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Within the field of eating disorders, anorexia nervosa crystallized out as a separate and distinct disorder over the course of the last century. It had the advantage of one criterion that was both undisputed and easy to measure, namely low weight. However, it was the description of the characterizing beliefs and behaviors that led to the disorder being separated off from other states with weight loss. Furthermore, it was the description of similar beliefs and behaviors in people of unremarkable weight that led to the definition of bulimia nervosa and its relatives. However, it is arguably when the definition of mental disorder relies upon the mental state -- as it almost inevitably should -- that classification becomes more difficult. Can we really measure people's thoughts and feelings reliably and is it reasonable to expect that they should fit neatly into categories? Even classifying behaviour is problematic enough. However, if we do observe that people come to suffer in similar ways and with similar beliefs then this may give clues not only about sociological generalizations but also, perhaps especially, about innate and probably biological mechanisms which may underpin their disorder.

People may come to be more similar when they are stuck within a morbid process than when they are well because the range of their behaviour and experience is at least in part constrained by potentially definable processes in which such biological mechanisms are playing some limiting part. Tolstoy wrote, 'all happy families resemble one another, but each unhappy family is unhappy in its own way'. This is questionable even with regard to families and unhappiness, but with individuals and disorder it seems likely that the reverse is true. The range of what is morbid is narrower than the range of the non-morbid. Anti-psychiatrists tend to emphasize the prescriptive nature of `normality' and to portray the person who is 'labeled' mentally disordered as something of a free spirit. However, the psychiatric perspective is different. The patient suffering from a mental disorder is seen as constrained and trapped by forces that are out with his or her control. It is the sufferer who is the tram compared with the normal person who resembles the bus in having much more freedom. Both the bus and the tram are limited by their physical attributes but the tram is additionally constrained by the rails. Study of the patterns of disorder could give clues as to the nature of these `rails'.

An ideal classification should consist of categories that are mutually exclusive and collectively exhaustive. Its entities should be discreet and together they should cover the ground. The classification of eating disorders measures up to these standards rather poorly. The canon contains only two major categories -- anorexia nervosa (AN) and bulimia nervosa (BN). Anorexia nervosa has low weight as an essential criterion. Bulimia nervosa has binge eating as a necessary criterion. The two disorders share the criterion of what in broad terms might be described as an over-concern about body weight and size although some would see a major difference in degree or emphasis in the typical ideas held by sufferers from AN and BN. In DSM-IV, AN takes precedence over BN in the sense that the presence of the former bars the diagnosis of the latter. In contrast in the earlier version, DSM-III-R, it was possible to make the dual diagnosis of both AN and Bulimia Nervosa (APA, 1987). There is in DSM-IV, however, a new sub-classification of AN into binge-purging and pure restricting subtypes. The rules in both of these sets of criteria represent different responses to the fact that low weight and bingeing occur together commonly and that, hence, the cardinal features of AN and BN are closely related even in cross-section. When longitudinal course over time is considered then the overlap becomes even more striking. In many series, a substantial minority of BN sufferers have a past history of AN. The reverse transition from BN to AN is less common, but does occur. Thus, AN and BN are far from being entirely discreet disorders and can be made to seem so only by dint of a certain sophistry. However, if the classification of the eating disorders fails to meet fully the ideal of providing discreet entities, it fails even more in respect of the second criterion, that of covering the ground. Many people present with eating disorders that fulfill criteria for neither of the two main disorders. . .

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