Emily Burton

Prospective Relations Between Bulimic Pathology, Depression, and Substance Abuse: Unpacking Comorbidity in Adolescent Girls.

To elucidate the processes that contribute to the comorbidity between bulimic pathology, depression, and substance abuse, the authors tested the temporal relations between these disturbances with prospective data from adolescent girls (N = 496). Multivariate analyses indicated that depressive symptoms predicted onset of bulimic pathology but not of substance abuse, bulimic symptoms predicted onset of depression but not of substance abuse, and substance abuse symptoms predicted onset of depression but not of bulimic pathology. Results suggest that the comorbidity arises because certain disorders are risk factors for the other disorders. Findings also provide support for select etiologic theories and further establish the clinical significance of these conditions by showing that they increase risk for onset of other psychiatric disturbances.

A Prospective Test of the Stress-Buffering Model of Depression in Adolescent Girls: No Support Once Again.

The stress-buffering model posits that social support mitigates the relation between negative life events and onset of depression, but prospective studies have provided little support for this assertion. The authors sought to provide a more sensitive test of this model by addressing certain methodological and statistical limitations of past studies with prospective data from 496 adolescent girls. Deficits in peer support predicted increases in depressive symptoms, and negative life events predicted onset of depressive pathology. However, none of the 14 prospective tests provided support for the stress-buffering model despite sufficient power. Results provide scant support for the stress-buffering model and suggest that it might be time to shift attention to alternative multivariate models concerning these risk factors.

Maintenance Factors for Persistence of Bulimic Pathology: A Prospective Natural History Study

OBJECTIVE To characterize the natural course of bulimia nervosa and identify potential maintenance factors that predict persistence of bulimic pathology in order to advance knowledge of processes that perpetuate this eating disturbance and permit the design of more efficacious treatments. METHOD We followed 96 women with threshold or subthreshold bulimia nervosa over a 1-year period with quarterly interviews. RESULTS There were high rates of remission and relapse on a month-to-month basis, but remission became more likely to persist after a period of approximately 4 months of symptom abstinence. Initial elevations in thin-ideal internalization, expectations for reward from eating, and binge frequency predicted greater time to remission of binge eating. Initial elevations in dietary restraint and compensatory behavior frequency predicted greater time to remission of compensatory behaviors. DISCUSSION Results imply that treatments for eating disorder may be more effective if they can reduce thin-ideal internalization, eating expectancies, and ineffective dieting and produce rapid cessation of binge eating and compensatory behaviors.

A Prospective Test of Cognitive Vulnerability Models of Depression with Adolescent Girls.

This study sought to provide a more rigorous prospective test of two cognitive vulnerability models of depression with longitudinal data from 496 adolescent girls. Results supported the cognitive vulnerability model in that stressors predicted future increases in depressive symptoms and onset of clinically significant major depression for individuals with a negative attributional style, but not for those with a positive attributional style, although these effects were small. This model appeared to be specific to depression, in that it did not predict future increases in bulimia nervosa or substance abuse symptoms. In contrast, results did not support the integrated cognitive vulnerability self-esteem model that asserts stressors should only predict increased depression for individuals with a confluence of negative attributional style and low self-esteem, and this model did not appear to be specific to depression.