The Diagnostic & Statistical Manual of Mental Disorders, fourth edition, (DSM-IV-TR) is published by the American Psychiatric Association. It provides physicians and mental-health professionals with the criteria for diagnosing specific mental disorders, including anorexia nervosa.
A person must meet all of the current DSM criteria to be diagnosed with anorexia nervosa:
- Weight loss or a failure to gain weight, resulting in a weight that is 85% (or less) of what would be expected for someone's age, sex and height.
- Fear of becoming fat or of gaining weight.
- Have a distorted view of themselves and of their condition. Examples of this might include the person thinking that he or she is overweight when they are actually underweight, or believing that they will gain weight from eating one meal. A person with anorexia might also make excuses or deny that there is a problem with being at a low body weight. These thoughts are known to professionals as "distortions."
- Females who have gone through puberty, amenorrhea. This means they have stopped having their period for at least three months.
The DSM-IV-TR also allows professionals to specify subcategories of anorexia nervosa:
- Restricting Type: This is a subtype that is typically associated with the stereotypical view of anorexia nervosa. The person does not regularly engage in binge eating.
- Binge-Eating/Purging Type: The person regularly engages in binge eating and purging behaviors, such as self-induced vomiting and/or the misuse of laxatives or diuretics. The binge eating/purging subtype is similar to bulimia nervosa; however, there is no weight-loss criterion for bulimia nervosa.
It is important to note that many professionals recognize people who are suffering from the thought patterns and behaviors of anorexia nervosa but are not currently meeting the physical (weight loss and/or amenorrhea) criteria for a full diagnosis. As such, the new edition of the DSM, the DSM-V, which is slated for 2013, is expected to change these criteria. Potential changes may include expanding the weight criterion from 85% of ideal body weight to "a significantly low weight," and removal of the criterion for amenorrhea.
If you or someone you know is suffering from some or all of the above criteria, it is important they see a physician, dietician or a mental-health professional for an assessment.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Washington, DC: Author.