Eating disorders (ED) include those mental disorders that focus on food, body perception, and fear of weight gain. Typical eating disorders are anorexia nervosa and bulimia.

However, when not all criteria are met, but important symptoms do appear, we talk about an unspecified eating disorder . In this article we will know eight of them. We will also discuss the causes and treatments of eating disorders.

Eating disorders (ED): what are they?

Eating disorders (ED) are mental disorders that can be very serious. In these disorders, the patient’s primary concerns are food and body shape perception.

The quintessential ATTs are anorexia nervosa and bulimia. In both, there is an excessive fear of gaining weight; they are similar disorders, although with different symptoms . The difference between these two disorders, roughly speaking, is that in anorexia nervosa body weight is usually lower than in bulimia (and by extension the Body Mass Index [BMI] as well).

In addition, in bulimia, the presence of binge eating and inappropriate compensatory behaviors (vomiting, use of laxatives, diuretics…) appears as a diagnostic criterion, which does not occur in anorexia. This does not mean that in anorexia these symptoms cannot appear.

Eating disorder not otherwise specified

However, symptoms of one of these two eating disorders may occur, but not all . That is, it may be 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 eating disorder not otherwise specified (EDNOS), a type of disorder that affects 3-5% of the population. In addition, the terms “atypical anorexia nervosa” or “atypical bulimia” have often been used to refer to the existence of an eating disorder not otherwise specified.

On the other hand, in addition to the cases discussed, the unspecified eating disorder also includes 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 severe as another specified ACT, or even more so . This is why they should always be given the importance they deserve.

What disorders fall into this category?

Let’s look at the types of Unspecified Eating Disorder listed in the DSM-IV-TR (Diagnostic Manual of Mental Disorders).

1. Anorexia nervosa with regular menstruation

In this type of unspecified ACT, all the diagnostic criteria for anorexia nervosa appear except the criterion referring to absent (amenorrhea) or irregular menstruation . In this case, the patient has a regular menstruation. It should be mentioned that the criterion of amenorrhea present in the DSM-IV-TR is eliminated in the 5th edition of the manual (DSM-5).

2. Anorexia nervosa with normopause

The second type of Unspecified Eating Disorder refers to the presence of anorexia nervosa (with all its criteria), but that does not meet the criterion indicating that the weight is less than expected in relation to the age, height and size of the patient .

In other words, even if the patient has lost a considerable amount of weight, his/her weight is currently normative (within the parameters of normality).

3. Atypical bulimia

Another type of eating disorder not specified is atypical bulimia , in which the diagnostic criteria for this disorder are met, except for the criteria of frequency and duration of binges and inappropriate compensatory behaviors; in this case, these occur less than 2 times per week (the criterion requires a minimum of 2 times per week), or last less than 3 months.

It could also be the case of an atypical bulimia where some other criteria are not met, but all the others are.

4. Regular inappropriate compensatory behaviors

This unspecified eating disorder involves the occurrence of inappropriate compensatory behaviors on a regular basis , after eating small amounts of food. The patient has a normal weight according to his/her age, height, and height.

However, no other symptoms characteristic of any other eating disorder are present for a diagnosis of bulimia or anorexia, for example.

5. Chewing 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 DSM-IV-TR (proposed for investigation in Appendix B of the same, and finally included as “binge eating disorder” in DSM-5), constitutes another unspecified eating behavior disorder.

This is characterised by the fact that the sufferer eats large amounts of food without subsequently applying any inappropriate compensatory behaviour (typical of bulimia nervosa).

Other Unspecified TCAs

Beyond the reference diagnostic manuals (DSMs), 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 are increasingly so) in the population.

We’re talking about vigorexia and orthorexia. But what is each of them?

1. Vigorexia

Vigorexia is the pathological obsession with being muscular . It affects men more often than women, and is a disorder of recent appearance (relatively), which is increasing its prevalence.

This obsession with the muscular body translates into behaviors such as repeatedly looking at oneself in the mirror throughout the day (whether at the gym, at home, in the window…), and eating only those substances that promote muscle growth (proteins and carbohydrates). In other words, the person reduces his fat intake (or eliminates it completely) to avoid losing muscle.

People with vigorexia are so obsessed with looking muscular that, paradoxically to what is believed, they may even feel embarrassed to be seen or looked at (for example at the gym), as they feel they never have “enough muscle that they would like”.

2. Orthorexia

The second new, unspecified eating disorder, also of recent appearance, is orthorexia. Unlike the previous one, in this case the obsession is with eating only healthy foods (that is, biologically “pure” foods). Unlike the “classic” ACTs (bulimia and anorexia), where the obsession lies in the amount of food (whatever is the minimum), in orthorexia the obsession lies in the quality of the food (which must be the best and healthiest).

Thus, people with orthorexia make diets and healthy eating the center and main goal of their lives; everything revolves around it. If they have to get up early to cook, they do so; if they have to go to a wedding, they take a tupperware to not eat anything unhealthy, and so on. All these behaviours become pathological and only feed the obsession for what is healthy.

These are people who can spend several hours a day thinking about the diet they should be on, the foods they should cook, etc. All these symptoms end up causing them a significant psychological discomfort, as well as physical, since they end up abandoning products and foods that are essential for the proper and healthy functioning of the body.

Causes

The causes of both eating disorders and unspecified ACTs are often multifactorial, encompassing social, personal, biological, hormonal, etc. factors . However, there are often especially related causal factors; social pressure to be thin and fads are at the root 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 eating disorder not otherwise specified, treatment for eating disorder that most closely resembles eating disorder not otherwise specified should be pursued. On the other hand, it is always advisable to address dysfunctional thoughts related to food, weight, and body shape through cognitive behavioral therapy.

Behavioral therapy, on the other hand, is also widely used in this type of disorder, through token economy, positive reinforcement, differential reinforcement, etc.

Bibliographic references:

  • Ackard D, Fulkerson J, Neumark-Sztainer D. (2007). Prevalence and utility of DSM-IV eating disorder diagnostic criteria among youth. International Journal of Eating Disorders; 40(5): 409-17.

  • APA (2014). DSM-5. Diagnostic and statistical manual of mental disorders. Madrid. Panamericana.

  • Muñoz, R. and Martínez, A. (2007). Orthorexia and vigorexia: new eating disorders? Eating Disorders, 5: 457-482.