When your pediatrician or family doctor tells you that your child is not in the symptom range to be diagnosed with anorexia nervosa or bulimia, you may still be dealing with a dangerous, potentially life-threatening eating disorder. A recent study by Stanford University School of Medicine and Lucile Packard Children’s Hospital, addresses the catch-all diagnosis of “Eating Disorder Not Otherwise Specified” (EDNOS). This diagnosis could delay treatment for some very seriously ill children.
Dr. Rebecka Peebles, an instructor in pediatrics at Stanford, is also an adolescent medicine specialist with the Comprehensive Eating Disorders Program at Packard Children’s Hospital. Her research team fielded a study with over 1,300 patients who had been treated for the eating disorders anorexia, bulimia or EDNOS. They added the disorder categories "partial anorexia" and "partial bulimia." The results are shocking. According to the Stanford Web site:
“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 catch-all; 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."
In addition to the possibility of a false sense of security accompanying an EDNOS diagnosis, of added concern is the fact that many insurance carriers reimburse less for EDNOS diagnoses than for anorexia or bulimia, even though some of the symptoms contained in that diagnosis may be even more immediately life-threatening.
Danielle Friedman at The Daily Beast writes:
"What most people don’t realize about eating disorders is that of the nearly 10 million Americans who suffer from these conditions, more than 60 percent are diagnosed with EDNOS."
In 2013, the American Psychiatric Association will be producing a new edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The current proposal is for inclusion of an additional category of eating disorder binge eating disorder, which is like bulimia but with no purging. Clarifications are also on the docket for the diagnoses of anorexia nervosa and bulimia.
Ms. Friedman writes in The Daily Beast that she would add four additional disorders to the list -- eating behaviors that are "secret" disorders, often hidden. Her list includes:1. ORTHOREXIA
This is a controversial disorder. Friedman describes people with orthorexia as those who: "compulsively avoid foods thought to be unhealthy or unnatural -— including foods with trans fats, artificial colors or flavors, high-fructose corn syrup, and preservatives. Many opt instead for strict vegan or raw foods diets. They’ll choose to eat nothing over something processed -— and as a result, often end up malnourished and excessively thin." The keywords here are "compulsively" and "malnourished."
2. CHEWING AND SPITTING
Ms Friedman points out that: " ... Glamour magazine dubbed it a 'scary new eating disorder' in 2008, it rarely manifests as a standalone problem, usually surfacing in conjunction with other behaviors."
These folks take a bite, chew it, and spit it out without swallowing it. Here is a v-blog entry from SarahIleen on her former chewing and spitting behavior (the direct discussion starts at about 2:50.)
What is truly alarming are the number of YouTube videos I saw that recommended this practice.3. NIGHT EATING SYNDROME
Friedman states: "As many as 6 million people suffer from Night Eating Syndrome, including about 9 percent of extremely obese individuals." These people consume about one-fourth of their daily calories in the middle of the night. This also results in sleeplessness, difficulty concentrating because one is sleep-deprived, and it may also affect hormone levels.4. PURGING DISORDER
This disorder occurs when people of average weight purge after meals of normal size or use laxatives to purge. Experts state that this disorder may be even more widespread than anorexia and bulimia combined.
Clearly, we have diagnosis problem. If your child is diagnosed with EDNOS, it is not cause for relief. It is cause for further treatment, further immediate treatment.
~~ Contributing Editor, Mata H. also blogs right along at Time's Fool
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