Eating Disorder Diagnosis - Coursework Example

Eating Disorder Diagnosis Table of Contents Table of Contents 2 3 Introduction 4 Eating disorders and their diagnosis4 Conclusion 10 References 11 Abstract The research paper is a summary and analysis of the diagnostic process for eating disorders over the course of history to date. Initially, anorexia nervosa was the point of emphasis, but this changed in 1980 when bulimia was introduced. Subsequent alterations have largely involved fine tuning mechanisms for detecting either of these conditions, but gaps arose when most patient did not fall in the primary categories and instead belonged to the otherwise not specified group. Proposals have been made to correct this problem by either relaxing criteria for admission into the primary category or introducing a third group known as binge eating disorder. Analyses into the efficacy of making these change supports alteration of the DSM IV criteria as it would reduce the number of patients falling in the residual group. Introduction Eating disorders are highly prevalent psychiatric disorders in western societies, with 10% of females affected by it and even more in specific parts of the region. Considerable progress has been made in the diagnosis of the disease but an overrepresentation of the residual category in the DSM-IV criteria has caused experts to consider revising their methods of diagnosis. These issues will be examined in greater detail with reference to the history of the debate and relevance to clinical reality concerning prevalence of traditional and proposed diagnostic criteria. Eating disorders and their diagnosis Three particular clinical ailments have been at the heart of the eating disorder discussion: Anorexia Nervosa (AN), Bulimia Nervosa (BN) and Binge Eating Disorder (BED), with preference in literature given to each outcome in order of appearance. Anorexia is a psychiatric problem characterized by excessive emaciation and denial of the severity of weight loss even when it is at alarming levels (Stice et al., 2000). Individuals tend to be unsettled about their body size and shape, and may place too much importance on the level of influence that these physical features have in their life. They also suffer from a deep fear of weight gain even though their current body size or measurements may already be too low. The American Psychiatric Association also recognizes amenorrhea as another indication of the condition, even though many arguments have been brought forward about the latter aspect (this will be discussed in subsequent sections of the paper). Conversely, Bulimia Nervosa is a condition characterized by uncontrollable, recurrent eating of food and drink normally in large amounts followed by subsequent compensatory reactions done to minimize weight gain (Stice et al., 2000). Subjects may perform too much exercise; induce vomiting, abuse laxatives as well as diuretics in order to achieve this objective. Just like anorexia, bulimics tend to assess themselves based on their body size or shape, and may have the illness throughout a substantial part of their life. Instances of substance abuse may occur as well as other comorbid pathologies such as affective and anxiety disorders throughout the illness course. Lastly, Binge-eating disorder is a condition in which the subject will repeatedly engage in uncontrollable eating, and will exhibit peculiar characteristics like hasty eating or eating in private to diminish shame. This habit of binge eating causes severe stress in the subject but is not normally accompanied by compensatory behavior as is the case with Bulimia Nervosa (Stice et al., 2000). Other complications and comorbidities associates with the illness include obesity, weight fluctuations and other psychiatric conditions. Prior to 1980, emphasis was given to anorexia as the primary eating disorder in clinical practice as well as research, but this changed in that year when bulimia was added. The latter condition was later changed to bulimia nervosa; together anorexia and bulimia became the primary disorders being diagnosed in clinical practice. Several iterations were made on the DSM classification scheme, but most of the changes largely revolved around the two conditions of anorexia and bulimia. The DSM IV criteria for eating disorders is what many clinical experts rely on, and have done so since 1994 when it was first introduced (Trace et al., 2013). Some changes have occurred in the field, since eating disorder diagnosis and treatment is no longer a preserve for clinical settings alone; community programs are now deeply involved. This transition has demonstrated that there is more to eating disorders than mere bulimia and anorexia, so stakeholders have called for an alteration in diagnostic schemes in order to accommodate complexities in the assessment of the ailments. Common practice from 1994 to date is that certain thresholds must be met for clinical conditions before a diagnosis can be