Initial manifestations of disordered eating behavior: dieting versus binging

We examined the onset of binge eating and dieting in 108 women with bulimia nervosa to determine whether (1) dieting always preceded binge eating; (2) dieting always preceded the onset of bulimia nervosa; and (3) individuals who manifested early initial binge eating differed from those whose earliest manifestation of disordered eating behavior was dieting in terms of lifetime psychopathology and temperament.

One hundred eight women were assessed at entry to a randomized 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.

Seventeen percent of women reported early binge eating prior to any dieting behavior. The mean age of onset of binging in this group was approximately 10 years. Neither the clinical picture of bulimia nervosa nor lifetime psychopathology differed between initial binge eaters and initial dieters. Individuals with early binge eating endorsed higher novelty seeking and lower harm avoidance.

In a minority of women with bulimia nervosa, binge eating precedes dieting. These women display markedly higher novelty seeking and lower harm avoidance. Possible links between the dopamine system, novelty seeking, and appetitive behavior are discussed.