NEDA TOOLKIT for Coaches and Trainers
Types of eating disorders
By Kathryn Ackerman, MD, MPH, internist, endocrinologist and sports medicine specialist, Children’s Hospital
Boston and Massachusetts General Hospital; instructor, Harvard Medical School; team physician, US Rowing and
Community Rowing, Inc.
Anorexia Nervosa is defined by the following criteria:
• Restriction of energy intake relative to
requirements leading to a significantly low
body weight in the context of age, sex,
developmental trajectory, and physical health.
Either an intense fear of gaining weight or
of becoming fat, or persistent behavior that
interferes with weight gain (even though
significantly low weight).
• Disturbance in the way one’s body weight
or shape is experienced, undue influence of
body shape and weight on self-evaluation,
or persistent lack of recognition of the
seriousness of the current low body weight.
Anorexia nervosa is then subdivided into a restricting
type and a binge eating/purging type.
Bulimia Nervosa is defined by the following criteria:
• Recurrent episodes of binge eating. An episode
of binge eating is characterized by both of the
following: Eating, in a discrete period of time
(e.g., within any 2-hour period), an
amount of food that is definitely larger
than most people would eat during a
similar period of time and under similar
circumstances. A sense of lack of control over eating
during the episode (e.g., a feeling that
one cannot stop eating or control what
or how much one is eating).
• Recurrent inappropriate compensatory
behavior in order to prevent weight gain, such
as self-induced vomiting, misuse of laxatives,
diuretics, or other medications, fasting, or
excessive exercise.
• The binge eating and inappropriate
compensatory behaviors both occur, on
average, at least once a week for three months.
• Self-evaluation is unduly influenced by body
shape and weight.
• These behaviors do not occur exclusively
during episodes of anorexia nervosa.
Athletes suffering from bulimia nervosa may have
some or all of the general disordered eating signs and
symptoms, but also are at higher risk for esophageal
tears from vomiting, gastrointestinal complications
such as diarrhea or constipation, and dental caries and
calluses on their hands from induced vomiting.
Binge Eating Disorder (BED) is characterized by the
following: • Recurrent episodes of binge eating. An episode
of binge eating is characterized by both of the
following: Eating, in a discrete period of time
(e.g., within any 2-hour period), an
amount of food that is definitely larger
than most people would eat during a
similar period of time and under similar
circumstances. A sense of lack of control over eating
during the episode (e.g., a feeling that
one cannot stop eating or control what
or how much one is eating).
• The binge eating episodes are associated with
three or more of the following:
eating much more rapidly than normal
eating until feeling uncomfortably full
eating large amounts of food when not
feeling physically hungry
eating alone because of feeling
embarrassed by how much one is
eating feeling disgusted with oneself,
depressed or very guilty afterward
• Marked distress regarding binge eating is
present • Binge eating occurs, on average, at least once a
week for three months
• Binge eating is not associated with the
recurrent use of inappropriate compensatory
behaviors (methods to compensate for
overeating, such as self-induced vomiting) as in
bulimia nervosa and does not occur exclusively
during the course of bulimia nervosa or
anorexia nervosa.
Bulimia nervosa is subdivided into purging and non-
purging types.
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