Bulimia: Factors associated with its etiology and maintenance

Fifty female patients with bulimia at normal body weight were examined in a prospective study to determine factors associated with the onset and maintenance of their disorder. Factors given by patients and interpretations drawn by the psychiatrist for the underlying, precipitating, and maintenance factors of bulimia were recorded. Bulimic patients describe a remarkably similar and consistent series of underlying factors, particularly centered on doubts concerning femininity but also including a poor relationship with parents, academic striving, parental marital conflict, and poor peer group relationships. All patients described at least one and usually two or three major groups of life events: sexual conflicts, major changes in life circumstances, and “loss” acting upon the above underlying factors which together with carbohydrate-abstinent dieting precipitated the onset of the condition. Maintenance factors included carbohydrate craving, binge eating for its sedative qualities or, alternatively, as a stimulant to replace loneliness or boredom.