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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. Page  | 5