G. Terence Wilson
Carolyn Black Becker
Eating disorders consist of severe disturbances in eating behavior, maladaptive and unhealthy efforts to control body weight, and abnormal attitudes about body weight and shape. The two most well-established eating disorders are anorexia nervosa (AN) and bulimia nervosa (BN). The former is characterized by a refusal to maintain a normal body weight. The latter is characterized by recurrent episodes of binge eating and inappropriate behaviors designed to control body weight and shape, such as self-induced vomiting or laxative misuse. Dysfunctional attitudes toward body weight and shape are a prominent feature of both disorders. Disorders that are closely related to AN and BN, but do not meet all of the formal diagnostic criteria, are classified as “eating disorder not otherwise specified” (EDNOS) (Fairburn & Walsh, 2002). A large number of the patients seen in clinical practice would receive the diagnosis of EDNOS. However, the different variations of eating disorders that are grouped within this category are not well specified, and as a whole they have been relatively ignored in the clinical and research literature. The single exception, and perhaps the most common example of this category, is what the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) labels “binge-eating disorder” (BED) and designates in an appendix as a diagnosis provided for further study (American Psychiatric Association, 1994). This disorder is characterized by recurrent binge eating, in the absence of inappropriate weight control behaviors as in BN. In this chapter, we focus on the three disorders of AN, BN, and BED.
AN has been identified as a psychiatric disorder for well over a century (Gull, 1873). What we now know as BN was originally described by Russell (1979) in England. Shortly thereafter, “bulimia” was included as a disorder in the American Psychiatric Association's DSM-III in 1980. It is now widely accepted that BN emerged as a clinical disorder during the 1970s. This development can be seen in an analysis of referrals to prominent centers for the treatment of eating disorders in different countries (Fairburn, Hay, & Welch, 1993). For example, in Toronto the referral rates for AN between 1975 and 1986 were relatively stable, but there was a noticeable increase in referral rates for BN. The alternative view is that BN had simply not previously come to the attention of mental health professionals. According to this line of reasoning, either the disorder had been overlooked or misdiagnosed by clinicians, or people only began seeking treatment in the 1970s. These possibilities seem implausible.
The inclusion of BED within the category of EDNOS in DSM-IV (American Psychiatric Association, 1994) was in response to reports of large numbers of patients who engaged in binge eating, but who did not meet the diagnostic criteria for BN (Spitzer et al., 1992). Most patients with this disorder are overweight. In fact, Stunkard (1959) had identified the problem of binge eat-