Should bulimia nervosa be subtyped by historyof anorexia nervosa? A longitudinal validation

Abstract

Objective: To determine whether a past diagnosis of anorexia nervosa (AN) predicts longitudinal course and outcome among women with bulimia nervosa (BN).Method: A subset (n 5 176) of participants in the Longitudinal Study of Anorexia and Bulimia Nervosa who met DSM-IV criteria for BN either at study intake (n 5 144) or during follow-up (n 5 32; 4 had restricting AN at intake, 28 had binge/purge AN at intake) were included in this report. Over a median of 9 years, weekly eating disorder symptom data were collected from participants using the Longitudinal Interview Followup Examination, Eating Disorders Version.Results: While there were no betweengroup differences in likelihood of partial recovery, women with BN who had a history of AN were more likely to have a protracted illness, relapsing into AN during follow-up, compared to those with no AN history who were more likely to move from partial to full recovery. Conclusion:Lifetime AN is an important prognostic indicator among women with BN and these longitudinal data would support the subtyping of BN on the basis of AN history. V V C 2007 by Wiley Periodicals, Inc.

Diagnostic Crossover in Anorexia Nervosa and Bulimia Nervosa: Implications for DSM-V

“…The long-term risk of relapse into anorexia nervosa suggests that a lifetime history of anorexia nervosa may carry important prognostic information; even after crossing over to bulimia nervosa, these women remain vulnerable to relapsing into anorexia nervosa. This finding supports the validity of distinguishing between anorexia nervosa and bulimia nervosa and suggests the clinical relevance of noting a lifetime history of anorexia nervosa in individuals, even when the low weight criterion is no longer met (18).…”

Bulimia nervosa with history of anorexia nervosa: Could the clinical subtype of anorexia have implications for clinical status and treatment response?

“…5 With regard to treatment response, it has been reported that BN patients with a history of prior AN are more likely to have a protracted illness. 9 Our BN/AN1 patients had lower BMI than our BN/AN2 patients and had a longer time of evolution. The time of evolution for both populations (4.4 years longer in BN/AN1 patients, on average) is coincident with the observation that crossover from AN to BN often occurs by the 5th year of illness.…”

“…1,[8][9][10][11] In fact, BN/AN1 patients tend to have higher levels of dietary restraint and purging, lower weight, 8 lower percentages of body fat and muscle mass, and a higher percentage of extracellular water. 10 When outcome is examined, BN/AN1 patients seem to be more likely to have a protracted illness 3,12 or to relapse into AN.…”

“…10 When outcome is examined, BN/AN1 patients seem to be more likely to have a protracted illness 3,12 or to relapse into AN. 9 Keel et al have reported on the differences in relapse of patients with AN and BN. 13 According to these authors, patients with the restricting subtype of AN (ANR) tend to develop bulimic symptoms during relapse, whereas patients with the bingepurge subtype of AN (ANBP) and BN tend to return to bulimic patterns during relapse.…”

Are Anorexia nervosa and bulimia nervosa separate disorders? Challenging the ‘transdiagnostic’ theory of eating disorders

“…50% of AN patients will develop bulimic symptoms and migrate to a binge/purge subtype of AN and one third of those with BN have a history of AN (Bulik et al, 1997b;Eckert et al, 1995;Eddy et al, 2007;Eddy et al, 2002;Strober et al, 1997;Tozzi et al, 2005 SMR BN: 2.0 (95% CI) Prevalence Prevalence AN: 0.2 and 0.5% BN: 1.1-4.2% Course and outcome Course and outcome AN: less favourable than BN (Fichter & Quadflieg, 2004) BN: more favourable than AN (Fichter & Quadflieg, 2004) Addiction Liability Addiction Liability AN: AN-R shows significantly less drug-consumption behaviours and alcohol abuse (Corcos et al, 2001) BN: BN shows a significantly higher risk of developing a psychoactive substance dependence during his/her lifetime. (Bulik, 1987;Bulik et al, 1997a;Dansky et al, 2000;Goodman, 2007;Herzog et al, 2006;Holderness et al, 1994;Jones et al, 1985;Lacey, 1993;Mitchell et al, 1985;Mitchell et al, 1991;Welch & Fairburn, 1996;Wilson, 1992) Genetics Genetics Linkage analysis: less number of linkage signals, with minimal overlap with BN (Bacanu et al, 2005) Linkage analysis: greater number of linkage signals, with minimal overlap with AN (Bacanu et al, 2005) Susceptibility locus: chromosome 1 (Grice et al, 2002), 2, and 13 (Devlin et al, 2002) with inclusion of core behavioural covariates Susceptibility locus: chromosome 10p,with a suggestive linkage on chromosome 14 (Bulik et al, 2003 …”