The American Psychiatric Association publishes the Diagnostic and Statistical Manual of Mental Disorders (DSM) to provide the standard for classification and diagnosis of mental disorders. It sounds kind of boring, but it actually opened up our eyes to just how many behaviors and mindsets eating disorders encompass. The section of “Feeding and Eating Disorders” has eight different disorders, and we list two of them below. We copied and pasted these directly from the latest manual (DSM 5), and what you read might surprise you.
Anorexia Nervosa
Diagnostic Criteria:
A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
In Plain English:
The DSM's first criteria specifies that the restriction is relative to each specific person. This might seem obvious but if you're working out a lot, are taller than your friends or any number of other factors, you'll need more energy. Be careful when comparing yourself to others.
Most people have, at some point, been self–conscious or critical about some aspect of how they look (like that pimple that won’t go away or the unibrow hair you always forget about until it's too late). When how someone thinks about his or her weight or body takes too much control over their life, or drifts too far from actuality, it poses a problem.
Bulimia Nervosa
Diagnostic Criteria
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
1. Eating, in a discrete period of time (e.g., within any two–hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.
2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.
C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.
D. Self-evaluation is unduly influenced by body shape and weight.
E. The disturbance does not occur exclusively during episodes of anorexia nervosa.
In Plain English:
We all have the occasional (read: biweekly) 2 a.m. Allegro rampage or Hill brunch ball–out, but a sense of lack of control during those times is what may raise a red flag.
Contrary to popular belief, bulimia doesn’t always mean throwing up. The compensatory behaviors include anything that prevents weight gain, even too much exercise.
While movies and TV shows may make it seem like the standard for bulimia is binging and purging after every meal, the DSM says "at least once a week for three months.” That’s way different from what people often think. For example, throwing up after a rough night at Smokes’ might suck, but doesn’t really seem like the end of the world. However, if that last shot that puts someone over the edge is, at the back of their mind, a reason to throw up to get rid of whatever they ate before, that fits in these criteria.
Important disclaimer: Street is not medically certified, nor are we experts. However, if anything here rings a bell either for you or a friend, seek help. It might not be easy, but it will be worth it.
CAPS: 215-898-7021
National Eating Disorder Association Hotline: 1-800-931-2237
