DSM 5

Although Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder are the most commonly known eating disorders, there are other feeding and eating disorders recognized by the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association.

DSM 5 ED

DSM V ED Diagnostic Criteria

 

Anorexia Nervosa

  • Persistent restriction of energy intake leading to significantly low body weight (in context of what is minimally expected for age, sex, developmental trajectory, and physical health) .
  • Either an intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain (even though significantly low weight).
  • Disturbance in the way one’s body weight or shape is experienced, undue influence of body shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

Subtypes:
Restricting type
Binge-eating/purging type

 

Bulimia Nervosa

  • Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
    • Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
    • 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).
  • Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
  • The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.
  • Self-evaluation is unduly influenced by body shape and weight.
  • The disturbance does not occur exclusively during episodes of Anorexia Nervosa.

 

Binge Eating Disorder

  • Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
    • Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
    • 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).
  • The binge eating episodes are associated with three or more of the following:
    • eating much more rapidly than normal
    • eating until feeling uncomfortably full
    • eating large amounts of food when not feeling physically hungry
    • eating alone because of feeling embarrassed by how much one is eating
    • feeling disgusted with oneself, depressed or very guilty afterward
  • Marked distress regarding binge eating is present
  • Binge eating occurs, on average, at least once a week for three months
  • Binge eating not associated with the recurrent use of inappropriate compensatory behaviors as in Bulimia Nervosa and does not occur exclusively during the course of Bulimia Nervosa, or Anorexia Nervosa methods to compensate for overeating, such as self-induced vomiting.

Note: Binge Eating Disorder is less common but much more severe than overeating. Binge Eating Disorder is associated with more subjective distress regarding the eating behavior, and commonly other co-occurring psychological problems.

 

Pica

  • Persistent eating of non-nutritive substances for a period of at least one month.
  • The eating of non-nutritive substances is inappropriate to the developmental level of the individual.
  • The eating behavior is not part of a culturally supported or socially normative practice.
  • If occurring in the presence of another mental disorder (e.g. autistic spectrum disorder), or during a medical condition (e.g. pregnancy), it is severe enough to warrant independent clinical attention.

Note: Pica often occurs with other mental health disorders associated with impaired functioning.

 

Avoidant/Restrictive Food Intake Disorder (ARFID)

  • An Eating or Feeding disturbance as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:
  1. Significant loss of weight (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
  • The behavior is not better explained by lack of available food or by an associated culturally sanctioned practice.
  • The behavior does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way one’s body weight or shape is experienced.
  • The eating disturbance is not attributed to a medical condition, or better explained by another mental health disorder. When is does occur in the presence of another condition/disorder, the behavior exceeds what is usually associated, and warrants additional clinical attention.

 

Other Specified Feeding or Eating Disorder (OSFED)

A diagnosis might then be allocated that specifies a specific reason why the presentation does not meet the specifics of another disorder (e.g. Bulimia Nervosa- low frequency). The following are further examples for OSFED:

  • Atypical Anorexia Nervosa: All criteria are met, except despite significant weight loss, the individual’s weight is within or above the normal range.
  • Binge Eating Disorder (of low frequency and/or limited duration): All of the criteria for BED are met, except at a lower frequency and/or for less than three months.
  • 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 behavior occurs at a lower frequency and/or for less than three months.
  • Purging Disorder: Recurrent purging behavior to influence weight or shape in the absence of binge eating
  • Night Eating Syndrome: Recurrent episodes of night eating. Eating after awakening from sleep, or by excessive food consumption after the evening meal. The behavior is not better explained by environmental influences or social norms. The behavior causes significant distress/impairment. The behavior is not better explained by another mental health disorder (e.g. BED).

Unspecified Feeding or Eating Disorder (UFED)

 

According to the DSM-5 criteria this category applies to where behaviors cause clinically significant distress/impairment of functioning, but do not meet the full criteria of any of the Feeding or Eating Disorder criteria. This category may be used by clinicians where a clinician chooses not to specify why criteria are not met, including presentations where there may be insufficient information to make a more specific diagnosis (e.g. in emergency room settings).

 

 

 

 

 

 

 

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