Running head: EATING DISORDERS

1
Eating Disorders
Chalese Meyer
University of Utah
EATING DISORDERS 2
Astra!t
Eating disorders are one of the uns"o#en se!rets that affe!t all ages and genders of "eo"le$ This
literature revie% fo!uses on the &ental health disorder that affe!ts adoles!ent %o&en
s"e!ifi!ally$ The "ur"ose of the revie% is to introdu!e readers to the disorder' etiology'
"revalen!e rates' re!o&&ended treat&ent' and a""ro"riate interventions for the Re!reational
Thera"ist$ Although &illions of A&eri!ans are affli!ted %ith this disorder every year' and &ost
of the&' u" to () "er!ent' are adoles!ent and young %o&en$ *hy are adoles!ent and young
%o&en so sus!e"tile to getting an eating disorder+ A!!ording to the National Institute of
Mental ,ealth' it is e!ause during this "eriod of ti&e' %o&en are &ore li#ely to diet to try and
#ee" a sli& figure and-or try stringent dieting$ Certain s"orts .su!h as gy&nasti!s/ and !areers
.su!h as &odeling/ are es"e!ially "rone to reinfor!ing the need to #ee" a fit figure' even if it
&eans "urging food or not eating at all .Grohol' 0)12/$
Keywords: Eating disorder' Anore3ia' 4uli&ia' 4inge Eating' 5urging' 6asting' Dieting'
E3er!ise' Adoles!en!e
EATING DISORDERS 3
Overvie%
Eating disorders involve serious disturan!es in eating ehavior' su!h as e3tre&e and
unhealthy redu!tion of food inta#e or severe overeating' as %ell as feelings of distress or e3tre&e
!on!ern aout ody sha"e or %eight$ The four &ost !o&&on eating disorders are Anore3ia
Nervosa' 4uli&ia Nervosa' 4inge Eating Disorder' and 6eeding or Eating Disorders Not
Else%here Classified$ Eating disorders !urrently affe!t a""ro3i&ately 07 &illion A&eri!ans' in
%hi!h a""ro3i&ately 078 are &ale .The Allian!e for Eating Disorders A%areness' 0)19/$
Eating disorders !an o!!ur in all ages' genders' !lass' and ra!e: no one is i&&une$
Although food is a definite fa!tor involved %ith eating disorders it is not the only fa!tor;
!ontriuting fa!tors in!lude: 4iologi!al fa!tors .Eating disorders often run in fa&ilies$ The ris#
of develo"ing an eating disorder is 7):<)8 deter&ined y geneti!s/' So!ial fa!tors .unrealisti!
"ressures to otain the ="erfe!t= ody; the !onstant influ3 of i&ages of "erfe!tion; and narro%
definitions of eauty/' 5sy!hologi!al fa!tors .sustantial !o:&oridity %ith other &ental health
disorders : i$e$ de"ression' an3iety' Osessive:Co&"ulsive Disorder' lo% self:estee&; and
feelings of la!# of !ontrol/' and Inter"ersonal fa!tors .history of ause; eing teased for si>e or
%eight; trau&ati! life event.s/; and diffi!ulty e3"ressing feelings and e&otions/' .The Allian!e
for Eating Disorders A%areness' 0)19/$
The three &ain eating disorders fo!used in this "a"er are anore3ia' uli&ia' and inge
eating disorders .4ED/$ Anore3ia .also #no%n as anore3ia nervosa/ is the na&e for si&"ly
starving oneself e!ause the "ersons? are !onvin!ed they are over%eight$ If an individual is at
least 17 "er!ent under their nor&al ody %eight and they are losing %eight through not eating'
the individual &ay e suffering fro& this disorder$ Sy&"to&s fro& anore3ia vary fro& &ild
EATING DISORDERS 4
.%hen the disorder first starts/ to life threating .as the disorder "rogresses/$ Individuals usually
e3"erien!e an intense and over%hel&ing fear of gaining %eight or e!o&ing fat$ This fear !an
see& irrational fro& an outside "ers"e!tive e!ause the "erson@s visile %eight &ay see&
average for their ody or severely under healthy$ This sy&"to& %ill often !ontinue even %hen
the "erson is near death fro& starvation$ Most !o&&only anore3ia is related to a "erson@s "oor
self:i&age' %hi!h is also a sy&"to& of this disorder$ The individual suffering fro& this disorder
elieves that their ody %eight' sha"e and si>e is dire!tly related to ho% good they feel aout
the&selves or a sense of !ontrol in their lives$ 5ersons %ith this disorder often deny the
seriousness of their !ondition and !annot oAe!tively evaluate their o%n %eight$ Restri!ting and
inge eating-"urging are t%o ty"es of anore3ia nervosa$ Restri!ting is %hen the "erson
