Eating Disorder Service
Creating Hope Together

Healthcare Professional's Area

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Diagnosis

Anorexia Nervosa

  1. Refusal to maintain body weight at or above a minimally normal weight for their age and height resulting in a Body Mass Index (BMI) of less than 17.5 (or weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).
  2. Intense fear of gaining weight or becoming fat despite being underweight.
  3. Abnormal perception of weight or shape, and self evaluation unduly influenced by body shape and weight.
  4. Denial of seriousness of low weight.
  5. Absence of at least three consecutive menstrual cycles in post-menarcheal females (A woman is still considered to have amenorrhoea if her periods occur only following hormone administration, e.g. oestrogen). 

Anorexia Nervosa is divided into the following types:

a)     Restricting type

During the current episode, the person has not regularly engaged in binge eating or purging behaviour, and uses only food intake to control weight.

b)    Binge eating / Purging type

During the current episode, the person has regularly engaged in binge eating or purging behaviour (i.e. self-induced vomiting or the misuse of laxatives, diuretics or enemas), in addition to using food intake to control weight.

Bulimia Nervosa

  1. Recurrent episodes of binge eating, which are characterised by both of the following:
    1. Eating in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat under similar circumstances.
    2. A sense of lack of control over eating during the episode.
  2. Recurrent inappropriate compensatory behaviour in order to prevent weight gain (such as fasting, self-induced vomiting, excessive exercise or misuse of diuretic, laxative, enemas or other medications).
  3. The binge eating and inappropriate compensatory behaviours both occur, on average, at least twice weekly for three months.
  4. Body weight and shape unduly influence self-evaluation.
  5. The disturbance does not exclusively occur during episodes of anorexia nervosa.

Patients are divided into the following types:

a)     Purging type

During the current episode, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas.

b)    Non-purging type

During the current episode, the person has used other inappropriate compensatory behaviours, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas.

Atypical Eating Disorders

This category is for disorders of eating that do not meet the criteria for any specific eating disorder.

Examples include:

  1. For females, all of the criteria for anorexia nervosa are met except the individual has regular menses.
  2. All the criteria for anorexia nervosa are met except that, despite significant weight loss, the individual’s current weight is in the normal range.
  3. All the criteria for bulimia nervosa are met except that the binge eating and the inappropriate compensatory mechanisms occur at frequency of less than twice a week or for a duration of less than 3 months.
  4. The regular use of inappropriate compensatory behaviour by an individual of normal body weight after eating small amounts of food (e.g. self-induced vomiting after consumption of two cookies).
  5. Repeatedly chewing and spitting out, but not swallowing, large amounts of food.

Binge Eating Disorders

  • Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
    • eating, in a discrete period of time (for example, within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances
    • a sense of lack of control over eating during the episode (for example, a feeling that one cannot stop eating or control what or how much one is eating)
  • The binge-eating episodes are associated with three (or more) of the following:
    • eating much more rapidly than normal
    • eating until feeling uncomfortably full 
    • eating large amounts of food when not feeling physically hungry 
    • eating alone because of feeling embarrassed by how much one is eating
    • feeling disgusted with oneself, depressed, or very guilty afterwards
  • Marked distress regarding binge eating is present.
  •  The binge eating occurs, on average, at least once a week for three months.
  • The binge eating is not associated with the recurrent use of inappropriate compensatory behavior (for example, purging) and does not occur exclusively during the course Anorexia Nervosa, Bulimia Nervosa, or Avoidant/Restrictive Food Intake Disorder.

Differential Diagnoses

  • Depression / mood disorders
  • Anxiety disorders
  • Obsessive compulsive disorder
  • Psychotic illness
  • Personality disorder
  • Physical illness (diabetes, thyroid dysfunction)
  • Alcohol misuse / dependence
  • Illicit drug use