446 CHAPTER 10
the eating disorder at the time she is diagnosed. Similarly, the types of each eating
disorder—restricting and binge-eating/purging types for anorexia and purging and
nonpurging types for bulimia—may represent different paths of the same underly-
ing eating disorder. Consistent with this view, the two eating disorders and their
types, as outlined in DSM-IV-TR, do not provide unique information about the
course or prognosis of the disorder (Eddy et al., 2007; Franko et al., 2004).
In fact, the characteristics of the binge-eating/purging type of anorexia have
more in common with those of bulimia than with those of the restricting type of
anorexia (Gleaves, Lowe, Green, et al., 2000; Herzog et al., 1999). All that distin-
guishes the binge-eating/purging type of anorexia from bulimia is the low weight
and consequent amenorrhea. In contrast, the restricting type of anorexia involves
both a very different approach to eating (or not eating) and different coping styles,
such as extreme self-regulation.Eating Disorder Not Otherwise Specifi ed
Many people with signifi cantly disturbed eating don’t meet all the criteria for anorexia
or bulimia; those individuals are diagnosed with eating disorder not otherwise
specifi ed (EDNOS). Studies have found that as many patients arediagnosed with
EDNOS, 4–6% of the general population of Americans (Herzog & Delinsky, 2001), as
with anorexia and bulimia combined (Andersen, Bowers, & Watson, 2001; Fairburn
& Bohn, 2005; Fairburn & Walsh, 2002; Ricca et al., 2001).
DSM-IV-TR defi nes EDNOS as follows: “The mental disorder appears to fall
within the larger category [of eating disorders] but does not meet the criteria of any
specifi c disorder within that category” (American Psychiatric Association, 2000).
The defi nition of EDNOS does not specify particular criteria, and so people who
are given this diagnosis have a wide range in the number and duration of symp-
toms. Nevertheless, people diagnosed with EDNOS often fall into one of three
groups. One group consists of people with partial cases, meaning that their symp-
toms meet some of the diagnostic criteria for a specifi c disorder but not enough
to justify the diagnosis of that disorder. An example of a partial case of anorexia
would be a woman whose symptoms meet all the other criteria for the disorder but
who is not amenorrheic; she would thus be diagnosed with EDNOS.
Another group consists of people with subthreshold cases; they have symptoms
that fi t all the diagnostic criteria for a specifi c disorder, but at levels lower than re-
quired for the diagnosis of that disorder. Jen, described earlier, has a subthreshold case
of bulimia because she usually binges only once a week, which is less frequently than
twice weekly as specifi ed by the DSM-IV-TR criterion (Fairburn & Walsh, 2002); Jen
would therefore be diagnosed with EDNOS if her symptoms impaired her function-
ing or caused her signifi cant distress.
A third group consists of people who have a variant of an eating disorder that
has received signifi cant attention: binge-eating disorder, which is characterized by
frequent episodes of rapid uncontrolled eating of large quantities of food, even
when not hungry, without subsequent purging (American Psychiatric Association,
2000). Typically, those with binge-eating disorder feel distressed by their binge eat-
ing; people with this eating pattern are usually overweight (Grucza, Przybeck, &
Cloninger, 2007; Hudson et al., 2007). Binge-eating disorder is not listed as an
“offi cial” eating disorder in DSM-IV-TR. Rather, it is a provisional diagnosis; ongo-
ing research will help determine whether it should be included as a distinct disorder
in DSM-V and, if so, what the specifi c diagnostic criteria should be. Research to date
suggest that the prevalence of binge-eating disorder is more similar for males and
females than is found for other eating disorders, and that this disorder is more com-
mon than anorexia nervosa and bulimia nervosa combined (Grucza, Przybeck, &
Cloninger, 2007; Hudson et al., 2007).
Most people with EDNOS have attitudes and behaviors regarding weight,
food, and body image that are similar to those of people with anorexia and bulimia.
The only signifi cant difference is that people with EDNOS don’t meet the specifi cEating disorder not otherwise
specifi ed (EDNOS)
The diagnosis given when an individual’s
symptoms of disordered eating cause
signifi cant distress or impair functioning but
do not meet the full criteria for a diagnosis of
anorexia nervosa or bulimia nervosa.
Partial cases
The designation given to cases in which
patients have symptoms that meet only some
of the necessary criteria, but not enough
symptoms to meet all the criteria for the
diagnosis of a disorder.
Subthreshold cases
The designation given to cases in which
patients have symptoms that fi t all the
necessary criteria, but at levels lower than
required for the diagnosis of a disorder.
Binge-eating disorder
A provisional diagnosis of the variant of an
eating disorder characterized by frequent
episodes of rapid uncontrolled eating of large
quantities of food, even when not hungry,
without subsequent purging; according
to DSM-IV-TR, patients with binge-eating
disorder receive a diagnosis of EDNOS.