Eating Disorder Pro » DSM-IV diagnoses of Eating Disorders

News You Can Use – Jan 9 – 16 2012

Dr. J Renae Norton — Tue, 17 Jan 2012 02:31:17 +0000

There is so much information in the news about our health these days, that it can become quite overwhelming. In hopes of relieving some of the stress this can inflict on both my patients and my readers, I’ve highlighted some of the weekly health news that was of particular interest to me. Here is your news update for the week of Jan 9-15 2012!

Does Internet Addiction Disorder change teens’ brains?

Are ’50s moms to blame for today’s obesity rates?

Aspirin guidelines need overhaul, researchers say

Receptor for Tasting Fat Identified in Humans

Magnesium-rich diet tied to lower stroke risk

Exercise Hormone May Fight Obesity and Diabetes

Trans-Fats STILL Lurking In Grocery Store Foods

Will Ding Dongs, Wonder Bread, and Twinkies disappear? Hostess Brands to file Chapter 11 bankruptcy, again

New Approach To Diagnosing Anorexia Nervosa By Stages Of Severity

High-Fructose Corn Syrup is Harmful, New Research Concludes

Were there any news articles that you saw this week that really grabbed your attention? Leave a comment with a link. If the article helped you, it will likely help some of my other readers!

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Medical Advice Disclaimer: The information included on this site is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan. Reading the information on this website does not create a physician-patient relationship.

News You Can Use – Jan 1 – Jan 8, 2012

Dr. J Renae Norton — Tue, 10 Jan 2012 02:01:09 +0000

Vitamin D Deficiency Linked to Depression

Georgia Draws Fire for Grim Childhood Obesity PSAs

Chemical in Fast Food Wrappers Show Up In Human Blood

Standardize Measurement of Child Eating Disorders

Deep Brain Stimulation Appears Effective for Depression, Bipolar Disorder

The Biggest Food System Threat of 2012

Why We’re Fat: Outside Forces Affect What We Eat + How Much Exercise We Get

MSG, Transfats, High Fructose Corn Syrup Boost Liver Disease Risk

Binge Eating Disorder May Be Added to DSM-5

Were there any news articles that you saw this week that really grabbed your attention? Leave a comment with a link. If the article helped you, it will likely help some of my other readers!

Bulimarexia: Why Are We Seeing More of It?

Dr. J Renae Norton — Tue, 04 May 2010 22:38:37 +0000

There is definitely an increase in the number of patients coming my way who are Bulimarexic, or suffering from symptoms of both Anorexia and Bulimia. This is consistent with the information we have seen from our online survey. (Please take the survey if you haven’t already done so by following the survey link at the bottom of this page.)

Check out the chart for percentages of individuals reporting the type of Eating Disorder from which they are suffering.

The survey has been up for approximately two years. The number of people reporting being Bulimarexic has tripled in that time. One year ago the percentage for Bulimarexia was only 24.9%, now it is nearly 48%!(Part of this is likely due to increased familiarity with the term.)

The question is why? According to our survey at the Norton Center of more than 200 individuals who report having been in treatment for an eating disorder, 16% of those suffering exclusively from Anorexia upon entering an inpatient program report being discharged with symptoms of Bulimia that they acquired during their inpatient stay. Likewise, 11% of those surveyed, report that they entered in-patient treatment suffering exclusively from symptoms of Bulimia and exited with symptoms of Anorexia as well.

Anyone treating this population knows that the most difficult group to treat by far is the group suffering from symptoms of both Anorexia and Bulimia, or Bulimarexia. Likewise the risk of mortality is greater with this group than that of either group alone. If it isn’t apparent, the medical consequences of cycling between restricting sufficiently to be at an extremely low weight, followed by periods of bingeing and purging, are dramatic and often deadly. Thus, a treatment approach that may actually increase the likelihood of the development of Bulimarexia is a serious problem.

Obviously not all patients with Bulimarexia have developed the disorder while in an in-patient program. However, I am finding that an alarmingly high number of individuals “graduating” from inpatient treatment end up with Bulimarexia. Since I often see patients that other practitioners will not take into their practice because they are so sick, the number of Bulimarexic patients I see is probably higher than it would be in most practice settings. None-the-less, this issue doesn’t appear to be on the radar of researchers and many practitioner groups which is a serious problem in my opinion.

To date, there is not even a diagnostic code specifically for Bulimarexia in the Diagnostic and Statistical Manual, Fourth Edition (DSM IV).

In the DSM-IV, the closest thing we have is a code for two types of Anorexia:

Restricting Type: During the current episode of Anorexia Nervosa, the person has not regularly engaged in binge-eating or purging behavior (self-induced vomiting or misuse of laxatives, diuretics, or enemas).
Binge Eating/Purging Type: During the current episode of Anorexia Nervosa, the person has regularly engaged in binge-eating or purging behavior.

These definitions do not capture the nature of Bulimarexia. For example, whether the individual started as Anorexic or Bulimic makes a difference in terms of their current symptoms. The more Anorexic Type restricts most of the time and may or may not binge, but purges almost everything she does eat. In other words, she is more likely to have “subjective” binges, i.e. a small amount of food seems like a binge to her so she is forced to purge it.

The more Bulimic Type of Bulimarexic can keep some food down, and/or has more flexibility in terms of what she allows herself to eat, i.e. she may eliminate fat altogether from her diet but allow foods with carbohydrates. She will have some criteria that she uses to establish a “good” day versus a “bad” day. “Bad” days trigger the need to binge and purge whereas a “good” day allows her to skip this part of the cycle. These distinctions may not seem important, but they are critically important when it comes to treatment effectiveness. The therapist that does not understand such subtleties is going to be much less effective treating these disorders and could end up doing more harm than good.

More attention needs to be paid to this problem, we need better in-patient alternatives and we need more research on outcomes in general, i.e. we need to look at the impact that both inpatient and outpatient therapy has on the incidence of Bulimarexia. Graduate students looking for research opportunities contact me at drnorton@eatingdisorderpro.com.

My experience treating this population has been that treatment effectiveness is driven by customizing strategies to the individual and not using a One Size Fits All © approach. In general, I believe that inpatient approaches have tended to lump all eating disorders together in terms of treatment. The upshot is often an increase in the type of symptoms during or following discharge, or crossover from one disorder to another. This is a serious problem given the increased medical and psychological complications that result.