Eating-disorder clients show low motivation, poor follow-through, and inordinate premature dropout rates in treatment. To date, little research has been conducted that might provide clinicians with an understanding of the critical factors that may aid clients' recovery. Such factors may be used by clinicians to better motivate clients to collaborate in treatment. The purpose of this study was to identify some of the critical factors that women with eating disorders believed were crucial in prompting or facilitating their recovery. Identification of these factors was accomplished through a systematic content analysis of semistructured interviews with recovered or recovering bulimics and anorexics. This study may contribute significantly to future research into the development of motivational supplements to eating disorder therapy ( e.g., psychoeducational materials or therapy orientation programs). Of interest were what personal, interpersonal, or environmental factors anorexic and bulimic clients reported increased their motivation to recover, and prompted them to begin the recovery process, maintain recovery, and cope with the threat of relapse. Also, factors that subjects reported hindered their progress in recovery were examined. The anorexic and bulimic subjects reported social support as a critical factor across three stages of recovery, including beginning recovery, maintaining recovery, and coping with relapse. Being "tired" of the disorder and therapy were indicated to be relevant to beginning recovery. Improved self-esteem was deemed significant in helping subjects both maintain recovery and cope with the threat of relapse. Establishing healthy eating habits and attitudes was a necessary factor required to maintain recovery. Subjects shared that developing healthy ways to deal with emotions enabled them to deal successfully with the threat of relapse. Anorexic subjects reported that people and societal expectations, fear of becoming fat, incentive to numb emotions, and poor eating habits and attitudes impeded their recovery. Bulimic subjects indicated that people and societal expectations, incentive to numb emotions, lack of understanding, and poor eating habits and attitudes hindered their recovery.

Recent research indicates that 2% to 4% of the population meet diagnostic criteria for the newly proposed binge eating disorder, and that it is much more common (30%) among the treatment-seeking obese. Although recognized as a significant problem, binge eating disorder is l1l not well understood, and there is debate about whether binge eating disorder is a distinct disorder. It has been argued that binge eating disorder is simply a variant or milder form of bulimia nervosa and not a separate and distinct disorder. Researchers have begun to study this population in greater depth in order to assess the characteristics of individuals with binge eating disorder, the similarities and differences between individuals with binge eating disorder, bulimia nervosa, and obese individuals who do not engage in binge eating, and the effectiveness of various treatments for binge eating disorder. Previous reviews of the literature (using non-meta-analytic strategies) have examined these areas and have yielded inconsistent conclusions. Therefore, a more comprehensive, current, and empirical integration of the data was conducted. In total, 297 studies of individuals with binge eating disorder, bulimia nervosa and/or obese individuals who do not engage in binge eating were collected, coded, and statistically analyzed across studies (by calculating standardized mean difference effect sizes). The key characteristics of individuals with binge eating disorder were assessed, diagnostic groups were systematically compared, and treatment outcomes (from 19 studies) were evaluated. The results indicated that individuals with binge eating disorder have a number of differences from both bulimia nervosa and obese non binge eating individuals. However, the extent of these differences was not great, and there was a general trend for binge eating disorder individuals to fall between the two groups on most measures of disturbed eating and psychopathology. These findings tend to support the continuum/variant conceptualization of binge eating disorder rather than that of a distinct disorder. In addition, data from primary research studies on the treatment of binge eating disorder indicated that, overall, psychosocial interventions were helpful in decreasing binge eating and psychopathological symptoms, but were less effective at reducing weight. The clinical implications of these findings are discussed, as are suggestions for future research.

The current study examined whether elevations on four variables (drive for thinness, depressed mood, maladaptive cognitions, and ineffectiveness) were related to increased risk of developing an eating disorder over a 4-year prospective interval. Subjects (N = 191) were female undergraduates who were assessed with the Anorexia-Bulimia Inventory (ABI), Eating Disorder Inventory (EDI), and a structured clinical interview. Results indicated that individuals with elevated scores on each of the four variables at the initial assessment did not show higher absolute eating disorder incidence rates over the 4-year interval. However, initial scores on the four variables together lll explained approximately 13% of both anorexia and bulimia symptom severity variance at the final assessment. Changes over time in the four variables were more highly related to later symptom severity, explaining 34% of the variance in anorexic severity and 16% in bulimic severity. Thus, the findings suggest that initial scores, and especially changes in scores, on the four variables were related to severity of symptoms 4 years later. However, a large proportion of the variance in eating disorder severity remained unexplained. Examination of the role of each risk variable individually revealed that initial elevations on maladaptive cognitions and drive for thinness subscales were related to higher anorexic symptom severity at the later assessment. Of interest was the absence of significant relationships between early scores on maladaptive cognitions and drive for thinness and subsequent bulimic symptoms, suggesting that anorexia and bulimia may have somewhat different risk pathways. The pretest scores on the depressed mood and ineffectiveness subscales were not significantly correlated with symptom severity at the later assessment, and were not identified by the regression analyses as parsimonious or efficient predictors of eating disorder symptoms. This finding suggests that perhaps early difficulties with depression and low self-esteem are less related to onset of later eating disorders than previously believed. Finally, the overall 4-year incidence rate of .6% found in the current study suggests that as women move through their college years, they are departing the developmental period of high risk for onset of eating disorders, and thus, new cases become increasingly rare.

