Mortality in Bulimia Nervosa

A study highlights risks of heart disease and death with BN.

Mortality risk is known to be elevated in people with anorexia nervosa.   Whether this is also true for those with BN is less clear; some studies have shown increased risks, but other have not, and overall there is less research on mortality in BN.  Moreover, if there is increased risk, it is unclear if it represents medical risk or risk of suicide (or both).  A recent study from Quebec shows that risk of heart disease and of death is elevated in those with BN.

In this study, Tith et al. (JAMA Psychiatry, published online, October 16, 2019) examined 818 women hospitalized for BN.  About 415,000 women hospitalized for pregnancy-related reasons were used as the comparison group.  All participants were followed for 12 years.

Increased risks identified

The results showed that there was a 4.25-fold increase in risk for heart disease, and a 4.7-fold increase in risk of dying overall.  The authors note one caveat:  participants were in the hospital for treatment of BN. Hospitalization for treatment of BN is not common, suggesting that these patients were severely ill.

These are important results that emphasize the magnitude of the risks related to BN. They also tend to question prevailing ideas about the lower severity of BN as opposed to AN.  Finally, they seem to pose a strong argument for pushing to identify the presence of BN as early as possible.  We know from experience that people with BN often first present in treatment 3 to5 years after the onset of symptoms, but it seems very unlikely that medical risks are similarly delayed.

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