Eating Disorders Diagnostic Features of Anorexia Nervosa Bulimia Nervosa

Overview l Anorexia is characterized by a refusal to maintain a minimally normal body weight. l 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. l A disturbance in perception of body shape and weight is an essential feature of both Anorexia and Bulimia.

Anorexia Nervosa Diagnostic Criteria l 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) l Intense fear of gaining weight or becoming fat, even though underweight. l 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. l In postmenarcheal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles.

Anorexia Nervosa Associated Features l Depressed mood, social withdrawal, irritability, insomnia, and diminished interest in sex. l May meet the symptomatic requirements for Major Depressive Disorder, which is secondary, or a manifestation of starvation. l Obsessive-compulsive features, both related and unrelated to food (perfectionism) l Constipation l Abdominal pain l Intolerance to cold l Lethargy l Excess energy l Emaciation

Bulimia Nervosa Diagnostic Criteria l Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: l 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 l Sense of lack of control over eating during the episode (feeling that one cannot stop eating or control how much) l 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. l Binge eating/compensatory behaviors both occur, on average, at least twice a week for 3 months. l Self-evaluation is unduly influenced by body shape and weight.

Bulimia Nervosa Associated Features l Typically within the normal weight range (some may be slightly under or overweight) l Between binges, individuals typically restrict their total caloric consumption and avoid foods they perceive to be fattening or likely to trigger a binge. l While binge-eating, food types tend to be high in carbohydrates, cakes, ice-cream, cookies but are not exclusive to these. l Increased frequency of depressive symptoms (low self-esteem; deflated mood) l Increased frequency of anxiety symptoms (fear of social situations; agitation) l 1/3 to 1/2 meet the criteria for Borderline Personality Disorder l Two sub-types: Purging Type and Non-purging Type l Those who do not purge (vomit) tend to fast or exercise excessively following an episode of binge eating.