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Outside the “Diagnostic Box”: A Case of Bulimia and Obsessive–Compulsive Disorder

Outside the “Diagnostic Box”: A Case of Bulimia and Obsessive–Compulsive Disorder

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One of the many challenges of being a primary care physician—and a naturopathic primary care physician—is an inherent directive to consider every patient as a new and unique, highly individualized and complex case.
We do not turn to diagnostic manuals as a first order of business but rather spend a significant amount of time talking with the patient, conducting a physical exam, and requesting any laboratory or others tests we may feel are relevant to the case. The true “art” (or perhaps “discipline”) of diagnosis lies not only in undertaking these steps but also in not allowing our clinical considerations to be constrained by “popular” thought or practice.
A 32-year-old woman came for help with an eating disorder previously diagnosed by other clinicians. She described a daily cycle of vomiting after evening meals with constant underlying anxiety that heightened as evening hours (and thus the evening meal) approached.
The woman was below average weight, with some alopecia. She had consulted with several physicians over her 18-year course with this condition but without apparent success. She did not reveal appreciable physical or psychological trauma or challenges to body image and self-image. These are standard psychological approaches to addressing bulimia and eating disorders, and clinicians often focus on body image, social pressure, or on the act of vomiting. She also didn’t reveal any other features consistent with a psychological origin to her condition.
However, I approach these cases in a different way. My clinical experience and research have shown me that conditions such as hers are an autoimmune disorder affecting the central nervous system. My focus in this case was to determine the biological cause of the woman’s bulimia and determine if it could be eradicated.

One of the many challenges of being a primary care physician—and a naturopathic primary care physician—is an inherent directive to consider every patient as a new and unique, highly individualized and complex case.
We do not turn to diagnostic manuals as a first order of business but rather spend a significant amount of time talking with the patient, conducting a physical exam, and requesting any laboratory or others tests we may feel are relevant to the case. The true “art” (or perhaps “discipline”) of diagnosis lies not only in undertaking these steps but also in not allowing our clinical considerations to be constrained by “popular” thought or practice.
A 32-year-old woman came for help with an eating disorder previously diagnosed by other clinicians. She described a daily cycle of vomiting after evening meals with constant underlying anxiety that heightened as evening hours (and thus the evening meal) approached.
The woman was below average weight, with some alopecia. She had consulted with several physicians over her 18-year course with this condition but without apparent success. She did not reveal appreciable physical or psychological trauma or challenges to body image and self-image. These are standard psychological approaches to addressing bulimia and eating disorders, and clinicians often focus on body image, social pressure, or on the act of vomiting. She also didn’t reveal any other features consistent with a psychological origin to her condition.
However, I approach these cases in a different way. My clinical experience and research have shown me that conditions such as hers are an autoimmune disorder affecting the central nervous system. My focus in this case was to determine the biological cause of the woman’s bulimia and determine if it could be eradicated.

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Published by: InnoVision Health Media on Nov 20, 2012
Copyright:Traditional Copyright: All rights reserved
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05/13/2014

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