According to the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), EDNOS is a classification “for disorders of eating that do not meet the criteria for any specific Eating Disorder.” This does NOT mean that EDNOS is not a “real” eating disorder; it’s simply that there are elements of EDNOS that are missing or significantly different in some way from Anorexia or Bulimia.
Sarah Blake, Social Worker and Outreach Coordinator at the Center for Eating Disorders at Sheppard Pratt puts it this way:
“The diagnosis of EDNOS can mean a wide range of things. It can mean you meet the criteria for Anorexia Nervosa, but you have maintained a menstrual cycle. It could mean that you struggle with severely restricting your food intake and have lost significant weight, but are at a fairly normal weight for your height. It could mean that you meet the criteria for Bulimia Nervosa but binges occur less than twice a week, or that the cycles have occurred for less than a duration of 3 months. It could mean that you eat small amounts of food and then do something to compensate for having ingested the food. It could mean that you engage in a recurrent pattern of binge eating without any compensatory behaviors.
What is important to note here is that just because a person does not fit the exact criteria for Anorexia or Bulimia, does not mean they do not have a serious illness that requires attention. Countless individuals who are diagnosed with EDNOS are at risk for the same medical complications as those who are diagnosed with Anorexia and Bulimia. These include (but are not limited to) dehydration, electrolyte imbalance, hormone imbalance, osteoporosis, heart attack, and death. These are still eating disorders requiring necessary medical attention and psychological support.”
People with EDNOS represent the majority of individuals with eating disorders. According to Eating Disorders: The Journal of Treatment and Prevention, 50% of the people who present for the treatment of an eating disorder are given the diagnosis of EDNOS. This is in part because EDNOS also includes the sub-diagnosis of Binge Eating Disorder. And although there are elements of EDNOS that differ from the two other major disorders, clinical specialists are beginning to recommend that treatment focus on what most of the eating disorders have in common:
- Over-evaluation of weight and shape
- Rigid, rule-ridden approaches to food and eating
- Focus on over-exercising and other means of purging
It is now becoming clear that genetics and biological predisposition play a critical, though not exclusive role in the development of an eating disorder. Studies of people with anorexia and bulimia have found links to specific chromosomes, and a 2006 study led by the University of North Carolina, Chapel Hill, estimated that 56% of the responsibility for developing anorexia nervosa is determined genetically. Other studies have examined variations in serotonin and dopamine receptors in patients with anorexia and bulimia which could serve to reinforce eating disorder symptoms like food restriction.
Firstly, it can lessen some of the shame and blaming that goes on when someone develops an eating disorder. Too often, people with eating disorders blame themselves for becoming preoccupied with food and their bodies, not realizing the extent to which these obsessions can be driven by biological susceptibilities. People can be much more compassionate with themselves when they understand that—even though there may have been times when they’ve consciously chosen to use a disordered behavior in order to cope—they didn’t choose the disorder itself. Understanding the biological contribution may also allow some people to feel less shame about utilizing psychiatric medications like antidepressants or anti-anxiety drugs as part of their recovery.
Does this mean that socio-cultural factors aren’t important in the development of an eating disorder?
Not at all. Plenty of people have variable neurotransmitter levels and do not struggle with eating or body image, and many other people with eating disorders have no corresponding predisposition. Even for people with a predisposition, it is the environment in which they live that can mitigate or promote the expression of their genetic tendencies. This is one of the reasons that it remains critical to address the “thinness culture.” Another is that dieting—with its potential for malnourishment and disruption of brain chemistry—can contribute to an existing problem in susceptible individuals, or create a completely new one to deal with. In fact, dieting has been called “ a necessary, but not sufficient condition for the development of an eating disorder.” When it comes to understanding and treating eating disorders, it’s important to think in terms of both nature and nurture.
It can be difficult to understand why anyone would repeatedly engage in a behavior that is ultimately harmful, but it’s important to remember that eating and exercise disorders are, first and foremost, an attempt at a solution.
Eating disorders often begin with a sense of dissatisfaction that is perceived to be about the body. People start to diet or exercise, never intending or anticipating that they will develop a serious problem. As they engage in the dieting and exercise behaviors, however, and particularly if their efforts are praised or reinforced by other people, the changes in behavior and changes in body size and shape can begin to take on powerful psychological functions. People may find that the disorder provides them with a sense of control, self-esteem, identity, power or safety that felt lacking for them previously. Suddenly, they find that the choice of what to have for breakfast, or whether or not to exercise, is emotionally “loaded” out of all proportion to rationality, and because of that, it becomes enormously difficult to challenge the disordered behaviors, even if they know the consequences are negative. That eating disorders take on a life of their own psychologically, is strongly reinforced by genetic susceptibilities that can heighten an individual’s response in terms of brain chemistry, metabolism, and other important physiological processes.
In a culture that glorifies body types radically at odds with physiological health, and that normalizes extremes of behavior with dieting and exercise, it can be difficult for someone with an eating disorder to believe that they have a problem with food, exercise, or weight. Even if he or she is able to acknowledge some concern, the fear of losing what might feel like their primary source of safety or self-esteem is often powerful enough to make them want to defend or preserve this way of coping.
Dan Reiff, MPH RD, and co-author of Eating Disorders: Nutrition Therapy in the Recovery Process, uses an analogy he calls “The Helicopter Story.” In it, he likens the ambivalence of someone considering eating disorder recovery to a person, unable to swim, who has been stranded in the middle of the ocean with only a life-jacket to keep them afloat. Rescue by helicopter will prevent them from ultimately drowning or dying of hypothermia, but the helicopter team tells the swimmer that he or she will need to give up their life-jacket in order to be pulled on board. It’s a daunting prospect, and it’s also the reason why people with eating disorders need time and lots of expert support in order to give up their behaviors and recover completely.
When medical support, nutrition work and psychotherapy are utilized, recovery is completely possible for people with eating disorders. Chances for complete recovery are highest when people receive early, specialized treatment at the right level of intensity.
If you are worried that a friend has an eating disorder, click for information and resources.
BWell Health Promotion 401.863-2794
Located on the third floor of Health Services.
Confidential information or care is available through individual appointments or phone consultation with a Nutritionist. Students can discuss personal eating concerns, as well as any concerns they may have regarding a friend, a roommate, or a teammate. Health Promotion also offers workshops, pamphlets, and reading materials covering these and related issues. There are no fees for Health Promotion services.
University Health Services 401.863-3953
Located at the corner of Brown and Charlesfield streets.
Confidential information and care is available on a walk-in, or by scheduled appointment basis. Care is available for initial, current or past disordered eating patients. There are no fees for medical care at Health Services. However, there may be fees incurred if laboratory tests, medications, specialist or emergency hospital care is needed.
Counseling and Psychological Services 401.863-3476
Located on the fifth floor of J. Walter Wilson.
Confidential appointments are available at Counseling and Psychological Services for students concerned about their eating issues. Guidance is also available for those who are concerned about a friend, roommate, or teammates' eating. Services include crisis intervention, short-term psychotherapy and referrals. There are no fees for appointments at Counseling and Psychological Services.
Disclaimer: BWell Health Promiotion is part of Health Services at Brown University. Health Promotion maintains this site as a resource for Brown students. This site is not intended to replace consultation with your medical providers. No site can replace real conversation. Health Promotion offers no endorsement of and assumes no liability for the currency, accuracy, or availability of the information on the sites we link to or the care provided by the resources listed. Health Services staff are available to treat and give medical advice to Brown University students only. If you are not a Brown student, but are in need of medical assistance please call your own health care provider or in case of an emergency, dial 911. Please contact us if you have comments, questions or suggestions.