Journal of Youth and Adolescence

, Volume 44, Issue 8, pp 1580–1591 | Cite as

Distinguishing Between Risk Factors for Bulimia Nervosa, Binge Eating Disorder, and Purging Disorder

  • Karina L. Allen
  • Susan M. Byrne
  • Ross D. Crosby
Empirical Research


Binge eating disorder and purging disorder have gained recognition as distinct eating disorder diagnoses, but risk factors for these conditions have not yet been established. This study aimed to evaluate a prospective, mediational model of risk for the full range of binge eating and purging eating disorders, with attention to possible diagnostic differences. Specific aims were to determine, first, whether eating, weight and shape concerns at age 14 would mediate the relationship between parent-perceived childhood overweight at age 10 and a binge eating or purging eating disorder between age 15 and 20, and, second, whether this mediational model would differ across bulimia nervosa, binge eating disorder, and purging disorder. Participants (N = 1,160; 51 % female) were drawn from the Western Australian Pregnancy Cohort (Raine) Study, which has followed children from pre-birth to age 20. Eating disorders were assessed via self-report questionnaires when participants were aged 14, 17 and 20. There were 146 participants (82 % female) with a binge eating or purging eating disorder with onset between age 15 and 20 [bulimia nervosa = 81 (86 % female), binge eating disorder = 43 (74 % female), purging disorder = 22 (77 % female)]. Simple mediation analysis with bootstrapping was used to test the hypothesized model of risk, with early adolescent eating, weight and shape concerns positioned as a mediator between parent-perceived childhood overweight and later onset of a binge eating or purging eating disorder. Subsequently, a conditional process model (a moderated mediation model) was specified to determine if model pathways differed significantly by eating disorder diagnosis. In the simple mediation model, there was a significant indirect effect of parent-perceived childhood overweight on risk for a binge eating or purging eating disorder in late adolescence, mediated by eating, weight and shape concerns in early adolescence. In the conditional process model, this significant indirect effect was not moderated by eating disorder group. The results support a prospective model of risk that applies to bulimia nervosa, binge eating disorder and purging disorder. Common prevention approaches may be possible for bulimia nervosa, binge eating disorder and purging disorder.


Adolescence Bulimia nervosa Binge eating disorder Purging disorder Risk factors Raine Study 



We are extremely grateful to the Raine Study participants and their families who took part in this study and to the whole Raine Study team for cohort management and data collection. We would also like to acknowledge the National Health and Medical Research Council (NHMRC) of Australia and the Telethon Kids Institute for their long-term support of the Raine Study. The first author is supported by an early career research fellowship from the National Health and Medical Research Council (NHMRC) of Australia. Core funding for the Western Australian Pregnancy Cohort (Raine) Study is provided by the Raine Medical Research Foundation; The University of Western Australia (UWA); the Faculty of Medicine, Dentistry and Health Sciences at UWA; the Telethon Kids Institute; the Women’s and Infant’s Research Foundation; Curtin University; and Edith Cowan University. Funding for the 14-year Raine Study follow-up was provided by the Raine Medical Research Foundation and NHMRC project grants. Funding for the 17-year follow-up was provided by NHMRC programme grant 35314. Funding for the 20-year follow-up was provided by the Canadian Institutes of Health Research and NHMRC project grants.

Author contributions

KA conceived of the study, conducted the statistical analyses and drafted the initial manuscript; RC provided statistical advice, assisted with the interpretation of results, and helped edit the manuscript; SB contributed to the study design and helped edit the manuscript. All authors read and approved the final manuscript.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Karina L. Allen
    • 1
    • 2
  • Susan M. Byrne
    • 1
  • Ross D. Crosby
    • 3
    • 4
  1. 1.School of PsychologyThe University of Western AustraliaCrawleyAustralia
  2. 2.Telethon Kids InstituteThe University of Western AustraliaCrawleyAustralia
  3. 3.Department of Clinical NeuroscienceUniversity of North Dakota School of Medicine and Health SciencesGrand ForksUSA
  4. 4.Department of BiostatisticsNeuropsychiatric Research InstituteSalt Lake CityUSA

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