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Bulimia nervosa: an ominous variant of anorexia nervosa

  • Gerald Russell (a1)
Synopsis
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.

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Corresponding author
1Address for correspondence: Professor Gerald Russell, Academic Department of Psychiatry, Royal Free Hospital, London NW3 2QG
References
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Avery Jones F. & Godding E. W. (1973). Management of Constipation, p. 117. Blackwell Scientific Publications: Oxford.
Beumont P. J. V., George G. C. W. & Smart D. E. (1976). ‘Dieters’ and ‘vomiters and purgers’ in anorexia nervosa. Psychological Medicine 6, 617622.
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).
Bruch H. (1974). Eating Disorders: Obesity, Anorexia Nervosa and the Person Within, pp. 250255. Routledge and Kegan Paul: London.
Crisp A. H. (1974). Primary anorexia nervosa or adolescent weight phobia. The Practitioner 212, 525535.
Crisp A. H., Fenton G. W. & Scotton L. (1968). A controlled study of the electro-encephalogram in anorexia nervosa. British Journal of Psychiatry 114, 11411160.
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. 5565. Raven Press: New York.
Dally P. (1969). Anorexia Nervosa, pp. 59, 107. Heinemann: London.
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. 405416. Life Sciences Research Report 2.
Green R. S. & Rau J. H. (1977). The use of diphenylhydantoin in compulsive eating disorders: further studies. In Anorexia Nervosa (ed. Vigersky R.), pp. 377382. Raven Press: New York.
Hsu L. K. G. (1978). Anorexia nervosa - a prognostic study, pp. 183184. M.D. Thesis: University of Hong Kong.
Hsu L. K. G., Crisp A. H. & Harding B. (1979). Outcome of anorexia nervosa. Lancet i, 6165.
Kendell R. E. (1974). A new look at hysteria. Medicine (19721974) 30, 17801783.
Kendell R. E. (1975). The Role of Diagnosis in Psychiatry. Blackwell Scientific Publications: Oxford.
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, 355371.
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. 131164. Butterworths: London.
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. 277289. Raven Press: New York.
Russell G. F. M. (1977 b). The present status of anorexia nervosa. Psychological Medicine 7, 363367.
Smith B. (1968). Effect of irritant purgatives on the myenteric plexus in man and the mouse. Gui 9, 139143.
Theander S. (1970). Anorexia nervosa. A psychiatric investigation of 94 female cases. Acta Psychiatric Scandi. navica, Suppl. 214.
Wigley R. D. (1960). Potassium deficiency in anorexia nervosa, with reference to renal tubular vacuolation. British Medical Journal ii, 110113.
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, 257261.
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Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
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