The development of an instrument to assess the antecedents and consequences of binge eating and purging

Bulimia nervosa is an eating disorder which affects mostly adolescent and young adult females. Presently, there is little agreement among mental health professionals about the factors maintaining this disorder and a lack of understanding of how binge eating and purging behaviors are functional to the individual. The purpose of this study was to develop and validate a new instrument, the Binge-Purge Maintenance Scale (BPMS), designed to identify antecedent and consequent variables maintaining binge eating and purging by vomiting in individuals who struggle with these behaviors. The BPMS is a 92-item questionnaire that assesses 26 maintaining variables from 4 categories (emotional, cognitive, proprioceptive, and behavioral/situational), 13 related to binge eating behavior and 13 related to purging. The item and subscale analyses indicated that 35 of the 92 items (38%) should be examined and reworded or replaced, and some of the subscales could be combined. An assessment of the top 10 most strongly endorsed antecedents and consequences showed that, for the population studied (college women), antecedents to the binge and purge included approximately equal representation from each of the four variable categories. In contrast, consequences to the binge were mostly proprioceptive, and consequences to the purge were mostly emotional. In the reliability study (test-retest), all but one of the binge-related subscales correlated significantly 4 to 6 weeks later, suggesting that the binge-related half of the questionnaire has some stability. However, several of the purge-related subscales did not reach significance. Internal consistency reliability was also modest: the mean alpha for the binge-related subscales was.64, and the mean positive alpha for the purge-related subscales was.61. The results of the validity study (correlations with other measures) showed that 19 of the 26 BPMS subscales (73%) correlated significantly with at least one other comparison scale or subscale. In general, the binge-related subscales performed better than the purge-related subscales, and the antecedents subscales performed better than the consequences subscales. The BPMS is presented as a behaviorly-focused adjunct to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994) and other assessment methods, designed to help counselors provide more effective treatment