Psychological Medicine

Original Article

Health problems, impairment and illnesses associated with bulimia nervosa and binge eating disorder among primary care and obstetric gynaecology patients

J. G.  JOHNSON  c1 a1, R. L.  SPITZER  a1 and J. B. W.  WILLIAMS  a1
a1 From Columbia University and the New York State Psychiatric Institute, New York, NY, USA


Background. Although psychiatric patients with eating disorders are known to be at risk for a variety of health problems, relatively little is known about eating disorders and associated health problems in other populations. An epidemiological study was conducted to investigate health problems and impairment associated with bulimia nervosa (BN) and binge eating disorder (BED) among female primary care and obstetric gynaecology patients.

Methods. Psychiatric disorders, physical illnesses, disabilities, functional status and stress were assessed among 4651 female patients (age range:18 to 99 years) at 8 primary care and 7 obstetric gynaecology clinics throughout the United States.

Results. Two hundred eighty-nine women (6·2%) were diagnosed with BN or BED. The prevalence of BN was approximately 1% among young and middle-aged women. The prevalence of BED increased steadily from early (3·3%) through middle (8·5%) adulthood. Anxiety disorders, mood disorders and diabetes were much more common among women with BN or BED than among women without these eating disorders. Women with BN or BED reported markedly poorer functioning and much higher levels of disability, health problems, insomnia, psychosocial stress and suicidal thoughts than did women without BN or BED, after co-occurring psychiatric disorders were controlled statistically. Yet, fewer than one of ten cases of BN or BED was recognized by the patients’ physicians.

Conclusions. Patients with BN or BED often experience considerable disability, impairment, distress and co-occurring illnesses. Increased recognition of eating disorders may be a crucial step towards encouraging more patients to seek treatment for these disabling conditions.

c1 Address for correspondence: Dr Jeffrey G. Johnson, Biometrics Research Unit, New York State Psychiatric Institute, Unit 60, 1051 Riverside Drive, New York, NY 10032, USA.