Statement of Principles
concerning
EATING DISORDER
No. 47 of 2008
for the purposes of the
Veterans’ Entitlements Act 1986
and
Military Rehabilitation and
Compensation Act 2004
Title
1.
This Instrument may be cited
as Statement of Principles concerning eating disorder No. 47 of 2008.
Determination
2.
This Statement of Principles
is determined by the Repatriation Medical Authority under subsection 196B(2)
of the Veterans’ Entitlements Act 1986 (the VEA).
Kind of injury, disease
or death
3. (a) This
Statement of Principles is about eating disorder and death from
eating disorder.
(b)
For the purposes of this Statement
of Principles, "eating disorder" means the psychiatric
conditions anorexia nervosa, bulimia nervosa and eating disorder not otherwise
specified which are manifested by a dysfunctional eating pattern, where:
"anorexia nervosa" means a psychiatric condition meeting the following
diagnostic criteria (derived from DSM-IV-TR):
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 postmenarchal
females, amenorrhoea (i.e., the absence of at least three consecutive cycles).
"bulimia nervosa"
means a psychiatric condition meeting the following diagnostic criteria
(derived from DSM-IV-TR):
A.
Recurrent episodes of
binge eating. An episode of binge eating is characterised by both of the
following:
(1) Eating, in a
discrete period of time (e.g., within any 2-hour period), an amount of food
that is definitely larger than most people would eat during a similar period of
time and under similar circumstances.
(2) 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).
B.
Recurrent
inappropriate compensatory behaviour in order to prevent weight gain, such as
self-induced vomiting; misuse of laxatives, diuretics, enemas or other
medications; fasting or excessive exercise.
C.
The binge eating and
inappropriate compensatory behaviours both occur, on average, at least twice a
week for 3 months.
D.
Self-evaluation is
unduly influenced by body shape and weight.
"eating disorder not otherwise
specified" means a psychiatric
condition meeting the following criteria (derived from DSM-IV-TR):
A.
For females, all of the criteria
for anorexia nervosa are met except that the individual has regular menses.
B.
All of the criteria for anorexia
nervosa are met except that, despite significant weight loss, the individual's
current weight is in the normal range.
C.
All of the criteria for bulimia
nervosa are met except that the binge eating and inappropriate compensatory
mechanisms occur at a frequency of less than twice a week or for a duration of
less than 3 months.
D.
The regular use of inappropriate
compensatory behaviour by an individual of normal body weight after eating
small amounts of food.
E.
Repeatedly chewing and spitting
out, but not swallowing, large amounts of food.
F.
For binge-eating disorder:
recurrent episodes of binge eating in the absence of the regular use of
inappropriate compensatory behaviours characteristic of bulimia nervosa.
Basis for determining the
factors
4. The Repatriation Medical Authority is of the view that there
is sound medical-scientific evidence that indicates that eating disorder and
death from eating disorder can be related to relevant service rendered by
veterans, members of Peacekeeping Forces, or members of the Forces under the
VEA, or members under the Military Rehabilitation and Compensation Act 2004
(the MRCA).
Factors that must be
related to service
5. Subject to clause 7, at least one of the factors set out in
clause 6 must be related to the relevant service rendered by the person.
Factors
6. The factor that must as a minimum exist before it can be said
that a reasonable hypothesis has been raised connecting eating disorder or
death from eating disorder with the circumstances of a person’s relevant
service is:
(a)
experiencing a category 1A stressor
within the two years before the clinical onset of eating disorder; or
(b)
experiencing a category 1B stressor
within the one year before the clinical onset of eating disorder; or
(c)
experiencing a category 2 stressor within
the one year before the clinical onset of eating disorder; or
(d)
experiencing the death of a
significant other within the one year before the clinical onset of eating disorder; or
(e)
having a clinically significant
psychiatric condition as specified, within the two years before the clinical
onset of eating disorder; or
(f)
having a medical illness or injury which
is life-threatening or which results in serious physical or cognitive
disability, within the two years before the clinical onset of eating disorder;
or
(g)
having experienced severe childhood abuse
within the ten years before the clinical onset of eating disorder; or
(h)
experiencing a category 1A stressor
within the two years before the clinical worsening of eating disorder; or
(i)
experiencing a category 1B stressor
within the one year before the clinical worsening of eating disorder; or
(j)
experiencing a category 2 stressor within
the one year before the clinical worsening of eating disorder; or
(k)
experiencing the death of a
significant other within the one year before the clinical worsening of eating disorder; or
(l)
having a clinically significant psychiatric
condition as specified, within the two years before the clinical worsening of
eating disorder; or
(m)
having a medical illness or injury which
is life-threatening or which results in serious physical or cognitive
disability, within the two years before the clinical worsening of eating
disorder; or
(n)
inability to obtain appropriate clinical
management for eating disorder.
