The clinical eating disorders include anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified (Table 1) . To be diagnosed with a clinical eating disorder, an individual must meet a standard set of criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) . Clinical eating disorders are psychiatric conditions and go beyond simple body weight/shape dissatisfaction and involve more than just abnormal eating patterns or pathogenic weight control behaviors. Individuals with clinical eating disorders often display severe feelings of insecurity and worthlessness, have trouble identifying and displaying emotions, and experience difficulty forming close relationships with others . In addition, clinical eating disorders are often accompanied by comorbid psychological conditions, such as obsessive-compulsive disorder, depression, and anxiety disorder .
Clinical eating disorders
A significant loss of body weight, the maintenance of an extremely low body weight (85% of normal weight for height), or both An intense fear of gaining weight or ''becoming fat'' Severe body dissatisfaction and body image distortion Amenorrhea (absence of >3 consecutive menstrual periods) Bulimia nervosa
Episodes of binge eating (ie, consuming a large amount of food in a short period) followed by purging (via laxatives, diuretics, enemas, or self-induced vomiting) that have occurred at least twice a week for 3 mo A sense of lack of control during the bingeing or purging episodes Severe body image dissatisfaction and undue influence of body image on self-evaluation Eating disorders not otherwise specified (EDNOS) All the criteria for anorexia nervosa are met except amenorrhea
All the criteria for anorexia nervosa are met except that, despite significant weight loss, the individual's current weight is within the normal range All the criteria for bulimia nervosa are met except that the binge and purge cycles occur at a frequency of less than twice a week for a duration of <3 mo An individual of normal body weight regularly uses purging behaviors after eating small amounts of food (e.g., self-induced vomiting after consuming only 2 cookies) An individual repeatedly chews and spits out, but does not swallow, large amounts of food
Adapted from American Psychological Association. Diagnostic and statistical manual of mental disorders. 4th edition. Washington, DC: APA; 1994.
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