Developmental and cultural factors in bulimia nervosa: A comparative study of Croatian and German female patients across age cohorts

Objective: The aim of this study was to compare eating disorders (EDs) symptoms, traumatic experiences, family functioning and emotional regulation between Croatian and German bulimia nervosa (BN) female patients. Methods: The study included a total of 192 participants; 50 Croatian BN female patients ranging from 15 to 25 years old, treated at University Hospital Center Zagreb, and 55 German BN female patients between 20 and 45 years old, treated at University Hospital Ulm. Croatian control group consisted of 50 subjects, and German control group consisted of 37 subjects that are matched with par- ticipants of clinical groups by to the essential characteristics. Participants were asked to fill out EDI-2, ETISR-SF, FAD and DERS. Results: We obtained differences between Croatian and German BN female patients in age range and in multiple clinical scales. After controlling for the age variable, we found no statistically significant difference between groups in ED symptoms on EDI-2, nor in family functioning with respect to FAD. The Croatian participants showed more traumatic experiences on the ETISR-SF (General trauma, Physical punishment) and German participants showed more difficulties with emotional regulation on DERS (Awareness), whereas higher levels of exposure to General trauma (OR=.25; 95% CI =.09-.70; p<.01) and Physical punishment (OR=.06; 95% CI=.01-.37; p<.01) increased the odds for participant to be categorized as part of the Croatian group, while lack of emotional Aware- ness (OR=7.07; 95% CI=1.33-37.05; p<.05) increases the odds for participant to belong to the German group. Conclusions: The Croatian group exhibited more traumatic experiences, whereas German participants demonstrated greater lack of emotional awareness. On the whole, we found no statistically significant difference between Croatian and German BN female patients in ED symptoms as neither in family functioning.