14 - Bulimia in daily life: a context-bound syndrome

Summary

Introduction

The sudden widespread appearance of bulimia nervosa in the last 15 years has given psychiatry the opportunity, usually reserved for pathologists, to test its skills at identifying, describing, and developing a treatment for a new disorder. Given this challenge, controversy quickly emerged between those who sought to assimilate it into existing nosology and those invested in defining bulimia as a new disease entity. One viewpoint has seen the cycle of binge eating and purging that characterizes bulimics as merely a new symptomatic expression of existing disorders, particularly affective disorders. Another has sought to characterize it as the manifestation of a novel condition with a unique internal organization.

In this paper we demonstrate that information on the day-to-day patterns of patients' lives can be useful in clarifying the structure of pathology associated with a condition such as bulimia. In particular, we show bulimia to be associated with a disturbed experience of daily solitude. Since the controversy about bulimia is most acute for the substantial subclass of bulimic patients who have never met the criteria of anorexia nervosa, we will focus on this group. We also demonstrate that information on daily life, which describes the disease as patients experience it and localizes its manifestation, is particularly useful if our goal is to engage patients as allies in a process of treatment.