Caught in the Bulimic Trap? On the Incidence, Persistence and State Dependence of Bulimia Among Blacks and

Eating disorders are an important and growing health concern, and bulimia nervosa (BN) accounts for the largest fraction of eating disorders (ED). Health consequences of BN are substantial and especially serious given the increasingly compulsive nature of the disorder. However, remarkably little is known about the mechanisms underlying the persistent nature of BN and the socioeconomic groups that are most likely to be at risk. Using a unique panel data set on young women and instrumental variable techniques, we document that unobserved heterogeneity plays a role in the persistence of BN, but strikingly up to two thirds is due to true state dependence. Our results, together with support from the medical literature, provide strong evidence that bulimia should be considered an addiction. We also \u85nd that African Americans are more likely to exhibit and persist in bulimic behavior than Whites; as are girls from low income families compared to middle and high income families. These results stand in stark contrast to the popular conceptions of who is most likely to experience an ED, and we argue that an important cause of this is di¤erences in diagnosis across racial and income classes. Our ndings have important implications for public policy since they i) provide direction t