DSM- Feeding, Eating, and Elimination Disorders

What is the high-yield picture of Pica?

Persistent eating of nonfood, nonnutritive substances inappropriate to developmental level and culture.

Timeline/onset: 1+ month

Spectrum/severity: No

Important note: May occur with pregnancy or other disorders.

What timeframe, age, or number is most important for Pica?

1+ month

How do you differentiate Pica on an exam vignette?

Rule out culturally sanctioned practice.

What is the high-yield picture of Rumination Disorder?

Repeated regurgitation of food, which may be rechewed, reswallowed, or spit out.

Timeline/onset: 1+ month

Spectrum/severity: No

Important note: Not due to GI condition or exclusively during another eating disorder.

What timeframe, age, or number is most important for Rumination Disorder?

1+ month

How do you differentiate Rumination Disorder on an exam vignette?

Differentiate from vomiting and GERD.

What is the high-yield picture of Avoidant/Restrictive Food Intake Disorder?

Avoidance/restriction causing weight loss, deficiency, supplements dependence, or psychosocial interference, without body-image disturbance.

Timeline/onset: No fixed minimum

Spectrum/severity: No

Important note: Drivers may be sensory sensitivity, low interest, or fear of consequences.

What timeframe, age, or number is most important for Avoidant/Restrictive Food Intake Disorder?

No fixed minimum

How do you differentiate Avoidant/Restrictive Food Intake Disorder on an exam vignette?

Vs. anorexia: ARFID lacks fear of weight gain/body-image disturbance.

What is the high-yield picture of Anorexia Nervosa?

Restriction leading to significantly low weight, intense fear of weight gain or behavior preventing gain, and body-image disturbance/lack of recognition.

Timeline/onset: No fixed minimum

Spectrum/severity: Yes: severity by BMI/percentile

Important note: Restricting or binge-eating/purging type.

What timeframe, age, or number is most important for Anorexia Nervosa?

No fixed minimum

How do you differentiate Anorexia Nervosa on an exam vignette?

Vs. bulimia: anorexia requires significantly low body weight.

What is the high-yield picture of Bulimia Nervosa?

Recurrent binge eating with loss of control plus compensatory behaviors; self-evaluation overly influenced by weight/shape.

Timeline/onset: At least 1x/week for 3 months

Spectrum/severity: Yes: severity by frequency

Important note: Not exclusively during anorexia.

What timeframe, age, or number is most important for Bulimia Nervosa?

At least 1x/week for 3 months

How do you differentiate Bulimia Nervosa on an exam vignette?

Vs. binge-eating disorder: bulimia includes compensatory behaviors.

What is the high-yield picture of Binge-Eating Disorder?

Recurrent binge episodes with distress and associated rapid/eating-alone/overfull features, without regular compensatory behavior.

Timeline/onset: At least 1x/week for 3 months

Spectrum/severity: Yes: severity by frequency

Important note: Not exclusively during bulimia/anorexia.

What timeframe, age, or number is most important for Binge-Eating Disorder?

At least 1x/week for 3 months

How do you differentiate Binge-Eating Disorder on an exam vignette?

Vs. bulimia: no recurrent compensatory behaviors.

What is the high-yield picture of Enuresis?

Repeated urination into bed/clothes, voluntary or involuntary, at developmentally inappropriate age.

Timeline/onset: 2x/week for 3 months or clinically significant; age 5+

Spectrum/severity: No

Important note: Nocturnal, diurnal, or both.

What timeframe, age, or number is most important for Enuresis?

2x/week for 3 months or clinically significant; age 5+

How do you differentiate Enuresis on an exam vignette?

Rule out substances/medical conditions.

What is the high-yield picture of Encopresis?

Repeated passage of feces in inappropriate places, voluntary or involuntary.

Timeline/onset: 1x/month for 3 months; age 4+

Spectrum/severity: No

Important note: With or without constipation/overflow.

What timeframe, age, or number is most important for Encopresis?

1x/month for 3 months; age 4+

How do you differentiate Encopresis on an exam vignette?

Rule out medical causes.