The release of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) changed the definitions for certain eating disorders, including anorexia and bulimia, and added binge eating disorder. These changes allow more people suffering from these conditions to receive appropriate, evidence-based diagnoses and treatment. The DSM-5 no longer features eating disorder not otherwise specified (EDNOS); the category existed in the DSM-IV to treat those who did not meet the previously stricter qualifications for anorexia, bulimia, or binge eating disorder.
What Was EDNOS, and How Has It Changed?
Previously, individuals who had some of the characteristics of a more specific eating disorder – such as restrictive eating, overeating then purging, and excessive weight loss – without meeting enough criteria for a specific diagnosis would often receive the label EDNOS. They still struggled with disordered eating of some kind, but they were not below normal body weight, did not binge and purge very often, or continued to enjoy food while tightly controlling calories. Additionally, definitions of anorexia were geared toward women, with amenorrhea (the loss of menstrual cycles) a required aspect of the disorder. The DSM-5 removed this qualification, so boys and men who have anorexia can receive appropriate treatment rather than the more frustrating and vague EDNOS diagnosis.
Before it was removed from the DSM-5, EDNOS was the most common diagnosis for disordered eating. A meta-analysis of data from eating disorder clinics showed that between 40 percent and 60 percent of individuals seeking treatment had EDNOS as their diagnosis.
In non-specialty settings, EDNOS diagnoses were more common; one community prevalence study found that up to 75 percent of young women in one program, and 90 percent of women in an outpatient psychiatry practice, reported EDNOS diagnoses. Because of the definitions attached to anorexia and bulimia, along with societal expectations around eating disorders, more men received EDNOS diagnoses as well.
The changes to broaden the definitions of bulimia, anorexia, and binge eating disorder are very important. One meta-analysis suggested that up to 40 percent of people who were diagnosed with EDNOS developed either anorexia or bulimia within one year after the presentation of their initial eating disorder. This suggests that the original diagnosis was incorrect, and those who need eating disorder treatment can benefit from a clearer initial diagnosis and treatment plan.
Risk factors for any eating disorder, including among those formerly diagnosed with EDNOS, include:
- Being female
- Adolescence or young adulthood
- Family history of stress or eating disorders
- Mental illness
- Excessive dieting
- High-stress environment
- Pursuing a career based on image, including modeling or professional sports
The Most Common Eating Disorders
There are a variety of recognized eating disorders that include symptoms like vomiting, worry about ingesting food or gaining weight, excessive preoccupation with meals that can impact daily life, and losing weight to the point of being malnourished. Up to 3 percent of women develop some eating disorder over their lifetime; only about 10 percent of reported eating disorders of any kind involve men. Age of onset ranges from 12 to 25 years old.
- Anorexia nervosa: intentional self-starvation, which may lead to unhealthy weight loss
- Bulimia nervosa: compulsive overeating, followed by a form of purging calories to avoid gaining weight via vomiting, taking too many laxatives, or excessive exercise
- Binge eating disorder: compulsive overeating, leading to weight gain
- Other specified feeding or eating disorder (OSFED): may be assumed to have taken over for EDNOS, but there are actually several subcategories of eating disorders that fit into the larger umbrella of OSFED, including rumination disorder, avoidant or restrictive food intake, and pica
The exact cause of eating disorders is unknown, although it may be a combination of environmental stress, family history, and genetics, much like addiction disorders or mental illness.
Symptoms of EDNOS and Other Eating Disorders
Symptoms formerly associated with EDNOS can indicate a different eating disorder. Typically, these were listed as:
- Constant concern about food and calorie intake
- Excessive worry about weight gain
- Behaviors that restrict eating
- Behaviors associated with purging, including excessive exercise
- Hiding meals or eating in secret
- Binge eating behaviors, including spending too much money on food, the disappearance of large amounts of food, eating for long periods of time, or noticeable blocks of time when the person is alone
- The inability to stop worry or fear about food, and associated behaviors
- Placing foods into specific categories of “good” or “safe” and “bad”
- Changing one’s diet to consume only “good” foods, and strict avoidance and fear of “bad” foods
- Becoming a vegetarian or vegan, coupled with rapid weight loss
- Callouses on the knuckles or reddened hands due to vomiting
- Changes in eating habits, including less food in the home
- Spending more time alone, or more time exercising, than before
- Obsession with one’s image, searching for flaws or weight gain
- Obsession with weight measurements
There are many risks associated with eating disorders, including for people formerly diagnosed with EDNOS. These include:
- Inflammation of the esophagus
- Damage to the teeth due to vomiting
- Rupture of the esophagus or stomach from frequent vomiting
- Chronic constipation or diarrhea
- Osteoporosis due to low nutrition
- Irregular or slowed heartbeat
- Increased risk of heart failure
- Loss of menstruation or fertility
- Kidney damage and failure
How to Know if a Person Has an Eating Disorder
Few people will receive a diagnosis of EDNOS these days, but the broader definitions of anorexia, bulimia, and binge eating disorder may make accurate diagnoses slightly more difficult for clinicians. Still, if a person is becoming too preoccupied with food, weight loss, or health, to the point that it is intrusive in life, getting help from a physician or therapist can lead to an appropriate diagnosis and treatment plan.
Warnings signs of EDNOS included:
- Preoccupation with nutritional content
- Preoccupation with counting calories
- Eating only certain foods
- Cooking specific foods or quantities
- Denial that one is hungry
- Obsessive exercise
- Hair loss as malnutrition begins
- Feeling cold as core body temperature lowers due to insufficient calorie intake
- Menstrual irregularities
- Being unable to voluntarily stop eating
- Shame or guilt about food
- Eating until uncomfortably full
- Eating alone or in secret
When these behaviors or thoughts become intrusive; make enjoyable social activities, family life, and work difficult; or lead to malnutrition and physical harm, it is time to get help. Medical professionals can diagnose eating disorders or refer patients to specialists who can begin treatment.
It’s not too late to start over