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

Abstract

The influence of the AN subtype in BN/AN+ patients is worthy of further study as it might have clinical implications.

Trait‐level and momentary correlates of bulimia nervosa with a history of anorexia nervosa

“…Consistent with previous studies (9–13), the BN+ group had a lower mean BMI than the BN− group, although the two groups did not differ on exercise frequency or on self-reported dietary restriction, either at the daily level or over the months prior to the study. It is possible that the BN+ group endorsed a stricter threshold for dietary restriction than BN−, given their AN history, thus accounting for these seemingly contradictory findings.…”

“…Moreover, both groups appear to have similar levels of impairment secondary to their eating disorder (e.g., shape and weight concerns, anxiety), as measured by both trait and momentary assessments. Based on these findings, it is likely that similar treatments will be equally efficacious for both groups, although preliminary findings suggest a somewhat poorer short-term treatment outcome for BN+ (9). …”

“…We also did not assess the full range of psychopathology (e.g., personality variables), thus further investigation of similarities and differences between BN with and without history of AN is warranted. Further research is also needed to determine whether BN with a history of AN differs by previous AN subtype (e.g., binge eating and purging compared to restricting subtype)(9), a question that could not be investigated in this study due to lack of power. Finally, since participants were not followed after the 2-week EMA recording period, it is unknown how many may have transitioned to AN status over time.…”

“…Although BN is currently classified as a distinct psychiatric disorder (2), significant diagnostic crossover occurs within the eating disorders (3). Specifically, up to 65% of individuals with anorexia nervosa (AN) go on to develop BN over time (4–7), a trajectory that has been associated with a poorer prognosis and greater likelihood of relapse (8; 9). Compared to BN without a history of AN (BN−), BN with a history of AN (BN+) has been associated with lower current body mass index (BMI; kg/m 2 ) and higher levels of dietary restraint, and some, but not all, studies report higher rates of lifetime anxiety disorders and greater shape- and weight-related concern in these individuals (10–13).…”

Bulimia nervosa in overweight and normal-weight women

“…This has included comparisons of behavioral and eating disorder-related functioning for individuals with BN and differing histories of anorexia nervosa (AN) [1–3], for individuals with BN who use different methods of compensatory behaviors [4], for individuals who have recurrent episodes of binge eating but not compensatory behaviors (e.g., binge eating disorder (BED) [5]), for individuals who do not binge eat but do engage in recurrent compensatory behaviors (e.g., purging disorder [6]), and for individuals with BN who have personality disorder or substance abuse comorbidities [7, 8]. Thus, much has been learned about the behavioral and eating disorder pathology of individuals with BN or behaviorally similar eating disorders in relation to eating disorder history, method and presence of compensatory behaviors, and presence of binge eating and other comorbidities.…”