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What Is Eating Disorder Not Otherwise Specified

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Eating Disorders Are Serious Mental Illnesses

What is EDNOS (eating disorder not otherwise specified)? OSFED

The diagnosis of EDNOS has not received as much media or public attention as other eating disorder diagnoses, such as anorexia and bulimia nervosa. Further, some individuals mistakenly believe that a diagnosis of EDNOS means that their eating disorder is not as serious as the more traditional diagnoses.

However, this is utterly false. All eating disorders are serious mental illnesses-which can deadly if an individual does not receive appropriate treatment and support.

In fact, Many studies have shown that individuals with the EDNOS diagnosis experience eating pathology and medical consequences that are just as, if not more, severe than individuals who receive a formal anorexia or bulimia diagnosis. Furthermore, one recent study found that 75% of individuals with EDNOS had co-occurring psychiatric disorders and 25% endorsed suicidality.

Other Specified Feeding Or Eating Disorder

Other Specified Feeding or Eating Disorders was previously known as Eating Disorder Not Otherwise Specified in past editions of the Diagnostic and Statistical Manual. Despite being considered a catch-all classification that was sometimes denied insurance coverage for treatment as it was seen as less serious, OSFED/EDNOS is a serious, life-threatening, and treatable eating disorder. The category was developed to encompass those individuals who did not meet strict diagnostic criteria for anorexia nervosa or bulimia nervosa but still had a significant eating disorder. In community clinics, the majority of individuals were historically diagnosed with EDNOS.

Research into the severity of EDNOS/OSFED shows that the disorder is just as severe as other eating disorders based on the following:

  • Children hospitalized for EDNOS had just as many medical complications as children hospitalized for anorexia nervosa
  • Adults with atypical or subclinical anorexia and/or bulimia scored just as high on measures of eating disorder thoughts and behaviors as those with DSM-diagnosed anorexia nervosa and bulimia nervosa
  • People with EDNOS were just as likely to die as a result of their eating disorder as people with anorexia or bulimia


A diagnosis might then be assigned that addresses the specific reason why the presentation does not meet the specifics of another disorder . The following are further examples for OSFED:


The Icd Code F509 Is Used To Code Eating Disorder Not Otherwise Specified

Eating disorder not otherwise specified is an eating disorder that does not meet the criteria for anorexia nervosa or bulimia nervosa. 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.


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Ednos: This Quietly Common Eating Disorder Is The Most Lethal

Despite being one of the least recognizable categories of eating disorders, EDNOS is both the most common and most lethal eating disorder in the U.S. In an interview with ABC News, a young 20-year-old woman named Taylor shed some light on this eating disorder category and described her own perplexing path to being diagnosed with EDNOS.

“Originally I was diagnosed with bulimia,” recalled Taylor. “Then my symptoms didn’t match bulimia. So then they diagnosed me as anorexia, binge/purge type because there are two different types. And then I didn’t meet the weight criteria for anorexia. So then they said, ‘OK, you have EDNOS.’ And I was like, ‘Well, what is that?'”

The answer Taylor received was eating disorder not otherwise specified. As a broad umbrella category, the five most common types of EDNOS conditions are atypical anorexia nervosa, low-frequency atypical bulimia nervosa, binge eating disorder of low frequency and/or limited duration, purging disorder, and night eating syndrome. According to research conducted by the National Association of Anorexia and Associated Disorders, up to 70 percent of all eating disorders are now categorized as EDNOS conditions.

“It’s still a misperception out there that these are relatively benign sorts of disorders or diets gone bad,” said Dr. Bunnell. “These are life-threatening, serious illnesses. They have the highest mortality rate of any psychiatric diagnosis.

Its Not Called Ednos Anymore

A Case Against Eating Disorder Not Otherwise Specified ...

In the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition, the term Eating Disorder Not Otherwise Specified has undergone a name change. Now referred to as Other Specified Feeding and Eating Disorders , the criteria for OSFED is more specific than that of EDNOS. Previously, a large percentage of cases being treated at eating disorder treatment centers and non-specialty clinics were considered EDNOS. With a more refined category, the percentage of individuals diagnosed with OSFED is less than that with EDNOS.

