Eating Disorders

What is an eating disorder?

Eating disorders are the #2 leading cause of death in mental illnesses (following Opiate abuse). Eating disorders are a serious medical illness characterized by severe disturbances in the way a person eats or compensates for eating. Obsession with food, body weight, exercising, or rituals around food may be a sign of an eating disorder. They can impact a person’s physical and psychological health in extreme ways. Fortunately, eating disorders can be treated and full recovery is possible. They are not a lifestyle choice, or a phase, they are a serious biologically-influenced medical and psychological illness. 

What do feeding and eating disorders look like?

Anorexia Nervosa: People with Anorexia Nervosa avoid and restrict food, extreme diet, or only eat small portions of certain foods. They may weigh themselves and mirror/body check frequently. They may or may not feel like they need to lose weight or have an extreme fear of gaining weight. One subtype (binge-purge type) also may have infrequent episodes of binging and purging (vomiting, using laxatives/pills)  in addition to their severe restriction of food. 

Bulimia Nervosa: People with bulimia nervosa have multiple episodes (at least once a week) of eating large amounts of food (binging) and then using compensation behaviors after the binge. Compensation behaviors can include: vomiting, excessive exercising, excessive restriction of food intake, manipulating pills or insulin, using laxatives, or diuretics.

Binge Eating Disorder: Unlike Bulimia, people who struggle with binge eating disorder eat large amounts of food (more than the average person for a similar situation) and do not purge or fast afterwards. Binge eating disorder is not a “willpower” or “laziness” issue and is not treatable by “going on a diet”. Binge eating disorder is the most common but least treated/recognized eating disorder. If you struggle with a pattern of consistently over-eating, please see a specialist to be screened for BED. 

ARFID (Avoidant Restrictive Food Intake Disorder): People with ARFID are characterized by having rigid rules around food that impact their eating (socially and/or physically) and are not attributable to a person trying to manipulate or being dissatisfied with their weight or appearance. Examples include only eating certain food colors, textures, only drinking liquids for nutrient intake, or only having a select amount of food one eats based on fears and anxieties with other foods. Many people are young when they first exhibit these behaviors, however, ARFID could exhibit later on, especially as a result of a trauma, surgery, or illness. 

OSFED (Other specified feeding and eating disorder): This category covers those who don’t match the criteria for other Eating Disorders but have a relationship with food that causes dysfunction and impairment in their physical and emotional wellbeing. 

What are the warning signs & Symptoms?

  • Obsession or preoccupation with food, weight, calories, dieting and/or body image.
  • Changes in behaviors and attitudes around meal time.
  • Feelings of isolation, depression, anxiety, or irritability. 
  • Withdrawal from friends and activities.
  • Development of secretive, abnormal, and/or extreme food rituals, routines, or eating behaviors.
  • Evidence of purging behaviors including: vomiting, excessive exercise, misuse of laxatives, diuretics, or other “weight loss” pills. 
  • Stained teeth, brittle nails, lanugo (development of white hair), dry skin, hair loss, or marked changes in weight (in either direction or fluctuating).

How does the DSM define Eating Disorders?

*Please note that this is intended for educational purposes only. For a diagnosis of SUD, you must have a complete history & evaluation completed by a behavioral health specialist.*

DSM-5: Feeding and Eating Disorders 

Anorexia Nervosa: 307.1 (F50.01 or F50.02) 

A. Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected. 

B. Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight. 

C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight. 

Specify if: 

In partial remission: After full criteria for anorexia nervosa were previously met, Criterion A has not been met for a sustained period, but either Criterion B or C is still met. 

In full remission: After full criteria for anorexia nervosa were previously met, none of the criteria have been met for a sustained period of time. 

Specify current severity: The minimum level of severity is based, for adults, on current body mass index (BMI) (see below) or for children and adolescents, on BMI percentile. The ranges below are derived from World Health Organization categories for thinness in adults; for children and adolescents, corresponding BMI percentiles should be used. The level of severity may be increased to reflect clinical symptoms, the degree of functional disability, and the need for supervision. 

Mild: BMI > 17 kg/m2 

Moderate: BMI 16-16.99 kg/m2 

Severe: BMI 15-15.99 kg/m2 

Extreme: BMI < 15 kg/m2 

Bulimia Nervosa: 307.51 (F50.2) 

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by BOTH of the following: 1. Eating in a discrete amount of time (ex: within a 2 hour period) an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances. 2. Sense of lack of control over eating during an episode.

B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise. 

