User:Sarahngolan/sandbox

=Diagnosis=

Recommended Screening Measures:

 * 1) Structured Clinical Interview for DSM Diagnoses Anorexia Nervosa module (SCID): See Appendix A
 * 2) Eating Disorder Examination (EDE): See Appendix B
 * 3) Eating Disorder Examination Questionnaire (EDE-Q): See Appendix C
 * 4) Eating Attitudes Test (EAT-26): See Appendix D

Diagnostic Criteria
Diagnostic efficiency information for all included measures is based on criteria from DSM-IV or earlier. As of the compilation of this portfolio, diagnostic efficiency information for these measures based on DSM-5 criteria is unavailable. Once sufficient time for implementation of DSM-5 has passed, measures should be re-evaluated for efficiency with new data. The Feeding and Eating Disorders section of the DSM has undergone notable revision with the shift from DSM-IV to DSM-5, with a primary goal of reducing the large number of Eating Disorder Not Otherwise Specified (EDNOS) diagnoses due to many individuals not fully meeting criteria for Anorexia Nervosa or Bulimia Nervosa as delineated by DSM-IV. Base rates of Feeding and Eating Disorders are likely to shift once DSM-5 criteria have been fully incorporated into clinical practice and research.

Anorexia Nervosa diagnostic criteria have changed as follows:
 * The requirement for amenorrhea was eliminated in DSM-5
 * Criterion A (low body weight) wording was edited for clarification
 * Criterion B (fear of weight gain) expanded to include both expressed fear of weight gain and persistent behavior interfering with weight gain

DSM-IV Anorexia Nervosa Diagnostic Criteria (307.1)
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.)

Specify 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 laxatives, 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 laxatives, diuretics, or enemas)

DSM-5 Anorexia Nervosa Diagnostic Criteria (307.1)
A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected. See Note on Weight below.

B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.

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 persistent lack of recognition of the seriousness of the current low body weight.

Coding note: The ICD-9-CM code for anorexia nervosa is 307.1, which is assigned regardless of the subtype. The ICD-10-CM code depends on the subtype (see below).

Specify whether:
 * (F50.01) Restricting type: During the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise.
 * (F50.02) Binge-eating/purging type: During the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).

Specify if:
 * In partial remission: After full criteria for anorexia nervosa were previously met, Criterion 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 self-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 from World Health Organization categories for thinness in adults; for children and adolescents, corresponding BMI percentiles should be used. The level of severity may be increased to reflect clinical symptoms, the degree of functional disability, and the need for supervision.
 * Mild: BMI ≥ 17 kg/m2
 * Moderate: BMI 16–16.99 kg/m2
 * Severe: BMI 15–15.99 kg/m2
 * Extreme: BMI < 15 kg/m2

Note on Weight: The Centers for Disease Control and Prevention and the World Health Organization use a Body Mass Index (BMI) of 18.5 kg/m2 as the lower limit of normal body weight. As such, individuals with BMIs of greater than or equal to 18.5 kg/m2 would generally not be considered to meet the significantly low weight criterion. Individuals with BMIs less than 17.0 kg/m2 would generally be considered to meet the significantly low weight criterion. Adults with BMIs between 17.0 and 18.5 kg/m2 could be considered to meet the significantly low weight criterion based on clinical history or other information.