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Unspecified feeding or eating disorder

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Unspecified feeding or eating disorder
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Eating disorder not otherwise specified (EDNOS) is an eating disorder that does not meet the criteria for anorexia nervosa or bulimia nervosa.[1] Thus, individuals who have clinically significant eating disorders that do not meet DSM-V criteria for anorexia nervosa or bulimia nervosa are diagnosed with EDNOS. Individuals with EDNOS usually fall into one of three groups: sub-threshold symptoms of anorexia nervosa or bulimia nervosa, mixed features of both disorders, or extremely atypical eating behaviors that are not characterized by either of the other established disorders.[2]

Many people think that this type of eating disorder is not as serious compared to anorexia and bulimia. However, that is not the case because more people are diagnosed with EDNOS than anorexia and bulimia combined. Also, the symptoms and behaviors of people suffering from EDNOS are similar to those that are suffering from anorexia and bulimia. People with EDNOS can face the same dangerous risk as people with anorexia and bulimia.[3]

Eating disorders not otherwise specified is the most frequently diagnosed eating disorder in the United States. About 60% of adults that gets treatment for eating disorders are diagnosed with EDNOS. Many think that women are more likely to have eating disorders, but this is not the case. EDNOS can happen in both men and women.[4]

Research is required into how many of these "residual" EDNOS diagnoses were eventually replaced by that of a recognized medical condition, whether psychologically or organically caused. While all organic causes should be ruled out prior to making a diagnosis of an eating disorder; it is difficult to diagnosed people with eating disorders due different factors. People with eating disorder can result in weight lost as well as mood changes. Along with clinical help, family members and friends should watch out if a loved one have for warning signs of eating disorders such as mood change or weight lost. The consequences of eating disorders can be life threatening, as it can lead to constipation, tooth decay and even cardiac problems.[5]

Characteristics

Cover of DSM IV (Image Credit: Richard Masoner)

Rather than providing specific diagnostic criteria for EDNOS, DSM-IV lists six non-exhaustive example presentations, including individuals who:[6]

  1. Meet all criteria for anorexia nervosa except their weight falls within the normal range
  2. Meet all criteria for bulimia nervosa except they engage in binge eating or purging behaviors less than twice per week or for fewer than three months
  3. Purge after eating small amounts of food while retaining a normal body weight
  4. Repeatedly chew and spit out large amounts of food without swallowing
  5. Meet criteria for binge eating disorder

Epidemiology

Although EDNOS (formerly called “atypical eating disorder”) was originally introduced in DSM-III to capture unusual cases,[7] it is now the most commonly diagnosed eating disorder. In addition, EDNOS was found to have a higher prevalence than other eating disorders.[8] Specifically, EDNOS accounts for approximately 40%[9] to 60%[10][11][12][13] of cases in eating disorder specialty clinics, and up to 90% of eating disorder diagnoses conferred in non-specialty psychiatric settings.[14] The lifetime prevalence of EDNOS in the National Comorbidity Survey Replication, a large epidemiological study that interviewed a nationally representative sample of U.S. residents, was 4.64% among adults and 4.78% among adolescents.[15] In addition, in a study based on a questionnaire regarding eating disorders sampled Norway's general female population and found that EDNOS had a lifetime prevalence of 3.0%.[16] While in Spain, the prevalence of EDNOS ranged from 1.3% to 4.04%.[8] EDNOS is an especially prevalent category in populations that have received inadequate research attention such as young children, males, ethnic minorities, and non-Western groups.[17][18]

Presentation and course

Despite its subclinical status in DSM-IV, available data suggest that EDNOS is no less severe than the officially recognized DSM-IV eating disorders. In a comprehensive meta-analysis of 125 studies, individuals with EDNOS exhibited similar levels of eating pathology and general psychopathology to those with anorexia nervosa and binge eating disorder, and similar levels of physical health problems as those with anorexia nervosa.[19] Although individuals with bulimia nervosa scored significantly higher than those with EDNOS on measures of eating pathology and general psychopathology, EDNOS exhibited more physical health problems than bulimia nervosa.[19]

