Eating disorders and substance abuse can cover such a wide range of conditions, but it’s still impossible to categorize every single type of eating disorder, or every single type of substance abuse. There are so many factors to take into consideration when diagnosing a substance abuse problem or an eating disorder that it has become necessary to create a catchall class for conditions that don’t fit into the recognized and established conventions. This classification is called “not otherwise specified” (or simply “not specified”)
Eating Disorder Not Otherwise Specified
An eating disorder not otherwise specified (EDNOS) is one that does not fulfill all of the diagnostic requirements for anorexia or bulimia, two of the most common types of eating disorder. Someone diagnosed with EDNOS may have milder symptoms of bulimia or anorexia, a mixture of both conditions, or show entirely different symptoms that would not fall under either of the two more recognized categories.
For example, the National Institutes of Health advises that “menstrual periods are often infrequent or absent” for girls who have reached puberty when they develop anorexia nervosa. The Office of Women’s Health of the U.S. Department of Health and Human Services explains that this happens as a result of a woman’s body not getting the required energy and nutrients from foods. However, a woman who exhibits all the symptoms of anorexia nervosa but still has regular periods would be considered for an eating disorder not otherwise specified.
Similarly, a patient who chews and spits out food without swallowing would be a candidate for an EDNOS diagnosis, since there is no pre-existing category for that particular eating disorder.
Even though the creation of an “undefined” category implies that EDNOS are rare, the National Alliance on Mental Illness says that “far more” people identify with eating disorders not otherwise specified than they do the more established categories of anorexia and bulimia. The spectrum of eating problems that can develop in a person, for any number of reasons – mental health, substance abuse, peer pressure, etc. – could be a reason that the journal Psychological Bulletin said EDNOS diagnoses were the most prevalent of all eating disorder diagnoses. The journal cited a number of other studies that showed EDNOS accounted for 40 to 60 percent of treatment at specialty clinics, while the number skyrocketed to 90 percent in non-specialty, community-based facilities.
Symptoms of Eating Disorder Not Otherwise Specified
Trying to understand the causes and symptoms of eating disorders not specified is counterintuitive; by nature, EDNOS is a “default” category, defined by what it is not. The article in Psychological Bulletin says that because EDNOS is “so diverse,” trying to explain it in the way we might explain conditions that are more easily categorized would undermine the disorder’s functionality as a repository for conditions that do not fit expected symptoms of other eating disorders.
However, the lack of concrete definition does not take away the severity of an eating disorder not specified. Australia’s National Eating Disorders Collaboration warns that people suffering from EDNOS still have:
- Extremely unhealthy eating habits
- Distorted perceptions and ideas of body image
- Intense fear of gaining weight
These symptoms are also true of people who more closely fit the characteristics of anorexia nervosa (by starving themselves so they don’t gain weight), or bulimia (people who binge and purge for the same reasons). Other physical symptoms may include:
- Inability to maintain a consistent weight
- Loss of menstrual periods in women; loss of libido in men
- Weakened immune system
- Frequent vomiting
- Weakness and fatigue
The unifying factor of all eating disorders – both those specified and those not specified – is the lack of self-esteem and shame of the body, which causes its sufferers to go to extreme measures to get to what they believe to be their ideal body weight.
Substance Abuse and Eating Disorder Not Specified
Substance abuse is a serious problem in the presence of eating disorders. A report by the National Center for Addiction and Substance Abuse at Columbia University explains that people with eating disorders were five times as likely to have substance abuse problems as those without eating disorders. Also, patients who drank or used drugs were up to 11 times as likely to have eating disorders as those who did not abuse drugs or alcohol.
The report goes on to say that 50 percent of individuals with eating disorders abused alcohol or drugs, while only nine percent of the general population (those without eating disorders) did so. Up to 35 percent of individuals who abused controlled substances, or were otherwise dependent on them, have had eating disorders, compared to only three percent of the general population.
Similarly, in a publication entitled “Eating Disorders and Alcohol Use Disorders,” the National Institute of Alcohol Abuse and Alcoholism reports that “alcoholism and [eating disorders] frequently co-occur,” especially when other psychiatric conditions are present. An advisory published by the Substance Abuse and Mental Health Services Administration cites a number of studies that show that women with either a substance abuse problem or an eating disorder were four times as likely to develop the other disorder than women who had neither. Another study cited in the advisory found that 14 percent of women who had a substance abuse problem had anorexia nervosa, while another 14 percent had bulimia.
As the severity of the eating disorder increased – more extreme fluctuations in weight gain, increased negative perception of body image, etc. – the number of different illicit substances used increased. Attempts to lose weight by purging, as opposed to patients depriving themselves of food, were associated with abusing stimulants, like amphetamines.
The advisory posited that patients with eating disorders may turn to substance abuse as a coping, self-medicating mechanism against the depression and low self-esteem that are part of their eating disorder. Alcohol and drugs can even be abused in recovery and treatment for eating disorders, as patients become increasingly desperate for relief from the changes that their bodies are undergoing. Conversely, patients who are in rehabilitation for a substance abuse problem may attempt to compensate for the sudden cessation of their addictive behavior by binge eating, and then purging or starving themselves.
Getting Help for an Eating Disorder Not Otherwise Specified
If you have an eating disorder, there’s a good chance you’ll have an eating disorder not otherwise specified. Regardless of the category in which you fall, eating disorders can be deadly. They cause depression, anxiety, obsessive thoughts about food, and very harmful dietary habits, like binge eating, starving, and purging. People with eating disorders are also at risk for low heart rate, low blood pressure, and osteoporosis.
All this can sound scary – and it should– but there’s hope. FRN has trained professionals who can help you or your loved one with substance abuse problems and mental health concerns. Dual Diagnosis care that treats both issues simultaneously can help you regain control of your life. We can help you develop a healthy attitude toward food and your body through various therapy programs that will help you understand the fundamental reasons behind your issues with body image, food, and substance abuse. Please call now to talk with one of our admissions coordinators about how we can help.
Further Reading About Substance Abuse and Eating Disorders Not Specified
David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.
Reviewed by: Kim Chin and Marian Newton