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Eating Disorders & DSM-5

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  1. Eating Disorders & DSM-5 Brenda L. Wolfe, Ph.D. Eating Disorders Institute of New Mexico (SM) www.EatingDisordersNM.com blwolfe@swcp.com

  2. Disclaimer • I am the Director of the Eating Disorders Institute of New Mexico. • I am adjunct/volunteer faculty to University of New Mexico Psychology Department & School of Medicine. • All the pages of my DSM-IV are dog-eared and frayed. Those of my DSM-5 are still almost pristine (except for the F&E D/O pages).

  3. Objective:Identify the changes in diagnostic criteria for eating disorders from DSM IV to DSM 5

  4. Mutually Exclusive May be Diagnosed with Other F&ED • Rumination Disorder • IV – F&ED of Infancy or Early Childhood • Avoidant/Restrictive Food Intake D/O • IV – F&ED of Infancy or Early Childhood • Anorexia Nervosa • Bulimia Nervosa • Binge Eating Disorder • IV – ED NOS (Appendix) • Other Specified/Unspecified F or E D/O • IV – ED NOS • Pica • IV – F&ED of Infancy or Early Childhood Feeding and Eating Disorders

  5. Pica 307.52(F98.3 kids, F50.8 adults) • Persistent eating of non-nutritive, nonfood substances > 1 month • The eating ... is inappropriate to the developmental level … • … not part of a culturally supported or socially normative practice. • If … in the context of another mental … medical d/o, is sufficiently severe to warrant additional clinical attention. Specify: In remission if full criteria not met for a sustained period of time

  6. Rumination Disorder 307.53 (F98.21) • Repeated regurgitation of food > 1 month, … re-chewed, re-swallowed, or spit out. • … not attributable to assoc GI or other medical condition. • … not exclusively during AN, BN, BED, ARFID • If … context of other d/o, … severe to warrant additional clinical attention. Specify: In remission … full criteria not met … sustained period of time

  7. Avoidant/Restrictive Food Intake D/O 307.59 (F50.8) • … (e.g., lack of interest … ; avoidance based on sensory characteristics …; concern about aversive consequences of eating) … by persistent failure to meet appropriate nutritional and/or energy needs associated with 1+ of: • Significant weight loss (or failure to achieve expected … in children). • Significant nutritional deficiency. • Dependence on enteral feeding or oral nutritional supplements. • … interference w/psychosocial functioning. • Not … lack of available food or culturally sanctioned practice. • … not … exclusively during AN or BN, and no … disturbance in the way one's body weight or shape is experienced. • If … context of other d/o, … severe to warrant additional clinical attention Specify: In remission …Critical change: greater specificity

  8. Anorexia Nervosa 307.1 • Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal, or, for children and adolescents, less than that minimally expected. • Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight. • Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight. • (deleted amenorrhea requirement)

  9. AN – cont’d Specify whether: • (F50.01) Restricting: … last 3 mo, has not engaged in … binge … purge … weight loss … by dieting, fasting, excessive exercise. • (F50.02) Binge-eating/purging: … last 3 mo Specify if: • In partial remission: … sustained … B or C still met • In full remission: … no criteria … sustained period of time Specify current severity: • Mild < 17, Mod 16-16.99, Sev 15-15.99, Extr < 15

  10. Bulimia Nervosa 307.51(F50.2) • Recurrent … binge eating. … characterized by both …: • Eating, in a discrete period of time (e.g., w/in 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time 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 behaviors … to prevent weight gain, e.g., self-induced vomiting, misuse of laxatives, diuretics, (deleted “enemas”) or other medications, fasting; or excessive exercise. • The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months. • Self-evaluation is unduly influenced by body shape and weight. • … does not occur exclusively during episodes of AN.

  11. BN – cont’d Specify if: • In partial remission: … some but not all criteria have been met for sustained time • In full remission: … none of criteria met for sustained time Specify current severity: (adjustable) • Mild 1–3 icb/wk, moderate 4-7 icb/wk, severe 8-13 icb/wk, extreme 14+ icb/wk (Deleted purging/non-purging types)

  12. Binge Eating D/O 307.51 (F50.8) • Recurrent episodes of binge eating. An episode of binge eating is characterized by both : • Eating, in a discrete period of time (e.g., … 2-hrs), an amount … that is definitely larger than most …would eat in a similar period of time/circumstances • A sense of lack of control … • The binge-eating episodes are associated with 3+ 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 after overeating • Marked distress regarding binge eating is present.. • The binge eating occurs, on average, at least once a week for 3 months. • … not associated with the recurrent use of inappropriate compensatory behavior and does not occur exclusively during the course BN or AN.

  13. BED – cont’d Specify if: • In partial remission — frequency < 1 binge/wk for sustained time • In full remission — no criteria met for sustained time Specify current severity: • Mild: 1–3 binge/wk • Moderate: 4-7 binge/wk • Severe: 8-13 binge/wk • Extreme 14+ binge/wk

  14. Other Specified F or E D/O 307.59 (F50.8) … Sx … do not meet full criteria … [and] the clinician chooses to communicate the specific reason … e.g.: • Atypical AN: [specifics] • BN of low freq and/or limited duration: [specifics] • BED low freq or ltd duration • Purging d/o: [all but binge] • Night Eating Syndrome: not better explained by …

  15. Unspecified Feeding or Eating Disorder 307.50 (F50.9) Same as Other Specified F or E D/O but either the clinician chooses not to specify the reason diagnostic criteria for another F&E D/O are not met, or there is insufficient information to make a more specific diagnosis

  16. Dr. Brenda L. Wolfe, Ph.D. 505-884-5700, Extension 101 blwolfe@swcp.com www.EatingDisordersNM.com (SM) Service Mark of Brenda L Wolfe PhD PC Eating Disorders Instituteof New Mexico(SM)