Diagnosing, Conceptualizing, and Treating Eating Disorders Not Otherwise Specified: A Comprehensive Practice Model

Abstract

This article presents research and evidence‐based practices for identifying, understanding, diagnosing, conceptualizing, and providing a continuum of treatment for the most commonly experienced types of eating‐related counseling concerns—namely, eating disorders not otherwise specified—among the population most likely to present these types of needs: adolescent girls and young adult and adult women.

College Women Eating Disorder Diagnostic Profile andDSM-5

“…According to the profile, college women engage in a wider range of clinically significant behaviors than that which could be captured by atypical anorexia, low-threshold bulimia or binge eating, or purging disorder alone. 12,[14][15][16][17][18][19] For example, in one study, Schwitzer et al 15 found that among college women with EDNOS, 83% reported moderate eating concerns, 79% binged periodically, 13% severely restricted eating on occasions, 86% engaged in compensatory exercise, 17% vomited, and 5% used laxatives. Further, they experienced a combination of weight fluctuations, drive for thinness and body dissatisfaction, and low self-esteem and perfectionism that is not fully described by the cognitive and affective features of the anorexia diagnosis alone, bulimia diagnosis alone, Binge Eating Disorder alone, or their subthreshold counterparts characterized by Other Specified Eating Disorder.…”

“…12,20 Although male students also experience eating disorders, they are far outnumbered by girls and women. 21, 22 Further, eating disorders now appear among females across various ethnic populations [23][24][25] ; in fact, researchers recently reported finding few differences in problematic eating symptoms among African American, Latina, and European American college women.…”

“…7,8 Although eating disorder prevalence is estimated to be less than 5% in the overall general population, 9,10 higher risk exists among late adolescents and young adult women, where eating disorder rates may be as high as 10% to 15%. 11 On college campuses specifically, researchers report especially high rates of eating problems among female college students, 12 and about one fourth of college and university counseling center directors report recent increases in clients or patients with eating disorders. 13 Correspondingly, over approximately the past decade, a comprehensive model has been established for recognizing, diagnosing, and responding to the most commonly experienced types of eating concerns among late adolescent and young adult female college students.…”

“…13 Correspondingly, over approximately the past decade, a comprehensive model has been established for recognizing, diagnosing, and responding to the most commonly experienced types of eating concerns among late adolescent and young adult female college students. 12,[14][15][16][17][18][19] The model, which we refer to here as the college women eating disorder diagnostic profile, was established on the basis of a series of research studies and clinical reviews. 12,[14][15][16][17][18][19] To develop the model, researchers performed the following steps: (a) they first examined the clinical records of more than 100 women being treated over a 6-year period in a combined university counseling-and health-center eating disorder treatment program; (b) they next confirmed the model by assessing a nonclinical population at a second university; and (c) they then corroborated the new findings with the extant literature.…”

“…12,[14][15][16][17][18][19] The model, which we refer to here as the college women eating disorder diagnostic profile, was established on the basis of a series of research studies and clinical reviews. 12,[14][15][16][17][18][19] To develop the model, researchers performed the following steps: (a) they first examined the clinical records of more than 100 women being treated over a 6-year period in a combined university counseling-and health-center eating disorder treatment program; (b) they next confirmed the model by assessing a nonclinical population at a second university; and (c) they then corroborated the new findings with the extant literature. 12,[14][15][16][17][18][19] To date, this diagnostic framework has been associated with the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision) 1 Eating Disorders Not Otherwise Specified (EDNOS) diagnostic category; however, the EDNOS category no longer appears among the revised eating disorder diagnoses of the recently published DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition).…”