Both psychological and physiological data support the concurrent validity of distinguishing between bulimia nervosa (BN) and purging disorder (PD) based on the presence vs. absence of binge-eating episodes, respectively. However, limited data exist on the predictive validity of this distinction. Differences in outcome or predictors of outcome would support the clinical utility of distinguishing between the two disorders, a key criterion for diagnoses within the Diagnostic and Statistical Manual of Mental Disorders. The current study sought to describe the long-term outcome of PD and compare that outcome to BN and to examine cognitive (shape/weight concerns), cognitive-affective (depressive symptoms, loss of control eating), and behavioral (eating episode size) predictors of outcome. Exploratory analyses tested if predictors of outcome differed between diagnoses and examined physiological (leptin and postprandial cholecystokinin response) predictors of outcome. Women (N = 217; N = 84 PD, N = 133 BN) were invited to completed diagnostic interviews and questionnaires at a mean (SD) of 10.60 (3.72) years following baseline assessments. Two outcomes were examined: eating disorder status and purging frequency. Of the women sought, 94% were successfully located, and 58 PD and 91 BN participated. Diagnostic stability was observed at follow-up, but outcome did not differ between PD and BN. Within PD, greater depressive symptoms predicted a lower likelihood of remission, and lower leptin levels predicted higher purging frequency at follow-up. Within BN, no variables predicted eating disorder status at follow-up. Fewer shape/weight concerns, greater loss of control eating frequency, and a larger postprandial cholecystokinin response each predicted a higher purging frequency in BN at follow-up; however, these models should be interpreted cautiously due to difficulties with model fit. Exploratory analyses indicated that baseline diagnosis did not significantly moderate associations between predictors and outcome. Taken together, results do not provide conclusive support for distinguishing between PD and BN based on outcome or predictors of outcome. Findings may reflect the longer duration of follow-up in this study compared to prior work. More work on empirically supported treatments in PD, and potential differences in response between PD and BN, are needed to fully evaluate the clinical utility of distinguishing between PD and BN and to inform diagnostic schemes. / A Dissertation submitted to the Department of Psychology in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Spring Semester 2018. / April 16, 2018. / bulimia nervosa, loss of control eating, outcome, purging, purging disorder / Includes bibliographical references. / Pamela K. Keel, Professor Directing Dissertation; Mark Winegardner, University Representative; Thomas E. Joiner, Committee Member; Norman B. Schmidt, Committee Member; Diana L. Williams, Committee Member.
| Identifer | oai:union.ndltd.org:fsu.edu/oai:fsu.digital.flvc.org:fsu_647223 |
| Contributors | Forney, Katherine Jean (author), Keel, Pamela K., 1970- (professor directing dissertation), Winegardner, Mark, 1961- (university representative), Joiner, Thomas (committee member), Schmidt, Norman B. (committee member), Williams, Diana L. (committee member), Florida State University (degree granting institution), College of Arts and Sciences (degree granting college), Department of Psychology (degree granting departmentdgg) |
| Publisher | Florida State University |
| Source Sets | Florida State University |
| Language | English, English |
| Detected Language | English |
| Type | Text, text, doctoral thesis |
| Format | 1 online resource (111 pages), computer, application/pdf |
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