Lydia's Official Anorexia Nervosa Diagnosis Post
Disclaimer: I am not a health care professional and do not have the proper qualifications to diagnose anyone with a mental illness. The purpose of this post is to share public information that is readily available to others and give my interpretation of that information. I will solely be going off of the Diagnostic and Statistical Manual of Mental Disorders (the DSM). Always keep in mind that a doctor or other qualified health care professional is the only one who can diagnose you with a mental illness and that regardless if you fit all medical criteria or not, they have the final say in what they choose to diagnose you with.
Now, onto the post. There are a lot of people who spread around misinformation in regards to the Anorexia Nervosa diagnosis. I’m going to break this post down into questions so it’s easier to navigate and read.
1.) What was the Anorexia Nervosa diagnosis in the DSM-4?
A.) Refusal to maintain body weight at or above a minimally normal weight for age and height, for example, weight loss leading to maintenance of body weight less than 85% of that expected or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected.
B.) Intense fear of gaining weight or becoming fat, even though underweight.
C.) Disturbance in the way one’s body weight or shape is experienced, undue influence of body weight or shape on self evaluation, or denial of the seriousness of the current
low body weight.
D.) In postmenarcheal females, amenorrhea, i.e., the absence of at least 3 consecutive menstrual cycles. A woman having periods only while on hormone medication (e.g. estrogen) still qualifies as having amenorrhea.
Restricting Type: During the current episode of Anorexia Nervosa, the person has not regularly engaged in binge-eating or purging behavior (self-induced vomiting or misuse of laxatives, diuretics, or enemas).
Binge Eating/Purging Type: During the current episode of Anorexia Nervosa, the person has regularly engaged in binge-eating or purging behavior.
2.) What is the AN diagnosis in the DSM-5?
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. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.
B.) Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even thought 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.
Restricting Type: During the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior. This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise.
Binge-eating/purging type: During the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior.
In partial remission: After full criteria for anorexia nervosa were previously met, Criterion A (low body weigh) has not been met for a sustained period, but either Criterion B (intense fear of gaining weight or becoming fat or behavior that interferes with weight gain) or Criterion C (disturbances in self-perception of weight and shape) is still met.
In full remission: After full criteria for anorexia nervosa were previously met, none of the criteria have been met for a sustained period of time.
Specify current severity: the minimum level of severity is based, on current body mass index, or, for children and adolescents, on BMI percentile. The ranges below are derived from World Health Organization categories for thinness in adults; for children ad adolescents, corresponding BMI percentiles should be used. The level of severity may be increased to reflect clinical symptoms, the degree of functional disability, and the need for supervision.
Mild: BMI greater than or equal to 17.
Moderate: BMI 16-16.99.
Severe: BMI 15-15.99.
Extreme: BMI < 15.
3.) What’s the difference between the DSM-4 diagnosis and the DSM-5 diagnosis?
The first change is the weight criterion. A person diagnosed with AN no longer has to weigh less than 85% of their expected body weight for height/age/sex.
The second change is “interference of weight gain” has been added to the second criterion.
The requirement of loss of period for three consecutive months has been removed.
A section for “remission” and “partial remission” has been aded.
A section for “severity” has been added that is based on BMI and/or inability to function.
4.) So, do you still have to be underweight to be diagnosed with AN?
Technically, yes. But here’s what that means:
A doctor simply has to deem you significantly underweight for your age/height/sex. They’ve defined it as “weight that is less than minimally normal.” So depending on your normal weight, if you are under that, you may be diagnosed with AN as long as you fit the other criteria.
5.) Does that mean I have to be emaciated?
Absolutely not. You can still be underweight and look relatively normal. As long as you are deemed under where you should be, you may fit this criterion and that does not mean you have to be 60 pounds!
6.) What if I’m not underweight but have lost a significant amount of weight in a short period of time? The first criterion says “leading to a significant low body weight.” Doesn’t that mean I fit this criterion as long as I am on my way to becoming underweight?
No. If this were the case, the DSM-5 wouldn’t have added “Atypical Anorexia” under the OSFED (Other Specified Feeding or Eating Disorder, formerly known as EDNOS) diagnosis. “…leading to a significant low body weight” means you’ve already become underweight.
7.) Well, what’s Atypical Anorexia?
Atypical Anorexia Nervosa: In atypical AN, individuals meet all of the criteria for AN, with the exception of the weight criterion: the individual’s weight remains within or above the normal range, despite significant weight loss.
It states right in the diagnosis that even if you’ve had significant weight loss, you would still be diagnosed as OSFED: Atypical Anorexia if your weight remains within or above the normal range.
8.) But isn’t Atypical Anorexia the same thing as Anorexia?
Yes and no. It’s technically a subset of OSFED and does not fall under the Anorexia Nervosa diagnosis. So although you could technically say you suffer from Atypical Anorexia, you still wouldn’t be suffering from Anorexia Nervosa. You would be suffering from OSFED.
9.) The DSM-5 AN diagnosis is so unfair — they’ve completely turned it into a competition by adding that BMI severity chart!
No, they haven’t. If you read the diagnosis carefully, although they are using BMI has a severity scale, a doctor may move the severity based on the individuals specific symptoms: "The level of severity may be increased to reflect clinical symptoms, the degree of functional disability, and the need for supervision."
What that means is if a person has a BMI of 17 (considered “mild”) but cannot function in their daily life for whatever reason, or they have a lot of medical issues going on, a doctor may move their severity to the “extreme” category in order for proper diagnosis and treatment.
Your doctor will take both things into consideration and won’t lump you into the “mild” category just because of your weight.
10.) What if I was anorexic but gain weight in recovery and still feel mentally sick?
You would be considered to be suffering from Anorexia Nervosa in Partial Remission: “In partial remission: After full criteria for anorexia nervosa were previously met, Criterion A (low body weigh) has not been met for a sustained period, but either Criterion B (intense fear of gaining weight or becoming fat or behavior that interferes with weight gain) or Criterion C (disturbances in self-perception of weight and shape) is still met.”
11.) What if I was anorexic but don’t fit any of the criteria anymore?
You would either be in Full Remission (After full criteria for anorexia nervosa were previously met, none of the criteria have been met for a sustained period of time.) assuming you are in some type of recovery or symptom management, or you would be diagnosed with a different eating disorder if you are still sick.
12.) I still feel the AN diagnosis encourages competition and is unfair to all the people who restrict but are not underweight!
That type of thinking only minimizes the OSFED diagnosis. OSFED is probably the most diagnosed eating disorder and can be just as detrimental and deadly as anorexia or bulimia.
13.) But why not just get rid of the weight criterion at all? What’s the point in having it?
Different eating disorders will have different treatments. There are specific criteria for each eating disorder for a reason. Someone who is severely underweight may not have the cognitive ability to function as well as someone who is not underweight. The person who is underweight may need to undergo intense refeeding in order to even get to a point of being able to think clearly, and although that may also be the case for someone who is a normal weight, someone who is underweight also must go through weight restoration. ALL recovery efforts are difficult, but they are also very different. That is important to remember.
14.) I still feel I should be diagnosed with anorexia!
That is a you issue that should probably be addressed. If you are more invested into being diagnosed with Anorexia Nervosa than coming to acceptance with another ED, that says more about your insecurities than it does the AN diagnosis.
15.) I didn’t see my question and/or I still don’t understand?