When I read this piece in the New York Times today about a new category of eating disorder not encapsulated by traditional definitions of anorexia and bulimia, it reminded me of the classes I taught on body image when I was an adjunct professor at two colleges in Oregon.
After making my way through many studies, texts, student papers, and other research for those classes, I came to the sweeping conclusion that too many women fall within the bounds of categorized eating disorders and all women have, to some degree, disordered eating and distorted body image. It is a big statement, I know. But with messages from the media, our families, our peers, and the nagging voices so many of us have in our own heads, how is it to be avoided?
My frustration in teaching, within my friendships (every single one of my college roommates had an active eating disorder while we lived together) and also in my own struggles to come to peace with food and with my belly, is that there were not enough words to describe what was going on when women manifested all those weird and secretive and destructive ways of controlling the numbers on the scale and the food on the plate.
Those frustrations, however, may finally be over. Or at least, there are at least a few more ways to encapsulate exactly what bulimia without the binge or anorexia without the emaciation really is.
The American Psychiatric Association produces a reference manual, The Diagnostic and Statistical Manual of Mental Disorders (D.S.M.), that is used by doctors, counselors, clinicians, case workers, health insurance and pharmaceutical companies, and many others who assist people in need. In its current edition, contains a diagnosis for? Ednos, which stands for “eating disorder not otherwise specified.” This definition covers a wide range of eating disorders that do not specifically fall under the guidelines for anorexia or bulimia, including night eating syndrome, overly picky eating, binge eating, and others.
The concern by some medical professionals is that the definition is too wide open and will be overused in diagnoses. The APA is reacting by assigning a work group to study “traditional” eating disorder definitions and potentially reconfigure the diagnostic criteria for Ednos, which will be published in the D.S.M.-5 edition in 2013. The New York Times cites statistics from the National Eating Disorders Association that say 4% of American women are diagnosed with Ednos each year. This diagnosis outnumbers those for anorexia and bulimia, making Ednos the most common eating disorder in this country.
A study published last year in the International Journal of Eating Disorders reported that Ednos is commonly the mid-point as a woman goes from having a well-cultivated eating disorder into recovery, or from normalized eating to delving deep into an eating disorder.
Some doctors say that patients feel the need to have a concrete diagnosis before they will seek treatment for an eating disorder, which makes the Ednos category an important tool in helping women. And even though anorexia, for example, is not necessarily indicated by a starved-looking body, some women note they’ve been ignored or dismissed by doctors if they appear normal or overweight and have been engaging in anorexic behavior.
This disconnect is one reason eating disorder specialist and founder of Health at Every Size Dr. Deb Burgard says weight standards should be lifted from definitions of eating disorders.
“I have worked with plenty of restricting average-sized and fat patients who really should be diagnosed with anorexia nervosa. But there is confusion based on the current D.S.M. whether they meet the criteria for the diagnosis if they are not at a low B.M.I. — even if their current weight is extremely low for them individually and they’re showing signs of starvation,” she told the New York Times.
What does count in the category of Ednos? Psychologists say that the eating and behavior related to eating has to be disordered. For example, if work or social life are impacted, then that person could fall under the Ednos guidelines. Signs might include severe chronic dieting, compulsive exercising, purging, or overeating at night.
Just as I did when I passed out packets of articles and projects filled with definitions, statistics, and anecdotes about treatment and recovery to my students years ago, what the inclusion of new and reworked definitions of eating disorders will mean for women personally.
Will it mean that more women will get the help they need to eat healthier, feel better in their bodies, and find peace that can so easily be disrupted on a scale, at the kitchen table, in intimate situations, or in a dressing room?
Will it mean that many of us, maybe even most of us, are now diagnosable, or at least could have been during dark or tumultuous or stressful parts of our lives?
What are your thoughts on the broadly-defined eating disorder category of Ednos?
Is there, as there could be for all of us who struggle with food and weight, more work to be done?