Editing Bulimia nervosa (section)

=== Risk factors ===
Being female and having bulimia nervosa takes a toll on mental health. Women frequently reported an onset of anxiety at the same time of the onset of bulimia nervosa.<ref>{{Cite journal |last1=Bulik |first1=Cynthia M |last2=Sullivan |first2=Patrick F |last3=Carter |first3=Frances A |last4=Joyce |first4=Peter R |date=September 1996 |title=Lifetime anxiety disorders in women with bulimia nervosa |url=http://dx.doi.org/10.1016/s0010-440x(96)90019-x |journal=Comprehensive Psychiatry |volume=37 |issue=5 |pages=368–374 |doi=10.1016/s0010-440x(96)90019-x |pmid=8879912 |issn=0010-440X}}</ref> The approximate female-to-male ratio of diagnosis is 10:1.<ref name="DSM5" /> In addition to cognitive, genetic, and environmental factors, childhood gastrointestinal problems and early pubertal maturation also increase the likelihood of developing bulimia nervosa.<ref>{{Cite journal |last1=Jacobi |first1=Corinna |last2=Hayward |first2=Chris |last3=de Zwaan |first3=Martina |last4=Kraemer |first4=Helena C. |last5=Agras |first5=W. Stewart |date=2004 |title=Coming to Terms With Risk Factors for Eating Disorders: Application of Risk Terminology and Suggestions for a General Taxonomy. |url=https://doi.apa.org/doi/10.1037/0033-2909.130.1.19 |journal=Psychological Bulletin |language=en |volume=130 |issue=1 |pages=19–65 |doi=10.1037/0033-2909.130.1.19 |pmid=14717649 |issn=1939-1455}}</ref> Another concern with eating disorders is developing a coexisting [[substance use disorder]].<ref>{{Cite journal |last1=Carbaugh |first1=Rebecca |last2=Sias |first2=Shari |date=2010-04-01 |title=Comorbidity of Bulimia Nervosa and Substance Abuse: Etiologies, Treatment Issues, and Treatment Approaches |url=http://dx.doi.org/10.17744/mehc.32.2.j72865m4159p1420 |journal=Journal of Mental Health Counseling |volume=32 |issue=2 |pages=125–138 |doi=10.17744/mehc.32.2.j72865m4159p1420 |issn=1040-2861}}</ref>