Bulimia Test-Revised Research Articles

Low Overlap and High Heterogeneity Across Common Measures of Eating Disorder Pathology: A Content Analysis.

This study evaluated symptoms assessed in common measures of eating disorder pathology and tested overlap to evaluate the extent to which measures may be interchangeable. Six measures were included: Bulimia Test-Revised, Eating Attitudes Test-26, Eating Disorder Diagnostic Scale, Eating Disorder Examination Questionnaire, Eating Pathology Symptoms Inventory, and Questionnaire for Eating Disorder Diagnoses. Content overlap was quantitatively estimated using the Jaccard Index. Mean overlap was low (.195), likely due to the wide range of symptoms (87) assessed. The mean overlap of each measure with all others was .117 - .267, and the overlap among individual measures was .083 - .382. Implications of low overlap among measures include variable characterization of eating disorder phenotypes and the risk for lower generalizability of findings due to measurement variability.

Emotional reactivity to binge food and erotic cues in women with bulimia nervosa symptoms

BackgroundStudies on food cue reactivity have documented that altered responses to high-calorie food are associated with bulimic symptomatology, however, alterations in sexual motivations and behaviors are also associated clinical features in this population, which justify their inclusion as a research target. Here, we study responses to erotic cues—alongside food, neutral and aversive cues—to gain an understanding of specificity to food versus a generalized sensitivity to primary reinforcers.MethodsWe recorded peripheral psychophysiological indices –the startle reflex, zygomaticus, and corrugator responses—and self-reported emotional responses (valence, arousal, and dominance) in 75 women completing the Bulimia Test-Revised (BULIT-R). Multiple regression analysis tested whether BULIT-R symptoms were predicted by self-reported and psychophysiological responses to food versus neutral and erotic versus neutral images.ResultsThe results showed that individuals with higher bulimic symptoms were characterized by potentiated eye blink startle response during binge food (vs. neutral images) and more positive valence ratings during erotic (vs. neutral) cues.ConclusionsThe results highlight the negative emotional reactivity of individuals with elevated bulimic symptoms toward food cues, which could be related to the risk of progression to full bulimia nervosa and thereby addressed in prevention efforts. Results also point to the potential role of reactivity to erotic content, at least on a subjective level. Theoretical models of eating disorders should widen their conceptual scope to consider reactivity to a broader spectrum of primary reinforcers, which would have implications for cue exposure-based treatments.Plain English summaryWe examined appetitive and aversive cue responses in college women to investigate how bulimic symptoms relate to primary reinforcers such as food and erotic images. We recorded peripheral psychophysiological indices (the startle reflex, zygomaticus, and corrugator responses) and self-reported emotional responses (valence, arousal, and dominance) in 75 college women that were presented with the Spanish version of the Bulimia Test-Revised. The results showed that bulimic symptoms increase both psychophysiological defensiveness toward food cues and subjective pleasure toward erotic cues. The findings suggest a generalized sensitivity to primary reinforcers in the presence of bulimic symptoms, and emphasize the relevance of adopting a wider framework in research and treatment on bulimia nervosa.

The Bulimia Test-Revised (BULIT-R): Psychometric properties in a non-clinical sample of White and Latina college women

The Bulimia Test-Revised (BULIT-R) is a measure of bulimia nervosa and binge eating disorder symptoms. While this measure can serve as a useful screening tool, the validity of the BULIT-R in White and Latina samples is uncertain. Previous research has proposed several different BULIT-R factor structures, but has yet to find consistent support for a measurement model or to test measurement invariance. To address this gap, the current study attempted to examine the factor structure and measurement invariance of the BULIT-R among 699 non-clinical White (40.9%) and Latina (59.1%) undergraduate women. Analyses indicated that none of the previously published factor structures in adult samples of the BULIT-R were an acceptable fit in either Latina or White undergraduates. These findings further underscore difficulties in replicating the BULIT-R factor structure, even when using similar sample characteristics to those in the literature. Given the lack of an adequate fitting measurement model, tests of measurement invariance were not conducted. In the absence of measurement invariance of the BULIT-R, there is uncertainty regarding group comparisons, such as whether group differences reflect true differences or are artifacts of measurement error. This study highlights the need for additional psychometric investigation of the BULIT-R. The focus should be on diverse groups as well as non-clinical samples, with the latter being less likely to endorse extreme eating behaviors. Special consideration should be given to the number of items included in the measurement model and the number of indicators per latent factor. Caution should be exercised when interpreting scores on this instrument.

