Think EDNOS isn't serious? Think again...

Anorexia is the most lethal of all psychiatric disorders, and up to 20% of chronic sufferers will die from their illness.

A new study shows that the mortality rates for other eating disorders (bulimia, EDNOS) are essentially equal to those of anorexia. The authors followed those who presented at an eating disorders clinic for 8 to 25 years, and they found that the crude mortality rate is 4.0% for anorexia, 3.9% for bulimia, and 5.2% for EDNOS.

The authors concluded that:

All-cause standardized mortality ratios were significantly elevated for bulimia nervosa and eating disorder not otherwise specified; suicide standardized mortality ratios were elevated for bulimia nervosa and eating disorder not otherwise specified. Individuals with eating disorder not otherwise specified, which is sometimes viewed as a "less severe" eating disorder, had elevated mortality risks, similar to those found in anorexia nervosa. This study also demonstrated an increased risk of suicide across eating disorder diagnoses.

What this study will mean for DSM-V, I don't know. I do think we need to better define eating disorders, and studies like this will help provide the basis for these definitions.

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Jessi said...

hmm this brings home the seriousness of my current behaviour as i linger somewhere between anorexia, bulimia or perhaps EDNOS!!

Thanks Carrie!

Cathy (UK) said...

As ever, I love your mind Carrie :)

I once recall my psychiatrist (who I have a lot of time for) informing me that approx. 70% of the patients he had managed in 25 yrs of practice have EDNOS.

According to DSM IV, when I had a BMI of 13 I had EDNOS - because I didn't fit the body image criterion for DSM IV anorexia nervosa. But, I restricted my energy intake below 1,000 kcal/day and exercised for up to 2 hours per day - to feel 'in control' (of emotions and anxiety). To all intents and purposes I was anorexic and needed re-feeding.

The recent issue of IJED features a review article by Anne Becker et al. about 'non fat phobic' anorexia nervosa. I was not phobic of fat, but I was phobic of weight - and there's no current definition for that 'non fat phobic weight phobic anorexia nervosa', because it is assumed that weight phobia = fat phobia. No, it does not. I was phobic of weight gain because weight gain signified that I couldn't properly control my bodily impulses. I could see that I was far too thin and looked 'gross'. For that reason I wore baggy/bulky clothes and avoided the mirror. Had I not been treated I would have died of apparent EDNOS...

Prof. Robert Palmer (UK) has suggested that food restriction in anorexia nervosa be described as 'motivated eating restraint' - which doesn't imply a specific cause of food restriction. I agree. Surely what constitutes effective treatment for EDs is for therapists to address specific, possibly unique, individual fears and not to develop a mainstream treatment approach that is specific to anorexia nervosa, bulimia nervosa, or EDNOS?

Putting people in specific boxes may assist with (e.g.) disability assessments, but in real life, people with EDs have very individual 'life' issues that trigger their ED and hinder recovery.

Jessi said...

well said cathy!

Alexandra Rising said...

Have you read 'Regaining Your Self"? I'm sure you've heard of the writer. He seems to be very against the stigma that ED NOS is "not serious".

Carrie Arnold said...


Yes, I have read that book. And most of the times I've been in the worst shape, medically and mentally, I've been diagnosed with EDNOS- mostly because my periods were/are fairly regular.

Alexandra Rising said...

Makes sense. I feel the same. I'm only halfway through the book, curious to see where it takes me.

Becky said...

Thank you for sharing this important information. I would like to share it in the chapter I am currently writing on EDNOS for my upcoming book. Can you please let me know the source of this study so that I can credit them in the book?

Becky Henry

Anonymous said...

I agree, it has a lot to do with the definition. Considering the stringent guidelines for anorexia as well as the physical toll any amount of restriction, binge/purge, and laxative abuse has... its not just about weight.

My low bmi was 12.8. It was during re-feeding and after achieving a hbw that my body responded with a heart attack. To those who don't understand eating disorders, their response was "You don't LOOK like you have an ED."

Just because you don't LOOK it doesn't mean there isn't an issue, folks.

Anonymous said...

I have all the signs of ednos. But I dont have a period. Ive tryed to get help but they see nothing wrong. Im depressed I just want to die.

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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