Bulimia: its epidemiology and management.

The prevalence of the syndromes bulimia and bulimia nervosa is not known. Although existing epidemiological studies have produced somewhat conflicting findings, it appears likely that these syndromes constitute a significant source of psychiatric morbidity. It is interesting to note that prior to 1980 there appear to have been few patients who fulfil diagnostic criteria for these syndromes, whereas since then the number of such patients seems to have greatly increased. Whilst it is possible that the recent publicity may have engendered new cases by suggesting that self-induced vomiting is an effective means of weight control, there are two other likely explanations for the increase. First, the publicity may have helped people with these conditions divulge their eating problems to doctors. Second, doctors may have been alerted to the fact that people with a normal body weight may nevertheless have an eating disorder which requires a specialist's help. If these explanations are correct, the upsurge in referrals may be a short-lived phenomenon during which existing cases of varying duration will come to attention. Thereafter, it would be predicted that the referral rate will decline to a level which more accurately reflects the incidence of the two conditions (22). The emergence of these syndromes is not simply of theoretical interest. They pose a challenging therapeutic problem which has necessitated the development of specific psychological approaches to their treatment. However, before any treatment for bulimia can be advocated, its use should be supported by data from controlled outcome studies in which changes in each facet of the condition are assessed including patients' eating habits, moods, and most importantly, their attitudes to their weight and shape. As has been discussed, behavioural improvement is likely to be short-lived unless it is accompanied by significant attitude change.