Classification of Eating disorder not otherwise specified (EDNOS)

Eating disorder not otherwise specified (EDNOS) involves disordered eating patterns. EDNOS is described in the DSM-IV-TR as a “category [of] disorders of eating that do not meet the criteria for any specific eating disorder”.

This category is frequently used for people who meet some, but not all, of the diagnostic criteria for anorexia nervosa, bulimia nervosa or binge eating disorder. For example, a person who shows almost all of the symptoms of anorexia nervosa, but who still has a normal menstrual cycle and/or body mass index, can be diagnosed with EDNOS. Or someone that restricts and shows most of the symptoms of anorexia but has occasional episodes of bingeing without purging. A sufferer may experience episodes of bingeing and purging, but may not do so frequently enough to warrant a diagnosis of bulimia nervosa. A person may also engage in bingeing episodes without the use of inappropriate compensatory behaviors; this is referred to as binge eating disorder.

People diagnosed with EDNOS may frequently switch between different eating patterns, or may with time fit all diagnostic criteria for anorexia or bulimia.

People who eat a normal amount of food, but become exceedingly obsessed with healthy eating, or strictly categorize normal foods or entire food groups as “safe” and “off-limits”, may be referred to as having orthorexia. However, this diagnosis is not formally accepted by the psychiatric community.

Eating Disorder Not Otherwise Specified (EDNOS) refers to disordered eating that falls outside of the main categories of eating disorders: Anorexia Nervosa and Bulimia Nervosa. The main types of categorized EDNOS are Binge Eating Disorder (BED), Sub threshold Anorexia Nervosa (SAN) and Sub threshold Binge Eating Disorder (SBED). Although these are the main subcategories, there are many other types of disordered eating that would fall under “EDNOS.” The causes of EDNOS are similar to that of Anorexia Nervosa and Bulimia Nervosa. It is a combination of both environmental and biological factors. In order to diagnose EDNOS first the clinicians must evaluate that the patient has an eating disorder, then the exclusion of Anorexia Nervosa and Bulimia Nervosa must be done. There are currently no positive indications of EDNOS for diagnosis. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) is responsible for categorizing eating disorders and currently is under re-evaluation due to the prevalence of EDNOS. Right now, the DSM has criteria for BED but no other type of EDNOS has DMS status.

Other Qualifications for EDNOS

The examples of EDNOS as given by the DSM-IV TR are for females, all of the criteria for Anorexia Nervosa are met except that the individual has regular menses. 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. All of the criteria for Bulimia Nervosa are met except that the binge eating and inappropriate compensatory mechanisms occur at a frequency of less than twice a week or for a duration of less than 3 months. 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 two cookies.

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 characteristic of Bulimia Nervosa

It’s hard to gauge the prevalence of EDNOS because it has not been has heavily studied as other eating disorders, however some statistics have been found. EDNOS is most common in females, however among those who do have EDNOS, the number of binge eaters are equal between males and females. EDNOS is the most common eating disorder compared to Anorexia Nervosa and Bulimia Nervosa. 80.97% of adolescents and 75.38% of adults with eating disorders have either EDNOS alone or another type of eating disorder and EDNOS. For adolescents, SBED is the most common type of EDNOS followed by BED and SAN. For adults, BED is the most common type of EDNOS followed by SAN then SBED. Individuals who are diagnosed with EDNOS show more signs of mood disorders compared to anorexia nervosa. EDNOS is the most prevalent eating disorder in America, with an estimated prevalence rate of 4-6% compared to 2-3% for bulimia and 1% for anorexia, and makes up 50-70% of diagnosed cases of eating disorders. The suffering of EDNOS exists on a spectrum, and is as serious of an eating disorder as anorexia or bulimia. In one study published by the American Journal of Psychiatry, the mortality rate of EDNOS was found to be 5.2%, compared to 3.9% for bulimia and 4.0% for anorexia

Controversy Surrounding the EDNOS Diagnosis

The authors of the DSM-IV claim the EDNOS category was “intended to be a residual category…for rare cases” and that the high prevalence of EDNOS “suggests a problem with the DSM-IV nomenclature for this class of disorders”. Because of the high prevalence rates and it’s use as a “catch-all” diagnosis, EDNOS is not considered as seriously by health insurance agencies, and many of them do not cover their treatment as they would for anorexia and bulimia. EDNOS is criticized to be too wide of a diagnosis, and including a wide variety of disorders makes finding one traditional treatment model nearly impossible. Proposed solutions to this problem include making the separate diagnosis of anorexia nervosa and bulimia nervosa less stringent

The Future of EDNOS; DSM-V, Proposed

Due to the criticisms of the EDNOS diagnosis being to broad, it is seen in the proposed revision of the DSM-V that EDNOS has been greatly broken down into separate, narrower, categories . Whereas before, eating disorders included only the diagnosis (and then subtypes) of anorexia nervosa, bulimia nervosa, and EDNOS, there is now seen to be the additions of Pica, Rumination Disorder, Avoidant/Restrictive Food Intake Disorder, Other Specified Feeding or Eating Disorder, and Unspecified Feeding or Eating Disorder. All of these additional disorders used to be categorized as EDNOS, though they may have had a name before (Ex: Someone with pica would be said to have pica, but be diagnosed with EDNOS). Binge eating disorder, a previous example of EDNOS, is now seen to be its own diagnosis. The core diagnosis of pica is “Persistent eating of non-nutritive, non-food substances over a period of at least 1 month,“ such as a teenager obsessively eating chalk (among other foods), or even her own hair, for a month or longer.

Rumination disorder is characterized as “repeated regurgitation of food over a period of at least 1 month. Regurgitated food may be re-chewed, re-swallowed, or spit out,” and includes a lesser known condition previously referred to as “chew-and-spit”.

The major criteria for avoidant/restrictive food intake disorder is given as: An “Eating or feeding disturbance (including but not limited to apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; or concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one or more of the following:
1. Significant weight loss (or failure to gain weight or faltering growth in children);
2. Significant nutritional deficiency;
3. Dependence on enteral feeding;
4. Marked interference with psychosocial functioning.”

Though similar to classic anorexia nervosa, this disorder is very different, the primary difference being a lack of preoccupation with thinness or body image. The new EDNOS is proposed to be a category called Other Specified Feeding or Eating Disorder, under which multiple conditions, both old and new, are included. These include atypical anorexia nervosa (all criteria for AN but still has a normal BMI), sub-threshold bulimia nervosa (all criteria for BN except less than once a week or under three months), sub-threshold binge eating disorder (all criteria for BED except less than once a week or under three months), purging disorder (inappropriate compensatory behavior without excessive eating), and night eating syndrome (repeatedly engaging in night eating, episodes which are not forgotten the next day). The last condition under Other Specified Eating or Feeding Disorder is Other Feeding or Eating Disorder Not Elsewhere Classified, a last “residual category” of EDNOS. There are currently no proposals for the criteria of Unspecified Feeding and Eating Disorders .

References

1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author. Web. 5 Oct 2010.

2. Anderson, Pauline. “Mortality From “Mild” Eating Disorders Greater Than Rates for Anorexia and Bulimia.” Medscape Today. WebMD, 23 Oct. 2009. Web. 10 Dec. 2010.

3. Mellace, Jennifer. “Eating Disorders Not Otherwise Specified: Real Disorders, Real Risks.” Social Work Today July-Aug. 2010: 14. Social Work Today. Great Valley Publishing Co., Inc., July-Aug. 2010. Web. 10 Dec. 2010.

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