Eating Disorder Not Otherwise Specified (ED NOS)
What is it?
Eating disorders are very complex and there can be many variations in the standard signs and symptoms and not all of these will apply to all people. Eating Disorder Not Otherwise Specified category is for people who do not meet the strict criteria for either Anorexia or Bulimia Nervosa, but who have significant concerns about eating and body image. According to the DSM-IV (Diagnostic and Statistical Manual, Volume 4) which provides guidelines and criteria for mental disorders the Eating Disorder Not Otherwise Specified category (EDNOS) is for disorders of eating that do not meet the strict criteria for any specific Eating Disorder.
Examples include:
- For females, all the criteria for Anorexia Nervosa are met except that the individual has normal or irregular menstruation.
- All the criteria for Anorexia Nervosa are met except that, despite significant weight loss, the individual’s current weight is in the normal range.
- All 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.
- An individual of normal body weight is engaging in the regular use of inappropriate compensatory behaviour after eating small amounts of food
- Repeatedly chewing and spitting out, but not swallowing, large amounts of food.
- Binge-eating disorder: recurrent episodes of binge eating without the regular use of inappropriate compensatory behaviours characteristic of Bulimia Nervosa.
These examples above illustrate the variety of ways in which disordered eating can look when a person has EDNOS, but it is by no means an exhaustive list and does not provide a complete picture of the very many different ways that eating disorder symptoms can occur.
Effects of EDNOS
It is important to remember that whilst EDNOS is not a clinical definition, those with EDNOS are not immune to suffering and often times need just as much help and assistance as someone with any other eating disorder. The “not otherwise specified” tag often wrongly suggests to people that these disorders are not as important or as serious as the more common place eating disorders. There are more individuals that suffer from EDNOS than from bulimia and anorexia combined, and the risks associated with having EDNOS are often just as profound.
Individuals with EDNOS who are losing weight and restricting their caloric intake often report the same fears and obsessions as patients with anorexia. They may be excessively driven to be thin, have very negative body image, restrict their caloric intake and may eventually suffer the same psychological, physiological and social consequences of anorexic sufferers. Those who binge and/or purge, also usually report the same concerns as people with bulimia, namely purging to control their weight, fear of losing control over their eating and becoming addicted to binging and/or purging as a coping strategy. People with EDNOS draw many parallels to those with anorexia or bulimia, and are just as likely to need specialised treatment.
Individuals with EDNOS are at risk for the many medical consequences of other eating disorders, such as anorexia or bulimia, depending on the symptoms they have. Those who binge and purge are party to the risks similar to bulimia in that they can severely damage their bodies, sometimes irreversibly. EDNOS may cause electrolyte imbalance and dehydration which can lead to cardiac complications, stomach rupture and very occasionally, sudden death. Those with EDNOS whose behaviours include restriction of food may have low blood pressure, a slower heart rate, hormone disturbance, issues with bone growth, alongside the significant mental and emotional problems.
What causes EDNOS?
EDNOS effects both men and women. As with other eating disorders that have been more widely studied, the cause of EDNOS is most likely a combination of environmental and biological factors. Whilst each individual may feel their issues surrounding food and weight are unique, they are often surprised to discover that other people have similar obsessions, fears, and self-hatred. Although every individual has their own reasons and triggers, the role of factors such as self esteem, family relationships, peer pressure, the media and dieting culture are often significant to the development of the condition.
How is Ednos treated?
Unfortunately, treatment studies specifically for EDNOS are rare, possibly due to the complexity of the condition. Cognitive-behavioural therapy, either in a group setting or individual therapy session, has been shown to benefit many people with bulimia and therefore could be applicable to those with EDNOS who binge or purge. It focuses on self-monitoring of eating and purging behaviors as well as changing the distorted thinking patterns associated with the disorder. Cognitive-behavioral therapy is often combined with nutritional counseling and/or antidepressant medication.
Treatment plans should be adapted to meet the needs of the individual, but usually a comprehensive treatment plan involving a variety of experts and approaches is best. It is important to take an approach that involves developing support for the person with an eating disorder and looking at the potential causes and triggers of the disorder.
References:
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th Ed.) United States of America: American Psychiatric Association.
