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Clinical Diagnosis Of Eating Disorders What Is Anorexia Nervosa? The most obvious characteristic of someone who has developed anorexia nervosa is significant, deliberate, self-starvation and consequent weight loss, together with an intense fear of being fat irrespective of their current weight and shape. Initially, behaviour around developing anorexia may be difficult to distinguish from normal dieting, but it soon becomes obvious that the behaviour has an abnormal drive and resolve to it, and it is relentlessness. Anorexia nervosa is a serious and complex mental health condition and people may die if it is left untreated. To be diagnosed with anorexia nervosa using the DSM-5 Diagnostic tool, a person will meet the following criteria: ÊÊ 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. ÊÊ Intense fear of gaining weight or becoming fat, or persistent behaviour that interferes with weight gain, even though the person is a at significantly low weight. ÊÊ Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on selfevaluation, or persistent lack of recognition of the seriousness of the current low body weight.
There are two subtypes of anorexia nervosa: 1. Restricting type During the last three months, the individual has not engaged in recurrent episodes of binge eating or purging behaviour (specifically, self-induced vomiting, or the misuse of laxatives, diuretics, or enemas). This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise. 2. Binge eating or purging type During the last three months, the individual has engaged in recurrent episodes of binge eating or purging behaviour (specifically self-induced vomiting, or the misuse of laxatives, diuretics, or enemas). The minimum level of severity is based, for adults, on current body mass index (BMI) 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 Anorexia: ≥ 17 BMI Moderate Anorexia: 16–16.99 BMI Severe Anorexia: 15–15.99 BMI Extreme Anorexia: < 15 BMI (American Psychiatric Association, 2013)
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