DSM Criteria for Eating Disorders Explained in Detail

Heather Campbell
 min read

DSM criteria for eating disorders is a critical tool in the correct diagnosis of eating disorders.

DSM Criteria for Eating Disorders Explained in DetailMost specialized care facilities for eating disorders follow the Diagnostic and Statistical Manual of Mental Disorders (DSM) to diagnose bulimia, anorexia, or Binge Eating Disorder.

As a whole, the Diagnostic and Statistical Manual of Mental Disorders is an American manual for the diagnosis and statistics of mental disorders. Nutrition and eating disorders are severe psychological disorders that need professional help and DSM lists the criteria needed for a correct diagnosis.

We’ve done the research, all you need to do is read on to know the details.

DSM criteria for eating disorders: Introduction

The Diagnostic and Statistical Manual of Mental Disorders is an American manual for the diagnosis and statistics of mental disorders.

In most countries, this manual is considered the standard in psychiatric diagnosis.

The DSM also lists the criteria of eating disorders such as anorexia nervosa, bulimia nervosa and Binge Eating Disorder as recognized eating disorders.

DSM criteria for anorexia nervosa

Anorexia nervosa, which mainly affects adolescent girls and young women, is characterized by an intense fear of becoming fat, a distorted body image, and excessive dieting leading to severe weight loss.

The DSM criteria for anorexia nervosa are as follows:

  • A distorted perception of their body weight or body shape.
  • Body weight or body shape disproportionately influences one’s judgment of oneself.
  • People do not recognize the severity of the current low body weight.
  • Limiting energy intake relative to energy requirements resulting in a significantly underweight body for age, sex, growth curve, and physical health. Very underweight is defined as a weight less than the minimum average weight or, in children and adolescents, weight less than what is expected to be minimum.
  • Intense fear of gaining weight, becoming fat, or persistent behavior preventing weight gain, even if the person is significantly underweight.

DSM criteria for bulimia nervosa

Bulimia nervosa is characterized by frequent episodes of overeating (binge eating), followed by compensatory behaviors such as vomiting (self-induced) to avoid weight gain.

The DSM criteria for bulimia nervosa are as follows:

  • This eating disorder does not occur exclusively during episodes of anorexia nervosa.
  • Binge eating and compensatory behaviors occur at least once a week for at least 3 months.
  • Repeated inappropriate compensatory behaviors to counter weight gains such as inducing vomiting, fasting, abuse of laxatives or other medications, or excessive exercise.
  • Body shape and body weight have a disproportionate impact on judgments of oneself.
  • Repeated episodes of binge eating.
  • A binge eating episode is characterized by both of the following features:
    • Eating in a given time (e.g., 2 hours) such an amount of food that is significantly greater than most people would eat in such a period under similar circumstances.
    • Feeling no control over eating during this period (e.g., feeling unable to stop or having no control over what and how much they eat).

DSM criteria for Binge Eating Disorder (BED)

Binge Eating Disorder or eating disorders are recurrent episodes of eating significantly more food in a short period than usual, with episodes marked by feelings of loss of control.

A person with BED may eat too quickly (in a hurry) even when they do not feel hungry.

The person may have feelings of guilt, shame or envy and may binge eat only to hide the behavior.

This eating disorder is associated with marked distress (loss) and occurs on average at least once a week for 3 months.

This change (adaptation) is intended to emphasize substantial differences between BED and the common phenomenon of overeating.

While overeating is challenging for many people, recurrent BED is much less common and often worse. It is associated with significant psychological problems.

The DSM criteria for Binge Eating Disorder are as follows:

  • Binge eating is not accompanied by repeated inappropriate compensatory behavior (self-induced vomiting, for example) as in bulimia nervosa. It does not occur exclusively in the course of bulimia nervosa or anorexia nervosa.
  • Binge eating episodes are associated with 3 (or more) of the following characteristics:
    • Eating only out of shame about the amount of food the person consumes.
    • Feeling disgusted with themselves afterward, feeling gloomy or very guilty.
    • Eating through until there is a tremendously unpleasant full feeling.
    • Eating much faster than usual.
    • Consuming large amounts of food without having physical cravings.
  • Repeated episodes of binge eating. A binge eating episode is characterized by a combination of the following 2 features:
    • Eating in a given time (e.g., 2 hours) an amount of food much greater than most other people would eat in such a period under similar circumstances.
    • Feeling no control over eating during the period (e.g., feeling unable to stop or having no control over what and how much they eat).
  • There is obvious suffering as a result of binge eating.
  • Binge eating occurred at least once a week on average for 3 months.

DSM criteria for Other specified feeding or eating disorder and Eating disorder not otherwise specified

In the previous version of the DSM, DSM-IV, these 2 groups fell into the category of eating disorder not otherwise specified (EDNOS). This is a category for patients who usually have some, but not all, of the corresponding characteristics of the more specific eating disorders mentioned above.

Recently, professionals and researchers have become increasingly aware that many people with eating disorders do not fall within the DSM-IV criteria of anorexia nervosa or bulimia nervosa.

As a result, many people with eating disorders were diagnosed with Eating Disorder Not Otherwise Specified (EDNOS), which is no longer recognized. It has now been replaced in the DSM-5 by Other Specified Feeding or Eating Disorder (OSFED).

Studies show that many of these people are likely to have BED (Binge Eating Disorder). This eating disorder was subsequently added to the DSM-5.

Other specified feeding or eating disorder

Some examples of the category of other specified eating disorders include the following:

  • Nocturnal eating syndrome: Repeated episodes of nocturnal eating manifested by eating after waking during the night or excessive consumption after the evening meal. The person is aware of the food and can remember it. Nocturnal eating causes significant suffering and/or limitations in functioning.
  • Purge disorder: Repeated purging behaviors to affect body weight or shape, such as inducing vomiting, abusing laxatives or other medications without binge eating.
  • Eating disorder with low frequency and/or limited duration: One fully meets the criteria for an eating disorder except that the binge eating occurs on average less than once a week and/or for less than 3 months.
  • Atypical anorexia nervosa: One meets the criteria for anorexia nervosa, except that the weight is within or above normal despite significant weight loss.
  • Bulimia nervosa (with low frequency and/or of limited duration): One meets the criteria for bulimia nervosa, except that the binge eating and repeated inappropriate compensatory behaviors occur on average less than once a week and/or for less than 3 months.

Eating disorder not otherwise specified

The unspecified eating or eating disorder category is the last category added in the DSM-5.

This classification should only be used when the professional service provider cannot further explain why the criteria for a particular eating and nutrition disorder have not been met. Then there is insufficient information (for example, in an emergency department).

DSM criteria for eating disorders: Conclusion

Nutrition and eating disorders are severe psychological disorders with often somatic consequences that do not go away on their own.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) describes several recognized eating and nutrition disorders.

Above are the descriptions of these eating disorders. Beware: Only a licensed physician can diagnose an eating disorder.

Therefore, if you have any suspicions or doubts, you would do well to contact your doctor.

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About Heather Campbell

As a nutritionist, my field of specialization is science-based nutritional advice but more importantly, it is my goal to share capturing and inspiring stories, examples and solutions which can help plus-size individuals overcome their specific difficulties. Read More