Tuesday, September 12, 2006


Eating Disorder Not Otherwise Specified (EDNOS) is a clinical eating disorder that captures eating-disordered thoughts, feelings, and behavior that do not meet full criteria for Anorexia Nervosa or Bulimia Nervosa. While no specific criteria distinguish this diagnosis, the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM IV-TR) offers the following examples of symptoms that would warrant a clinical diagnosis:

1. For females, all of the criteria for Anorexia Nervosa are met except that the individual has regular menses.
2. All of the criteria for Anorexia Nervosa are met except that, despite significant weight loss, the individual’s current weight is in the normal range.
3. All of 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 three months.
4. The regular use of inappropriate compensatory behavior by an individual of normal body weight after eating small amounts of food (e.g., self-induced vomiting after the consumption of two cookies).
5. Repeatedly chewing and spitting out, but not swallowing, large amounts of food.
6. Binge-eating disorder: recurrent episodes of binge eating in the absence of the regularly use of inappropriate compensatory behaviors characteristic of Bulimia Nervosa.
DrStaceyny’s input (by number):
1. One of the required symptoms for a diagnosis of anorexia is that you present with amenorrhea (having no menstrual period for at least three months). So, if you meet all other criteria for anorexia (less than or equal to 85% of what you should weigh, fears of gaining weight, body-image disturbance), but are still getting your period, your diagnosis would likely be EDNOS.
2. The first criterion for anorexia is “refusal to maintain body weight at or above a minimally normal weight for age and height.” This is often translated to the 85% rule stated above. However, some people might have started out at a heavier weight, and thus, even if they lose lots of weight, they’re actually not below “normal” weight expectations.
3. Think of this one as less-frequent bulimia—there is bingeing and purging, but not at the same rate (or for the same duration) as what would be required for a bulimia diagnosis.
4. This example captures those who don’t, by definition, binge, but who still rely on compensatory strategies (vomiting, laxative use) following even small amounts of food consumption (sometimes referred to as “purging disorder”).
5. Pretty straight-forward.
6. Binge Eating Disorder is, as of now, what’s called a “criteria set.” The American Psychiatric Association has recognized the condition as one which warrants further empirical attention, and it’s quite possible, that by the next revision of the DSM (supposedly in 2010), Binge Eating Disorder will be recognized as its own diagnosable (read: reimbursable) condition. Other disorders similarly on deck include: Premenstrual Dysphoric Disorder (now coded under a type of depression), Mixed Anxiety-Depressive Disorder, and Caffeine Withdrawal.

The list of six examples given above is not intended to be a comprehensive list of all of the symptom constellations that might qualify as EDNOS. Symptom presentations, as individual, may vary, and it is important to recognize that for those who suffer from EDNOS, this is a serious condition no less painful, no less subjectively detrimental, no less of a personal hell than anorexia or bulimia. While it is likely that EDNOS is not as fatal as anorexia or bulimia, EDNOS can still cause substantial ruin. EDNOS can ruin your self-concept. It can ruin relationships. It can ruin your work and your interests. It can still ruin. . . you.


PalmTreeChick said...

Great post, Doc! IF I were to diagnose myself (you didn't know I had a phd, did ya;) I'd say that I have an EDNOS. I've know about EDNOS and though it is considered an eating disorder, I still kind of think of it as being "fake." It's hard for me to explain. I guess I feel like I don't really had an ed because I'm not underweight and I still get my period. So, because I am physically healthy I feel like I don't have a problem. Obviously the obsessiveness and all the mental aspects of an eating disorder are there, and some of my actions. So, I get the diagnosis of EDNOS. But, I still feel like I don't really have an ed.

Your last paragraph was very strong though, Stacey. Thanks for posting. I may have more to say on this later, when I'm not as rushed.

drstaceyny said...

ptc--it's very real, as you know (at some level). Thanks for writing. . .

Haley-O said...

So, basically, every woman has an eating disorder. ;)

Haley-O said...

I personally think that eating disorders (in some forms, anyway) are a class of OCD or manifestations of gross anxiety disorder. I'm not a psychiatrist, but this is what I've learned from my own experience of going from weight obsession to out-of-control obsession/anxiety (when I became pregnant).

drstaceyny said...

haley--; )

There is a large overlap b/w e.d.'s and anxiety. Many of the e.d. thoughts and behaviors (similar to OCD presentations) can be interpreted as a way to avoid deeper and more difficult emotions.

TeleTechGeek said...

This is always such a hard diagnosis to read. It feels awful to me that I've just become Not Otherwise Specified.

I guess on some level it was a childish mentality to assume I might be able to continually warrent the kind of worry- to summon doctors and parents and shrinks with a waive of a rather bony hand. It hurts that I can't.

Ednos might be physically less threatening, but I personally think it might actually be more emotionally difficult. Now in addition to having a body I've always assumed resembled a manatee, I'm just not physically sick enough either.

Rough times.