How many of these people have an eating disorder? (photo by cesarastudillo)
How can you find a solution to a problem without really knowing the problem? This is the question plaguing physicians, psychologists, therapists, dietitians, and other professionals who treat patients with disordered eating. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), a book that lists and defines all psychiatric disorders, patients can be classified as having anorexia, bulimia, or an Eating Disorder-Not Otherwise Specified (EDNOS).
The clinical definitions for anorexia and bulimia are so rigid, that over half of the patients with eating disorders cannot be diagnosed as one of those and instead are diagnosed with EDNOS. There is a wide range of patients who are given this diagnosis, but as researchers point out, conditions vary greatly and many patients can identify more with the symptoms and criteria of anorexia or bulimia.
This leads to several problems. First and foremost, there is little research that discusses how clinicians should treat EDNOS patients. From a patient perspective, some insurance companies will not cover medical expenses related to this diagnosis.
I have a problem with how the term “not otherwise specified” can be misinterpreted as a less serious eating disorder, or not quite an eating disorder yet. This notion may cause patients to be less motivated in participating in their own treatment, or cause loved ones to dismiss it. Even though all psychiatric disorders include a not otherwise specified diagnosis, the percentage of patients with this diagnosis is far less than the astonishing 50% of EDNOS diagnoses.
So what can be done? And why? Many professionals believe that reducing the stringency of the anorexia and bulimia definitions would allow more patients to be diagnosed as one or the other, and maybe even both. Experts also see a need for a defined binge eating disorder and a separate purging disorder for patients who purge but do not binge.
Why is it important to have these clear diagnostic criteria available?
- 1 in 5 women struggle with an eating disorder or disordered eating.National Institute of Mental Health’s (NIMH) guide, Eating Disorders: Facts About Eating Disorders and the Search for Solutions
- Only 1 in 10 people with eating disorders receive treatment.
- Without treatment, up to 20% of people with serious eating disorders die. With treatment, the mortality rate falls to 2-3%
- According to eating disorders statistics, about 80% of the girls/women who have accessed care for their eating disorders do not get the intensity of treatment they need to stay in recovery.
These changes may seem small, but once a psychiatric condition is listed in the DSM, there is an increase in research of the condition, as well as an increase in the general awareness. As a result, clinicians will be able to better treat patients with disordered eating, and patients will take their diagnosis more seriously and will be more accountable for their recovery. Additionally, Insurance companies may reimburse for more diagnoses, and there could be an increase in the coordination of care among health care professionals because there will be a standardized language for the various diagnoses. With these changes, patients will definitely see an improvement in the level and quality of their care.
