Impulsivity and dyscontrol in bulimia nervosa: is impulsivity an independent phenomenon or a marker of severity?

Abstract

Fifty-eight normal-weight DSM-III-R bulimia nervosa patients were compared with 27 normal controls on measures of bulimia nervosa, depression, impulsivity, obsessionality and impulse control (dyscontrol) behaviours. Patients scored higher than controls on all these measures. Almost half the patient cohort met Lacey's multi-impulsive bulimia criteria. When bulimic symptoms were controlled for in an analysis of covariance, multi-impulsive bulimics did not score significantly differently to non-impulsive bulimics on psychometric measures of impulsivity, obsessionality and depression. The concept of impulsivity is critically reviewed and newer concepts linking obsessionality and impulsivity are explored.

Pediatric Obesity: Parallels with Addiction and Treatment Recommendations

“…Eating disorders are an example of this comorbidity, as patients with BN and binge eating disorders may exhibit both obsessive-compulsive and impulsive traits 121,[126][127][128][129] . However, findings regarding correlates of compulsivity and impulsivity in this population are mixed.…”

“…Other researchers conceptualize impulsivity and compulsivity as two separate and distinct, but often co-existing, traits [121][122][123] . Supporting this conceptualization is the high comorbidity for obsessive-compulsive and impulse-control disorders 124,125 .Eating disorders are an example of this comorbidity, as patients with BN and binge eating disorders may exhibit both obsessive-compulsive and impulsive traits 121,[126][127][128][129] . However, findings regarding correlates of compulsivity and impulsivity in this population are mixed.…”

Bulimia and Impulsive Behaviour in Middle Adolescence

“…This syndrome is reported to have a worse outcome than bulimia without excessive impulsivity [13, 17, 18, 19]. However, patients with comorbid disorders seek treatment more frequently than those with single diagnoses (Berkson’s bias) [20].…”

“…DSM-III-R impulse control disorders are characterised by failure to resist an impulse to perform an act that is harmful to the individual, increasing sense of arousal or tension before and enjoyment during the act [15]. Psychometric approaches to impulsivity describe tendencies to make fast decisions, to act without thinking, and to indulge in risk-taking behaviour [18]. Because of the crucial difference between the two approaches, Newton et al [18]proposed a distinction between the trait ‘impulsivity’ as measured by psychometric tests and behavioural difficulties described in DSM-III-R impulse control disorders.…”

Bulimia Nervosa and Personality: A Review

“…So that, it seems that impairment (primary or secondary) in the brain function would be common to these disorders, which would explain the frequency with which they appear jointly. Studies of some authors could even pose to understand bulimia as a variant of impulse control disorder that would have its outer manifestation in eating behaviour, as there are several similarities in the structure of both psychopathological disorders: the inclination to carry out a detrimental act to themselves or others, inability to resist the impulsive act, feelings of restlessness or anxiety that increases progressively before the impulsive act, which are relieved when this is done to give way to feelings of shame or guilt (Fahy & Eisler, 1993;Newton, Freeman, et al, 1993;Westen & Harnden-Fischer, 2001). …”