Are the eating disorders discrete diagnostic entities or do they fall along one or more continua ranging from normal body weight, eating behavior, and weight concerns to severely disturbed patterns? Researchers have debated this question for at least 30 years and have used numerous creative strategies to examine this and related questions. This body of research is reviewed with particular attention to the more recent use of taxometric methods. Although somewhat mixed, much of the earlier research has been interpreted as supporting the continuity model. However, more recent taxometric research suggests the presence of one or more latent discontinuities, particularly with disorders associated with binge eating. These findings have implications for assessment, treatment, and possible prevention of eating disorders, and may ultimately allow us to better predict who will or will not develop an eating disorder in response to dieting, as well as who will or will not respond to particular treatments for an existing eating disorder.
American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC: Author.
2.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
3.
Bruch, H. (1973). Eating disorders. New York: Basic Books.
4.
Button, E. J., & Whitehouse, A. (1981). Subclinical anorexia nervosa. Psychological Medicine, 11, 509-516.
5.
Clarke, M. G., & Palmer, R. L. (1983). Eating attitudes and symptoms in university students. British Journal of Psychiatry, 142, 299-304.
6.
Crisp, A. H. (1965). Clinical and therapeutic aspects of anorexia nervosa: A study of 30 cases. Journal of Psychosomatic Research, 9, 67-78.
7.
Dancyger, I. F., & Garfinkel, P. E. (1995). The relationship of partial syndrome eating disorders to anorexia and bulimia nervosa. Psychological Medicine, 25, 1019-1025.
8.
Franko, D. L., & Omori, M. (1999). Subclinical eating disorders in adolescent women: A test of the continuity hypothesis and its psychological correlates. Journal of Adolescence, 22, 389-396.
9.
Gangestad, S., & Snyder, M. (1985). “To carve nature at its joints”: On the existence of discrete classes in personality. Psychological Review, 92, 317-349.
10.
Garner, D. M., Olmsted, M. P., Bohr, Y., & Garfinkel, P. E. (1982). The Eating Attitudes Test: Psychometric features and clinical correlates. Psychological Medicine, 12, 871-878.
11.
Garner, D. M., Olmsted, M. P., & Garfinkel, P. E. (1983). Does anorexia nervosa occur on a continuum?International Journal of Eating Disorders, 2, 11-20.
12.
Gleaves, D. H., Lowe, M. R., Green, B. A., Cororve, M. B., & Williams, T. L. (2000). Do anorexia and bulimia nervosa occur on a continuum? A taxometric analysis. Behavior Therapy, 31, 195-219.
13.
Gleaves, D. H., Lowe, M. R., Snow, A. C., Green, B. A., & Murphy-Eberenz, K. P. (2000). The continuity and discontinuity models of bulimia nervosa: A taxometric investigation. Journal of Abnormal Psychology, 109, 56-68.
14.
Hay, P., & Fairburn, C. (1998). The validity of the DSM-IV scheme for classifying bulimic eating disorders. International Journal of Eating Disorders, 23, 7-15.
15.
Heatherton, T. F., & Polivy, J. (1992). Chronic dieting and eating disorders: A spiral model. In J. Crowther, S. E. Hobfall, M. A. P. Stephens, & D. L. Tennenbaum (Eds.), The etiology of bulimia: The individual and family context (pp. 133-155). Washington, DC: Hemisphere.
16.
Hendren, R. L., Barbar, J. K., & Sigafoos, A. (1986). Eating-disordered symptoms in a nonclinical population: A study of female adolescents in two private schools. Journal of the American Academy of Child Psychiatry, 25, 836-840.
17.
Joiner, T. E. (2000). Special series: Samples from four frontiers of eating disorders research— Overview of the special series. Behavior Therapy, 31, 187-193.
18.
Kutlesic, V., Williamson, D. A., Gleaves, D. H., Barbin, J. M., & Murphy-Eberenz, K. P. (1998). The Interview for the Diagnosis of Eating Disorders–IV: Application to DSM-IV diagnostic criteria. Psychological Assessment, 10, 41-48.
19.
