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PubMed1998

Smoking and bulimia nervosa.

OBJECTIVE: Little is known about the long-term physical consequences of bulimia nervosa. Some physical morbidity may result from high rates of cigarette smoking. The aim of the present study was to test three hypotheses regarding smoking among women with bulimia nervosa. METHOD: The subjects were 102 women with DSM-IV bulimia nervosa, 204 matched normal controls, and 102 matched controls with affective or anxiety disorders. All three groups were recruited from the same community sample. Interview measures were used for diagnosis and for information on smoking. RESULTS: A higher proportion of the bulimia nervosa cases were smokers than of either comparison group. Of those smokers who had achieved a period of abstinence, bulimia nervosa cases were more likely than normal control subjects to have resumed smoking, and more likely to attribute their resumption to concern about their weight. DISCUSSION: Smoking-related morbidity should be assessed in long-term follow-up studies of bulimia nervosa.

Adult↗

PubMed1994

Relationships between bulimia, childhood sexual abuse, and family environment.

Prior studies investigating the relationship between childhood sexual abuse and bulimia have yielded mixed to weak empirical support for such an association. The current research, utilizing relatively restrictive definitions of abuse and bulimia, obtained significant associations between bulimia, sexual abuse, and a chaotic family environment in female college students. Among abuse victims, severity of abuse was also associated with bulimia. Although some analyses suggested that a chaotic family environment moderated the abuse--bulimia association, sexual abuse, and family environment appeared to combine in an additive manner to increase the probability of bulimia.

Adolescent↗

PubMed1995

Coping and depression in bulimia nervosa.

OBJECTIVE: While theoretical models of bulimia have tended to emphasize single dimensions of the disorder, such as cognition or depression, factor analytic studies suggest that bulimia is best represented by a multifactorial model. In this study, we explore whether bulimia nervosa patients with different levels of depression display different types of coping. METHOD: Bulimia nervosa clinic patients were divided into four subgroups based on level of depression and asked to respond to the Coping Strategies Inventory. RESULTS: The results suggest that avoidant or disengaged coping may be more related to affective symptoms than to bulimia, itself. While problem solving and cognitive restructuring did not appear to differ between the subgroups in this study, there were significant differences in social support seeking among the four groups. DISCUSSION: The findings suggest that bulimic patients who present with the affective and personality disordered dimension of bulimia need interventions that focus on the utilization of social support.

Adaptation, Psychological↗

PubMed2001

Total energy expenditure as measured by doubly-labeled water in outpatients with bulimia nervosa.

OBJECTIVE: This study measured total energy expenditure (TEE) in symptomatic outpatient women with bulimia nervosa and normal controls. The study aimed to test the conceptual model of bulimia nervosa as an illness characterized by a physiological state of starvation, despite normal weight. METHOD: Total fat and fat-free mass were measured using hydrodensitometry and total energy expenditure was assessed via the doubly-labeled water method, in nine normal weight outpatient females with DSM-III-R bulimia nervosa and ten healthy female controls. RESULTS: Patients and controls were similar in age, body mass index, weight, lean body mass, and levels of exercise and general activity. Patients had an average baseline binge frequency of 14.7 episodes per week and purge frequency of 16.8 times per week, and had been ill for an average of 11.9 years. Group mean TEE did not differ between patients and controls (patients 2380 +/- 482 kcal/day, controls 2368 +/- 515 kcal day). Observed TEE in the bulimic subjects did not differ significantly from TEE predicted on the basis of data from the controls. DISCUSSION: This finding of normal TEE in symptomatic outpatients with bulimia nervosa is consistent with a previous study that found no difference in TEE in a sample of symptomatic inpatients with bulimia nervosa. These data suggest that the energy conserving metabolic adaptations characteristic of semi-starvation do not occur in patients with bulimia nervosa.

Adult↗

PubMed1993

Detection of bulimia in a primary care setting.

OBJECTIVE: To develop a screening tool for the identification of bulimia in ambulatory practice. DESIGN: Administration of a 112-item questionnaire about eating and weight-control practices to women with known bulimia and to healthy control patients. Questions were compared with DSM-III-R criteria of bulimia as a "gold standard." SETTING: Self-help group for eating disorders and hospital-based primary care practice. SUBJECTS: Thirty of 42 women with known bulimia met DSM-III-R criteria for current bulimia, and 124 of 130 control patients met the criterion of no history of an eating disorder. MAIN RESULTS: Thirteen individual questions discriminated between bulimic subjects and control subjects with a sensitivity and specificity of > 75%. When these questions were entered into a stepwise logistic model, two questions were independently significant. A "no" response to the question "Are you satisfied with your eating patterns?" or a "yes" response to "Do you ever eat in secret?" had a sensitivity of 1.00 and a specificity of 0.90 for bulimia. The positive predictive value, based on a 5% prevalence, was 0.36. CONCLUSIONS: A set of two questions may be as effective as a more extensive questionnaire in identifying women with eating disorders, and could be easily incorporated into the routine medical history obtained from all women.

