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The DSM-5 Eating Disorders Work Group has made several revisions to the diagnostic criteria, which they hope will reduce the reliance on EDNOS in clinical settings, and promote treatment-seeking and research among affected individuals. The DSM-5, published in May 2013, expands the diagnostic criteria for anorexia nervosa and bulimia nervosa, and elevates binge eating disorder to a formally recognized diagnosis. Furthermore, DSM-5 renames the EDNOS category Feeding or Eating Disorder Not Elsewhere Classified (FEDNEC), and provides the following named descriptions of example presentations:
The DSM-5 Eating Disorders Work Group has made several revisions to the diagnostic criteria, which they hope will reduce the reliance on EDNOS in clinical settings, and promote treatment-seeking and research among affected individuals. The DSM-5, published in May 2013, expands the diagnostic criteria for anorexia nervosa and bulimia nervosa, and elevates binge eating disorder to a formally recognized diagnosis. Furthermore, DSM-5 renames the EDNOS category Other Specified Feeding or Eating Disorder, and provides the following named descriptions of example presentations:
# Atypical Anorexia Nervosa in which all criteria for anorexia nervosa are met except that the individual’s weight is within or above the normal range
# Atypical Anorexia Nervosa in which all criteria for anorexia nervosa are met except that the individual’s weight is within or above the normal range
# Subthreshold Bulimia Nervosa (low frequency or limited duration) in which all criteria for bulimia nervosa are met except the binge eating and compensatory behaviors occur on average less than once a week and for less than 3 months
# Subthreshold Bulimia Nervosa (low frequency or limited duration) in which all criteria for bulimia nervosa are met except the binge eating and compensatory behaviors occur on average less than once a week and for less than 3 months
Eating disorder not otherwise specified (EDNOS) is an eating disorder that does not meet the criteria for anorexia nervosa or bulimia nervosa. Thus, individuals who have clinically significant eating disorders that do not meet DSM-V criteria for anorexia nervosa or bulimia nervosa are diagnosed with EDNOS. Individuals with EDNOS usually fall into one of three groups: sub-threshold symptoms of anorexia nervosa or bulimia nervosa, mixed features of both disorders, or extremely atypical eating behaviors that are not characterized by either of the other established disorders.
Many people think that this type of eating disorder is not as serious compared to anorexia and bulimia. However that is not the case. More people are diagnosed with EDNOS than anorexia and bulimia combined. Also, the symptoms and behaviors of people suffering from EDNOS are similar to those that are suffering from anorexia and bulimia. People with EDNOS can face the same dangerous risk as people with anorexia and bulimia.
Eating disorders not otherwise specified is the most frequently diagnosed eating disorder in the United States. About 60% of adults that gets treatment for eating disorders are diagnosed with EDNOS. Many think that women are more likely to have eating disorders, but this is not the case. EDNOS can happen in both men and women.
Research is required into how many of these "residual" EDNOS diagnoses were eventually replaced by that of a recognized medical condition, whether psychologically or organically caused. While all organic causes should be ruled out prior to making a diagnosis of an eating disorder; it is difficult to diagnosed people with eating disorders due different factors. People with eating disorder can result in weight lost as well as mood changes. Along with clinical help, family members and friends should watch out if a loved one have for warning signs of eating disorders such as mood change or weight lost. The consequences of eating disorders can be life threatening, as it can lead to constipation, tooth decay and even cardiac problems.
Characteristics
Cover of DSM IV (Image Credit: Richard Masoner)
Rather than providing specific diagnostic criteria for EDNOS, DSM-IV lists six non-exhaustive example presentations, including individuals who:
Meet all criteria for anorexia nervosa except their weight falls within the normal range
Meet all criteria for bulimia nervosa except they engage in binge eating or purging behaviors less than twice per week or for fewer than three months
Purge after eating small amounts of food while retaining a normal body weight
Repeatedly chew and spit out large amounts of food without swallowing
Despite its subclinical status in DSM-IV, available data suggest that EDNOS is no less severe than the officially recognized DSM-IV eating disorders. In a comprehensive meta-analysis of 125 studies, individuals with EDNOS exhibited similar levels of eating pathology and general psychopathology to those with anorexia nervosa and binge eating disorder, and similar levels of physical health problems as those with anorexia nervosa. Although individuals with bulimia nervosa scored significantly higher than those with EDNOS on measures of eating pathology and general psychopathology, EDNOS exhibited more physical health problems than bulimia nervosa.
