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Eating disorders - Management
Clinical features of atypical eating disorders
- Most eating disorders encountered in the community are atypical.
- An eating disorder is described as atypical if it has features that closely resemble anorexia nervosa or bulimia nervosa but does not meet the precise diagnostic criteria for either, for example:
- The person's weight may be just above the diagnostic threshold for anorexia nervosa.
- If the body mass index is less than 17.5 kg/m2, the woman may still be menstruating.
- Binge eating and purging may occur infrequently.
- Over-concern with weight and shape is generally present.
- Many people with atypical eating disorders have experienced anorexia or bulimia nervosa in the past, or may subsequently go on to develop the full syndrome.
- Atypical eating disorders are relatively commonly diagnosed in childhood, partly because it is difficult to strictly apply existing diagnostic criteria for anorexia nervosa and bulimia nervosa to children.
- Atypical eating disorders are also known as 'eating disorders not otherwise specified' under the DSM-IV American Classification System.
- Binge eating is an example of an atypical eating disorder.
- A large amount of food is eaten over a short period of time, along with feelings of loss of control.
- Binge eating episodes are associated with three or more of the following:
- Eating more rapidly than normal.
- Eating until feeling uncomfortably full.
- Eating large amounts of food when not physically hungry.
- Eating alone or in secret through embarrassment at the amount that is being eaten.
- Feeling disgust or extreme guilt after overeating.
- Marked distress regarding binge eating is present and social avoidance is common. Depressive features and dissatisfaction with shape are common, though over-evaluation of the importance of weight and shape is less marked than in bulimia nervosa.
- Many people with binge eating disorder are obese. They experience recurrent episodes of bingeing, similar to that in bulimia nervosa but without the extreme compensatory behaviours seen in people with bulimia nervosa. People tend to be older and there are more men with this disorder than is the case with the other eating disorders.
[WHO, 1992; DSM-IV, 1994; National Collaborating Centre for Mental Health, 2004]
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