Bulimia nervosa: a placebo controlled double-blind therapeutic trial of mianserin.

Anorexia nervosa is a disorder which is reported as increasing in prevalence (Duddle, 1973; Kendell et al., 1973; Crisp et al., 1976; Jones et al., 1980), a finding that could represent a true increase in prevalence or be due merely to increased recognition and seeking of help. At the same time eating problems, allied to, but not typical of anorexia, are being referred to hospital (Palmer, 1979). One such allied eating disorder is compulsive binge eating or bulimia, often accompanied by vomiting or purging. The relationship of bulimia to anorexia nervosa is not yet agreed. In a review of 11 studies of anorexia nervosa followed-up for a minimum of 22 years, bulimia was present in 14-50% (Hsu, 1980). However, two recent studies have indicated that there are characteristics which distinguish anorexia patients who develop bulimia from those who do not (Casper et al., 1980; Garfinkel et al., 1980). These authors suggested that the presence of bulimia constitutes a distinct subgroup, not just an 'end-stage' of chronic anorexia nervosa. Indeed cases have been described of bulimia, combined with a morbid fear of fatness, occurring without any history of anorexia (Russell, 1979; Fairburn, 1980). Furthermore it is now evident that binge eating and vomiting behaviour occur in normal weight and even ovcrweight people and this has led to the classification of bulimia as a disorder distinct from anorexia nervosa in the 3rd edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-III, 1980). Moreover a recent survey of a college population has suggested a prevalence for bulimia of 13%, indicating that binge eating may represent a very serious and growing public health problem (Halmi et al., 1981). The underlying causes of anorexia nervosa and allied disorders remain unclear. Investigation of the psychopathology in several studies has revealed a strong relationship between anorexia nervosa and affective disorder (Kay & Leigh, 1954; Warren, 1968; Cantwell et al., 1977) and two of these studies noted a high rate of affective disorder in families of the study sample (Cantwell et al. and Warren). Cantwell stated, 'data suggest a hypothesis that at least some cases of anorexia nervosa may be a variant of affective disorder'.