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

Bulimic symptoms and interpersonal functioning among college students

Integrating interpersonal theory and the stress generation hypothesis, two studies investigated the association between bulimic symptoms and interpersonal distress and the mechanism underlying this association. In Study 1, 36 pairs of female roommates completed self-report questionnaires in a laboratory while Study 2 recruited 539 undergraduate men and women to participate in a longitudinal online study by completing self-report measures at two time points. Multilevel modeling revealed that targets' bulimic symptoms predicted roommates' intention to continue living with them in Study 1. Greater bulimic symptoms predicted lower intention. In Study 2, bulimic symptoms had a direct and an indirect effect on interpersonal distress, with reassurance-seeking as a mediator in the indirect effect. Findings replicated previous studies showing that bulimic symptoms generate further distress and, in our studies, interpersonal distress specifically. Moreover, reassurance-seeking was a newly identified mechanism underlying this association. These findings provide support for the usefulness of interpersonal theory and the stress generation hypothesis as a framework for understanding bulimic symptomatology. Clinicians may find it useful to target reassurance-seeking behaviors during the treatment of bulimic symptoms in order to improve treatment outcomes.

The effects of social support and stress perception on bulimic behaviors and unhealthy food consumption

Two studies tested a model where perceived stress was the proposed mediator for the relationship between perceived social support and bulimic behaviors, and between perceived social support and unhealthy food consumption among undergraduate students. Study 1 was a longitudinal, online study in which undergraduate students completed the Multidimensional Scale of Perceived Social Support and the Bulimia Test-Revised at the Time 1 assessment, and the Perceived Stress Scale and the Eating Disorder Examination Questionnaire at the Time 2 assessment, approximately four weeks later. Study 2 was an experimental study in which female participants were randomly assigned into a group with or without social support. Stress was induced with a speech task, followed by a bogus taste task paradigm designed to assess unhealthy food consumption. Bootstrap analyses revealed an indirect effect of perceived social support on bulimic behaviors and unhealthy food consumption through perceived stress. Perceived social support was associated with lower perceived stress in both studies. Lower perceived stress was associated with less self-reported bulimic behaviors in Study 1 and greater consumption of unhealthy foods in Study 2. The negative association between perceived stress and calorie consumption in Study 2 was moderated by dietary restraint. Findings suggest that stress perception helps to explain the relationship between perceived social support and bulimic behaviors, and between perceived social support and calorie consumption. Stress perception may be an important treatment target for eating disorder symptoms among undergraduate students.

Assessment of Eating Disorders in Women

This article reviews current eating disorder self-report and interview measures and makes recommendations for choosing assessment devices for practice and research. The authors also incorporate overviews of related measures, such as body satisfaction and restrained eating. The presentation of women with eating disorders on measures of general psychological functioning (such as the Minnesota Multiphasic Personality Inventory) is also discussed. Implications and recommendations for practice are presented, as are recommendations for future research. The lack of validation of, and urgent need for, eating disorder assessment measures with ethnic minority women is discussed throughout.

An examination of the prospective impact of bulimic symptoms and dietary restraint on life hassles and social support

BACKGROUND

The stress generation hypothesis posits that individuals with psychopathology engage in maladaptive behaviors that create stress. Although extensively researched in the depression literature, few studies have investigated whether the stress generation hypothesis applies to eating disorders. This study examined whether bulimic symptoms and dietary restraint predict future life hassles and low social support among undergraduate students.

METHODS

Three hundred seventy-four undergraduate students participated in this two-part prospective study through a secure online system. They completed questionnaires assessing depressive symptoms, bulimic symptoms, dietary restraint, life hassles, and social support.

RESULTS

Regression analyses revealed that baseline bulimic symptoms predicted greater life hassles but not lower social support one month later, after statistically controlling for baseline measures. Baseline dietary restraint did not predict future life hassles or social support.

