Diagnostic Changes: Feeding and Eating Disorders

By Musci, Rashelle J.; Hart, Shelley R. | National Association of School Psychologists. Communique, June 2014 | Go to article overview

Diagnostic Changes: Feeding and Eating Disorders


Musci, Rashelle J., Hart, Shelley R., National Association of School Psychologists. Communique


Feeding and eating disorders are primarily characterized by severe and persistent disturbance in eating behaviors, and individuals with these disorders often show severe consequences even after the feeding or eating disorder has gone into remission. The disturbance in eating behaviors results in impairments in physical health as well as psychosocial functioning (American Psychiatric Association [APA], 2013). Included in this category of disorders are: pica, rumination, avoidant/restrictive food intake, anorexia nervosa, bulimia nervosa, and binge eating disorders. Additionally, the other specified and unspecified feeding and eating disorders categories are present, in line with all diagnostic categories in DSM-5. Though there are some commonalities, there is a fair amount of heterogeneity in the typical age of disorder onset. For example, pica and rumination disorder typically have an onset during childhood (APA, 2013), while anorexia nervosa and bulimia nervosa are both typically diagnosed during adolescence, but can have an onset in early adulthood (Hudson, Hiripi, Pope, & Kessler, 2007).

Feeding and eating disorders are relatively uncommon, particularly pica and rumination disorder. Anorexia nervosa and bulimia nervosa are more common, with prevalence estimates ranging from under 1% of men to 4% of women (Hudson et al., 2007). More specifically, the lifetime prevalence for anorexia nervosa is 0.9% in adult women and 0.3% in adult men. Rates are higher for bulimia nervosa at 1.5% for adult women and 0.5% for adult men. Binge eating disorder has shown the highest prevalence rates (3.5% in women and 2% in men; Hudson et al., 2007). Rates are similar in adolescents (Kessler et al., 2012; Swanson, Crow, Le Grange, Swendsen, & Merikangas, 2011).

This group of disorders has been shown to frequently co-occur with such disorders as autism spectrum, anxiety, depressive, personality, and suicidal behavior disorders (APA,2013). Eating disorders, specifically anorexianervosa,bulimianervosa,and binge eating disorder, have been shown to be highly comorbid with mood, anxiety, impulsecontrol, and substance use disorders (Hudson et al., 2007). Disordered eating, while rare, has a significant association with other psychiatric disorders, role impairment, and suicidal thoughts and behaviors (Swanson et al., 2011).

CHANGES FROM DSM-IV-TR AND RATIONALE FOR THE CHANGES

The changes to the feeding and eating disorders category from the DSM-IV-TR (APA, 2000) to the DSM-5 were made in order to put greater emphasis on lifespan diagnoses and lessen the number of individuals being placed in the eating disorder not otherwise specified category (Attia et al., 2013). Additionally, the DSM-5 has placed a greater emphasis on the influence of development, sex, and culture on the diagnostic criteria (Hoek, 2013). One of the biggest changes to the new edition is the removal of the feeding disorders in infancy and childhood category. Individuals previously diagnosed with this disorder would now be diagnosed with a disorder new to DSM-5, avoidant/restrictive food intake disorder (ARFID; Bryant-Waugh, 2013). This disorder describes individuals who have a restrictive food intake pattern but no fear of weight gain or body image issues (Omstein et al., 2013). Diagnostic criteria of ARFID include an eating or feeding disturbance along with one or more of the following: significant weight loss, significant nutritional deficiency, dependence on nutritional supplements, and interference with psychosocial functioning. Additionally, pica and rumination have been moved from the childhood-specific chapter (i.e., "Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence," which was eliminatedfromDSM-5)totheeatingandfeedingdisordercategory (APA, 2013). These changes were part of a more global attempt to make the DSM-5 have a lifespan focus.

A second major change was to the diagnostic criteria for anorexia nervosa. The amenorrhea criterion (i. …

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