Eating Disorder Not Otherwise Specified (EDNOS)

What Is EDNOS?

Eating disorder not otherwise specified (EDNOS) is a category in DSM-V reserved for eating disorders of clinical severity that do not meet diagnostic criteria for anorexia and bulimia nervosa.¹ While lesser known, EDNOS is the most common eating disorder in both adolescents and adults.²

EDNOS Vs. OSFED

Individuals with other specified feeding and eating disorders (OSFED) exhibit similar disordered eating behaviors, negative self-beliefs, and poor body image of other eating disorders but do not meet the criteria for diagnosis. Professionals previously recognized OSFED as an eating disorder NOS.

EDNOS Symptoms & Signs

Symptoms of EDNOS vary from person to person, as no two individuals experience eating disorders the same way. While common themes of low self-esteem and poor body image are present, people can exhibit a spectrum of atypical behavior. Some may struggle with restrictive food intake, while others feel out of control around food. More noticeable physical signs of EDNOS include weight changes, fatigue, and sleep disturbances.

Common signs and symptoms of EDNOS include:

• Obsessive calorie counting
• Skipping meals
• Pushing food around on a plate rather than eating it;
• Exercising excessively
• Ingesting an excessive amount of food, even when not hungry
• “Grazing” as long as food is available
• Hiding eating habits due to shame or embarrassment
• Showing excessive interest in weight, body image, and fasting.
• Refusing to eat certain foods (i.e., carbs, sugar, dairy)
• Frequent comments about feeling “fat” or overweight
• Denying hunger cues
• Low self-esteem
• Symptoms of depression
• Symptoms of anxiety
• Noticeable fluctuations in weight
• Sleep problems
• Gastrointestinal symptoms (i.e., stomach cramps, constipation, acid reflux)
• Menstrual irregularities and amenorrhea (missing periods)
• Difficulty concentrating
• Anemia

Types of EDNOS

As mentioned, EDNOS encompasses a spectrum of disordered eating habits and thoughts. Individuals may not meet clinical diagnostic criteria for anorexia or bulimia, but mental health professionals can recognize similarities between specific behaviors.

In some cases, people with EDNOS feel strong urges to eat inedible foods or large amounts of food in a short period. Others may struggle with purging behavior without the characteristic binge episodes associated with bulimia.

Types of EDNOS may include:

• Pica: Pica is the consumption of non-nutritive substances, such as paper, cigarette ashes, or washing detergent. This type of EDNOS often stems from nutritional deficiencies.
• Prader-Willi Syndrome: PWS is a genetic disorder that causes life-threatening obesity in children. Those with PWS will continue eating unless others intervene or they run out of food.³
• Night eating syndrome: Individuals with night eating syndrome experience a strong urge to eat large amounts of food after dinner and before bedtime. They also struggle with restrictive food intake throughout the day.⁴
• Bigorexia: Bigorexia (muscle dysmorphia) refers to an obsession with increasing muscle mass and decreasing body fat, often accompanied by a preoccupation with body image.⁵
• Atypical anorexia nervosa: Those with atypical anorexia nervosa meet most of the criteria for anorexia. For example, they may restrict food, participate in food rituals, and exercise excessively but fall within normal weight.
• Subthreshold bulimia nervosa:  An individual with this eating disorder meets most of the criteria for bulimia without the frequency or duration of binge episodes.
• Subthreshold binge eating disorder: An individual with subthreshold binge eating disorder may binge at a lower frequency than someone diagnosed with binge eating disorder.
• Purging disorder: Purging involves the forceful evacuation of matter from the body, most often through self-induced vomiting or laxative misuse. Those with purging disorder are not underweight and engage in purging behavior without binging.⁶

How Is Eating Disorder Not Otherwise Specified Diagnosed?

A licensed professional can diagnose EDNOS if an individual meets most but not all criteria for a specific eating disorder. An evaluation typically includes multiple assessments of symptoms, family and personal mental health history, and eating habits. The professional may also look for signs of underlying conditions that may influence disordered eating, such as nutritional deficiencies.

Below are examples of instances in which EDNOS may be diagnosed:

• Meeting the weight criteria for anorexia but still menstruating
• Purging without the presence of binging episodes
• Meeting the criteria for bulimia nervosa but only binge eats once a week
• Eating non-nutritive items (i.e., washing detergent or clay)

What Causes EDNOS?

EDNOS, like other eating disorders, has no specific or known cause. The development of this disorder varies from person to person and could result from psychological, sociocultural, biological, or a combination of factors. In many cases, societal expectations and accepted norms can contribute to an eating disorder. Other times, chronic stress can lead to individuals using food as a coping skill or restricting food intake.

Below are possible triggers and causes of EDNOS:⁷

• Peer pressure
• Societal expectations
• Family history of disordered eating
• Different brain functioning
• Trauma
• Bullying
• Chronic or toxic stress
• History of dieting

Health Risks of EDNOS

EDNOS poses serious health risks, some of which can be life-threatening. Those who restrict food intake can develop kidney problems, low blood pressure, and even bone loss. For individuals with pica, ingesting toxic or non-edible items can result in intestinal blockages and poisoning. While prolonged disordered eating is most likely to cause severe problems, even short-term unhealthy habits can negatively affect health.

