Research review: Two pathways toward impulsive action: An integrative risk model for bulimic behavior in youth

Background This study provides an integrative review of existing risk factors and models for bulimia nervosa (BN) in young girls. We offer a new model for BN that describes two pathways of risk that may lead to the initial impulsive act of binge eating and purging in children and adolescents. Scope We conducted a selective literature review, focusing on existing and new risk processes for BN in this select population. Findings We identify two ways in which girls increase their risk to begin engaging in the impulsive behavior of binge eating and purging. The first is state-based: the experience of negative mood, in girls attempting to restrain eating, leads to the depletion of self-control and thus increased risk for loss of control eating. The second is personality-based: elevations on the trait of negative urgency, or the tendency to act rashly when distressed, increase risk, particularly in conjunction with high-risk psychosocial learning. We then briefly discuss how these behaviors are reinforced, putting girls at further risk for developing BN. Conclusions We highlight several areas in which further inquiry is necessary, and we discuss the clinical implications of the new risk model we described.