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Compares the clinical characteristics of binge eating disorder (BED) and the related syndrome bulimia nervosa (BN). Findings suggest individuals with BED are distinguishable from those with BN on a number of traits, including higher rates of obesity and lower levels of eating concern and dietary restraint. (Contains 29 references and 2 tables.) (GCP)

Eating disorders involve serious disturbances in eating behavior, such as extreme and unhealthy reduction of food intake or severe overeating, as well as feelings of distress or extreme concern about body shape or weight. Anorexia nervosa and bulimia nervosa are the two main types of eating disorders. Eating disorders frequently co-occur with other psychiatric disorders such as depression, substance abuse, and anxiety disorders. People who suffer from such disorders often experience a range of physical health complications. Treatment requires a comprehensive treatment plan involving medical care and monitoring; psychosocial interventions; nutritional counseling; and medical management when warranted. People with eating disorders often do not realize when they need help. Family and friends can be instrumental in assisting them in the interventions necessary for recovery. (Contains 17 references.) (JDM)

The use of the MMPI and MMPI-2 to assist in the understanding of individuals with bulimia nervosa is examined. DSM-IV criteria for diagnosis of bulimia nervosa are reviewed. It is also important to understand the personality variables or psychological correlates associated with this disorder. The structure and history of the MMPI and MMPI-2 are briefly reviewed; findings from studies using MMPI and MMPI-2 are discussed; and the information these tests provide about individuals with bulimia nervosa is presented. Personality variables and psychological correlates associated with bulimia nervosa are examined and their relation to particular MMPI-2 scales is considered. Implications for potential prevention and intervention strategies are discussed. Although the use of the MMPI-2 does not provide clear cut answers or completely consistent profiles of individuals with bulimia, the test may help in putting together general personality characteristics common to individuals with bulimia and in understanding basic commonalties among individuals with bulimia. The specific variables underlying a particular person's struggle with bulimia may become more apparent when test data is considered in conjunction with data from the clinical interview. Further research with MMPI-2 may help to identify persons at-risk for bulimia nervosa. (EMK)

In recent years, bulimia nervosa has plagued young women and become a major issue in mental health care. Strategies for training counseling students so as to acquaint them with clinical research on treatments for bulimia are presented in this report. It reviews empirically supported treatments (ESTs) concerning eating disorders in order to facilitate this educational process. The ESTs and evidence-based treatments described here are grounded in studies recommended by the American Psychological Association. Priority was given to carefully controlled, double-blind, randomized studies with adequate sample size and measures to assure high-treatment fidelity. Included in the treatment summaries are techniques of cognitive behavior therapy, behavioral treatment, and interpersonal psychotherapy (IPT). The steps involved in explaining the IPT concepts and contract and the way in which group therapy sessions should be structured and conducted are included in each overview. The core procedures to be utilized through Cognitive Behavior Therapy are outlined and information on the cognitive distortions and dysfunctional thinking patterns involved with eating disorders and how they affect therapy for patients with these disorders are presented. The report likewise discusses maintenance and how to cope with lapses. (MKA)

Reviews of the pertinent literature reveal a lack of consensus as to whether there is an association between sexual abuse history and eating disorders. Therefore, an examination of the relationship between sexual abuse and a bulimic behavior (purging) in a large sample of female adolescents was undertaken. Answers taken from a sample of 8,680 female adolescents and involved 43 middle and high schools in 36 communities throughout a Midwestern state, who filled out the Search Institute's Profiles of Student Life: Attitude and Behavior Questionnaire, were used for this research. The results indicate that a relationship does exist between sexual abuse and purging. Moreover, this relationship remained significant even when several other factors were included in the analysis. For example, a significant relationship was found between physical abuse and bulimia. The identification of significant familial and extra-familial factors related to bulimia did not seem to confound the relationship between sexual abuse and bulimia. Ethnicity was also found to be associated with bulimic behaviors. It is noted that these results are limited by the measurement instrument used. Future research is needed to examine what leads to successful coping among female adolescents as not all teens with a history of abuse engage in bulimic behaviors. Contains 26 references. (RJM)

