Eating Disorder Examination Interview Research Articles

Comparison of methods for identifying and assessing obese patients with binge eating disorder in primary care settings

Given the prevalence and health significance of binge eating disorder (BED) it is important to determine if time-efficient self-reports can adequately assess BED and its features in primary care settings. We compared the Eating Disorder Examination-Questionnaire (EDE-Q) and Questionnaire for Eating and Weight Patterns-Revised (QEWP-R), administered to obese patients with BED in primary care setting to the Eating Disorder Examination (EDE) interview. Sixty-six participants completed the questionnaires and were interviewed. The EDE interview was significantly correlated with the EDE-Q (binge eating, four subscales, and global score) and the QEWP-R (binge eating, distress, and body image). The EDE-Q yielded significantly lower estimates of binge eating and significantly higher scores on the EDE subscales. The QEWP-R yielded significantly higher scores on the behavioral indicators and distress about binge eating and body image variables. These findings suggest that these two self-report measures have potential utility for identifying BED in obese patients in primary care.

Two novel treatments to reduce overeating in overweight children: A randomized controlled trial.

Our purpose in this study was to examine 2 treatments targeted at reducing eating in the absence of hunger in overweight and obese children. Thirty-six overweight and obese 8- to 12-year-old children (58% female; mean age = 10.3 years, SD = 1.3), with high scores on eating in the absence of hunger, and their parents were randomly assigned to an 8-week children's appetite awareness training or cue exposure treatment-food. Children completed an eating in the absence of hunger (EAH) paradigm, an Eating Disorder Examination interview for children, and three 24-hr dietary recalls, and their height and weight were measured. Parents completed the EAH Questionnaire and the Binge Eating Scale, and their height and weight were measured. Assessments were conducted at baseline, posttreatment, and 6 and 12 months posttreatment. Results showed that both treatments resulted in significant decreases in binge eating in children over time. Additionally, children in the food cue exposure treatment showed significant decreases in EAH posttreatment and 6 months posttreatment, but children in the appetite awareness training showed no change in EAH. Neither treatment produced significant effects on caloric intake in children or on any of the parent outcomes. This study demonstrates that training in food cue responsitivity and appetite awareness has the potential to be efficacious for reducing EAH and binge eating in children. Because these data are preliminary, further treatment development and randomized controlled studies are needed.

Accuracy of Self-Reported Weight and Height and Resulting Body Mass Index Among Obese Binge Eaters in Primary Care

This study assessed the accuracy of self-reported weight, height, and body mass index in obese patients with binge-eating disorder (DSM-IV-TR criteria) presenting at primary care clinics and tested whether the degree of inaccuracy was associated with demographic factors or eating disorder and depressive features. Sixty-six participants were interviewed using the Eating Disorder Examination interview, completed the Eating Disorder Examination Questionnaire and the Beck Depression Inventory, and had their height and weight measured between November 2007 and May 2009. Self-reported and measured weight did not differ significantly, but participants significantly overestimated their height (P < .01), and this discrepancy resulted in a significantly lower self-reported than measured body mass index (P < .05). Discrepancy scores did not differ by eating disorder or depressive symptoms, sex, or ethnicity, although increasing age was associated with overestimation of height and underestimation of body mass index. The findings suggest that obese patients with binge-eating disorder in primary care settings are reasonably accurate reporters of weight and height and that the degree of inaccuracy does not appear to be systematically related to eating disorder psychopathology or depressive features.

