Eating Disorders

Diagnostic Criteria

The Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), published by the American Psychiatric Association, establishes criteria used in diagnosing and distinguishing eating disorders.

AN is diagnosed according to four diagnostic criteria: a refusal to maintain body weight within a normal range for the person's age and height; an intense fear of gaining weight; a severe disturbance of body image in which body image becomes responsible for self-worth accompanied by a denial of the gravity of the illness; and in women past the age of menarche, an absence of more than three menstrual cycles (amenorrhea). Additionally, there are two currently recognized subtypes of AN: restricting (ANR) and bingeing/purging (ANBP). Individuals with ANR use constraint in their eating to reduce their weight and are, in general, more perfectionistic and restrictive in their eating behaviors. In contrast, individuals with ANBP may binge and use purging methods (i.e., vomiting, laxatives) to control their weight; the ANBP subtype is typically more categorically impulsive, older, and may be more likely to be suicidal or to have substance abuse problems.

The DSM-IV criteria for BN include recurrent episodes of binge eating accompanied by a feeling of a loss of control (binge eating constitutes a consumption of larger-than-normal quantities of food in a discrete period); recurrent compensatory measures to avoid gaining weight post-binge that either involve purging (e.g., self-induced vomiting) or nonpurging activities (e.g., excessive exercise or fasting); the bingeing and purging behaviors occur a minimum of two times a week for a duration of three months; self-evaluation is disproportionately influenced by body shape and weight. In addition, these disturbances do not occur during episodes of AN.

Also included in the DSM-IV is the category eating disorder not otherwise specified, which includes all clinically significant eating behaviors that do not fit neatly into the categories of AN or BN. Although it is referred only as a research diagnosis, binge-eating disorder falls into this category and is receiving much [Page 578]attention in the current contexts of the obesity epidemic as well as in the pending revisions to the DSM

IV. Binge-eating disorder's hallmark characteristic is binge eating (i.e., consuming in a discrete period a larger-than-normal amount of food for that particular time) at least two days a week for a duration of six months. These binges are similar to those that occur with BN, but in addition, meet at least three of the five following criteria: eating more rapidly than normal; eating until uncomfortably full; eating large amounts of food when not otherwise feeling physically hungry; eating alone out of embarrassment; or feeling disgusted with oneself or guilty after overeating.

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