A risk and maintenance model for bulimia nervosa: From impulsive action to compulsive behavior

Carolyn M. Pearson, Stephen A. Wonderlich, Gregory T. Smith

Research output: Contribution to journalArticlepeer-review

142 Scopus citations


This article offers a new model for bulimia nervosa (BN) that explains both the initial impulsive nature of binge eating and purging, as well as the compulsive quality of the fully developed disorder. The model is based on a review of advances in research on BN and advances in relevant basic psychological science. It integrates transdiagnostic personality risk, eating-disorder-specific risk, reinforcement theory, cognitive neuroscience, and theory drawn from the drug addiction literature. We identify both a state-based and a trait-based risk pathway, and we then propose possible state-by-trait interaction risk processes. The state-based pathway emphasizes depletion of self-control. The trait-based pathway emphasizes transactions between the trait of negative urgency (the tendency to act rashly when distressed) and high-risk psychosocial learning. We then describe a process by which initially impulsive BN behaviors become compulsive over time, and we consider the clinical implications of our model.

Original languageEnglish
Pages (from-to)516-535
Number of pages20
JournalPsychological Review
Issue number3
StatePublished - Jul 1 2015

Bibliographical note

Publisher Copyright:
© 2015 American Psychological Association.


  • Addiction
  • Bulimia nervosa
  • Compulsivity
  • Impulsivity
  • Urge

ASJC Scopus subject areas

  • General Psychology


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