Factor Structure of the Eating Disorder Examination Interview in Patients With Binge‐eating Disorder

Despite the widespread use of the Eating Disorder Examination (EDE) as a primary assessment instrument in studies of eating and weight disorders, little is known about the psychometric aspects of this interview measure. The primary purpose of this study was to evaluate the factor structure of the EDE interview in a large series of patients with binge-eating disorder (BED). Participants were 688 treatment-seeking patients with BED who were reliably administered the EDE interview by trained research clinicians at three research centers. Exploratory factor analysis (EFA) performed on EDE interview data from a random split-half of the study group suggested a brief 7-item 3-factor structure. Confirmatory factor analysis (CFA) performed on the second randomly selected half of the study group supported this brief 3-factor structure of the EDE interview. The three factors were interpreted as Dietary Restraint, Shape/Weight Overvaluation, and Body Dissatisfaction. In this series of patients with BED, factor analysis of the EDE interview did not replicate the original subscales but revealed an alternative factor structure. Future research must further evaluate the psychometric properties, including the factor structure, of the EDE interview in this and other eating-disordered groups. The implications of these factor analytic findings for understanding and assessing the specific psychopathology of patients with BED are discussed.

Relations of dietary restraint and depressive symptomatology to loss of control over eating in overweight youngsters

This study investigated the dietary restraint and depression pathway to loss of control over eating among a sample of overweight youngsters based on the assumptions of the extended cognitive behavioural theory for bulimia nervosa. The children's version of the eating disorder examination interview and the children's depression inventory were administered to 350 overweight youngsters (with a mean age of 13.30 years old). Structural equation modelling indicated that the over-evaluation of eating, weight and shape was significantly associated with dietary restraint, which in turn was significantly associated with loss of control over eating. Evidence was also found for a direct pathway between depressive symptoms and loss of control over eating. It can be concluded that in general, the main components to maintain the bulimic cycle in eating disordered patients operate in a similar way to maintain loss of control over eating in overweight youngsters.

Salivary Cortisol and Binge Eating Disorder in Obese Women After Surgery for Morbid Obesity

BackgroundBinge eating episodes characterized by loss of control are hypothesized to be accompanied by changes in hypothalamic pituitary adrenal (HPA) axis functioning. Cortisol is an end product of this neuroendocrine stress system.PurposeThe aim of this study was to examine the cortisol levels and the awakening cortisol response (ACR) in obese persons showing binge eating after surgery for morbid obesity.MethodSixteen obese women with binge eating disorder (BED) and 18 obese women without BED participated in the study. Means±SD: age 43 ± 15, body mass index 40 ± 8. Salivary cortisol, anthropometric assessments, and the eating disorder examination interview were taken.ResultsWomen with BED showed a significantly lower waist-to-hip ratio and cortisol levels during the day than women without BED, whereas the ACR did not differ.ConclusionOur cross-sectional study in a small sample generates the hypothesis that neuroendocrine regulation differs between obese women with and without BED after obesity surgery. This finding needs replication in future studies that should also examine the causal direction of the observed association.

Prediction of the Onset of Disturbed Eating Behavior in Adolescent Girls With Type 1 Diabetes

OBJECTIVE—The purpose of this study was to identify predictors of the onset of disturbed eating behavior (DEB) in adolescent girls with type 1 diabetes.RESEARCH DESIGN AND METHODS—In this prospective study, participants completed the Children's Eating Disorder Examination interview and self-report measures at baseline and at four follow-up assessments over 5 years. Participants were 126 girls with type 1 diabetes, aged 9–13 years at baseline. Of the 101 girls who did not have DEB at baseline, 45 developed DEB during the follow-up period; the 38 for whom data were available for the assessment before onset of DEB were compared with 38 age-matched girls who did not develop DEB. DEB was defined as dieting for weight control, binge eating, self-induced vomiting, or the use of diuretics, laxatives, insulin omission, or intense exercise for weight control.RESULTS—Logistic regression indicated that a model including BMI percentile, weight and shape concern, global and physical appearance-based self-worth, and depression was significantly associated with DEB onset (χ2 = 46.0, 5 d.f., P < 0.0001) and accounted for 48.2% of the variance.CONCLUSIONS—Even though scores on the measures were within the published normal range, the onset of DEB was predicted by higher depression and weight and shape concerns and lower global and physical appearance–based self-worth as well as higher BMI percentile 1–2 years earlier compared with those not developing DEB. Early interventions focused on helping girls with diabetes develop positive feelings about themselves, their weight and shape, and their physical appearance may have protective value.