C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months. 

D. Self-evaluation is unduly influenced by body shape and weight. 

E. The disturbance does not occur exclusively during episodes of anorexia nervosa. 

Specify if: 

In partial remission: After full criteria for bulimia nervosa were previously met, some, but not all of the criteria have been met for a sustained period of time. 

In full remission: After full criteria for bulimia nervosa were previously met, none of the criteria have been met for a sustained period of time. 

Specify current severity: The minimum level of severity is based on the frequency of inappropriate compensatory behaviors (see below). The level of severity may be increased to reflect other symptoms and the degree of functional disability. 

Mild: An average of 1-3 episodes of inappropriate compensatory behaviors per week 

Moderate: An average of 4-7 episodes of inappropriate compensatory behaviors per week 

Severe: An average of 8-13 episodes of inappropriate compensatory behaviors per week 

Extreme: An average of14 or more episodes of inappropriate compensatory behaviors per week 

Binge Eating Disorder: 307.51 (F50.8) 

A. Recurrent episodes of binge eating. An episode of binge eating is characterized 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 what most people would eat in a similar period of time under similar circumstances. 2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating). 

B. The binge-eating episodes are associated with three (or more) of the following: 1. Eating much more rapidly than normal. 2. Eating until feeling uncomfortably full. 3. Eating large amounts of food when not feeling physically hungry. 4. Eating alone because of feeling embarrassed by how much one is eating. 5. Feeling disgusted with oneself, depressed, or very guilty afterward. 

C. Marked distress regarding binge eating is present. 

D. The binge eating occurs, on average, at least once a week for 3 months. 

E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa. 

Specify if: 

In partial remission: After full criteria for binge-eating disorder were previously met, binge eating occurs at an average frequency of less than one episode per week for a sustained period of time. In full remission: After full criteria for binge-eating disorder were previously met, none of the criteria have been met for a sustained period of time. 

Specify current severity: The minimum level of severity is based on the frequency of episodes of binge eating (see below). The level of severity may be increased to reflect other symptoms and the degree of functional disability. 

Mild: 1-3 binge-eating episodes per week 

Moderate: 4-7 binge-eating episodes per week 

Severe: 8-13 binge-eating episodes per week 

Extreme: 14 or more binge-eating episodes per week 

Other Specified Feeding or Eating Disorder: 307.59 (F50.8) 

This category applies to presentation in which symptoms characteristic of a feeding and eating disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the feeding and eating disorders diagnostic class. The other specified feeding or eating disorder category is used in situations in which the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for any specific feeding and eating disorder. This is done by recording “other specified feeding or eating disorder” followed by the specific reason (e.g., bulimia nervosa of low frequency). 

Examples of presentations that can be specified using the “other specified” designation include the following: 

1. Atypical anorexia nervosa: All of the criteria for anorexia nervosa are met, except that despite significant weight loss, the individual’s weight is within or above the normal range. 

2. Bulimia nervosa (of low frequency and/or limited duration): All of the criteria for bulimia nervosa are met, except that the binge eating and inappropriate compensatory behaviors occur, on average, less than once a week and/or for less than 3 months.

3. Binge-eating disorder (of low frequency and/or limited duration): All of the criteria for binge-eating disorder are met, except the binge eating occurs, on average, less than once a week and/or for less than 3 months. 

4. Purging Disorder: Recurrent purging behavior to influence weight or shape (e.g., self-induced vomiting, misuse of laxatives, diuretics, or other medications) in the absence of binge eating. 

5. Night eating syndrome: Recurrent episodes of night eating, as manifested by eating after awakening from sleep or by excessive food consumption after the evening meal. There is awareness and recall of the eating. The night eating is not better explained by external influences such as changes in the individual’s sleep-wake cycle or by local social norms. The night eating causes significant distress and/or impairment in functioning. The disordered pattern of eating is not better explained by binge-eating disorder or another mental disorder, including substance use, and is not attributable to another medical disorder or to an effect of medication. 

Unspecified Feeding or Eating Disorders: 307.50 (F50.9) 

This category applies to presentation in which symptoms characteristic of a feeding and eating disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the feeding and eating disorders diagnostic class. The unspecified feeding and eating disorder category is used in situations in which the clinician chooses not to specify the reason that the criteria are not met for a specific feeding and eating disorder, and includes presentations in which there are insufficient information to make a more specific diagnosis (e.g., in emergency room settings) 


Source: American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th Ed. Arlington, VA, American Psychiatric Association, 2013.