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Anorexia
To be diagnosed as having anorexia nervosa, according to the DSM-IV-TR, a person must display:
1. 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).
2. Intense fear of gaining weight or becoming fat.
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, premenopausal females (women who have had their first menstural period but have not yet gone
through menopause), amenorrhea (the absence of at least three consecutive menstrual cycles).
Furthermore, the DSM-IV-TR specifies two subtypes:
* Restricting Type: during the current episode of anorexia nervosa, the person has not regularly engaged in binge-eating
or purging behavior (that is, self-induced vomiting, over-exercise or the misuse of laxatives, diuretics, or enemas)
* Binge-Eating Type or Purging Type: during the current episode of anorexia nervosa, the person has regularly engaged
in binge-eating OR purging behavior (that is, self-induced vomiting, over-exercise or the misuse of laxatives, diuretics,
or enemas).
The ICD-10 criteria are similar, but in addition, specifically mention: i) ways that individuals might induce weight-loss
or maintain low body weight (avoiding fattening foods, self-induced vomiting, self-induced purging, excessive exercise, excessive
use of appetite supressants or diuretics); ii) physiological features, including "widespread endocrine disorder involving
hypothalamic-pituitary-gonadal axis is manifest in women as amenorrhoea and in men as loss of sexual interest and potency.
There may also be elevated levels of growth hormones, raised cortisol levels, changes in the peripheral metabolism of thyroid
hormone and abnormalities of insulin secretion"; and iii) if the onset if before puberty, development is delayed or arrested.
Bulimia
The following six criteria should be met for a patient to be diagnosed with bulimia[1] [2]:
1. The patient feels incapable of controlling the urge to binge, even during the binge itself, and consumes a larger
amount of food than a person would normally consume at one sitting.
2. The patient purges him or herself of the recent intake, resorting to vomiting, laxatives, diuretics, exercising,
etc.
3. The patient engages in such behavior at least twice per week for three months.
4. The patient is focused upon body image and desperate desire to appear thin.
5. The patient does not meet the diagnostic criteria for anorexia nervosa. (Some anorexics may demonstrate bulimic
behaviours in their illness: binge-eating and purging themselves of food on a regular or infrequent basis at certain times
during the course of their disease. Alternatively, some individuals might switch from having anorexia to having bulimia. The
mortality rate for anorexics who practice bulimic behaviors is twice that of anorexics who do not. [3])
6. The patient is of normal weight or overweight.
Please note that, in general, diagnostic criteria are considered a guide. A legitimate clinical diagnosis can be made
when the majority of the criteria are met.
ED-NOS
Eating Disorder Not Otherwise Specified (ED-NOS)
The most common element surrounding ALL Eating Disorders is the inherent presence of a low self esteem
Having an "Eating Disorder not Otherwise Specified" can mean a number of things... It can mean the individual
suffers from Anorexia but still gets their period; It can mean they may still be an "average healthy weight" but
be suffering Anorexia; It can mean the sufferer equally participates in some Anorexic as well as Bulimic behaviors (sometimes
referred to as being Bulimirexic).
Just as it is important to remember that doctors can make mistakes, it is also important to keep in mind that it has only
been until very recently (in the last 10 years) that awareness on the subject Eating Disorders has really begun to surface.
People are frequently confused (including doctors) about the real differences between Anorexia and Bulimia (Anorexia essentially
being self-starvation, and Bulimia being defined as going through binge and purge cycles - simply put), and often times know
nothing at all about Binge-Eating Disorder.
For example, a doctor relies completely on his diagnostic manuals and reads the criteria to diagnose an individual as
having Anorexia. He finds that his patient has regularly practiced self-starvation techniques, thinks of herself unrealistically
as overweight, and seems to be hard on herself... BUT she still has her monthly period (the diagnostic criteria states that
there must be loss of monthly menstrual cycles). He may technically diagnose the patient as having "An Eating Disorder
not Otherwise Specified".
Another example would be that of a person suffering through binge and purge cycles once a week, who feels that they are
overweight and who feels depressed. (The diagnostic criteria states that the sufferer must binge and purge, on average, at
least twice a week.)
Practically speaking, in the first example the person suffers from Anorexia and the second suffers from Bulimia. Clinically
speaking, according to the "text book" they would suffer from "An Eating Disorder not Otherwise Specified".
In either case, both people are suffering with an Eating Disorder, both are in danger of potentially deadly physical complications,
and both need to make a choice for recovery.
The most important thing to remember is that Eating Disorders, Anorexia, Bulimia, Compulsive Overeating, Binge-Eating
Disorder, any combination of them, (or any that fall into the clinical category of EDNOS), are ALL psychological illnesses,
none less or more serious than the next. They all have their physical dangers and complications, they all present themselves
through an array of disordered eating patterns in one way or another, and they all stem from emotional turmoil such as a low
self-esteem, a need to forget feelings and/or stress, a need to block pain, anger and/or people out, and most of all, a need
to cope. The bottom line is that we are ALL suffering. If you find you suffer from any Eating Disorder then it's time to reach
in to yourself.
Diagnostic Criteria
The following is considered the "text book" definition of an Eating Disorder Not Otherwise Specified, to assist
doctors in making a clinical diagnosis... it is in no way representative of what a sufferer feels or experiences in living
with an Eating Disorder. It is important to note that this is a Clinical definition, and is in no way meant to say that any
sufferer does not struggle, and that the condition is not serious. It is not meant to say you do not have Anorexia or Bulimia
(or a combination of both sometimes known as Bulimirexia). This is a clinical category of disordered eating meant for those
who suffer but do not meet all the diagnostic criteria for another specific disorder.
Examples Include:
1. All of the criteria for Anorexia Nervosa are met except the individual has regular menses.
2. All of the criteria for Anorexia Nervosa are met except that, despite substantial weight loss, the individual's current
weight is in the normal range.
3. All of the criteria for Bulimia Nervosa are met except binges occur at a frequency of less than twice a week or for
a duration of less than 3 months.
4. An individual of normal body weight who regularly engages in inappropriate compensatory behavior after eating small
amounts of food (eg, self-induced vomiting after the consumption of two cookies).
5. An individual who repeatedly chews and spits out, but does not swallow, large amounts of food.
6. Binge eating disorder; recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory
behaviors characteristic of bulimia nervosa.
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