Bulimia Test Research Articles

The Role of Familial Factors in Bulimia Nervosa

This research investigated three levels of family variables--general family dysfunction, family eating attitudes and behaviors, and negative familial communication regarding physical appearance and encouragement to diet--as predictors of the severity of bulimic symptomatology in a sample of 345 undergraduate women. Participants completed The Bulimia Test--Revised (Thelen, Farmer, Wonderlich, & Smith, 1991), the Family Environment Scale (Moos & Moos, 1984), and the Family Eating Attitude and Behavior Scale (Hogen, 1988) and rated the frequency with which family members made negative statements regarding their physical appearance and the need to diet. A hierarchical multiple regression analysis indicated that all three levels of family variables accounted for significant proportions of the variance in bulimic symptomatology. When the contribution of other variables to the regression equation was controlled, negative family communications, external control of food intake, and rules related to family mealtimes remained as significant predictors. These results illustrate the importance of investigating the relative contribution of different classes of familial variables to our understanding of bulimia nervosa and suggest important foci for the prevention of eating problems and eating disorders among young women.

An examination of willingness to self-disclose in women with bulimic symptoms considering the context of disclosure and negative affect levels.

This study explored the relationship between bulimic symptoms and self-disclosure. It examined whether women who reported greater bulimic symptomatology were generally less willing to self-disclose in intimate relationships or whether reluctance to disclose was confined to eating and weight concerns. Women with high and low scores on the Bulimia Test Revised (BULIT-R) were compared on self-disclosure about three topics (daily activities, eating, and weight) and sexual and relationship issues to three targets (mother, friend, and partner). There were significant main and interaction effects for BULIT-R score, target, and topic of self-disclosure. When depression was controlled for, it partially explained the association between bulimic behavior and self-disclosure. Results supported a contextual model of self-disclosure. Compared with nonbulimic women, women with bulimic symptoms were less willing to self-disclose certain topics to particular targets. Levels of depression explained low willingness to disclose on topics unrelated to eating and weight to some targets.

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.

Factorial validity of the Bulimia Test-Revised in adolescent boys and girls

The present study examined the psychometric properties and principal components structure of the Bulimia Test Revised (BULIT-R; [Thelen, M.H., Farmer, J., Wonderlich, S. & Smith, M. (1991). A revision of the Bulimia Test: the BULIT-R. Psychological Assessment, 3, 119–124.]) using a sample of early adolescent males and females. Three hundred and six girls (mean age=13.66; S.D.=1.12) and 297 boys (mean age=13.89: S.D.=1.13) from grades 7–10 completed the BULIT-R as part of a larger study investigating disordered eating in early adolescence. In comparison to the 5 factors identified in adult female samples, the factor analysis identified four similar factors for adolescent boys and girls: bingeing, control, normative weight loss (dieting and exercise) and extreme weight loss behaviors (vomiting, diuretics and laxatives). The findings highlight similarities between boys and girls and differences in the factorial nature of the BULIT-R for adult and adolescent samples. The BULIT-R also demonstrated good reliability with adolescent samples and adequate concurrent validity with the DFT, DEBQ and binge eating as defined by the DSM-IV criteria. The emergence of bingeing and control as two distinct factors is an important distinction that needs to be considered when attempting to provide accurate incidence rates of binge eating and bulimic symptomatology in adolescents.

Development and Validation of a Screening Tool to Identify Eating Disorders in the Female Athlete

Participation in competitive athletics is associated with social pressures and performance anxieties that may increase the risk of eating disorders. Psychometric instruments routinely used in the general population may not accurately estimate eating disorders in the female athlete. Recognizing the need for a screening instrument to distinguish between those behaviors which are essential to athletic performance versus those which maintain eating pathology, we developed the development of the Female Athlete Screening Tool (FAST). The FAST was randomly administered to a diverse sample of 32 Division I university athletes. Concurrent validity, commonly known as comparison to a gold standard, was obtained by asking each subject to also complete the Bulimia Test Revised: BULIT-R and the Eating Disorder Inventory 2: EDI-2. FAST correlations with the BULIT-R inventory (r=0.69,p<0.0001) and four related subscales of the EDI-2: Drive for Thinness (r=0.70,p<0.0001), Bulimia (r=0.035,p<0.04), Body Dissatisfaction (r=0.78,p<0.000 l), and Perfectionism (r=0.48,p<0.006) supported its concurrent validity. To test the internal characteristics of the scale, a reliability analysis was performed. Using Cronbach's alpha, a high internal consistency of the remaining items (α=0.88) was demonstrated. Average item-to-total correlation was 0.51(0.30-0.74). Our results demonstrate the process involved in the initial validation of a new measure, the FAST. These findings support the internal reliability and concurrent validity of this measure.

