Individuals with Bulimia Nervosa typically are within the normal weight range, although some may be

The Eating Disorders are characterized by severe disturbances in eating behavior. This section includes two specific diagnoses, Anorexia Nervosa and Bulimia Nervosa.

Anorexia Nervosa is characterized by a refusal to maintain a minimally normal body weight.

Bulimia Nervosa is characterized by repeated episodes of binge eating followed by inappropriate compensatory behaviors such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.

A disturbance in the perception of body shape and weight is an essential feature of both Anorexia Nervosa and Bulimia Nervosa. An Eating Disorder Not Otherwise Specified category is also provided for coding disorders that do not meet the criteria for a specific Eating Disorder.

Simple obesity is included in the International Classification of Diseases (ICD) as a general medical condition but does not appear in DSM-IV because it has not been established that it is consistently associated with a psychological or behavioral syndrome. However, when there is evidence that psychological factors are of importance in the etiology or course of a particular case of obesity, this can be indicated by noting the presence of Psychological Factors Affecting Medical Condition (p. 675).

Disorders of Feeding and Eating that are usually first diagnosed in infancy or early childhood (i.e., Pica, Rumination Disorder, and Feeding Disorder of Infancy or Early Childhood) are included in the section "Feeding and Eating Disorders of Infancy or Early Childhood" (p. 94).

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Written by Joanna Poppink, MFT. Joanna is a psychotherapist in private practice specializing in eating disorder recovery, stress, PTSD, and adult development.

She is licensed in CA, AZ, OR and FL. Author of the Book: Healing Your Hungry Heart: Recovering from Your Eating Disorder

Appointments are virtual.

For a free telephone consultation, e-mail her at This email address is being protected from spambots. You need JavaScript enabled to view it.

You, like the butterfly, can find the right support and nourishment you need.

Often a person with an eating disorder covers her pain so well that when she tells the truth about her suffering, people don't believe her. They think she is exaggerating, overreacting or in a mood that will pass.

She can look so good or so happy that people who love her and think they know her well, cannot get past what they wish to see and hear. They can also be too afraid to believe that her descriptions of personal pain might be true.

If that eating disorder person is you, you may be in a situation where many well-meaning people in your life do not take your anguish seriously.

1. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
   1. eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances
   2. a sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)
2. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise.
3. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.
4. Self-evaluation is unduly influenced by body shape and weight.
5. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.

Specify type:

Purging Type: during the current episode of Bulimia Nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas

Nonpurging Type: during the current episode of Bulimia Nervosa, the personas used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas.