Skip to main content
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 12
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Botero-Franco, Diana Palacio-Ortíz, Juan David Arroyave-Sierra, Pilar and Piñeros-Ortíz, Sandra 2016. Implicaciones clínicas de los cambios del DSM-5 en psiquiatría infantil. Fortalezas y debilidades de los cambios. Revista Colombiana de Psiquiatría, Vol. 45, Issue. 3, p. 201.

    Micali, Nadia Horton, N. J. Crosby, R. D. Swanson, S. A. Sonneville, K. R. Solmi, F. Calzo, J. P. Eddy, K. T. and Field, A. E. 2016. Eating disorder behaviours amongst adolescents: investigating classification, persistence and prospective associations with adverse outcomes using latent class models. European Child & Adolescent Psychiatry,

    Schreyer, C.C. Makhzoumi, S. Coughlin, J.W. and Guarda, A.S. 2016. Encyclopedia of Food and Health.

    Gray, Emily K. Murray, Helen B. and Eddy, Kamryn T. 2015. The Wiley Handbook of Eating Disorders.

    Plessow, Franziska and Eddy, Kamryn T. 2015. Encyclopedia of Feeding and Eating Disorders.

    Utzinger, Linsey M. Mitchell, James E. Cao, Li Crosby, Ross D. Crow, Scott J. Wonderlich, Stephen A. and Peterson, Carol B. 2015. Clinical utility of subtyping binge eating disorder by history of anorexia or bulimia nervosa in a treatment sample. International Journal of Eating Disorders, Vol. 48, Issue. 6, p. 785.

    Micali, Nadia Ploubidis, George De Stavola, Bianca Simonoff, Emily and Treasure, Janet 2014. Frequency and Patterns of Eating Disorder Symptoms in Early Adolescence. Journal of Adolescent Health, Vol. 54, Issue. 5, p. 574.

    Castiglioni, Marco Faccio, Elena Veronese, Guido and Bell, Richard C. 2013. The Semantics of Power Among People With Eating Disorders. Journal of Constructivist Psychology, Vol. 26, Issue. 1, p. 62.

    Ekeroth, Kerstin Clinton, David Norring, Claes and Birgegård, Andreas 2013. Clinical characteristics and distinctiveness of DSM-5 eating disorder diagnoses: findings from a large naturalistic clinical database. Journal of Eating Disorders, Vol. 1, Issue. 1, p. 31.

    Koch, Sonja Quadflieg, Norbert and Fichter, Manfred 2013. Purging Disorder: A Comparison to Established Eating Disorders with Purging Behaviour. European Eating Disorders Review, Vol. 21, Issue. 4, p. 265.

    von Ranson, Kristin M. Wallace, Laurel M. Holub, Alice and Hodgins, David C. 2013. Eating Disorders, Substance Use Disorders, and Impulsiveness among Disordered Gamblers in a Community Sample. European Eating Disorders Review, Vol. 21, Issue. 2, p. 148.

    Garcia, Frederico Duarte Grigioni, Sébastien Allais, Elodie Houy-Durand, Emmanuelle Thibaut, Florence and Déchelotte, Pierre 2011. Detection of eating disorders in patients: Validity and reliability of the French version of the SCOFF questionnaire. Clinical Nutrition, Vol. 30, Issue. 2, p. 178.


How should DSM-V classify eating disorder not otherwise specified (EDNOS) presentations in women with lifetime anorexia or bulimia nervosa?

  • K. T. Eddy (a1), S. A. Swanson (a2), R. D. Crosby (a3) (a4), D. L. Franko (a1) (a5), S. Engel (a3) (a4) and D. B. Herzog (a1)
  • DOI:
  • Published online: 05 January 2010

Anorexia nervosa (AN) and bulimia nervosa (BN) are marked by longitudinal symptom fluctuations. DSM-IV-TR does not address how to classify eating disorder (ED) presentations in individuals who no longer meet full criteria for these disorders. To consider this issue, we examined subthreshold presentations in women with initial diagnoses of AN and BN.


A total of 246 women with AN or BN were followed for a median of 9 years; weekly symptom data were collected at frequent intervals using the Longitudinal Interval Follow-up Evaluation of Eating Disorders (LIFE-EAT-II). Outcomes were ED presentations that were subthreshold for ⩾3 months, including those narrowly missing full criteria for AN or BN, along with binge eating disorder (BED) and purging disorder.


