Many young people with eating disorders do not get proper treatment because their behaviors and symptoms do not match the exact definition in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), according to a new study in the journal Pediatrics.

Physicians use the manual to diagnose and treat mental diseases. Insurance companies often require that patients meet the criteria in the manual for a certain disease before they will pay for its treatment. Some of these criteria for eating disorders may be missing a menstrual period for three months in a row, being below 75 percent normal body weight, and losing weight at a fast pace, according to Dr. Rebecka Peebles, lead author.

"Some patients who are at normal weight or even overweight are still very medically scary," she said. "We're seeing patients younger and younger, patients as young as five years old. Certainly, seven to 12 years of age, that is not uncommon anymore."

Dr. Peeples and her research team from Stanford University School of Medicine studied 1310 children and adolescents, ages 8 to 19 years old . More than 60 percent of those with "eating disorders not otherwise specified" had trouble getting insurance coverage. The majority of patients in this group met criteria for hospitalization and were usually sicker than patients diagnosed with bulimia.

About 10 million women and one million men in the United States suffer from eating disorders, according to the National Eating Disorders Association. Binge eating disorder, which is now considered one of the non-specified eating disorders, may be a problem for 25 million people.

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A woman recently wrote into CNNs Expert Q&A column, asking about eating disorders in small children. CNNs Living Well Expert, Dr. Jennifer Shu, provided a response that included the following information:

[Sari Fine Shepphird, Ph.D., a clinical psychologist and author of "100 Questions and Answers about Anorexia Nervosa"] reports that although the majority of new cases of anorexia are diagnosed between the ages of 13 and 18, about 10 percent of patients with eating disorders show an onset of their symptoms before age 10, and eating disorders have been reported in children as young as 5.

Recent studies show that it is increasingly common for young children to be on a diet and to express a fear of gaining weight and that even young kids may engage in unhealthy and potentially harmful diet behaviors.

While an otherwise healthy child's "picky eating" is likely just a phase that will go away, there are many signs that can signal a potential concern. These include the unhealthy behaviors listed above as well as unexpected changes in weight, a preoccupation with one's weight and "feeling fat," hoarding food and persistent refusal of all but a few types of food.

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Most eating disorder attention is focused on conditions that make a person too thin, such as anorexia and bulimia. But some people believe that doctors are overlooking equally dangerous disorders that cause people to become too heavy.

"Compulsive eating is also fatal," eating disorder expert Dr. Kimberly Dennis says. "It's just a much slower, gentler killer than anorexia or bulimia." ... In Kansas City, Dr. Dennis talked to health professionals about treating and recognizing all eating disorders.

Dennis believes there's as much denial around overeating and binge eating and there is around other eating disorders, and that psychological therapy is a necessary part of treatment. Source: KSHB-TV (Kansas City)

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Young people often suffer in silence from eating disorders, but a treatment center in Birmingham, England, hopes to change that by equipping general practitioners with a questionnaire aimed at helping them recognize the disorders.

"Sent to 2,000 GPs across the region, the checklist containing five questions about feelings and behavior towards food is designed to help GPs spot problems and ensure patients receive vital treatment as soon as possible."

Though they may not mention the eating habits directly, people with eating disorders often go to their doctors with medical issues related to their disorder. The better equipped a doctor is at confirming suspicions of an eating disorder, the sooner the patient can get the most effective treatment. Source: Sutton Coldfield (UK) News

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Parents don't always recognize the signs of an eating disorder in their child, and often don't become aware of the problem until the child is extremely sick. But a routine dental check-up can provide important clues.

"Key signs of a potential eating disorder include bad breath, sensitive teeth, enamel that is worn and appears translucent, mouth sores, dry mouth, cracked lips, bleeding gums along with a tender mouth, throat and salivary glands."

Dr. Katina Morelli, dental director for Delta Dental of Illinois, says the organization's policy is for dentists to encourage patients with eating disorder symptoms to seek help. Delta Dental provides counseling referrals as well. Source: About.com

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Susan Barry knows all too well that eating disorders don't affect only girls and women. Her son died of anorexia at the age of 22.

"About 10 percent of the eight million people in the United States who have an eating disorder are men, though many of them go undiagnosed and suffer in silence, according to Judy Teffer of the National Association of Anorexia Nervosa and Associated Disorders."

