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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.
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:
The most common diagnosed eating disorders are:
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 formerly associated with EDNOS can indicate a different eating disorder. Typically, these were listed as:
There are many risks associated with eating disorders, including for people formerly diagnosed with EDNOS. These include:
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.
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