Continuity and discontinuity models of bulimia nervosa: a taxometric investigation.

Past research evaluating the continuity and discontinuity models of bulimia has produced inconclusive results. In the current study, we performed a taxometric analysis of bulimia nervosa using means above minus below a sliding cut and maximum covariance analysis with a sample of women diagnosed with bulimia nervosa (n = 201) or women college students (n = 412). Indicators were derived from the Bulimia Test--Revised and the Eating Attitudes Test--26, and both a mixed sample and the nonclinical sample were analyzed. With both taxometric methods and both mixed and nonclinical samples, results were consistently suggestive of a latent taxon for bulimia. These results challenge a dimensional model of bulimia nervosa.

Scope and significance of posttraumatic symptomatology among women hospitalized for an eating disorder.

OBJECTIVE: To examine posttraumatic symptomatology among women with eating disorders. METHOD: A sample of 294 women diagnosed as having anorexia nervosa (n = 121), bulimia nervosa (n = 103), or eating disorder-not otherwise specified (n = 70) completed a version of the posttraumatic stress disorder (PTSD) Symptom Scale along with instruments measuring specific eating disorder symptomatology and comorbid psychopathology. RESULTS: Of the total sample, 154 (52%) reported current symptomatology consistent with PTSD. However, severity of PTSD symptomatology was unrelated to either type or eating disorder or severity of either anorexic or bulimic symptomatology. Severity of PTSD symptoms was significantly associated with depression, anxiety, and dissociative experiences. DISCUSSION: The findings suggest that PTSD symptomatology is common and an important clinical variable among women with eating disorders, although apparently it is not directly related to the eating disorder per se.

On the relation of dieting and bingeing in bulimia nervosa.

The continuum model of bulimia nervosa suggests that dieting plays a major role in the etiology and maintenance of bulimia. However, a previous study (M. R. Lowe et al., 1996) recently found no relationship between dieting intensity and binge eating problems in nonclinical participants differing widely in eating and weight concerns. The present study extended these findings by examining the relationship between dieting and bingeing among individuals with bulimia. Three samples of individuals diagnosed with bulimia were divided into frequent and infrequent weight-loss dieters and were compared on multiple measures of binge eating. No diet-binge relationship was found in 1 sample, whereas in the other 2 samples frequent dieters binged less than infrequent dieters. These results raise new questions about the continuum model of bulimia and suggest that weight-loss dieting may not play as prominent a role in the maintenance of bulimia as it does in its initiation.

Correlates of dissociative symptoms among women with eating disorders.

We examined the relationship between dissociative symptoms and other Axis I and Axis II symptoms among a sample of 53 women diagnosed as having anorexia nervosa (n = 18), bulimia nervosa (n = 27), or eating disorder NOS (n = 8). Dissociative symptoms were measured by the Dissociative Experiences Scale and the dissociation scale from the Trauma Symptom Checklist 40. Severity of dissociative symptoms was generally unrelated to severity of bulimic or anorexic symptomatology but was significantly associated with severity of anxiety and depression. In terms of Axis II symptoms, dissociative symptoms were most highly correlated with schizotypal symptomatology (r = .59), uncorrelated with borderline or antisocial symptomatology, and slightly negatively correlated with histrionic symptomatology.

Assessing dissociative symptoms in eating disordered patients: construct validation of two self-report measures.

Dissociative symptomatology has been reported among patients with eating disorders, necessitating the availability of valid assessment instruments. In the current investigation, we examined the construct-related validity of two self-report instruments for assessing dissociative symptoms: the Dissociative Experiences Scale and the Trauma Symptom Checklist-40. The instruments were administered, along with instruments measuring depressive, anorexic, and bulimic symptomatology, to a sample of 125 eating disordered subjects. The dissociation measures demonstrated good convergent and discriminant validity, with a convergent validity coefficient (r = .73) that was approximately equal to that for the instruments measuring each of the three other psychological constructs. A principal components analysis further supported the construct-related validity of the dissociation scales. Severity of dissociative symptoms was generally unrelated to anorexic or bulimic symptomatology, but was significantly associated with depression. The results supported the construct validity of the dissociation instruments and the general status of dissociation as a valid and well-defined psychological phenomenon.

Clarifying body-image disturbance: analysis of a multidimensional model using structural modeling.

A multidimensional model of body-image disturbance was tested. The model incorporated the concepts of body-size distortion, preference for thinness, body dissatisfaction, and fear of fatness as predictors of restrictive eating. The LISREL 7 program was used to perform a structural modeling analysis of the theoretical model. A total of 175 women participated in the study (54 eating-disordered patients and 121 undergraduate students). The results supported the hypothesized four-dimensional model relative to alternative one-, two-, and three-dimensional models. Body dissatisfaction appeared to be directly affected by both body-size distortion and preference for thinness. Fear of fatness was found to be the best predictor of restrictive eating. The results appeared consistent across the clinical and nonclinical samples. These data may help resolve many of the current controversies in the body-image literature. The results also suggested the need to develop more sound assessment instruments for fear of fatness.

Validating a multidimensional model of the psychopathology of bulimia nervosa.

In a recent preliminary report, a multidimensional model for bulimia nervosa was proposed with latent dimensions body dissatisfaction, restricting behaviors, bulimic behaviors, and affective and personality disorder. It was suggested that body dissatisfaction clearly represented a distinct dimension of the disorder. In the current investigation, we cross-validated the prior results on a larger sample with a different set of variables and tested the fit against alternative models. Subjects were 497 women diagnosed as having bulimia nervosa. We performed a confirmatory factor analysis using the LISREL 7 program. The results supported the fit of the four-dimensional model, but also suggested that self-injurious behaviors may represent additional separate dimensions of the disorder, relatively independent of the affective disturbance.

An examination of the internal consistency and factor structure of the eating disorder inventory-2 in a clinical sample.

We examined the internal consistency and factor structure of the newly revised version of the Eating Disorder Inventory (EDI), with particular emphasis on the examination of the three new provisional scales: Asceticism, Impulse Regulation, and Social Insecurity. Subjects were 300 women who were seeking treatment at a residential treatment facility for women with eating disorders. Chronbach's alphas ranged from .80 to .91 for the eight original scales whereas coefficients for the three new scales were all less than .80, the criterion stated as being necessary for inclusion in the test. Item-total correlations were also substantially lower for the three new scales. The results of principal components analyses with orthogonal rotation supported the factor structure of the original 64-item EDI, but not the three additional scales. These data generally supported the reliability and factor structure of the original eight scales but did not support the reliability or validity of the three provisional scales.

Sexual abuse histories among treatment-resistant bulimia nervosa patients.

Although cognitive behavior therapy has been found to be an effective treatment for bulimia nervosa, it has been noted that a subset of patients fail to engage in treatment. We examined the connection between a history of sexual abuse and symptoms suggestive of poor prognosis including a history of multiple therapists or hospitalizations, self-injury or suicide attempts, and alcohol or drug problems. Subjects were 464 bulimic women in treatment at a residential facility for women with eating disorders. Of the women with all of the indicators of poor prognosis, approximately 71% reported a history of sexual abuse. Of the women who reported none of the symptoms indicative of poor prognosis, only 15% reported a history of abuse, and none of these women reported recurrent abuse (greater than five times). We discuss the possible connections between previous treatment failures and histories of abuse and discuss the implications for successful case formulation and treatment.