2011) “Caught in the Bulimic Trap? Persistence and State Dependence of Bulimia Among Young Women,”mimeo

Eating disorders are an important and growing health concern, and bulimia nervosa (BN) ac-counts for the largest fraction of eating disorders. Health consequences of BN are substantial and especially serious given the increasingly compulsive nature of the disorder. However, re-markably little is known about the mechanisms underlying the persistent nature of BN. We use data from a unique panel data set, the National Heart, Lung, and Blood Institute Growth and Health Study, which was conducted for ten years on young women aged 9-10 at the start of the survey (in 1987). Using instrumental variable techniques, we document that unobserved heterogeneity plays a role in the persistence of BN, but, strikingly, up to two thirds of this per-sistence is due to true state dependence. Our \u85ndings have important implications for public policy since they suggest that the timing of policy is crucial: preventive educational programs should be coupled with more intense (rehabilitation) treatment at the early stages of bingeing and purging behaviors. Our results are robust to di¤erent model speci\u85cations and identifyin