Thursday, October 15, 2009
Not Otherwise Specified – How Sick are You?
There is an article in the American Journal of Psychiatry titled ‘Increased Mortality in Bulimia Nervosa and Other Eating Disorders’ which compared mortality statistics between diagnoses of anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified.
There are limitations to this study and the author’s do a good job of recognising them, so I’m not going to critique the work. I do agree with them though that information such as duration of illness and comorbidity would be interesting to look at.
The highlight of this paper was that morbidity for EDNOS (eating disorder not otherwise specified) was comparable to other eating disorders.
This is where duration of illness information would come in handy. For patients without a severe eating disorder, obtaining treatment can be difficult. And what we’re left with, at the very least, is a persistent and un-treated (possible unrecognized) nutritional disorder which can lead to other medical problems.
There is also the issue of unresolved mental health problems which can further exacerbate eating disorders as well as increase other dangerous behaviours.
In all three groups ‘medical’ causes were the leading cause of death; it would be interesting to do a detailed study of this area in order to determine if there was a higher instance of nutrition related deaths (e.g. diabetes) and if ‘traumatic’ deaths were related to behaviour.
Another article advocating for DSM V recognition of EDNOS.
A note on Dietitians and the help they can offer.