Bulimia nervosa five times more common in cities than in rural areas

Bulimia nervosa is five times more common in cities than in more rural areas, even though the related eating disorder anorexia nervosa is just as prevalent in rural areas as in cities. This is a further indication that they are two distinct disorders that therefore require different treatments. Psychologist Gabriëlle van Son thinks that they are still lumped together too often. She will be awarded a PhD by the University of Groningen on 27 October 2010.

Approximately 40,000 people suffer from a severe eating disorder in the Netherlands. These people suppress their appetite and have an extreme desire to be thin (anorexia nervosa), or they suffer from binge eating, are very focused on weight control and are extremely concerned about their body shape and weight (bulimia nervosa). In order to keep their weight under control, these patients vomit, use laxatives or exercise excessively. Eating disorders are more prevalent in women than in men: of all patients suffering from anorexia nervosa, one in ten is male; the number is even lower for bulimia nervosa.

Five times more common in cities

Bulimia nervosa and anorexia nervosa are often lumped together. Although there are indeed many similarities, it is better to make a clear distinction between the two. Gabriëlle van Son’s research shows that bulimia is five times more common in cities than in rural areas, while anorexia occurs as frequently in rural areas as in urban areas. Van Son: ‘This is a very remarkable result. It shows that the two disorders might have different causes and should therefore be treated differently. So far, too little attention has been paid to this.’

Buying food anonymously

Van Son has not been able to find the exact difference between the two disorders. ‘Further research is needed,’ she adds. ‘Perhaps the more stressful city life plays a larger role in the case of bulimia nervosa. Anonymity may also play a role; in big cities it is easier to buy food anonymously because you can go to many different shops and chemists to buy food and laxatives.’

Late detection

Her research also shows that patients have a greater chance to recover from an eating disorder if it is detected at an early age (before their 20th birthday). According to Van Son, ‘the longer eating disorders remain untreated, the more they might become ingrained in habits, behaviour and thinking.’ This is particularly a challenge for GPs because they have trouble recognizing these psychological problems. ‘Usually, patients do not just tell their GP that they have an eating disorder,’ says Van Son. ‘Instead, they talk of abdominal pain, menstrual pain or other symptoms. These patients often think that their GP does not understand them. It may also take a long time before they find out and admit to themselves that they have an eating disorder.’

Curriculum vitae

Gabriëlle van Son (Hoorn, 1972) studied Psychology in Leiden. She conducted her research at the Center for Eating Disorders Ursula in Leidschendam, where she works as a psychologist and researcher in cooperation with the Parnassia Bavo group and NIVEL (Netherlands institute for health services research). The research has been partially financed by the GGZ Rivierduinen (mental health centre). Van Son was supervised by Prof. H.W. Hoek and will be awarded a PhD by the Faculty of Medical Sciences. The title of her thesis is ‘The epidemiology of eating disorders’.

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