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Incidence and outcomes of bulimia nervosa: a nationwide population-based study

Published online by Cambridge University Press:  08 September 2008

A. Keski-Rahkonen ,
H. W. Hoek ,
M. S. Linna ,
A. Raevuori ,
E. Sihvola ,
C. M. Bulik ,
A. Rissanen  and
J. Kaprio
A. Keski-Rahkonen*
Affiliation:
Department of Public Health, University of Helsinki, Finland Department of Psychiatry, Helsinki University Central Hospital, Finland Department of Epidemiology, Columbia University, USA
H. W. Hoek
Affiliation:
Department of Epidemiology, Columbia University, USA Parnassia, The Hague, The Netherlands Department of Psychiatry, Groningen University, The Netherlands
M. S. Linna
Affiliation:
Department of Public Health, University of Helsinki, Finland
A. Raevuori
Affiliation:
Department of Public Health, University of Helsinki, Finland Department of Epidemiology, Columbia University, USA
E. Sihvola
Affiliation:
Department of Public Health, University of Helsinki, Finland Department of Psychiatry, Helsinki University Central Hospital, Finland
C. M. Bulik
Affiliation:
Departments of Psychiatry and Nutrition, University of North Carolina at Chapel Hill, USA
A. Rissanen
Affiliation:
Department of Psychiatry, Helsinki University Central Hospital, Finland
J. Kaprio
Affiliation:
Department of Public Health, University of Helsinki, Finland Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland Academy of Finland, Center of Excellence in Complex Disease Genetics, Finland
*
*Address for correspondence: Dr A. Keski-Rahkonen, Embaixada de Finlândia, SES Av. das Nações, Qd 807, Lt 7, CEP 70417-900, Brasília DF, Brasil. (Email: [email protected])
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Abstract

Background

Little is known about the epidemiology of bulimia nervosa outside clinical settings. We report the incidence, prevalence and outcomes of bulimia nervosa using for the first time a nationwide study design.

Method

To assess the incidence and natural course and outcomes of DSM-IV bulimia nervosa among women from the general population, women (n=2881) from the 1975–79 birth cohorts of Finnish twins were screened for lifetime eating disorders using a two-stage procedure consisting of a questionnaire screen and the Structured Clinical Interview for DSM-IV (SCID). Clinical recovery was defined as 1-year abstinence from bingeing and purging combined with a body mass index (BMI) ⩾19 kg/m2.

Results

The lifetime prevalence of DSM-IV bulimia nervosa was 2.3%; 76% of the women suffered from its purging subtype and 24% from the non-purging subtype. The incidence rate of bulimia nervosa was 300/100000 person-years at the peak age of incidence, 16–20 years, and 150/100000 at 10–24 years. The 5-year clinical recovery rate was 55.0%. Less than a third of the cases had been detected by health-care professionals; detection did not influence outcome. After clinical recovery from bulimia nervosa, the mean levels of residual psychological symptoms gradually decreased over time but many women continued to experience significantly more body image problems and psychosomatic symptoms than never-ill women.

Conclusions

Few women with bulimia nervosa are recognized in health-care settings. Symptoms of bulimia are relatively long-standing, and recovery is gradual. Many clinically recovered women experience residual psychological symptoms after attaining abstinence from bingeing and purging.

Keywords

Bulimia nervosaepidemiologyincidencenatural courseoutcomeprevalence
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 5 , May 2009 , pp. 823 - 831
Copyright
Copyright © Cambridge University Press 2008

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