Eating disorders are becoming more complex. Researchers and treatment professionals aren't really sure what's behind this increasing complexity, although it's often suggested that a thin-obsessed media and heightened digital access to endless information about diet, exercise and achieving the "perfect body" are -- at least in part -- fueling creativity in disordered thoughts and behaviors. This complexity means that the women, men and children with eating disorders are presenting with more medical and psychiatric comorbidities, and associated behaviors and phobias are often more severe.[1]
A byproduct of this evolving eating disorders pathology came in the early '90s when the mental health community acknowledged that the two official eating disorders diagnoses currently in place, anorexia nervosa and bulimia nervosa, were inadequate to describe the diverse presentation of individuals with disordered eating and related issues. Both illnesses had a very clear set of symptoms outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM), and while many patients continued to display the traditional characteristics of the two illnesses, a growing subset were atypical.
For example, loss of menstruation is among the diagnostic criteria for anorexia, so what was a health care professional to make of the severely low-weighted patient with all the requisite signs and symptoms of anorexia except that she still had a menstrual period? Or what about the patient that concedes to bingeing and purging once a week over a period of two months? Do they not technically have an eating disorder if the threshold criteria dictate there must be at least two binge/purge episodes per week for longer than three months to warrant a diagnosis of bulimia? These patients clearly have serious eating and body weight-related disorders, but which kind? Without an official diagnosis, eating disorders treatment professionals struggled to address these illnesses, while patients and families often struggled to secure insurance coverage for treatment in the higher levels of care.
As a result, eating disorder not otherwise specified (EDNOS) was made an official diagnosis in the fourth edition of the DSM to be a "catch-all" of sorts, a clinical category of disordered eating meant for those who clearly suffer from serious thoughts and behaviors but don't meet all the diagnostic criteria for another specific diagnosis. Individuals with EDNOS experience severe disturbances in their eating behaviors, such as extreme reduction of food intake, overeating, use of purging mechanisms (vomiting, laxative use or over-exercising), and often have feelings of extreme distress or concern about body weight or shape.
Today, EDNOS diagnoses significantly outnumber cases of anorexia and bulimia. In fact, Eating Disorders: The Journal of Treatment and Prevention reported findings that suggest EDNOS develops in 4 to 6 percent of the general population, with 50 to 70 percent of the individuals who present for treatment of an eating disorder being diagnosed with this illness. Dr. Ovidio Bermudez, a colleague at Eating Recovery Center and one of the world's foremost experts on eating disorders, has said in regards to the evolution of disordered eating thoughts, behaviors and diagnoses: "The atypical has become the typical."
Despite being the most common diagnosis among individuals seeking eating disorders treatment, EDNOS is widely misunderstood. There's a common misconception floating around that EDNOS is somehow less serious than other eating disorder diagnoses, and that individuals with atypical symptoms and behaviors suffer less than their counterparts with anorexia or bulimia. The reality is that EDNOS can potentially be just as serious and life-threatening. In my experience, EDNOS can be particularly dangerous because these eating disorders more commonly go undiagnosed by health care professionals for longer periods of time due to lack of awareness or inexperience with "other" eating disorders. During this prolonged period of time before diagnosis and appropriate treatment is sought, the medical, psychological and sociocultural symptoms have time to intensify and can sometimes become life-threatening for men, women and children with eating disorder not otherwise specified.
To chat live with a master's-level eating disorders therapist about EDNOS concerns, visit Eating Recovery Center's website at www.EatingRecoveryCenter.com.
References:
[1] "Program Design Supporting Emerging Eating Disorder Pathology in Children and Adolescents," The Road to Recovery, Volume 1, Issue 4, July 2011.
For more by Kenneth L. Weiner, M.D., FAED, CEDS, click here.
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If you're struggling with an eating disorder, call the National Eating Disorders helpline at 1-800-931-2237.