Anorexia nervosa is characterized by restricted food intake leading to low body weight from an intense fear of gaining weight. Changes in the brain from starvation can make it difficult for those with anorexia nervosa to recognize they are unwell. There are two subtypes: restricting type who lose weight by dieting/fasting/exercise, and binge-eating/purging type who also engage in intermittent binge eating and purging.

1. Anorexia nervosa is characterised by restriction
of energy intake leading to significantly low
body weight accompanied by an intense fear of
weight gain and body image disturbance.
Changes that happen in the brain because of
starvation and malnutrition can make it hard for
a person with anorexia nervosa to recognise
that they are unwell, or to understand the
potential impacts of the illness. There are two
subtypes of anorexia nervosa:
● Restricting type, in which individuals lose
weight primarily by dieting, fasting or
excessively exercising
● Binge-eating/purging type in which
persons also engage in intermittent
binge eating and/or purging behaviors.
Anorexia Nervosa
● Menstrual periods cease
● Dizziness or fainting from dehydration
● Brittle hair/nails, cold intolerance
● muscle weakness and wasting
● Heartburn and reflux (in those who vomit)
● Severe constipation, bloating and fullness
after meals
● Stress fractures from compulsive exercise
as well as bone loss resulting in osteopenia
or osteoporosis (thinning of the bones)
● Depression, irritability, anxiety, poor
concentration and fatigue
Diagnostic criteria

2. Bulimia nervosa is characterised by recurrent
episodes of binge eating, followed by
compensatory behaviours, such as vomiting
or excessive exercise to prevent weight gain.
A person with bulimia nervosa can become
stuck in a cycle of eating in an out-of-control
manner, followed by attempts to compensate
for this, which can lead to feelings of shame,
guilt and disgust. These behaviours can
become more compulsive and uncontrollable
over time, and lead to an obsession with food,
thoughts about eating (or not eating), weight
loss, dieting and body image.
Bulimia nervosa
● Frequent trips to the bathroom right after meals
● Large amounts of food disappearing or
unexplained empty wrappers and food
containers
● Chronic sore throat
● Swelling of the salivary glands in the cheeks
● Dental decay resulting from erosion of tooth
enamel by stomach acid
● Heartburn and gastroesophageal reflux
● Laxative or diet pill misuse, recurrent
unexplained diarrhea
● Misuse of diuretics (water pills)
● Feeling dizzy or fainting from excessive purging
behaviors resulting in dehydration
Diagnostic criteria

3. BED is characterised by recurrent episodes of
binge eating, which involves eating a large
amount of food in a short period of time.
During a binge episode, the person feels
unable to stop themselves eating, and it is
often linked with high levels of distress. A
person with BED will not use compensatory
behaviours, such as self-induced vomiting or
over exercising after binge eating.
Binge Eating Disorder
The diagnosis of ARFID requires that difficulties with
eating are associated with one or more of the
following:
● Significant weight loss (or failure to achieve
expected weight gain in children).
● Significant nutritional deficiency.
● The need to rely on a feeding tube or oral
nutritional supplements to maintain sufficient
nutrition intake.
● Interference with social functioning (such as
inability to eat with others).
Diagnostic criteria

4. ARFID is characterised by a lack of interest,
avoidance and aversion to food and eating.
The restriction is not due to a body image
disturbance, but a result of anxiety or phobia
of food and/or eating, a heightened sensitivity
to sensory aspects of food such as texture,
taste or smell, or a lack of interest in food
and/or eating. ARFID is associated with one
or more of the following: significant weight
loss, significant nutritional deficiency,
dependence on enteral (tube) feeding or
supplementation, and a marked interference
with psychosocial functioning.
Avoidant/restrictive food
intake disorder (ARFID)
● Low appetite and lack of interest in eating or
food.
● Extreme food avoidance based on sensory
characteristics of foods e.g. texture,
appearance, color, smell.
● Anxiety or concern about consequences of
eating, such as fear of choking, nausea,
vomiting, constipation, an allergic reaction, etc.
The disorder may develop in response to a
significant negative event such as an episode
of choking or food poisoning followed by the
avoidance of an increasing variety of foods
Diagnostic criteria

5. A person with OSFED may present with many
of the symptoms of other eating disorders
such as anorexia nervosa, bulimia nervosa or
binge eating disorder but will not meet the full
criteria for diagnosis of these disorders. This
does not mean that the eating disorder is any
less serious or dangerous. The medical
complications and eating disorder thoughts
and behaviours related to OSFED are as
severe as other eating disorders.
Other specified feeding or
eating disorders (OSFED)
● Eating more rapidly than normal
● Eating until uncomfortably full
● Eating large amounts of food when not feeling
hungry
● Eating alone because of feeling embarrassed
by how much one is eating
● Feeling disgusted with oneself, depressed or
very guilty afterward
Diagnostic criteria

6. The essential feature of pica is the eating of one
or more non-nutritive, non-food substances on a
persistent basis over a period of at least 1 month
that is severe enough to warrant clinical attention.
Typical substances ingested tend to vary with age
and availability and might include paper, soap,
cloth, hair, string, wool, soil, chalk, talcum powder,
paint, gum, metal, pebbles, charcoal, or coal, ash,
clay, starch, or ice. There is typically no aversion
to food in general.
The eating of non-nutritive, non-food substances
can be an associated feature of other mental
disorders (e.g., intellectual development disorder
[intellectual disability], autism spectrum disorder,
schizophrenia).
Pica
Other presentations

7. Rumination disorder involves the regurgitation
of food, which may be re-chewed, re-swallowed
or spit out. Rumination typically occurs every
day, and at every meal, usually within 30
minutes of eating.
There are no clear causes for rumination
disorder, but it is understood to be
subconscious behaviour, not conscious.
It is known to occur in infants and people with
intellectual development disorders, but it can
also occur in other children, adolescents and
adults.
Rumination disorder
Other presentations

8. A person with Unspecified Feeding or Eating
Disorder experiences symptoms which are
characteristic of a feeding and eating disorder,
causing significant distress or impairment in
social, occupational or other important areas of
functioning. They do not however meet the full
criteria for any of the disorders in the feeding and
eating disorders diagnostic class.
It is different to an Other Feeding or Eating
Disorder diagnostic in that the clinician has
chosen not to specify the reason that the criteria
are not met for a specific feeding and eating
disorder, and includes presentations in which
there is insufficient information to make a more
specific diagnosis.
Unspecified Feeding or Eating
Disorder
Other presentations