Eating Disorder Diagnostic Criteria from DSM IV-TR
307.1 Anorexia Nervosa
* Refusal to maintain body weight at or above a minimally normal weight for age and height, for example, 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 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 3 consecutive menstrual cycles. A woman having periods only while on hormone medication (e.g.estrogen) still qualifies as having amenorrhea.
Restricting Type: During the current episode of Anorexia Nervosa, the person has not regularly engaged in binge-eating or purging behavior (self-induced vomiting or 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.
307.51 Bulimia Nervosa
* Recurrent episodes of binge eating characterized by both
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, (such as a feeling that one cannot stop eating or control what or how much one is eating).
* Recurrent inappropriate compensatory behavior to prevent weight gain, such as selfinduced vomiting, misuse of laxatives, diuretics, enemas, or other medications, fasting, or excessive exercise.
* The binge eating and inappropriate compensatory behavior 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.
Purging Type: During the current episode of Bulimia Nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas.
Nonpurging Type: During the current episode of Bulimia Nervosa, the person has used other inappropriate compensatory behavior but has not regularly engaged in self-induced vomiting or misused laxatives, diuretics, or enemas.
307.50 Eating Disorder Not Otherwise Specified
This diagnosis includes disorders of eating that do not meet the criteria for the above two eating disorder diagnoses. Examples include:
1. For female patients, all of the criteria for Anorexia Nervosa are met except that the patient has regular menses.
2. All of the criteria for Anorexia Nervosa are met except that, despite significant weight loss, the patient’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 less than twice a week or for less than 3 months.
4. The patient has normal body weight and regularly uses inappropriate compensatory behavior after eating small amounts of food (e.g., self-induced vomiting after consuming two cookies).
5. The patient engages in repeatedly chewing and spitting out, but not swallowing, large amounts of food.
6. Binge-eating disorder: recurrent episodes of binge eating in the absence if regular inappropriate compensatory behavior characteristic of Bulimia Nervosa.
Adapted from American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed, text rev. Washington, DC, American Psychiatric Association, 2000.
Listed in the DSM IV-TR appendix as a diagnosis for further study, Binge Eating Disorder is defineds as uncontrolled binge eating without emesis or laxative abuse. It is often, but not always, associated with obesity symptoms. Night Eating Syndrome includes morning anorexia, increased appetite in the evening, and insomnia. These patients can have complete or partial amnesia for eating during the night.