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Date of Award


Degree Type


Degree Name



Educational Psychology

First Advisor

Barry Markman


The relationship between bulimia nervosa-purging type (BN-P) and comorbidity has been well established in the literature. Five comorbid features have been identified as most common: depression, anxiety, personality disorders, substance abuse, and history of sexual abuse. The DSM IV added the subtype of bulimia nervosa---nonpurging type (BN-NP) and proposed binge eating disorder (BED) as an appendix diagnosis requiring further examination. Thus, three binge eating syndromes are now classified as distinct entities in the DSM IV. The extent to which there are comorbid similarities and/or differences remains unclear. The purpose of this study was to examine the relationship between BN-P, BN-NP and BED in terms of comorbidity. It was hypothesized that for each comorbid condition, the BN-P group would exhibit the highest level of severity, the BED group would exhibit the least, with the BN-NP group representing an intermediate position. One hundred one clinic subjects were recruited from therapists in Southeast Michigan who specialize in the treatment of eating disorders. Three groups were diagnosed based on DSM IV criteria: BN-P (n = 38), BN-NP (n = 21), and BED (n = 42). Subjects completed a questionnaire packet containing an instrument to assess eating disorder diagnosis (Questionnaire on Eating and Weight Patterns-Revised), and instruments assessing depression (Beck Depression Inventory), anxiety (State-Trait Anxiety Inventory-Form Y-2), history of sexual abuse (Covert-Overt Sexual Abuse Questionnaire), personality disturbance (Personality Disorder Questionnaire-4+), and alcohol abuse (Michigan Alcohol Screening Test). Test scores were analyzed by MANCOVA and ANCOVA. No differences between groups on overall rates of depression were found. However, the two bulimic groups were more severely depressed. As hypothesized, the BN-P group exhibited the highest levels of anxiety and the BED group exhibited the least. No differences were found between groups on overall levels of personality disturbance. The BN-P group exhibited the highest rates of alcohol abuse, while the BN-NP and BED groups reported lower and similar levels. There were no differences between groups on levels of covert or overt sexual abuse. All three groups reported high rates of both covert and overt forms of sexual abuse. This study lends some support to the diagnostic distinction between BN-P, BN-NP, and BED. The BN-P group exhibited the most severe type of binge eating syndrome. The BN-NP group was more similar to the BN-P group on some measures and closer to the BED group on others. More research in needed to clarify the position of BN-NP in relation to BN-P and BED.

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