Bulimia: an analysis of moods and behavior

Serotonin and bulimia nervosa

Serotonin (5HT) is one of several neuromodulators of feeding. Experimentally reducing 5HT activity in animals increases food intake, while increasing 5HT activity has the opposite effect. Studies suggest that women with bulimia nervosa show signs of reduced 5HT activity, which may be related to binge eating. Data supporting the theory that reduced central nervous system 5HT activity may play a role in the pathophysiology of bulimia nervosa is reviewed. Disturbances of 5HT activity and the relationship to other psychopathology in bulimia nervosa, such as depression, substance abuse, and impulsivity, are also reviewed.

The last supper: emotional determinants of pretreatment weight fluctuation in obese binge eaters

The tendency of some dieters to overeat and gain weight prior to beginning a diet is well known. We examined whether emotional variables might account for this phenomenon among a group of 86 obese individuals preparing to begin a treatment program for binge eating and weight loss. Whereas subjects' baseline mood state (anger, anxiety, and depression) did not influence pretreatment weight variability, the self-reported tendency to overeat in response to specific negative emotions had a significant influence. Specifically, subjects who characteristically overeat in response to anger and depression gained weight pretreatment, whereas subjects who overeat in response to anxiety lost weight. The findings are discussed in relation to the influence of specific cognitive and emotional responses to the prospect of dieting.

Co-morbidity of eating disorders and substance abuse review of the literature

The comorbidity of eating disorders and substance use and abuse has frequently been reported in the past 15 years. To date, however, no synthesis of this literature exists. Here, 51 studies reporting on these associations are reviewed. Studies of substance use and abuse in eating disordered women are considered, as are studies of eating disorders among women classified as substance abusers. The rates of substance abuse among eating disordered women are also examined. This review indicates that associations are stronger with bulimia, and "bulimic" behaviors, than with anorexia nervosa. Analogously, bulimic anorectics report more substance use and abuse than restricters. The prevalence of drug abuse was not found to differ between the relatives of bulimics and anorectics. Several mechanisms explaining the eating disorder-substance use/abuse link are considered, and suggestions for future research made.

Binge eating versus nonpurged eating in bulimics: is there a carbohydrate craving after all?

Food selection and macro nutrient content were evaluated in a group of bulimic subjects, both during the nonpurged intake and the bingeing. Dietary data was assessed by single 24-hour recall. As expected, energy distribution and food selection differed markedly between the nonpurged diet and the binges. The main differences were related to an inverse relationship in the order of macro nutrients, fat being the dominant and protein the least important source of macro nutrients during binge eating. The nutrient content during binges admittedly had a preponderance for fat. Nevertheless, the primary choice of food items during binges was carbohydrates, which was shown both by a greater quantity and by the subjects' own desires.

A digest of memory phenomena for addiction research

The implications for addiction research of recent knowledge about human memory are described. It is important that research using self-reported data understands the limits of such data. The nature of human memory and the selective, constructive processes of remembering provide one set of limits. Abandoning retrospective data entirely is not feasible in addiction research, for it would require the abandonment of current and prospective self-reported data as well, as they are also subject to memory biases. Because of memory distortions, self-reports, even by rigorous questionnaire, are biased narratives rather than incomplete but otherwise accurate evocations of past events. These limits necessitate caution and humility in the interpretation of findings, and cannot be eliminated by any particular set of research methods. There will never be a philosophers' stone which will convert self-reported data into absolutely accurate figures of quantity, frequency and timing. Nor is it straightforward to infer social and psychological causality from the organization and timing of events as remembered.

Personality and bulimic symptomatology

This study examined the relationship between bulimic symptomatology as measured by scores on the BULIT-R and personality characteristics based on the EPQ-R in a nonclinical sample of 166 female college students. A relationship was obtained between Neuroticism, Addictiveness, and scores on the BULIT-R.

Effects of eating behavior on mood: a review of the literature

The literature focusing on the use of food as a regulator of a negative mood state is reviewed. This literature reveals that individuals experiencing a negative mood state arising from disorders ranging from tobacco withdrawal to premenstrual symptoms make use of carbohydrate ingestion, especially simple carbohydrates, to provide a temporary lifting of mood. However, other evidence suggests that some individuals may obtain a more permanent control of their negative mood stay by eliminating simple carbohydrates from their diet. While the literature is consistent in demonstrating that carbohydrate consumption can alter a negative mood state, the underlying mechanism mediating this relationship is unknown.

