A prospective study of the influence of the UPPS model of impulsivity on the co-occurrence of bulimic symptoms and non-suicidal self-injury Claire M. Peterson ⁎, Sarah Fischer University of Georgia, United States abstract article info Article history: Received 20 December 2011 Received in revised form 20 April 2012 Accepted 31 May 2012 Available online 15 June 2012 Keywords: Bulimia nervosa (BN) Non-suicidal self-injury (NSSI) Impulsivity Negative urgency UPPS Individuals with bulimia nervosa (BN) often report co-morbid symptoms of non suicidal self-injury (NSSI). This study examined the influence of (lack of) perseverance, (lack of) premeditation, sensation seeking, and negative urgency (the tendency to act rashly when experiencing negative affect) on these two behavior patterns. We hypothesized that negative urgency influences vulnerability to multiple maladaptive behavior patterns, thus influencing the co-occurrence of NSSI and BN symptoms. 489 young adult women completed baseline assessments, and 209 completed an eight month follow-up assessment. Structural equation model- ing was used to examine the influence of four personality pathways to impulsive behavior simultaneously on both behaviors at baseline, and the incremental predictive utility of traits on both behaviors at eight month follow up. Additionally, we examined the influence of NSSI at baseline on symptoms of BN at follow up, and symptoms of BN at baseline on NSSI at follow up. Negative urgency accounted for significant variance in NSSI and eating pathology. Baseline (lack of) perseverance contributed significantly to binge eating frequency at follow-up, when accounting for baseline symptoms. NSSI at baseline was associated with increased purging at follow-up. Individual differences in impulsivity appear to influence both NSSI and eating pathology. © 2012 Elsevier Ltd. All rights reserved. 1. Introduction A substantial percentage of individuals with bulimia nervosa (BN) endorse self-injurious behavior (Claes, Vandereycken, & Vertommen, 2001; Ross, Heath, & Toste, 2009; Solano, Fernandez-Aranda, Aitken, Lopez, & Vallejo, 2005). For example, ED symptoms, such as fasting and self-induced vomiting, are associated with elevated risk for a later suicide attempt (Crow, Eisenberg, Story, & Neumark-Sztainer, 2008; Johnson, Cohen, Kasen, & Brook, 2002). Both BN symptoms and self- injury are thought to be influenced by impulsive reactions to negative affect (Favazza, 1998; Gratz, 2001; Kamphuis, Ruyling, & Reijntjes, 2007). While suicide has received considerable empirical attention in conjunction with eating pathology (e. g. Franko & Keel, 2006), non- suicidal self-injury (NSSI) has been examined less frequently. NSSI is defined as direct and deliberate self-inflicted harm to body tissue with- out suicidal intent (Favazza, 1998). NSSI behaviors occur in between 26% and 55.2% of individuals with BN (Svirko & Hawton, 2007). One proposed link between BN symptoms and NSSI is that the desire to quickly reduce negative affect is an antecedant for both behaviors (Muehlenkamp et al., 2009; Ross et al., 2009; Svirko & Hawton, 2007). NSSI has largely been conceptualized as the result of deficits in impulse control, particularly in response to distress (Favazza, 1998; Klonsky, 2007; Muehlenkamp et al., 2009). Ecological momentary assessment studies indicate that impulsive maladaptive reactions to increases in negative affect characterize BN symptoms such as binge eating and purging (Crosby et al., 2009; Smyth et al., 2007). Similar studies have documented that increases in distress trigger NSSI in women with BN (Muehlenkamp et al., 2009). Researchers also note affect regulation motives for NSSI behaviors (Nock & Prinstein, 2004; Nock, Prinstein, & Sterba, 2009), and disordered eating behaviors (Jackson, Cooper, Mintz, & Albino, 2003), with common reasons cited for engaging in NSSI and binge eating as escape from negative mood (Klonsky, 2007). Overall it appears that both NSSI and bulimic behaviors may serve sim- ilar negative affect alleviation functions. 1.1. Negative urgency, impulsivity, and BN Recent advances in the study of impulsivity theoretically clarify the role of reactivity to negative affect in impulsive action. Historically, sev- eral aspects of impulsive behavior have been combined under one broad label ‘impulsivity’, which may have obscured the distinctions be- tween different paths to impulsive behaviors. Four primary distinct trait based paths to impulsive behavior have been identified; sensation seek- ing, lack of premeditation, negative urgency, and lack of perseverance (Smith et al., 2007; Whiteside & Lynam, 2001). Negative urgency is the tendency to act rashly in response to negative affect (Smith et al., 2007; Whiteside & Lynam, 2001). Individuals with high levels of negative urgency may associate negative affect reduction with immediately acces- sible behaviors, such as binge eating or cutting, thus increasing the likeli- hood of maladaptive behaviors via negative reinforcement pathways. Eating Behaviors 13 (2012) 335–341 ⁎ Corresponding author at: University of Georgia, Department of Psychology, 125 Baldwin St., Athens, GA 30602, United States. E-mail address: Cmpete@uga.edu (C.M. Peterson). 1471-0153/$ – see front matter © 2012 Elsevier Ltd. All rights reserved. doi:10.1016/j.eatbeh.2012.05.007 Contents lists available at SciVerse ScienceDirect Eating Behaviors