LIMITATIONS

Limitations include use of self-report measures, suboptimal response rates at the follow-up assessment, and use of a non-clinical sample with primarily White participants.

CONCLUSIONS

These results provide preliminary support for the stress generation hypothesis in relation to bulimic symptoms. Individuals with bulimic symptoms may generate stressors similar to those experiencing depressive symptoms. Our findings suggest that emphasizing stress management in the treatment of individuals with bulimic symptoms could potentially improve treatment outcomes.

Measuring eating disorder attitudes and behaviors: a reliability generalization study

BACKGROUND

Although score reliability is a sample-dependent characteristic, researchers often only report reliability estimates from previous studies as justification for employing particular questionnaires in their research. The present study followed reliability generalization procedures to determine the mean score reliability of the Eating Disorder Inventory and its most commonly employed subscales (Drive for Thinness, Bulimia, and Body Dissatisfaction) and the Eating Attitudes Test as a way to better identify those characteristics that might impact score reliability.

METHODS

Published studies that used these measures were coded based on their reporting of reliability information and additional study characteristics that might influence score reliability.

RESULTS

Score reliability estimates were included in 26.15% of studies using the EDI and 36.28% of studies using the EAT. Mean Cronbach's alphas for the EDI (total score = .91; subscales = .75 to .89), EAT-40 (total score = .81) and EAT-26 (total score = .86; subscales = .56 to .80) suggested variability in estimated internal consistency. Whereas some EDI subscales exhibited higher score reliability in clinical eating disorder samples than in nonclinical samples, other subscales did not exhibit these differences. Score reliability information for the EAT was primarily reported for nonclinical samples, making it difficult to characterize the effect of type of sample on these measures. However, there was a tendency for mean score reliability to be higher in the adult (vs. adolescent) samples and in female (vs. male) samples.

CONCLUSIONS

Overall, this study highlights the importance of assessing and reporting internal consistency during every test administration because reliability is affected by characteristics of the participants being examined.

Evaluating the acquired preparedness model for bulimic symptoms and problem drinking in male and female college students

Individuals who act impulsively under stress show increased risk for both problematic alcohol use and problems with food. These two issues evidence significant comorbidity; many models have explored the relation between these conditions. The current study examines the relation of trait urgency and disorder-specific expectancies to alcohol problems and eating. Previous studies have examined these variables together in females, and this investigation evaluates this model in a combined sample of men and women. The findings from this study are consistent with an acquired preparedness model, indicating that trait urgency and expectancies enhance risk for both alcohol and eating problems. Furthermore, expectancies moderate the relationship between urgency and bulimic symptoms. The relationship between urgency, expectancies, and drinking depends on gender.

The acquired preparedness model of risk for bulimic symptom development

The authors applied person-environment transaction theory to test the acquired preparedness model of eating disorder risk. The model holds that (a) middle-school girls high in the trait of ineffectiveness are differentially prepared to acquire high-risk expectancies for reinforcement from dieting or thinness; (b) those expectancies predict subsequent binge eating and purging; and (c) the influence of the disposition of ineffectiveness on binge eating and purging is mediated by dieting or thinness expectancies. In a three-wave longitudinal study of 394 middle-school girls, the authors found support for the model. Seventh-grade girls' scores on ineffectiveness predicted their subsequent endorsement of high-risk dieting or thinness expectancies, which in turn predicted subsequent increases in binge eating and purging. Statistical tests of mediation supported the hypothesis that the prospective relation between ineffectiveness and binge eating was mediated by dieting or thinness expectancies, as was the prospective relation between ineffectiveness and purging. This application of a basic science theory to eating disorder risk appears fruitful, and the findings suggest the importance of early interventions that address both disposition and learning.

