Anorexia Nervosa

  • Medical Author:
    Roxanne Dryden-Edwards, MD

    Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

Quick GuideEating Disorders: Anorexia, Bulimia, Binge Eating

Eating Disorders: Anorexia, Bulimia, Binge Eating

How is anorexia nervosa diagnosed?

Anorexia nervosa can be a difficult disorder to diagnose, since individuals with anorexia often attempt to hide the disorder. Denial and secrecy frequently accompany other symptoms. It is unusual for a person with anorexia to seek professional help because the individual typically does not accept that she or he has a problem (denial). In many cases, the actual diagnosis is not made until medical complications have developed. The individual is often brought to the attention of a professional by family members only after marked weight loss has occurred. When anorexics finally come to the attention of a health-care professional, they often lack insight into their problem despite being severely malnourished and may be unreliable in terms of providing accurate information. Therefore, it is often necessary to obtain information from parents, a spouse, or other family members in order to evaluate the degree of weight loss and extent of the disorder. Health professionals will sometimes administer symptom questionnaires as part of screening for the disorder.

Warning signs of developing anorexia or one of the other eating disorders include excessive interest in dieting or thinness. One example of such interest includes a movement called "thinspiration," which promotes extreme thinness as a lifestyle choice rather than as a symptom of illness. There are a variety of web sites that attempt to inspire others toward extreme thinness by featuring information on achieving that goal, photos of famous, extremely thin celebrities, and testimonials, as well as before and after pictures of individuals who ascribe to extreme thinness.

The actual criteria for anorexia nervosa are found in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V).

There are three basic criteria for the diagnosis of anorexia nervosa that are characteristic:

  1. Restriction of food intake that leads to markedly low body weight for age, gender, developmental course and medical health
  2. An intense fear of gaining weight or becoming fat, or persistent behavior that prevents weight gain, despite the person being significantly underweight
  3. Self-perception that is grossly distorted, excessive emphasis on body weight and shape in self-assessment, and weight loss or the seriousness thereof that is either minimized or not acknowledged completely

The DSM-V further identifies two subtypes of anorexia nervosa. In the binge-eating/purging type, the individual regularly engaged in binge eating or purging behavior in at least the past three months, which involves self-induced vomiting or the misuse of laxatives, diuretics, or enemas during the current episode of anorexia. In the restricting type, the individual has severely restricted food intake and/or excessively exercised for at least the past three months but does not regularly engage in the behaviors seen in the binge-eating type.

In order to diagnose anorexia, the health-care professional distinguishes this illness from being a symptom of an underlying medical disorder or of another eating disorder. As a symptom of a medical disorder, the term anorexia (in general, rather than anorexia nervosa, the condition discussed in this article) describes the considerable weight loss that may be the result of serious illness that may afflict terminally ill patients who are receiving hospice care.

Unlike the binge-eating/purging type of anorexia nervosa, bulimia nervosa does not result in weight reduction below the minimal normal weight. Bulimia nervosa is characterized by episodes of eating significantly excessive amounts of food that the individual feels they cannot stop themselves from engaging in (binges), alternating with episodes of attempts to counteract the binges using inappropriate behaviors (purging) like self-induced vomiting, misuse of medications, fasting, and/or excessive exercising. Most individuals with an eating disorder do not fit neatly into either the diagnosis of anorexia or bulimia and are therefore classified as either suffering from "other specified feeding or eating disorder" or "unspecified feeding or eating disorder." Examples of other specified feeding or eating disorders include people with binge-eating disorder who experience episodes of binge eating but do not regularly engage in purging or restricting behaviors; individuals with recurrent purging behaviors without binge eating and recurrent episodes of night eating that is not better explained by binge eating disorder or another mental-health disorder. Those eating disorders that do not meet diagnostic criteria for any specific eating disorder are classified as an "unspecified feeding or eating disorder."

Medically Reviewed by a Doctor on 3/8/2016

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