The Dangers of an Unspecified Eating Disorder
Posted by Mark Warren on Fri, Apr 23, 2010 @ 11:29 AM
In the DSM IV there are three eating disorder diagnoses: Anorexia Nervosa, Bulimia Nervosa, and Eating Disorder, Not Otherwise Specified (EDNOS). The use of the term “EDNOS” somehow makes people who fall into this category seems less ill than people who have one of the classic eating disorder diagnoses. This assumption, however, has recently been show to be quite untrue. In fact, we now know that people with EDNOS have as high a risk of illness, hospitalization, and death as people with anorexia or bulimia. This finding is critically important since somewhere from 60-70% of people with an eating disorder fall into the category of EDNOS.
The reasons for this are complicated but worth exploring. Both anorexia and bulimia are diagnostic categories that were defined for research purposes. As a result, the categories are exclusive rather than inclusive. That is, these categories were drawn as tightly as possible so that research can be done on a group of similar people rather than focusing on the largest group that requires treatment. Unfortunately, it turns out that many people with life threatening eating disorders fall into the excluded categories.
Commonly, people who fall into the category of an unspecified eating disorder include:
- Someone with significant weight loss who may not be markedly underweight but may have all the other criteria for anorexia.
- Someone who purges and/or restricts but may not binge, or someone who binges but does not purge or restrict.
- Someone who uses dangerous behaviors to lose weight, but not at a frequency recognized by the DSM IV.
- Someone who once met criteria for anorexia, has had some increase in weight, but continues to have all the life threatening behaviors they once had.
- Someone who meets all criteria for a diagnosis aside from amenorrhea, which has been shown to be irrelevant in the diagnosis.
A
recent study by Dr. Rebecka Peebles highlights these issues. Her study demonstrates that the diagnosis of EDNOS does not present a less serious eating disorder than anorexia or bulimia. In fact, mortality may be higher. But even if mortality rates are only the same, one should never think that “NOS” means that the diagnosis isn’t as serious as traditional anorexia or bulimia. Eating disorders come in many forms, they all represent life threatening illnesses for which we now know there is effective treatment.
Contributions by Sarah Emerman