The present study examined whether there was a relationship between daughters' eating disorder symptomology and maternal food control and health-conscious eating attitudes. Eighty-eight females with a continuum of eating disorder behaviors (DSM-IV eating disorders through nondieters) and 74 of their mothers participated. Participants completed the Anorexia Bulimia Inventory, two subscales from the Eating Disorder Inventory, the Three Factor Eating Questionnaire , the Family Environment Scale, the Maternal Food Control and Meal Preparation Scale, and the Marlowe-Crowne Social Desirability Scale. Results indicated that, in general, daughters' reported eating disorder symptomology and perceived familial control were related. Some of the more specific maternal food control variables perceived by daughters were also related to their reported symptomology. Yet, maternal reports on these same variables tended not to correspond to daughters' reported symptomology. Specifically, regression analyses indicated that a combination of perceived high familial control, perceived low maternal concern with healthy meal preparation and restriction, and perceived high maternal anxiety regarding healthy eating predicted higher levels of reported anorexic symptomology. Similar variables predicted reported bulimic symptomology, but only increased general familial control predicted symptoms characteristic of both disorders. Analyses also revealed that daughters' eating disorder symptomology tended to be inversely related to responding in a socially desirable manner. Perceptual differences were noted and discussed between mothers' and daughters' reports of familial control. Lastly, mothers' report of food control was not correlated with reported familial control. This study was the first to examine the more specific maternal control issues, maternal health-conscious attitudes, and their relationship to daughters' maladaptive eating behaviors. The results of the present study are consistent with the speculation that a combination of daughters' perception of high familial control, high maternal anxieties about children's eating practices, and low maternal concern with healthy meal preparation might contribute to the development or maintenance of anorexic and bulimic symptomology. Finally, limitations were discussed and recommendations were made for future research.

Public view removed at the authors request. 16/07/2006 / The daily experience of anorexia nervosa sufferers has not previously been studied and yet it is fundamental to understanding anorexia nervosa. This study examined and compared the daily experiences of anorexia nervosa patients and control participants in terms of sense of self, mood states and flow states. Flow is characterised by undivided concentration and interest in an activity for intrinsic benefits. Flow is not always desirable, as some ways of experiencing it may be harmful to the individual and society. Anorexia nervosa participants were recruited from hospitals and private practices of clinicians specialising in the treatment of anorexia nervosa. Exclusion criteria included male gender, chronic anorexia nervosa, drug abuse, and current participation in an inpatient program. Anorexia nervosa participants completed a series of questionnaires at baseline, 3-6 month follow-up and 7-12 month follow-up (stage one, two and three respectively). The questionnaires were designed to measure the severity of their eating disorder. Anorexia nervosa and control group participants completed Experience Sampling Forms (ESF) and a Repertory Grid at baseline and 3-6 months. The ESFs were completed each time a pager was activated. The pager was activated seven times a day, for four days at random times between 8.00am and 10.00pm. The pager signals were a minimum of two hours apart. The Repertory Grid consisted of 23 constructs and 13 elements provided to the participant. Thirty-one anorexia nervosa sufferers and thirty-two control participants completed stage one and eighteen anorexia nervosa sufferers and twenty-seven control group participants completed stage two of the study. Eighteen anorexia nervosa sufferers completed stage three of the study. Control participants were not required to participate in stage three. There was no difference in the severity of anorexia nervosa between completers and drop-outs The analysis of the ESFs at stage one indicated that the anorexia nervosa group participants did not spend more time alone at home or more time alone in any situation than the control group. For both groups, being alone had a negative influence on mood state, but had no effect on sense of self. The anorexia nervosa group felt lonelier and less sociable than the control group. The mood state and sense of self for the anorexia nervosa group was significantly lower over all the ESFs when compared to the control group. They were also more self-critical, experienced higher levels of guilt, were less able to live up to their own expectations, and were less satisfied with their performance in the activity they were doing. The anorexia nervosa group experienced less flow states than the control group at stage one. There was an improvement in mood state, sense of self and self-criticism for the anorexia nervosa group when they were in a flow state compared to when they were not in a flow state. There was an improvement in mood state, sense of self, guilt and self-criticism for the control group when they experienced flow, however these differences were not significant. The anorexia nervosa group had a more positive mood state and sense of self at stage two when compared to stage one. Correspondingly, there was a trend towards a reduced severity of the disorder indicated by a significant improvement on some of the psychological tests (EAT, REDS, BDI, DT). There was also a significant improvement in BMI. However, there was a significant decline in the amount of flow of anorexia nervosa participants experienced at stage two when compared to stage one. This result may be attributed to the significant decline in the response rate on ESFs in the second stage of the study for both the anorexia nervosa and control groups. Anorexia nervosa non-responders at stage two reported more severe symptoms of anorexia nervosa than anorexia nervosa responders, although this was a trend and reached significance only on minor indicators of eating disorder severity. The identification of a factor that predicted severity over a six-month period was not possible. The repertory grid analysis showed that the construct system of the anorexia nervosa participants was tighter and less complex than that of the control group. The anorexia nervosa group construed themselves as dissimilar from the way they would like to be in any context. The control group construed themselves as similar to the way they would like to be when they were alone, but as dissimilar from the way they would like to be when they were with other people. While the most salient element for both the anorexia nervosa and control groups was 'alone at home', it appears that the controls use this time for goal-directed activities. In contrast, this time was dominated by fear of losing control for the anorexia nervosa group. Although there was a trend towards a decrease in the amount of variance accounted for by the first component for the anorexia nervosa group at stage two compared to stage one, the interpretation of this result was complicated by mixed result of the control group. The anorexia nervosa groups' daily experience of life was bleak when compared to the daily experience of the control group, except for periods when the anorexia nervosa participants experienced a flow state. DeVries (1992) has documented the success of therapeutic interventions that involve the identification and replication of activities that resulted in a flow state. This investigation suggests that a similar result may be possible in the treatment of anorexia nervosa.

