Eating disorder not otherwise specified

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Eating Disorder Not Otherwise Specified (EDNOS)
Classification and external resources
ICD-10 F50.9
ICD-9 307.50

Eating disorder not otherwise specified (EDNOS) is an eating disorder that does not meet the criteria for anorexia nervosa or bulimia nervosa.[1] 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: subthreshold 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.[2]

Many people think that this type of eating disorder is not as serious compared to anorexia and bulimia. However, that is not the case because 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.[3]

As EDNOS was initially thought to be rare, and as 5 of the 6 proposed DSM-5 EDNOS presentations are well-defined, it seems likely that the "residual" (undefined) presentation accounts for most of the 40% of eating disorder cases diagnosed as EDNOS. Research is required into how many of these "residual" EDNOS diagnoses were eventually replaced by that of a recognised medical condition, whether psychologically or organically caused. While all organic causes should be ruled out prior to making a diagnosis of an eating disorder, in practice this is difficult as many physical conditions can also result in low weight, and may develop over time.[citation needed]

Characteristics[edit]

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:[4]

  1. Meet all criteria for anorexia nervosa except have regular menstrual cycles
  2. Meet all criteria for anorexia nervosa except their weight falls within the normal range
  3. 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
  4. Purge after eating small amounts of food while retaining a normal body weight
  5. Repeatedly chew and spit out large amounts of food without swallowing
  6. Meet criteria for binge eating disorder

Epidemiology[edit]

Although EDNOS (formerly called “atypical eating disorder”) was originally introduced in DSM-III to capture unusual cases,[5] it is now the most commonly diagnosed eating disorder. In addition, EDNOS was found to have a higher prevalence than other eating disorders.[6] Specifically, EDNOS accounts for approximately 40%[7] to 60%[8][9][10][11] of cases in eating disorder specialty clinics, and up to 90% of eating disorder diagnoses conferred in non-specialty psychiatric settings.[12] 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.[13] 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%.[14] While in Spain, the prevalence of EDNOS ranged from 1.3% to 4.04%.[6] 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.[15][16]

Presentation and course[edit]

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.[17] 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.[17]

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[18] to two years.[19]

Medical complications[edit]

The many 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:

[23] A person cannot be diagnosed with having both anorexia nervosa (AN) and bulimia nervosa (BN), and when a person shows tendencies to one or the other or both, is said to have an eating disorder not otherwise specified (EDNOS). Some patients are on the verge of AN, but they do not meet all the AN symptoms, such as missed periods and extreme weight loss. Other patients may be of normal weight but they still do things seen in BN; they either binge with no purging a few days a week, or simply purge without binging so they can’t be completely categorize with BN.Those who neglect getting treatment for EDNOS could easily develop AN or BN.

People suffering with either AN, BS or EDNOS consecutively, may already have or develop psychiatric disorders, such as substance abuse, obsessive compulsive disorders (OCD) become extremely depressed, anxious, develop anger episodes, mood swings and bi-polar tendencies.

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.

In one study a high number of men with eating disorders, including those with EDNOS, had comorbidity disorders, meaning that they have more than one underlying health condition associated with or separate to their unhealthy eating habits.[24]

EDNOS Diagnosis[edit]

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.[25] 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.[26]

Changes made in the DSM-5[edit]

Cover of DSM 5 (Image Credit: Yoshikia2001)

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:

  1. 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
  2. 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
  3. 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
  4. Purging Disorder (PD) in which patients purge without binging; they consume a normal amount of food and typically maintain normal weight
  5. Night Eating Syndrome (NES) in which patients have nocturnal eating episodes, or eat a large proportion of their daily calorie intake after dinner
  6. 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 [27]

References[edit]

