Eating Disorder NOS: What Does This Really Mean?

Most everyone has heard of the two most common eating disorders, Anorexia Nervosa and Bulimia Nervosa. Recently binge eating disorder (BED) has been added to this list of major eating disorders. For those who do not fit into any of these categories, is another, often confusing diagnosis: Eating Disorder NOS (Not Otherwise Specified). This clinical term is misunderstood by many. What does EDNOS really mean? In this article, I will explain, as well as debunk some common misconceptions about this disorder.

When a clinician (psychologist, psychiatrist, counselor, physician, etc.) diagnoses a person with any psychological disorder, the standard reference tool is the Diagnostic and Statistical Manual of Mental Disorders, or DSM. There have been several revisions of this manual, the current one being the DSM-IV-TR (forth edition, text revision). This manual is published by the American Psychiatric Association (APA). Mental health professionals use this manual as a sort-of “cookbook” for mental illness. The DSM standardizes diagnoses so that there are fewer discrepancies among professionals. The insurance companies also like this manual, as they can understand exactly what a particular diagnosis is, and subsequently decide if they will cover treatment.

The problem with this very black-and-white approach to mental illness is that humans are not that simple. It is very difficult to place people neatly into categories. This is the issue with eating disorder specifications. Each disorder in the DSM, eating disorders included, have a list of criteria required to make a specific diagnosis. For example, to be diagnosed with Anorexia Nervosa, the patient must have and intense fear of gaining weight, refusal to maintain body weight at or above a minimally normal weight for age and height (85% of ideal body weight), disturbance in the way one’s body weight or shape is experienced, and in postmenarcheal females, amenorrhea (the absence of at least three consecutive periods) (DSM-TR-IV).

This very specific, technical list of symptoms dictates diagnosis in a patient. For example, if a young women exhibits all of the other symptoms, but has not lost her period, she can not be accurately diagnosed with Anorexia. Similarly specific guidelines describe Bulimia Nervosa. For this disorder, there are frequency of binges and duration of disorder criteria in the DSM.

So what if someone doesn’t fit neatly into one of these categories? What about the young woman who hasn’t lost her period? What about the girl who binges and purges, but only once a week, one binge short of the two-per-week cut-off for Bulimia? These individuals are still suffering from an eating disorder. For these and millions of other American women (and men), there is the term Eating Disorder Not Otherwise Specified (NOS).

The DSM-IV-TR lists examples of EDNOS:

1. For females, all of the criteria for Anorexia Nervosa are met except that the individual has regular menses.

2. All of the criteria for Anorexia Nervosa are met except that, despite significant weight loss, the individual’s current weight is in the normal range.

3. All of the criteria for Bulimia Nervosa are met except that the binge eating and inappropriate compensatory mechanisms (purging of some sort) occur at a frequency of less than twice a week or for the duration of less than 3 months.

4. The regular use of inappropriate compensatory behavior by an individual of normal body weight after eating small amounts of food (e.g., self-induced vomiting after the consumption of 2 cookies).

5. Repeatedly chewing and spitting out, but not swallowing, large amounts of food.

6. Binge-eating disorder: recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory behaviors found in Bulimia Nervosa.Note: These are the criteria listed in the DSM-IV-TR. Binge Eating Disorder is now recognized as a separate disorder. For more information, refer to my article about the recent research on BED.

The most common misconception about Eating Disorder NOS is that it is not a true disorder, or not life-threatening. EDNOS is absolutely a diagnosable disorder, as listed in the DSM. The idea that EDNOS is not serious is a dangerous myth. Any eating disorder is harmful and potentially life-threatening. This diagnosis simply means that the individual did not fit perfectly into one of the other main disorders. It has no implication on the severity of the problem.

As with any eating disorder, if you or someone you know exhibits any of these symptoms, seek advice of a physician or mental-health professional. There is a lot less research and publicity on this more common disorder (a fact that is little-known). Despite this, websites such as www.something-fishy.org and other such websites can provide helpful and valuable information. In this day of age, when eating disorders Anorexia and Bulimia are household terms, Eating Disorder Not Otherwise Specified should be equally as discussed.

Reference:

• www.something-fishy.org