is less common in the developing world. bulimia is about nine times more likely to occur in women than men. among women, rates are highest in young adults. bulimia was named and first described by the british psychiatrist gerald russell in 1979. at the turn of the century, bulimia (overeating) was described as a clinical symptom, but rarely in the context of weight control. purging, however, was seen in anorexic patients and attributed to gastric pain rather than another method of weight control. in 1930, admissions of anorexia nervosa patients to the mayo clinic from 1917 to 1929 were compiled. fifty-five to sixty-five percent of these patients were reported to be voluntarily vomiting to relieve weight anxiety. records show that purging for weight control continued throughout the mid-1900s. several case studies from this era reveal patients with the modern description of bulimia nervosa. in 1939, rahman and richardson reported that out of their six anorexic patients, one had periods of overeating, and another practiced self-induced vomiting. wulff, in 1932, treated "patient d", who would have periods of intense cravings for food and overeat for weeks, which often resulted in frequent vomiting. patient d, who grew up with a tyrannical father, was repulsed by her weight and would fast for a few days, rapidly losing weight. ellen west, a patient described by ludwig binswanger in 1958, was teased by friends for being fat and excessively took thyroid pills to lose weight, later using laxatives and vomiting. she reportedly consumed dozens of oranges and several pounds of tomatoes each day, yet would skip meals. after being admitted to a psychiatric facility for depression, ellen ate ravenously yet lost weight, presumably due to self-induced vomiting. however, while these patients may have met modern criteria for bulimia nervosa, they cannot technically be diagnosed with the disorder, as it had not yet appeared in the diagnostic and statistical manual of mental disorders at the time of their treatment. an explanation for the increased instances of bulimic symptoms may be due to the 20th century's new ideals of thinness. the shame of being fat emerged in the 1940s when teasing remarks about weight became more common. the 1950s, however, truly introduced the trend of aspiration for thinness. in 1979, gerald russell first published a description of bulimia nervosa, in which he studied patients with a "morbid fear of becoming fat" who overate and purged afterward. he specified treatment options and indicated the seriousness of the disease, which can be accompanied by depression and suicide. in 1980, bulimia nervosa first appeared in the dsm-iii. after its appearance in the dsm-iii, there was a sudden rise in the documented incidents of bulimia nervosa. in the early 1980s, incidents of the disorder rose to about 40 in every 100,000 people. this decreased to about 27 in every 100,000 people at the end of the 1980s/early 1990s. however, bulimia nervosa's prevalence was still much higher than anorexia nervosa's, which at the time occurred in about 14 people per 100,000. in 1991, kendler et al. documented the cumulative risk for bulimia nervosa for those born before 1950, from 1950 to 1959, and after 1959. the risk for those born after 1959 is much higher than those in either of the other cohorts.