Disturbances in identity and self-regulation in bulimia nervosa: implications for a metaphorical perspective of "body as self"

This study investigates a metaphorical account of bulimia that proposes that bulimics lack a clearly defined sense of self, and subsequently utilize their physical bodies as a means of self-definition and regulation. Three major aspects of this perspective were assessed: identity disturbance; use of the binge and purge as means of emotional regulation; and sensitivity to interpersonal contact. Differences among bulimics, binge eaters, and normal controls were explored. Bulimics reported greater amounts of identity confusion, enmeshment, and overall instability in self-concept than normal controls and binge eaters. The binge led to an escape from self-awareness for bulimics, and the purge served to manage negative affect. Bulimics also showed greater sensitivity to interpersonal contact with positive people, and with their mother than both binge eaters and controls. Implications of the findings are discussed as well as future directions for research.

A double-blind placebo-controlled glucose challenge in bulimia nervosa: psychological effects

Nineteen bulimic women and 22 age-matched controls were randomly assigned to receive 25 g of glucose or a placebo injection under double-blind conditions. Blood samples of glucose, insulin, and glucagon, and psychometric assessments of mood and food cravings were obtained 10 min before, and 0, 5, 10, 20, 30, 45, and 60 min after injection. Blood levels of the large neutral amino acids (LNAAs) tryptophan, tyrosine, leucine, valine, phenylalanine, and leucine were determined at 10 min before and 60 min after the injection. Bulimic subjects were found to report more symptoms of distressed mood throughout the entire monitoring period than controls. Five minutes following glucose ingestion the self-reports of depression, fatigue, anxiety, and bewilderment rose to a level among the bulimic subjects that was above that at baseline, and was higher than that of bulimia nervosa (BN) subjects receiving placebo. No comparable change in mood was observed among controls. Blood glucose levels were correlated with mood in the bulimic group, but not in controls. In addition, the glucose injection induced a heightened urge to binge in the bulimic group (compared to placebo at 10 and 60 min), whereas reducing food cravings (for sweets) in the controls (at 5 min). When collapsed across time and injection condition, the blood glucose level of bulimics was lower than that of controls. There were no differences in insulin response between the groups. The bulimic group was found to have lower baseline levels of blood tryptophan, whereas no differences in the tryptophan/LNAA ratio were observed either at baseline or following glucose.(ABSTRACT TRUNCATED AT 250 WORDS)

Binge eating among the obese: a descriptive study

Nineteen obese females applying for treatment for binge eating were administered a semistructured interview assessing the presence or absence of food restrictions, thoughts, feelings and physical sensations associated with binges, typical precipitants to binges, and factors identified as useful in avoiding binge eating. Both negative mood and abstinence violations emerged as important precipitants. The results also suggested that these precipitants constitute separate, independent pathways to binge eating. Implications of these findings with respect to restraint theory are discussed.

Food craving, dietary restraint and mood

A common assumption is that dieting causes food cravings, probably as a result of food energy deprivation. This issue was investigated in a two-phase study. In phase one, 206 women completed the Dutch Eating Behaviour Questionnaire, the Three-Factor Eating Questionnaire and a food craving scale. A correlational analysis showed food craving to be only weakly related to dietary restraint, but highly and significantly correlated with external eating, emotional eating and susceptibility to hunger. In phase two, ten women who regularly experienced food cravings and ten who rarely craved food kept prospective records of their food intake, daily mood and food craving episodes. There were few differences in eating behaviour, although the cravers tended to consume slightly more daily energy than the non-cravers. The cravers had higher ratings of boredom and anxiety during the day, and dysphoric mood was prominent prior to the cravings themselves. Food deprivation does not appear to be a necessary condition for food cravings to occur. Rather, food cravings are closely associated with mood, in particular as an antecedent to craving and also as a consequence of craving.