Importantly, an EDNOS diagnosis may presage future diagnostic crossover into officially recognized eating disorder categories. For example, 40% of individuals with EDNOS go on to develop anorexia nervosa or bulimia nervosa within one[20] to two years.[21]

Medical complications

The many health problems associated with EDNOS are varied due to the heterogeneous nature of the diagnosis. They are both psychological and physical, and vary greatly in severity. They include:

[25] Medical Complications (Continued) and Treatment.Big textBig text A person cannot be diagnosed with having both anorexia nervosa (AN) and bulimia nervosa (BN), and when a person shows tendencies to one or the other or both, is said to have an eating disorder not otherwise specified (EDNOS). Those who neglect getting treatment for EDNOS could easily develop AN or BN. Further, if EDNOS progresses into AN, risks associated with cardiac arrhythmias can potentially represent life threatening situations, as well as very low blood pressure and decreased heart rate. Significantly, in some cases the mass of the heart of a patient have been reported to have been significantly reduced. Cardiovascular problems associated with the proper functioning of the heart have been linked to deaths in patients suffering with the disease.

People with EDNOS can develop complications with their digestive tract, and in some cases their brain mass is reduced due to continued starvation. Further complications related to constipation and tardy intestinal evacuation may develop as a consequence of their eating disorder. There has been evidence of brain disfiguration, where tissue have been lost as a result of ingesting little to no food. Even after treatment it is still not certain whether the brain will recover its original mass and function again properly.

People suffering with either AN, BS or EDNOS consecutively, may already have or develop psychiatric disorders, such as substance abuse, obsessive compulsive disorders (OCD) become extremely depressed, anxious, develop anger episodes, mood swings and bi-polar tendencies.

Amenorrhea, osteoporosis and osteopenia are also medical complications associated with EDNOS. Amenorrhea is when the hypothalamus does not work properly due to excessive exercise, weight loss, reduction in body fat and stress, which in turn affects the proper release of the gonadotropin hormone. Osteoporosis, where the density and mass of the bone decreases, and osteopenia where the bone mineral density lowers, can create irreversible medical complications where the bone never attains full normal growth, thus making it easy for bone fractures and shrinkage in the vertebra to occur. It is important to note than in younger patients bone restoration is easier, however it has been shown that even with increase doses of calcium, which helps prevent bone loss, it has not been proven to completely restore bone mass and density.

People with EDNOS who starve themselves will develop low blood sugar levels (hypoglycemia), and even though they eat a fat-free diet, their cholesterol levels tend to be high due to low bile acid emissions and the effects of their disturbed eating behaviors. Some of the side effects of binge eating in people with EDNOS are electrolyte imbalances that come with the abuse of laxatives. When people binge and purge, extreme dehydration, fatigued, muscle weakness, and teeth erosion (due to the bile acid that is released each time they vomit) are most likely to develop. Hypokalemia which means potassium deficiency. and hypochloremic alkalosis which produces a deficiency in chloride are both due to too much purging. EDNOS patients can further develop mental disturbances and often feel guilty after eating. Medical complications arise further, because those who suffer with EDNOS, and binge and vomit on a regular basis, create an imbalance in their digestive tracts, often causing constipation, bloating and flatulence (heavy passing of gas).

EDNOS (Eating Disorders not Otherwise Specified) consists of neither AN or BN but a combination of both or tendencies to go for one or the other in higher magnitudes, but never fully becoming AN or BN, unless off course if left untreated it can certainly become a chronic case of AN or BN. EDNOS patients can start being very restrictive with food in the beginning, but then give up and start binging when they realize they can’t continue to starve, or feel their bodies are no longer feeling healthy. In other cases after being restrictive they can then start heavily binging and purging, but there are days in between their binge and purge episodes where they keep a somewhat normal life with no binging and purging, but then go back to binging and it becomes a vicious cycle all around. Some patients are on the verge of AN, but they do not meet all the AN symptoms, such as missed periods and extreme weight loss. Other patients may be of normal weight but they still do things seen in BN; they either binge with no purging a few days a week, or simply purge without binging so they can’t be completely categorize with BN; therefore proper diagnose and treatment should be implemented.

