EDNOS: Eating Disorders Not Otherwise Specified: Scientific and Clinical Perspectives on the Other E

---

Introduction Detecting cases of eating disorders ED among large populations is of interest to clinicians and health planners, as well as epidemiologists. Most ED screenings carried out on community samples use a two-stage method in order to limit costs: In Schoemaker wrote that the problem of false negatives remained usually unappreciated Schoemaker Therefore we consulted the Medline database and we found very little research on eating disorders in which the problems of sensitivity of screening tests and especially of false negatives were analysed.

It has left a concern about the frequency of false negatives, due too to the tendency of some subjects with ED to deny or hide their illness. Although this does not modify the negative predictive value NPV significantly because of low prevalence of ED , it might be such as to produce a systematic underestimation of the prevalence of these disorders.

Related terms:

If this were true the effectiveness of the screening studies would diminish significantly Schoemaker To verify this hypothesis, we decided to carry out an epidemiological study on a community sample in which all subjects were examined in the first stage with commonly used, well validated self-administered questionnaires. In the second stage a structured interview was undertaken. What distinguished this study was that the diagnostic interview was conducted not only with possible cases -selected on the basis of the questionnaire scores- but also with all subjects of the original sample, including the low scorers.

Subjects and methods Subjects Participants included the female population of the 4th year of two secondary state schools in the city of Rome, Italy. All the girls who were absent on the day of the testing were examined a few days later, giving a final sample size of subjects.

Eating disorder not otherwise specified

This sample size was the best compromise between the requirements and aims of the study and the costs due to the administration of a semi-structured clinical interview to all subjects. Procedure and instruments A two-stage method was followed.

First, two questionnaires were administered: In this phase, weight and height were also measured and the BMI was calculated. Second, all the subjects, including the low scorers, were submitted to a detailed semi-structured clinical interview to establish a definite diagnosis, Eating Disorder Examination-EDE The interviews were performed, after a period of training, by psychiatrists and psychologists with at least two years of clinical experience with eating disordered patients. Diagnostic doubts were discussed jointly with a psychiatrist with a great deal of experience in the field of ED.

Results The mean age of the final sample of girls was The mean EAT40 total score was Table III displays the confirmatory data concerning the areas under the ROC curves of the questionnaires a random classifier has an area of 0. Discussion ED screenings carried out on community samples have used, for the most part, a two-stage design.

This type of methodology has considerable value but, at least, four important limits: Use of any self-report can be affected by denial and social desirability.

Not all people with AN have high levels of fat phobia and drive for thinness. This group have lower scores on other measures of eating disorder psychopathology e. These instruments assess the individual at one point in time. In a recent study Lee et al. In other words, these attributions are not static but they vary according to environment, life span and body weight.

Because the eating disorders are relatively uncommon in a population even when using questionnaires with adequate specificity, the PPV is low. Many of those interviewed in the second stage prove to be false positives and this increases the costs, thus reducing the efficiency of the screening studies. Specificity and PPV of a test used can be calculated, while sensitivity, frequency of false negatives and NPV of the same tests are usually not available.

Such studies have not been performed to determine these estimates for eating disorders Schoemaker Furthermore, the evaluation of sensitivity and specificity of the questionnaires are often based on the validation studies performed on clinical samples with ED full syndromes compared with control groups, not infrequently with a very small sample size. To reduce the number of false negatives in the selection of the possible cases many researchers have added other criteria e.

BMI, amenorrhea to the scores of the self-administered scales, but only very few researchers have tried to detect the false negatives by a direct diagnostic assessment. For example, a recent Spanish two-stage survey tackled the problem of false negatives in the epidemiology of ED Rodriguez-Cano et al. At the second stage of this research, probable cases on the basis of the self-administered questionnaires and controls randomly selected from the remaining sample were examined by means of a structured interview, the Spanish version of the SCAN system or Schedules for Clinical Assessment in Neuropsychiatry Vazquez-Barquero et al.

The authors found that 4 subjects, all women 3. If we compare these data with those of our research we can find similar figures.

The results of our study show that if we use the cutoff points suggested by the authors 30 for EAT40 and 50 for EDI the sensitivity of the two questionnaires is very low. To sum up, even though the areas under the ROC curves indicate certain discriminant ability, the percentages are not adequate for accurate case identification. We think that this low sensitivity might be explained, in the first place, by the fact that all cases in our sample, except one case of BN, which showed up in both questionnaires, are composed of EDNOS. Because of this it is likely that the introduction of the EDNOS diagnoses as part of the eating disorders increases the PPV of the two questionnaires, but lowers their sensitivity.

