Increases In Bulimic Symptoms Research Articles

Avoidance coping during mealtimes predicts higher eating disorder symptoms.

Eating disorders (EDs) are characterized by significant anxiety during mealtime that contributes to food avoidance and weight loss. Individuals with EDs commonly use avoidance coping (e.g., distraction) to tolerate meals and comply with meal plans. Although this strategy may be effective short term, a large body of anxiety literature suggests that avoidance can lead to worsening of psychological symptoms long term. The current study (N = 66 individuals diagnosed with ED) used ecological momentary assessment (EMA) to examine the short-term and long-term associations of avoidance coping on ED symptoms. Distraction during meals predicted a reduction in anxiety in the short term, and both distraction and avoidance of emotions predicted increases in excessive exercise in the short term. Distraction and avoidance of emotions predicted increases in bulimic symptoms 1 month after completion of EMA. These results are consistent with prior literature on avoidance and suggest that avoidance coping during meals may contribute to the increase of ED behaviors in the long term. Coping strategies that encourage approach and tolerance of difficult thoughts and emotions (e.g., acceptance-based strategies) rather that avoidance coping may promote longer-term symptom reduction.

An examination of eating and thinness expectancies as predictors of eating disturbances in females: evidence for cultural differences between European American and Chinese college students.

This study sought to examine the utility of eating expectancy, thinness expectancy, and the interactive role of both, in predicting eating disturbances (viz., bulimic symptoms and drive for thinness) in European American and Chinese female college students. A sample of 237 European American and 221 Chinese female college students completed measures of eating and thinness expectancies and eating disturbances. Results of hierarchical regression analyses revealed that thinness expectancy significantly predicted increases in both drive for thinness and bulimic symptoms (with these increases being greater for European Americans), whereas eating expectancy predicted increases in bulimic symptoms only. In addition, for European Americans, a significant interaction for bulimic symptoms was found, revealing a synergistic increase in bulimic symptoms for those with both a high thinness expectancy and a high eating expectancy. For Chinese, a significant interaction for drive for thinness was found, demonstrating that for those with a high thinness expectancy, a higher eating expectancy was actually associated with a lower drive for thinness. The present findings point to the value of examining for the co-presence of both expectancies in predicting eating disturbances while also highlighting cultural variations in the study of eating pathology. Descriptive cross-sectional study, level V.

Are perfectionism dimensions risk factors for bulimic symptoms? A meta-analysis of longitudinal studies

BackgroundCase histories, theoretical accounts, and empirical studies suggest an important relationship between perfectionism and bulimic symptoms. However, whether perfectionism confers vulnerability for bulimic symptoms is unclear. ObjectiveTo address this, we conducted a meta-analysis testing if socially prescribed perfectionism, concern over mistakes, doubts about actions, personal standards, self-oriented perfectionism and EDI-perfectionism predict increases in bulimic symptoms over time. MethodOur literature search yielded 12 longitudinal studies for inclusion. Samples were composed of adolescents, undergraduates, and community adults. ResultsMeta-analysis using random effects models showed perfectionistic concerns and EDI-perfectionism, but not perfectionistic strivings, had positive relationships with follow-up bulimic symptoms, after controlling for baseline bulimic symptoms. ConclusionResults lend credence to theoretical accounts implicating perfectionism in the development of bulimic symptoms. Our review of this literature also underscored the need for additional longitudinal studies that use multisource designs and that assess perfectionism as a multidimensional construct.

Status Update: Maladaptive Facebook usage predicts increases in body dissatisfaction and bulimic symptoms

BackgroundThe current study examined the effects of online social evaluations and comparisons on body dissatisfaction and bulimic symptoms. MethodsWe tested the effects of maladaptive Facebook usage (defined as the tendency to seek negative social evaluations and/or engage in social comparisons via Facebook) on body dissatisfaction and bulimic symptoms in a sample of 232 college females followed for approximately 4 weeks. ResultsResults provided evidence that maladaptive Facebook usage significantly predicted increases in bulimic symptoms and episodes of over-eating approximately four weeks later. Body dissatisfaction was found to fully mediate the relationship between maladaptive Facebook usage and increases in over-eating episodes, whereas body dissatisfaction partially mediated the relationship between maladaptive Facebook usage and increases in bulimic symptoms more broadly. LimitationsLimitations include the use of a novel measure of maladaptive Facebook usage due to the absence of an existing measure and a non-clinical sample. ConclusionsThe results of this study suggest that reducing maladaptive Facebook usage may be a fruitful target for interventions aimed at reducing body dissatisfaction and symptoms of eating pathology.

