Understanding Eating Disorder Not Otherwise Specified (EDNOS)

Comprehensive Overview of a Complex Disorder

What Is EDNOS?
Eating disorder not otherwise specified (EDNOS) is less well known than higher-profile diagnoses like anorexia nervosa, bulimia nervosa, and binge eating disorder. Despite its lack of public attention, as a catch-all category that includes a wide range of symptoms, EDNOS is actually the most common eating disorder diagnosis, representing an estimated 32% to 53% of all people with eating disorders. It was developed to encompass people who did not meet the full diagnostic criteria for anorexia nervosa or bulimia nervosa but still had a significant eating disorder.
Symptoms Of EDNOS
Behavioral symptoms of EDNOS often include a preoccupation with weight, food, calories, fat grams, dieting, and exercise, including:

- Refusing to eat certain foods (restriction against categories of food like no carbs, no sugar, no dairy)
- Frequent comments about feeling “fat” or overweight
- Denial about feeling hungry
- Fear of eating around others
- Binge eating
- Purging behaviors (frequent trips to the bathroom after meals, signs and/or smells of vomiting, wrappers or packages of laxatives or diuretics)
- Food rituals (such as excessive chewing or not allowing foods to touch)Skipping meals or eating small portions at regular meals
- Stealing or hoarding food
- Drinking excessive amounts of water (or non-caloric beverages)Using excessive amounts of mouthwash, mints, and gum
- Hiding body with baggy clothes
- Exercising excessively (despite weather, fatigue, illness, or injury)

The emotional symptoms of EDNOS can include:

- Low self-esteem
- Depression
- Strong need for approval
- Anxiety
- Little motivation to engage in relationships or activities
- Easily irritated
- Extremely self-critical

The physical symptoms of EDNOS include:

- Noticeable fluctuations in weight
- Gastrointestinal symptoms (such as stomach cramps, constipation, and acid reflux)
- Menstrual irregularities and amenorrhea (missing periods)
- Difficulty concentrating
- Anemia
- Low thyroid and hormone levels
- Low potassium
- Low blood cell counts
- Slow heart rate
- Dizziness
- Fainting/syncope
- Feeling cold all the time
- Sleep troubles
-Cuts and calluses across the top of finger joints (a result of inducing vomiting)
- Dental problems (such as discolored teeth, enamel erosion, cavities, and tooth sensitivity)
- Dry skin
- Dry and brittle nails
- Swelling around area of salivary glands
- Fine hair on body
- Thinning of hair or dry and brittle hair
- Muscle weakness
- Yellow skin (from eating large quantities of carrots)
- Cold, mottled hands and feet
- Swelling of feet
- Poor wound healing
- Impaired immune system
Causes of EDNOS
EDNOS is a complex illness and, while we don't know the exact cause, genetics and environmental factors both appear to play a role. When it comes to eating disorders, it's often said that "genes load the gun, but environment pulls the trigger.”

In other words, in those who are genetically vulnerable, certain situations and events contribute to or trigger the development of an eating disorder.

Environmental Factors Include:
- Dieting
- Weight stigma
- Bullying
- Abuse
- Illness
- Puberty
- Stress
- Life transitions
- Media influence
Diagnosis of EDNOS
One problem with psychiatric diagnoses, in general, is that many patients do not fit neatly into the typical diagnostic categories. It’s not always clear-cut. Sometimes people meet most but not all of the criteria for a diagnosis.

In the case of eating disorders, a person who does not qualify for a specific eating disorder diagnosis would be classified as EDNOS. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) includes five examples of patients who would be classified as EDNOS:

Atypical anorexia nervosa: The person meets many but not all of the criteria for anorexia nervosa. For example, they may restrict food intake and display other features of anorexia nervosa without meeting the low weight criteria.
Subthreshold bulimia nervosa: The person may meet most of the criteria for bulimia nervosa, but the binge eating and/or purging behaviors occur at a lower frequency and/or is of limited duration than required for a bulimia diagnosis.
Subthreshold binge eating disorder: The person meets the criteria for binge eating disorder but binge eating occurs at a lower frequency and/or is of a limited duration.
Purging disorder: The person engages in a purging of calories (by vomiting, misuse of laxatives or diuretics, and/or excessive exercising) aimed to influence weight or body shape, but does not binge eat, which is the factor that distinguishes this disorder from bulimia nervosa.
Night eating syndrome: The individual engages in recurrent episodes of night eating, eating after awakening from sleep, or engages in excessive food consumption after the evening meal, and there is awareness and recall of the eating.

One misconception about EDNOS is that it is less severe or subclinical. This is not necessarily true, and it keeps many people from seeking help.

While some people who are diagnosed with EDNOS may have less severe diagnoses, many of the people with EDNOS have as severe an eating disorder as those who meet criteria for clearly defined disorders like anorexia nervosa, bulimia nervosa, and binge eating disorder.
Health Risks
Potential Consequences of EDNOS
People with EDNOS will experience health risks similar to those of the other eating disorders, including:
- Weakened bones
- Loss of brain mass
- Cardiovascular problems
- Gastrointestinal problems (chronic constipation or diarrhea)
- Dental issues from self-induced vomiting
- Dry skin
- Loss of area
- Loss of menstrual cycle, amenorrhea
- Increased risk of infertility
- Kidney failure

At least one previous study showed the mortality rate for EDNOS was as high as for people who meet the defined thresholds for anorexia.

Furthermore, since eating disorder diagnoses are not stable over time, it is not uncommon for people to meet the diagnosis of EDNOS on their way to a diagnosis of anorexia, bulimia, or binge eating disorder, or on their way to recovery.
Treatment Approaches
Even if your symptoms and experience don't seem to fit a specific diagnosis, if you are experiencing distress related to eating, exercise, body shape, and weight, you should consult a professional as soon as possible. Research supports that early intervention makes a big difference in EDNOS recovery.

In general, treatment recommendations will be based on the eating disorder that most closely resembles your symptoms. For example, if you're mostly showing symptoms of lower frequency bulimia, your treatment plan will involve the same therapies and medications used for bulimia.

Because eating disorders are mental illnesses, your treatment team should include a psychologist, psychiatrist, social worker, or other licensed counselor as well as primary care physician or pediatrician and registered dietitian.

Article Sources

1. Machado PP, Gonçalves S, Hoek HW. DSM-5 reduces the proportion of EDNOS cases: evidence from community samples. Int J Eat Disord. 2013;46(1):60-5. doi:10.1002/eat.22040
2. National Eating Disorder Association. Other Specified Feeding or Eating Disorder.
3. 2018.Thomas JJ, Vartanian LR, Brownell KD. The relationship between eating disorder not otherwise specified (EDNOS) and officially recognized eating disorders: Meta-analysis and implications for DSM. Psychol Bull. 2009;135(3):407-33. doi:10.1037/a0015326
4. Crow SJ, Peterson CB, Swanson SA, et al. Increased mortality in bulimia nervosa and other eating disorders. Am J Psychiatry. 2009;166(12):1342-6. doi:10.1176/appi.ajp.2009.09020247
5. Agras WS, Crow S, Mitchell JE, Halmi KA, Bryson S. A 4-year prospective study of eating disorder NOS compared with full eating disorder syndromes. Int J Eat Disord. 2009;42(6):565-70. doi:10.1002/eat.20708