Abnormal Psychology: Eating Disorder Not Otherwise Specified (EDNOS)
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Significance of the Topic
Although anorexia nervosa, bulimia nervosa, and binge eating disorder have gotten more media attention, Eating Disorder Not Otherwise Specified (EDNOS) is actually the most prevalent eating disorder in the general population. The estimated prevalence is 4.78% in adolescents and 4.64% in adults, according to one research study (LeGrange, et al., 2012). Although individuals with this disorder may not have the dangerously low or high body weight or frequency of purging behavior of the better-known eating disorders, the eating behaviors of sufferers still cause significant distress.
Connection to Abnormal Psychology
The existence of far more diversity within the category of eating disorders than recently thought, including the inclusion of binge eating disorder as a medically classified mental illness, versus solely being viewed as a failure of willpower, highlights the degree to which research on eating disorders, and the best ways to classify and understand them, continues to evolve.
Eating disorders remain one of the most troubling categories for psychologists to analyze. They are both physical and mental in their effects. They can cause significant developmental complications for adolescents in terms of normal physical and social development, although they can affect individuals of any age. Eating disorders have been understood through a number of lenses, including biological ones (determining physical triggers for the illness, including genetics), environmental and cultural ones, as well as understanding eating disorders through both the lens of addiction and obsessive-compulsive compulsions and rituals. It can also be very difficult to determine if the physical manifestations of the disorders impact comorbidity for other disorders, such as malnutrition triggering depression and anxiety. Individuals with eating disorders, even when the disorder causes them profound distress, can also be extremely ambivalent about abandoning their behaviors.
Review of the Literature
According to the literature, the diagnosis of EDNOS has likewise frustrated clinicians. The diagnostic category was created for individuals with eating disorders whose physical and emotional behaviors caused them to fall outside of the often rigid criteria specified in the other categories (LeGrange, et al., 2012). However, the fact that EDNOS is actually the most prevalent disorder calls into question the utility of existing categories, suggesting that much may be missed by the rigid classification system. All eating disorders pose significant health risks to patients, psychologically and physically, so greater refinement seems to be needed to ensure the categories meaningfully reflect patient’s lives.
Individuals diagnosed with EDNOS may encompass individuals who fail to meet specific weight criteria, number of times a week regarding purging behavior, and “the heterogeneity of an EDNOS diagnosis is problematic and limits the information conveyed with this classification. Relatively precise sets of diagnostic criteria are mapped out for AN and BN…yet no other criteria for EDNOS are specified†(LeGrange, et al., 2012, par.5). Such heterogeneity is not useful for either treatment or determination of the extent of health risk. Arguments against an elimination of eating disordered subcategories emphasize the different psychologies and physical effects of the disorders, including the fact that EDNOS sufferers report a higher degree of comorbidities for mood and anxiety disorders, according to one study by LeGrange (et al., 2012). Another study by Dahlgren (et al., 2019) found significantly less cognitive flexibility in individuals with anorexia nervosa, versus other eating disorders. This also suggests that despite the less clearly defined nature of EDNOS, there may be significant features to distinguish the types of ways in which it manifests itself in clinical populations.
Critique of the Literature
One useful aspect of the LeGrange (et al., 2012) study is that it raises important questions to how eating disorders are viewed by clinicians. It examines ways to provide greater structure to treatment of EDNOS, including a reconsideration to at least review the current subdivision of categories of individuals diagnosed with the disorder. (LeGrange, et al., 2012, par.3). Conversely, it also examines the possibility of eliminating the categories of different eating disorders for a more transdiagnostic approach (LeGrange, et al., 2012). It notes that given that many anorexics may engage in purging behavior (although there is a specific, purging subtype), and many bulimics engage in restrictive behavior between bulimic episodes, rigid diagnostic categories my hinder treatment. On the other hand, there are still distinctive patterns which emerge within the existing diagnostic categories, such as higher degrees of comorbidity with non-eating disordered mental illnesses for EDNOS sufferers, and greater anxiety and rigidity about eating and exercise habits in anorexics specifically, versus other eating disordered patients (Dahlgren, et al., 2019).
Recommendations
It is critical to end the stigma attached to eating disorders, or to suggest that EDNOS is less serious than anorexia, bulimia, or binge eating. EDNOS can still have significant physical and mental health consequences. There also may be some unique clinical manifestations of EDNOS that must be explored, including the tendency for comorbidity with other psychological illnesses. Overall, eating disordered patients, although there may be different behavior patterns and complications between the diagnostic categories, must be treated as individuals, not as the sum of their illness. Future research into the distinctive nature of EDNOS is required, as well as a consideration for further subdivision of the diagnostic category regarding specific behaviors that are not adequately explained by the fact that the patient does not meet the criteria for other eating disorders.
Reference
Dahlgren, C. L., Hage, T. W., Wonderlich, J. A., & Stedal, K. (2019). General and eating
disorder specific flexibility: Development and validation of the Eating Disorder Flexibility Index (EDFLIX) Questionnaire. Frontiers in Psychology, 10, 663. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6454114/
Le Grange, D., Swanson, S. A., Crow, S. J., & Merikangas, K. R. (2012). Eating disorder not
otherwise specified presentation in the US population. The International Journal of Eating Disorders, 45(5), 711–718. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4408273/
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