Original ArticlesSexuality and reproduction in bulimia nervosa patients over 10 years
Introduction
Little is known about the reproductive and sexual histories of women who have or are recovering from bulimia nervosa. The psychosexual histories of 20 young women with bulimia nervosa showed a wide range of sexual knowledge, attitudes, and practices [1]. When compared with other young women who were matched for age, marital status, occupation, and parity, the groups were similar. Their ages at their first significant relationship and at first sexual intercourse were similar to women who had no eating disorder, in contrast to anorexia nervosa patients who had sexual intercourse at a younger age. The bulimic group was more sexually experienced and more sexually experimental. A small number of bulimic patients were very sexually active, three of whom had had more than 10 sexual partners. The menstrual histories of the bulimia women only differed in the frequency of amenorrhea secondary to weight loss. The bulimia patients were more likely than control women to achieve orgasm through masturbation and less likely to achieve orgasm during sexual intercourse. They were more likely to believe their libido to be above average (40%) and to believe that their body weight influences their libido (65%).
The psychosexual histories of anorexia nervosa patients who binge eat are similar to those of women with bulimia nervosa 2, 3.
Pregnancy is a challenge to women's body shape and weight. Conflicts about bodily changes, alterations in roles, and concerns about a woman's own mothering and psychological separation are considered to be of paramount importance in the psychology of eating disorders [4]. The effect of pregnancy on women suffering from bulimia nervosa is not clear.
A combination of the results of our studies suggests that anorexic and bulimic behaviors during pregnancy may impair maternal and fetal health [5].
The studies suggest that the maternal complications of bulimia nervosa include: increased symptoms during pregnancy; low and high maternal weight gain; miscarriage; and hypertension. The birth complications of infants born to bulimia nervosa women suggested by the studies include: stillbirth; low infant birth weight; low Apgar scores; breech delivery; and cleft palate. Unfortunately, these studies contain data from both anorexia and bulimia nervosa women and the numbers of bulimic patients in each study are small.
This is a predominantly descriptive study. Its aims are to describe the reproductive and sexual histories of bulimia nervosa on women after 10 years and to investigate what aspects of women's reproductive and sexual histories need research in the future.
Section snippets
Subjects
Of 48 consecutive female bulimia nervosa patients, 43 were available for this study 10–15 years after their first presentation for treatment of bulimia nervosa. One patient had died of a drug overdose, two patients did not wish to take part, and two could not be traced. These women had been followed up 5 years after first presentation for treatment [6].
A group of 43 “well” women attending for routine pap smears, who had no other major medical or gynecological problems and no psychiatric
Results
All patients fulfilled the DSM-IV criteria for bulimia nervosa at first presentation. After 10–15 years, 11 (26%) patients were considered to have an eating disorder (active ED). Two patients still had bulimia nervosa, none had anorexia nervosa, and nine women were diagnosed as having an eating disorder not otherwise specified (ED-NOS). Thirty-two (74%) patients were considered to have recovered (RECOV). The descriptive characteristics are shown in Table 1 for the three groups. There was a
Discussion
Ten to 15 years after first presenting for treatment of bulimia nervosa, 11 of the 43 women continued to have an eating disorder, including 2 with bulimia nervosa. The EDE subscale scores Restraint and Eating Concern of the ED women differed from the RECOV women. The scores of the ED group resembled those of “restrained eaters” [9]or “atypical eating disorders,” whereas the scores of the RECOV group resembled those of “normal” women [10].
Women who have bulimia at the time they marry are more
Acknowledgements
Acknowledgments—The author thanks Doctors Michael Mira, Richard Clarkson, Betty Liounis, Robert Heard, and Sharon Wise for their contribution to this study.
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