My new FAVORITE article.
Diagnostic Crossover in Anorexia Nervosa and Bulimia Nervosa:
Implications for DSM-V
(Am J Psychiatry 2008; 165:245–250)
I actually think this whole study was amazing and definitely recommend reading it if you can (and I’m always a skeptic, so this is rare that I’d say this). That said, I don’t think that the study does much for defining, validating, or invalidating the ED-NOS diagnosis.
I think that this is brilliant, and should be used for actual diagnosis… not just as a measure in this study:
The Eating Disorders Longitudinal Interval Follow-up Evaluation was used to assess symptoms at intake and to assign DSM-IV-TR diagnoses during the follow-up period. This instrument yielded weekly psychiatric status rating scores (ordinal, symptom-oriented scale scores based on Research Diagnostic Criteria ratings) for anorexia nevosa and bulimia nervosa for each participant. Psychiatric status ratings range from 0 to 6 for anorexia nevosa and bulimia nervosa, where:
0 = no history of the disorder
1 = a past disorder with no current symptoms
2 = residual symptoms (e.g., minor eating disorder cognitions without current behavioral symptoms)
3 = partial symptoms (i.e., does not meet for criteria)
e.g., for anorexia nervosa is ≥ 90% ideal body weight with significant cognitive symptoms
e.g., for bulimia nervosa, experiences binge eating and/or compensatory behaviors 1 – 3 times a month with significant cognitive symptoms
4 = marked symptoms (just misses full criteria:
e.g., for anorexia nervosa is >85% ideal body weight with significant congitive symptoms
e.g., for bulimia nervosa, experiences binge eating and compensatory behaviors 4 – 7 times a month
5 and 6 = full criteria, depending on symptoms severity or degree of impairment
e.g., for anorexia nervosa, a 5 would indicate ≤ 85% ideal body weight, and a 6 would indicate ≤ 75% ideal body weight.
e.g., for bulimia nervosa, a 5 would indicate binge eating/compensatory behaviors 2+ times a week, and a 6 would indicate daily binge eating/compensatory behaviors.
DSM-IV-TR diagnoses were assigned as follows:
AN, restricting-type = Max AN psychiatric status rating ≥5 and max BN rating ≤2.
AN, binge eating/purging type = Max AN psychiatric status rating ≥5 and max BN rating was ≥3.
BN = BN psychiatric status rating was ≥5 and max AN rating was ≤4.
Partial recovery = max status rating was for both AN and BN was 3 or 4.
Full recovery = max psychiatric status rating for both AN and BN was ≤2.
I really think that their psychiatric status rating could be a huge asset to DSM-IV diagnosis. There is a lot of discussion about mental illness (in general) as a continuum, rather than clusters of individually-defined disorders. This study proposes a continuum within a specific diagnosis. This seems like a great way to approach it, since a big criticism of the continuum theory is diagnostic specificity. Diagnoses are necessary for treatment (and research). Moreover, the scale eliminates the confusion between sick, in recovery, in remission, and fully recovered. You could have a diagnosis of ANR-1: anorexia nervosa, restricting type, recovered but with a history of the disorder. These disorders can affect your health decades after the height of the illness, and this ANR-1 note would be useful to future physicians.
As an individual, I think it feels much more validating to have an ANR-#, ANP-#, or BN-# diagnosis. You could be IN a treatment facility and cross over that 85% body weight mark… and suddenly not qualify for the disorder anymore. With treatment centers often treating physical symptoms before mental/emotional issues, I think that this psychiatric status rating would be a much more accurate diagnosis.
Tags: Eating disorder, eating disorder diagnosis, psychiatric status rating, DSM-IV, chronic anorexia, eating disorder recovery
Grey Thinking 