Diagnoses of eating or dieting disorders: what may we learn from past mistakes?

A brief history of a patient is given and an attempt is made to reconcile the clinical realities she presents with the various diagnostic criteria that have been proposed for eating disorders. Despite much deliberation and many formulations, no scheme fully encompasses her not-uncommon problem. Rather than tinker yet again with the criteria for the syndromes of anorexia and bulimia nervosa, or introduce yet another new condition such as binge eating disorder, the authors suggest a unitary approach to diagnosis. Emphasis should be placed on the preoccupation with weight loss, the illness should be conceptualized as a dieting disorder rather than an eating disorder, and patient status should be accorded only when the disturbance results in significant psychological or physical ill-effects. The term anorexia nervosa should be retained for such cases, and all anorexia nervosa patients should be categorized on three parameters, viz: their current state of nutrition; the presence or absence of significant purging behaviors; and whether or not they have binge eating episodes.