Body Image Concern and Eating Disorder Symptoms Among Elite Icelandic Athletes.

The aim of this study was to analyse body image concerns and symptoms of eating disorders in elite Icelandic athletes according to their sex, and sport practiced. The participants were 755 athletes (24.8 ± 3.5 years in age) who compete at the highest possible level in Iceland. Representing 20 different sports, they were divided into five sports groups. Three questionnaires were used: the Body Shape Questionnaire to assess body image concerns; the Bulimia Test-Revised to assess the main symptoms of bulimia; and the Eating Disorder Examination Questionnaire to identify disordered eating attitudes and behaviours. A chi-squared test was used to analyse differences in prevalence of body image concern and eating disorders, a t-test for the differences between men and women, and a one-way ANOVA to compare the different sports. The main findings were that 17.9% of the athletes presented severe or moderate body image dissatisfaction, and 18.2% (25.3% of the women) were above the clinical cutoff for body image concern. Women’s scores were higher than men’s (whole sample and ball games) in all variables except restraint. These results seem to point to the existence of a real problem that athlete, coaches, doctors, and institutions need to take into account.

Eating disorders and weight control behaviors change over a collegiate sport season.

Determine whether the prevalence of eating disorder classifications (i.e., clinical eating disorder, subclinical eating disorder, and asymptomatic) and pathogenic weight control behaviors (e.g., bingeing, vomiting) change over a five-month sport season. Longitudinal study. Female collegiate gymnasts and swimmers (N=325) completed the Questionnaire for Eating Disorder Diagnoses as well as six items from the Bulimia Test-Revised at Time 1 (two weeks into the beginning of their athletic season) and Time 2 (final two weeks of the athletic season); data collections were separated by five months. Over the course of the season, 90% of the athletes (18 out of 20) retained a clinical eating disorder diagnosis or moved to the subclinical classification. Of the 83 subclinical athletes at Time 1, 37.3% persisted with that classification and 10.8% developed a clinical eating disorder; the remainder became asymptomatic/healthy eaters by Time 2. The majority of Time 1 asymptomatic athletes (92.3%) remained so at Time 2. Exercise and dieting/fasting were the most frequent forms of weight control behaviors, though each was used less frequently at Time 2 (exercise=35.4%; dieting=9.2%) than at Time 1 (exercise=42.5%; dieting=12.3%). Eating disorder classifications, particularly clinical and subclinical, remain stable across a competitive season, supporting the need for early detection and purposeful intervention. Athletes engage in weight control behaviors that may be reinforced in the sport environment (e.g., supplemental exercise), making identification more challenging for sports medicine professionals.

The interactive role of distress tolerance and eating expectancies in bulimic symptoms among substance abusers

Difficulties tolerating distress and the expectancy that eating will relieve negative affect have been linked with bulimic symptoms, which commonly co-occur with other forms of psychopathology characterized by emotion dysregulation (e.g., substance abuse). Indeed, problems with emotional functioning may be of particular relevance to bulimic symptoms in at-risk populations with heightened emotion dysregulation (such as substance use disorder patients). This study examined the interactive role of two emotion-related constructs (distress tolerance and the expectancy that eating relieves negative affect) in relation to bulimic symptoms among patients (N=93) recruited from a residential substance abuse treatment facility. Participants completed the Bulimia Test-Revised, the Positive and Negative Affect Schedule, the Distress Tolerance Scale, and the Eating Expectancy Inventory. A hierarchical multiple regression analysis was conducted to examine the main effects and interaction of distress tolerance and negative affect eating expectancies in relation to bulimic symptoms, controlling for participant gender and overall negative affect. Significant main effects were found for both distress tolerance and negative affect eating expectancies, and these two constructs were found to significantly interact in the prediction of bulimic symptoms. Interventions that address these constructs may be useful in treating those with bulimic symptoms, as well as those with co-occurring bulimic symptoms and substance use disorders.