Since sports can sometimes lend themselves to eating disorders, coaches and sports administrators must get involved in the detection and treatment of this problem. While no reliable studies or statistics exist on the incidence of anorexia nervosa and/or bulimia among athletes, some research suggests that such disorders occur frequently among children and young adults in activities like gymnastics, figure skating, middle and long distance running, swimming and diving, rowing, and wrestling. One study demonstrated that the sport itself can be a factor in either precipitating or preventing pathogenic weight control. Sports which emphasize endurance, aesthetics, and weight levels featured the highest number of athletes at risk for developing an eating disorder. A recent survey by the National Collegiate Athletic Association (NCAA) revealed that eating disorders have become a significant health problem among college athletes, with 93 percent of the reported problems involving women's sports. Another predicament arises from the medical community's constant warnings against over eating while doctors virtually ignore the health risks presented by underweight individuals. The study examines the treatment problems commonly encountered with athletes and argues for more stringent guidelines in the sports community so as to monitor and assist those at risk for developing eating disorders. Contains 19 references. (RJM)

Maladaptive eating behaviors are a growing phenomenon which has captured the interest of not only health and psychology professionals, but also the general public. This paper examines the various types of treatment and counseling approaches for treating anorexia nervosa and bulimia nervosa. Definitions for both disorders are provided, followed by discussion of the epidemiology of eating disorders. Similarities and differences between anorexia and bulimia are presented by comparing their psychological, behavioral, and physical characteristics. In addition to discussing several theoretical perspectives which explain the etiological factors of eating disorders, the types of treatment for these conditions are described, including medical assessments, inpatient care, outpatient care, and pharmacological treatment. In-depth discussion of various counseling approaches for treating anorexia and bulimia are offered, covering such concerns as preventative programs, factors concerning treatment selection, and characteristics of the therapist. Such factors as age, gender, severity of the illness, and motivation to change are all important when selecting treatment. Early intervention and appropriate selection of treatment and therapists are necessary in preventing these disorders from resulting in tragic consequences. Contains 20 references. (RJM)

Through a review of the literature, this presentation provides information on eating disorders as they relate to sport and fitness and examines the role of all physical and health education teachers, coaches, administrators, and guidance counsellors in either precipitating or preventing anorexia nervosa or bulimia. These professionals are in a position to provide a counterculture to five sociocultural influences identified with eating disorders: (1) pressure to be thin; (2) glorification of youth; (3) changing roles of women; (4) the popular media; and (5) athletic elitism and cosmetic fitness. Teachers and coaches are encouraged to familiarize themselves with the signs, symptoms and characteristics of eating disorders so that they can play their role in detection, referral, treatment, and prevention. In addition, they should familiarize themselves with the following five "Ps," i.e., who is Predisposed to an eating disorder; what might Precipitate and Perpetuate an eating disorder; what is available by way of Professional help and what role do teachers and coaches have to play in Prevention. The paper also discusses results of a National Collegiate Athletic Association Survey; sport/fitness programs and maladaptive behavior; competitiveness in sport/fitness and eating disorders; and referral and treatment of athletes with eating disorders. (Contains approximately 75 references.) (LL)

In this study the relationship of parental attachment and psychological separation to levels of eating disorder symptoms was examined for a sample of college women (N=162) from English classes at a private, urban, coeducational Jesuit university in the northeast. Participants resonded to the Parental Attachment Questionnaire, the Parental Separation Inventory, and the Eating Disorder Inventory. Consistent with expectations the results suggested that family relationships characterized by secure parental attachment are associated with adaptive psychological functioning and low levels of dysfunctional eating behaviors involving compulsive binge eating and self-induced vomiting. Contrary to expectations, characteristics of parental attachment were not associated with Drive for Thinness and Body Dissatisfaction. Other research has shown that high levels of body dissatisfaction are common among college women, while the psychological traits associated with clinical eating disorders, such as maturity fears, are less common. The expectation that characteristics of psychological separation would be useful in identifying maladaptive aspects of family relationships was partially supported. The findings suggest that characteristics of secure attachment, including positive affect, parental support for autonomy, and use of parents as a source of emotional support, in conjunction with freedom from feelings of guilt, anxiety, anger, and resentment in the parental relationship and the expression of attitudes similar to one's parents are associated with low incidence of bulimic behavior, feelings of personal effectiveness and an absence of maturity fears among first-year college women. (ABL)

