Diagnostic Criteria for Anorexia Nervosa

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The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) was published in 2013 by the American Psychiatric Association. It provides physicians and mental health professionals with the criteria for diagnosing specific mental disorders, including anorexia nervosa. 

Previous Criteria

The criteria in the previous edition of the diagnostic manual, the DSM-IV (published in 1994), was problematic because as many as three-quarters of patients diagnosed with an eating disorder fell into the catchall and varied category of Eating Disorder Not Otherwise Specified (EDNOS). The broad ambiguity of the category made it hard for researchers and clinicians to adequately define and treat the range of patients in this group.

Changes

The DSM-5 also merged the former categories of "Eating Disorders" and "Feeding Disorder in Infancy or Early Childhood" and formed the new category: "Feeding and Eating Disorders." The DSM-5 also attempted to relax some of the criteria and broaden the categories for the specific disorders in order to reduce the number of patients in the EDNOS (now called OSFED) group.

In terms of the criteria for anorexia nervosa, there were two primary changes from the DSM-IV to the DSM-5:

  • Amenorrhea (loss of a menstrual period) was eliminated as a criterion. This is important because it allows males to meet the criteria for anorexia nervosa. It also allows official inclusion of the small minority of females who continue menstruating despite extreme weight loss and malnutrition.
  • The low weight criterion was revised to allow more subjectivity and clinical judgment. This is also an important revision because we know that anorexia nervosa can occur in individuals who are not what would be considered objectively low weight on a BMI chart. The new criteria allows professionals to take into account an individual's unique growth trajectory and weight history. (Criterion A, which included the word "refusal" in terms of weight maintenance and implied willfulness on the part of patients, was changed to focus on behaviors like restricting calorie intake.)

DSM-5 Criteria for Anorexia Nervosa

A person must meet all of the current DSM criteria to be diagnosed with anorexia nervosa:

  • Restriction of food intake leading to weight loss or a failure to gain weight resulting in a "significantly low body weight" of what would be expected for someone's age, sex, and height.
  • Fear of becoming fat or gaining weight.
  • Have a distorted view of themselves and of their condition (Examples of this might include the person thinking that they are overweight when they are actually underweight, or believing that they will gain weight from eating one single meal. A person with anorexia might also not believe there is a problem with being at a low body weight; these thoughts are known to professionals as "distortions.")

The DSM-5 also allows professionals to specify subcategories of anorexia nervosa:

  • Restricting type: This is a subtype typically associated with the stereotypical view of anorexia nervosa. The person does not regularly engage in binge eating.​
  • Binge-eating/purging type: The person regularly engages in binge eating and purging behaviors, such as self-induced vomiting and/or the misuse of laxatives or diuretics. The binge eating/purging subtype is similar to bulimia nervosa, however, there is no weight-loss criterion for bulimia nervosa. As in previous editions of the DSM, anorexia nervosa "trumps" bulimia nervosa, meaning that if a person meets criteria for both anorexia nervosa and bulimia nervosa, then anorexia nervosa (binge-eating/purging type) is diagnosed.

Diagnostic guidelines in the DSM-5 also allow professionals to specify if the person is in partial remission or full remission (recovery), as well as to specify the current severity of the disorder, based on BMI.

Related Conditions

For patients who do not meet the full criteria for anorexia nervosa, Other Specified Feeding and Eating Disorder (OSFED) may be an appropriate diagnosis. Being diagnosed with OSFED as opposed to anorexia nervosa does not mean that the person is not ill and does not need help.

It is important to note that people may meet the criteria for different eating disorders at different times as symptoms can change. There is not a distinct line between healthy and disordered, but many shades of grey in the middle.

Getting Help

Anorexia nervosa can cause a number of serious health consequences. Recovery from anorexia nervosa is definitely possible. Getting help early improves the chance of a complete and lasting recovery. If you or someone you know is suffering from some or all of the above criteria, it is important they see a physician, dietician, or a mental health professional for an assessment.

Anorexia Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Mind Doc Guide

Treatment for anorexia nervosa can occur in a variety of settings. Though it can be extremely difficult for someone with anorexia to seek help (and difficult for loved ones to intervene), encouragement to speak to a doctor is key. This could be the first step in eventual treatment and recovery.

If you or a loved one are coping with an eating disorder, contact the National Eating Disorders Association (NEDA) Helpline for support at 1-800-931-2237. 

For more mental health resources, see our National Helpline Database.

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