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eating disorder not otherwise specified & other types

Eating Disorder Not Otherwise Specified (E.D.N.O.S.)

Eating Disorder Not Otherwise Specified (E.D.N.O.S.) is a term used when the sufferer has disordered eating but does not meet some of the diagnostic criteria for any one specific condition. This is also sometimes known as an “atypical” eating disorder. For example, a person could show all of the psychological signs of anorexia and be losing weight, but still be menstruating and is not yet underweight for their height.

The term “Eating Disorder Not Otherwise Specified” comes about because a doctor, when making an assessment of a patient, only has certain diagnostic criteria to go by according to the Diagnostic and Statistical Manual of Mental Disorders. If the patient meets some but not all of the criteria, a doctor may diagnose an E.D.N.O.S.

Situations where a doctor may diagnosis E.D.N.O.S. include:
  • The patient has a negative body image, is fasting regularly and appears to be losing weight but is still menstruating
  • The patient is purging after eating large meals and believes they are fat when it is clear to everyone else they are not but they are not binging and the purging is infrequent
  • The patient is binging on large quantities of food but this is only happening occasionally, even though they have gained weight
In all three examples above, the individual is indeed suffering from an eating disorder but it cannot be categorized specifically. Practically speaking, they are suffering from anorexia in the first instance, bulimia in the second and binge-eating disorder in the third. However, from a diagnostic standpoint, they have atypical types of eating disorder. In many situations, it simply means that the illness has been caught early, before more serious symptoms have started to show.

Diagnostic criteria for all eating disorders

Body Dysmorphic Disorder (B.D.D.)

Body Dysmorphic Disorder (B.D.D.)is an obsession with a perceived defect in the sufferer’s body or appearance. The most common area of dissatisfaction is the face, typically the size and shape of noses, eyes, ears and mouths, eyebrows, chins, and jaws. A sufferer may agonize over wrinkles and blemishes (real or perceived) and will regularly check their appearance in the mirror.

Body Dysmorphic Disorder is not limited to a person’s face; a sufferer can obsess about any part of their body, including the legs, hips, arms, belly and genitals. When the sufferer’s obsession is with their weight or being “fat”, it is possible they have anorexia or bulimia.

According to Mental Help Net, a person with Body Dysmorphic Disorder exhibits the following symptoms:
  • Preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person’s concern is markedly excessive.
  • The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  • The preoccupation is not better accounted for by another mental disorder (for example, dissatisfaction with body shape and size in anorexia nervosa)
The sufferer may become more and more withdrawn socially, often avoiding contact with other people for fear of them noticing their “defect.” There is also the possibility that the sufferer will make comparisons between themselves and their acquaintances.

According to, selective serotonin reuptake inhibitors (S.S.R.I.s) like Prozac and Zoloft have proved to be effective medications, as well as cognitive behavioral therapy. Psychiatric treatment is also often successful in decreasing BDD symptoms, with the therapist helping the person with B.D.D. resist compulsive behaviors. also reports that the last 30 years or so have seen a dramatic increase in the number of people who are dissatisfied with their appearance. In 1972, 23% of American women were unhappy with the way they looked, but this had risen to 56% by 1997. Similarly, 38% of men are now dissatisfied with the size of their chests and 43% of women are dissatisfied with their breasts.


Pica is a condition where the sufferer will crave and eat non-food items. The types of items consumed can vary, but common ones include:
  • Dirt and clay
  • Paint chips, plaster and chalk
  • Cornstarch, laundry starch, baking soda
  • Coffee grounds
  • Cigarette ashes, burnt match heads
  • Rust
Although it is often harmless, medical advice should be sought if the individual consumes something toxic. Also, some items may contain hidden bacteria or parasites and can lead to intestinal infections or a blocked intestine that can be life threatening.

Pica is quite common in children and sometimes has solid medical reasons behind it. For example, if a child is regularly licking or eating the paint around the house it may be because it is old paint that contains lead. Lead is sweet to the taste but has a number of side effects, including nausea, vomiting and, eventually, lead poisoning which can be fatal. According to A.N.R.E.D., an estimated 10-20% of children will exhibit signs of pica at some point in their childhood.

Pica is more likely to affect some people than others. It is usually found in:
  • Pregnant women
  • People whose diets are deficient in minerals contained in the consumed substances
  • People who have psychiatric disturbances such as hysteria
  • People with developmental disabilities or similar impairments
  • People whose family or ethnic customs include eating certain non-food substances
  • People who diet, become hungry, and then try to ease hunger and cravings with low-calorie, non-food substances
For many people, eating non-food items is an every day routine. It can go on for years with no harmful side effects, but individuals should take care to avoid toxic substances. They must also be alert to potential medical problems and look out for symptoms such as irregular bowel movements, abdominal bloat and distention that suggest the substance has formed an indigestible mass that has blocked the intestines. Immediate medical attention must then be sought.
Purging Disorder

Purging Disorder is similar to bulimia in that the sufferer purges (through self-induced vomiting, laxative or diuretic abuse, or other compensatory behaviors) after eating. However, the sufferer does not meet other criteria normally associated with bulimia, particularly binge eating. Additionally, the sufferer maintains a normal or near normal weight.

The dangers of purging disorder are similar to those of bulimia, including tooth decay, dehydration, and electrolyte imbalances. A 2007 study conducted by Pamela Keel of the University of Iowa in conjunction with colleagues at Harvard Medical School showed that women with purging disorder and bulimics shared emotional and psychological characteristics, including body image problems, anxiety and depression.

