Rates of bulimia nervosa increased threefold
Feb 10, 2005 - 5:54:38 PM

During the years 1988-1993 the incidence of anorexia nervosa detected in primary care remained stable, but rates of bulimia nervosa increased threefold. Since then, they have been falling. This study, published in the February 2005 issue of the British Journal of Psychiatry, set out to determine whether the incidence of anorexia remained stable, and that of bulimia nervosa continued to increase, in the years 1994-2000.

The General Practice Research Database was screened for new cases of anorexia and bulimia nervosa for those years. Annual incidence rates were calculated for females aged 10-39, and compared with rates for the previous five years.

It was found that annual incidence rates of anorexia nervosa remained remarkably stable over the period studied. Overall there was an increase in the incidence of bulimia, but rates declined after a peak in 1996.

The incidence rate for anorexia varied dramatically according to the age-gender group. In 2000 the incidence of anorexia diagnosed in primary care was 4.7 per 100,000 population. The relative risk for females to males was 12:1; and the highest incidence, 34.6 per 100,000, was found in females aged 10-19.

The results for bulimia were very different. The early 1990s showed a marked increase in women aged 10-39, which continued until 1996. Although there was an overall increase in reported cases of bulimia from 1988-2000, the incidence rate has fallen by 38.9% since this peak.

The relative risk of bulimia for females to males was about 18:1. The highest incidence, 35.8 per 100,000, was in females aged 10-19.

The authors of the study comment that there are several possible explanations for the peak in incidence of bulimia seen in the 1990s and its subsequent decline. Patients may now seek help from sources other than general practice. During the period studied, the UK-based Eating Disorders Association has experienced a dramatic increase in demand for its web-based messaging and e-mail service.

Another possible explanation relates to changes in professional or public attention to eating disorder symptoms. The earlier period of rising incidence might have been the result of increased recognition and detection efforts given to a new and 'fashionable'; diagnosis.

Intense press coverage of bulimia during the 1990s might also have contributed to the apparent rise in incidence. For example, the first reports of Princess Diana';s battle with bulimia appeared in Andrew Morton';s 1992 book, and subsequent media interest might have focused attention on bulimic symptoms and improved public awareness of the disorder.

It is notable that the Princess';s death in 1997 coincided with the beginning of the decline in bulimia incidence.

The authors of the study suggest that special detection and treatment efforts should be aimed at young women aged 10-19, as this is the group with the highest risk of both anorexia and bulimia nervosa.

General practitioners need more information about the presentation of eating disorder symptoms and the treatments available, to allow early and effective intervention.

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