Being in the Grip of Bulimia: New Evidence on how Bulimia Relates to Addictive Behavior

Using longitudinal data that tracks bulimic behavior among young girls (National Heart, Lung, and Blood Institute Growth and Health Study), we examine (1) whether the persistence in bulimia nervosa (BN) can be attributed to slow learning about the deleterious health effects of BN or if it reflects tolerance formed from an addiction; and 2) whether bulimic behavior is consistent with addiction criteria as stated in the Diagnostic and Statistical Manual of Mental Disorders DSM-IV. To address the endogeneity of past behavior, we use instrumental variables, and show that past BN positively and significantly impacts current BN after controlling for individual heterogeneity. When accounting for BN ”stock,” the parameter estimates of past behavior are not negative, which casts doubt on the importance of learning. Making the case for treating BN as an addiction has important policy implications. First, it suggests that the timing of educational policy and treatment is crucial: preventive educational programs aimed at instructing girls about the deleterious health effects of BN, as well as treatment interventions, will be most effective if provided in the early stages. Second, it would put those exhibiting BN on more equal footing (from a treatment reimbursement perspective) with individuals with drug or alcohol addictions.