The heterogeneity of bulimic symptomatology: Cognitive and behavioral dimensions

Abstract

The present study assessed use of food as a coping mechanism and cognitive distortions regarding food and weight in relation to extent of bulimic symptomatology. Subjects were 19 women who fulfilled an operationalized defination of the DSM‐III diagnostic criteria for bulimia (bulimics), 35 women who fulfilled an operationalized definition of an absence of bulimic symptomology (symptom‐free), and 41 women who fulfilled some but not all bulimic criteria (bulimic‐like). The symptom‐free, bulimic‐like, and bulimic groups each differed from one another in a linear fashion from low to high on measures of use of food as a coping mechanism, five of eight types of cognitive distortions regarding food and weight (dichotomous thinking, worry, exaggeration, superstitious thinking, and personalization), drive for thinness, and lack of interoceptive awareness. The bulimic and bulimic‐like groups evidenced greater perfectionism, defeatism, regret, and body dissatisfaction than the symptom‐free group. Variation in the extent of use of food and cognitive distortions accounted for 70% of explained variance in the severity of DSM‐III bulimic symptomatology. These results suggest that behavioral, affective, and cognitive indices of bulimia fall along parallel continua of symptomatic severity. The results also support the relevance of preventative and therapeutic programs with multidimensional foci.

Bulimia: An entity in search of definition

“…Two studies (Johnson, Stuckey, Lewis, & Schwartz, 1983; Thompson et al, 1987) operationalized the DSM-111 via a questionnaire that has not been validated. One study (Mickalide & Anderson, 1985), which utilized data abstracted retrospectively, did not state how the authors had modified the DSM-111 criteria.…”

“…Yet, six studies that will be evaluated focused on this particular behavior (Cooper & Fairburn, 1983; Fairburn & Cooper, 1982; Grace et al, 1985;Nagelberg et al, 1984;Norman et al, 1983). Only the Thompson et al (1987) study evaluated the other compensatory methods listed in the DSM-111, as well as evaluating the role of exercise. In addition, some of these studies rewrote the DSM-I11 criteria and used this as the hallmark for determining the personality correlates of bulimics.…”

“…Bulimic Thompson et al, 1987. with and without concomitant psychological disturbances. However, we also must evaluate the incidence of the other compensatory methods listed in the DSM-I11 (2.2 & 2.3, Table 1) because the research reviewed indicates that these behaviors and attitudes do exist in obese, anorexic, and normal-weight individuals.…”

“…For these reasons, individuals who have a history of anorexia nervosa should be placed in a separate category and evaluated as such when included in these studies. The studies by Holmgren et al (1983), Johnson et al (1983), and Thompson et al (1987) provide an excellent guideline as to how this can be done, even though there are methodological problems with each of these studies.…”

“…Studies have shown that individuals will talk about bingeing, vomiting, and their concerns about food (Mann, Wood, Monck, Dobbs, & Szmukler, 1983;Schwartz, 1982). There is some agreement that there needs to be a method to discriminate cognitively an individuals's perception of what constitutes a binge because this can affect the data obtained (Fairburn & Cooper, 1982;Mackenzie, 1985;Nagelberg et al, 1984; Thompson et al, 1987). Separating individuals by different weight categories and utilizing an interview, when using self-reports, could help researchers to operationalize what constitutes binge eating, as experienced by these individuals.…”