What are the DSM-5 eating disorder diagnoses?
The DSM-5-TR defines three primary eating disorder diagnoses, each with distinct criteria, medical risk, and treatment implications:
- Anorexia Nervosa (AN) — restriction of energy intake leading to significantly low body weight, intense fear of weight gain, and body image disturbance. Subtypes: restricting type and binge-eating/purging type. Highest mortality of any psychiatric illness at 5–10% (Crow 2009).
- Bulimia Nervosa (BN) — recurrent binge eating episodes followed by inappropriate compensatory behaviors (self-induced vomiting, laxative misuse, fasting, excessive exercise), at least once weekly for three months. Body weight typically in normal range.
- Binge Eating Disorder (BED) — recurrent binge eating without compensatory behaviors, at least once weekly for three months. Most common eating disorder in U.S. adults.
- OSFED and ARFID — Other Specified Feeding or Eating Disorder and Avoidant/Restrictive Food Intake Disorder cover clinically significant presentations outside the three primary diagnoses.
Accurate diagnosis drives the level of medical monitoring, the choice of therapy modality, and the appropriate level of care.
How does CBT-E (Enhanced CBT) treat eating disorders?
CBT-Enhanced (CBT-E), developed by Christopher Fairburn at Oxford, is the leading evidence-based treatment for adult eating disorders across diagnoses, with response rates near 60% in randomized trials. CBT-E is transdiagnostic, addressing the shared cognitive-behavioral mechanisms across AN, BN, and BED.
- Stage 1 (sessions 1–8) — engagement, psychoeducation, real-time self-monitoring of eating, weekly weighing, and establishment of regular eating (three meals plus two-to-three snacks).
- Stage 2 (review) — formal review of progress, identification of obstacles, and decision to use focused (eating-disorder symptoms only) or broad (additional modules) version.
- Stage 3 (sessions 9–17) — targeting of the core maintaining mechanisms: overvaluation of shape and weight, dietary restraint, event-driven eating changes, and mood intolerance.
- Stage 4 (final sessions) — relapse prevention, maintenance planning, and consolidation.
Standard course is 20 sessions over 20 weeks for non-underweight patients; 40 sessions over 40 weeks for underweight patients to support weight restoration.
Questions About How does CBT-E (Enhanced?
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What is the SCOFF screening questionnaire?
The SCOFF questionnaire is a five-item validated screening tool developed by Morgan, Reid, and Lacey (1999, BMJ) to identify likely eating disorders in primary care and clinical settings. A score of two or more positive responses indicates a likely eating disorder and warrants full diagnostic evaluation.
- S — Do you make yourself Sick because you feel uncomfortably full?
- C — Do you worry you have lost Control over how much you eat?
- O — Have you recently lost more than One stone (14 pounds) in a three-month period?
- F — Do you believe yourself to be Fat when others say you are too thin?
- F — Would you say Food dominates your life?
The SCOFF demonstrates sensitivity above 84% and specificity above 89% in validation studies. Ascend administers the SCOFF at intake for every patient with SUD, given the documented 25–50% comorbidity rate, alongside the Eating Disorder Examination Questionnaire (EDE-Q) for those who screen positive.
“Eating disorders carry the highest mortality of any psychiatric illness, and the comorbidity with substance use is severely underdiagnosed. We screen every SUD patient with the SCOFF, deliver CBT-E and DBT with fidelity, and run the medical monitoring required to keep weight restoration safe. One care team, one chart.”
How are eating disorders and substance use disorder treated together?
NIDA documents that 25–50% of individuals with eating disorders have a co-occurring substance use disorder — five-fold higher than the general population. Stimulants and alcohol are most common, often used to suppress appetite, manage weight, or numb post-binge distress.
Integrated treatment is required because each disorder maintains the other. Restriction depletes nutrients needed for medication response and cognitive engagement in therapy; binge-purge cycles increase impulsivity that drives substance use; alcohol disinhibits binge episodes. Ascend coordinates CBT-E, DBT, medical monitoring, nutritional rehabilitation, and SUD-focused therapy under a single clinical plan.
Medical screening is non-negotiable — electrolytes, EKG, vitals, and weight are tracked because refeeding syndrome, cardiac instability, and hypokalemia can be life-threatening, especially when withdrawal from alcohol or benzodiazepines overlaps with nutritional rehabilitation.