Compulsive exercise to control shape or weight in eating disorders: prevalence, associated features, and treatment outcome

Objective The study was aimed at assessing the prevalence of compulsive exercising to control shape and weight in eating disorders (EDs) and its relationship with treatment outcome. Method Compulsive exercising to control shape and weight, defined according to a modified version of the Intense Exercising to Control Shape or Weight section of the Eating Disorder Examination (EDE), was assessed in 165 consecutive ED inpatients entering a protocol based on the transdiagnostic cognitive behavior theory and treatment of EDs. Baseline assessment also included anthropometry, the global EDE interview, the Beck Depression Inventory, the State-Trait Anxiety Inventory (STAI), the Eating Disorders Inventory–Perfectionism Scale, and the Temperament and Character Inventory. Results Of the patients, 45.5% were classified as compulsive exercisers, the prevalence being highest (80%) in restricting-type anorexia nervosa (AN), lowest in EDs not otherwise specified (31.9%), and intermediate in binge/purging AN (43.3%) and in purging-type bulimia nervosa (39.3%). Compulsive exercising to control shape and weight was independently predicted by the EDE restraint score (odds ratio, 1.32; 95% confidence interval, 1.06-1.64; P = .014) after adjustment for ED; the total amount of exercise was associated with EDE restraint, as well as with the Temperament and Character Inventory reward dependence. At follow-up, an improved EDE global score was predicted by lower baseline values, higher baseline STAI and STAI improvement, and lower amount of exercise in the last 4 weeks. Voluntary treatment discontinuation was not predicted by baseline exercise. Discussion Compulsive exercising to control shape and weight is a behavioral feature of restricting-type AN, associated with restraint and temperament dimensions, with influence on treatment outcome.

Psychometric properties of the Eating Disorders in Obesity questionnaire: Validating against the Eating Disorder Examination interview

Inconclusive results of how weight-loss treatment (WLT) results are affected by participants' eating disorders and/or binge eating are partly due to the variation caused by the multitude of assessment instruments used. The objective of the present study was to evaluate the psychometric properties of a short DSM-IV-based assessment instrument designed to be used specifically in WLT settings, the Eating Disorders in Obesity (EDO) questionnaire. Participants were 97 patients seeking WLT at four surgical and one non-surgical clinics. Participants were assessed by the EDO and the Eating Disorder Examination (EDE) interview . The validity and reliability of the EDO was measured as concordance with the EDE, and test-retest agreement of the EDO, respectively. Validity as well as reliability was found to be good for both eating disorders diagnoses and binge eating as a distinct symptom. Results suggest that the EDO is a short, easily administered instrument with good psychometric properties which makes it a suitable, economical method of assessing eating disorders and binge eating in clinical WLT settings.

Assessing eating disordered behaviour in overweight children and adolescents: bridging the gap between a self-report questionnaire and a gold standard interview

The current study compared two measurements assessing eating disorder psychopathology in overweight children and adolescents: an interview and a self-report questionnaire. An adjusted version of the Child Eating Disorder Examination Questionnaire (ChEDE-Q) was compared with the Child Eating Disorder Examination interview (ChEDE), which is considered the gold standard. Thirty-eight overweight children and adolescents (aged 8-14) participated in the study. Regarding objective bulimic episodes, the current study found that using smaller chunks of information decreased the discrepancy between interview and questionnaire. The chances are that the gap between ChEDE-Q and ChEDE can be reduced if more attention is paid to children’s abilities concerning the understanding of complex concepts. (Netherlands Journal of Psychology, 63, 102-106)

Natural history and predictors of disturbed eating behaviour in girls with Type 1 diabetes

