By Miranda Milana, Psy.D.
In today’s world with the toxicity and normalization of diet culture, it can be difficult to identify possible signs and symptoms of a more serious problem such as an eating disorder. At what point does counting calories cross over into anorexia? When does binge eating meet criteria for bulimia? Listed below are the criteria for several eating disorders, possible warning signs, as well as information on how to seek help if you believe your child needs further help/treatment.
Anorexia nervosa is an eating disorder characterized by the restriction of food intake and is characterized by two subtypes: restrictive and binge-purging.
For both presentations, criteria for anorexia nervosa include:
- Restriction of food intake leading to a significantly low body weight for age, sex, and developmental trajectory
- Intense fear of gaining weight that interferes with one’s ability to gain weight
- Feeling disturbed by one’s weight or shape, reduced self-worth second to weight/body shape, or a lack of recognition of the seriousness of their low bodyweight
Criteria for the restricting type include not having recurrent binge eating or purging within the last 3 months
Criteria for the binge eating/purging type include recurrent episodes of binge eating or purging within the last 3 months
Bulimia nervosa is an eating disorder characterized by recurrent episodes of binge eating that include the following:
- Eating a “definitively” larger amount of food in a 2-hour period than what most other individuals would eat in similar circumstances
- Feeling as though one cannot stop eating or control how much they are eating
- Recurrent and inappropriate behaviors aimed at preventing weight gain (e.g., self-induced vomiting, misusing laxatives, fasting, excessive exercise) that occur, on average, at least once a week for 3 months
- Self-evaluation being dependent on body shape/weight
- Symptoms not occurring exclusively during episodes of anorexia nervosa
Bulimia nervosa is also characterized by two subtypes: purging type and nonpurging type.
To meet criteria for the purging type, one must have regularly engaged in self-induced vomiting, the misuse of laxatives, diuretics, or enemas.
To meet criteria for the nonpurging type, one must have used inappropriate behaviors, such as fasting or excessive exercise without self-induced vomiting, the misuse of laxatives, diuretics, or enemas.
Binge eating disorder and avoidant restrictive food intake disorder (ARFID) are also eating disorders recognized in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5).
Binge eating disorder is characterized by:
- Recurrent episodes of binge eating (defined by eating an amount of food in a 2-hour period larger than what most people would eat in a similar period of time under similar circumstances as well as feeling a lack of control during the binge eating episode)
- Three or more of the following: eating more rapidly than normal, eating until feeling uncomfortably full, eating large amounts of food when not hungry, eating alone due to embarrassment over the amount of food being consumed, feeling disgusted, depressed, or guilty after overeating.
- Distress regarding binge eating
- Binge eating occurring on average at least 1 day a week for 3 months
- Binge eating not associated with the regular use of inappropriate compensatory behaviors, such as purging, fasting, and/or excessive exercise, and does not occur exclusively during the course of anorexia nervosa or bulimia nervosa
Avoidant restrictive food intake disorder (ARFID) is characterized by:
- A lack of interest in eating or food, avoidance of food based on sensory characteristics, and/or concern about consequences of eating that lead to one or more of the following:
- Significant weight loss or failure to achieve expected weight gain
- Dependence on enteral feeding or oral nutritional supplements
- Interference with psychosocial functioning
- The eating challenges should not be attributable to a medical condition or better explained by another mental health diagnosis. If there is another mental health diagnosis, the severity of the eating disturbance must exceed what is routinely associated with the mental health condition
- The eating challenges should not be better explained by a lack of available food or associated with cultural practices
- The eating challenges should not occur exclusively during the course of anorexia nervosa or bulimia nervosa
What are warning signs of an eating disorder that I should be looking out for?
- A preoccupation with weight loss, dieting, exercise, and/or controlling food consumption
- Refusing to eat certain foods, such as carbohydrates or fats
- Not being comfortable eating around others, skipping meals, or eating smaller portions
- Withdrawing from friend groups and/or typical activities
- Noticeable fluctuations in weight
- Stomach complaints/digestive concerns
- Menstrual irregularities
- Difficulties concentrating
- Sleep challenges
- An increase in dental problems
If you suspect your child has an eating disorder, begin by talking to a medical or mental health professional. You can also contact the National Eating Disorders Association (NEDA) Helpline at 1-800-931-2237 or by texting NEDA to 741-741. The Multi-Service Eating Disorders Association (MEDA) is another source of information with support groups and resources. More information can be found at https://www.medainc.org/.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Warning signs and symptoms. National Eating Disorders Association. (2021, July 14) https://www.nationaleatingdisorders.org/warning-signs-and-symptoms
About the Author
Dr. Miranda Milana provides comprehensive evaluation services for children and adolescents with a wide range of concerns, including attention deficit disorders, communication disorders, intellectual disabilities, and learning disabilities. She particularly enjoys working with children and their families who have concerns regarding an autism spectrum disorder. Dr. Milana has received specialized training on the administration of the Autism Diagnostic Observation Schedule (ADOS).
Dr. Milana places great emphasis on adapting her approach to a child’s developmental level and providing a testing environment that is approachable and comfortable for them. She also values collaboration with families and outside providers to facilitate supports and services that are tailored to a child’s specific needs.
Before joining NESCA, Dr. Milana completed a two-year postdoctoral fellowship at Boston Children’s Hospital in the Developmental Medicine department, where she received extensive training in the administration of psychological and neuropsychological testing. She has also received assessment training from Beacon Assessment Center and The Brenner Center. Dr. Milana graduated with her B.A. from the University of New England and went on to receive her doctorate from William James College (WJC). She was a part of the Children and Families of Adversity and Resilience (CFAR) program while at WJC. Her doctoral training also included therapeutic services across a variety of settings, including an elementary school, the Family Health Center of Worcester and at Roger Williams University.
Dr. Milana grew up in Maine and enjoys trips back home to see her family throughout the year. She currently resides in Wrentham, Massachusetts, with her husband and two golden retrievers. She also enjoys spending time with family and friends, reading, and cheering on the Patriots, Bruins, Red Sox, and Celtics.
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