Awareness of male anorexia is on the rise, thanks in large part to people like Barry who are willing to share their experiences. Barry currently writing a book about her son's battle with anorexia and poor body image, which started when he was in the eighth grade. Source: The Flint (MI) Journal

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A 15-year-old girl who has spent most of her life dieting wrote a letter to a Pennsylvania newspaper advice columnist to express concerns that she may be anorexic. She shared her story (which includes teasing by family members) and symptoms (which include four months of missed periods), and asked for advice.

"Your obsession with your weight and your changed attitude toward eating are certainly warning signs for anorexia, but it's not possible to know if you are too thin without more information. I recommend an appointment with your family physician... The Internet is an excellent source of information, but spending time with a professional who can listen to your individual needs will help most."

The advice columnist noted that missed menstrual periods are also a potential sign of anorexia, though other causes could be to blame. She also suggested that the girl address the matter with her family, to tell them how she feels when they tease her and to ask them to stop. Source: Observer-Reporter

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Results of a new study by Rhode Island Hospital and Brown University have found that the DSM-IV criteria for eating disorders are not sufficient for accurate diagnoses. DSM stands for "Diagnostic and Statistical Manual of Mental Disorders". It is meant to offer a broad-based outline of diagnostic criteria for the medical community.

"Researchers noted that in treatment center programs for eating disorders more than half of the patients are diagnosed with an eating disorder 'not otherwise specified' (NOS)... 'The NOS category of the DSM-IV was intended to be a residual category of diagnosis... for relatively infrequent cases... '"

The fact that so many patients are being diagnosed with an eating disorder "not otherwise specified" indicates that eating disorder classifications in the DSM-IV are not broad enough. Read more at Huliq.com.

Have a teenager who has been difficult to diagnosis? The Aspen Institute specializes in providing a comphrehensive disagnotic picture of even the most troubled teen, and then offering a complete treatment plan.

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The old saying goes that "an ounce of prevention is worth a pound of cure". That's especially true of serious illnesses like eating disorders. Learning to recognize the signs that a young person may be prone to developing an eating disorder can help avert a potentially deadly condition.

"The researchers [from University College Dublin] went back to look at data from the 2002 Health Behavior in School-Aged Children study involving 2,649 children. This showed that 32[percent] of the adolescents were underweight and, of this group, one in 10 'thought they were fat'."

The latter group, which also were more likely to choose a large silhouette as "mirroring" their body image, was identified as being at risk of developing an eating disorder.

This group was also generally more unhappy, more dissatisfied with life and more likely to perceive themselves as 'not good looking'.

Though they're general indicators, they can help identify a young person with self-image issues serious enough to lead to an eating disorder.
 

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One of the signs that many doctors look for when diagnosing eating disorders in young girls is "secondary amenorrhea", or the starting and stopping of the menstrual cycle. A recent study by the University of North Carolina at Chapel Hill warns that if a girl has irregular menstruation, eating disorders should be "on the radar".

"Nearly 80 percent of women with anorexia reported secondary amenorrhea, meaning they had begun having periods before age 16 but had stopped menstruating for at least three months in a row at least once. About 36 percent of women with bulimia nervosa had secondary amenorrhea."

The study's findings indicated that, though eating disorder subtypes can't be distinguished simply by a patient's menstrual status, irregularities should be a red flag.

Read more at nlm.nih.gov.

Labels: diagnosis, signs_of_eating_disorders, amenorrhea

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Eating disorders are most commonly associated with women and young girls. But a recent study by Harvard researchers shows that eating disorders among men and boys may be more prevalent than previously thought.

"In the male population, adolescents and young adults are at greatest risk for eating disorders. Although the risk factors and signs of eating disorders are very similar in both males and females... the condition is more frequently overlooked and less likely to be diagnosed and treated in males. One reason for this is that most research, general information, and media attention is focused on the female patients with eating disorders."

Previously, it was estimated that eating disorders occurred ten times more often among women than men. The Harvard study, however, states that a ratio of 3-to-1 is more accurate. Read more at News.Nurse.com.

Boys struggling with their emotions coupled with learning disorders often lash out at the very people who are trying to help them. Stone Mountain School is a boys boarding school that can teach boys to control their emotions and also help with ADD, ADHD, and other learning disorders.