To determine the natural history and psychosocial predictors of disturbed eating behaviour in girls with Type 1 diabetes (T1D) over a 1-year period. One hundred and six girls with T1D, 9-13 years of age at Time 1, completed a Children's Eating Disorder Examination (cEDE) interview at Time 1 and again 1 year later (Time 2). Potential Time 1 predictors of Time 2 disturbed eating behaviour were body mass index (BMI), self-esteem, depressive symptoms, attachment to parents, and parental eating attitudes. Glycated haemoglobin (HbA(1c)) was measured. Disturbed eating behaviour was reported by 14% (15/106) of girls at Time 1, and 17% (18/106) at Time 2, and persisted in 8/15 girls over 1 year. Lower self-esteem, higher BMI and more disturbed maternal eating attitudes at Time 1 accounted for 35% of the variance in Time 2 cEDE score, while higher BMI and more disturbed attachment to one's mother predicted new-onset disturbed eating behaviour at Time 2. Glycaemic control was not associated with or predicted by disturbed eating behaviour. There was only moderate stability in disturbed eating behaviour status over a 1-year period. In this preliminary study, disturbed eating behaviour was associated with and, to a lesser degree, predicted by physical, psychological and family factors. Although the long-term clinical course of the mild disturbances identified is not known, prevention and early intervention efforts in this high-risk medical group should begin in the pre-teen years, and should probably target multiple factors in order to prevent the persistence and worsening of disturbed eating behaviour and its medical sequelae.

Inter-Rater and Test-Retest Reliability of the Spanish Language Version of the Eating Disorder Examination Interview: Clinical and Research Implications

To examine the inter-rater and test-retest reliability of the Spanish Language version of the Eating Disorder Examination (S-EDE) in monolingual Latina women. Established measures are needed to study Latino groups, and short-term test-retest reliability findings are needed to provide context for clinical treatment and outcome studies. Inter-rater reliability (IRR) and short-term (5-14 days) test-retest reliability (TRR) of the S-EDE (using intraclass correlation coefficients [ICCs]) were examined in a non-clinical study group of 60 monolingual Latina women. IRR was excellent for objective bulimic episodes (ICC = 0.99) but was modest for subjective bulimic episodes (ICC = 0.55). TRR was good for objective bulimic episodes (ICC = 0.79) but was unacceptable for subjective bulimic episodes (ICC = 0.22). IRR and TRR kappa coefficients (0.56 and 0.37, respectively) for identifying the presence or absence of objective bulimic episodes were modest. For the S-EDE subscales, both IRR (ICCs ranged from 0.80 to 0.98) and TRR (ICCs ranged from 0.67 to 0.90) were good to excellent. These findings provide preliminary support for the reliability of the S-EDE for use with Latina women. The constructs of eating disorder psychopathology measured by the S-EDE subscales (restraint, eating concern, weight concern, and shape concern) and the core feature of binge eating (objective bulimic episodes) show high short-term consistency. The results for subjective bulimic episodes are consistent with previous studies that have questioned whether these eating behaviors are reliable indicators of eating disorders. Additional evaluation is needed with clinical groups.

Cognitive Behavioral Therapy Guided Self-Help and Orlistat for the Treatment of Binge Eating Disorder: A Randomized, Double-Blind, Placebo-Controlled Trial

Cognitive behavioral therapy (CBT) has efficacy for binge eating disorder (BED) but not obesity. No controlled studies have tested whether adding obesity medication to CBT facilitates weight loss. We performed a randomized, placebo-controlled study of orlistat administered with guided self-help CBT (CBTgsh). Fifty obese BED patients were randomly assigned to 12-week treatments of either orlistat plus CBTgsh (120 mg three times a day [t.i.d.]) or placebo plus CBTgsh and were followed in double-blind fashion for 3 months after treatment. Seventy-eight percent of patients completed treatments without differential dropout between orlistat+CBTgsh and placebo+CBTgsh. Intent-to-treat remission rates (zero binges for past 28 days on Eating Disorder Examination Interview) were significantly higher for orlistat+CBTgsh than placebo+CBTgsh (64% versus 36%) at posttreatment but not at 3-month follow-up (52% in both). Intent-to-treat rates for achieving 5% weight loss were significantly higher for orlistat+CBTgsh than placebo+CBTgsh at posttreatment (36% versus 8%) and 3-month follow-up (32% versus 8%). Significant and comparable improvements in eating disorder psychopathology and psychological distress occurred in both treatments. The addition of orlistat to CBTgsh was associated with greater weight loss than the addition of placebo to CBTgsh. Clinical improvements were generally maintained at 3-month follow-up after treatment discontinuation.

