The purpose of this article is to integrate diverse research efforts in an attempt to move toward an understanding of risk factors for bulimia. For this task, three questions in particular require attention. Because 90% of bulimics are women, a first question to address is, Why women? Second, despite the high prevalence of dieting and weight concerns among women in general, it is still a minority who evidence the clinical syndrome of bulimia, leading to the question, Which women in particular? These questions are considered from a range of perspectivesusociocultural, developmental, psychological, and biological Third, the rapidly increasing prevalence of bulimia in recent years raises yet another question, Why now? Our analysis points to research questions that must be examined before we can expand our understanding of the etiology of bulimia.

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The prevalence of disordered eating among college students was assessed at the beginning and the end of the freshman year. The study aimed to identify factors related to worsening of disordered eating during the year. Questionnaires were completed by 590 males and 450 females at baseline and 546 males and 403 females at follow‐up. At baseline, the prevalence of bulimia nervosa was 3.8% for females and 0.2% for males. The prevalence of disordered eating symptoms was considerably higher. The prevalence of bulimia nervosa at follow‐up was virtually unchanged. However, many students experienced an onset of disordered eating during the year. Analyses of changes during the year revealed that worsening of disordered eating among females was associated with increasingly dysphoric feelings about weight, decreased ratings of their attractiveness, high perceived stress, increased weight dissatisfaction, and increased ineffectiveness.

The study examined influences on body satisfaction, disordered eating, and exercise behavior of a male subculture that places a heightened emphasis on appearance: the homosexual male subculture. Subjects were 71 homosexual and 71 heterosexual men. Relative to heterosexual men, homosexual men showed more body dissatisfaction and considered appearance more central to their sense of self. Also, their exercise was more motivated by a desire to improve attractiveness. Among the homosexual but not the heterosexual group, men who desired to be thinner showed more attitudes and behaviors associated with disordered eating than men who were thinner than their desired size. In contrast, heterosexual but not homosexual men who wished to be heavier had lower self-esteem scores than men who were heavier than or equal to their desired size. The findings support a view that a male subculture that emphasizes appearance may heighten the vulnerability of its members to body dissatisfaction and disordered eating.

Bulimic women appear preoccupied not only with their physical presentation but also with their "social self-how others perceive them in general. This study examined the relationship of the social self to body esteem and to bulimia nervosa. In Phase 1, in which 222 nonclinical women (aged 16 to 50) participated, the social-self measures of Perceived Fraudulence, Social Anxiety, and Public Self-Consciousness were negatively associated with body esteem. In Phase 2, 34 bulimic women were compared with 33 Ss scoring high on the Eating Attitudes Test (EAT) and 67 matched control. Bulimic Ss, high-EAT Ss, and control Ss all differed on Perceived Fraudulence, and bulimic Ss and high-EAT Ss scored higher than control Ss on Public Self-Consciousness and Social Anxiety. The findings strongly support the hypothesized link of social-self concerns to body dissatisfaction and bulimia nervosa.A central symptom of eating disorders is preoccupation with appearance-a constant concern with how the physical self is viewed by others. Beneath this manifest symptom seems to lie a pervasive concern with how others view the self in general. Eating disordered patients appear preoccupied with self-presentation and with how others perceive and evaluate them, a facet of the self first designated the "social self" by William James (1890/1983).'Research suggests that women with bulimia nervosa and anorexia nervosa experience significant difficulties in the area of social adjustment, characterized by social anxiety, impoverished relationships, and social isolation (