Diagnostic Characteristics

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Anorexia nervosa is characterized by refusal to maintain a normal body weight, along with a fear of gaining weight. Diagnostic criteria for anorexia nervosa are shown in Table 1. The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) (1) criteria divide anorexia into the restricting and binge-eating/purging subtypes. Approximately 50% of patients with anorexia nervosa experience binge eating and/or purging at some point in their illness (3).

Bulimia nervosa is characterized by frequent episodes of binge eating accompanied by emotional distress, plus the presence of frequent compensatory behaviors to avoid weight gain (Table 1) (1). The DSM-IV further classifies patients as belonging to the purging or nonpurging subtypes. Purging is common in bulimia nervosa, and

Table 1 Diagnostic Criteria for Eating Disorders

Anorexia nervosa

A. Refusal to maintain body weight at or above a minimally normal weight for age and height

B. Intense fear of gaining weight or becoming fat, even though underweight

C. Disturbance in the way in which one's body or shape is experienced

D. In postmenarchal females, amenorrhea

E. Type: Restricting type Binge-eating/purging type

Bulimia nervosa

A. Recurrent episodes of binge eating

B. Recurrent inappropriate compensatory behaviors to prevent weight gain

C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months

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

E. Type: Purging type Nonpurging type

Binge eating disordera

A. Recurrent episodes of binge eating

B. The binge eating episodes are associated with at least three behavioral indicators of loss of control

C. Marked distress regarding binge eating

D. The binge eating occurs, on average, at least 2 days a week for 6 months

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

Night eating syndromeb

A. Morning anorexia, even if the subject eats breakfast

B. Evening hyperphagia; at least 50% of the daily caloric intake is consumed in snacks after the last evening meal

C. Awakenings at least three nights a week

D. Frequent consumption of snacks during the awakenings

E. The pattern occurs for a period of at least 3 months a Diagnostic criteria for binge eating disorder are listed in the Appendix of the DSM-IV as an example of eating disorder, not otherwise specified.

b Criteria proposed by Birketvedt et al. (7). Source: Ref. 1.

includes vomiting (80-90%) and laxative use (38-75%) (4,5). Less common forms of purging include diuretic abuse, abuse of thyroid hormone or anorexiant medications, induction of vomiting through use of ipecac, and use of enemas. Diabetics have been known to withhold insulin to avoid weight gain (6).

Binge eating disorder is an eating disorder characterized by frequent episodes of binge eating accompanied by emotional distress, but without the regular use of compensatory behaviors (Table 1). Binge eating disorder is listed in the DSM-IV in an appendix as an example of an Eating Disorder Not Otherwise Specified (EDNOS). A diagnosis of EDNOS is also used for disordered eating that does not meet criteria for one of the established eating disorders (e.g., purging only once weekly, weight loss without amenorrhea, etc.).

Night Eating Syndrome is characterized by morning anorexia, evening and nighttime overeating, sleep onset and sleep maintenance insomnia, and the consumption of high carbohydrate snacks during many of the awakenings. It was described recently in detail by Birketvedt et al. (7). Diagnostic criteria for this syndrome are evolving, and it is not included as a diagnostic category in the DSM-IV. Proposed clinical criteria are shown in Table 1.

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