Mood variability in adolescents: a study of depressed, nondepressed and comorbid patients

In a study to examine the variability of mood in psychiatrically disturbed adolescents, 30 inpatients aged 13-17 reported on current depressive symptoms three times a day for seven consecutive days, using a set of visual analog scales (the Adolescent Mood Scale: AMS) to record DSM-IIIR and other depressive symptoms. Ten of the patients had no depressive diagnosis; 11 had both a depressive and an 'externalizing' diagnosis (mainly conduct disorders and substance abuse disorders), and nine had depressive diagnoses but no externalizing disorder. Variability was defined in terms of (1) range of AMS scores; (2) amount of change from one test point to the next; (3) rhythmicity, measured by the autocorrelation function across 21 test points. All three groups had high levels of depressive symptoms throughout the week. On all measures of severity of depression, the depressed girls were more depressed than the depressed boys, irrespective of comorbidity. Measures of variability, however, showed no effect of sex, but comorbid patients were more likely to have a wide range of mood scores, and reported a 45% greater amount of mood change. Only five subjects had a significant lag1 autocorrelation function, and there was no indication of diurnal rhythmicity. Implications for research and diagnosis are discussed.

Seasonal mood symptoms in bulimia nervosa and seasonal affective disorder

Mood and appetite disturbances are commonly found in bulimia nervosa and seasonal affective disorder (SAD). To investigate seasonality of mood symptoms, we administered the Seasonal Pattern Assessment Questionnaire (SPAQ) to 38 consecutive bulimic patients, 38 age- and sex-matched SAD patients, and 25 age- and sex-matched normal controls. The SPAQ is a reliable, retrospective, self-rated questionnaire that assesses seasonal changes in mood, sleep, weight, and social activity. The SAD patients had significantly higher Global Seasonality Scores (GSS) than the bulimic patients, who had higher scores than the control group (F = 78.6, df = 2.98, P less than .0001). Forty-two percent of bulimics met case-finding SPAQ criteria for SAD, compared with none of the control group (chi 2 = 14.1, df = 1, P less than .0005). These data suggest that a significant number of unselected bulimic patients have seasonal mood symptoms as severe as that seen in SAD. We propose that a common neurobiologic abnormality, such as serotonergic dysfunction, may underlie the common symptoms found in bulimia and SAD.

Bulimics' perceptions of emotional responding during binge-purge episodes

The concept of changes in emotional arousal during the binge-purge cycle plays a principal role in bulimia theory. Female bulimic patients (n = 29) retrospectively rated the intensity of several emotions during their binge-purge cycle. When collapsed into positive versus negative emotion categories, both categories showed significant changes in emotions over the course of the binge-purge episode. Negative emotion increased after a binge and decreased during the purge. Positive emotion decreased after binging and increased during and after purging.

Experience sampling with elderly persons: an exploration of the method

The daily lives of a sample of elderly widows (greater than 69 years of age) were studied using the method of experience sampling developed by Csikszentmihalyi and his colleagues. The purpose of the study was to investigate the response of elderly people to experience sampling as a means of collecting information about their activities, thoughts, and moods during the course of one week. The method proved acceptable to the majority of participants and yielded reliable, valid data about their home lives, particularly from among the younger, more physically able women. Experience sampling was, within certain limits, a useful method of obtaining information from elderly people.

Influence of personality attributes and daily moods on bulimic eating patterns

Relationships among personality attributes, mood states, and eating patterns were examined in a nonclinical sample of females with bulimic symptomatology and binge eaters. Thirteen subjects in each group completed trait measures of depression, anxiety, hostility, and locus of control. Subsequently, they self-monitored affect and eating patterns over a 20-day period. Greater state depression, anxiety, and hostility all were associated significantly with subsequent daily binge eating, and with purging for bulimic subjects. The association of binge occurrence with state anxiety and hostility was significantly greater for bulimics than for binge eaters. Locus of control and trait hostility were important in influencing reactivity of binge eating to daily moods. As trait hostility and externality increased, reactivity of binges to negative mood states also increased.

