granola37 (granola37) wrote in ed_ucate,

Diagnostic Criteria guessing game

Don't click on the cut until you've read the piece above the cut.

I'm just going to try a little experiment and then give my input about the subject. I'm posting an excerpt from a case study book that I borrowed from the psychiatrist that I work with (I guess I should give this book back on Tuesday, not that she's looking for it. I do this all the time.) I'll post the book information at the end. The diagnosis is based on the DSM III, but the usual disorders are used (anorexia, bulimia, EDNOS, pica, rumination, etc). This excerpt and the answer that the authors give really surprised me:

Slim and Trim
A very slim, attractive, articulate, 22-year-old graduate student consulted the counseling services about an eating problem. Since age 17 she had been preoccupied with her weight. Between the ages of 17 and 21 she had dieted and reduced her weight from 127 to 94 pounds. Her weight has been stable for the last year.
The patient is not afraid of becoming obese, but feels angry and guilty if she gains a few pounds. She often goes on what she calls "binges," during which she typically consumes two or three sandwiches and a salad, and then feels guilty. During the late afternoons and early mornings she becomes ravenous, and has gone into classrooms searching through trashcans for any leftover food, which she will eat. At times she has experienced excitement at the thought that she might be seen doing this. When she was finally "caught" by a classmate, she was very embarrassed; and this was the stimulus to seek treatment.
She denies persistent anxiety or depression, and has always functioned well both academically and interpersonally. She has not used laxatives or excessive exercise to lose weight, and has never been amenorrheic, although her periods have often been irregular.

Here's the answer that the authors gave:

This young woman has a problem with food! There are suggestions in the case of both Anorexia Nervosa and Bulimia, but she does not have the full syndrome of either disorder. She does not have the fear of becoming obese or the disturbed body image that is characteristic or Anorexia Nervosa. She refers to her loss of control of the impulse to eat as a "binge," but she apparently does not consume enormous amounts of food in a short period of time as in a true binge. What she does have a preoccupation with her weight and her eating behavior and a morbid thrill at the prospect of being seen eating garbage. The residual diagnosis of Atypical Eating Disorder is therefore appropriate.
Axis I: 307.50 which is EDNOS to you and I.

Why am I surprised? I don't know. I guess I've gotten too used to only thinking of EDNOS in terms of someone who falls short of one of the two major diagnoses. I keep forgetting that the "examples" given in the DSM under EDNOS are just that - examples. They aren't written in blood. Because it's obvious that a graduate student who gets a kick out of being caught eating trash has some sort of problem. It's just hard to fit her into the anorexia or bulimia category. But she also doesn't fit any of those EDNOS examples that we are used to seeing. I think this was the original reason why the Atypical category was devised, not so much for people who fall short of AN or BN, but just whacking eating in general. Wonky eating is an ED too.
I'm sort of curious about it now. Would someone who, say, eats only one thing and won't deviate from that pattern be diagnosed with EDNOS? I like to think that they would. What about someone who only eats during certain times of the week or picky eaters? I think as long as it interferes with your life or mental processes significantly it might be enough to give someone a diagnosis as EDNOS. The list could go on.

The book is called: DSM III Case Book (very original title). by R. Spitzer MD, A. Skodol, MD, M. Gibbon MSW, J. Williams MSW. 1st edition. APA, 1981. pp 208-209.

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