Adolescent↗

PubMed2001

[Bulimia nervosa in homosexuality and HIV infection in the man. Case report].

A male with bulimia nervosa is reported whose homosexual behavior resulted in HIV infection. The goal of this case study is to shed light on the course characteristics of bulimia nervosa occurring together with HIV infection in connection with homosexuality. The patient had experienced a number of traumas including sexual abuse, which surely had an influence on his developing bulimia nervosa. His longing for slimness, shown by the excessive preoccupation and dissatisfaction with body shape and weight may be considered typical for bulimia nervosa in homosexual men. Furthermore, male subjects with eating disorders often seem to be overweight prior to the start of bulimia nervosa, which also was the case in this subject. The course of his HIV infection so far has had no effect on severity of the bulimic symptoms. However, his bulimia nervosa apparently did had negative effects on the course of the HIV infection.

Adult↗

PubMedDate not supplied

A controlled study of phenomenology and family history in outpatients with bulimia nervosa.

We administered structured diagnostic interviews and family history evaluations to 69 outpatient women meeting the new DSM-III-R criteria for bulimia nervosa. This group was compared with 50 women with DSM-III bulimia, 24 women with major depression, and 28 nonpsychiatric control women, all recruited during previous studies. On both phenomenologic and family history assessments, the women with DSM-III-R bulimia nervosa closely resembled the women with DSM-III bulimia, and both groups differed significantly from controls in their prevalence of personal and familial major mood disorders. These data support a relationship between bulimia nervosa and major mood disorders, consistent with that suggested by studies of bulimia assessed by earlier diagnostic criteria.

Adult↗

PubMed1994

Elevated sweet taste pleasantness ratings in bulimia nervosa.

Recent studies suggest that some patients with bulimia nervosa may experience elevated pleasantness responses to sweet taste. This study explored possible associations between symptoms patterns and pleasantness ratings for sucrose solutions in bulimic patients. Subjects included 15 women meeting DSM III-R criteria for narrowly defined bulimia nervosa (no history of other eating disorder); five patients with current bulimia nervosa and a past history of anorexia nervosa; and 20 healthy age-matched female controls. Subjects ate a standardized breakfast prior to the morning study visit. Sucrose-water solutions (0% to 40% sucrose) were rated for sweetness intensity and pleasantness. Patients with narrowly defined bulimia nervosa showed significantly higher pleasantness ratings for 40% sucrose solutions than controls and patients with a history of anorexia nervosa. Pleasantness ratings were not significantly correlated with frequency of binge eating or purging behaviors. These results extend previous evidence for altered sweet taste pleasantness responses in bulimia nervosa, and for differences in eating-related behaviors between patients with narrowly defined bulimia nervosa vs. those with past anorexia nervosa.

Adult↗

PubMed1992

Duration of bulimia nervosa and symptom progression: a retrospective analysis of treatment-seeking bulimics.

Severity of bulimia nervosa upon presentation for treatment may be influenced by duration and age of onset of bulimic behaviors. This hypothesis was investigated in a retrospective study by correlating duration of bulimia and age of onset with sets of variables measuring the primary symptoms and other psychopathology associated with bulimia nervosa. The experimental design was cross-sectional. The sample included 153 women who had been diagnosed with bulimia nervosa. Canonical correlations indicated that younger age of onset and longer duration were associated with more severe bulimic symptoms and increased body image distortion. Anorexic symptoms were reduced over time, however, and weight gain (at a rate of about 0.54 Kg [1.2 lbs] per year) was correlated with duration of bulimic behaviors. Also, older age of onset and longer duration were associated with increasing social introversion. These findings were interpreted as supportive of the hypothesis that younger age of onset and longer duration of bulimic behaviors are associated with more severe bulimia and general psychopathology. Though limited by the retrospective nature of the study, these results substantiate the need for longitudinal investigations of bulimia nervosa.

Adolescent↗

PubMed2006

Low density and high affinity of platelet [3H]paroxetine binding in women with bulimia nervosa.

