Psychiatry

Eating Disorders and Psychiatric Comorbidities in Female Inpatients

Tetyana 7 Comments

Patients with eating disorders commonly exhibit comorbid psychiatric disorders, including anxiety, depression and OCD. The presence of comorbid disorders has been shown to exacerbate the severity and chronicity of the disorder, and unfavourably affect treatment outcome. Moreover, comorbid disorders may necessitate specialized treatment plans that take into account all the co-occuring disorders. Recovery from an eating disorder is hard enough, but when it is complicated by depression and severe anxiety, it can be a lot harder.

Nonetheless, commonly co-occuring psychiatric disorders may also provide researchers and clinicians clues about the etiology of eating disorders, the underlying neuronal processes as well as possible pharmacological interventions.

Researchers have been identifying disorders that commonly co-occur with eating disorders and studying the differences in co-morbidity between disorders. I picked one to write about today, it is a study by Blinder and colleagues that came out in 2007. It is by no means the best, … Continue reading →

More on the Problematic EDNOS Category (and Diagnostic Crossover)

Tetyana 2 Comments

I’ve been thinking a lot lately about the eating disorder not otherwise specified (EDNOS) category. ED-NOS is a diagnostic category for all individuals with subthreshold anorexia or bulimia nervosa or those with a mix of symptoms that don’t fit neatly into AN or BN. ED-NOS is essentially everything else. A mixed bag, if you will. It doesn’t tell the clinician nor the researcher anything useful, outside of what it isn’t. So, is there any use for it? If it doesn’t tell the clinician about patient symptoms or guide choice of treatment, why even bother? Does it help researchers understand EDs or do they just want to avoid this messy and heterogenous group (that by the way makes up most of those with eating disorders)? In this entry (and many more to come), I want to further explore these questions.

There’s been a push by researchers to minimize the … Continue reading →

A Case Against Eating Disorder Not Otherwise Specified (EDNOS)

Tetyana 7 Comments

This study is a follow up on the previous study (last entry) which examined the problems with the EDNOS classification, the frequency of transitions between eating disorders and how the DSM should be changed to reflect the clinical reality of eating disorders (and what is the clinical reality?)

In this study, Eddy and colleagues followed 246 women who were initially diagnosed with either AN or BN, for an average of 9 years. The main goal was to study the growing disparity between (1) the consensus that eating disorders are not stable overtime and how (2) the current diagnostic criteria which do not adequately address this, by following the clinical presentation of EDs overtime and providing suggestions for the upcoming DSM-V.

EDNOS is an often ignored category in research–in main part because it is difficult to study such a heterogeneous group. Nonetheless, Eddy et al. summarize some interesting findings … Continue reading →

The Instability of Eating Disorder Diagnoses

Tetyana 5 Comments

Eating disorders are rarely static. Symptoms fluctuate, waxing and waning as circumstances change. Often, these fluctuations lead to diagnostic crossover–between subtypes of one disorder or to a different eating disorder altogether. The heterogeneity of symptom severity and frequency led to the establishment of the “eating disorder not otherwise specified” diagnosis in the Diagnostic and Statistical Manual. Essentially, it is everything that doesn’t quite fit into the “anorexia nervosa” or “bulimia nervosa” categories. (For example, I would guess that it is a common diagnosis for patients who fail to meet the “amenorrhea” criterion for the AN diagnosis.)

ED-NOS is a category for everything that doesn’t conform to some rather arbitrary criteria required for bulimia nervosa and anorexia nervosa, meaning: it is the diagnosis for a lot of people. Okay, that’s not very scientific, I know, but I wouldn’t trust these numbers anyway–usually people who fall into this category don’t feel “sick … Continue reading →