The nature of bulimia nervosa

In the past decade, an eating disorder has been identified with clinical features similar to those found in anorexia nervosa. In America it has been termed bulimia and in Britain bulimia nervosa. It occurs in young women of normal weight and is characterised by episodes of loss of control over eating followed by behaviour designed to compensate for overeating, principally self-induced vomiting and laxative abuse. Patients have grossly disturbed attitudes about shape and weight, high levels of depression and anxiety, and are at risk for significant physical complications. It has been argued that the condition is a form of affective disorder, but the evidence adduced in support of this contention does not stand up to scrutiny. Rather, the behavioural disturbances found in bulimia nervosa appear to be maintained by the patients' abnormal beliefs and values about shape and weight. With the recent development of standardised procedures to assess this core psychopathology, investigations can proceed into its role in the development, maintenance and treatment of the disorder.