Eating Disorder Not Otherwise Specified: What Is It?
Eating disorders (ED) encompass mental disorders focused on food, body perception, and fear of gaining weight. Typical eating disorders are anorexia nervosa and bulimia.
However, When all the criteria for them are not met, but important symptoms do appear, we speak of an unspecified eating disorder In this article we will learn about eight of them. We will also talk about the causes and treatments of EDs.
Eating disorders (ED) are mental disorders that can be very serious. In them, the patient’s fundamental concerns are food and the perception of body silhouette.
The EDs par excellence are anorexia nervosa and bulimia. In both there appears an excessive fear of gaining weight; They are similar disorders, although with different symptoms The difference between these two disorders, broadly speaking, is that in anorexia nervosa the body weight is usually lower than in bulimia (and by extension the Body Mass Index (BMI) as well).
Furthermore, in bulimia the presence of binge eating and inappropriate compensatory behaviors (vomiting, use of laxatives, diuretics…) appears as a diagnostic criterion, something that does not occur in anorexia. This does not mean that these symptoms cannot appear in anorexia.
Unspecified eating disorder
However, It may happen that symptoms of one of these two eating disorders appear, but not all That is, it may happen that a person meets some diagnostic criteria for bulimia or anorexia (or for another eating disorder), but does not meet all of them.
In this case, we are talking about an unspecified eating disorder (ONED), a type of disorder that affects 3-5% of the population. In addition, the terms “atypical anorexia nervosa” or “atypical bulimia” have also frequently been used to refer to the existence of an unspecified eating disorder.
On the other hand, in addition to the cases mentioned, unspecified eating disorder also encompasses those cases in which the patient is in the initial phase of an eating disorder, or in the process of recovery from it.
These are disorders that can be as serious as another specified eating disorder, or even more so That is why they should always be given the importance they deserve.
What disorders does this category include?
Let’s see the types of Unspecified Eating Disorder included in the DSM-IV-TR (Diagnostic Manual of Mental Disorders).
1. Anorexia nervosa with regular menstruation
In this type of unspecified ED, all the diagnostic criteria for anorexia nervosa appear, minus the criterion that refers to absent (amenorrhea) or irregular menstruations In this case, the patient has regular menstruation. It is worth mentioning that the amenorrhea criterion present in the DSM-IV-TR is eliminated in the 5th edition of the manual (DSM-5).
2. Anorexia nervosa with normal weight
The second type of unspecified eating disorder refers to the presence of anorexia nervosa (with all its criteria), but which does not meet the criterion that indicates that the weight is less than expected in relation to the age, height and height of the patient
That is, although the patient has lost a considerable amount of weight, at the current time his/her weight is normative (it is within the parameters of normality).
3. Atypical bulimia
Another type of unspecified eating disorder is atypical bulimia, in which the diagnostic criteria for it are met, minus the criteria for the frequency and duration of binge eating and inappropriate compensatory behaviors; In this case, these occur less than 2 times a week (the criterion requires a minimum of 2 times a week), or last less than 3 months.
There could also be the case of atypical bulimia where some criterion other than the one mentioned is not met, but all the others are met.
4. Regular inappropriate compensatory behaviors
This unspecified eating disorder involves the appearance of inappropriate compensatory behaviors on a regular basis, after eating small amounts of food. The patient who suffers from it has a weight within normal limits according to his/her age, size and height.
However, other symptoms of another eating disorder do not appear for bulimia or anorexia to be diagnosed, for example.
5. Chew without swallowing
It may be the case that the patient chews the food and then expels it, without swallowing anything. This occurs with large amounts of food, and forms another type of unspecified eating disorder.
6. Compulsive disorder
The so-called compulsive disorder in the DSM-IV-TR (proposed for research in Appendix B of the same, and finally included as “binge eating disorder” in the DSM-5), constitutes another unspecified eating disorder.
This is characterized because the person who suffers from it eats large amounts of food without subsequently applying any compensatory behavior inappropriate (typical of bulimia nervosa).
Other unspecified TCAs
Beyond the diagnostic reference manuals (DSM), and in clinical practice, we can find two more types of unspecified eating disorders that, although they do not appear as official diagnoses in the same manuals, do exist (and increasingly occur more frequently) in the population.
We talk about vigorexia and orthorexia. But what does each of them consist of?
1. Vigorexia
Vigorexia is the pathological obsession with being muscular It affects men more frequently than women, and is a relatively recent disorder that is increasing in prevalence.
This obsession with a muscular body translates into behaviors such as repeatedly looking in the mirror throughout the day (whether at the gym, at home, in shop windows…), and eating only those substances that promote muscle growth. muscle (proteins and carbohydrates). That is, the person reduces their fat intake (or eliminates it completely) to avoid losing muscle.
People with vigorexia are so obsessed with looking muscular that, paradoxically, they can feel ashamed of being seen or looked at (for example in the gym), since they feel that they never have “enough muscle to “they would like.”
2. Orthorexia
The second new unspecified eating disorder, which has also recently appeared, is orthorexia. Unlike the previous one, In this case the obsession is to eat only and exclusively healthy foods (i.e., biologically “pure” foods). Unlike “classic” EDs (bulimia and anorexia), where the obsession lies in the quantity of food (which must be the minimum), in orthorexia the obsession is with the quality of the food (which must be the best and healthier).
Thus, people with orthorexia make diets and healthy food the center and main objective of their lives; everything revolves around it. If they have to get up earlier to cook, they do it; If they have to go to a wedding, they take a tupperware so as not to eat anything that is unhealthy, etc. All these behaviors become pathological and only feed the obsession with health.
They are people who can spend several hours a day thinking about the diet they should follow, the foods they should cook, etc. All of these symptoms end up causing them significant psychological discomfort, as well as physical discomfort, since they end up abandoning products and foods that are essential for the correct and healthy functioning of the body.
Causes
The causes of both eating disorders and unspecified EDs are usually multifactorial, encompassing social, personal, biological, hormonal factors, etc However, there are usually especially related causal factors; Social pressure to be thin and fashions are at the basis of anorexia, for example, especially among women.
On the other hand, binge eating behaviors, for example, are related to poor coping mechanisms, characterized by impulsivity and an anxious personality.
Treatment
Ideally, to treat unspecified eating disorder, the treatment for the eating disorder that most closely resembles the unspecified eating disorder itself is followed. On the other hand, it will always be advisable to address dysfunctional thoughts related to food, weight and body shape, through cognitive behavioral therapy.
Behavior therapy, for its part, is also widely used in this type of disorders, through token economy, positive reinforcement, differential reinforcement, etc.