A comprehensive investigation of putative correlates of bulimia among college-age women: object relations, dependency, ego defenses, trait anxiety, and depression

This study investigated putative correlates of bulimia, which included measures of object relations impairment, dependency, ego defenses, trait anxiety and depression. Subjects were college-age women drawn from a larger sample ( n = 417) and selected on the basis of their scores on the revised version of the Bulimia Test. The bulimia group was composed of those scoring in the top 5% ( n = 23), concordant with the base rate of bulimia in this population, whereas controls ( n = 23) were conservatively selected from those scoring around the mean (56th–61st percentile). A multivariate analysis of variance revealed a significant group difference across dependent variables ( p < .05), and univariate Fs uniformly demonstrate predicted group differences. A stepwise discriminant analysis was performed to assess the relative contribution of these variables toward the differentiation between psychometrically defined, bulimic and nonbulimic women, revealing that trait anxiety, dependency, and depression reliably differentiated these groups, accounting for 37% of between-groups variance. In replicating and extending prior research, the results have implications for elucidating the phenomenology and potential etiologic factors associated with bulimia and for informing treatment and future research.

Bulimia as a disturbance of narcissism: Self-esteem and the capacity to self-soothe

A review of the literature on eating disorders reveals that, although psychodynamic formulations linking narcissistic dynamics—particularly difficulties with self-soothing—and eating disorders are common in the theoretical and clinical literature, little empirical work has attempted to substantiate this claim. In this study, 117 women completed the Eating Disorder Inventory and the Bulimia Test Revised and four scales that measure different components of narcissism (the Multidimensional Self-Esteem Inventory, measuring self-esteem, the Self-Care Questionnaire, and two subscales of the Ego Functioning Assessment Questionnaire, measuring self-soothing). The four scales used to assess narcissism were all highly correlated with each other, indicating that they measure a similar construct. In addition, the eatingdisorder measures were correlated with the measures of narcissism, suggesting that a relationship exists between bulimia and narcissism, as assessed using self-report instruments.

Self-directed hostility and family functioning in normal-weight bulimics and overweight binge eaters

The aim of this study was to examine whether overweight binge eaters demonstrate similar perceptions of family interactions and views of the self as do normal-weight bulimics. We compared 37 obese binge eaters and 37 normal-weight bulimics to 38 normal-weight nonbulimic controls, and 10 overweight nonbulimic controls on the Bulimia Test (BULIT), Profile of Mood States (POMS), Structural Analysis of Social Behavior (SASB) Short Form, which includes measure of hostility of family interactions and self-directed hostility; the Family Interaction Survey (FIS), and a measure of history of physical and sexual abuse and familial psychopathology. Both normal-weight bulimics and overweight binge eaters differed from nonbulimic controls across all measures of symptomatology, family functioning, history of abuse, familial psychopathology, and self-directed hostility. Normal-weight bulimics demonstrated significantly higher BULIT scores and self-directed hostility than did overweight binge eaters. Post hoc analysis showed that among binge eaters and bulimics, self-directed hostility accounted for a significant percentage of the variance of BULIT scores when controlling for the effects of age, BMI, family hostility, and mood. The possible role of self-directed hostility in the maintenance of bulimic symptomatology is discussed.

Subclinical and clinical eating disorders in IDDM negatively affect metabolic control.

To characterize the relationship of subclinical and clinical eating disorders to HbA1c values in women with IDDM. Ninety women with IDDM (18-46 years of age) were recruited from diabetes clinics throughout Connecticut and Massachusetts. Subjects were categorized into one of three groups according to the Diagnostic Statistical Manual of Mental Disorders (DSM-III-R) criteria for eating disorders as follows: the clinical group (n = 14), the subclinical group (partially fulfilling the diagnostic criteria; n = 13), and the control group (n = 63). Group differences in the degree of dietary restraint, binge eating, and bulimic behaviors and weight, shape, and eating concerns were assessed with the Eating Disorder Examination (EDE) and the Bulimia Test Revised (BULIT-R). Women with subclinical and clinical eating disorders had clinically elevated HbA1c results and more diabetes-related complications, compared with the control subjects. The severity of bulimic behaviors, weight concerns, reduced BMI, and decreased frequency of blood glucose monitoring were associated with elevated HbA1c. HbA1c may have clinical utility in the identification of eating disorder behavior in females with IDDM. Health care professionals should be aware of the potent effect of subclinical and clinical eating behaviors including insulin misuse in weight-conscious women with IDDM who have poor glycemic control.

