Are Diagnostic Criteria for Eating Disorders Markers of Medical Severity

The objective of this study was to compare the medical severity of adolescents who had eating disorders not otherwise spec- ified (EDNOS) with those who had anorexia nervosa (AN) and bulimia nervosa (BN). METHODS: Medical records of 1310 females aged 8 through 19 years and treated for AN, BN, or EDNOS were retrospectively reviewed. Pa- tients with EDNOS were subcategorized into partial AN (pAN) and par- tial BN (pBN) when they met all Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria but 1 for AN or BN, respec- tively. Primary outcome variables were heart rate, systolic blood pres- sure, temperature, and QTc interval on electrocardiogram. Additional physiologically significant medical complications were also reviewed. RESULTS: A total of 25.2% of females had AN, 12.4% had BN, and 62.4% had EDNOS. The medical severity of patients with EDNOS was interme- diate to that of patients with AN and BN in all primary outcomes. Pa- tients with pAN had significantly higher heart rates, systolic blood pressures, and temperatures than those with AN; patients with pBN did not differ significantly from those with BN in any primary outcome variable; however, patients with pAN and pBN differed significantly from each other in all outcome variables. Patients with pBN and BN had longer QTc intervals and higher rates of additional medical complica- tions reported at presentation than other groups. CONCLUSIONS: EDNOS is a medically heterogeneous category with se- rious physiologic sequelae in children and adolescents. Broadening AN and BN criteria in pediatric patients to include pAN and pBN may prove to be clinically useful. Pediatrics 2010;125:e1193-e1201