Eating Disorders and Obsessive-Compulsive Disorder: An ...

& Gao, 2005). More often than not, a period of dieting precipitates an individual’s first
episode of binge eating, with subsequent compensatory behaviours being triggered by
feelings of regret, guilt, and shame (Polivy & Herman, 2002). When compared with the
restricting subtype of AN, patients with BN report a greater incidence of impulsive,
spontaneous, and risky behaviours such as substance abuse, promiscuity, and suicide
attempts (Matsunaga et al., 2000; Wiederman & Pryor, 1996). Engaging in long periods
of fasting in conjunction with high impulsivity is associated with increased susceptibility
to binge eating and the development of BN or the binge eating/purging subtype of AN
(Forbush, Heatherton, & Keel, 2007).
Eating Disorder Not Otherwise Specified (EDNOS). The final eating disorder
category, EDNOS, characterises those individuals who meet some but not all criteria
for AN or BN (American Psychiatric Association, 2000; Keel et al., 2005). Common
EDNOS presentations include females who meet most criteria for AN whilst still
maintaining a regular menstrual cycle or a weight that is within the normal range.
Individuals who have engaged in binge eating and purging more than twice a week but
for less than three months also meet criteria for EDNOS (American Psychiatric
Association, 2000). The prevalence of EDNOS is at least double that of AN or BN, and
EDNOS represents approximately 50% of individuals with an eating disorder (Shafran,
2002). Due to the variety of EDNOS presentations and the high proportion of cases
that fit into this diagnostic category, subtypes of EDNOS have recently emerged within
the research literature (Binford & le Grange, 2005; Keel et al., 2005; Wade, Bergin,
Tiggemann, Bulik, & Fairburn, 2006b). For example, the EDNOS – purging only
subtype (EDNOS-P) captures those patients who, for the purpose of maintaining
control over their weight, engage in frequent purging behaviours (at least twice a week
for three months) in the absence of any objective binge episodes (OBEs) (Wade,
2007). Refer to Appendix C for a summary of the current DSM-IV-TR diagnostic criteria
for EDNOS.
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