THE HETEROGENEITY OF BULIMIA

This study examined subgroups of bulimics based on the method of weight restriction used. Sixty Caucasian women (45 normal-weight bulimics and 15 normal-weight controls) served as subjects. The bulimic subjects were 15 fasters, 15 vomiters, and 15 laxative abusers. They all fulfilled an operational definition of the diagnostic criteria for bulimia found in the Diagnostic and Statistical Manual of Mental Disorders (DSM III; American Psychiatric Association, 1980). All subjects were administered the Brief Symptom Inventory, the Beck Depression Inventory, and the Personal Attributes Questionnaire, the Attitudes Toward Women Scale, the State Trait Anxiety Scale-A Trait, the Reid-Ware Internal External Scale, the Rosenberg Self-Esteem Scale, and a body image assessment. Each subject was also asked to complete a structured interview. The bulimic women contrasted significantly with the controls in several areas. For instance, the bulimic subjects evidenced significantly more psychological distress. They were more depressed and anxious, had greater interpersonal sensitivity and lower self-esteem, experienced more difficulty with self-control, and had a poorer body image. Among the bulimic groups there were also major differences. The laxative abusers had significantly more overall distress than the vomiters and fasters. They were more depressed, anxious, and hostile. The vomiting and fasting groups responded similarly on many of the variables. These results suggest qualitative differences among bulimics and provide empirical support for the consideration of subgroups in future diagnostic criteria for bulimia.