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An eating disorder is an extreme form of food and weight preoccupation. There are strict criteria to define clinically diagnosable eating disorders, and many eating disorders go undiagnosed. We encourage you to access desired support for disordered eating thoughts and behaviours whether or not you have a clinical diagnosis.

›Definitions are used to help health professionals understand how each condition develops and progresses, and how to treat people with similar symptoms.

Eating Disorder Diagnostic Criteria from DSM V (Diagnostic and Statistical Manual of Mental Disorders)

 

Anorexia Nervosa

Diagnostic Criteria (DSM V)

  • Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
  • 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.
  • Binge/Purge Subtype: Accompanied by episodes of self-induced vomiting and/or misuse of laxatives, diuretics, or enemas.
  • Restricting Subtype: Not accompanied by episodes of self-induced vomiting and/or misuse of laxatives, diuretics, or enemas.

Psychosocial Signs and Symptoms

  • Preoccupation with food, calories, weight, or size.
  • Social withdrawal or avoidance of activities.
  • Denial of hunger or frequent explanation of food abstinence.
  • Development of food rituals.
  • Increased irritability or drastic shifts in mood.

Physical Signs and Symptoms

  • Cold intolerance.
  • Paleness or development of yellowish skin tone.
  • Thinning of hair.
  • Frequent fatigue or headaches.
  • Increased susceptibility to illness and injury (bruising, fracture, etc.).

Potential Health Consequences

  • Poor circulation, especially to hands and feet.
  • Low blood pressure and fainting spells.
  • Slow or irregular heartbeat.
  • Dehydration and kidney failure.
  • Chronic constipation.
  • Muscle loss and weakness.
  • Amenhhorea (loss of menstrual cycle).
  • Osteoporosis (decrease in bone density).
  • Growth of lanugo hair.
  • Memory loss and disorientation.

Bulimia Nervosa

Diagnostic Criteria (DSM V)

  • Recurrent episodes of binge eating characterized by BOTH of the following:

>Eating in a discrete amount of time (within a 2 hour period) large amounts of food.

>Sense of lack of control over eating during an episode.

  • Recurrent inappropriate compensatory behavior in order to prevent weight gain (purging).
  • The binge eating and compensatory behaviors both occur, on average, at least once a week for three months.
  • Self-evaluation is unduly influenced by body shape and weight.
  • The disturbance does not occur exclusively during episodes of anorexia nervosa.

Psychosocial Signs and Symptoms

  • Preoccupation with food, calories, weight, and shape.
  • Excessive, compulsive exercise despite fatigue, illness, or injury.
  • Secretive eating and/or missing food.
  • Frequent trips to the bathroom after meals.
  • Chronic expression of guilt or shame.

Physical Signs and Symptoms

  • Rapid fluctuations in weight.
  • Persistent sore throat and/or heartburn.
  • Tooth discoloration or decay.
  • Emergence of calluses on the back of hands or knuckles.
  • Swollen parotid glands (in cheek or neck) or broken blood vessels in eyes or face.

Potential Health Consequences

  • Dehydration and nutrient deficiencies.
  • Chronic kidney problems or kidney failure.
  • Inflammation and possible rupture of the esophagus.
  • GI problems, including tears in the lining of the stomach.
  • Electrolyte imbalance producing seizures or cardiac events.

Binge Eating Disorder

Diagnostic Criteria (DSM V)

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

>eating, in a discrete period of time (for example, within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances

>a sense of lack of control over eating during the episode (for example, a feeling that one cannot stop eating or control what or how much one is eating)

  • The binge-eating episodes are associated with three (or more) of the following:

>eating much more rapidly than normal   

>eating until feeling uncomfortably full

>eating large amounts of food when not feeling physically hungry

>eating alone because of feeling embarrassed by how much one is eating

>feeling disgusted with oneself, depressed, or very guilty afterwards

  • Marked distress regarding binge eating is present.
  • 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 behaviour (for example, purging) and does not occur exclusively during the course of Anorexia Nervosa, Bulimia Nervosa, or Avoidant/Restrictive Food Intake Disorder.

Potential Health Consequences

  • Type II Diabetes
  • Heart Disease
  • Sleep Apnea
  • Chronic Kidney Problems
  • Osteoarthritis

Related Disorders

Avoidant/Restrictive Food Intake Disorder (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 disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.
  • 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 Dysmorphic Disorder (DSM IV TR)

  • Preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person’s concern is markedly excessive.
  •  The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  • The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in Anorexia Nervosa).

Feeding or Eating Disorders Not Otherwise Classified (DSM V) Disturbances in eating behavior that do not necessarily fall into the specific category of anorexia, bulimia, or binge eating disorder, including:

  • Purging Disorder

>Recurrent purging behaviour to influence weight or shape (e.g., self-induced vomiting, misuse of laxatives, diuretics, or other medications) in the absence of binge eating.

  • Night Eating Syndrome

>Recurrent episodes of night eating, as manifested by eating after awakening from sleep or by excessive food consumption after the evening meal. There is awareness and recall of the eating. The night eating is not better explained by external influences such as changes in the individual’s sleep-wake cycle or by local social norms. The night eating causes significant distress and/or impairment in functioning. The disordered pattern of eating is not better explained by binge-eating disorder or another mental disorder, including substance use, and is not attributable to another medical disorder or to an effect of medication.

Source: American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Text-Revision