Introduction: since the Enhanced-Cognitive behavioural (CB) model of Bulimia Nervosa (BN) was devolved to expand the original CB model by encapsulating four additional maintenance factors thought to account for the persistence of BN and interfere with or inhibit treatment effectiveness, examining whether the predictive ability of the E-CB model would be improved by thaddition of interpersonal problems, core low self-esteem, clinical perfectionism, and mood intolerance could potentially have implications for understanding BN maintenance. The study aimed at examining and comparing the original and enhanced CB maintenance models amongst patients with BN. Methods: data collected from 479 patients seeking treatment for BN (n = 360) or atypical BN (n = 119), who were interviewed and completed standardized self-report measures, were analysed using a structural equation modelling approach. Results: although both models provided a good fit to the data, the enhanced model accounted for a greater proportion of variance in restraint, binge eating, and purging than the original one. In the enhanced model, interpersonal problems, clinical perfectionism and core low self-esteem were indirectly associated with restraint through over-evaluation of shape and weight. Interpersonal problems and mood intolerance were directly linked to binge eating but the path from restraint to binge eating was non-significant. Increased mood intolerance and binge eating were associated with increased purging. Structural path differences across groups were not observed. Conclusions: in addition to dysfunctional cognitions and behaviour, assessment and target of the additional maintenance factors may result in improved treatment outcomes amongst patients with BN seeking treatment.
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