Feeding and Eating Disorders in Children and Adolescents

Vocabulary flashcards differentiating Feeding Disorders from Eating Disorders based on Dr. Erica Dashow's clinical dimensions and DSM-5-TR diagnostic criteria.

Shared Outward Signs of Feeding and Eating Disorders

Outward behaviors that mirror one another when a child struggles to maintain a balanced diet, including limited food intake and severe food selectivity, disruption to family dynamics and social interactions, and potential for nutritional deficiencies and weight issues.

Feeding Disorders (Core Drivers)

Clinical diagnoses primarily driven by sensory sensitivities, oral motor challenges, and negative past experiences, focusing on physical and environmental factors rather than concerns about body weight or shape.

Eating Disorders (Core Drivers)

Clinical diagnoses primarily driven by deep emotional distress, control issues, body image concerns, and complex internal conflict, focusing on psychological and emotional entanglement.

Dr. Dashow's Four Diagnostic Dimensions

The four core distinctions used by clinicians at the Center for CBT to achieve diagnostic clarity: 1. Motivation, 2. Age of Onset, 3. Behavioral Features, and 4. Emotional Component.

Dimension 1: Underlying Motivation

Distinction where food limitation in feeding disorders is a response to physical properties of food (sensory avoidance), whereas in eating disorders it is a response to an internal fear of weight gain and body shape dissatisfaction.

Dimension 2: Season of Onset

Developmental distinction where feeding disorders typically take root in infancy and early childhood, whereas eating disorders most commonly emerge during adolescence and early adulthood.

Dimension 3: Behavioral Features

Distinction where feeding disorders feature externalizing and sensory refusal (visible behaviors like tantrums, throwing food, or refusing to sit at the table), whereas eating disorders feature internalizing and compensatory control (hidden behaviors like limiting intake based on caloric density, purging, hiding food, or compulsive exercise).

Dimension 4: Focal Point of Emotional Distress

Distinction where feeding disorders involve food-specific anxiety regarding the physical act of eating without body shame, whereas eating disorders involve body-centric shame, guilt, and embarrassment tied to self-worth.

Dr. Dashow's Diagnostic Matrix

A clinical summary matrix categorizing Feeding Disorders (Sensory Avoidance, Infancy/Early Childhood, Tantrums/Sensory Refusal, Food-specific Anxiety) versus Eating Disorders (Body Dissatisfaction, Adolescence/Early Adulthood, Caloric Restriction/Purging/Over-exercising, Body-centric Shame and Guilt).

Feeding Disorders Care Pathway

Interventions aimed at tending the physical environment, starting with comprehensive assessment of dietary habits, sensory preferences, and real-time meal observation, using structure, behavioral strategies, exposure therapy, coping tools, and medical management.

Eating Disorders Care Pathway

A long-term, multidisciplinary treatment model tending to the mind and perception, involving mental health professionals, dietitians, and medical doctors using Cognitive-Behavioral Therapy, Family-Based Therapy, Nutritional Counseling, and Emotional Regulation.

DSM-5-TR

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (published in 2022 by the American Psychiatric Association), containing diagnostic criteria to assist clinicians in effective assessment and diagnosis of mental health disorders.

Feeding and Eating Disorders (DSM-5-TR Definition)

A class of disorders characterized by a persistent disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning.

Anorexia Nervosa (AN)

An eating disorder characterized by restriction of energy intake leading to a significantly low body weight, intense fear of gaining weight or becoming fat, and a disturbance in how body weight or shape is experienced.

Anorexia Nervosa Restricting Type

A subtype of Anorexia Nervosa where, during the last 3 months, the individual has not engaged in recurrent binge eating or purging; weight loss is achieved primarily through dieting, fasting, and/or excessive exercise.

Anorexia Nervosa Binge-Eating/Purging Type

A subtype of Anorexia Nervosa where, during the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior (e.g., self-induced vomiting or misuse of laxatives, diuretics, or enemas).

Anorexia Nervosa Severity Levels

Severity levels based on Body Mass Index in adults: Mild ($\text{BMI} ≥ 17\,kg/m^2$), Moderate ($\text{BMI } 16–16.99\,kg/m^2$), Severe ($\text{BMI } 15–15.99\,kg/m^2$), and Extreme ($\text{BMI} < 15\,kg/m^2$).

Bulimia Nervosa (BN)

An eating disorder characterized by recurrent episodes of binge eating accompanied by a sense of lack of control, followed by inappropriate compensatory behaviors (vomiting, laxatives, fasting, excessive exercise) occurring on average at least once a week for 3 months.

Bulimia Nervosa Severity Levels

Severity based on the average weekly frequency of inappropriate compensatory behaviors: Mild ($1–3$ episodes/week), Moderate ($4–7$ episodes/week), Severe ($8–13$ episodes/week), and Extreme ($14$ or more episodes/week).

Binge Eating Disorder (BED)

An eating disorder characterized by recurrent episodes of rapid consumption of large quantities of food with loss of control and marked distress, occurring on average at least once a week for 3 months, without recurrent compensatory behaviors.

Binge Eating Disorder Severity Levels

Severity based on the average weekly frequency of binge eating episodes: Mild ($1–3$ episodes/week), Moderate ($4–7$ episodes/week), Severe ($8–13$ episodes/week), and Extreme ($14$ or more episodes/week).

Avoidant/Restrictive Food Intake Disorder (ARFID)

A feeding disorder marked by extreme food selectivity or avoidance based on sensory characteristics, lack of interest, or fear of aversive consequences, resulting in weight loss, nutritional deficiency, supplement dependency, or psychosocial interference, without body image disturbance.

Pica

A feeding disorder characterized by persistent consumption of non-nutritive, non-food substances (e.g., dirt, clay, paper) over a period of at least 1 month, beyond developmentally appropriate toddler years.

Rumination Disorder

A feeding disorder characterized by the repeated involuntary regurgitation of previously swallowed food over a period of at least 1 month, which is then re-chewed, re-swallowed, or spit out.

Other Specified Feeding and Eating Disorder (OSFED)

A DSM-5-TR category for presentations causing clinically significant distress or impairment that do not meet full criteria for any specific disorder, where the clinician records the specific reason (e.g., Atypical Anorexia Nervosa, Purging Disorder).

Atypical Anorexia Nervosa

An OSFED presentation where all criteria for Anorexia Nervosa are met, except that despite significant weight loss, the individual's weight is within or above the normal range.

Purging Disorder

An OSFED presentation characterized by recurrent purging behavior (such as self-induced vomiting or misuse of laxatives or diuretics) to influence weight or shape in the absence of binge eating.

Night Eating Syndrome

An OSFED presentation involving recurrent episodes of night eating (awakening from sleep to eat or excessive consumption after the evening meal) with awareness and recall, causing significant distress or impairment.

Unspecified Feeding or Eating Disorder (UFED)

A category used when symptoms typical of a feeding and eating disorder cause significant distress or impairment but do not meet full criteria, and the clinician chooses not to specify the reason or there is insufficient information.

Body Dysmorphic Disorder with Muscle Dysmorphia

An obsessive-compulsive related disorder involving preoccupation with perceived physical appearance flaws; the muscle dysmorphia specifier indicates a preoccupation that one's body build is too small or insufficiently muscular.

Orthorexia Nervosa (ON)

A proposed clinical entity marked by an obsessive focus on 'healthy' eating, compulsive adherence to restrictive dietary rules, and exaggerated distress over perceived unhealthy foods, leading to malnutrition or social impairment without primary weight loss intent.