Subclinical versus formal eating disorders: Differentiating psychological features

Abstract

Sixty referrals to a Pediatric Eating Disorder clinic were compared on a number of demographic, clinical, and psychological variables. Twelve patients met definite diagnostic criteria for anorexia nervosa and 14 met criteria for a diagnosis of bulimia nervosa. Twenty‐one patients had a subclinical form of anorexia nervosa and eight had subclinical bulimia nervosa. Five patients could not be classified. The subclinical and definite diagnostic groups were compared across a number of demographic, eating pathology, and general psychological variables. The results revealed a clear pattern of difference between the two bulimia nervosa groups on variables related to the regulation of affects and impulses. There was no clear pattern of difference between the definite and subclinical anorexia nervosa groups. The results suggest that the DSM‐III‐R criteria for anorexia nervosa may substantially underestimate the number of individuals with a psychologically distressing eating disorder, but provide tentative support for the maintenance of strict diagnostic criteria for bulimia nervosa.

The natural course of bulimia nervosa and eating disorder not otherwise specified is not influenced by personality disorders

“…This represents a research need for several reasons. Many patients who present for treatment of EDs meet EDNOS criteria (Bunnell, Shenker, Nussman, Jacobson, & Cooper, 1990). They have significant features and associated impairment but fail to meet diagnostic threshold for either of the "formal" categories (BN or AN).…”

Differential diagnosis of eating disorders with the use of classification trees (decision algorithm)

“…With the correct diagnosis, they may significantly aid the treatment process. Empirical characteristics and differentiation of diagnostic criteria (including the psycho-social criteria) in people suffering from anorexia, bulimia or compulsive overeating is an issue tackled in contemporary scientific research worldwide [5][6][7][8][9][10][11][12][13].…”

Identification and Management of Eating Disorders in Children and Adolescents

“…Still, studies have shown that more than half of all children and adolescents with eating disorders may not fully meet all DSM-IV-TR criteria for AN or BN because they do not articulate body-image dissatisfaction or because their inadequate nutrition is manifest by growth failure rather than weight loss to less than 85% of expected weight. 63,64 These patients experience the same medical and psychological consequences of their disorders as do patients who meet criteria for AN or BN. Indeed, because the sequelae of weight loss (or failure to gain weight appropriately) may have even more worrisome implications for younger patients, relaxation of the diagnostic criteria for children and adolescents has been proposed in the development of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders to facilitate earlier diagnosis and treatment.…”