A prospective test of the dual pathway model of bulimic pathology: Mediating effects of dieting and negative affect

Because there have been few longitudinal investigations of integrative etiological theories of bulimia nervosa, this study prospectively tested the dual-pathway model using random regression growth curve models and data from a 3-wave community sample of adolescent girls ( N = 231). Initial pressure to be thin and thin-ideal internalization predicted subsequent growth in body dissatisfaction, initial body dissatisfaction predicted growth in dieting and negative affect, and initial dieting and negative affect predicted growth in bulimic symptoms. There was prospective evidence for most of the hypothesized mediational effects. Results are consistent with the assertion that pressure to be thin, thin-ideal internalization, body dissatisfaction, dieting, and negative affect are risk factors for bulimic pathology and provide support for the dual-pathway model. Approximately 4 % of adolescent girls will suffer from bulimia nervosa ( Rand & Kuldau, 1992; Whitaker et al., 1990), making it one of the more prevalent psychiatric problems faced by this population. Bulimia nervosa is characterized by a persistent course, can result in serious medical complications, and is associated with comorbid psychopathology, including affective disorders, anxiet