Diagnostic criteria

Anorexia nervosa

• is an eating disorder characterized by an intense fear of gaining weight and the refusal to maintain a minimally normal body weight
• individuals with anorexia also exhibit a misperception of body shape and/or size
• comparing DSM-IV and DMS-5 criteria for anorexia nervosa
  • in DSM-IV, a diagnosis of anorexia nervosa was excluded if the patient maintained bodyweight at or above the 85th percentile for his or her height/age
    • in DSM-5 this criterion is similar, but adds sex, developmental norms, and physical health and uses body mass index data
  • DSM-5 adds “persistent behavior that interferes with weight gain” as an added way to meet a criterion
  • DSM-5 does not include criteria on menstruating females’ absence of three consecutive menses, as previously was ub DSM-IV
  • restrictive type and binge-eating/purging types differ in that DSM-IV specifies “during the current episode” and DSM-5 specifies “during the past 3 months.”
  • DSM-5 adds criteria for partial and full remission, while the DSM-IV does not include this information
  • a study compared 215 youth 8 to 21 years enrolled as new patients with eating disorders in clinic settings and showed an increase from 30 percent to 40 percent in anorexia nervosa when comparing DSM-IV and DSM-5 criteria

A. Restriction of energy intake relative to requirements, leading to a significant low body weight in the context of the age, sex, developmental trajectory, and physical health (less than minimally normal/expected)

• severity is based on body mass index (BMI) derived from World Health Organization categories for thinness in adults; corresponding percentiles should be used for children and adolescents:
  • Mild: BMI greater than or equal to 17 kg/m2,
  • Moderate: BMI 16–16.99 kg/m2,
  • Severe: BMI 15–15.99 kg/m2,
  • Extreme: BMI less than 15 kg/m2

B. Intense fear of gaining weight or becoming fat or persistent behavior that interferes with weight gain.

C. Disturbed by one’s body weight or shape, self-worth influenced by body weight or shape, or persistent lack of recognition of seriousness of low bodyweight.

**Dropped from DSM-IV D. In menstruating females, absence of at least 3 consecutive non-synthetically induced menstrual cycles.

Restricting type:

• During the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behaviour (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise
• (previously in DSM-IV "During current episode..")

Binge-eating/purging type:

• During the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behaviour (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)
• (previously in DSM-IV "During current episode..")

Added criteria for "full remission" and "partial remission"

Partial remission: After full criteria met, low bodyweight has not been met for sustained period, BUT at least one of the following two criteria still met:

• Intense fear of gaining weight/becoming obese or behavior that interferes with weight gain
• OR
• Disturbed by weight and shape.

Full remission: After full criteria met, none of the criteria met for sustained period of time.

Reference:

• Ornstein, R. M. et al. Distribution of eating disorders in children and adolescents using the proposed DSM-5 criteria for feeding and eating disorders. Journal of Adolescent Health 2013; 53(2): 303–305. doi:10.1016/j.jadohealth.2013.03.025
• DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet].