Eating disorders are complex, brain-based illnesses that affect millions of people. Over the years, eating disorder diagnoses have evolved, as doctors and researchers learn more about the causes, symptoms, and characteristics of these conditions. This article will help you recognize some common eating disorder symptoms, walk you through eating disorder diagnostic criteria, and explain how changes in this criteria can affect treatment and recovery. 

Eating Disorders: Know the Signs

An eating disorder is a serious condition that involves disruptions in how a person relates to food, eating, and their body. Eating disorders include conditions like anorexia nervosa, bulimia nervosa, and binge eating disorder. Individuals experiencing eating disorders often struggle with disordered eating patterns, preoccupations with food, and a focus on body weight, size, or shape. These behaviors often coincide with mental health challenges such as anxiety, depression, obsessive-compulsive disorder, and substance use.

The symptoms of eating disorders can vary greatly from person to person. Some common behaviors may include:

• Restrictive eating habits or extreme dieting
• Excessive exercise and misuse of supplements
• Bingeing and purging behaviors
• A preoccupation with body weight and shape
• Weight fluctuations
• Avoidance of specific food groups
• Obsession with calories and nutrients
• Misuse of diuretics and laxatives
• Secretive and ritualized eating patterns

The development of eating disorders is influenced by a variety of factors. One of the strongest predictors of developing an eating disorder is having a family member who has struggled with an eating disorder. Biological influences, such as hormone imbalances or gut-brain connection, can also play a major role in the onset and persistence of these disorders. Eating disorders can affect anyone, regardless of their background, and often require treatment by healthcare professionals. It is important to remember that help is available and recovery is possible.

Diagnosis and the DSM

The first step to recovery is receiving an eating disorder diagnosis from a healthcare professional. Doctors and clinicians refer to a manual called the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, or the DSM-5 to deliver a diagnosis. The DSM-5 is a guidebook published by the American Psychiatric Association (APA) that offers a standardized classification of mental health disorders. It is widely used by healthcare professionals in the U.S. and around the world to diagnose and discuss mental health conditions such as eating disorders. This handbook provides the full criteria that guides medical professionals in diagnosis. In the most recent version of the DSM-5, released in 2022, you can find eight classifications of eating disorders listed. This updated document, called the DSM-5-TR (Text Revision), includes the following eating disorders and their criteria:

Anorexia nervosa (AN)

Anorexia nervosa is an eating disorder that involves extreme food restriction and an intense fear of gaining weight. The DSM-5 lays out specific criteria for diagnosing anorexia nervosa, which include:

• Severely restricting food intake: The person eats far less than what their body needs, leading to a dangerously low body weight. This is judged based on their age, sex, and physical health.
• Fear of gaining weight: The person has an overwhelming fear of gaining weight. This fear often leads them to take extreme measures to prevent weight gain.
• Distorted body image: The person sees their body differently from how it actually is. They may focus on their weight or shape as the main factor in determining their self-worth.

Bulimia nervosa (BN)

Bulimia nervosa is an eating disorder characterized by recurring episodes of binge eating, where a person consumes an excessive amount of food in a short period of time, followed by compensatory behaviors, such as self-induced vomiting, excessive exercise, or fasting. According to the DSM-5-TR, bulimia nervosa is diagnosed when these binge-eating and purging behaviors occur at least once a week for three months. Additionally, the individual’s self-evaluation is heavily influenced by their body shape and weight, often leading to a distorted body image.

Binge Eating Disorder (BED)

Binge eating disorder (BED) is an eating disorder marked by recurrent episodes of eating an unusually large amount of food in a short period, often accompanied by a sense of loss of control. According to the DSM-5-TR, BED is diagnosed when these binge eating episodes occur at least once a week for three months. Unlike bulimia nervosa, individuals with BED do not engage in purging behaviors, such as vomiting or excessive exercise. People with this disorder may feel distressed or ashamed about their eating habits, and the binge episodes can lead to significant emotional and physical consequences.

