Listing 12.13 is reserved for anorexia nervosa, bulimia nervosa, binge-eating disorder, avoidant/restrictive food-intake disorder, and other specified feeding or eating disorders when the abnormal eating behaviors and their medical or psychological sequelae produce marked or extreme work-related limitations (or show a “serious-and-persistent” course). Because these illnesses can involve life-threatening weight loss, electrolyte imbalance, repeated hospitalizations, or obsessive preoccupation with body image and food, they may qualify a claimant for disability at Step 3 of the sequential evaluation.
Regulatory Text
12.13 Eating disorders, satisfied by A and B, or A and C
- Medical documentation of one or more of the following:
1. Restriction of energy intake leading to a significantly low body weight;
2. Recurrent episodes of binge eating or purging (for example, self-induced vomiting, misuse of laxatives or diuretics);
3. Persistent disturbance of eating or eating-related behavior resulting in a significant change in weight or nutritional absorption;
4. Preoccupation with weight and body shape leading to clinically significant distress or impairment of social, occupational, or other functioning.
AND
- Extreme limitation of one, or marked limitation of two, of the following areas of mental functioning (12.00 F):
1. Understand, remember, or apply information;
2. Interact with others;
3. Concentrate, persist, or maintain pace;
4. Adapt or manage oneself;
OR
- Serious and persistent disorder (12.00 G2): evidence over a ≥ 2-year period plus
1. Ongoing medical treatment, mental-health therapy, psychosocial support, or a highly structured environment that diminishes symptoms; and
2. Marginal adjustment—minimal capacity to adapt to changes not already part of daily life.
(Source: 20 C.F.R. Pt 404, Subpt P, App 1; effective Jan 17 2017; technical corrections May 18 2018.)
Key Elements
- Criterion A – Core Eating-disorder Behaviors
- Significant low weight from caloric restriction or
- Binge/purge cycles or
- Other pathological eating behaviors with functional impact and distress.
- Functional Severity
- Paragraph B: Extreme limit in 1—or marked in 2—of the 4 mental-function domains.
- Paragraph C: ≥ 2 years of documented disorder plus ongoing treatment/structured setting and marginal adjustment.
- Duration
- Must last (or be expected to last) ≥ 12 months (B) or meet the 2-year “serious-and-persistent” standard (C).
Tips on Proving Listing 12.13
| Evidence | What to Collect | How It Supports Criteria |
|---|---|---|
| Medical & hospital records | BMI trends; labs showing electrolyte imbalance, anemia, cardiac arrhythmias; NG-tube or TPN notes | Document low body weight, purging complications, medical severity (Criterion A). |
| Psychiatric evaluations | DSM-5 diagnosis (AN, BN, BED, ARFID); EDE-Q or SCOFF results; comorbid mood/anxiety notes | Solidifies diagnosis & psychosocial impact. |
| Treatment history | Inpatient/residential eating-disorder units, partial hospitalization, IOP, CBT-E, DBT, nutrition counseling, weight-monitor logs | Shows ongoing therapy/support (Paragraph C) and persistence of symptoms. |
| Standardized scales & tests | Eating Disorder Inventory-3 (EDI-3), MARSIPAN risk assessments | Quantify obsessionality, body-image distortion, and functional impairment. |
| Mental RFCs / clinician letters | Notes on obsessive calorie counting, ritualistic exercise, inability to maintain pace, social withdrawal, self-harm threats | Address Paragraph B domains directly. |
| Collateral statements | Family, roommates, employers observe food hoarding, workplace purging, fainting, irritability, rigid routines | Illustrate real-world limitations in interaction, adaptation, pace. |
| Structured-setting proof | Supervised meal plans, residential logs, guardianship arrangements | Demonstrate “highly structured environment” & marginal adjustment (Paragraph C). |
SSA Medical-Tests Guide (2024) Cues
- DEXA for bone-density loss; resting metabolic rate tests to show malnutrition effects.
- Serum electrolyte panels (K⁺, Cl⁻, HCO₃⁻) and EKG QT-interval monitoring substantiate medical risk.
Practical Takeaway
To meet Listing 12.13, a Social Security Disability lawyer can help present objective medical evidence of an eating disorder’s core features and tie those symptoms to marked/extreme mental-function limits (Paragraph B) or a two-year pattern of treatment-resistant impairment with marginal adjustment (Paragraph C). Integrate hospital data, specialized treatment records, standardized rating scales, and vivid functional accounts for the strongest Step 3 argument.