New Eating Disorder Proposed

University of Iowa psychologist Pamela Keel has proposed a new eating disorder. Purging disorder is similar to bulimia in that it usually involves throwing up after eating to control weight. Both groups “experience greater depression, anxiety, dieting and body image disturbance than women without eating disorders.” But unlike bulimia, those affected by purging disorder do not binge. Keel discovered that “women with purging disorder differed from women with bulimia on a physiological mechanism that influences food intake. Those with purging disorder also reported greater fullness and stomach discomfort after eating compared to women with bulimia and women without eating disorders.”

This is incredibly exciting news. The DSM-IV definitions of eating disorders are narrow and out-dated. This has been debated for a while in the ED community, both by professionals and patients, but I believe this is the first time an alternative disorder has been propsed. Expanding the criteria so they include the full range of eating disorders is vital to the recovery, treatment and ultimae survival of those with eating disorders. I think this is such an important issue that I am going to disect it in a few different posts. Here’s what I plan to talk about:

1.) Current diagnostic criteria are very limiting and problematic. This is especially true with anorexia nervosa. It requires both the cessation of menses and extreme thinness, which is further defined as “refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).” Bulimia requires binging along with purging, but according to this study the purging can be an issue without binging.

2.) For chronic sufferers, eating disorders are rather fluid. They often cycle back and forth, in and out of phases, even mixing the various behaviors together at the same time. The underlying issues do not change, there is always a serious problem to be addressed, but the outward symptoms can vary.

3.) There is a competitive aspect to the disease. Striving to be thin, fighting against the body, struggling to be perfect. Anorexia is precieved as a “better” disease than bulimia. It is fast, effective, pure. People will make a point to move into the more ideal category. It is difficult to summarize, this really needs a whole post to explain, but I have spent time in the Pro-Ana and Pro-Choice communities and have seen this unfold on messages boards between thousands of girls with eating disorders.

4.) Due to mental health parity issues, most insurance companies find loopholes when it comes to paying for eating disorder treatment. Because the definitions are so narrow and specific, insurers will use the DSM-IV to determine who has a “real” eating disorder. If you don’t fit the mold, they can deny care from that angle as well.

The psychological and physical manifestations of eating disorders are so diverse. The definition of this disease shouldn’t be inexplicably exclusionary. The point is to identify the problem so people that need help can get it. Please tune in over the next few days to learn more.