Diana Bulimia

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Diana's bulimia was revealed in Andrew Morton's 1992 book

Rates of the eating disorder bulimia appear to have been influenced by revelations Princess Diana had battled with the condition, a study suggests.

British Journal of Psychiatry research found rates rose in the early 1990s - when news of Diana's illness appeared.

However, her death in 1997 coincided with the beginning of the decline in the rate of bulimia seen by GPs.

But eating disorder experts said bulimia rates had not fallen - instead fewer people were talking about it.

Seeing people like Diana talking about their illness does encourage people to come forward Steve Bloomfield, Eating Disorders Association

The Eating Disorders Association said the coverage of Diana's illness, following revelations in Andrew Morton's 1992 book, had raised awareness, and enabled people with bulimia to come forward.

Now, with less coverage of the condition, they said a stigma had once again grown around bulimia, and people were more likely to be suffering in silence.

A spokesman said people were more likely to hide bulimia than anorexia because it involved binging and vomiting, which people were unwilling to admit to doing.

Rates of anorexia remained stable during the 1990s.

Annual incidence

The study by London-based Institute of Psychiatry experts found rates of anorexia remained stable over the same period.

The researchers screened the General Practice Research Database for new cases of anorexia and bulimia nervosa for females aged 10 to 39.

During the years 1988 to 1993 the incidence of anorexia nervosa detected in primary care remained stable.

But rates of bulimia had more than doubled by the mid-1990s.

In 1990, there were more than 25 cases of bulimia per 100,000 women in the population aged 10 to 39, reaching a peak of around 60 per 100,000 in 1996.

Since then, the rate of bulimia has declined.

Writing in the British Journal of Psychiatry, the researchers led by Laura Currin, said: "Identification with a public figure's struggle with bulimia might have temporarily decreased the shame associated with the illness, and encouraged women to seek help for the first time.

"This would suggest that some of the 1990s peak might have been caused by the identification of long-standing cases rather than a true increase in community incidence."

However, the researchers also suggested that rising rates of bulimia may have been due to increased recognition and detection efforts given to a new and "fashionable" diagnosis.

They call for detection and treatment efforts to be aimed at young women aged 10 to19, as this is the group with the highest risk of both anorexia and bulimia nervosa.

Steve Bloomfield, spokesman for the Eating Disorders Association, told the BBC News Website: "We believe that the incidence of bulimia hasn't changed.

"What's changed is the number of people who've reported to their GP that there is a problem.

"Seeing people like Diana talking about their illness does encourage people to come forward."

But he added: "Now, the symptoms and diagnosis are not widely talked about.

"I think we are probably seeing more people suffering in silence, who don't understand that they aren't the only people with this problem."