made. For anorexia, a patient must demonstrate loss of her menses (amenorrhea) for a period of no less than three months/ cycles. The patient should also show also meet certain weight indices for being emaciated. Under the bulimic category, diagnosis for the condition can only be made if a person has demonstrated instances of binge eating continuously for 3 months. The term ‘continuous’ in the DSM-IV for this condition means that the subject should binge eat and show compensatory behaviors at least twice weekly (Keel et al., 2011). DSM-IV had three key categories for eating disorders, and these included the above-mentioned ones; that is, anorexia and bulimia, and not otherwise specified (NOS). The latter category consists of those cases in which the severity is not sufficient enough to place them in the two primary categories; this group is thus a residual one and is often presented as the following acronym: EDNOS or eating disorder not otherwise specified. Binge eating disorder has traditionally been classified as a residual condition belonging to the EDNOS category, but many clinical studies and observations are showing that the condition is significantly different from the two classical ones. Bulimia and anorexia are continuous conditions, yet binge eating is intermittent; subjects may not binge eat for long but could eventually resume (Fairburn and Cooper, 2011). A serious problem has thus been reported in clinical practice; that DSM IV criteria lead to an overrepresentation of EDNOS patients. In fact, this is the most common condition being treated in hospital settings to date, with half of the patients belonging to this category. Clearly, there appears to be a problem if a criteria fails to capture the primary categories and places most subjects in a residual one (Fairburn and Cooper, 2011). It has also been shown that the individuals in the EDNOS category all have features that closely resemble those of anorexia and bulimia except for the thresholds in these categories. The heterogeneous and undiagnosed groups that falls in the eating disorder not otherwise specified group have the features prevalent in the classical conditions only in divergent variations or combinations. For instance, many of them will be severely disturbed by the feeling of being fat and may check their weight frequently. Alternatively some of them may exhibit instances of weight control behavior such as avoidance of food or extreme dieting. It is apparent that certain changes have to be made in order to accommodate these missing categories, and several suggestions have been made on how to do so. Failure to make changes could result in neglect and poor treatment of the ailment. Few studies exist on treatment of EDNOS throughout the scientific community, and this could partly be attributed to its residual status. Research sponsors tend to refrain from such categories because they are not priority areas; the result is that patient care is undermined. Three solutions have been proposed for the diagnosis of the eating disorders in the oncoming DSM-V scheme, with some suggestions being rather aggressive while others continue to work with current classifications. The first one is to reduce the threshold for the diagnosis of the two classical eating disorders as many EDNOS categories already possess traits similar to anorexia and bulimia. For anorexia, analysts have suggested the requirement for amenorrhea be dropped as this is an indication of nutritional status and not a key element of the illness (Keel et al., 2011). In just the same way that body temperate and blood pressure alterations could be consequences of a specific ailment, amenorrhea should also be treated as such. Additionally for the above condition, it has been suggested that if a subject shows considerable control over their eating without necessarily demonstrating concern of their weight and shape, then they should also be considered. Even issues regarding the threshold for excess weight loss should also be revised as the weight threshold is concurrently very strict. Clinicians need to stick to the fact that the patients are still underweight but should not hold on so tightly to the actual weight loss. Some suggestions have also been made on bulimia nervosa with the primary concern being that the twice weekly threshold is too high for most patients. Patients with slightly lower instances of binge eating should be accommodated in this category as they are likely to posses the other characteristics for bulimia. However, some analysts have warned that doing so may result in making diagnostic criteria for anorexia and bulimia virtually unrecognizable. The second alternative would be to alter the NOS classification since majority of the patients have elements of both anorexia and bulimia, so they have mixed diagnoses. This recommendation must work in tandem with the first one that involves relaxing the threshold for admission of subjects in the two categories. Those that are not