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What is an eating disorder?

When people here the phrase “eating disorder” they often think anorexia first. Then, they often think, I’ve never known anyone with an eating disorder (ED). They might be surprised. The fact of the matter is eating disorders come in several forms (Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, Night Eating Syndrome, and EDNOS) and I would venture to guess that almost every American’s life has been touched by an ED – be it a friend, a loved one, a colleague or an acquaintance. Up to 24 million people (men and women, boys and girls) suffer from some form of ED in the US today. 10 – 15% of these people are male.

Anorexia

Anorexia Nervosa (AN)

To be diagnosed as having Anorexia Nervosa a person must display:

  • Persistent restriction of energy intake leading to significantly low body weight (in context of what is minimally expected for age, sex, developmental trajectory, and physical health) .
  • Either an intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain (even though significantly low weight).
  • Disturbance in the way one’s body weight or shape is experienced, undue influence of body shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

Subtypes:
Restricting type
Binge-eating/purging type

Bulimia

Bulimia Nervosa (BN)

To be diagnosed as having Bulimia Nervosa a person must display:

  • Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
    • 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.
    • 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).
  • Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
  • The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.
  • Self-evaluation is unduly influenced by body shape and weight.

The disturbance does not occur exclusively during episodes of Anorexia Nervosa

Binge Eating

Binge Eating Disorder (BED)

To be diagnosed as having Binge Eating Disorder a person must display:

  • Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
    • 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.
    • 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).
  • The binge eating episodes are associated with three or more of the following:
    • eating much more rapidly than normal
    • eating until feeling uncomfortably full
    • eating large amounts of food when not feeling physically hungry
    • eating alone because of feeling embarrassed by how much one is eating
    • feeling disgusted with oneself, depressed or very guilty afterward
  • Marked distress regarding binge eating is present
  • Binge eating occurs, on average, at least once a week for three months
  • Binge eating not associated with the recurrent use of inappropriate compensatory behaviors as in Bulimia Nervosa and does not occur exclusively during the course of Bulimia Nervosa, or Anorexia Nervosa methods to compensate for overeating, such as self-induced vomiting.

Note: Binge Eating Disorder is less common but much more severe than overeating. Binge Eating Disorder is associated with more subjective distress regarding the eating behavior, and commonly other co-occurring psychological problems

Other

Other Specified Feeding or Eating Disorder (OSFED)

To be diagnosed as having OSFED a person must present with feeding or eating behaviors that cause clinically significant distress and impairment in areas of functioning, but do not meet the full criteria for any of the other feeding and eating disorders.

A diagnosis might then be allocated that specifies a specific reason why the presentation does not meet the specifics of another disorder (e.g. Bulimia Nervosa- low frequency). The following are further examples for OSFED:

  • Atypical Anorexia Nervosa: All criteria are met, except despite significant weight loss, the individual’s weight is within or above the normal range.
  • Binge Eating Disorder(of low frequency and/or limited duration)All of the criteria for BED are met, except at a lower frequency and/or for less than three months.
  • Bulimia Nervosa(of low frequency and/or limited duration): All of the criteria for Bulimia Nervosa are met, except that the binge eating and inappropriate compensatory behavior occurs at a lower frequency and/or for less than three months.
  • Purging Disorder:Recurrent purging behavior to influence weight or shape in the absence of binge eating
  • Night Eating Syndrome:Recurrent episodes of night eating. Eating after awakening from sleep, or by excessive food consumption after the evening meal. The behavior is not better explained by environmental influences or social norms. The behavior causes significant distress/impairment. The behavior is not better explained by another mental health disorder (e.g. BED).

Unspecified

Unspecified Feeding Disorder (UFED)

This category applies to where behaviors cause clinically significant distress/impairment of functioning, but do not meet the full criteria of any of the Feeding or Eating Disorder criteria. This category may be used by clinicians where a clinician chooses not to specify why criteria are not met, including presentations where there may be insufficient information to make a more specific diagnosis (e.g. in emergency room settings).

Definitions are taken from the Diagnostic and Statistical Manual for Mental Disorders 5 (DSM5), which is published by the American Psychiatric Association, and written/edited by a panel of psychiatric physicians.  http://www.dsm5.org