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Eating Disorder Not Otherwise Specified Symptoms

EDNOS is a diagnosis that is often received when an individual meets many, but not all, of the criteria for anorexia or bulimia.

For females, all the criteria for anorexia are met except that of loss of regular periods.

All the criteria for anorexia are met except that, despite significant weight loss, the individuals current weight is in the normal range.

All the criteria for bulimia are met except that the binge eating and the behaviours designed to offset the binge eating are inappropriate and occur at a frequency of less than twice a week or for a duration of less than 3 months.

The regular use of weight controlling behaviours by an individual of normal body weight after eating small amounts of food .

Repeatedly chewing and spitting out, but not swallowing, large amounts of food.

If you have an eating disorder, talk to your GP.

What Are Eating Disorders Not Otherwise Specified

Eating disorders not otherwise specified are any eating disorders that do not meet the diagnostic criteria for either specific eating disorder – anorexia nervosa or bulimia nervosa. However, the eating disorders in this category are all very similar to anorexia and bulimia, with some variations. Binge eating disorder is one such EDNOS.

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Elimination Of Not Otherwise Specified

In DSM-5, the diagnostic category Not Otherwise Specified has been replaced by two designations: Other Specified and Unspecified. This change applies to all psychiatric diagnoses, including eating disorders. If one is unable to specify one of the established listed diagnoses, such as Anorexia Nervosa, for example, one may diagnose by preceding the general category with or above. In this case, a clinician might choose Other Specified Feeding and Eating Disorder or Unspecified FED .

Bulimia Nervosa Of Low Frequency And/or Duration

Eating Disorders – Not Otherwise Specified Diagnosis

Symptoms of this form of EDNOS are similar to that of Bulimia except they occur less often and/or for a shorter period of time. Symptoms include consuming a portion of food larger than what most people would eat while simultaneously feeling regret, shame, and a lack of control. This is followed by compensatory behaviors such as self-induced vomiting, over-exercising, laxative use, fasting, and other methods in order to avoid weight gain.2 These symptoms can occur less than once a week and/or for fewer than three months.

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Osfed Concerns And Misconceptions

OSFED is sometimes misinterpreted as a subclinical or sub-threshold diagnosis. This can be misleading in terms of severity. In the past, studies have shown that individuals who are diagnosed with EDNOS experience eating pathology and medical consequences that are just as severe, if not more severe, than those among individuals who receive a formal diagnosis of AN or BN. Furthermore, one study found that 75% of individuals with EDNOS had co-occurring psychiatric disorders and 25% had suicidal thoughts .Individuals with OSFED often require the same level of treatment and support as those with AN or BN. Without treatment, a significant number of individuals with OSFED may go on to meet full criteria for AN, BN, or BED at some point during the course of their illness.

Examples of presentations that can be specified using the other specified designation includethe following:

  • Atypical AN: All of the criteria for AN are met, except that despite significant weight loss, the individuals weight is within or above the normal range.
  • BN : All of the criteria for a diagnosis of BN are met, except that the binge eating and inappropriate compensatory behaviors occur, on average, less than once a week and/or for less than 3 months.
  • BED : All of the criteria for BED are met, except that the binge eating occurs, on average, less than oncea week and/or for lessthan 3 months.
  • Purging Disorder: Recurrent purging behavior to influence weight or shape in the absence of binge eating.
  • Ednos: Deadliest Eating Disorder Is Quietly The Most Common

    Up to 70 percent of all eating disorders come under the EDNOS banner.

    EDNOS: Most Dangerous, Unheard of Eating Disorder

    “It really feels like it is a second person inside of you,” she said. “It’s like your best friend but your enemy at the same time. It’s hard to distinguish sometimes the ED talking and what’s Taylor talking.”

    “ED” is the nickname Taylor, 20, gives to her eating disorder diagnosis, which, as she puts it, was “switched all over the place.”

    “Originally I was diagnosed with bulimia,” she said. “Then my symptoms didn’t match bulimia. So then they diagnosed me as anorexia, binge/purge type, because there are two different types. And then I didn’t meet the weight criteria for anorexia. So then they said, ‘OK, you have EDNOS.’ And I was like, ‘Well, what is that?'”

