Support for Reevaluation of Diagnostic Criteria for Eating Disorders in Children and Adolescents
The F.E.A.S.T. Board of Directors has voted to support the recommendations of the authors of the article “Are Diagnostic Criteria for Eating Disorders Markers of Medical Severity?” published online by Pediatrics, the Official Journal of the American Academy of Pediatrics, on April 12, 2010.
The authors of the article examined the medical records of all 1,310 female patients treated for eating disorders between 1997 and 2008 in a specialized eating disorders treatment unit in a children’s hospital. Nearly two-thirds of the patients studied had not met diagnostic criteria for either Anorexia Nervosa (AN) or Bulimia Nervosa (BN), but instead had been diagnosed with Eating Disorders Not Otherwise Specified (EDNOS). The researchers found that although the EDNOS group had not met criteria for AN or BN, fully 60 percent nevertheless met medical criteria for hospitalization and many were suffering from worse medical complications than many of the patients with an AN or BN diagnosis.
In particular, the authors found that the EDNOS patients displayed similar disease duration, rates of weight loss, QTc prolongation, orthostasis, and hypokalemia as their full diagnostic counterparts. The authors noted several conclusions from the study, including
- A diagnosis of EDNOS does not imply a reassuring medical profile.
- Patients who have EDNOS and narrowly miss criteria for AN and BN are often medically compromised and in need of treatment.
- Excluding patients with partial AN and partial BN from a diagnosis of AN or BN effectively forces them into a diagnostic category that lacks definition, health care coverage for many, and indadequate medical knowledge.
- Early intervention is needed, even when young patients do not meet full diagnostic criteria for AN or BN.
- Broadening AN and BN criteria in pediatric patients to include partial AN and partial BN may prove to be clinically useful.
On April 19, 2010, the F.E.A.S.T. board submitted our support for these recommendations as part of the DSM-V public comment process and we encourage others to do so as well: (http://www.dsm5.org) The public comment period ends April 20, 2010. The recommendations of the authors of this recent paper in Pediatrics represents the work of some of the leading researchers and clinicians in the eating disorders field. We want to thank them for their work, as well as the organizations that funded their study. Countless sufferers and their families around the world will benefit.