%ithholds their food inta#e and does not engage in inge:eating or "urging ehavior .Grohol'
0)12/$
An overvie% of signs to "ay attention to if a "erson are suffering fro& anore3ia nervosa:
strange or se!retive food rituals' "reo!!u"ation %ith food' "retending to eat or lying aout eating'
osession %ith !alories' fat gra&s' and nutrition' and dieting des"ite eing thin$ 5hysi!al
sy&"to&s fro& anore3ia nervosa in!lude: a""earan!e and ody i&age signs li#e dra&ati! %eight
loss, feeling fat: des"ite eing under%eight, fi3ation on ody i&age, harshly !riti!al of
a""earan!e, and denial of eing too thin .S&ith B Segal' 0)12/$
4uli&ia .also #no%n as uli&ia nervosa/ is !hara!teri>ed y e3!essive eating' and then
ridding oneself of the food y vo&iting' ausing la3atives or diureti!s' ta#ing ene&as' or
e3er!ising osessively$ 5urging is a ehavior "ersons %ith uli&ia suffer fro&' and it is %hen
they rid the&selves of the !alories fro& !onsu&ed food$ This disorder is !hara!teri>ed y
EATING DISORDERS 5
re!urrent e"isodes of inge eating' o!!urring at least t%i!e a &onth for a &ini&u& of three
&onths !ou"led %ith the la!# of !ontrol over eating$ 5eo"le %ith uli&ia nervosa eat and then
%or# very hard to get rid of %hat they have eaten y any &eans ne!essary$ 5eo"le %ith uli&ia
inge eat' %hi!h is eating large .&ore than the average "erson/ a&ounts of food in a s&all
a&ount of ti&e$ They often lose !ontrol over their eating' and are unale to sto" until the food is
gone$ *hen the food is gone' guilt over the !onsu&"tion a""ears and they have to get rid of the
eviden!e$ There are t%o ty"es of uli&ia nervosa: "urging ty"e %here the "erson regularly
engages in self: edu!es vo&iting' or use la3atives' diureti!s' ene&as or other &edi!ations ta#es
"la!e$ The se!ond ty"e is non:"urging %here the "erson so&eti&es they !hoose to fast for days
or e3er!ise e3!essively' ut has not regularly engaged in self:edu!ed vo&iting or &isuse of
la3atives$ Overall the goal is to not asor or to urn off any of the !alories that %ere !onsu&ed
in the inge resulting in the "revention fro& gaining any %eight .Grohol' 0)12/$
Signs to "ay attention to if a "erson are suffering fro& uli&ia nervosa: la!# of !ontrol
over eating' se!re!y surrounding eating' eating unusually large a&ounts of food' disa""earan!e
of food' alternating et%een overeating and fasting' going to the athroo& after &eals' using
la3atives' diureti!s' or ene&as' s&ell of vo&it' and e3!essive e3er!ising$ Sy&"to&s for uli&ia
nervosa and inge eating !an e the &ost severe and &ay in!lude %eight gain' !hroni!
!onsti"ation fro& la3ative ause' %ea#ness and di>>iness' ado&inal "ain' loating' s%elling of
the hands and feet' !hroni! sore throat' hoarseness' ro#en lood vessels in the eyes' s%ollen
!hee#s and salivary glands' tooth de!ay and &outh sores' a!id reflu3 or ul!ers' ru"tured sto&a!h
or eso"hagus' and loss of &enstrual "eriods .S&ith B Segal' 0)12/$
EATING DISORDERS 6
4inge eating disorder is one of the &ost !o&&on of the eating disorder' yet least studied$
4inge eating involves freCuent e"isodes of un!ontrollale inge eating' follo%ed y feeling
e3tre&ely distressed or u"set during or after ingeing' and unli#e uli&ia' there are no regular
atte&"ts to D&a#e u"E for the inges through vo&iting' fasting' or over:e3er!ising$ 4inge eating
&ay e !o&forting for a rief &o&ent' ut then reality sets a!# in' along %ith regret and self:
loathing$ 4inge eating often leads to %eight gain and oesity' %hi!h only reinfor!es !o&"ulsive
eating$ The %orse a inge eater feels aout the&selves and their a""earan!e' the &ore they use
food to !o"e$ It e!o&es a vi!ious !y!le: eating to feel etter' feeling even %orse' and then
turning a!# to food for relief .S&ith B Segal' 0)12/$ Sy&"to&s of inge eating disorder are
generally ehavioral and e&otional and in!lude: inaility to sto" eating or !ontrol %hat you?re
eating' ra"idly eating large a&ounts of food' eating even %hen you@re full' hiding or sto!#"iling
food to eat later in se!ret' eating nor&ally around others' ut gorging %hen you?re alone' eating
!ontinuously throughout the day' %ith no "lanned &ealti&es' feeling stress or tension that is only
