There are different kinds of eating disorders meaning compulsive, overeating, bulimia and anorexia nervosa. The medical definitions for anorexia nervosa, bulimia and binge eating disorder or what's called eating disorder not otherwise specified. Those definitions come from a diagnostic manual put up by the American Psychiatric Association. Sometimes referred to as a DSM4 or Diagnostic Statistical Manual and this is the fourth edition. So, they typically define anorexia nervosa as a patient who has the following symptoms, one being at least 20% below normative weight, the other being amenorrhea or cessation of a woman's period and the third generally having to do with that person having a phobia about weight gain or relentless pursuit of either maintaining a low weight or pursuit of losing more weight in the face of consequences physically and then lastly having a distortion or distorted sense of size or distorted body image. Bulimia is usually defined by three or more episodes of binge or compulsive overeating of at least 2000 or more calories per episode followed by one or more of the following, self inducing vomiting, ingesting laxatives or compulsive exercising and also a preoccupation with body weight and food. The definition for what I would call compulsive overeating is usually referred to as a binge eating disorder which is a relatively new category and has to do with three or more episodes per week of significant overeating beyond 2000 or more calories per episode, but not necessarily followed by purging via laxatives, exercise, diuretics or self-induced vomiting. In my experience, one of the first ways with which a physician or professional can diagnose an eating disorder is basing that diagnosis on what someone looks like or what they weigh and the reason for that is that patients can present having normal weight for instance and be suffering with bulimia, binge eating disorder, etc. and sometimes when patients are overweight they kind of flip flop between a compulsive overeating pattern but also the patient is anorexic or fasting stance. So when it varies, someone who is overweight, trying to loose weight by restricting their intake let's say 500 calories a day and they have been mimicking the behavioral pattern of someone with anorexia, but they would not be diagnosed until their weight drop below 20% of normative weight. An example that is coming to light is, some patients who are gastric bypass patients and these patients are massively overweight when they have the surgery. A contention of those patients begin losing weight and are unable or unwilling to stop and then suffer from malnutrition, malabsorption and some times an iatrogenic ally or physician induced problem such as anorexia can emerge. So grouping this all together, I would say that the first measure is defining an eating disorder in terms of what somebody weighs and the better measure of defining an eating disorder is the extent to which their life and thoughts consistently center on issues of body image, dieting and food. In other words the mental component of the illness is more relevant than the physical in my mind. What alienates most people who are concerned about their weight and diet frequently from an eating disorder population is sort of on the continuum of severity. So there is a difference between a weight disorder and an eating disorder. On that continuum I would say that someone crosses the line into an eating disorder from just being neurotic about their weight and appearance when their actions or their behaviors around food and weight become debilitating or have severe consequences to their quality of life. It's very similar in some respects to what alienates a social drinker or a heavy drinker from an alcoholic. The alcoholic and the social drinker can drink the same amount of alcohol with the same frequency and one I would define one as alcoholic and the other a heavy social drinker because the alcoholic has severe consequences either physically or family or otherwise associated with what they drink. In other words its not so much how much you drink or how often but what happens to you when you do drink and then lastly what alienates those two would be a loss of control. Despite not wanting to drink, the alcoholic finds himself drinking at the end of the day despite not wanting to and the social drinker if for instance was told that he needs or she needs to stop drinking for a little while because they have some liver damage would probably find that it is possible for them to stop, where the alcoholic despite the consequences, will continue to drink. If you carry that analogy over to someone with an eating disorder what alienates the weight disorder from the eating disorder in all three categories will be if someone were underweight and they were told by their physician or their family that they weren't looking well or that they needed to gain some weight or they needed to increase the amount of their eating. The person with the weight disorder could probably do that with very little uncomfortable feelings associated with that, whereas someone who is anorectic would find that despite seeing themselves as either too thin or hearing that from credible sources would not be able to on their own increase their intake or gain weight because of the emotional consequence to doing that. For instance, if you took 10 women; young women who are binge eating and purging on the college campus or in a sorority you might find that seven out of those ten grow out of it or just simply stop or do it only once in a while or you might find three or 30% of those 10 find that they don't stop or continue doing that even outside that environment and into later life. So again making this analogy between alcohol patterns and eating disorders, most people have experiences with over drinking but not all people that over drink become alcoholic and most people have experiences with overeating but not all develop an eating disorder. So I took you a long way around to get a feel for how we define this.