Further, people suffering with EDNOS have symptoms similar to those suffering with BED (Binge Eating Disorder) which basically entails constant and continuous binging, without vomiting afterwards. Most people suffering with BED develop high blood pressure, diabetes, cancer, high cholesterol, are obese and also have gallbladder disorder. Sadly BED patients are mostly diagnosed under people who are simply put: overweight candidates that need to work on weight reduction, but in reality they have an eating disorder that led them to their current situation. That is why it is very important that people suffering with EDNOS also be treated for AN, BN and BED when symptoms are otherwise present in enormous magnitudes, and showing medical complications derived from any or all. Registered dietitians together with psychologists can better assist those suffering with EDNOS to come up with a proper diet plan depending on their body type and medical history; in combination with one on one therapy sessions that can potentially diagnose and treat the cause pertaining to why they developed EDNOS in the first place.

CBT (Cognitive-behavioral therapy) may help patients recover from EDNOS. CBT consists of creating a balance meal plan, and teaching patients about eating patterns in order to normalize them to be able to get into a healthy weight relevant to their height and body type. Notwithstanding, it is important that these patients understand the misconceptions about going on a diet, and what it means to eat a balanced meal without having to exclude certain types of foods that would otherwise be consider binge or forbidden foods permanently from their diets, but that slowly they can learn to incorporate them back in moderate amounts into their diets. Consequently, these patients can gain a sense of fulfillment and satisfaction that can help them stop their destructive eating behaviors and follow a healthy lifestyle.

Studies from a journal named Eating disorders and depressive symptoms: An epidemiological study in a male population, it was reported that a high number of men (the study was based on young French men ages 18-30) with eating disorders, including those with EDNOS, have comorbidity disorders, meaning that they have more than one underlying health condition associated with or separate to their unhealthy eating habits. EDNOS participants represented 15 percent of the study population, so helping people with EDNOS is highly suggested. All of the participants confessed to engaging in unhealthy eating and exercise patterns, by starving themselves for a period of time while exercising vigorously at the same time, which can significantly lead to obsessions with gaining muscle mass and acquiring an extra lean physique. This obsession leads to many health problems in the long run, if continued to be implemented. [26]

EDNOS Diagnosis

An EDNOS diagnosis can be described as a mixture of symptom patterns that lasts a short period of time. These symptoms can be categorized to better understand the heterogeneity of an EDNOS diagnosis.[27] The three general categories for an EDNOS diagnosis are subthreshold symptoms of anorexia or bulimia, a mixture of both anorexia or bulimia, and eating behaviors that are not particularized by anorexia and bulimia. Thus, these symptoms describe a person who is predominantly likely to develop, or recover from, anorexia nervosa or bulimia nervosa, as well as from BED (Binge Eating Disorder). The symptoms an individual undergoes depends on the phase of the disorder the individual is in.[28]

Changes made in the DSM-5

File:Dsm-5-released-big-changes-dsm5.jpg
Cover of DSM 5 (Image Credit: Yoshikia2001)

The DSM-5 Eating Disorders Work Group has made several revisions to the diagnostic criteria, which they hope will reduce the reliance on EDNOS in clinical settings, and promote treatment-seeking and research among affected individuals. The DSM-5, published in May 2013, expands the diagnostic criteria for anorexia nervosa and bulimia nervosa, and elevates binge eating disorder to a formally recognized diagnosis. Furthermore, DSM-5 renames the EDNOS category Feeding or Eating Disorder Not Elsewhere Classified (FEDNEC), and provides the following named descriptions of example presentations:

