Week 1 – Eating
DMS-V Criteria
Anorexia Nervosa
A person must meet all of the current DSM criteria to be diagnosed with anorexia nervosa:
1. Restriction of food intake leading to weight loss or a failure to gain weight resulting in
a "significantly low body weight" of what would be expected for someone's age, sex,
and height.
2. Fear of becoming fat or gaining weight.
3. Have a distorted view of themselves and of their condition (Examples of this might
include the person thinking that they are overweight when they are actually
underweight, or believing that they will gain weight from eating one single meal. A
person with anorexia might also not believe there is a problem with being at a low
body weight; these thoughts are known to professionals as "distortions.")
The DSM-5 also allows professionals to specify subcategories of anorexia nervosa:
- Restricting type: This is a subtype typically associated with the stereotypical view of
anorexia nervosa. The person does not regularly engage in binge eating.
- Binge-eating/purging type: The person regularly engages in binge eating and purging
behaviors, such as self-induced vomiting and/or the misuse of laxatives or diuretics.
The binge eating/purging subtype is similar to bulimia nervosa, however, there is no
weight-loss criterion for bulimia nervosa. As in previous editions of the DSM,
anorexia nervosa "trumps" bulimia nervosa, meaning that if a person meets criteria
for both anorexia nervosa and bulimia nervosa, then anorexia nervosa (binge-
eating/purging type) is diagnosed.
Diagnostic guidelines in the DSM-5 also allow professionals to specify if the person is in
partial remission or full remission (recovery), as well as to specify the current severity of the
disorder, based on BMI.
For patients who do not meet the full criteria for anorexia nervosa, Other Specified Feeding
and Eating Disorder (OSFED) may be an appropriate diagnosis. Being diagnosed with OSFED
as opposed to anorexia nervosa does not mean that the person is not ill and does not need
help.
Bulimia Nervosa
Binge-eating Disorder
a. Recurrent episodes of binge eating. An episode of binge eating is characterized by
both of the following:
- Eating, in a discrete period of time (for example, within any two-hour period), an
amount of food that is definitely larger than most people would eat in a similar
period of time under similar circumstances
- A sense of lack of control over eating during the episode (for example, a feeling that
one cannot stop eating or control what or how much one is eating)
b. The binge-eating episodes are associated with three (or more) of the following:
- Eating much more rapidly than normal
, - Eating until feeling uncomfortably full
- Eating large amounts of food when not feeling physically hungry
- Eating alone because of feeling embarrassed by how much one is eating
- Feeling disgusted with oneself, depressed, or very guilty afterwards
c. Marked distress regarding binge eating is present.
d. The binge eating occurs, on average, at least once a week for three months.
e. The binge eating is not associated with the recurrent use of inappropriate
compensatory behavior (for example, purging) and does not occur exclusively during
the course of anorexia nervosa, bulimia nervosa, or avoidant/restrictive food intake
disorder.
Specify if:
In partial remission: After full criteria for binge-eating disorder were previously
met, binge eating occurs at an average frequency of less than one episode per
week for a sustained period of time.
In full remission: After full criteria for binge-eating disorder were previously met,
none of the criteria have been met for a sustained period of time.
Specify current severity:
The minimum level of severity is based on the frequency of episodes of binge eating (see
below). The level of severity may be increased to reflect other symptoms and the degree of
functional disability.
- Mild: 1-3 binge-eating episodes per week.
- Moderate: 4-7 binge-eating episodes per week.
- Severe: 8-13 binge-eating episodes per week.
