A comparison of eating disorder symptomatology in a clinical population of adolescents with subjective versus objective bulimic episodes

Objective: Research is pointing towards equalising the status of objective bulimic episodes (OBEs) and subjective bulimic episodes (SBEs) in the classification of eating disorders due to similarities observed between OBE and SBE groups on eating disorder symptomatology. However, the clinical utility of differentiating between bulimic episodes in adolescent clinical populations remains unclear. The validity of bulimic episode classification in adolescents was therefore examined. Method: Four hundred and eighty female patients (<18 years) referred to treatment for an anorectic type or a bulimic type eating disorder completed the Eating Disorder Examination interview prior to treatment and differences in eating disorder symptomatology between bulimic groups were examined. Results: In total, 10.6% of patients had regular OBEs and 27.5% of patients had regular SBEs. For bulimic type patients, the OBE group was found to be significantly older, heavier and reported more vomiting than the SBE group, after adjusting for age and weight, differences on vomiting were no longer significant. No significant differences were observed between OBE and SBE groups for anorectic type patients. Discussion: Loss of control over eating may be a more important marker of symptom severity than binge size. The role of SBEs in the classification of eating disorders, in eating disorder progression and in adolescent development is discussed