  1. Atypical Anorexia Nervosa in which all criteria for anorexia nervosa are met except that the individual’s weight is within or above the normal range
  2. Subthreshold Bulimia Nervosa (low frequency or limited duration) in which all criteria for bulimia nervosa are met except the binge eating and compensatory behaviors occur on average less than once a week and for less than 3 months
  3. Subthreshold Binge Eating Disorder (low frequency or limited duration) in which all criteria for binge eating disorder are met, except the binge eating occurs on average less than once a week and for less than 3 months
  4. Purging Disorder (PD) in which patients purge without binging; they consume a normal amount of food and typically maintain normal weight
  5. Night Eating Syndrome (NES) in which patients have nocturnal eating episodes, or eat a large proportion of their daily calorie intake after dinner
  6. Other Feeding or Eating Condition Not Elsewhere Classified which is a residual category for all other cases that are clinically significant but do not meet the criteria for formal eating disorder diagnoses [29]

References

  1. ^ Christopher G. Fairburn and Kristin Bohn (June 2005). "Eating disorder NOS (EDNOS): an example of the troublesome "not otherwise specified" (NOS) category in DSM-IV". Behaviour Research and Therapy. 43 (6): 691–701. doi:10.1016/j.brat.2004.06.011. PMC 2785872. PMID 15890163.
  2. ^ Fairburn, Christopher G.; Bohn, Kristin (2005). "Eating disorder NOS (EDNOS): An example of the troublesome "not otherwise specified" (NOS) category in DSM-IV". Behaviour Research and Therapy. 43 (6): 691–701. doi:10.1016/j.brat.2004.06.011. PMC 2785872. PMID 15890163.
  3. ^ "Eating Disorder Not Otherwise Specified (EDNOS)". National Alliance of Mental Illness.
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  7. ^ American Psychiatric Association (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: American Psychiatric Association.[page needed]
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  9. ^ Button, Eric J.; Benson, Elizabeth; Nollett, Nollett; Palmer, Robert L. (2005). "Don't forget EDNOS (eating disorder not otherwise specified): Patterns of service use in an eating disorders service". Psychiatric Bulletin. 29 (4): 134–6. doi:10.1192/pb.29.4.134.
  10. ^ Fairburn, Christopher G.; Cooper, Zafra; Bohn, Kristin; O’Connor, Marianne E.; Doll, Helen A.; Palmer, Robert L. (2007). "The severity and status of eating disorder NOS: Implications for DSM-V". Behaviour Research and Therapy. 45 (8): 1705–15. doi:10.1016/j.brat.2007.01.010. PMC 2706994. PMID 17374360.
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  13. ^ Turner, Hannah; Bryant-Waugh, Rachel (2004). "Eating disorder not otherwise specified(EDNOS): Profiles of clients presenting at a community eating disorder service". European Eating Disorders Review. 12: 18–26. doi:10.1002/erv.552.
  14. ^ Zimmerman, Mark; Francione-Witt, Caren; Chelminski, Iwona; Young, Diane; Tortolani, Christina (2008). "Problems Applying the DSM-IV Eating Disorders Diagnostic Criteria in a General Psychiatric Outpatient Practice". The Journal of Clinical Psychiatry. 69 (3): 381–4. doi:10.4088/JCP.v69n0306. PMID 18348598.
  15. ^ Le Grange, Daniel; Swanson, Sonja A.; Crow, Scott J.; Merikangas, Kathleen R. (2012). "Eating disorder not otherwise specified presentation in the US population". International Journal of Eating Disorders. 45 (5): 711–8. doi:10.1002/eat.22006. PMID 22407912.
