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How should DSM-V classify eating disorder not otherwise specified (EDNOS) presentations in women with lifetime anorexia or bulimia nervosa?

Published online by Cambridge University Press:  05 January 2010

K. T. Eddy ,
S. A. Swanson ,
R. D. Crosby ,
D. L. Franko ,
S. Engel  and
D. B. Herzog
K. T. Eddy*
Affiliation:
Harris Center, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
S. A. Swanson
Affiliation:
National Institute of Mental Health, Section on Developmental Genetic Epidemiology, Bethesda, MD, USA
R. D. Crosby
Affiliation:
Neuropsychiatric Research Institute, Fargo, ND, USA Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
D. L. Franko
Affiliation:
Harris Center, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA Department of Counseling and Applied Educational Psychology, Northwestern University, Boston, MA, USA
S. Engel
Affiliation:
Neuropsychiatric Research Institute, Fargo, ND, USA Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
D. B. Herzog
Affiliation:
Harris Center, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
*
*Address for correspondence: K. T. Eddy, Ph.D., Massachusetts General Hospital, Department of Psychiatry, 2 Longfellow Place, Ste 200, Boston, MA 02214, USA. (Email: keddy@partners.org)
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Abstract

Objective

Anorexia nervosa (AN) and bulimia nervosa (BN) are marked by longitudinal symptom fluctuations. DSM-IV-TR does not address how to classify eating disorder (ED) presentations in individuals who no longer meet full criteria for these disorders. To consider this issue, we examined subthreshold presentations in women with initial diagnoses of AN and BN.

Method

A total of 246 women with AN or BN were followed for a median of 9 years; weekly symptom data were collected at frequent intervals using the Longitudinal Interval Follow-up Evaluation of Eating Disorders (LIFE-EAT-II). Outcomes were ED presentations that were subthreshold for ⩾3 months, including those narrowly missing full criteria for AN or BN, along with binge eating disorder (BED) and purging disorder.

Results

During follow-up, most women (77.6%) experienced a subthreshold presentation. Subthreshold presentation was related to intake diagnosis (Wald χ2=8.065, df=2, p=0.018). Individuals with AN most often developed subthreshold presentations resembling AN; those with BN were more likely to develop subthreshold BN. Purging disorder was experienced by half of those with BN and one-quarter of those with AN binge/purge type (ANBP); BED occurred in 20% with BN. Transition from AN or BN to most subthreshold types was associated with improved psychosocial functioning (p<0.001).

Conclusions

Subthreshold presentations in women with lifetime AN and BN were common, resembled the initial diagnosis, and were associated with modest improvements in psychosocial functioning. For most with lifetime AN and BN, subthreshold presentations seem to represent part of the course of illness and to fit within the original AN or BN diagnosis.

Keywords

Anorexia nervosabulimia nervosaclassificationeating disorder not otherwise specifiedlongitudinal
Type
Original Articles
Information
Psychological Medicine , Volume 40 , Issue 10 , October 2010 , pp. 1735 - 1744
Copyright
Copyright © Cambridge University Press 2010

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