Nonbulimic Women Research Articles

Interaction of the Bc II glucocorticoid receptor polymorphism and childhood abuse in bulimia nervosa (BN): Relationship to BN and to associated trait manifestations

We recently documented a gene-environment interaction suggesting that individuals with Bulimia Nervosa (BN) differed from normal eaters as to the combined presence of the low-function allele of the glucocorticoid receptor polymorphism, Bc II, and childhood abuse. The present study examined the extent to which any such interaction effect may have been attributable to behavioral impulsivity, sensation seeking, affective instability or depression. We had 174 bulimic and 130 nonbulimic women provide blood for genetic assays, and measured psychopathological traits and childhood abuse using structured interviews and self-report questionnaires. As expected, we observed a significant Bc II × abuse interaction indicating genetic and environmental susceptibilities to co-occur significantly more often in bulimic than in nonbulimic individuals. The Bc II × abuse interaction was attenuated when levels of depression were accounted for, but was surprisingly unaffected by controls for motoric impulsivity, sensation seeking or affective instability. Our findings suggest that stress-induced alterations in glucocorticoid sensitivity contribute to BN and depressive disturbances—without being associated with the behavioral/affective dysregulation seen in many BN sufferers. We discuss theoretical and clinical implications of these observations.

The Alien-Hand Experiment

This article reintroduces a phenomenological experiment designed in the early 1960’s, The Alien-Hand Experiment (TAHE), and it illustrates how phenomena denoted by theoretical concepts like body image, body schema and agency can be studied via the experiment. An analysis of the verbal reports from 26 subjects who participated in TAHE is presented in this article. Subjects were divided into three groups: A group of non-bulimic men, a group of non-bulimic women and a group of female bulimics. The group of (female) bulimics was studied due to the widely spread notion that subjects suffering from eating disorders have a distorted body image. TAHE can be thought of as both a qualitative and quantitative way to study the phenomena arising when the normal relationship between motor behaviour and body experience is disrupted. The present investigation is not an operational definition of body schema and body image, but the two concepts offer a useful interpretive framework.

Implications of compulsive and impulsive traits for serotonin status in women with bulimia nervosa

Studies of bulimia nervosa (BN) often report decreased brain serotonin (5-hydroxytryptamine: 5-HT) activity. Across populations, impulsivity has been linked to reduced 5-HT activity, but compulsivity has been associated (at least inconsistently) with an increase. We therefore became interested in the association between behavioral-trait variations and 5-HT status in BN. In 56 bulimic and 29 non-bulimic women, we measured eating symptoms, personality traits, platelet paroxetine binding, and neuroendocrine responses following oral meta-chlorophenylpiperazine (m-CPP). Relative to normal eaters, bulimic women showed reduced density ( B max) of platelet paroxetine-binding sites, blunted prolactin (PRL) responses following m-CPP, and (as a trend) lower basal PRL levels. However, after effects of binge–purge frequencies, body mass, and other extraneous factors were controlled, PRL levels at baseline and other moments in the serial sampling varied systematically with presence of impulsive and compulsive traits. PRL was generally low in BN, but ‘high-compulsive’/‘low-impulsive’ traits were associated with higher (normal-range) PRL values. Comparable trait-related variations were not observed on paroxetine-binding indices. Our findings suggest that 5-HT status in BN may correspond to impulsive or compulsive traits, and they encourage multidimensional modeling of the pathophysiological role of 5-HT in BN.

Childhood and adulthood abuse in bulimic and nonbulimic women: prevalences and psychological correlates.

We evaluated associations between childhood physical and sexual abuse in bulimic women and eating disturbances, psychiatric symptoms, and likelihood of later abuse in adulthood. Fifty-one bulimics and 25 normal eaters participated in this study. Semistructured interviews and self-report measures were used to assess eating symptoms, comorbid psychiatric disturbances, personality pathology, and childhood and adulthood abuse. Compared with the normal eaters, bulimic women reported higher levels of childhood abuse. Although bulimic women showed more psychopathology than nonbulimic women, there was a correspondence between the presence and severity of abuse and the severity of concurrent psychopathologic symptoms. Results linked dissociation and submissiveness to most severe forms of abuse. Abuse in adulthood was almost always preceded by earlier abuse during childhood. Our findings suggest an association between certain psychopathologic traits and the likelihood of abuse (especially when occurring both in childhood and adulthood). Observed associations could implicate causal effects of childhood abuse on personality development, influences of personality traits in heightening the risk of abuse, or both.

