CHAPTER 25
Eating Disorders
Anorexia nervosa and bulimia nervosa are the two best-described eating
disorders. People affected by these disorders share a strong tendency to
judge their own worth largely on the basis of their weight, their shape,
and their ability to control that weight and shape. In anorexia, the single-
minded pursuit of weight loss is so ‘successful’ that it undermines physical
health and can even result in death. In bulimia, body weight remains in
the normal range because the pursuit of weight loss is balanced out by
repeated episodes of binge eating in which the individual loses control and
consumes a large amount of food. Besides anorexia and bulimia, there
are also many variations on similar themes, including partial and hybrid
disorders, sometimes lumped together as Eating Disorder Not Otherwise
Specified (EDNOS). Although the remainder of this chapter focuses on
anorexia and bulimia, readers should not be surprised if they often
meet young people whose lives are seriously affected by anorexic and/or
bulimic symptoms that do not quite meet the official criteria for either
disorder.
Anorexia nervosa
Diagnosis
The main ICD-10 diagnostic criteria for anorexia nervosa are shown in
Box 25.1. DSM-IV criteria are similar, with an optional division into two
subtypes:
1 Therestrictingtype involves weight loss purely via reduced food intake
and excessive exercise.
2 Thebinge-eating/purgingtype involves added features, namely episodes
of binge eating that are offset bypurging(that is, self-induced vomiting
or the misuse of laxatives, enemas or diuretics).
Whether these really are two distinct subtypes as opposed to points
on a continuum is still in doubt. Depressive and obsessional features are
common, sometimes warranting additional diagnoses.
Child and Adolescent Psychiatry, Third Edition. Robert Goodman and Stephen Scott.
©c2012 Robert Goodman and Stephen Scott. Published 2012 by John Wiley & Sons, Ltd.
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