Bulimic Eating Disorders in Primary Care: Hidden Morbidity Still?
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
The current study examined the features of women with bulimic-type eating disorders (n = 24) attending primary care in two smaller urban regions of the USA. The assessment included measures of eating disorder psychopathology, medical comorbidity, impairment in role functioning, potential barriers to treatment and actual use of health services. Eating disorders, primarily variants of bulimia nervosa and binge eating disorder not meeting formal diagnostic criteria, were associated with marked impairment in psychosocial functioning. Although two-thirds of participants recognized a problem with their eating, less than 40% had ever sought treatment from a health professional for an eating or weight problem and only one in ten had sought such treatment from a mental health specialist. Only one-third had ever been asked about problems with eating by a primary care practitioner or other health professional. However, more than 80% had sought treatment from a health professional for symptoms of anxiety or depression. Most reported some degree of discomfort in discussing eating problems with others, and half reported that they would not be truthful about such problems if asked. Having an eating disorder was associated with several chronic medical conditions, including joint pain, gastrointestinal problems and fatigue. Although the small sample size limits any firm conclusions, the findings suggest that the health burden of bulimic-type eating disorders is substantial but remains largely hidden. Efforts may be needed to improve the eating disorders “mental health literacy” of both patients and primary care practitioners in order to facilitate early, appropriate intervention.
- American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.) (DSM-IV). Washington, DC: Author.
- Anderson, R., & Newman, J. (1973). Societal and individual determinants of medical care utilization in the United States. Millbank Memorial Fund Quarterly, 51, 91–124.
- Crow, S. J., Peterson, C. B., Levine, A. S., Thuras, P., & Mitchell, J. E. (2004). A survey of binge eating and obesity treatment practices among primary care providers. International Journal of Eating Disorders, 35, 348–353. CrossRef
- Currin, L., Schmidt, U., Treasure, J., & Jick, H. (2005). Time trends in eating disorder incidence. British Journal of Psychiatry, 186, 132–135. CrossRef
- Currin, L., Waller, G., & Schmidt, U. (2009). Primary care physicians’ knowledge of and attitudes toward the eating disorders: Do they affect clinical actions? International Journal of Eating Disorders, 42, 453–458. CrossRef
- Devlin, M. J., & Fischer, S. E. (2005). Treatment of binge eating disorder. In S. Wonderlich, J. Mitchell, M. de Zwann, & H. Steiger (Eds.), Eating disorders review: Part 1 (pp. 27–41). Oxford: Radcliffe.
- Fairburn, C. G., & Beglin, S. J. (1994). Assessment of eating disorders: Interview or self-report questionnaire? International Journal of Eating Disorders, 16, 363–370.
- Fairburn, C. G., & Cooper, Z. (1993). The Eating Disorder Examination (12th ed.). In C. G. Fairburn & G. T. Wilson (Eds.), Binge eating: Nature, assessment and treatment (pp. 317–360). New York: Guilford Press.
- Garvin, V., & Striegel-Moore, R. H. (2001). Health services research for eating disorders in the United States: A status report and a call to action. In R. H. Striegel-Moore & L. Smolak (Eds.), Eating disorders: Innovative directions in research and practice (pp. 135–152). Washington: American Psychological Association. CrossRef
- Goldberg, D. (1995). Epidemiology of mental disorders in primary care settings. Epidemiological Reviews, 17, 182–190.
- Gowers, S. G., & Shore, A. (1999). The stigma of eating disorders. International Journal of Clinical Practice, 53, 386–388.
- Hay, P. J., & Bacaltchuk, J. (2009). Bulimia nervosa. Clinical evidence. BMJ Publishing Group. clinicalevidence.bmj.com.
- Hay, P. J., de Angelis, C., Millar, H., & Mond, J. M. (2006). Towards a better understanding of unmet care needs: Eating disorders mental health literacy of general practitioners. Primary Care Psychiatry, 10, 103–108.
