Feeding and Eating Disorders

 

Learn more about the symptoms of Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder, Avoidant/Restrictive Food Intake Disorder, Pica and Rumination Disorder. Treatments for these disorders include inpatient hospitalization, psychotherapy, and medications, such as antidepressants.


Anorexia Nervosa

  • Restriction of energy intake relative to requirements (eating less food than needed), leading to a significantly low body weight.
  • Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain.
  • Disturbance in the way in which one’s body weight or shape is perceived, unwarranted influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight

Restricting type: During the last three months, the individual has not engaged in episodes of binge eating or purging behaviors (such as self-induced vomiting or the excessive use of laxatives, diuretics, or enemas).  Weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise.

Binge-eating/purging type: During the last three months, the individual has engaged in episodes of binge eating or purging behavior (such as self-induced vomiting or the excessive use of laxatives, diuretics, or enemas).

Severity is based on current body mass index (BMI):

  • 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

  • Recurrent episodes of binge eating.  An episode of binge eating is characterized by both:
    • Eating, in a discrete period of time, an amount of food that is definitely larger than what most individuals would eat in a similar period of time.
    • A sense of lack of control over eating during the episode.
  • Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; the excessive use of laxatives, diuretics, or other medications; fasting; or excessive exercise.
  • The binge eating and inappropriate compensatory behaviors both occur at least once a week for three months.
  • Self-evaluation is excessively influenced by body weight and shape.
  • The disturbance does not occur during episodes of anorexia nervosa.

Severity is based on the frequency of inappropriate compensatory behaviors. 

  • 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 of 14 or more episodes of inappropriate compensatory behaviors per week.

Binge-Eating Disorder

  • Recurrent episodes of binge eating.  An episode of binge eating is characterized by both:
    • Eating, in a discrete period of time, an amount of food that is definitely larger than what most individuals would eat in a similar period of time.
    • A sense of lack of control over eating during the episode.
  • The binge-eating episodes are associated with at least three of the following:
    • Eating much quicker than normal.
    • Eating until feeling uncomfortably full.
    • Eating large amount of food despite not feeling hungry.
    • Eating alone because of embarrassment by the amount one is eating.
    • Feeling disgusted with oneself, guilty, or depressed afterward.
  • Significant distress about binge eating is present.
  • The binge eating occurs at least once a week for three months.
  • The binge eating is not associated with the recurrent use of inappropriate compensatory behavior (such as self-induced vomiting; the excessive use of laxatives, diuretics, or other medications; fasting; or excessive exercise) and does not occur during the course of bulimia nervosa or anorexia nervosa.

Avoidant/Restrictive Food Intake Disorder

  • An eating disturbance caused by a lack of interest in eating or food; avoidance of food; or concern about the negative consequences of eating; that causes a persistent failure to meet the necessary nutritional and/or energy needs associated with at least one of the following:
    • Significant weight loss (or failure to achieve expected weight gain or growth in children).
    • Significant nutritional deficiency.
    • Dependence on enteral feeding (“tube feeding”) or oral nutritional supplements.
    • Significant interference with psychological and social functioning.
  • The disturbance is not caused by a lack of food or other cultural practice.
  • The disturbance does not occur during the course of anorexia nervosa or bulimia nervosa and there is no disturbance in the way in which one’s body weight or shape is perceived.
  • The disturbance is not caused by another medical or mental condition.

Pica

  • Persistent eating of non-nutritious, nonfood substances for at least one month.
  • The eating of non-nutritious, nonfood substances is inappropriate to the developmental level of the individual.
  • The eating behavior is not a socially normal or culturally supported.
  • If the eating behavior occurs in the context of another mental disorder (such as intellectual disability) or medical conditions (including pregnancy), it is sufficiently severe to warrant additional clinical attention.

Rumination Disorder

  • Repeated regurgitation of food for at least one month.  Regurgitated food may be re-chewed, re-swallowed, or spit out.
  • The repeated regurgitation is not associated with a medical condition.
  • The eating disturbance does not occur during another eating disorder.
  •  If the symptoms occur in the context of another mental disorder (such as intellectual developmental disorder), they are sufficiently severe to warrant additional clinical attention.
 

The above criteria are adapted from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Fifth Edition.