Q & A: Self-Esteem and Bulimia Nervosa

Q: Many of my patients with bulimia nervosa (BN) have remarkably low self-esteem, and I’ve wondered if that could be a central contributor to this disorder. Is there any data to support that idea? (K.R., Omaha, NE)

A: It’s been known for years that patients with BN have very low self-esteem, and studies have shown that patients with BN may, in fact, score lower on self-esteem questionnaires than do virtually all other female populations. The extent to which low self-esteem may contribute to BN and, conversely, the extent to which having the disorder reduces self-esteem is difficult to tease apart. Most studies have shown some improvement of self-esteem among women with BN who have recovered. However, of note, a recent cross-sectional study of women who were in remission from BN for an average of 80 months and who were no longer clinically depressed has shown that although their self-esteem was higher than that of women with BN, their self-esteem was still lower than that of normal controls (Int J Eat Disorders 41:159-163, 2008). Further research will be needed to show whether these women’s self-esteem will continue to improve with time, whether this is an enduring finding, and how specific this is to women with BN versus other psychiatric disorders as well. In any event, therapeutic interventions that help improve self-esteem in recovering patients are warranted.

— J.Y.