What is an Unspecified Feeding or Eating Disorder?

Introduction

Unspecified feeding or eating disorder (UFED) is a Diagnostic and Statistical Manual of Mental Disorders (DSM-5 category of eating disorders that, along with other specified feeding or eating disorder (OSFED), replaced eating disorder not otherwise specified (EDNOS) in the DSM-IV-TR.

UFED is an eating disorder that does not meet the criteria for: anorexia nervosa, bulimia nervosa, binge eating disorder, or OSFED. Individuals with EDNOS have similar symptoms and behaviours to those with anorexia and bulimia, and can face the same dangerous risks.

Signs and Symptoms

Rather than providing specific diagnostic criteria for EDNOS, the fourth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) listed six non-exhaustive example presentations, including individuals who:

  • Meet all criteria for anorexia nervosa except they have regular menses.
  • Meet all criteria for anorexia nervosa except their weight falls within the normal range.
  • Meet all criteria for bulimia nervosa except they engage in binge eating or purging behaviours less than twice per week or for fewer than three months.
  • Use inappropriate compensatory behaviour (such as purging, excessive exercise, or fasting) after eating small amounts of food while retaining a normal body weight.
  • Repeatedly chew and spit out large amounts of food without swallowing.
  • Meet criteria for “binge eating disorder”: recurrent binge eating and no regular inappropriate compensatory behaviours.

Despite its subclinical status in DSM-IV, available data suggest that EDNOS is no less severe than the officially recognized DSM-IV eating disorders. In a comprehensive meta-analysis of 125 studies, individuals with EDNOS exhibited similar levels of eating pathology and general psychopathology to those with anorexia nervosa and binge eating disorder, and similar levels of physical health problems as those with anorexia nervosa. Although individuals with bulimia nervosa scored significantly higher than those with EDNOS on measures of eating pathology and general psychopathology, those with EDNOS exhibited more physical health problems than those with bulimia nervosa.

Diagnosis

Although no longer in the DSM-5, the three general categories for an EDNOS diagnosis are subthreshold symptoms of anorexia or bulimia, a mixture of both anorexic or bulimic symptoms, and clinically-significant disordered eating behaviours that are not described by anorexia and bulimia. EDNOS is no longer considered a diagnosis in DSM-5. Because some diagnostic criteria were loosened and new diagnoses were introduced in DSM-5, those displaying symptoms of what would previously have been considered EDNOS are now classified under anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant/restrictive food intake disorder(ARFID), other specified feeding or eating disorder (OSFED), or unspecified feeding or eating disorder (UFED).

Epidemiology

Although EDNOS (formerly called atypical eating disorder) was originally introduced in DSM-III to capture unusual cases, it accounts for up to 60% of cases in eating disorder specialty clinics. EDNOS is an especially prevalent category in populations that have received inadequate research attention such as young children, males, ethnic minorities, and non-Western groups.

Treatment

When treating any eating disorder, including unspecified disorders, it is important to include a registered dietician or nutritionist working with the treatment team. Even though eating disorders are a psychological diagnosis, psychologists are not certified or licensed in dietetics or nutrition, so it is important that psychologists are not practicing outside their bounds of competence. Medical Nutrition Therapy is vital in the treatment and management of eating disorders. The dietician assists the patient by creating a meal plan that is tailored to their individual needs and treatment goals. The dietician will also provide psychoeducation that challenges nutrition misinformation and will ideally create a space where the patient feels comfortable asking questions.

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