Eating disorder not otherwise specified (EDNOS) is a term used by the American Psychiatric Association to describe dangerous or medically counterproductive eating behaviors that don’t match the official definitions established for the disorders anorexia nervosa and bulimia nervosa. Over 50 percent of all Americans with an eating disorder have some form of EDNOS, and the problems grouped under this label can have health implications that are just as severe as those associated with bulimia and anorexia. Since EDNOS is a collection of conditions, doctors can’t rely on an established protocol for effective treatment. However, certain steps can potentially help an affected individual recover good health.
Understanding an EDNOS Diagnosis
In the U.S., the American Psychiatric Association has the responsibility for creating the official definitions for specific eating disorders, as well as the definitions for all other disorders that have a harmful impact on sound mental health. Periodically, members of the Association hold meetings to review the latest verifiable scientific information and decide whether or not to update, eliminate, or otherwise alter the disorder definitions currently in use. They publish the results of this review in a comprehensive document called the “Diagnostic and Statistical Manual,” or DSM.
According to the most current DSM available in 2012, known as DSM-IV, anorexia and bulimia are the two classic, clearly defined eating disorders that doctors in America can officially diagnose. Generally speaking, anorexia involves a distorted body image, an obsessive fear of weight gain, and a severe restriction in calorie intake designed to prevent weight gain. Bulimia involves similar underlying motivations, but typically manifests as incidents of excessive food intake (binging) followed by incidents of food purging through methods such as vomiting (regurgitation) and laxative abuse.
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DSM-IV sets the bar for anorexia and bulimia diagnoses pretty high. If you have some of the key symptoms of these disorders, but not others, your doctor will probably make an EDNOS diagnosis. Because of this method of diagnosis, the only thing all people with EDNOS technically have in common is the fact that they don’t officially have either bulimia or anorexia. In reality, people with EDNOS frequently have conditions that strongly resemble these officially defined disorders. For instance, people with the most well known eating disorder not otherwise specified—known as binge eating disorder—take in excessive amounts of calories just like people with bulimia. The two conditions differ because people with binge eating disorder don’t try to purge food from their systems. Like bulimia and anorexia, binge eating disorder and other forms of EDNOS can have catastrophic health consequences.
Unfortunately, because of the predominance of anorexia and bulimia in both the DSM and ongoing research efforts, general physicians and mental health professionals have not dedicated very many resources for the treatment of the various forms of EDNOS. In part, this treatment gap is understandable, since an EDNOS diagnosis does not require the identification of a specific collection of symptoms in any given patient. Still, because EDNOS-related symptoms frequently mirror those found in anorexia or bulimia to some degree, doctors addressing an unspecified eating disorder can often use some of the same techniques used to help anorexics and bulimics recover their health.
Forms of psychotherapy used in these circumstances may include cognitive behavioral therapy (CBT), which focuses on learning healthy mental reactions to stressful situations; interpersonal therapy, which emphasizes learning new ways to relate socially to others; and dialectic behavior therapy, which features aspects of both CBT and interpersonal therapy. Although no medications have been specifically developed to treat any form of EDNOS, doctors sometimes take medications meant for other purposes and adapt their use as necessary. Examples of medications used in this way include a class of antidepressants called tricyclic antidepressants; a separate class of antidepressants, known as SSRIs (selective serotonin reuptake inhibitors); and a drug called topiramate (Topomax), which is usually employed in the treatment of serious seizures.
In addition to these steps, effective recovery from any form of EDNOS also typically includes ongoing input from a registered nutritionist who has practical experience dealing with eating disorders. Depending on individual circumstances, this input may include general instruction in healthy eating habits; personalized instruction that gradually addresses specific nutrition-related concerns; and a review of daily eating routines designed to detect any behaviors that can lead to an eating disorder relapse. Other common components of an effective plan for EDNOS recovery include participation in some form of regular exercise and increased participation in activities that decrease the likelihood of serious social isolation.