The cognitive-behavioral model of bulimia nervosa: A direct evaluation

Objective This study represented the first attempt to directly evaluate Fairburn et al's (1986) cognitive‐behavioral model of bulimia nervosa — the model on which the most widely used treatment for bulimia nervosa is based. Method The major predictions of the model were tested using structural equation modeling. Data were collected from the responses of 526 subjects to a number of self‐report measures. Results The factors of self‐esteem, overconcern with weight and shape, and dietary restraint accounted for a large proportion of the variance in binge eating and purging. The key pathway in the model was the link between overconcern with weight and shape and the adoption of purgative behaviors, which then fed into a vicious cycle of binge eating and purging. Contrary to Fairburn’s hypothesis, high levels of dietary restraint did not predict increased binge eating. Discussion The results suggest that the components of Fairburn's model may operate to maintain the bulimic cycle in a slightly different way to that originally proposed. © 2002 by John Wiley & Sons, Inc. Int J Eat Disord 31: 17–31, 2002.