It should be noted that purging disorder is not yet a format diagnosis but it does seem to be separate from bulimia.


“Muscle dysmorphia”, “reverse anorexia” and “bigorexia” are all terms meaning essentially the same thing: somebody who believes they are underweight and puny when the opposite is true. It tends to affect bodybuilders and avid gym-goers, often to the extent that they will check their appearance in the mirror dozens of times a day. The individual’s social life can be severely affected, with some sufferers ashamed to show their bodies in public (even wearing shirts), believing they are too small.

Dr. Harrison Pope, chief of the biological psychiatry laboratory at McLean Hospital in Belmont, Massachusetts, suspects a link to anorexia nervosa. “They are both disorders of body image,” he says. “The preoccupations simply go in opposite directions.” Unlike anorexia, bigorexia isn’t in itself life threatening, but sufferers are at risk if they take steroids or other muscle-enhancing drugs.

Bigorexia tends to affect males more than females because men are under more pressure to be toned and muscular. Charles Staley of the International Sports Sciences Association says: “Bodybuilding can be a way for people with low self-esteem to call attention to themselves. If someone doesn’t have much else going on in their life, their whole self-image gets caught up in their body.” Bigorexia does also affect females to a lesser degree, particularly bodybuilders.

A 1993 study of steroid use among weightlifters indicated that 10% of the 156 men interviewed by Dr. Harrison Pope saw themselves as being punier than they really were. Another study revealed that 32 out of 38 competitive female bodybuilders had symptoms of bigorexia (Chamberlain, Claudine – “Weightlifters’ Woe: ‘Bigorexia'” – ABC News, November 21 2002).

Please note that bigorexia is still a relatively new term and is unlikely to be diagnosed by a doctor.

Prader-willi syndrome

According to the Prader-Willi Syndrome Association Prader-Willi Syndrome is a disorder of chromosome 15 and affects approximately 1 in 12,000 to 1 in 15,000 people. It can affect anyone, regardless of their gender or race. It is a complete genetic disorder that usually causes low muscle tone, short stature, incomplete sexual development, cognitive disabilities, problem behaviors, and a chronic feeling of hunger that can lead to excessive eating and life threatening obesity.

A person with Prader-Willi Syndrome has a flaw in the hypothalamus part of his or her brain. This usually regulates feelings of hunger and satiety but, when defective, means that the person never feels full, even after eating large quantities of food. The problem is compounded because people with Prader-Willi Syndrome have less muscle than normal and tend to burn fewer calories.

Obsessive and compulsive disorders are extremely common with people who have PWS. Behaviors such as hoarding possessions and picking at skin irritations are fairly typical examples. A feeling of a loss of control can trigger aggressive behaviors, such as tears, tantrums and physical violence. Psychotropic medications can help some people, but the best strategy for minimizing difficult behaviors is a careful structuring of the individual’s environment and a regular use of positive behavior management.

Orthorexia nervosa

Orthorexia is a pathological obsession with eating proper food. The exact type of food may vary, but the individual has a fixation on only eating food they consider to be healthy or beneficial – to them, it is “pure” food.

Somebody who is orthorectic will spend more and more of their time thinking about food and how to plan their meals. They impose rigid regimes on themselves and must be punished if they “break the rules”. The punishments do not tend to be as extreme as someone with anorexia or bulimia and usually involve imposing even tighter restrictions on what they can and cannot eat. By the same token, they may reward themselves if they do not give in to temptation and avoid foods that are not “pure.”

At first glance, there seems to be little difference between orthorexia and anorexia. However, there ARE many differences, the biggest one being that an orthorectic is not consumed by thoughts of being “thin” and losing weight. Also, somebody with anorexia (or bulimia, for that matter) focuses on the quantity of food, whereas an orthorectic concentrates on the quality.

The long-term consequences of orthorexia depend on the diet the person has imposed upon themselves. Often, the health risks are not particularly greater than that of a vegetarian or vegan. Many of the problems tend to be social ones, with the individual finding it harder and harder to maintain a conversation that doesn’t involve food. They may also be isolated, often eating alone and spending a considerable amount of time planning and buying food.

Please note that orthorexia is still a relatively new term and is unlikely to be diagnosed by a doctor.

Nocturnal Sleep-Related Eating Disorder (N.S.-S.E.D.)

Nocturnal Sleep-Related Eating Disorder (N.S.-S.E.D.) is a fairly new term that is still being investigated. Somebody with N.S.-S.E.D. eats in their sleep, often waking up with candy wrappers around them but having no memory of what happened. The eating may or may not be in the form of a binge.

In spite of its name, it is not, strictly speaking, an eating disorder because the sufferer is not consciously aware of their behavior. The episodes probably occur when the person is between wakefulness and sleep.

According to A.N.R.E.D., an estimated 1-3% of the genereal population may experience N.S.-S.E.D. at some time, but those with an eating disorder are more susceptible. Approximately 10-15% of eating disorder sufferers may go through N.S.-S.E.D.

Sleeping pills are not a recommended treatment for N.S.-S.E.D., since they are likely to cause even more confusion and this might lead to injury during episodes of N.S.-S.E.D. Stress management courses, assertiveness training and counseling can call help reduce the frequency of N.S.-S.E.D. episodes.