Table 1. DSM-IV diagnostic criteria
for common eating disorders2
Anorexia nervosa
1. Refusal to maintain body weight at or above a minimally
normal weight for age and height (eg. 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, even
though underweight
3. Disturbance in the way that body weight, size or shape is
experienced, undue influence of body shape and weight on
self evaluation, or denial of the seriousness of current low
body weight
4. In postmenarchal females, amenorrhoea, ie. the absence of
at least three consecutive menstrual cycles
Types
• Restricting type: during the current episode of anorexia
nervosa, the person has not regularly engaged in binge
eating or purging behaviour (self induced vomiting,
misuse of laxatives, diuretics, or enemas)
• Binge eating/purging type: during the current episode
of anorexia nervosa, the person has regularly engaged
in binge eating or purging behaviour (ie. self induced
vomiting or the misuse of laxatives, diuretics, or enemas)
Bulimia nervosa
1. Recurrent episodes of binge eating. An episode of binge
eating is characterised by both of the following:
• Eating in a discrete period of time (eg. within any 2
hour period) an amount of food that is definitely larger
than most people would eat during a similar period of
time and under similar circumstances
• A sense of lack of control over eating during the
episode (eg. a feeling that one cannot stop eating or
control what, or how much, one is eating)
2. Recurrent inappropriate compensatory behaviour in
order to prevent weight gain such as self induced
vomiting, misuse of laxatives, diuretics, enemas, or other
medications, fasting, or excessive exercise
3. Binge eating and inappropriate compensatory behaviours
both occur on average at least twice a week for 3 months
4. Self evaluation is unduly influenced by body shape and
weight
5. The disturbance does not occur exclusively during
episodes of anorexia nervosa
Types
• Purging type: during the current episode of bulimia
nervosa, the person has regularly engaged in self
induced vomiting or the misuse of laxatives, diuretics,
or enemas
• Nonpurging type: during the current episode of bulimia
nervosa, 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
Reprinted from Australian Family Physician Vol. 40, No. 3, march 2011 109
FOCUS Eating disorders – early identification in general practice