An evaluation of the reliability and construct validity of eating disorder measures in white and black women.

Most measures of eating disorder symptoms and risk factors were developed in predominantly White female samples. Yet eating disorders affect individuals of all racial and ethnic backgrounds. Black women appear more vulnerable to certain forms of eating pathology, such as binge eating, and less susceptible to other eating disorder symptoms and risk factors, such as body dissatisfaction, compared with their White peers. Despite concern that extant measures do not adequately assess eating concerns among Black women, the construct validity of scores on most of these measures has not been adequately examined within this population. This study included 2,208 Black and White women who completed the following: the Binge Eating Scale (BES), the Eating Disorder Diagnostic Scale (EDDS), the Eating Attitudes Test-26 (EAT-26), the Eating Disorder Inventory Body Dissatisfaction and Drive for Thinness subscales, the Bulimia Test-Revised (BULIT-R), the Multidimensional Body-Self Relations Questionnaire-Appearance Evaluation subscale (MBSRQ-AE), and the Objectified Body Consciousness Scale (OBCS). Most measures yielded internally consistent scores in both races. Confirmatory factor analyses indicated that loadings for some measures, including the EAT-26 and EDDS, were not invariant across groups and thus do not assess equivalent constructs in White and Black women. However, others, including the BULIT-R, BES, OBCS, and MBSRQ-AE, exhibited factorial invariance in both races. Results suggest scores are likely not equivalent across races for several popular measures of eating disorder symptoms and risk factors. Thus, it is recommended that researchers and clinicians obtain additional information regarding racial/cultural factors when using these instruments with Black women.

The Smoking-Related Weight and Eating Episodes Test (SWEET): Development and Preliminary Validation

Many smokers believe that smoking helps them to control their weight, and concerns about weight gain can interfere with smoking cessation. As researchers typically assess general weight concerns, a measure specific to smoking-related weight concerns is needed. The Smoking-related Weight and Eating Episodes Test (SWEET) was created by generating items from 4 content domains: Hunger, Craving, Overeating, and Body Image. Female undergraduate smokers (N = 280) rated their postcessation weight gain concern and completed the SWEET, Fagerström Test for Nicotine Dependence, Brief Smoking Consequences Questionnaire-Adult, Eating Attitudes Test (EAT)-26, Bulimia Test-Revised (BULIT-R), and Body Shape Questionnaire. Factor analysis of the initial items suggested a 4-factor solution, suggesting 4 subscales: Smoking to suppress appetite, smoking to prevent overeating, smoking to cope with body dissatisfaction, and withdrawal-related appetite increases. Based on these results, the SWEET subscales were revised and shortened. The resulting 10-item SWEET showed excellent internal consistency (total α = .94; mean α = .86) and evidence of validity by predicting smoking frequency, eating pathology, and body image concerns (ps < .05). Smoking frequency, eating pathology, and body image concerns were significantly predicted by the SWEET while controlling for existing measures of postcessation weight gain concern. The SWEET appears to be a reliable and valid measure of tendencies to smoke in response to body image concern and nicotine withdrawal and as a way to control appetite and overeating.

The EDE-Q, BULIT-R, and BEDT as self-report measures of binge eating disorder

Binge eating disorder, currently classified as an eating disorder not otherwise specified, is a valid and clinically useful psychiatric diagnosis. Given its probable inclusion in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), identification of self-report measures with high levels of diagnostic utility should improve the likelihood and accuracy of screening. The aim of the current study was to assess the diagnostic utility of two widely used measures of eating disorder symptoms, namely the Eating Disorder Examination-Questionnaire (EDEQ) and the Bulimia Test-Revised (BULIT-R), as well as a factor of the BULIT-R (coined the Binge Eating Disorder Test or BEDT), newly created specifically for the assessment of BED. Participants included 15 individuals with BED and 26 non-BED controls, as determined via the diagnostic section of the Eating Disorder Examination, who met criteria for being overweight or obese. Results showed that the BEDT achieved 100% sensitivity, specificity, positive and negative predictive values. The BULIT-R and Eating Concern subscale of the EDE-Q evidenced strong sensitivity (100 vs 87), specificity (96 vs 100), positive predictive values (94 vs 100), and negative predictive values (100 vs 93), respectively. Results suggest that the BEDT is an excellent overall measure of BED in obese populations. The BULIT-R affords the advantage of ruling out compensatory behaviors, particularly of the non-purging variety (e.g., severe restriction outside of binges), while the brevity of the Eating Concern subscale of the EDE-Q makes it optimal for use in brief screening situations.