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.

What Triggers Abnormal Eating in Bulimic and Nonbulimic Women?; The Role of Dissociative Experiences, Negative Affect, and Psychopathology

Dissociative experiences and abnormal eating were examined in 92 non-eating-disordered women and 61 age-matched bulimic women. In the nonclinical sample of women, dissociative experiences were associated with abnormal eating attitudes and behavior, even after controlling for other forms of psychopathology; furthermore, dissociation mediated the relationships between abnormal eating and sexual abuse, abnormal eating and emotional distress, and abnormal eating and impulsivity Analyses using both bulimic women and occasional binge eaters among the controls showed that a combination of reported negative affect and dissociative experiences preceding a binge was associated with the highest levels of abnormal eating. Finally, in both bulimic women and occasional binge eaters, feelings of panic appeared to decrease as a binge episode progressed, whereas, in bulimic women only, dissociative experiences appeared to increase during binge eating. The implications for the role of dissociation in combination with emotional distress in triggering and reinforcing abnormal eating in women are discussed.

Self-destructiveness and serotonin function in bulimia nervosa

Studies have linked bulimia nervosa (BN) to alterations in brain serotonin (5-hydroxytryptamine: 5-HT) activity and to heightened propensity for parasuicidality and self-injuriousness. The coincidence of self-destructiveness and 5-HT abnormality in BN is of interest, given documentation (in various populations) of an inverse association between 5-HT activity and potential for self-harm. The present study examined the connection between 5-HT status and self-destructiveness in BN. Structured interviews and self-report questionnaires were used to assess 40 bulimic and 21 normal-eater women for: (a) history of parasuicidal or self-injurious acts; and (b) mood and impulse-regulation problems. We then applied tests, presumed to reflect 5-HT function, of serial prolactin (PRL) and cortisol (CORT) responses after oral administration of the partial 5-HT agonist, meta-chlorophenylpiperazine (m-CPP). Relative to non-bulimic women, bulimic women (on average) showed blunting of PRL and CORT following m-CPP. The blunting of neuroendocrine responses was, however, most remarkable in bulimic women with a history of self-destructiveness. These findings suggest that some serotonergic anomalies reported in BN sufferers (i.e. reduced neuroendocrine response after m-CPP) may be most characteristic of individuals in the population showing clear-cut self-destructive potential.

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.

MMPI-2 and Family Environment Differences between Bulimic and Nonbulimic Women and their Parents

We examined the relationships among psychological adjustment, perceptions of family environment, and the presence of bulimia. Twenty-nine bulimics and 33 nonbulimics completed the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and Family Environment Scale (FES) parents of bulimics and nonbulimics were sent the FES to complete independently. Bulimics had higher scores than nonbulimics on MMPI-2 F, Hs, D, Hy, Pd, Pa, Pt, and Sc scales and lower scores on the L and K scales, with a clinically elevated mean configuration of 7-8-1. No differences in perceptions of family environment were found between bulimics and nonbulimics or between their fathers. Mothers of bulimics perceived more active-recreational orientation and less control than mothers of nonbulimics. For bulimics, perceived family cohesion was positively correlated with the Si scale of the MMPI-2. Finally, there was qualitatively less agreement on perceptions of family environment within bulimic than nonbulimic families. We discuss the clinical and research implications of these findings.

Gender identity and bulimic eating behavior

From a social-psychological perspective, the disproportionate number of women compared to men affected by bulimia nervosa implies that gender (i.e., the social construction of sex) plays an important part in the etiology of this disorder. From this perspective it was hypothesized that the risk of developing bulimia depends, in part, on the composition of a woman's gender identity. Three questionnaire studies conducted in the United States and former West Germany tested competing hypotheses on the relationship between gender identity and bulimia. Respondents were predominantly middle class and Caucasian. Study 1 was conducted in West Germany and tested the hypothesis that bulimia is related to a hyperfeminine gender identity [M. Boskind-Lodahl (1976) “Cinderella's stepsisters: A feminist perspective on anorexia nervosa and bulimia,” Signs, Vol. 2, pp. 342–356]. Twenty-six bulimic women were compared to 26 nonbulimic women. Results from Study 1 indicated that bulimic women typically had a gender-typed identity, whereas nonbulimic controls tended to be androgynous. However, between-group differences were based on hypomasculinity rather than hyperfemininity on part of bulimic women. Study 2 and Study 3 explored the idea that masculinity positively contributes to general esteem and reduces the risk of bulimia nervosa. In Study 2, three competing theories of the optimal relationship between mental health and gender identity (congruence, androgyny, and masculinity) were related to bulimia and tested with structural equation modeling in a sample of 301 North American undergraduates. In Study 3, the findings of Study 2 were cross-validated in a sample of 464 West German high school students. The results indicate that masculinity had significant positive effects on eating behavior via esteem, whereas the effects of femininity were negligible.

