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Self-damaging and Addictive Behaviour in Bulimia Nervosa: A Catchment Area Study

  • J. Hubert Lacey (a1)

This study examines the prevalence of self-damaging and addictive behaviour in a consecutive series of 112 normal-weight bulimic women all stemming from the same urban catchment area. A quarter reported consuming over 36 units of alcohol a week, and nine drank over 50 units. Twenty-eight per cent abused drugs, 21% repeatedly stole, 18% repeatedly overdosed, and 8% regularly cut themselves. In all, 40% reported self-damaging and addictive behaviour, 80% of whom gave a history of three or more behaviours together. Alcohol abuse was significantly associated with drug abuse and repeated overdosing; repeated cutting was significantly associated with drug abuse. Repeated stealing and overdosing were markers of severity and did not occur in isolation. A core group, termed and defined by the author as ‘multi-impulsive bulimics', were older, less likely to be employed, married, or in a stable union, but were more likely to have an alcohol-abusing partner or to come from a family with a history of alcohol abuse. They were also more likely to give a history of sexual abuse.

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American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM-III). Washington, DC: APA.
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM-III-R). Washington, DC: APA.
Beary, M. D., Lacey, J. H. & Merry, J. (1986) Alcoholism and eating disorders in women of fertile age. British Journal of Addiction, 81, 685689.
Breeze, E. (1985) Women and Drinking. Office of Population, Censuses and Surveys. London: HMSO.
Crisp, A. H. (1970) Anorexia nervosa: feeding disorder, nervous malnutrition or weight phobia? World Revue of Nutrition and Dietetics, 12, 452504.
Fairburn, C. G. & Cooper, P. J. (1984) The clinical features of bulimia nervosa. British Journal of Psychiatry, 144, 238246.
Hare, R. D. (1980) A research scale for the assessment of psychopathy in criminal populations. Personality and Individual Differences, 1, 111120.
Hudson, J. I., Pope, H. G. & Jonas, J. M. (1984) Psychosis in anorexia nervosa and bulimia. British Journal of Psychiatry, 145, 420423.
Kemsley, W. F. (1952) Body weight at different ages and heights. Annals of Eugenics, 16, 1.
Kennedy, H. G. & Grubin, D. H. (1990) Hot-headed or impulsive? British Journal of Addiction, 85, 639643.
Lacey, J. H. (1982) The bulimic syndrome at normal body weight: reflections on pathogenesis and clinical features. International Journal of Eating Disorders, 2, 5966.
Lacey, J. H. (1983) Bulimia nervosa, binge-eating and psychogenic vomiting: a controlled treatment study and longterm outcome. British Medical Journal, 286, 16091631.
Lacey, J. H. (1986) An integrated behavioural and psychodynamic approach to the treatment of bulimia. British Revue of Bulimia and Anorexia Nervosa, 1, 1926.
Lacey, J. H. (1990) Incest, incestuous fantasy and indecency: a clinical catchment area study of normal-weight bulimic women. British Journal of Psychiatry, 157, 399403.
Lacey, J. H. (1992a) The treatment demand for bulimia: a catchment area report of referral rates and demography. Psychiatric Bulletin, 16, 203205.
Lacey, J. H. (1992b) Homogamy: the relationships and sexual partners of normal-weight bulimics. British Journal of Psychiatry, 161, 638642.
Lacey, J. H. & Evans, C. D. H. (1986) The impulsivist: a multi-impulsive personality disorder. British Journal of Addiction, 81, 715723.
Lacey, J. H. & Mourelli, E. (1986) Bulimic alcoholics: some features of a clinical subgroup. British Journal of Addiction, 81, 389393.
McCown, W. (1988) Multi-impulsive personality disorder and multiple-substance abuse: evidence from members of self-help groups. British Journal of Addiction, 83, 431432.
McCown, W. (1989) The relationship between impulsivity, empathy and involvement in twelve-step self-help substance abuse treatment groups. British Journal of Addiction, 84, 391393.
McCown, W. (1990) The effective impulsivity and empathy on abstinence of poly-substance abusers: a perspective study. British Journal of Addiction, 85, 635637.
Nace, E. P., Saxon, J. J. & Shore, N. (1983) A comparison of borderline and non-borderline alcholic patients. Archives of General Psychiatrics, 40, 5456.
Office of Population Censuses & Surveys (OPCS) (1982) Census 1981. Sex, Age and Marital Status. London: HMSO.
Pyle, R. L., Mitchell, J. E. & Eckert, E. D. (1981) Bulimia: a report of 34 cases. Journal of Clinical Psychiatry, 42, 6064.
Russell, G. F. M. (1979) Bulimia nervosa: an ominous variant of anorexia nervosa. Psychological Medicine, 9, 429448.
Schaffer, C. B., Carroll, J. & Abramowitz, S. I. (1982) Selfmutilation and the borderline personality. Journal of Nervous and Mental Disease, 170, 468473.
Schukit, M. A. & Morrissey, E. R. (1979) Drug abuse among alcoholic women. American Journal of Psychiatry, 136, 607611.
Sohlberg, S., Norring, E. C., Holmgren, S., et al (1989) Impulsivity and long-term prognosis of psychiatric patients with anorexia nervosa/bulimia nervosa. Journal of Nervous and Mental Disease, 177, 249258.
Snyder, S. & Pitt, W. M. (1984) Characterising anger in the DSM-III borderline personality disorder. Acta Psychiatrica Scandinavica, 72, 464469.
World Health Organization (1978) Mental Disorders: Glossary and Guide to their Classification in Accordance with the Ninth Revision of the International Classification of Diseases (ICD-9). Geneva: WHO.
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  • ISSN: 0007-1250
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Self-damaging and Addictive Behaviour in Bulimia Nervosa: A Catchment Area Study

  • J. Hubert Lacey (a1)
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