NRSA Fellowship for H. Davis: Do Bulimic Behaviors Increase Shame? Toward an Understanding of Transdiagnostic Risk

Comorbidity estimates of BN and any other psychiatric diagnosis is 74.4%. The intent of this proposal is to test the possibility that engagement in bulimic behaviors increases risk for multiple other forms of psychological dysfunction, and does so through a transdiagnostic risk process. Prior studies of comorbidity have been largely descriptive, thus making it difficult to draw conclusions about whether BN is a risk factor for, or consequence of, comorbid conditions. One recent study reported that engagement in binge eating in elementary school increased risk for transdiagnostic psychopathology in high school. A possible mechanism for the development of transdiagnostic psychopathology in BN is the experience of shame, which appears to be pervasive across a range of psychological problems, including conditions comorbid with BN: depression, anxiety, and substance use. An important step in understanding comorbidity in BN is to test mechanisms for the development of transdiagnostic psychopathology. The research component of this proposal will be a controlled, laboratory test to examine whether eating while in a negative mood increases shame in women with BN as compared to healthy controls. It will also be tested whether higher levels of state shame contribute to greater risk for transdiagnostic dysfunction including heightened anxiety and depression, and increased urges to use substances. This project will include a laboratory study that has great promise in uncovering binge eating’s influence on shame and shame’s impact on transdiagnostic risk. Didactic and experiential training in higher level research will include (1) coursework covering ethics and advanced statistics, (3) intensive statistics training program, (4) visiting scholar training with leaders in the field of eating disorders and shame. In order to foster professional development, proposed activities include (1) attending and presenting research at national conferences and (2) pursuing additional research questions with access to an R01-funded longitudinal dataset of eating disorder and transdiagnostic behaviors. Finally, a substantial emphasis will be placed on ethical training including (1) a course on ethical research with clinical populations, (2) a course based on NIH guidelines for Responsible Conduct of Research, and (3) regular meetings with advisors to discuss ethical issues. This proposal provides extensive training to build a research career devoted to the development of a novel research program to investigate mechanisms for combordity in BN and, eventually, interventions for BN comorbidity.