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Sharp drop in new cases of bulimia nervosa

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26 September 2016

Looking good at school protects against eating problems; being liked might indicate a risk

The number of new cases of the eating disorder bulimia nervosa has dropped sharply over the past three decades. On the other hand, the number of new cases of anorexia nervosa remained stable during the same period. This is probably because bulimia is more sensitive to sociocultural developments than anorexia, as also seen in the increase in obesity in the past few years. This is the result of research carried out by psychiatrist Frédérique Smink from the Parnassia Groep. She will be awarded a PhD for her thesis by the University of Groningen on 28 September. Her research also shows that looking good as a young adolescent (11-13) protects against the later development of eating problems. Strangely enough, being liked by lots of classmates appeared to be a predictor.

Eating disorders are serious psychiatric conditions which largely develop during adolescence. Relatively little is known about the causes. Smink examined whether the number of new cases of anorexia nervosa and bulimia nervosa registered by Dutch GP practices had changed during the course of time, also finding out which eating disorders were the most common among Dutch adolescents. She also studied whether social status in early adolescence was a risk factor.

Drop in the number of new cases since the 1980s

Smink's thesis shows that the number of new cases of bulimia nervosa dropped substantially over the past three decades, while the number of new cases of anorexia nervosa during the same period remained stable. Bulimia nervosa is probably more sensitive to sociocultural developments than anorexia nervosa, such as the rise in the average body mass index (BMI) in the population, for example. This has made overweight more socially acceptable. It is possible that this has lowered the pressure to cancel out the consequences of binge eating through compensatory behaviour. It is this compensatory behaviour that is the key to bulimia nervosa. Other developments that may help to explain the drop in incidence include the rise in prevention measures and self-help, boosted by the swift growth in access to the internet.

Most common eating disorders

The most common eating disorders among Dutch adolescent girls are anorexia nervosa and binge-eating disorder, and among adolescent boys, binge-eating disorder. In most cases, illness severity was mild to moderate. The majority of the eating disorders were not recognised as such by healthcare services (including mental healthcare services).

Effect of appearance

Smink also studied whether social status in early adolescence (11-13 years of age) plays a role. Her study shows that adolescents who look good, in their own eyes or in those of their classmates, are less likely to develop eating problems in young adulthood. Strangely enough, being liked by lots of classmates appeared to be a predictor of eating problems.

Curriculum Vitae

F.R.E. Smink (Amersfoort, 1983) studied Medicine at Leiden University. In 2009, she started a combined PhD and psychiatrist training programme with the Parnassia Groep in The Hague. Part of her thesis is based on data from the TRAILS study, an ongoing multidisciplinary research project studying the mental, social and physical development of adolescents and young adults. Her thesis is entitled: 'Through the looking glass. Epidemiological studies on eating disorders in primary care and the community'. Smink works as a psychiatrist for the Parnassia Groep.