Impaired serotonin transmission has been suggested to be implicated in the pathophysiology of bulimia nervosa. As an indirect measure of brain serotonergic activity, the binding of tritiated ligands to platelet serotonin transporters has been studied in bulimia nervosa as well as in other putatively serotonin-related psychiatric disorders. In this study, the density and affinity of platelet serotonin transporters were assessed in 20 women meeting the DSM-IV criteria for bulimia nervosa and in 14 controls without previous or ongoing eating disorder using [(3)H]paroxetine as a ligand. In comparison to controls, women with bulimia nervosa had a significantly reduced number of platelet binding sites (B(max) = 721 +/- 313 vs. 1145 +/- 293 fmol/mg protein) and an increase in the affinity for the ligand demonstrated by a lower dissociaton constant (K(d) = 33 +/- 10 vs. 44 +/- 10 pM). A significant correlation between B(max) and K(d) values was found in patients but not in controls. Our results support the notion that bulimia nervosa is associated with a reduction in platelet serotonin transporter density. In addition, our study is the first to report that this reduced transporter density in women with bulimia nervosa is accompanied by an increase in the affinity of the transporter for the ligand.

Adult↗

PubMed2001

Bulimia nervosa during pregnancy: a review.

Pregnant women with bulimia nervosa present interesting practice challenges for dietitians and healthcare professionals due to potential complications of bulimia nervosa for both mothers and fetuses. This review summarizes case study reports, case series reports, and retrospective studies of women with bulimia nervosa during pregnancy, and focuses on relationships among bulimic behaviors, pregnancy results, and birth outcomes. Pregnancy and birth outcomes of women with bulimia nervosa varied among individuals and studies. Material outcomes of concern included miscarriages, inappropriate weight gains (excessive or inadequate), complicated deliveries, and resumed and/or continued bulimic behaviors shortly after parturition. Fetal complications included low birth weights, prematurity, malformations, and low Apgar scores. Screening to detect bulimic behaviors is recommended, as is multidisciplinary treatment of pregnant women with bulimia nervosa to emphasize adequate dietary intakes, promote appropriate weight gains, and help achieve healthy infant outcomes in addition to long-term, healthy eating habits for these women. Future research regarding maternal and fetal outcomes of women with bulimia nervosa during pregnancy, conducted by registered dietitians, is needed to provide greater clarity and understanding of the impact of bulimic behaviors, dietary intakes, and nutritional status during pregnancy on maternal and fetal health.

Birth Weight↗

PubMedDate not supplied

Lifetime comorbidity of alcohol dependence in women with bulimia nervosa.

To determine how women with comorbid bulimia nervosa and alcohol dependence differed from those with bulimia nervosa alone, 114 women with DSM-III-R bulimia nervosa were assessed at intake for a randomized clinical trial with structure diagnostic interviews and psychometric instruments. The sample was divided on the basis of the presence (47%) or absence (53%) of lifetime alcohol dependence. Axis I and Axis II disorders, clinical features of bulimia, and personality and temperament characteristics were then compared. Women with comorbid alcohol dependence and bulimia nervosa reported a higher prevalence of suicide attempts, anxiety disorders, other substance dependence, conduct disorder and personality disorders (especially borderline and histrionic), and higher scores on novelty seeking, impulsivity, and immature defenses. There were few differences in the severity of bulimic symptoms. Findings revealed that women with comorbid bulimia nervosa and alcohol dependence bear a greater burden of Axis I and Axis II psychopathology and display greater symptoms of impulsivity and novelty seeking.

Adolescent↗

PubMed1994

Course of multi-impulsive bulimia.

Thirty-two consecutively admitted females with bulimia nervosa (purging type) according to DSM-IV and additional impulsive behaviours (multi-impulsive bulimia (MIB)) and 32 age-matched female controls with DSM-IV bulimia nervosa (purging type) (uni-impulsive bulimia (UIB)) were assessed longitudinally on admission and at discharge following in-patient therapy and at a 2-year follow-up. Multi-impulsive bulimics were defined as presenting at least three of the six of the following impulsive behaviours in their life-time in addition to their bulimic symptoms at admission: (a) suicidal attempts, (b) severe autoaggression, (c) shop lifting (other than food), (d) alcohol abuse, (e) drug abuse, or (f) sexual promiscuity. Multi-impulsive bulimics were more frequently separated or divorced, had less schooling and held less-skilled jobs. Except for interoceptive awareness (EDI), which was more disturbed in multi-impulsive bulimics, there were no differences concerning scales measuring eating disturbances and related areas. Multi-impulsive bulimics showed more general psychopathology--anxiety, depression, anger and hostility, psychoticism--differed in several personality scales from uni-impulsive bulimics (e.g. increased excitability and anger/hostility) and had overall a less favourable course of illness. Multi-impulsive bulimics also received more in- and out-patient therapy previous to the index treatment and during the follow-up period. The data support the notion that 'multi-impulsive bulimia' or 'multi-impulsive disorder' should be classified as a distinct diagnostic group on axis I or that an 'Impulsive Personality Disorder' should be introduced on axis II. The development of more effective treatment for multi-impulsive bulimia is warranted.

