Depression and drive for thinness are associated with persistent bulimia nervosa in the community.
OBJECTIVE
To examine psychiatric comorbidity and factors that influence the outcome of bulimia nervosa (BN) in the general population.


METHODS
Women from the nationwide birth cohorts of Finnish twins were screened for lifetime BN (N = 59) by using questionnaires and the Structured Clinical Interview for DSM-IV. We assessed psychiatric comorbidity and other prognostic factors.


RESULTS
Among women with lifetime BN, the following were more common than among unaffected women: current major depressive disorder (p = 0.004), lifetime major depressive disorder (p = 0.00001) and heavy drinking (p = 0.01). Decreased likelihood of recovery was associated with a history of lifetime major depressive disorder (hazard ratio (HR) 0.44, 95% confidence interval (CI) 0.23-0.84) and high drive for thinness at time of assessment (HR 0.96, 95% CI 0.93-0.99).


CONCLUSIONS
Heavy drinking and depression present challenges for many women with BN. Major depressive disorder emerged as the only statistically significant prognostic factor of BN in this nationwide cohort; high drive for thinness was characteristic of the persistently ill.
Department of Public Health, The Hjelt Institute, University of Helsinki, Helsinki, Finland. anna.keski-rahkonen@helsinki.fi
Anna
A
Keski-Rahkonen
Anu
A
Raevuori
Cynthia M
CM
Bulik
Hans W
HW
Hoek
Elina
E
Sihvola
Jaakko
J
Kaprio
Aila
A
Rissanen
D000328:Adult; D000437:Alcoholism / Q000453:epidemiology; D001828:Body Image / Q000523:psychology; D052018:Bulimia Nervosa / Q000145:classification / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000453:epidemiology*; D004200:Diseases in Twins / Q000453:epidemiology*; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008297:Male; D011795:Surveys and Questionnaires; D013851:Thinness / Q000523:psychology*; D013997:Time Factors; D055815:Young Adult