Temporal stability of the Eating Disorder Examination Questionnaire.

The current study examined the stability and internal consistency of the Eating Disorder Examination Questionnaire (EDE-Q) in a general population sample. The EDE-Q was administered to a community sample of women aged 18-45 on two occasions, with a median test-retest interval of 315.0 days. Pearson correlations between items of the EDE-Q assessing attitudinal features of eating disorder psychopathology ranged from 0.57 for the Restraint subscale to 0.77 for the Eating Concern subscale. The stability of items addressing eating disorder behaviors was much lower, with phi coefficients for the occurrence of objective bulimic episodes, subjective bulimic episodes, and use of exercise as a compensatory behavior of 0.44, 0.24, and 0.31, respectively, and Kendall's tau b correlations of 0.44, 0.28, and 0.31, respectively, for the frequency of these behaviors, across occasions. The internal consistency of the EDE-Q was high, with a Cronbach alpha coefficient for the global scale of 0.93, compared with a value of 0.90 for the Eating Disorder Examination interview. Items of the EDE-Q assessing attitudinal features of eating disorder psychopathology demonstrate a high degree of temporal stability, whereas the stability of items addressing eating disorder behaviors is much lower. In the case of compensatory eating disorder behaviors, low stability is likely to reflect actual trait variation, whereas the low stability of binge eating behaviors, in particular subjective bulimic episodes, is likely to reflect both trait variation and measurement error. The high internal consistency of EDE-Q items supports its use as a screening instrument in two-phase epidemiologic studies.

Short-term follow-up of adults with long standing anorexia nervosa or non-specified eating disorder after inpatient treatment.

There are few follow-up studies on outcome for patients with long standing anorexia nervosa (AN) or non-specified eating disorder with several comorbid psychiatric disorders. Inpatient treatment is one option for these patients. The aim of this prospective study was to report one-year follow-up for a consecutive sample of these patients after an inpatient treatment program. All 24 patients with a mean age of 28 years and mean duration of an eating disorder of 11 years were treated in a 23-week inpatient group treatment program for AN. Patients were assessed using Eating Disorder Examination interview (EDE), Eating Disorder Inventory (EDI) and Symptom Check List (SCL-90-R) at pre-treatment, post-treatment and at one year after start of treatment. At the follow-up 24 patients were personally interviewed. On admission 12 (50%) had AN, 8 (33%) non-specified eating disorder (EDNOS) and 4 (17%) bulimia nervosa (BN). All had previously suffered from AN and were clinically evaluated to have mostly anorectic psychopathology. Ten (42%) patients had improved at follow-up and 14 (58%) had a poor outcome. There was a moderate but significant improvement on the EDE, EDI and GSI from pre-treatment to follow-up. The improvement occurred during inpatient treatment, and no significant differences from post-treatment to follow-up were found. Patients with low weight on admission showed a significant mean weight increase of about 4 kg at the follow-up. At one-year follow-up there was a moderate reduction of eating disorder symptoms and general psychiatric symptoms for patients with long standing anorexic symptoms. The improvement occurred during inpatient treatment. Inpatient treatment may be a treatment option in long-time rehabilitation for some of these patients.

