Bulimia. Its incidence and clinical importance in patients with anorexia nervosa

Among the various eating patterns encountered in anorexia nervosa, the occurrence of bulimia (rapid consumption of large amounts of food in a short period of time) is a perplexing phenomenon, because its presence contradicts the common belief that patients with anorexia nervosa are always firm in their abstinence from food. We studied the eating habits of 105 hospitalized female patients within the context of a prospective treatment study on anorexia nervosa: 53% had achieved weight loss by consistently fasting, whereas 47% periodically resorted to bulimia. The two groups were contrasted with regard to their developmental and psychosocial history, clinical characteristics, and psychiatric symptomatology. Fasting patients were more introverted, more often denied hunger, and displayed little overt psychic distress. In contrast, bulimic patients were more extroverted, admitted more frequently to a strong appetite and tended to be older. Vomiting was frequent, and kleptomania almost exclusively present in bulimic patients, who manifested greater anxiety, depression, guilt, interpersonal sensitivity, and had more somatic complaints. This association of bulimia with certain personality features and a distinct psychiatric symptomatology suggests that patients with bulimia form a subgroup among patients with anorexia nervosa.