Keski-Rahkonen A, Hoek H W, Linna M S, Raevuori A, Sihvola E, Bulik C M, Rissanen A, Kaprio J
Department of Public Health, University of Helsinki, Finland.
Psychol Med. 2009 May;39(5):823-31. doi: 10.1017/S0033291708003942. Epub 2008 Sep 8.
Little is known about the epidemiology of bulimia nervosa outside clinical settings. We report the incidence, prevalence and outcomes of bulimia nervosa using for the first time a nationwide study design.
To assess the incidence and natural course and outcomes of DSM-IV bulimia nervosa among women from the general population, women (n=2881) from the 1975-79 birth cohorts of Finnish twins were screened for lifetime eating disorders using a two-stage procedure consisting of a questionnaire screen and the Structured Clinical Interview for DSM-IV (SCID). Clinical recovery was defined as 1-year abstinence from bingeing and purging combined with a body mass index (BMI) 19 kg/m2.
The lifetime prevalence of DSM-IV bulimia nervosa was 2.3%; 76% of the women suffered from its purging subtype and 24% from the non-purging subtype. The incidence rate of bulimia nervosa was 300/100000 person-years at the peak age of incidence, 16-20 years, and 150/100000 at 10-24 years. The 5-year clinical recovery rate was 55.0%. Less than a third of the cases had been detected by health-care professionals; detection did not influence outcome. After clinical recovery from bulimia nervosa, the mean levels of residual psychological symptoms gradually decreased over time but many women continued to experience significantly more body image problems and psychosomatic symptoms than never-ill women.
Few women with bulimia nervosa are recognized in health-care settings. Symptoms of bulimia are relatively long-standing, and recovery is gradual. Many clinically recovered women experience residual psychological symptoms after attaining abstinence from bingeing and purging.
在临床环境之外，关于神经性贪食症的流行病学情况知之甚少。我们首次采用全国性研究设计报告神经性贪食症的发病率、患病率及转归情况。
为评估普通人群中女性的DSM-IV神经性贪食症的发病率、自然病程及转归情况，对芬兰1975 - 1979年出生队列中的2881名双胞胎女性进行了终生饮食失调筛查，采用两阶段程序，包括问卷调查筛查和DSM-IV结构化临床访谈（SCID）。临床康复定义为停止暴饮暴食和催吐1年，且体重指数（BMI）≥19kg/m²。
DSM-IV神经性贪食症的终生患病率为2.3%；76%的女性患有清除型亚型，24%患有非清除型亚型。神经性贪食症的发病率在发病高峰年龄16 - 20岁时为300/100000人年，在10 - 24岁时为150/100000人年。5年临床康复率为55.0%。不到三分之一的病例被医疗保健专业人员检出；检出情况不影响转归。从神经性贪食症临床康复后，残余心理症状的平均水平随时间逐渐下降，但许多女性仍持续经历比从未患病女性明显更多的身体形象问题和身心症状。
在医疗保健环境中，很少有神经性贪食症女性被识别出来。神经性贪食症的症状相对持久，康复是渐进的。许多临床康复的女性在停止暴饮暴食和催吐后仍有残余心理症状。
