Eating Disorders 447
DSM-IV-TR criteria for either of those other eating disorders (Fairburn, Palmer et
al., in preparation; Turner & Bryant-Waugh, 2004). Some people diagnosed with
EDNOS may have had anorexia or bulimia but then improved to the point where
their symptoms no longer meet the criteria for either disorder. These people still have
clinically signifi cant symptoms of an eating disorder, however. This was true of Marya
Hornbacher: As her eating disorder symptoms abated, she no longer met the criteria
for either anorexia or bulimia, and her diagnosis was changed to EDNOS.
Based on research fi ndings, an alternative system for categorizing anorexia andbulimia would require three fundamental changes (Gleaves, Lowe, Green, et al.,
2000):
- Eliminate the purging and nonpurging types of bulimia because they do not
meaningfully distinguish course or outcome. - Create a separate diagnosis for bingeing and purging (both bulimia and binge-
eating/purging type of anorexia) as distinct from a restricting type of anorexia.
Moreover, this new diagnosis of bulimia (bingeing and purging, regardless of
weight) may be better conceptualized on a continuum (Lowe et al., 1996), with-
out a rigid cutoff of duration and frequency of symptoms; such a reformulation
would reduce the number of EDNOS diagnoses. - Within the binge-eating/purging type, put those with anorexia and normal-
weight bulimia on the same continuum, but at different points with regard to
weight.
Key Concepts and Facts About Bulimia Nervosa
- Bulimia nervosa is characterized by recurrent episodes of binge
eating followed by inappropriate efforts to prevent weight gain. - DSM-IV-TR specifies two types of bulimia: the purging type
(which is characterized by vomiting or the use of diuretics, laxa-
tives, or enemas) and the nonpurging type (which involves fast-
ing or excessive exercise). - Bulimia is twice as prevalent as anorexia, and much more com-
mon among women than men. - All purging methods can cause dehydration, which leads to
electrolyte imbalances and possibly death. Chronic vomiting
can lead to enlarged parotid and salivary glands and can erode
dental enamel. Chronic laxative use can lead to permanent loss
of intestinal functioning. - Aspects of the DSM-IV-TR criteria for a diagnosis of bulimia have
been criticized: The defi nition of “binge eating” is subjective,
the purging/nonpurging distinction does not correlate mean-
ingfully with course or prognosis, and bulimia and anorexia do
not appear to be distinct disorders but rather may be different
phases of the same disorder.- Problems with the criteria for anorexia and bulimia are apparent
in the prevalence of eating disorder not otherwise specified
(EDNOS), which is greater than anorexia and bulimia combined.
One subset of patients with EDNOS have binge-eating disorder.
Making a Diagnosis
- Reread Case 10.2 about Gabriella, and determine whether or not
her symptoms meet the criteria for bulimia nervosa. Specifi cally,
list which criteria apply and which do not. If you would like more
information to determine her diagnosis, what information—
specifi cally—would you want, and in what ways would the infor-
mation infl uence your decision?
Understanding Eating Disorders
Why do eating disorders arise? Marya Hornbacher asked this question and ven-
tured the following response:
While depression may play a role in eating disorders, either as cause or effect, it cannot
always be pinpointed directly, and therefore you never know quite what you’re deal-
ing with. Are you trying to treat depression as a cause, as the thing that has screwed
up your life and altered your behaviors, or as an effect? Or simply depressing? Will
drug therapy help, or is that a Band-Aid cure? How big a role do your upbringing
and family play? Does the culture have anything to do with it? Is your personality just