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Many With Serious Eating Disorders Could Go Undiagnosed

Too-rigid guidelines miss urgent cases of anorexia, bulimia, researchers say

MONDAY, April 12 (HealthDay News) -- The standard criteria psychiatrists use to diagnose anorexia nervosa and bulimia may be too rigid and exclude many patients who urgently require treatment for eating disorders, a new study suggests.

These patients are typically categorized as "Eating Disorder Not Otherwise Specified" (EDNOS), which has become a "mosh pit" that lumps dissimilar patients into a single category that's poorly recognized by doctors and health insurers, according to primary author Dr. Rebecka Peebles, an adolescent medicine specialist with the Comprehensive Eating Disorders Program at Lucile Packard Children's Hospital in California.

The EDNOS label is "a bit misleading to patients -- it can make them feel like they don't have a real eating disorder," Peebles said in a hospital news release.

She and her colleagues investigated whether adolescents with EDNOS are less ill than those who meet the full diagnostic criteria for anorexia or bulimia. The researchers examined the medical records of more than 1,300 female patients treated for eating disorders at Packard Children's, and created categories of "partial anorexia nervosa" and "partial bulimia nervosa" for patients who didn't quite meet the full criteria for these diseases.

Among the findings:

  • Nearly two-thirds of the patients had been categorized as EDNOS.
  • Patients with partial anorexia were more similar to patients with full-blown anorexia than to other EDNOS patients with partial bulimia.
  • About 60 percent of the EDNOS patients met medical criteria for hospitalization and, on average, were sicker than patients diagnosed with full-blown bulimia.

The sickest EDNOS patients were those who had lost more than 25 percent of their body weight before diagnosis and had severe malnutrition. These girls had been overweight and lost weight too fast and dangerously in order to achieve what's considered a normal weight. In some ways, these girls were worse off than underweight patients diagnosed with anorexia.

"People were initially just patting them on the back for their weight loss. It often took months or years for others to realize that what they were doing didn't seem healthy," Peebles said in the news release.

She believes that the findings, published online April 12 in the journal Pediatrics, suggest the need for re-evaluation of the medical criteria for eating disorders.

More information

The U.S. National Women's Health Information Center has more about eating disorders.

-- Robert Preidt

SOURCE: Lucille Packard Children's Hospital, news release, April 12, 2010

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