This article includes discussion of anorexia that may be challenging for some readers.

September 7, 2022
By Ashlyn Byers, Drexel University College of Medicine

The Diagnostic and Statistical Manual of Mental Disorders Edition-5 (DSM-5) is the most recent publication by American Psychiatric Association to guide in the diagnosis and classification of mental health disorders. The DSM-5 contains sets of diagnostic symptoms grouped into disorders, which assists clinicians and researchers with effective diagnosis and treatment. According to the DSM-5 chapter “Feeding and Eating Disorders,” there are four groups of eating disorders: anorexia nervosa, bulimia nervosa, binge eating disorder, and unspecified eating disorders (American Psychiatric Association, 2013). As the most common eating disorder among both female and male adolescents is anorexia nervosa (AN), this post further explores the definition, treatments and challenges to recovering from AN.

In the DSM-5, anorexia nervosa is defined as “A. Restriction of energy intake relative to requirements, leading to a significant low body weight in the context of the age, sex, developmental trajectory, and physical health. B. Intense fear of gaining weight or becoming fat or persistent behavior that interferes with weight gain for at least 3 months.” In addition, the DSM-5 specifies that diagnosis of AN is based on an underweight body mass index (BMI) (American Psychiatric Association, 2013). As a normal BMI is between 18.5 and 24.9, a patient must have a BMI lower than 18.5 to meet criteria for AN as defined by the DSM-5.

If a patient is given a diagnosis of AN, the first step is setting up a treatment plan. The Mayo Clinic divides eating disorder treatment into four categories: psychological treatment, nutritional education, medication and hospitalization (Eating Disorder Treatment, 2022). For eating disorders, psychological therapy is considered the most important component of treatment. This may include cognitive behavioral therapy, group behavioral therapy, family-based therapy or a combination based on the patient’s needs. In addition to therapy, patients may meet with a registered dietician to establish regular eating patterns or a psychiatrist to medically manage symptoms of depression and anxiety. Alternatively, hospitalization may be necessary to treat serious physical or mental health problems associated with the eating disorder (Types of Treatment, 2018). Though only 20% of individuals with an eating disorder pursue treatment, almost all major health care providers offer coverage for mental health services. This often includes 12 therapy sessions and 30 to 60 days of inpatient treatment per year (Blue Cross Blue Shield Association Eating Disorder Coverage, 2022). Insurance plans may also increase coverage at the recommendation of a health care provider, to ensure that the patient receives adequate treatment.

An additional challenge to eating disorder treatment and recovery is the patient’s attitude. In a study by Fogarty and Ramjan, an online questionnaire found that self-acceptance, being understood and hope for life after AN were the top three factors in successful treatment and recovery from the eating disorder (2016). Unfortunately, even among patients who receive treatment for AN, approximately 30% relapse within the first 4 to 16 months (Berends et al., 2016). These studies suggest that more focus should be placed on research, education and personalized relapse prevention plans for eating disorders. This is being pursued at Drexel University Center for Weight, Eating and Lifestyle Science (WELL), which aims to improve research, training and clinical care for obesity, poor diet and disordered eating (WELL Center, 2022). With these resources, health care providers can improve the psychological and medical treatment options and outcomes for eating disorders.

For more information about receiving treatment, participating in research, or joining the Drexel University Center for Weight, Eating and Lifestyle Science, visit drexel.edu/coas/academics/departments-centers/well-center/.

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Sources/Resources:

• American Psychiatric Association. (2013). Feeding and eating disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
• Berends T, van Meijel B, Nugteren W, Deen M, Danner UN, Hoek HW, van Elburg AA (2016). Rate, timing, and predictors of relapse in patients with anorexia nervosa following a relapse prevention program: a cohort study. BMC Psychiatry, 16:316. doi: 10.1186/s12888-016-1019
• Blue Cross Blue Shield Association Eating Disorder Coverage. (2022). Retrieved on July 25, 2022 from Psych Guides website https://www.psychguides.com/eating-disorder/treatment/blue-cross-blue-shield/.
• Eating Disorder Treatment: Know Your Options. (2022). Retrieved on July 25, 2022 from Mayo Clinic website https://www.mayoclinic.org/diseases-conditions/eating-disorders/in-depth/eating-disorder-treatment/art-20046234.
• Fogarty S, Ramjan L (2016). Factors impacting treatment and recovery in Anorexia Nervosa: qualitative findings from an online questionnaire. Journal of Eating Disorders, 4:18. doi: 10.1186/s40337-016-0107-1
• Types of Treatment. (2018). Retrieved on July 25, 2022 from National Eating Disorders Association website https://www.nationaleatingdisorders.org/types-treatment/.
• WELL Center. (2022). Retrieved on July 27, 2022 from Drexel University College of Arts and Sciences website https://drexel.edu/coas/academics/departments-centers/well-center/