TABLE 3.

Diagnosis of Anorexia Nervosa, Bulimia Nervosa, and Eating Disorders Not Otherwise Specified, From DSM-IV25

Anorexia Nervosa
1. Intense fear of becoming fat or gaining weight, even though underweight.
2. Refusal to maintain body weight at or above a minimally normal weight for age and height (ie, weight loss leading to maintenance of body weight <85% of that expected, or failure to make expected weight gain during period of growth, leading to body weight <85% of that expected).
3. Disturbed body image, undue influence of shape or weight on self-evaluation, or denial of the seriousness of the current low body weight.
4. Amenorrhea or absence of at least 3 consecutive menstrual cycles (those with periods only inducible after estrogen therapy are considered amenorrheic).
 Types:
  Restricting—no regular bingeing or purging (self-induced vomiting or use of laxatives and diuretics).
  Binge eating/purging—regular bingeing and purging in a patient who also meets the above criteria for anorexia nervosa.
Bulimia Nervosa
1. Recurrent episodes of binge eating, characterized by:
 a. Eating a substantially larger amount of food in a discrete period of time (ie, in 2 h) than would be eaten by most people in similar circumstances during that same time period.
 b. A sense of lack of control over eating during the binge.
2. Recurrent inappropriate compensatory behavior to prevent weight gain; ie, self-induced vomiting, use of laxatives, diuretics, fasting, or hyperexercising.
3. Binges or inappropriate compensatory behaviors occuring, on average, at least twice weekly for at least 3 mo.
4. Self-evaluation unduly influenced by body shape or weight.
5. The disturbance does not occur exclusively during episodes of anorexia nervosa
 Types:
  Purging—regularly engages in self-induced vomiting or use of laxatives or diuretics.
  Nonpurging—uses other inappropriate compensatory behaviors; ie, fasting or hyperexercising, without regular use of vomiting or medications to purge.
Eating Disorder Not Otherwise Specified (those who do not meet criteria for anorexia nervosa or bulimia nervosa, per DSM-IV
1. All criteria for anorexia nervosa, except has regular menses.
2. All criteria for anorexia nervosa, except weight still in normal range.
3. All criteria for bulimia nervosa, except binges <twice a wk or <3 times a mo.
4. A patient with normal body weight who regularly engages in inappropriate compensatory behavior after eating small amounts of food (ie, self-induced vomiting after eating 2 cookies).
5. A patient who repeatedly chews and spits out large amounts of food without swallowing.
6. Binge eating disorder: recurrent binges but does not engage in the inappropriate compensatory behaviors of bulimia nervosa.