Do Bulimic Behaviors Increase Shame? Toward an Understanding of Transdiagnostic Risk

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There is abundant evidence documenting the comorbidity of bulimia nervosa (BN), internalizing disorders such as anxiety and depression, and externalizing disorders such as substance misuse. One important line of research is to move beyond descriptions of comorbidity to determine underlying mechanisms that may account for it. The intent of the proposed research is to begin to test the possibility that engagement in one behavior in a specified set of comorbid, dysfunctional behaviors increases the experience of shame, and that the increased shame contributes to risk for others of the comorbid behaviors. The scientific basis for investigating this possibility is that (a) estimates of comorbidity between BN, internalizing, and externalizing disorders are as high as 74.4% (Ulfvebrand et al, 2015); (b) prior research on comorbidity has often been descriptive, highlighting the need to investigate mechanisms to explain it; (c) the experience of shame is associated with each of these disorders; and (d) in recent longitudinal work, my colleagues and I demonstrated that binge eating in elementary school predicts increased levels of depression, alcohol use, and tobacco smoking four years later in high school. The research component of this proposal is a study designed to begin to test this idea, using bulimic behaviors by women with BN as an entry point for studying this comorbidity model. Specifically, I propose to test, in the laboratory, whether eating while in a negative mood increases state shame in women with BN as compared to healthy controls. After an ad lib eating session following negative mood induction, women with BN will experience an increase in state shame that is greater than any increase in state shame for the healthy control group and these increases will predict subsequent increases in state anxiety and depression as well as increased urges to use substances. Demonstration of increased state shame and transdiagnostic risk following a distress-based eating session for women with BN is a crucial step in a program of research I hope to conduct, using both experimental and longitudinal designs. The training component of this proposal includes the following: (1) training in the design and execution of laboratory, experimental studies; (2) training in the construct of shame, its distinction from related constructs such as guilt, the role of shame transdiagnostically, methods of measuring shame, and the possibility of reducing shame; (3) training in multilevel modeling: my planned program of research will involve studies of observations nested within people, nested within groups; (4) further advanced training in research ethics, including a second graduate course on ethical research with clinical populations, attendance at the University's clinical ethics grand rounds and research ethics lecture series; (5) preparation of research reports for publication, including learning how to respond effectively to revise and resubmit decisions; (6) presenting original research at leading, international scientific meetings; and (7) training in the mentoring of junior graduate students and undergraduate research assistants, including those assisting with the proposed research.