The Anxiety Model of Bulimia Nervosa and Treatment with Exposure Plus Response Prevention

Abstract

As with most complex behavior disorders there is probably no single cause of bulimia nervosa. Instead, there are many interacting risk factors and pathways. Most often cited in the literature are: cultural pressures on women to be slim (e.g., Orbach 1978); the desire to achieve some idealized image of the perfect body in order to compensate for low self-esteem and fears of rejection (e.g., Boskind-Lodahl and White 1978); negative mood states including depression (e.g., Hudson et al. 1983); interpersonal stress with poorly developed problem-solving and assertion skills (e.g., Wolchik et al. 1986); poor eating and weight control habits especially including the attempt to adhere to an unrealistically rigid and drastically restrained diet (e.g., Johnson et al. 1986); and a host of distorted cognitions about nutrition, weight, and appearance (Fairburn 1981; Fairburn 1985; Fairburn et al. 1986).