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Psychol Med. 1998 May;28(3):599-610.

The epidemiology and classification of bulimia nervosa.

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  • 1Department of Psychiatry, Virginia Commonwealth University/Medical College of Virginia, Richmond, USA.



We sought to determine whether there was empirical support for the diagnostic thresholds of DSM-IV bulimia nervosa (BN) and whether an empirically derived typology resembled the diagnostic categories of DSM-IV.


Detailed information about bulimic behaviours were assessed via personal interview in a population-based sample of 1897 Caucasian female twins. We assessed the lifetime prevalence of the component bulimic behaviours and DSM-IV and DSM-III-R BN. Latent class analysis of nine separate bulimic symptoms was used to develop an empirical typology of bulimic behaviour.


Although the lifetime prevalences of bingeing (23.6%) and vomiting (4.8%) were relatively common, DSM-IV BN was distinctly uncommon (0.5%). The criterion that specified the frequency and duration of bingeing and vomiting was an important limiting condition. Analysis of alternative thresholds found little support for the DSM-IV thresholds requiring an average of twice per week for 3 months. Latent class analysis yielded an interpretable four class solution that had little overlap with the DSM-IV typology.


As in other studies of unselected samples of women, the lifetime presence of bulimic behaviours are relatively high. Our results suggest that the DSM-IV approach to categorizing bulimic behaviour inadequately captures the spectrum of lifetime bulimic behaviours in the general population.

[PubMed - indexed for MEDLINE]
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