Psychological Medicine

Original Articles

A latent profile analysis of the typology of bulimic symptoms in an indigenous Pacific population: evidence of cross-cultural variation in phenomenology

J. J. Thomasa1a2a3 c1, R. D. Crosbya4a5, S. A. Wonderlicha4a5, R. H. Striegel-Moorea6 and A. E. Beckera1a3a7

a1 Eating Disorders Clinical and Research Program, Massachusetts General Hospital, USA

a2 Klarman Eating Disorders Center, McLean Hospital, USA

a3 Department of Psychiatry, Harvard Medical School, USA

a4 Neuropsychiatric Research Institute, USA

a5 University of North Dakota School of Medicine and Health Sciences, USA

a6 Department of Psychology, Montana State University, USA

a7 Department of Global Health and Social Medicine, Harvard Medical School, USA


Background Previous efforts to derive empirically based eating disorder (ED) typologies through latent structure modeling have been limited by the ethnic and cultural homogeneity of their study populations and their reliance on DSM-IV ED signs and symptoms as indicator variables.

Method Ethnic Fijian schoolgirls (n=523) responded to a self-report battery assessing ED symptoms, herbal purgative use, co-morbid psychopathology, clinical impairment, cultural orientation, and peer influences. Participants who endorsed self-induced vomiting or herbal purgative use in the past 28 days (n=222) were included in a latent profile analysis (LPA) to identify unique subgroups of bulimic symptomatology.

Results LPA identified a bulimia nervosa (BN)-like class (n=86) characterized by high rates of binge eating and self-induced vomiting, and a herbal purgative class (n=136) characterized primarily by the use of indigenous Fijian herbal purgatives. Both ED classes endorsed greater eating pathology and general psychopathology than non-purging participants, and the herbal purgative class endorsed greater clinical impairment than either the BN-like or non-purging participants. Cultural orientation did not differ between the two ED classes.

Conclusions Including study populations typically under-represented in mental health research and broadening the scope of relevant signs and symptoms in latent structure models may increase the generalizability of ED nosological schemes to encompass greater cultural diversity.

(Received August 26 2009)

(Revised January 03 2010)

(Accepted January 16 2010)

(Online publication March 29 2010)


c1 Address for correspondence: J. J. Thomas, Ph.D., Eating Disorders Clinical and Research Program, Massachusetts General Hospital, WAC 816D, 15 Parkman St, Boston, MA 02114, USA. (Email:


Portions of this paper were presented at the NIMH-sponsored meeting on Eating Disorder Classification in Arlington, Virginia on 16 March 2009 (R13MH081447) and at the American Psychological Association Convention in Toronto, Canada on 6 August 2009.