Early psychopathological signs in bulimia nervosa. A retrospective comparison of the period of puberty in bulimic and control girls

While bulimia nervosa (BN) typically begins in girls during late adolescenc e, puberty and associated developmental changes have been linked to negativ e body image and onset of a variety of psychological problems. This study a imed to identify early psychopathological signs, which could have marked th e period of puberty in subjects whom later developed BN. In a case control study, we compared 49 girls with BN according to DSM-IV, aged between 18 an d 20 years, to 49 girls of the same age, who were free of any past or curre nt psychiatric diagnosis. Psychiatrists or clinical psychologists, using a semi-structured clinical interview including retrospective assessment of th e emotional and behavioural changes that had occurred in puberty evaluated both groups. Before the onset of a clinical eating disorder, the subjects w ith BN presented significantly more often than controls weight related conc erns, attitudes of withdrawal and social isolation, and negative chan ges i n their body image and self-image, as well as in their relationships with s iblings and peers. The results suggest that early psychological distress pr ecedes the onset of an eating disorder in many cases, and that prevention e fforts should be directed towards peripubertal psychopathology.