Feeding and Eating Disorders

Feeding and eating disorders

are characterized by a persistent disturbance of eat ing or eating-related behavior that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning

Pica

is an eating disorder characterized by the persistent eating of non-food substances

• A. Persistent eating of nonnutritive, nonfood substances over a period of at least 1 month.

• B. The eating of nonnutritive, nonfood substances is inappropriate to the developmental level of the individual.

• C. The eating behavior is not part of a culturally supported or socially normative practice.

• D. If the eating behavior occurs in the context of another mental disorder (e.g., intellectual disability [intellectual developmental disorder], autism spectrum disorder, schizophre nia) or medical condition (including pregnancy), it is sufficiently severe to warrant ad ditional clinical attention.

Diagnostic Criteria for Pica

1 month

(Pica) Persistent eating of nonnutritive, nonfood substances over a period of at least —

In remission

Specify if: — After full criteria for pica were previously met, the criteria have not been met for a sustained period of time.

intellectual disability

Among individuals with—, the prev alence of pica appears to increase with the severity of the condition.

potential medical risks

The diagnosis of pica during pregnancy is only appropriate if such cravings lead to the ingestion of nonnutri tive, nonfood substances to the extent that the eating of these substances poses —

rumination disorder

• is a condition in which someone repeatedly regurgitates undigested or partially digested food from the stomach.

• The regurgitated food is then chewed again and swallowed or spit out.

• Previously swallowed food that may be partially digested is brought up into the mouth without apparent nausea, involuntary retching, or disgust.

• A. Repeated regurgitation of food over a period of at least 1 month. Regurgitated food may be re-chewed, re-swallowed, or spit out.

• B. The repeated regurgitation is not attributable to an associated gastrointestinal or other medical condition (e.g., gastroesophageal reflux, pyloric stenosis).

• C. The eating disturbance does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder. 

• D. If the symptoms occur in the context of another mental disorder (e.g., intellectual dis ability [intellectual developmental disorder] or another neurodevelopmental disorder), they are sufficiently severe to warrant additional clinical attention.

Diagnostic Criteria for Rumination Disorder

1 month

(Rumination Disorder) Repeated regurgitation of food over a period of at least —-.

In remission

Specify if: — : After full criteria for rumination disorder were previously met, the criteria have not been met for a sustained period of time

Avoidant/Restrictive Food Intake Disorder

• is a condition characterized by significant limitation in the amount or variety of foods consumed.

• This restriction can lead to significant health problems, including malnutrition, weight loss, and psychosocial difficulties.  

• associated with insufficient intake or lack of interest in eat ing most commonly develops in infancy or early childhood and may persist in adulthood.

• A. An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoid ance based on the sensory characteristics of food; concern about aversive conse quences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following: 1. Significant weight loss (or failure to achieve expected weight gain or faltering growth in children). 2. Significant nutritional deficiency. 3. Dependence on enteral feeding or oral nutritional supplements. 4. Marked interference with psychosocial functioning.

• B. The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.

• C. The eating disturbance does not occur exclusively during the course of anorexia ner vosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.

• D. The eating disturbance is not attributable to a concurrent medical condition or not bet ter explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.

Diagnostic Criteria for Avoidant/Restrictive Food Intake Disorder

anxiety disorders, obsessive-compulsive disorder, and neurodevelopmental disorders (specifically autism spectrum disorder, attention-deficit/hyperactivity disor der, and intellectual disability [intellectual developmental disorder]).

most commonly observed disorders comorbid with avoidant/restrictive food intake disorder are

Anorexia Nervosa

• a serious eating disorder characterized by an intense fear of gaining weight, a distorted body image, and a relentless pursuit of thinness.

• People with — often restrict their calorie intake severely and may engage in excessive exercise, purging behaviors (such as vomiting or using laxatives), or both.

• A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Sig nificantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.

• B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.

• C. Disturbance in the way in which one’s body weight or shape is experienced, undue in fluence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

Diagnostic Criteria for Anorexia Nervosa

Restricting Type (Anorexia Nervosa)

During the last 3 months, the individual has not engaged in re current episodes of binge eating or purging behavior (i.e., self-induced vomiting or the mis use of laxatives, diuretics, or enemas). This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise.

Binge-eating/purging type (Anorexia Nervosa)

During the last 3 months, the individual has en gaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).

In partial remission

After full criteria for anorexia nervosa were previously met, Cri terion A (low body weight) has not been met for a sustained period, but either Criterion B (intense fear of gaining weight or becoming fat or behavior that interferes with weight

In full remission

After full criteria for anorexia nervosa were previously met, none of the criteria have been met for a sustained period of time.

