Classification and Diagnosis
of Eating Disorders
PAUL E. GARFINKEL
There has been rapid evolution in the classification and understanding of eating disorders in a relatively brief period of time. Anorexia nervosa was the first eating disorder to be classified, with specific diagnostic criteria developed in the 1970s. In 1979, bulimia nervosa was described. In the 1980s, the existence of atypical eating disorders (that is, eating disorders other than anorexia nervosa and bulimia nervosa—see Chapter 30) was recognized. Most recently, two new eating disorders have been demarcated—namely, “binge eating disorder” and the “night eating syndrome” (see Chapters 31 and 32, respectively)—although their diagnostic status remains the subject of debate.
The focus of this chapter is on the classification and diagnosis of the two best established eating disorders, anorexia nervosa and bulimia nervosa.
Since 1969, a variety of operational criteria for anorexia nervosa that emphasize signs and symptoms have been developed. The first such criteria were proposed by Gerald Russell in 1970. Russell emphasized (1) a behavioral disturbance, (2) a characteristic psychopathology, and (3) an endocrine disorder. The behavioral disturbance leads to a marked loss of body weight; the psychopathology is characterized by a morbid fear of getting fat; and the endocrine disorder manifests itself clinically by amenorrhea in females and loss of sexual potency and sexual interest in males. These criteria have evolved into the current DSM-IV and ICD-10 criteria (shown in Tables 28.1 and 28.2, respectively).