This study was conducted to examine the list of identifying factors and predictors of childhood physical abuse, extrafamilial sexual abuse, and incest among male and female adolescents in the general population. In 1989, a survey was administered to 6,224 9th and 12th grade students in public schools in Minnesota. The findings revealed that more American Indian and African American than White adolescents reported the three types of abuse (incest, extrafamilial sexual abuse, physical abuse). Physically and sexually abused males and females more often reported eating disorders. Females and minority adolescents also were more likely to report more eating disorders. Adolescents with eating disorders reported lower self-esteem, more stress, more anxiety, more hopelessness, and more suicide ideation than did their peers. Having an eating disorder correlated with cigarette use, alcohol consumption, hard drug use, and sexual activity. Adolescents with eating disorders also were more likely to have family histories of alcoholism and drug addiction. All of these variables were also significantly related to histories of physical abuse, extrafamilial sexual abuse, and incest. Findings were significant for males as well as for females. More sexually abused males and females were overweight than were their peers, although obesity was related to incest among females only. Underweight males and females were more likely to be physically abused and underweight males were more likely to have been sexually abused extrafamilially. (NB)

The prevalence of sexual conflicts in many patients with eating disorders has been well documented. A parallel has been found between psychological problems experienced by victims of childhood sexual abuse and patients with anorexia nervosa and/or bulimia. Past studies have used inpatient clinical samples; however, this study extended this area of inquiry to a non-inpatient sample. Subjects (N=89) were undergraduates at Ursinus College in Pennsylvania. Each subject completed a 66-item questionnaire on the extent of eating disorders, perception of maternal weight conflicts, and types of unwanted sexual experiences. Several maternal behaviors were strongly associated with disordered eating in both daughters and sons. Mothers who were perceived as being preoccupied with fat, food, and weight were more likely to have children who exhibited eating disorder behaviors of the mother. For females, maternal dieting and preoccupation with fat were significantly associated with sexual abuse. A mother's sexual withdrawal from her spouse may enhance a daughter's risk for sexual abuse. Subjects who experienced some form of sexual abuse were more preoccupied with fat and food and wore loose fitting clothes. The failure to find any significant correlates with physical abuse in females may have been due to an extremely low rate of physical abuse in females. Additional studies should be conducted to clarify the extent to which mothers unknowingly contribute to their children's eating disorder. (ABL)

Following a review of research literature on eating disorders and the fitness image, the report finds that five socio-cultural influences have been associated with the increase and prevalence of eating disorders: the pressure to be thin; glorification of youth; the changing role of females; media image and marketing of the super woman; and the sport and fitness craze. These pressures have increased in modern society as society has passed the Greek idea of sport, to the current idea of fitness and better teams through starvation and steroids. Health professionals, sport coaches, instructors, and administrators should work against the following mainstream sport culture influences: (1) the "thinning edge" for judges and coaches; (2) obsolescent adolescent athletes; (3) harassed"Golden Girls" in a paternalistic sport world; (4) Sports Illustrated and Vogue fitness market; and (5) Anorexica Athletica and Bulimic Cosmetic Fitness. In summary the paternalistic sport power structure which controls power, prestige and privilege has led to the great "weight shift" which prompted women and men to turn to the "one stone solution" (one stone equals 14 pounds). If she could just lose one stone through starvation and he could gain just one stone through steroids, they would be winners. An opinionnaire and survey results are attached. (ABL)

The literature regarding the relationship between sexual abuse and eating disorders was reviewed. Overall, women with anorexia and bulimia seem to have similar to slightly higher incidences of childhood sexual abuse than has the general population. At the same times, rates of abuse among eating disordered women, including those who experienced adult sexual trauma, seem comparable to rates of abuse in the general psychiatric population. Other variables have been suggested as influencing the incidence of eating disorders subsequent to sexual abuse. Extrafamilial childhood sexual abuse and physical victimization, including rape and physical abuse, have been suggested as particularly related to bulimia. Parental lack of care and support has been identified as well as a common trait in eating disordered and abusive families. Conclusions are difficult to reach since few controlled studies have been conducted, and those with controls either covered a limited population or had limited statistical analysis. Without controlled studies, comparisons can only be made with percentage rates from different studies which almost invariably use different definitions of sexual abuse or eating disorders in obtaining their data. Such comparisons are therefore only speculative at best. To date the question of whether eating disorders and sexual abuse are related seems yet to be answered acceptably. (ABL)

