In partial remission: Al'ter full criteria for anorexia nervosa were previously met, Cri- terion A (low body weight) has not been met for a sustained period, but either Criterion
B (intense fear of gaining weight or becoming fat or behavior that interferes with weight gain) or Criterion C (disturbances in seIf-perception of weight and shape) is still met.
In full remission: After full criteria for anorexia nervosa were previously met, none of the criteria have been met for a sustained period of time.
Specify current severity:
The minimum level of severity is based, for adults, on current body mass index (BMI) (see below) or, for children and adolescents, on BMI percentile. The ranges below are derived cents, corresponding BMI percentiles should be used. The level of severity may be in— creased to reflect clinical symptoms, the degree of functional disability, and the need for supervision.
Mild: BM|217 kg/m2
Moderate: BMI 16—16.99 kg/m2
Severe: BMI 15—15.99 kg/m2
Extreme: BMI < 15 kg/m2
Most individuals with the binge-eating/purging type of anorexia nervosa who binge eat also purge through self—induced vomiting or the misuse of laxatives, diuretics, or enemas.
Some individuals with this subtype of anorexia nervosa do not binge eat but do regularly purge after the consumption of small amounts of food.
Crossover between the subtypes over the course of the disorder is not uncommon; therefore, subtype description should be used to describe current symptoms rather than longitudinal course.
There are three essential features of anorexia nervosa: persistent energy intake restriction; intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain; and a disturbance in self—perceived weight or shape. The individual main- tains a body weight that is below a minimally normal level for age, sex, developmental tra- jectory, and physical health (Criterion A). Individuals’ body weights frequently meet this criterion following a significant weight loss, but among children and adolescents, there may alternatively be failure to make expected weight gain or to maintain a normal devel- opmental trajectory (i.e., while growing in height) instead of weight loss.
Criterion A requires that the individual’s weight be significantly low (i.e., less than minimally normal or, for children and adolescents, less than that minimally expected).
Weight assessment can be challenging because normal weight range differs among indi- viduals, and different thresholds have been published defining thinness or underwzeight status. Body mass index (BMI; calculated as weight 1n kilograms /he1ght1n mezters 2') 1s a useful measure to assess body weight for height. For adults, a BMI of 18.5 kg/m 2has been employed by the Centers for Disease Control and Prevention (CDC) and the World Health
Organization (WHO) as the lower limit of2 normal body weight. Therefore, most adults with a BMI greater than or equal to 18.5 kg/m2 would not be considered tzo have a significantly low body weight. On the other hand, a BMI of lower than 17.0 kg/m 2has been considered by the WHO to indiczate moderate or severe thinness; therefore, an individual with a BMI less than 17. 0 kg/m 2would likely be considzered to have a significantly low weight An adult with a BMI between 17. 0 and 18.5 kg/mz, or even above 18.5 kg/m ,might be consid- ered to have a significantly low weight if clinical history or other physiological informa- tion supports this judgment.