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Anorexia nervosa. Types: Restricting or binge-eating/purging

Diagnostic and Statistical Manual of Mental Disorders (DSM) IV

  • Exaggerated drive for thinness

  • Refusal to maintain a body weight above the standard minimum (eg,

  • Intense fear of becoming fat with self-worth based on weight or shape

  • Evidence of an endocrine disorder

85% of expected weight)

Proposed for DSM V

  • Restricted energy intake relative to requirements leading to a markedly low body weight

  • Intense fear of gaining weight or becoming fat or persistent behavior to avoid weight gain, even though at a markedly low weight

  • Disturbance in the way in which one’s body weight or shape is experienced

Bulimia nervosa DSM IV

  • Overwhelming urges to overeat and inappropriate compensatory behaviors or purging that follow the binge episodes (eg, vomiting, excessive

exercise, alternating periods of starvation, and abuse of laxatives or drugs)

  • Similar to anorexia nervosa, individuals with bulimia nervosa also display psychopathology, including a fear of being overweight

Proposed for DSM V

  • Recurrent episodes of binge eating with a sense of a lack of control with inappropriate compensatory behavior

  • Self-evaluation is unduly influenced by body shape and weight

  • The disturbance does not occur exclusively during episodes of anorexia nervosa.

Binge eating disorder DSM IV

  • Classified under eating disorders not otherwise specified

Proposed for DSM V

  • Repeated episodes of overconsumption of food with a sense of a lack of control with a list of possible descriptors such as how much is eaten

and distress about the episode

  • Frequency described as at least once a week for 3 months

Eating disorders not otherwise specified DSM IV

  • Considered to be partial syndromes with frequency of symptoms that vary from above diagnostic criteria

  • Distinguishing feature of binge eating disorder is binge eating, with a lack of self-control, without inappropriate compensatory behaviors

Proposed for DSM V

  • Diagnostic criteria to be established for binge eating disorder

  • Possible descriptions of eating problems such as purging disorder and night eating syndrome

Figure 1. Comparison of proposed revisions in diagnostic criteria for eating disorders. Data from references (1,2).

EPIDEMIOLOGIC FACTORS

The frequency and distribution of in- dividuals affected by EDs is unknown because the condition may exist for a considerable time period before clini- cal detection. Cases may go unre- ported due to the sensitive nature and secretive behaviors associated with the condition, and epidemiologic re- search is lacking from all population groups. Risk factors found to precede an ED diagnosis include sex, ethnicity, early childhood eating and gastrointes- tinal problems, elevated weight and shape concerns, negative self-evalua- tion, sexual abuse and other traumas, and general psychiatric morbidity (13). Prospective studies indicate risk for

eating pathology and include perceived pressure for thinness, thin-ideal inter- nalization, body dissatisfaction, self-re- ported dietary restraint, negative af- fect, and substance use (14).Genet- ics and neurobiological vulnerabilities are emerging as predisposing factors (15,16).

The National Comorbidity Survey Replication study (17) reported life- time prevalence rates for anorexia nervosa at 0.3% in men and 0.9% in women, for bulimia nervosa 0.5% in men and 1.5% in women, and for binge eating disorder 2% in men and 3.5% in women (17). As expected, a diagnosis of anorexia nervosa was as- sociated with lower body mass index

status and the reverse pattern found for binge eating disorder (17). Despite consideration that homosexuality may be a risk factor for EDs among men, evidence is lacking (18). Age trends differ within conditions, with the greatest frequency of anorexia nervosa and bulimia nervosa occur- ring during adolescence, whereas binge eating disorder occurs well into adulthood. Evidence also suggests an increasing trend in EDs for middle- aged women (19). In longitudinal re- search of girls aged 12 to 15 years, Stice and colleagues (20) found that 12% of these adolescents experienced some form of ED. An important consid- eration for prevention of EDs and asso-

August 2011 Journal of the AMERICAN DIETETIC ASSOCIATION

1237

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