Table 1

Key features of eating disorders8 9

Eating disorderClinical features
Anorexia nervosa
  • Energy intake restriction with the aim of body weight reduction or body shape change

  • Intense fear of weight gain

  • Behaviours that interfere with weight gain (eg, excessive exercise, use of laxatives or diuretics, appetite suppression medication)

  • BMI for age of <5th percentile, or a rapid weight loss (eg, more than 20% within 6 months) not accounted for by another medical condition or unavailability of food

  • These are not diagnostic, but you may also see features such as emaciation, loss of muscle strength, dry skin, lanugo hair, cold extremities, amenorrhoea, bradycardia and osteopenia

Bulimia nervosa
  • Recurrent binge eating episodes often associated with distress

  • Recurrent inappropriate compensatory behaviour (eg, vomiting, purging, excessive exercise, laxative use)

  • A preoccupation with body shape or weight

  • Bloating

  • Fullness

  • These are not diagnostic, but you may see Russell’s sign (knuckle calluses from induced vomiting), loss of enamel on teeth from repeated vomiting or parotid swelling

eating disorder
  • Recurrent binge eating episodes

  • Bingeing is often accompanied by negative emotions, for example, guilt or disgust. It may lead to weight gain and in some cases obesity

  • No regular inappropriate compensatory behaviour

Avoidant/restrictive food intake disorder
  • There may be a low interest in eating or a sensory-based avoidance as examples

  • Intake of an insufficient quantity or variety of food to meet energy and nutritional requirements

  • May result in weight loss, nutritional deficiencies or other negative impacts on the physical health of the person, or impairment in other aspects of their life, for example, unable to socialise due to distress associated with eating

  • Not related to beliefs about weight/shape

specified feeding/eating disorder
  • Features of AN, BN or BED

  • Not clinically met by ICD-11 criteria