Eating disorders

Eating disorders are complex mental health conditions characterized by unhealthy attitudes and behaviors related to food, eating, body weight, and body image. Their manifestation often aligns with specific developmental phases, with a significant prevalence during transitional and sensitive periods, such as puberty. The etiology of these disorders is multifaceted, resulting from the interplay of organic (biological) and non-organic (environmental and psychological) factors.

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Developmental Considerations

Feeding and eating disorders during childhood arise due to a blend of multiple factors:

• Medical Conditions: Various illnesses can precipitate or exacerbate eating disorders in children.
• Developmental Issues: Delayed or altered development might lead to unusual eating patterns.
• Temperament: Innate personality traits can predispose an individual to eating disorders.
• Environmental Factors: The surrounding environment, particularly parental behaviors and societal norms, plays a role in the onset and progression of eating disorders in young individuals.

Given this intricate web of causative factors, an integrated approach encompassing both biological and behavioral aspects is crucial for accurate diagnosis and intervention.

DSM-5 Revisions

The DSM-5—the latest edition of the Diagnostic and Statistical Manual of Mental Disorders—has incorporated several changes to enhance the diagnostic precision for professionals treating patients with eating disorders. Unlike its predecessors, the DSM-5 offers a more nuanced approach, focusing on developmental variations in symptom presentation rather than merely the age of the patient.

Avoidant/Restrictive Intake Disorder (ARFID)

Avoidant/Restrictive Intake Disorder (ARFID) is a new addition to the DSM-5. It caters to a segment of patients who were previously labeled under Eating Disorder Not Otherwise Specified (EDNOS)—a rather generic category.

History

The inception of ARFID in the DSM-5 aimed to more effectively delineate this subset of patients. Preliminary research validates ARFID as a unique eating disorder, distinguishable from Anorexia (AN) and Bulimia (BN). Typically, ARFID patients exhibit symptoms for a longer duration before diagnosis and have an earlier onset than their AN or BN counterparts. Additionally, they are more prone to have a co-morbid medical condition or anxiety disorder.

Diagnostic Criteria

ARFID diagnosis revolves around persistent feeding disturbances. The DSM-5 provides specific criteria encompassing:

• Apparent disinterest in food or eating.
• Food avoidance due to its sensory properties.
• Worries about negative eating outcomes.

These disturbances can lead to:

1. Noticeable weight loss or inadequate weight gain in children.
2. Substantial nutritional deficiencies.
3. Reliance on enteral feeding or oral supplements.
4. Significant disruption in social functioning.

The diagnosis necessitates that the disturbance is not better explained by the unavailability of food, culturally endorsed practices, or other eating disorders. It should also not be a byproduct of another medical or psychological condition.

Recent studies have echoed the diagnostic criteria, emphasizing the persistence of selective eating in ARFID patients, often starting in infancy or early childhood. While some display comorbid medical or anxiety disorders, they are less likely to have mood disorders.

Pica

Pica entails the consumption of non-food or inedible materials.

Diagnostic Criteria

DSM-5 outlines the criteria for Pica as:

• Consistent consumption of non-nutritive substances for at least a month.
• The behavior is developmentally inappropriate.
• It isn't a part of culturally accepted or normative practices.
• If associated with another disorder, its severity necessitates clinical intervention.

Though Pica primarily surfaces in children, it can manifest at any age, especially in those with intellectual disabilities or developmental disorders. Some individuals with schizophrenia also display Pica symptoms.

Rumination Disorder

Rumination disorder (RD) is characterized by regurgitating partially consumed or digested food.

Diagnostic Criteria

DSM-5 defines RD as:

• Regular regurgitation for a minimum of one month.
• The behavior isn't due to a gastrointestinal or other medical condition.
• It doesn't exclusively appear during other eating disorders.

Much like Pica, RD primarily affects children with developmental disorders or intellectual disabilities, though it can emerge at any age. The presentation in older children and adolescents can vary slightly, as they might spit out regurgitated food. Some individuals with Anorexia or Bulimia also exhibit rumination behavior.

Anorexia Nervosa

Anorexia nervosa is marked by severe food restriction, leading to significant weight loss.

Diagnostic Criteria

Anorexia is typified by:

• Reduced energy intake causing low body weight.
• Overwhelming fear of weight gain.
• Distorted body image and denial of

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