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Tijdschrift voor Psychiatrie 57 (2015) 4, 258 - 264

Review article

EDNOS is an eating disorder of clinical relevance, on a par with anorexia and bulimia nervosa

A.E. Dingemans, E.F. van Furth

background The category ‘eating disorder ‘not otherwise specified’’ (ednos) in dsm-iv is restricted to eating disorders of clinical severity that do not completely fulfil the criteria for anorexia and bulimia nervosa. The ednos category is, by definition, often regarded as a a residual category and in principle designed to incorporate a small group of patients with atypical characteristics. Health insurance companies argue that the treatment of patients diagnosed with ednos should not be treated in mental health institutions and therefore should not get their treatment costs reimbursed by the insurance companies. The most important argument of the insurance companies is that patients in the ednos category do not display serious psychiatric symptoms.
aim The aim of this paper is to show that ednos is an eating disorder category of clinical relevance. The article provides a critical overview of literature on ednos which studies the prevalence, severity and course of the disorder. We also discuss to what extent the fifth version of dsm solves the problems relating to this residual category.
method We reviewed the literature.
results The classification given in dsm-iv is not an accurate reflection of clinical reality. Half of the patients presenting with an eating disorder and seeking treatment do meet the criteria for ednos. The duration and the severity of eating disorder psychopathology, the presence of comorbidity, the mortality, and the use of the mental health care services by individuals with an eating disorder appear to be very similar in ednos patients and in patients with anorexia and bulimia nervosa. Eating disorder classifications can be regarded as snapshots taken throughout the course of an illness. Over of the years patients can be afflicted with various subtypes of an eating disorder. dsm-5 places fewer patients in the ednos category that did dsm-iv.
conclusion In the latest version of dsm, namely dsm-5, the number of patients with an eating disorder classified as ednos has declined. There appears to be sufficient scientific evidence for ednos to be considered as an eating-disorder category of clinical severity, comparable to anorexia and bulimia nervosa. In our view, patients classified as having ednos should be offered regular treatment in mental health institutions.

keywords comorbidity, course, eating disorders, prevalence, severity