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Bulimia nervosa: an ominous variant of anorexia nervosa

Published online by Cambridge University Press:  09 July 2009

Gerald Russell
Gerald Russell*
Affiliation:
Academic Department of Psychiatry, Royal Free Hospital, London
*
1Address for correspondence: Professor Gerald Russell, Academic Department of Psychiatry, Royal Free Hospital, London NW3 2QG
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Synopsis

Thirty patients were selected for a prospective study according to two criteria: (i) an irresistible urge to overeat (bulimia nervosa), followed by self-induced vomiting or purging; (ii) a morbid fear of becoming fat. The majority of the patients had a previous history of true or cryptic anorexia nervosa. Self-induced vomiting and purging are secondary devices used by the patients to counteract the effects of overeating and prevent a gain in weight. These devices are dangerous for they are habit-forming and lead to potassium loss and other physical complications. In common with true anorexia nervosa, the patients were determined to keep their weight below a self-imposed threshold. Its level was set below the patient‘s healthy weight, defined as the weight reached before the onset of the eating disorder. In contrast with true anorexia nervosa, the patients tended to be heavier, more active sexually, and more likely to menstruate regularly and remain fertile. Depressive symptoms were often severe and distressing and led to a high risk of suicide.

A theoretical model is described to emphasize the interdependence of the various symptoms and the role of self-perpetuating mechanisms in the maintenance of the disorder. The main aims of treatment are (i) to interrupt the vicious circle of overeating and self-induced vomiting (or purging), (ii) to persuade the patients to accept a higher weight. Prognosis appears less favourable than in uncomplicated anorexia nervosa.

Type
Research Article
Information
Psychological Medicine , Volume 9 , Issue 3 , August 1979 , pp. 429 - 448
Copyright
Copyright © Cambridge University Press 1979

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References

Avery, Jones F. & Godding, E. W. (1973). Management of Constipation, p. 117. Blackwell Scientific Publications: Oxford.Google Scholar
Beumont, P. J. V., George, G. C. W. & Smart, D. E. (1976). ‘Dieters’ and ‘vomiters and purgers’ in anorexia nervosa. Psychological Medicine 6, 617–622.CrossRefGoogle ScholarPubMed
Beumont, P. J. V., Abraham, S. F., Argall, W. J. & Simson, K. G. (1980). The sexual behaviour, knowledge and attitudes of girls and women with anorexia nervosa. Psycho. logical Medicine (in the press).Google Scholar
Bruch, H. (1974). Eating Disorders: Obesity, Anorexia Nervosa and the Person Within, pp. 250–255. Routledge and Kegan Paul: London.Google Scholar
Crisp, A. H. (1974). Primary anorexia nervosa or adolescent weight phobia. The Practitioner 212, 525–535.Google ScholarPubMed
Crisp, A. H., Fenton, G. W. & Scotton, L. (1968). A controlled study of the electro-encephalogram in anorexia nervosa. British Journal of Psychiatry 114, 1141–1160.CrossRefGoogle Scholar
Crisp, A. H., Kalucy, R. S., Lacey, J. H. & Harding, B. (1977). The long-term prognosis in anorexia nervosa: some factors predictive of outcome. In Anorexia Nervosa (ed. Vigersky, R.), pp. 55–65. Raven Press: New York.Google ScholarPubMed
Dally, P. (1969). Anorexia Nervosa, pp. 59, 107. Heinemann: London.Google Scholar
Garrow, J. S., Crisp, A. H., Jordan, H. A., Meyer, J.-E., Russell, G. F. M., Silverstone, J. T., Stunkard, A. J. & Van Itallie, T. B. (1976). In Report on the Dahlem Workshop on Appetite and Food Intake, Berlin 1975 (ed. Silverstone, T.), pp. 405–416. Life Sciences Research Report 2.Google Scholar
Green, R. S. & Rau, J. H. (1977). The use of diphenylhydantoin in compulsive eating disorders: further studies. In Anorexia Nervosa (ed. Vigersky, R.), pp. 377–382. Raven Press: New York.Google Scholar
Hsu, L. K. G. (1978). Anorexia nervosa - a prognostic study, pp. 183–184. M.D. Thesis: University of Hong Kong.Google Scholar
Hsu, L. K. G., Crisp, A. H. & Harding, B. (1979). Outcome of anorexia nervosa. Lancet i, 61–65.CrossRefGoogle Scholar
Kendell, R. E. (1974). A new look at hysteria. Medicine (1972–1974) 30, 1780–1783.Google Scholar
Kendell, R. E. (1975). The Role of Diagnosis in Psychiatry. Blackwell Scientific Publications: Oxford.Google Scholar
Morgan, H. G. & Russell, G. F. M. (1975). Value of family background and clinical features as predictors of long- term outcome in anorexia nervosa: four-year follow-up study of 41 patients. Psychological Medicine 5, 355–371.CrossRefGoogle ScholarPubMed
Russell, G. F. M. (1970). Anorexia nervosa: its identity as an illness and its treatment. In Modern Trends in Psychological Medicine, Volume 2 (ed. Price, J. H.), pp. 131–164. Butterworths: London.Google Scholar
Russell, G. F. M. (1977 a). General management of anorexia nervosa and difficulties in assessing the efficacy of treatment. In Anorexia Nervosa (ed. Vigersky, R.), pp. 277–289. Raven Press: New York.Google ScholarPubMed
Russell, G. F. M. (1977 b). The present status of anorexia nervosa. Psychological Medicine 7, 363–367.CrossRefGoogle ScholarPubMed
Smith, B. (1968). Effect of irritant purgatives on the myenteric plexus in man and the mouse. Gui 9, 139–143.Google ScholarPubMed
Theander, S. (1970). Anorexia nervosa. A psychiatric investigation of 94 female cases. Acta Psychiatric Scandi. navica, Suppl. 214.Google Scholar
Wigley, R. D. (1960). Potassium deficiency in anorexia nervosa, with reference to renal tubular vacuolation. British Medical Journal ii, 110–113.CrossRefGoogle Scholar
Wolff, H. P., Vecsei, P., Krück, F., Roscher, S., Brown, J. J., Düsterdieck, G. O., Lever, A. F. & Robertson, J. I. S. (1968). Psychiatric disturbances leading to potassium depletion, sodium depletion, raised plasma-renin concentration, and secondary hyperaldosteronism. Lancet i, 257–261.CrossRefGoogle Scholar