Weight and eating concerns among pre- and young adolescent boys and girls

The emergence of weight and eating concerns in pre- and young adolescents and the relations of these concerns to daily experience and psychologic adjustment were investigated. Four hundred eighty-one children from fifth to ninth grades completed a Weight and Eating Concerns Scale, a depression inventory, self-esteem and body image scales, and reported their daily experiences by the Experience Sampling Method. Girls tended to report more weight and eating concerns than boys. This discrepancy increased with age. In older girls (eighth and ninth graders) extreme weight and eating concerns were associated with other signs of emotional maladjustment. Girls who experience emotional distress may try to compensate for the strain by controlling body shape and in doing so, may place themselves at risk for developing an eating disorder. Boys currently appear to be protected from this difficulty. Our findings suggest that excessive weight and eating concerns in young adolescent girls signal psychologic maladjustment which may require attention.

Why group therapy for bulimia?

Many treatment approaches for bulimia rely on the use of a group format. However, descriptions of the treatments do not reveal that the powers of group process are curative in themselves. The dynamics of the group parallel and are metaphorical for the dynamics of the disorder. Therefore, group therapy can be facilitated so that the members resolve the physical, psychological, and social aspects of their disorder through attending to these aspects of the group system. Case material is offered to illustrate symptomatic expressions and therapeutic responses.

Early family experiences of women with bulimia and depression

This study characterizes the early family experiences of 30 women with bulimia nervosa and 15 women with major depression, and compares them with 100 women controls, with particular emphasis placed on parental rearing practices, family conflict resolution, sexual mistreatment, problematic childhood indicators, and childhood separation experiences. There is little research on these patient populations in relation to their childhood experiences, and thus, it is difficult to identify markers for women at risk for these disorders. The findings show that there are significant differences between the experiences these women had growing up and those of the control group, and a profile of children at risk based upon the study indicators is presented.

Experiential aspects of bulimia nervosa. Implications for cognitive behavioral therapy

Fifty female bulimic patients were asked to complete a questionnaire describing their experience during a binge-vomit episode. Findings indicated that starvation was a common precipitant of bingeing, as were situations such as being alone and eating something, and dysphoric feelings such as anxiety and frustration. Significant others, particularly the mother and the boyfriend or husband, might also precipitate a binge. Although many feelings increased or decreased in a linear fashion as the episode progressed, others such as depression and relief waxed and waned at different points in the episode. Implications of these findings for cognitive behavior therapy were discussed.

Methylphenidate treatment of bulimia nervosa after surgery

Methylphenidate (MPT) was prescribed four days after an uncomplicated appendectomy in a 27 year old woman who had suffered from bulimia nervosa (BN) for at least nine years. Before the onset of appendicitis, her bingeing and self-induced vomiting had occurred several times daily. With MPT the patient reported a calm emotional state and an absence of temptation to binge or to induce vomiting. Previously published reports of treatment of BN with MPT could not be found. This may be the first. Vulnerability to surgical disorders and to postoperative complications as well as the safety and efficacy of MPT in patients suffering from BN deserve further study.

Is feeling "in control" related to happiness in daily life?

This research concerns the relation of subjective control and happiness within normal daily experience. Respondents from several nonclinical samples rated their feelings of control at randomly-selected moments during a week in their lives, following the procedures of the Experience Sampling Method. Analyses consider the relation of these ratings to similar ratings of affective states, first, within persons and, second, between persons. The within-person analyses show relatively little moment-to-moment correlation of subjective control and affective states. For many persons there is no correlation at all and on the average people report feeling only slightly more happy at times when feeling in control. The between-persons analyses yield findings that are more in line with explanations of subject control, showing that individuals reporting higher average daily control also experience greater average happiness. The results confirm that a generalized sense of control is important to well being in daily life, but for nondisturbed individuals short-term experiences of discontrol are not accompanied by substantial distress.