Mild (anorexia nervosa)

BMI ≥ 17 kg/m

Moderate (anorexia nervosa)

BMI 16–16.99 kg/m2

Severe (anorexia nervosa)

BMI 15–15.99 kg/m2

Extreme (anorexia nervosa)

BMI < 15 kg/m2

starvation

Many of the physical signs and symptoms of anorexia nervosa are attributable to

Bipolar, depressive, and anxiety disorders

commonly co-occur with anorexia nervosa

Bulimia Nervosa

• is a serious eating disorder characterized by a cycle of binge eating followed by purging behaviors.

• During a binge, individuals consume large amounts of food in a short period of time, feeling a loss of control over their eating.

• To compensate for the binge, they engage in purging behaviors, such as self-induced vomiting, excessive use of laxatives or diuretics, or excessive exercise.

• A. Recurrent episodes of binge eating. An episode of binge eating is characterized 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 what most individuals would eat in a similar period of time 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 behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.

• C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.

• D. Self-evaluation is unduly influenced by body shape and weight.

• E. The disturbance does not occur exclusively during episodes of anorexia nervosa.

Diagnostic Criteria for Bulimia Nervosa

in partial remission

After full criteria for bulimia nervosa were previously met, some, but not all, of the criteria have been met for a sustained period of time

in full remission

After full criteria for bulimia nervosa were previously met, none of the criteria have been met for a sustained period of time

mild (bulimia nervosa)

An average of 1–3 episodes of inappropriate compensatory behaviors per week

moderate (bulimia nervosa)

An average of 4–7 episodes of inappropriate compensatory behaviors per week.

severe (bulimia nervosa)

An average of 8–13 episodes of inappropriate compensatory behaviors per week.

extreme (bulimia nervosa)

An average of 14 episodes of inappropriate compensatory behaviors per week.

3 months

(Bulimia Nervosa) The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for —

Binge-Eating Disorder

• is a serious eating disorder characterized by recurrent episodes of binge eating.

• During a binge, individuals consume large amounts of food in a short period of time, feeling a loss of control over their eating.

• Unlike bulimia nervosa, individuals with — do not engage in purging behaviors to compensate for the binge.

• A. Recurrent episodes of binge eating. An episode of binge eating is characterized 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 what most people would eat in a similar period of time 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. The binge-eating episodes are associated with three (or more) of the following:

  • 1. Eating much more rapidly than normal.

  • 2. Eating until feeling uncomfortably full.

  • 3. Eating large amounts of food when not feeling physically hungry.

  • 4. Eating alone because of feeling embarrassed by how much one is eating.

  • 5. Feeling disgusted with oneself, depressed, or very guilty afterward.

• C. Marked distress regarding binge eating is present.

• D. The binge eating occurs, on average, at least once a week for 3 months.

• E. The binge eating is not associated with the recurrent use of inappropriate compensa tory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

Diagnostic Criteria for Binge-Eating Disorder

In partial remission

After full criteria for binge-eating disorder were previously met, binge eating occurs at an average frequency of less than one episode per week for a sustained period of time.

In full remission

After full criteria for binge-eating disorder were previously met, none of the criteria have been met for a sustained period of time

Mild (binge-eating disorder0

1–3 binge-eating episodes per week.

moderate (binge-eating disorder)

4–7 binge-eating episodes per week.

Severe (binge-eating disorder)

8–13 binge-eating episodes per week.

Extreme (binge-eating disorder)

14 or more binge-eating episodes per week.

3 months

The essential feature of binge-eating disorder is recurrent episodes of binge eating that must occur, on average, at least once per week for —-

discrete period of time

A “—” refers to a limited period, usually less than 2 hours

Atypical anorexia nervosa

All of the criteria for anorexia nervosa are met, except that despite significant weight loss, the individual’s weight is within or above the normal range.

Bulimia nervosa (of low frequency and/or limited duration)

All of the criteria for bulimia nervosa are met, except that the binge eating and inappropriate compensatory behaviors occur, on average, less than once a week and/or for less than 3 months

Binge-eating disorder (of low frequency and/or limited duration)

All of the criteria for binge-eating disorder are met, except that the binge eating occurs, on average, less than once a week and/or for less than 3 months.

Purging disorder

Recurrent purging behavior to influence weight or shape (e.g., self induced vomiting; misuse of laxatives, diuretics, or other medications) in the absence of binge eating.

Night eating syndrome

• Recurrent episodes of night eating, as manifested by eating after awakening from sleep or by excessive food consumption after the evening meal.

• There is awareness and recall of the eating.

• The night eating is not better explained by external influences such as changes in the individual’s sleep-wake cycle or by local so cial norms. The night eating causes significant distress and/or impairment in function ing.

• The disordered pattern of eating is not better explained by binge-eating disorder or another mental disorder, including substance use, and is not attributable to another medical disorder or to an effect of medication.