  16. ^ Götestam, K. Gunnar; Agras, W. Stewart. "General population-based epidemiological study of eating disorders in Norway". International Journal of Eating Disorders. 18 (2): 119–126. doi:10.1002/1098-108X(199509)18:2<119::AID-EAT2260180203>3.0.CO;2-U. Retrieved 12 October 2014.
  17. ^ Becker, Anne E.; Thomas, Jennifer J.; Pike, Kathleen M. (2009). Walsh, B. Timothy (ed.). "Should non-fat-phobic anorexia nervosa be included in DSM-V?". International Journal of Eating Disorders. 42 (7): 620–35. doi:10.1002/eat.20727. PMID 19655370.
  18. ^ Thomas, J. J.; Crosby, R. D.; Wonderlich, S. A.; Striegel-Moore, R. H.; Becker, A. E. (2010). "A latent profile analysis of the typology of bulimic symptoms in an indigenous Pacific population: Evidence of cross-cultural variation in phenomenology". Psychological Medicine. 41 (1): 195–206. doi:10.1017/S0033291710000255. PMID 20346191.
  19. ^ a b Thomas, Jennifer J.; Vartanian, Lenny R.; Brownell, Kelly D. (2009). "The relationship between eating disorder not otherwise specified (EDNOS) and officially recognized eating disorders: Meta-analysis and implications for DSM". Psychological Bulletin. 135 (3): 407–33. doi:10.1037/a0015326. PMC 2847852. PMID 19379023.
  20. ^ Milos, Gabriella; Spindler, Anja; Schnyder, Ulrich; Fairburn, Christopher G. (2005). "Instability of eating disorder diagnoses: Prospective study". The British Journal of Psychiatry. 187 (6): 573–8. doi:10.1192/bjp.187.6.573. PMC 2710504. PMID 16319411.
  21. ^ Herzog, David B.; Hopkins, Julie D.; Burns, Craig D. (1993). "A follow-up study of 33 subdiagnostic eating disordered women". International Journal of Eating Disorders. 14 (3): 261–7. doi:10.1002/1098-108X(199311)14:3<261::AID-EAT2260140304>3.0.CO;2-N. PMID 8275062.
  22. ^ "Osteoporosis in women with eating disorders: comparison of physical parameters, exercise, and menstrual status with SPA and DPA evaluation". 31 (3). March 1990: 325–31. PMID 2308003. {{cite journal}}: Cite journal requires |journal= (help)
  23. ^ Turner, Hannah; Peveler, Robert (April 2005). "Eating disorders and type 1 diabetes mellitus". Psychiatry. 4 (4): 30–33. doi:10.1383/psyt.4.4.30.63442. {{cite journal}}: |access-date= requires |url= (help); Check date values in: |accessdate= (help)
  24. ^ Johansson, Ann-Katrin; Norring, Claes; Unell, Lennart; Johansson, Anders (2012). "Eating disorders and oral health: a matched case-control study". European Journal of Oral Sciences. 120 (1): 61–68. doi:10.1111/j.1600-0722.2011.00922.x. {{cite journal}}: |access-date= requires |url= (help)
  25. ^ "Position of the American Dietetic Association: Nutrition Intervention in the Treatment of Anorexia Nervosa, Bulimia Nervosa, and Eating Disorders not Otherwise Specified (EDNOS)". ournal of the American Dietetic Association. 101 (7): Pages 810–819. July 2001. doi:10.1016/S0002-8223(01)00201-2. Retrieved March 2003. {{cite journal}}: Check date values in: |accessdate= (help)
  26. ^ Valls, M; Callahan, S; Rousseau, A; Chabrol, H (Jun 2014). "Eating disorders and depressive symptoms: An epidemiological study in a male population". ENCEPHALE-REVUE DE PSYCHIATRIE CLINIQUE BIOLOGIQUE ET THERAPEUTIQUE. 40 (3): 223–230. doi:10.1016/j.encep.2013.05.003.
  27. ^ Ranson, K M von. "Eating Disorder Not Otherwise Specified". www.go.galegroup.com. V.S. Ramachandram. Retrieved 30 October 2014.
  28. ^ Le Grange D. "A Closer Look at Eating Disorder Not Otherwise Specified (EDNOS)". www.eatingdisorder.org. Retrieved 30 October 2014.
  29. ^ American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013. Web. [access date: 18 October 2014]. dsm.psychiatryonline.org
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