Biomedical subjects

C M Bulik

Publications and source records attributed to C M Bulik.

At least 73 records · Page 4Linked to original sources

PubMed1996

Effect of mood and food cues on body image in women with bulimia and controls.

OBJECTIVE: The present study evaluated body image assessment and cue reactivity in women with bulimia and controls in response to neutral, mood, and food cues in isolation, and mood and food cues in combination. METHOD: Subjects were 7 women with bulimia nervosa and 8 control women. Food cues were individualized high-risk/favorite foods. Low mood was elicited using the Musical Mood Induction Procedure. Order of cue presentation was random across subjects. Body image and cue reactivity were assessed using a computer version of the silhouette method and self-report ratings, respectively. RESULTS: Women with bulimia consistently rated their current body as being larger and their body image satisfaction as being lower than control women. In addition, women with bulimia differentially rated their current body and a picture of a healthy weight woman as being larger following exposure to food and/or mood cues. Ratings of ideal body were differentially affected by mood cues for control women. Ratings of body satisfaction were not affected by cue presentation. Mere presentation of high-risk foods in the absence of eating was sufficient to elicit urges to binge in women with bulimia. DISCUSSION: Body size estimation is not only affected by enduring characteristics (i.e., bulimia nervosa), but also more transient factors such as short-term exposure to salient food and mood cues.

Adolescent↗

PubMed1996

A case of comorbid anorexia nervosa, bulimia nervosa, and Munchausen's syndrome.

Reports of comorbid eating disorders and Munchausen's syndrome are rare. As part of a follow-up study of the outcome of anorexia nervosa, medical records and direct structured psychiatric interview data were collected on all women treated for anorexia nervosa in Christchurch, New Zealand between 1981-1984. On interview, one participant received diagnoses of anorexia nervosa, bulimia nervosa, and factitious disorder (Munchausen's syndrome). The subject interwove symptoms of her eating disorders with factitious presentations on several occasions. This diagnosis had not been apparent prior to compilation of all medical records.

Adult↗

PubMed1996

Correlates of severity in bulimia nervosa.

OBJECTIVE: We sought to clarify the correlates of severity in women with bulimia nervosa. METHOD: We studied 114 bulimic women at entry to a randomized clinical trial. We used eight definitions of severity that encompassed the DSM-III-R criteria set for bulimia nervosa (i.e., binging, purging, and body dissatisfaction in the current and worst lifetime time frames) and global functioning and symptomatology. We operationalized 28 possible correlates of severity that covered demographic, Axis I psychiatric, personality, family background, symptoms, and neuropsychological domains. We used regression techniques to investigate the associations between the correlates and severity indices. RESULTS: The regression models were all statistically significant and tended to account for a sizeable proportion of variance. In particular, earlier age of onset of bulimia and lower character scores (measured by the Temperament and Character Inventory) correlated with greater severity. Worse mean parental care (from the Parental Bonding Instrument), the absence of any lifetime anxiety disorder, and the presence of any lifetime mood disorder emerged as independent correlates in several models. CONCLUSIONS: As these were hypothesis-generating analyses, confirmation or refutation of these results awaits further study. In particular, age of onset of bulimia and personality traits related to character may be important modifiers of the severity of illness in bulimia nervosa.

Adolescent↗

PubMed1996

The significance of a prior history of anorexia in bulimia nervosa.

OBJECTIVE: Some authors stratify women with current, normal-weight bulimia nervosa into groups defined by the presence or absence of a past history of anorexia nervosa. Unlike the distinction between current anorexia nervosa with or without bulimic symptoms, fewer studies have investigated the significance of stratifying bulimic women by a past history of anorexia. METHOD: One hundred and fourteen women with bulimia nervosa in a clinical trial were studied via structured clinical interviews covering Axis I and II disorders and measures of personality and symptomatology. Prospective, 14-day dietary analysis was available for a subset of subjects. RESULTS: Bulimic women with a past history of anorexia nervosa were significantly more likely to have a lifetime anxiety disorder, lower current body mass index, increased cooperativeness on the Temperament and Character Inventory, and increased mature and neurotic scores on the Defense Style Questionnaire. These women also reported lower scores on the bulimia subscale of the Eating Disorders Inventory, but these self-report data were not consistent with the numbers of objective binges or reported energy intake. The prevalence of other Axis I disorders, Axis II personality disorders, and bulimic symptomatology was quite similar across groups. CONCLUSIONS: Although bulimic women with a prior history of anorexia nervosa differed in limited respects from those without such a history, the differences were outweighed by the similarities. A past history of anorexia nervosa did not appear to define particularly meaningful subgroups of women with current, normal-weight bulimia nervosa.

Adolescent↗

PubMed1996

Salivary reactivity in restrained and unrestrained eaters and women with bulimia nervosa.

