The British Journal of Psychiatry

Abstract

BACKGROUND Bulimia nervosa affects women at a peak age of reproductive functioning, but few studies have examined the impact of pregnancy on bulimia.

AIM To examine the impact of pregnancy on symptoms of bulimia nervosa and associated psychopathology.

METHOD Women actively suffering from bulimia nervosa during pregnancy (n = 94) were interviewed using the eating disorder examination (12th edn) and structured clinical interview for DSM-III-R, with additional structured questions. Behaviours were recorded at conception, each trimester and postnatally. Relative risks were calculated for prognostic factors.

RESULTS Bulimic symptoms improved throughout pregnancy. After delivery, 57% had worse symptoms than pre-pregnancy, but 34% were no longer bulimic. Relapse was predicted by behavioural severity and persistence, previous anorexia nervosa ('Type II' bulimia), gestational diabetes and 'unplanned' pregnancy. Unplanned pregnancies were the norm, usually resulting from mistaken beliefs about fertility. 'Postnatal depression' was suggested in one-third of the sample, and in two-thirds of those with'Type II' bulimia, and was predicted by alcohol misuse, symptom severity and persistence.

CONCLUSIONS Postnatal treatment intervention should focus on women 'at risk' of relapse, but all women with bulimia should be assessed for postnatal depression.