relieved y eating' e&arrass&ent over ho% &u!h you?re eating' feeling nu& %hile ingeingF
li#e you?re not really there or you?re on auto:"ilot' never feeling satisfied' no &atter ho% &u!h
you eat' feeling guilty' disgusted' or de"ressed after overeating' and des"eration to !ontrol %eight
and eating haits .S&ith B Segal' 0)12/$
5revalen!e- Mortality Rate
5revalen!e for the three eating disorders !an e gathered in the &o&ent' yearly and
%ithin a lifeti&e s"an$ Many studies to !olle!t data use a stru!ture intervie% su!h as the
Co&"osite International Diagnosti! Intervie% .CIDI/' usually ad&inistered y lay:intervie%ers'
to assess the "revalen!e of eating disorders in a large "o"ulation sa&"le$ In the tale elo% the
EATING DISORDERS 7
infor&ation is ased on a &eta:analysis of ,oe# and van ,oe#en in 0))9 and !orre!ted for &ore
re!ent findings of a de!rease in "oint "revalen!e and in!iden!e of uli&ia nervosa$ One !an
!on!lude fro& tale 1 that the &aAority of "atients %ith anore3ia nervosa in the !o&&unity do
not enter the &ental health!are syste&$
Tale 1 Esti&ates of one:year "revalen!e rates "er 1)) ))) young fe&ales at different levels of
!are:
Gevel of &oridity Anore3ia nervosa 4uli&ia nervosa
Co&&unity 9H) 1)))
5ri&ary !are 1I) 17)
Mental health !are 10H H7
In a large re"resentative sa&"le of US adoles!ents the lifeti&e "revalen!e of anore3ia nervosa
%as )$9 8 in 19J1< year old fe&ales as %ell as &ales$ In a re!ent study y S&in#' ,oe#en'
,ans' and ,oe# .0)10/ of a nationally re"resentative sa&"le of US adoles!ents' a lifeti&e
"revalen!e of uli&ia nervosa of 1$9 8 and )$7 8 %as found a&ong 19J1< year old fe&ales and
&ales' res"e!tively$ In a US sa&"le of 2(I adoles!ent fe&ales' follo%ed for < years' a lifeti&e
"revalen!e of 1$I 8 for uli&ia nervosa %as found at age 0) years follo%ed for < years' a
lifeti&e "revalen!e of 1$I 8 for uli&ia nervosa %as found at age 0) years$ The lifeti&e
"revalen!e of inge eating disorders in the US a&ong adults: %o&en 9$7 8; &en 0$) 8' and
a&ong 19J1< year old adoles!ents: girls 0$9 8; oys )$< 8$
Anore3ia nervosa has the highest &ortality rate and sui!idal ehavior a&ong all
"sy!hologi!al disorders$ In the arti!le: Increased Mortality in Bulimia Nervosa and Other Eating
Disorders fo!uses on anore3ia nervosa' uli&ia nervosa' and eating disorder not other%ise
s"e!ified and ho% they are asso!iated %ith in!reased all:!ause &ortality or sui!ide &ortality$
Using !o&"uteri>ed re!ord lin#age to the National Death Inde3' the authors Cro% et al$ .0))(/
EATING DISORDERS 8
!ondu!ted a longitudinal assess&ent of &ortality over < to 07 years in 1'<<7 individuals %ith
anore3ia nervosa .NK1HH/' uli&ia nervosa .NK()I/' or eating disorder not other%ise s"e!ified
.NK<)0/ %ho "resented for treat&ent at a s"e!iali>ed eating disorders !lini! in an a!ade&i!
&edi!al !enter$ Results on &ortality rates %ere 2$)8 for anore3ia nervosa' 9$(8 for uli&ia
nervosa' and 7$08 for eating disorder not other%ise s"e!ified$ All:!ause standardi>ed &ortality
ratios %ere signifi!antly elevated for uli&ia nervosa and eating disorder not other%ise
s"e!ified; sui!ide standardi>ed &ortality ratios %ere elevated for uli&ia nervosa and eating
disorder not other%ise s"e!ified$ *ith these results it de&onstrated an in!reased ris# of sui!ide
a!ross eating disorder diagnoses; not Aust anore3ia nervosa Cro% et al$ .0))(/$
Statisti! for &orality rates a&ong eating disorders:
A revie% of nearly fifty years of resear!h !onfir&s that anore3ia nervosa has the highest
&ortality rate of any "sy!hiatri! disorder .Ar!elus' Mit!hell' *ales' B Nielsen' 0)11/$
Gifeti&e "revalen!e rates for AN' 4N' and 4ED tend to e higher a&ong %o&en than in
&en$
o Gifeti&e "revalen!e of AN K )$(8 in %o&en and )$98 in &en
o Gifeti&e "revalen!e of 4N K 1$78 in %o&en and )$78 in &en
o Gifeti&e "revalen!e of 4ED found to e 9$78 in %o&en and 0$)8 in &en
The average lifeti&e duration of 4N is found to e a""ro3i&ately <$9 years ,udson at al$
.0))H/$
EATING DISORDERS 9
There has een a rise in in!iden!e of anore3ia in young %o&en 17:1( in ea!h de!ade
sin!e 1(9) .,oe#B van ,oe#en' 0))9/$