All teachers, coaches, and guidance counselors should be concerned about eating disorders as a health and life threatening illness. While no reliable research studies or statistics exist on the incidence of eating disorders among athletes and aerobic exercisers, estimates suggest that 10-20% of the female high school population and a much higher percentage of college and university female populations are involved in some form of eating disorder. Studies have shown that the incidence is much higher among children and young adults involved in activities such as dance, gymnastics, figure skating, middle distance and marathon running, swimming and diving, rowing and wrestling. Although eating disorders are generally perceived as a female adolescent problem, there are statistics that suggest that a growing number of males and young adults are also engaged in eating disorders. This document reviews the literature on eating disorders in the areas of: (1) eating disorders and sport/fitness activity; (2) sports/fitness programs and maladaptive behavior; (3) competitiveness in sport/fitness and eating disorders; and (4) sociocultural factors. Research is reviewed and books and publications on eating disorders are discussed. Over 80 references are included. (NB)

This document reviews the research linking excessive exercise with eating disorders. Seven steps are listed that an individual follows in going from someone who starts out using exercise and aerobic dance as a stress management technique or a hobby to becoming an exercise dependent individual with addictive behavior. Studies are reviewed, the results of which suggest that while exercise participants and aerobic instructors are generally "healthy" from an eating disorder and body image standpoint, there is a significant minority of underweight participants and instructors who overestimate their body size and have tendencies toward anorexia nervosa and bulimia. It is recommended that those interested in organizing and conducting exercise and fitness programs be concerned by the results of these studies. Included in the document are tables describing red flags for eating disorders, distinguishing features of the athlete/fitness participant, and distinguishing features of the athlete/exercise anorectic/bulimic; danger signs for physicians/researchers and for coaches/fitness instructors; and tips for prevention of eating disorders. Publications on eating disorders that have come from research in the sport and athletic area are recommended. (NB)

This paper reviews the literature on the physiological causes of bulimia and investigates the rationale behind the usage of antidepressant medication in the treatment of bulimia nervosa. No definite conclusions can be stated regarding the physiology of bulimia, but a number of hypotheses are suggested. It appears that the hypothalamus is involved in bulimia nervosa, and that endorphins related to obesity are also apparent. The literature further hypothesizes that the satiety function is impaired in bulimics, and that serotonin and norepinephrine levels are also impaired. The treatment of bulimia nervosa with tricyclic antidepressants remains controversial. These drugs work with many people, but the reasons why they work remain somewhat unclear. One hypothesis states that major depression may be associated with a lack of activity of norepinephrine in the brain, and that serotonin may also be involved in major depression. Both of these neurotransmitters have been implicated as being dysfunctional in bulimics, leading to the hypothesis that bulimia and mood disorders are somehow related. Chemotherapy as an effective treatment modality for bulimia should remain under investigation. It is hypothesized that desipramine will be effective in reducing the bingeing and purging behaviors of bulimics, and that an adequate blood level needs to be reached before desipramine produces its desired effects. If this hypothesis proves to be valid, it will add to the support that chemotherapy is a viable treatment option for bulimia, that bulimia may somehow be linked with affective disorder, and that bulimia may have a physiological basis. (LLL)

Due to concerns that body shape preferences contribute to eating disorders among women, a new method to assess observer preferences for female body shapes was devised. In prior studies women have preferred thin models, but men have preferred models of average weight. In Experiment 1, an underweight female model was photographed in a white top and jeans. Later, she was padded to match the measurements of an average weight model and rephotographed. A slide of either the thin or padded model was shown to two separate Introductory Psychology classes, the first with 26 students and the second with 18 students. Due to low numbers of women in one condition, the results for the female subjects were inconclusive. But, contrary to prior findings, male subjects tended to find the thin model to be more appealing. In Experiment 2, student ratings indicated that the model was not perceived to be of the sizes intended. While subjects significantly differentiated the average model from the thin and very thin models, they did not clearly differentiate between the latter two. Because of this, body shape preferences could not be analyzed. The findings pinpoint certain limitations in the method of assessment. All photographs of models need to be pretested. Also, the finding that men prefer thin over average weight women is contrary to prior findings and seems worthy of further study. (Author/LLL)