- Extreme: 14 or more binge-eating episodes per week
Other specified feeding or eating disorder
a. Atypical anorexia nervosa: All of the criteria for anorexia nervosa are met, except
that despite significant weight loss, the individual’s weight is within or above the
normal range.
b. Bulimia nervosa (of low frequency and/or limited duration): All of the criteria for
bulimia nervosa are met, except that the binge eating and inappropriate
compensatory behaviors occur, on average, less than once a week and/or for less
than 3 months.
c. Binge-eating disorder (of low frequency and/or limited duration): All of the criteria
for binge-eating disorder are met, except that the binge eating occurs, on average,
less than once a week and/or for less than 3 months.
d. Purging disorder: Recurrent purging behavior to influence weight or shape (e.g.,
selfinduced vomiting: misuse of laxatives, diuretics, or other medications) in the
absence of binge eating.
e. Night eating syndrome: Recurrent episodes of night eating, as manifested by eating
after awakening from sleep or by excessive food consumption after the evening meal.
There Is awareness and recall of the eating. The night eating is not better explained
by external influences such as changes in the individual’s sleep-wake cycle or by local
social norms. The night eating causes significant distress and/or impairment in
functioning. The disordered pattern of eating is not better explained by binge-eating
, disorder or another mental disorder, including substance use, and is not attributable
to another medical disorder or to an effect of medication.
Eating Disorders in Men: Underdiagnosed, Undertreated and Misunderstood (Strother)
Abstract:
- Survey of eating disorders in men: they are underdiagnosed, undertreated and
misunderstood
- Ongoing research is expected to result in assessment tools and treatment
interventions that will advance positive outcomes for men with eating disorders
Introduction
- Males suffering from EDs may have a huge stigma to overcome, which is why they
are neglected in diagnosis and treatment
- We need more research focusing on males and gender-specific issues in order to
understand and treat men succsessfully
- The National Institute of Mental Health reports in 2008 that roughly one million
males struggle with eating disorders and that is likely an underestimate
Issues for men
1. Weight history
- Men frequantly have been mildly to moderately obese at one point in their lives
before developing an eating disorder, and were more susceptible if obesity was
present in childhood (whereas women were usually normal weight)
- Compensatory behaviours are used more by men than women, in order to avert
developing potential medical complications (whereas women want to achieve
thinness)
- More men are motivated to lose/gain weight in order to achieve optimal
performance in sports
2. Sexual abuse and other trauma
- About 30% of ED patients had a history of sexual abuse: for men this is likely
underreported because of a disproportionate amount of shame and stigmatization
- Males who are victim of sexual abuse may develop issues around sexual
orientation/fear of experiencing sexuality because most sexual perpetrators are also
male through disordered eating, males may deny natural hormonal mandates
- Childhood bullying is also common in males
3. Sexual orientation
- Symptoms related to eating disorder issues were found to increase 10 times more
with gay and bisexual men than with heterosexual men concern over body shape
and weight is prevalent among homosexual males
- Some men find comfort in weight loss when experiencing confusion around sexual
orientation
- Men with ‘feminine’ gender roles may be at higher risk for developing an ED than
males with ‘masculine’ gender roles
, 4. Depression and shame
- Males with ED often experience depression and shame
- Hidden depression drives some problems we think of as typically male (e.g. alcohol
and drug abuse, violence, etc.)
- Promotion of accepted culture that allows vulnerability in men may create a safe
environment where males with EDs could be helped
5. Exercise and body image
- Exessive exercise is frequent among men with EDs > this can become addictive
- Muscle dysmophia – focus on muscle mass or body sixe (often resulting in
restlessness and physical over-activity)
- Use of steroids and growth hormones is also specific to males > long-term use is
linked to physical and psychological complications
6. Comorbid chemical dependency
- People with ED often struggle with comorbid psychiatric disorders such as substance
abuse > bidirectional relationship between substance abuse and EDs
- Substances can help to control weight
- Substance abuse diagnoses can sometimes cause EDs to be overlooked
7. Media pressures
- Intense focus on muscularity in media portrayals which influences the current male
body image ideals
Interventions
Intervention should incluse standard approaches used for females as well as approaches
which adress male specific issues
- Muscle dysmorphia needs to be targeted specifically
- All-male therapeutic groups are generally recommended as they encourage
vulnerability through empathy: other men may feel safer when one men discloses his
issues
- Focus on issues unique to males mentioned above can lead to improces intervention
techniques