- Hay, P. J., Marley, J., & Lemar, S. (1998). Covert eating disorders: The prevalence, characteristics and help-seeking of those with bulimic eating disorders in general practice. Primary Care Psychiatry, 4, 95–99.
- Hoek, H. W. (1991). The incidence and prevalence of anorexia nervosa and bulimia nervosa in primary care. Psychological Medicine, 21, 455–460. CrossRef
- Hudson, J. I., Hiripi, E., Pope, H. G., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61, 348–358. CrossRef
- Johnson, J. G., Spitzer, R. L., & Williams, J. B. W. (2001). Health problems, impairment and illnesses associated with bulimia nervosa and binge eating disorder among primary care and obstetric gynaecology patients. Psychological Medicine, 31, 1455–1466. CrossRef
- Keel, P. K., Mayer, S. A., & Harnden-Fischer, J. H. (2001). Importance of size in defining binge eating episodes in bulimia nervosa. International Journal of Eating Disorders, 29, 294–301. CrossRef
- King, M. B. (1989). Eating disorders in a general practice population. Prevalence, characteristics and follow-up at 12 to 18 months. Psychological Medicine Monographs, 14(Suppl. 14), 1–34. CrossRef
- Meadows, G. N., Palmer, R. I., Newball, E. U. M., & Kenrick, J. M. T. (1986). Eating attitudes and disorder in young women: A general practice based survery. Psychological Medicine, 16, 351–357. CrossRef
- Mond, J. M., & Hay, P. J. (2007). Functional impairment associated with eating disorder behaviours in a community sample of women and men. International Journal of Eating Disorders, 40, 391–398. CrossRef
- Mond, J. M., Hay, P. J., Rodgers, B., & Owen, C. (2006). Eating Disorder Examination Questionnaire (EDE-Q): Norms for young adult women. Behaviour Research and Therapy, 44, 53–62. CrossRef
- Mond, J. M., Hay, P. J., Rodgers, B., & Owen, C. (2007). Health service utilization for eating disorders: Findings from a community-based study. International Journal of Eating Disorders, 40, 399–408. CrossRef
- Mond, J. M., Hay, P. J., Rodgers, B., & Owen, C. (2008). Eating disorders “mental health literacy”: What do women with bulimic eating disorders think and know about bulimia nervosa and its treatment? Journal of Mental Health, 17, 565–575. CrossRef
- Mond, J. M., Hay, P. J., Rodgers, B., Owen, C., & Beumont, P. J. V. (2004). Validity of the Eating Disorder Examination Questionnaire (EDE-Q) in screening for eating disorders in community samples. Behaviour Research and Therapy, 42, 551–567. CrossRef
- Mond, J. M., Hay, P. J., Rodgers, B., Owen, C., Crosby, R., & Mitchell, J. E. (2006). Use of extreme weight control behaviors with and without binge eating in a community sample of women: Implications for the classification of bulimic-type eating disorders. International Journal of Eating Disorders, 39, 294–302. CrossRef
- Mond, J. M., Myers, T. C., Crosby, R. D., Hay, P. J., Rodgers, B., Morgan, J. F., et al. (2008). Screening for eating disorders in primary care: EDE-Q versus SCOFF. Behaviour Research and Therapy, 46, 612–622. CrossRef
- Mond, J. M., Rodgers, B., Hay, P. J., Korten, A., Owen, C., & Beumont, P. J. V. (2004). Disability associated with community cases of commonly occurring eating disorders. Australian and New Zealand Journal of Public Health, 28, 246–251.
- Mond, J. M., Rodgers, B., Hay, P. J., & Owen, C. (2006). Self-recognition of disordered eating among women with bulimic-type eating disorders: A community-based study. International Journal of Eating Disorders, 39, 747–753. CrossRef
- Mond, J. M., Rodgers, B., Hay, P. J., Owen, C., & Beumont, P. J. V. (2004). Non-response bias in a general population survey of eating-disordered behaviour. International Journal of Eating Disorders, 36, 89–98. CrossRef
- Morgan, J. F., Reid, F., & Lacey, J. H. (1999). The SCOFF questionnaire: Assessment of a new screening tool for eating disorders. BMJ, 319, 1467–1468.
