Statement of Principles
concerning
EATING DISORDER
No. 48 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. 48 of 2008.
Determination
2.
This Statement of Principles
is determined by the Repatriation Medical Authority under subsection 196B(3)
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. On the sound medical-scientific evidence available, the
Repatriation Medical Authority is of the view that it is more probable than not
that eating disorder and death from eating disorder can be
related to relevant service rendered by veterans 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 exist before it can be said that, on the
balance of probabilities, eating disorder or death from eating
disorder is connected with the circumstances of a person’s relevant service
is:
(a)
experiencing a category 1A
stressor within the one year 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 one year
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 one year before the clinical onset
of eating disorder; or
(g)
having experienced severe
childhood abuse within the five years before the clinical onset of eating
disorder; or
(h)
experiencing a category 1A
stressor within the one year 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 one year
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 one year 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) eligible war
service (other than operational service) under the VEA; or
(b)
defence service (other than
hazardous service) under the VEA; or
(c)
peacetime 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. 48 of 2008)
The Statement of Principles concerning eating disorder
(Instrument No. 48 of 2008) in force under section 196B(3) 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. 48 of 2008)
|
25 June 2008
|
2 July 2008
|
|
|
Amendment
of Statement of Principles concerning eating disorder (Instrument No. 48 of
2009)
|
23 June 2009
|
1 July 2009
|
|
Table of Amendments
|
ad. = added or inserted am. = amended rep.
= repealed rs. = repealed and substituted
|
|
Provision affected
|
How affected
|
|
Clause 9 – ‘severe childhood abuse'.............
|
rs. Instrument No.48 of 2009
|