Community study traces bulimia's origins

Young women afflicted with bulimia nervosa careen between feast and famine. Frantic binges of food consumption alternate with fasting, self-induced vomiting, and other efforts to shed weight.

 Many potential culprits have been proposed to explain why 1 to 3 percent of females in many Western nations develop bulimia as teenagers or young adults. But a new study, which takes a rare look at this eating disorder among women not being treated by mental health clinicians, has considerably narrowed down the factors implicated in bulimia's emergence.

 Current bulimia sufferers often viewed themselves with extreme disdain during childhood, had encountered certain types of conflict with their parents, and had grappled with obesity early in life, assert psychiatrist Christopher G. Fairburn of the University of Oxford in England and his coworkers. Bouts of depression or other psychiatric conditions often preceded their bulimia, the researchers add.

"This is a terribly important study," says psychologist Kelly D. Brownell of Yale University. "It's the best analysis by far of risk factors for bulimia."

 Prior research on eating disorders had mainly focused on anorexia nervosa, which is marked by self-starvation and occurs much less often than bulimia.

 Fairburn's group interviewed women and girls, ages 16 to 35, selected from the patient lists of general practitioners in urban and rural parts of southern England. The investigators compared 102 participants who were diagnosed with bulimia with two other groups: 102 individuals displaying some other psychiatric disorder (mostly depression or severe anxiety) and 204 volunteers who exhibited no psychiatric problems and cited no past mental disorders.

 Many traits distinguished the bulimia group from psychologically healthy controls, the scientists report in the June Archives of General Psychiatry. These included childhood physical and sexual abuse, severe physical health problems, perfectionism, and parents who had suffered from depression.

 However, only a few characteristics separated bulimia from other psychiatric conditions. These consisted of several risk factors for obesity and dieting -- childhood or parental obesity, current dieting by other family members, and critical comments from family members about shape, weight, or eating habits.

 Bulimia also developed more frequently in women who had begun to menstruate by age 12 than in those who began later. Early changes in body shape associated with puberty may represent another spur to dieting, Fairburn's team suggests.

 Bulimic women said that their parents maintained minimal contact with them, expressed high expectations for their daughters' achievement, and had often abused alcohol. Self-esteem reached particularly low levels in the bulimia group.

 Moreover, about two-thirds of those diagnosed with bulimia had first suffered from another psychiatric disorder.

"Our findings suggest that bulimia nervosa is most likely to develop in dieters who are at risk of obesity and psychiatric disorder in general," the investigators conclude.

 The new study provides a "preliminary glimpse" at the forces underlying bulimia, writes Katherine A. Halmi, a psychiatrist at Cornell University Medical College in White Plains, N.Y., in an accompanying comment.

 Limitations of the British project, according to Halmi, include its reliance on women's self-reports of prior behavior, rather than data gathered from childhood into young adulthood, and its failure to interview family members.

 A long-term study of bulimia's onset is sorely needed but unlikely to be conducted anytime soon because of its cost, Halmi notes.

 For now, school programs aimed at quelling widespread dieting among girls may need to focus on those exhibiting high risks for obesity and psychiatric disorders in general, Fairburn and his coworkers propose.