Eating DisordersEating Disorders

Diagnostic Features ofDiagnostic Features of

Anorexia NervosaAnorexia Nervosa

Bulimia NervosaBulimia Nervosa

OverviewOverview

Anorexia is characterized by a refusal to maintain a Anorexia is characterized by a refusal to maintain a minimally normal body weight.minimally normal body weight.

Bulimia is characterized by repeated episodes of binge Bulimia is characterized by repeated episodes of binge eating followed by inappropriate compensatory behaviors eating followed by inappropriate compensatory behaviors such as self-induced vomiting; misuse of laxatives, such as self-induced vomiting; misuse of laxatives, diuretics, fasting, or excessive exercise.diuretics, fasting, or excessive exercise.

A disturbance in perception of body shape and weight is an A disturbance in perception of body shape and weight is an essential feature of both Anorexia and Bulimia. essential feature of both Anorexia and Bulimia.

Anorexia NervosaAnorexia NervosaDiagnostic CriteriaDiagnostic Criteria

Refusal to maintain body Refusal to maintain body weight at or above a minimally weight at or above a minimally normal weiht for age and height normal weiht for age and height (e.g., weight loss leading to (e.g., weight loss leading to maintenance of body weight maintenance of body weight less than 85% of that expected: less than 85% of that expected: or failure to make expected or failure to make expected weight gain during period of weight gain during period of growth, leading to body weight growth, leading to body weight less than 85% of that expected)less than 85% of that expected)

Intense fear of gaining weight Intense fear of gaining weight or becoming fat, even though or becoming fat, even though underweight.underweight.

Disturbance in the way in Disturbance in the way in which one’s body weight or which one’s body weight or shape is experienced, undue shape is experienced, undue influence of body weight or influence of body weight or shape on self-evaluation, or shape on self-evaluation, or denial of the seriousness of the denial of the seriousness of the current low body weight.current low body weight.

In postmenarcheal females, In postmenarcheal females, amenorrhea, i.e., the absence of amenorrhea, i.e., the absence of at least three consecutive at least three consecutive menstrual cycles.menstrual cycles.

Anorexia NervosaAnorexia NervosaAssociated FeaturesAssociated Features

Depressed mood, social withdrawal, irritability, insomnia, and diminished Depressed mood, social withdrawal, irritability, insomnia, and diminished interest in sex.interest in sex.

May meet the symptomatic requirements for Major Depressive Disorder, May meet the symptomatic requirements for Major Depressive Disorder, which is secondary, or a manifestation of starvation.which is secondary, or a manifestation of starvation.

Obsessive-compulsive features, both related and unrelated to food Obsessive-compulsive features, both related and unrelated to food (perfectionism)(perfectionism)

ConstipationConstipation Abdominal painAbdominal pain Intolerance to coldIntolerance to cold LethargyLethargy Excess energyExcess energy EmaciationEmaciation

Bulimia NervosaBulimia NervosaDiagnostic CriteriaDiagnostic Criteria

Recurrent episodes of binge Recurrent episodes of binge eating. An episode of binge eating. An episode of binge eating is characterized by both eating is characterized by both of the following:of the following:

Eating, in a discrete period of Eating, in a discrete period of time (e.g., within any 2-hour time (e.g., within any 2-hour period), an amount of food that period), an amount of food that is definitely larger than most is definitely larger than most people would eat during a people would eat during a similar period of time and similar period of time and under similar circumstancesunder similar circumstances

Sense of lack of control over Sense of lack of control over eating during the episode eating during the episode (feeling that one cannot stop (feeling that one cannot stop eating or control how much)eating or control how much)

Recurrent inappropriate Recurrent inappropriate compensatory behavior in order compensatory behavior in order to prevent weight gain, such as to prevent weight gain, such as self-induced vomiting; misuse self-induced vomiting; misuse of laxatives, diuretics, enemas, of laxatives, diuretics, enemas, or other medications: fasting; or or other medications: fasting; or excessive exercise.excessive exercise.

Binge eating/compensatory Binge eating/compensatory behaviors both occur, on behaviors both occur, on average, at least twice a week average, at least twice a week for 3 months.for 3 months.

Self-evaluation is unduly Self-evaluation is unduly influenced by body shape and influenced by body shape and weight.weight.

Bulimia NervosaBulimia NervosaAssociated FeaturesAssociated Features

Typically within the normal weight range (some may be slightly under Typically within the normal weight range (some may be slightly under or overweight)or overweight)

Between binges, individuals typically restrict their total caloric Between binges, individuals typically restrict their total caloric consumption and avoid foods they perceive to be fattening or likely to consumption and avoid foods they perceive to be fattening or likely to trigger a binge.trigger a binge.

While binge-eating, food types tend to be high in carbohydrates, While binge-eating, food types tend to be high in carbohydrates, cakes, ice-cream, cookies but are not exclusive to these.cakes, ice-cream, cookies but are not exclusive to these.

Increased frequency of depressive symptoms (low self-esteem; Increased frequency of depressive symptoms (low self-esteem; deflated mood)deflated mood)

Increased frequency of anxiety symptoms (fear of social situations; Increased frequency of anxiety symptoms (fear of social situations; agitation)agitation)

1/3 to 1/2 meet the criteria for Borderline Personality Disorder1/3 to 1/2 meet the criteria for Borderline Personality Disorder Two sub-types: Purging Type and Non-purging TypeTwo sub-types: Purging Type and Non-purging Type Those who do not purge (vomit) tend to fast or exercise excessively Those who do not purge (vomit) tend to fast or exercise excessively

following an episode of binge eating.following an episode of binge eating.