    EDNOS stands for “eating disorder not otherwise specified,” and up to 70 percent of all eating disorders come under the EDNOS banner. According to the National Association of Anorexia Nervosa and Associated Disorders, 24 million people in the U.S. of all ages and genders suffer from an eating disorder.

    Many of the EDNOS symptoms are the same as other eating disorders, such as bulimia or anorexia, but don’t fully meet the criteria of those disorders. On the other hand, EDNOS sufferers might exhibit a combination of eating disorders, such as being severely strict with counting calories but then still purging after eating.

    EDNOS: Warning Signs and Symptoms

    EDNOS: Warning Signs and Symptoms

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    Signs Of Osfed To Look Out For Might Include:

    • Overly focused on and/or secretive behaviour around food
    • Self-consciousness when eating in front of others
    • Low confidence and self-esteem
    • Feelings of shame, guilt, and anxiety
    • Difficulty concentrating

    Its not always obvious that someone has an eating disorder remember, they are mental illnesses. If youre worried about yourself or someone you know, even if only some of the signs on this page are present, you should still seek help immediately, as this gives the best chance of recovery. The first step is usually to make an appointment with the GP.

    Length Of Contact And Status After 3 Years

    What Is an Eating Disorder Not Otherwise Specified?

    The median length of contact with the service was 5.7 months, but the length of contact with the service was highly variable, as illustrated in Fig. 1.

    Fig. 1. Percentage of patients in contact over time.

    There is a marked drop-out during the first 3 months, by which time only around 60% of patients assessed are still in contact. The rate at which patients lose contact declines steadily during the next year, so that by 12 months around one-third are still in contact. At the end of 3 years, only 18 patients were still active and 87% were discharged.

    The most common reason for discharge from the service was drop-out . A further 7.8% of discharges involved referral to another service and in one-third of patients there was an agreed discharge, in which patient and therapist had jointly agreed to end therapy.

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    Eating Disorder Not Otherwise Specified Is Not A Catch

    Eating Disorder Not Otherwise Specified is an eating disorder that, while it may display some characteristics of other disorders, does not meet the requirements of anorexia nervosa, bulimia nervosa or binge eating disorder. People with EDNOS might show symptoms of one, both, or neither disorder but still demonstrate an unhealthy obsession with food, weight control or loss, or exercise. While it might be known now as the term OSFED , there is a specific list of criteria that must be met in order for an individual to have EDNOS.

    Symptoms Of Ednos And Other Eating Disorders

    Symptoms formerly associated with EDNOS can indicate a different eating disorder. Typically, these were listed as:

    • Constant concern about food and calorie intake
    • Excessive worry about weight gain
    • Behaviors that restrict eating
    • Behaviors associated with purging, including excessive exercise
    • Hiding meals or eating in secret
    • Binge eating behaviors, including spending too much money on food, the disappearance of large amounts of food, eating for long periods of time, or noticeable blocks of time when the person is alone
    • The inability to stop worry or fear about food, and associated behaviors
    • Placing foods into specific categories of good or safe and bad
    • Changing ones diet to consume only good foods, and strict avoidance and fear of bad foods
    • Becoming a vegetarian or vegan, coupled with rapid weight loss
    • Changes in eating habits, including less food in the home
    • Spending more time alone, or more time exercising, than before
    • Obsession with ones image, searching for flaws or weight gain
    • Obsession with weight measurements

    There are many risks associated with eating disorders, including for people formerly diagnosed with EDNOS. These include:

    • Inflammation of the esophagus
    • Damage to the teeth due to vomiting
    • Rupture of the esophagus or stomach from frequent vomiting
    • Chronic constipation or diarrhea
    • Osteoporosis due to low nutrition
    • Irregular or slowed heartbeat

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    Symptoms & Warning Signs

    Individuals with OSFED all share the common trait of having disordered thoughts and behaviors about food and eating. Here are a few of the warning signs of OSFED:

    • Preoccupation with food and eating
    • Preoccupation with body shape or weight
    • Extreme body dissatisfaction
    • Having a distorted body image.
    • Depression, anxiety or irritability
    • Heightened anxiety and/or irritability around meal times
    • Refuses to eat certain categories of foods
    • Low self-esteem and feelings of shame, self-loathing or guilt

    Osfed Versus Ednos: What Is The Difference

    Eating Disorder Not Otherwise Specified | Eating Disorders

    Contributor: Jennifer Rollin, MSW, LGSW, writer for Eating Disorder Hope

    Eating Disorder Not Otherwise Specified was a diagnosis from the DSM IV-which was utilized for individuals who had eating disorder symptomology and significant distress, but did who not meet the full criteria for any of the other eating disorder diagnoses.

