بیماران بی اشتهایی عصبی با سابقه بولیمیا

Objectives To investigate clinical and psychological features of patients with anorexia nervosa (AN) with a previous history of bulimia nervosa. Method Three hundred thirty-three patients with a full diagnosis of AN were assessed by the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, the Eating Disorders Inventory, and the Hopkins Symptom Checklist. Results Twenty-four patients (7%) reported a previous diagnosis of bulimia nervosa and were compared with a control group of 48 patients without a history of bulimia, matched for diagnostic subtype. Among the patients with a history of bulimia nervosa, 11 were of the restricting type and 13 of the binge eating/purging type. Among restricting anorexic patients, those with a history of bulimia reported greater age of onset, more psychiatric symptoms, more family psychiatric morbidity, and a higher rate of sexual abuse. On the contrary, among patients with the AN bingeing-purging subtype, the presence of a previous bulimia nervosa was not associated with any of the investigated variables. Conclusions Patients with restricting AN who report a history of previous bulimia nervosa are not frequent among those referring to an outpatient eating disorders unit. However, our findings in this small group of subjects confirm that a lifetime history of bingeing and purging in patients with eating disorder, irrespective of when it occurs, is always associated with more psychopathology compared with those restricting patients with AN who have never had a period of bingeing and purging.

A large proportion of patients with eating disorder tend not to adhere to their Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnosis over time but migrate between the diagnostic categories [1] and [2]. One of the most common shifts from one diagnosis to another is from anorexia nervosa (AN) to bulimia nervosa (BN) [1] and [3]. It has been estimated that about 30% of patients with restricting AN develop BN [4] and [5]. In an epidemiological study performed on a general female population sample, about 33% of BN cases reported an episode of AN or subthreshold AN preceding the development of BN [2]. BN patients with a history of AN seem more often to have a lifetime comorbidity with anxiety disorders [3] and [6], to weigh less [3] and [7], to vomit more frequently, and to report an earlier age of onset of their bulimic symptoms [8]. Kassett et al [9] observed that the reverse shift is also possible. However, the development of AN among subjects who suffer from BN seems uncommon [10]. That is probably why this peculiar evolution between diagnostic categories has received little attention in the literature. The main aim of the present study is to investigate the prevalence and clinical features of AN patients with a history of bulimia.