The confluence of perfectionism, body dissatisfaction, and low self-esteempredicts bulimic symptoms: Clinical implications

We present a brief overview of empirically supported risk factors of bulimi c behavior. We then propose an empirically supported, interactive, three-fa ctor model of bulimic symptom occurrence from which we derive clinical impl ications for assessment, treatment, and prevention. Our research finds that perfectionism, body dissatisfaction, and self-esteem interact to predict b ulimic symptoms. In particular, women who consider themselves overweight an d who have elevated levels of perfectionism and lower levels of self-esteem show the greatest risk for bulimic symptoms. Thus, our model identifies th ree theoretically related targets for intervention: perfectionism, body dis satisfaction, and low self-esteem. Assessment of these factors is recommend ed. The extent to which cognitive-behavioral therapy for bulimia and interp ersonal therapy for bulimia address these factors is reviewed and evaluated , and theory-based recommendations are made for prevention efforts.