Restraint, Dieting, and the Continuum Model of Bulimia Nervosa Michael R. Lowe Department of Clinical and Health Psychology Allegheny University of the Health Sciences David H. Gleaves Department of Psychology Texas A & M University Rosalie T. DiSimone-Weiss Department of Clinical and Health Psychology Allegheny University of the Health Sciences Cornelius Furgueson Department of Clinical and Health Psychology Allegheny University of the Health Sciences Christine A. Gayda Department of Clinical and Health Psychology Allegheny University of the Health Sciences Pam A. Kolsky Department of Clinical and Health Psychology Allegheny University of the Health Sciences Tracy Neal-Walden Department of Clinical and Health Psychology Allegheny University of the Health Sciences Lori A. Nelsen Department of Clinical and Health Psychology Allegheny University of the Health Sciences Shortie McKinney Department Nutrition and Food Science Drexel University ABSTRACT The authors evaluated the continuity model of bulimia nervosa, which suggests that bulimia results from extreme weight concern and dieting practices. Individuals with bulimia, current dieters, restrained nondieters, and unrestrained nondieters were compared on measures of general psychopathology, eating-disorder-specific psychopathology, and overeating. Multiple methods, including questionnaires, clinical interviews, and food records, were used to collect data. The continuity and discontinuity models were tested with trend and regression analyses. The results of most analyses were consistent with the continuity perspective. However, binge eating behavior exhibited a clear nonlinear trend, which occurred because binge eating was common in bulimic individuals but virtually nonexistent in the other 3 groups. Current dieters scored higher than restrained nondieters on restraint/weight concern, but not on psychopathology or binge eating. Overall, the results suggest that "normal" dieting is associated with psychological, but not consummatory, symptoms of bulimia. Portions of these data were presented at the 27th annual convention of the Association for Advancement of Behavior Therapy, Atlanta, Georgia, November 1993. We thank Karen Alberts, Katie Miskowski, and Kimberly Moss for their conscientious assistance in conducting this study. This research was supported by a grant from Sandoz Nutrition Company. Correspondence may be addressed to Michael R. Lowe, Department of Clinical and Health Psychology, Allegheny University of the Health Sciences, Philadelphia, Pennsylvania, 19102. Electronic mail may be sent to [email protected] Received: March 21, 1994 Revised: December 20, 1995 Journal of Abnormal Psychology © 1996 by the American Psychological Association November 1996 Vol. 105, No. 4, 508-517 For personal use only--not for distribution. Page 1 of 1711/6/2000http://spider.apa.org/ftdocs/abn/1996/november/abn1054508.htmlAccepted: January 30, 1996 Eating disorders experts generally agree that dieting is a contributing factor to the development of bulimia nervosa ( Fairburn, Marcus, & Wilson, 1993 ; Hsu, 1990 ; Polivy & Herman, 1985 ). Beyond this general point of agreement, there are two perspectives on the relationship between dieting and the development of bulimia. The continuity model ( Hsu, 1990 ; Polivy & Herman, 1987 ) suggests that bulimia develops when a person shows the more extreme manifestations (e.g., starve/binge cycles, self-induced vomiting) of the same weight and dieting concerns that plague many women in American society. The discontinuity model ( Bruch, 1973 ) acknowledges the causal role that dieting usually plays in the development of bulimia, but also suggests that dieting develops into bulimia only among individuals with other predisposing characteristics (depression, impulse control problems, etc.). In prior research, models of continuity or discontinuity have been tested by comparing unrestrained eaters, restrained eaters, and individuals with bulimia. If bulimic risk factors or symptoms increase as one moves from unrestrained eaters to restrained eaters to those with bulimia, then the continuity perspective is supported. If, on the other hand, such a trend is not observed and restrained eaters appear generally similar to unrestrained eaters, with both types of individuals differing significantly from bulimic individuals, then the discontinuity perspective is supported. Past research has found evidence of both continuity and discontinuity between bulimic individuals, restrained eaters, and unrestrained eaters. Laessle, Tuschl, Waadt, and Pirke (1989) and Rossiter, Wilson, and Goldstein (1989) both found evidence of continuity on measures of dietary and weight concern, but evidence of discontinuity on measures of general psychopathology. Ruderman and Besbeas (1992) found evidence of both continuity and discontinuity on various personality and psychopathology measures, although the preponderance of their results favored the discontinuity perspective. The present study was designed to build on past investigations of continuity/discontinuity in three ways. First, past studies did not differentiate between restrained eating and dieting to lose weight. The need to do so was documented in a review of the restraint literature ( Lowe, 1993 ), which concluded that (a) disinhibition in restrained eaters stems from their dieting/overeating history, not from their current level of dietary or cognitive restraint; (b) only about 40% of restrained eaters identified by the Restraint Scale ( Herman & Polivy, 1980 ) are dieting to lose weight at a given point in time; and (c) current dieters respond to disinhibitory influences differently than restrained eaters who are not currently dieting. According to Lowe (1993) , frequency of past dieting and overeating is the critical construct that explains why restrained eaters are vulnerable to counterregulatory and emotional eating. Because bulimic individuals have an extensive history of dieting and overeating, comparing them with low and high scorers on the Restraint Scale appears to be an appropriate method for evaluating the continuity/discontinuity models described above. However, people with bulimia not only have an extensive history of dieting and overeating, but most are presumably on a weight loss diet at any given time. Indeed, because purging is viewed as a means of compensating for food consumed during binges ( American Psychiatric Association, 1994
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