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Diagnostic Criteria for Eating Disorder - Not Otherwise Specified

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Updated February 16, 2012

The Diagnostic & Statistical Manual of Mental Disorders, 4th Ed. Text Revision (DSM-IV-TR) is published by the American Psychiatric Association and provides physicians and mental health professionals with the criteria for diagnosing specific mental disorders, including "eating disorder, not otherwise specified (ED-NOS)." ED-NOS is considered to be a catch-all category by many professionals as it essentially covers anyone who is struggling with some but not all of the criteria for anorexia nervosa or bulimia nervosa. The DSM-V, which is slated to be published in 2013, is expected to clarify and change this category as many of those people who are currently diagnosed as ED-NOS will be more appropriately diagnosed with anorexia nervosa, bulimia nervosa or binge-eating disorder.

Examples given by the DSM-IV-TR of someone who may meet criteria for ED-NOS are:

  • Meeting all of the criteria for anorexia nervosa, except the patient still has a menstrual period and/or his or her weight is higher than 85% of ideal body weight.
  • The person meets all of the criteria for bulimia nervosa except that their episodes of binging and purging occur less frequently than specified.
  • Someone who repeatedly chews and spits out food but does not swallow food.
  • Someone who uses compensatory behaviors similar to bulimia nervosa but does not engage in binge eating.

Within the DSM-IV-TR, binge-eating disorder is not its own diagnosis, instead, it's technically diagnosed as ED-NOS. However, binge-eating disorder is expected to be made an official diagnosis by the DSM-V. The DSM-V is also expected to make changes to the current criteria for binge eating disorder regarding the frequency of binge episodes. The current criteria include:

Repeated episodes of binge eating. An episode of binge eating is defined as eating "an amount of food that is definitely larger than most people would eat" during the same amount of time. The person also must feel as though they have lost control over eating and are unable to stop themselves or control how much they are eating.

The person is very distressed about binge eating.

The binge eating occurs, on average, two days per week for six months.

There are no associated compensatory behaviors (purging/excessive exercise) that would be seen with bulimia nervosa.

The episodes of binge eating are associated with three (or more) of the following criteria:

  • Eating faster than normal
  • Eating until a person is so full they are uncomfortable
  • Binge eating even when not physically hungry
  • Eating alone because of embarrassment about the binge
  • Feeling disgusted/depressed/guilty after eating

If you, or someone you know is suffering from some or all of the above criteria it is important to be assessed by a physician or a mental health professional such as a psychologist, social worker, therapist or a dietician.

Source:

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Washington, DC: Author.

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