INITIAL MANIFESTATIONS OF DISORDERED EATING BEHAVIOR - DIETING VERSUSBINGING

Objective: We examined the onset of binge eating and dieting in 108 wo men with bulimia nervosa to determine whether (7) dieting always prece ded binge eating; (2) dieting always preceded the onset of bulimia ner vosa; and (3) individuals who manifested early initial binge eating di ffered from those whose earliest manifestation of disordered eating be havior was dieting in terms of lifetime psychopathology and temperamen t. Method: One hundred eight women were assessed at entry to a randomi zed clinical trial of cognitive-behavioral therapy for bulimia nervosa using structured diagnostic methodology. Retrospective recall of the onset of disordered eating behavior was used to categorize individuals as initial binge eaters or initial dieters. We then compared lifetime psychopathology and temperament across the two groups. Results: Seven teen percent of women reported early binge eating prior to any dieting behavior. The mean age of onset of binging in this group was approxim ately 10 years. Neither the clinical picture of bulimia nervosa nor li fetime psychopathology differed between initial binge eaters and initi al dieters. Individuals with early binge eating endorsed higher novelt y seeking and lower harm avoidance. Conclusion: In a minority of women with bulimia nervosa, binge eating precedes dieting. These women disp lay markedly higher novelty seeking and lower harm avoidance. Possible links between the dopamine system, novelty seeking, and appetitive be havior are discussed. (C) 1997 John Wiley & Sons, Inc.