    Additionally it is important to note that, EDNOS used to be the most commonly diagnosed eating disorder and encompassed a varied group of people. Approximately 40-60% of cases in eating disorder treatment centers fell into the EDNOS category and about 75% of individuals with eating disorders seen at non-specialty community settings had EDNOS.

    The Diagnostic & Statistical Manual currently lists six clinical examples of EDNOS.

  • All criteria for anorexia are met, however the individuals weight falls within normal range .
  • All criteria for anorexia are met, however the individual has regular menstrual cycles.
  • All criteria for bulimia are met, however purging or binge-eating episodes happen less than two times per week or for fewer than three months.
  • Someone purges after eating a small amount of food and has a normal body weight.
  • An individual repeatedly chews and spits large amounts of food.
  • All of the criteria are met for binge eating disorder.
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    Pica Rumination Disorder And Avoidant/restrictive Food Intake Disorder

    The diagnoses Pica and Rumination Disorder were both transferred from the previous DSM-IV section of Disorders Usually First Diagnosed in Infancy, Early Childhood, or Adolescence . Also in the same section, the diagnosis Feeding Disorder in Infancy or Early Childhood, , has been expanded and transferred to the new general category of Feeding and Eating Disorders. In this transformation, the name changes to Avoidant/Restrictive Food Intake Disorder or by its acronym, ARFID. Unlike FDIEC, ARFID can be diagnosed past age 6.

    Given that the essential feature of Pica involves the repeated eating of non-nutritive, non-food substances, and given the mutually exclusive classification scheme for DSM-5 eating disorders, it is the only Feeding and Eating Disorder which can be diagnosed simultaneously with another eating disorder.

    Rumination behavior, which involves the regurgitation of food which is then either re-chewed, re-swallowed or spit out, may exist as part of active AN or BN or as a sole diagnosis, Rumination Disorder. It may remain as a residual problem after apparent recovery from another eating disorder and may go undetected unless it is suspected and inquired about, since patients may not be forthcoming about its existence. This may give the practitioner a flawed complacency that the patient is in full recovery. A recent patient of mine illustrates this point:

    What To Do If You Suspect Ednos

    If you ever suspect that you or a family member may have EDNOS, seek immediate counseling. EDNOS is very difficult to treat because there is no formal definition of the eating disorder. However, proper counseling is essential to be started as soon as possible to avoid complications. Constant thoughts and worries about food and weight is a precautionary sign about EDNOS. Also, behaviors of food restriction or binge eating may flag an eating disorder.

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    Ednos: Eating Disorder Not Otherwise Specified

    There are life threatening disorders perfectly described like bulimia nervosa and anorexia nervosa. In anorexia, there is low body weight, a body image distortion and obsessive fear of gaining weight. Bulimia is a little different. In Bulimia, people eat a lot of food in a short period of time, that is, they engage in binge eating. A sensation of guilt and fear comes after binge eating so the person may try to eliminate all the food eaten by vomiting or taking laxatives.

    The Risks Arent Just Physical

    Weighing The Facts: EDNOS: Eating Disorders Not Otherwise ...

    Those with EDNOS not only suffer from physical consequences but psychological ones as well. In a study conducted by researchers from the University of Chicago, Harvard School of Public Health, and the University of Minnesota, 75% of people with EDNOS also suffered from psychiatric disorders at the same time as EDNOS. Men, in general, are more likely to suffer from depression at the same time as suffering from an eating disorder.

    With any suspected eating disorder, professional medical help should be sought at the onset of warning signs. Keeping educated on the symptoms and facts about Eating Disorder Not Otherwise Specified, as well as educated on anorexia nervosa and bulimia nervosa will help you recognize problems early on and seek professional help for yourself or your loved one. With the many forms of EDNOS that exist , its more important than to be able to decipher the facts from the fiction when talking about this dangerous disorder.

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