  1. ^ Christopher G. Fairburn and Kristin Bohn (June 2005). "Eating disorder NOS (EDNOS): an example of the troublesome "not otherwise specified" (NOS) category in DSM-IV". Behaviour Research and Therapy 43 (6): 691–701. doi:10.1016/j.brat.2004.06.011. PMC 2785872. PMID 15890163. 
  2. ^ Fairburn, Christopher G.; Bohn, Kristin (2005). "Eating disorder NOS (EDNOS): An example of the troublesome "not otherwise specified" (NOS) category in DSM-IV". Behaviour Research and Therapy 43 (6): 691–701. doi:10.1016/j.brat.2004.06.011. PMC 2785872. PMID 15890163. 
  3. ^ "Eating Disorder Not Otherwise Specified (EDNOS)". National Alliance of Mental Illness. 
  4. ^ American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association. [page needed]
  5. ^ American Psychiatric Association (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: American Psychiatric Association. [page needed]
  6. ^ a b Sancho, C.; Arija, M.V; Asorey, O.; Canals, J. (December 2007). "Epidemiology of Eating Disorders". European Child and Adolescent Psychiatry 16 (8): 495–504. 
  7. ^ Button, Eric J.; Benson, Elizabeth; Nollett, Nollett; Palmer, Robert L. (2005). "Don't forget EDNOS (eating disorder not otherwise specified): Patterns of service use in an eating disorders service". Psychiatric Bulletin 29 (4): 134–6. doi:10.1192/pb.29.4.134. 
  8. ^ Fairburn, Christopher G.; Cooper, Zafra; Bohn, Kristin; O’Connor, Marianne E.; Doll, Helen A.; Palmer, Robert L. (2007). "The severity and status of eating disorder NOS: Implications for DSM-V". Behaviour Research and Therapy 45 (8): 1705–15. doi:10.1016/j.brat.2007.01.010. PMC 2706994. PMID 17374360. 
  9. ^ Martin, Corby K.; Williamson, Donald A.; Thaw, Jean M. (2000). "Criterion validity of the multiaxial assessment of eating disorders symptoms". International Journal of Eating Disorders 28 (3): 303–10. doi:10.1002/1098-108X(200011)28:3<303::AID-EAT7>3.0.CO;2-I. PMID 10942916. 
  10. ^ Nollett, C. L.; Button, E. J. (2005). "Questionnaire measures of psychopathology in eating disorders: Comparisons between clinical groups". European Eating Disorders Review 13 (3): 211–5. doi:10.1002/erv.632. 
  11. ^ Turner, Hannah; Bryant-Waugh, Rachel (2004). "Eating disorder not otherwise specified(EDNOS): Profiles of clients presenting at a community eating disorder service". European Eating Disorders Review 12: 18–26. doi:10.1002/erv.552. 
  12. ^ Zimmerman, Mark; Francione-Witt, Caren; Chelminski, Iwona; Young, Diane; Tortolani, Christina (2008). "Problems Applying the DSM-IV Eating Disorders Diagnostic Criteria in a General Psychiatric Outpatient Practice". The Journal of Clinical Psychiatry 69 (3): 381–4. doi:10.4088/JCP.v69n0306. PMID 18348598. 
  13. ^ Le Grange, Daniel; Swanson, Sonja A.; Crow, Scott J.; Merikangas, Kathleen R. (2012). "Eating disorder not otherwise specified presentation in the US population". International Journal of Eating Disorders 45 (5): 711–8. doi:10.1002/eat.22006. PMID 22407912. 
  14. ^ Götestam, K. Gunnar; Agras, W. Stewart. "General population-based epidemiological study of eating disorders in Norway". International Journal of Eating Disorders 18 (2): 119–126. doi:10.1002/1098-108X(199509)18:2<119::AID-EAT2260180203>3.0.CO;2-U. Retrieved 12 October 2014. 
  15. ^ Becker, Anne E.; Thomas, Jennifer J.; Pike, Kathleen M. (2009). Walsh, B. Timothy, ed. "Should non-fat-phobic anorexia nervosa be included in DSM-V?". International Journal of Eating Disorders 42 (7): 620–35. doi:10.1002/eat.20727. PMID 19655370. 
  16. ^ Thomas, J. J.; Crosby, R. D.; Wonderlich, S. A.; Striegel-Moore, R. H.; Becker, A. E. (2010). "A latent profile analysis of the typology of bulimic symptoms in an indigenous Pacific population: Evidence of cross-cultural variation in phenomenology". Psychological Medicine 41 (1): 195–206. doi:10.1017/S0033291710000255. PMID 20346191. 
  17. ^ a b Thomas, Jennifer J.; Vartanian, Lenny R.; Brownell, Kelly D. (2009). "The relationship between eating disorder not otherwise specified (EDNOS) and officially recognized eating disorders: Meta-analysis and implications for DSM". Psychological Bulletin 135 (3): 407–33. doi:10.1037/a0015326. PMC 2847852. PMID 19379023. 
  18. ^ Milos, Gabriella; Spindler, Anja; Schnyder, Ulrich; Fairburn, Christopher G. (2005). "Instability of eating disorder diagnoses: Prospective study". The British Journal of Psychiatry 187 (6): 573–8. doi:10.1192/bjp.187.6.573. PMC 2710504. PMID 16319411. 
  19. ^ Herzog, David B.; Hopkins, Julie D.; Burns, Craig D. (1993). "A follow-up study of 33 subdiagnostic eating disordered women". International Journal of Eating Disorders 14 (3): 261–7. doi:10.1002/1098-108X(199311)14:3<261::AID-EAT2260140304>3.0.CO;2-N. PMID 8275062. 
  20. ^ "Osteoporosis in women with eating disorders: comparison of physical parameters, exercise, and menstrual status with SPA and DPA evaluation." 31 (3). March 1990. pp. 325–31. PMID 2308003. 
  21. ^ Turner, Hannah; Peveler, Robert (April 2005). "Eating disorders and type 1 diabetes mellitus". Psychiatry 4 (4): 30–33. doi:10.1383/psyt.4.4.30.63442. 
  22. ^ Johansson, Ann-Katrin; Norring, Claes; Unell, Lennart; Johansson, Anders (2012). "Eating disorders and oral health: a matched case-control study". European Journal of Oral Sciences 120 (1): 61–68. doi:10.1111/j.1600-0722.2011.00922.x. 
  23. ^ "Position of the American Dietetic Association: Nutrition Intervention in the Treatment of Anorexia Nervosa, Bulimia Nervosa, and Eating Disorders not Otherwise Specified (EDNOS)". ournal of the American Dietetic Association 101 (7): Pages 810–819. July 2001. doi:10.1016/S0002-8223(01)00201-2. Retrieved March 2003. 
  24. ^ Valls, M; Callahan, S; Rousseau, A; Chabrol, H (Jun 2014). "Eating disorders and depressive symptoms: An epidemiological study in a male population". ENCEPHALE-REVUE DE PSYCHIATRIE CLINIQUE BIOLOGIQUE ET THERAPEUTIQUE 40 (3): 223–230. doi:10.1016/j.encep.2013.05.003. 
  25. ^ Ranson, K M von. "Eating Disorder Not Otherwise Specified". www.go.galegroup.com. V.S. Ramachandram. Retrieved 30 October 2014. 
  26. ^ Le Grange D. "A Closer Look at Eating Disorder Not Otherwise Specified (EDNOS)". www.eatingdisorder.org. Retrieved 30 October 2014. 
  27. ^ American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013. Web. [access date: 18 October 2014]. dsm.psychiatryonline.org

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