Anorexia Nervosa and Bulimia: Understanding Eating Disorders

Posted on Oct 31, 2024 in Physical Education

Anorexia Nervosa

DSM-IV-TR Criteria for Anorexia Nervosa (307.1)

  1. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to a weight less than 85% of that expected).
  2. Intense fear of gaining weight or becoming fat, even though underweight.
  3. 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.
  4. In postmenarcheal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles.

Specify Type:

Restricting Type:

During the current episode of Anorexia Nervosa, the person has not regularly engaged in binge-eating or purging behavior.

Binge-Eating/Purging Type:

During the current episode of Anorexia Nervosa, the person has regularly engaged in binge-eating or purging behavior.

Anorexia Nervosa ICD-10 Diagnostic Guidelines

All of the following must be present:

  1. Significant weight loss (body mass index less than 17.5).
  2. Weight loss is self-induced by avoidance of “fattening foods” and one or more of the following: self-induced vomiting, self-induced purging, excessive exercise, use of appetite suppressants or diuretics.
  3. Body image distortion: a dread of fatness persists as an intrusive overvalued idea, and the patient imposes a low weight threshold on themselves.
  4. Endocrine disorder involving the hypothalamic-pituitary-gonadal axis (amenorrhea in females; loss of sexual interest and potency in males).
  5. Delayed or arrested puberty if onset is before puberty.

Bulimia Nervosa

DSM-IV-TR Criteria for Bulimia Nervosa (307.51)

  1. 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).
  2. 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.
  3. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.
  4. Self-evaluation is unduly influenced by body shape and weight.
  5. 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.

Bulimia Nervosa ICD-10 Diagnostic Guidelines

Characterized by repeated bouts of overeating and an excessive preoccupation with the control of body weight, leading to a pattern of overeating followed by vomiting or purging.

The following features must be present:

  1. Preoccupation with eating, with irresistible cravings for food, leading to episodes of overeating.
  2. The patient attempts to counteract the fattening effects of food by one or more of the following: self-induced vomiting, abuse of purgatives, periods of starvation, use of drugs such as appetite suppressants, thyroid preparations, or diuretics.
  3. Morbid dread of fatness. There is often, but not always, a history of an episode of anorexia nervosa, the interval between the two disorders ranging from a few months to several years. The episode of anorexia nervosa may be fully developed, or may have been a minor or cryptic form with a moderate loss of weight or a transient phase of amenorrhea.

Binge Eating Disorder

Binge Eating Disorder ICD-10 (F50.3 Atypical Bulimia Nervosa)

This category should be used for disorders that fulfill most, but not all, of the criteria for bulimia nervosa. Patients often have normal weight or are even overweight, but present with repeated bouts of overeating, followed by vomiting or purging.

Binge Eating Disorder ICD-10 (F50.4 Overeating Associated with Other Psychological Disturbances)

Overeating in response to stressful events, leading to obesity. Bereavement, accidents, surgery, and emotionally distressing events may lead to “reactive obesity,” particularly in predisposed individuals.

Binge Eating Disorder

Many people engage in occasional binge eating, but it becomes a disorder when there is a loss of control over eating and it occurs repeatedly.

Binge Eating Disorder is characterized by recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory behaviors characteristic of Bulimia Nervosa.

During these episodes, individuals eat an unusually large amount of food in a relatively short period of time. They may feel a loss of control over their eating and experience shame, guilt, or distress afterward.

Binge Eating Disorder is more common in women than men, but the difference is less pronounced than in Anorexia Nervosa or Bulimia Nervosa.

DSM-IV Diagnostic Criteria for Binge Eating Disorder

  1. 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 in a similar period of time 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).
  2. The binge-eating episodes are associated with three (or more) of the following:
    1. Eating much more rapidly than normal.
    2. Eating until feeling uncomfortably full.
    3. Eating large amounts of food when not feeling physically hungry.
    4. Eating alone because of feeling embarrassed by how much one is eating.
    5. Feeling disgusted with oneself, depressed, or very guilty afterward.
  3. Marked distress regarding binge eating is present.
  4. The binge eating occurs, on average, at least 2 days a week for 6 months.
  5. The binge eating is not associated with the regular use of inappropriate compensatory behaviors (e.g., purging, fasting, excessive exercise) and does not occur exclusively during the course of Anorexia Nervosa or Bulimia Nervosa.