The incidence of eating disorders is much higher among children and young adults involved in sport and fitness activities. When weight loss is followed by excessive exercise, certain biological and social reinforcers become evident. This is also followed by a diminished appetite, increased narcissistic investment in the body, and an elevated production of endorphins which enhances mood. A number of studies at the University of Windsor Sport Institute for Research/Change Agent Research (SIR/CAR) conducted throughout the 1970's and 1980's showed that when youth sports programs are professionalized, commercialized, and politicized, maladaptive behavior among participants was a probable outcome. Sport- and fitness-induced eating disorders, and steroid use are a form of iatrogenesis, or education and health profession induced illness. Parents, sport administrators, teachers, coaches, and fitness instructors do not cause, cannot control, and cannot cure eating disorders or drug abuse. They can nevertheless contribute, either positively or negatively, to the prevention of the problem or prognosis in this illness. They can contribute positively through identification, facing up to the problem, practicing tough love intervention techniques, providing a referral to a qualified health professional, and providing both the eating-disordered individual and themselves with alternative coping mechanisms and lifestyle behaviors. (LLL)

The eating disorder known as bulimia is a relatively new and baffling phenomenon. This paper raises questions that college and university counseling center professionals need to address regarding this phenomenon. The first section focuses on defining the term "bulimia" and its evolution. The second section identifies numerous symptoms that need to be evaluated during assessment and diagnosis. Behavioral, physical, personality, and interpersonal and family characteristics of bulimics are listed. The third section is a succinct discussion of treatment modalities, noting that the consensus of opinion is that a comprehensive multidimensional approach or program is desired. It is stated, however, that when the problem is assessed as unidimensional and specific in a given area, a single or noncomprehensive program may be effective. To illustrate the variance in size and scope of treatment strategies, a few examples of programs are given. The fourth section raises issues which college and university counseling center professionals need to address, including whether college and university counseling centers should treat clients with bulimia. The paper concludes with a brief summary statement. References are included. (TE)

The purpose of this literature review is to examine prevalence and incident rates of both anorexia nervosa and bulimia nervosa. In addition, this article will review the psychological and sociological factors that contribute to the development and maintenance of an eating disorder. Finally, different treatment approaches will be discussed in relation to their effectiveness in addressing anorexia or bulimia. (Contains 36 references.) (GCP)

Reviews the current literature on psychological and psychopharmacologic treatments for bulimia nervosa in the adolescent population. Describes the two most researched psychological treatments--cognitive behavior therapy and interpersonal therapy--in terms of treatment protocols and outcome research. Reviews psychopharmacologic treatment, including treatment indications, contraindications, dose respondent information, and the need for future research. (Author/EV)

Eating disorders among teens and younger children have reached epidemic levels. The school's primary role in helping students who may have eating disorders is referring them to specialists. Schools can also help students learn good eating habits and designate a resource person to serve as a liaison with community medical and mental health services. (MLF)

Presents an overview for college counselors of the literature on bulimia treatment outcomes for purposes of screening, treatment, and referral. Outlines pretreatment characteristics that seem amenable to success in brief therapy, as well as those that do not lead to a positive outcome. (Contains 37 references and 2 tables.) (Author/GCP)

Investigates connection between eating disorder symptomatology and several psychological correlates-obsessiveness, dependency, assertiveness, locus of control, and self esteem. Regression analyses indicated that obsessiveness and two factors of dependency accounted for 21% of the variance in a measure of anorexic attitudes and behaviors. One factor of dependency and obsessiveness accounted for 20% of the variance in bulimic symptomatology. (Contains 65 references and 1 table.) (GCP)

It has been suggested that a lack of assertiveness may be an important component of the psychological make-up of bulimic women, and that bulimic women may experience particular difficulties in asserting themselves in interactions with men. In this study, 23 women reporting the symptoms of bulimia by high scores on the Bulimia Test (BULIT) and 21 women reporting low BULIT scorers completed several self-report scales, including the Beck Depression Inventory (BDI) before interacting with either a male or a female confederate who made five increasingly demanding requests. In vivo interactions were videotaped and tapes were rated for behavior by a rater blind to subjects' BULIT scores. The results revealed that, compared to low scorers, high scorers on the BULIT obtained significantly higher scores on the BDI, displayed significantly shorter latencies of response to the confederate's requests, and manifested significantly lower overall verbal assertiveness in response to confederate's requests. Compared to other conditions, a disproportionate number of high scorers complied with all requests of the male confederate. (Author/NB)

