Eating disorders in adolescent females with and without type 1 diabetes: cross sectional study

Diagnostic criteria for eating disorders

Anorexia nervosa*

• Refusal to maintain body weight at or above a minimally normal weight for age and height

• Intense fear of gaining weight or becoming fat, even though underweight

• Disturbance in the way in which body weight or shape is experienced; undue influence of body weight and shape on self evaluation, or denial of the seriousness of current low body weight

• In postmenarchal females, amenorrhea—that is absence of at least three consecutive menstrual cycles (a woman is considered to have amenorrhea if her periods occur only after hormone administration)

Bulimia nervosa*

• Recurrent episodes of binge eating

• Recurrent inappropriate compensatory behaviour to prevent weight gain, such as self induced vomiting; misuse of laxatives, diuretics, or other drugs (including insulin); fasting; or excessive exercise

• Binge eating and inappropriate compensatory behaviours both occur, on average, at least twice a week for three months

• Self evaluation is unduly influenced by body shape and weight

• Disturbance does not occur exclusively during episodes of anorexia nervosa

Eating disorder not otherwise specified

• All the criteria for anorexia nervosa except amenorrhea; or

• All criteria for anorexia nervosa, except that the subject does not report a fear of weight gain or a disturbance in the way in which her body weight or shape is experienced; or

• All criteria for bulimia nervosa except that the subject does not report self evaluation being unduly influenced by shape or weight; or

• All the criteria for bulimia nervosa except that binge eating and purging behaviour occurred at least once a week for past 3 months, or twice a week over the previous four weeks; or

• Regular inappropriate compensatory behaviour in the absence of binge eating—for example, recurrent self induced vomiting or insulin omission for shape and weight control at least once a week for past three months or twice weekly over previous four weeks; or

• Recurrent episodes of objective binge eating (at least once a week for past three months or twice weekly over past four weeks)

Subthreshold disorders

• Occasional (a minimum of three episodes) binge eating or purging over past three months; or

• Repeated chewing and spitting out of food to prevent weight gain (at least once a week over the preceding three months or twice a week over the past four weeks); or

• Regular extreme dietary restraint (<2.1 MJ/day) or excessive exercising (more than 120 minutes, 5 times a week) for purpose of weight loss over past 4 weeks in absence of binge eating

*Minimum of four symptoms needed for diagnosis