Lowe, M. R., Gleaves, D. H., Di-Simone-Weiss, R. T., Feurgeuson, C., Gayda, C. A., Kolsky, P. A., et al. (1996). Restraint, dieting, and the continuum model of bulimia nervosa. Journal of Abnormal Psychology, 105, 508-517.
20.
Meehl, P. E. (1992). Factors and taxa, traits and types, differences of degree and differences of kind. Journal of Personality, 60, 117-174.
21.
Meehl, P. E. (1995). Bootstrap taxometrics: Solving the classification problem in psycho-pathology. American Psychologist, 50, 266-275.
22.
Meehl, P. E., & Golden, R. R. (1982). Taxometric methods. In P. Kendall & J. Butcher (Eds.), Handbook of research methods in clinical psychology (pp. 127-181). New York: John Wiley.
23.
Meehl, P. E., & Yonce, L. Y. (1994). Taxometric analysis I: Detecting taxonicity with two quantitative indicators using means above and below a sliding cut (MAMBAC procedure). Psychological Reports, 74(Suppl. 1), 1059-1274.
24.
Meehl, P. E., & Yonce, L. Y. (1996). Taxometric analysis: II. Detecting taxonicity using covariance of two quantitative indicators in successive intervals of a third indicator (MAXCOV procedure) [Monograph]. Psychological Reports, 78(Suppl. 1), 1091-1227.
25.
Nylander, I. (1971). The feeling of being fat and dieting in a school population. Acta Socio-Medica Scandinavica, 1, 17-26.
26.
Polivy, J., & Herman, C. P. (1987). Diagnosis and treatment of normal eating. Journal of Consulting and Clinical Psychology, 55, 635-644.
27.
Ruderman, A. J., & Besbeas, M. (1992). Psychological characteristics of dieters and bulimics. Journal of Abnormal Psychology, 101, 383-390.
28.
Ruscio, J., & Ruscio, A. M. (2002). Structure-based approach to psychological assessment: Matching measurement models to latent structure. Assessment, 9, 4-16.
29.
Selvini-Palazzoli, M. (1978). Self-starvation: From individuation to family therapy in the treatment of anorexia nervosa. New York: Aronson.
30.
Snow, A. C. (1999, June). An examination of the continuity and discontinuity models of anorexia nervosa. Dissertation Abstracts International: Section B: The Sciences and Engineering, 59(12-B), 6497-6497.
31.
Snow, A. C., Pearson, C. A., Brown, J. D., Cororve, M. B., & Gleaves, D. H. (2000, August). A taxometric analysis of anorexia nervosa. Paper presented at the meeting of the American Psychological Association, Washington, DC.
32.
Stice, E., Killen, J. D., Hayward, C., & Taylor, C. B. (1998). Support for the continuity hypothesis of bulimic pathology. Journal of Consulting and Clinical Psychology, 66, 784-790.
33.
Stice, E., Ziemba, C., Margolis, J., & Flick, P. (1996). The dual pathway model differentiates bulimics, subclinical bulimics, and controls: Testing the continuity hypothesis. Behavior Therapy, 27, 531-549.
34.
Strube, M. J. (1989). Evidence for the type in Type A behavior: A taxonomic analysis. Journal of Personality and Social Psychology, 56, 972-987.
35.
Thelen, M. H., Farmer, J., Wonderlich, S., & Smith, M. (1991). A revision of the Bulimia Test: The BULIT-R. Psychological Assessment, 3, 119-124.
36.
Tylka, T., & Subich, L. M. (1999). Exploring the construct validity of the eating disorder continuum. Journal of Counseling Psychology, 46, 268-276.
37.
Waller, N. G., & Meehl, P. E. (1998). Multivariate taxometric procedures: Distinguishing types from continua. Thousand Oaks, CA: Sage.
38.
Waller, N. G., Putnam, F. W., & Carlson, E. B. (1996). Types of dissociation and dissociative types: A taxometric analysis of dissociative experiences. Psychological Methods, 1, 300-321.
39.
Williamson, D. A., Womble, L. G., Smeets, M. A. M., Netemeyer, R. G., Thaw, J. M., Kutlesic, V., et al. (2002). The latent structure of eating disorder symptoms: A factor analytic and taxometric investigation. American Journal of Psychiatry, 159, 412-418.
