Researchers who are beginning to tease out differences between the two eating disorders say that bulimia, the more common condition affecting 1 to 2 per cent of young women, may well be a response to parental neglect.
Dr Ulrike Schmidt, now consultant psychiatrist at St Mary's Hospital, London, said yesterday that she believed anorexia, which results in 10 to 20 per cent of deaths among sufferers, was more likely to have a genetic connection.
'It is much more common for the women suffering from bulimia to have childhood trauma and it is becomming clear that genetic factors might contribute to anorexia nervosa. It is not quite clear what this genetic factor really is that allows people to starve themselves into non-existence, almost,' she said at a press briefing.
'But if you have a particular talent, or predisposition to starve . . . then when something unpleasant happens to you in adult life, you respond to that by losing weight and it takes on a life of its own.'
Her study involved 203 women in their twenties, who had eating disorders for about five years, attending a clinic at the Maudsley Hospital, south London.
Dr Schmidt told the winter meeting of the Royal College of Psychiatrists in London that 45 per cent of the bulimic women had suffered neglect, including being left alone unsupervised and having to look after younger brothers and sisters, compared with 20 per cent of the anorexic women.
But she said that one of the most striking differences was found where parents were highly controlling and very harsh and who used inappropriate punishments. More than 40 per cent of the women with bulimia had been harshly treated. Within this group a quarter had experienced severe physical abuse compared with 3 to 4 per cent with anorexia.
She found that an equal number, about 30 per cent, of bulimics and anorexics had been sexually abused.
Some of the treatment meeted out to women with bulimia had been extreme - 'over the top' - and for 'something totally trivial' she said. 'Children were locked in a cellar for hours or sent to their room for days. One stepfather made the children eat dog food as a punishment.'
Dr Schmidt said bulimia may be a modern response to an unhappy childhood. One study of mothers and their daughters who had both experienced difficult childhoods found that while the mothers tended to be depressed, their daughters were more likely to respond to early problems with eating disorders.
She said that evidence of a genetic association with anorexia was based on studies of twins. Anorexia was found to be more likely in one twin if the other twin suffered from it.Reuse content