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Although numerous risk factors for bulimia nervosa have been identified, no multivariate models of bulimia have been empirically investigated with longitudinal data. The current study provided a confirmatory test of the dual pathway model of bulimia nervosa using prospective data from a community sample of adolescents (N = 218). Latent variable modeling indicated that negative affect and dietary restraint predicted future bulimic symptomatology. Further, these two factors mediated the effects of initial perceived pressure for a thin body, body mass, ideal body internalization, and body dissatisfaction on subsequent bulimic pathology. These findings provide additional support for the dual pathway model of bulimia, suggest variables that might be targeted in prevention and treatment efforts, and point to several directions for future research.
Bulimic pathology affects numerous individuals, yet few integrative etiologic models of the disorder have been postulated or tested. The dual pathway model is a developmental account of bulimia centering around dietary restraint and affect-regulation mechanisms (Stice, 1994). This model proposes that sociocultural pressure to have a thin body promotes internalization of the ideal-body stereotype, body dissatisfaction, and restraint. Body mass is also thought to contribute to perceived sociocultural pressure and body dissatisfaction. This theory was termed the dual pathway model because it posits that negative affect and restraint are the final proximal predictors of bulimic pathology, and that these two variables mediate the effects of the other predictors. Theoretical mechanisms and empirical support for each factor will be reviewed in turn.
PERCEIVED PRESSURE FOR A THIN BODY
The dual pathway model proposes that social pressure for a thin body leads to an internalization of the ideal-body image, body dissatisfaction, and restraint. Repeated messages about the value of a thin body are thought to promote an internalization of the ideal-body stereotype. Perceived pressure might contribute to body dissatisfaction not only through ideal-body internalization, but also directly. It is possible that a woman could consciously reject the ideal, but still be adversely affected by messages that her body is not attractive. Further, perceived pressure is thought to have a direct effect on restraint, over and above its indirect effects through ideal-body internalization and body dissatisfaction. In support of this, perceived pressure to be thin from family, friends, dating partners, and the media predicted ideal-body internalization,...