1. I’ve spent enough time in my life counting calories (and want those hours back!
2. It’s triggering
3. I feel guilty for eating more, weighing more, needing more, wanting more, thinking I deserve more, etc
4. Paranoia that I’m eating too much
5. I’m a little competitive

I’ve been extremely lucky to find very normal eaters for friends… relatively healthy eaters, but non-dieting friends. We get ice cream, go out for pizza, have snacks, etc. And this is all so so so helpful.

I visited family a couple of weekends ago, and my two younger sisters are dieting. I don’t think they have eating disorders (knocking on wood). One is out of college and the other is half-way through. Yes, I know that 1/3rd of women at Renfrew are now adults… but I’d like to think that they would have shown disordered behaviors by now were either of them prone to developing an ED.

My parents don’t discourage the dieting… actually I’d go so far as to say that they support it. You wouldn’t think this would be the case after having one daughter in and out of treatment facilities for most of high school… but I guess my parents never really did get involved with treatment. Anyway, when I told my mother that my boyfriend would be coming, she was excited to bake because “no one around here eats anymore.” Yes, this was going to be a problem…

The drive to my parent’s house was eight hours, and apparently my boyfriend does not like to stop for meals or snacks along the way. Notice that unless we were driving in the middle of the night (which we were not), this interferes with the “normal eating” model.

I realize that it’s probably normal for people to skip an occasional meal (I’ve talked about this before), but sometimes I feel like I should wear a sign: Warning: Do not approach if you do not eat 3 meals and a snack.

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Diagnostic Crossover in Anorexia Nervosa and Bulimia Nervosa:
Implications for DSM-V
(Am J Psychiatry 2008; 165:245–250)

I actually think this whole study was amazing and definitely recommend reading it if you can (and I’m always a skeptic, so this is rare that I’d say this).  That said, I don’t think that the study does much for defining, validating, or invalidating the ED-NOS diagnosis.

 I think that this is brilliant, and should be used for actual diagnosis… not just as a measure in this study:

The Eating Disorders Longitudinal Interval Follow-up Evaluation was used to assess symptoms at intake and to assign DSM-IV-TR diagnoses during the follow-up period.  This instrument yielded weekly psychiatric status rating scores (ordinal, symptom-oriented scale scores based on Research Diagnostic Criteria ratings) for anorexia nevosa and bulimia nervosa for each participant.  Psychiatric status ratings range from 0 to 6 for anorexia nevosa and bulimia nervosa, where:

0 = no history of the disorder

1 = a past disorder with no current symptoms

2 = residual symptoms (e.g., minor eating disorder cognitions without current behavioral symptoms)

3 = partial symptoms (i.e., does not meet for criteria)
    e.g., for anorexia nervosa is ≥ 90% ideal body weight with significant cognitive symptoms
    e.g., for bulimia nervosa, experiences binge eating and/or compensatory behaviors 1 – 3 times a month with significant cognitive symptoms

4 = marked symptoms (just misses full criteria:
    e.g., for anorexia nervosa is >85% ideal body weight with significant congitive symptoms
    e.g., for bulimia nervosa, experiences binge eating and compensatory behaviors 4 – 7 times a month

5 and 6 = full criteria, depending on symptoms severity or degree of impairment
    e.g., for anorexia nervosa, a 5 would indicate ≤ 85% ideal body weight, and a 6 would indicate ≤ 75% ideal body weight.
    e.g., for bulimia nervosa, a 5 would indicate binge eating/compensatory behaviors 2+ times a week, and a 6 would indicate daily binge eating/compensatory behaviors.

DSM-IV-TR diagnoses were assigned as follows:
AN, restricting-type = Max AN psychiatric status rating ≥5 and max BN rating ≤2.
AN, binge eating/purging type = Max AN psychiatric status rating ≥5 and max BN rating was ≥3.
BN = BN psychiatric status rating was ≥5 and max AN rating was ≤4.

Partial recovery = max status rating was for both AN and BN was 3 or 4.
Full recovery = max psychiatric status rating for both AN and BN was ≤2.

I really think that their psychiatric status rating could be a huge asset to DSM-IV diagnosis.  There is a lot of discussion about mental illness (in general) as a continuum, rather than clusters of individually-defined disorders.  This study proposes a continuum within a specific diagnosis.  This seems like a great way to approach it, since a big criticism of the continuum theory is diagnostic specificity.  Diagnoses are necessary for treatment (and research).  Moreover, the scale eliminates the confusion between sick, in recovery, in remission, and fully recovered.  You could have a diagnosis of ANR-1: anorexia nervosa, restricting type, recovered but with a history of the disorder.  These disorders can affect your health decades after the height of the illness, and this ANR-1 note would be useful to future physicians.

As an individual, I think it feels much more validating to have an ANR-#, ANP-#, or BN-# diagnosis.  You could be IN a treatment facility and cross over that 85% body weight mark… and suddenly not qualify for the disorder anymore.  With treatment centers often treating physical symptoms before mental/emotional issues, I think that this psychiatric status rating would be a much more accurate diagnosis.

Tags: Eating disorder, eating disorder diagnosis, psychiatric status rating, DSM-IV, chronic anorexia, eating disorder recovery