An empirical assessment of bulimic patients using multiple measures

This paper examines personality and clinical assessment data from bulimic patients and from a control group of normal volunteer subjects. Thirty-eight bulimic females representing consecutive admissions to an outpatient treatment program were administered a battery of tests including the MMPI, FIRO-B, Beck Depression Inventory, Moos Family Environment Scale, Bem Sex Role Inventory, and Conte Borderline Syndrome Index. Twenty-six normal females also completed this testing battery. As expected, bulimics differed from normals on several clinical scales, including the MMPI, Beck Depression Inventory, and Conte Borderline Syndrome Index. More importantly, however, were the results of the cluster analysis of the bulimic MMPI scores which demonstrated two clearly defined subtypes of bulimia: a mildly disturbed group that shows developmental conflicts and adjustment difficulties, and a severely disturbed group that displays low ego strength and characteristics suggesting an Axis II personality disturbance. The other testing measures failed to reach significance levels. Implications for assessment and treatment are explored in the context of these results.

Emotional and somatic consequences of binge episodes

The present study investigated emotional and somatic consequences of the daily eating episodes of 19 bulimics, 15 bingers, and 20 normal control subjects. For 1 week, subjects rated 21 emotional and somatic states immediately following all eating episodes and 1 h later. Results indicated that bulimics and bingers reported significantly greater negative and somatic consequences immediately following their binge episodes than normal eaters following all of their eating episodes. For both groups, these negative emotional consequences persisted over time. Following nonbinge episodes, only bulimics reported experiencing significantly greater negative emotions than normal controls. Comparisons of the binge and nonbinge episodes of the bulimics and bingers indicated that binge episodes are followed by greater immediate and delayed negative and somatic consequences than nonbinge episodes. Furthermore, the positive emotions that occur immediately after a binge significantly decrease in intensity within 90 min after the episode. Theoretical and clinical implications of these findings are discussed.

Lactate infusions in patients with bulimia

We performed lactate infusions in 18 bulimic patients and 11 normal controls. On the basis of blind ratings, bulimic patients appeared to react to the infusion with greater anxiety than controls. The frequency of lactate-induced panic, per se, was lower in bulimic patients than rates reported for panic disorder patients. However, it would be premature to conclude that bulimia is not a heterogeneous syndrome which includes a group of patients who panic with lactate.

Depression as a correlate of starvation in patients with eating disorders

The relationship between depressive symptoms and starvation, reflected by body weight and biochemical parameters, was investigated in 64 patients fulfilling DSM-III criteria for anorexia nervosa or bulimia. Multiple regression analysis revealed significant effects of body weight and beta-hydroxybutyric acid, respectively, on such specific depressive symptoms as depressed or dysphoric mood when controlling for severity of psychopathology of the eating disorder.

Bingeing behavior and plasma amino acids: a possible involvement of brain serotonin in bulimia nervosa

It has been suggested that bingeing and vomiting behavior may be an attempt to suppress hunger or reduce dysphoria. Theoretically, such relationships could involve a mechanism whereby bingeing and vomiting change plasma amino acids which, in turn, enhance brain serotonin-mediated satiety and/or improvement in mood. This hypothesis is based on data showing that the intake of dietary carbohydrates increases the uptake of tryptophan (TRP), the precursor of serotonin, into the brain by increasing the plasma TRP ratio (the ratio of the plasma TRP concentration to the summed concentrations of other amino acids that compete with TRP for brain uptake). Plasma prolactin (PRL) release might reflect the activation of this system. We found that an increase in the TRP ratio during bingeing and vomiting was associated with satiety (i.e., cessation of bingeing and vomiting), but not change in mood. In other words, bulimic subjects who developed an increased plasma TRP ratio during bingeing and vomiting had fewer cycles of bingeing and vomiting and a greater increase in plasma PRL than did subjects who did not develop an increase in the plasma TRP ratio. This study raises the possibility that an increase in the TRP ratio may be associated with the termination of bingeing and vomiting, perhaps due to its effects on brain serotonin metabolism.

Cognitive characteristics of bulimic and drug-abusing women

This descriptive study contrasted specific coping styles, attitudes, and irrational beliefs among three groups of women: bulimics, drug abusers, and a normative comparison group. The substance abuse groups were found to be more irrational than the comparison group and were moodier and more socially alienated. They also were prone to a negative view of the world and a bleak outlook toward the future. Bulimic subjects put considerable importance on others' approval, tended to denigrate themselves, and were under a lot of self imposed pressure and chronic tension; drug abuse subjects were more introversive, perfectionistic, and subject to recent stress. By contrast, the normative comparison group appeared confident, sociable, and optimistic.