Eating Disorders Examination versus Eating Disorders Examination-Questionnaire in adolescents with full and partial-syndrome bulimia nervosa and anorexia nervosa

The current study compared the Eating Disorders Examination (EDE) and the Eating Disorders Examination-Questionnaire (EDE-Q) in adolescents with eating disorders. Adolescents (N = 70) with bulimia nervosa (BN; n = 21), partial-syndrome BN (PBN; n = 25), and anorexia nervosa (AN; n = 24) were assessed with the EDE and EDE-Q. Moderate to high correlations were found on all four subscales within and between diagnostic groups. The discrepancy between the EDE and EDE-Q was significantly greater in BN relative to PBN and AN for the Eating Concern subscale. Objective binge episode (OBE) frequency in BN and subjective binge episode (SBE) frequency in BN and PBN were higher with the EDE compared with the EDE-Q. Self-induced vomiting was highly correlated between the two measures. Adolescents with BN, PBN, and AN exhibited strong correspondence between the EDE interview and questionnaire formats. However, this consistency was not as pronounced for BN as it was for PBN and AN. The current study lends preliminary credibility to the use of the EDE-Q in adolescent eating disorder samples.

The prevalence of DSM-IV personality pathology among individuals with bulimia nervosa, binge eating disorder and obesity.

There are numerous reports of personality disorder pathology in different eating disorders. However, few studies have directly compared personality pathology in bulimia nervosa, binge eating disorder and obesity. The present study examines group differences in DSM-IV personality pathology, considering the potential utility of understanding personality disorders in terms of diagnosis and dimensional scores. Eating disorder diagnoses were established using the Eating Disorder Examination interview. Thirty-five bulimia nervosa patients, 15 binge eating disorder patients and 37 obese patients were assessed and compared on the International Personality Disorder Examination using categorical and dimensional personality disorder scores. For most personality disorders, there was a dichotomy of binge eaters versus non-binge eaters. In contrast, there was a continuum of severity in borderline personality disorder pathology between the groups. The dimensional system of measurement of personality pathology allowed for clearer differentiation between the groups. The study strongly indicates that personality disorder difficulties are present in patients who binge eat, while obese patients who do not binge eat display significantly less personality disorder pathology. Assessment of bulimia nervosa, binge eating disorder and obesity needs to address personality disorders and pathology. Dimensional markers of personality pathology can be used to supplement categorical diagnoses, providing information about the traits that underlie diagnosis.

Short‐term follow‐up of severe bulimia nervosa after inpatient treatment

AbstractObjective:There are few follow‐up studies on outcome for treatment‐resistant bulimics with comorbid personality disorders. Inpatient treatment may be one option for patients who have not responded to outpatient therapy. The aim of this prospective study was to report on the 1‐year follow‐up of long‐term severe bulimic patients treated in an inpatient eating disorder unit.Method:Fifty‐four patients were treated in a 4‐month specialized group treatment programme for bulimia nervosa. Patients were assessed using the Eating Disorder Examination interview (EDE), the Eating Disorder Inventory (EDI) and the Symptom Check List (SCL‐90‐R) at pre‐treatment, post‐treatment and at 1 year after the start of treatment. Fifty patients with a mean age of 31 years were available for the follow‐up assessment. On admission 72 per cent of the patients had bulimia nervosa, 26 per cent had unspecified eating disorder (EDNOS) and 2 per cent had the bulimic subtype of anorexia nervosa.Results:Twenty‐two (44 per cent) patients had good outcome at follow‐up (i.e. reduction of binges and/or purging by more than 75 per cent). Fourteen (28 per cent) had intermediate outcome (i.e. 25–74 per cent reduction of binges and/or purging) and 14 (28 per cent) had poor outcome (i.e. less than 25 per cent reduction in binging and/or purging or a symptom increase). There were significant reductions in most EDE, EDI and SCL‐90‐R subscale scores from pre‐treatment to follow‐up. The improvement on all of these subscales occurred during inpatient treatment and there were no significant changes from post‐treatment to follow‐up.Conclusion:Bulimic symptoms and general psychiatric symptoms were substantially reduced during the 4‐month inpatient treatment and these improvements were sustained at the follow‐up. Inpatient treatment may thus be an option for treatment‐resistant bulimia nervosa. Copyright © 2003 John Wiley &amp; Sons, Ltd and Eating Disorders Association.

