What is EDNOS (aka Eating Disorder Not Otherwise Specified)?
Have you ever heard of this eating disorder diagnosis with the strangely long acronym? This post will walk you through the history and meaning of EDNOS, signs and symptoms to be aware of and what it means to receive this diagnosis.
History of EDNOS
As stated above, EDNOS stands for Eating Disorder Not Otherwise Specified. It was a catchall diagnosis for those patients for whom the other eating disorder diagnoses did not apply. Diagnoses are described in the Diagnostic and Statistical Manual of Mental Disorders (DSM). In early versions of the DSM, namely editions 3 and 4, EDNOS was a primary eating disorder category alongside Anorexia Nervosa and Bulimia Nervosa. It wasn’t until the publication of the DSM-5 that EDNOS was dropped and renamed Other Specified Feeding or Eating Disorder (OSFED). Some older clinicians in the field may still use EDNOS, as OSFED was not introduced as an umbrella term until 2013. Happy 10th birthday to the DSM-5!
Meaning of EDNOS
EDNOS, now called OSFED, is home to several other eating disorder diagnoses, including Atypical Anorexia Nervosa, Atypical Bulimia Nervosa, Atypical Binge Eating Disorder, Purging Disorder, and Night Eating Syndrome. If you have received a diagnosis of EDNOS or OSFED, it indicates that your primary care physician, psychiatrist, or therapist has concluded that you meet the criteria for one of the diagnoses listed above. Registered Dietitians cannot diagnosis patients or clients and rely on other members of the care team for this!
Let’s talk about the Word Atypical
Thesarus.com offers synonyms for atypical like abnormal, peculiar, strange, divergent, odd and unnatural. You might ask yourself… “So why is my eating disorder atypical? Does it mean I’m abnormal? That nobody struggles with this? Am I weird?” The answer to all of those questions is NO. Atypical was the term chosen to describe these diagnoses, when in fact, there is nothing abnormal about them at all. Atypical is not strange, odd, or peculiar...it’s incredibly common!
To illustrate this point, let’s look at the actual clinical criteria for anorexia nervosa versus atypical anorexia nervosa as listed in the DSM-5.
Anorexia Nervosa:
In order to meet the clinical criteria for anorexia nervosa, the following three things must be present:
A. Persistent restriction of energy intake leading to significantly low body weight (in the context of what is minimally expected for age, sex, developmental trajectory and physical health).
B. An intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain (even though individual is at a significantly low weight).
C. Disturbance in the way one’s body weight or shape is experienced, undue influence of body shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
Aypical Anorexia Nervosa:
In order to meet the clinical criteria for atypical anorexia nervosa, the following must be true:
All of the criteria for anorexia nervosa are met, except that despite significant weight loss, the individual’s weight is within or above the normal range (*according to BMI).
There is a persistent stereotype that anorexia nervosa affects affluent, thing, young, cisgender, heterosexual, able-bodied females, but this couldn’t be further from the truth. Patients with atypical anorexia nervosa don’t meet the weight criteria or don’t have a “significantly low body weight.” Patients with atypical anorexia often live in bodies that are “normal” according to the outdated BMI screening tool or even in higher BMI weight ranges that are deemed “unhealthy.” What does that mean? It means that a lot of people struggling with a life-threatening eating disorder are not being screened due to their body weight.
That’s not health care, that’s weight stigma and anti-fat bias.
The statistics speak for themselves:
In a community study of young women, lifetime prevalence by age 20 was 2.8% for atypical anorexia nervosa compared with 0.8% for anorexia nervosa.
A study published in April 2021 of 1,137 US military veterans who served in Iraq and/or Afghanistan found that 13.6% of women and 4.9% of men met criteria for probable atypical AN.
Signs and Symptoms of EDNOS:
So you might be asking yourself, what are the signs and symptoms of someone living with EDNOS? What are the signs and symptoms of an eating disorder like Atypical Anorexia Nervosa?
Behavioral Indicators:
· Fixation on health and eating “healthy”
· Counting calories
· Eating smaller portions of food
· Skipping meals
· Discomfort eating with others
· Drinking large amounts of water or other beverages like coffee, tea, energy drinks or green juices
· Fixation on body weight or shape, often hiding the body in all-black clothing, large baggy clothing, or wearing multiple layers
· Pacing or excessive walking
· Maintain a rigid exercise routine
· Exercising in all conditions (e.g. even when it’s very hot or very cold)
Physical Indicators:
· Thinning hair and hair loss
· Dry skin
· Poor wound healing
· Bruising easily
· Dizziness
· Fainting
· Difficulty falling asleep and staying asleep
· Getting sick often (weak immune system)
· Constantly feeling cold
· Weight fluctuations
Receiving a diagnosis of atypical anorexia nervosa is just as serious as anorexia nervosa. Just because someone is not clinically underweight or does not appear “emaciated” (which is highly subjective, btw) does not mean that someone is not struggling. Eating disorders do not have a look or shape. Unfortunately, something like atypical anorexia is often underdiagnosed due to weight stigma and anti-fat bias.
EDNOS and Medical Instability
Medical instability can happen in a body of any size. Instability generally refers to a constellation of vital signs that demonstrate the body is struggling to survive. It includes: dehydration, abnormally low heart rate, blood pressure abnormalities, body temperature abnormalities and, of course, malnutrition. When a client is beginning to show signs of medical instability, this greatly increases risk, especially the risk of fainting and falling.
Lastly, diagnoses are complicated. It’s ok to have conflicting feelings about receiving a diagnosis of EDNOS or OSFED. A diagnosis can be important when communicating with medical providers and obtaining insurance coverage. It can also be more difficult to obtain a diagnosis of OSFED or atypical anorexia nervosa when so many clinicians are still unfortunately limited by their own internal size biases. The medical field has a long way to go!
Help is Available for EDNOS/OSFED
If you think you are struggling with Other Specified Feeding or Eating Disorder like Atypical Anorexia Nervosa, please reach out to me to schedule a free discovery call. Together we can help re-build your relationship with food and your body and I’d be honored to walk the path with you.