A slimming program for eating disorders not otherwise specified. Reconceptualizing a confusing, residual diagnostic category

Abstract

This study suggests that the category of EDNOS as currently defined is overly broad, representing many cases that could be more helpfully subsumed within AN or BN diagnostic criteria without changing the essential features of these categories but by rethinking the currently overly restrictive, perhaps research-derived criteria. The reconceptualizing of AN as a syndrome resulting from a decrement between setpoint versus illness-driven final weight avoids the inherent problems of imposing a category on a dimension. A rethinking of AN suggests that a specific female-only abnormality of reproductive hormone functioning, 3 months of amenorrhea, is too restrictive. Instead, a more encompassing criterion recognizing the multiple medical, social, and psychologic functional impairments that result from substantial starvation would be appropriate in its place. Clinicians who otherwise confidently treat AN and BN patients would welcome the clearer diagnostic categorization of the potentially confusing EDNOS category. Third party payers who currently, albeit wrongly, exclude EDNOS diagnoses from insurance payment, would have less difficulty with a smaller group of EDNOS. In summary, the currently overly broad category of EDNOS as currently used would benefit from a thoughtful dieting regimen.