The American Psychological Association definition of eating disorder?

Answer 1

DSM-5 Proposed Diagnostic Criteria for Anorexia Nervosa

A. Restriction of food intake relative to caloric requirements leading to the maintenance of a body weight less than 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 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, or persistent behavior to avoid weight gain, 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 persistent lack of recognition of the seriousness of the current low body weight.

Specify current type:

Restricting Type: during the last three months, the person has not engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)

Binge-Eating/Purging Type: during the last three months, the person has engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)

Rationale

Criterion A:

The word "refusal" in DSM-IV was viewed as possibly pejorative and difficult to assess, as it implies intention. Rewording of the criterion to focus on behaviors is recommended.

Level of change: Clarification.

References: Literature review (http://wiki.answers.com/Documents/EatingDisorders Reviews/Becker cognitive_IJED 2009.pdf). Also, Workgroup for Classification of Eating Disorders in Children and Adolescents (WCEDCA) (Bravender et al., 2007).

Criterion B:

In DSM-IV, "fear of weight gain" is required. A significant minority of individuals with the syndrome explicitly deny such fear. Therefore, the addition of a clause to focus on behavior is recommended.

Level of change: Clarification.

References: Literature review (http://wiki.answers.com/Documents/EatingDisorders Reviews/Becker cognitive_IJED 2009.pdf). Also, Workgroup for Classification of Eating Disorders in Children and Adolescents (WCEDCA) (Bravender et al., 2007).

Criterion D:

In DSM-IV, amenorrhea is required. However, individuals have been clearly described who exhibit all other symptoms and signs of Anorexia Nervosa but who report at least some menstrual activity. In addition, this criterion cannot be applied to pre-menarchal females, to females taking oral contraceptives, to post-menopausal females, or to males. However, there are some data that women who endorse amenorrhea have poorer bone health than do women who fail to meet this criterion.

Deletion of this criterion is recommended.

Level of change: Modest/substantial.

References: Literature review (http://wiki.answers.com/Documents/EatingDisorders Reviews/Attia ammenorrhea_IJED 2009.pdf).

Subtyping

DSM-IV requires that sub-type (binge eating/purging or restricting) be specified for the current episode. While there are data that such sub-typing is useful clinically and for research purposes, there is significant cross-over between sub-types, and resultant difficulty in specifying the subtype for the "current episode" of illness. Therefore, it is recommended that the sub-typing be specified for the last 3 months; 3 months is the timeframe used for Bulimia Nervosa and proposed for Binge Eating Disorder.

Level of change: Clarification.

References: Literature review (http://wiki.answers.com/Documents/EatingDisorders Reviews/Wonderlich subtyping_IJED 2009.pdf).

Literature Cited:

http://wiki.answers.com/Documents/EatingDisorders Reviews/Attia ammenorrhea_IJED 2009.pdf

http://wiki.answers.com/Documents/EatingDisorders Reviews/Becker cognitive_IJED 2009.pdf

Bravender T, Bryant-Waught R, Herzog D, et al.: Classification of child and adolescent eating disturbances. Workgroup for Classification of Eating Disorders in Children and Adolescents (WCEDCA). Int J Eat Disord 40 Suppl:S117-122, 2007.http://wiki.answers.com/Documents/EatingDisorders Reviews/Wonderlich subtyping_IJED 2009.pdf

Peat C, Mitchell JE, Hoek HW, et al.: Validity and utility of subtyping anorexia nervosa. Int J Eat Disord 42:590-594, 2009.

Severity Criteria:

BMI (assessed appropriately for developmental stage).

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 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)

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Restricting Type: during the last three months, the person has not engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)

Binge-Eating/Purging Type: during the last three months, the person has engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)

Rationale

Criterion A:

The word "refusal" in DSM-IV was viewed as possibly pejorative and difficult to assess, as it implies intention. Rewording of the criterion to focus on behaviors is recommended.

Level of change: Clarification.

References: Literature review (http://wiki.answers.com/Documents/EatingDisorders Reviews/Becker cognitive_IJED 2009.pdf). Also, Workgroup for Classification of Eating Disorders in Children and Adolescents (WCEDCA) (Bravender et al., 2007).

Criterion B:

In DSM-IV, "fear of weight gain" is required. A significant minority of individuals with the syndrome explicitly deny such fear. Therefore, the addition of a clause to focus on behavior is recommended.

