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.

There is another NOS category that is generating a great deal of attention among eating disorder specialists; the Binge Eating Disorder. Although this condition, at present, remains in the NOS category, it’s likely that by the time the DSM-V is released it will be a category of its own. The Binge Eating Disorder involves recurrent episodes of binge eating without compensatory behaviors and purges like 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.

The eventual release of the DSM-V will be the deciding factor as to whether the Binge Eating Disorder is formally classified as a separate, different type of eating disorder with diagnostic criteria all its own. Most mental health professionals have no doubt that the condition exists; it’s now up to the social researchers to prove its existence through solid empirical research studies.

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