Classification

ICD-10(102) (including patients with premenarchal onset(98))

1. Body weight is maintained at least 15 per cent below that expected for health. Prepubertal children may fail to gain the weight expected during the growth spurt. Weight loss is caused by avoidance of 'fattening' foods, possibly with the addition of self-induced vomiting, purgative abuse, excessive exercise, or the use of appetite suppressants.

2. The patient holds the overvalued idea of a dread of fatness and keeps her weight below a self-imposed threshold.

3. There is an endocrine failure manifest in women as amenorrhoea and in men as a loss of sexual interest and potency.

4. If the onset is premenarchal, the sequence of pubertal events is delayed: growth is arrested; in girls the breasts do not develop and there is a primary amenorrhoea; in boys the genitals remain juvenile.

DSM-IV(103)

1. Refusal to maintain body weight above the minimally normal weight for age and height (e.g. weight less than 85 per cent of that expected).

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

3. Disturbance in the way in which one's body weight or shape is experienced.

4. In postmenarchal females, there is amenorrhoea of at least three menstrual cycles.

DSM-IV subdivides anorexia nervosa as follows.

1. Restricting type, without regular binge-eating or 'purging' behaviour (in the United States this term includes self-induced vomiting and the misuse of diuretics as well as laxatives).

2. Binge-eating/purging type.

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