Eating disorders are serious mental illnesses with complex causes that result in serious physical and emotional problems. As the name implies, all eating disorders are characterized by problems regarding food and/or weight. However, people with eating disorders also often struggle with issues related to self esteem, anxiety, depression and perfectionism. Eating disorders are treatable, and understanding how to recognize eating disorders and help sufferers seek treatment can save lives.
The Diagnostic & Statistical Manual of Mental Disorders, 4th Ed. Text Revision (DSM-IV-TR) provides physicians and mental health professionals with the official diagnostic criteria for several eating disorders including anorexia nervosa and bulimia nervosa. The DSM-IV-TR also provides two additional diagnostic categories. One is binge eating disorder, a category that is provided for research purposes, meaning that researchers and treatment professionals can use the proposed criteria and then give feedback to the American Psychiatric Association so that the criteria can be revised for the fifth edition of the manual. Eating disorder, not otherwise specified (ED-NOS) is also included in the DSM-IV-TR, which encompasses people who are struggling with some but not all of the symptoms of other eating disorders.
The newest addition of the diagnostic manual, the DSM-V, is expected to be published in 2013. It will likely include some changes to diagnostic criteria of eating disorders such as reducing the frequency of binge and purge episodes to qualify for a diagnosis of bulimia nervosa as well as removing the criteria of amenorrhea from anorexia nervosa. The DSM-V is also expected to clarify and rename the diagnosis of eating disorder, not otherwise specified and to include binge eating disorder.
Anorexia Nervosa is characterized by severe weight loss (at, or below 85% of ideal body weight) and self-starvation. In certain ways, it is considered the most lethal of any mental illness. People with anorexia nervosa suffer from thought distortions in which they believe that they are overweight when, in fact, they are not. They often become obsessed with exercise, counting calories and fat grams, and may refuse to eat certain foods. Some people with anorexia nervosa also engage in binging and purging behaviors, similar to bulimia nervosa. Ritualistic and compulsive behaviors regarding food and eating is common as well.
Bulimia Nervosa is characterized by binge eating (eating larger than normal amounts in one sitting) and compensatory behaviors such as purging or excessive exercise. Unlike anorexia nervosa, people who struggle with bulimia nervosa may be of average weight, underweight or overweight. However, similar to anorexia, people with bulimia typically struggle with body image distortions and obsessions regarding food and weight. Most people with bulimia nervosa report feeling a great deal of shame and guilt about their behaviors and may become very secretive. Loved ones may notice behaviors such as always leaving the table immediately after meals, and/or large amounts of food missing from the pantry.
Eating Disorder, Not Otherwise Specified (ED-NOS) is an official diagnosis which encompasses people who struggle with some, but not all, of the criteria for anorexia nervosa or bulimia nervosa. For example, DSM-IV criteria states that in order to diagnose someone with anorexia, their weight must be at 85% or below their ideal body weight. A person who is experiencing the other symptoms of anorexia but has not lost enough weight to be at 85% of their ideal body weight would be officially diagnosed as ED-NOS.
Binge Eating Disorder is characterized by repeated episodes of binge eating in which larger than normal amounts of food are eaten in short periods of time. People who struggle with binge eating disorder are often overweight but may be of average weight as well. Similar to bulimia nervosa, shame and guilt are common with sufferers, resulting in secretive binging. Loved ones may notice large amounts of food missing from the pantry or secret stashes of food as a symptom of binge eating disorder.
Disordered Eating is another term used by many mental health professionals who recognize that there are people struggling with other problems related to food and eating that don't fit into the other categories but may still need professional help. These problems may include issues such as chronic dieting, emotional overeating and orthorexia (a term used to describe someone who is obsessed with healthy eating).
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Washington, DC: Author.
Costin, C. (2007). The eating disorder sourcebook (3rd Ed.). New York, NY: McGraw Hill.