Bulimics and restrained eaters: a personality comparison

This study compared the psychological characteristics of restrained eaters and bulimics. One hundred and thirty six female undergraduates completed the Restraint Scale, the Bulimia Test, the Narcissistic Personality Disorder Scale, a borderline personality disorder scale, the Body Cathexis Scale, and the Tennessee Self-Concept Scale which yields six measures of self-esteem (physical self, moral-ethical self, personal self, family self, social self, and total self-esteem) and four measures of psychopathology (general maladjustment, psychosis, personality disorder, and neurosis). Stepwise regression analyses were done using restraint and bulimia as dependent measures and the other measures as predictor variables. Both the regression equation for bulimia and the one for restraint included physical self-esteem and narcissism as predictor variables. As a third variable, general maladjustment was entered in the bulimia equation and moral self-esteem in the restraint equation. The results indicate that both bulimics and restrained eaters are dissatisfied with their bodies and have narcissistic qualities. However, bulimics show an element of psychopathology which restrained eaters do not and restrained eaters perceive themselves as morally virtuous, whereas bulimics do not.

Monitoring the process of recovery. Using electronic pagers as a treatment intervention

Research aimed at understanding the process of recovery has focused on evaluating the treatment outcomes of alcohol or drug abuse programs. The goal is to identify the characteristics of people who report doing well posttreatment. Such research does not describe how recovery occurs. Rather, it indicates the characteristics associated with those who recover. Electronic pagers were employed in a research project to document the process of recovery as it occurs. This research has led to a clinical trial where such monitoring is part of the aftercare treatment.

Depressive symptoms and substance use among adolescent binge eaters and purgers: a defined population study

We surveyed 646 tenth grade females in Northern California to assess the prevalence of binge eating and purging behaviors. Of these, 10.3 per cent met study criteria for bulimia and an additional 10.4 per cent reported purging behaviors for weight control. Bulimics and purgers were heavier, had greater triceps and subscapular skinfold thicknesses, and reported higher rates of drunkenness, marijuana use, cigarette use, and greater levels of depressive symptomatology.

Validity and reliability of the Experience-Sampling Method

To understand the dynamics of mental health, it is essential to develop measures for the frequency and the patterning of mental processes in every-day-life situations. The Experience-Sampling Method (ESM) is an attempt to provide a valid instrument to describe variations in self-reports of mental processes. It can be used to obtain empirical data on the following types of variables: a) frequency and patterning of daily activity, social interaction, and changes in location; b) frequency, intensity, and patterning of psychological states, i.e., emotional, cognitive, and conative dimensions of experience; c) frequency and patterning of thoughts, including quality and intensity of thought disturbance. The article reviews practical and methodological issues of the ESM and presents evidence for its short- and long-term reliability when used as an instrument for assessing the variables outlined above. It also presents evidence for validity by showing correlation between ESM measures on the one hand and physiological measures, one-time psychological tests, and behavioral indices on the other. A number of studies with normal and clinical populations that have used the ESM are reviewed to demonstrate the range of issues to which the technique can be usefully applied.

Emotional reactivity and eating in binge eating and obesity

The present study investigated daily mood fluctuations and moods during eating in normal and overweight binge and nonbinge eaters (N = 56) and moods during binge and nonbinge episodes of individuals who binge eat (N = 29). For 2 weeks, subjects completed the Multiple Affect Adjective Checklist each morning and continuously recorded the mood during eating and the type and quantity of food eaten during each eating episode. The results indicated that bingers experience greater fluctuations of anxiety and depression than nonbingers and overweight individuals experience greater fluctuations in anxiety, hostility, and depression than normal-weight individuals. In addition, for bingers, negative mood states are experienced during a significantly greater proportion of binge episodes than nonbinge episodes, although the intensity of the negative mood state was not related to the severity of the binge-eating episode. Theoretical and clinical implications of these findings are discussed.

