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Study reveals
shortcomings in diagnosis criteria
(May
2008 Issue)
By Phyllis Hanlon
In February, Rhode Island Hospital released study findings that
suggest shortcomings in current DSM-IV guidelines for certain eating
disorders. The findings include recommendations for more inclusive
definitions.
Lead investigator Mark Zimmerman, M.D., director of outpatient
psychiatry at Rhode Island Hospital and associate professor of psychiatry
and human behavior at The Warren Alpert Medical School of Brown
University, and fellow researchers assessed 330 patients diagnosed
with a lifetime history of an eating disorder. "In this study, most
individuals had co-occurring disorders such as mood or anxiety disorders,"
says Zimmerman. "Comprehensive evaluation detected the presence
of an eating disorder."
The goal of the study was to examine the clinical usefulness of
current eating diagnoses criteria.
The study is part of the hospital's Methods to Improve Diagnostic
Assessment and Services (MIDAS) Project, which used comprehensive
diagnostic methods to evaluate 2,500 psychiatric outpatients.
Zimmerman says, "In the DSM, only two diagnoses have defined criteria:
bulimia and anorexia." In this study, 90 percent of subjects reported
binge eating, but did not meet all other criteria for anorexia or
bulimia. However, even in the absence of all DSM-IV criteria for
diagnosis, the research team concurred than an eating disorder was
present. "This is not a matter of idiosyncratic rating," says Zimmerman.
"Binge eating is listed in the appendix, not the official main text.
It should be diagnosed as an eating order NOS [not otherwise specified]."
Zimmerman reports that most subjects expressed a desire to address
their eating disorder. "From a consumer-oriented perspective, detection
of NOS was important," he says, explaining that a more definitive
diagnosis ensures more effective therapeutic treatment. "When developing
treatment and examining efficacy of treatment for an individual
with specific disorders, the more accurate the diagnosis, the better
the plan," he says. While general treatment can be applied, the
question of efficacy remains unclear. "A less severe form [of the
disorder] might be more responsive to nonspecific treatment," says
Zimmerman.
After reviewing existing literature on the issue of diagnostic
criteria, Zimmerman notes that his team's findings were replicated
in other studies. "If you open up the diagnosis criteria to those
who don't meet all the criteria, significant progress would be demonstrated,"
he says.
The study recommends broadening the criteria for bulimia, anorexia
and binge eating to include sub-threshold variants, says Zimmerman.
"As originally conceived, the NOS diagnosis was intended to catch
a few patients who didn't meet the criteria. It was not intended
to represent the majority."
If the researchers are successful in their lobbying efforts to
broaden the diagnostic criteria for eating disorders to include
sub-thresholds that would distinguish variants, the new guidelines
could be part of the DSM-V, which is preliminarily scheduled for
publication in 2012.
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