Objective and subjective bulimic episodes in the classification of bulimic-type eating disorders: Another nail in the coffin of a problematic distinction

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Abstract

We sought to further explore the validity of the distinction between objective bulimic episodes (OBEs) and subjective bulimic episodes (SBEs) in the study of bulimic-type eating disorders. Drawing on data obtained at the second, interview phase of a large-scale epidemiological study, we identified mutually exclusive subgroups of women with bulimic-type eating disorders who engaged in regular OBEs but not SBEs (n = 37) or regular SBEs but not OBEs (n = 52). These subgroups were compared on a wide range of outcomes, including socio-demographic characteristics, current levels of eating disorder psychopathology, general psychological distress and impairment in role functioning, current and lifetime impairment in quality of life specifically associated with an eating problem, (self)-recognition of an eating problem, health service utilization and use of psychotropic medication. The only difference between groups was that participants who reported regular OBEs were heavier than those who reported regular SBEs. The findings converge with those of previous research in suggesting that bulimic-type eating disorders characterized by regular SBEs, but not OBEs, do not differ in any clinically meaningful way from those characterized by regular OBEs, but not SBEs. Inclusion of bulimic-type eating disorders characterized by regular SBEs as a provisional category requiring further research in DSM-V appears warranted.

Section snippets

Study design and participants

The research was conducted as part of the Health and Well-Being of Female ACT Residents Study, a two-phase epidemiological study of disability, health service utilization and “mental health literacy” associated with community cases of the more commonly occurring (BN-type) eating disorders (Mond et al., 2008, Mond et al., 2007a, Mond et al., 2006). The study was carried out in the Australian Capital Territory (ACT) region of Australia (population 314,000 in 2002), a highly urbanized region that

Results

As can be seen in Table 1, participants in the OBEs group were heavier than those in the SBEs group. There were no significant differences between groups on any of the socio-demographic variables assessed, nor did any of these comparisons approach significance (all p > 0.10).

Table 2 shows the comparison between OBEs and SBEs groups on measures of eating disorder psychopathology (EDE-Q subscales and global score), impairment in role functioning (SF-12 PCS, MCS), general psychological distress

Summary of main findings

In a community sample of women with bulimic-type eating disorders, we identified subgroups of participants who reported regular OBEs but not SBEs and regular SBEs but not OBEs. These groups were compared on a wide range of outcomes, including socio-demographic characteristics, current levels of eating disorder psychopathology, general psychological distress and impairment in role functioning, current and lifetime occurrence of extreme weight-control behaviors, current and lifetime occurrence of

Acknowledgements

Associate Professor Mond is supported by a National Health and Medical Research Council Sidney Sax Fellowship. The Health and Well-Being of Female ACT Residents Study was funded by The Canberra Hospital, the ACT Department of Health and Community Care and ACT Mental Health.

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