Diagnostic Criteria for Anorexia Nervosa (DSM-V)

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Anorexia nervosa is a severe psychiatric disorder characterized by starvation and malnutrition, a high prevalence of coexisting psychiatric conditions, marked treatment resistance or no response to treatment, frequent medical complications, and a substantial risk of death.

Diagnostic Criteria for Anorexia Nervosa

Diagnostic criteria

  • Restriction of energy intake relative to requirements, leading to significantly low body weight for the patient’s age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than the minimal normal weight or, in children and adolescents, less than the minimal expected weight.
  • Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though the patient has a significantly low weight.
  • 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.

Subtype designation

  • Restricting type: During the past 3 months, the patient has not engaged in recurrent episodes of binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). Weight loss is accomplished primarily through dieting, fasting, excessive exercise, or all of these methods.
  • Binge-eating and purging type: During the past 3 months, the patient has engaged in recurrent episodes of binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).

Current severity

  • Mildly severe low body weight is defined as a BMI of ≥17.†
  • Moderately severe low body weight is defined as a BMI of 16–16.99.
  • Severe low body weight is defined as a BMI of 15–15.99.
  • Extremely severe low body weight is defined as a BMI of <15.

† A patient who has undergone bariatric surgery may be considered to have mildly severe low body weight even with a BMI of 22 if the patient continues to “feel fat,” have symptoms of starvation, and persist in severely limiting energy intake in order to achieve further weight loss.

 

References:

  1. Mitchell JE, Peterson CB. Anorexia Nervosa. N Engl J Med. 2020;382(14):1343–1351. [Medline]
  2. Gibson D, Workman C, Mehler PS. Medical Complications of Anorexia Nervosa and Bulimia Nervosa. Psychiatr Clin North Am. 2019;42(2):263–274. [Medline]
  3. Diagnostic and statistical manual of mental disorders, 5th ed.: DSM V. Washington, DC: American Psychiatric Association, 2013.

Created Apr 07, 2020.