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.

Objective: This study examined gender differences in prevalence of eating disorder symptoms including body image concerns (body checking or avoidance), binge eating, and inappropriate compensatory behaviors.Method: A random sample of members (ages 18-35 years) of a health maintenance organization was recruited to complete a survey by mail or on-line. Items were drawn from the Patient Health Questionnaire and the Body Shape Questionnaire.Results: Among the 3,714 women and 1,808 men who responded, men were more likely to report overeating, whereas women were more likely to endorse loss of control while eating. Although statistically significant gender differences were observed, with women significantly more likely than men to report body checking and avoidance, binge eating, fasting, and vomiting, effect sizes (''Number Needed to Treat'') were small to moderate.Discussion: Few studies of eating disorders include men, yet our findings suggest that a substantial minority of men also report eating disorder symptoms.

The authors review research on risk factors for eating disorders, restricting their focus to studies in which clear precedence of the hypothesized risk factor over onset of the disorder is established. They illustrate how studies of sociocultural risk factors and biological factors have progressed on parallel tracks and propose that major advances in understanding the etiology of eating disorders require a new generation of studies that integrate these domains. They discuss how more sophisticated and novel conceptualizations of risk and causal processes may inform both nosology and intervention efforts.

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