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

Health and mental health professionals have been responding increasingly to gender-related counseling needs (Arnstein, 1995; Carter & Parks, 1996; Choate, 2008). Correspondingly, this article presents a comprehensive model for recognizing, diagnosing, conceptualizing, and responding to the most commonly experienced types of eating-related counseling problems--namely, eating disorders not otherwise specified (EDNOS)--with the population most likely to experience these types of needs: late adolescent girls and young adult and adult women. The model is based on a series of research studies that I conducted with my colleagues and is described in this article to assist counselors in their everyday work with clients who present with eating-related concerns. Although boys and men also experience eating disorders (Ousley, Cordero, & White, 2008), they are greatly outnumbered by girls and women with eating-related problems (Hoek, 2006; Wittichen & Jacobi, 2005). In fact, internationally, eating disorders are among the 10 most common causes of psychological distress in young adult women (Mathers, Vos, Stevenson, & Begg, 2000). On college campuses, which have large concentrations of female students, the high incidence of eating disorders is especially well documented (Gallagher, Golin, & Kelleher, 1992; Koszewski, Newell, & Higgins, 1990; Miller & Rice, 1993). In addition, although eating disorders historically were associated primarily with European American girls and women, these problems now appear among various ethnic populations (Becker, Franko, Speck, & Herzog, 2003; Cachelin & Striegel-Moore, 2006; Tsai, Hoerr, & Song, 1998). In fact, Rich and Thomas (2008) recently found few differences in disordered eating symptoms among African American, Latina, and European American women in college (Rich & Thomas, 2008). Furthermore, although the major eating disorders, anorexia nervosa and bulimia nervosa, occur with some regularity among girls and women, the most commonly observed eating-related concerns are the heterogeneous group of less severe problems characterized as EDNOS (Ash & Piazza, 1995; Klemchuck, Hutchinson, & Frank, 1990; Schwitzer et al., 2008; Schwitzer, Rodriguez, Thomas, & Salimi, 2001). In a variety of studies with college populations, only 6% of female students reported concerns about anorexia or bulimia, whereas 25% to 40% reported moderate problems falling under the umbrella of EDNOS, including body image worries, problems stemming from weight management, and out-of-control eating (Bishop, Bauer, & Baker, 1998; Schwitzer et al., 2001; Tsai et al., 1998). Beyond collegiate populations, researchers have agreed that, generally, the majority of young adult women with eating-related difficulties experience disorders that fall in the EDNOS category (Fairburn & Bohn, 2005; Schwitzer et al., 2008; Shisslak, Crago, & Estes, 1995; Wilson, Grilo, & Vitousek, 2007; Wonderlich, Joiner, Keel, Williamson, & Crosby, 2007). Counselors working with young adult women should have the knowledge and skills to work effectively with these clients. In response to this professional need, I first discuss the most common diagnostic symptoms, features, and themes comprising the EDNOS syndrome; next offer counseling and treatment suggestions; and then present future directions and conclusions. * EDNOS Diagnostic and Conceptual Model Table 1 describes the typical client presentation of late adolescent and young adult women with EDNOS. The diagnostic and conceptual model shown in Table 1 organizes typical eating disorder client presentations into eating disorder diagnostic features and co-occurring features; common psychological and developmental themes; common psychosocial, environmental, and family stressors; and help-seeking characteristics. Eating Disorder Diagnostic Features Three types of eating disorders are included in the Diagnostic and Statistical Manual of Mental Disorders (4th ed. …