In our culture, where many people seem obsessed losing weight, the latest diet craze, and changing their appearance, how do we know when someone is suffering from an eating disorder or just going through the latest fad? The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) is the latest edition of the diagnostic manual used worldwide to assist health practitioners with effective diagnoses and care of people with mental health disorders. Here I will give a brief overview of the types of eating disorders and their diagnostic criteria.
One criterion of eating disorders is excessive concerns about shape and weight leading to damaging weight control behaviours. Eating disorders are characterised by a negative or distorted body image, and often people who suffer an eating disorder will experience their emotions as ‘feeling fat’. For example if someone was feeling sad on a particular day, they will not so much recognise and identify the feeling of sadness, they will experience their body as feeling fat and become anxious about it, fuelling eating disordered behaviour.
Binge eating disorder
Binge eating disorder is characterised by:
- recurrent episodes of binge eating.
- Sufferers experience eating in a set period of time, an amount of food that is larger than most people would eat during a similar period of time and under similar circumstances, and also a feeling of lack of control over eating during this time.
- Binge eating episodes are associated with three or more of the following:
eating faster than normal, eating until feeling uncomfortably full, eating large amounts of food when not hungry, eating alone because of feeling embarrassed by how much one is eating, feeling depressed, ashamed, or guilty afterward
- Marked distress regarding binge eating is present
- Binge eating occurs, at least once a week for three months
- Binge eating not associated with the recurrent use of inappropriate compensatory behaviours
Anorexia is characterised by:
- one eating less energy than is needed to maintain a weight normal for height and age.
- an intense fear of weight gain or attempts to prevent weight gain.
- a disturbance in body image which intensifies as weight is lost and refusal to acknowledge or act on the risks of being underweight.
Bulimia is characterised by:
- recurrent episodes of binge eating.
- Sufferers experience eating, in a set period of time an amount of food that is larger than most people would eat during a similar period of time and under similar circumstances, and also a feeling of lack of control over eating during this time.
- recurrent inappropriate compensatory behaviour in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
- the binge eating and inappropriate compensatory behaviours occur at least once a week for three months
Other Specified Feeding or Eating Disorder (OSFED)
According to the DSM-5 criteria, to be diagnosed as having OSFED a person must present with a feeding or eating behaviours that cause clinically significant distress and impairment in areas of functioning, but do not meet the full criteria for any of the other feeding and eating disorders. For example purging disorder is defined as recurrent purging behaviour to influence weight or shape in the absence of binge eating.
Unspecified Feeding or Eating Disorder (UFED)
According to the DSM-5 criteria this category applies to where behaviours cause clinically significant distress/impairment of functioning, but do not meet the full criteria of any of the Feeding or Eating Disorder criteria.
Beyond a diagnosis
I want to make it very clear that the classifications of eating disorders provided in the DSM can seem removed from the level of personal distress an eating disorder sufferer experiences, and while a diagnosis can be helpful to identify behaviours and put a name to what one is suffering, every persons experience is individual and unique, and will require a tailored individual treatment plan. You may have many of the symptoms of an eating disorder but not fully fit into a classification – do not let this put you off getting help, as it can be very dangerous to wait and make it all the harder to recover. For example if you have all the symptoms of anorexia if can be catastrophic to wait until you are at a very low weight before seeking help. If you think you might be suffering from any one of these eating disorders, its very important to get help as early on as you can. Contact your GP and tell them your concerns, confide in a trusted friend. You don’t need to suffer alone; help and support is available.