The in!iden!e of uli&ia in 1):9( year old %o&en TRI5GED et%een 1(<< and 1((9
.,oe#B van ,oe#en' 0))9/$
The "revalen!e of eating disorders is si&ilar a&ong Non:,is"ani! *hites' ,is"ani!s'
Afri!an-A&eri!ans' and Asians in the United States; %ith the e3!e"tion that anore3ia
nervosa is &ore !o&&on a&ong Non:,is"ani! *hites .,udson et al$' 0))H; *ade et al$'
0)11/$
,ealth ConseCuen!es' In!luding Mortality:
In anore3ia nervosa?s !y!le of self:starvation' the ody is denied the essential nutrients it needs
to fun!tion nor&ally$ Thus' the ody is for!ed to slo% do%n all of its "ro!esses to !onserve
energy' resulting in:
Anor&ally slo% heart rate and lo% lood "ressure' %hi!h &ean that the heart &us!le is
!hanging$ The ris# for heart failure rises as the heart rate and lood "ressure levels sin#
lo%er and lo%er$
Redu!tion of one density .osteo"orosis/' %hi!h results in dry' rittle ones$
Mus!le loss and %ea#ness$
Severe dehydration' %hi!h !an result in #idney failure$
6ainting' fatigue' and overall %ea#ness$
Dry hair and s#in; hair loss is !o&&on$
EATING DISORDERS
10
Gro%th of a do%ny layer of hairF!alled lanugoFall over the ody' in!luding the fa!e' in
an effort to #ee" the ody %ar&$
The re!urrent inge:and:"urge !y!les of uli&ia !an affe!t the entire digestive syste& and !an
lead to ele!trolyte and !he&i!al i&alan!es in the ody that affe!t the heart and other &aAor
organ fun!tions$ ,ealth !onseCuen!es in!lude:
Ele!trolyte i&alan!es that !an lead to irregular hearteats and "ossily heart failure and
death$
Ele!trolyte i&alan!e is !aused y dehydration and loss of "otassiu&' sodiu& and
!hloride fro& the ody as a result of "urging ehaviors$
5otential for gastri! ru"ture during "eriods of ingeing$
Infla&&ation and "ossile ru"ture of the eso"hagus fro& freCuent vo&iting$
Tooth de!ay and staining fro& sto&a!h a!ids released during freCuent vo&iting$
Chroni! irregular o%el &ove&ents and !onsti"ation as a result of la3ative ause$
5e"ti! ul!ers and "an!reatitis$
4inge eating disorder often results in &any of the sa&e health ris#s asso!iated %ith !lini!al
oesity' in!luding:
,igh lood "ressure$
,igh !holesterol levels$
,eart disease as a result of elevated trigly!eride levels$
EATING DISORDERS
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Ty"e II diaetes &ellitus$
Gallladder disease$
.Ar!elus' Mit!hell' *ales' B Nielsen' 0)11/$
Etiology
There are &any &is!on!e"tions in our so!iety aout %hat !auses eating disorders$ Eating
disorders are rarely aout food or %anting to e thin$ Instead' "eo"le %ho suffer fro& these
disorders use food and unhealthy ehaviors li#e dieting' starving' ingeing and "urging to !o"e
%ith un"leasant and over%hel&ing e&otions and stressful situations$ In a short ter& sense these
ehaviors relieve an3iety and stress' ut long ter& they a!tually in!rease an3iety and stress and
!reate other serious !o&"li!ations$ There is not Aust one !ause to %hy "eo"le suffer %ith an
eating disorder$ Resear!hes and s!ientist have studied "ersonalities' geneti!s' environ&ents' and
io!he&istry of "eo"le %ith eating disorders to try and understand %hat the !auses e3a!tly are$
In anore3ia' uli&ia' and inge eating "ersonality traits su!h as' lo% self:estee&' feelings of
hel"lessness' and a fear of e!o&ing fat all see& to e %ays to hel" the& !o"e %ith stress and
an3ieties$ Geneti! and environ&ental !an "lay a huge "art in the sus!e"tiility of eing
diagnosed %ith an eating disorder$ S!ientists have found that eating disorders do tend to run in
fa&ilies: &ore !o&&only fe&ales$ ,o%ever' ehavioral and environ&ental as"e!ts "lay a larger
role$ One re!ent study found that &others %ho are overly !on!erned aout their daughters@
%eight and "hysi!al attra!tiveness &ay "ut the girls at in!reased ris# of develo"ing an eating
disorder$ In addition' girls %ith eating disorders often have father and rothers %ho are overly
!riti!al of their %eight .Grohol' 0)12/$
EATING DISORDERS
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A!!ording to ArauAo et al$ .0)1)/ s!ientists have een studying and gathering resear!h on