Eating Disorder symptomatology: prevalence among Latino college freshmen students

This study investigated the prevalence of eating disorder symptoms in first-year students at the University of Puerto Rico. Responses to the Bulimia Test Revised (BULIT-R), the Eating Attitudes Test (EAT-26), and the Beck Depression Inventory (BDI) were analyzed in a sample of 2,163 freshman students. The percentage of students at or above the clinical cut-off points was 3.24% for the BULIT-R and 9.59% for the EAT-26, and 1.88% met the cut-off point for both instruments. The 36.44% of the students who screen positive on eating disorders measures scored 18 or more on the BDI and 5.93% on this group presented high suicidal risk based on their responses to BDI items assessing suicidal thoughts. Eating disorder symptoms occur frequently in Puerto Rican college students, and prevention, detection, and treatment efforts are needed.

Cigarette smoking is associated with body shape concerns and bulimia symptoms among young adult females

Elevated rates of cigarette smoking have been reported among individuals with Bulimia Nervosa. However, little is known about eating disorder symptoms within non-clinical samples of smokers. The purpose of the present study was to compare the eating disorder symptoms of young adult female smokers ( n = 184) and non-smokers ( n = 56), to determine whether smokers were more likely to endorse bulimic symptoms and report greater body shape concern than non-smokers. Analyses indicated that smokers scored significantly higher than non-smokers on the Body Shape Questionnaire, p = .03, and the Bulimia Test-Revised, p = .006. In addition, a higher proportion of smokers than non-smokers scored ≥ 85 on the Bulimia Test-Revised, p = .05, suggesting the possibility that Bulimia Nervosa diagnoses were more prevalent among smokers. No differences were found between smokers and non-smokers on other measures of eating behavior. Overall, findings suggest that smoking is specifically associated with symptoms of Bulimia Nervosa and body shape concern among young adult females.

The point prevalence of bulimic disorders from 1990 to 2004

This study investigated the point prevalence of probable cases of bulimia nervosa (BN), eating disorder not otherwise specified (EDNOS), and specific eating disorder symptomatology among 6,844 undergraduate women at a single site, examining changes across five 3-year time periods and on a yearly basis from 1990 to 2004. Participants completed a self-report checklist that assessed the diagnostic criteria for BN (American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 1994) and the Bulimia Test (Smith and Thelen, J Consult Clin Psychol, 52, 863-872, 1984) (BULIT) or Bulimia Test-Revised (Thelen et al., Psychol Assess, 3, 119-124, 1991) (BULIT-R). Chi-square analyses comparing the percentages of probable cases of BN and EDNOS and the percentages of women who reported frequent binge eating and most compensatory weight control strategies were nonsignificant. Only the percentages of women who endorsed overconcern with weight and shape and diuretic use and excessive exercise as compensatory weight control strategies changed over time. Consistent with Keel et al.'s (Keel et al., Psychol Med, 36, 119-127, 2006) findings regarding the point prevalence rates of BN from 1992 to 2002, results indicated that probable cases of eating disorders remained relatively stable. Methodologically, this research illustrates the importance of examining multiple data points when investigating stability or change in behavior.

