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Testing the cognitive-behavioural maintenance models across DSM-5 bulimic-type eating disorder diagnostic groups: A multi-centre study

Dakanalis, Antonios, Carrà, Giuseppe, Calogero, Rachel M., Zanetti, M. Assunta, Gaudio, S., Caccialanza, R., Riva, G., Clerici, M. (2014) Testing the cognitive-behavioural maintenance models across DSM-5 bulimic-type eating disorder diagnostic groups: A multi-centre study. European Archives of Psychiatry and Clinical Neuroscience, 265 (8). pp. 663-676. ISSN 0940-1334. E-ISSN 1433-8491. (doi:10.1007/s00406-014-0560-2) (KAR id:49236)


The original cognitive-behavioural (CB) model of bulimia nervosa, which provided the basis for the widely used CB therapy, proposed that specific dysfunctional cognitions and behaviours maintain the disorder. However, amongst treatment completers, only 40–50 % have a full and lasting response. The enhanced CB model (CB-E), upon which the enhanced version of the CB treatment was based, extended the original approach by including four additional maintenance factors. This study evaluated and compared both CB models in a large clinical treatment seeking sample (N = 679), applying both DSM-IV and DSM-5 criteria for bulimic-type eating disorders. Application of the DSM-5 criteria reduced the number of cases of DSM-IV bulimic-type eating disorders not otherwise specified to 29.6 %. Structural equation modelling analysis indicated that (a) although both models provided a good fit to the data, the CB-E model accounted for a greater proportion of variance in eating-disordered behaviours than the original one, (b) interpersonal problems, clinical perfectionism and low self-esteem were indirectly associated with dietary restraint through over-evaluation of shape and weight, (c) interpersonal problems and mood intolerance were directly linked to binge eating, whereas restraint only indirectly affected binge eating through mood intolerance, suggesting that factors other than restraint may play a more critical role in the maintenance of binge eating. In terms of strength of the associations, differences across DSM-5 bulimic-type eating disorder diagnostic groups were not observed. The results are discussed with reference to theory and research, including neurobiological findings and recent hypotheses.

Item Type: Article
DOI/Identification number: 10.1007/s00406-014-0560-2
Uncontrolled keywords: DSM-5; Bulimic-type eating disorders; Binge eating; Maintenance factors; Cognitive-behavioural theory; Latent variable structural equation modelling
Subjects: B Philosophy. Psychology. Religion > BF Psychology
Divisions: Faculties > Social Sciences > School of Psychology
Depositing User: Rachel Calogero
Date Deposited: 07 Jul 2015 13:04 UTC
Last Modified: 29 May 2019 14:46 UTC
Resource URI: (The current URI for this page, for reference purposes)
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