Initial Questions

Knowledge Translation Commentary

DSM-V for Anorexia Nervosa

1. Restriction of energy intake relative to requirement, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children adolescents, less than that of minimally expected.
2. Intense fear of gaining weight or becoming fat, or persistent behaviour that interferes with weight gain, even though at a significantly low weight.
3. Disturbance in the way that one’s body weight and 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.

Restricting type:

During the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behaviour (ie. 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 exercise.

Binge eating/purging type:

During the last 3 months the individual has engaged in recurrent episodes of binge eating, or purging behaviours (ie. self induced vomiting, or the misuse of laxatives, diuretics or enemas).

Specify current severity

• Mild (BMI >17)
• Moderate (16-16.99)
• Severe (15-15.99)
• Extreme (< 15)

Consider screening for an eating disorder when these or similar questions are raised:

• A mother asks about her daughter who has been hiding food.
• A female asks why her periods have become irregular or have stopped.
• You are asked about the long-term impact of laxatives.
• A mother indicates that her daughter is not seeing her friends anymore, spends most of her time doing school work, and is avoiding eating meals with the family.
• A teen has a significant drop in his or her weight, changing the trajectory of his/her growth curve.
• A patient complains about a sudden unexplained weight increase, states it is non-food related, and is now dieting to reduce weight.

Anorexia Nervosa has the highest mortality rate of any psychiatric disorder.