Eating Disorders
Eating Disorders Diagnostic Criteria and prevalence
DSM 5 – Diagnostic and Statistical Manual of Mental Disorders 5th Pub. by American Psychiatric Association 2013. Revised Criteria
Feeding and Eating Disorders category
307.1 (Pg. 338) Anorexia Nervosa
Restricting Type
Binge-eating/purging type
307.51 (Pg.345) Bulimia Nervosa
307.51 (Pg.350) Binge-Eating Disorder
307.59 (Pg.353) Other Specified Feeding or Eating Disorder
307.50 (Pg.354) Unspecified Feeding or Eating Disorder
ICD 10 – Classification of Mental and Behavioural Disorders : Clinical Descriptions and diagnostic guidelines. Pub. By World Health Organisation, Geneva Reprinted 2004. In the process of being reviewed for ICD 11.
Behavioural syndromes associated with physiological disturbances and physical factors category
F 50.0 (pg 176) Anorexia Nervosa
F 50.1 (pg 178) Atypical anorexia nervosa
F 50.2 (pg 178) Bulimia Nervosa
F 50.3 (pg 179) Atypical bulimia nervosa
F50.4 (pg 179) Overeating assoc. With other psychological disturbances
F 50.5 (pg 180) Vomiting assoc. With other psychological disturbances
F 50.8 (pg 181) Other eating Disorders
F 50.9 (pg 181) Eating disorder, unspecified
For the researcher it is worth noting the subtle differences in each classification. In the new DSM clinicians’ may not use EDNOS (Eating Disorder not otherwise specified) as a category and may use either 307.59, where the clinician communicates the specific reason the criteria is not met or 307.50, where the clinician may not be able to specify the diagnosis because there is insufficient information.
The DSM 5 classification is the newer of the two classification systems. DSM 4TR was regularly used in NHS recording systems and should now be updated to reflect this newer system.
For those who are new to Eating Disorders as a mental illness they will need to understand the basic differences in behaviour around food, as a starting point. Body weight and body shape are also distressing issues in these disorders.
Using the DSM 5:
307.1 The DSM states that there is an ‘intense fear of becoming fat (which) is not alleviated by weight loss. (pg 340)
Anorexia is divided in behaviours which involve restricting eating and dangerous weight loss. The Body Mass Index (BMI) is less than>17.0 in adult patients. Children and Adolescents need to be weighed and measured by using the Growth Charts which provide a BMI for age percentile.
How to Calculate adult BMI
Height in meters squared Eg. 1.60m x 1.60m = 2.56m
Weight in kilogrammes = 40kgs
Divide the weight by the squared height
Eg. 40kgs divided by 2.56m = BMI 15.6 (well into AN >17).
Anorexia is also behaviour which involves restricting food intake, sometimes bingeing (not always) and then purging through taking laxatives or vomiting or a variety of other purging behaviours eg enemas.
Severity for Anorexia Nervosa is categorised as:
Mild: Body Mass Index (BMI) of less than 17
Moderate: BMI 16-16.99
Severe: BMI 15-15.99
Extreme: BMI of less than 15
See BMI calculation below
These severity measures are for thinness in adults.
For children and adolescents BMI percentiles should be used.
Risk factors, apart from low weight, include clinical symptoms, the degree of functional disability and the need for supervision.
Description of Anorexia Nervosa
‘Persistent energy intake restriction; intense fear of gaining weight, and a disturbance in self-perceived weight or shape.’ Pg 339
Weight is below the normal levels for age, sex, developmental growth and physical health. So for children and adolescents there is a failure to maintain a normal developmental trajectory.
307.51 Bulimia Nervosa – covers those who eat large amounts of food (< ‘most individuals would eat in the same time period, under similar circumstances’) in a discrete period of time eg. in a 2 hour stretch. Plus they would have purging behaviours to prevent weight gain eg vomiting, laxatives, diuretics and other medications. Patients experience a profound sense of feeling out of control while bingeing.
This behaviour has to be present for at least 3 months.
Severity Scale:
Mild: an average of 1-3 episodes of compensatory behaviours per week.
Moderate: 4-7 episodes of compensatory behaviours per week.
Severe: 8-13 episodes of compensatory behaviours per week.
Extreme: An average of 14 or more episodes of compensatory behaviours per week.
Weight would be in the normal or slightly over the normal range – BMI 18.5 – 30.
307.51 Binge-Eating Disorder – an episode of bingeing is the same as for Bulimia Nervosa and also includes criteria for the times the binges take place and do not include a to resort to compensatory behaviours.
307.59 – Other Specified Feeding or Eating Disorder. These are feeding behaviours which cause distress, and medical complications but do not meet the full criteria for Anorexia, Bulimia or Binge-Eating Disorder. The DSM gives 5 examples and includes ‘Night Eating Syndrome’.
307.50 – Unspecified Feeding or Eating Disorder – is the category which allows clinicians not to state a diagnosis in mainly non psychiatric settings.
Further Guidance
1. National Institute for Health and Care Excellence
www.nice.org.uk
Publication CR9 – Eating disorders: Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. Issued January 2004
2. Royal College of Psychiatrists
www.rcpsych.ac.uk
Publication CR162 - MARSIPAN: Management of Really Sick Patients with anorexia nervosa
Issued October 2010
Publication CR 168 – Junior MARSIPAN: Management of Really Sick Patients under 18 with Anorexia Nervosa
Issued January 2012
3. Kings College London
www.kcl.ac.uk
Put Eating Disorders into the search box
There are pages on:
Signs of an Eating Disorder
Treatment and recovery
Resources
Getting Help
Schools Project
There is a link to the Royal College of GP’s containing ‘A GP’s Guide to Eating Disorders’