In this article:
- EDNOS stands for “Eating Disorder Not Otherwise Specified” and it accounts for as much as 80% of eating disorder diagnoses.
- The diagnosis refers to a broad cluster of disordered eating, rooted in a desire to either lose or gain weight, that becomes a threat to the person’s health.
- One of the biggest threats EDNOS poses is its invisibility. Someone with all the symptoms of anorexia might go without proper diagnosis simply because they aren’t thin enough to fit the standard image of an anorexic person.
- But just 6% of those suffering from an eating disorder are medically classified as underweight.
You’ve felt dissatisfied with your body before.
It doesn’t matter how confident you are or how objectively attractive you actually look. People have a knack for tearing their self-esteem apart. We can’t seem to help but compare ourselves to other people or, if we look better than most other people, hyperfocus on perceived flaws.
As easy as it is to think of this as negative behavior, it’s largely just a normal impulse based on our natural drive for improvement.
There are evolutionary advantages to fitting standards of attractiveness. With reproduction being necessary for the survival of our DNA, being perceived as attractive improves your chances of passing on your genes. The more attractive you are to others, the more opportunities you have to sow those wild oats (read: genetic material).
But the pressure to be attractive can cause mental health problems in the form of eating disorders. These eating disorders take dieting and exercise to a level of obsession that can kill people who suffer from them. While anorexia and bulimia are the first things to come to mind when we talk about eating disorders, they’re actually far from being the most common.
The dominant eating disorder throughout the globe is actually EDNOS and chances are, you’ve never heard of it before.
What Is EDNOS?
EDNOS stands for “Eating Disorder Not Otherwise Specified” and it’s a label slapped on anything that’s an eating disorder but doesn’t quite fit the diagnostic criteria for anorexia nervosa, binge eating disorder, or bulimia nervosa.
A person might get an EDNOS diagnosis if they have what’s called atypical anorexia, which meets all the diagnostic criteria except being underweight. Others might exhibit low-frequency bulimia or binge eating, which would both count as the actual disorders if they met the frequency conditions set by the Diagnostic and Statistical Manual of Mental Disorders.
To understand why EDNOS counts as an eating disorder, let’s figure out what an eating disorder is. According to the American Psychiatric Association, an eating disorder is a “behavioral condition characterized by severe and persistent disturbances in eating behaviors.” But it isn’t just weird eating habits. Eating weird combinations of food are often still normal.
It’s when the second condition is met that weird eating becomes disordered eating. Once eating habits become associated with emotional distress, like eating to soothe depressive thoughts, it starts to make that transition from preference to disorder.
EDNOS consists of a cluster of disordered behaviors ranging from anorexia-leaning to bulimia-leaning. People with EDNOS may worry excessively about avoiding weight gain or they might want to gain weight.
Either way, the compulsion to lose or gain weight is brought to a point that it’s detrimental to their health. They might also develop symptoms of body dysmorphic disorder and spend copious amounts of time worrying in front of their mirror about a near non-existent double chin.
Some people with EDNOS can have more binge eating disorder-like symptoms and go as far as hiding food and eating in secret to disguise the true extent of their unhealthy eating habits.
Eating Disorder Not Otherwise Specified: The Vital Statistics
EDNOS sits in a weird mental disorder limbo. It’s clearly a real disorder in that it adversely affects the lives who have it but at the same time, it doesn’t meet the widely agreed-upon criteria for specified eating disorders.
This undefined character of EDNOS lets it fly under the radar both in media and in real life. As bad as this sounds, it’s harder to show that your favorite TV show character has anorexia if you don’t see them losing weight. That’s just what we think of when we think of anorexia nervosa.
These blinders on what we think of as disordered eating extend to real life. The signs could all be there: worn down teeth and cuts on knuckles, but we still don’t pick up on the fact that there’s something wrong with the relationship another person, or we ourselves, have with food.
But the statistics on EDNOS don’t lie.
Between 2013 and 2017, there have been 1,788 members of the U.S. Armed Forces who were diagnosed with an eating disorder. Of these 1,788 servicemembers, around 46.4% suffered from an Other Specified Feeding or Eating Disorders, the new name for EDNOS beginning with the DSM-V update.
On a global scale, at least 9% of people are suffering from an eating disorder. Of that 9%, less than 6% are medically classified as underweight. You can probably see where this is going.
EDNOS is currently the most common eating disorder both among adolescents and adults. People suffering from an unspecified eating disorder make up as much as 75.38% to 80.97% of eating disorder statistics.
As if that isn’t bad enough, the statistics reveal an even more worrying trend. People who have EDNOS are getting younger. The increasingly younger skew of EDNOS demographics comes down to a number of factors that are still difficult to pin down. But there are certain risk factors for EDNOS and eating disorders in general that psychologists and researchers have managed to identify.
