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Am J Psychiatry 1996; 153:386-391
Copyright © 1996 by American Psychiatric Association
Bias and bulimia nervosa: how typical are clinic cases?
CG Fairburn, SL Welch, PA Norman, ME O'Connor and HA Doll
Oxford University Department of Psychiatry, Warneford Hospital, United Kingdom.
OBJECTIVE: Since patients being treated for bulimia nervosa constitute only
a minority of persons with the disorder, the cases seen in clinics may be
subject to sampling bias. The aim of this study was to investigate sampling
bias as it affects secondary referrals for bulimia nervosa. METHOD: The
personal and family characteristics of a consecutive series of 60 women
with secondary referrals for bulimia nervosa (clinic subjects) were compare
with those of 83 subjects with bulimia who were recruited directly from the
community. Most of the data were collected by interview. RESULTS: The
demographic characteristics of the two groups were similar. The clinic
subjects had a more severe eating disorder and much greater impairment of
social functioning. There was no difference between the groups in duration
of the eating disorder or level of general psychiatric disturbance. The
community subjects were heavier and had stronger family histories of
obesity. CONCLUSIONS: There is sampling bias among secondary referrals for
bulimia nervosa. The relative absence of persons prone to obesity among
secondary subjects is important, since there is evidence that vulnerability
to obesity is a poor prognostic feature as well as being a risk factor for
the development of bulimia nervosa. The greater social impairment among the
clinic subjects is suggestive of greater personality disturbance in this
group. Caution is warranted when generalizing from clinic cases to the
disorder as a whole.
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