Avoidant/Restrictive Food Intake Disorder (ARFID)

Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating disorder characterized by a limited or highly selective range of foods, leading to nutritional deficiencies, significant weight loss, or a failure to gain weight during growth periods. According to the DSM-5-TR, ARFID is diagnosed when an individual shows a consistent pattern of avoiding or restricting food, which can be driven by a lack of interest in eating, sensory sensitivities (such as dislike of certain textures or smells), or fear of negative consequences (like choking). Unlike other eating disorders, ARFID is not motivated by concerns about body weight or shape.

Other Specified Feeding and Eating Disorders (OSFED)

Other Specified Feeding or Eating Disorder (OSFED) is a category used in the DSM-5-TR for eating disorders that do not fully meet the criteria for conditions like anorexia nervosa, bulimia nervosa, or binge eating disorder. OSFED can include a wide range of eating-related behaviors, such as atypical binge eating, restrictive eating patterns, or purging without the specific features required for other disorders. This does not mean that these disorders are any less harmful for the people who experience them. For example, someone might engage in disordered eating behaviors but not meet the frequency or duration required for a diagnosis of bulimia nervosa.

Pica

Pica is an eating disorder characterized by the persistent consumption of non-food substances, such as dirt, chalk, hair, or paper. According to the DSM-5-TR, pica is diagnosed when this behavior lasts for at least one month and is developmentally inappropriate, meaning it occurs beyond the typical age at which children may experiment with non-food items. Pica can be dangerous, leading to serious health complications like poisoning, digestive issues, or infections. The disorder is often seen in individuals with developmental disabilities, but it can also occur in people without these conditions.

Rumination disorder

Rumination disorder is an eating disorder where a person repeatedly regurgitates food, either to re-chew, re-swallow, or spit it out. According to the DSM-5-TR, rumination disorder is diagnosed when this behavior occurs consistently, at least once a month, and is not due to a medical condition or a voluntary act. Unlike vomiting caused by illness or purging behaviors seen in disorders like bulimia nervosa, rumination involves a repetitive process where food is brought back up, often within an hour after eating. The disorder can lead to malnutrition, weight loss, and other health complications if left untreated.

Changes and Challenges

The Diagnostic and Statistical Manual of Mental Disorders (DSM) has been a key tool for diagnosing mental health conditions since its first edition was published in 1952 by the American Psychiatric Association (APA). Originally created to bring consistency to mental health diagnoses, the DSM has undergone several revisions, with each edition reflecting advances in psychological research and evolving cultural attitudes. Over time, the manual has expanded to include a broader range of mental health disorders, and its criteria have become more detailed and nuanced. Today, the DSM is widely used by mental health professionals around the world to ensure accurate diagnosis and improve patient care. 

Though the DSM-5 is often a helpful tool for diagnosing eating disorders, there are challenges that can arise when using a more rigid tool to categorize unique, qualitative experiences. One of the biggest challenges is that mental health is deeply personal and shaped by unique cultural, social, and individual factors. People may experience symptoms differently, yet the DSM relies on standardized criteria that sometimes oversimplify or fail to capture the nuances of each individual’s situation. Additionally, the rigid structure of diagnostic categories can lead to overgeneralization, leaving out those who don’t fit neatly into any one diagnosis, potentially leading to a misdiagnosis or a lack of proper care. The challenge lies in balancing the need for structured frameworks with the reality that each person’s mental health journey is distinct and multifaceted.

In 2022, the DSM-5-TR introduced several updates to improve the accuracy and inclusivity of mental health diagnoses, including those related to eating disorders. One significant change is the refinement of criteria for disorders like Avoidant/Restrictive Food Intake Disorder (ARFID) and Binge Eating Disorder (BED), offering a clearer understanding of how these conditions manifest in different populations. These updates help doctors, dietitians, and therapists provide more precise diagnoses, ensuring that patients with eating disorders receive more personalized and appropriate care. By recognizing a wider range of symptoms and eating behaviors, the DSM-5-TR aims to improve treatment outcomes, offering hope for better support and interventions for those struggling with these complex disorders.

Seek Help

If you or a loved one is experiencing symptoms of an eating disorder, you are not alone. Help is available and recovery is possible with the National Alliance for Eating Disorders.