DSM-5: Feeding and Eating Disorders

Click here for an easy to print, PDF version of this page.

Anorexia Nervosa

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

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.

Binge Eating Disorder

Binge Eating Disorder:   307.51  (F50.81)

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 on 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

Other Specified Feeding or Eating Disorder :  307.59  (F50.89)

 

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.[/text_divider]

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.