Bulimia nervosa (BN) is a growing health concern and its consequences are especially serious given the compulsive nature of the disorder. However, little is known about the mechanisms underlying the persistent nature of BN. Using data from the NHLBI Growth and Health Study and
instrumental variable techniques, we document that unobserved heterogeneity plays a role in the persistence of BN, but up to two-thirds of it is due to state dependence. Our findings suggest that the timing of policy is crucial: Preventive educational programs should be coupled with more intense (rehabilitation) treatment at the early stages of the BN behaviors.