Changes in internal states across the binge–vomit cycle in bulimia nervosa

While there is considerable evidence that bulimic behaviors serve the function of modifying internal states (e.g., satiety, mood), there is less clarity over the roles of the different behaviors across the binge-purge cycle. The present study examines the impact of bingeing and vomiting upon these internal states at different time points, and evaluates the potential reinforcement of those behaviors by the changes in internal states. Twenty-three women with diagnoses of bulimia nervosa completed a diary of all binge-vomit episodes over the course of 7 days, rating their internal states (satiety, negative mood, positive mood) at four time points during each episode. There were substantial changes across the cycle in levels of hunger, fullness, guilt/shame, anxiety/worry, and happiness/relief, but not in other states. The changes indicate that the binge-vomit cycle is maintained by the effects of both behaviors, but that the vomiting behavior evokes the strongest pattern of reinforcement. Further research is needed to determine the levels of internal states during the binge itself

Core beliefs in bulimia nervosa and depression: the discriminant validity of Young's Schema Questionnaire

It has been suggested that depression and bulimia nervosa share common patterns of core beliefs, despite their differences in more superficial levels of cognition (negative automatic thoughts; dysfunctional assumptions). Although recent research appears to support this proposal, its methodological limitations precluded the ability to assess potentially important differences in core beliefs across the groups. The present study addresses those limitations, assessing a broad range of core beliefs among five groups: nonclinical women, nondepressed bulimics, mildly depressed bulimics, severely depressed bulimics, and major depressive disorder patients. Young's Schema Questionnaire (YSQ) was used as the measure of core beliefs. All of the clinical groups reported less healthy core beliefs than the comparison women, but the major depressive disorder patients and the severely depressed bulimics had more unhealthy core beliefs than the nondepressed bulimics. Multivariate analysis demonstrated differences between all five groups, including the depressed patients and the severely depressed bulimics. These findings support the discriminant validity of the YSQ, suggesting that bulimia and depression are differentiated by core beliefs as well as by more superficial cognitive representations. These preliminary results suggest that the YSQ may be a clinically useful measure of schema-level representations in these disorders, although it will also be necessary to consider the role of schema process in different disorders. If the role of core beliefs in depression and bulimia is confirmed in future research, then there may be a need to adapt cognitive-behavioral treatments for these disorders accordingly