According to the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders), there is a classification of disordered eating that falls outside of the criteria for Anorexia, Binge Eating and Bulimia. This category is referred to as “EDNOS”, or “Eating Disorders Not Otherwise Specified.” These are also sometimes referred to as ‘sub-clinical’ or ‘sub-threshold’ disorders.
Persons struggling with EDNOS can range from ‘less-extreme’ behaviors like common dieting, frequent concern about body size, and/or occasional overeating, to more extreme behaviors including frequent purging, obsessive dieting, obsessive exercising and more.
EDNOS doesn’t mean it’s not serious…
Just because a person doesn’t fit the criteria for anorexia or bulimia does not mean they don’t have an eating disorder requiring attention. And don’t be fooled by appearances; most disordered eaters are normal weight or overweight, not skinny. But they can still struggle as seriously as an anorexic or underweight bulimic. In fact, many who struggle in the EDNOS category are at risk for the same dangers as those who meet criteria for other disorders, including the risk of heart attacks, dehydration, electrolyte imbalance and even death.
DSM-IV Technical Criteria for EDNOS
Because of the wide range of eating behaviors that exist outside of anorexia, bulimia and now binge eating disorder (which is becoming more formally recognized by the professional community), EDNOS does not have a comprehensive list of technical criteria at this time. However, the DSM-IV does provide some parameters/examples, as listed below:
- All of the criteria for Anorexia Nervosa are met except the individual has regular menses (periods).
- All of the criteria for Anorexia Nervosa are met except that, despite substantial weight loss, the individual’s current weight is in the normal range.
- All of the criteria for Bulimia Nervosa are met except binges occur at a frequency of less than twice a week or for a duration of less than 3 months.
- An individual of normal body weight who regularly engages in inappropriate compensatory behavior after eating small amounts of food (eg, self-induced vomiting after the consumption of two cookies).
- An individual who repeatedly chews and spits out, but does not swallow, large amounts of food.
Binge eating disorder; recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory behaviors characteristic of bulimia nervosa.
A Range of Behaviors
Based on the limited technical criteria above, following are some additional examples of the behaviors associated with persons struggling with EDNOS. (Please note: this is by no means a comprehensive listing).
- You’re always on a diet, always coming off a diet, or always getting ready to go on one again (chronic dieting).
- You categorize foods as ‘safe’ and ‘off limits’, but weigh within normal ranges and are not participating in bulimia.
- You starve yourself regularly, but are not significantly underweight (i.e. less than 85% ideal weight)
- You eliminate entire food groups from your diet (yes, that includes carbs!).
- You are obsessed with exercising but eat fairly regularly.
- You binge and/or purge, but not more than once a week.
- You substitute supplements and fad diets for real food, but weigh within normal ranges.
- You skip social occasions because you feel fat, or because you are afraid of what’s being served, yet your weight is normal.
- You are obsessed with eating only organic, natural or raw foods (orthorexia).
- You believe that everyone is as focused on your weight as you are.
- You refuse to eat regular meals, choosing instead to ‘nibble’ throughout the day on small portions of food (which usually leads to bingeing).
A Common Struggle
As you might imagine from the lists above, which are not comprehensive in scope, EDNOS is a widespread problem. In fact, our discussions with respected professionals in the field of eating disorders suggest that as many as four out of five people might qualify for some type of disordered eating. If this number is accurate (which is difficult to say given the lack of research on EDNOS), it would suggest that only one out of five people have a truly healthy relationship with food – eating for physical, not psychic, reasons, not obsessing about weight, not worrying about calories, fat grams, and so on.
The Eating Continuum
When thinking about eating disorders, it is helpful to think of eating as being on a continuum, as pictured here:
Schematic 1.0 “The Eating Continuum”
as featured in Life Inside the Thin Cage, by Constance Rhodes.
Published by Shaw Books. Page 19. Used by permission.
Because eating issues appear as on a continuum, ranging from healthy to life threatening, it is common for some individuals to swing from one end of the continuum to the other. For example, a person who frequently diets might suddenly discover quicker weight loss through the use of purging. The more they engage in this behavior, the farther down the continuum they get from healthy eating. On the other hand, a person who once struggled with anorexia may now be at a healthier weight, and be having regular periods (females) but still be afraid of eating certain foods, which could place them into the EDNOS category, still making their way back to healthy eating.
