title: Which comes first in the pathogenesis of bulimia nervosa: dieting or bingeing?
abstract: OBJECTIVE
  Clinical experience has indicated that dieting usually precedes the onset of binge eating in the development of bulimia nervosa (BN). However, data confirming this in nonclinical, representative samples are lacking.
  
  
  METHODS
  Using results obtained from the National Women's Study (NWS), we were able to determine the chronological relationship between age of onset of significant dieting (attempting to lose 15 lbs) and onset of bingeing in 85 respondents who met DSM-III-R criteria for BN. These respondents were a subset of over 3,000 female adult U.S. women who completed a random telephone interview (averaging 40 min and including screenings for rape, sexual molestation, aggravated assault, posttraumatic stress disorder [PTSD], and BN).
  
  
  RESULTS
  We found that the age of first serious attempt to diet preceded the age of first binge in 46% of cases. There were no significant differences in histories of victimization experiences among the groups. First binge preceded first serious diet in 37% of cases, and these behaviors occurred during the same age in 17% of cases.
  
  
  CONCLUSIONS
  These data confirm that dieting is more likely to precede binge eating, although binge eating precedes significant dieting in a substantial proportion of bulimic respondents.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
authors.forename: T D
authors.initials: TD
authors.lastname: Brewerton
authors.forename: B S
authors.initials: BS
authors.lastname: Dansky
authors.forename: D G
authors.initials: DG
authors.lastname: Kilpatrick
authors.forename: P M
authors.initials: PM
authors.lastname: O'Neil
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002032:Bulimia / Q000175:diagnosis / Q000523:psychology*; D004038:Diet, Reducing / Q000523:psychology*; D005260:Female; D006801:Humans; D006963:Hyperphagia / Q000175:diagnosis / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012494:Sampling Studies