io!he&istry and the !o&"le3ity of fun!tioning of the &ind and ody in relation to %hy eating
disorders e3ist$ Individuals %ith eating disorders &ay have anor&al levels of !ertain !he&i!als
that regulate su!h "ro!esses as a""etite' &ood' slee" and stress$ 6or instan!e' oth "eo"le %ith
uli&ia and anore3ia have higher levels of the stress hor&one !ortisol$ So&e resear!h also
suggests that individuals %ith anore3ia have too &u!h serotonin' %hi!h #ee"s the& in a !onstant
state of stress$ Other !auses are trau&ati!-life !hanging events li#e: s!hool transition'
relationshi" !hanges' death of a fa&ily &e&er' ho&e and Ao transition' illness-hos"itali>ation'
and ause-se3ual assault-in!est .Grohol' 0)12/$
Treat&ent
A&ong &ental disorders' treat&ent of eating disorders !an so&eti&es e es"e!ially
!hallenging :: for the "erson %ith the disorder' their fa&ily and loved ones' and even for the
&ental health "rofessional$ Eating disorders are !hara!teri>ed in &ost adults %ho have the& y
a life:long "attern of eating and asso!iating food %ith e&otional fulfill&ent or !o"ing %ith
negative e&otions$ Many "eo"le %ho do this don@t even reali>e the asso!iation they@ve &ade$
Therefore one !o&"onent of &any "eo"le@s su!!essful treat&ent %ill e to hel" the "erson gain
that insight .Grohol' 0)12/$
Eating disorders are est treated %hen treated-diagnosed early$ The hardest osta!le'
even after diagnoses' is !onfronting the "erson %ith the eating disorder e!ause they tend to deny
that they have a "role&$ Therefore' "eo"le %ith anore3ia &ay not re!eive ne!essary treat&ent
until they have already e!o&e dangerously thin and &alnourished$ 5eo"le %ith uli&ia are
often nor&al %eight and are ale to hide their illness fro& others for year; %hi!h essentially !an
e %orse in the long run$ ConseCuently' getting and #ee"ing "eo"le %ith these disorders into
EATING DISORDERS
13
treat&ent !an e e3tre&ely diffi!ult$ Ulti&ately the est o"tion is to see# out treat&ent as soon
as "ossile efore long ter& treat&ent is reCuired$ 5ersons %ith this disorder enefit &ost fro&
%or#ing %ith a treat&ent tea& that in!ludes: an internist' a nutritionist' an individual
"sy!hothera"ist .!ondu!ting !ognitive:ehavioral or grou" "sy!hothera"y/' and a "sy!ho
"har&a!ologist .using a""ro"riate &edi!ations in !o&ination %ith "sy!hothera"ies .Grohol'
0)12/$
RT Interventions
Re!reational thera"ists .RT/ !an i&"le&ent a variety of treat&ent "roto!ols for
individuals %ith eating disorders$ 6irst and fore&ost the RT should e fa&iliar %ith the "atient
and their history$ It is est to #no% the "atters of the "erson?s ehaviors and their "ast ehaviors
to deter&ine a""ro"riate goals$ Re!ogni>e that individuals %ith eating disorders are usually
Cuite a&ivalent aout getting %ell$ At ti&es they &ay %ant re!overy' and other ti&es they &ay
%ant to retreat into the safety and se!urity of their rituals$ Re!reation thera"y interventions !an
e used to rea# the addi!tive !y!le and fa!ilitate self:a%areness and self:e3"ression$
Interventions that en!o&"asses "ushing "ast the fear' tea&%or#' !o&&uni!ation' assertiveness'
leadershi"' !onfiden!e' self:!o&"assion' a!!e"tan!e of self and others' relying on higher "o%er'
and trust !an e e3"erien!ed %ith the %hole self .ody' &ind' and s"irit/ !an e &ost enefi!ial
for individuals suffering fro& eating disorders$
A great intervention to e i&"le&ented is a ro"es !hallenge !ourse e!ause it !an
"rovide an e3"erien!e %here residents !an over!o&e "hysi!al !hallenges %hi!h then relate a!#
to e&otional !hallenges$ Re!reational thera"ists !an also "res!rie a""ro"riate for&s of healthy
e3er!ise and en!ourage that their e3er!ise a!tivities are "ro"erly &otivated$ This is done y
EATING DISORDERS
14
i&"le&enting the a!tivities in a %ay of eing fun so that "atient doesn?t Aust fo!us on the
!hallenge of losing %eight' ut rather enAoying %hat they are doing$ Ulti&ately "atients !an
enefit fro& &any different for&s of treat&ent &odalities fro& a re!reational thera"ist$
Con!lusion
Anore3ia nervosa and uli&ia are "sy!hiatri! disorders that often lead to serious &edi!al
!o&"li!ations' and should not e ta#en lightly and needs to e treated as soon as "ossile$ It is
