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

online April 12 in Pediatrics, examined records from all 1,310 female patients treated for eating disorders at Packard Children's between January 1997 and April 2008. They verified patients' diagnoses of anorexia, bulimia or EDNOS, and created categories of "partial anorexia nervosa" and "partial bulimia nervosa" to analyze patients who barely missed cutoffs for these diseases.

"Our purpose was to ask if the diagnostic criteria now in use are really separating out the sickest of the sick," Peebles said. Patients' conditions were assessed by noting signs of malnutrition such as low heart rate, low blood pressure, low body temperature, low blood levels of potassium and phosphorus and long QT interval (an electrocardiogram measurement linked to risk of sudden cardiac death).

Nearly two-thirds of the patients studied had EDNOS. As the researchers suspected, the EDNOS category acted as a catchall; patients with partial anorexia were more similar to those with full-blown anorexia than to other EDNOS patients with partial bulimia, for instance. In addition, 60 percent of EDNOS patients met medical criteria for hospitalization and this group was, on average, sicker than patients diagnosed with full-blown bulimia.

The sickest EDNOS patients were those who had dropped more than 25 percent of their body weight before diagnosis. These patients had been overweight and had lost weight too quickly and dangerously in order to end up at what is typically considered a normal weight.

"People were initially just patting them on the back for their weight loss," Peebles said. "It often took months or years for others to realize that what they were doing didn't seem healthy." Despite their normal body weights, this group was in some ways worse off than underweight patients diagnosed with anorexia, she added. "They manifested criteria of severe malnutrition."

In sum, Peebles said, the study suggests that medical criteria for eating diso
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Contact: Robert Dicks
rdicks@lpch.org
650-497-8364
Stanford University Medical Center
Source:Eurekalert

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