Atypical eating disorder

Making a diagnosis

Atypical eating disorder image

This classification of eating disorders is sometimes called eating disorders not otherwise specified (EDNOS – US classification) and includes binge eating disorder. This categorisation covers individuals that meet some but not all of the diagnostic criteria for anorexia nervosa or bulimia. Individuals in this category may shift to a different diagnostic entity, occasionally meeting all the diagnostic criteria for both anorexia nervosa and bulimia.

Examples include:

  • Frequent self- induced vomiting as a compensatory behaviour in the absence of binge eating (for example self-induced vomiting after eating a small chocolate)
  • Bulimic behaviour which is less than twice a week or has not lasted for 3 months
  • Chewing food and spitting it out on a repeated cycle
  • In a female patient – all diagnostic criteria are met but experiencing regular menses
  • Binge eating disorder – individuals indulge in binge eating but do not exhibit the compensatory behaviour

In order to diagnose binge eating disorder the eating episodes are associated with three or more of the following:

  • Eating much more rapidly than normal
  • Eating until feeling uncomfortably full
  • Eating large amounts of food when not physically hungry
  • Eating alone through embarrassment at the amount one is eating
  • Feeling disgust or extreme guilt after overeating.

Marked distress regarding binge eating is present and social avoidance is common.

Management and treatment strategies in atypical Eating Disorder

Nice recommendation for a treatment strategy states:

  • In the absence of evidence to guide the management of atypical eating disorders (eating disorders not otherwise specified) other than binge eating disorder, it is recommended that the clinician considers following the guidance on the treatment of the eating problem that most closely resembles the individual patient’s eating disorder.
  • There has been no research specifically directed at the treatment of atypical eating disorders other than BED (binge eating disorder). The view of the GDG (guidelines development group) is that clinicians should manage the large number of these cases according to the guidelines for anorexia nervosa or bulimia nervosa depending on the clinical presentation and age of the patient.
  • With regard to BED, given the apparently good response, at least in the short term, to a range of different psychological interventions including self-help and given the lower level of acute physical and psychiatric risk compared to anorexia and bulimia nervosa, treatment for BED may often be deliverable in primary care through the use of evidence based self-help manuals. Children and adolescents with binge eating problems should receive the same type of treatment as adults but adapted to suit their age, circumstances and level of development, with appropriate family involvement.

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