DSM-IV-TR Diagnostic Criteria for Eating Disorders

There are two official DSM diagnoses for eating disorders, with two variations each. This gives us four options: Anorexia Nervosa, Restricting Type; Anorexia Nervosa, Binge Eating/Purging Type; Bulimia Nervosa, Purging Type; Bulimia Nervosa, Nonpurging Type.

This is are direct direct quotes from the DSM-IV-TR. “Postmenarcheal” means after the onset of the menstrual cycle. In addition to Anorexia Nervosa and Bulimia Nervosa, there is a category with no diagnostic criteria called Eating Disorder Not Otherwise Specified that clinician can give to someone “for disorders of eating that do not meet the criteria for any specific Eating Disorder.” People diagnosed with EDNOS are even more likely to die from their conditions than those in AN or BN.

[This post first appeared on Nathen’s Miraculous Escape, March 17, 2010.]

Diagnostic criteria for 307.1 Anorexia Nervosa

A. 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 a period of growth, leading to body weight less than 85% of that expected).

B. Intense fear of gaining weight or becoming fat, even though underweight.

C. 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.

D. 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)

Diagnostic criteria for 307.51 Bulimia Nervosa

A. 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)

B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxative, diuretics, enemas, or other medications; fasting; or excessive exercise.

C. The binge eating and inappropriate compensatory behavior both occur, on average, at least twice a week for 3 months.

D. Self-evaluation is unduly influenced by body shape and weight.

E. 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 the misuse of 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

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10 Things Parents Can Do to Help Prevent Eating Disorders

This is a handout I got in my Medical Family Therapy class. The copyright at the bottom says “(c) 2005 National Eating Disorders Association. Permission is granted to copy and reprint materials for educational purposes only. National Eating Disorders Association must be cited and web address listed. www.NationalEatingDisorders.org Information and Referral Helpline: 800.931.2237.” I think that covers me. I’m willing to take the risk, anyway, because eating disorders are a huge problem. The most conservative estimates, using the most strict definitions, are that six million people in the US struggle with disordered eating. Estimates using less strict definitions (including Eating Disorder Not Otherwise Specified in the DSM-IV-TR), but still very realistic, are at about 20 million. And eating disorders are the most deadly mental disorder. If not treated, 20-25% of those with serious eating disorders die from them. You won’t find that statistic in many official sources, though, because for some very strange reason, coroners will not list Anorexia or Bulimia Nervosa as a cause of death. They prefer “Cause of death unknown” in those cases. Plus, eating disorders are learned behavior. Don’t let your kids learn the values that encourage disordered eating from you!

OK, here it is. It’s by Michael Levine, PhD:

1. Consider your thoughts, attitudes, and behaviors toward your own body and the way that these beliefs have been shaped by the forces of weightism and sexism. Then educate your children about (a) the genetic basis for the natural diversity of human body shapes and sizes and (b) the nature and ugliness of prejudice.

*Make an effort to maintain positive attitudes and health behaviors. Children learn from the things you say and do!

2. Examine closely your dreams and goals for your children and other loved ones. Are you overemphasizing beauty and body shape, particularly for girls?

*Avoid conveying an attitude which says in effect, “I will like you more if you lose weight, don’t eat so much, look more like the slender models in ads, fit into smaller clothes, etc.”

*Decide what you can do and what you can stop doing to reduce the teasing, criticism, blaming, staring, etc. that reinforce the idea that larger or fatter is “bad” and smaller or thinner is “good.”

3. Learn about and discuss with your sons and daughters (a) the dangers of trying to alter one’s body shape through dieting, (b) the value of moderate exercise for health, and (c) the importance of eating a variety of foods in well-balanced meals consumed at least three times a day.

*Avoid categorizing and labeling foods (e.g. good/bad or safe/dangerous). All foods can be eaten in moderation.

*Be a good role model in regard to sensible eating, exercise, and self-acceptance.

4. Make a commitment not to avoid activities (such as swimming, sunbathing, dancing, etc.) simply because they call attention to your weight and shape. Refuse to wear clothes that are uncomfortable or that you don’t like but wear simply because they divert attention from your weight or shape.

5. Make a commitment to exercise for the joy of feeling your body move and grow stronger, not to purge fat from you body or to compensate for calories, power, excitement, popularity, or perfection.

6. Practice taking people seriously for what they say, feel, and do, not for how slender or “well put together” they appear.

7. Help children appreciate and resist the ways in which television, magazines, and other media distort the true diversity of human body types and imply that a slender body means power, excitement, popularity, or perfection.

8. Educate boys and girls about various forms of prejudice, including weightism, and help them understand their responsibilities for preventing them.

9. Encourage your children to be active and to enjoy what their bodies can do and feel like. Do not limit their caloric intake unless a physician requests that you do this because of a medical problem.

10. Do whatever you can to promote the self-esteem and self- respect of all of your children in intellectual, athletic , and social endeavors. Give boys and girls the same opportunities and encouragement. Be careful not to suggest that females are less important than males, e.g., by exempting males form housework or childcare. A well-rounded sense of self and solid self-esteem are perhaps the best antidotes to dieting and disordered eating.

[This post first appeared on Nathen’s Miraculous Escape, March 16, 2010.]

What Makes a Good Food Day?

I just had my last Medical Family Therapy lecture. It was on eating disorders. My professor, Deanna Linville, is a specialist. One of the questions she recommended asking clients dealing with eating disorders was “What’s a good food day for you?” Also, “What’s a bad food day?”

I think those are good questions for anyone. Here are my answers:

A good food day is when I eat plenty and take the time to really enjoy the food. It usually means I’ve eaten real meals, not just snacked through the day. It means I wait long enough to feel hungry and then eat enough to feel full. It means I haven’t fixated on any food to the point where I ate it until I didn’t feel good.

A bad food day usually means I didn’t eat enough, or enough variety, usually because I let myself get too busy. It’s easy to eat nuts and raisins instead of a meal, or sometimes just forget to eat a meal, and I always regret it. I get weak, irritable, and stupid. If I eat too much on a bad food day, it’s most often because I fixated on a food (usually sugar, sometimes bread and/or cheese, occasionally meat at a BBQ or something) and ate it until I was uncomfortable. Sometimes it’s because I didn’t space my meals out enough and piled new food on top of old. Sometimes it’s a bad food combination, at a potluck or something, that gets me feeling uncomfortable. A random, moldy raisin made yesterday a bad food day.

How about you?

[First published on Nathen’s Miraculous Escape, March 14, 2010.]