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Eating disorder cutoffs miss some of sickest patients, Stanford/Packard study finds
Date:4/11/2010

STANFORD, Calif. Diagnostic cutoffs for anorexia nervosa and bulimia nervosa may be too strict, a study from the Stanford University School of Medicine and Lucile Packard Children's Hospital has found. Many patients who do not meet full criteria for these diseases are nevertheless quite ill, and the diagnosis they now receive, "Eating Disorder Not Otherwise Specified," may delay their ability to get treatment.

"There's mounting evidence that we should reconsider the EDNOS categorization for young people," said Rebecka Peebles, MD, the study's primary author.

The EDNOS diagnosis has become a "mosh pit," lumping dissimilar patients into a single category that gets poor recognition from clinicians and health insurers, she said. "It is a bit misleading to patients it can make them feel like they don't have a real eating disorder," said Peebles, an instructor in pediatrics at Stanford and an adolescent medicine specialist with the Comprehensive Eating Disorders Program at Packard Children's Hospital.

Anorexia and bulimia affect about 1 percent and between 2 and 5 percent of teen girls, respectively, and both diseases are more common among females than males. Their diagnostic criteria were developed by expert consensus, without the benefit of studies to track patients' health. An anorexia diagnosis is now based on being at less than 85 percent of the expected body weight, loss of menstrual periods for at least three months and fear of weight gain despite being dangerously thin. Bulimia patients repeatedly binge on large quantities of food, then "purge" calories by vomiting, abusing laxatives or diuretics, or overexercising. Both diseases can cause serious long-term health problems, and severe cases may lead to death.

Peebles' team conducted the first-ever large study to ask whether adolescents with EDNOS are less ill than those who meet the full diagnostic criteria for anorexia or bulimia. The research, which will be published
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Contact: Robert Dicks
rdicks@lpch.org
650-497-8364
Stanford University Medical Center
Source:Eurekalert

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