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 ner- vosa5ulimia according to the DSM-Ill, 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 pa- tients. 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.