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Purpose: Recent research has begun investigating the impact of eating disorders on health-related quality of life (QOL). The present study examined the impact of eating disorder psychopathology on QOL within a community sample., Methods: Two hundred and fourteen women completed questionnaires assessing eating disorder symptoms, body dissatisfaction, body checking and body avoidance behaviors, and general psychopathology., Results: Eating disturbance and body image dissatisfaction were associated with poorer QOL. In addition, eating disorder psychopathology uniquely predicted QOL above and beyond the variance accounted for by general psychopathology. Both subjective bulimic episodes and objective bulimic episodes were associated with impairments in QOL., Conclusions: These results indicate that eating disorder psychopathology may adversely affect the lives of women within the community. Early intervention and detection could reduce the negative impact of eating disorder psychopathology on women's lives and protect individuals with mild eating disorder symptoms from a further reduction in QOL.

The link between negative affect and binge eating in those with binge eating disorder (BED) has been well established. The present study examined the efficacy of a treatment for BED designed to increase recognition and regulation of negative emotion, replicating and extending a previous investigation (Clyne, C., & Blampied, N.M. [2004]. Training in emotion regulation as a treatment for binge eating: A preliminary study. Behaviour Change, 21, 269-281) by including a control group, a larger number of participants, and formal diagnoses rather than classifying binge eating symptomatology from self-report questionnaires. Twenty-three women diagnosed with subthreshold or full syndrome BED (using the Eating Disorders Examination) participated in a treatment program that focused on increasing emotional regulation skills. Each participant completed the Eating Disorders Examination Questionnaire, the Binge Eating Scale, the Emotional Eating Scale, and completed self-monitoring records of binge episodes. Binge abstinence rates following treatment (post-treatment and 1 year follow-up were 78% and 87% respectively) were comparable to other empirically supported treatments for BED. Other positive changes in eating and general pathology were observed. These effects were well-maintained up to 1 year later.

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.

The purpose of this investigation was to develop a brief self-report inventory which could be used to evaluate treatment outcome for anorexia and bulimia nervosa. The Multifactorial Assessment of Eating Disorders Symptoms (MAEDS) was constructed to measure six symptom clusters which have been found to be central to the eating disorders: depression, binge eating, purgative behavior, fear of fatness, restrictive eating, and avoidance of forbidden foods. The factor structure of the MAEDS was found to be stable and it was found to have satisfactory reliability and validity. Normative data were collected so that raw scores could be converted to standardized scores. While still in the experimental stages, the MAEDS shows promise as a valid and economical measure of treatment interventions for anorexia and 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.

The authors evaluated the continuity model of bulimia nervosa, which suggests that bulimia results from extreme weight concern and dieting practices. Individuals with bulimia, current dieters, restrained nondieters, and unrestrained nondieters were compared on measures of general psychopathology, eating-disorder-specific psychopathology, and overeating. Multiple methods, including questionnaires, clinical interviews, and food records, were used to collect data. The continuity and discontinuity models were tested with trend and regression analyses. The results of most analyses were consistent with the continuity perspective. However, binge eating behaviour exhibited a clear nonlinear trend, which occurred because binge eating was common in bulimic individuals but virtually non-existent in the other 3 groups. Current dieters scored higher than restrained nondieters on restraint/ weight concern, but not on psychopathology or binge eating. Overall, the results suggest that "normal" dieting is associated with psychological, but not consummatory, symptoms of bulimia.

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.

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.

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.

We examined the relationship between actual caloric intake and subjective perceptions of amount eaten using self-monitoring data. Forty subjects participated in the study: 20 bulimia nervosa patients and 20 normal controls. All subjects monitored their eating for a 2-week period and rated each eating episode on a Likert-type scale ranging from an undereat to a binge. Estimates of actual caloric intake were compared with these subjective ratings. Bulimics were found to overrate the amount consumed, relative to controls. The effect increased as caloric intake increased. Bulimics' ratings of amount eaten and binging were found to be predicted by the estimate of the actual amount eaten, the type of foods eaten, and the subjects' mood prior to eating, while nonbulimics' ratings were predicted only by the estimated actual amount. Subjective ratings of amount were found to be the best predictor of purgative activity. The results are discussed in terms of a perceptual bias theory, treatment implications, and possible revisions to the current DSM criteria for bulimia nervosa.

A silhouette method, the Body Image Assessment, was used to measure self-evaluation of current and ideal body size in three groups: Ss with with anorexia nervosa (n = 37), Ss with bulimia nervosa (n = 59), and normal control Ss (n = 95). Current and ideal body size measures were contrasted across the three groups using body mass index as a covariate to control for the Ss actual body size. Both eating disorder groups judged current body size to be larger and ideal body size to be thinner relative to control Ss. When actual body size was not statistically controlled, Ss with anorexia nervosa judged current body size to be thinner than did control Ss and Ss with bulimia nervosa. These data illustrate the importance of controlling for actual body size when investigating the self-evaluation of body size.

In a recent investigation of the psychopathology of bulimia nervosa by Tobin, Johnson, Steinberg, Staats, and Dennis (1991), a multidimensional model for bulimia nervosa was presented, based on the results of an exploratory factor analysis. In the present investigation, these results and the multidimensional model were tested by means of confirmatory factor analysis with 100 women diagnosed as having bulimia nervosa. The results not only support the multidimensional model with the higher order dimensions Affective and Personality Disorder, Bulimic Behaviors, and Restricting Behaviors, but also demonstrate the importance of body dissatisfaction as a significant, and possibly independent, component of bulimia nervosa.

To investigate the hypothesis that problems characteristic of eating disorders may often be associated with distance running, 20 women who had lost weight through distance running were compared with a control group who did not exercise and had not lost weight and a comparison group of bulimia nervosa patients. Dependent variables were measures of depression, bulimia nervosa symptomatology, and body image disturbance. No differences were found between the runner group and the normal controls. Bulimics differed from runners and controls on most measures. Thus, the results did not support the proposition that weight loss through running leads to problems related to eating and body image. The failure to find disturbances in body image in runners suggests that body image disturbances are not a direct result of weight loss, as suggested by some theorists.