Factors that apply only
to material contribution or aggravation
7. Paragraphs 6(h) to 6(n) apply only to material
contribution to, or aggravation of, eating disorder where the person’s eating
disorder was suffered or contracted before or during (but not arising out of)
the person’s relevant service.
Inclusion of Statements of Principles
8. In this Statement of Principles if a relevant factor applies
and that factor includes an injury or disease in respect of which there is a
Statement of Principles then the factors in that last mentioned Statement of
Principles apply in accordance with the terms of that Statement of Principles
as in force from time to time.
Other definitions
9.
For the purposes of this
Statement of Principles:
"a category 1A stressor" means one or more of the following severe traumatic
events:
(a)
experiencing
a life-threatening event;
(b)
being
subject to a serious physical attack or
assault including rape and sexual molestation; or
(c)
being threatened with a weapon,
being held captive, being kidnapped, or being tortured;
"a category 1B stressor" means one of the following severe traumatic events:
(a)
being an eyewitness to a person
being killed or critically injured;
(b)
viewing corpses or critically
injured casualties as an eyewitness;
(c)
being an eyewitness to atrocities
inflicted on another person or persons;
(d)
killing or maiming a person; or
(e)
being an eyewitness to or
participating in, the clearance of critically injured casualties;
"a category 2 stressor" means one or more of the following negative life
events, the effects of which are chronic in nature and cause the person to feel
on-going distress, concern or worry:
(a)
being
socially isolated and unable to maintain friendships or family relationships,
due to physical location, language barriers, disability, or medical or
psychiatric illness;
(b)
experiencing
a problem with a long-term relationship including: the break-up of a close
personal relationship, the need for marital or relationship counselling,
marital separation, or divorce;
(c)
having
concerns in the work or school environment including: on-going disharmony with
fellow work or school colleagues, perceived lack of social support within the work
or school environment, perceived lack of control over tasks performed and
stressful work loads, or experiencing bullying in the workplace or school
environment;
(d)
experiencing
serious legal issues including: being detained or held in custody, on-going involvement
with the police concerning violations of the law, or court appearances
associated with personal legal problems;
(e)
having
severe financial hardship including: loss of employment, long periods of
unemployment, foreclosure on a property, or bankruptcy;
(f)
having a
family member or significant other experience a major deterioration in their
health; or
(g)
being a
full-time caregiver to a family member or significant other with a severe
physical, mental or developmental disability;
"a clinically significant psychiatric condition
as specified" means any of the
Axis I mood disorders, anxiety spectrum disorders, substance abuse or substance
dependence disorders, or attention-deficit and disruptive behaviour disorders
of mental health that attract a diagnosis under DSM-IV-TR and is sufficient to
warrant ongoing management. The ongoing management may involve regular visits
(for example, at least monthly), to a psychiatrist, clinical psychologist or
general practitioner;
"a significant other" means a person who has a close family bond or a close
personal relationship and is important or influential in one’s life;
"an eyewitness" means a person who observes an incident first hand and
can give direct evidence of it. This excludes a person exposed only to media
coverage of the incident;
"death from eating disorder" in relation to a person includes death from a terminal
event or condition that was contributed to by the person’s eating disorder;
"DSM-IV-TR" means the American Psychiatric Association: Diagnostic
and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision.
Washington, DC, American Psychiatric Association, 2000.
"relevant service" means:
(a)
operational service under the VEA;
(b)
peacekeeping service under the VEA;
(c)
hazardous service under the VEA;
(d)
warlike service under the MRCA; or
(e)
non-warlike service under the MRCA;
"severe
childhood abuse" means:
(a)
serious physical, emotional,
psychological or sexual harm whilst a child aged under 16 years; or
(b)
neglect involving a serious
failure to provide the necessities for health, physical and emotional
development, or wellbeing whilst a child aged under 16 years;
where such serious harm or neglect has been
perpetrated by a parent, a care provider, an adult who works with or around
that child, or any other adult in contact with that child;
"terminal event" means the proximate or ultimate cause of death and
includes:
(a)
pneumonia;
(b)
respiratory failure;
(c)
cardiac arrest;
(d)
circulatory failure; or
(e)
cessation of brain function.
Date of effect
10. This Instrument takes effect from 2 July 2008.
Notes to Statement of Principles concerning eating
disorder (Instrument No. 47 of 2008)
The Statement of Principles concerning eating disorder
(Instrument No. 47 of 2008) in force under section 196B(2) of the Veterans’
Entitlements Act 1986, as shown in this compilation is amended as indicated
in the Tables below.
Table
of Instruments
|
Title
|
Date of notification
in Gazette or FRLI registration
|
Date of
commencement
|
Application, saving or
transitional provisions
|
|
Statement
of Principles concerning eating disorder (Instrument No. 47 of 2008)
|
25 June 2008
|
2 July 2008
|
|
|
Amendment
of Statement of Principles concerning eating disorder (Instrument No. 47 of
2009)
|
23 June 2009
|
1 July 2009
|
|
Table of Amendments