Eating Disorders
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Anorexia Nervosa
Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected). Intense fear of gaining weight or becoming fat, even though underweight. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight. In postmenarcheal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen, administration.)
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Binge Eating Disorder
Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
The binge eating occurs, on average, at least once a week for three months. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior (for example, purging) and does not occur exclusively during the course Anorexia Nervosa, Bulimia Nervosa, or Avoidant/ Restrictive Food Intake Disorder. (Adapted from DSM-V, in which this disorder now appears for the first time as a unique disorder) |
Bulimia Nervosa
Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months. Self-evaluation is unduly influenced by body shape and weight. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.
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Avoidant/Restrictive Food Intake Disorder (ARFID)
An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:
The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced (body image).
The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.
(Adapted from DSM-V)
An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:
- Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).
- Significant nutritional deficiency.
- Dependence on enteral feeding or oral nutritional supplements.
- Marked interference with psychosocial functioning.
The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced (body image).
The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.
(Adapted from DSM-V)
Diabulimia
Eating disorder in people with diabetes, most commonly Type 1 diabetes, characterized by intentional restriction and/or manipulation of insulin dosage for the purpose of weight loss. Diabulimia does not have a unique diagnostic code; the specific diagnosis will depend on a patient's eating disorder behaviors. The DSM-5 classifies insulin omission as a purging behavior, therefore it may be coded as bulimia nervosa if the behavior is characterized by binging and restriction of insulin, or as anorexia nervosa, purging type if the behavior is characterized by normal eating with restriction of insulin, or anorexia nervosa if restriction of both food and insulin are present. Diabulimia can also be diagnosed as Other Specified Feeding and Eating Disorder (OSFED).
Eating disorder in people with diabetes, most commonly Type 1 diabetes, characterized by intentional restriction and/or manipulation of insulin dosage for the purpose of weight loss. Diabulimia does not have a unique diagnostic code; the specific diagnosis will depend on a patient's eating disorder behaviors. The DSM-5 classifies insulin omission as a purging behavior, therefore it may be coded as bulimia nervosa if the behavior is characterized by binging and restriction of insulin, or as anorexia nervosa, purging type if the behavior is characterized by normal eating with restriction of insulin, or anorexia nervosa if restriction of both food and insulin are present. Diabulimia can also be diagnosed as Other Specified Feeding and Eating Disorder (OSFED).
Assessment & Screening
- EAT-26 (includes links to scoring and interpretation instructions)
Position Papers & Practice Parameters
- Guide: Critical Points for Early Recognition & Medical Risk Management in the Care of Individuals with Eating Disorders (AED-Academy for Eating Disorders, 2012)
- Diagnosis of Eating Disorders in Primary Care (AAFP, 2003)
- Identification and Management of Eating Disorders in Children and Adolescents (AAP, 2010)
- Society for Adolescent Medicine Position Paper: Eating Disorders in Adolescents (2003)
- National Athletic Trainers' Association Position Statement: Preventing, Detecting, and Managing Disordered Eating in Athletes (2008)
- Treatment for Patients with Eating Disorders (APA, 2006); very comprehensive practice guideline, http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/eatingdisorders.pdf
Articles
- Eating Disorders in Children and Adolescents: State of the Art Review (AAP, 2014)
- The Female Athlete Triad (American College of Sports Medicine, 2007)
Resources
For Professionals:
- Level of Care Guidelines for Patients with Eating Disorders
- Related Video: Eating Disorders in the DSM-5: Implications of Changes in the Diagnostic Categories and Criteria, by DSM-5 committee members Dr. B. Timothy Walsh, Dr. Evelyn Attia and Dr. Steven Wonderlich
- Diabulimia research summary from Diabulimia Helpline
- Body Positive
- Recovery Record eating disorder app for patients and clinicians
- Healthy body image toolkits (NEDA) for coaches and trainers and for educators
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Quick links: Eating disorders
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Organizations
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