Salivary and cognitive reactivity to a highly palatable food cue were examined in 19 women with bulimia nervosa, 19 restained eaters and 19 unrestrained eaters. Salivary reactivity at presentation of the palatable food varied significantly across the three groups but not baseline. Bulimic women displayed significantly less salivary reactivity than either restrained or unrestrained eaters. Bulimic women were depressed and self-reported markedly greater anxiety (SUDS) at all points during the procedure. SUDS were not significantly correlated with salivary reactivity. Depression as measured by the Beck Depression Inventory was significantly and inversely correlated with salivary reactivity. Potential cognitive and physiological explanations for decreased salivary reactivity in women with bulimia are discussed.

Adult↗

PubMed1996

Bulimia nervosa and substance dependence: association and family transmission.

Alcohol and drug use disorders are common among women with bulimia nervosa (BN) and their family members. However, it is not known whether there is a familial relationship between BN and substance use disorders. We compared 47 women with BN and 44 non-eating-disordered community control women, and their first-degree relatives (177 and 190, respectively). BN probands were stratified by the presence (43%) or absence (57%) of lifetime alcohol and/or drug dependence. The first-degree relatives of substance-dependent BN probands had significantly higher lifetime rates of alcohol/drug dependence (38%), compared with relatives of nonsubstance-dependent BN probands (10%) or relatives of community controls (18%). These data suggest that BN and substance dependence are transmitted independently in families.

Adult↗

PubMed1995

Laxative withdrawal and anxiety in bulimia nervosa.

Symptoms of anxiety can be prominent during treatment of bulimia nervosa. Our experience is that bulimics who abuse laxatives have the most prominent symptoms of anxiety. We conducted ratings of anxiety in 23 bulimics who purge with laxatives and 17 who purge by vomiting. We found that the laxative-abusing group had higher levels of state but not trait anxiety and that they were more likely to be treated with medication for anxiety during hospitalization. These data suggest an association between laxatives and anxiety in bulimia nervosa.

Adult↗

PubMed1995

Temperament in eating disorders.

This study examined dimensional personality and temperamental characteristics in women with eating disorders. Clinical symptoms, personality, and temperament were examined in 30 women with anorexia nervosa (AN), 32 women with bulimia nervosa with no history of anorexia nervosa (BN), and 20 women with comorbid anorexia and bulimia nervosa (AB). Temperament differed markedly across the groups on the Tridimensional Personality Questionnaire (TPQ) with AN women showing greater reward dependence, BN women scoring higher on novelty seeking subscales, and AB women showing high harm avoidance. The TPQ subscales also displayed higher classification accuracy than other personality and symptom measures. Temperamental features are distinct across eating disorder subtypes. Temperament could reflect differential vulnerabilities for the development of specific eating disorder symptom clusters.

Anorexia Nervosa↗

PubMed1995

Temperament, character, and personality disorder in bulimia nervosa.

In a sample of 76 women participating in a clinical treatment trial for bulimia nervosa, we examined the clinical differences between subjects with and without concurrent personality disorders and the ability of "self-directedness" (a character scale of Cloninger's Temperament and Character Inventory) to predict the presence of personality disorder. Sixty-three percent of the sample had at least one personality disorder diagnosis. Fifty-one percent of personality disorders were in cluster C, 41% were in cluster B, and 33% were in cluster A. The presence of personality disorder was associated with greater depressive symptoms, worse global functioning, laxative use, greater body dissatisfaction, higher harm avoidance, and lower self-directedness. As hypothesized, low self-directedness scores were associated with a markedly increased probability of a personality disorder.

Adult↗

PubMed1995

The significance of a history of childhood sexual abuse in bulimia nervosa.

BACKGROUND: Childhood sexual abuse (CSA) is found to have occurred to a substantial minority of women with bulimia nervosa. Its clinical significance is unclear. METHOD: We studied 87 bulimic women in a clinical trial. Structured interviews determined the presence of CSA, DSM-III-R disorders, global functioning, and depressive and bulimic symptoms. RESULTS: Forty-four per cent reported a history of CSA. Bulimic women with CSA reported earlier onset of bulimia, greater depressive symptoms, worse global functioning and more suicide attempts, and were more likely to meet criteria for bipolar II disorder, alcohol and drug dependence, conduct disorder and avoidant personality disorder. CONCLUSIONS: Although those with CSA had greater comorbidity, it was not an important modifier of bulimic symptoms.

Adolescent↗

PubMed1994

Total cholesterol and suicidality in depression.

There exists considerable controversy regarding an association between low total cholesterol and increased mortality from suicide. As suicide mortality is a crude marker for suicidal ideation and behavior, we investigated the association between total cholesterol and suicidality in a depressed sample. Ninety men and women meeting structured criteria for a major depressive episode of at least moderate severity participated in a study of predictors of treatment response. A three level variable codified the degree of suicidality in the previous month: no suicidal thoughts (39/90), suicidal ideation or plan (38/90), and a suicide attempt (13/90). There was a significant univariate association between lower cholesterol levels and increasing degrees of suicidality. In a multivariate analysis, this association was the only one that neared statistical significance (p = 0.068). Although it is premature to conclude that these variables are causally associated, data from a number of sources suggest that this association is worthy of further study.

Adult↗

PubMed1994

Cosmetic breast augmentation and eating disorders.

