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 bulimia nervosa.
A person must meet all of the DSM criteria to be diagnosed with bulimia nervosa:
- Repeated episodes of binge eating. An episode of binge eating is defined as eating "an amount of food that is definitely larger than most people would eat" during the same amount of time. The person also must feel as though they have lost control over eating and are unable to stop themselves or control how much they are eating.
- Using inappropriate behaviors to avoid weight gain or to compensate for the binge eating. Professionals often refer to these behaviors as "compensatory behaviors." They include self-induced vomiting, the misuse of laxatives, diuretics and/or enemas, and excessive exercise.
- Both the binge eating and compensatory behaviors occur at least twice a week for three months.
- The person's weight and/or body shape has a significant impact on the way the person views himself or herself.
The DSM-IV-TR also allows professionals to specify subcategories of bulimia nervosa:
- Purging Type: The sufferer uses self-induced vomiting or the misuse of laxatives, diuretics or enemas to compensate for binges.
- Nonpurging Type: The sufferer doesn't use purging behaviors regularly. Instead, he or she uses other behaviors, such as fasting or excessive exercise, to compensate for binge eating.
It is important to note that many professionals recognize people who are suffering from the thought patterns and behaviors of bulimia nervosa, but are not currently meeting the time constraints (two times per week for three months) for a full diagnosis of bulimia. As such, it's anticipated that the new edition of the DSM, the DSM-V, expected in 2013, will change these criteria. Potential changes may include decreasing the frequency of binge and purge episodes necessary to qualify for a diagnosis.
If you or someone you know is suffering from some or all of the above criteria it is important that he or she see a physician, dietician or mental-health professional for an assessment.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Washington, DC: Author.