Prevalence and correlates of bulimia nervosa and bulimic behaviors in a racially diverse sample of undergraduate students in two universities in southeast Texas.

This cross-sectional survey used a self-report questionnaire to measure the prevalence and correlates of bulimia nervosa and bulimic behaviors in a sample of undergraduate students enrolled in two state-supported universities in Texas in 1990. In one university, the student population was predominantly white; in the other, it was predominantly nonwhite. Bulimia status was assessed using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R), of the American Psychiatric Association and was operationalized using the Revised Bulimia Test. Overall, 0.9% of the sample, 1.3% of the females, and 0.2% of the males were classified as having bulimia nervosa. The prevalence of bulimic behaviors was 5.4% overall, 6.6% for females, and 3.6% for males. There was no racial/ethnic difference in the prevalence of bulimia nervosa or bulimic behaviors; 1.5% of the whites (n = 459) and 0.4% of the nonwhites (n = 693) were classified as having bulimia nervosa, while 5.5% of the whites and 5.3% of the nonwhites reported bulimic behaviors. In univariate analysis, female sex, obesity, dieting behavior, and a family history of alcoholism, drug abuse, and depression were statistically associated with bulimic behaviors. After adjustment for covariates, only obesity and dieting behavior were statistically significant. We concluded that the sex difference in bulimic behaviors reported in other studies may be due to the failure to control for confounding factors.

The association of maternal psychopathology and family socioeconomic status with psychological problems in obese children.

In an earlier study we found parental psychiatric symptoms to be a better correlate of behavioral problems in obese children than either child or parental obesity. This study sought to extend this research by assessing the association of general maternal distress, specific maternal psychopathology, family socioeconomic status and child obesity with the psychological problems of 152 children seeking treatment for obesity in two cohorts. Child psychological problems were measured using the Child Behavior Checklist/4-18 (CBCL) in each cohort. In sample 1 maternal general psychiatric symptoms were measured using the Cornell Medical Index (psychiatric subscales) and the Inventory of Interpersonal Problems whereas specific psychopathology was assessed with the Beck Depression Inventory and the Bulimia Test. In sample 2 the Symptom Checklist-90 and Binge Eating Scale provided general and specific measures of psychopathology. In the combined sample, 58% percent of the boys and 44% of the girls met criteria on at least one CBCL behavioral problem scale, with Social Problems the most prevalent problem in both boys and girls. For both samples, child obesity did not account for any variance in child psychosocial problems beyond that accounted for by maternal psychopathology and family SES. Family SES accounted for a significant increment in variance in child behavioral problems in only two scales. This study systematically replicates previous research, adding support for a broader conceptualization of factors that influence psychological problems in obese treatment-seeking children than one which focuses on child obesity.

Perfectionism traits and perfectionistic self-presentation in eating disorder attitudes, characteristics, and symptoms

The purpose of this study was to assess the association between several dimensions of perfectionism and measures of eating disorder symptoms, body image, and appearance self-esteem in college students. A sample of 81 female university students completed the Multidimensional Perfectionism Scale, the Perfectionistic Self-Presentation Scale, the Eating Attitudes Test, the Bulimia Test, the Body Image Avoidance Questionnaire, and two measures of self-esteem. It was found that whereas self-oriented perfectionism was related only to anorexic symptoms, the social facets of perfectionism, especially socially prescribed perfectionism and the perfectionistic self-presentation dimensions, were related to eating disorder symptoms as well as body image avoidance and self-esteem. The findings support the usefulness of differentiating personal and interpersonal dimensions of perfectionism as well as trait versus self-presentational aspects of perfectionism in investigating personality and attitudes and behaviors related to eating disorders.

Relation among self-defeating personality, troubled eating patterns, and dissociation.

Significant small correlations were found between scores on a measure of self-defeating personality with scores on the Bulimia Test-Revised (r = .27) and also scores on the Dissociative Experiences Scale (r = .20) for a sample of 165 college women. The correlation between the Bulimia Test and the Dissociative Experiences Scale was .26. Although the research literature led us to expect stronger relationships on theoretical and empirical grounds, it appears these small relationships were more likely due to the fact that scoring higher on all these measures indicates greater psychopathology.