Distinctions Between Two Expectancies in the Prediction of Maladaptive Eating Behavior

In this longitudinal study, the authors provide support for the validity of the claim that differences in the nature of the reinforcement that adolescent girls expect from eating contribute to the development of different forms of maladaptive eating. The learned expectancy that eating is pleasurable and rewarding predicted higher levels of social/celebratory overeating across the first year of middle school but did not predict higher levels of clinical binge eating. In contrast, the expectancy that eating helps one manage negative affect predicted higher levels of binge eating but not of social/celebratory overeating across the same time period (n = 394). The results also supported a reciprocal model in which binge eating predicted higher levels of the expectancy that eating will manage negative affect but not that eating is pleasurable and rewarding; conversely, social/celebratory overeating predicted higher levels of the expectancy that eating is pleasurable and rewarding but not that eating will manage negative affect.

Reliability of self-reported eating disorders: Optimizing population screening

OBJECTIVE

The objective of this study was to assess whether short self-report eating disorder screening questions are useful population screening methods.

METHOD

We screened the female participants (N = 2881) from the 1975-1079 birth cohorts of Finnish twins for eating disorders, using several short screening questions and three Eating Disorder Inventory (EDI) subscales. Comparing these measures with clinician-conducted semi-structured diagnostic interviews (N = 549) of Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) anorexia and bulimia, we calculated their sensitivities and specificities and drew receiver operating characteristic curves to further compare these items.

RESULTS

For current and lifetime bulimia, best tradeoffs between sensitivity and specificity were reached by addressing purging behaviors. For current and lifetime anorexia, the questions "Have you ever had anorexia" and "Has anybody ever suspected that you might have an eating disorder?" optimized tradeoffs between sensitivity and specificity. These questions generally outperformed EDI subscales.

CONCLUSION

Simple screening questions, although less than ideal, are at least as good as other available instruments for community screenings.

Factor structure of the Bulimia Test-Revised in college women from four ethnic groups

The factor structure of the Bulimia Test--Revised (BULIT-R) was investigated using confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). The sample consisted of 2,671 female college students (African American, Asian American, Caucasian American, and Latino American). Reliability coefficients were excellent across groups. African Americans scored significantly lower on the BULIT-R than Caucasian Americans. Across groups, CFA and EFA results suggest a six-factor solution is most appropriate. Consistent across groups were factors representing bingeing, body image, purging, and extreme weight loss behaviors, while few differences were observed across groups. These findings suggest that the measure is reliable and valid for use with diverse ethnic groups. Future research should focus on culturally salient psychological correlates of disordered eating in diverse ethnic groups.

Plasma ghrelin in anorexia, bulimia, and binge-eating disorder: relations with eating patterns and circulating concentrations of cortisol and thyroid hormones

The present study was designed to investigate the relations between plasma ghrelin concentrations, eating patterns, and circulating concentrations of cortisol and thyroid hormones in women with anorexia nervosa, bulimia nervosa, and binge-eating disorder. The patterns of disordered eating behavior were assessed using the Eating Attitudes Test (EAT-26) and the Bulimia Test-Revised (BULIT-R). In women with eating disorders, but not in healthy control women, plasma ghrelin concentrations were negatively correlated with body mass index (BMI) and plasma concentrations of thyreotropin (TSH), free T3 and free T4, and positively correlated with plasma concentrations of cortisol. The ghrelin concentrations of women with binge-eating and purging behavior were significantly lower than those of women with anorexia nervosa, restricting type, and there was a negative relation between the frequency and severity of binge-eating and purging behavior, as measured by the BULIT-R total score, and ghrelin concentrations. In a multivariate regression model controlling for the confounding effects of body mass index (BMI) and age, higher ghrelin concentrations were correlated with lower BULIT-R total scores. The results of this study did not confirm the hypothesis advanced in previous studies that ghrelin concentrations are higher in patients with binge-eating/purging forms of eating disorders. Based on these data, we suggest that, in women with eating disorders, ghrelin concentrations best reflect nutritional status rather than specific patterns of disordered eating behavior.

