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Eating-disorder diagnosis may delay, prevent treatment

Each year, millions of adolescents are diagnosed with an eating disorder. While many are labeled with anorexia or bulimia, others are told they fall under the "Eating Disorder Not Otherwise Specified" umbrella - meaning they have disordered eating patterns but don't meet the criteria for a specific disorder. New research, though, shows that this "catch-all" diagnosis may be delaying or preventing sick patients from getting treatment.

In a study appearing in Pediatrics, Rebecka Peebles, MD, an adolescent medicine specialist with Stanford and Lucile Packard Children's Hospital, and colleagues examined health records of more than 1,300 female patients treated for eating disorders. They found:

Nearly two-thirds of the patients studied had EDNOS. As the researchers suspected, the EDNOS category acted as a catchall; patients with partial anorexia were more similar to those with full-blown anorexia than to other EDNOS patients with partial bulimia, for instance. In addition, 60 percent of EDNOS patients met medical criteria for hospitalization and this group was, on average, sicker than patients diagnosed with full-blown bulimia.

Peebles said the findings that EDNOS patients are sometimes as sick as patients with full-fledged anorexia or bulimia suggest that medical criteria for eating disorders should be re-evaluated. It's an important issue, she said, because health insurers provide less coverage for EDNOS treatment than for treatment of anorexia or bulimia. And a diagnosis of EDNOS can also be misleading to parents:

"I think that when parents walk out of a doctor’s office having heard their kid doesn’t meet criteria for anorexia, they’re relieved," Peebles said. But they shouldn’t let their guard down: in many cases, the child’s disturbed eating patterns still need treatment.

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