Level of change: Clarification.

References: Literature review (http://wiki.answers.com/Documents/EatingDisorders Reviews/Becker cognitive_IJED 2009.pdf). Also, Workgroup for Classification of Eating Disorders in Children and Adolescents (WCEDCA) (Bravender et al., 2007).

Criterion D:

In DSM-IV, amenorrhea is required. However, individuals have been clearly described who exhibit all other symptoms and signs of Anorexia Nervosa but who report at least some menstrual activity. In addition, this criterion cannot be applied to pre-menarchal females, to females taking oral contraceptives, to post-menopausal females, or to males. However, there are some data that women who endorse amenorrhea have poorer bone health than do women who fail to meet this criterion.

Deletion of this criterion is recommended.

Level of change: Modest/substantial.

References: Literature review (http://wiki.answers.com/Documents/EatingDisorders Reviews/Attia ammenorrhea_IJED 2009.pdf).

Subtyping

DSM-IV requires that sub-type (binge eating/purging or restricting) be specified for the current episode. While there are data that such sub-typing is useful clinically and for research purposes, there is significant cross-over between sub-types, and resultant difficulty in specifying the subtype for the "current episode" of illness. Therefore, it is recommended that the sub-typing be specified for the last 3 months; 3 months is the timeframe used for Bulimia Nervosa and proposed for Binge Eating Disorder.

Level of change: Clarification.

References: Literature review (http://wiki.answers.com/Documents/EatingDisorders Reviews/Wonderlich subtyping_IJED 2009.pdf).

Literature Cited:

http://wiki.answers.com/Documents/EatingDisorders Reviews/Attia ammenorrhea_IJED 2009.pdf

http://wiki.answers.com/Documents/EatingDisorders Reviews/Becker cognitive_IJED 2009.pdf

Bravender T, Bryant-Waught R, Herzog D, et al.: Classification of child and adolescent eating disturbances. Workgroup for Classification of Eating Disorders in Children and Adolescents (WCEDCA). Int J Eat Disord 40 Suppl:S117-122, 2007.http://wiki.answers.com/Documents/EatingDisorders Reviews/Wonderlich subtyping_IJED 2009.pdf

Peat C, Mitchell JE, Hoek HW, et al.: Validity and utility of subtyping anorexia nervosa. Int J Eat Disord 42:590-594, 2009.

Severity Criteria:

BMI (assessed appropriately for developmental stage).

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 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)

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Restricting Type: during the last three months, the person has not engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)

Binge-Eating/Purging Type: during the last three months, the person has engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas

Restricting Type: during the last three months, the person has not engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)

Binge-Eating/Purging Type: during the last three months, the person has engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)

Rationale

Criterion A:

The word "refusal" in DSM-IV was viewed as possibly pejorative and difficult to assess, as it implies intention. Rewording of the criterion to focus on behaviors is recommended.

Level of change: Clarification.

References: Literature review (http://wiki.answers.com/Documents/EatingDisorders Reviews/Becker cognitive_IJED 2009.pdf). Also, Workgroup for Classification of Eating Disorders in Children and Adolescents (WCEDCA) (Bravender et al., 2007).

Criterion B:

In DSM-IV, "fear of weight gain" is required. A significant minority of individuals with the syndrome explicitly deny such fear. Therefore, the addition of a clause to focus on behavior is recommended.

Level of change: Clarification.

References: Literature review (http://wiki.answers.com/Documents/EatingDisorders Reviews/Becker cognitive_IJED 2009.pdf). Also, Workgroup for Classification of Eating Disorders in Children and Adolescents (WCEDCA) (Bravender et al., 2007).

Criterion D:

In DSM-IV, amenorrhea is required. However, individuals have been clearly described who exhibit all other symptoms and signs of Anorexia Nervosa but who report at least some menstrual activity. In addition, this criterion cannot be applied to pre-menarchal females, to females taking oral contraceptives, to post-menopausal females, or to males. However, there are some data that women who endorse amenorrhea have poorer bone health than do women who fail to meet this criterion.

Deletion of this criterion is recommended.

Level of change: Modest/substantial.

References: Literature review (http://wiki.answers.com/Documents/EatingDisorders Reviews/Attia ammenorrhea_IJED 2009.pdf).

