Eating disorder not otherwise specified
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|Eating Disorder Not Otherwise Specified (EDNOS)|
Eating disorder not otherwise specified (EDNOS) is an eating disorder that is no longer recognized in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM). In 2013, it was replaced by other specified feeding or eating disorder (OSFED) in DSM-5.
Eating disorder not otherwise specified is an eating disorder that does not meet the criteria for: anorexia nervosa or bulimia nervosa.  Individuals with EDNOS usually fall into one of three groups: sub-threshold symptoms of anorexia or bulimia, mixed features of both disorders, or extremely atypical eating behaviors that are not characterized by either of the other established disorders.
People with EDNOS have similar symptoms and behaviors to those with anorexia and bulimia, and can face the same dangerous risks.
Signs and symptoms
Rather than providing specific diagnostic criteria for EDNOS, the fourth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) listed six non-exhaustive example presentations, including individuals who:
- Meet all criteria for anorexia nervosa except they have regular menses.
- 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.
- Use inappropriate compensatory behavior (such as purging, excessive exercise, or fasting) after eating small amounts of food while retaining a normal body weight.
- Repeatedly chew and spit out large amounts of food without swallowing.
- Meet criteria for "binge eating disorder": recurrent binge eating and no regular inappropriate compensatory behaviors.
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, those with EDNOS exhibited more physical health problems than those with bulimia nervosa.
The three general categories for an EDNOS diagnosis are subthreshold symptoms of anorexia or bulimia, a mixture of both anorexic or bulimic symptoms, and clinically-significant disordered eating behaviors that are not described by anorexia and bulimia.[medical citation needed] EDNOS is no longer considered a diagnosis in DSM-5. Because some diagnostic criteria were loosened and new diagnoses were introduced in DSM-5, those displaying symptoms of what would previously have been considered EDNOS are now classified under Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, Other Specified Feeding or Eating Disorder, or Unspecified Feeding or Eating Disorder.
Although EDNOS (formerly called atypical eating disorder) was originally introduced in DSM-III to capture unusual cases, it accounts for up to 60% of cases in eating disorder specialty clinics. 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.
- Fairburn, CG; Bohn, K (June 2005). "Eating disorder NOS (EDNOS): an example of the troublesome "not otherwise specified" (NOS) category in DSM-IV". Behav Res Ther. 43 (6): 691–701. doi:10.1016/j.brat.2004.06.011. PMC 2785872. PMID 15890163.
- "Eating Disorder Not Otherwise Specified (EDNOS)". National Alliance of Mental Illness. Retrieved December 21, 2014.
- Thomas JJ, Vartanian LR, Brownell KD (May 2009). "The relationship between eating disorder not otherwise specified (EDNOS) and officially recognized eating disorders: meta-analysis and implications for DSM". Psychol Bull. 135 (3): 407–33. doi:10.1037/a0015326. PMC 2847852. PMID 19379023.
- American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.
- Aouad, Phillip; Hay, Phillipa; Soh, Nerissa; Touyz, Stephen (2016-01-01). "Chew and Spit (CHSP): a systematic review". Journal of Eating Disorders. 4 (1): 23. doi:10.1186/s40337-016-0115-1. ISSN 2050-2974. PMC 4994215. PMID 27555914.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- American Psychiatric Association (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: American Psychiatric Association.[page needed]
- Becker AE, Thomas JJ, Pike KM (November 2009). "Should non-fat-phobic anorexia nervosa be included in DSM-V?". Int J Eat Disord. 42 (7): 620–35. doi:10.1002/eat.20727. PMID 19655370.