Relation between the syndromes of bulimia nervosa and obsessive compulsive disorder

Bulimia nervosa (BN) has been conceptualized as similar to obsessive compulsive disorder (OCD). The results of studies investigating the relation between BN and OCD, however, are inconclusive. Our goal was to attempt to clarify the relation between the syndromes of BN and OCD. The Padua Inventory (PI), a measure of OCD, and the Bulimia Test—Revised (BULIT-R), a measure of bulimic behaviors, were administered to 981 women and 722 men. A significant relationship, equal in magnitude for women and men, was found between BN and OCD. Bulimic symptoms also had a stronger relation to obsessions than compulsions. Finally, 6 of 23 women (26%) who met the diagnostic criteria for BN also met the criteria for OCD, while 1 of 1 man who met the criteria for BN also met the criteria for OCD. Implications for similarities between the two disorders as well as future issues in the study of comorbidity are discussed.

Dissociative states and disordered eating.

To investigate the relationship between eating problems and dissociation, 142 college women completed the Eating Disorders Inventory, the Bulimia Test, the Dissociative Experiences Scale, the Perceptual Alteration Scale, and a demographic information worksheet. The two eating-disorder inventories were strongly correlated (rs = .71). The two dissociation scales, however, were only moderately correlated (rs = .32), suggesting they are measuring different underlying experiences. The pattern of the correlations of the subscales of the dissociation scales with the eating disorder scales suggested that cognitive distortions were not as important in the relationship with eating disorders (all correlations were less than .21) as were dissociation of feelings and loss of control (the correlations for eating related subscales ranged as high as .51). These results were interpreted to suggest that dissociation of feelings might underlie eating problems. These results indicate the value of the use of hypnotherapy in working with eating-disordered clients.

Relationships among dysfunctional cognitions, depressive symptoms, and bulimic tendencies

This study assessed the relationships among dysfunctional cognitions, depression, and bulimia tendencies. Female undergraduates (N = 160) completed the Bulimia Test, Beck Depression Inventory, Center for Epidemiologic Studies—Depression Scale, Dysfunctional Attitude Scale, General Attitude and Belief Scale, Irrational Beliefs Scale, and Cognitive Error Questionnaire. Both bulimia and depression scores were significantly correlated with the cognitive scales. When depression was entered first into a regression equation, significant variance in bulimia scores was still accounted for by the cognitive measures. Results are consistent with a model of dysfunctional cognitions having a relationship with bulimic symptomatology which is at least partially independent of depression.

Eating disorders symptomatology in a registry-based sample of women with insulin-dependent diabetes mellitus

It has been noted that women with insulin-dependent diabetes mellitus (IDDM) may be at increased risk to develop disordered eating because their medical regimen requires an intense focus on diet. Thus the goal of the present study was to determine the prevalence of eating disorders symptomatology in a registry-based sample of women with IDDM and to assess the relationship between eating disorders symptomatology and blood sugar control. One hundred eighty-eight women with IDDM completed the Bulimia Test (BULlT) and the Eating Disorders Inventory (EDl). BULIT and EDI scores of diabetic subjects were comparable to those of nondiabetic subjects in standardization samples

Bulimic symptomatology and coping in a nonclinical sample.

This study examined the relationship between bulimic symptomatology as measured by scores on the Bulimia Test--Revised and coping orientation as measured by Endler and Parker's Coping Inventory for Stressful Situations given to a nonclinical sample of 164 female college students. A relationship was obtained among emotionally oriented coping, task-oriented coping, and scores on the Bulimia Test.

Bulimic women's perceptions of their family relationships.

This study examined the relationship between bulimia and family variables. Eight hundred twenty female college students completed a personal history questionnaire, the Bulimia Test, and the Eating Disorders Inventory. Twenty-four subjects who met the DSM-III-R criteria for bulimia were compared with 24 subclinical bulimics and 24 symptom-free subjects on demographic and family variables, including subscales from the Family Environment Scale and the Parental Bonding Instrument. Significant group differences indicated that the families of bulimics differ from other families. However, in contrast to the findings of research done in treatment settings, bulimics in this nonclinical setting did not report more family conflict or less caring from their parents than did symptom-free subjects.

The relationships among the general attitude and belief scale, other dysfunctional cognition measures, and depressive or bulimic tendencies

This study assessed the relationships between the General Attitude and Belief Scale (GABS) and measures of 1) irrational beliefs derived from Ellis' older and newer theorizing, 2) reasoning errors based on Beck's theory, and 3) affective and behavioral disorder, specifically depression and bulimia. Female undergraduates (n=160) completed the GABS, Irrational Beliefs Scale, Irrational Beliefs Test, Rational Behaviors Inventory, Dysfunctional Attitude Scale, Cognitive Error Questionnaire and the Beck Depression Inventory, Center for Epidemiologic Studies — Depression Scale, and Bulimia Test. Results supported the internal consistency and construct validity of the GABS; progressively higher correlations were obtained with measures more similar to the GABS theoretically.