Bulimic Pathology in Black Students in South Africa: Some Unexpected Findings

A high frequency of behaviours and attitudes associated with bulimia nervosa among black respondents, including males, has recently been reported in South Africa. The aims of the present study were to replicate these findings using a sampling procedure which would yield few refusals or dropouts, and to interview black males with bulimic symptoms to gain an understanding of their behaviour and motivation. In total, 40 black females, 39 black males, 40 white females and 42 white males who were students in residence at Rhodes University completed the Bulimia Test (BULIT). The criterion for marked bulimic pathology was exceeded by 25% of white females, 10% of black females and 5% of black males. The mean BULIT score for white females was significantly greater than that of the other groups and the other three groups did not differ significantly among themselves. Interviews revealed marked variability in understanding technical terms related to eating disordered behaviour, particularly among black males. When respondents who answered inconsistently were identified and removed from the analysis, the main conclusions from the analysis of variance were unaltered although the mean BULIT for black males was reduced by 3.7 and only one (2.5%) black male remained above the cut-off. It is concluded that subgroups of educated blacks may show relatively little bulimic pathology, and that the previous finding of significant bulimic pathology among black males might be artifactual and needs to be replicated under carefully controlled conditions.

Using item response theory in the development and validation of the College-Oriented Eating Disorders Screen

The current study examined the psychometric characteristics of the College-Oriented Eating Disorders Screen (COEDS), a college-student-focused screening measure to assess and identify individuals at-risk for the development of eating disordered pathology. By screening a large pool of pilot questions and using methods based in item response theory (IRT), seven items were identified with well-targeted contents that discriminated well across the continuum of eating disorder severity. The resulting measure evidenced a unidimensional factor structure and correlated highly with the original COEDS, standard measures of eating disorders pathology, and a measure of associated symptomatology (e.g., depressive symptoms). Based on these results, we discuss the utility of the COEDS as a prognostic indicator for risk of eating disordered pathology among college students.

Examining the inventory of interpersonal problems as a tool for conducting analogue studies of mechanisms underlying Borderline Personality Disorder

Despite recent advancements in the treatment of Borderline Personality Disorder (BPD), little is known about the underlying mechanisms in the development and maintenance of the disorder. To examine these issues, it is first necessary to identify a brief screening measure that can be used to assess factors underlying BPD. Considering this need, the current investigation examined the utility of a BPD-related composite consisting of the Inventory of Interpersonal Problems-Interpersonal Sensitivity (IIP-IS) and Aggression (IIP-Ag) subscales of the IIP in a sample of college students ( [Formula: see text] ) and a sample of individuals seeking residential drug use treatment ( [Formula: see text] ). Data indicated that score on this composite measure (IIP-BPD) was positively related to scores on measures tapping BPD-related symptomotology, as well or better than the IIP total score in all cases. These data suggest the specificity of the IIP-BPD and support its use in analogue studies to better understand the mechanisms underlying the disorder.

Reliability, stability, and factor structure of the Bulimia Test-Revised and Eating Disorder Inventory-2 scales in adolescence

The Eating Disorder Inventory-2 (EDI-2) and Bulimia Test-Revised (BULIT-R) have demonstrated strong reliability and validity in college students and adults. Although used in adolescent samples, little is known about the psychometric properties of these measures for adolescents. The reliability, factor structure, and mean levels of five EDI-2 scales and the BULIT-R were evaluated over 3 years. Data were collected yearly from two samples of adolescent females, one recruited from three public middle schools (n = 239, mean baseline age = 12.8) and one from two public high schools (n = 119, mean baseline age = 15.9). Results provide strong evidence for the reliability and stability of these measures. Mean levels of both measures appeared remarkably consistent over the 3 years. These results provide evidence of good psychometric performance for these scales in adolescence. The lack of change in these measures raises questions about the developmental trajectory of these variables through adolescence.

