A Word About Eating Disorders

Eating disorders are not rare—actually, they are common. In sororities, women’s athletic teams, and in certain other groups—such as actresses, models, dancers, cheerleaders, and others—as many as 20% can have an eating disorder.

In spite of eating disorders being so common, it can be difficult to find a physician with expertise in this area. Dr. Tyson has been educating others about eating disorders for 15 years and takes the chance to lecture on this topic whenever he can. He has spoken to the public and professionals as well as to universities and medical schools. He regularly teaches on this subject at the University of Texas in the Department of Kinesiology and Health Education.

To continue in the effort to educate and assist those needing more information, this website will devote much of its space to that cause. We intend for this to be information that is user-friendly and applicable, not just the usual pamphlet handed out by someone who does not really want to spend any time talking about it. Most of the topics will be what Dr. Tyson’s patients have told him they want answers to. Hopefully, a humorous perspective may be thrown in, as well.

Eating Disorders—Defined
….as well as we can

The technical definitions of eating disorders are contained in the DSM IV (Diagnostic and Statistical Manual for Mental Disorders, Fourth Version) published by the American Psychiatric Association in 1994. This is a reference that lists all the technical criteria to make a diagnosis about any psychiatric problem and is the standard that most use to officially diagnose these disorders. The next revision, DSM V, will be published in 2013. There are more details on these disorders in the DSM, should you be inclined to study it further.
Caveat: Up to 50% or so of people who seek treatment for an eating disorder do not fit the official criteria listed in the DSM IV. So, the definitions listed are very specific but not as sensitive or encompassing as perhaps would be more useful. Also, binge-eating disorder is not listed as an official diagnosis. It is being considered as a separate diagnosis with its own CPT code, but that is not "official" yet. But keep in mind, it is more important what a person does than how we label the disorder.

Another word about definitions of eating disorders-
You notice that these definitions do not really address the medical complications that can occur from having an eating disorder. Do not think that these are just "psychiatric" problems. While Anorexia has the highest mortality rate of any psychiatric disorder, the reason most people die from it do so because of medical complications. Having a thorough medical evaluation can be critical for the well-being and recovery of someone with an eating disorder.

Be aware: Your insurance company may insist that eating disorders are just psychiatric problems. Therefore, they will say they only cover it as a psychiatric disorder, which it so happens often requires them to pay less in coverage. Any medical issues would be covered at that lower level as well...that is, if you accept that decision. Many across the country are fighting this very issue. In Texas, there is a very strong effort to hold insurance companies accountable for this approach. Please ask Dr. Tyson to direct you to where you can get more information.

These are the definitions (direct quotes) from the DSMIV:

Anorexia Nervosa
A. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).

B. Intense fear of gaining weight or becoming fat, even though underweight.

C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

D. In postmenarcheal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen, administration.)

Specific type:
Restricting type: During the current episode of Anorexia Nervosa, the person has not regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxative, diuretics, or enemas)

Binge-Eating/Purging Type: During the current episode of Anorexia nervosa, the person has regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxative, diuretics, or enemas)

Bulimia Nervosa
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
(1) 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

(2) 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)

B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise.

C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.

D. Self-evaluation is unduly influenced by body shape and weight.

E. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.

Specific type:
Purging Type: During the current episode of Bulimia Nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas

Nonpurging Type: During the current episode of bulimia Nervosa, the person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas


Eating Disorder Not Otherwise Specified
The Eating Disorder Not Otherwise Specified category is for disorders of eating that do not meet the criteria for any specific Eating Disorder. Examples include
1. For females, all of the criteria for Anorexia nervosa are met except that the individual has regular menses.

2. All of the criteria for Anorexia Nervosa are met except that, despite significant weight loss, the individual’s current weight is in the normal range.

3. All of the criteria for Bulimia Nervosa are met except that the binge eating and inappropriate compensatory mechanisms occur at a frequency of less than twice a week or for a duration of less than 3 months.

4. The regular use of inappropriate compensatory behavior by an individual of normal body weight after eating small amounts of food (e.g., self-induced vomiting after the consumption of two cookies).

5. Repeated chewing and spitting out, but not swallowing, large amounts of food.

6. Binge-eating disorder: recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory behaviors characteristic of Bulimia Nervosa.

Caveat: Up to 50% or so of people who seek treatment for an eating disorder do not fit the official criteria listed in the DSM IV. So, the definitions listed are very specific but not as sensitive or encompassing as perhaps would be more useful. Also, binge-eating disorder is not listed as an official diagnosis. It is being considered as a separate diagnosis with its own CPT code, but that is not "official" yet.

Another word about definitions of eating disorders—

You notice that these definitions do not really address the medical complications that can occur from having an eating disorder.

Do not think that these are just "psychiatric" problems. While anorexia has the highest mortality rate of any psychiatric disorder, the reason most people die from it do so because of medical complications!

Having a thorough medical evaluation can be critical for the well-being of someone with an eating disorder.

Be aware: Your insurance company may insist that eating disorders are just psychiatric problems. Therefore, they will say they only cover it as a psychiatric disorder, which it so happens usually requires them to pay less in coverage. Any medical would be covered at that lower level as well…

…that is, if you accept that decision. Many across the country are fighting this very issue. In Texas, there is a very strong effort to hold insurance companies accountable for this approach. Please follow this link to learn more about this issue. Link to Lifelines

I recommend that you persist in your efforts to be treated appropriately by the insurance companies if that occurs in your case.

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