Risk Factors for EDNOS
1. Peer Pressure and Bullying
Peer pressure and bullying are often the primary driving forces behind why teenagers and even children develop an EDNOS. If you still remember what it was like being a kid or a teen, you probably remember that younger people can be vicious, especially to each other.
There’s a very “in your face” pressure to do what a friend group does and adopt the same behaviors and beliefs because if you don’t, you risk getting treated as the odd one out. For adults, it’s a bit more obvious (hopefully) that situations where your peers are pressuring you into harming yourself aren’t healthy. But keep in mind that for children and teenagers, their friend group is a big deal.
“Some kids will go through a phase of starving themselves because their friends are doing it. When they are on their own they might be fine, but for others, it is a trigger for a lifelong struggle,” Psychologist Linda Buchan explained to the Calgary Herald.
Okay, so why not just cut all ties with other people?
2. Exposure to Messages That Promote Body Dissatisfaction
If you were a teen on Tumblr around the late 2000s to mid-2010s, you might be familiar with the Pro-Ana movement. Movement is a nice way of putting it because “pro-ana” stood for “pro-anorexia.” Tumblr users in their teens, or even younger, were bombarded with images of pencil-thin models and other girls their age achieving enviable model-like bodies.
Black and white or sepia images of women with their bones showing through their skin were plastered on the feeds of young Tumblr users everywhere in the world. Along with each image was a promise: You could be conventionally attractive, too.
It was called “thinspiration” and it was the propaganda of what was essentially a shared compulsion to starve to death. To call pro-ana and its bulimia counterpart, pro-mia, a death cult wouldn’t be too far of an exaggeration.
Tumblr started cracking down on blogs that promoted self-harm and eating disorders around the early to mid-2010s but pro-ana and pro-mia are showing up elsewhere on YouTube as well as newer social media apps like TikTok which are geared toward younger Gen Z users.
3. A History of OCD And/or Perfectionist Behavior
There’s a strong link between obsessive-compulsive disorder, EDNOS, and perfectionist behavior.
If you think about it, OCD and eating disorders share a key facet: obsessive and compulsive behavior. Except for eating disorders like EDNOS, the pathological behaviors are about eating rather than switching your lights on and off again exactly 29 times before you can leave the bathroom.
People with eating disorders have higher rates of OCD compared to the general population and it can range from 11% to 69%. People with anorexia have been found to have a need to gain or keep control of their environment while bulimics often purge to absolve themselves of the feelings of guilt associated with binge eating.
A study published in the American Journal of Psychiatry uncovered another link between perfectionism and eating disorders. Perfectionism, as a personality style, is characterized by an excessive need for approval or, phrased another way, to be “right” or “good.”
Perfectionists are overly critical of themselves which can include excessive criticism of their appearance, leading to EDNOS-related behaviors hence its inclusion as a risk factor of developing an eating disorder.
4. Sexual Abuse
There’s a strong correlation between sexual abuse and eating disorders, especially among women.
While only 28% of non-anorexic and non-bulimic people were sexually abused at some point in their life, around 50% of patients suffering from anorexia and bulimia reported having been raped or sexually assaulted.
You might think that the disordered eating habits that coincide with sexual abuse are exclusively related to binge eating or bulimia nervosa because it can serve as a way to “eat” your feelings.
But it’s more to do with a distorted idea of sexual attractiveness and self-worth as a result of abuse and a need to re-establish a sense of control, which can take the form of disordered eating.
Some women who have suffered sexual abuse will try to either destroy their physical appearance or improve it. The ones who fixate on improvement may develop anorexia-related symptoms as they try to become more attractive to other people, especially men, since the abuse they’ve gone through has distorted their perception of self-worth.
Others might try to protect themselves by striving to be “uglier.” Women and girls may start overeating on purpose to make themselves less conventionally attractive, a trait that they are led to believe will keep them under the radar of future sexual abusers.
These may often tie into feelings that the EDNOS is actually a means of regaining control over their lives.
Sexual abuse is deeply violative and shatters a person’s sense of bodily autonomy. For some women, being able to control their weight through how they eat is a means to re-establish that sense of control despite how dangerous EDNOS can become for them. It provides a false feeling of relief until the person suffering from an EDNOS realizes that they are no longer in control once again. It’s the disorder that’s controlling them.
What To Do if You Suspect You or Someone You Love Has an EDNOS
The key to approaching any mental health concern is empathic listening. It’s hard to suspend our own judgments of whether someone looks “thin” enough to have anorexia or “fat” enough to have bulimia or a binge eating disorder.
These perceptions are what allow EDNOS to go unchecked until a person spirals to the point that their health is destroyed or they develop an eating disorder that meets diagnostic criteria. This applies both when you’re the one you think might have an EDNOS or if it’s a friend.
Acknowledge their or your distress and try to direct them or yourself to a mental health professional who specializes in eating disorders, especially EDNOS, who can help uncover the underlying problems of the eating disorder and come up with ways to combat the thoughts that come with it.