ANOREXIA-NERVOSA - EMPIRICAL-BASIS FOR THE RESTRICTING AND BULIMIC SUBTYPES

The future revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) will describe diagnostic criteria for two anorexia nervosa subgroups: a binge eating or bulimic subtype, and a severe fo od restriction subtype. The present literature review will help orient nutrition nd dietetic students, educators and researchers to the empi rical lases for these subtypes. Available research on these two subtyp es is equivocal. However, some important trends have emerged. Compared with restricting anorexics, bulimic anorexics are described by others as being significantly more unhappy during childhood and displaying a greater range of impulsive behaviors. In addition, bulimic anorexics have a higher lifetime prevalence of formal mood disorders, tend to us e more alcohol and drugs, and tend to meet the criteria for DSM III-R Cluster B Personality disorders rather than those for Cluster C. Also, the bulimic subtype tends to have a more chaotic family environment. Finally, more patients of the bulimic subtype seem to show subaverage bone density, suggesting a higher risk for chronic osteoporosis. The p resent review discusses the significant research and treatment implica tions of the differences between these anorexic subtypes.