Eating disorder not otherwise specified: what is it?

We talk about this subtype of ED.

Eating disorders (ED) encompass mental disorders centered on food, body perception and fear of gaining weight. Typical EDs are anorexia nervosa and bulimia.

However, when not all the criteria for these disorders are met, but significant symptoms are present, we speak of an eating disorder not otherwise specified.. In this article we will learn about eight of them. We will also discuss the causes and treatments of ED.

Eating disorders (ED): what are they?

Eating disorders (ED) are mental disorders that can become very serious. In these disorders, the patient's main concerns are food and the perception of body shape.

The most common EDs are anorexia nervosa and bulimia. In both cases, there is an excessive fear of gaining weight; they are similar disorders, although with different symptomatology.. The difference between these two disorders, broadly speaking, is that in anorexia nervosa body weight is usually lower than in bulimia (and by extension the Body Mass Index [BMI] as well).

Moreover, in bulimia the presence of binge eating and inappropriate compensatory behaviors (vomiting, use of laxatives, diuretics...) appears as a diagnostic criterion, which does not occur in anorexia. This does not mean that these symptoms cannot appear in anorexia.

Eating disorder not specified

However, symptoms of one of these two eating disorders may occur, but not all of them.. That is, it may happen that a person meets some diagnostic criteria for bulimia or anorexia (or for another ED), but does not meet all of them.

In this case, we are talking about an eating disorder not otherwise specified (EDNOS), a type of disorder that affects 3-5% of the population. In addition, the terms "atypical anorexia nervosa" or "atypical bulimia" have also frequently been used to refer to the existence of an eating disorder not otherwise specified.

On the other hand, in addition to the cases mentioned above, eating disorder not otherwise specified also includes those cases in which the patient is in the initial phase of an eating disorder, or in the process of recovery from it.

These are disorders that can be as severe as, or even more severe than, another specified ED.. That is why they should always be given the importance they deserve.

What disorders are included in this category?

Let's see the types of eating disorders not specified in the DSM-IV-TR (Diagnostic Manual of Mental Disorders).

1. Anorexia nervosa with regular menses

In this type of unspecified ED, all the diagnostic criteria for anorexia nervosa appear, except the criterion referring to absent (amenorrhea) or irregular menses.. In this case, the patient has regular menses. It is worth mentioning that the amenorrhea criterion present in the DSM-IV-TR is eliminated in the 5th edition of the manual (DSM-5).

2. Anorexia Nervosa with normopesity

The second type of eating disorder not otherwise specified refers to the presence of anorexia nervosa (with all its criteria), but which does not meet the criterion indicating that the person has anorexia nervosa (with all its criteria), but does not meet the criterion indicating that the person has anorexia nervosa with normal weight. does not meet the criterion indicating that the weight is lower than expected in relation to the patient's age, height and stature..

That is, although the patient has lost a considerable amount of weight, at the present time his/her weight is normative (within the parameters of normality).

3. Atypical bulimia

Another type of unspecified eating disorder is atypical bulimia, in which the criteria for atypical bulimia are met.in which the diagnostic criteria for bulimia are met, minus the criterion of frequency and duration of binge eating and inappropriate compensatory behaviors; in this case, these occur less than 2 times per week (the criterion requires a minimum of 2 times per week), or last less than 3 months.

It could also be the case of atypical bulimia where some other criterion than the one mentioned above is not met, but all the others are met.

4. Regular inappropriate compensatory behaviors

This unspecified eating disorder involves the occurrence of inappropriate compensatory behaviors on a regular basis.after ingesting small amounts of food. The patient has a weight within the normal range according to his/her age, height and stature.

However, there are no other symptoms typical of any other eating disorder for a diagnosis of bulimia or anorexia, for example.

5. Chewing without swallowing

It can be the case that the patient chews the food and later expels it, without swallowing anything.without swallowing anything. This occurs with large amounts of food, and is another type of eating disorder not specified.

6. Compulsive disorder

The so-called compulsive disorder in the DSM-IV-TR (proposed for research in Appendix B of the DSM-IV-TR, and finally included as "binge eating disorder" in the DSM-5), constitutes another unspecified eating disorder.

This is characterized by the sufferer eating large amounts of food without any subsequent inappropriate compensatory behavior (typical of bulimia nervosa). (typical of bulimia nervosa).

Other unspecified EDs

Beyond the reference diagnostic manuals (DSM), and in clinical practice, we can find two more types of unspecified eating disorders which, although they do not appear as official diagnoses in the same manuals, do exist (and are increasingly common) in the population.

We are talking about vigorexia and orthorexia. But what does each of them consist of?

Vigorexia

Vigorexia is the pathological obsession to be muscular..... It affects men more often than women, and is a relatively recent disorder, but its prevalence is increasing.

This obsession with a muscular body translates into behaviors such as repeatedly looking at oneself in the mirror throughout the day (whether at the gym, at home, in shop windows...), and eating only those substances that favor Muscle growth (proteins and carbohydrates). In other words, the person reduces his or her fat intake (or eliminates it completely) to avoid losing muscle.

People with vigorexia are so obsessed with looking muscular that, paradoxically to what is believed, they may even feel ashamed of being seen or looked at (for example at the gym), as they feel they never have "enough muscle as they would like".

2. Orthorexia

The second new unspecified eating disorder, also of recent appearance, is orthorexia. Unlike the previous one, in this case the obsession is with eating only and exclusively healthy foods. (i.e. biologically "pure" food). Unlike the "classic" EDs (bulimia and anorexia), where the obsession lies in the quantity of food (that it be the minimum), in orthorexia the obsession is with the quality of the food (which must be the best and healthiest).

Thus, people with orthorexia make dieting and healthy eating the center and main goal of their lives; everything revolves around it. If they have to get up earlier to cook, they do it; if they have to go to a wedding, they take a tupper so as not to eat anything unhealthy, and so on. All these behaviors become pathological and only feed the obsession with healthiness.

These are people who can spend several hours a day thinking about the diet they should be on, the food they should be cooking, etc. All these symptoms end up causing them significant psychological discomfort, as well as physical, since they end up abandoning products and foods that are essential for the correct and healthy functioning of the organism.

Causes

The causes of both eating disorders and unspecified EDs are usually multifactorial, encompassing social, personal, biological, hormonal, etc. factors.. However, there are often particularly related causal factors; social pressure to be thin and fads are at the basis of anorexia, for example, especially among women.

On the other hand, binge eating behaviors, for example, are related to poor coping mechanisms, characterized by impulsivity and an anxious personality.

Treatment

Ideally, to treat the eating disorder not otherwise specified, the treatment for the eating disorder that most closely resembles the eating disorder not otherwise specified should be followed. On the other hand, it will always be advisable to address dysfunctional thoughts related to food, weight and body shape through cognitive behavioral therapy.

Behavioral therapy, on the other hand, is also widely used in this type of disorders, through token economy, positive reinforcement, differential reinforcement, etc.