Repeated binge/purge cycles in bulimia nervosa: role of glucose and insulin.

The available data indicate that over half of patients with bulimia nervosa binge and purge daily with repetitions of the binge/purge cycle being common. An understanding of the biobehavioral mechanisms associated with frequent binge/purge cycles may aid the general conceptualization of bulimia nervosa including its development and maintenance. Binging and purging have demonstrable physiological effects that may be partially responsible for the repetition of binge/purge episodes. In the present study, the cephalic phase oversecretion of insulin and high insulin levels subsequent to purging were investigated as possible mediators of repeated binging and purging. Insulin and glucose levels of bulimic and nonbulimic women were measured in response to: thinking about food, the presence of food, while eating, and for the bulimic group, after purging. Bulimic subjects displayed a dramatic reduction in both insulin and glucose after purging the test meal. When these same subjects ate a subsequent meal that was not purged, they displayed elevations in insulin and glucose similar to those of the normal controls. The hypoglycemia resulting from purging appears to be partially responsible for the continuation of repeated binge/purge episodes.

Bulimia Nervosa: An Examination of the Anxiety-Inhibiting Properties of the Prospect of Vomiting

The anxiety-inhibiting properties of the prospect of vomiting were assessed and contrasted in 12 women with bulimia nervosa and an equal number of non-bulimic women. Subjects were exposed to a pleasant control scene and six food-related scenes in which they imagined eating standardized test meals with the knowledge that vomiting could or could not occur afterwards. The level of anxiety evoked by the scenes was assessed using subjective, behavioural and physiological measures. As predicted, bulimics reported that they would consume more of the meal when vomiting could occur after. No such difference was found for control subjects. However, the groups did not differ on subjective and physiological measures of anxiety. The results of the present study suggest that bulimics may utilize a hierarchy of control strategies to mediate the anxiety evoked by eating that may be amenable to cognitive-behavioural interventions.

The relationship between childhood sexual abuse and subsequent onset of bulimia nervosa

Seventy-two young adult women identified by the Bulimic Investigatory Test, Edinburgh (BITE) as having a high probability of suffering from bulimia nervosa were compared with 72 matched controls who did not display bulimic symptoms. Both groups were given measures of sexual abuse history, dissociation, and early family mealtime experiences. Rates of self-reported sexual abuse after the age of 12 with an adult relative as the perpetrator were significantly greater in the women diagnosed as bulimic. Nonsignificant but high rates of sexual abuse prior to age 12 were also found for this group. Dissociative experiences were also significantly more common in the bulimic group overall, and higher still for bulimic women who reported sexual abuse as children. Bulimic women had more negative and unusual mealtime experiences than nonbulimic women. Results suggest that sexual abuse may be related to the subsequent onset of bulimia nervosa for some women.

An ongoing cross-sectional study of the prevalence of eating disorders in freshman college students

Our third cross-sectional survey designed to elicit DSM-III inclusion criteria for bulimia was completed by 1836 students, 97.2% of those surveyed. Based on operationalized criteria, 4.7% of females reported a current eating disorder diagnosis. These included bulimia (4.3%), bulimia nervosa (2.2%), bulimia with weekly binge/purging behavior (1.1%), and anorexia nervosa (0.1%). Current bulimia was reported by 0.1% of males and current bulimia nervosa by 0.3%. Those women with current bulimia were more likely to report a history of treatment for alcoholism and drug abuse than those bulimic women in remission. The data suggest that fear of loss of control over eating is an important part of the diagnostic criteria for bulimia nervosa, while fear of being fat is less apt to differentiate between bulimic and nonbulimic women. The desire for low weight was more pronounced in bulimic female students in the current survey than in previous surveys. The percentage of women who reported a history of bulimia with weekly binge eating and purging went from 1% in 1980 to 3.2% in 1983 and to 2.2% in the current survey indicating that the prevalence for this disorder may have peaked and may be declining.

Body weight and bulimia as discriminators of psychological characteristics among anorexic, bulimic, and obese women.

