Are diagnostic criteria for eating disorders markers of medical severity?
OBJECTIVE
The objective of this study was to compare the medical severity of adolescents who had eating disorders not otherwise specified (EDNOS) with those who had anorexia nervosa (AN) and bulimia nervosa (BN).


METHODS
Medical records of 1310 females aged 8 through 19 years and treated for AN, BN, or EDNOS were retrospectively reviewed. Patients with EDNOS were subcategorized into partial AN (pAN) and partial BN (pBN) when they met all Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria but 1 for AN or BN, respectively. Primary outcome variables were heart rate, systolic blood pressure, temperature, and QTc interval on electrocardiogram. Additional physiologically significant medical complications were also reviewed.


RESULTS
A total of 25.2% of females had AN, 12.4% had BN, and 62.4% had EDNOS. The medical severity of patients with EDNOS was intermediate to that of patients with AN and BN in all primary outcomes. Patients with pAN had significantly higher heart rates, systolic blood pressures, and temperatures than those with AN; patients with pBN did not differ significantly from those with BN in any primary outcome variable; however, patients with pAN and pBN differed significantly from each other in all outcome variables. Patients with pBN and BN had longer QTc intervals and higher rates of additional medical complications reported at presentation than other groups.


CONCLUSIONS
EDNOS is a medically heterogeneous category with serious physiologic sequelae in children and adolescents. Broadening AN and BN criteria in pediatric patients to include pAN and pBN may prove to be clinically useful.
Peebles
Rebecka
R
Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Mountain View, CA 94040, USA. rpeebles@stanford.edu
Hardy
Kristina K
KK
Wilson
Jenny L
JL
Lock
James D
JD
D000293:Adolescent; D000856:Anorexia Nervosa / Q000145:classification / Q000175:diagnosis*; D052018:Bulimia Nervosa / Q000145:classification / Q000175:diagnosis*; D002648:Child; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D001068:Feeding and Eating Disorders / Q000145:classification / Q000175:diagnosis*; D005260:Female; D006801:Humans; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult
Int J Eat Disord. 1998 Jan;23(1):7-15
9429914
Int J Eat Disord. 2007 Jan;40(1):1-6
16958118
Acta Psychiatr Scand. 2003 Sep;108(3):175-82
12890271
J Adolesc Health. 2006 Dec;39(6):800-5
17116508
Int J Eat Disord. 1993 Nov;14(3):261-7
8275062
Int J Eat Disord. 2002 Nov;32(3):301-8
12210644
Psychol Med. 2005 Nov;35(11):1563-72
16219114
Am J Psychiatry. 2006 Jul;163(7 Suppl):4-54
16925191
Int J Eat Disord. 2007 Nov;40 Suppl:S95-8
17886266
Pediatrics. 2003 Jan;111(1):e98-108
12509603
J Adolesc Health. 2006 Dec;39(6):819-27
17116511
Eat Weight Disord. 2001 Sep;6(3):157-65
11589418
Eur Eat Disord Rev. 2007 Sep;15(5):340-9
17701944
Pediatrics. 2000 May;105(5):1100-5
10790469
Int J Eat Disord. 2007 Nov;40 Suppl:S99-S103
17879988
Behav Res Ther. 2005 Jun;43(6):691-701
15890163
Int J Eat Disord. 2010 Sep;43(6):492-7
19718666
Am J Psychiatry. 2000 Jun;157(6):886-95
10831467
J Adolesc Health. 2003 Dec;33(6):496-503
14642712
Int J Eat Disord. 2007 Apr;40(3):212-7
17173324
Int J Eat Disord. 2008 Sep;41(6):498-504
18433024
Eat Weight Disord. 2001 Sep;6(3):121-9
11589414
Int J Eat Disord. 2009 Sep;42(6):565-70
19544557
Behav Res Ther. 2007 Aug;45(8):1705-15
17374360
Int J Eat Disord. 2000 Nov;28(3):317-24
10942918
J Clin Psychiatry. 2007 May;68(5):738-46
17503983
J Nerv Ment Dis. 2003 Sep;191(9):589-94
14504568
J Am Coll Cardiol. 2006 Jan 17;47(2):362-7
16412861
J Am Acad Child Adolesc Psychiatry. 2008 Feb;47(2):156-164
18176335
Arch Gen Psychiatry. 2004 Feb;61(2):192-200
14757596
Int J Eat Disord. 2006 Sep;39(6):462-7
16715488
Lancet. 2001 Apr 21;357(9264):1254-7
11418150
Am Psychol. 2007 Apr;62(3):167-80
17469896
Behav Res Ther. 2008 Dec;46(12):1290-4
18848697
J Adolesc Health. 2003 Dec;33(6):418-26
14642704
Int J Eat Disord. 2005 Jan;37(1):1-10
15690459
Lancet. 2005 Jan 1-7;365(9453):79-81
15639682
Int J Eat Disord. 1998 Apr;23(3):233-42
9547658
Eat Behav. 2005 Jan;6(1):53-62
15567111
Psychol Bull. 2009 May;135(3):407-33
19379023
Arch Gen Psychiatry. 2006 Dec;63(12):1377-84
17146012
Int J Eat Disord. 2007 Nov;40 Suppl:S117-22
17868122
Int J Eat Disord. 2009 Dec;42(8):754-64
19650083