Servicios Personalizados

By the way, in a review article about the state of eating disorder screens Jacobi et al. The great frequency with which the mass media describe ED symptoms and in recent years the appearance of harmful pro-AN chat lines on the web has furthered a positive view of these disorders and probably makes it increasingly easier to hide them. How can we explain the difference? Is it possible that the type of diagnostic interview SCAN vs. EDE plays a role? We are not able, obviously, to exclude sociocultural factors to explain these differences. On the other hand, they may also be due to the fact that the diagnostic interview used by Canals et al.

Another two cases of atypical AN were found in this study using diagnostic clinical methods and criteria that were not described. It is interesting to examine the EAT results. The mean EAT scores But when comparing the percentages of subjects with EDNOS diagnoses, the differences seem particularly significant 8. In other words, according to the EAT40 total score, the samples appear to be very similar. It is therefore possible that the difference in the frequency of EDNOS diagnoses depends fundamentally on differences between the two diagnostic interviews used. Oxygen is a necessary substrate for eNOS.

A pivotal role for EDNO has been demonstrated during the transitional period, namely from fetal to neonatal life at birth, in the changes that occur in the pulmonary circulation triggered by birth-related stimuli. In late-gestation fetal lambs there is a dramatic reduction in PVR and marked increase in pulmonary blood flow caused by ventilation alone, oxygenation alone, or an increase in shear stress by partial compression of the ductus arteriosus, and this increase is largely eliminated by the inhibition of NOS.

In ovine fetal pulmonary arterial endothelial cells, shear stress acutely stimulates NO production through a reduction in phosphorylation of eNOS at Thr and an increased phosphorylation of eNOS at Ser In newborn pigs 5 minutes to 2 hours after birth , relaxation of the pulmonary artery in response to acetylcholine ACh is negligible. Ach-induced relaxation becomes greatest at 3 to 10 days and then decreases with age.

These responses are largely inhibited by N G -monomethyl- l -arginine, suggesting that they are mainly mediated by EDNO. Hsp90 is a constitutively expressed molecular chaperone. There was less binding of eNOS to Hsp90 in pulmonary resistance arteries from 2-day-old piglets than in vessels from 5- to 7- and day-old piglets.

This eNOS-Hsp90 interaction increases in the first 2 weeks of life in association with enhanced basal and agonist-stimulated EDNO-dependent relaxation of pulmonary arteries. This change in interaction may be contributing to the postnatal fall in PVR and changes in agonist-induced pulmonary vascular responses in the neonatal period. The first are instances where the individual's presentation closely resembles AN or BN nervosa, but he or she just fails to meet the diagnostic thresholds body weight or frequency of bingeing.

Screening for eating disorders: false negatives and eating disorders not otherwise specified

However, these cases should not be thought of as non-severe. The fact that they appear in clinical practice suggests that they warrant clinical attention. The second subtype are cases in which the clinical features of AN and BN are combined in ways other than in the two recognized syndromes. Another subtype described specifically in the adolescent literature is that of individuals who purge but do not binge Binford and Le Grange, Patients do not meet all the criteria for either AN or BN but have features of either or both Chamay-Weber et al, EDNOS has been described as an atypical eating disorder or partial syndrome eating disorder.

Although patients may not have full syndrome AN or BN, their medical symptoms may be just as severe. Symptoms and side effects are related to the specific eating disorder behavior.

Monitoring and treatment discussed in the AN and BN sections apply and are guided by the specific manifestations of behavior. Careful attention by clinicians to patient concerns about body weight and dieting behavior can provide clues to the diagnosis. Mitan MD, in Adolescent Medicine , DSM-IV defines eating disorders not otherwise specified NOS as abnormal eating behaviors, dissatisfaction with body weight or shape, and harmful weight control behaviors in the absence of full criteria for anorexia nervosa or bulimia nervosa.

This is the most common set of eating disorders during adolescence, and management strategies are similar to those described previously. Early diagnosis and intervention improves outcome in all eating disorders.

Most adolescents with eating disorders respond best to outpatient, team-based care delivered by medical, mental health, and nutritional health providers. Individual and family therapy are effective in adolescents with anorexia nervosa; findings from medication trials are inconsistent. Elisa Mott, in Treatment of Eating Disorders , Therefore, clinicians must not be rigid in utilizing interventions based only on a narrow diagnostic perspective. Instead, a broader, transdiagnostic approach will be most effective for holistic healing practices. If the person with BED is obese, then including calorie restriction is useful even though countering such restriction would be an important part of the treatment of BN.

The clinical picture of BED seems to be less stable than that of BN, and both apparent treatment response and relapse are common.

• Blurbs From the Burbs
• Argumentative Indicators in Discourse: A Pragma-Dialectical Study: 12 (Argumentation Library)
• Giovannis Room (Penguin Modern Classics)
• After the Crisis
• An Evening at the Lake (Daddy and I)
• The Night of Knives
• Science and the Indian Tradition: When Einstein Met Tagore (India in the Modern World)