Imagine that your doctor told you that you suffered from a disorder that was "not otherwise specified." How would you feel about the seriousness of your condition? Would you feel nervous? Or maybe you would dismiss it as unimportant? These are the questions that confront nearly 70 percent of patients with eating disorders. We have all heard of anorexia and bulimia, but what you may not know is that there is a class of eating disorders called Eating Disorder Not Otherwise Specified (EDNOS).
EDNOS causes more deaths than either anorexia or bulimia (1). Currently, patients are diagnosed with EDNOS if they fail to meet all the requirements for anorexia and bulimia. However, the newest revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM), a cornerstone of psychiatry, plans to address this vagueness so that current EDNOS patients will no longer struggle with that uncertainty.
In our image-obsessed society -- where fashion models are fired for not being skinny enough and a clothing company can cause uproar by featuring the slogan "Eat Less" on a t-shirt -- eating disorders are a dangerous reality. More Americans suffer from eating disorders than Alzheimer's disease and schizophrenia combined (2). In addition, more than a third of normal dieters develop an eating disorder (3).
Eating disorders often point to more serious underlying mental illnesses, like body image issues or depression. Disrupted eating patterns are the common sign, but there are other signs that suggest that someone is suffering from an eating disorder. These include never wanting to eat, uncontrollable eating tied to emotional states, repeatedly chewing and spitting out food without swallowing, frequently using laxatives or enemas, and self-evaluation heavily dependent on body image (4).
To address the high number of EDNOS cases, DSM-5 (the latest version of the manual) will better specify illnesses like Binge Eating Disorder, for example. This is useful because many disorders that are grouped together under EDNOS are not very similar; they have different characteristics and require separate attention and treatment. By doing this, both doctors and patients have a clearer understanding of which eating behaviors need to be treated, instead of shrugging it off as "unspecified."
If you were a patient, wouldn't you feel more positive about the outcome of your disease knowing that it is more than just "non-anorexia" or "non-bulimia?" Also, doctors will be able to choose more suitable strategies for how to treat these behaviors.
This change is not without controversy, though, as some doctors think that "over-specifying" these disorders in DSM-5 means patients will be diagnosed with disorders that they don't truly have (5). Will this really happen? We don't know, but I believe it will allow for eating disorders in patients to be identified more clearly and treated more effectively.
Eating disorders are a serious medical condition. If you notice these signs in yourself or someone you know, get help. Speak with a doctor about counseling. Join a local support group or one on the internet. Educate yourself on the signs of eating disorders and learn how to prevent them.
As updates to the DSM show, these disorders are legitimate mental illnesses and they require treatment; they don't just go away on their own. The medical community is doing its part to deal with unspecified eating disorders by revising its guidelines, and we each need to do our parts by educating ourselves and intervening when we suspect eating disorders in friends or loved ones.
Follow John Whyte, M.D., MPH on Twitter: www.twitter.com/drjohnwhyte