A Closer Look at Eating Disorder Not Otherwise Specified (EDNOS)
Eating Disorder Not Otherwise Specified (EDNOS) is a diagnostic category used when an individual’s symptoms are problematic and definitely represent disordered eating but do not fit neatly within the strict criteria for anorexia or bulimia. Though many people have never heard of it, EDNOS is by far the most commonly diagnosed eating disorder. Approximately 40-60% of cases in eating disorder treatment centers fall into the EDNOS category. About 75% of individuals with eating disorders seen at non-specialty community settings have EDNOS. The EDNOS diagnosis usually captures the following three general categories of symptoms:
A) Subthreshold symptoms of anorexia or bulimia
B) Mixed features of both anorexia and bulimia
C) Atypical eating behaviors that are not characterized by either anorexia or bulimia
Diagnostic examples of Eating Disorder Not Otherwise Specified
The Diagnostic & Statistical Manual (DSM-IV) currently lists six clinical examples of EDNOS. It’s important to note that this list in not exhaustive, and there are other situations and variations of symptoms that would also warrant an EDNOS diagnosis:
- All criteria for anorexia nervosa are met except the individuals has regular menstrual cycles
- All criteria for anorexia nervosa are met except that, despite significant weight loss, the individual’s current weight falls within the normal range
- All criteria for bulimia nervosa are met except that binge eating or purging behaviors occur less than twice per week or for fewer than three months
- An individual purges after eating small amounts of food while retaining a normal body weight
- Repeatedly chewing and spitting out large amounts of food without swallowing
- All criteria are met for binge eating disorder
Signs & Symptoms of EDNOS
Because individuals with EDNOS represent such a heterogeneous group, symptoms could look very different even among individuals with the same EDNOS diagnosis. Reviewing the signs and symptoms listed for anorexia, bulimia and binge eating disorder would be helpful if you suspect someone you love may have EDNOS. In general you will see warning signs related to 1) weight and shape concerns, 2) food & eating behaviors and 3) changes in personality and social behavior.
EDNOS Concerns & Misconceptions
EDNOS is sometimes referred to as a “subclinical” or “sub-threshold” diagnosis. This can be misleading in terms of severity, and some individuals may interpret it as being a less serious illness than anorexia or bulimia. This is far from the truth. Many studies have shown that individuals with the EDNOS diagnosis experience eating pathology and medical consequences that are just as, if not more, severe than individuals who receive a formal anorexia or bulimia diagnosis. Furthermore, one recent study found that 75% of individuals with EDNOS had co-occurring psychiatric disorders and 25% endorsed suicidality (Le Grange, et al. 2012).
This diagnosis is not to be taken lightly, and individuals with EDNOS often require the same level of treatment and support as those with anorexia or bulimia. Unfortunately, some insurance companies still resist coverage for the EDNOS diagnosis despite the fact that without treatment, a significant number of individuals with EDNOS will go on to meet full criteria for anorexia or bulimia at some point during the course of their illness.
The future of EDNOS…
The DSM-IV is scheduled for updated publication in 2013. It is expected that the DSM-5 will include expanded diagnostic criteria for anorexia nervosa and bulimia nervosa, and elevate binge eating disorder to a formally recognized diagnosis. Furthermore, DSM-5 plans to rename the EDNOS category Feeding or Eating Disorder Not Elsewhere Classified, and to provide named descriptions of example presentations. Professionals are hopeful that these changes will address some of the concerns related to the expansive EDNOS category, increase opportunities for research on effective treatment for more people, and improve insurance approvals for those individuals who need treatment.
Many people have very serious eating disorders yet don’t meet the full criteria for anorexia or bulimia. If you think you or a loved may fit into the Eating Disorder Not Otherwise Specified category, it’s important to seek help. Please call us at (410) 427-3886 and one of our admissions coordinators would be happy to answer any questions you have about eating disorders and treatment.
Le Grange D, et al (2012). Eating disorder not otherwise specified presentation in the US population.
Int J Eat Disord. 2012 Jul;45(5):711-8.