Importantly, an EDNOS diagnosis may presage future diagnostic crossover into officially recognized eating disorder categories. For example, 40% of individuals with EDNOS go on to develop anorexia nervosa or bulimia nervosa within one to two years.
Health problems associated with EDNOS are varied due to the heterogeneous nature of the diagnosis. They are both psychological and physical, and vary greatly in severity.
They include :
People suffering with EDNOS may have symptoms similar to those suffering with BED (Binge Eating Disorder), which entails continuous binging without vomiting afterwards.
CBT (Cognitive-behavioral therapy) may help patients recover from EDNOS. CBT consists of creating a balanced meal plan, and teaching patients about eating patterns in order to normalize them.
An EDNOS diagnosis can be described as a mixture of symptom patterns that lasts a short period of time. These symptoms can be categorized to better understand the heterogeneity of an EDNOS diagnosis. The three general categories for an EDNOS diagnosis are subthreshold symptoms of anorexia or bulimia, a mixture of both anorexia or bulimia, and eating behaviors that are not particularized by anorexia and bulimia. Thus, these symptoms describe a person who is predominantly likely to develop, or recover from, anorexia nervosa or bulimia nervosa. The symptoms an individual undergoes depends on the phase of the disorder the individual is in.
The DSM-5 Eating Disorders Work Group has made several revisions to the diagnostic criteria, which they hope will reduce the reliance on EDNOS in clinical settings, and promote treatment-seeking and research among affected individuals. The DSM-5, published in May 2013, expands the diagnostic criteria for anorexia nervosa and bulimia nervosa, and elevates binge eating disorder to a formally recognized diagnosis. Furthermore, DSM-5 renames the EDNOS category Other Specified Feeding or Eating Disorder, and provides the following named descriptions of example presentations:
Atypical Anorexia Nervosa in which all criteria for anorexia nervosa are met except that the individual’s weight is within or above the normal range
Subthreshold Bulimia Nervosa (low frequency or limited duration) in which all criteria for bulimia nervosa are met except the binge eating and compensatory behaviors occur on average less than once a week and for less than 3 months
Subthreshold Binge Eating Disorder (low frequency or limited duration) in which all criteria for binge eating disorder are met, except the binge eating occurs on average less than once a week and for less than 3 months
Purging Disorder (PD) in which patients purge without binging; they consume a normal amount of food and typically maintain normal weight
Night Eating Syndrome (NES) in which patients have nocturnal eating episodes, or eat a large proportion of their daily calorie intake after dinner
Other Feeding or Eating Condition Not Elsewhere Classified which is a residual category for all other cases that are clinically significant but do not meet the criteria for formal eating disorder diagnoses
Epidemiology
Although EDNOS (formerly called “atypical eating disorder”) was originally introduced in DSM-III to capture unusual cases, it is now the most commonly diagnosed eating disorder. In addition, EDNOS was found to have a higher prevalence than other eating disorders. Specifically, EDNOS accounts for approximately 40% to 60% of cases in eating disorder specialty clinics, and up to 90% of eating disorder diagnoses conferred in non-specialty psychiatric settings. The lifetime prevalence of EDNOS in the National Comorbidity Survey Replication, a large epidemiological study that interviewed a nationally representative sample of U.S. residents, was 4.64% among adults and 4.78% among adolescents. In addition, in a study based on a questionnaire regarding eating disorders sampled Norway's general female population and found that EDNOS had a lifetime prevalence of 3.0%. While in Spain, the prevalence of EDNOS ranged from 1.3% to 4.04%. EDNOS is an especially prevalent category in populations that have received inadequate research attention such as young children, males, ethnic minorities, and non-Western groups.
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