During follow-up, most women (77.6%) experienced a subthreshold presentation. Subthreshold presentation was related to intake diagnosis (Wald χ2=8.065, df=2, p=0.018). Individuals with AN most often developed subthreshold presentations resembling AN; those with BN were more likely to develop subthreshold BN. Purging disorder was experienced by half of those with BN and one-quarter of those with AN binge/purge type (ANBP); BED occurred in 20% with BN. Transition from AN or BN to most subthreshold types was associated with improved psychosocial functioning (p<0.001).


Subthreshold presentations in women with lifetime AN and BN were common, resembled the initial diagnosis, and were associated with modest improvements in psychosocial functioning. For most with lifetime AN and BN, subthreshold presentations seem to represent part of the course of illness and to fit within the original AN or BN diagnosis.

Corresponding author
*Address for correspondence: K. T. Eddy, Ph.D., Massachusetts General Hospital, Department of Psychiatry, 2 Longfellow Place, Ste 200, Boston, MA02214, USA. (Email:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

WS Agras , S Crow , JE Mitchell , KA Halmi , S Bryson (2009). A 4-year prospective study of eating disorder NOS compared with full eating disorder syndromes. International Journal of Eating Disorders 42, 565570.

KT Eddy , DJ Dorer , DL Franko , K Tahilani , H Thompson-Brenner , DB Herzog (2008). Longitudinal diagnostic crossover of anorexia and bulimia nervosa: implications for DSM-V. American Journal of Psychiatry 165, 245250.

CG Fairburn , K Bohn (2005). Eating disorder NOS (EDNOS): an example of the troublesome ‘not otherwise specified’ (NOS) category in DSM-IV. Behaviour Research and Therapy 43, 691701.

DB Herzog , DJ Dorer , PK Keel , SE Selwyn , ER Ekeblad , AT Flores , DN Greenwood , RA Burwell , MB Keller (1999). Recovery and relapse in anorexia and bulimia nervosa: a 7.5-year follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry 38, 829837.

DB Herzog , JD Hopkins , CD Burns (1993). A follow-up study of 33 subdiagnostic eating disordered women. International Journal of Eating Disorders 14, 261267.

PK Keel (2007). Purging disorder: subthreshold variant or full-threshold eating disorder? International Journal of Eating Disorders 40, S89S94.

PK Keel , DJ Dorer , DL Franko , SC Jackson , DB Herzog (2005). Postremission predictors of relapse in women with eating disorders. American Journal of Psychiatry 162, 22632268.

PK Keel , Striegel-Moore (2009). The validity and clinical utility of purging disorder. International Journal of Eating Disorders 42, 706719.

MB Keller , PW Lavori , B Friedman , E Nielsen , J Endicott , P McDonald-Scott , NC Andreasen (1987). The Longitudinal Interval Follow-Up Evaluation: a comprehensive interview for assessing outcome in prospective longitudinal studies. Archives of General Psychiatry 44, 540548.

AC Leon , DA Solomon , TI Mueller , J Endicott , M Posternak , LL Judd , PJ Schlettler , HS Akiskal , MB Keller (2000). A brief assessment of psychosocial functioning of subjects with bipolar I disorder: the LIFE-RIFT. Longitudinal Interval Follow-Up Evaluation Range of Impaired Functioning Tool. Journal of Nervous and Mental Disease 188, 805812.

AC Leon , DA Solomon , TI Mueller , CL Turvey , J Endicott , MB Keller (1999). The Range of Impaired Functioning Tool (LIFE-RIFT): a brief measure of functional impairment. Psychological Medicine 29, 869878.

G Milos , A Spindler , U Schnyder , CG Fairburn (2005). Instability of eating disorder diagnoses: prospective study. British Journal of Psychiatry 187, 573578.

JJ Thomas , LR Vartanian , KD Brownell (2009). The relationship between eating disorder not otherwise specified (EDNOS) and officially recognized eating disorders: meta-analysis and implications for DSM. Psychological Bulletin 135, 407433.

F Tozzi , LM Thornton , KL Klump , MM Fichter , KA Halmi , AS Kaplan , M Strober , DB Woodside , S Crow , JE Mitchell , A Rotondo , M Mauri , G Cassano , P Keel , KH Plotnikov , C Pollice , LR Lilenfeld , WH Berrettini , CM Bulik , WH Kaye (2005). Symptom fluctuation in eating disorder: correlates of diagnostic crossover. American Journal of Psychiatry 162, 732740.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *