Prevalence of personality disorders among bulimics,nonbulimic binge eaters,and normal controls

We examined the comorbidity of bulimia and personality pathology among college women. Subjects included women (n=23) meeting DSM-III-R criteria for bulimia nervosa (bulimics), women (n=23) who reported binge eating but did not fulfill the criteria for bulimia nervosa (binge eaters), and women (n=23) who did not binge eat (normals). The subjects completed an assessment battery consisting of the Personality Disorders Examination and the SCID as well as the Beck Depression Inventory, the Rosenberg Self-Esteem Index, and measures of impulsivity and self-defeating tendencies. Fourteen of 23 bulimics (61%) met criterion for a personality disorder using DSM-III-R Axis II criteria. In comparison, 3 of 23 (13%) binge eaters and 1 of 23 (4%) normal subjects received an Axis II diagnosis. Borderline and self-defeating diagnoses were the predominant personality disorders in 96% of the bulimics exhibiting clinically significant personality pathology. Bulimics also exhibited significantly more depression, impulsivity, and self-defeating behavior and lower self-esteem than binge eaters and normals. The findings are discussed within a conceptual framework that posits an interaction between personality pathology and restrained eating.     

Gender-Related Self-Discrepancies and Bulimic Eating Behavior

The purpose of this study was to explore a hypothetical link between the development of bulimic eating behavior and the suppression of masculine traits in adolescence. Discrepancies between the actual and the ideal self were examined as precursors of negative self-evaluation and binge–purge behavior. Using the Bem Sex-Role Inventory (Bem, 1974), 821 German students between the ages of 13 and 20 were questioned anonymously. Data were analyzed with structural equation modeling. For girls in contrast to boys, the discrepancy between how much adolescents believed that they possess masculine traits (actual self) and how much they would like to (ideal self) was significantly greater at older ages. For both sexes, gender-related self-discrepancies were related to bulimic symptoms indirectly, via self-esteem and dieting.     

The neglected bulimic: The nonpurger

For nearly 10 years bulimia has been recognized officially as a distinct eating disorder, and yet in that time only minimal attention has focused on the nonpurging subtype. The present investigation compared 21 DSM-III-R diagnosed nonpurging bulimics with 22 non-eating-disordered controls on three standardized questionnaires and during a unique assessment task. In this procedure subjects imagined that they were the character in a series of slides and audiotaped flooding scenes. The content of the stimuli ranged from food and weight cues to issues hypothesized to play a role in the development or maintenance of bulimia (e.g., rejection or loss of control fears). A MANOVA conducted on the three questionnaires was highly significant, with the Beck Depression Inventory and the Restraint Scale being responsible for the elevated bulimic scores. A repeated-measures ANOVA performed on the self-report ratings during the exposure task also achieved significance, as the bulimics reported higher anxiety reactions than controls to each experimental stimulus. Significant skin conductance reactions were detected when a group of only the most psychophysiologically responsive bulimics and controls were compared. The importance of continued comprehensive evaluations with DSM-III-R nonpurging bulimics was emphasized.This research was supported by grants both from the University of New Mexico's Research Allocation Committee and the Biomedical Research Support Grant committee. Portions of this paper were presented at the Association for the Advancement of Behavior Therapy annual conference, Boston, November 1987.     

Confirmatory factor analysis of eating disorder symptoms in college women

Recent studies have found that the eating disorders can best be conceptualized as multidimensional. Four factors have consistently emerged from factor analytic studies of eating disorder symptoms: dietary restraint, bulimic behaviors, neurotic personality characteristics, and body image/body dysphoria. Confirmatory factor analysis was utilized to determine if this four-factor structure of eating disorder symptoms would be found in a sample of college women. Principal components analysis extracted four factors which were supported with a confirmatory factor analysis procedure. These four factors were negative affect and body dysphoria, bulimic behaviors, restrictive eating, and body image. The negative affect and body dysphoria factor was positively correlated with the other factors (i.e., bulimic behaviors, restrictive eating, and body image). This factor structure was similar to the factor structure found in samples of patients with bulimia and anorexia nervosa, except that the factors were more highly intercorrelated in the nonclinical sample. Results suggest that the measures of eating disorder symptoms used in this investigation are measuring the same multidimensional constructs in clinical and nonclinical subjects.This paper is partially based upon the master's thesis of the first author.     

Health-Related Quality of Life in Women with Eating Disorders: Association with Subjective and Objective Binge Eating

This study examined health-related quality of life (QOL) and its association with different forms of binge eating in 53 women with eating disorders. Participants had enrolled in treatment for anorexia nervosa, bulimia nervosa, binge eating disorder, or other eating disorders not otherwise specified and completed measures of QOL, eating-related psychopathology, and mood disturbance. Eating- and mood-related psychopathology, and to a lesser extent, mental-component QOL scores, were severely impaired in this sample relative to population norms. QOL was significantly and independently predicted by subjective bulimic episodes and compensatory behaviors, including food avoidance, laxative abuse, and self-induced vomiting, accounting for 32% of the variance. Subjective bulimic episodes and food avoidance also independently predicted the physical-component QOL, accounting for 27% of the variance. These findings suggest that subjective bulimic episodes may be independently associated with impairment in QOL and may require specific attention as targets of treatment.     

Loss of control over eating reflects eating disturbances and general psychopathology

This study examined the clinical significance of the loss of control over eating as a key component of eating disorders. It investigated the association of eating-related psychopathology and general psychopathology with objective bulimic episodes (OBEs; experiencing a loss of control while consuming large amounts of food) and subjective bulimic episodes (SBEs; experiencing a loss of control while consuming small/moderate amounts). A community sample of 81 women with a range of disordered eating was recruited: binge-eating disorder, bulimia nervosa, subclinical eating disturbances, or no eating disorders. They were interviewed using the Eating Disorder Examination and completed measures of eating-related and general psychopathology. Both OBE and SBE frequencies correlated significantly with measures of eating-related and general psychopathology, and no significant differences were found between the magnitudes of the correlations with either binge episode type. SBE frequency significantly and independently predicted global eating disorder psychopathology. The loss of control over eating, without consuming large amounts of food, was as closely associated with specific eating disorder psychopathology and general mental health as were traditionally defined OBEs. SBEs may be an important target of treatment and should be considered for future diagnostic classifications of eating disorders.     

Objective and subjective bulimic episodes in the classification of bulimic-type eating disorders: Another nail in the coffin of a problematic distinction

We sought to further explore the validity of the distinction between objective bulimic episodes (OBEs) and subjective bulimic episodes (SBEs) in the study of bulimic-type eating disorders. Drawing on data obtained at the second, interview phase of a large-scale epidemiological study, we identified mutually exclusive subgroups of women with bulimic-type eating disorders who engaged in regular OBEs but not SBEs (n = 37) or regular SBEs but not OBEs (n = 52). These subgroups were compared on a wide range of outcomes, including socio-demographic characteristics, current levels of eating disorder psychopathology, general psychological distress and impairment in role functioning, current and lifetime impairment in quality of life specifically associated with an eating problem, (self)-recognition of an eating problem, health service utilization and use of psychotropic medication. The only difference between groups was that participants who reported regular OBEs were heavier than those who reported regular SBEs. The findings converge with those of previous research in suggesting that bulimic-type eating disorders characterized by regular SBEs, but not OBEs, do not differ in any clinically meaningful way from those characterized by regular OBEs, but not SBEs. Inclusion of bulimic-type eating disorders characterized by regular SBEs as a provisional category requiring further research in DSM-V appears warranted.