What are different types of eating disorders?
The Diagnostic and Statistical Manual of Mental Disorder (DSM), fifth edition, broadly covers variations of this impairment, including:6,7
- Anorexia nervosa
- Bulimia nervosa
- Binge eating disorder
- Avoidant/restrictive food intake disorder (ARFID)
- Pica disorder
- Rumination disorder
- Unspecified feeding or eating disorder (UFED)
- Other specified feeding and eating disorders (OSFED), also known as eating disorder not otherwise specified (EDNOS)
Table 1: Each is distinct and has different clinical courses, treatments, and prognoses
DSM offers clear explanations and relevant details that are carefully updated – a valuable resource for underwriters and claims managers to use in developing and applying guidelines on an ongoing basis.
What impact do eating disorders have on mortality or morbidity?
Eating disorders increase the risk of mortality. The all-cause mortality among individuals with eating disorders ranges from 125% to 200% compared to the general population.8,9
Anorexia nervosa has the greatest excess mortality, reaching as high as 400%; however, this could result from higher reporting among patients with severe cases and/or those under emergency care. For the remaining eating disorder types, excess mortality ranges from 50% to 150%, depending on symptom severity.10
The impact of eating disorders on morbidity is equally significant. Due to reduced quality of life, eating disorders significantly burden public health resources through disability, physical complications, and increased healthcare expenditures.
Individuals with eating disorders commonly report various cardiovascular events, although the effect on cancer incidence remains inconclusive as of this writing.11,12
Co-occurring non-eating psychiatric disorders are relatively common among individuals with eating disorders and can adversely impact an individual’s prognosis. Furthermore, a bidirectional correlation exists where co-morbid eating disorders may develop among those suffering from other mental health disorders.
Data projects that more than 50% of people suffering from an eating disorder will experience at least one co-morbid psychiatric condition in their lifetime. Some of the most commonly reported include:13,14,15
- Major depressive disorder
- Anxiety disorder
- Obsessive-compulsive disorder
- Post-traumatic stress disorder
- Body dysmorphic disorder
- Drug or substance abuse
- Alcohol dependence
- Suicidality and self-injury
Therefore, when assessing applicants with an eating disorder, underwriters may also need to consider the presence of multiple co-morbid physical and mental disorders and should use judgment best aligned with their company’s overall risk philosophy.