The anorectic bulimic conflict. An alternative diagnostic approach to anorexia nervosa and bulimia

Abstract

The reported increase over the last decades in the incidence of eating disorders seems to be accompanied by a shift in the symptomatic spectrum, so that the clinician now more often comes in contact with individuals not matching the picture of the “typical” anorexia nervosa patient. Seventy‐nine patients assessed at the clinic over the last two and a half years were studied with respect to the differential diagnostic problems arising in this context. A considerable overlap in symptomatology was found between all sub‐ categories (anorexia nervosa, bulimia, double diagnosis of anorexia nervosa/bulimia according to the DSM‐III, and “anorexic‐like”). Furthermore, 49% had previously passed through at least one phase when a diagnosis other than that currently applicable would have been appropriate. These results, in combination with similar observations reported several times in the literature, imply the existence of some common feature among all the patients. In the ABC‐model, a conflict between anorectic and bulimic impulses is suggested as a concept capable of expressing this commonality while still representing a phenomenon identifiable at a clinical‐descriptive level. The possible difficulties in detecting the conflict in the everyday clinical work are discussed along with the practical and theoretical advantages associated with applying the ABC‐model to diagnosis, prognosis and treatment in eating disorders.

Impulse Regulation in Anorexia Nervosa and Bulimia Nervosa: Some Formulations

“…This does not only refer to interaction between neurotransmitters and neuromodulators making realistic models more complex than those that associate a particular behaviour with stably abnormal levels of one substance, but to the basic data as well. An embarrassment to all straightforward models that contrast restrictors with bulimics is the fact that a substantial minority of patients change from one mode to the other, sometimes even more than once (Holmgren et at., 1983).…”

“…There is now consensus that preoccupation with weight and shape is an important characteristic of bulimia nervosa (DSM-III-R; Fairburn and Garner, 1986;Holmgren et al, 1983;Russell, 1979), but eating large amounts of food in a state of dyscontrol is the hallmark of the disorder and its most easily diagnesed feature. Simultaneously, one of the most common ways to introduce the phenomenology of anorexia nervosa is to tell how the name is a misnomer since patients are not anorexic at all: they are intensely hungry, except if the disorder goes to a very chronic stage when hunger feelings can actually be absent.…”

Two year outcome in anorexia nervosa/bulimia: A controlled study of an eating control program combined with psychoanalytically oriented psychotherapy

“…Subjects for the present study were selected retrospectively from a pool of all eating disorder patients (weight phobia and bulimic impulseshehavior, Holmgren et al, 1983) who were either assessed or assessed and treated in our clinic after that date. All partiapated voluntarily, and confidentiality was guaranteed.…”

Sociocultural influences on eating disorders in professional female ballet dancers

“…Dancers with and without self-reported anorexia nervosa exhibit different psychological profiles, similar to studies of non-athletic women (Garfinkel, Moldofsky & Gamer, 1980;Holmgren et al, 1983). In addition, the importance of weight maintenance in the professional dancer or athlete seems to make it more likely that eating problems will occur.…”