Bulimic women from underweight (n = 20), normal-weight (n = 31), and overweight (n = 22) categories were compared with restrictor anorexics (n = 20), normal controls (n = 31), and obese subjects (n = 22). Each subject was administered the Minnesota Multiphasic Personality Inventory, the Internal-External Locus of Control Scale, the Rosenberg Self-Esteem Scale, and the Semantic Differential Potency Scale. Bulimic women in all 3 weight categories exhibited greater psychopathology, more external locus of control, lower self-esteem, and lower sense of personal effectiveness than nonbulimic women at similar weight levels. The highest psychopathology, lowest self-esteem, and most external locus of control were found among the underweight bulimic women. Significant differences between bulimic women of different weight levels suggest the need for some modification of treatment approaches depending on the bulimic women's weight level.

An Investigation Into the Cognitive Functioning of Bulimic Women

The present study examined differences in selected areas of cognitive functioning of 18 bulimic and 23 nonbulimic women. The participants were compared on variables related to cognitive and behavioral coping and self‐efficacy. Our results indicated differences between bulimic and nonbulimic women on all measures. Bulimic women demonstrated higher levels of dietary restraint; lower self‐appraised problem‐solving ability; lower sense of personal efficacy with regard to successful performance in a variety of life tasks; and a tendency to attribute positive events to external, global, and unstable factors. The results are discussed in the context of previous research and also present implications for practicing counselors.

Social dependency and social support in bulimic and nonbulimic women

We tested the hypotheses that bulimic women would be characterized by a high degree of social dependency and low levels of social support and that bulimic and nonbulimic women would differ in the interaction of these two variables. A secondary hypothesis, derived from Boskind-White and White's feminist account of bulimia, was that bulimic women are characterized in particular by social dependency on men and a lack of social support from men. A group of 23 normal-weight bulimic women were compared with 38 control subjects and were found to differ only in that they reported more social dependency. There was no evidence that bulimics were lacking in social support, compared with controls, nor was there any relation between bulimia and the interaction of social dependency with social support. Contrary to Boskind-White and White's theory, both bulimic and nonbulimic women reported more social dependency on men than on women, and the size of this discrepancy was found to be equal for both samples.

Bulimia nervosa and resting metabolic rate

This study investigated the relationship between bulimia nervosa and resting metabolic rate. It was hypothesized that severe levels of bulimia, characterized by purging through self-induced vomiting as well as restrictive eating patterns, would be associated with a decrease in the rate of energy utilization and thus a lower resting metabolic rate. Forty-two female subjects participated in the metabolic assessment. Twenty-six were given the diagnosis of bulimia nervosa, and only those subjects purging through self-induced vomiting were included. Sixteen nonbulimic women of comparable age, height, and weight were included as a control group. Resting metabolic rate was measured by continuous monitoring of expired oxygen and carbon dioxide fractions by indirect calorimetry via open-circuit spirometry. Mean values of kilocalories per hour per kilogram were utilized as the dependent variable in the statistical analysis. Bulimic subjects were divided into severe and less severe groups using a median split on the Bulimia Test (BULIT) and compared with normals. Results showed a negative correlation between severity of bulimia, as measured by the BULIT, and resting metabolic rate. It was found that severe bulimics had lower resting metabolic rates than less severe bulimics and normals, who did not differ. These data indicate that severe levels of bulimia are associated with lower resting metabolism, although the correlational nature of the data prohibits a direct causal statement regarding bulimic behavior and its effects on metabolism.

Body-image disturbances in bulimia nervosa: influences of actual body size.

This study evaluated body-image distortion and ideal body-size preferences in 423 nonbulimic women and 108 bulimics. Analyses of covariance were utilized to compare the bulimic and nonbulimic groups on measures of current and ideal body size. Weight was used as a covariate to evaluate the influence of actual body size on perception of current body size and selection of ideal body size. Bulimics chose current body sizes that were significantly larger than those picked by nonbulimics regardless of actual body size. Bulimics also chose thinner ideal body sizes than did nonbulimics, regardless of actual body size. These results suggest that body-image distortion and extreme preference for thinness are a fundamental characteristic of bulimia nervosa. These results were discussed in terms of how perception of a large body size and preference for a very thin body size might interact to produce a high degree of dissatisfaction and overconcern with body size in bulimia nervosa.

Predictors of binge eating in bulimic and nonbulimic women

Predictors of binge eating in bulimic and nonbulimic women