i&"ortant to e a%are of signs and sy&"to&s of individuals suffering fro& eating disorders
e!ause often ti&es the individuals %ill not as# for the hel" that they need$ In !on!lusion eating
disorders are treatale through "ro"er !are and thera"y$ Though these disorders !an e treated
they %ill never e !o&"letely !ured; they are &ore Dunder !ontrolE than anything$ So Aust
e!ause a "erson &ay start to eat &ore does not &ean that everything is over and should e
forgotten$ Unfortunately' %hat needs to !hange is &ore a%areness of these "role&s in today?s
so!iety$
EATING DISORDERS
15
A""endi3 I
Classification
In the revised DSM:L &aAor eating disorders !an e !lassified as anore3ia nervosa .4o3 1/'
uli&ia nervosa .4o3 0/' inge eating disorder s"e!ified .4o3 9/' "i!a .4o3 2/' ru&ination
disorder .4o3 7/' avoidant-restri!tive food inta#e disorder .AR6ID/ .4o3 I/' other s"e!ified
feeding or eating disorder .OS6ED/ .4o3 H/' and uns"e!ified feeding or eating disorder .U6ED/
.4o3 </$ Although !riteria of the Diagnosti! and Statisti!al Manual of Mental Disorders' fifth
edition' te3t revision .DSM L:TR/' allo% diagnosis of a s"e!ifi! eating disorder' &any "atients
de&onstrate a &i3ture of oth anore3ia and uli&ia$ U" to 7)8 of "atients %ith anore3ia
nervosa develo" uli&i! sy&"to&s' and a s&aller "er!entage of "atients %ho are initially
uli&i! develo" anore3i! sy&"to&s$
Box 1: DSM V-TR Criteria for Anorexia Nervosa
Criteria
A!!ording to the DSM:7 !riteria' to e diagnosed as having Anore3ia Nervosa a "erson &ust
dis"lay:
A!!ording to the DSM:7 !riteria' to e diagnosed as having Anore3ia Nervosa a "erson
&ust dis"lay:
5ersistent restri!tion of energy inta#e leading to signifi!antly lo% ody %eight .in !onte3t
of %hat is &ini&ally e3"e!ted for age' se3' develo"&ental traAe!tory' and "hysi!al
EATING DISORDERS
16
health/$
Either an intense fear of gaining %eight or of e!o&ing fat' or "ersistent ehavior that
interferes %ith %eight gain .even though signifi!antly lo% %eight/$
Disturan!e in the %ay one@s ody %eight or sha"e is e3"erien!ed' undue influen!e of
ody sha"e and %eight on self:evaluation' or "ersistent la!# of re!ognition of the
seriousness of the !urrent lo% ody %eight$
Type
Restri!ting ty"e: During the !urrent e"isode of anore3ia nervosa' the "erson has not
regularly engaged in inge:eating or "urging ehavior .self:indu!ed vo&iting or &isuse
of la3atives' diureti!s' or ene&as/$
4inge:eatingJ"urging ty"e: During the !urrent e"isode of anore3ia nervosa' the "erson
has regularly engaged in inge:eating or "urging ehavior .self:indu!ed vo&iting or the
&isuse of la3atives' diureti!s' or ene&as/$
Box 2: DSM V-TR Criteria for Bli!ia Nervosa
Criteria
A!!ording to the DSM:7 !riteria' to e diagnosed as having 4uli&ia Nervosa a "erson &ust
dis"lay:
Re!urrent e"isodes of inge eating !hara!teri>ed y oth:
1$ Eating' in a dis!rete "eriod of ti&e .e$g$' %ithin any 0:hour "eriod/' an a&ount of
food that is definitely larger than &ost "eo"le %ould eat during a si&ilar "eriod of
ti&e and under si&ilar !ir!u&stan!es
0$ A sense of la!# of !ontrol over eating during the e"isode' defined y a feeling that
one !annot sto" eating or !ontrol %hat or ho% &u!h one is eating
Re!urrent ina""ro"riate !o&"ensatory ehavior to "revent %eight gain
1$ Self:indu!ed vo&iting
0$ Misuse of la3atives' diureti!s' ene&as' or other &edi!ations
9$ 6asting
2$ E3!essive e3er!ise
The inge eating and ina""ro"riate !o&"ensatory ehavior oth o!!ur' on average' at
least t%i!e a %ee# for 9 &onths$
EATING DISORDERS
17
Self evaluation is unduly influen!ed y ody sha"e and %eight$
The disturan!e does not o!!ur e3!lusively during e"isodes of anore3ia nervosa$
Type
5urging ty"e: During the !urrent e"isode of uli&ia nervosa' the "erson has regularly
engaged in self:indu!ed vo&iting or the &isuse of la3atives' diureti!s' or ene&as$
Non"urging ty"e: During the !urrent e"isode of uli&ia nervosa' the "erson has used
ina""ro"riate !o&"ensatory ehavior ut has not regularly engaged in self:indu!ed
vo&iting or &isused la3atives' diureti!s' or ene&as$

Box ": DSM V-TR Criteria for Bin#e $atin# Disor%er
