Which comes first in the pathogenesis of bulimia nervosa: Dieting or bingeing

Objective: Clinical experience has indicated that dieting usually precedes the onset of binge eating in the development of bulimia nervosa (BN). Howev er, data confirming this in nonclinical, representative samples are lacking . Method: Using results obtained from the National Women's Study(NWS) we we re able to determine the chronological relationship between age of onset of significant dieting (attempting to lose 15 lbs) and onset of bingeing in 8 5 respondents who met DSM-III-R criteria for BN. These respondents were a s ubset of over 3,000 female adult U.S. women who completed a random telephon e interview (averaging 40 min and including screenings for rape, sexual mol estation, aggravated assault, posttraumatic stress disorder [PTSD] and BN). Results: We found that the age of first serious attempt to diet preceded t he age of first binge in 46% of cases. There were no significant difference s in histories of victimization experiences among the groups. First binge p receded first serious diet in 37% of cases, and these behaviors occurred du ring the same age in 17% of cases. Discussion: These data confirm that diet ing is more likely to precede binge eating although binge eating precedes s ignificant dieting in a substantial proportion of bulimic respondents. (C) 2000 by John Wiley & Sons, Inc.