What causes and maintains bulimia nervosa? recovered and nonrecovered women's reflections on the disorder

Through a comparison of the similarities and differences between recovered and nonrecovered bulimic women's reports of factors contributing to the cause and maintenance their disorder, this study speculates about the process of recovery from bulimia nervosa. Causes cited by both groups include family difficulties, desire for "control" or "perfection," negative affects (e.g., fear, sadness, anger), and peer pressure to be thin. Maintaining factors cited by both groups include a perceived sense of "addiction," use of purging as a weight loss method, and negative affects. Despite these similarities, three times more nonrecovered than recovered women mentioned failed diets or weight loss methods, and three times more recovered than nonrecovered women mentioned lack of self-acceptance or low self-esteem, as causes of their disorder. Also, while one quarter of the nonrecovered group mentioned positive factors (e.g., power and mood elevation) as maintaining their disorder, none of the recovered women did so. Findings imply that recovery may challenge women to look beyond the relatively superjicial issues of weight and shape to deeper, more fundamental causes, such as family dificulties and a desire for control or pegection; recognize their low self-esteem or lack of self-acceptance and its impact on their disorder; and stop attributing positive benefits to the maintainence of their disorder. The authors provide narrative examples to illustrate women's experience with the disorder.