Eating and Feeding Disorders – A Newly Reorganized Mental Health Category
The fifth edition of the Diagnostic and Statistical Manual is commonly referred by both professionals and laypeople as DSM 5. In May 2013, DSM 5 officially replaced the fourth edition of the manual, known as DSM IV. All editions and supplemental revisions of the DSM come from a psychiatrists’ professional organization called the American Psychiatric Association. For roughly the last 60 years, members of this organization have reviewed the most recent scientific findings and doctors’ reports and used this information to create working definitions for all kinds of mental illness. These definitions, and detailed criteria used to flesh out each definition, form the bulk of each new or revised DSM. For decades, the information contained in the latest DSM has been used as a main reference and diagnostic guideline by doctors, law- and policymakers, pharmaceutical firms, and insurance companies.
Previous Definition of Eating Disorders
The final revision of DSM IV lists only two conditions as officially recognized eating disorders: anorexia nervosa and bulimia nervosa. People with anorexia have a disproportionate, dysfunctional fear of getting fat or gaining weight, and therefore explicitly or passively avoid maintaining their body weight at a minimum healthy level (within 85 percent of normal). People with bulimia also have a dysfunctional relationship to their body weight and body shape, and go through periods where they eat excessively large amounts of food in a narrow timeframe. In the aftermath of these binges, affected individuals do such things as vomit intentionally or use laxatives in order to avoid putting on pounds. According to the DSM IV guidelines, all other eating-related conditions in adults fall into an unofficial, loosely defined category called “eating disorder not otherwise specified” or EDNOS.
Previous Definition of Feeding and Eating Disorders of Infancy or Early Childhood
Conditions identified as feeding and eating disorders of infancy or early childhood in the final revision of DSM IV include feeding disorder of infancy or early childhood, rumination disorder, and pica. Children affected by feeding disorder of infancy or early childhood don’t eat enough food to properly gain weight, or alternately, fail to eat enough food to avoid weight loss. Children affected by rumination disorder regurgitate and rechew their food for 30 days or more after learning how to swallow and/or chew normally. Children with pica eat items or materials, such as dirt or paper, not culturally considered to be food for at least 30 days.
Feeding and Eating Disorders
The new feeding and eating disorders category included in the DSM 5 retains both anorexia and bulimia from the old DSM IV eating disorders category, and also upgrades binge eating disorder from a form of EDNOS to an officially diagnosable disorder. Binge eaters experience the same bouts of excessive food consumption as people with bulimia, but don’t follow up those bouts with calorie-purging behaviors. The new category also contains both pica and rumination disorder, which no longer fall under the heading of disorders of infancy or early childhood. In addition, the new DSM 5 listing includes a reworked form of feeding disorder of infancy or early childhood, now known as avoidant/restrictive food intake disorder or ARFID. People with ARFID avoid eating more or less like people with anorexia; however, they don’t have the weight obsessions that underlie anorexic behavior.
ARFID was created, in part, because practicing physicians generally found the guidelines for feeding disorder of infancy or early childhood too broadly termed to be useful. It was also created because current scientific evidence indicates that some teenagers and adults without anorexia also purposefully avoid eating or excessively limit their food intake. Pica and rumination disorder were also stripped of their exclusive association with infancy or early childhood because they sometimes occur in teenagers or adults.
DSM 5’s feeding and eating disorders category also includes conditions called “other specified feeding or eating disorder” and “unspecified feeding or eating disorder.” The “other specified…” listing takes over part of the role once played by the EDNOS classification, and contains fairly well-defined problems that don’t meet the criteria for one of the officially recognized feeding and eating disorders. The “unspecified…” listing takes over the rest of the role once played by EDNOS, and contains poorly defined or understood problems related to disordered eating or feeding.