A!!ording to the DSM:7 !riteria' to e diagnosed as having 4inge Eating Disorder a "erson &ust
dis"lay:
Re!urrent e"isodes of inge eating$ An e"isode of inge eating is !hara!teri>ed y oth of
the follo%ing:
o Eating' in a dis!rete "eriod of ti&e .e$g$ %ithin any 0:hour "eriod/' an a&ount of
food that is definitely larger than &ost "eo"le %ould eat during a si&ilar "eriod of
ti&e and under si&ilar !ir!u&stan!es$
o A sense of la!# of !ontrol over eating during the e"isode .e$g$ a feeling that one
!annot sto" eating or !ontrol %hat or ho% &u!h one is eating/$
The inge eating e"isodes are asso!iated %ith three or &ore of the follo%ing:
o Eating &u!h &ore ra"idly than nor&al
o Eating until feeling un!o&fortaly full
o Eating large a&ounts of food %hen not feeling "hysi!ally hungry
o Eating alone e!ause of feeling e&arrassed y ho% &u!h one is eating
o 6eeling disgusted %ith oneself' de"ressed or very guilty after%ard
Mar#ed distress regarding inge eating is "resent
4inge eating o!!urs' on average' at least on!e a %ee# for three &onthsM
4inge eating not asso!iated %ith the re!urrent use of ina""ro"riate !o&"ensatory
ehaviors as in 4uli&ia Nervosa and does not o!!ur e3!lusively during the !ourse of
4uli&ia Nervosa' or Anore3ia Nervosa &ethods to !o&"ensate for overeating' su!h as
self:indu!ed vo&iting$
EATING DISORDERS
18
Note
Note: 4inge Eating Disorder is less !o&&on ut &u!h &ore severe than overeating$
4inge Eating Disorder is asso!iated %ith &ore suAe!tive distress regarding the eating
ehavior' and !o&&only other !o:o!!urring "sy!hologi!al "role&s$
Box &: DSM V-TR Criteria for 'ica
A!!ording to the DSM:7 !riteria' to e diagnosed %ith 5i!a a "erson &ust dis"lay:
5ersistent eating of non:nutritive sustan!es for a "eriod of at least one &onth$
The eating of non:nutritive sustan!es is ina""ro"riate to the develo"&ental level of the
individual$
The eating ehavior is not "art of a !ulturally su""orted or so!ially nor&ative "ra!ti!e$
If o!!urring in the "resen!e of another &ental disorder .e$g$ autisti! s"e!tru& disorder/' or
during a &edi!al !ondition .e$g$ "regnan!y/' it is severe enough to %arrant inde"endent
!lini!al attention$
Note
5i!a often o!!urs %ith other &ental health disorders asso!iated %ith i&"aired fun!tioning
Box (: DSM V-TR Criteria for R!ination Disor%er
A!!ording to the DSM:7 !riteria' to e diagnosed as having Ru&ination Disorder a "erson &ust
dis"lay:
Re"eated regurgitation of food for a "eriod of at least one &onth Regurgitated food &ay
e re:!he%ed' re:s%allo%ed' or s"it out$
The re"eated regurgitation is not due to a &edi!ation !ondition .e$g$ gastrointestinal
!ondition/$
The ehavior does not o!!ur e3!lusively in the !ourse of Anore3ia Nervosa' 4uli&ia
Nervosa' 4ED' or Avoidant-Restri!tive 6ood Inta#e disorder$
If o!!urring in the "resen!e of another &ental disorder .e$g$ intelle!tual develo"&ental
disorder/' it is severe enough to %arrant inde"endent !lini!al attention$
EATING DISORDERS
19
Box ): DSM V-TR Criteria for Avoi%ant*Restrictive +oo% ,nta-e Disor%er .AR+,D/
A!!ording to the DSM:7 !riteria' to e diagnosed as having AR6ID a "erson &ust
dis"lay:
An Eating or 6eeding disturan!e as &anifested y "ersistent failure to &eet a""ro"riate
nutritional and-or energy needs asso!iated %ith one .or &ore/ of the follo%ing:
o Signifi!ant loss of %eight .or failure to a!hieve e3"e!ted %eight gain or faltering
gro%th in !hildren/$
o Signifi!ant nutritional defi!ien!y
o De"enden!e on enteral feeding or oral nutritional su""le&ents
o Mar#ed interferen!e %ith "sy!hoso!ial fun!tioning
The ehavior is not etter e3"lained y la!# of availale food or y an asso!iated
!ulturally san!tioned "ra!ti!e$
The ehavior does not o!!ur e3!lusively during the !ourse of anore3ia nervosa or uli&ia
nervosa' and there is no eviden!e of a disturan!e in the %ay one?s ody %eight or sha"e
is e3"erien!ed$
The eating disturan!e is not attriuted to a &edi!al !ondition' or etter e3"lained y
another &ental health disorder$ *hen is does o!!ur in the "resen!e of another
!ondition-disorder' the ehavior e3!eeds %hat is usually asso!iated' and %arrants