A prospective test of the influence of negative urgency and expectancies on binge eating and purging.

It has been proposed that both trait negative urgency (NU; the tendency to act rashly when distressed) and learned outcome expectancies for eating and restricting behavior contribute to the development of symptoms of bulimia nervosa (BN). The current study provides the first prospective test of whether these factors, and their interaction, predict increases in bulimic symptoms over time. In a sample of 355 first-year college women assessed at the start and then at the end of the first semester, prospective tests indicated that (a) baseline NU and eating expectancy endorsement predicted increased odds of binge eating at Time 2; (b) and baseline NU and thinness/restricting expectancies interacted to predict increased frequency of purging at Time 2. These findings are consistent with the hypothesis that NU and learned expectancies together increase risk for symptoms of BN.

Perfectionism, Body Dissatisfaction, and Bulimic Symptoms: The Intervening Role of Perceived Pressure to be Thin and Thin Ideal Internalization

Mounting evidence suggests that perfectionism contributes to the development and maintenance of eating disorder (ED) symptoms. Research adopting a multidimensional conceptualization of perfectionism has shown evaluative concerns (EC) perfectionism to be more strongly associated with ED pathology compared to personal standards (PS) perfectionism. However, less research has addressed the underlying mechanisms accounting for these relations. Based on the sociocultural theory, the aim of this study was to examine perceived pressure to be thin and thin ideal internalization as intervening variables through which PS and EC perfectionism could relate to body dissatisfaction and bulimic symptoms. A total of 559 adolescents (59% female; mean age = 13.9 years) participated in a three-wave longitudinal study. Structural equation modeling (SEM) analyses showed that EC perfectionism and PS perfectionism were related differentially to the intervening variables, with EC perfectionism being primarily related to perceived pressure to be thin and with PS perfectionism being primarily related to thin ideal internalization. Further, whereas EC perfectionism was related to increases in bulimic symptoms both directly and indirectly, PS perfectionism was only indirectly related to body dissatisfaction and bulimic symptoms through the sociocultural variables.

Weight suppression and risk of future increases in body mass: effects of suppressed resting metabolic rate and energy expenditure

Weight suppression, which reflects the difference between the highest previous weight and current weight, has predicted future increases in body mass index (BMI) and bulimic pathology; however, the mechanisms underlying these predictive effects are unclear. The current study sought to test whether weight suppression predicts future increases in BMI and bulimic symptoms and whether suppressed resting metabolic rate (RMR) and suppressed total energy expenditure (TEE) drive these relations. A randomly selected subsample of 91 young women in their first year of college with body image concerns completed an RMR assessment--a doubly labeled water assessment of TEE--and provided data on weight suppression and change in BMI and bulimic symptoms over a 6-mo follow-up period. Weight suppression predicted future increases in BMI and correlated inversely with suppressed RMR and TEE, yet this predictive effect did not decrease when suppressed RMR and TEE were controlled for. Weight suppression, however, did not predict future increases in bulimic symptoms. The results provide additional evidence that weight suppression predicts future increases in BMI but not in bulimic symptoms. Weight suppression showed moderate relations with suppressed RMR and TEE, but these variables do not appear to drive the predictive effect on future increases in BMI. This trial was registered at clinicaltrials.gov as NCT00433680.

Depression and eating pathology: Prospective reciprocal relations in adolescents

The association between disordered eating and depression has been established, but less is known about the temporal relations between these two disturbances. Accordingly, the current study examined the reciprocal relations between depressive and bulimic symptoms over an 8-year period, with longitudinal data from a community sample of 496 female adolescents. Depressive symptoms predicted future increases in bulimic symptoms, and bulimic symptoms likewise predicted increases in depressive symptoms, controlling for earlier levels of symptoms for each outcome. These results provide evidence consistent with the hypothesis that the two disorders contribute reciprocally to each other, and indicate that successful prevention or treatment of one disorder may yield effects for the other. However, the relatively small predictive effect sizes imply that some third variable may contribute to both conditions (e.g., temperamental negative affectivity).

An experimental test of the effects of dieting on bulimic symptoms: The impact of eating episode frequency

Prospective studies suggest dieting increases bulimic symptoms, but experiments suggest that dieting decreases bulimic symptoms. One possible explanation for the conflicting findings is that real world dieting involves less healthy dieting techniques, such as meal skipping, than prescribed diets. We tested whether the manipulation of eating episode frequency during dieting impacted bulimic symptoms. We expected that people on a diet involving fewer eating episodes would exhibit greater increases in bulimic symptoms than people on a diet involving more frequent eating episodes or waitlist controls. Participants on both 6-week diets lost more weight than controls, confirming dieting was manipulated, and showed greater reductions in bulimic symptoms than controls; however, the dieting conditions did not differ on either outcome. Results provide further experimental evidence that dieting does not increase bulimic symptoms, but suggests that eating episode frequency has little impact on this outcome.

