Q & A: Bulimia Nervosa: How Does Prior Anorexia Affect Patients?

Q: In my practice I see patients with bulimia nervosa, some of whom have had prior anorexia nervosa, and some of whom haven’t. Should I be looking out for any particular clinical differences between these groups?  (F.S.  Washington, D.C.)

A: Your interesting question has been studied in a multi-site study conducted at five Midwestern sites.  By means of community advertising 37 patients with bulimia nervosa who reported prior anorexia nervosa and 101 women with bulimia nervosa but no prior anorexia nervosa were recruited, phone screened and then interviewed and assessed in person.   The key differences found between the groups include several findings that are likely to be clinically important.  Bulimic patients with prior anorexia nervosa reported higher levels of all types of childhood neglect and abuse, predominanty physical abuse, as well as higher levels of dietary restraint and purging than the bulimic patients without prior histories of anorexia nervosa.  Those with prior anorexia nervosa also had lower BMIs.  Of note, no differences were found between these two groups on other clinically interesting measures, those involving perfectionism and impulsivity (Bardone-Cone et al.  IJED 41: 697, 2008).  The take-home message from this study is that each patient requires careful individual assessment, and that treatment plans should be tailored accordingly.

– J.Y.