AIMS: To comment on the relation between eating disorders and requests for cosmetic surgery in some women. METHODS: We report two cases of women who were accepted for cosmetic breast augmentation while suffering from current anorexia and bulimia nervosa. RESULTS: For both women, the motivation for seeking cosmetic surgery was directly related to the body image distortion and dissatisfaction which were an inherent part of the eating disorder. CONCLUSION: It is our contention that women with eating disorders require treatment to address the distortion in body image, and the belief that cosmetic surgery will result in satisfaction with their bodies. Screening for eating disorders and body image disturbance should be a routine part of assessment for cosmetic surgery.

Adult↗

PubMed1994

Self-induced abortion in a bulimic woman.

We report the case of a woman with bulimia nervosa, several personality disorders, and a past history of anorexia nervosa who deliberately induced an abortion via self-imposed starvation and vigorous exercise. Her history reveals severe obsessive-compulsive and narcissistic personality disorders as well as a lifelong pattern of denial of affect and illness.

Abortion, Induced↗

PubMed1994

Defense style in women with eating disorders.

A relatively new instrument, the Defense Style Questionnaire (DSQ), represents an efficient method by which to quantify an individual's psychological defense style. We administered the DSQ to 66 women hospitalized for anorexia nervosa, bulimia nervosa, or concurrent anorexia and bulimia nervosa. Contrary to our expectations, there were no consistent patterns of identifiable defense styles specific to these groups in qualitative, univariate, and multivariate analyses. The failure of the DSQ to demonstrate specificity across eating disorder subgroups suggests it is not informative in regard to the pathogenesis of these specific syndromes. In contrast, in a previous study, we found temperamental measures to be informative.

Adult↗

PubMed1994

The effect of food deprivation on the reinforcing value of food and smoking in bulimic and control women.

The reinforcing value of both food and cigarettes was examined in female smokers with and without bulimia nervosa. Subjects underwent two food-deprivation (18 h) and two nondeprivation conditions and worked for either food vs. money or cigarettes vs. money on concurrent progressive variable ratio schedules. Schedules for food/cigarettes increased progressively while schedules for money remained the same. Results indicated no differences in the amount of time subjects spent working for food or the number of points earned for food in either bulimics or controls when examining the entire eight-game trial. Results of the initial two-game trial indicated marked differences, with the reinforcing value of food increasing after deprivation in control but not bulimic women and the total amount of time spent working for cigarettes increased after deprivation in controls. These results highlight that the effects of experimental food deprivation are most salient immediately after the deprivation and at low unit prices, and that bulimic and control women respond differently to a food-deprivation paradigm.

Adolescent↗

PubMed1994

Direction of weight change in depression.

Direction of weight change in depression has recently been reported to be mediated by Body Mass Index (BMI). The present study examined the relation between direction of weight change in unipolar depression, BMI, and clinical variables such as severity of depression, melancholia, chronicity and recurrence in 89 patients with major depression. While the BMIs of individuals who gained weight when depressed were significantly higher than individuals with no weight change, the BMIs of individuals who lost weight were not significantly lower than those with no weight change. Direction of weight change was not predicted by severity of depression, melancholia, chronicity or recurrence. Concerns regarding conceptual and methodological difficulties in research on predictors of direction of weight change in depression are discussed.

Adult↗

PubMed1994

Characteristics of bulimic women with and without alcohol abuse.

We compared the characteristics of hospitalized women with bulimia nervosa alone (N = 19) and with bulimia nervosa plus alcohol abuse (N = 13) using standard measures of depression, eating disorders, general psychiatric symptomatology, and temperament. Bulimic women with alcohol abuse had significantly higher lowest past weight, but did not differ from women with bulimia alone on age, age of onset of bulimia, current weight, and highest past weight. There were no differences in clinical symptoms of bulimia, depression, or general psychiatric symptomatology. On Cloninger's Tridimensional Personality Questionnaire (TPQ), bulimic women with alcohol abuse scored significantly higher on Total Novelty Seeking, on the Novelty Seeking Subscale Disorderliness, and on the Reward Dependence Subscale Attachment. Implications for understanding the relation between bulimia and substance abuse are discussed.

Adolescent↗

PubMed1993

Comorbidity of bulimia and substance abuse: perceptions of family of origin.

Clinical characteristics and perceptions of family of origin were examined in 16 bulimic women with comorbid alcohol abuse or dependence, 17 women with bulimia alone, and 30 normal controls. Family Environment Scale self-report and Family Environment Q-sort analysis of taped semi-structured interviews about family environment revealed that while there were no differences across groups in global family environment items, differences existed in specific parental characteristics. Fathers of bulimic women (with or without alcohol abuse or dependence) were perceived as being significantly more seductive than fathers of normal controls. Bulimic women (with or without alcohol abuse or dependence) tended to view their mothers as more neurotic and to have experienced less enjoyment in their maternal role. Mothers of bulimic women with alcohol abuse tended to place the greatest emphasis on weight, exercise, and appearance.

Adult↗