 2 vol. 1439 pp, each $40.

persons to be impaired psychological­Iy, or deviant, must be reconsidered.Although small, this study presentsevidence that this alternative dietarystyle does not necessarily coexist withpsychopathology. 0

MotSkil/s24474,1969.15 Dwyer JT. Mayer LD, Kandel RF. et al: The

'new vegetarians.' Group affiliations and di·etary strictures related to attitudes and life·style. J Am Diet Assoc 64:376-382, 1973.

16 Brooks R, Kemm JR Vegan diet and lifestyle.Proc NUIr Soc 38: 15A, 1979.

17. Calkins A: Observations on vegetarian di­etary practice and social factors J Am DietAssoc 74:353-355,1979

18 Dwyer JT, Mayer J: Vegetarianism in drug us·ersLancet2:1429-1430,1971.

19. Lester 0 Food fads and psychologicalhealth Psychol Rep 44:222, 1979

20. Friedman S On vegetarianism. J Am Psy·choanal Assoc 23:396-406, 1975.

21. Bergan JT, Brown PT: Nutritional status of newvegetarians. J Am Diet Assoc 76:151-155,1980

1983 Year Book of P ycbiatryand Applied Mental Healthby Daniel . Freedman. Lawrence

. K lb. Reginald S. Lourie, Her­ben Y. Meltzer, John C. Nemiahand Herbert Weiner. hicago, YearBook Medical Publi her. 19 3.380 pp. 9.95.

Functional GastrointestinalDisorders: A BehavioralMedicine Approachby Paul Latimer, New York. prin­ger Publi hing 1983, 174 pp,23.95.

dvances in BiologicalP ycbiatry: BiologicalRhythm and Behavioredited by 1. Mendelwiez. N. M.Van Praag Basel, witzerland. .Karger, 19 3, 150 pp, $59.50(paperback).

527