Events and the onset of eating disorders: correcting an "age old" myth

Previous reports have suggested differences between early and late onset cases both in anorexia nervosa and bulimia nervosa. In anorexia nervosa, women with late onset are thought to be more likely to develop symptoms in response to life events than early onset cases. Women developing anorexia in response to life events are also considered to show different background features. In bulimia nervosa, it is not known whether rates of life events before onset differ in bulimics who develop their disorder at different stages in life.

Previously published data were reanalyzed to examine differences between women whose eating disorder did or did not develop in response to stress. Seventy-two women with anorexia nervosa (48 with a severe provoking agent) and 29 women with bulimia nervosa (22 with a severe provoking agent) were administered semistructured interviews to assess life events and difficulties in the year before onset, childhood adversity, and other clinical features.

In both anorexia nervosa and bulimia nervosa, subjects with or without a severe provoking agent did not differ from each other on age or childhood variables. The only significant difference found was that, in women developing anorexia nervosa, those who later developed bulimic symptoms alongside their anorexia reported a lower rate of provoking agents (31%) than those anorexic women who either maintained their restriction (76%) or went on to develop normal weight bulimia nervosa (69%).

There are no differences between women whose eating disorder develops in response to stress and those who do not. Women presenting for treatment with anorexia nervosa of the binge-purge subtype are unlikely to have developed their illness in response to a severe provoking agent.