Pamela K. Keel

Introduction: Although individuals with bulimia nervosa (BN) demonstrate elevated reward sensitivity and reward valuation‐effort (RV‐e) compared to controls, whether BN differs from its other specified feeding or eating disorder variant (OSFED‐BN), remains unclear. Further, whether differences best reflect categorical distinctions or correlations with symptom severity is unknown. This study examined whether trait and behavioural reward indicators differentiate BN, OSFED‐BN, and controls, predict diagnostic status, and correlate with bulimic symptom severity. Methods: Participants were 349 women (153 BN, 118 OSFED‐BN, 78 controls). Group comparisons, multinomial logistic regression, and correlational analyses were conducted on the Sensitivity to Punishment/Sensitivity to Reward‐Reward subscale (SPSRQ‐Reward), Behavioural Activation System‐Drive (BAS‐Drive) scale, and progressive ratio tasks assessing RV‐e for food and game rewards. Results: BN and OSFED‐BN demonstrated higher SPSRQ‐Reward scores than controls but did not differ from each other. OSFED‐BN, but not BN, showed higher food and game RV‐e compared to controls. SPSRQ‐Reward predicted higher odds of BN or OSFED‐BN versus controls, whereas BAS‐Drive predicted lower odds. SPSRQ‐Reward was positively associated with bulimic symptom frequencies. Food RV‐e was inversely associated with purging frequency. Discussion: Findings supported the role of reward‐related processes in contributing to both dimensional and categorical differences between BN, OSFED‐BN, and controls.

Societal and cultural shifts can influence psychological well-being and development in adulthood. Maturity fears, an individual's desire to retreat to the security of childhood, have been found to be increasing in younger generations. The present study explored how maturity fears change over adult development in three cohorts of university students assessed in 1982, 1992, and 2002 and followed over time. The study employed a sequential design in which university students (N = 2,482, 69.8% female) completed self-report surveys in college and at 10-year and 20-year follow-up. At baseline, female in the 2002 cohort showed the highest maturity fears, followed by 1992 and then 1982, with all cohorts having decreases in maturity fears over time. There was a significant Cohort × Time interaction, such that compared to the 1982 cohort, both the 1992 and 2002 cohorts demonstrated significantly greater declines in maturity fears over time. Males in the 1992 and 2002 cohorts showed greater maturity fears than those in the 1982 cohort. As with the females, for males there was a significant Cohort × Time interaction. Compared to the 1982 cohort, both the 1992 and 2002 cohorts demonstrated significantly greater declines in maturity fears over time. Overall, the pattern of findings indicates higher levels of maturity fears during college in more recent cohorts, a decrease in maturity fears during adult development, and greater declines in more recent generations. Additional research is needed to not only replicate these findings but also explore potential mechanisms underlying cohort differences. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Objective: This narrative review provides an accessible overview of purging disorder for clinicians, researchers, policymakers, and the public, emphasizing the importance of accurate communication and early detection for effective intervention. Method: Key findings are synthesized on diagnostic characteristics, prevalence, risk factors, cultural and gender considerations, comorbidity, functional impairment, and treatment needs. Results: Although currently embedded in the DSM‐5 “Other Specified Feeding and Eating Disorders” (OSFED) category, research demonstrates that purging disorder has distinct clinical features, medical risks, and developmental pathways. Discussion: This narrative review highlights ongoing debates regarding classification and outlines public‐health priorities for improving detection, research, and care.

The Eating Disorder Inventory (EDI) is one of the oldest and most widely used surveys of eating disorder thoughts and behaviors. Its recent and frequent use to study differences in eating pathology across ethnoracial groups underscores importance of establishing its measurement invariance across groups. However, mixed evidence has emerged, and studies have focused on Black, mixed-race Hispanic/Latino, and White women. The present study aimed to establish the measurement invariance of the EDI Drive for Thinness, Bulimia, Perfectionism, Maturity Fears, and Interpersonal Distrust subscales across four ethnoracial groups in a sample of women and men. Participants (N = 2,931) were Hispanic White (7%), non-Hispanic Asian (18%), non-Hispanic Black or African American (7%), and non-Hispanic White (68%) college students (67% female) recruited in a cohort-based epidemiological, longitudinal study of health and eating patterns. First, multigroup confirmatory factor analysis examined whether the EDI performed comparably across ethnoracial groups in the full sample. Next, the same approach was followed in sensitivity analyses within each sex. Evaluation of changes in comparative fit index indicated that full metric invariance, scalar invariance, and uniqueness were supported across ethnoracial groups in the full sample and in women (change in comparative fit index ≤ .01). Only partial measurement invariance was supported in analyses of non-Hispanic Asian and non-Hispanic White men. Analyses support use of the EDI in ethnoracially diverse samples including women and men or only women. Limited score variance in men suggests the need for tests of measurement invariance in larger samples. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Objective: Bulimia nervosa and related syndromes (BN‐S) are clinically heterogeneous and complex disorders. Frequent comorbidity with anxiety disorders (ADs) and substance use disorders (SUDs) implicates inherent fear‐ and approach‐based tendencies in BN‐S. This study aimed to clarify how comorbid ADs and SUDs, along with fear‐ and approach‐based traits, influence the presentation and severity of BN‐S. Method: Women ( N = 399) with BN‐S ( n = 321) or no history of eating disorders ( n = 78) completed the Eating Disorder Examination, Structured Clinical Interview for DSM‐5 Disorders, Behavioural Inhibition System/Behavioural Activation System scales, and the Sensitivity to Punishment and Sensitivity to Reward Questionnaire. Results: Diagnostic features, symptom frequencies, and eating pathology scores were not significantly affected by comorbidity with ADs or SUDs. Controlling for ADs, participants with BN‐S scored significantly higher than controls on fear‐based traits. Similarly, controlling for SUDs, individuals with BN‐S showed elevated sensitivity to reward. Finally, elevated fear‐ and approach‐based traits both contributed to elevated severity across a range of bulimic symptoms. Conclusion: Fear‐ and approach‐based traits coexist in individuals with BN‐S and were associated with the same symptoms. Although BN‐S are currently placed within the Hierarchical Taxonomy of Psychopathology's internalising spectrum, findings indicate overlap with the externalising spectrum.

