Reprinted from Eating Disorders Review
November/December 2005 Volume 16, Number 6
©2005 Gürze Books
(Edited by Claes Norring and Bob Palmer. New York: Routledge, 2005; 338 pages; $52.95)
Studies suggest that as many as 50% of patients with eating disorders seen in specialty treatment programs are most accurately diagnosed as having an “Eating Disorder Not Otherwise Specified,” currently labeled “EDNOS,” rather than anorexia nervosa or bulimia nervosa per se. In this first-ever volume totally dedicated to the EDNOS collection, Drs. Norring and Palmer, distinguished European eating disorders experts, have brought together 29 international authorities to address multiple aspects of this heterogenous group. As befits such a volume, to help frame the field the volume starts with several good chapters that attend to issues of classification, typology, and the atypical eating disorders. Clinicians and administrators will find the discussions of atypical eating disorders to be particularly useful. A variety of lumping-together and splitting-apart techniques, using advanced statistical methods, are used to supplement the old-fashioned and still useful methods of careful clinical description of odd and unusual cases. As you would expect, binge eating disorder, still subsumed under EDNOS in the DSM-IV, figures prominently here, and is well considered in several chapters, by in relation to course and obesity.
Among other clinical syndromes striving for independent recognition, we are informed about such things as anorexia athletica; non-purging bulimia nervosa; food avoidance emotional disorder, and the night eating syndrome. Chapters elucidate attempts to understand the nature, origins and pathogenesis of EDNOS syndromes from a variety of perspectives. These include biology, genetics (including twin studies), cross-cultural, psychoanalytic, developmental, and neurodevelopmental perspectives. Eating disorders in children and in athletes and in relation to diabetes are nicely reviewed as not quite falling within current diagnostic boundaries. Finally, among many excellent chapters, I was particularly taken with a final chapter that provocatively discusses the nature of diagnosis, including why we diagnose and the psychology of diagnoses, including a good discussion of “fuzzy sets” – the sort of mathematics that may move these fields to the next conceptual level, away from simple categories.
To sum up, EDNOS has long deserved the special attention given to it in this welcome volume. Those who’d like to bring the important and mixed group of clinical syndromes and disorders now hidden under the EDNOS umbrella into proper perspective would do well to read this volume.