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Frequent comorbidity with anxiety disorders (ADs) and substance use disorders (SUDs) implicates inherent fear\u2010 and approach\u2010based tendencies in BN\u2010S. This study aimed to clarify how comorbid ADs and SUDs, along with fear\u2010 and approach\u2010based traits, influence the presentation and severity of BN\u2010S.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>\n                      Women (\n                      <jats:italic>N<\/jats:italic>\n                      \u00a0=\u00a0399) with BN\u2010S (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0321) or no history of eating disorders (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a078) completed the Eating Disorder Examination, Structured Clinical Interview for DSM\u20105 Disorders, Behavioural Inhibition System\/Behavioural Activation System scales, and the Sensitivity to Punishment and Sensitivity to Reward Questionnaire.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Diagnostic features, symptom frequencies, and eating pathology scores were not significantly affected by comorbidity with ADs or SUDs. Controlling for ADs, participants with BN\u2010S scored significantly higher than controls on fear\u2010based traits. Similarly, controlling for SUDs, individuals with BN\u2010S showed elevated sensitivity to reward. Finally, elevated fear\u2010 and approach\u2010based traits both contributed to elevated severity across a range of bulimic symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Fear\u2010 and approach\u2010based traits coexist in individuals with BN\u2010S and were associated with the same symptoms. Although BN\u2010S are currently placed within the Hierarchical Taxonomy of Psychopathology's internalising spectrum, findings indicate overlap with the externalising spectrum.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/erv.70088","type":"journal-article","created":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T05:41:02Z","timestamp":1770442862000},"page":"981-992","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Comorbid Anxiety and Substance Use Disorders and Fear and Approach\u2010Based Traits in Bulimic Syndromes"],"prefix":"10.1002","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3643-5826","authenticated-orcid":false,"given":"Inge Estefania","family":"Guerrero","sequence":"first","affiliation":[{"name":"Department of Psychology Florida State University  Tallahassee Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5362-8770","authenticated-orcid":false,"given":"Alejandra Medina","family":"Fernandez","sequence":"additional","affiliation":[{"name":"Department of Psychology Florida State University  Tallahassee Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6542-5147","authenticated-orcid":false,"given":"Pamela K.","family":"Keel","sequence":"additional","affiliation":[{"name":"Department of Psychology Florida State University  Tallahassee Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,6]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2019.01.007"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.comppsych.2024.152515"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.paid.2009.04.007"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/10640266.2020.1723371"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2008.06.012"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eatbeh.2013.10.013"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291719001818"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychires.2020.07.032"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1037\/0022\u20103514.67.2.319"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/PSY.0b013e31820a1838"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1521\/jscp.2014.33.3.250"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40337\u2010025\u201001319\u20106"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu13103327"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eatbeh.2006.05.001"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12888\u2010024\u201006345\u20103"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eatbeh.2018.07.004"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.paid.2016.03.084"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40337\u2010017\u20100138\u20102"},{"key":"e_1_2_10_20_1","unstructured":"Fairburn C. 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