Objective: Specific diagnostic criteria for purging disorder (PD) are not currently provided in the DSM‐5. The current study aims to compare point prevalence estimates and evidence of predictive validity for four alternative criteria sets for PD for men and women. Method: Survey data collected in college ( N = 3291) and at 10‐year follow‐up ( n = 2223) were used in analyses. Point prevalence was assessed at both time points and compared in men versus women as well as in college versus at 10‐year follow‐up. Predictive validity was assessed using multiple linear regressions to determine prospective associations for each PD definition versus no eating disorder across external validators. Results: Point prevalence was greater in women than in men in college across all definitions of PD, and no sex differences were found at follow‐up. Point prevalence was greater in college than at follow‐up in all but the narrowest definition of PD which required purging, on average, twice per week. Predictive validity was supported for PD defined by self‐induced vomiting, laxative or diuretic misuse, with evidence of lower satisfaction with work and career at follow‐up. Discussion: Together, findings support defining PD through self‐induced vomiting, laxative use, or diuretic use to influence body shape or weight, on average, at least once per week. Specifying diagnostic criteria for PD that demonstrate evidence of concurrent and predictive validity will contribute to improved diagnostic reliability, screening, assessment, and support future research efforts to improve treatment.

Objective: Suicidal ideation represents a serious experience common in individuals with eating disorders. To inform screening and clinical assessment and advance theoretical work, the current study compared clinical characteristics between adult women with and without current suicidal ideation and examined whether binging, fasting, and purging behaviors are uniquely associated with suicidal ideation above and beyond existing psychiatric diagnoses. Method: Data come from four studies conducted between 2000 and 2023 ( N = 732) that evaluated current suicidal ideation in all participants. Participants completed diagnostic interviews assessing lifetime psychiatric diagnoses and current eating disorder diagnoses and behavioral symptom frequencies. Five hundred and fifty‐three participants had DSM‐5 eating disorders (54.6% bulimia nervosa, 15.0% purging disorder [PD], 28.2% other specified [excluding PD], 1.4% anorexia nervosa, and 0.7% binge‐eating disorder). Results: Individuals with current suicidal ideation had a greater prevalence of most psychiatric diagnoses and greater frequency of binging, fasting, and purging. Additionally, purging frequency was associated with current suicidal ideation independent of binging, fasting, and lifetime psychiatric comorbidities. Discussion: Results support prior work suggesting that purging may fall on the self‐harm continuum with nonsuicidal self‐injury. Further, findings support screening for purging and suicide risk assessment in individuals with eating disorders.

Background: Formation of Diagnostic and Statistical Manual of Mental Disorders (DSM) subcommittees combined with recently approved coding designations for bulimia nervosa (BN) in partial remission highlights the need to examine the validity of the threshold that distinguishes BN from other specified feeding or eating disorders (OSFED) BN of low frequency and/or limited duration (OSFED‐BN). Methods: Women ( N = 344) who met DSM‐5 criteria for BN ( n = 153) or OSFED‐BN ( n = 118) or had no lifetime eating disorder symptoms ( n = 78) completed assessments of height, weight, weight history, percent body fat, structured clinical interviews for DSM‐5 disorders, suicidality, trauma, and treatment histories, and self‐report questionnaires covering a range of validators related to eating disorders, psychological traits, and general psychopathology. Comparisons across groups tested the validity of OSFED‐BN and whether prior history of DSM‐5 BN impacted evidence of its clinical significance and distinctiveness. Results: Lower frequency of binge eating was the primary reason for diagnosis of OSFED‐BN vs. BN; more than 80% of those with OSFED‐BN met or exceeded frequency and duration criteria for inappropriate compensatory behaviors. The current DSM‐5 threshold distinguishing BN from its OSFED variant or from BN in partial remission produced few differences relative to several large differences observed for comparisons of these diagnostic groups and non‐eating disorder controls. Discussion: Despite being associated with distinct DSM‐5 diagnostic codes, BN, BN in partial remission, and OSFED‐BN appear to represent a single condition that may, at most, capture some dimensional differences in severity. Findings support lowering the current minimum frequency thresholds for diagnosing BN.