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Impulsivity or Comorbidity in Bulimia Nervosa

A Controlled Study of Deliberate Self-Harm and Alcohol and Drug Misuse in a Community Sample

Published online by Cambridge University Press:  02 January 2018

Sarah L. Welch  and
Christopher G. Fairburn
Sarah L. Welch*
Affiliation:
Addiction Research Unit, Institute of Psychiatry, London
Christopher G. Fairburn
Affiliation:
Oxford University Department of Psychiatry, Warneford Hospital, Oxford
*
Dr Sarah Welch, Addiction Research Unit, Institute of Psychiatry, DeCrespigny Park, London SE5 8AZ
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Abstract

Background

Studies showing high rates of alcohol and drug misuse and deliberate self-harm in bulimia nervosa have led some authors to call for a distinct diagnostic subgroup, sometimes termed “multi-impulsive bulimia”. However, these studies have been uncontrolled and of clinic samples and may be subject to sampling bias.

Method

One hundred and two women with DSM–III–R bulimia nervosa were compared with 204 normal controls and 102 controls with other psychiatric disorders, all recruited from the same community sample. Interview measures were used for diagnosis and for the assessment of alcohol and drug misuse and deliberate self-harm.

Results

Bulimia nervosa cases did not differ from either of the control groups in terms of current alcohol consumption. Bulimia nervosa cases used more illicit drugs than either control group, but loss of control over drug use was very uncommon. Bulimia nervosa cases had a higher rate of deliberate self-harm than the controls. Only six (6%) bulimia nervosa cases had two or more of these behaviours concurrently.

Conclusion

Sampling bias is present in clinic-based studies of comorbidity in bulimia nervosa. Those with comorbid substance misuse and deliberate self-harm are probably heterogeneous in character, and their classification as a subgroup would therefore be premature.

Type
Papers
Information
The British Journal of Psychiatry , Volume 169 , Issue 4 , October 1996 , pp. 451 - 458
Copyright
Copyright © 1996 The Royal College of Psychiatrists 

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