additional !lini!al attention$
Box 0: DSM V-TR Criteria for 1t2er Specifie% +ee%in# or $atin# Disor%er .1S+$D/
A!!ording to the DSM:7 !riteria' to e diagnosed as having OS6ED a "erson &ust "resent %ith a
feeding or eating ehaviors that !ause !lini!ally signifi!ant distress and i&"air&ent in areas of
fun!tioning' ut do not &eet the full !riteria for any of the other feeding and eating disorders$
A diagnosis &ight then e allo!ated that s"e!ifies a s"e!ifi! reason %hy the "resentation does not
&eet the s"e!ifi!s of another disorder .e$g$ 4uli&ia Nervosa: lo% freCuen!y/$ The follo%ing are
further e3a&"les for OS6ED:
Aty"i!al Anore3ia Nervosa: All !riteria are &et' e3!e"t des"ite signifi!ant %eight loss'
the individual?s %eight is %ithin or aove the nor&al range$
EATING DISORDERS
20
4inge Eating Disorder .of lo% freCuen!y and-or li&ited duration/: All of the !riteria for
4ED are &et' e3!e"t at a lo%er freCuen!y and-or for less than three &onths$
4uli&ia Nervosa .of lo% freCuen!y and-or li&ited duration/: All of the !riteria for
4uli&ia Nervosa are &et' e3!e"t that the inge eating and ina""ro"riate !o&"ensatory
ehavior o!!urs at a lo%er freCuen!y and-or for less than three &onths$
5urging Disorder: Re!urrent "urging ehavior to influen!e %eight or sha"e in the asen!e
of inge eating
Night Eating Syndro&e: Re!urrent e"isodes of night eating$ Eating after a%a#ening fro&
slee"' or y e3!essive food !onsu&"tion after the evening &eal$ The ehavior is not
etter e3"lained y environ&ental influen!es or so!ial nor&s$ The ehavior !auses
signifi!ant distress-i&"air&ent$ The ehavior is not etter e3"lained y another &ental
health disorder .e$g$ 4ED/$
Box 3: DSM V-TR Criteria for 4nspecifie% +ee%in# or $atin# Disor%er .4+$D/
A!!ording to the DSM:7 !riteria this !ategory a""lies to %here ehaviors !ause !lini!ally
signifi!ant distress-i&"air&ent of fun!tioning' ut do not &eet the full !riteria of any of the
6eeding or Eating Disorder !riteria$ This !ategory &ay e used y !lini!ians %here a !lini!ian
!hooses not to s"e!ify %hy !riteria are not &et' in!luding "resentations %here there &ay e
insuffi!ient infor&ation to &a#e a &ore s"e!ifi! diagnosis .e$g$ in e&ergen!y roo& settings/$
Ada"ted fro& A&eri!an 5sy!hiatri! Asso!iation: Diagnosti! and Statisti!al Manual of Mental
Disorders' 7th ed$' te3t rev Arlington' LA$' A&eri!an 5sy!hiatri! Asso!iation' 0)19$
EATING DISORDERS
21
Referen!es
A&eri!an 5sy!hiatri! Asso!iation$ .0)19/$ Diagnostic and statistical manual of mental disorders
.7th ed$/$ Arlington' LA: A&eri!an 5sy!hiatri! 5ulishing$
ArauAo' Daniele' Marano Ro!ha' Giovana 6onse!a' Da Silva Santos' and Antonio EgNdio Nardi$
=4inge eating disorder and de"ression: A syste&ati! revie%$= World Journal of Biological
sychiatry 11$0O0 .0)1)/: 1((:0)H$ 5rint$
Ar!elus' P$' Mit!hell' A$ P$' *ales' P$' B Nielsen' S$ .0)11/$ Mortality rates in "atients %ith
Anore3ia Nervosa and other eating disorders$ !rchives of "eneral sychiatry# $%.H/' H02:
H91$
EATING DISORDERS
22
Cro%' S$ P$' C$ 4$ 5eterson' S$ A$ S%anson' N$ C$ Ray&ond' S$ S"e!#er' E$ D$ E!#ert' and P$ E$
Mit!hell$ =In!reased Mortality in 4uli&ia Nervosa and Other Eating Disorders$=
!merican Journal of sychiatry 1II$10 .0))(/: 1920:192I$ 5rint$
=Eating Disorders Statisti!s$= &he !lliance for Eating Disorders !wareness$ The Allian!e for
Eating Disorders A%areness' 0)19$ *e$ 12 May 0)12$
Grohol Pohn M$' 5sy$D$ DEating Disorders
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,udson' P$ I$' ,iri"i' E$' 5o"e' ,$ G$ B Qessler' R$ C$ .0))H/$ The 5revalen!e and Correlates
of Eating Disorders in the National Co&oridity Survey Re"li!ation$ Biological
sychiatry' I1.9/' 92<:97<$
Melinda' S&ith' M$A$ and Segal' 5h$D$ Peanne$ =Anore3ia Nervosa: Signs' Sy&"to&s' Causes'
and Treat&ent$= (el)guide hel)s you hel) yourself and others$ N$"$' n$d$ *e$ 1I May
0)12$ Rhtt":--%%%$hel"guide$org-inde3$ht&S$
S&ith and Segal .0)12/ founded OR .S&ith B Segal' 0)12/$
S&in#' 6rTdTriCue R$ E$' Da"hne ,oe#en' and ,ans *$ ,oe#$ =E"ide&iology of Eating
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S&in#' ,oe#en' ,ans' and ,oe#