title: Initial manifestations of disordered eating behavior: dieting versus binging.
abstract: OBJECTIVE
  We examined the onset of binge eating and dieting in 108 women with bulimia nervosa to determine whether (1) dieting always preceded binge eating; (2) dieting always preceded the onset of bulimia nervosa; and (3) individuals who manifested early initial binge eating differed from those whose earliest manifestation of disordered eating behavior was dieting in terms of lifetime psychopathology and temperament.
  
  
  METHODS
  One hundred eight women were assessed at entry to a randomized clinical trial of cognitive-behavioral therapy for bulimia nervosa using structured diagnostic methodology. Retrospective recall of the onset of disordered eating behavior was used to categorize individuals as initial binge eaters or initial dieters. We then compared lifetime psychopathology and temperament across the two groups.
  
  
  RESULTS
  Seventeen percent of women reported early binge eating prior to any dieting behavior. The mean age of onset of binging in this group was approximately 10 years. Neither the clinical picture of bulimia nervosa nor lifetime psychopathology differed between initial binge eaters and initial dieters. Individuals with early binge eating endorsed higher novelty seeking and lower harm avoidance.
  
  
  CONCLUSIONS
  In a minority of women with bulimia nervosa, binge eating precedes dieting. These women display markedly higher novelty seeking and lower harm avoidance. Possible links between the dopamine system, novelty seeking, and appetitive behavior are discussed.
authors.affiliation: Department of Psychiatry, Medical College of Virginia, Richmond 23298-0710, USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Bulik
authors.forename: P F
authors.initials: PF
authors.lastname: Sullivan
authors.forename: F A
authors.initials: FA
authors.lastname: Carter
authors.forename: P R
authors.initials: PR
authors.lastname: Joyce
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D001362:Avoidance Learning; D002032:Bulimia / Q000523:psychology*; D004038:Diet, Reducing / Q000523:psychology*; D005106:Exploratory Behavior; D005260:Female; D006801:Humans; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D013694:Temperament; D013997:Time Factors