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A study released today shows that eating disorders among Australians have increased from two percent ten years ago to almost five perfect today. Though extreme disorders like anorexia remained fairly stable, there was a sharp rise in so-called "minor" eating disorders.

"The study showed the number of people with regular eating disordered behavior - those who binged or displayed other extreme weight control problems at least weekly - had ballooned from 4.7 percent to 11 percent. And the people considered to have a full-blown eating disorder grew from two percent to 4.6 percent over the decade."

Unspecified eating disorders like fasting, purging and the use of laxatives were of special concern. Read more at News.com.au.

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Boys, men, and some ethnicities may cause doctors to overlook the possibility of eating disorders among these groups, according to researchers at Lucile Packard Children's Hospital and the Stanford University School of Medicine.

"'We need to think more broadly about who struggles with eating disorders,' said adolescent medicine and eating disorder specialist Rebecka Peebles, MD, instructor in pediatrics (adolescent medicine). Peebles pointed out that diagnostic and even treatment criteria were developed with Caucasian women or girls in mind. 'We may not be asking the right questions for these other groups at all.'"

One of the studies conducted by Peebles surveyed the differences in eating disorders among boys and girls ages 8 to nineteen. The most common "alarm" for eating disorders is an expressed desire to be thin - but most boys express a desire to be healthy, not necessarily thin. And they aren't as likely as girls to starve themselves, but instead resort to over-exercising and severely limiting food intake, which can create the same damaging results. Read more at Huliq.com.

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Eating disorders often go undiagnosed in special needs children. Unusual eating patterns are often attributed to some other diagnoses.

"If you feel that your child has experienced unusual weight loss or weight gain, please consult the family doctor or pediatrician. If you are advised to 'wait and see' whether the change continues and still feel uneasy about your child's weight, consider a second opinion."

There are many reasons why the eating habits of a special needs child could change. Though parents shouldn't become alarmed, they should take note of the change and try to determine its cause. Read more at BellaOnline.com.

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Though eating disorder sufferers struggle with everything from eating nothing to eating everything, only two types of disorders have official diagnoses: anorexia and bulimia. All others fall into a catch-all category known as “Eating Disorders Not Otherwise Specified (EDNOS).”

“What most people don’t realize about eating disorders is that of the nearly 10 million Americans who suffer from these conditions, more than 60 percent are diagnosed with EDNOS.

The catch-all category includes many patients who fall just one or two criteria short of anorexia nervosa or bulimia nervosa: They haven’t stopped menstruating for three months in a row, for example. … Or they binge and purge once a week, instead of twice a week, as ‘official’ bulimics do.” [Source: The Daily Beast'

Because the EDNOS “diagnosis” is so vague, some clinicians, parents, insurance companies and patients fail to take it as seriously as they should. They figure a person diagnosed with EDNOS isn’t as sick when in fact they often have more health issues than people who are officially diagnosed with anorexia or bulimia.

 

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Obesity and overeating will not be listed as mental disorders in the latest addition of the Diagnostic and Statistical Manual of Mental Diseases (DSM). However, the editors of the newest "physician's Bible" will add binge eating to their list of official eating disorders, according to Dr. Timothy Walch, who is chairing DSM work group in this area.

He said there is not enough hard evidence to support a psychiatric diagnosis for either overeating or obesity, noting "we have to follow the field, not lead it."

The DSM is used by physicians to diagnose and treat mental disorders. Anorexia, bulimia, binge eating disorder, and eating disorders not otherwise specified will be the only ones in the new edition of the book.

In order to be diagnosed as a binge eater, a person must have three of the following symptoms

1. Eating more rapidly than normal.
2. Eating until uncomfortably full
3. Eating large amounts of food when not hungry
4. Eating alone because of embarrassment about the amounts consumed
5. Feeling disgusted, depressed or guilty after overeating episodes.

Dr. Walsh said they also loosened the criteria for anorexia. An anorexic can now be someone of "markedly low weight," rather than 85 percent of recommended body weight, and a lack of menstrual periods has been taken off the list of symptoms. A person can now be diagnosed as bulimic if purging episodes occur only once a week, as opposed to twice a week in the current DSM.
 

Labels: diagnosis, binge eating, dsm

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