Maintenance Factors for Persistence of Bulimic Pathology: A Prospective Natural History Study

Objective: To characterize the natural course of bulimia nervosa and identify potential maintenance factors that predict persistence of bulimic pathology in order to advance knowledge of processes that perpetuate this eating disturbance and permit the design of more efficacious treatments. Method: We followed 96 women with threshold or subthreshold bulimia nervosa over a 1-year period with quarterly interviews. Results: There were high rates of remission and relapse on a month-to-month basis, but remission became more likely to persist after a period of approximately 4 months of symptom abstinence. Initial elevations in thin-ideal internalization, expectations for reward from eating, and binge frequency predicted greater time to remission of binge eating. Initial elevations in dietary restraint and compensatory behavior frequency predicted greater time to remission of compensatory behaviors. Discussion: Results imply that treatments for eating disorder may be more effective if they can reduce thin-ideal internalization, eating expectancies, and ineffective dieting and produce rapid cessation of binge eating and compensatory behaviors. (C) 2008 by Wiley Periodicals, Inc.