The following information is the official diagnostic criteria as set forth by the American Psychiatric Association (APA), as outlined in its Diagnostic and Statistical Manual- 4th edition (DSM-IV). Please note that not every eating disordered individual fits neatly into one diagnostic category or another. Each person is a unique individual, and the guidelines set forth by the APA are intended to be general guidelines. In reality, few people fit precisely into one category or another.
Please note that the following is NOT provided for diagnostic purposes, but rather for your information and education.
DSM-IV Criteria for Anorexia Nervosa
- Refusal to maintain body weight at or above a minimally normal weight for age and height (eg, weight loss leading to maintenance of body weight less than 85 percent of that expected or failure to make expected weight gain during period of growth, leading to body weight less than 85 percent 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 postmenarchal females, amenorrhea ie, the absence of at least three consecutive cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, eg, estrogen administration.)
Restricting Type: During the current episode of anorexia nervosa, the person has not regularly engaged in binge-eating or purging behavior (ie, 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 (ie, self-induced vomiting or the misuse of laxatives, diuretics, or enemas).
DSM-IV Criteria for Bulimia Nervosa
- 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 (eg, 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 (eg, a feeling that one cannot stop eating or control what or how much one is eating).
- 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.
- The binge eating and inappropriate compensatory behaviors 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 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.
Eating Disorder Not Otherwise Specified (EDNOS)
Disorders of eating that do not meet the criteria for any specific eating disorder.
- For females, all of the criteria for anorexia nervosa are met except that the individual has regular menses.
- 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.
- 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 duration of less than 3 months.
- The regular use of inappropriate compensatory behavior by an individual of normal body weight after eating small amounts of food (eg, self-induced vomiting after the consumption of two cookies).
- Repeatedly chewing and spitting out, but not swallowing, large amounts of food.
The vast majority of people with Eating Disorders will actually be diagnosed with EDNOS. However, this category encompasses a very wide variety of symptoms, behaviors, thoughts, and severities. Possibly the most confusing factor with the EDNOS category is that a person will be diagnosed in this category if their disorder is either still developing, or not severe or severe and pervasive, yet atypical. The broad category of EDNOS is a subject of contention among researchers, and we hope that the criteria will develop and become more specific in subsequent versions of the DSM.
Binge-eating disorder: recurrent episodes of binge eating in the absence if the regular use of inappropriate compensatory behaviors characteristic of bulimia nervosa.
Other Eating Disorders Not Listed in the DSM
Binge-eating disorder/Compulsive overeating: recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory behaviors characteristic of bulimia nervosa.
Pica: is defined as having the compulsion to lick, eat, or chew foods that are non-food items or items that bear little to no nutritional value. Examples include: dirt, mud, chalk, ashes, paint, ice, q-tips, cotton balls and plaster. Pica is often associated with mineral deficiencies (such as iron or zinc) and is common in pregnant women.
Orthorexia Nervosa: “Orthorexia” is a term commonly used to define the tendency to become obsessed with the quality and nutritional value of food consumed. A person may become obsessed with obtaining the highest-quality organic foods, or may aim to get a specific balance of vitamins, minerals, or macronutrients in order to achieve their perceived “ideal” diet.