Self-competence and the prediction of bulimic symptoms in older women

Previous research in undergraduate women has demonstrated that an individual's level of self-competence was a stronger predictor of bulimic symptom change than their level of self-liking ( Bardone, Perez, Abramson, & Joiner, 2003 ). The authors examined whether self-competence would similarly predict bulimic symptom change in a sample of older women. In April 2000, a large group of adults attending mood disorder conferences completed questionnaires about eating disorder symptoms and self-esteem. Approximately 2.5 years later, 150 women, 45 years of age and older, were contacted for a follow-up study. Eighty-eight women completed follow-up eating disorder and self-esteem measures. Consistent with prior research, self-competence emerged as a stronger predictor of bulimic symptom change than self-liking, such that lower self-competence was associated with an increase in bulimic symptoms. The results indicate that self-competence may serve as a useful prognostic indicator and therapeutic target for older women seeking treatment for eating disorders.

A test of an interactive model of bulimic symptomatology in adult women

An interactive model of bulimic symptom development, first suggested by Vohs et al. (1999), was tested in adult women (mean age = 45.19). The following hypothesis was examined in a longitudinal design over 2.5 years: Women high in perfectionism, low in self-esteem, and who perceive themselves as overweight would be the most likely to experience an increase in bulimic symptoms. Results supported the model with regard to maintenance and exacerbation, but not onset, of bulimic symptoms. Furthermore, the interactive model was tested to see if it showed specificity to bulimic, versus depressive or anxious, symptoms. Some support for the model's specificity to bulimic symptoms was observed; however, the increase of anxious symptoms was also observed. Clinical and theoretical implications are discussed.

Perfectionism, body dissatisfaction, and self-esteem in predicting bulimic symptomatology: lack of replication.

Few prospective studies have tested multivariate models of bulimic pathology development, but two studies have found support for a Perfectionism x Body Dissatisfaction x Self-Esteem etiologic model (Vohs, K.D., Bardone, A.M., Joiner, T.E., Abramson, L.Y., & Heatherton, T.F., 1999;108:695-700; Vohs et al., 2001;20:476-497). The current study sought to provide an independent replication of these promising findings. Data from 496 adolescent girls that were followed prospectively over a 1-year period were used to test this predictive model. Although our study should have provided a more sensitive test of this model because we used a sample at higher risk for bulimic symptom increases, more sensitive diagnostic interviews, a longer follow-up period, and a larger sample, the three-way interaction did not predict subsequent increases in bulimic symptoms. Results suggest that the predictive power of this interactive model may not be as robust as previously believed.

Bulimic symptoms and the development of depressive symptoms: The moderating role of attributional style

Using a prospective design, we examined whether attributional style moderated the relationship between the presence of bulimic symptoms and subsequent increases in depressive symptoms. As predicted, the presence of bulimic symptoms in college females at one point in time (T1) was associated with increases in depressive symptoms from T1 to T2 (3 weeks after T1) for subjects who exhibited a negative attributional style, but not for subjects who exhibited a positive attributional style. Depressive symptoms at T1 were not associated with increases in bulimic symptoms from T1 to T2. Of importance to the hopelessness theory of depression (Abramson, Metalsky, & Alloy, 1989), the presence of bulimic symptoms alone did not predict onset of depressive symptoms; it was only when bulimic symptoms and the negative attributional style were combined that depressive symptoms emerged. The hypothesis that these effects would be mediated by hopelessness obtained marginal support, and effects were obtained for depressive and anhedonic symptoms but not for anxious symptoms. We discussed implications for future work, including the value of the hopelessness theory of depression in explaining the co-occurrence of depressive and bulimic symptoms.

Bulimic Symptomatology in High School Girls

This study tests the explanatory power of an integrated sociocultural and personality model in predicting bulimic symptomatology. Family, peer, and personality factors were assessed at three levels of analysis. The first level of the model measured the general functioning of the family system and friendship network. The second level assessed the extent to which the family system and friendship network were concerned with issues of weight and dieting, as well as the rate of eating disorders among members in these groups. The third level investigated the relationship of certain personality variables to bulimic symptoms. Based on self-report data from approximately 400 high school girls, correlates of bulimic symptomatology at each of the three levels of analysis were identified. An integrated model, in which the three levels of analysis were considered in unison, demonstrated that risk factors at each level of analysis cumulatively contribute to an increase in bulimic symptoms.