Anorexia nervosa classification
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Joseph Nasr, M.D.[2]
Classification
Anorexia nervosa is classified as a feeding and eating disorder in both the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) and the World Health Organization International Classification of Diseases, 11th Revision (ICD-11). The diagnostic criteria for eating disorders in DSM-5-TR and ICD-11 are described as similar, with both systems defining anorexia nervosa by a substantial disturbance in eating behavior accompanied by characteristic psychological and behavioral features.[1] [2]
Subtypes
Two subtypes of anorexia nervosa are recognized in the DSM-5-TR classification system. The restricting subtype refers to individuals who achieve weight loss primarily through restriction of food intake and/or excessive exercise, without regular engagement in binge-eating or purging behaviors. The binge-eating/purging subtype includes individuals who, in addition to restrictive eating, engage in binge-eating episodes and/or purging behaviors such as self-induced vomiting or misuse of laxatives.[1]
These subtypes are used to describe patterns of eating-related behaviors and may change over time within the same individual rather than representing distinct disease entities.[1]
Atypical Anorexia Nervosa
The term atypical anorexia nervosa was introduced in DSM-5 in 2013 to describe individuals who experience substantial weight loss and exhibit many of the psychological, behavioral, and physiologic characteristics of anorexia nervosa but whose body weight remains within the normal or overweight range.[3][4]
Emerging epidemiologic data cited in this review suggest that the lifetime prevalence of atypical anorexia nervosa may be similar to that of typical anorexia nervosa, with reported prevalence estimates of 2.9% and 3.1%, respectively[5] (Harrop et al., 2021). However, due to limited evidence regarding the natural history and treatment response of atypical anorexia nervosa, it is not discussed further in the review.[4]
Scope and Limitations of Classification
The review does not describe formal severity staging systems, alternative phenotypic classifications, or neurobiological subtyping of anorexia nervosa. Classification is limited to diagnostic framework alignment between DSM-5-TR and ICD-11, recognition of behavioral subtypes, and acknowledgment of atypical anorexia nervosa as a related diagnostic entity.[6]
References
- ↑ 1.0 1.1 1.2 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. American Psychiatric Association Publishing; 2022.
- ↑ World Health Organization. ICD-11: International Classification of Diseases, 11th Revision. Accessed May 22, 2024. https://icd.who.int/en
- ↑ American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association Publishing; 2013.
- ↑ 4.0 4.1 Walsh BT, Hagan KE, Lockwood C. A systematic review comparing atypical anorexia nervosa and anorexia nervosa. Int J Eat Disord. 2023;56(4):798- 820. doi:10.1002/eat.23856
- ↑ Harrop EN, Mensinger JL, Moore M, Lindhorst T. Restrictive eating disorders in higher weight persons: a systematic review of atypical anorexia nervosa prevalence and consecutive admission literature. Int J Eat Disord. 2021;54(8): 1328-1357. doi:10.1002/eat.23519
- ↑ Attia, E. and Walsh, B.T. (2025) ‘Eating disorders’, JAMA, 333(14), p. 1242. doi:10.1001/jama.2025.0132.