Family Interactions Predict Intraindividual Symptom Variation for Adolescents with Bulimia Deborah M. Okon, 1 * Anita L. Greene, 1 and Jane Ellen Smith 2 1 Pacific Graduate School of Psychology, Palo Alto, California 2 Department of Psychology, University of New Mexico, Albuquerque, New Mexico Accepted 20 November 2002 Abstract: Objective: Following family systems and stress theories, this study considered predictors of symptom variation experienced by adolescents with bulimia. Methods: Using experience sampling methodology, 20 girls clinically diagnosed with bulimia nervosa com- pleted questionnaires about hassles and bulimic symptoms for 1 week, eight times daily, whenever they were contacted by pager. Perceived family environment was defined by the Family Environment Scale and the Conflict Behavior Questionnaire. Results: Regression analyses found that potent family hassles were positive predictors of bulimic symptoms later that day for girls who perceived their family as having high levels of conflict or low levels of emotional expressiveness. This was not found when girls perceived their family environment as more normal. Discussion: Within the context of a perceived dysfunctional family environment, potent family hassles can predict interindividual and intraindividual bulimic symptom variation for adolescent girls. # 2003 by Wiley Periodicals, Inc. Int J Eat Disord 34: 450–457, 2003. Key words: family interactions; intraindividual symptom variation; adolescents; experience sampling method; bulimia INTRODUCTION Although research on bulimia nervosa has focused primarily on adults, a sizable number of adolescent girls are diagnosable (Gross & Rosen, 1988). Both adults and adolescents with bulimia are a heterogeneous group, with high symptom variability between individuals and within individual binge/purge episodes (Kirkley, Burge, & Ammerman, 1988). Much is unknown about this variability in presentation and etiology in general. Two major etiologic considerations for adolescents are family systems approaches that explain symptom development and maintenance as embedded within dysfunctional family interactions (Steiner & Lock, 1998) and environmental stress *Correspondence to: Dr. Deborah M. Okon, College of Counseling and Human Services, University of Phoenix, 7471 Pan American Freeway, NE, Albuquerque, NM 87109. E-mail: dmokon@highstream.net Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/eat.10215 # 2003 by Wiley Periodicals, Inc.