Uncontrollable behavior or mental illness? Exploring constructions of bulimia using Q methodology

Kate Churruca*, Janette Perz, Jane M. Ussher

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)
9 Downloads (Pure)


Background: In medical and psychological literature bulimia is commonly described as a mental illness. However, from a social constructionist perspective the meaning of bulimia will always be socially and historically situated and multiple. Thus, there is always the possibility for other understandings or constructions of bulimia to circulate in our culture, with each having distinct real-world implications for those engaging in bulimic behaviors; for instance, they might potentially influence likelihood of help-seeking and the success of treatment. This study used Q methodology to explore culturally-available constructions of bulimia nervosa. Methods: Seventy-seven adults with varying experience of eating disorders took part in this Q methodological study. Online, they were asked to rank-order 42 statements about bulimia, and then answer a series of questions about the task and their knowledge of bulimia. A by-person factor analysis was then conducted, with factors extracted using the centroid technique and a varimax rotation. Results: Six factors satisfied selection criteria and were subsequently interpreted. Factor A, "bulimia as uncontrolled behavior" , positions bulimia as a behavioral rather than psychological issue. Factor B, entitled "bulimia is a distressing mental illness" , reflects an understanding of bulimic behaviors as a dysfunctional coping mechanism, which is often found in psychological literature. Other perspectives position bulimia as about "self-medicating with food" (Factor C), "the pathological pursuit of thinness" (Factor D), "being the best at being thin" (Factor E), or as "extreme behavior vs. mentally ill" (Factor F). These constructions have distinct implications for the subjective experience and behavior of those engaged in bulimic behaviors, with some constructions possibly being more useful in terms of help-seeking (Factor B), while others position these individuals in ways that may be distressing, for instance as shallow (Factor D) or to blame (Factor E). Conclusions: This study has identified a range of distinct constructions of bulimia. These constructions are considered to have implications for the behaviors and experiences of those engaging in bulimic behaviors. As such, further research into constructions of bulimia may illuminate factors that influence help-seeking and the self-perceptions of such individuals.

Original languageEnglish
Article number22
Pages (from-to)1-14
Number of pages14
JournalJournal of Eating Disorders
Publication statusPublished - 29 Jul 2014
Externally publishedYes

Bibliographical note

Copyright the Author(s) 2014. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.


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