The Etiology and Treatment of Bulimia Nervosa: A Biopsychosocial Perspective

The Etiology and Treatment of Bulimia Nervosa: A Biopsychosocial Perspective

The Etiology and Treatment of Bulimia Nervosa: A Biopsychosocial Perspective

The Etiology and Treatment of Bulimia Nervosa: A Biopsychosocial Perspective

Excerpt

It is an honor and a sincere pleasure to have been asked to provide introductory remarks to a volume from investigators who, with their colleagues, have shaped and greatly enriched the literature related to bulimia. It is hard to believe that only a decade ago the disorder that has come to be known as bulimia or bulimia nervosa simply did not appear in the psychiatric nomenclature. Prior to the 1940s, the symptoms of bulimia were reported almost exclusively within the context of anorexia nervosa. Reports appearing in the late 1970s and early 1980s identifying the symptom of binge eating in nonemaciated individuals spawned a veritable explosion of research aimed at the identification, understanding, and treatment of this disorder. Reading this volume has made us aware of just how far our understanding of this disorder has come in a relatively brief span of time. We thought that it might be useful to highlight, from our own (admittedly biased) perspective, some of the most interesting things we have learned about this disorder as well as some fundamental questions that remain to be answered.

Less than a decade ago, virtually nothing was known about the clinical features and the epidemiology of bulimia nervosa. There has been remarkable consistency in the clinical description of the signs and symptoms characteristic of the syndrome. In contrast to early reports that emphasized the uniformity across patients, bulimia nervosa is now largely viewed as a more heterogeneous syndrome that can be associated with a variety of personality profiles. Patients' sense that their eating is out of control, and the variety of weight-losing behaviors they engage in, has been described consistently. Whether they have the necessary and sufficient features to warrant a diagnosis of bulimia nervosa is another matter, and will be discussed later.

During the past few years much has been learned about the epidemiology of the disorder. Early reports were plagued by methodological flaws and overly inclusive definitions, but in the past few years more reliable estimates have indicated that between 1 and 5 percent of adolescent and young adult women from the upper and middle socioeconomic strata have serious cases of bulimia nervosa. Although the prevalence for men is not as high, cases do exist and these may have been under-reported . . .

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