- Ogg, E. D., Millar, H. R., Pusztai, E. E., & Thom, A. S. (1997). General practice consultation patterns preceding diagnosis of eating disorders. International Journal of Eating Disorders, 22, 89–93. CrossRef
- Regier, D. A., Narrow, W. E., Kuhl, E. A., & Kupfer, D. J. (2009). The conceptual development of DSM-V. American Journal of Psychiatry, 166, 645–650. CrossRef
- Rothman, K. J. (1990). No adjustments are needed for multiple comparisons. Epidemiology, 1, 43–46. CrossRef
- Sanderson, K., & Andrews, G. (2002). Prevalence and severity of mental health-related disability and relationship to diagnosis. Psychiatric Services, 53, 80–86. CrossRef
- Sansone, R. A., Wiederman, M. W., & Sansone, L. A. (1997). Health-care utilization among women with eating-disordered behavior. American Journal of Managed Care, 3, 1721–1723.
- Spitzer, R. L., Kroenke, K., & Williams, J. B. W. (1999). Validation and utility of a self-report version of PRIME-MD. JAMA, 282, 1737–1744. CrossRef
- Striegel-Moore, R. H., Dohm, F.-A., Kraemer, H. C., Schreiber, G. B., Crawford, P. B., & Daniels, S. R. (2005). Health services use in women with a history of bulimia nervosa or binge eating disorder. International Journal of Eating Disorders, 37, 11–18. CrossRef
- Striegel-Moore, R. H., Perrin, N., DeBar, L., Wilson, G. T., Rosselli, F., & Kraemer, H. C. (in press). Screening for binge eating disorders using the patient health questionnaire in a community sample. International Journal of Eating Disorders. doi:10.1002/eat.20694.
- Turnbull, S., Ward, A., Treasure, J., Jick, H., & Derby, L. (1996). The demand for eating disorder care: An epidemiological study using the general practice research database. British Journal of Psychiatry, 169, 705–712. CrossRef
- Ustun, T. B. (2000). Unmet need for management of mental disorders in primary care. In G. Andrews & S. Henderson (Eds.), Unmet need in psychiatry (pp. 157–171). Cambridge: Cambridge University Press. CrossRef
- van Son, G. E., van Hoeken, D., Bartelds, A. I., van Furth, E. F., & Hoek, H. W. (2006). Time trends in the incidence of eating disorders: A primary care study in the Netherlands. International Journal of Eating Disorders, 39, 565–569. CrossRef
- Ware, J. E., Kosinski, M., & Keller, S. D. (1996). A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34, 220–233. CrossRef
- Whitehouse, A. M., Cooper, P. J., Vize, C. V., Hill, C., & Vogel, L. (1992). Prevalence of eating disorders in three Cambridge general practices: Hidden and conspicuous morbidity. British Journal of General Practice, 42, 57–60.
- Wilfley, D. E., Bishop, M. E., Wilson, G. T., & Agras, W. S. (2007). Classification of eating disorders: Toward DSM-V. International Journal of Eating Disorders, 40, S123–S129. CrossRef
- Bulimic Eating Disorders in Primary Care: Hidden Morbidity Still?
Journal of Clinical Psychology in Medical Settings
Volume 17, Issue 1 , pp 56-63
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Eating disorders
- Bulimia nervosa
- Binge eating disorder
- Primary care
- Mental health literacy
- Author Affiliations
- 1. School of Biomedical and Health Sciences, University of Western Sydney, Campbelltown Campus, Locked Bag 1797, Penrith DC, NSW, 1797, Australia
- 2. Neuropsychiatric Research Institute, Fargo, USA
- 3. School of Medicine, University of Western Sydney, Campbelltown, Australia