Skip to main content
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 814
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Forney, K. Jean Buchman-Schmitt, Jennifer M. Keel, Pamela K. and Frank, Guido K.W. 2016. The medical complications associated with purging. International Journal of Eating Disorders, Vol. 49, Issue. 3, p. 249.

    Kowalska, Irina Karczewska-Kupczewska, Monika Strączkowski, Marek and Rubin, Robert T. 2016. Endocrinology: Adult and Pediatric.

    Pirie, Iain 2016. Disordered eating and the contradictions of neoliberal governance. Sociology of Health & Illness, Vol. 38, Issue. 6, p. 839.

    Smink, F. R. E. van Hoeken, D. Donker, G. A. Susser, E. S. Oldehinkel, A. J. and Hoek, H. W. 2016. Three decades of eating disorders in Dutch primary care: decreasing incidence of bulimia nervosa but not of anorexia nervosa. Psychological Medicine, Vol. 46, Issue. 06, p. 1189.

    Brewerton, Timothy D. 2015. The Wiley Handbook of Eating Disorders.

    Bryant-Waugh, Rachel 2015. Changing Times. Advances in Eating Disorders, Vol. 3, Issue. 2, p. 119.

    Chaulet, S. Riquin, É. Avarello, G. Malka, J. and Duverger, P. 2015. Trastornos de conducta alimentaria en el adolescente. EMC - Pediatría, Vol. 50, Issue. 3, p. 1.

    Crow, Scott 2015. The Wiley Handbook of Eating Disorders.

    Glasofer, Deborah R. Attia, Evelyn and Timothy Walsh, B. 2015. Psychiatry.

    Gordon, Richard A. 2015. The Wiley Handbook of Eating Disorders.

    Johansson, Ann-Katrin Johansson, Anders Nohlert, Eva Norring, Claes Åstrøm, Anne Nordrehaug and Tegelberg, Åke 2015. Eating disorders - knowledge, attitudes, management and clinical experience of Norwegian dentists. BMC Oral Health, Vol. 15, Issue. 1,

    Keel, Pamela K. and Forney, K. Jean 2015. The Wiley Handbook of Eating Disorders.

    Keel, Pamela K. 2015. The Encyclopedia of Clinical Psychology.

    Kim, Youl-Ri Kim, Jeong-Hyun Kim, Chan-Hyung Shin, Jae Gook and Treasure, Janet 2015. Association between the Oxytocin Receptor Gene Polymorphism (rs53576) and Bulimia Nervosa. European Eating Disorders Review, Vol. 23, Issue. 3, p. 171.

    Lock, James and La Via, Maria C. 2015. Practice Parameter for the Assessment and Treatment of Children and Adolescents With Eating Disorders. Journal of the American Academy of Child & Adolescent Psychiatry, Vol. 54, Issue. 5, p. 412.

    Mehler, Philip S and Rylander, Melanie 2015. Bulimia Nervosa – medical complications. Journal of Eating Disorders, Vol. 3, Issue. 1,

    Murray, Stuart B. and Anderson, Leslie K. 2015. Deconstructing “Atypical” Eating Disorders: an Overview of Emerging Eating Disorder Phenotypes. Current Psychiatry Reports, Vol. 17, Issue. 11,

    Palmer, R.L. Abbas, S. Sekar, M. Sen, S. and Meyer, C. 2015. A magazine study of eating disorders in India: a puzzling failure?. Advances in Eating Disorders, Vol. 3, Issue. 3, p. 316.

    Rosenvinge, Jan H. and Pettersen, Gunn 2015. Epidemiology of eating disorders, part I: introduction to the series and a historical panorama. Advances in Eating Disorders, Vol. 3, Issue. 1, p. 76.

    Vázquez Arévalo, Rosalia Aguilar, Xochitl López Ocampo Tellez-Girón, María Trinidad and Mancilla-Diaz, Juan Manuel 2015. Eating disorders diagnostic: from the DSM-IV to DSM-5. Revista Mexicana de Trastornos Alimentarios, Vol. 6, Issue. 2, p. 108.


Bulimia nervosa: an ominous variant of anorexia nervosa

  • Gerald Russell (a1)
  • DOI:
  • Published online: 01 July 2009

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.

Corresponding author
1Address for correspondence: Professor Gerald Russell, Academic Department of Psychiatry, Royal Free Hospital, London NW3 2QG
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

A. H. Crisp , G. W. Fenton & L. Scotton (1968). A controlled study of the electro-encephalogram in anorexia nervosa. British Journal of Psychiatry 114, 11411160.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *