Louisiana State University LSU Digital Commons LSU Historical Dissertations and Theses Graduate School 1989 The Affective Variant Hypothesis: How Is Bulimia Nervosa Related to Depression? Rita C. Prather Louisiana State University and Agricultural & Mechanical College Follow this and additional works at: https://digitalcommons.lsu.edu/gradschool_disstheses Recommended Citation Prather, Rita C., "The Affective Variant Hypothesis: How Is Bulimia Nervosa Related to Depression?" (1989). LSU Historical Dissertations and Theses. 4870. https://digitalcommons.lsu.edu/gradschool_disstheses/4870 This Dissertation is brought to you for free and open access by the Graduate School at LSU Digital Commons. It has been accepted for inclusion in LSU Historical Dissertations and Theses by an authorized administrator of LSU Digital Commons. For more information, please contact [email protected]. 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Ann Arbor, MI 48106 The Affective Variant Hypothesis: How is Bulimia Nervosa Related to Depression? A Dissertation Submitted to the Graduate Faculty of the Louisiana State University in partial fulfillment of the requirements for the degree of Doctor of Philosophy m The Department of Psychology by Rita C. Prather B.A.. University of Central Florida, 1983 M.A., Louisiana State University, 1985 December 1989 Acknowledgements With infinite thanks I acknowledge my dissertation committee members, Donald A. Williamson, Ph.D., W. Drew Gouvier, Ph.D., Mary Lou Kelly, Ph.D., Arthur J. Riopelle, Ph.D., and William F. Waters, Ph.D. In addition to participation in this dissertation, each Professor has influenced my professional career in several unique and positive ways. Special acknowledgement and gratitude goes to Dr. Williamson for serving as chairman of my dissertation committee. I thank him for the time and interest spent on my behalf. I wish also to thank William G. Johnson, Ph.D., University of Mississippi Medical Center, for aiding in subject recruitment and reviewing this manuscript and making several important suggestions. Mr. Jeff Baker was instrumental in the completion of this dissertation. He supervised much of the data collection which meant many hours of work and attention to troubleshooting and problem-solving. It is very difficult to communicate the depth of appreciation that goes to Mr. Baker. This acknowledgement could not be complete without recognition of Robert E. Prather whose support and participation have always been freely given. His support has been absolutely invaluable throughout my personal and career development. Table of Contents Acknowledgements................................. ii-iii List of Tables........................................ vi List of Figures......................................vii Abstract......................................... viii-ix Introduction........................................ 1-42 Bulimia and Bulimia Nervosa............... 1- 7 Major Depression and Dysthymia............7-10 Affective Variant Hypothesis.............10-26 Comparison of Bulimia Nervosa and Depression.............................26-27 Affective Variant Hypothesis: Further Evaluation........................ 27-40 Summary......................................40-42 Method..............................................43-52 Research Participants.....................43-45 Assessment Instruments................... 46-51 Procedure.................................. 51-52 Resul ts.............................................53-63 Discussion......................................... 64-79 References......................................... 80-103 Appendices........................................ 104-162 Appendix A: Demographic Questionnaire..105-107 iv. Appendix B: Diagnostic Interview Bulimia Nervosa............. 108-113 Appendix C: The Bulimia Test............ 114-121 Appendix D: Schedule for Affective Disorders....................122-130 Appendix E: Beck Depression Inventory..131-133 Appendix F: Center for Epidemiological Studies Depression Scale ... 134-136 Appendix G: Dysfunctional Attitude Scale........................ 137-141 Appendix H: Pleasant Events Schedule ... 142-150 Appendix I: Maudsley Obsessive-Compulsive Inventory....................151-153 Appendix J: State-Trait Anxiety Inventory....................154-156 Appendix K: Informed Consent Form.......157-158 Appendix L: DSM-IIIR Diagnostic Checkl ists...................159-162 Bulimia Nervosa....... 160 Major Depression...... 161 Dysthymia.............. 162 Vita.............................................. 163-169 v. List of Tables Table 1. Russell Diagnostic Criteria for Bulimia Nervosa............................. 3 Table 2. DSM-III Diagnostic Criteria for Bulimia Nervosa............................. 4 Table 3. DSM-IIIR Diagnostic Criteria for Bulimia Nervosa............................. 4 Table 4. DSM-IIIR Diagnostic Criteria for Major Depression............................ 8 Table 5, DSM-IIIR Diagnostic Criteria for Dysthymia.....................................11 Table 6. Beck's Cognitive Dysfunctions............. 30 Table 7. Group Demographics..........................45 Table 8. Tests of Bulimia, Depression, and their Interaction .....................55 Table 9. Summary of Combined Effects................57 Table 10. Correlational Analyses..................... 59 Table 11 Stepwise Multiple Regression: BULIT.......61 Table 12. Stepwise Multiple Regression: BDI......... 61 vi . List of Figures Figure 1. Anxiety Model of Bulimia................. 35 vi i . Abstract Bulimia nervosa patients frequently score from mild to severe on measures of depressive symptoms. This association between bulimia nervosa and depression led some researchers to hypothesize that bulimia nervosa is a variant of the affective disorder of depression. The main purpose of this study was to provide further evaluation of the affective variant hypothesis of bulimia nervosa. It was postulated that bulimia nervosa patients with and without depression would differ from each other and from depressives without eating disorders on specific measures of cognitive, behavioral, and somatic symptoms associated with depression. Secondly, it was hypothesized that the nondepressed and depressed bulimic patients would differ from depressives but not from each other on measures of anxiety and obsessiveness which would lend support to the anxiety model of bulimia nervosa. The results did not support either the affective variant hypothesis or the anxiety model of bulimia nervosa. The depressed bulimia nervosa patients evidenced higher levels of somatic symptoms, cognitive dysfunction, state anxiety, and obsessiveness than nondepressed bulimics. These two groups were similar in severity only in trait anxiety and anhedonia. The bulimic and nonbulimic depressed patients did not statistically differ on any measure when the bulimic was also clinically depressed. The dually diagnosed patients were more disturbed than either the nondepressed bulimics or the nonbulimic depressed patients. The nonbulimic depressed patients' scores were more severe than the normals' on four of the six significant measures (somatic symptoms, cognitive dysfunction, state anxiety, trait anxiety), the depressed bulimics' more severe on all six, and the nondepressed bulimics' more severe on only three measures (cognitive dysfunction, anhedonia, trait anxiety). While no measure was associated with bulimia nervosa, several measures were highly associated with depression. The Affective Variant Hypothesis: How is Bulimia Nervosa Related to Depression? Introduction This dissertation presents an overview of bulimia nervosa and depression as well as a review of the research literature addressing the affective variant hypothesis of bulimia nervosa. The affective variant hypothesis explains bulimia nervosa as a variant