have wondered what happens to those people who don’t always fit into the specific diagnosis for anorexia or bulimia, the ones who skip meals once in a while, yet maintain healthy weight — but do it for the same reasons that the anorexic starves themselves, something often found among college students and adolescents. I searched the web and came up with a lot of information, discovering that there is a category all its own named Eating Disorders Not Yet Specified, which is indeed in the DSM IV.

This diagnosis is applied to a poorly defined group, consisting of those who simply fail to meet the diagnostic criteria of anorexia or bulimia nervosa, for example, people normal weight due to beginnings of anorexic, as well those with distinct conditions. The latter group may include those who vomit when they are anxious or who are unable to swallow in public. "It is thought that this diagnosis may be applied to as many as 5% of the population." (www.gpnotebook.co.uk).

Aside from clinical criteria these are some other characteristics of an eating disorder "not-otherwise-specified":

• Reporting a version of the notion, "I don't have an eating disorder, but I think about food all of the time."

• Being knowledgeable counters of calorie and fat levels

• Highly scale oriented, and frequent weighers

• Engaging in secretive eating

• Engaging in excessive exercise or thinking about exercise

• Resisting nutrition education

• Exhibiting common fluctuations in weight

• Experiencing moderate depression and low self-esteem

There are variants of eating difficulties or worries that do not meet the diagnostic criteria for anorexia nervosa or bulimia nervosa, but these might yet be eating disorders requiring attention. A substantial number of people with possible eating disorders fit into this category. Individuals with eating disordered behaviours that resemble anorexia nervosa or bulimia nervosa but whose eating behaviours do not meet one or more essential diagnostic criteria may be diagnosed with what are called "eating disorders not otherwise specified" (EDNOS). Examples include those who meet criteria for anorexia nervosa but continue to menstruate, those who regularly purge but do not binge eat, or who meet criteria for bulimia nervosa, but binge eat less often than twice weekly. Being diagnosed with EDNOS may mean that a person is not in any less danger or suffers any less.

The most important thing to remember is that Eating Disorders, Anorexia, Bulimia, Compulsive Overeating, or any combination of them, are potentially very serious psychologically and have their physical dangers and complications. They all present themselves through a variety of disordered eating patterns. They stem from issues such as low self-esteem, a need to ignore emotional states such as depression, anger, pain, anger, and most of all they have developed as a means to cope with one's current state.

Diagnostic Criteria: EDNOS
The following definition of an Eating Disorder Not Otherwise Specified is meant to assist mental health professionals in making a clinical diagnosis. This clinical category of disordered eating is meant for those who suffer but do not meet all the diagnostic criteria for another specific disorder. Examples Include:
1. For females, all of the criteria for Anorexia Nervosa are met except that the individual has regular menses.
2. All of the criteria for Anorexia Nervosa are met except that, despite significant weight loss, the individual’s current weight is in the normal range.
3. All of the criteria for Bulimia Nervosa are met except that the binge-eating inappropriate compensatory mechanisms occur at a frequency of less than twice a week or for a duration of less than 3 months.
4. The regular use of inappropriate compensatory behavior by an individual of normal body weight after eating small amounts of food (e.g., self-induced vomiting after the consumption of two cookies).
5. Repeatedly chewing and spitting out, but not swallowing, large amounts of food.
6. Binge-eating disorder; recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory behaviors characteristic of Bulimia Nervosa. (DSM IV)

Medical nutrition therapy and psychotherapy are two integral parts of the treatment of eating disorders. The transtheoretical model of change suggests that an individual progresses through various stages of change and uses cognitive and behavioural processes when attempting to change health-related behaviour (Prochaska, Norcross & DiClemente,1994). Stages include precontemplation, contemplation, preparation, action, and maintenance. Those with eating disorders often progress along these stages with frequent backsliding along the way to recovery (Prochaska, Johnson& Lee, 1998). The role of the nutritional therapist is to help move sufferers along the continuum until they reach the maintenance stage.

I was intrigued by the information I found, both on-line and in journals through my school. I was unaware that the question I posed at the beginning had been answered with so much research. I can understand when people say they don’t have an eating disorder because they are not anorexic or bulimic. However many really do, and need intervention and treatment. The physical damage done to the body is detrimental, especially if the problem is severe. I am glad to have been able to see the wide range of sources, treatment facilities and knowledge in the professional world about the disorder, however I think we need to continue the education in high-schools, colleges and housewife communities where the common saying is ‘I don’t have it." because they don’t know about it.

Sources
American Psychiatric Association (1998), Eating Disorders.
Diagnostic and Statistical Manual of Mental Disorders. (4th ed.). Washington, DC: American Psychological Association, 1994.
http://www.edreferral.com
http://www.gpnotebook.co.uk
Eating Disorders among college women: Prevention, education, treatment responses," in Journal of American College Health, March 1998 (no author)
Prochaska, J, Norcross, J. DiClemente, C. Changing for Good. New York, NY: William Morrow and Company; 1994.
Prochaska J, Johnson S, Lee P. The Transtheoretical model of behaviour change. In Shumaker SA, Schron EB, Ockene J, McBee WL, editors. The Handbook of Health Behavior Change. New York: Springer Publishing Company; 1998:5-32.