Overview of evidence on the underpinnings of bulimia nervosa

There is no single etiology or basis for any of the eating disorders, including bulimia nervosa, but similar to other mental disorders, bulimia results from the dynamic interplay between biological, psychological and social factors that operate along a developmental continuum. In this chapter these factors are further subdivided into predisposing, precipitating and perpetuating factors (the "3 P's), which creates nine categories of underpinnings from which to examine the evidence as it relates to bulimia nervosa. Latent vulnerability theory suggests strong genetic predisposing factors linked to anxiety, harm avoidance, obsessive-compulsiveness and drive for thinness, which are exposed, triggered and/or exacerbated by behaviors geared toward weight loss. Among a host of psychosocial factors, traumatic experiences often play important roles in predisposing, precipitating and perpetuating bulimic disorders, especially when there is psychiatric comorbidity.