Self-prescribed laxative use: a drug-utilization review

This study was conducted to determine the reasons for the choice of self-prescribed laxatives and to acquire information on how they were used and tolerated. From November 1999 to February 2000, 70 pharmacies, uniformly located throughout the Campania region of southern Italy, distributed a questionnaire to purchasers of over-the-counter laxatives. The average age of the (mostly female) respondents was 45.9 years; 23.8% were elderly. Among the 7324 individuals who completed the survey, 77.6% selected an oral product; 22.4% preferred rectal administration. A physician influenced the choice of a laxative in 37.7% of the cases, a pharmacist in 20.5%; other suggestions came from relatives (14%), acquaintances (12.1%), advertisements (11.7%), and miscellaneous sources (4%). Only 59.8% of respondents used these drugs correctly, and 58.2% consulted a physician or pharmacist because of constipation. Adverse effects, mainly gastrointestinal symptoms, occurred in 6.1% of those surveyed. The long-term use or abuse of laxatives can cause serious medical consequences, as well as mask diseases, delaying diagnosis and appropriate treatment. Physicians, pharmacists, and other health-care personnel should counsel patients on the proper use of these easily available, ubiquitous drugs.

Validation of eating and dieting expectancy measures in two adolescent samples

OBJECTIVE

To demonstrate the validity of two measures of eating and dieting expectancies (The Eating Expectancy Inventory [EEI] and the Thinness and Restricting Expectancy Inventory, [TREI]) for use with adolescents.

METHOD

Seventh (N = 392) and tenth graders (N = 300) completed the Bulimia Test-Revised (BULIT-R), the Eating Disorder Inventory (EDI-II), and two factors of the Three-Factor Eating Questionnaire (TFEQ).

RESULTS

Findings replicated for the two adolescent samples. The expectancy that thinness leads to overgeneralized life improvement correlated with measures of "successful" dieting, dieting plus disinhibition, and bulimic symptomatology. Expectancies for negative reinforcement from eating (e.g., eating helps manage negative affect and alleviate boredom) correlated with dieting plus disinhibition and bulimic symptoms, but not with successful dieting. Negative reinforcement from eating and reinforcement from thinness expectancies accounted for different bulimic symptom variance than that accounted for by the personality factors of perfectionism, interpersonal distrust, and ineffectiveness.

DISCUSSION

Results were consistent with prior work on college and clinical samples, thus supporting use of the expectancy measures with adolescents.

Bulimia in children and adolescents

Although there have been many recent advances in research, much work remains to be done in the area of child and adolescent eating disorders. More data are needed regarding the normal development of eating behavior, resilience and risk factors for eating pathology, and treatment studies in children and adolescents. The best studied areas include epidemiology, short-term treatment for bulimia nervosa (BN), and outcome in anorexia nervosa. A case report of the single blind use of repetitive transcranial magnetic stimulation in a patient with BN has been reported, but its safe use in children and adolescents remains to be established.

Dietary restraint and negative affect as mediators of body dissatisfaction and bulimic behavior in adolescent girls and boys

Stice's dual pathway model of dietary restraint and negative affect was examined in both adolescent girls and boys. Self-report measures assessing body dissatisfaction, dietary restraint, negative affect and bulimic behavior were administered to 267 girls and 199 boys aged between 12 and 16 years. The findings for the girls were consistent with Stice's model, in that they indicated that both dietary restraint and negative affect mediated the relationship between body dissatisfaction and bulimic behavior. For the boys who desired a thinner body size, only negative affect was found to mediate the relationship between body dissatisfaction and bulimic behavior. On the other hand, for boys who desired a larger body size, both body dissatisfaction and dietary restraint were found to exert an independent effect on bulimic behavior. As boys can aspire to two contrasting and seemingly opposite body size ideals, the findings highlight that the relationship between body dissatisfaction, dietary restraint, negative affect and bulimic behavior are more complex in males than in females. Further research using longitudinal designs is needed in order to test the directional and bidirectional nature of the observed interrelationships.