Confusion over the core psychopathology of bulimia nervosa

There has been particular confusion concerning two aspects of the psychopathology of bulimia nervosa: dissatisfaction with body shape and overvalued ideas about shape and weight. Whilst these features are closely related, they are nevertheless distinct. Body shape dissatisfaction is commonly found in these patients but is not necessarily present; whilst the over-valued ideas about shape and weight are a necessary diagnostic feature. Analysis of the relationship between these two features and depressed mood and self-esteem showed that, in the course of treatment, change in body shape dissatisfaction was closely associated with change in mood; and change in the overvalued ideas was closely associated with change in self-esteem. This finding supports the distinction between these two facets of the core psychopathology of bulimia nervosa.