Trait‐level and momentary correlates of bulimia nervosa with a history of anorexia nervosa

Abstract

Objective Some investigators have suggested subtyping bulimia nervosa (BN) by anorexia nervosa (AN) history. We examined trait-level and momentary eating-related and psychosocial factors in BN with and without an AN history. Method Interview, questionnaire, and ecological momentary assessment data of eating-related and psychological symptoms were collected from 122 women with BN, including 43 with (BN+) and 79 without an AN history (BN−). Results Body mass index (kg/m2) was lower in BN+ than BN− (p=.001). Groups did not differ on trait-level anxiety, shape/weight concerns, psychiatric comorbidity, or dietary restraint; or on momentary anxiety, dietary restriction, binge eating, purging, or exercise frequency, or affective patterns surrounding binge/purge behaviors. Negative affect increased prior to exercise and decreased thereafter in BN+ but not BN−, although groups did not statistically differ. Discussion Results do not support formally subtyping BN by AN history. Exercise in BN+ may modulate negative affect, which could have important treatment implications.

Clinical utility of subtyping binge eating disorder by history of anorexia or bulimia nervosa in a treatment sample

“…Extant literature on diagnostic “crossover” may help to interpret these findings, as previous studies of AN, BN, and BED have demonstrated more severe symptomatology in those with a history of a different ED. 3,10-13,17-18 First, the presence of higher rates of comorbid mood disorders in our BED subgroup with a history of AN/BN is consistent with ED crossover in general, as both AN to BN and BN to AN transitions are associated with depression. 3,17 Second, crossover from AN or BN to BED involves a change in the symptoms required for diagnosis, but not necessarily a change in global ED severity.…”

Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders

“…People should be assessed for a past history of other eating disorders, especially anorexia nervosa, as this may be associated with increased likelihood of relapse and a poorer outcome in some (but not all) studies (Eckert et al, 1995;Goldschmidt et al, 2013;Mitchison et al, 2013;Vaz-Leal et al, 2011). People should be assessed for a past history of other eating disorders, especially anorexia nervosa, as this may be associated with increased likelihood of relapse and a poorer outcome in some (but not all) studies (Eckert et al, 1995;Goldschmidt et al, 2013;Mitchison et al, 2013;Vaz-Leal et al, 2011).…”

Hard exercise, affect lability, and personality among individuals with bulimia nervosa

“…These results provide in-the-moment evidence that exercise may serve as a means of down-regulating negative affect among individuals with BN. Additionally, using ecological momentary assessment methodology, Goldschmidt et al (in press) found that individuals with BN and a history of anorexia nervosa (AN), but not those without a history of AN, reported a decrease in negative affect following exercise (although this difference was not statistically significant). This finding tentatively suggests that a history of AN may influence the extent to which exercise is motivated by affect regulation.…”