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While we may prefer our world to be well-ordered and predictable, with everything neatly categorized, mental health professionals have long known that human behavior often defies neat categorization. Just as social scientists think they have everything in order, there are always mental health patients who break all the rules. The best evidence of this phenomenon is the Diagnostic and Statistical Manual of the American Psychiatric Association, Version Four, Text Revision (DSM-IV-TR), and the “bible” of classifying the diagnostic criteria for all known mental health disorders is in its fourth edition, with the fifth revision due shortly. This appears to be “proof positive” that we are still progressing in our study and the diagnosing of mental health disorders.

At present, the only eating disorders that are given full diagnostic criteria, co-morbid conditions, medical and laboratory findings, and courses of treatment are Anorexia Nervosa and Bulimia Nervosa. However, there is one more category contained in the section of the DSM-IV-TR pertaining to eating disorders: the Eating Disorder NOS (Not Otherwise Specified). Students of the DSM-IV-TR soon learn that the NOS category is merely a catch-all diagnosis; when a patient’s symptoms almost but not quite fit into a clearly defined category, the NOS diagnosis is given. Thus, Eating Disorder NOS contains eating behavior that has elements of both anorexia and bulimia. It must be emphasized that the Eating Disorder NOS is just as dangerous as clearly-defined Anorexia Nervosa and Bulimia Nervosa.

Examples of this disorder include:

With women, all the criteria for Anorexia Nervosa are present except the cessation of menstrual periods.

All diagnostic criteria for Anorexia Nervosa are met, yet the patient’s current weight is within normal limits.

All diagnostic criteria for Bulimia Nervosa are met except that binge eating and purging are infrequent.

Regular use of compensatory behaviors such as vomiting, enemas, and abuse of laxatives by individuals who eat only small amounts of food rather than large binges.

Chewing food and spitting it out, not swallowing.

Another NOS category that is gaining popularity among disorder specialists is the Binge Eating Disorder. For the moment, the Binge Eating Disorder remains in the NOS category, however, it is likely that by the time the fifth edition of the DSM comes out this eating disorder will have a category all its own. Unlike Bulimia Nervosa, the Binge Eating Disorder involves recurrent episodes of binge eating without other behaviors like purges and vomiting.

The current research of the Binge Eating Disorder focuses on individuals who eat huge amounts of food in a rapid manner, eating alone to avoid embarrassment, feeling shame about their lack of control over their eating, but without compensatory behaviors, eating when they’re not particularly hungry, eating until uncomfortably full, and binges that occur at least two days a week. Unlike Anorexia Nervosa and Bulimia Nervosa, the Binge Eating Disorder appears to be a secondary diagnosis that evolves from the individual’s primary diagnosis of Major Depression, a Personality Disorder, or a Substance Abuse Disorder. Plus, individuals with Binge Eating Disorder are virtually all morbidly obese - not the case with anorexics and bulimics. They report feeling numb or “spaced out” while binge eating - a kind of disassociate state. They continue binging and gaining weight, even though their weight interferes with social relationships, with their work, and their self-esteem. Although they seldom admit it, those with Binge Eating Disorder have even higher feelings of self-disgust and guilt than those who suffer from Bulimia Nervosa.

By Health Editor