Affective lability versus depression as determinants of bing eating

The relationships between dietary restraint, various affective disturbances, and binge eating were assessed in a sample of 73 college women unselected for bulimia. It was found, replicating earlier results, that the interaction of dietary restraint and depression was a significant predictor of binge eating. However, the interaction of dietary restraint and biphasic mood shifts was an even better predictor of the severity of binge eating and in fact accounted for all of the variance in the relationship of dietary restraint, depression, and binge eating. The results were discussed in terms of the possible role of affective liability in the development of binge eating.

Alcohol use and depression in women with bulimia

In a preliminary study examining affective and addictive components of the bulimia syndrome, individual tendencies toward alcohol abuse and depression as well as family histories of alcoholism and affective disorder were examined. Twelve women meeting DSM-III criteria for bulimia and 12 matched controls participated in the investigation. Bulimic women were significantly more depressed than controls. Although there were no significant differences in global alcoholism scores, a subgroup of bulimics emerged for whom bulimia was one of multiple and debilitating addictions. In addition, bulimic women evidenced a significantly greater family history of alcoholism than controls. Bulimia is described as a disorder with salient disruptions in eating behavior yet strongly influenced by affective and addictive components.

Bulimia: prevalence and component factors in college women

Using a measure of bulimia (BULIT) that has demonstrated validity and reliability, the prevalence of bulimia among three samples of college females was found to range from 2.0 to 3.8%. These percentages are substantially lower than most previous reports would suggest. Factor analysis of the BULIT data revealed that the binging factor accounted for 63% of the variance. Other factors identified include vomiting, negative feelings about overeating, menstruation problems, preference for high caloric/easily ingested food, and weight fluctuations. The intercorrelations among the factors were examined and the implications of these data for the proposed revised DSM-III criteria for bulimia are discussed.

Object relations ego deficits in bulimic college women

Two types of bulimic (purging and restricting) and two types of non-bulimic (binging or normal) eating patterns were reported by 547 undergraduate women who also were assessed for ego function deficits on the four subscales of the Bell Object Relations Inventory. As predicted by psychoanalytic theory, the two bulimic subgroups appeared significantly more pathological on the Insecure Attachment subscale, which identifies ambivalent interpersonal relations and fear of object loss. When the four groups were ranked according to severity of type of eating disorder, a linear increase in group means and in the proportion of high scoring subjects was found on Insecure Attachment and also on the Egocentricity subscale, which indicates suspicious and manipulative attitudes toward others. Results are interpreted to support theories that relate eating disorders to disturbances in object relations ego functioning.

Relationship of mood alterations to bingeing behaviour in bulimia

Twelve women with bulimia participated in a study in which they binged and vomited on the day after hospital admission. Caloric intake, time spent bingeing and vomiting, and self-reported mood ratings demonstrated much variation from subject to subject. Both subjective and objective ratings of mood indicated that anxiety decreased more frequently and to a greater extent than depression, both during and after bingeing and vomiting. The present data, obtained in a controlled setting, tend to confirm previous information on binge episodes obtained by self-report from bulimic patients. Bingeing and vomiting episodes may provide bulimic patients with a physiological mechanism for temporarily relieving a dysphoric mood state.

Bulimic vomiting alters pain tolerance and mood

Bulimia, a disorder of episodic binging and purging, remains without a known etiology. A case report is presented of a patient who attributed bulimic episodes to efforts at inducing euphoria. Experimental pain tolerance was increased by bulimic vomiting, blocked by naloxone, but not by saline. Vomiting was also associated with falls in depression and anxiety. Plasma ACTH and cortisol, putative markers for beta-endorphin, also rose following vomiting. It is hypothesized that in some bulimics, the disorder arises by virtue of an addiction to one's own internally released endogenous opioid peptides.

Bulimia and depression

Fifty-six adult females with DSM-III bulimia were evaluated for personal and family histories of other psychopathologies. Forty-three subjects (77%) evidenced mild depression of which 13 (23%) reported moderate-severe symptoms by the Beck Depression Inventory--a finding confirmed with Hamilton Rating Scale for Depression and the SCL-90-D scale. A personal history of affective disorder was found in 52%, while 59% reported first degree relative(s) with affective disorder. Subjects with first-degree relatives with drug dependence, alcoholism, or depression had an earlier onset of bulimia than those without such relatives. Bulimia may be symptomatically or pathophysiologically related to depression.