Table 1

Adapted from the DSM-IV-TR: necessary diagnostic criteria for eating disorders (axis-1)

Anorexia nervosa: rare in individuals with diabetes.
    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 <85% of that expected or failure to make expected weight gain during period of growth, leading to body weight <85% of that expected).
    Intense fear of gaining weight or becoming fat, despite being underweight.
    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 seriousness of the current low body weight.
Bulimia nervosa: low prevalence rate of diagnosis but commonly reported behavior in individuals with diabetes.
    Recurrent episodes of binge eating, characterized by:
        Eating, in a discrete period of time (e.g., within any 2-h 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, enemas, or other medications (insulin omission); and fasting or excessive exercise.
    Binge eating and inappropriate compensatory behaviors both occur, on average, ≥2 episodes per week for ≥3 months.
    Self-evaluation is unduly influenced by body shape and weight concerns.
Eating disorder not otherwise specified (EDNOS): more commonly diagnosed in individuals with diabetes and includes disorders of eating that do not meet the criteria for any specific eating disorder.
    All of the criteria for bulimia nervosa are met except that the binge eating and inappropriate compensatory mechanisms occur at a frequency of <2 episodes per week or for duration <3 months.
    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 or insulin omission or reduction after consumption of normal amount of food).
Binge eating disorder (BED): most prevalent diagnosis in individuals with diabetes.
    Recurrent episodes of binge eating. An episode is characterized by eating a larger amount of food than normal during a short period of time (within any 2-h period) and lack of control over eating during the binge episode (i.e., the feeling that one cannot stop eating).
    Binge eating episodes are associated with three or more of the following:
        Eating until feeling uncomfortably full.
        Eating large amounts of food when not physically hungry.
        Eating much more rapidly than normal.
        Eating alone because you are embarrassed by how much you are eating.
        Feeling disgusted, depressed, or guilty after overeating.
            Marked distress regarding binge eating is present.
            Binge eating occurs, on average, ≥2 days per week for ≥6 months.
            The binge eating is not associated with the regular use of inappropriate compensatory behavior (i.e., purging, excessive exercise, etc.) and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.