Anorexia Nervosa and Bulimia

To the Editor.  —Because of our own ongoing psychological and endocrine research concerning anorexia nervosa (AN), we read with interest the three articles on this subject in the September 1980 issue of the Archives. In particular, we would like to comment on certain aspects of the two articles dealing with the question of bulimia in AN.Garfinkel and associates (1980; 37:1036-1040) and Casper and associates (1980;37:1030-1035) bring to general attention an important fact that has become increasingly evident to workers in this special area, namely the widespread occurrence of bulimia in patients who meet traditional criteria for AN. Indeed, despite the apparent lack of attention to the significance of this symptom in the early literature on AN, our experience is similar to that of both groups in indicating that perhaps as many as 50% of those persons with AN who are ill enough to warrant psychiatric-medical intervention will give histories