The central question of this study was to examine the moral orientation and the role of self in subject generated moral dilemmas for information on the developmental and cultural forces contributing to the etiology and maintenance of eating disorders in college women. The research was based on the theories of Carol Gilligan (1982, 1988, 1990). Twelve women identified as bulimic by therapists and twelve women with no eating disorder were administered the BULIT-R and the moral conflict and choice interview. A Guide to Reading Narratives of Moral Conflict and Choice for Self and Moral Voice provided the framework for analyzing the the interviews. Using Chi squares to analyze the data, no significant differences were found between the two groups on presence, predominance, and alignment of the moral voices of care and justice or on relationship framework, although a trend toward the bulimic sample aligning both with the justice and care orientations was noted. The bulimic sample expressed one or more of the vulnerabilities of care and both care and justice significantly more often than the comparison sample. No difference was found for expression of self care, though the quality of self care expressed was different. Subjects from the bulimic sample mentioned self care in conjunction with self-preservation, while subjects in the comparison group mentioned self-care as an ordinary consideration in conflicts. A significant difference was found between the two groups on mention of a problematic relationship with father, with bulimics describing an emotionally distant relationship with father more often. Finally, the quality of the conflicts described by bulimics tended to be more critical to self than those described by the comparison sample. Results were related to what Gilligan (1990) calls the biggest challenge of the adolescent female: how to integrate inclusion of self with inclusion of others. Disturbances in relationships within the family resulted in the women from the bulimic sample having difficulty with this task. Two coping styles were identified: role reversal and hostile avoidant (Salzman, 1990). The relevance of these coping styles to bulimia was discussed. Implications for therapy were reviewed and recommendations were made for future research. / Graduation date: 1992

Thesis (Ph. D.)--University of Missouri-Columbia, 2000. / Typescript. Vita. Includes bibliographical references (leaves 51-58). Also available on the Internet.

The entire thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file; a non-technical public abstract appears in the public.pdf file. Title from PDF of title page (University of Missouri--Columbia, viewed on March 19, 2010). Thesis advisor: Dr. Anna Bardone-Cone. Includes bibliographical references.

No description available.

General relationships between the proposed risk factors of perfectionism, body dissatisfaction, depression, and interoceptive awareness and the presence of bulimic symptoms were examined in this study. Interactions between these risk factors presented by previous theoretical models were also explored through Structural Equation Modeling (SEM) analysis. A sample consisting of 200 female undergraduate students completed the following measures: The Multidimensional Perfectionism Scale (MPS), The Beck Depression Inventory-II (BDI-II), the Toronto Alexithymia Scale (TAS-20), and the Questionnaire for Eating Disorder Diagnoses (Q-EDD). Taken together, the proposed risk factors of perfectionism, body dissatisfaction, depression, and interoceptive awareness were found to make a difference in predicting the presence of eating disorder symptoms. Body dissatisfaction served as the strongest predictor of bulimic symptoms in college women of all risk factors tested in this study. Direct relationships between perfectionism and depression, depression and body dissatisfaction, and body dissatisfaction and bulimic symptoms were supported by the current study's data. Clinical implications and suggestions for future research are discussed. / Department of Counseling Psychology and Guidance Services