Richard L. Pyle

The incidence of bulimia in freshman college students

This paper reports the results of a questionnaire survey administered to 1355 college freshman (98.3% response rate) and to a comparison group of 37 female bulimic patients. Questions were contructed to elicit information which would allow identification of those respondents who would meet DSM-III requirements for diagnosis of bulimia. 2.1% of the student population (4.5% of females, 0.4% of males) met these modified criteria and the additional criterion of weekly binge-eating. The identified “bulimic” female students differed from female bulimic patients in their use of fasting instead of self-induced vomiting for weight control, and in their tendency to be overweight. “Bulimic” female students are also compared with nonbulimic students.

The increasing prevalence of bulimia in freshman college students

A self-report questionnaire designed to elicit the DSM-III inclusion criteria for bulimia was completed by 1389 students (95.9% of those surveyed) from the same geographic area surveyed 3 years previously. Approximately 8% of the female students endorsed the criteria for bulimia in each survey. Even with the more stringent criteria used in the current survey, the percentage of female students who reported all the operationalized criteria for bulimia and in addition engaged in weekly binge-purging behavior increased from 1% in 1980 to 3.2% in 1983. The female college students reporting bulimia in the current survey more closely resembled the bulimic patients coming for treatment than those in the previous survey, particularly in the reported frequency of daily binge eating, self-induced vomiting for weight control, and the endorsement of DSM-III Criterion B behaviors. Validation studies indicated that self-report questionnaires may not correctly identify binge eating, fear of loss of control over eating behaviors, or self-deprecatory thoughts after binge eating, when compared with professional assessment by interview.

Similarities and differences on the MMPI between women with bulimia and women with alcohol or drug abuse problems

This study compared the MMPI MacAndrew Scale, mean profile, mean scale scores, and codetypes of women with bulimia and women with alcohol or drug abuse problems. Women with alcohol or drug abuse problems scored significantly higher on the MacAndrew Scale and several mean MMPI scale scores than women with bulimia. However, mean MMPI profiles and distribution of MMPI codetypes were similar between these two groups.

Electrolyte and other physiological abnormalities in patients with bulimia

The frequencies of various forms of eating-related behaviour (such as vomiting and laxative abuse) are reported for a series of non-anorectic bulimia patients seen for evaluation in an eating disorders clinic. The results of serum electrolyte, glucose and other screening tests in these patients are presented. Electrolyte abnormalities were found in 82 of the 168 patients (48.8%) who were diagnosed as having either bulimia or atypical eating disorder. The most common abnormality was metabolic alkalosis (27.4%); hypochloremia (23.8%) and hypokalemia (13.7%) were also commonly seen. No significant blood sugar abnormalities were encountered. An elevated serum amylase level was found to be associated with frequent binge-eating and vomiting behaviour. The pathophysiology of electrolyte abnormalities in this patient group is briefly reviewed.

Affective disorder and substance abuse in women with bulimia

One hundred and eight women with bulimia were evaluated for affective disorder and alcohol or drug abuse, by means of the DSM-III diagnostic criteria. In this sample, 43.5% had a history of affective disorder and 18.5% had a history of alcohol or drug abuse. Approximately 56% of the bulimia patients scored within the moderate to severe range of depression on the Beck Depression Inventory.

The bulimia syndrome: Course of the illness and associated problems

Abstract Data concerning the longitudinal course of illness and associated problems reported by a series of 275 female patients with bulimia are presented. Eighty-five percent of these patients indicated that they had started binge-eating during a period of voluntary dieting, and the majority indicated that they had perceived pressure from family members and/or friends to lose weight in association with this dieting episode. Although the development of binge-eating usually preceded or coincided with the development of self-induced vomiting behavior, a pattern of habitual self-induced vomiting developed prior to the onset of binge-eating in 44 (18.4%) patients. Most patients reported having experienced several periods of abstinence from bulimic behavior during the course of the illness, with the majority indicating periods of abstinence of at least two weeks in duration, suggesting that the symptoms of bulimia may wax and wane over time. Several problems were reported at high frequencies by this patient group including a history of self-injurious behavior (34.4%) and a history of at least one suicide attempt (18.8%).

The bulimic syndrome in normal weight individuals: A review

Available studies indicate that the bulimia syndrome is a fairly common problem in young women. However, the exact incidence is unknown. In addition to binge-eating, patients with the problem usually either selfinduce vomiting or abuse laxatives as a means to rid themselves of unwanted food. A variety of medical complications have been described in association with bulimia including electrolyte abnormalities, parotid gland swelling, gastric dilatation and dental problems. Medical conditions which can mimic the bulimia syndrome are discussed. Little is known about the longitudinal course of this disorder.

An ongoing cross-sectional study of the prevalence of eating disorders in freshman college students

Our third cross-sectional survey designed to elicit DSM-III inclusion criteria for bulimia was completed by 1836 students, 97.2% of those surveyed. Based on operationalized criteria, 4.7% of females reported a current eating disorder diagnosis. These included bulimia (4.3%), bulimia nervosa (2.2%), bulimia with weekly binge/purging behavior (1.1%), and anorexia nervosa (0.1%). Current bulimia was reported by 0.1% of males and current bulimia nervosa by 0.3%. Those women with current bulimia were more likely to report a history of treatment for alcoholism and drug abuse than those bulimic women in remission. The data suggest that fear of loss of control over eating is an important part of the diagnostic criteria for bulimia nervosa, while fear of being fat is less apt to differentiate between bulimic and nonbulimic women. The desire for low weight was more pronounced in bulimic female students in the current survey than in previous surveys. The percentage of women who reported a history of bulimia with weekly binge eating and purging went from 1% in 1980 to 3.2% in 1983 and to 2.2% in the current survey indicating that the prevalence for this disorder may have peaked and may be declining.

Characteristics of patients with bulimia only, bulimia with affective disorder, and bulimia with substance abuse problems

Characteristics of patients with a diagnosis of bulimia only (N = 46), bulimia with a history of affective disorder (N = 34), and bulimia with a history of substance abuse (N = 34) were compared. Results showed that compared to patients with bulimia only or with bulimia and affective disorders, patients with bulimia and substance abuse experienced a higher rate of diuretic use to control weight, financial and work problems, stealing before and after the onset of the eating disorder, previous psychiatric inpatient treatment, and greater amount of alcohol use after the onset of the eating disorder. Both the substance abuse group and affective disorder group showed a higher incidence of attempted suicide, more social problems, and greater overall treatment rate than the bulimia only group. There were no significant differences among groups in their family histories.

Alexithymia, obesity, and binge eating disorder

Eighty-three obese subjects with binge eating disorder (BED) were compared with 99 obese subjects not meeting criteria for BED on the Toronto Alexithymia Scale (TAS). Overall, the subjects in our sample were not significantly alexithymic, the mean global TAS score being 62.8 (SD = 10.2) which is comparable with the values found in non-patient control samples. Furthermore, the mean TAS scores did not differ between obese subjects with and without BED. However, we found a slightly higher prevalence of alexithymia (TAS total score 74 and above) in BED subjects compared with non-BED subjects (24.1% and 11.1%, respectively). A series of stepwise multiple regression analyses were run, exhibiting a significant relationship between the TAS and educational level and the Eating Disorder Inventory (EDI) subscales Interpersonal Distrust and Ineffectiveness. Age, body mass index, measures of depression, and eating pathology did not predict TAS scores.