Dissociation in the Binge–Purge Cycle of Bulimia Nervosa

ABSTRACT

Objective: This study focused on whether those suffering from bulimia nervosa may experience dissociative symptoms in relation to bulimic behavior rather than as a general pattern.

Method: In this study, which used an experience sampling methodology, 12 adult women who met Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for bulimia nervosa completed questionnaires measuring state levels of dissociation during 5 sequential binge–purge cycles and at a random time not associated with bingeing or purging.

Results: Participants did experience dissociative symptoms, which were higher during bingeing and purging. Dissociation varied within the binge–purge cycle, rising throughout the cycle until after the purge, then declining slightly.

Conclusion: Women with bulimia nervosa reported experiencing higher levels of dissociative symptoms during binge–purge episodes, and dissociative symptoms returned to normal levels after completion of the purge. These data support the idea that bulimia nervosa is associated with dissociation, but that the dissociative symptoms are expressed most dramatically during binges. They are also supportive of models of bingeing as an escape.

KEYWORDS:

• Eating disorders
• dissociation
• bulimia nervosa
• dissociative disorders

This research was conducted for the first author's doctoral dissertation at Saybrook Graduate School and Research Center. The authors gratefully acknowledge the openness of participants to this research and dissertation committee members Zonya Johnson, Marc Pilisuk, Ruth Richards, Linda Riebel, and three anonymous reviewers for their comments on earlier versions of this work.