Subtyping

DSM-IV requires that sub-type (binge eating/purging or restricting) be specified for the current episode. While there are data that such sub-typing is useful clinically and for research purposes, there is significant cross-over between sub-types, and resultant difficulty in specifying the subtype for the "current episode" of illness. Therefore, it is recommended that the sub-typing be specified for the last 3 months; 3 months is the timeframe used for Bulimia Nervosa and proposed for Binge Eating Disorder.

Level of change: Clarification.

References: Literature review (http://wiki.answers.com/Documents/EatingDisorders Reviews/Wonderlich subtyping_IJED 2009.pdf).

Literature Cited:

http://wiki.answers.com/Documents/EatingDisorders Reviews/Attia ammenorrhea_IJED 2009.pdf

http://wiki.answers.com/Documents/EatingDisorders Reviews/Becker cognitive_IJED 2009.pdf

Bravender T, Bryant-Waught R, Herzog D, et al.: Classification of child and adolescent eating disturbances. Workgroup for Classification of Eating Disorders in Children and Adolescents (WCEDCA). Int J Eat Disord 40 Suppl:S117-122, 2007.http://wiki.answers.com/Documents/EatingDisorders Reviews/Wonderlich subtyping_IJED 2009.pdf

Peat C, Mitchell JE, Hoek HW, et al.: Validity and utility of subtyping anorexia nervosa. Int J Eat Disord 42:590-594, 2009.

Severity Criteria:

BMI (assessed appropriately for developmental stage).

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 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)

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DSM-5 Proposed Diagnostic Criteria for 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 laxatives, or diuretics.

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

B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, or diuretics.

C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once 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.

Rationale

Criterion C:

DSM-IV requires that episodes of binge eating and inappropriate compensatory behaviors both occur on average twice/week over the last three months. A literature review found that the clinical characteristics of individuals reporting a lower frequency of once/week were similar to those meeting the current criterion. Therefore, it is recommended that the required minimum frequency be reduced to once/week over the last three months.

Level of change: Modest.

References: Literature review (http://wiki.answers.com/Documents/EatingDisorders Reviews/Wilson binges_IJED 2009.pdf).

Subtyping

DSM-IV requires that sub-type (purging or non-purging) be specified. A literature review indicated that the non-purging subtype had received relatively little attention, and the available data suggested that individuals with this subtype more closely resemble individuals with Binge Eating Disorder. In addition, precisely how to define non-purging inappropriate behaviors (e.g., fasting or excessive exercise) is unclear.

Deletion of this subtype is recommended. This also requires rewording of Criterion B.

Level of change: Modest.

References: Literature review (http://wiki.answers.com/Documents/EatingDisorders Reviews/Hoek subtyping_IJED 2009.pdf).

Literature Cited:

http://wiki.answers.com/Documents/EatingDisorders Reviews/Hoek subtyping_IJED 2009.pdf

http://wiki.answers.com/Documents/EatingDisorders Reviews/Wilson binges_IJED 2009.pdf

Severity Criteria

Frequency of inappropriate compensatory behavior (episodes per week).

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 laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise.

C. The binge eating and inappropriate compensatory behaviors 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

It is recommended that Binge Eating Disorder, described in this section of DSM-IV, be recognized as an independent disorder in DSM-5. Recommended changes in the criteria for Anorexia Nervosa, Bulimia Nervosa, and for eating and feeding disorders usually beginning in childhood should also reduce the need for Eating Disorder Not Otherwise Specified.

If these recommendations are accepted, the examples in Eating Disorder Not Otherwise Specified will be changed accordingly.

The work group is also considering whether it may be useful and appropriate to describe other eating problems (such as purging disorder--recurrent purging in the absence of binge eating, and night eating syndrome) as conditions that may be the focus of clinical attention. Measures of severity would be required, and these conditions might be listed in an Appendix of DSM-5. DSM-5 Proposed Diagnostic Criteria for Rumination Disorder

A. Repeated regurgitation of food over a period of at least 1 month. Regurgitated food may be re-chewed, re-swallowed, or spit out.

B. There is no evidence that an associated gastrointestinal or other general medical condition (e.g., esophageal reflux) is sufficient to account alone for the repeated regurgitation.

C. The eating disturbance does not occur exclusively during the course of Anorexia Nervosa, Bulimia Nervosa, or Binge Eating Disorder.

D. If the symptoms occur exclusively in the context of another mental disorder (e.g. Mental Retardation or a Pervasive Developmental Disorder), they are sufficiently severe to warrant independent clinical attention