diagnosed as anorexic or bulimic under these relaxed conditions should then be placed in a new category called mixed eating disorder (Fairburn and Bohn, 2005). Finally, clinicians have the alternative of totally redefining the EDNOS category by creating a new class known as Binge eating disorder or BED. The latter condition has been shown to be clinically different from anorexia and bulimia both cognitively and behaviorally. Clinical interventions in binge eating disorder and EDNOS were characteristically different with much promise emanating from cognitive behavior therapy rather than behavior weight loss methods. If binge eating disorder becomes a new category, it ought to have certain traits. (These traits had already been outlined in the introduction paragraph). For precision, practitioners ought to ensure that the binge-eating has occurred at least weekly for a period of 3 months or more (Keel et al., 2011). The rest who do not fall in the anorexic, bulimic and binge-eating group could then be placed in the EDNOS category. Some studies have been done on the effect of these proposed criteria on the multitude of EDNOS cases as the key objective to these proposals is to lower the number oo patients who fall in the residual category. Fairburn and Bohn (2005) carried out one such research and found that the first proposal that lowers the threshold for admission of patients into the bulimia and anorexic categories is not effective. It does not minimize the number of subjects diagnosed with EDNOS significantly thus indicating that another intervention is necessary. Keel et al (2011) also carried out an analysis in which they combined both the first and third proposal; that is, they relaxed definitions for bulimia and anorexia and also accommodated a binge-eating disorder category. The authors found that in combination, the proposals significantly minimized the number of patients in the EDNOS group from 68% to 53%. This indicates that the proposed solutions may work in combination with each other, yet they still did not change the degree of recognition of BN and AN. Similarly, some scientists in Portugal also studied the effect of expanding the classic two categories of AN and BN as well as including binge eating disorder (Machado et al., 2011). They found that the number of EDNOS patients reduced from 85 to 5 in DSM IV and DSM V respectively. However, when they only included the new proposed category (BED) they found that the number only reduced from 85 in the EDNOS category to 55. The reclassification involved community samples of n-3048 that had initially been diagnosed using DSM IV, so their conditions were analyzed and put in different categories. Trace et al (2013) also augmented these findings when they analyzed the effect of introducing BED and minimizing thresholds for bulimia. Their 13,295-strong analysis in Sweden found that detection of binge eating was done more accurately and this did not affect the lifetime prevalence of either of the two eating disorders. Conclusion A history of diagnostic criteria for eating disorders indicates that certain gaps were prevalent in the scheme for detecting these conditions in the past. Most patients fell in the residual group rather than the anorexic or bulimic category, and this had profound effects on research, treatment efficacy as well as policy priorities. Proposed changes included relaxing the strictness for the two former categories or introducing a binge eating category. Studies indicate that in isolation, the changes may not be as effective but in combination they substantially minimize subjects diagnosed for the residual EDNOS group. Therefore, these DSM IV changes need to be embraced and utilized in critical practice in order to strengthen treatment outcomes for patients. References Fairburn, C. and Bohn, K. (2005). Eating disorder NOS (EDNOS): An example of the troublesome “not otherwise specified” (NOS) category in DSM-IV. Behavior Research Therapy, 43(6), 691-701. Fairburn, C. and Cooper, Z. (2011). Eating disorders, DSM-5 and clinical reality. The British Journal of Psychiatry, 198, 8-10. Keel, P., Brown, T., Holm-Denoma, J., Lindsay, P. and Bodell, B. (2011). Comparison of DSM-IV versus proposed DSM-5 diagnostic criteria for eating disorders: Reduction of eating disorder not otherwise specified and validity. International Journal of Eating Disorders, 44(6), 553-560. Machado, P. et al. (2012). Update: EDNOS: A diminished diagnosis in DSM-V? Eating Disorders Review, 23(1), 44. Stice, E., Telch, C., and Rizvi, S. (2000). Development and validation of the eating disorder diagnostic scale. Psychological Assessment, 12(2), 123-131. Trace, S., Thronton, L., Root, T., Mazeo, S., Lichtenstein, P., Perdersen, N. and Bulik, C. (2013). Effects of reducing the frequency and duration criteria for binge eating on lifetime prevalence of bulimia nervosa and binge eating disorder: Implications for DSM-5. International Journal of Eating Disorder, 45(4), 531-536. Read More