Is bulimia nervosa increasing in frequency?

Objective: To assess whether or not claims of an increase in the incidence of bulimic disorders are empirically justified. Method: Review of the epidemiological data informative to gauge time trends: Studies based on hospital records or registers, community surveys of bulimic disorders, questionnaire-based investigations. Results: Epidemiological studies conducted since 1980 do not show an upward trend in rates. Reports of increased rates among recent birth cohorts were unreliable and did not control for con founding comorbid disorders. Changes in diagnostic and referral practices are likely to account for higher numbers of patients seen in specialized treatment centers. Discussion: Although based on a limited number of studies, the empirical evidence does not support secular changes in the incidence of bulimic disorders. In keeping with this conservative conclusion, it is noted that high rates of dieting and body dissatisfaction were already reported 30 years ago among adolescent girls.