Disorders usually first diagnosed in infancy childhood and adolescence

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Eating Disorders and Body Image There have been a number of changes from the DSM-IV to the DSM-5 related to classification and description of these disorders. First, categories have been expanded and disorders grouped according to similarities observed in manifestation and expression.

Feeding and Eating Disorders

This new DSM-5 classification includes diagnoses formerly included under eating disorders and disorders usually first diagnosed in infancy, childhood, and adolescence. This group of disorders is defined by the similarities in disruption to normal eating behaviors. It includes pica, rumination disorder, avoidant/restrictive food intake disorder, anorexia nervosa, bulimia nervosa, binge-eating disorder, other specified feeding or eating disorder, and unspecified feeding or eating disorder. Two of these diagnoses are new to the DSM-5: other specified feeding or eating disorder and unspecified feeding or eating disorder. These take the place of eating disorder NOS in the DSM-IV, which has been removed in the DSM-5. Both of these diagnoses represent significant clinical distress or impairment based on criteria for feeding or eating disorders but do not meet full criteria for a specific diagnosis in this class. Clinicians should use other specified feeding or eating disorder and add the specific reason for the more general diagnosis (e.g., weight or compensatory behavioral observations which vary from specific diagnostic criteria). The latter diagnosis —unspecified feeding or eating disorder— is used when clinicians cannot (or choose not to) identify reasons for the inability to make a more specific diagnosis yet clearly observe multiple criteria from the feeding and eating disorders classification. The following is a brief summary of key changes to diagnoses in this group. Pica The diagnostic criteria for pica remain largely unchanged in the DSM-5. The most significant change is the recognition that the diagnosis can be made in both children and adults—previously, it had been included in the chapter on disorders usually first diagnosed in infancy, childhood, and adolescence. A remission specifier has also been added. Rumination Disorder The diagnostic criteria for rumination disorder remains largely unchanged in the DSM-5, with the exception that Criterion C from the DSM-IV has been divided into two separate criteria with language added for clarity. In addition, the DSM-5 includes the recognition that the diagnosis can be made in both children and adults—previously, it had been included in the chapter on disorders usually first diagnosed in infancy, childhood, and adolescence. A remission specifier has also been added. Avoidant/Restrictive Food Intake Disorder This new diagnosis takes the place of feeding disorder of infancy or childhood, found in the DSM-IV. The criteria have been considerably expanded, to include symptoms related to weight, behavior, physical health, and psychosocial functioning. Differential diagnosis now includes

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reference to other disorders and medical conditions. Lastly, a specifier that pertains to remission status has been added. Anorexia Nervosa Descriptions found under this diagnosis have been expanded considerably, though the core symptomology remains unchanged. For example, Criterion A has been revised for clarity, reflecting the manifestation of symptoms related to weight. In addition, Criterion D from the DSM-IV has been entirely removed; this criterion included the requirement of amenorrhea. Lastly, remission specifiers have been added as well as specifiers linking severity with body mass index (BMI). Bulimia Nervosa The diagnostic criteria for this disorder in the DSM-5 are nearly identical to those found in the DSM-IV, with two noted exceptions: First, Criterion C now includes once per week for 3 months as the threshold duration. Second, severity specifiers that are directly related to frequency of compensatory behaviors have been added. Binge-Eating Disorder This is a new disorder in the DSM-5, having been moved from Appendix B of the DSM-IV following extensive research. The minimum frequency is different from that noted in the DSM- IV; the DSM-5 notes that the binge eating must occur an average of once per week for 3 months.

Obsessive-Compulsive and Related Disorders This classification—new to the DSM–5—recognizes the similarities in presentation and diagnostic criteria of disorders characterized by obsessions and/or compulsions. The former refers to thoughts that are persistent and intrusive, while the latter denotes behaviors an individual feels compelled to perform. This group of disorders is examined more in depth with the topic of fears, phobias and anxieties. However, one diagnosis with this group is included with this week’s topics, as it relates to concepts of self-perception, often associated with eating disorders and body image. Body Dysmorphic Disorder This diagnosis has been moved from the somatoform disorders to this new classification and several criteria altered, including specifications for repetitive behavior and preoccupied thoughts. In addition, a specifier of “with muscle dysmorphia,” which denotes a persistent belief that the individual’s body is insufficiently developed in size and/or musculature, has been added. The inclusion of the “absent insight/delusional beliefs” specifier when applicable eliminates the potential for a second diagnosis of delusional disorder, somatic type that was possible under DSM-IV diagnostic criteria.

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Reference:

• American Psychiatric Association (2013). Highlights of changes from DSM-IV-TR to DSM-5. Retrieved from http://www.dsm5.org/Documents/changes%20from%20dsm-iv- tr%20to%20dsm-5.pdf