Thus it is important to be aware of the ways in which an individual feels about food, so that the seriousness of their issues are clear, in order for that individual to begin making intentional steps toward the healthy end of the continuum. This process is a difficult but worthwhile one, requiring the individual’s desire to change, the therapeutic involvement of others (doctors, nutritionists, counselors, friends) and, most importantly, God.
Facts & Figures
While there is not a lot of data on EDNOS in particular, the following facts and figures reinforce the widespread problem of disordered eating and body image concerns:
- 3/4 of women have some sort of eating issue.
- As many as 66% of women and 52% of men report feelings of dissatisfaction or inadequacy regarding their weight
- 35% of dieters in the US engage in “Pathological Dieting”
- The body-mass index for most Miss America winners in the past 3 decades lies within the range of under-nutrition
- ¾ of women whose weights fall in the “normal” range feel too fat and wish to lose weight, desiring on average to weigh only slightly more than weights in the Anorexia Nervosa range
- Sub-Clinical disorders are documented as being the most common type of disordered eating among college women
- Nearly 3 out of 4 adolescent girls have been or are currently dieting
- Athletes with higher levels of weight and diet concerns also show higher levels of neuroticism and lower levels of emotional “well-being” and stability
- Sub-Clinical eating disorders often lead to the development of more serious, clinical eating disorders
- In addition to early onset during childhood, adolescence and first independence, eating disorders are often developed later in life, triggered by age related weight gain, as well as life events such as marriage, pregnancy, and loss of a loved one
- 95% of dieters suffer from “weight cycling” (losing, regaining and even gaining add’l pounds)
1. “The Disorder Next Door,” Tula Karris, Self Magazine, April 2008 (research conducted by Cynthia Bulik, PhD)
2-4: “Body Image In The Balance”, Devlin, Zhu, JAMA, The Journal of the American Medical Association, Nov 7, 2001 v286 i17 p2159
5: Has Our Healthy Lifestyle Generated Eating Disorders?”, Joel Yager, The Western Journal of Medicine, Dec 1992 v157 n6 p679(2)
6: “The Eating Disorders NOS Diagnostic Profile Among College Women”, Schwitzer, Rodriguez, Thomas, Salimi, Journal of American College Health, Jan 2001 v49 i4 p157
7: “Fear Of Fat”, Pediatrics For Parents, April 1989 v10 n4 p8(1)
8-9: “Sub-Clinical Eating Disorders in Female Athletes”, Beals, JOPERD – The Journal of Physical Education, Recreation and Dance, Sept 2000, v71 i7 p23
10: “Dying To Be Thin”, Leslie Vreeland, Good Housekeeping, March 1998 v226 n3 p137(3); Dr. Donald Durham, Ph.D.
11: “Yo-Yo Dieting”, Toni Luppino, American Fitness, Jul/Aug 1992 v10 n4 p60(1)
What To Do?
We’re glad you asked! If you or someone you care about struggles with EDNOS, we suggest you spend some more time checking out the videos featured on our site. There are many that address EDNOS specifically, as well as several offering insight into how to break free from this and other patterns of disordered eating.
Additional next steps for recovery might include:
- Finding someone to talk to who can offer objective and balanced advice, addressing the physical, emotional, intellectual and spiritual aspects of your issues. For tips on who to talk to, read the “Finding Treatment” article on this site. For those seeking information on finding a nutritionist, read the “Finding A Nutritionist” article.
- Exploring “Eat Well, Live Well” section of this site, which offers tips and nutrition information to help you find your way back to a healthy balance with regard to eating and weight control.
- Buy or borrow a copy of the book Life Inside the Thin Cage, which specifically addresses EDNOS (most books on ED’s don’t).
- Search our Helpful Books for more books that apply directly to your unique struggle.
- Give yourself permission to take your time. It took a while to get to where you are – you need to allow yourself to slowly find your way back to balance. The goal is to stop jumping from one extreme to the next, so that you can find the peace of balance. You deserve that!
The Bottom Line:
Struggling with eating issues, no matter how extreme they are, steals from your life. It promises happiness, control, acceptance, affirmation, and security, but these promises are false. Only by breaking free of your disorder will you experience the life you crave.