Bulimia nervosa: Friend or foe? The pros and cons of bulimia nervosa


  • Lucy Serpell,

    Corresponding author
    1. Department of Psychiatry, St. Georges Hospital Medical School and Huntercombe Manor Hospital, London, United Kingdom
    • Department of Psychiatry, St. George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, United Kingdom
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  • Janet Treasure

    1. Eating Disorders Unit, Institute of Psychiatry, University of London, London, United Kingdom
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  • This study forms part of the doctoral thesis of the first author.



The aim of the current study was to use a qualitative approach to investigate the attitude of people with bulimia nervosa (BN) to their illness.


Patients with BN were asked to write two letters to their bulimia, one addressing it as a friend and the other addressing it as an enemy. We used a coding scheme to classify themes in letters of people with anorexia nervosa (AN) to group together themes expressed by those with BN. We revised the coding scheme to include themes that were not present in the letters of people with AN.


There were both similarities and differences in the themes described by AN and BN patients. Two positive themes (BN allowing the individuals to eat and not get fat and BN as a way of dealing with boredom) and two negative themes (shame or low self-esteem resulting from BN and obsessive thoughts of weight and shape) were added to the coding scheme to account for these differences.


The positive and negative aspects of BN differ in some important ways from those expressed by patients with AN. The meaning of these differences is discussed with reference to the wider symptom pattern of BN compared with AN and their importance with reference to motivation for change is outlined. © 2002 by Wiley Periodicals, Inc. Int J Eat Disord 32: 164–170, 2002.