Bulimia nervosa and depression: a theoretical and clinical appraisal in light of the binge-purge cycle.

This review seeks to familiarize clinicians with several major theoretical perspectives on the relationship between bulimia nervosa and depression. It begins by clarifying the affective changes which occur within the binge-purge cycle. Six hypotheses relating negative affect to bulimia nervosa are then reviewed in light of these changes, with their strengths, weaknesses and clinical implications clearly outlined. The author concludes that, although none of these perspectives has received universal support, recent hypotheses which focus upon specific portions of the binge-purge cycle are best suited to integration. These include the restraint, escape and hopelessness hypotheses. An integrative model is proposed to account for data across the binge-purge cycle, to assist in understanding the maintenance of bulimia nervosa, and to guide clinical intervention.