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This overview provides information on the diagnostic features of anorexia nervosa and bulimia nervosa, including the refusal to maintain a normal body weight, episodes of binge eating, compensatory behaviors, and disturbances in the perception of body shape and weight. It also includes associated features and diagnostic criteria for both disorders.
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Eating Disorders Diagnostic Features of Anorexia Nervosa Bulimia Nervosa
Overview • Anorexia is characterized by a refusal to maintain a minimally normal body weight. • Bulimia is characterized by repeated episodes of binge eating followed by inappropriate compensatory behaviors such as self-induced vomiting; misuse of laxatives, diuretics, fasting, or excessive exercise. • A disturbance in perception of body shape and weight is an essential feature of both Anorexia and Bulimia.
Refusal to maintain body weight at or above a minimally normal weiht 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. Anorexia NervosaDiagnostic Criteria
Anorexia NervosaAssociated Features • Depressed mood, social withdrawal, irritability, insomnia, and diminished interest in sex. • May meet the symptomatic requirements for Major Depressive Disorder, which is secondary, or a manifestation of starvation. • Obsessive-compulsive features, both related and unrelated to food (perfectionism) • Constipation • Abdominal pain • Intolerance to cold • Lethargy • Excess energy • Emaciation
Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: 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 Sense of lack of control over eating during the episode (feeling that one cannot stop eating or control how much) Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications: fasting; or excessive exercise. Binge eating/compensatory behaviors both occur, on average, at least twice a week for 3 months. Self-evaluation is unduly influenced by body shape and weight. Bulimia NervosaDiagnostic Criteria
Bulimia NervosaAssociated Features • Typically within the normal weight range (some may be slightly under or overweight) • Between binges, individuals typically restrict their total caloric consumption and avoid foods they perceive to be fattening or likely to trigger a binge. • While binge-eating, food types tend to be high in carbohydrates, cakes, ice-cream, cookies but are not exclusive to these. • Increased frequency of depressive symptoms (low self-esteem; deflated mood) • Increased frequency of anxiety symptoms (fear of social situations; agitation) • 1/3 to 1/2 meet the criteria for Borderline Personality Disorder • Two sub-types: Purging Type and Non-purging Type • Those who do not purge (vomit) tend to fast or exercise excessively following an episode of binge eating.