This document reports on the model and method used to design, implement, coordinate, and evaluate a summer camp for young people with eating disorders. The basic approach used at the camp is described as the Sports Institute for Research model, a systems analysis model which focuses on: (1) the ultimate goal or mission; (2) obstacles or problems preventing achievement of this goal; (3) structure in terms of administration and control; (4) significant individuals and groups of both clients and providers in terms of their traits, situations, and behaviors; (5) social stress from outside the sponsoring organizations; and (6) constituent strain from within the specific project, leading to recommended changes, restructuring, and realignment of individuals and groups to establish a trend. The model was applied specifically to the Bulimia Anorexia Nervosa Association-Canadian/American summer camp and change agent research was used in each of the individual camps; quantitative and qualitative data obtained in the research evaluation are presented. Includes charts. (NB)

This document reports on the quantitative and qualitative evaluation of "A Preventive Curriculum for Anorexia Nervosa and Bulimia" (Carney and Veilleux, 1986) which was published by the Bulimia Anorexia Nervosa Association-Canadian/American (BANA-Can/Am), an organization which was formed in 1983 by parents, professionals, and patients in southwestern Ontario who were concerned about the epidemic spread of eating disorders. Three phases in the development of the curriculum are described: (1) identification and delineation of an outline for the curriculum, and a model and method for evaluation of the curriculum; (2) the review of the first draft by selected target groups such as the funding agency, health professionals, teachers, and consultants; followed by a second draft to be used in the formal evaluation; and (3) actual pilot testing of the curriculum along with qualitative and quantitative evaluations. The quantitative evaluation is described and results from pretests (N=315) and posttests (N=362) of the Eating Disorders Inventories and measures assessing knowledge and attitudes are presented. Changes in the curriculum suggested by verbal and written comments from students and teachers in the qualitative evaluation are listed. Plans for future evaluations of the curriculum in various settings are discussed. (NB)

Most studies of bulimics have used an identified, clinical sample of individuals who have been evaluated and diagnosed by professional mental health workers. In this study, self-reported food addicts completed a questionnaire that assessed demographic as well as behavioral and cognitive factors related to their eating. The intent was to describe the characteristics of a large community sample of persons with compulsive eating disorders, as well as to describe demographic and behavioral differences between bulimics and compulsive overeaters or food addicts who generally are obese. Data were collected through the Food Addiction Hot Line, a national referral and information source advertised to compulsive eaters which referred callers to Overeater's Anonymous and sent them a packet of information about food addiction and compulsive eating and a data-collection survey. Approximately 11,000 calls have been logged, with more than 2,500 surveys returned. Except for differences in the incidence of purging or other abnormal weight-control methods, the sample was homogeneous. Most respondents were obese, worried about their weight and shape, had out-of-control eating, ate refined carbohydrates in binges, and usually had binges more than once a day. Although most individuals would not be diagnosed as bulimic, they suffered from similar compulsive eating disorders. The data reflect a real public health issue that needs to be addressed. (ABL)

Little previous research has compared bulimics to dieters who do not binge eat but who are also concerned with their weight. This study examined differences between college students who were classified as either bulimic (N=21), chronic dieters (N=29), or controls (N=83). The extent to which remarks made by significant others and failure experiences affect how subjects feel about their bodies was examined as was the frequency of social comparisions regarding weight, self-esteem, and perceptions of the extent to which their parents consider various factors important for success. Both bulimics and dieters reported a significantly greater tendency for weight-related remarks and failure experiences to influence the way they felt about their bodies than did control subjects. Bulimics scored significantly higher than controls or dieters on self-esteem and the tendency to make social comparisons regarding weight; dieters scored significantly higher than controls on these measures. Compared to fathers of dieters or controls, fathers of bulimics placed significantly greater importance on good athletic performance, popularity among female peers, and thinness in viewing their daughters as successful. Both bulimics and dieters scored significantly higher than controls in terms of the extent to which their mothers considered good athletic performance important in viewing their daughters as successful. (Author/ABL)