Social Work Practice with a Bulimic Population: A Comparative Evaluation of Purgers and Nonpurgers

Abstract

The traditional definition of bulimia has focused on persons who engage in purging behavior. Limited research has been conducted on bulimics, either obese or non-obese, who do not purge. These nonpurging bulimics are often frustrated in their attempts to obtain treatment because their condition is not sufficiently serious to warrant treatment. Because the incidence of bulimia in the general population is high, social workers are likely to see clients who are struggling with this problem. This study compared groups of purging and nonpurging bulimics who had received cognitive-behavioral treatment in a social work practice. It measured change on a number of dimensions related to eating behaviors, feelings, and life functioning. The study found few, if any, significant differences between purging and nonpurging bulimics 2 to 5 years following treatment. Although all groups showed significant improvement at follow-up, some bulimic symptoms remained. In addition, the disordered eating patterns of obese and non-obese bulimics were similar across weight categories. The results suggest that out-of-control eating behavior, not purging, may be the key distinguishing feature of bulimia and that greater attention must be directed at relapse prevention and aftercare once treatment has been completed.

Get full access to this article

View all access options for this article.

References

American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC: American Psychiatric Press.

Beck, A. T. , Wood, C. H. , Mendelson, M. , Mock, J. E. , & Erbaugh, J. (1961). An inventory for measuring depression . Archives of General Psychiatry, 4, 561-571.

Fairburn, C. C. , & Beglin, S. J. (1985). Studies of epidemiology of bulimia nervosa. American Journal of Psychiatry, 147, 401-408.

Garfinkle, P. , Moldofsky, H. , & Garner, D. ( 1980). The heterogeneity of anorexia nervosa. Archives of General Psychiatry, 37, 1036.

Garner, D. M. , Fairburn, C. M. , & Davis, R. ( 1987). Cognitive-behavioral treatment of bulimia nervosa: A critical reappraisal. Behavior Modification, 11, 398-431.

Gormally, J. , Black, S. , Daston, S. , & Rardin, D. (1982). The assessment of binge eating severity among obese persons. Addictive Behaviors, 7, 47-55.

Grace, P. S. , Romey, S. J. , & Fullage, C. J. ( 1985). A pilot comparison of purging and non-purging bulimics . Journal of Clinical Psychology, 41, 173-180.

Hudson, J. I. , Pope, H. G. , Jr., Wurtman, J. , Yurgelun-Todd, D. , Mark, S. , & Rosenthal, D. E. (1988). Bulimia in obese individuals: Relationships to normal weight bulimia. Journal of Nervous and Mental Disease , 176, 144-152.

Loro, A. D. , & Orleans, C. S. (1981). Binge eating in obesity: Preliminary findings and guidelines for behavioral analysis and treatment. Addictive Behaviors, 6, 155-166.

10.

Marcus, M. D. , & Wing, R. R. (1987). Binge eating among the obese . Annals of Behavioral Medicine, 9, 23-27.

11.

Marcus, M. D. , Wing, R. R. , Ewing, L. , Kern, E. , Gooding, W. , & McDermott, M (1990). Psychiatric disorders among obese binge eaters. International Journal of Eating Disorders, 9,69-77.

12.

Marcus, M. D. , Wing, R. R. , & Hopkins, J. ( 1988). Obese binge eaters: Affect, cognitions and response to behavioral weight control. Journal of Consulting and Clinical Psychology, 56, 433-439.

13.

Mitchell, J. E. , Pyle, R. L. , Hatsukami, D. , Goff, G. , Glotter, D. , & Harper, J. (1989). A 2-5 year follow-up study of patients treated for bulimia. International Journal of Eating Disorders, 8, 157-165.

14.

Polivy, J. , & Herman, C. P. (1985). Dieting and bingeing: A causal analysis. American Psychologist, 40, 193-201.

15.

Rosen, J. C. , Leitenberg, H. , Fisher, C. , & Khazam, C. (1986). Binge-eating episodes in bulimia nervosa: The amount and types of food consumed. International Journal of Eating Disorders, 5, 255-267.

16.

Saunders, R. , & Saunders, D. (1989). Non-purging bulimics: An ignored population. British Review of Anorexia and Bulimia, 3, 79-85.

17.

Society of Actuaries and Association of Life Insurance Medical Directors of America (1980). Build study 1979 . Chicago: Author.

18.

SPSS, Inc. (1991). SPSSx user's guide, Chicago: Author.

19.

Stucky, M. , Lewis, B. , Johnson, C. , & Schwartz, D. (1981). Eating Problems Questionnaire. Chicago: Michael Reese Hospital.

20.

Willmuth, M. E. , Leitenberg, H. , Rosen, J. C. , & Cado, S. (1988). A comparison of purging and non-purging normal weight bulimics. International Journal of Eating Disorders, 8, 825-835.

21.

Wolf, D. M. , & Crowther, J. H. (1992). An evaluation of behavioral and cognitive-behavioral group interventions for the treatment of bulimia nervosa in women. International Journal of Eating Disorders, 11, 3-15.