The Confluence of Perfectionism, Body Dissatisfaction, and Low Self-Esteem Predicts Bulimic Symptoms: Clinical Implications

We present a brief overview of empirically supported risk factors of bulimic behavior. We then propose an empirically supported, interactive, three-factor model of bulimic symptom occurrence from which we derive clinical implications for assessment, treatment, and prevention. Our research finds that perfectionism, body dissatisfaction, and self-esteem interact to predict bulimic symptoms. In particular, women who consider themselves overweight and who have elevated levels of perfectionism and lower levels of self-esteem show the greatest risk for bulimic symptoms. Thus, our model identifies three theoretically related targets for intervention: perfectionism, body dissatisfaction, and low self-esteem. Assessment of these factors is recommended. The extent to which cognitive-behavioral therapy for bulimia and interpersonal therapy for bulimia address these factors is reviewed and evaluated, and theory-based recommendations are made for prevention efforts.