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BACKGROUND: There is empirical evidence suggesting that individuals with bulimia nervosa vary considerably in terms of psychiatric co-morbidity and personality functioning. In this study, latent profile analysis was used to attempt to identify clusters of bulimic subjects based on psychiatric co-morbidity and personality. METHOD: A total of 178 women with bulimia nervosa or a subclinical variant of bulimia nervosa completed a series of self-report inventories of co-morbid psychopathology and personality, and also provided a buccal smear sample for genetic analyses. RESULTS: Three clusters of bulimic women were identified: an affective-perfectionistic cluster, an impulsive cluster, and a low co-morbid psychopathology cluster. The clusters showed expected differences on external validation tests with both personality and eating-disorder measures. The impulsive cluster showed the highest elevations on dissocial behavior and the lowest scores on compulsivity, while the affective-perfectionistic cluster showed the highest levels of eating-disorder symptoms. The clusters did not differ on genetic variations of the serotonin transporter gene. CONCLUSIONS: This study corroborates previous findings suggesting that the bulimia nervosa diagnostic category is comprised of three classes of individuals based on co-morbid psychopathology and personality. These differences may have significant etiological and treatment implications. [ABSTRACT FROM AUTHOR]

Background: Individuals with eating disorders (EDs) often struggle with markedly low self- esteem and are at risk for suicidal behavior. Dissociation and perceived burdensomeness are often cited as facilitators of suicidal outcomes. Specifically, perceived burdensomeness is comprised of self-hate and liability on others, although it remains unclear which variables most heavily influence suicidal behavior in EDs., Methods: In a sample of 204 women with bulimia nervosa, the present study examined the potential impact of self-hate and dissociation on suicidal behavior. We hypothesized that suicidal behavior would be equally, and potentially more strongly, related to self-hate than dissociation. Regression analyses investigated the unique effects of these variables on suicidal behavior., Results: Consistent with our hypothesis, a significant relationship emerged between self-hate and suicidal behavior (B = 0.262, SE = 0.081, p < .001, CIs = 0.035-0.110, R-squared =0.07) but not between dissociation and suicidal behavior (B = 0.010, SE = 0.007, p = .165, CIs = -0.389-2.26, R-squared =0.010). Additionally, when controlling for one another, both self-hate (B = 0.889, SE = 0.246, p < .001, CIs = 0.403-1.37) and capability for suicide (B = 0.233, SE = 0.080, p = .004, CIs = 0.076-0.391) were uniquely and independently associated with suicidal behavior., Limitations: Future work should include longitudinal analyses to understand temporal relationships among study variables., Conclusions: In sum, when considering suicidal outcomes, these findings support a view that highlights personal loathing rooted in self-hate rather than de-personalizing aspects of dissociation. Accordingly, self-hate may emerge as a particularly valuable target for treatment and suicide prevention in EDs., Competing Interests: Declaration of competing interest The authors have no competing interests to disclose., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Therapeutic realizations are one of five universal, session-level change processes explicated in the Generic Model of Psychotherapy. Realizations refer to session impacts, the moment-to-moment accomplishments that patients experience within sessions. This study establishes the psychometric characteristics and factor structure of a modified patient-rated measure of session-level effects, the Therapeutic Realization Scale-Revised (TRS-R). In addition, it shows the relationship of the TRS-R to treatment process and outcome from the perspective of both patients and therapists. The findings provide support for the TRS-R as a reliable and valid, multidimensional index of session-level treatment effects.

The generic model of psychotherapy is offered as a transtheoretical model of universal change processes. Session 3 change processes are examined in a naturalistic study of dynamic therapy guided by the generic model. Findings replicate and extend earlier work addressing propositions of the generic model in dynamic therapy. Openness and bond contributed to in-session realizations, whereas bond and realizations fostered session progress. Session progress, bond, use of experiential operations, and less frequent use of dynamic interventions contributed to change between Sessions 2 and 4. Discussion outlines a model of change in early dynamic therapy and highlights the usefulness of the generic model for the evaluation of change processes.

This naturalistic study examined effective microprocesses in early sessions of dynamic psychotherapy. A multiple-regression data analytic strategy focused on the proportion of variance accounted for by process variables in session outcome as judged by the patient. This measure of session outcome in early sessions of dynamic therapy was associated with overall treatment outcome. Specific microprocesses differentially emerged as contributors to session progress as therapy proceeded, accounting for 55% of the variance in session 3 and 58% in session 7. Findings are discussed in terms of specific as well as fundamental change processes in early sessions of dynamic psychotherapy. The usefulness of the generic model of psychotherapy for guiding exploratory change process research is also highlighted.

This study examined the propositions of Orlinsky and Howard's generic model of psychotherapy with regard to self-relatedness, therapeutic bond, therapeutic realizations, session outcome, and termination outcome. Measures representing these constructs were derived from therapy session reports obtained from patients after sessions three and seven. A multiple-regression data analytic strategy was used that focused on the proportion of variance accounted for by single variables as well as combinations of process and outcome variables. Self-relatedness and therapeutic bond accounted for significant proportions of variance in therapeutic realizations. In addition, therapeutic realizations, therapeutic bond, and self-relatedness accounted for significant proportions of variance in session outcome. Finally, session outcome accounted for a significant proportion of variance in termination outcome.