Women follow Diana down road to bulimia

Cases treble in five years, reports Susan Emmett

The number of women suffering from bulimia, the bingeing disorder, tripled in five years and substantially overtook the figure for those suffering from anorexia, according to a new report which calls for greater understanding of eating problems from GPs.

A joint study by the Institute of Psychiatry in London and Boston University, covering a period from 1988-1993, reveals a jump from 15 out of 100,000 women suffering from bulimia at the start to more than 50 per 100,000 at the end. The figure for anorexia remained steady at just under 20 per 100,000.

Dr Janet Treasure, head of the Eating Disorders Unit at the Institute of Psychiatry, said that the rise in reported numbers suffering from the illness which afflicted the Princess of Wales and which affects nearly 50 times more women than men, could reflect the increasing number seeking help. But she said an earlier American study provided evidence that actual numbers of women suffering from bulimia had been increasing for decades.

She said: "It's to do with the culture of thinness and weight-watching. It's also a way people now find of expressing distress.

"Whereas a hundred years ago people might have developed hysterical reactions, they now try to take charge. It's part of the work-ethic society that people feel they need to solve all their problems themselves and they develop bulimia as a way of dealing with them."

Anorexia, however, is thought to be related to genetics rather than purely cultural factors. That would help explain why the number of women suffering from the disorder has remained largely steady although it was first diagnosed in 1873.

Anorexia is mostly found in girls aged between 10 and 19. The study shows they are the largest risk group, with GPs detecting a rate of 34 per 100,000. Bulimia mainly affects women aged between 20 and 39 - GPs identified 56 cases per 100,000. But the rate for the 10-19 age group is also high, at 41 per 100,000.

The Princess of Wales, in an emotional revelation about her own struggle to conquer the eating disorders she believes were rooted in her childhood, spoke in 1993 of how sufferers were driven to "dissolve and disappear" as a way of coping with unbearable situations.

She said: "I have it on very good authority that the quest for perfection our society demands can leave the individual gasping for breath. This pressure inevitably extends to the way we look."

Sufferers, by focusing their energies on controlling their bodies, found a refuge from having to face the more painful issues at the centre of their lives, she went on. "It was a way of coping, albeit destructively and pointlessly, with a situation they were finding unbearable."

Diana's confession, at an international conference about children with eating disorders, helped to raise bulimia's profile. But experts say that there is still a need for a greater understanding of it and the new report calls for more effective management of the disorder by GPs, as the majority of cases of eating disorders are referred to hospitals and clinics.

The Association of Eating Disorders agreed that many GPs had little knowledge of - or sympathy for the sufferers from - bulimia, which was only diagnosed as recently as 1979. "Many people who call us say their GPs have failed to understand what they are going through," a spokeswoman said. "They don't know what to do after that."

Part of the problem was that bulimia - characterised by bingeing and "purging"- was difficult to detect, as sufferers did not usually lose weight like anorexics.

She added that there was still not enough help available to the increasing numbers of sufferers and that the association was inundated with callers.