Definition of Eating Disorder Not Otherwise Specified

Diagnostic Criteria

What is an Eating Disorder Not Otherwise Specified, or Eating Disorder NOS? Most of us are somewhat familiar with more common disorders--anorexia nervosa and bulimia nervosa. But there are other patterns of disordered eating that don't fit the criteria for either of these diagnoses. When eating is disordered but cannot be diagnosed as one of the above, the definition of Eating Disorder NOS may apply.

Why Eating Disorder NOS Is Important

The Eating Disorder NOS definition is important because it gives legitimacy to the pain of those who deal with other kinds of eating problems. Anorexia and bulimia are glitzy and can receive a lot of media attention. But even without all the symptoms of these two disorders, problems with eating can strongly affect a person's quality of life.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) does not provide hard and fast criteria for a diagnosis of Eating Disorder NOS.

It does give some examples, however (APA, 1994):

• A female who meets all the criteria for anorexia nervosa but continues to have normal menstrual cycles
• A person who meets all the criteria for anorexia nervosa, but whose current weight is in the "normal" range (the person's weight is at least 85% of what is expected for someone of the same age and height). This can be the case even if the person has already lost significant weight
• A person who meets all the criteria for bulimia nervosa, but who has been binging and compensating for the binging 1) for less than three months, or 2) less than twice a week
• There is compensatory behavior (purging, laxative use, excessive exercise, or other behaviors) after eating small amounts of food; i.e., there is no binging
• Continued chewing and spitting out large amounts of food without swallowing
• Binge-eating disorder

Note that this is not an exhaustive list. Diagnosis of Eating Disorder NOS is very subjective under its current definition. Consider the definition of bulimia nervosa. It requires that the person's evaluation of self be "unduly influenced by body shape and weight." If Janice binges and purges frequently, but her opinion of self does not depend on her body shape or weight, she does not qualify for a diagnosis of bulimia nervosa. Janice does qualify, however, for a diagnosis of Eating Disorder NOS.

Reference

American Psychiatric Association (APA). 1994. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, D.C., American Psychiatric Association.