EDNOS - Eating Disorders Not Otherwise Specified
What's The Difference Between EDNOS & Anorexia, Bulimia?

EDNOS (Eating Disorders Not Otherwise Specified) is category used for atypical eating disorders. It's also known as a catch-all for those who do not meet all of the formal criteria to warrant a full anorexia diagnosis or bulimia diagnosis, yet their disordered eating behavior is serious enough to call for therapy.

According to the 10th edition of The World Health Organization's International Classification Of Diseases (ICD-10), 'atypical eating disorders' (EDNOS) are defined as those where the overall general features support a diagnosis of anorexia nervosa or bulimia nervosa, however one or more of the key factors is either missing, or only present in a minor degree.

In other words, if a woman or teenager severely restricts their food intake and maintains a dangerously low weight, but they still menstruate, it would be classified as EDNOS, or 'Eating Disorders Not Otherwise Specified'. She cannot be diagnosed with anorexia nervosa because menstruation has not ceased, which is required under the formal DSM-IV definition of anorexia.

Similarly, if someone loses weight through excessive exercise, diet and purging, but they have not lost enough to put them below 85 percent of normal, they would be neither anorexic nor bulimic. The weight loss is not enough to diagnose anorexia nervosa, and purging without binge eating does not meet the full bulimia nervosa diagnostic criteria. Again, this would be classified as EDNOS.

Binge eating disorder also falls under this category. Without the binge and purge cycles, it cannot be diagnosed under bulimia nervosa, yet it's quite clear that there are disturbed eating patterns that require intervention.

Controversy, Dangers And Health Risks Of EDNOS

The classification of EDNOS has been a subject of controversy and debate in the medical, insurance and eating disorders fields. Its very definition seems to imply that this is a category for patients who are "almost anorexic" or "almost bulimic" but they aren't quite "sick enough" to get a full diagnosis.

Nothing could be further from the truth. In fact, recent studies show that at least 60 percent of patients diagnosed with Eating Disorders Not Specified meet the medical criteria for hospitalization.

However, in most cases these people are overlooked and do not get the treatment they require simply because they do not fall into any cookie-cutter definition of an eating disorder. Insurance companies refuse to pay, and doctors have nothing to hang their hat on (so to speak) with regards to a formal diagnosis.

These patients are allowed to become sicker and sicker until it's too late. Or, sometimes an individual becomes so ill that treatment costs are far greater than they would have been if the person was treated sooner. (See this article from CNN about Anorexia Symptoms vs Eating Disorder Not Otherwise Specified).

How It Feels To Be Diagnosed With EDNOS

Telling someone with disordered eating issues that they have EDNOS as opposed to anorexia nervosa or bulimia nervosa is more of a gut-wrenching experience than you might think. In some ways it even perpetuates and plays into the eating disorder.

Early on, I was diagnosed with EDNOS. I met all of the diagnostic criteria for anorexia nervosa, with the exception of one thing. What was going through my head at the time? Chaos! So many conflicting and confusing thoughts all at the same time.

First, I felt like a failure. I failed at anorexia because I never "made the grade" with a full anorexia diagnosis. It's not that I was trying to have anorexia, or that I wanted it.... It was just the idea of not having accomplished something to its fullest extent. That was 'failure' in my mind.

The other part of me knew that I was very sick. But then my eating disordered mind would cut in and convince me that Eating Disorders Not Otherwise Specified was a good thing to have because it meant that I could keep doing what I was doing. After all, I didn't actually have anorexia nervosa, so I must not be that sick. It served the purpose of helping me minimize or deny my illness.

I felt like a misfit - alienated and alone. I knew that my thoughts and feelings were not normal, so I didn't fit in with 'normal people'. But then I didn't fit into any particular group of eating disorders either. I was neither here nor there. It was a very trying experience - one that I don't wish on anybody!

If you've been told that you have EDNOS, I hope you're able to get help from someone who has experience treating eating disorders. These specialists are all too familiar with the unique thoughts, feelings and frustrations that surround this diagnosis.

Hopefully we will see a revision - or elimination - of this category in the new DSM-5 (Diagnostic And Statistical Manual Of Mental Disorders), which - as of April 2011 - has a proposed publication date of May 2013.

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