The bulimic syndrome at normal body weight: Reflections on athogenesis and clinical features

Abstract

Based on a clinical study of 80 patients, the aetiology, pathogenesis and clinical features of the Bulimic Syndrome is presented. The use of the term in patients at normal body weight who have had previous Anorexia Nervosa is questioned, not least as the pathonomonic psychological features of Anorexia Nervosa remain. Rather, the view is advanced, with supporting social evidence, that the majority of bulimic patients at normal body weight are a variant of massive, but thwarted obesity. The condition is divided clinically into three groups—a “neurotic” group, a “personality disordered” group and an “epileptiform” group: clinical divisions which have important implications for treatment. Data is presented showing that there is a tendency to move Social Class by education and employment prior to illness and of disturbed menstruation. This latter feature seems to be the result of a fluctuating carbohydrate intake. It is suggested that there is a sensitive switch, possibly hormonal, linking carbohydrate ingestion to ovulation.