Eating Disorders Not Otherwise Specified Explained

Today, we ran an article about an increase in eating disorders not otherwise specified (EDNOS) among college students. But what does EDNOS really mean?

The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) defines eating disorders not otherwise specified as "disorders of eating that do not meet the criteria for any specific eating disorder." The EDNOS classification encompasses a wide range of patients: Individuals who are at 87 percent of their ideal body weight instead of the 85 percent required to be considered as anorexic. Females who meet the weight criteria for anorexia but continue to menstruate. People who repeatedly chew and spit out—but do not swallow—large amounts of food. Binge eaters.

"It's a wastebasket diagnosis," says Susan Ice, the vice president and medical director of Philadelphia's Renfrew Center, which specializes in the treatment of eating disorders. "It [EDNOS] is a hodgepodge of things that don't necessarily belong together, except that they don't belong anywhere else."

Still, patients with an EDNOS have a "clinically significant" problem, according to Michael Lowe, a professor of psychology at Drexel University who researches the prevention and treatment of eating disorders and obesity. Indeed, those diagnosed with EDNOS are at risk for many of the same medical complications as those with anorexia or bulimia, including hormone imbalance, osteoporosis, heart attack, and death. In Lowe's view, the distinctions between EDNOS and full-blown eating disorders are arbitrary. "Someone who would get an EDNOS diagnosis is in need of treatment just as much as someone with a full diagnosis," Lowe says.

But in most states, insurance won't cover patients who don't meet the full criteria for anorexia or bulimia. In order to get around the conservative definition of eating disorders, some therapists exaggerate their patients' symptoms, according to Lowe. For example, they might say that a patient binged twice instead of once a week in order to meet the criteria for bulimia. People with eating disorders typically also suffer from mental health issues, so therapists might also choose to identify anxiety or depression—both covered disorders—as a patient's primary health problem. "It doesn't matter what diagnoses you give them to get them covered—just that you give them an official diagnosis," says Lowe, who estimates that about four percent of American women have an EDNOS.

Eating disorder specialists expect that the DSM-V, slated to come out in 2013, will reclassify eating disorders so that those in need of coverage can get it. "That's what needs to happen, and that's what will happen," Ice says.

-- Johannah Cornblatt