While these are real diagnostic entities, it turns out the majority of people who are referred to eating disorders specialists end up being diagnosed with neither AN nor BN, but rather with something called EDNOS – “eating disorder, not otherwise specified.” In fact, up to 60% of people with eating disorders are diagnosed with EDNOS, a heterogeneous entity that includes people with subthreshold eating disorders, binge eating disorder (not yet an official DSM diagnosis), and a smattering of other diagnostic entities. The problem is that the EDNOS diagnosis is too broad to guide our treatment decisions.
Well, a recent article in the International Journal of Eating Disorders lays out a blueprint for DSM-V in order to remedy this problem (Wilfley DE et al., 2007, early view, published online Aug 8 2007). According to the authors, all of whom are prominent researchers in the field, the following changes are likely to be incorporated in DSM-V.
Of course, anytime the DSM adds or broadens diagnoses, there is a concern among some that a hidden agenda is to bring more potential customers into the psychiatric fold. In this case, however, it’s likely that the total number of patients diagnosed with eating disorders won’t change drastically. Instead, the “EDNOS” category will shrink at the expense of AN, BN, and BED, all of which will expand. Hopefully, this will allow us to make our eating disorder diagnoses significantly more precise.
How is all this helpful for front-line clinicians right now? Be less insistent about applying rigid binge frequency criteria in your bulimia diagnoses, and throw out the amenorrhea criterion for AN. Focus less on checklists of symptoms and more on the core psychopathology of most eating disorders, which is, in its essence, the excess concern about body shape and weight.
As I have adopted this different mind-set in my own practice, I’ve been picking up on important body image and weight concerns in many more patients, even in those who would not qualify for a formal eating disorder. This leads to productive discussions and in some cases, informs treatment.
You can also view the entire article here: https://www.portsidetechnologies.com/thecarlatreport/index.asp?page=wp927200711453&menu=wp927200711453
Also, I apologize if this is old news to many of you.