A risk and maintenance model for bulimia nervosa: From impulsive action to compulsive behavior.

Abstract

This paper offers a new model for bulimia nervosa (BN) that explains both the initial impulsive nature of binge eating and purging as well as the compulsive quality of the fully developed disorder. The model is based on a review of advances in research on BN and advances in relevant basic psychological science. It integrates transdiagnostic personality risk, eating disorder specific risk, reinforcement theory, cognitive neuroscience, and theory drawn from the drug addiction literature. We identify both a state-based and a trait-based risk pathway, and we then propose possible state-by-trait interaction risk processes. The state-based pathway emphasizes depletion of self-control. The trait-based pathway emphasizes transactions between the trait of negative urgency (the tendency to act rashly when distressed) and high-risk psychosocial learning. We then describe a process by which initially impulsive BN behaviors become compulsive over time, and we consider the clinical implications of our model.

Integrating affect and impulsivity: The role of positive and negative urgency in substance use risk

“…Concerning specific addictive behaviors, negative urgency is associated with bulimic behaviors but positive urgency is not (Cyders et al, 2007). This finding is consistent with risk models for bulimia nervosa, which identify bulimic behaviors as responses to intense negative mood but not as responses to positive mood (Pearson et al, 2015). Many addictive behaviors, such as alcohol and drug use, risky sex, and gambling behavior can occur during either extreme positive moods (such as parties and celebrations) or extreme negative moods (such as to achieve negative reinforcement; Baker et al, 2004).…”

Reduced Inferior and Orbital Frontal Thickness in Adolescent Bulimia Nervosa Persists Over Two-Year Follow-Up

“…The remaining 11 met criteria for other specified feeding or eating disorder (OSFED) with subjective or objective loss of control eating episodes 30 and compensatory behaviors to avoid weight gain (i.e., OSFED-BN), and were included since adolescents with less-severe BN symptoms tend to engage in more frequent binge-eating and purging behaviors over time. 31, 32 Baseline demographic and clinical characteristics across BN subtypes are presented in Table S3 (available online). FU1 MRI and clinical/demographic data were available from 27 adolescents with BN and 22 HC adolescents (Mean time from baseline =15.7 months, SD time from baseline =6.182), and FU2 data from 18 adolescents with BN and 12 HC adolescents (Mean time difference from FU1 =14.8 months, SD time difference from FU1 =3.275).…”

Dimensions of emotion dysregulation in anorexia nervosa and bulimia nervosa: A conceptual review of the empirical literature

“…Given the increasing recognition of the role of emotion regulation processes in psychopathology (see Aldao, Nolen-Hoeksema, & Schweizer, 2010), clinically-informed conceptualizations emphasizing the link between emotion dysregulation and maladaptive behaviors have emerged (e.g., Mennin & Fresco, 2009; Selby, Anestis, & Joiner, 2008). Of particular relevance to this review, a number of theories (e.g., Haynos & Fruzzetti, 2011; Pearson, Wonderlich, & Smith, in press) and treatments (e.g., Wildes & Marcus, 2011; Wonderlich et al, 2014) have been developed that are consistent with an emotion dysregulation conceptualization of ED psychopathology.…”