Don't Wait to Treat Early Forms of Bulimia: Experts

Teens who binge and purge less frequently than full-blown bulimics resemble bulimics in many ways, and should therefore be treated as if they had the condition, researchers argue in a new report.

The investigators compared the characteristics of teens with "partial-syndrome" bulimia nervosa, in which they exhibited the typical characteristics of bulimia-binge eating followed by a purge. Partial-syndrome progresses to bulimia when binging and purging occurs at least twice per week for 3 months.

The researchers found that teens with bulimia and partial-syndrome bulimia showed similar levels of self-esteem and depression (extensive information in the HealthyPlace Depression Community Center).

The findings suggest that doctors should treat partial-syndrome bulimia as seriously as they do full-blown bulimia, study author Dr. Daniel le Grange of the University of Chicago told Reuters Health.

"We shouldn't 'wait' for someone with a partial syndrome presentation to develop the full syndrome before we intervene," he said.

An estimated 1 to 5 percent of teen girls develop full-blown bulimia. The partial form of the condition is even more common, with recent research estimating that between 10 and 50 percent of teen girls and boys binge eat and purge on a frequent basis.

To investigate how partial bulimia differs from bulimia, le Grange and his colleagues surveyed a sample of 120 teens in an eating disorder program. All teens were diagnosed with anorexia, bulimia or partial-syndrome bulimia.

Reporting in the Archives of Pediatrics & Adolescent Medicine, the researchers found "more similarities than differences" between bulimics and partial-syndrome bulimics. In contrast, teens with either form of bulimia differed from those with anorexia on "almost every variable examined," the authors note.

For instance, compared with bulimic teens, those with anorexia nervosa tended to weigh less and be younger, and were more likely to come from intact families.

Partial-syndrome bulimics were asked how many times each week they binged--meaning, how many times they overate and felt as if they lost control over food.

Using established guidelines, interviewers estimated that partial bulimics binged less than once per week. However, teens themselves said they felt like they had binged around 5 times each week, even if they had only eaten a normal or small amount.

Although binging often goes hand-in-hand with purging, partial bulimics purged more than 4 times per week, which more closely matches their perception of how many times they had binged, rather than the actual number of episodes.

"It would appear that the size of the binge does not matter to the adolescent--it is the perception of being out of control and the concomitant distress that lead to purging," le Grange explained.

SOURCE: Archives of Pediatrics & Adolescent Medicine, May 2004

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