Adult↗

PubMed1997

Life events and the onset of bulimia nervosa: a controlled study.

BACKGROUND: Life events may play a role in precipitating the onset of bulimia nervosa. This study aimed to determine the rates of occurrence of certain life events during the year before onset of disordered eating in women with bulimia nervosa, and to compare them with the rates among age-matched normal controls. METHODS: The subjects were 102 women with bulimia nervosa and 204 women without an eating disorder, all recruited from the same community sample of young adult women. Interview measures were used for diagnosis and for assessment of life events. RESULTS: The bulimia nervosa cases reported more life events during the year before onset of disordered eating than were reported by controls of the same age. Events involving disruption of family or social relationships, or a threat to physical safety, were especially common among the bulimia nervosa cases. CONCLUSIONS: These findings suggest that certain life events may play a role in precipitating the onset of bulimia nervosa. The study was retrospective in design. Prospective studies of the role of life events would be valuable, but difficult to perform.

Adolescent↗

PubMed1991

Multifactorial assessment of bulimia nervosa.

We investigated a multifactorial approach to the assessment of bulimia nervosa by means of hierarchical factor analysis. Two hundred forty-five bulimia nervosa patients and 68 patients with either anorexia nervosa or eating disorders not otherwise specified were administered a self-report battery that was organized into 21 dimensions relevant to eating disorder patients. When dimensions from this battery were subjected to hierarchical factor analysis, support for bulimia nervosa as a unique diagnostic category was obtained. However, the emergence of 3 secondary factors and 6 primary factors suggests that bulimia nervosa can also be described more complexly. The emergence of a multifactorial model of bulimia nervosa that incorporates several existing undimensional models suggests the potential for both divergent and complicated clinical presentation in bulimia nervosa patients.

Bulimia↗

PubMed1998

On the relation of dieting and bingeing in bulimia nervosa.

The continuum model of bulimia nervosa suggests that dieting plays a major role in the etiology and maintenance of bulimia. However, a previous study (M. R. Lowe et al., 1996) recently found no relationship between dieting intensity and binge eating problems in nonclinical participants differing widely in eating and weight concerns. The present study extended these findings by examining the relationship between dieting and bingeing among individuals with bulimia. Three samples of individuals diagnosed with bulimia were divided into frequent and infrequent weight-loss dieters and were compared on multiple measures of binge eating. No diet-binge relationship was found in 1 sample, whereas in the other 2 samples frequent dieters binged less than infrequent dieters. These results raise new questions about the continuum model of bulimia and suggest that weight-loss dieting may not play as prominent a role in the maintenance of bulimia as it does in its initiation.

Adolescent↗

PubMed2000

Continuity and discontinuity models of bulimia nervosa: a taxometric investigation.

Past research evaluating the continuity and discontinuity models of bulimia has produced inconclusive results. In the current study, we performed a taxometric analysis of bulimia nervosa using means above minus below a sliding cut and maximum covariance analysis with a sample of women diagnosed with bulimia nervosa (n = 201) or women college students (n = 412). Indicators were derived from the Bulimia Test--Revised and the Eating Attitudes Test--26, and both a mixed sample and the nonclinical sample were analyzed. With both taxometric methods and both mixed and nonclinical samples, results were consistently suggestive of a latent taxon for bulimia. These results challenge a dimensional model of bulimia nervosa.

Adult↗

PubMed2004

Bulimia from a gynecological view: hormonal changes.

Gynecological problems are one of the most frequent somatic complications of eating disorders. The purpose of the present study was to assess the role of improper eating habits in the aetiology of menstrual disturbances, anovulation and hormonal related changes. Bulimia nervosa is the focus of attention since amenorrhea is considered a diagnostic criterium in anorexia nervosa. Subjects of the BITE (Bulimia Investigation Test, Edinburgh) test who were infertile were studied (n = 58) In the studied population there were 6 cases of clinical and 8 cases of subclinical bulimia nervosa. Symptoms and severity subscales of the BITE test significantly correlated with body mass index (p = 0.003). All 14 patients suffering from clinical and subclinical bulimia nervosa had pathologically low FSH and LH hormone levels. In those with clinical bulimia nervosa (n = 6) we diagnosed 4 cases of multicystic ovary (MCO) and in the eating disorder not otherwise specified (EDNOS) group (n = 22) there were 2 cases of MCO and 5 cases of polycystic ovary syndrome (PCOS). The results suggest that unsatisfactory nutrition (binges and "crash diet") in bulimia nervosa results in hormonal dysfunction, menstrual disturbances and infertility. The authors question the necessity for immediately estrogen replacement: they consider the reversibility of the hormonal status by early treatment of eating disorders is more appropriate. Excessive use of hormonal contraceptives in therapy has to be questioned.

Adult↗