A two-stage risk model for bulimic behavior

In recent years, eating disorder researchers have made good progress on understanding risk factors for the development of eating disorder pathology. It may also be true that bulimic behavior itself may heighten risk for the development of other forms of psychopathology. We present a two-stage theory of risk for bulimic dysfunction that spans development from adolescence into adulthood. The first stage of the model presents transactions among risk factors that lead to the development of binge eating and purging. We provide an overview of research that has shown longitudinal associations between pubertal onset, personality risk factors such as negative affect and urgency, and psychosocial learning that lead to the development of binge eating and purging behavior in youth. The second stage of the model represents a theory of how early engagement in bulimic behavior is a risk factor for other types of dysfunction, including internalizing disorders, such as depression and anxiety, and externalizing disorders such as substance use. We discuss future directions in research to clarify the possible long-term sequela of eating disorder behaviors.