Anorexia Nervosa: Diagnostic Criteria

1. 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).
2. Intense fear of gaining weight or becoming fat, even thought under-weight.
3. 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.
4. 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.)

Specify type:

Restricting Type: during the current episode of Anorexia Nervosa, the person has not regularly engaged in binge-eating or purging behavior (i.e. self-induced vomiting or the misuse of laxatives, diuretics, or enemas)

Binge-Eating/Purging Type: during the current episode of Anorexia Nervosa, the person has regularly engaged in binge-eating or purging behavior (i.e. self-induced vomiting or the misuse of laxatives, diuretics, or enemas) (p. 545).

Bulimia Nervosa: Diagnostic Criteria

1. Recurrent episodes of binge eating.  An episode of binge eating is characterized by both of the following:
   1. eating, in  a discrete period of time (e.g., within any 2-hour period) an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances
   2. a sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating)
2. Recurrent inappropriate compensatory behavior in order to prevent: weight gain, such a self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise.
3. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.
4. Self-evaluation is unduly influenced by body shape and weight.
5. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.

Specify type:

Purging Type: during the current episode of Bulimia Nervosa, the person has regularly engaged in self-induced vomiting or misuse laxatives, diuretics, or enemas

Nonpurging Type: during the current episode of Bulimia Nervosa, the person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas (p. 549-550).

Eating Disorder Not Otherwise Specified

The Eating Disorder Not Otherwise Specified category is for disorders of eating that do not meet the criteria for any specific Eating Disorder. Examples include:

1. For females, all of the criteria for Anorexia Nervosa are met except that the individual has regular menses.
2. All of the criteria for Anorexia Nervosa are met except that, despite significant weight loss, the individual’s current weight is in the normal range.
3. All of the criteria for Bulimia Nervosa are met except that the binge eating and inappropriate compensatory mechanisms occur at a frequency of less than twice a week or for a duration of less than 3 months.
4. The regular use of inappropriate compensatory behavior by an individual of normal body weight after eating small amounts of food (e.g. self-induced vomiting after the consumption of two cookies).
5. Repeatedly chewing and spitting out, but not swallowing, large amounts of food.
6. Binge-eating disorder: recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory behavior characteristic of Bulimia Nervosa (p. 550).

Binge Eating Disorder

The essential features are recurrent episodes of binge eating  associated with subjective and behavioural indicators of impaired control over, and significant distress about, the binge eating and the absence of the regular use of inappropriate compensatory behaviours (such as self-induced vomiting, misuse of laxatives and other medications, fasting and excessive exercise) that are characteristic of bulimia nervosa…Indicators of impaired control include eating very rapidly, eating until feeling uncomfortably full, eating large amounts of food when not hungry, eating alone because of embarrassment over how much one is eating, and feeling disgust, guilt, or depression after overeating…(p. 729). The duration of a binge-eating episode can vary greatly and many individuals have difficulty separating the binge eating into discrete episodes… Most individuals with this eating pattern are overweight (although some have never been overweight) [and it should be noted that not all overweight individuals exhibit binge-eating behaviours]….In comparison with individuals of equal weight without this pattern of eating, these individuals report higher rates of self-loathing, disgust about body size, depression, anxiety, somatic concern, and interpersonal sensitivity (p. 730).

References

American Psychiatric Association. Diagnostic and Statistical Manual of
       Mental Disorders, 4th ed, Revised Washington, DC: American
       Psychiatric Association, 1994.