Bulimic pathology is one of the most common psychiatric problems faced by adolescent females, is characterized by a persistent course, can result in serious medical complications, and is associated with comorbid psychopathology and functional impairment. Although longitudinal studies have identified risk factors for bulimic pathology, these factors are relatively weak predictors of symptom onset and little is known about how these factors work together to promote this disorder. There have also been few studies on the factors that predict persistence of bulimic pathology (maintenance factors) or the role of comorbid psychiatric conditions in the etiology or maintenance of bulimic pathology. Finally, past etiologic and maintenance studies have been limited by certain methodological shortcomings (e.g., small samples, short follow-up periods, high attrition, reliance on self-report data, and a lack of structured diagnostic interviews). Accordingly, the primary and secondary aims of the proposed study are to:

  • (1) investigate a set of putative risk and maintaining factors for bulimic pathology,
  • (2) test mediational and moderational theories concerning how these factors work together to promote and maintain bulimic pathology, and
  • (3) examine the role of comorbid psychopathology in onset and maintenance of bulimic pathology.

A tertiary aim is to further document the impact of bulimic pathology on subjective distress, psychosocial functioning, and health care utilization. These aims will be achieved by following a large representative cohort of adolescent females (N = 496), which has been assessed annually since age 13, for another four years. When complete, this cohort will have been followed annually for 8 years, making it the longest prospective study of adolescent bulimic pathology to date. Certain methodological limitations of past studies will be addressed (e.g., by collecting multiple-reporter data and using structured psychiatric interviews). Cutting-edge quantitative methods will be used to test hypotheses. Thus, the proposed continuation of this longitudinal study should advance our knowledge of the risk and maintenance factors for bulimic pathology and therefore provide direction for the design of prevention and treatment programs for this serous and pervasive psychiatric problem.