Psychosocial Correlates of Disordered Eating Among Male Collegiate Athletes

Few studies have been conducted examining male athletes and eating disorders, even though the sport environment may increase their risk. Thus, little information exists regarding the relationship of putative risk factors to eating disorders in this group. To address this issue, we examined the relationship of eating disorder classification to the risk factors of body image concerns (including drive for muscularity), negative affect, weight pressures, and disordered eating behaviors. Male college athletes (N= 199) from three different NCAA Division I universities participated. Only two athletes were classified with an eating disorder, though 33 (16.6%) and 164 (82.4%), respectively, were categorized as symptomatic and asymptomatic. Multivariate analyses revealed that eating disorder classification was unrelated to the majority of the risk factors, although the eating disorder group (i.e., clinical and symptomatic) did report greater fear of becoming fat, more weight pressures from TV and from magazines, and higher levels of stress than the asymptomatic athletes. In addition, the eating disorder group had higher scores on the Bulimia Test-Revised (Thelen, Mintz, &amp; Vander Wal, 1996), which validated the Questionnaire for Eating Disorder Diagnosis (Mintz, O’Halloran, Mulholland, &amp; Schneider, 1997) as a measure of eating disorders with male athletes. These findings suggest that variables that have been supported as risk factors among women in general, and female athletes in particular, may not apply as strongly, or at all, to male athletes.

Psychometric properties of eating disorder instruments in Black and White young women: Internal consistency, temporal stability, and validity.

Most of the major instruments in the eating disorder field have documented psychometric support only in predominantly White samples. The current study examined the internal consistency, temporal stability, and convergent and discriminant validity of a variety of eating disorder measures in Black (n = 97) and White (n = 179) female undergraduates. Internal consistency coefficients were good (>.76) for all measures for both groups. Temporal stability across 5 months was also adequate in both groups, but with evidence for dietary restraint and subjective binge eating being less stable in Black women (e.g., for the Restraint subscale of the Three-Factor Eating Questionnaire [TFEQ], r = .63 for Black women and r = .82 for White women). Scores on the bulimic symptoms and dietary restraint instruments converged and diverged in a theoretically consistent pattern. Findings suggest these eating disorder measures are reliable (internally consistent; temporally stable over 5 months) and that the bulimic symptom measures of the Bulimia Test-Revised, the Bulimia subscale of the Eating Disorder Inventory, and the dietary restraint measures from the Eating Disorder Examination-Questionnaire and TFEQ demonstrate convergent and discriminant validity in Black college women.

The role of emotional intelligence and negative affect in bulimic symptomatology

Emotions, particularly emotion dysregulation, play an important role in the development and maintenance of eating disorders as evidenced by the emphasis given to addressing emotions in a number of psychotherapeutic approaches that have been adapted for the treatment of women with disordered eating. The purpose of this study was to assess the role of emotional intelligence and other emotion regulation variables in the relationship between negative affect and bulimic symptomatology. One hundred fifty undergraduate females were assessed via a packet of self-report questionnaires that included measures of emotion regulation, including emotional intelligence (BarOn Emotional Quotient Inventory—Short Form), alexithymia (Twenty-Item Toronto Alexithymia Scale), and coping (Brief COPE Inventory), negative affect (Positive and Negative Affect Schedule—Expanded Form and Affect Intensity Measure), and bulimic symptomatology (Bulimia Test—Revised). Results of multiple regression analyses indicated that each conceptual area of interest contributed to the prediction of bulimic symptomatology. In addition, the measures of emotion regulation accounted for significant variance in bulimic symptomatology even after controlling for negative affect. Emotional intelligence and other emotion regulation variables did not moderate the relationship between negative affect and bulimic symptomatology. However, results highlight the role of emotion in disordered eating behaviors and support the negative affect and emotion dysregulation theories of eating disorders.

Cross‐cultural assessment of eating disorders: psychometric properties of a Spanish version of the Bulimia Test‐Revised

The purpose of this study was to examine the psychometric properties of a Spanish version of the Bulimia Test-Revised (BULIT-R). The goal was to test the factor-structure equivalence of the BULIT-R across two samples of college students from two different cultures, Spain and the US. Researchers using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) have reported different model solutions for the factor-structure of the BULIT-R: a one-factor model, a four-factor model, a five-factor model and a six-factor model. For the two samples, CFA did not support any of the models previously reported in the literature. EFA supported a six- and a four-factor models for the US and Spanish samples, respectively.

"Factor structure of the Bulimia Test-Revised in college women from four ethnic groups": Correction to Fernandez, Malacme, Wilfley, and McGuaid (2006).