Potential health risks of EDNOS include:

• Weakened bones
• Cardiovascular problems
• Damage to the structure and function of the heart
• Irregular heart rate
• Low blood pressure
• Slowed breathing and pulse
• Drop in internal body temperature
• Gastrointestinal issues (including damage to the esophagus and stomach)
• Constipation
• Diarrhea
• Kidney damage
• Slowed growth (in young people)
• Infertility in men and women
• Lethargy or sluggishness

Treatment for EDNOS

Treatment for EDNOS is similar to that of more established and recognized eating disorders. A multidisciplinary team of physicians, therapists, and nutritionists typically work together to address food, body image, and weight-related issues. Most therapy modalities will focus on establishing healthy eating patterns while exploring the underlying causes of distress.

Common therapies used to treat EDNOS include:

• Enhanced cognitive behavioral therapy (CBT-E): CBT-E helps individuals address, disrupt, and modify thoughts and feelings that maintain eating disorders. They work toward replacing negative self-talk with positive alternatives to facilitate change and healthier habits.
• Interpersonal therapy (IPT): Interpersonal therapy focuses on resolving social aspects that contribute to an eating disorder. For example, a therapist and client may examine unhealthy relationships that lead to low moods related to disordered habits.
• Dialectical behavioral therapy (DBT): DBT for eating disorders helps individuals recognize and replace disordered eating patterns. Clients learn mindfulness, distress tolerance, and emotional regulation skills to combat anxiety related to eating and negative beliefs about food.
• Family therapy: Family therapy allows the family to provide support while helping the individual learn healthy eating patterns. This method can be especially beneficial for young children and teens with EDNOS.
• Acceptance and commitment therapy (ACT): ACT rests on the fundamental premise that pain, grief, disappointment, illness, and anxiety are inevitable features of life. Clients learn to productively adapt to challenges by developing greater psychological flexibility rather than engaging in counterproductive disordered eating.⁸

How to Cope With EDNOS

Coping with EDNOS is possible with self-acceptance, patience, and dedication to change. Take time to appreciate where you are on this journey while identifying ways to manage and eliminate unhealthy patterns. For example, journaling can help you to reflect on and adjust the emotional reactions that precede disordered eating to create new habits.

Below are ways to cope with EDNOS:

1. Listen to Your Body

Connect with your body by paying attention to how you feel when triggered. What emotions do you feel before an episode of restricting, binging, or body dysmorphia? Recognizing and understanding these factors can help you catch yourself before falling into a cycle of disordered eating.

2. Find a Support Network

Eating disorders are complicated, and many individuals with EDNOS feel alone in their journey toward recovery. However, other people have faced similar experiences to you, and their shared insight can be invaluable when coping with EDNOS. Support groups are a safe space for you to connect with these individuals.

You can find both in-person and online eating disorder support groups, depending on your personal preference and the availability of local resources. Your therapist may also have recommendations for groups in your area, or you can contact your insurance provider for a list of in-network options.

3. Focus on Self-Acceptance

While difficult, developing a healthier relationship with food and improving your body image is possible. Start by accepting where you are in recovery, even after slipping up or falling back into unhealthy habits. Celebrate your accomplishments and reward yourself for making positive changes.

Recovery is not linear, and you may feel emotionally drained some days. However, allow yourself to feel your emotions and accept them as they peak and pass. How you view yourself will set the foundation for healthier eating habits, self-esteem, and well-being.

4. Re-Evaluate How You See Food

We often develop internal beliefs about food based on society and life experiences. You may be afraid of eating, gaining weight, or losing control, but food is a necessary aspect of living. Food is also often a central aspect of finding comfort, like during holidays or birthdays. Food is neutral, not something you should see as “bad.” Start healing the relationship with yourself and eating by learning to see food as something your body needs and an outlet for social connection, celebration, and happiness.

5. Learn to Replace Unhealthy Habits

Examine your behavior around food. What habits would you like to replace with healthier alternatives? Do you feel the urge to eat large amounts of food? Do you find yourself restricting after having a “bad” food day? Focus on finding an activity to distract you from and override these urges. For example, practice mindfulness, watch your favorite TV show, work on a puzzle, or listen to music when feeling triggered. Over time, you may notice an improved sense of resilience and power over your disordered eating behavior.

Where to Find Professional Help for EDNOS

Finding the right therapist specializing in eating disorders is the first step in recovery and establishing a healthy relationship with food. You can start your search using an online therapist directory or ask your doctor for a referral.

If you prefer at-home care, online therapy options are convenient and equally effective as in-person services. Apps, such as Within Health, are also beneficial when living with EDNOS. These services allow for intensive online treatment while receiving outpatient support.

Does Insurance Cover Treatment for EDNOS?

Some insurance companies may not cover treatment specifically for EDNOS, as this condition is lesser known and established.⁹ However, insurance is more likely to cover treatment for individuals diagnosed with bulimia, binge eating disorder, and anorexia nervosa. Consult your insurance provider or research sliding-scale therapy options if concerned about coverage.