On the relation of attempting to lose weight, restraint, and binge eating in outpatients with binge eating disorder.

To examine the relationship among attempts to lose weight, restraint, and eating behavior in outpatients with binge eating disorder (BED). Participants were 93 consecutive outpatients evaluated for a clinical trial who met Diagnostic and Statistical Manual, Fourth edition criteria for BED. The Eating Disorder Examination Interview was administered to assess attempts at weight loss, restraint, different forms of overeating, and the attitudinal psychopathology of eating disorders (i.e., concerns regarding eating, shape, and weight). In addition, the Three-Factor Eating Questionnaire was used to assess cognitive restraint, hunger, and disinhibition. Psychometrically established measures were given to assess body dissatisfaction, depression, and self-esteem. The majority of participants (75.3%; N = 70) reported attempting to lose weight, but only 37.6% (N = 35) reported dietary restraint on at least half the days of the month. Dietary restraint and cognitive restraint were not associated with any form of binge eating or overeating. Dietary restraint and cognitive restraint were positively correlated with weight concern, shape concern, and body dissatisfaction, and negatively correlated with body mass index. To further examine the interplay between attempting to lose weight and restraint, three study groups were created: unrestrained nonattempters (21.5%, N = 20), unrestrained attempters (40.9%; N = 38), and restrained attempters (34.4%; N = 32). The three groups did not differ significantly on binge eating or other eating behaviors; however, significant differences were observed for weight concern, shape concern, and body dissatisfaction. Attempts to lose weight and restraint are not synonymous for patients with BED. Although 75.3% of BED patients reported that they were attempting to lose weight, only 37.6% reported dietary restraint on at least half the days of the previous month. While restraint was negatively associated with body mass index, it was not related to binge eating or overeating. Our findings raise questions about prevailing models that posit restraint as a predominant factor in the maintenance of binge eating in BED.

Childhood Abuse and Platelet Tritiated-Paroxetine Binding in Bulimia Nervosa

Co-occurrence of bulimia nervosa and borderline personality disorder has been attributed to shared factors, including childhood abuse and disturbances in central serotonin (5-hydroxytryptamine; 5-HT) mechanisms. To explore this notion, we conducted a controlled assessment of childhood abuse and 5-HT function in bulimics with and without borderline personality disorder. Forty patients with bulimia nervosa, confirmed with the Eating Disorders Examination interview (14 with borderline personality disorder and 26 without), and 25 normal-eater controls were assessed for clinical symptoms (eating disturbances, mood lability, impulsivity, and dissociation) and childhood sexual and physical abuse. We also conducted tests of platelet tritiated-paroxetine binding in blood samples from 27 of the bulimics (11 with borderline personality disorder and 16 without) and 16 of the controls. Relative to normal eaters, bulimics showed greater affective instability, overall impulsivity, and a history of physical abuse. However, borderline bulimics alone showed elevated motor impulsivity, dissociation, and rates of sexual abuse. Paroxetine-binding tests indicated no differences attributable to comorbid borderline personality disorder, instead linking bulimia nervosa with or without borderline personality disorder to substantially reduced 5-HT transporter density. Results suggest relatively autonomous pathologic entities: one, relevant to bulimia nervosa, being associated with abnormal 5-HT transporter function and affective instability, but relatively independent of childhood sexual abuse; another, relevant to borderline personality disorder, onto which sexual abuse, dissociative symptoms, and behavioral impulsivity converge. We propose that abnormal 5-HT function may, however, constitute one basis for the frequent co-occurrence of bulimic and borderline disturbances.