"Factor structure of the Bulimia Test-Revised in college women from four ethnic groups": Correction to Fernandez, Malacme, Wilfley, and McGuaid (2006).

Factor structure of the Bulimia Test-Revised in college women from four ethnic groups.

The factor structure of the Bulimia Test--Revised (BULIT-R) was investigated using confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). The sample consisted of 2,671 female college students (African American, Asian American, Caucasian American, and Latino American). Reliability coefficients were excellent across groups. African Americans scored significantly lower on the BULIT-R than Caucasian Americans. Across groups, CFA and EFA results suggest a six-factor solution is most appropriate. Consistent across groups were factors representing bingeing, body image, purging, and extreme weight loss behaviors, while few differences were observed across groups. These findings suggest that the measure is reliable and valid for use with diverse ethnic groups. Future research should focus on culturally salient psychological correlates of disordered eating in diverse ethnic groups.

Reducing maladaptive weight management practices: Developing a psychoeducational intervention program

Previous research has addressed the issues of behavior change and eating disorder prevention among adolescents and young women. The current study was designed to evaluate: (a) whether an 8-week psychoeducational intervention can reduce maladaptive weight-management practices in women (University females, N = 24) with sub-clinical levels of eating pathology; and (b) whether its implementation reduces the risk of developing more severe eating pathology across time. Participants were randomly assigned to an experimental (EX) group or a self-monitoring control (SMC) group. Statistically significant changes on measures of eating pathology, including the Eating Attitudes Test-26 [Garner, D. M., Olmsted, M. P., Bohr, Y., & Garfinkel, P. (1982). The Eating Attitudes Test: psychometric features and clinical correlates. Psychological Medicine, 12, 871–878]; Forbidden Food Survey [Ruggerio, L., Williamson, D. A., Davis, C. J., Schlundt, D. G., & Carey, M. P. (1988). Forbidden Food Survey: Measure of bulimic's anticipated emotional reactions to specific foods. Addictive Behaviors, 13, 267–274]; and Bulimia Test-Revised [Thelen, M. H., Farmer, J., Wonderlich, S., & Smith, M. (1991). A revision of the bulimia test: The BULIT-R. Journal of Consulting and Clinical Psychology, 3(1), 119–124] were observed, as were changes in body image, as measured by the Body Shape Questionnaire [Cooper, P. J., Taylor, M. J., Cooper, Z., & Fairburn, C. G. (1987). The development and validation of the body shape questionnaire. International Journal of Eating Disorders, 6(4), 485–494]. Additional significant between-group differences in eating behavior, as measured by daily meal records, were also seen. Participants in the EX group evidenced improvements in scores which were significantly different from those observed in the SMC group. Unfortunately, attrition limited the utility of follow up data.

Plasma Ghrelin in Anorexia, Bulimia, and Binge-Eating Disorder: Relations with Eating Patterns and Circulating Concentrations of Cortisol and Thyroid Hormones

The present study was designed to investigate the relations between plasma ghrelin concentrations, eating patterns, and circulating concentrations of cortisol and thyroid hormones in women with anorexia nervosa, bulimia nervosa, and binge-eating disorder. The patterns of disordered eating behavior were assessed using the Eating Attitudes Test (EAT-26) and the Bulimia Test-Revised (BULIT-R). In women with eating disorders, but not in healthy control women, plasma ghrelin concentrations were negatively correlated with body mass index (BMI) and plasma concentrations of thyreotropin (TSH), free T3 and free T4, and positively correlated with plasma concentrations of cortisol. The ghrelin concentrations of women with binge-eating and purging behavior were significantly lower than those of women with anorexia nervosa, restricting type, and there was a negative relation between the frequency and severity of binge-eating and purging behavior, as measured by the BULIT-R total score, and ghrelin concentrations. In a multivariate regression model controlling for the confounding effects of body mass index (BMI) and age, higher ghrelin concentrations were correlated with lower BULIT-R total scores. The results of this study did not confirm the hypothesis advanced in previous studies that ghrelin concentrations are higher in patients with binge-eating/purging forms of eating disorders. Based on these data, we suggest that, in women with eating disorders, ghrelin concentrations best reflect nutritional status rather than specific patterns of disordered eating behavior.