Family environment and psychiatric history in women with bulimia

Part One of this thesis provides a comprehensive review of models of bulimia, including affective, dietary, addictive, sociocultural, psychodynamic, and family models of the disorder. Part Two presents the empirical portion of the study examining family environment and family psychiatric history in women with bulimia.; Thirty-five women meeting DSM-III criteria for bulimia and thirty-five healthy controls participated in the investigation. This study was designed to examine the presence of other addictive pathology in women with bulimia as well as in their family members by using structured diagnostic interviews.; A subgroup of women with bulimia emerged who displayed a poly-addictive behavior pattern marked by binging and alcohol or drug abuse. A full 23% of bulimic women met DMS III criteria for alcohol dependence, significantly more than controls, and more than expected in the general female population. Likewise, family psychiatric history investigation revealed that alcoholism was present significantly more frequently in the first and second degree relatives of women with bulimia than in families of controls.; In addition to addictive pathology, results indicated that 60% of the women with bulimia suffered from major affective disorder. Affective pathology was likewise significantly elevated in first and second degree relatives of bulimics.; Family environment interviews revealed that families of bulimics were markedly more disturbed than families of controls, and much more so than expected based of family environment information associated with the related eating disorder anorexia nervosa. Although the families of bulimics were heterogeneous, the interviews indicated high rates of discord and chaos, poor communication, lack of impulse control, and frequent physical and sexual abuse in the families of bulimics.; Treatment implications of this investigation include the importance of careful screening for concomitant addictive and affective pathology in bulimic women and encourage the implementation of family therapy as an adjunct modality in the clinical management of bulimia.; The development of bulimia is discussed in relation to familial predispositions to alcoholism and depression and sociocultural factors influencing the development of alcoholism in women.