Do anorexia and bulimia nervosa occur on a continuum? A taxometric analysis

We investigated the question of whether anorexia and bulimia nervosa occur on a continuum versus being discrete classes using two taxometric procedures: Mean Above Minus Below a Cut (MAMBAC) and Maximum Covariance (MAXCOV) analysis. Participants were N = 959 women diagnosed as having anorexia nervosa (n = 165), bulimia nervosa (n = 562) or atypical eating disorder (n = 18) or were nonclinical controls (n = 214). Indicators for the taxometric analyses were derived from the Eating Disorder Inventory, and we also included body mass index (BMI). Results replicated earlier taxometric findings in that both purging and nonpurging types of bulimia seemed qualitatively different from normative eating behavior. The distinction between restricting and binge-eating/purging types of anorexia nervosa also seemed to be qualitative rather than quantitative. However, results most consistently supported the conclusion that anorexia nervosa, binge-eating/purging type, occurs on a continuum with bulimia nervosa (both purging and nonpurging types) and that the two types of bulimia nervosa differ in degree rather than in kind. Overall, the results suggest that anorexia nervosa, binge-eating/purging type, is more qualitatively distinct from anorexia, restricting type, than from either type of bulimia nervosa, perhaps suggesting that these disorders should be reclassified in future editions of the Diagnostic and Statistical Manual of Mental Disorders.

[1]  Maria DaCosta,et al.  Classifications of anorexia nervosa: Question of subtypes , 1992 .

[2]  A. Ruderman,et al.  Psychological characteristics of dieters and bulimics. , 1992, Journal of abnormal psychology.

[3]  A. Beck,et al.  Subtyping major depression: a taxometric analysis. , 1994, Journal of abnormal psychology.

[4]  G. Scarano,et al.  A Description of the Continuum of Eating Disorders: Implications for Intervention and Research , 1994 .

[5]  P. Santonastaso,et al.  Family Psychiatric Morbidity in Eating Disorders , 1997 .

[6]  Paul E. Meehl,et al.  Taxometric analysis. I: Detecting taxonicity with two quantitative indicators using means above and below a sliding cut (MAMBAC procedure) , 1994 .

[7]  The role of impulsiveness in normal and disordered eating. , 1993 .

[8]  P. Meehl.  Factors and Taxa, Traits and Types, Differences of Degree and Differences in Kind , 1992 .

[9]  David H. Gleaves,et al.  The psychopathology of anorexia nervosa: A factor analytic investigation , 1993 .

[10]  D. Williamson,et al.  Empirical classification of eating disorder not otherwise specified: Support for DSM-IV changes , 1992 .

[11]  G Russell,et al.  Bulimia nervosa: an ominous variant of anorexia nervosa , 1979, Psychological Medicine.

[12]  W C Follette,et al.  Models of scientific progress and the role of theory in taxonomy development: a case study of the DSM. , 1996, Journal of consulting and clinical psychology.

[13]  P. Meehl,et al.  Taxometric Analysis: II. Detecting Taxonicity Using Covariance of Two Quantitative Indicators in Successive Intervals of a Third Indicator (Maxcov Procedure) , 1996 .

[14]  D. Watson,et al.  Diagnosis and classification of psychopathology: challenges to the current system and future directions. , 1995, Annual review of psychology.

[15]  L. Subich,et al.  Exploring the construct validity of the Eating disorder continuum , 1999 .

[16]  M Strober,et al.  A controlled family study of anorexia nervosa and bulimia nervosa: psychiatric disorders in first-degree relatives and effects of proband comorbidity. , 1998, Archives of general psychiatry.

[17]  K. Pirke,et al.  Starvation models and eating disorders. , 1995 .

[18]  D. Williamson,et al.  The Interview for the Diagnosis of Eating Disorders-Iv: Application to DSM-IV Diagnostic Criteria. , 1998 .

[19]  D. Gleaves,et al.  Continuity and discontinuity models of bulimia nervosa: a taxometric investigation. , 2000, Journal of abnormal psychology.

[20]  D. Garner,et al.  Handbook of treatment for eating disorders, 2nd ed. , 1997 .

[21]  M. Lenzenweger,et al.  The taxonicity of schizotypy: a replication. , 1995, Journal of abnormal psychology.

[22]  D. Gleaves,et al.  An examination of the internal consistency and factor structure of the eating disorder inventory-2 in a clinical sample. , 1994, The International journal of eating disorders.

[23]  D. Gleaves,et al.  Restraint, dieting, and the continuum model of bulimia nervosa , 1996 .

[24]  K. Kendler,et al.  Anorexia nervosa and anorexic-like syndromes in a population-based female twin sample. , 1995, The American journal of psychiatry.

[25]  K. Pirke,et al.  The significance of subgroups of bulimia and anorexia nervosa: Lifetime frequency of psychiatric disorders , 1989 .

[26]  P. Meehl.  Bootstraps taxometrics. Solving the classification problem in psychopathology. , 1995, The American psychologist.

[27]  D. Garner,et al.  Diagnoses of eating or dieting disorders: what may we learn from past mistakes? , 1994, The International journal of eating disorders.

[28]  A. Kuruoglu.  Genetic factors in eating disorders , 2000 .

[29]  N. Waller,et al.  Types of dissociation and dissociative types: A taxometric analysis of dissociative experiences , 1996 .

[30]  N G Waller,et al.  The prevalence and biometric structure of pathological dissociation in the general population: taxometric and behavior genetic findings. , 1997, Journal of abnormal psychology.

[31]  Mark Snyder,et al.  "To Carve Nature at Its Joints": On the Existence of Discrete Classes in Personality , 1985 .

[32]  Paul E. Meehl,et al.  Multivariate Taxometric Procedures: Distinguishing Types from Continua , 1997 .

[33]  J. Thompson,et al.  Correlation between the EAT-26 and the EAT-40, the Eating Disorders Inventory, and the Restrained Eating Inventory , 1986 .

[34]  D. Garner,et al.  The Eating Attitudes Test: an index of the symptoms of anorexia nervosa , 1979, Psychological Medicine.

[35]  M. Hersen,et al.  Adult psychopathology and diagnosis , 1984 .

[36]  Michael J. Strube,et al.  Evidence for the Type in Type A behavior: A taxometric analysis. , 1989 .

[37]  C. Shisslak,et al.  Body weight and bulimia as discriminators of psychological characteristics among anorexic, bulimic, and obese women. , 1990, Journal of abnormal psychology.

[38]  Mark H. Thelen,et al.  A revision of the bulimia test : the BULIT-R , 1991 .

[39]  Support for the continuity hypothesis of bulimic pathology. , 1998 .

[40]  H. Doll,et al.  The classification of bulimic eating disorders: a community-based cluster analysis study , 1996, Psychological Medicine.