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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by zazenducky on October 30, 2006, at 15:10:23
It doesn't make any sense. If anorexia requires a particular weight why doesn't Binge Eating Disorder?
Obesity is treated seperately from BED and I think emaciation should be considered separately from anorexia.
I think the weight requirement should be dropped from the anorexia diagnosis. They are 2 different things. One may or may not follow from the other. No other diagnosis has a physical requirement does it? If BPD required a particular number of stitches to be declared self-injury and make a person eligible for help from a treatment center wouldn't that just increase the severity of cutting?
Posted by Racer on October 30, 2006, at 19:23:48
In reply to Why no weight requirement for BED diagnosis?, posted by zazenducky on October 30, 2006, at 15:10:23
Apparently, the DSM V will be dropping the amenorrhea requirement for AN, and modifying the weight criteria. I'm not sure what they're doing to replace the 85% part, but the working group has apparently decided that they agree with you, at least in part.
I don't think it should be done away with entirely, though. There's a world of difference between someone who is afraid of becoming fat, and someone who is afraid of becoming fat and so drops to dangerously low weights. That, of course, is just my opinion, and everyone is free to disagree with it.
Posted by Racer on October 30, 2006, at 19:27:43
In reply to Why no weight requirement for BED diagnosis?, posted by zazenducky on October 30, 2006, at 15:10:23
As for BED, though, I think it's the behavior which defines it, not the results. I don't think it really needs any sort of weight requirement.
Again, just my opinion.
Posted by Meri-Tuuli on October 31, 2006, at 7:15:47
In reply to Whoops. I got distracted from the point..., posted by Racer on October 30, 2006, at 19:27:43
Perhaps there should be a spectrum? Like with so many things, its not either/or. I mean, I would say in the past I had definately anorexic type behavours - I would eat 500 cals/day, for example, and my weight dropped to 18.5 BMI. Although I still got periods and I was in the 'normal' weight range, my behavours clearly weren't normal.
But on the other hand, I wasn't clinically anorexic per se. Perhaps the 'anorexia nervosa' is a label for one end of the spectrum and I dunno, 'anorexic type disorder' should be a milder form or something.
Because I do think you can have anorexic type behaviours which clearly aren't healthy, but you're not strictly anorexic either.
Disordered eating disorder perhaps????
Kind regards
Meri
Posted by Racer on October 31, 2006, at 9:55:03
In reply to Re: Whoops. I got distracted from the point..., posted by Meri-Tuuli on October 31, 2006, at 7:15:47
There's already the "ED-NOS" diagnosis. Eating Disorder Not Otherwise Specified. In theory, that covers things like the behavior you mention -- excessive dieting without excessive weight loss or amenorrhea. It's also where BED actually falls.
My personal opinion on the subject is that the EDNOS category needs to be broken down into smaller chunks. Right now, it's a catch-all. Those 80 pound women who still get their periods are in there, along with those people who binge eat when they're upset, or those with severe food aversions, or any number of miscellaneous eating related issues. Some of those issues are so close to the other dxs that you may as well combine them -- thus dropping the amenorrhea requirement for AN -- and some are pretty discrete behavioral patterns -- like BED -- that may as well get their own diagnostic code.
Anyway, some thoughts...
Posted by Meri-Tuuli on November 1, 2006, at 1:52:46
In reply to Re: Whoops. I got distracted from the point... » Meri-Tuuli, posted by Racer on October 31, 2006, at 9:55:03
> There's already the "ED-NOS" diagnosis.
Hey!
Yeah I read about that. But with my example, for instance, I could have easily slipped into clinical anorexia - and if I were diagnosed (which I wasn't, but I did and mention it to several doctors but anyway) it would be better to reflect the anorexic part in the 'label' - I was thinking something like they have for bipolar these days, ie bipolar spectrum disorder, so we could get something like 'anorexia spectrum disorder' for people like me, and then proper 'anorexia nervosa' for the end of the sprectum.
Whatcha think?
Well, personally I don't care for labels much. Its what it actually is, if you see what I mean. Someone might call something purple, another lilic, another mauve...if you see what I mean. And just because you don't have a label, doesn't mean you don't have a disorder....
But anyway I think a whole lot of women would fall into the ED-NOS category if diagnosed.......
Have you heard about orthorexia?
Kind regards
Meri
Posted by Racer on November 1, 2006, at 2:16:23
In reply to Re: Whoops. I got distracted from the point... » Racer, posted by Meri-Tuuli on November 1, 2006, at 1:52:46
> > > Have you heard about orthorexia?
>
> Kind regards
>
> Merilol! The nurse practioner at the fertility clinic was talking with us in one of the doctors' offices, and mentioned that the box of cookies on the console was from some holiday long past, and that the doctor never ate anything like cookies -- only healthy food. I didn't even think, just said, "that's called orthorexia..."
Yeah, if you really want to get down into it, there are a ton of flavors for eating disorders. One very common one that I don't know the name for is refusing to eat any food one hasn't prepared oneself. One woman from my group used to come over sometimes for dinner -- bulimic, not AN -- and she'd bring her own food. (She missed out. I'm an excellent cook.) (Of course, that was when I was still seeing the dietitian.)
I don't know. I do think the criteria as it now stands is too strict. Full syndrome anorexia affects about .5% of American women, full syndrome bulimia about 1.5 - 2%, but I've heard numbers ranging up to 14% for disordered eating. That means that something's probably wrong with the criteria, that so many women fall into the miscellaneous category.
I don't quite like the idea of the "anorexia spectrum disorder," though, partly because that's basically been tried. The old criteria was closer to what you're describing. I can't put my finger on it, but I think the catastrophic weight loss really is pretty key in AN, maybe because it is a big part of the cause of some of the worst mental aspects of AN. Someone who's not eating enough, and loses weight, and is afraid of becoming fat does have a problem. But within normal weight ranges, the other parts don't seem to be there: the severe obsessionality, the weird hyperactivity, some of the chemical changes like paradoxical high cholesterol. A lot of those things really don't show up until past a critical point in weight loss.
Then again, what the heck do I know? That's just my opinion...
OH! I know this one thing for sure: it's past my bedtime, and I'm not making much sense anymore... 'Night, all!
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