The significance of bulimia in juvenile anorexia nervosa: An exploration of possible etiologic factors

This paper reports on a study comparing clinical symptomatology, premorbid functioning, family relations, life stress, and parent medical and psychiatric history in two matched groups of juvenile anorexia nervosa patients, one with and one without the syndrome of bulimia. In comparison to nonbulimic anorectics, bulimics evidenced higher levels of core anorectic sympomatology and were more likely to show affective disturbance and alchohol use. Bulimia was more strongly associated with affective instability and other signs of behavioral deviance during childhood. The family environment of bulimics was characterized by significantly greater conflict and negativity, less cohesion, and less structure than the nonbulimic anorectic family, and bulimics experienced more stressful life changes prior to illness onset than did nonbulimic patients. Parents of bulimic anorectics also reported significantly higher levels of marital discord, were rated as more emotionally distant from their daughters, and exhibited greater psychiatric morbidity and physical health problems. Results were consistent with the author's hypothesis that the disposition toward bulimia is rooted in early disturbances in ego functioning, personality adaptation, and other maladaptive factors. Study of the pathological effects of psychological, genetic, and physiological factors on appetite controlling mechanisms in anorectic subgroups deserves further investigation.