How many times a month must one purge before being classified as having an eating disorder? The New York Times reports (free registration required) that some patients often fall into a nosological gray area. In other words, they have symptoms very similar to anorexia nervosa and bulimia nervosa, but not quite the illness itself. Under the guidelines of the American Psychiatric Association's manual, these individuals:

would fall into a category that doctors have been relying on for years, a vague nondiagnosis known by the acronym Ednos: eating disorder not otherwise specified.

Ednos was the subject of a recent conference on eating disorders in Amsterdam, and there is some forthcoming literature on the topic. That said, the story elaborates on the significance of this classification, saying:

Much is at stake in whether a condition is elevated to the status of a full-fledged diagnosis. Because no laboratory tests or other objective criteria exist for making psychiatric diagnoses, the American Psychiatric Association's manual is the definitive arbiter of the line between normal and abnormal. Its definitions help determine such practical matters as insurance reimbursement, competence and eligibility for disability. But they also help determine something more elusive, and probably more important: whether someone's behavior should be considered a personality quirk or a symptom of mental illness.

So what determines when an illness is taken from the category of Ednos, and subsequently labeled a distinct disorder?

The first requirement is that a significant number of patients must be affected [says Dr. Michael First, associate professor of clinical psychiatry at Columbia]. Second, there has to be evidence of an existing and effective treatment.

The second criterion sounds problematic. One wonders how treatment can be found if research is inhibited or if the evidence is new and unique. Moreover, if this already appears tough, there is a third condition:

The third criterion for removing a condition from the Not Otherwise Specified category is the trickiest to meet. It relates to a kind of diagnosis-creep. Experts working on Diagnostic and Statistical Manual panels must ask how close the condition is to behavior that could be considered normal. For binge eating disorder, for instance, they must ask: When is such behavior a true psychiatric condition, and when is it the kind of thing that almost everyone engages in every Thanksgiving?

This is all very important in that it is not just an esoteric debate within the field, devoid of real implications. The story concludes:

As experts debate what to do about Ednos - pull out distinct disorders from the grab bag category, change the diagnostic criteria for the existing disorder, give the grab bag a more scientific-sounding name - people with disordered eating are left in a kind of therapeutic limbo.

Eventually, the hope is, the uncertainties will be resolved, and the woman with anorexia who still menstruates and the woman with bulimia who only purges once a week, will be able to get the diagnosis and treatment that they need.

Indeed.

Cigarette

Cleveland, OH

April 2004

DEC 02, 2004 12:27 AM

IANAMD, but wouldn't this kind of hazy terminology be applicable to all fields of mental disorders, not just eating disorders? OCD and the like?

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NEWS: Trials of Nosology

bredoteau

I'm lost

April 2004

DEC 01, 2004 09:26 PM

Cigarette

Cleveland, OH

April 2004

DEC 02, 2004 12:27 AM