Die 'Gewichtsphobie' - Ein Diskussionsbeitrag zum Problem der 'atypischen' oder 'nicht näher bezeichneten'Eß- und Gewichtsstörungen

A number of authors have stated that the problem of classifying patients whose diagnosis does not meet all the criteria of anorexia and bulimia nervosa has not been satisfactorily solved. The question has been asked if it is justified to regard characteristics like "weight phobia" or body image disturbance as valid diagnostic criteria. In the present study the differences observed in three groups of patients with eating and weight disorders (anorexia: n = 42; bulimia: n = 29; atypical group without "weight phobia": n = 14) were compared using the Giessen-Test. The atypical group was shown to be significantly more "tractable" on scale 2 than the main groups, which achieved a higher score on "dominance". Significant differences between the atypical group and the "uncontrolled" group of patients with bulimia were noted for scale 3, with the atypical group showing comparable results to those recorded in the anorexic group on "compulsiveness". The authors discuss the significance of the results under an epistemological aspect. The description and classification of clinical phenomena which is based on the clinical manifestation of the disorder independently of theoretical concepts is therefore indispensible for realising a uniform basis for communication by researchers worldwide. Equally indispensible is the differentiation or "extension" of the classification to allow a more detailed systematic categorisation guided along specific theoretical concepts. This requires the operational definition of psychopathological and psychodynamic criteria as, e.g. "the struggle for identy" or the "relentless pursuit of thinness". The experiences with the OPD (Operationalized Psychodynamic Diagnosis; 1996) have shown this to be a difficult but viable approach.