A. Bulimia nervosa may have a genetic predisposition. Other predisposing factors include psychologic and personality factors, such as perfectionism, impaired self-concept, affective instability, poor impulse control and an absence of adaptive functioning to maturational tasks and developmental stressors (eg, puberty, peer and parental relationships, sexuality, marriage and pregnancy).
B. Bulimia nervosa appears to have a chronic, sometimes episodic course in which periods of remission alternate with recurrences of binge/purge cycles. Thirty percent of patients with bulimia nervosa rapidly relapse and up to 40 percent remain chronically symptomatic.
C. Comorbid major depression is commonly noted. There is an increased incidence of rapid cycling mood disorders and anxiety and substance-related disorders. Substance abuse involving alcohol and stimulants, occurs in one third of patients with bulimia nervosa. Between 2 and 50 percent of women with bulimia nervosa have borderline, antisocial, histrionic or narcissistic personality disorder.
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